Genitourinary System 1.

The nurse is aware that the following findings would be further evidence of a urethral injury in a male client during rectal examination? a. A low-riding prostate b. The presence of a boggy mass c. Absent sphincter tone d. A positive Hemoccult 2. When a female client with an indwelling urinary (Foley) catheter insists on walking to the hospital lobby to visit with family members, nurse Rose teaches how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information? a. The client sets the drainage bag on the floor while sitting down. b. The client keeps the drainage bag below the bladder at all times. c. The client clamps the catheter drainage tubing while visiting with the family. d. The client loops the drainage tubing below its point of entry into the drainage bag. 3. A female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client? a. This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually. b. The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days. c. The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual intercourse. d. The human papillomavirus (HPV), which causes condylomata acuminata, cant be transmitted during oral sex. 4. A male client with bladder cancer has had the bladder removed and an ileal conduit created for urine diversion. While changing this clients pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should nurse Katrina conclude? a. The skin wasnt lubricated before the pouch was applied. b. The pouch faceplate doesnt fit the stoma. c. A skin barrier was applied properly. d. Stoma dilation wasnt performed. 5. The nurse is aware that the following laboratory values supports a diagnosis of pyelonephritis? a. Myoglobinuria b. Ketonuria c. Pyuria d. Low white blood cell (WBC) count 6. A female client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, nurse Sarah knows that the client is most likely to experience: a. hematuria. b. weight loss. c. increased urine output. d. increased blood pressure. 7. Nurse Lea is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention? a. Rashes on the palms of the hands and soles of the feet b. Cauliflower-like warts on the penis c. Painful red papules on the shaft of the penis d. Foul-smelling discharge from the penis 8. Nurse Agnes is reviewing the report of a clients routine urinalysis. Which value should the nurse consider abnormal? a. Specific gravity of 1.03 b. Urine pH of 3.0 c. Absence of protein d. Absence of glucose 9. A male client is scheduled for a renal clearance test. Nurse Maureen should explain that this test is done to assess the kidneys ability to remove a substance from the plasma in:

a. 1 minute. b. 30 minutes. c. 1 hour. d. 24 hours. 10. A male client in the short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should: a. keep the clients knee on the affected side bent for 6 hours. b. apply pressure to the puncture site for 30 minutes. c. check the clients pedal pulses frequently. d. remove the dressing on the puncture site after vital signs stabilize. 11. A female client is admitted for treatment of chronic renal failure (CRF). Nurse Juliet knows that this disorder increases the clients risk of: a. water and sodium retention secondary to a severe decrease in the glomerular filtration rate. b. a decreased serum phosphate level secondary to kidney failure. c. an increased serum calcium level secondary to kidney failure. d. metabolic alkalosis secondary to retention of hydrogen ions. 12. Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a female clients uremia. Which finding signals a significant problem during this procedure? a. Potassium level of 3.5 mEq/L b. Hematocrit (HCT) of 35% c. Blood glucose level of 200 mg/dl d. White blood cell (WBC) count of 20,000/mm3 13. For a male client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important? a. Encouraging coughing and deep breathing b. Promoting carbohydrate intake c. Limiting fluid intake d. Providing pain-relief measures 14. A female client requires hemodialysis. Which of the following drugs should be withheld before this procedure? a. Phosphate binders b. Insulin c. Antibiotics d. Cardiac glycosides 15. A client comes to the outpatient department complaining of vaginal discharge, dysuria, and genital irritation. Suspecting a sexually transmitted disease (STD), Dr. Smith orders diagnostic tests of the vaginal discharge. Which STD must be reported to the public health department? a. Chlamydia b. Gonorrhea c. Genital herpes d. Human papillomavirus infection 16. A male client with acute pyelonephritis receives a prescription for co-trimoxazole (Septra) P.O. twice daily for 10 days. Which finding best demonstrates that the client has followed the prescribed regimen? a. Urine output increases to 2,000 ml/day. b. Flank and abdominal discomfort decrease. c. Bacteria are absent on urine culture. d. The red blood cell (RBC) count is normal. 17. A 26-year-old female client seeks care for a possible infection. Her symptoms include burning on urination and frequent, urgent voiding of small amounts of urine. Shes placed on trimethoprim-sulfamethoxazole (Bactrim) to treat possible infection. Another medication is prescribed to decrease the pain and frequency. Which of the following is the most likely medication prescribed? a. nitrofurantoin (Macrodantin) b. ibuprofen (Motrin)

c. acetaminophen with codeine d. phenazopyridine (Pyridium) 18. A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation, the nurse is aware that the functions of the three lumens include: a. Continuous inflow and outflow of irrigation solution. b. Intermittent inflow and continuous outflow of irrigation solution. c. Continuous inflow and intermittent outflow of irrigation solution. d. Intermittent flow of irrigation solution and prevention of hemorrhage. 19. Nurse Claudine is reviewing a clients fluid intake and output record. Fluid intake and urine output should relate in which way? a. Fluid intake should be double the urine output. b. Fluid intake should be approximately equal to the urine output. c. Fluid intake should be half the urine output. d. Fluid intake should be inversely proportional to the urine output. 20. After trying to conceive for a year, a couple consults an infertility specialist. When obtaining a history from the husband, nurse Jenny inquires about childhood infectious diseases. Which childhood infectious disease most significantly affects male fertility? a. Chickenpox b. Measles c. Mumps d. Scarlet fever 21. A male client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region, which radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site? a. Kidney b. Ureter c. Bladder d. Urethra 22. A female client with acute renal failure is undergoing dialysis for the first time. The nurse in charge monitors the client closely for dialysis equilibrium syndrome, a complication that is most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes: a. confusion, headache, and seizures. b. acute bone pain and confusion. c. weakness, tingling, and cardiac arrhythmias. d. hypotension, tachycardia, and tachypnea. 23. Dr. Marquez prescribes norfloxacin (Noroxin), 400 mg P.O. twice daily, for a client with a urinary tract infection (UTI). The client asks the nurse how long to continue taking the drug. For an uncomplicated UTI, the usual duration of norfloxacin therapy is: a. 3 to 5 days. b. 7 to 10 days. c. 12 to 14 days. d. 10 to 21 days. 24. Nurse Joy is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultrahighfrequency sound waves to shatter renal calculi. The nurse should instruct the client to: a. limit oral fluid intake for 1 to 2 weeks. b. report the presence of fine, sandlike particles through the nephrostomy tube. c. notify the physician about cloudy or foul-smelling urine. d. report bright pink urine within 24 hours after the procedure. 25. A client is frustrated and embarrassed by urinary incontinence. Which of the following measures should nurse Bea include in a bladder retraining program? a. Establishing a predetermined fluid intake pattern for the client

b. Encouraging the client to increase the time between voidings c. Restricting fluid intake to reduce the need to void d. Assessing present elimination patterns Genitourinary System Part 2 1. After having transurethral resection of the prostate (TURP), a Mr. Locke returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the clients catheter is occluded? a. The urine in the drainage bag appears red to pink. b. The client reports bladder spasms and the urge to void. c. The normal saline irrigant is infusing at a rate of 50 drops/minute. d. About 1,000 ml of irrigant have been instilled; 1,200 ml of drainage have been returned. 2. Nurse Myrna is inserting a urinary catheter into a client who is extremely anxious about the procedure. The nurse can facilitate the insertion by asking the client to: a. initiate a stream of urine. b. breathe deeply. c. turn to the side. d. hold the labia or shaft of penis. 3. A female adult client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? a. Blood urea nitrogen (BUN) level of 22 mg/dl b. Serum creatinine level of 1.2 mg/dl c. Serum creatinine level of 1.2 mg/dl d. Urine output of 400 ml/24 hours 4. A 55-year old client with benign prostatic hyperplasia doesnt respond to medical treatment and is admitted to the facility for prostate gland removal. Before providing preoperative and postoperative instructions to the client, nurse Gail asks the surgeon which prostatectomy procedure will be done. What is the most widely used procedure for prostate gland removal? a. Transurethral resection of the prostate (TURP) b. Suprapubic prostatectomy c. Retropubic prostatectomy d. Transurethral laser incision of the prostate 5. A female client with suspected renal dysfunction is scheduled for excretory urography. Nurse July reviews the history for conditions that may warrant changes in client preparation. Normally, a client should be mildly hypovolemic (fluid depleted) before excretory urography. Which history finding would call for the client to be well hydrated instead? a. Cystic fibrosis b. Multiple myeloma c. Gout d. Myasthenia gravis 6. Nurse Kim is caring for a client who had a cerebrovascular accident (CVA). Which nursing intervention promotes urinary continence? a. Encouraging intake of at least 2 L of fluid daily b. Giving the client a glass of soda before bedtime c. Taking the client to the bathroom twice per day d. Consulting with a dietitian 7. When examining a female clients genitourinary system, nurse Sally assesses for tenderness at the costovertebral angle by placing the left hand over this area and striking it with the right fist. Normally, this percussion technique produces which sound? a. A flat sound b. A dull sound

c. Hyperresonance d. Tympany 8. A male client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should nurse Olivia assess first? a. Blood pressure b. Respirations c. Temperature d. Pulse 9. Nurse Hazel is ware that the following is an appropriate nursing diagnosis for a client with renal calculi? a. Ineffective tissue perfusion b. Functional urinary incontinence c. Risk for infection d. Decreased cardiac output 10. A male client develops acute renal failure (ARF) after receiving I.V. therapy with a nephrotoxic antibiotic. Because the clients 24-hour urine output totals 240 ml, nurse Andy suspects that the client is at risk for: a. cardiac arrhythmia. b. paresthesia. c. dehydration. d. pruritus. 11. After undergoing transurethral resection of the prostate to treat benign prostatic hyperplasia, a male client returns to the room with continuous bladder irrigation. On the first day after surgery, the client reports bladder pain. What should nurse Andrew do first? a. Increase the I.V. flow rate. b. Notify the physician immediately. c. Assess the irrigation catheter for patency and drainage. d. Administer meperidine (Demerol), 50 mg I.M., as prescribed. 12. When performing a scrotal examination, nurse Paul finds a nodule. What should the nurse do next? a. Notify the physician. b. Change the clients position and repeat the examination. c. Perform a rectal examination. d. Transilluminate the scrotum. 13. A male client who has been treated for chronic renal failure (CRF) is ready for discharge. Nurse Bea should reinforce which dietary instruction? a. Be sure to eat meat at every meal. b. Monitor your fruit intake, and eat plenty of bananas. c. Increase your carbohydrate intake. d. Drink plenty of fluids, and use a salt substitute. 14. Nurse Wayne is aware that the following statements describing urinary incontinence in the elderly is true? a. Urinary incontinence is a normal part of aging. b. Urinary incontinence isnt a disease. c. Urinary incontinence in the elderly cant be treated. d. Urinary incontinence is a disease. 15. The client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Nurse Yoly is aware that the following nursing interventions is appropriate? a. Tell the client to try to urinate around the catheter to remove blood clots. b. Restrict fluids to prevent the clients bladder from becoming distended. c. Prepare to remove the catheter. d. Use aseptic technique when irrigating the catheter. 16. A female client with a urinary tract infection is prescribed co-trimoxazole (trimethoprim-sulfamethoxazole). Nurse Don should provide which medication instruction? a. Take the medication with food. b. Drink at least eight 8-oz glasses of fluid daily. c. Avoid taking antacids during co-trimoxazole therapy. d. Dont be afraid to go out in the sun.

17. A male client is admitted for treatment of glomerulonephritis. On initial assessment, Nurse Rose detects one of the classic signs of acute glomerulonephritis of sudden onset. Such signs include: a. generalized edema, especially of the face and periorbital area. b. green-tinged urine. c. moderate to severe hypotension. d. polyuria. 18. A client reports experiencing vulvar pruritus. Which assessment factor may indicate that the client has an infection caused by Candida albicans? a. Cottage cheeselike discharge b. Yellow-green discharge c. Gray-white discharge d. Discharge with a fishy odor 19. A 24-year old female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client? a. This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually. b. The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days. c. The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual intercourse. d. The human papillomavirus (HPV), which causes condylomata acuminata, cant be transmitted during oral sex. 20. Nurse Vic is monitoring the fluid intake and output of a female client recovering from an exploratory laparotomy. Which nursing intervention would help the client avoid a urinary tract infection (UTI)? a. Maintaining a closed indwelling urinary catheter system and securing the catheter to the leg b. Limiting fluid intake to 1 L/day c. Encouraging the client to use a feminine deodorant after bathing d. Encouraging the client to douche once a day after removal of the indwelling urinary catheter 21. Nurse Eve is caring for a client who had a cerebrovascular accident (CVA). Which nursing intervention promotes urinary continence? a. Encouraging intake of at least 2 L of fluid daily b. Giving the client a glass of soda before bedtime c. Taking the client to the bathroom twice per day d. Consulting with a dietitian 22. A female client with an indwelling urinary catheter is suspected of having a urinary tract infection. Nurse Angel should collect a urine specimen for culture and sensitivity by: a. disconnecting the tubing from the urinary catheter and letting the urine flow into a sterile container. b. wiping the self-sealing aspiration port with antiseptic solution and aspirating urine with a sterile needle. c. draining urine from the drainage bag into a sterile container. d. clamping the tubing for 60 minutes and inserting a sterile needle into the tubing above the clamp to aspirate urine. 23. Nurse Grace is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention? a. Rashes on the palms of the hands and soles of the feet b. Cauliflower-like warts on the penis c. Painful red papules on the shaft of the penis d. Foul-smelling discharge from the penis 24. Nurse Ethel is planning to administer a sodium polystyrene sulfonate (Kayexalate) enema to a client with a potassium level of 5.9 mEq/L. Correct administration and the effects of this enema would include having the client: a. retain the enema for 30 minutes to allow for sodium exchange; afterward, the client should have diarrhea. b. retain the enema for 30 minutes to allow for glucose exchange; afterward, the client should have diarrhea. c. retain the enema for 60 minutes to allow for sodium exchange; diarrhea isnt necessary to reduce the potassium level. d. retain the enema for 60 minutes to allow for glucose exchange; diarrhea isnt necessary to reduce the potassium level.

25. When caring for a male client with acute renal failure (ARF), Nurse Fatima expects to adjust the dosage or dosing schedule of certain drugs. Which of the following drugs would not require such adjustment? a. acetaminophen (Tylenol) b. gentamicin sulfate (Garamycin) c. cyclosporine (Sandimmune) d. ticarcillin disodium (Ticar) Pharmacology Questions Part 1 1. Walter, teenage patient is admitted to the hospital because of acetaminophen (Tylenol) overdose. Overdoses of acetaminophen can precipitate life-threatening abnormalities in which of the following organs? a. Lungs b. Liver c. Kidney d. Adrenal Glands 2. A contraindication for topical corticosteroid usage in a male patient with atopic dermatitis (eczema) is: a. Parasite infection. b. Viral infection. c. Bacterial infection. d. Spirochete infection. 3. In infants and children, the side effects of first generation over-the-counter (OTC) antihistamines, such as diphenhydramine (Benadryl) and hydroxyzine (Atarax) include: a. Reyes syndrome. b. Cholinergic effects. c. Paradoxical CNS stimulation. d. Nausea and diarrhea. 4. Reyes syndrome, a potentially fatal illness associated with liver failure and encephalopathy is associated with the administration of which over-the-counter (OTC) medication? a. acetaminophen (Tylenol) b. ibuprofen (Motrin) c. aspirin d. brompheniramine/psudoephedrine (Dimetapp) 5. The nurse is aware that the patients who are allergic to intravenous contrast media are usually also allergic to which of the following products? a. Eggs b. Shellfish c. Soy d. acidic fruits 6. A 13-month-old child recently arrived in the United States from a foreign country with his parents and needs childhood immunizations. His mother reports that he is allergic to eggs. Upon further questioning, you determine that the allergy to eggs is anaphylaxis. Which of the following vaccines should he not receive? a. Hepatitis B b. inactivated polio c. diphtheria, acellular pertussis, tetanus (DTaP) d. mumps, measles, rubella (MMR) 7. The cell and Coombs classification system categorizes allergic reactions and is useful in describing and classifying patient reactions to drugs. Type I reactions are immediate hypersensitivity reactions and are mediated by: a. immunoglobulin E (IgE). b. immunoglobulin G (IgG). c. immunoglobulin A (IgA). d. immunoglobulin M (IgM). 8. Drugs can cause adverse events in a patient. Bone marrow toxicity is one of the most frequent types of druginduced toxicity. The most serious form of bone marrow toxicity is:

a. aplastic anemia. b. thrombocytosis. c. leukocytosis. d. granulocytosis. 9. Serious adverse effects of oral contraceptives include: a. Increase in skin oil followed by acne. b. Headache and dizziness. c. Early or mid-cycle bleeding. d. Thromboembolic complications. 10. The most serious adverse effect of Alprostadil (Prostin VR pediatric injection) administration in neonates is: a. Apnea. b. Bleeding tendencies. c. Hypotension. d. Pyrexia. 11. Mandy, a patient calls the clinic today because he is taking atrovastatin (Lipitor) to treat his high cholesterol and is having pain in both of his legs. You instruct him to: a. Stop taking the drug and make an appointment to be seen next week. b. Continue taking the drug and make an appointment to be seen next week. c. Stop taking the drug and come to the clinic to be seen today. d. Walk for at least 30 minutes and call if symptoms continue. 12. Which of the following adverse effects is associated with levothyroxine (Synthroid) therapy? a. Tachycardia b. Bradycardia c. Hypotension d. Constipation 13. Which of the following adverse effects is specific to the biguanide diabetic drug metformin (Glucophage) therapy? a. Hypoglycemia b. GI distress c. Lactic acidosis d. Somulence 14. The most serious adverse effect of tricyclic antidepressant (TCA) overdose is: a. Seizures. b. Hyperpyrexia. c. Metabolic acidosis. d. Cardiac arrhythmias. 15. The nurse is aware that the following solutions is routinely used to flush an IV device before and after the administration of blood to a patient is: a. 0.9 percent sodium chloride b. 5 percent dextrose in water solution c. Sterile water d. Heparin sodium 16. Cris asks the nurse whether all donor blood products are cross-matched with the recipient to prevent a transfusion reaction. Which of the following always require cross-matching? a. packed red blood cells b. platelets c. plasma d. granulocytes 17. A month after receiving a blood transfusion an immunocompromised male patient develops fever, liver abnormalities, a rash, and diarrhea. The nurse would suspect this patient has: a. Nothing related to the blood transfusion. b. Graft-versus-host disease (GVHD). c. Myelosuppression. d. An allergic response to a recent medication.

18. Jonas comes into the local blood donation center. He says he is here to donate platelets only today. The nurse knows this process is called: a. Directed donation. b. Autologous donation. c. Allogenic donation. d. Apheresis. 19. Nurse Bryan knows that the age group that uses the most units of blood and blood products is: a. Premature infants. b. Children ages 1-20 years. c. Adults ages 21-64 years. d. The elderly above age 65 years. 20. A child is admitted with a serious infection. After two days of antibiotics, he is severely neutropenic. The physician orders granulocyte transfusions for the next four days. The mother asks the nurse why? The nurse responds: a. This is the only treatment left to offer the child. b. This therapy is fast and reliable in treating infections in children. c. The physician will have to explain his rationale to you. d. Granulocyte transfusions replenish the low white blood cells until the body can produce its own. 21. A neighbor tells nurse Maureen he has to have surgery and is reluctant to have any blood product transfusions because of a fear of contracting an infection. He asks the nurse what are his options. The nurse teaches the person that the safest blood product is: a. An allogenic product. b. A directed donation product. c. An autologous product. d. A cross-matched product. 22. A severely immunocompromised female patient requires a blood transfusion. To prevent GVHD, the physician will order: a. Diphenhydramine hydrochloride (Benadryl). b. The transfusion to be administered slowly over several hours. c. Irradiation of the donor blood. d. Acetaminophen (Tylenol). 23. Louie who is to receive a blood transfusion asks the nurse what is the most common type of infection he could receive from the transfusion. The nurse teaches him that approximately 1 in 250,000 patients contract: a. Human immunodeficiency disease (HIV). b. Hepatitis C infection. c. Hepatitis B infection. d. West Nile viral disease. 24. A male patient with blood type AB, Rh factor positive needs a blood transfusion. The Transfusion Service (blood bank) sends type O, Rh factor negative blood to the unit for the nurse to infuse into this patient. The nurse knows that: a. This donor blood is incompatible with the patients blood. b. Premedicating the patient with diphenhydramine hydrochloride (Benadryl) and acetaminophen (Tylenol) will prevent any transfusion reactions or side effects. c. This is a compatible match. d. The patient is at minimal risk receiving this product since it is the first time he has been transfused with type O, Rh negative blood. 25. Dr. Rodriguez orders 250 milliliters of packed red blood cells (RBC) for a patient. This therapy is administered for treatment of: a. Thrombocytopenia. b. Anemia. c. Leukopenia. d. Hypoalbuminemia. 26. A female patient needs a whole blood transfusion. In order for transfusion services (the blood bank) to prepare the correct product a sample of the patients blood must be obtained for:

a. A complete blood count and differential. b. A blood type and cross-match. c. A blood culture and sensitivity. d. A blood type and antibody screen. 27. A male patient needs to receive a unit of whole blood. What type of intravenous (IV) device should the nurse consider starting? a. A small catheter to decrease patient discomfort b. The type of IV device the patient has had in the past, which worked well c. A large bore catheter d. The type of device the physician prefers 28. Dr. Smith orders a gram of human salt poor albumin product for a patient. The product is available in a 50 milliliter vial with a concentration of 25 percent. What dosage will the nurse administer? a. The nurse should use the entire 50 milliliter vial. b. The nurse should determine the volume to administer from the physician. c. This concentration of product should not be used. d. The nurse will administer 4 milliliters. 29. Central venous access devices (CVADs) are frequently utilized to administer chemotherapy. What is a distinct advantage of using the CVAD for chemotherapeutic agent administration? a. CVADs are less expensive than a peripheral IV. b. Once a week administration is possible. c. Caustic agents in small veins can be avoided. d. The patient or his family can administer the drug at home. 30. A female patients central venous access device (CVAD) becomes infected. Why would the physician order antibiotics to be given through the line rather than through a peripheral IV line? a. To prevent infiltration of the peripheral line b. To reduce the pain and discomfort associated with antibiotic administration in a small vein c. To lessen the chance of an allergic reaction to the antibiotic d. To attempt to sterilize the catheter and prevent having to remove it Pharmacology Questions Part 2 1. An infection in a central venous access device is not eliminated by giving antibiotics through the catheter. How would bacterial glycocalyx contribute to this? a. It protects the bacteria from antibiotic and immunologic destruction. b. Glycocalyx neutralizes the antibiotic rendering it ineffective. c. It competes with the antibiotic for binding sites on the microbe. d. Glycocalyx provides nutrients for microbial growth. 2. Central venous access devices are beneficial in pediatric therapy because: a. They dont frighten children. b. Use of the arms is not restricted. c. They cannot be dislodged. d. They are difficult to see. 3. How can central venous access devices (CVADs) be of value in a patient receiving chemotherapy who has stomatitis and severe diarrhea? a. The chemotherapy can be rapidly completed allowing the stomatitis and diarrhea to resolve. b. Crystalloid can be administered to prevent dehydration. c. Concentrated hyperalimentation fluid can be administered through the CVAD. d. The chemotherapy dose can be reduced. 4. Some central venous access devices (CVAD) have more than one lumen. These multi lumen catheters: a. Have an increased risk of infiltration. b. Only work a short while because the small bore clots off. c. Are beneficial to patient care but are prohibitively expensive. d. Allow different medications or solutions to be administered simultaneously.

5. Some institutions will not infuse a fat emulsion, such as Intralipid, into central venous access devices (CVAD) because: a. Lipid residue may accumulate in the CVAD and occlude the catheter. b. If the catheter clogs, there is no treatment other than removal and replacement. c. Lipids are necessary only in the most extreme cases to prevent essential fatty acid (EFA) deficiency. d. Fat emulsions are very caustic. 6. A male patient needs a percutaneously inserted central catheter (PICC) for prolonged IV therapy. He knows it can be inserted without going to the operating room. He mentions that, at least the doctor wont be wearing surgical garb, will he? How will the nurse answer the patient? a. You are correct. It is a minor procedure performed on the unit and does not necessitate surgical attire. b. To decrease the risk of infection, the doctor inserting the PICC will wear a cap, mask, and sterile gown and gloves. c. It depends on the doctors preference. d. Most doctors only wear sterile gloves, not a cap, mask, or sterile gown. 7. A male patient is to receive a percutaneously inserted central catheter (PICC). He asks the nurse whether the insertion will hurt. How will the nurse reply? a. You will have general anesthesia so you wont feel anything. b. It will be inserted rapidly, and any discomfort is fleeting. c. The insertion site will be anesthetized. Threading the catheter through the vein is not painful. d. You will receive sedation prior to the procedure. 8. What volume of air can safely be infused into a patient with a central venous access device (CVAD)? a. It is dependent on the patients weight and height. b. Air entering the patient through a CVAD will follow circulation to the lungs where it will be absorbed and cause no problems. c. It is dependent on comorbidities such as asthma or chronic obstructive lung disease. d. None. 9. Kent a new staff nurse asks her preceptor nurse how to obtain a blood sample from a patient with a portacath device. The preceptor nurse teaches the new staff nurse: a. The sample will be withdrawn into a syringe attached to the portacath needle and then placed into a vacutainer. b. Portacath devices are not used to obtain blood samples because of the risk of clot formation. c. The vacutainer will be attached to the portacath needle to obtain a direct sample. d. Any needle and syringe may be utilized to obtain the sample. 10. What is the purpose of tunneling (inserting the catheter 2-4 inches under the skin) when the surgeon inserts a Hickman central catheter device? Tunneling: a. Increases the patients comfort level. b. Decreases the risk of infection. c. Prevents the patients clothes from having contact with the catheter d. Makes the catheter less visible to other people. 11. The primary complication of a central venous access device (CVAD) is: a. Thrombus formation in the vein. b. Pain and discomfort. c. Infection. d. Occlusion of the catheter as the result of an intra-lumen clot. 12. Nurse Blessy is doing some patient education related to a patients central venous access device. Which of the following statements will the nurse make to the patient? a. These type of devices are essentially risk free. b. These devices seldom work for more than a week or two necessitating replacement. c. The dressing should only the changed by your doctor. d. Heparin in instilled into the lumen of the catheter to decrease the risk of clotting. 13. The chemotherapeutic DNA alkylating agents such as nitrogen mustards are effective because they: a. Cross-link DNA strands with covalent bonds between alkyl groups on the drug and guanine bases on DNA. b. Have few, if any, side effects. c. Are used to treat multiple types of cancer. d. Are cell cycle-specific agents.

14. Hormonal agents are used to treat some cancers. An example would be: a. Thyroxine to treat thyroid cancer. b. ACTH to treat adrenal carcinoma. c. Estrogen antagonists to treat breast cancer. d. Glucagon to treat pancreatic carcinoma. 15. Chemotherapeutic agents often produce a certain degree of myelosuppression including leukopenia. Leukopenia does not present immediately but is delayed several days to weeks because: a. The patients hemoglobin and hematocrit are normal. b. Red blood cells are affected first. c. Folic acid levels are normal. d. The current white cell count is not affected by chemotherapy. 16. Currently, there is no way to prevent myelosuppression. However, there are medications available to elicit a more rapid bone marrow recovery. An example is: a. Epoetin alfa (Epogen, Procrit). b. Glucagon. c. Fenofibrate (Tricor). d. Lamotrigine (Lamictal). 17. Estrogen antagonists are used to treat estrogen hormone-dependent cancer, such as breast carcinoma. Androgen antagonists block testosterone stimulation of androgen-dependent cancers. An example of an androgendependent cancer would be: a. Prostate cancer. b. Thyroid cancer. c. Renal carcinoma. d. neuroblastoma. 18. Serotonin release stimulates vomiting following chemotherapy. Therefore, serotonin antagonists are effective in preventing and treating nausea and vomiting related to chemotherapy. An example of an effective serotonin antagonist antiemetic is: a. ondansetron (Zofran). b. fluoxetine (Prozac). c. paroxetine (Paxil). d. sertraline (Zoloft). 19. Methotrexate, the most widely used antimetabolite in cancer chemotherapy does not penetrate the central nervous system (CNS). To treat CNS disease this drug must be administered: a. Intravenously. b. Subcutaneously. c. Intrathecally. d. By inhalation. 20. Methotrexate is a folate antagonist. It inhibits enzymes required for DNA base synthesis. To prevent harm to normal cells, a fully activated form of folic acid known as leucovorin (folinic acid; citrovorum factor) can be administered. Administration of leucovorin is known as: a. Induction therapy. b. Consolidation therapy. c. Pulse therapy. d. Rescue therapy. 21. A male Patient is undergoing chemotherapy may also be given the drug allopurinol (Zyloprim, Aloprim). Allopurinol inhibits the synthesis of uric acid. Concomitant administration of allopurinol prevents: a. Myelosuppression. b. Gout and hyperuricemia. c. Pancytopenia. d. Cancer cell growth and replication 22. Superficial bladder cancer can be treated by direct instillation of the antineoplastic antibiotic agent mitomycin (Mutamycin). This process is termed: a. Intraventricular administration. b. Intravesical administration.

c. Intravascular administration. d. Intrathecal administration. 23. The most common dose-limiting toxicity of chemotherapy is: a. Nausea and vomiting. b. Bloody stools. c. Myelosuppression. d. Inability to ingest food orally due to stomatitis and mucositis. 24. Chemotherapy induces vomiting by: a. Stimulating neuroreceptors in the medulla. b. Inhibiting the release of catecholamines. c. Autonomic instability. d. Irritating the gastric mucosa. 25. Myeloablation using chemotherapeutic agents is useful in cancer treatment because: a. It destroys the myelocytes (muscle cells). b. It reduces the size of the cancer tumor. c. After surgery, it reduces the amount of chemotherapy needed. d. It destroys the bone marrow prior to transplant. 26. Anticipatory nausea and vomiting associated with chemotherapy occurs: a. Within the first 24 hours after chemotherapy. b. 1-5 days after chemotherapy. c. Before chemotherapy administration. d. While chemotherapy is being administered. 27. Medications bound to protein have the following effect: a. Enhancement of drug availability. b. Rapid distribution of the drug to receptor sites. c. The more drug bound to protein, the less available for desired effect. d. Increased metabolism of the drug by the liver. 28. Some drugs are excreted into bile and delivered to the intestines. Prior to elimination from the body, the drug may be absorbed. This process is known as: a. Hepatic clearance. b. Total clearance. c. Enterohepatic cycling. d. First-pass effect. 29. An adult patient has been taking a drug (Drug A) that is highly metabolized by the cytochrome p-450 system. He has been on this medication for 6 months. At this time, he is started on a second medication (Drug B) that is an inducer of the cytochrome p-450 system. You should monitor this patient for: a. Increased therapeutic effects of Drug A. b. Increased adverse effects of Drug B. c. Decreased therapeutic effects of Drug A. d. Decreased therapeutic effects of Drug B. 30. Epinephrine is administered to a female patient. The nurse should expect this agent to rapidly affect: a. Adrenergic receptors. b. Muscarinic receptors. c. Cholinergic receptors. d. Nicotinic receptors. Oncologic Disorders 1. A 25 year old patient is inquiring about the methods or ways to detect cancer earlier. The nurse least likely identify this method by stating: a. Annual chest x-ray. b. Annual Pap smear for sexually active women only. c. Annual digital rectal examination for persons over age 40. d. Yearly physical and blood examination

2. The removal of entire breast, pectoralis major and minor muscles and neck lymph nodes which is followed by skin grafting is a procedure called: a. Simple mastectomy b. Modified radical mastectomy c. Radiation therapy d. Radical mastectomy 3. Chemotherapy is one of the therapeutic modalities for cancer. This treatment is contraindicated to which of the following conditions? a. Recent surgery b. Pregnancy c. Bone marrow depression d. All of the above 4. The nurse is preparing Cyclophosphamide (Cytoxan). Safe handling of the drug should be implemented to protect the nurse from injury. Which of the following action by the nurse should be corrected? a. The nurse should wear mask and gloves. b. Air bubbles should be expelled on wet cotton. c. Label the hanging IV bottle with ANTINEOPLASTIC CHEMOTHERAPY sign. d. Vent vials after mixing. 5. Neoplasm can be classified as either benign or malignant. The following are characteristics of malignant tumor apart from: a. Metastasis b. Infiltrates surrounding tissues c. Encapsulated d. Poorly differentiated cells 6. On a clinic visit a client who has a relative with cancer, is asking about the warning signs that may relate to cancer. The nurse correctly identifies the warning signs of cancer by responding: a. If a sore healing took a month or more to heal, cancer should be suspected. b. Presence of dry cough is one of the warning signs of cancer. c. A lump located only in the breast area may suggest the presence of cancer. d. Sudden weight loss of unexplained etiology can be a warning sign of cancer. 7. In staging and grading neoplasm TNM system is used. TNM stands for: a. Time, neoplasm, mode of growth b. Tumor, node, metastasis c. Tumor, neoplasm, mode of growth d. Time, node, metastasis 8. Breast self examination (BSE) is one of the ways to detect breast cancer earlier. The nurse is conducting a health teaching to female clients in a clinic. During evaluation the clients are asked to state what they learned. Which of the following statement made by a client needs further teaching about BSE? a. BSE is done after menstruation. b. BSE palpation is done by starting at the center going to the periphery in a circular motion. c. BSE can be done in either supine or standing position. d. BSE should start from age 20. 9. A client had undergone radiation therapy (external). The expected side effects include the following apart from: a. Hair loss b. Ulceration of oral mucous membranes c. Constipation d. Headache 10. Nurse Janet is assigned in the oncology section of the hospital. Which of the following orders should the nurse question if a client is on radiation therapy? a. Analgesics before meals b. Saline rinses every 2 hours c. Aspirin every 4 hours d. Bland diet

11. Skin reactions are common in radiation therapy. Nursing responsibilities on promoting skin integrity should be promoted apart from: a. Avoiding the use of ointments, powders and lotion to the area b. Using soft cotton fabrics for clothing c. Washing the area with a mild soap and water and patting it dry not rubbing it. d. Avoiding direct sunshine or cold. 12. Nausea and vomiting is an expected side effect of chemotherapeutic drug use. Which of the following drug should be administered to a client on chemotherapy to prevent nausea and vomiting? a. Metochlopramide (Metozol) b. Succimer (Chemet) c. Anastrazole (Arimidex) d. Busulfan (Myleran) 13. Radiation protection is very important to implement when performing nursing procedures. When the nurse is not performing any nursing procedures what distance should be maintained from the client? a. 1 feet b. 2 feet c. 2.5 feet d. 3 feet 14. The following are teaching guidelines regarding radiation therapy except: a. The therapy is painless b. To promote safety, the client is assisted by therapy personnel while the machine is in operation. c. The client may communicate all his concerns or needs or discomforts while the machine is operating. d. Safety precautions are necessary only during the time of actual irradiation. 15. Contact of client on radiation therapy should be limited only to how many minutes to promote safety of the therapy personnel? a. 1 minute b. 3 minutes c. 5 minutes d. 10 minutes 16. A client is taking Cyclophosphamide (Cytoxan) for the treatment of lymphoma. The nurse is very cautious in administering the medication because this drug poses the fatal side effect of: a. Alopecia b. Myeloma c. CNS toxicity d. Hemorrhagic cystitis 17. Cytarabine (Ara-C) is an antimetabolite that can cause a common cytarabine syndrome which includes the following apart from: a. Fever b. Myalgia c. Chest pain d. Diarrhea 18. To provide relief from the cytarabine syndrome, which drug is given? a. Analgesic b. Aspirin c. Steroids d. Allopurinol 19. Chemotherapeutic agents have different specific classifications. The following medications are antineoplastic antibiotics except: a. Doxorubicin (Adriamycin) b. Fluorouracil (Adrucil) c. Mitoxantrone (Novantrone) d. Bleomycin (Blenoxane) 20. Specific classification of the chemotherapeutic agent, Vincristine ((Oncovin) is: a. Hormone modulator

b. Mitotic inhibitor c. Antineoplastic antibiotic d. Antimetabolite 21. A client is diagnosed with progressive prostate cancer. The nurse expects which drug is given? a. Anstrazole (arimidex) b. Estramustine (Emcyt) c. Pclitaxel (Taxol) d. Irinotecan (Camptosar) 22. A client taking a chemotherapeutic agent understands the effects of therapy by stating: a. I will avoid eating hot and spicy foods. b. I should stay in my room all the time. c. I should limit my fluid intake to about 500 ml per day. d. I should notify the physician immediately if a urine color change is observed. 23. A client is diagnosed with breast cancer. The tumor size is up to 5 cm with axillary and neck lymph node involvement. The client is in what stage of breast cancer? a. Stage I b. Stage II c. Stage III d. Stage IV 24. The classic symptoms that define breast cancer includes the following except: a. pink peel skin b. Solitary, irregularly shaped mass c. Firm, nontender, nonmobile mass d. Abnormal discharge from the nipple 25. Surgical procedure to treat breast cancer involves the removal of the entire breast, pectoralis major muscle and the axillary lymph nodes is: a. Simple mastectomy b. Modified radical mastectomy c. Halstead Surgery d. Radical mastectomy Oncology Questions Part 2 1. Nina, an oncology nurse educator is speaking to a womens group about breast cancer. Questions and comments from the audience reveal a misunderstanding of some aspects of the disease. Various members of the audience have made all of the following statements. Which one is accurate? a. Mammography is the most reliable method for detecting breast cancer. b. Breast cancer is the leading killer of women of childbearing age. c. Breast cancer requires a mastectomy. d. Men can develop breast cancer. 2. Nurse Meredith is instructing a premenopausal woman about breast self-examination. The nurse should tell the client to do her self-examination: a. at the end of her menstrual cycle. b. on the same day each month. c. on the 1st day of the menstrual cycle. d. immediately after her menstrual period. 3. Nurse Kent is teaching a male client to perform monthly testicular self-examinations. Which of the following points would be appropriate to make? a. Testicular cancer is a highly curable type of cancer. b. Testicular cancer is very difficult to diagnose. c. Testicular cancer is the number one cause of cancer deaths in males. d. Testicular cancer is more common in older men. 4. Rhea, has malignant lymphoma. As part of her chemotherapy, the physician prescribes chlorambucil (Leukeran), 10 mg by mouth daily. When caring for the client, the nurse teaches her about adverse reactions to chlorambucil, such as alopecia. How soon after the first administration of chlorambucil might this reaction occur?

a. Immediately b. 1 week c. 2 to 3 weeks d. 1 month 5. A male client is receiving the cell cyclenonspecific alkylating agent thiotepa (Thioplex), 60 mg weekly for 4 weeks by bladder instillation as part of a chemotherapeutic regimen to treat bladder cancer. The client asks the nurse how the drug works. How does thiotepa exert its therapeutic effects? a. It interferes with deoxyribonucleic acid (DNA) replication only. b. It interferes with ribonucleic acid (RNA) transcription only. c. It interferes with DNA replication and RNA transcription. d. It destroys the cell membrane, causing lysis. 6. The nurse is instructing the 35 year old client to perform a testicular self-examination. The nurse tells the client: a. To examine the testicles while lying down b. That the best time for the examination is after a shower c. To gently feel the testicle with one finger to feel for a growth d. That testicular self-examination should be done at least every 6 months 7. A female client with cancer is receiving chemotherapy and develops thrombocytopenia. The nurse identifies which intervention as the highest priority in the nursing plan of care? a. Monitoring temperature b. Ambulation three times daily c. Monitoring the platelet count d. Monitoring for pathological fractures 8. Gian, a community health nurse is instructing a group of female clients about breast self-examination. The nurse instructs the client to perform the examination: a. At the onset of menstruation b. Every month during ovulation c. Weekly at the same time of day d. 1 week after menstruation begins 9. Nurse Cecilia is caring for a client who has undergone a vaginal hysterectomy. The nurse avoids which of the following in the care of this client? a. Elevating the knee gatch on the bed b. Assisting with range-of-motion leg exercises c. Removal of antiembolism stockings twice daily d. Checking placement of pneumatic compression boots 10. Mina, who is suspected of an ovarian tumor is scheduled for a pelvic ultrasound. The nurse provides which preprocedure instruction to the client? a. Eat a light breakfast only b. Maintain an NPO status before the procedure c. Wear comfortable clothing and shoes for the procedure d. Drink six to eight glasses of water without voiding before the test 11. A male client is diagnosed as having a bowel tumor and several diagnostic tests are prescribed. The nurse understands that which test will confirm the diagnosis of malignancy? a. Biopsy of the tumor b. Abdominal ultrasound c. Magnetic resonance imaging d. Computerized tomography scan 12. A female client diagnosed with multiple myeloma and the client asks the nurse about the diagnosis. The nurse bases the response on which description of this disorder? a. Altered red blood cell production b. Altered production of lymph nodes c. Malignant exacerbation in the number of leukocytes d. Malignant proliferation of plasma cells within the bone

13. Nurse Bea is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which of the following would the nurse expect to note specifically in this disorder? a. Increased calcium b. Increased white blood cells c. Decreased blood urea nitrogen level d. Decreased number of plasma cells in the bone marrow 14. Vanessa, a community health nurse conducts a health promotion program regarding testicular cancer to community members. The nurse determines that further information needs to be provided if a community member states that which of the following is a sign of testicular cancer? a. Alopecia b. Back pain c. Painless testicular swelling d. Heavy sensation in the scrotum 15. The male client is receiving external radiation to the neck for cancer of the larynx. The most likely side effect to be expected is: a. Dyspnea b. Diarrhea c. Sore throat d. Constipation 16. Nurse Joy is caring for a client with an internal radiation implant. When caring for the client, the nurse should observe which of the following principles? a. Limit the time with the client to 1 hour per shift b. Do not allow pregnant women into the clients room c. Remove the dosimeter badge when entering the clients room d. Individuals younger than 16 years old may be allowed to go in the room as long as they are 6 feet away from the client 17. A cervical radiation implant is placed in the client for treatment of cervical cancer. The nurse initiates what most appropriate activity order for this client? a. Bed rest b. Out of bed ad lib c. Out of bed in a chair only d. Ambulation to the bathroom only 18. A female client is hospitalized for insertion of an internal cervical radiation implant. While giving care, the nurse finds the radiation implant in the bed. The initial action by the nurse is to: a. Call the physician b. Reinsert the implant into the vagina immediately c. Pick up the implant with gloved hands and flush it down the toilet d. Pick up the implant with long-handled forceps and place it in a lead container. 19. The nurse is caring for a female client experiencing neutropenia as a result of chemotherapy and develops a plan of care for the client. The nurse plans to: a. Restrict all visitors b. Restrict fluid intake c. Teach the client and family about the need for hand hygiene d. Insert an indwelling urinary catheter to prevent skin breakdown 20. The home health care nurse is caring for a male client with cancer and the client is complaining of acute pain. The appropriate nursing assessment of the clients pain would include which of the following? a. The clients pain rating b. Nonverbal cues from the client c. The nurses impression of the clients pain d. Pain relief after appropriate nursing intervention 21. Nurse Mickey is caring for a client who is postoperative following a pelvic exenteration and the physician changes the clients diet from NPO status to clear liquids. The nurse makes which priority assessment before administering the diet? a. Bowel sounds

b. Ability to ambulate c. Incision appearance d. Urine specific gravity 22. A male client is admitted to the hospital with a suspected diagnosis of Hodgkins disease. Which assessment findings would the nurse expect to note specifically in the client? a. Fatigue b. Weakness c. Weight gain d. Enlarged lymph nodes 23. During the admission assessment of a 35 year old client with advanced ovarian cancer, the nurse recognizes which symptom as typical of the disease? a. Diarrhea b. Hypermenorrhea c. Abdominal bleeding d. Abdominal distention 24. Nurse Kate is reviewing the complications of colonization with a client who has microinvasive cervical cancer. Which complication, if identified by the client, indicates a need for further teaching? a. Infection b. Hemorrhage c. Cervical stenosis d. Ovarian perforation 25. Mr. Miller has been diagnosed with bone cancer. You know this type of cancer is classified as: a. sarcoma. b. lymphoma. c. carcinoma. d. melanoma. 26. Sarah, a hospice nurse visits a client dying of ovarian cancer. During the visit, the client expresses that If I can just live long enough to attend my daughters graduation, Ill be ready to die. Which phrase of coping is this client experiencing? a. Anger b. Denial c. Bargaining d. Depression 27. Nurse Farah is caring for a client following a mastectomy. Which assessment finding indicates that the client is experiencing a complication related to the surgery? a. Pain at the incisional site b. Arm edema on the operative side c. Sanguineous drainage in the Jackson-Pratt drain d. Complaints of decreased sensation near the operative site 28. The nurse is admitting a male client with laryngeal cancer to the nursing unit. The nurse assesses for which most common risk factor for this type of cancer? a. Alcohol abuse b. Cigarette smoking c. Use of chewing tobacco d. Exposure to air pollutants 29. The female client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing: a. Rupture of the bladder b. The development of a vesicovaginal fistula c. Extreme stress caused by the diagnosis of cancer d. Altered perineal sensation as a side effect of radiation therapy 30. The client with leukemia is receiving busulfan (Myleran) and allopurinol (Zyloprim). The nurse tells the client that the purpose if the allopurinol is to prevent: a. Nausea

b. Alopecia c. Vomiting d. Hyperuricemia Psychiatric Mental Health Nursing Questions Part 1 1. Flumazenil (Romazicon) has been ordered for a male client who has overdosed on oxazepam (Serax). Before administering the medication, nurse Gina should be prepared for which common adverse effect? a. Seizures b. Shivering c. Anxiety d. Chest pain 2. Nurse Tim is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is to: a. avoid shopping for large amounts of food b. control eating impulses c. identify anxiety-causing situations d. eat only three meals per day 3. A female client whos at high risk for suicide needs close supervision. To best ensure the clients safety, nurse Gio should: a. check the client frequently at irregular intervals throughout the night b. assure the client that the nurse will hold in confidence anything the client says c. repeatedly discuss previous suicide attempts with the client d. disregard decreased communication by the client because this is common in suicidal clients 4. Which of the following drugs should nurse Marlyn prepare to administer to a client with a toxic acetaminophen (Tylenol) level? a. deferoxamine mesylate (Desferal) b. succimer (Chemet) c. flumazenil (Romazicon) d. acetylcysteine (Mucomyst) 5. A male client is admitted to the substance abuse unit for alcohol detoxification. Which of the following medications is nurse Apple most likely to administer to reduce the symptoms of alcohol withdrawal? a. naloxone (Narcan) b. haloperidol (Haldol) c. magnesium sulfate d. chlordiazepoxide (Librium) 6. During postprandial monitoring, a female client with bulimia nervosa tells the nurse, You can sit with me, but youre just wasting your time. After you sat with me yesterday, I was still able to purge. Today, my goal is to do it twice. What is the nurses best response? a. I trust you not to purge. b. How are you purging and when do you do it? c. Dont worry. I wont allow you to purge today. d. I know its important for you to feel in control, but Ill monitor you for 90 minutes after you eat. 7. A male client admitted to the psychiatric unit for treatment of substance abuse says to the nurse, It felt so wonderful to get high. Which of the following is the most appropriate response? a. If you continue to talk like that, Im going to stop speaking to you. b. You told me you got fired from your last job for missing too many days after taking drugs all night. c. Tell me more about how it felt to get high. d. Dont you know its illegal to use drugs? 8. For a female client with anorexia nervosa, nurse Jay is aware that which goal takes the highest priority? a. The client will establish adequate daily nutritional intake b. The client will make a contract with the nurse that sets a target weight c. The client will identify self-perceptions about body size as unrealistic d. The client will verbalize the possible physiological consequences of self-starvation

9. When interviewing the parents of an injured child, which of the following is the strongest indicator that child abuse may be a problem? a. The injury isnt consistent with the history or the childs age b. The mother and father tell different stories regarding what happened c. The family is poor d. The parents are argumentative and demanding with emergency department personnel 10. For a female client with anorexia nervosa, nurse Rose plans to include the parents in therapy sessions along with the client. What fact should the nurse remember to be typical of parents of clients with anorexia nervosa? a. They tend to overprotect their children b. They usually have a history of substance abuse c. They maintain emotional distance from their children d. They alternate between loving and rejecting their children 11. In the emergency department, a client with facial lacerations states that her husband beat her with a shoe. After the health care team repairs her lacerations, she waits to be seen by the crisis intake nurse, who will evaluate the continued threat of violence. Suddenly the clients husband arrives, shouting that he wants to finish the job. What is the first priority of the health care worker who witnesses this scene? a. Remaining with the client and staying calm b. Calling a security guard and another staff member for assistance c. Telling the clients husband that he must leave at once d. Determining why the husband feels so angry 12. . Nurse Venus is caring for a client with bulimia. Strict management of dietary intake is necessary. Which intervention is also important? a. Fill out the clients menu and make sure she eats at least half of what is on her tray. b. Let the client eat her meals in private. Then engage her in social activities for at least 2 hours after each meal c. Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal d. Let the client eat food brought in by the family if she chooses, but she should keep a strict calorie count. 13. Nurse Mary is assigned to care for a suicidal client. Initially, which is the nurses highest care priority? a. Assessing the clients home environment and relationships outside the hospital b. Exploring the nurses own feelings about suicide c. Discussing the future with the client d. Referring the client to a clergyperson to discuss the moral implications of suicide 14. A 24-year old client with anorexia nervosa tells the nurse, When I look in the mirror, I hate what I see. I look so fat and ugly. Which strategy should the nurse use to deal with the clients distorted perceptions and feelings? a. Avoid discussing the clients perceptions and feelings b. Focus discussions on food and weight c. Avoid discussing unrealistic cultural standards regarding weight d. Provide objective data and feedback regarding the clients weight and attractiveness 15. Nurse Desmond is caring for a client being treated for alcoholism. Before initiating therapy with disulfiram (Antabuse), the nurse teaches the client that he must read labels carefully on which of the following products? a. Carbonated beverages b. Aftershave lotion c. Toothpaste d. Cheese 16. Nurse Faith is developing a plan of care for a client with anorexia nervosa. Which action should the nurse include in the plan? a. Restrict visits with the family until the client begins to eat b. Provide privacy during meals c. Set up a strict eating plan for the client d. Encourage the client to exercise, which will reduce her anxiety 17. Nurse Tina is aware that the victims of domestic violence should be assessed for what important information? a. Reasons they stay in the abusive relationship (for example, lack of financial autonomy and isolation) b. Readiness to leave the perpetrator and knowledge of resources

c. Use of drugs or alcohol d. History of previous victimization 18. A male client is hospitalized with fractures of the right femur and right humerus sustained in a motorcycle accident. Police suspect the client was intoxicated at the time of the accident. Laboratory tests reveal a blood alcohol level of 0.2% (200 mg/dl). The client later admits to drinking heavily for years. During hospitalization, the client periodically complains of tingling and numbness in the hands and feet. Nurse Gio realizes that these symptoms probably result from: a. acetate accumulation b. thiamine deficiency c. triglyceride buildup. d. a below-normal serum potassium level 19. A parent brings a preschooler to the emergency department for treatment of a dislocated shoulder, which allegedly happened when the child fell down the stairs. Which action should make the nurse suspect that the child was abused? a. The child cries uncontrollably throughout the examination b. The child pulls away from contact with the physician. c. The child doesnt cry when the shoulder is examined d. The child doesnt make eye contact with the nurse. 20. When planning care for a client who has ingested phencyclidine (PCP), nurse Wayne is aware that the following is the highest priority? a. Clients physical needs b. Clients safety needs c. Clients psychosocial needs d. Clients medical needs 21. The nurse is aware that the outcome criteria would be appropriate for a child diagnosed with oppositional defiant disorder? a. Accept responsibility for own behaviors b. Be able to verbalize own needs and assert rights. c. Set firm and consistent limits with the client d. Allow the child to establish his own limits and boundaries 22. A male client is found sitting on the floor of the bathroom in the day treatment clinic with moderate lacerations on both wrists. Surrounded by broken glass, she sits staring blankly at her bleeding wrists while staff members call for an ambulance. How should nurse Grace approach her initially? a. Enter the room quietly and move beside her to assess her injuries b. Call for staff back-up before entering the room and restraining her c. Move as much glass away from her as possible and sit next to her quietly d. Approach her slowly while speaking in a calm voice, calling her name, and telling her that the nurse is here to help her 23. A female client with anorexia nervosa describes herself as a whale. However, the nurses assessment reveals that the client is 5 8 (1.7 m) tall and weighs only 90 lb (40.8 kg). Considering the clients unrealistic body image, which intervention should nurse Angel be included in the plan of care? a. Asking the client to compare her figure with magazine photographs of women her age b. Assigning the client to group therapy in which participants provide realistic feedback about her weight c. Confronting the client about her actual appearance during one-on-one sessions, scheduled during each shift d. Telling the client of the nurses concern for her health and desire to help her make decisions to keep her healthy 24. Eighteen hours after undergoing an emergency appendectomy, a client with a reported history of social drinking displays these vital signs: temperature, 101.6 F (38.7 C); heart rate, 126 beats/minute; respiratory rate, 24 breaths/minute; and blood pressure, 140/96 mm Hg. The client exhibits gross hand tremors and is screaming for someone to kill the bugs in the bed. Nurse Melinda should suspect: a. a postoperative infection b. alcohol withdrawal c. acute sepsis. d. pneumonia.

25. Clonidine (Catapres) can be used to treat conditions other than hypertension. Nurse Sally is aware that the following conditions might the drug be administered? a. Phencyclidine (PCP) intoxication b. Alcohol withdrawal c. Opiate withdrawal d. Cocaine withdrawal Psychiatric Mental Health Nursing Questions Part 2 1. A male client with a history of cocaine addiction is admitted to the coronary care unit for evaluation of substernal chest pain. The electrocardiogram (ECG) shows a 1-mm ST-segment elevation the anteroseptal leads and T-wave inversion in leads V3 to V5. Considering the clients history of drug abuse, nurse Greg expects the physician to prescribe: a. lidocaine (Xylocaine). b. procainamide (Pronestyl). c. nitroglycerin (Nitro-Bid IV). d. epinephrine. 2. A 14-year-old client is brought to the clinic by her mother. Her mother expresses concern about her daughters weight loss and constant dieting. Nurse Kris conducts a health history interview. Which of the following comments indicates that the client may be suffering from anorexia nervosa? a. "I like the way I look. I just need to keep my weight down because Im a cheerleader." b. "I dont like the food my mother cooks. I eat plenty of fast food when Im out with my friends." c. "I just cant seem to get down to the weight I want to be. Im so fat compared to other girls." d. "I do diet around my periods; otherwise, I just get so bloated." 3. Nurse Fey is aware that the drug of choice for treating Tourette syndrome? a. fluoxetine (Prozac) b. fluvoxamine (Luvox) c. haloperidol (Haldol) d. paroxetine (Paxil) 4. A male client tells the nurse he was involved in a car accident while he was intoxicated. What would be the most therapeutic response from nurse Julia? a. "Why didnt you get someone else to drive you?" b. "Tell me how you feel about the accident." c. "You should know better than to drink and drive." d. "I recommend that you attend an Alcoholics Anonymous meeting." 5. A male adult client voluntarily admits himself to the substance abuse unit. He confesses that he drinks 1 qt or more of vodka each day and uses cocaine occasionally. Later that afternoon, he begins to show signs of alcohol withdrawal. What are some early signs of this condition? a. Vomiting, diarrhea, and bradycardia b. Dehydration, temperature above 101 F (38.3 C), and pruritus c. Hypertension, diaphoresis, and seizures d. Diaphoresis, tremors, and nervousness 6. When monitoring a female client recently admitted for treatment of cocaine addiction, nurse Aaron notes sudden increases in the arterial blood pressure and heart rate. To correct these problems, the nurse expects the physician to prescribe: a. norepinephrine (Levophed) and lidocaine (Xylocaine) b. nifedipine (Procardia) and lidocaine. c. nitroglycerin (Nitro-Bid IV) and esmolol (Brevibloc) d. nifedipine and esmolol 7. A 25 year old client experiencing alcohol withdrawal is upset about going through detoxification. Which of the following goals is a priority? a. The client will commit to a drug-free lifestyle b. The client will work with the nurse to remain safe c. The client will drink plenty of fluids daily d. The client will make a personal inventory of strength

8. A male client is admitted to a psychiatric facility by court order for evaluation for antisocial personality disorder. This client has a long history of initiating fights and abusing animals and recently was arrested for setting a neighbors dog on fire. When evaluating this client for the potential for violence, nurse Perry should assess for which behavioral clues? a. A rigid posture, restlessness, and glaring b. Depression and physical withdrawal c. Silence and noncompliance d. Hypervigilance and talk of past violent acts 9. A male client is brought to the psychiatric clinic by family members, who tell the admitting nurse that the client repeatedly drives while intoxicated despite their pleas to stop. During an interview with the nurse Linda, which statement by the client most strongly supports a diagnosis of psychoactive substance abuse? a. "Im not addicted to alcohol. In fact, I can drink more than I used to without being affected." b. "I only spend half of my paycheck at the bar." c. "I just drink to relax after work." d. "I know Ive been arrested three times for drinking and driving, but the police are just trying to hassle me." 10. A female client with borderline personality disorder is admitted to the psychiatric unit. Initial nursing assessment reveals that the clients wrists are scratched from a recent suicide attempt. Based on this finding, the nurse Lenny should formulate a nursing diagnosis of: a. Ineffective individual coping related to feelings of guilt. b. Situational low self-esteem related to feelings of loss of control c. Risk for violence: Self-directed related to impulsive mutilating acts d. Risk for violence: Directed toward others related to verbal threats 11. A male client recently admitted to the hospital with sharp, substernal chest pain suddenly complains of palpitations. Nurse Ryan notes a rise in the clients arterial blood pressure and a heart rate of 144 beats/minute. On further questioning, the client admits to having used cocaine recently after previously denying use of the drug. The nurse concludes that the client is at high risk for which complication of cocaine use? a. Coronary artery spasm b. Bradyarrhythmias c. Neurobehavioral deficits d. Panic disorder 12. A male client is being admitted to the substance abuse unit for alcohol detoxification. As part of the intake interview, the nurse asks him when he had his last alcoholic drink. He says that he had his last drink 6 hours before admission. Based on this response, nurse Lorena should expect early withdrawal symptoms to: a. begin after 7 days b. not occur at all because the time period for their occurrence has passed c. begin anytime within the next 1 to 2 days d. begin within 2 to 7 days 13. Nurse Helen is assigned to care for a client with anorexia nervosa. Initially, which nursing intervention is most appropriate for this client? a. Providing one-on-one supervision during meals and for 1 hour afterward b. Letting the client eat with other clients to create a normal mealtime atmosphere c. Trying to persuade the client to eat and thus restore nutritional balance d. Giving the client as much time to eat as desired 14. A female client begins to experience alcoholic hallucinosis. Nurse Joy is aware that the best nursing intervention at this time? a. Keeping the client restrained in bed b. Checking the clients blood pressure every 15 minutes and offering juices c. Providing a quiet environment and administering medication as needed and prescribed d. Restraining the client and measuring blood pressure every 30 minutes 15. Nurse Bella is aware that assessment finding is most consistent with early alcohol withdrawal? a. Heart rate of 120 to 140 beats/minute b. Heart rate of 50 to 60 beats/minute c. Blood pressure of 100/70 mm Hg d. Blood pressure of 140/80 mm Hg

16. Nurse Amy is aware that the client is at highest risk for suicide? a. One who appears depressed, frequently thinks of dying, and gives away all personal possessions b. One who plans a violent death and has the means readily available c. One who tells others that he or she might do something if life doesnt get better soon d. One who talks about wanting to die 17. Nurse Penny is aware that the following medical conditions is commonly found in clients with bulimia nervosa? a. Allergies b. Cancer c. Diabetes mellitus d. Hepatitis A 18. Ken, a high school student is referred to the school nurse for suspected substance abuse. Following the nurses assessment and interventions, what would be the most desirable outcome? a. The student discusses conflicts over drug use b. The student accepts a referral to a substance abuse counselor c. The student agrees to inform his parents of the problem d. The student reports increased comfort with making choice 19. A male client who reportedly consumes 1 qt of vodka daily is admitted for alcohol detoxification. To try to prevent alcohol withdrawal symptoms, Dr. Smith is most likely to prescribe which drug? a. clozapine (Clozaril) b. thiothixene (Navane) c. lorazepam (Ativan) d. lithium carbonate (Eskalith) 20. A male client is being treated for alcoholism. After a family meeting, the clients spouse asks the nurse about ways to help the family deal with the effects of alcoholism. Nurse Lily should suggest that the family join which organization? a. Al-Anon b. Make Today Count c. Emotions Anonymous d. Alcoholics Anonymous 21. A female client is admitted to the psychiatric clinic for treatment of anorexia nervosa. To promote the clients physical health, nurse Tair should plan to: a. severely restrict the clients physical activities b. weigh the client daily, after the evening meal c. monitor vital signs, serum electrolyte levels, and acid-base balance d. instruct the client to keep an accurate record of food and fluid intake 22. Kevin is remanded by the courts for psychiatric treatment. His police record, which dates to his early teenage years, includes delinquency, running away, auto theft, and vandalism. He dropped out of school at age 16 and has been living on his own since then. His history suggests maladaptive coping, which is associated with: a. antisocial personality disorder b. borderline personality disorder c. obsessive-compulsive personality disorder d. narcissistic personality disorder 23. Mark and May seek emergency crisis intervention because he slapped her repeatedly the night before. The husband indicates that his childhood was marred by an abusive relationship with his father. When intervening with this couple, nurse Gerry knows they are at risk for repeated violence because the husband: a. has only moderate impulse control b. denies feelings of jealousy or possessiveness c. has learned violence as an acceptable behavior d. feels secure in his relationship with his wife 24. A client whose husband just left her has a recurrence of anorexia nervosa. Nurse Vic caring for her realizes that this exacerbation of anorexia nervosa results from the clients effort to: a. manipulate her husband b. gain control of one part of her life

c. commit suicide d. live up to her mothers expectations 25. A male client has approached the nurse asking for advice on how to deal with his alcohol addiction. Nurse Sally should tell the client that the only effective treatment for alcoholism is: a. Psychotherapy b. total abstinence c. Alcoholics Anonymous (AA) d. aversion therapy