221) Which of the following are a result of antidiuretic hormone (ADH) secretion?
A. Sodium and water reabsorption
B. Urine concentration
C. Urine dilution
D. Potassium excretion and water reabsorption


ANSWER

220) A patient is preparing for an orthopedic surgery and the LPN is asked to help. For which of the following tasks must the RN confirm that the LPN has received special training?
A. Administering I.V. therapy
B. Ambulating the patient
C. Assisting the patient with a bath
D. Collecting a urine specimen

ANSWER

219) The nurse is caring for a patient with a hydromorphone (Dilaudid) PCA set at a basal rate of 0.1 mg per hour, with a 0.1 mg bolus every 10 minutes. The nurse finds the patient stuporous and difficult to arouse. After treating and stabilizing the patient, the nurse should:
A. Notify the physician and request a lower basal rate
B. Check the PCA pump to verify that the settings are correct
C. Request that the PCA be discontinued
D. Ask the patient to rate his pain

ANSWER

218) The nurse would teach a client that alcohol taken in conjunction with which of the following ordered medications can cause a reaction causing flushing, dizziness, pounding headache, sweating, abdominal cramps, nausea, irritability, and low blood pressure?
A) Cefoxitan (Mefoxin)
B) Metronidazole (Flagyl)
C) Clindamycin (Cleocin)
D) Ampicillin (Omnipen)

ANSWER

217) The nurse plans to administer which of the following intravenous (IV) treatments to a client for treatment of hyperkalemia associated with severe acidosis?
A) Calcium gluconate, to make the potassium shift from the intracellular fluid (ICF) to the extracellular fluid (ECF)
B) Insulin and dextrose, to make the client hypoglycemic
C) Sodium bicarbonate, to make the client alkalotic so the potassium will shift into the ECF
D) Normal saline (NS), to provide extra sodium so the potassium will move out of the ICF into the ECF

ANSWER

216) The client has the diagnosis of acquired immunodeficiency syndrome (AIDS). The nurse observes that the client is demonstrating changes in behavior that include memory difficulties, declining attention to personal hygiene, and frequent manifestations of angry and hostile behaviors. The nurse assists the client’s family and friends to understand this as an indication of which of the following?
A) Rapidly approaching death
B) Reversible symptoms of delirium
C) Chronic impairment of brain functioning
D) Treatable side effects of anti-AIDS medications

ANSWER

215) A client is being evaluated for a possible myocardial infarction. The nurse performs a 12-lead ECG for an episode of new chest pain. The nurse will monitor for which sign of acute myocardial injury?
A) ST depressions
B) ST elevations
C) New Q wave
D) New U wave

ANSWER

214) An order for which beta agonist should be questioned because it is contraindicated for a client with a history of atrial fibrillation?
A) Terbutaline (Brethine)
B) Pirbuterol (Maxair)
C) Isoproterenol (Isuprel)
D) Metaproterenol (Alupent)


ANSWER

213) When admitting a client with a diagnosis of cirrhosis, the nurse assesses the medications ordered. She should question the administration of which of the following?
A) Lactulose (Chronulac)
B) Neomycin (Mycifradin)
C) Meperidine (Demerol)
D) Acetaminophen (Tylenol)

ANSWER

212) Which of the following points should be included in a teaching plan for a client receiving medications to treat multiple sclerosis?
A) The signs and symptoms of pulmonary edema
B) The restriction of fluids
C) The requirement to remain restricted from crowds
D) The requirement to exercise to enhance muscle strength

ANSWER

211) A client at 10 weeks' gestation who has recently emigrated from Japan comes to the prenatal clinic because she is having some dark brown vaginal spotting, and is experiencing severe nausea and vomiting. The nurse interprets that these symptoms are compatible with which of the following conditions?
A) Gestational trophoblastic disease
B) Hyperemesis gravidarum
C) Placenta previa
D) Pregnancy-induced psychosis

ANSWER

210) The nurse writes on the worksheet for the shift to assess a client taking cholestyramine (Questran) for signs of possible deficiency of which vitamins?
A) Niacin and thiamine
B) Folic acid and Vitamin C
C) Vitamins A and D
D) Thiamine and cyanocobalamin

ANSWER

209) A 9-year-old male client with severe esophagitis is 12 hours status/post-Nissen fundoplication for gastroesophageal reflux. To implement appropriate nursing care, the nurse should do which of the following?
A) Encourage him to take small amounts of clear liquids every 4 hours.
B) Administer NG or gastrostomy feedings every 4 hours.
C) Ask him to choose a face on the Wong FACES pain rating scale.
D) Insert a pH probe to monitor esophageal acidity.

ANSWER

208) The nurse is caring for a client with a history of renal disease. The nurse most closely monitors the client for signs of nephrotoxicity if the client is ordered to receive which of the following medications?
A) Aminoglycoside antibiotics
B) Aspirin-containing drugs
C) Loop diuretics
D) Potassium supplements

ANSWER

207) A 4-year-old child with osteogenesis imperfecta (OI) is admitted to the hospital unit for an unrelated condition. The nurse determines that which nursing diagnosis has the highest priority for this child?
A) Impaired skin integrity related to cast
B) Pain related to fractures
C) Risk for injury related to disease state
D) Disturbed body image related to short stature

ANSWER

206) A female client complains of a burning, cramping pain in the top part of the abdomen that becomes worse in the middle of the afternoon and sometimes awakens her at night. She reports that eating something usually helps the pain go away but that the pain is now becoming more intense. Which of the following is the best conclusion for the nurse to draw?
A) These symptoms are consistent with an ulcer.
B) The client is probably developing cholelithiasis.
C) The client probably has indigestion and needs to watch what she eats.
D) A snack before bed should be recommended.

ANSWER

205) A 10-year-old client presents with weakness in the legs and history of the flu. The medical diagnosis is Guillain-Barré syndrome. It would be imperative for the nurse to inform the physician after observing which of the following?
A) Weak muscle tone in feet
B) Weak muscle tone in legs
C) Increasing hoarseness
D) Tingling in the hands


ANSWER

204) A child has been admitted to the hospital with a diagnosis of "rule out nephrosis." The nurse would assess the child for:
A) Hematuria.
B) Edema.
C) Petechial rash.
D) Dehydration.

ANSWER

203) The nurse needs to teach a client about newly prescribed sertraline (Zoloft). Which information is essential to include in the teaching? Select all that apply.
A) Sertraline is most often taken as a morning dose.
B) Constipation is a common side effect of sertraline.
C) Fever and flulike symptoms are bothersome but not dangerous side effects of sertraline.
D) Clients taking sertraline will usually recognize improvement within one week.
E) It is possible that sexual side effects will occur.


ANSWER

202) A client is being evaluated for hypothyroidism, and has had blood drawn to determine TSH and T4 levels. Which of the following would support the diagnosis?
A) An elevated TSH and elevated T4 levels
B) An elevated TSH and decreased T4 levels
C) A decreased TSH and elevated T4 levels
D) A decreased TSH and decreased T4 levels

ANSWER

201) A 68-year-old is admitted to the surgical unit after undergoing a total hip replacement. Which of the following interventions is most important to prevent dislocation of the prosthesis?
A. Maintain hip flexion of 90 degrees
B. Prevent abduction of the affected hip
C. Prevent internal rotation of the affected hip
D. Keep the affected hip adducted

ANSWER

200) A home health nurse is making a visit to a client who is terminally ill and whose condition is deteriorating. A family member reports to the nurse that his terminally ill father experienced rapid-onset diarrhea after eating breakfast. The nurse explains this was most likely due to:
A) Malabsorption.
B) Anal incontinence.
C) Fecal impaction.
D) Food poisoning.

ANSWER

199) A charge nurse on a pediatric unit has just been informed of a potential admission from the emergency department. Which of the following nurses should be assigned to admit the patient?
A. A nurse caring for a child with no family or visitors
B. A nurse who recently discharged two patients
C. A nurse preparing for a complex dressing change after surgery
D. A nurse caring for a child with multiple gastrointestinal bleeds

ANSWER

198) The nurse would monitor the client receiving which type of antihypertensive drug because it slows the AV node, and thus decreases the heart rate?
A) Angiotensin-converting enzyme (ACE) inhibitor
B) Beta blocker
C) Alpha blocker
D) Calcium channel blocker

ANSWER

197) A 60-year-old patient was examined by the nurse and the signs and symptoms indicate there is increased intracranial pressure, papilledema, and headache. There was no history of trauma and the vital signs showed BP of 120/70 mmHg, HR = 90 bpm, T = 98.9˚ F, RR = 23 cpm. With the assessment findings, the nurse thinks the patient has:
A. Brain tumor
B. Meningitis
C. Skull fracture
D. Encephalitis

ANSWER

196) An elderly client admitted with a diagnosis of heart failure has been taking furosemide (Lasix) for treatment of heart failure. Serum potassium level is 3.2 mEq/L. Which of the following ABG results would the nurse expect this client to manifest?
A) pH 7.20; PaCO2 50; HCO3- 22; PaO2 93
B) pH 7.30; PaCO2 48; HCO3- 36; PaO2 90
C) pH 7.49; PaCO2 36; HCO3- 30; PaO2 90
D) pH 7.50; PaCO2 49; HCO3- 18; PaO2 90

ANSWER

195) An elderly man is admitted to the hospital for possible urethritis. The nurse assesses the patient closely for what common symptom?
A. Dysuria and mucopurulent penile discharge
B. Hematuria and suprapubic pain
C. Hematuria and proteinuria
D. Hematuria and dysuria

ANSWER

194)A patient presents to the ER after being found unconscious and not breathing. Before endotracheal intubation, you get an arterial blood gas with which of the following results:

A. pH 7.28 PCO2 60 HCO3 26
B. pH 7.38 PCO2 45 HCO3 26
C. pH 7.31 PCO2 41 HCO3 18
D. pH 7.49 PCO2 50 HCO3 18

ANSWER

193) While assessing a newborn, the nurse suspects the presence of phenylketonuria. Which of the follow tests would confirm the diagnosis?
A. Guthrie test
B. Tandem mass spectrometry
C. Liver enzyme analysis
D. Urinalysis

ANSWER

192)The nurse is caring for a patient that sustained multiple fractures from a motor vehicle accident. Which nursing intervention is most important when caring for a patient on bedrest?

A. Reposition every 2 hours
B. Elevate the head of bed to promote lung expansion
C. Help with activities of daily living to help conserve the patient’s energy
D. Limit fluid intake to reduce edema

ANSWER

191) A nurse administers bacitracin ophthalmic ointment to a teenager with conjunctivitis. Which of the following symptoms indicates that the patient is experiencing an adverse effect of this medication?

A. Amblyopia
B. Diplopia
C. Strabismus
D. Blurred vision

ANSWER

190) The nurse has completed some child and family education for a child diagnosed with thalassemia. The medical plan of treatment includes blood transfusions when the anemia reaches a severe point. Which statement by the parents indicates a need for further education?
A) "Because of the anemia, my child will need extra rest periods."
B) "My child inherited this disorder from both of us."
C) "We should be alert to periods when our child seems paler than usual."
D) "My child needs an iron supplement."

ANSWER

189) The client is in the clinic for a follow-up visit following new onset of stable angina. The nurse should teach the client precipitating causes of angina such as exercise and stress. Which of the following should also be taught as a way to handle these precipitating causes?
A) Avoid these activities.
B) Perform such activities anyway.
C) Lead a sedentary lifestyle.
D) Use a nitroglycerin (NTG) tablet before the activity.

ANSWER

188) The nurse suspects hepatotoxicity evolving in a dark-skinned client who is on an antibiotic. In what area of the body should the nurse assess for jaundice?
A) Palms
B) Sclera
C) Conjunctivae
D) Hard palate of the oral cavity

ANSWER

187) Which of the following statements made by a parent of a child with osteogenesis imperfecta (OI) needs clarification by the nurse?
A) "My child may be able to participate in sports."
B) "There are no medications available to help this disease process."
C) "Surgery may be needed to place rods in the bone for stability."
D) "My child will need to be home schooled to protect him from injury."

ANSWER

186) You have been invited to talk to the Woman's Guild in your community about the cautions of aromatherapy. Which of the following would be correctly presented to the audience?
A) Aromatic oils are produced by a standard-quality formula.
B) The oils can be stored in any type of container.
C) The skin should always be tested for allergies by applying a small amount of oil to the area before treatment.
D) Oils should not be used during pregnancy.

ANSWER

185) A client who works in a mine presents to the Emergency Department with neurological problems. The nurse suspects which mineral imbalance could be a likely cause for this presentation?
A) Fluoride ingestion
B) Inhalation of manganese dust
C) Excess copper inhalation
D) Sodium deficiency due to dehydration
ANSWER

184)Which of the follow is likely to indicate abuse in a 6-year-old child?  *Select All That Apply

A. Exaggerated emotional response by the parents
B. Absent emotional response by the parents
C. Inappropriate physical appearance of the parents
D. Conflicting stories from the parents
E. Parents using vulgar language

ANSWER