'f?, 'of; \ .','!

"~~,t A primigra~jda at 26 weeks' gestation asks the.' .'iI' nurse what causes heartburn during pregnancy. The

'~ nurse should explain to the ,-lient that heartburn) during pregnancy is usually caused by which of the, following?

o 1. Increased peris.taItic action during pregnancy.02. Displacement of the stomach by the diaph-'

ragm.') 3. Decreased secretion of hydrochloric acid.u 4. BackfIow of stomach contents into the esopha-

gus.2.A client at a follow-up appointment after having a

miscarriage 2 weeks previously yells at the nurse,"How could God do this to me? I've never done

i anything wrong." Which of the following responses

J

. by the nurse would be most appropriate at this time?01. "God can handle your anger. It's OK." .

'. 02."1 know you are angry. It's so hard to lose your~ baby.". 03."It isn't God's fault. It was an accident."

04. "You're a strong person. You will get throughthis."

3. Aclient with cancer has been advised by the physi-cian that he should have chemotherapy. The client isconcerned about chemotherapy and wants to takeherbal treatments instead. The nurse's best responseto the client is which of the following?o I. "You are making a mistake and placing your

life in jeopardy."02. "Herbal treatments are not approved by the

FDA."03. "Herbal treatments have not. been researched

> with cancer."

~ 0 4. "Tell me about your concerns with chemother-.. apy."

,

4. A4-year-old child is admitted for a cardiac catheter-, ization. Which of the following is most important to

include as the nurse teaches this child about the car-. diac catheterization?

() 1. A plastic model ()f the heart.02. A catheter that will be inserted into the artery.o 3. The parents.04. Othl'r children undergoing a ciltheterizeltion.

5. A client has a reddened area over a bony promi-nence. The nurse finds a nursing assistant massag-ing this area. The nurse should01. reinforce the nursing assistant's use of this

intervention over the bony prominence.02. explain to the nursing assistant that massage is

effective because it improves blood flow to thearea.

o 3. inform the f).ursing assistant that massage iseven more .:ffective when combined with theuse of Ivtion.

o 4. instruct the nursing assistant that massage iscontraindicated because it decreases bloodflow to the area.

6. A worried mother confides in the nurse that she

wants to change physicians because her infant is notgetting better. The best response of the nurse iswhich of the following?o 1. "This doctor has been on our staff for 20 years."02. "I know you are worried, but the doctor has an

excellent reputation."03. "You always have an option to change. Tell me

about your concerns."04. "1 take my own children to this doctor."

7. A recently widowed, elderly male client is receivingchemotherapy. He tells the nurse thelt he does notlike to cook for himself. A community resource forthis client is01. Hospice Association.02. Visiting Nurses' Association (VNA).o 3. Meals on Wheels.o 4. American Association of Retired Persons

(AARP).8. The nurse assists the doctor in inserting a temporary

pacemaker into the client. The nurse knows that itwill be critical to document01. the client's cardiovascular status.02. the client's emotional state.o 3. the type of sedation used.04. pacemaker information: rate, type, settings.

9. The nurse judges that the mother of a 9-month-oldinfant in a hip ~pica cast understands how to feedher child when she states which of the following?

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tII

U 1. "I can lay my child flat and feed that way."02.. "I'll raise my child's head up and leave the hips

and legs on a pillow."o 3. "I can borrow a special feeding table to use."o 4. "It wilI take two of us, one to hold and one to

feed."10. The nurse is assessing a client who has had a

111\Kardial infarction. The nurse notes the cardiac

rhythm shown in Figure 1. The nurse identifies thisrhythm aso 1. atrial fibrillation.02. atrial tachycardia.o 3. premature ventricular contractions.o 4. ventricular tachycardia.

11. The nursing staff have finished a particularly diffi-cult restraint with an adolescent client. In additionto determining whether anyone was injured, thestaff are mandated to evaluate the incident to obtainwhich of the following ultimate outcomes?o 1. Coordinate documentation of the incident.o 2. Resolve negative feelings and attitudes.o 3. Improve the use of restraint procedures.04. Calm down before returning to the other

clients.12. The nurse is caring for a client who has experienced

severe multiple trauma. The client's arterial bloodgases reveal low arterial oxygen levels that are notresponsive to high concentrations of oxygen. Thenurse is aware that this finding is a major indicatorof the development of which of the following condi-tions?o 1. Hypostatic pneumonia.o 2. Hypovolemic shock.o 3. Acute respiratory distress syndrome (ARDS).04. Asthma.

13. A client asks the nurse why he was asked to com-plete an advance directive when he entered the hos-pital. The nurse's best response is which of the fol-lowing?

01. "This will provide a substitute for inform!'ddiscussion with the physician."

o 2. "It is a legal requirement for all clients enteringa hospital to be offered the chance to make anadvance directive."

03. ':The physician will make the best decisions foryou in an emergency."

04. "Are you. worried that extraordinary ml'an,wilI be taken' if you are dying?"

14. When witnessing the client's signature on a consentfor a procedure, the nurse verifies that the consentwas obtained in an appropriate manner. Whichofthe following is an unrealistic expectation for thenurse to verify?o 1. -That there was adequate disclosure of informa-

tion.o 2. That there was sufficient comprehension of

information.o 3. That there was voluntary consent on tll('

client's part. , ,o 4. That the client has full awareness of the reha-

bilitation process.15. An elderly client is diagnosed with temporal ,uteri-

tis. The medication of choice is01. Prednisone (Deltasone).02. Naproxen (Naprosyn).o 3. Aspirin.04. Azathioprine (Imuran).

16. A pregnant woman at 12 weeks' gestation is diag-nosed with gonorrhea. The physician orders doxy-cycline. The first action of the nurse should be too 1. instruct the client about the effects of the drug.o 2. make sure the record notes that the baby must

receive eye drops when born.03. have the physician add a single dose of ceftri-

axone (Rocephin).o 4. discuss with the physician the need to change

the order.

II

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117.After a ~lient undergoes a contraction stress test that

is negative, which of the following would the nurse

I

assess next?

o 1. Evidence of ruptured membranes.02. Viability status of the fetus.o 3. Indications that contractions have ceased.04. Fetal heart rate variability.

18.The infant is at risk for an ileus after surgery to cor-rect intussusception. Which dbservation would thenurse not include in an assessment for this compli-cation?

01. Measurement of urine specific gravity.o 2. Assessment of bowel sounds.o 3. Characteristics of the first stool.

04. Measurement of gastric output.19.A client with asthma asks the nurs'e if she should

use her salmeterol (Serevent) inhaler when she exer-cises and experiences wheezing and shortness ofbreath. The nurse's best response is which of the fol-lowing?o 1. "Yes, use the inhaler immediately for these

symptoms."lJ 2. "N,?, this drug is a maintenance drug, not a

re<.,cueinhaler."

'3. "Use the inhaler 5 minutes before you exerciseto prevent the wheezing."

'4. "This inhaler is for allergic rhinitis, notasthma."

. JI.\"hen assessing a client who is receiving clozapine(Clozaril), the nurse finds a pulse rate of 148 bpm.Whichof the following would the nurse do next?

, ::.1. Give the clozapine, and tell the client to liedown.

02. Withhold the clozapine, and tell the client togo to exercise group.

, 03. Aqminister the clozapine, and notify thephysician. ,

04. Withhold the clozapine, and notify the physician.Aclient has been diagnosed with absence seizures.Thenurse would expect the physician to prescribewhichof the following drugs?01. Valproic acid (Depakote).C)2. Phenytoin (Dilantin).(\3. Ga,bapentin (Neurontin).J 4. I'aroxclinl' «('axil).

n. Thenurse is watching two siblings, ages 7 and l)VI'.uS, vl'rhillly .lrgl'ling OVl'r il loy. '1'111'nursl' hilsCOUl1s('II'" 1111'lI1otlll'r bl'forl' ilbolll how 10 hi1l1dll'

this situation. The nurse would judge thai, theteaching has been effective when the mother doeswhichof the following?01. Tells the siblings to stop arguing and shake

hands.02. Ignores the arguing and continues what she is

doing..' ".

Comprehensive Test 4

o 3. Tells the children they will be punished whenthey go 1.0me.

04. SaY$-they will not go out to lunch now sincethey have argued.

23. A 64-year-old man is admitted with palpitations,hyperventilation, a choking sensation, and tightnessin the chest. The nurse analyzes the results of arte-rial blood gas studies. Which of the following meta-bolic factors will be depleted?01. Sodium.

o 2. Oxygen.03. Potassium.04. Carbon'dioxide.

24. A client is diagnosed with genital herpes, (herpessimplex virus type 2, or HSV-2). The nurse shouldinstruct the client that

o 1. using occlusive ointments may decrease thepain from the lesions.

02. reducing stressful life events may decrease theincidence of herpetic outbreaks.

03. there are no effective drug therapies to manageherpes symptoms.

'.; 4. herpes is transmitted to partners only whenlesions are weeping.

25. The client is having ototoxic effects of the vestibularbranch of the acoustic nerve. Which clinical mani-festation would not be associated with this problem?o 1. Vertigo.02. Tinnitus.

03. Nausea and vomiting with motion.o 4. Ataxia.

26. A young male client presents to the clinic with a bitehe received in a fight. He has a bite mark on his fore-arm and the skin is broken. His last tetanus shot wasabout 8 years ago. Recommended treatment shouldincludeo 1. administration of 0.5 mL of tetanus toxoid 1M.o 2. administration of 0.5 mL of tetanus toxoid IV.o 3. closure of the wound with sutures.o 4. withholding medication to see if signs of infec-

tion develop.27. At 6 weeks postpartum, the nurse instructs a primi-

parous client scheduled to received prescribed sub-dermal hormonal implants after dl'livery of a termneonate about the advantages of this method of con-traception. Which of the followin~ if statl'd by tl1l'dil'nl as an ildvilnlilgl', iqdil'illl's Slll'l'l'ssful tl'ilching?( ) I. Lack of 11ll'side dfl'cls associ.lled wilh progl's-

terone therapy.o 2. A slowed return of fertility after being discon-

tinued.

03. C mtinuation of breast-feeding without ad-verse effects.

o 4. ,Protection against sexually transmitted dis-eases.

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28. In the care and treatment of a client with heart fail-ure, the nurse would expect the client to be takingwhich of the following types of drugs?01. Selective serotonin reuptake inhibitors (SSRIs).02. Nonsteroidal anti-inflammatory drugs (NSAIDs).()~. Diurl'tics., ) ,I. Slt-mids.

29. A mother who is visibly upset tells the nurse shew<lnts to take her child home because the child is

dying. Which of the following would Ill' till' I1III'S("S/lesl response?o 1. "1 know how you feel, but the medication will

make your child feel better."02. "I can't let you do his without calling your

physician first."03. "Can you tell me why you want to take your

child home now?"

o 4. "1 can imagine how hard this is for you, but itsnot what's best for the child."

30. Clients with chronic obstructive pulmonary disease(COPD) may be bedridden at home and get littleexercise. Which of the following is a normal physio-logic reaction to prolbnged periods of bed rest andinactivity?o 1. Increased sodium retention.02. Increased calcium excretion.03. Increased insulin use.

04. Increased red blood cell production.31. Which of the following parameters would indicate

to the nurse that a 5-month-old weighing 15 poundsand being treated for dehydration has a normalurine output?01. 1 to 2 mL/kg per hour.02. 3 to 5 mL/kg per hour.03. 6 to 8 mL/kg per hour..04. 10 to 12 mL/kg per hour.

32. A 24-year-old client has been diagnosed with acuteosteomyelitis in the left leg. He complains of acutepain in the leg that intensifies when he moves it. Theclient has a temperature of 101°F (38.3°C) and a red-dened, warm area in the midcalf region over theshaft of the tibia. Based on this information, whichof the following nursing diagnoses would be mostappropriate for this client?o 1. Anticipatory Grieving rdated to possible left

lower leg amputatim..o 2. Activity Intolerance related to severe left leg

pain.03. Disturbed Body Image related to left leg

swelling and inflammation.o 4. Deficient Fluid Volume related to elevated tem-

perature of 101°F (38.3°C).33. A client has undergone a vasectomy. The nurse

instructs the client that he can begin having unpro-tected intercourse

o 1. when desiredate.

() 2. <IS soon as ~ tendeme51resolves.

03. when the spern lerlects sterilization.() 4. <Iftel' n to 10 ej<lculations.

:111. 1.01I/', l<'nll oIdlllinislr.llion 01 1'.('nl,lIlIv('ill .,tllI.II'

(Caralllycin) lo a clil'nl h,ls been disconlinul'd It:cli('nl should be instructed to hilve which (If till'"lowing ass('ssIH!'nls?( ) I. Ill'IHoglobin level in 2 weeks.o 2. White blood cell count in 2 weeks.o 3. Vestibular check in 3 to 4 weeks.() 4. Serum potassium level in 1 week.

35. Which of the following nursing interventions \\'lIulllbest accomplish the goal of preventing alelectc1Sband pneumonia in a postoperative client?o 1. Administer oxygen therapy as needed tomain-

tain adequate oxygenation.o 2. Offer pain medication 30 minutes before~

ing the client .cough and deep-breathe.o 3. Encourage the client to cough, deep-breathe.

and turn in bed once every 4 hours.o 4. Force fluids to 2000 mL every 24 hours.

36. A 7-year-old child is admitted tG the hospitalwi!rthe medical diagnosis of acute rheumatic fel't.'rWhen discussing long-term care for the child witt,the parents, the nurse should teach them that a Ilt.',essary part of this care iso 1. physical therapy.o 2. antibiotic therapy.03. psychological therapy.04. anti-inflammatory therapy.

37. The nurse is assessing the perineal changl's of ..woman in the second stage of labor.Figure2repre'sents which of the following perineal changes?o 1. Anterior-posterior slit.o 2. Oval opening.03. Circular shape.o 4. Crowning.

isimmedi-

~

Figure2.

38. A client is admitted to the hospital with a diagnosisof suspected pulmonary embolism. Physician ordersinclude the following: oxygen 2 to 4 L! mimite pernasal cannula, oximetry at all times, and intra-venous administration of 5% dextrose in water

(D5W) at 100 mL/hour. The client complains ofincreasing dyspnea and has a respiratory rate of 32breaths/minute. What is the nurse's first responseto this situation?01. Increase the oxygen flow rate from 2 to 4

L/minute.a 2. Call the physician immediately.a 3. Provide reassurance to the cli~nt.

a 4. Obtain a,!>amplefor arterial blood gas analysis.39. The mother of.a 10-month-old child calls the nurse

because her child has cold symptoms. The. motherasks how she can clear the infant's nose. Which of

the following woul4 be the nurse's bestrecommen-dation? r ,

a 1. Use a cool air vaporizer with plain water.a 2. Use sal~ne nose drops and then a bulb syringe.a 3. Blow into the child's mouth to clear the infant's

nose.a 4. Administer a nonprescription vasoconstrictive

nose spray.40. Clinical symptoms of metastatic lung cancer may

includea 1. diarrhea.a 2. constipation.a 3. voice hoarseness.

a 4. weight gain.41. A client is at risk for development of metabolic alka-

Imlia bt.!clluAeof peralstcnt vomiting. Which of thefollowing symptoms is indicative of metabolic alka-losis? '

a 1. Confusion.a 2. Hyperventilation.a 3. Diarrhea.a 4. Edema.

42. Which of the following would first alert the nursethat a child is hemorrhaging after a tonsillectomy?a 1. Mouth breathing.a 2. FreqUE;ntswallowing.a 3. Requests for a drink.a 4. Increased pulse rate.

43. Nursing interventions for a client having a transfu-sion reaction include all but which of the following?a 1. Discontinue the current intravenous site and

restart the infusion at a different site.a 2. Start a normal saline infusion at 30 mL/hour.a 3. Assess vital signs every 10 minutes.a 4. Send the blood bag and blood slip to the blood

bank.44. The nurse is to administer chloramphenicol 50 mg

IV in 100 mL of D5W over 30 roinutes. The infusion

set administers 10 gtt / mL. What is the flow rate ofthe infusion?a 1. 21 gtt/minute.a 2. 27 gtt/minute.a 3. 33 gtt/minute.a 4. 35 gtt/minute.

45. A client's belief in her "special mission from God"can be referred to as a religious delusion of gran-deur. The nurse incorporates this delusion into theclient's plan of care based on the understanding thatthe primary purpose of such a delusion is to providewhich of the following?a 1. Sexual outlet.a 2. Comfort.<)3. Safety.a 4. Self-esteem.

46. A client who has been vomiting for 2 days has anasogastric tube inserted. The nurse notes that overthe past 10 hours the tube has drained 2 L of fluid.

. The nurse should plan. to implement treatment thatwill prevent which of the following electrulyteimbalances?a 1. Hypermagnl -,ia.a 2. Hypernaitemia.a 3. Hypokalemia.a 4. Hypocalcemia.

47. During the clinical breast examination, which of thefollowing is a normal finding?a 1. Pronounced unilateral venous pattern.a 2. Peau d'orange breast tissue.a 3. Long-term, bilateral nipple inversion.a 4. Breast tissue that is darker than the areolae.

48. A child with sid~le cell crisis is being discharged. Aspart of dischargc'lcaching to prcvcnl furlher crisis,the nurse advises the parent to do which of the fol-lowing?a 1. Encourage the child to drink lots of liquids.a 2. Take the child's temperature every morning.a 3. Weigh the child every day.a 4. Offer the child a high-protein diet.

49. While assessing a neonate 30 minutes after birth, thenurse observes that the child has a short neck cov-ered with webbing. The nurse notifies the pediatri-cian based on the interpretation that this usual1yindicates which of the following?a 1. Genetic deviations'.a 2. Cleft palate.a 3. Potter's syndrome.a 4. Neural tube defects.

50. In a client with severe diarrhea, the nurse wouldconclude that the client was experiencing hy-pokalemia if which of the following signs wereobserved?a 1. Musde spasms.a 2. Thirst.

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03. Arrhythmia.() 4. ('on fusion.

S'I. Tlw nursl' idl'nlifil's clinical manifl'stations of a

supl'riml'lIs,'d infl'dion whl'n ,I clil'nl whll has bl'ent,lking .111antibiotic rl'lurils 10 till' nll'dical clinic.Which of the following is ""/ associated with asu pl'rinfl'clion?, I I. I\I,H'''' hairy !lInguI'.U 2. I'ruritus.o 3. Glossitis.\..!4. Anal itching.

52. Which of the following is the most reliable indicatorof the existence and intensity of acute pain?o 1. The client's vital signs.o 2. The client's self-report of pain.03. The nurse's assessment of the client.04. The severity of the condition causing the pain.

53. The nurse advises a mother with a 2-year-old childto avoid encouraging excessive milk consumption(more than 3.5 cups per day) by the infant becauseexcess milk consumption can lead too 1. vitamin C deficiency."- 2. iron deficiency.o 3. bioti!' deficiency.04. folate deficiency.

54. The nurse is caring for a client with a fracture of along bone. Which of the following assessmentswould be the earliest symptom of a fat embolism?o 1. Respiratory distress.02. Confusion.o 3. Petechiae.o 4. Fever.

55. A client tells the nurse, "Everybody smiles at mebecause they know that I was chosen by God for thismission." The nurse interprets this statement aswhich of the following?o 1. Idea of reference.o 2. Thought insertion.o 3. Visual hallucination.

04. Neologism.56. To test the hearing ability of a neonate at 12 hours of

age, the nurse claps the hands while standing awayfrom the neonate at approximately which of the fol-lowing distances?o 1. 3 inches.o 2. 6 inches.o 3. 12 inches.o 4. 24 inches.

57. The physician decides to change a client's currentdose of intramuscular (1M) meperidine hydrochlo-ride ,Demerol) to an oral dosage. The current 1Mdose is 75 mg every 4 hours as needed. What dosageof oral meperidine hydrochloride will be required toprovide an equivalent analgesic dose?o 1. 25 to 50 mg every 4 hours.

02. 75 to 100 mg every 4 hours.03. 125 to 140 mg every 4 hours.( ) 4. I~Oto 300 mg I'v('ry 4 hours.

SIt Which of thl' fllilowing nursing nH',ISUI'l'SIs IIIusdul in prl'vl'nting till' dl'velopml'nl of osk,,!,sis in a client who is immobilized?

()I. Beginning wl'ighl-bmring activitil's ,IS ,IH)ssibl(,.

U 2. Increasing the client's calcium inl,lk,' I ,diet.

() 3. Performing passive range-of-motion ('\.',four times a day.

04. Teaching the client to perform isomclril . "cises.

59. The mother of a toddler asks the nurse what sht-

should do with her toddler when he has a tell1pettantrum. Which of the following suggestions wouldbe most appropriate?o 1. Move the toddler to a time-out chair.

o 2. Try to talk the toddler out of the tantrum.o 3. Leave the toddler alone during the tantrum as

long as he is safe.04. Punish the toddler for having a kmf""

tantrum.

6'0. The. nurse who is stuck by a used needle but has !1\\~completed the hepatitis B immUl1ization shouldrecei ve

o 1. both active and passive immunization.02. active immunization.

03. passive immunization. . '04. immunization only after a blood titer Itasb.:.

drawn.61. Which of the following nursing intervention~ I..

appropriate for preventing pressure ulcers?o 1. Cleanse the skin daily using mild soap and hot

water.o 2. Perform a systematic skin assessment at least

once a day.o 3. Massage bony prominences gently every shift.o 4. Encourage the client to sit in a chair as muchas

possible.62. The nurse is evaluating the pin insertion site 01,\

client's skeletal traction. Which of the followingsigns would be indicative of a complication?01. Presence of crusts around the pin insertion sill'.02. Serous drainage on the dressing.03. Pin moves slightly at insertion site.04. Client does not feel pain at insertion site.

63. On the night before a 58-year-old wife and mother isto have a 10becto/JlYfor lung cancer, ~he remarks III

the nurse, ,,1I am so'scared of this cancer. I shouldhave quit smoking years ago. Now I've brought allthis fear and sadness on myself and now my fam-ily." What would be the nurse's best response to theclient?

01.

() 2.

1)3.

4.

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65. Thlrecpa'infoooo

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o 1. "It's normal to be scared. I would be too. We'llhelp you through it."

02. "Do you feel guilty because you smoked?"03. "Don't be so hard on yourself. Youdon't know if

your smoking caused the cancer."04. "It's okay to be scared. What is it about cancer

that you're afraid of?"64. The nurse is caring for an elderly client who has hip

pain related to rheumatoid arthritis. The nurse knowsthat the client is practicing appropriate self-care activ-ities when the client chooses to sit which of the fol-lowing chairs?o 1. R~cliner chair with arms to suppor~ wrists and

hands.

o 2. Couch with soft cushions to support thighs.o 3. Straight-back chair with elevated seat.o 4. Curved-back rocking chair. .

65. The nurse is with the parents of a 16-year-old boy whorecently attempted suicide. The nurse cautions theparents to be especially alert for which of the follow-ing in their son?01. Expression of a desire to date.02. Decision to try out for an extracurricular activity.03. The giving away of valued,p~Jsonal items.04. Desire to spend more time with his friends.

66. Which of the following responses would -be mostappropriate for the nurse when comforting a primi-parous client whose critically ill neonate delivered at25 weeks dies while the mother is present?o ]. "This is probably for the best because his organs

were so immature."o 2. "You should try to get pregnant again soon to get

over this loss."a 3. "You can stay with your baby as long as you

want and say anything you want."o 4. "If you want me to, I can call the chaplain to stay

with you."67. A 32-year-old woman recently diagnosed with Hodg-

kin's disease is admitted to the hospital outpatientclinic for staging by undergoing a bone marrow aspi-ration and biopsy. The nurse assesses the client'snutrition status. Which of the foll01vingblood exami-nations would be most helpful in determiningwheth~i'.the client's diet lacks protein?o 1. Red blood cell count.a 2. Direct and indirect buirubin levels.o 3. Reticulocyte count.a 4. Albumin level.

68.The nurse teaches a cl;ent taking desmopressin'(DDAVP)nasal spray about how to manage treat- ,

ment., The nurse determines that the client needs addi-tional instruction when he makes which of the follow-

ing comments?r; 1. "I should check for sores in my nose while takin~

Ihis I1wdicilliol1,"

a 2. "I should use the same nostril each time I takethe medir;ne."

03. "I should report nasal congestion."a 4. "I should report any signs of respiratory infec-

tion."

69. The nurse has an order to administer ampicillin 250mg IM. After reconstituting the ampicillin with sterilewater for injection, the solution available is 500mg/ mL. How many milliliters should the nurseadminister?a 1. 0.05 mL.a 2. 0.4 mL.a 3. 0.5 mL.a 4. 1.0 mL.

70. The nurse assesses a client and notes that he has a

weak, irregular pulse, as well as soft, flabby muscles.These findings are indicative of which electrolyteimbalance?a 1. Hypercalcemia.a 2. Hypematremia.a 3. Hypokalemia.a 4. Hypomagnesemia.

71. A primipara at 48 hours postpartum is to be givenmedroxyprogesterone acetate (Depo-Provera) 1 eforedischarge. Which of the following would the nurseinclude in the teaching plan before administering thismedication?a 1. There is an increased risk of ovarian cancer.a 2. Amenorrhea is common during the first 6

months. ,

a 3. Heavy menstrual bleeding may occur.a 4. The client may experience periods of increased

energy.72. The nurse estrlblishes the goal of preventing lhe devel-

opment of a stress ulcer in a bum client. Which of thefollowing interventions would most likely contributeto the achievement of this goal?a 1. Implementing relaxation exercises.a 2. Administering a sedative as needed.a 3. Providing a soft, bland diet.a 4. Administering cimetidine (Tagamet) as ordered.

73. A parent of a child with acquired immunodeficiencysyndrome (AIDS)asks the nurse how to look for signsand symptoms of infection. The nurse responds thatthey need to be especially alert for which of the fol-lowing?a 1. Erythema around the infected area.a 2. Rectal temperature higher than 100.5°F (38°C).a 3. Tenderness of the infected area.a 4. Warmth of the infected area.

. 74. The nurse is teaching a group of unlicensed person-nel new to psychiatry about providing care to clientswith deprL.>sion.To care effectively for these clients,the nur..;e would emphasize that caregivers demon-slralt' which of Ilw following l1l'hilviors?

a 1. Cheerful demeanor.a 2. Empathetic concern.a 3. Serious, business-like affect.<84. Humorous lightheartedness.

75. When fluids by mouth are appropriate for the infantaftl'r slIrj!;l'ry to correct intussusception, the nurselIIosllikl'ly would iniliall' fl'l'ding wilh() 1. cereal-thickened formula.a 2. full-strength formula.():1. half-slrl'nglh formula.( )4. orall'ledrolyle solulion.

76. A client is taking paroxetine (Paxil) 20 mg orally everymorning. The nurse would monitor the client forwhich of the following sic!c'effects?l) I. A hyperlensive crisis.a 2. Sexual problems.a 3. Sleep disturbance.a 4. Orthostatic hypotension.

77. The Dietary Approaches to Stop Hypertension(DASH) diet, includes ensuring the adequate intake ofvery specific nutrients. These specific nutrientsincludea 1. magnesium, potassium, vitamin C, and calcium.a 2. vitamins B(yBI21E, and A.a 3. iron, zinc, vitamin 0, and vitamin K.a 4. biotin, protein, riboflavin, and pantothenic acid.

78. Which of the following neurologic changes indicatesthat the client is in the progressive stage of shock?a 1. Restlessness.02. Confusion.a 3. Incoherent speech.a 4. Unconsciousness.

79. The code team and crash cart arrive in the room of aclient who has had a cardiac arrest. What is the first

piece of monitoring equipment applied to the clientby the code team members?l) I. Electrocardiogram (ECC) electrodes.o 2. Pulse oximeter.a 3. Blood pressure cuff.a 4. Doppler for pube check.

80. The nurse is talking to a group 0 parents about drugabuse among adolescents. One parent says he hashe<..d that you can tell which drug a person is using.by how the eyes look. The parent asks how you 'couldtell a person was taking heroin. Which of the follow-ing would the nurse use to describe the eyes of a per-son using heroin?a 1. Whites red and bloodshot.a 2. Pupils small and constricted.a 3. Pupils large and dilated.a 4. Drooping eyelids.

81. When performing routine health evaluations inschool-aged children, which of the followingwould alert the school nurse to pediculosis capitis(head lice)?

. ,

a 1. Spotty baldness.a 2. Wheals with scalp blistering.o 3. Frequent scalp scratching.04. Dry, scaly patches on the skin.

82. Which of the following best.indicates that a clienl',peristaltic activity is returning to normal after sur,gl'ry?() 1. The dienl passes flalus.a 2. The client says that she is hungry.03. Bowel sounds are hypoactive on ausculti1tion() 4. Perislalsis l'ill1be fe!loh abdominal palpilatilln

83. A client appears flushed and has shallow respir.,tions. The arterial blood gas report shows the fol-

I

lowing: pH, 7.24; pC02, 49 mm Hg; HCO] -, 2-1mEq/ L. These findings are indicative of which lit

the following acid-base imbalances?a 1. Metabolic acidosis.a 2. Metabolic alkalosis.a 3. Respiratory acidosis.a 4. Respiratory alkalosis. .

84. Which of the following measures is most importantfor pain management for a client after a lobectomy)a 1. Reposition the client immediately after admin-

istering pain medication.a 2. Reassess the client 30 minutes after administer-

ing pain mediF'ation.a 3. Reassure the' client after administering pain

medication. '

a 4. Readjust the pain medication dosage asneeded.

85. The nurse is' evaluating a female client's under-standing of how to prevent sexually transmitted dis-eases (STDs). Which of the following statementsindicates that the client understands how to prolL'ctherself?o 1. "I will be sure my partner uses a condom."() 2. "l need to be sure to take my birth conln,!

pills."a 3. "I will always douche after sexual intercourse:"a 4. "I will be sure to take antibiotics to prevent an

STD.II

86. While assessing a multigravid client ,at 10 weeks'gestation, the nurse notes a purplish color to thevagina anti. cervix~ The nurse documents this find-ing as which of the following?,a 1. Goodell's sign.a 2. Chadwick's sign.a 3. Hegar's sign.a 4. Melasma's sign. . .

87. A client with bipolar disorder, mania has flight ofideas and grand.iosity and becomes easily agitated.To prevent harmful behaviors, which of the follow-ing would the nurse do initially?a 1. Encourage the client to stay in his room.02. Seclude the client at the first sign of agitation.

03. Tell the client to seek out staff when feeling agi-tated.

o 4. Instruct the client to ask for medication whenagitated.

88. The nurse is preparing written information for aclient. Which of the following represents a soundapproach to providing information?01. Use charts to help convey information.02. Prepare information at an eighth-grade reading

level.03. Use short words.

o 4. Print the material in a medium-sized type.89. A nurse is evaluating the proper use of crutches by

a client who has fractured her right leg. Which state-ment by the client indicates that she is using the cor-rect technique?o 1. "1 move my left leg forward first as I swing

forward on my crutches."o 2. "1 need to increase my arm strength, because

my arms tingle after I use my crutches."03. "1 padded the tops of my crutches so that 1can

lean more comfortably on my crutches."o 4. "1feel pressure on the palms of my hands when

1am walking with my crutches."90. Which of the following fac~ors is a priority when

evaluating discharge plans for a 68-year-old manafter a lower left lobectomy for lung cancer?o 1. The distance the client lives from the hospital.02. Support available for assisting the client at

home.03. The client's ability to do home blood pressure

monitoring.04. The client's knowledge of the causes of lung

cancer.91. A primiparous client planning to breas~-feed her

term neonate delivered vaginally asks, "When willmy 'real' milk come in?" The nurse explains to theclient that after delivery breasts begin tp fill withmilk within which of the following periods?o 1. 12 hours.02. 24 hours.o 3. 2 to 4 days.04. 7 days.

92. The nurse is caring for an elderly, debilitated clientwho has been bedridden for an extended period.Which of the following is the p~edomin~nt clinicalfinding indicating that the clieni - has developedplll'U Ill! mi,]?() 1. Fl'Vl'r and chills.

( ) 2. I'rmludive ('ough.

t () 3. Confusion.

J04. Pleuritic chest pain.

..

.. 93.A child with rheumatic fever has polyarthritis and. chorea. An echocardiogram shows swelling of the

'.' cardiac tissue. Which of the following would the

,.

nurse include in the child's plan of care?o 1. Explaining that the chorea will disappear over

time. .o 2. Performing neurologic checks every 4 hours

until the chorea subsides.o 3. Promoting ambulation by administering

aspirin every 4 hours.04. Keeping the child in a slightly cool environ-

ment.

94. A 19-year-old unmarried college student who is vis-iting the clinic and is found to be approximately 8weeks pregnant asks, "If 1 have an abortion in thenext 2 or 3 weeks, how will it be done?" The nurseinstructs the client that at this gestational age anabortion is usually performed by which of the fol-lowing techniques? .o 1. Dilation and curettage.o 2. Menstrual extraction.o 3. Dilation and vacuum extraction.o 4. Saline induction. .

95. The nurse is performing a respiratory assessment ona client who has a pleural effusion. Which of the fol-lowing findings would the nurse anticipate findingto support this diagnosis?01. Decreased chest movement on the affected

side.02. Normal bronchial breath sounds.03. Hyperresonance on percussion.o 4. Fever.

96. Which of the following is an expected client out-come related to one of the nursing diagnoses madefor the child with intussusception: Acute Painrelated to cramping? The cliento 1. exhibits no manifestations of discomfort.o 2. is very still.o 3. has a normal bowel movement.04. has not vomited in 3 hours.

97. Garamycin 2S mg 1M has been ordered every 6hours. Garamycin 40 mg/ mL is available. Howmany mL should the nurse administer?o 1. 0.55 mL.o 2. 0.6 mL.03. 1.0mL.04. 1.6 mL.

98. As~essment of a 36-year-old woman complaining ofmalaise and dysuria reveals a temperature of WO°F(37.4°C)and painful blisters on the outside of hervagina. TIll' clil'nt tells till' nurse she had intercoursewith a new partner 5 d<1Ys<1go.Which of the follow-ing would till' nurse suspect as IIIOStlikely?() 1. Human immunodeficiency virus (HIV) infec-

tion.02. Chlamydia trachomatisinfection.03. Syphilis.o 4. Herpes genitalis.

99. A child with leukemia fails to respond to therapy.Which of the following statements offers the nursethe bestguide in making plans to assist the parents indealing with their child's imminent death?a 1. Knowing that the prognosis is poor helps pre-

pare relatives for the death of children.o 2. Relatives are especially grieved when a child

does well at first but then declines rapidly.o 3. Trust in health personnel is most often

destroyed by a death that is considereduntimely.

a 4. It is more difficult for relatives to accept thedeath of a 10-year-old than the death, of ayounger child whose family membership hasbeen short.

100. A client who states that he is allergic to p~nidllin hasan order to receive cefazolin (Ancef). The nurse's ini-tial response is to01. ask the client if he has taken cefazolin (Ancef)

before.

a 2. consult with the physician or a clinical pharma-cist.

a 3. administer cefazolin (Ancef) immediately.a 4. observe the client closely for urticaria.

101. A client with chronic renal failure tells the nurse thather skin feels dry and is constantly itching. Based onthese data, which of the following is an appropriatenursing diagnosis?o 1. Ineffective Health Maintenance related to poor

hygiene.o 2. Chronic Pain related to skin irritation.

o 3. Risk for Impaired Skin Integrity related to severepruritus.

o 4. Ineffective Coping related to manifestations ofchronic illness.

102. When preparing the teaching plan for a client and hisfamily about lithium therapy, the nurse would expectto include teaching about which of the following?01. Maintaining an adequate sodium intake.o 2. Discontinuing sodium in the diet.o 3. Buying foods labeled "low in sodium."o 4. Increasing sodium in the diet.

103. A client who is undergoing radiation therapy devel-ops mucositis. Which of the following interventionsshould be included in the client's plan of care?o 1. Increase mouth care to twice per shift.a 2. Provide the client with hot tea to drink.a 3. Promote regular flossing of teeth.04. Use half-strength hydrogen peroxide on mouth

ulcers.104. A parent calls the Poison Control Center because her

3-year-old has eaten 10 to 12 chewable acetamino-phen tablets. The nurse instructs the parent to takethe child to the emergency department after doingwhich of the following first?

o 1. Giving the child a large glass of milk.o 2. Giving the child water with syrup of ipecac.03. Giving the child baking soda in 4 ounces of

water.

o 4. Not allowing the child to drink any fluids.105. While waiting for the physician, the parent of a pre-

school-aged child tells the nurse that the child ishyperactive and something needs to be done. Whichof the following responses would be mostappropri-ate initially?a 1. "What makes you think your child is hyperac-, tive?" .02. "What do you think needs to be done ?" r

. a 3. "How does your child behave normally?"a~. "Why not wait and see what the doctor says?" -

106. When preparing for the discharge of a newbomaftersurgery to correct tracheoesophageal fistula (TEF),thenurse teaches the parents about the need for long-term health care because their child has a high proba-bility of developing which of the following?01. Recurrent mild diarrh~a with dehydrationo 2. Esophageal strictureo 3. Speech problemsa 4. Ulcers

107. A young man with Hodgkin's disease has beenrf'admitted to the hospital because of his 'aggressivedisease that is unresponsive to multiple therapies.Death appears imminent. One goal for this client isto .o 1. reduce feelings of isolation.o 2. reduce fear of pain.o 3. reduce fear of more aggressive therapies.o 4. reduce feelings of social inadequacy.

108. A nulligravid client is admitted in early active labo!at 39 weeks' gestation with intact membranesWhen assessing the fetal heart rate, the nurse locate,the heart sounds above the client's umbilicus d

midline. The nurse would suspect that the fetus!lying in which of the following positions?a 1. Cephalic. ,

o 2. Frank breech.o 3. Face.o 4. Transverse. .

109. The nurse is caring for a client who has been diaFnosed with pernicious anemia. Which of the follo\\ing statements by the client indicates an understanding of the treatment of pernicious anemia?o 1. "I will need to increase my dietary intakeI

foods that are high in vitamin B12'"a 2. "I will receive my first injection of vitamin B

tomorrow, and I will return for a follow-uinjection in 1 month."

o 3. "I und~istand that the oral form of vitamin Bis preferred because it is safer and less expe''sive than the injection form."

04. "I wiJl'need to take vitamin BI2replacements forthe rest of my life."

110. A client's 12:00noon blood glucose concentration wasinaccurately documented as 301 instead of 130. Thiserror was not noticed unti~ 1:00 PM.The nurse admin-

istered the sliding scale insulin for a blood sugar of310 instead of 130. What should the nurse do first?o 1. Notify the physician. .

o 2. Take orange juice to the client.o 3. Consult with the clinical pharmacist.o 4. Call the charge nurse.

111.An older infant who has been injured in an automo-bile accident has to wear a splint on the injured leg.The mother reports that the infant has become mobileeven while wearing the splint. The nurse wouldadvise the mother to do which of the following?01. Notify the physician immediately to adjust the

treatment plan.o 2. Confine the infant to one room in the apartment.o 3. Keep the infant in the splint at night, removing

it during the day.o 4. Remov.e any unsafe items from the area in which

the infant is mobile.

L12.While preparing a client for surgery, the nurseassesses for psychosocial problems that may causepreoperative anxiety. Which of the' following' isbelieved to be the IT,\Jstdistressing fear a preoperativeclient is likely to experience?a 1. Fear of the unknown.

02. Fear of changes in body image.a 3. Fear of the effects of anesthesia.a 4. Fear of being in pain. '" !

113.A56-year-old woman is admitted for a modified rad-ical mastectomy. The client appears anxious and asksmanyquestions.The nurse's bestcourse of actipn is toa 1. tell the client as much as she wants to know and

is able to understand.a 2. delay discussing the client's questions with her

until the convalescent phase of her care.a 3. delay discussing the client's questions with her

until her apprehension subsides.a 4. explain to the client that she should discuss her

questions with her physician.U4.The nurse asks the client to sign a consent form before

undergoing surgery. The client indicates that he wasnot told about the risks of the surgical procedure.Which of the following statements by the nurse ismost appropriate? .

a 1. "What are your concerns? I can an!~wer anyquestions that you have."

a 2. "You can go ahead and sign the form. I will besure to t~'Hthe surgeon you have questions."

03. ''It is important that your questions arcanswered before you consent to the procedure.I will contact the surgeon."

04. "Actually, the risks associated with this proce-dure are minim?l. The surgeon has performedthis surgery many times."

115. The nurse is assessing fetal position in a 32-year-oldwoman in her eighth month of pregnancy. From Fig-ure 3, the fetal position can be described aso 1. left occipital transverse.o 2. left occipital anterior.o 3. right occipital transverse.o 4. right occipital anterior.

116. The father of an .nfant states that the physician toldhim that his child has a urinary tract infection. Thefather calls the clinic to ask about the signs andsymptoms that he should watch out for in the futureto indicate a recurrence. Which of the followingwould the nurse tell the father?a 1. Increased urine output and clear urine.o 2. Loss of appetite and fussiness.o 3. Feeding problems and jaundice.o 4. Fever and dysuria.

117. After teaching a mother about the neonate's positiveBabinski's reflex, the nurse determines that themother understands the instructions when she saysthat a positive Babinski's reflex indicateso 1. possible partial paralysiso 2. possible lower limb defect03. immature central nervous system04. pcssible injury to nerves that innervate the legs

118. The nu"se should instruct a client who is taking dex-amethasone (Decadron) and furosemide (Lasix) toobserve for signs of hypokalemia, which includeo 1. excitability.o 2. muscle weakness.

Figure 3.

,.

o 3. diarrhea.04. increased thirst.

J19. A elk'llt with a suspected diagnosis of lung cancerhas a bronchoscopy with biopsy. Which of the fol-lowing interventions would be appropriate after theprocedure?o 1. Encourage the client to gargle with oral lido-

caine to decrease throat irritation.o 2. Monitor the client for signs of pneumothorax.o 3. Administer pain medication as needed to relieve

mediastinal discomfort.04. Advise the client not to talk 'Until the gag reflex

returns.120. A child is to receive 500 mL of an IV solution over 12

hours via tubing that delivers microdrips at 60drops/mL. The nurse would infuse the solution atwhich of the following rates?01. 21 drops/minute.02. 42 drops/minute.03. 63 drops/minute.04 84 drops/minute.

121. WhIch of the following techniques is correct whenadministeringa subcutaneousinjection? '

o 1. Use a I-inch needle for injection.o 2. Insert the needle at a 4S-degree angle to the skin. .o 3. Spread the skin tightly at the injection site.04. Draw 0.2 mL of air into the syringe before

administration.122. Which of the following is a prioritynursing diagnosis

for the client presenting with pelvic inflammatorydisease?

o 1. Imbalanced Nutrition: Less than Body Require-ments.

02. Bathing/Hygiene Self-Care Deficit.o 3. Acute Pain.o 4. Impaired Skin Integrity.

123. After talking with the mother of a child, the nursedetermines that the child has a difficult temperament.Which of the following would the nurse expect toinclude when developing this child's plan of care?o L Allow the child to determine when feeding

should occur.

o 2. Ensure that the child is fed even though cryingdoes not occur.

o 3. Provide structured feeding times and bedtimes.o 4. Instruct the mother to take extra safety precau-

tions around the house.124. Which of the following steps is appropriate for the

nurse to include when giving a client a tube feeding?o 1. Warm the feeding solution before administration.o 2. Position the client side-lying on the left side.o 3. Aspirate residual gastric. contents before the

feeding and discard.04. Verify position of the tube before beginning

feeding.

125. A multiparous client 48 hours postpartul1) .who.,breast-feeding tells the nurse, "I'm having 'a lot'elfcramping. This didn't I\appen when I nursed myfir.rtbaby." Which-of the following would be thl' nurw'.best response? .

01. "I will notify your doctor. It's possible there..some placental fragments remaining,"

02. "I need to check your lochial flow.YoumayI\n4ta clot that is being dislodged."

o 3. "You must have gotten a heavy dose of o~(Pitocin). It should wear off soon.,,\1

o 4. "The cramping is normal and is causedby'baby's 'sucking,which stimulatesthe n>lease1oxytocin." '

126. The mother of a child with moderate diarrheacaIIs-If1clinic to find out how to manage her child's iIIna:jWhich of the following would the nurse suggest?o 1. Begin ,clear liquids for 24 hours.o 2. Feed the child bananas, rice, applesauce,and:.

toast.o 3. Offer foods loat are low in fat.04. Conm:ue the cl}ild'sregular diet.

127. The nurse is performing routine tracheostomy care.Which of the following steps would be appropriatetOlthe nurse to include in the performance of the pl'Ol'l'-dure?o 1. Remove the inner cannula e'.;ery 2 hours fOl

cleaning.o 2. Secure the tracheostomy ties with a squareknot.03. Use cut gauze under the neck plate to protectthe

skin.o 4. Suction the inner cannula on completiOI)ofthe

procedure.128. What is the nurse's most appropriate response when

finding a sealed container of IV 50% dextrose in acatch-all bin on the unit?01. Leave it where found and notify risk manage-

ment.02. Send it to pharmacy.o 3. File an incident report.o 4. Discard it in a sharps container.

129. To reduce the risk of pressure ulcer formation, ;'vhichof the followingactivitieswould the nurse teachtheclient who is wheelchair-bound as a result of a spinalcord injury?01. Bathe daily.

. 0 2. Eat a high-carbohydrate diet.o 3. Shift your weight every is minutes.o 4. Move from the bed to the wheelchairevery2

hours.

130. A nulligravid client in the second stage of laborhashad no anesthesia or analgesia. Anatomically, whichof the followingwould be the mosteffective positionfor the client to begin pushing?o 1. Squatting with body curved in a C shape.

I

1

1

,

o 2. Side-lying while keeping the hea~ elevated.o 3. In the knee-chest position while keeping the

head down.

04. Squatting with the back arched.131. A client with antisocial personality disorder tells the

nurse, "I punched the guy out because he deservedit and then the cops arrested me." Which of the fol-lowing responses would be most helpful to theclient?

01. "It's wrong to punch others."o 2. "If you punch people out, you'll get into trou-

ble."

03. "I wouldn't do that again if I were you."04. "Don't ever do that again; you're an adult."

132. The nurse is teaming unlicensed personnel aboutthe care of clients with self-mutilation. Which of thefollowing, if stated by tq.e unlicensed personnelabout, self-mutilation, demonstrates that the teach-ing hn§ been effective?o 1. "It is a means of getting what the person

wants."o 2. "It is a nonserious event that can be ignored."o 3. "It is a way to express anger and rage."

. 0 4. "It is a fOrm of manipulation."133. The nurse has obtained the nursing history of ' .

client diagnosed with hepatitis C. What would beconsidered a potential risk factor for a<;:quiringhep-atitis C?o 1. Drinking contaminated water.o 2. Traveling to India.o 3. Having a tattoo.o 4. Eating shellfish.

134. A client is experiencing symptoms of early alcoholwithdrawal. His blood pressure is 150/85 mm Hgand his pulse is 98 bpm. The nurse would expect toadminister which of the following medications?o 1. Lorazepam (Ativan).02. Naltrexone (ReVia).o 3. Methadone (Dolophine)04. Imipramine (Tofranil).

135. After a child returns from the postanesthesia careunit after surgery, which of the following would thenurse assess first?o 1. The intravenous fluid access site.o 2. The child's level of pain.o 3. The surgical site dressing.o 4. The functioning of the nasogastric tube.

136. A critical nursing intervention to protect a clientwho has received tissue plasminogen activator (t-PA) or alteplase recombinant (Activase) therapyincludes

o 1. using the radial artery to obtain blood gas sam-ples.

02. maintaining arterial pressure for 10 seconds.03. administering intramuscular injections.

o 4. encouraging physical activity.137. Two clients have been following low-sodium diets

for several weeks. One of the clients states that hisblood pressure has not changed and asks the nursewhy not. The nurse should base the response on thefact that the percentage of the population that are ableto lower their blood pressure through a sodium-restricted diet is only which of the following?o 1. 10%.02. 25%.03. 50%.04. 70%.

138. A client is admitted with acute pancreatitis. Whichlaboratory value is indicative of pancreatitis?01. Decreased urinary amylase.o 2. Hypercalcemia.o 3. Hypoglycemia.o 4. Increased serum amylase and lipase.

139. For the client with a substance abuse problem,which of the following would be most helpful to aidthe client in dealing with feelings and concernsrelated to alcohol and drugs?o 1. Individual therapy.o 2. Group sessions.03. Solitary activities.o 4. Recreation.

140. Which of tl,e following assessment findings wouldthe nU~3eexpect to observe in a client with cystitis?o 1. Flank pain.o 2. Oliguria.03. Nausea and vomiting.o 4. Foul-smelling urine.

141. A client with acute stress disorder is telling thenurse about the tornado that leveled his house andkilled his wife and baby while he was out of townon business. He states, "If only I'd been at home, Icould have saved them." Which of the foIlowingresponses-would be most appropriate?01. "Don't blame yourself; you'II only feel worse."02. "It's not your fault; so stop feeling so guilty."03. "You might not have been at home."04. "You couldn't have prevented the tornado; it

just happened."142. On the first postpartum day, the nurse is caring for

a primiparous client who has recently emigratedfrom Japan to the United States and speaks only alittle English. The nurse observes that the client hasbeen bottle-feeding her neonate on occasion, butmost of the neonatal care is being performed by theclient's mother-jn-law. Which of the foIlowingactions would be most appropriate?o 1. Notify the social worker because bonding may

be affected.02. Document the unusual maternal behavior in

the client's chart.

;1"

03. Determine whether this is a cultural practicefor the client and her family.

04. .Obtain an order to make a home visit after the

c1ient's discharge.143. A client is scheduled for a creatinine clearance test.

Which one of the following preparations is appro:priate for the nurse to make?01. Instruct the client about the need to collo!ct

urine for 24 hours.o 2. Prepare to insert an indwelling urethral

catheter.o 3. Provide the client with a sterile urine collection

container.o 4. Instruct the client to force fluids to 3000

mL/day.144. When the nurse is assessing a client's cultural adap-

tation,which of the followingstatementsis leastsen-sitive to the client's needs?o 1. "What are some of your favorite foods?"o 2. "Describe any health problems in your past."o 3. "Please tell me how you would like to be

addressed."04. "Your eyes look dark; is this normal for you?"

145. After several months of taking olanzapine(Zyprexa), the client reports that he is no longerhearing voices of any kind. Which of the following .would confirm that the client is developing insightinto his illness?o 1. "That Zyprexa is the best medicine I have ever

had."02. "I didn't realize how sick I could get from a

chemical brain imbalance."o 3. "My mom is proud of me for staying on my

medicines."04. "I think I may be able to get a little part-time

job soon."146. A client who is a computer operator has developed

carpal tunnel syndrome. The nurse explains to theclient that carpal tunnel syndrome is caused bywhich of the following pathophysiologic condi-tions?o 1. Decreased circulation to the brachial nerve.

02. Muscle atrophy resulting from disuse.o 3. Median nerve compression.04. Progressive flexion contracture of the wrist.

147. In addition to milk and eggs, which of the followingfoods is most often implicated in allergic reactions?o 1. Peanuts. . .o 2. Soy.o 3. Fish.o 4. Orange juice.

148. A client who is recovering from a transurethralresection of the prostate (TURP) experiences urinaryincontinence. He tells the nurse that he hasdecreased his fluid intake because of the inconti-

nence. What. would be the nurse's best response tothe client? .o 1. "Yes, limiting your fluids can decrease your

incontinence.': , .

o 2. "Limiting yo~r', fluids will cause kidneystones."

03. "Drink 8 glasses of water a day and urinateevery 2 hours."

o 4. "If your incontinence continues, we will rein.sert your catheter."

149. An infant has surgery to correct a tracheoe-sophageal fistula. The most appropriate nursingdiagnosis for the nurse to identify after surgery iso 1. Risk for Infection.02. Acute Pain.o 3. Constipation.04. Impaired Physical Mobility.

150. The nurse teaches girls 10 to 12 years of age aboutself-care during menses. The nurse emphasizes thata risk factor for toxic shock syndrome (T55)iso 1. changing tampons every 3 hours.o 2. avoiding use of deodorized tampons.03. alternating tampons,with sanitary pads.o 4. using only tampons at night.

151. A client with a history of cystitis is admitted to thehospital with a diagnosis of pyelonephritis. Whichof the following assessment findings specificallysupports a diagnosis of pyelonephritis?o 1. Suprapubic pain.02. Dysuria.03. Urinary retention.04. Costovertebral tenderness.

152. A woman is taking oral contraceptives. The nurseteaches the client that medications that may inter-fere with oral contraceptive efficacy includeo 1. antihypertensives.o 2. antibiotics.o 3. diuretics.o 4. antihistamines.

153. A 28-year-old female client is prescribed danazol(Danocrine) for endometriosis. Which of the follow-ing would the nurse include as a side effect whenteaching the client about, the drug?o 1. Headaches.o 2. Weight loss.o 3. Increased libido.o 4. Hair loss. '

154. To which of the following unlicensed personnelshould the nurse assign a male client of MexicanAmerican descent who needs complete morningcare? .

o 1. Mary, who has 2 complete morning care clients.02. Joe, who has 1 complete morning care client.o 3. Jill, who hlis 4 partial morning care clients.o 4. Jim, who has 5 partial morning care clients.

.I.;);).f\. cnent with chronic renal failure is experiencingcentral nervous system (CNS) changes caused byuremic toxins. Which nursing intervention wouldbe most appropriate for addressing the changes?o 1. Allow ~he client, to grieve for body .image

changes.o 2; Restrict foods that are high in potassium.03. Restrict flujd intake to 1000 mLI day.o 4. Assess the client's mental status regularly.

156. The nurse,is preparing to give a subcutaneous injec-tion to an elderly, emaciated client. Which needlelength and angle would the nurse plan to use toadminister the injection safely?01. A J/.-inch needle at a 90-de'gree angle.02. A s/.-inch needle at a 4S-degree angle.o 3. A J/2-inc}1needle at a IS-degree angle.04. A sl.-inch needle at a 90-degree angle.

157. A young female client comes into the emergencydepartment with complaints of flank pain, dysuria,frequency, burning on urination, and malaise. Thenurse obtains a urine specimen because the nurseanticipates that the client's symptoms are related too 1. pelvic inflammatory disease.o 2. renal calculi. '03. urinary tract infection.o 4. renal failure.

158. A multigravid client at 38 weeks' gestation is admit-ted to the hospital's birthing center with dark, scantvaginal bleeding and abdominal pain. The nurseobsi:!rves frequent low-amplitude uterine activitywhile the client's contraction pattern is externallymonitored. Which of the folJowip.gwould the nursesuspect? .01. Abruptio placenta.o 2. Placenta accreta.o 3. Placenta previa.04. Battledore placenta.

159. A female client is treated for trichomoniasis with me-

tronidazole (Flagyl). The nurse instructs the clientthat01. the medication should not alter the color of the

urine.o 2. she should discontinue oral contraceptive use

during this treatment.03. she should,avoid alcohol during treatment and

for 24 hours after completion of the drug.o 4. her partner does not need treatment.

160. A client is in the advanced stages of osteoarthritis.Which of the following best describes the pain thatoccurs in the advanced stage of the disease?o 1. Pain occurs with minimal activity.02., Crepitation develops and intensifies pain.03. Joints are symmetrically affected by pain.

t 0 4. Fatigue accompanies pain.

1'61. A f.mHy m.y request lu h.ve . cHent nf V;~tn.mese

descent transferred to die at home because it is tra-ditionally believed thato 1. it is disloyal to their loved one to be left in the

hospital.o 2. the hospital cannot be trusted.o 3. the family can provide more com~.Irtat home.o 4. reincarnation will not occur in the hospital.

162. A client h;-s just been admitted with acute deliriumof unJ<nown etiology. The client's daughter statesthat she is worried about her mom because she hasnever been this sick before. Which of the followingwould be the most helpful statement to make to thedaughter?01. "Please don't worry. We will take good care of

your mother."02. "The doctor will order tests to find out what is

causing her condition."03. "We can help you learn how to take care of her

after. she is <;lischarged." ,04. "It helps if you avoid arguing when she talks

about seeing people who aren't there."163. A client with dementia is going to live with his

daughter who does not work outside of the home.The nurse would evaluate that the daughter needsfurther education when she makes which of the fol-lowing statements?01. "I've put special locks on all the doors that Dad

won't be able to unlock."02. "Dad said that what he missed most while he

was here was using his aftershave."o 3. "Dad will be in a bedroom that has nothing for

him to trip over getting to the bathroom."04. "I've taken the knobs off of the stove so he

won't be able to turn it on."164. Allopurinol (Zyloprim) is prescribed for a client

who has chronic gout. Which of the following com-ments indicates that the client understands how totake the allopurinol?o 1. "1 will take the medication whenever my joints

hurt."

o 2. "1 must take this drug on an empty stomach."o 3. "1 should drink plenty of fluids when taking

allopurinol."o 4. "1 should not take aspirin when taking allop-

urinol."

165. A client complains of severe vulvar itching. The nurserecognizes that a client with moniliasis (Candidaalbi-cans)has a vaginal discharge that iso 1. yellow-green in color.o 2. thick and white.o 3. fishy smelling.o 4. purulent.

166. The next-door neighbor of a nurse comes over to saythat her toddler just got burned on the arm. Thenurse should advise the mother tofirst

o 1. pack the arm in ice, then take the child to the. clQsestemergency room.o 2. rub the burned area with an antibac.erial oint-

ment, then call the doctor.

o 3. run coo! water over the burned area, then wrapit in a clean cloth.

04. call the child's health care provider immedi-ately, then wrap the arm in a clean cloth.

167. The nursing assessment of a client with osteomye-litis of the left great toe reveals pain with partialweight bearing, unsteady gait, and, complaints ofgeneral weakness. Based on these data, the prioritynursing diagnosis for the client iso 1. Impaired Physical Mobility.o 2. Impaired Skin Integrity.o 3. Ineffective Coping.o 4. Risk for Injury.

168. A client receiving a blood transfusion begins to com-plain of chills and headache within the first 15 min-utes of the transfusion. Based on these data, whatshould be the nurse's first response to the client'scomplaints?01. Administer acetaminophen.02. Take the client's blood pressure.o 3. Discontinue the transfusion.o 4. Check the infusion rate of the blood.

169. A 72-year-old client is referred for counseling. Dur-ing the initial nursing assessment, the client deniesthe need for counseling. The nurse would agreewith her if she made which of the following com-ments?

01. "!Vlydoctor just put me on an antidepressant,and I'll be fine in a week or so."

02. "My daughter sent me here. She's mad becauseI don't have the energy to take care of n.ygrandkids." ..

03. "Since I've gotten over the death of my hus-band, I've had more energy and been moreactive than before he died."

o 4. "My son got worried because I made this sillycomment about wanting to be with my hus-band in heaven."

170. A client takes isosorbide dinitrate (Isordil) as an anti-anginal medication. Which of the following state-ments indicates that the client understands the sideeffects of the drug? .

o 1. "1should take my pulse before taking the med-ication."

o 2. "1 should take Isordil with food."

o 3. "1 will need to change positions slowly so Iwon't get dizzy."

o 4. "It is important that I report any swelling in myankles."

171. The nurse is working on discharge ylans with aclient who is diagnosed with intermittent explosive

disorder, characterized by sudden angry outbursts.The nurse determines that the client is ready for dis-charge when he makes which of thefollow~g com-ments?

o 1. "I'm just not g9ing to let myself get angry any-more." '..

02. "Drinking doesn't help, but I like being withmy buddies at the bar." ,

o 3. "I'll be taking valproic acid (Depakote) andpropranoloI' (Inderal) iorever to help stay incontrol." . ( .

.0 4. "It would help if my mom would stop gE!tting'Onmy caseall the tiIbe." . .

172. The nurse walks, into a client's room to administerthe 9 AMmedications and notices ~at the dient is ll.tan awkward position in bed. What is the nurse'sfirst action? ,

o 1. Ask the client his name.o 2. Check the dient's name band.03. Straighten the client's pillow behind his back.o 4. Give the dient his medications.-

173. Which of the following would be an expected out-come for adient 24 hours after an abdominal hys-terectomy? ' II:!

o 1. Bowel sounds will be heard on auscultation. 0'.'0 2. The perineal pad will have a minimalamount.

of serous drainage. Io 3. The client will express feelings of a positive.~

body image. :

o 4. The ~lient will perform leg exercises hourly.174. A client has been Plescribed furosemide (Lasix)80

mg twice daily.. The.: cardiac monitor technidaninforms the nurse that'the client has started havmgrare premature ventricular contractions (PVC)f0l-lowed by runs of bigeminy lasting 2 minutes. DuJ..,ing the assessment, the nurse determines that theclient is asymptomatic and has stable vital si~Which 0,£the following actions should the nurseperform next?o 1. Call the physician.o 2. Check the client's potassium level.o 3. Summon the nurse manager.o 4. Adminis~er potassium.

175. During a home visit 3 weeks after delivery of a termneonate, a primiparous client tells the nurse that she ,

has had tremendous mood swings, uncontrollablecrying, loss of energy, and no appetite. Based on ananalysis of the client's assessment findings, which ofthe followmg would the nurse suspect?o 1. Postpartum blues.o 2. Postpartum depression.o 3. Postpartum psychosis.o 4. Normal postpartum adjustment.

176. After a child with leukemia dies, the mother asksthe .nurse, "What if we had brought her in when she

first complained of an earache?" Which of the fol-lowing would be the nurse's bestresponse to themother?

o 1. Explain that nothing could have helped thechild.

o 2. Provide comfort by saying that the child is nolonger suffering with an incurable illness.

o 3. Reassure the mother that all possible care wasgiven.

o 4. Explain th~t infections are often the result ofleukemia rather than the cause of it.

177. The nurse has received the following informationfrom unlicensed assistant personnel about variousclients. Which of the following clients should thenurse assess immediately?01. A postoperative client who has a temperature

of lOO°F(37.8°C).o 2. A client who had a TURP and complains of

bladder spasms with 60 mL of urine outputfrom his catheter. '

o 3. A client with an ileal conduit who has a urinaryappliance pouch that is one-third full of urine.

o 4~ A client recovering from a bronchoscopy with abiopsy who expectorates a small amount ofbloody sputum.

178. The physician orders 500 rt\L of 05W to be adminis-tered over 10 hours. Using a microdrip administra-tion set, t.:>what flow rate would the nurse adjustthe IV?01. 50 gtt/minute.02. 60 gtt/ minute.03. 75 gtt/minute.04. 100 gtt/ minute.

179. A client who had been takitig.phem!lzine (Nardil) isbeing switched to fluoxetine (Pr<:>zac)by the physi-.

., .

ciano Which of the following facts would the nurseemphasize with the client?o 1. The client rt\ust wait 14 days before he can start

taking fluoxetine (Prozac).o 2. The client must have his blood levels drawn

every week while taking fluoxetine (Prozac).03. The client must notify his physician before tak-

ing any over-the-counter medication.o 4. The client must report symptoms of headache

and nausea to the physician immediately.180. The nurse would evaluate that a client is coughing

effectively ..lftersurgery if the nurse observes whichof the following activities?o 1. .The client breathes through her nose, holds her

breath, and then exhales slowly before cough-ing.

o 2. The client takes short, panting breaths andcoughs from the throat to expectorate sputum.

o 3. The client takes a deep abdominal breath andthen "huff' coughs three or four times.

o 4. The client takes three deep breaths and thencoughs forcefully.

181. A 14-year-old nulligravid client with no history ofprenatal care is admitted to the birthing unit in activelabor. On admission, the client's cervix is dilated to 9em, completely effaced, at 1+ station. The client isthrashing in the bed, screaming and crying, and tellsthe nurse, "Dosomethingfor the pain!"Whichof the .

followingwould the nurse do first?:::> 1. Tellthe client to calm down immediately.o 2. Tell the client to breathe deeply with each con-

traction.03. Get the client's attention by looking her in the

eyes.o 4. Call the physician for an order for analgesia.

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