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Practice Exam I: NCLEX-RN Exam Cram, Third Edition

Practice Exam I: NCLEX-RN Exam Cram, Third Edition

1.The physician has ordered a urine specimen for vanillymandelic acid (VMA) levels in a client with severe uncontrolled hypertension. Which foods would interfere with VMA test results?

A.Whole grain breads and cereals
B.Chocolate pudding and gelatins
C.Spinach and kale
D.Beef and beef products

2.The nurse has just received the change of shift report. Which client should the nurse assess first?

A.A client two hours post lobectomy with 150 mls drainage in the past hour
B.A client two days post gastrectomy with scant drainage
C.A client with pneumonia with an oral temperature of 102°
D.A client with a fractured hip in Buck’s traction

3.A client with pernicious anemia has been receiving B12 injections for the past six weeks. Which laboratory finding indicates that the medication is having the desired effect?

A.Neutrophil count of 60%
B.Basophil count of 0.5%
C.Monocyte count of 2%
D.Reticulocyte count of 1%

4.The nurse is providing discharge teaching for a client taking phenelazine. The nurse should instruct the client to avoid eating:

A.Peanuts, dates, and raisins
B.Figs, chocolate, and eggplant
C.Cracked wheat, peas, and beef
D.Milk, cottage cheese, and ice cream

5.A client recovering from a stroke exhibits signs of unilateral neglect. Which behavior is suggestive of unilateral neglect?

A.The client is observed leaning to the left, although he believes he is sitting upright.
B.The client is unable to distinguish between two tactile stimuli presented simultaneously.
C.The client is unable to complete a range of vision without turning his head from side to side.
D.The client is unable to carry out cognitive and motor activities at the same time.

6.A client with acute lymphocytic leukemia develops severe neutropenia following chemotherapy. In addition to the institution of reverse isolation, the nurse should:

A.Request that foods be served with disposable utensils.
B.Ask the client to wear a mask when visitors are present.
C.Prep IV sites with mild soap and water.
D.Provide foods in sealed single-serving packages.

7.A new nursing graduate indicates in charting entries that he is a licensed registered nurse, although he has not yet received the results of the licensing exam. The graduate’s action can result in a charge of:


8.The nurse is assigning staff for the day. Which client should be assigned to the nursing assistant?

A.A six-month-old with bronchiolitis
B.An eight-year-old two days post appendectomy
C.A two-year-old with periorbital cellulites
D.A one-year-old with a fractured tibia

9.During the change of shift, the oncoming nurse notes a discrepancy in the number of meperidine ampules listed and the number present in the narcotic drawer. The nurse should:

A.Notify the hospital pharmacist.
B.Notify the nursing supervisor.
C.Notify the board of nursing.
D.Notify the director of nursing.

10.Due to a high census, a number of clients have had to be transferred to other units within the hospital. Which client should be transferred to the postpartum unit?

A.A 76-year-old female with a total knee replacement
B.A 45-year-old male with a herniated lumbar disc
C.A 20-year-old female with severe depression
D.A 28-year-old male with ulcerative colitis

11.A client with nephrotic syndrome is placed on a low-sodium diet. Which of the following snacks is suitable for a client with sodium restriction?

A.Peanut butter cookies
B.A grilled cheese sandwich
C.Cottage cheese and fruit
D.A fresh orange

12.A home health nurse is making preparations for her morning visits. Which one of the following clients should the nurse visit first?

A.A client with CVA with tube feedings
B.A client with emphysema who complains of nighttime dyspnea
C.A client who has had a mastectomy
D.A client with Parkinson’s disease

13.A client with Sjogren syndrome develops xerostomia. The nurse can help alleviate the discomfort associated with xerostomia by:

A.Instilling artificial tears
B.Administering analgesic meds
C.Splinting the affected joints
D.Providing a saliva substitute

14.The nurse is making assignments for the day. The staff consists of an RN, an LPN, and a nursing assistant. Which client should be assigned to the nursing assistant?

A.A client with laparoscopic cholecystectomy
B.A client with bacterial pneumonia
C.A client with suspected ectopic pregnancy
D.A client with transient ischemic attacks

15.The nurse is caring for a client with cerebral palsy, athetoid type. The nurse should provide frequent rest periods because:

A.Grimacing and writhing movements decrease with relaxation and rest.
B.Hypoactive deep tendon reflexes become more active with rest.
C.Stretch reflexes are increased with rest.
D.Fine motor movements are improved with rest.

16.The physician has ordered a culture from a child suspected of having pertussis. The nurse should obtain a culture of:

B.Nasopharyngeal secretions

17.Which of the following preoperative diets is the most appropriate for a client scheduled for a hemorrhoidectomy?

A.High fiber
B.Low residue
D.Clear liquid

18.An effective means of managing discomfort in a post-hemorrhoidectomy client is:

A.Medicated suppository
C.Sitz baths
D.Ice packs

19.To assist a blind client with ambulation, the nurse should walk:

A.To the side and slightly in front of the client while the client holds onto the nurse’s arm
B.To the front of the client while the client holds onto the nurse’s arm
C.To the front of the client while the nurse holds onto the client’s arm
D.To the side of the client while the nurse holds onto the client’s arm

20.A client is receiving blood. Which of the following findings should be reported immediately?

A.Pedal edema
B.Temperature of 99.2°
C.Blood pressure of 100/52
D.Adventitious breath sounds

21.Following renal transplantation, the client is started on oral doses of cyclosporine. Which of the following instructions should be included for a client receiving cyclosporine?

A.The diet should be supplemented with additional sources of iron.
B.Dilute the solution in chocolate milk and drink it immediately.
C.Store the medication in the refrigerator to preserve its effectiveness.
D.The medication will be gradually tapered off and discontinued after three months.

22.A client with chronic renal failure is placed on a low-protein diet. The nurse explains that a low-protein diet is best for those with renal disease because:

A.Protein breaks down into waste products that increase the workload of the kidneys.
B.Protein increases the amount of sodium and potassium to be regulated by the kidneys.
C.Protein decreases the amount of serum albumin and promotes edema formation.
D.Protein decreases serum calcium and phosphorus levels.

23.A client admitted with burn injury is determined to have second-degree partial thickness burns. Which of the following describes the client’s burns?

A.Reddened areas, dry texture
B.Brownish areas, dull appearance
C.Blackened area, not painful
D.Erythematous, moist area, painful

24.Which of the following clients would not be a candidate for therapy with imipramine (Tofranil)?

A.A client with a history of myocardial infarction
B.A client with a history of hepatitis
C.A client with a history of enuresis
D.A client with a history of gastric ulcers

25.An 18-month-old is hospitalized with intussusception. Which of the following observations best indicates that he is adequately hydrated?

A.The drainage from his nasogastric tube is gradually decreasing.
B.His IV is infusing at the prescribed rate.
C.He wets a diaper at least every 4 hours.
D.His urinary specific gravity is 1.012.

26.A client with depression fails to show improvement with amitriptyline (Elavil) and is started on a monoamine oxidase inhibitor. Which of the following symptoms can occur as a result of MAO food reaction?


27.An 11-year-old client with a fractured femur returns from surgery with a Steinmann pin through her lower femur and skeletal traction. Which of the following findings indicate that the traction is ineffective?

A.The client uses the trapeze to lift her hips off the bed when using the bedpan.
B.The foot plate is against the end of the bed.
C.The weights are suspended only 18 inches from the floor.
D.The ropes of the traction move freely through the pulley.

28.A four-year-old is admitted to the PICU following surgery to correct a Ventral Septal Defect (VSD). Several hours after surgery, he is noted to be restless and irritable. In the past hour, his pulse rate has increased from 106 to 110, his BP remains unchanged, and his respirations are rapid and shallow. The most likely interpretation of these findings is that:

A.He is developing fluid volume deficit.
B.He has symptoms of impending shock.
C.He is in pain.
D.He is developing heart failure.

29.A 15-year-old male is admitted with a closed head injury following an MVA. He has multiple abrasions, has fractures of the mandible, and was unconscious for several minutes after the accident. Which of the following orders should the nurse discuss with the doctor?

A.Keep the head elevated 30°.
B.Apply Neosporin ointment to the abrasions.
C.IV D5W at 75 ml/hr. for 8 hours.
D.Meperidine 75 mg IM q 3 hrs. PRN pain.

30.A client with a TURP returns from surgery with an indwelling catheter attached to a drainage bag and continuous bladder irrigation. Two hours after surgery, he complains of bladder spasms. The nurse should give priority to:

A.Offering him fluids by mouth
B.Administering the prescribed analgesic
C.Assessing catheter patency
D.Massaging the symphysis pubis

31.Which of the following instructions should be included in the discharge teaching of a client with mandibular wires?

A.Swallow saliva that collects in your mouth to help keep your mouth from becoming dry.
B.Move your lips as little as possible.
C.Clean the wires with saline-moistened cotton swabs.
D.Keep wire cutters with you at all times.

32.Following a cholescystetomy, the client’s diet should be:

A.Low residue
B.Low fat
C.Low protein
D.Low sodium

33.Obstructive biliary tract disease and gallbladder disease are often associated with:


34.Which of the following is a sign of osteomyelitis?

A.Fever and tachycardia
B.Nausea and dehydration
C.Erythema distal to the injury site
D.Fatigue and lethargy

35.A client with renal disease should be monitored frequently for complications of her illness. Which of the following is a complication of renal disease?


36.A client is being monitored for cardiac arrhythmias. While monitoring the client, the nurse recognizes bizarre QRS complexes that are lacking a P wave. The nurse would recognize these beats as:

A.Atrial tachycardia
B.Premature ventricular beats
C.Signs of a heart block
D.Premature atrial beats

37.A client with a diagnosis of trichimonas is treated with metronidazole (Flagyl). Which instruction should the nurse give the client taking Flagyl?

A.Take the medication with juice.
B.Do not drink alcohol while taking Flagyl.
C.Return to the clinic for regular eye exams.
D.Allow six weeks for the drug to be effective.

38.The nurse initiates cardioversion on the client in ventricular fibrillation. Cardioversion is synchronized with which part of the ECG complex?

B.S-T segment
C.Q-T interval
D.QRS complex

39.An elderly client is experiencing kyphosis. The nurse can help alleviate the pain associated with kyphosis by:

A.Administering a heating pad to the client’s back
B.Telling the client about relaxation exercises
C.Administering narcotics routinely
D.Applying ice to the client’s extremities

40.A client is scheduled for surgery and has an order for promethezine (Phenergan) to be administered with meperidine (Demerol). The nurse is aware that the promethezine is administered to:

A.Dry secretions
B.Decrease nausea
C.Provide pain relief
D.Prevent infections

41.While caring for a client receiving oxygen, the nurse identifies the odor of cigarette smoke. Which action by the nurse is most appropriate?

A.Tell the client that smoking is allowed only outside the hospital.
B.Ask the client whether he has been smoking.
C.Say nothing because she is unsure about where the smoke is coming from.
D.Call the head nurse and report the finding.

42.The urinary output of a client with a renal calculi in the urethra will most likely be:

D.Dark and foamy

43.The client having a voiding cystogram will be placed in which position?

B.Dorsal recumbent
D.Left Sims’

44.Glomerulonephritis is an example of which of the following types of renal disease?

A.Postrenal disease
B.Intrarenal disease
C.Prerenal disease
D.Extrarenal disease

45.The client has an order for ondansetron (Zofran). The nurse is aware that this medication is given to relieve:


46.The client is admitted with a painless lesion of the perineum. A positive FTA-ABS indicates that the client has syphilis. The medication most often given to treat syphilis is:

A.Dexamethasone (Decadron)
B.Penicillin-G (Penicillin)
C.Acyclovir (Zovirax)
D.Alendronate (Fosamax)

47.Infants with congenital heart defects are predisposed to the development of thrombi. Primary prevention of this complication includes:

A.Frequent change of position
B.Adequate hydration
C.Providing range of motion
D.Prevention of upper respiratory infections

48.A client receiving a thiazide diuretic should be instructed to eat a diet rich in:


49.A client with Parkinson’s disease is visited by the home health nurse. Which of the following environmental factors requires intervention by the nurse?

A.The client has a house cat.
B.The client has a bathroom down the hallway from his bedroom.
C.The client has a gas heater.
D.The client lives alone.

50.When preparing the preschool-aged child for surgery, the nurse should remember that preschoolers:

A.Have little awareness of their environment
B.Fear the loss of body integrity
C.Are able to conceptualize the surgery
D.Will resist any explanation about the surgery

51.Which of the following drugs, if overingested, can result in metabolic alkalosis?

D.Calcium carbonate

52.An elderly client with Alzheimer’s has become belligerent with her daughter because her daughter will not allow her to care for herself. According to Orem’s theory of nursing, which of the following actions will best assist the client with nighttime voiding?

A.Ask the client to void before retiring to bed.
B.Leave a night light on.
C.Wake the client periodically during the night.
D.Withhold fluids after 6 p.m.

53.A client is admitted to the chemical dependency unit for treatment of chronic alcoholism. It has been almost 12 hours since his last alcohol intake. On admission, the nurse should give priority to:

A.Obtaining the client’s vital signs every two hours
B.Obtaining a complete alcohol and drug history
C.Starting an IV of D5LR
D.Obtaining a CBC and urinalysis

54.Diuretic therapy with furosemide (Lasix) is ordered for a client with congestive heart failure. The nurse compares the admission data obtained three days earlier with today’s data. He determines that the medication is having its intended effect because the client’s:

A.Appetite has improved.
B.Urinary output has decreased.
C.Breath sounds have improved.
D.Temperature has decreased.

55.The client receiving chlordiazepoxide (Librium) should be taught to avoid:


56.The definitive diagnosis of benign prostatic hypertrophy is made by:

B.Pap smear
C.Rectal exam
D.Serum phosphatase elevations

57.A client with COPD is admitted with respiratory acidosis. The nurse determines that efforts to correct the client’s acidosis are effective by observing that:

A.The client’s CO2 level has decreased.
B.The client no longer complains of shortness of breath.
C.The client’s blood sugar is within normal limits.
D.The client’s ability to concentrate has improved.

58.A client is admitted with thrombophlebitis and started on intravenous heparin. Which diagnostic study will the nurse anticipate?

B.Partial thromboplastin time

59.Which of the following best indicates that the client understands teaching about stoma care?

A.The client asks questions about skin preparations for the stomal site.
B.The client is able to repeat the stoma care instructions.
C.The client performs proper skin care and applies a stomal bag.
D.The client asks for additional literature regarding management of a stoma.

60.A client scheduled for an arteriogram tells the nurse, “I’m afraid to have that test done.” The nurse’s best response would be:

A.“You seem upset, I’m sure you will feel better soon.”
B.“What about the test causes you fear?”
C.“Are you afraid that you won’t wake up?”
D.“You have nothing to be afraid of.”

61.The client who is taking warfarin sodium (Coumadin) should be taught:

A.To take the medication on an empty stomach
B.To limit his dietary intake of green, leafy vegetables
C.To report visual halos and blurring of vision
D.To increase his dietary intake of green, leafy vegetables

62.Which of the following selections would be best for a client with gallbladder disease?

A.A peanut butter and jelly sandwich, apple, and milk
B.A roast beef sandwich, pickle spear, and iced tea
C.Sliced chicken breast, cole slaw, fruit gelatin, and coffee
D.Baked fish, peas and carrots, sponge cake, and skim milk

63.Which of the following actions by the client indicates an acceptance of her mastectomy?

A.She verbalizes acceptance of the mastectomy.
B.She looks at the operative site.
C.She asks for information about breast reconstruction.
D.She remains silent during dressing changes.

64.An intramuscular injection of vitamin K (aquamephyton) is ordered to:

A.Prevent hyperbilirubinemia
B.Promote clotting
C.Prevent hypoglycemia
D.Promote respiratory stability

65.Which of the following menus is most appropriate for a client receiving cortisone?

A.A ham sandwich, potato chips, pickle slice, and cola
B.A tuna sandwich, tossed salad with thousand island dressing, and coffee
C.A hamburger on a whole wheat bun, fries, applesauce, and iced tea
D.Sliced turkey breast, roll with butter, green beans, baked potato, and iced tea

66.The nurse has explained to a client scheduled for surgery that he will not be able to eat or drink after midnight. The client asks whether he can smoke after that time. Which of the following responses by the nurse would be most appropriate?

A.“Smoking is not allowed because it will make you more thirsty.”
B.“I’ll check with your surgeon.”
C.“You can smoke because it will suppress your appetite before surgery.”
D.“Smoking is not permitted because it stimulates stomach secretions.”

67.Which of the following is most important to have on hand during a blood transfusion?

A.An alternative IV line
D.A tourniquet

68.A nurse can best assess edema in an extremity by:

A.Checking the extremity for pitting
B.Weighing the client
C.Measuring the circumference of the extremity
D.Observing the client’s output

69.Which of the following nursing interventions best prepares a six-year-old for a craniotomy?

A.Allow him to tour the pediatric intensive care unit.
B.Let him bandage a doll’s head.
C.Encourage him to talk about his fear.
D.Allow him to draw a picture.

70.The primary nursing diagnosis for a client with Parkinson’s disease is:

A.Alteration in tissue perfusion
B.Alteration in safety
C.Alteration in elimination
D.Alteration in thought processes

71.A client receiving intravenous Garamycin begins to complain of her “ears ringing.” The nurse’s first action should be to:

A.Slow the IV rate
B.Discontinue the medication
C.Call the doctor
D.Administer Benadryl

72.The nurse knows that a client receiving heparin has reached the therapeutic level when:

A.The client’s level is the same as the control.
B.The control is twice the client’s level.
C.The client’s level is 1 ½–2 times the control.
D.The control and client’s level are the same.

73.A client injured in a motor vehicle accident is placed on mechanical ventilation. A complication of mechanical ventilation is:


74.Which of the following staff should be assigned to care for a client with a C-section delivery of a 9-pound infant?

A.A licensed practical nurse with two years experience in labor and delivery
B.A registered nurse with two weeks experience on the postpartum unit
C.A registered nurse with six months experience on the postpartum unit
D.A registered nurse with five years experience in surgical intensive care

75.An obstetric client is admitted with spontaneous rupture of membranes. Exam reveals that the cervix is 8 cm dilated and an erratic fetal heart rate appears during contractions. The nurse should give priority to:

A.Applying an internal monitor
B.Turning the client onto her side
C.Assisting the client to ambulate
D.Moving the client to the delivery area

76.The primary nursing diagnosis for the client with Cushing’s disease is:

A.Alteration in nutrition
B.Potential for infection
C.Alteration in body image
D.Ineffective individual coping

77.Which of the following pediatric clients should be placed in reverse isolation?

A.A 7-year-old with acute lymphocytic leukemia
B.A 4-year-old with osteomyelitis
C.A 10-year-old with hepatitis A
D.A 6-year-old with spasmodic laryngitis

78.The nurse is taking the vital signs of a moribund client when the client suddenly grabs the nurse’s hand. The nurse should:

A.Continue to take the vital signs.
B.Obtain medication for the client’s agitation.
C.Talk calmly to the client while continuing to take the vital signs.
D.Cease taking the vital signs because it is making the client more agitated.

79.A client with a history of asthma has an allergy to both aspirin and penicillin. Which of the following medications should be avoided by the client?


80.A pediatric client with sensory hearing loss has received repeated antibiotic therapy for otitis media. Which of the following antibiotics could have contributed to her hearing loss?


81.The client with multiple sclerosis asks the nurse, “Will I have much pain as the disease worsens?” The nurse’s best response is:

A.“You can have severe headaches with multiple sclerosis.”
B.“The doctor can order analgesics that will help control the pain.”
C.“The amount of discomfort you feel will depend on your pain tolerance.”
D.“Pain is not a characteristic of multiple sclerosis.”

82.A client recuperating from a T-4 spinal injury wants to learn to use a wheelchair. To prepare the client for use of a wheelchair, the nurse should teach her to do:

A.Leg lifts to prevent hip contractures
B.Push-ups to strengthen her arm muscles
C.Balancing exercises to help her maintain equilibrium during transfer
D.Quadriceps setting exercises to maintain muscle tone

83.Which of the following activities would be most therapeutic for a withdrawn hallucinating client?

A.Watching a movie with several other clients
B.Working on a puzzle
C.Playing a game of solitaire
D.Taking a walk with the nurse

84.A client is admitted with a provisional diagnosis of Addison’s disease. Which of the following symptoms would the nurse expect to find as he performs the client’s physical assessment?

C.Pendulous abdomen
D.Dry skin

85.While caring for a client with Cushing’s disease, the nurse notes that the client experiences wide mood swings. The client’s emotional lability is most likely due to:

A.Increased glucocorticoid levels
B.Alteration in body image
C.Decreased aldosterone levels
D.Ineffective coping patterns

86.Which client is most likely to experience extreme uterine contractions (afterpains) after delivery?

A.Gravida 1 para 0
B.Gravida 2 para 0
C.Gravida 1 para 1
D.Gravida 3 para 3

87.The nurse observes that a client uses tissues to open all doors and to adjust knobs on the TV. No other staff members have reported the behavior. The nurse should:

A.Ignore the behavior.
B.Provide the client a can of disinfectant.
C.Talk with the client about the behavior.
D.Take the tissues away from the client.

88.The physician orders Rocephin 2 gm in 100 ml to infuse over 45 minutes. The IV is to infuse via a macrodrip (10 gtts per ml). The nurse should set the IV rate at:

A.12 gtts/min
B.22 gtts/min
C.32 gtts/min
D.42 gtts/min

89.Which of the following pieces of equipment should be kept at the bedside of a client immobilized with Crutchfield tongs?

A.Wire cutters
B.Torque wrench
D.Flat-head screwdriver

90.Which of the following patterns describes a reassuring fetal heart rate?

A.A fetal heart rate of 160–180 BPM
B.A baseline variability of 20–30 BPM
C.Ominous periodic changes that occur with fetal sleep
D.Acceleration of FHR with fetal movement

91.In evaluating the effectiveness of IV oxytocin for a client with secondary dystocia, the nurse should expect:

A.A precipitous delivery
B.Cervical effacement with delivery
C.Infrequent contractions lasting longer than 90 seconds
D.Progressive cervical dilation with contractions lasting less than 90 seconds

92.A test is scheduled for tomorrow. The student states, “I can’t think about that test today.” The student is using the defense mechanism known as:


93.A client is admitted for treatment of long-standing substance abuse. During the intake assessment, the client states, “I don’t know what everyone is so upset about. I don’t have a problem because I can quit anytime I want to.” The client’s statement is an example of:

D.Reaction formation

94.A client with borderline personality disorder refuses to talk with the staff and demands to see his doctor. He insists that only the doctor knows what is best for him. The client is using the defense mechanism referred to as:


95.A client is admitted for psychiatric evaluation after she attempted to stab her husband. On learning that he plans to visit, she states, “I’m so glad my husband is coming to see me.” The client is using the defense mechanism known as:

C.Conversion reaction
D.Reaction formation

96.A client admitted with frequent urinary tract infections is scheduled for an IVP. Preparation for an IVP includes:

A.Collection of a 24-hour urine
B.Administration of a laxative
C.A soft, bland diet the evening before the scheduled x-ray
D.Administration of radiopaque tablets the morning of the x-ray

97.A client with suspected renal cancer is admitted with complaints of hematuria. Further assessment of the client would most likely reveal the presence of:

A.Urinary casts
B.Costovertebral mass
C.Suprapubic pain
D.Burning on urination

98.A client with an acute attack of gouty arthritis is started on allopurinol. The client should be instructed to:

A.Take the medication 30 minutes before meals.
B.Increase his fluid intake to 3000 ml per day.
C.Take the medication before going to bed.
D.Rise slowly from a sitting position to prevent dizziness.

99.A client taking Atorvastation (Lipitor) asks the nurse the purpose of the medication. The nurse should tell the client that the medication will:

A.Decrease her blood pressure
B.Improve her appetite
C.Decrease her cholesterol level
D.Improve her bone density

100.A client with renovascular hypertension returns from having a renal arteriogram. The nurse should give priority to:

A.Applying warm wet packs to the insertion site
B.Encouraging the client to flex and extend the procedural leg
C.Withholding PO fluids for 4–6 hours after the procedure
D.Checking the color, temperature, and pulses in the procedural leg

101.Anasarca, a characteristic finding in clients with nephritic syndrome, is due to renal changes that result in:


102.Which of the following findings is most typical of a client with a fractured hip?

A.Pain in the hip and affected leg
B.Diminished sensation in the affected leg
C.Absence of pedal and femoral pulses in the affected extremity
D.Disalignment of the affected extremity

103.A client receiving aminophylline complains of nausea and “feeling jittery.” The nurse’s first action should be to:

A.Administer an antiemetic.
B.Check the client’s blood pressure.
C.Request a sedative.
D.Check the aminophylline level.

104.A gravida 2 para 0 is admitted from the ER with spontaneous rupture of membranes. She states that she has seen the doctor only twice during the pregnancy and that she is unsure of her exact due date. Exam reveals the presence of green-tinged fluid in the vaginal vault. The fetus is noted to be in a LOP position with an FHR of 110 BPM. Based on the assessment, the nurse suspects:

A.Fetal distress
B.The presence of an intrauterine infection
C.A post-mature fetus
D.That the fetus has a TE fistula

105.A male client is admitted for evaluation of a sudden hearing loss. No physical cause can be found for his sudden deafness; however, a friend reveals that the client’s fiancée recently canceled their engagement, saying that she needed more time to think about the marriage. The client’s deafness is an example of:

A.Conversion reaction
C.Reaction formation
D.Histrionic personality disorder

106.The best choice for the child following a tonsillectomy is:

A.Fruit punch
B.Strawberry soda
C.Banana Popsicle
D.Ice cream

107.The nurse is monitoring a client receiving an IV of Nipride in D5W. The IV bag has a foil covering, and the nurse notes that the IV fluid has a light brownish tint. The nurse should:

A.Discard the solution.
B.Obtain a bag of normal saline.
C.Cover both the solution bag and the IV tubing with foil.
D.Do nothing because the solution is expected to be light brown in color.

108.A client is admitted to the ER with reported heroin intoxication. Which of the following signs is consistent with opiate use?

A.The client’s pupils are dilated.
B.The client’s speech is rapid.
C.The client’s BP is elevated.
D.The client’s pupils are constricted.

109.A client with seizure disorder has an order for Dilantin (phenyltoin) IVP. The nurse knows that Dilantin should:

A.Be administered in a solution of D5W
B.Be administered in a solution of LR
C.Not be administered any faster than 50 mg/minute
D.Not be administered IVP

110.The client with COPD is admitted with a total hip replacement. The best position for the client with a right total hip replacement is:

A.With the right hip flexed 90°
B.With the right hip flexed 35°
C.Supine with pillows supporting the right leg
D.Sims’ position with the right leg adducted

111.An 18-month-old has been hospitalized six times for upper airway infections. Diagnostic studies including sweat analysis confirm the diagnosis of cystic fibrosis, an autosomal recessive disorder affecting the exocrine system. Which of the following statements describes the inheritance pattern for autosomal recessive disorders?

A.An affected gene is inherited from both the father and mother, who remain symptom free.
B.Males are affected at twice the rate as females.
C.Autosomal recessive disorders tend to skip generations, so the children of affected parents will have children with the disorder.
D.The disorder is transmitted by an affected gene on one of the six chromosomes.

112.A nine-month-old is seen in the well child clinic. During the nursing assessment, the mother asks, “Shouldn’t he be making baby sounds by now? My friend’s little boy is the same age and he is already saying dada.” The nurse reports the mother’s concerns to the doctor for follow-up based on the knowledge that infants should be making rudimentary sounds by age: month
B.two months
C.four months
D.eight months

113.A football player is well paid for his superior athletic ability. Described by his friends as quiet and brooding, on the field he is known for his overly aggressive plays. The client’s behavior is an example of:


114.A 15-month-old continually turns his cup upside down and shakes milk from the spout. The mother is convinced that he does this on purpose and asks the nurse what she should do. The nurse’s response should be guided by the knowledge that:

A.Toddlers often misbehave to get the attention of adults.
B.Toddlers are able to use thought processes to experience events and reactions.
C.Negative actions that are not immediately punished will be repeated.
D.Manipulation of objects in their environment enables the toddler to learn about spatial relationships.

115.A father suspected of child abuse tells the nurse, “I shouldn’t have grabbed him so hard. I had a really bad day at work and got all stressed out. The kid just wouldn’t listen to me.” The defense mechanism used by the father is:


116.A female client seen in the health department’s STD clinic is diagnosed with chlamydia. Before the client leaves the clinic, the nurse should:

A.Obtain the names and addresses of the client’s sexual contacts.
B.Tell the client to avoid alcohol while taking her prescription for Flagyl.
C.Instruct the client to avoid sexual relations until the infection is resolved.
D.Tell the client to douche after sexual intercourse.

117.A client with iron deficiency anemia is started on ferrous sulfate tablets. The nurse has instructed the client on the appropriate way to take her medication. Which of the following statements indicates that the client understands the nurse’s teaching?

A.“I can take my iron tablets with a glass of milk.”
B.“I need to take my iron tablets daily before breakfast.”
C.“Taking my iron tablets before I go to bed will cut down on stomach upset.”
D.“Taking my iron tablets with a glass of orange juice will help me absorb more of the medicine.

118.Which of the following infants is in need of additional growth assessment?

A.Baby girl A: age 4 months, BW 7 pounds 6 ounces, present weight 14 pounds 14 ounces
B.Baby girl B: age 2 weeks, BW 6 pounds 10 ounces, present weight 6 pounds 11 ounces
C.Baby girl C: age 6 months, BW 8 pounds 9 ounces, present weight 15 pounds 0 ounces
D.Baby girl D: age 2 months, BW 7 pounds 2 ounces, present weight 9 pounds 10 ounces

119.A client on assisted ventilation develops a right-sided tension pneumothorax. Which of the following signs is associated with a right-sided tension pneumothorax?

A.Diminished breath sounds on the right
B.Left-sided tracheal deviation
C.Right-sided tracheal deviation
D.Presence of bilateral ronchi

120.A client arrives at the emergency room with an HR of 120, an RR of 48, and hemoptysis. The nurse should give priority to:

A.Obtaining a history of the current illness
B.Applying oxygen via mask
C.Obtaining additional vital signs
D.Checking arterial blood gases

121.The nurse is performing a post-op assessment of an elderly client with a total hip repair. Although he has not requested medication for pain, the nurse suspects that the client’s discomfort is severe and prepares to administer pain medication. Which of the following signs would not support the nurse’s assessment of acute post-op pain?

A.Increased blood pressure
B.Inability to concentrate
C.Dilated pupils
D.Decreased heart rate

122.An obstetrical client elects to have epidural anesthesia with Marcaine. After the epidural anesthesia is given, the nurse should monitor the client for signs of:

A.Seizure activity
B.Respiratory depression
C.Postural hypotension

123.A client in the intensive care unit is overheard telling his wife, “It’s impossible to get any sleep in this place with all the noise and lights on all the time.” After talking with the client, the nurse determines that the client is bothered by sensory disturbance related to being in the ICU. Which laboratory finding would confirm the nurse’s assessment of sensory disturbance?

A.Increased urine catecholamines
B.Decreased TSH
C.Erratic changes in BUN levels
D.Increased blood glucose levels

124.Immediately after surgery the client with an above-the-knee amputation of the right leg refuses to look at the operative site. The most immediate diagnosis that can be made is:

A.Self-care deficit
B.Potential for infection
C.Disturbance in self-concept
D.Cognitive deficit

125.Which of the following describes the proximodistal development in the infant?

A.The infant is able to raise his head before he is able to sit.
B.The infant can control movements of his arms before he can control movements of his fingers.
C.The infant responds to pain with his whole body before he can localize pain.
D.The infant is able to make rudimentary vocalizations before using spoken words.

126.The RN is preparing to administer a transfusion of whole blood. Which action by the nurse predisposes the client to the development of hyperkalemia?

A.Allowing the blood to warm to room temperature
B.Administering blood that is 24 hours old
C.Administering blood with an 18-gauge needle
D.Filling the drip chamber below the level of the filter

127.A client with abdominal surgery is admitted to the recovery room with an NG tube to low suction. Which of the following lab values indicates a complication of NG suction?

A.Hgb 13.0 gm
B.Na 150 mEq/L
C.K 3.4 mEq/L
D.Cl 90 mEq/L

128.Which of the following statements regarding wound healing is correct?

A.Healing occurs within 10 days.
B.Healing by second intention results in excessive scar formation.
C.Third intention healing involves an open wound with healing taking place from the inside out.
D.Healing by third intention is accomplished through immediate wound closure by staples or sutures.

129.The nurse is teaching bladder management to a client with paraplegia. Which of the following statements indicates the client needs further teaching on dietary modifications to accommodate bladder changes?

A.“I need to eat plenty of citrus fruits to prevent bladder infections.”
B.“I need to drink at least eight glasses of water a day.”
C.“Including cranberry juice in my diet will prevent urinary infections.”
D.“I need to avoid milk and milk products.”

130.A client with mastoiditis has a left mastoidectomy with tympanoplasty. The nurse should observe the client for signs of damage to the sixth cranial nerve, which include:

A.Inability to chew
B.Inability to look laterally
C.Inability to swallow
D.Loss of scalp sensation

131.The nurse caring for a client with Meniere’s syndrome can help minimize attacks by teaching the client to limit her dietary intake of:


132.The nurse is caring for a dark-skinned client hospitalized with hepatitis. The nurse can best observe the presence of jaundice in the client by assessing the client’s:

A.Palms and soles
B.Nail beds
D.Hard palate

133.A two-year-old is hospitalized with gastroenteritis and dehydration. Which of the following methods is best for evaluating changes in skin turgor?

A.Pinching the abdominal tissue while the client is supine
B.Pinching the tissue of the forearm while the client is sitting
C.Pressing the skin of the lower extremities while the client is supine
D.Pinching the skin of the lower extremities while the client is sitting

134.Which of the following meals would be best tolerated by the client receiving Leukeran?

A.Peanut butter sandwich, orange juice, and Jell-O
B.Warm pea soup, apricot fruit slush, and ice cream
C.Lasagna with meat sauce, salad, and tea
D.Steak, baked potato, and milk

135.A client with myxedema should be prescribed which diet?

D.Low salt

136.The nurse is caring for a client from the Middle East. The nurse is aware that the client will most likely:

A.Want to take time for prayer during the day
B.Ask for specially prepared foods
C.Refuse blood products
D.Want to be treated by a medicine man

137.A 15-year-old hospitalized with a sarcoma is being treated with Adriamycin. Which action by the nurse indicates an understanding of the drug?

A.The nurse asks the client whether she would like to talk about the treatment she’s receiving.
B.The nurse implements isolation precautions.
C.The nurse provides the client with a wig.
D.The nurse strains the client’s urine.

138.Which of the following activities would be best tolerated by a client with muscular dystrophy?

B.Riding a bicycle
C.Playing golf

139.A client undergoes cryosurgery for the removal of a basal cell carcinoma on the ear. Which of the following best describes the appearance of the area a few days after surgery?

A.It’s dry, crusty, and itchy.
B.It’s oozing and painful.
C.It’s dry and tender.
D.It’s swollen, tender, and blistered.

140.A culture is taken of a lesion suspected of being herpes. The nurse knows that the specimen:

A.Should be packed on ice
B.Should be kept warm
C.Should be double-bagged
D.Requires no special handling

141.A client with AIDS shows symptoms of herpes simplex stomatitis. Which drug therapy can be anticipated for the client?


142.While assisting a client with AM care, the nurse notes small elevated skin lesions less than 0.5 cm in diameter over the client’s back. The nurse should describe the lesions as:


143.A six-month-old is brought to the ER by her mother. During the assessment, the nurse finds multiple bruises in different stages of healing and decreased range of motion of the right leg. X-ray confirms a fracture of the right femur. Which statement made by the mother would contribute to a diagnosis of child abuse?

A.“She got her leg caught in the crib and twisted it.”
B.“She hurt her leg while she was crawling.”
C.“I can’t remember her falling or getting hurt.”
D.“She fell out of her car seat before I could get the belt fastened.”

144.A client with a pyloric obstruction is admitted to the hospital with persistent vomiting. Which of the following blood gases would the nurse expect to see in the client with vomiting?

A.pH 7.33, PCO2 30 mm Hg
B.pH 7.50, PCO2 32 mm Hg
C.pH 7.30, PCO2 50 mm Hg
D.pH 7.47, PCO2 40 mm Hg

145.The doctor has ordered the insertion of an NG tube to determine the extent of gastric bleeding in a client with a gastric ulcer. To facilitate the insertion of the NG tube, the nurse should:

A.Place the NG tube in warm water prior to insertion.
B.Place the client in a supine position.
C.Ask the client to swallow as the tube is advanced.
D.Ask the client to hyperextend his neck as the nurse begins to insert the tube.

146.A client with acute leukemia has developed oral ulcerations. The nurse can increase the client’s comfort by suggesting that he:

A.Avoid brushing his teeth until the ulcers heal
B.Rinse his mouth frequently with normal saline
C.Rinse his mouth frequently with hydrogen peroxide
D.Cleanse his teeth and mouth with lemon and glycerin swabs

147.The parents of a child with cystic fibrosis discuss nutritional requirements and the need for vitamin supplements with the nurse. The nurse explains that it is necessary to give daily supplements of vitamins A, D, E, and K because:

A.Children with cystic fibrosis require vitamin supplements because their metabolism is increased.
B.Children with cystic fibrosis do not eat a well-balanced diet.
C.Children with cystic fibrosis do not absorb fat-soluble vitamins.
D.Children with cystic fibrosis have an increased excretion of water-soluble vitamins.

148.A client with a gastric ulcer is losing a significant amount of blood via the NG tube. The client’s pulse is weak and thready, and she is hypotensive. A continuous irrigation of normal saline is ordered. How should the client be positioned?

A.High Fowler’s
D.Left-side lying

149.A client with diabetes insipidus will require lifelong therapy with vasopressin. Which of the following should the nurse include in his teaching plan for the client?

A.The client will need to take her medication with meals.
B.The client will need to learn how to check the specific gravity of her urine.
C.The client will need to modify her daily activities.
D.The client will need to learn the proper method of drug administration.

150.Which of the following instructions should be included in the pre-op teaching of a client scheduled for a transphenoidal hypophysectomy for the removal of a pituitary tumor?

A.“It will be necessary to shave some of your hair.”
B.“It will be important for you to cough and deep breathe after the surgery.”
C.“You will need to lie supine for 24 hours after surgery.”
D.“You will not be able to brush your teeth for at least a week after surgery.”

151.A 34-year-old male is admitted to the hospital with a possible diagnosis of pheochromocytoma. Which of the following symptoms would the nurse not expect to see during an attack?


152.A client with suspected Addison’s disease is scheduled for a rapid corticotrophin stimulation test. Which of the following will the nurse include in her teaching?

A.The need to limit fluid intake
B.The need for periodic blood samples
C.The need for collection of a 24-hour urine
D.The need for frequent IV injections

153.Which of the following lab values might the nurse expect to see in a client with Addison’s disease?

A.WBC 10,000
B.BUN 22
C.K+ 3.5 mEq/L
D.Na+ 142 mEq/L

154.A 56-year-old male is admitted with a diagnosis of gastroesophageal reflux disease (GERD). The client is most likely to report esophageal discomfort following a meal of:

A.Chicken in lemon sauce, rice, and fruit juice
B.Turkey, salad, and a glass of red wine
C.Poached salmon, mashed potatoes, and milk
D.Hamburger, peas, and cola

155.A 28-year-old client is being treated with acute pelvic inflammatory disease. Which of the following positions will afford the most comfort for this client?

B.Flat, left Sims’
D.Flat, with legs elevated

156.A client with ulcerative colitis is placed on Azulfidine. Which of the following instructions should be included in the nurse’s teaching?

A.The client should be instructed to avoid exposure to sunlight because the drug causes sun sensitivity.
B.The client should be instructed to take the medication with meals.
C.The client should be instructed to take the medication even when he is feeling well.
D.The client should be instructed to take the medication as prescribed because it will stop the loss of blood in the stools.

157.A client with a C6 spinal injury begins to complain of a severe headache. When assessing the client, the nurse notes that her BP is 190/100 and she is diaphoretic. Which of the following nursing actions is most appropriate at this time?

A.Increase the rate of IV fluids.
B.Make sure that the Foley catheter is patent.
C.Place the client flat in bed.
D.Administer oxygen.

158.Which of the following lab reports indicates that a client with acute glomerulonephritis is improving?

A.Positive ASO titer
B.Increased C reactive protein
C.Negative eosinophil count
D.Decreased erythrocyte sedimentation rate

159.Which of the following snacks would be permitted for a child with acute renal failure?

A.Peanut butter and jelly sandwich
B.Orange juice and graham crackers
D.Cheese and crackers

160.Which of the following dietary choices should be avoided by a client with a recent bone marrow transplant?

B.Apple juice
C.Apple pie
D.Raw apple

161.Which of the following activities is most suitable for a 10-year-old with asthma?

D.Constructing model cars

162.Which of the following musical instruments is best for a teen with asthma?


163.A client returns from surgery after having a suprapubic prostatectomy. On assessing the client, the nurse notes that his urine is bright red with many clots. Which of the following nursing actions is most appropriate?

A.Check the client’s vital signs and notify the physician.
B.Check whether the continuous irrigation is working properly.
C.Recognize that this is a normal finding after surgery and continue post-op care.
D.Apply traction on the catheter and notify the physician.

164.Diuretic therapy for hypertension often necessitates the addition of high-potassium foods in the client’s diet. Which of the following diuretics does not require the client to increase his intake of potassium?

A.Spironolactone (Aldactone)
B.Furosemide (Lasix)
C.Hydrochlorothiazide (Hydrodiuril)
D.Ethacrynic acid (Edecrin)

165.Which of the following meals provides the lowest amount of potassium?

A.Orange, cream of wheat, bacon
B.Toast, jelly, soft boiled egg
C.Raisin bran, milk, grapefruit
D.Melon, pancakes, milk

166.Which of the following instructions should be included for the client taking calcium supplements?

A.The client should take her calcium with meals.
B.The client should take all her daily calcium supplement at one time.
C.The client should take her calcium supplement after meals to prevent stomach upset.
D.The client can use calcium-based antacids to supplement her diet.

167.When caring for a client with hypocalcemia, the nurse should assess for:

A.A decreased level of consciousness
D.Respiratory depression

168.A client is admitted to the burn unit with an electrical burn. Which of the following areas probably sustained the greatest degree of injury?

A.The skin
B.The intrathoracic
C.The muscles supporting the long bones
D.The bones

169.A client with hyperkalemia is to receive an infusion of 250 ml of 20% glucose with 20 units of regular insulin. The rationale for this therapy is:

A.Potassium elimination is enhanced.
B.Potassium binds with the glucose and is excreted by the kidneys.
C.Glucose uptake by the cell drives the potassium into the cell.
D.Insulin lowers the potassium by lowering blood glucose.

170.Which of the following organs is most likely to suffer permanent damage from hypovolemic shock?

A.The heart
B.The skin
C.The brain
D.The kidneys

171.A client has sustained second- and third-degree burns over her entire left arm and posterior trunk. Using the Rule of Nines, which percentage of the client’s body is burned?


172.A client who received complete thickness burns at 7:30 a.m. was rushed to the emergency room where IV therapy with lactated Ringer’s was begun. He is to receive 8,000 ml of solution in 24 hours. According to the Parkland formula, how much solution should he receive by 11:30 p.m.?

A.4,000 ml
B.5,000 ml
C.6,000 ml
D.7,000 ml

173.The drug of choice for managing status epilepticus is:

A.Carbamazepine (Tegretol)
B.Diazepam (Valium)
C.Clonazepam (Klonopin)
D.Valproic acid (Depakene)

174.Which of the following electrolytes must be maintained in a steady state for a client receiving lithium?


175.The greatest threat during the immediate post-burn period results from burn shock. Which of the following statements best describes why burn shock occurs?

A.Damaged tissues release histamine and other substances that can result in vasodilatation and increased capillary permeability with a loss of fluid from the vascular compartment to the interstitial space.
B.Large amounts of fluid are lost from the burn site, which results in a decrease in circulating volume.
C.Large amounts of epinephrine are released, leading to severe vasoconstriction and shock.
D.Release of epinephrine leads to tachycardia, ineffective cardiac output, and shock.

176.A client with an acute attack of gout is started on colchicine. She should be instructed to report which of the following symptoms?


177.A baby girl is born with a meningomyelocele. To prevent trauma to the sac, the nurse should place the infant:

A.Supine and flat
B.Prone with the hips slightly elevated
C.Prone with the head slightly elevated
D.Side lying

178.A client with a cholesterol level of 240 mg is instructed to modify his diet. Which of the following diets provides a low-cholesterol, low-saturated fat breakfast?

A.Oatmeal, skim milk, toast with margarine, orange juice, coffee
B.French toast, margarine, syrup, crisp bacon, coffee
C.Pancake, margarine, syrup, sausage, fresh fruit, tea
D.Toasted bagel, cream cheese, poached egg, coffee

179.While caring for a child who had a revision of a ventriculoperitoneal shunt, the nurse notes clear drainage from the incision. Which of the following actions should the nurse take first?

A.Notify the physician to obtain further orders.
B.Mark the dressing and continue to monitor.
C.Check the dressing for the presence of glucose.
D.No action is necessary because some drainage is expected.

180.Which of the following findings distinguishes a hydrocele from an inguinal hernia?

A.The swelling cannot be reduced and is translucent.
B.The swelling cannot be reduced and is opaque.
C.The swelling can be reduced and is translucent.
D.The swelling can be reduced and is opaque.

181.A client with lung cancer is advised to increase the protein and kilocalorie content of his diet. Which of the following choices will best meet his need for increased protein and calories?

A.Toast, jelly, chicken broth
B.Crackers, butter, fresh vegetables
C.Crackers, fresh fruit, ginger ale
D.Crackers, cheese, fruit yogurt

182.A child at summer camp comes to see the camp nurse 10 minutes after being stung by a bee. The child complains of tingling around her mouth and tightness in her chest. The nurse’s first action is to summon help and to:

A.Administer O2 at 4L/min by nasal cannula.
B.Apply a tourniquet proximal to the bee sting and give epinephrine subcutaneously.
C.Administer O2 at 6L/min and give Benadryl 25 mg PO.
D.Reassure the child that she is only excited due to the sting.

183.A 14-month-old is receiving Digoxin and Lasix twice a day. In planning his care, the nurse should assess for which complication?


184.The first postpartal bleeding noted by the mother after delivery is:

A.Lochia rubra
B.Lochia serosa
C.Lochia alba
D.Lochia canta

185.An elderly client has reduced hepatic functioning. Before giving medication, the nurse should be aware that diminished hepatic function will:

A.Decrease the possibility of drug toxicity
B.Prevent analgesics from being given
C.Reduce the blood level of certain drugs
D.Increase the possibility of drug toxicity

186.A client with seizure disorder is to receive Dilantin (phenytoin) and phenobarbital. The nurse knows that when she administers phenobarbital and phenytoin that:

A.A larger dose of phenobarbital might be required because of an increase in metabolism.
B.A smaller dose of phenobarbital might be required because of a decrease in metabolism.
C.There will be no need to alter the amount of phenobarbital given.
D.The two drugs cannot be given together.

187.While assessing a pre-op client, the nurse learns that the client is allergic to shellfish. How might this data affect the client’s surgical experience?

A.The anesthesiologist might need to alter the type of anesthesia used.
B.The physician might need to alter the type of skin preparation used.
C.The physician might need to alter the type of antibiotics ordered post-operatively.
D.The physician might need to monitor the client’s thyroid levels post-operatively.

188.The nurse is reviewing a client’s pre-op lab values. Which of the following lab results warrants immediate attention?

A.Prothrombin time of 1 minute and 20 seconds
B.Hematocrit 38 ml/dl
C.Hemoglobin 14 g/dl
D.White blood count 6,000/mm

189.Spinal headaches are a common occurrence following spinal anesthesia. Which of the following nursing interventions can help prevent a spinal headache?

A.Placing the client in a quiet room
B.Significantly increasing the client’s fluid intake
C.Administering PRN pain medication
D.Raising the head of the bed to 45°

190.A client with a recent spinal cord injury is experiencing dysreflexia and is noted to have a BP of 240/110. The nurse’s initial response should be to:

A.Check the client’s pulse and respiratory rate.
B.Elevate the client’s head to a 45° angle.
C.Place the client flat and supine.
D.Administer antihypertensive and recheck BP in 15 minutes.

191.Which of the following instructions should be given to a client regarding testicular self-exam?

A.The testicular exam should be done bimonthly.
B.The testicular exam should be done while in the shower or tub.
C.A small penlight should be used to transilluminate the scrotal sac.
D.The testicular exam should be done yearly.

192.A six-month-old has been hospitalized for the treatment of acute diarrhea. Discharge diet includes the use of Isomil instead of Similac formula until the next clinic appointment. Which of the following statements explains the change in infant formula?

A.Isomil is less expensive than Similac.
B.The infant has developed a permanent lactose intolerance.
C.Isomil is an excellent oral rehydration formula.
D.Infants commonly have a lactose intolerance after a diarrheal illness.

193.The client has a cast applied following a fracture of the femur. The doctor tells the nurse to petal the cast. The nurse is aware that he intends for her to:

A.Cut the cast down both sides.
B.Cut a window in the cast.
C.Cover the edges with cast batting.
D.Cut the cast down one side.

194.The client with a colostomy does not feel that the irrigating solution has drained completely. The nurse can enhance the effectiveness of the colostomy irrigation by telling the client to:

A.Massage the abdomen gently.
B.Reduce the amount of irrigation solution.
C.Increase his oral intake.
D.Place a heating pad on the abdomen.

195.A client with a partial bowel obstruction has a Miller-Abbot tube inserted to decompress the bowel. While the tube is in place, the nurse should give priority to:

A.Using only normal saline to irrigate the tube every four hours
B.Advancing the tube 3–4 inches as ordered by the physician
C.Changing the tape securing the tube to the client’s face daily to prevent skin breakdown
D.Attaching the tube to high constant suction

196.A client is brought to the emergency room with injuries sustained in an auto accident. While performing his assessment, the nurse notes the presence of Cullen’s sign. Cullen’s sign is suggestive of:

A.A neurological injury
B.A ruptured spleen
C.A bowel perforation
D.Retroperitoneal bleeding

197.A client with chronic pancreatitis is receiving pancreatin. Which of the following observations is most indicative that the drug treatment is having the desired effect?

A.The client’s appetite is improved.
B.The client’s weight loss is greater than 10 pounds.
C.The client’s stools contain less fat and occur with less frequency.
D.The client’s tissue bruises less easily.

198.A non-stress test has been ordered for a pregnant client with diabetes mellitus. Non-stress testing is a part of the diabetic’s prenatal care because:

A.Fetal movement is adversely affected by diabetes.
B.Maternal insulin levels can have a negative effect on fetal energy.
C.Diabetes can adversely affect development of placental vessels.
D.Fetal lung maturity is most easily determined by non-stress testing.

199.The obstetric client is determined to have oligohydramnios. Which fetal anomaly is associated with oligohydramnios?

B.Renal agenesis
C.Tracheo-esophageal fistula
D.Tracheo-esophageal atresia

200.A client receiving aminophylline IV complains of feeling nervous and shaky. The nurse is aware that these are symptoms of:

A.CNS depression that accompanies xanthine derivatives
B.CNS stimulation that sometimes accompanies xanthine derivatives
C.The anticholinergic effects of aminophylline
D.Cardiovascular depression that can accompany xanthine derivatives

201.The client with herpes zoster will most likely have an order for which category of medication?


202.A client with chronic bronchitis is admitted with complaints of chest pain. Which of the following drug orders should the nurse question?


203.Which of the following instructions should be included in the teaching for the client with arthritis?

A.Avoid exercise because it fatigues the joints.
B.Take prescribed anti-inflammatory medications with meals.
C.Apply hot compresses at night.
D.Avoid weight-bearing activity.

204.An elderly client with a fractured hip is placed in Buck’s traction. The primary purpose for Buck’s traction for this client is:

A.To decrease muscle spasms
B.To prevent the need for surgery
C.To alleviate the pain associated with the fracture
D.To prevent bleeding associated with hip fractures

205.Triage refers to the classification of injury severity during a disaster. Which of the following clients should receive priority during triage?

A.Open fractures of the tibia and fibula
B.Burns of the head and neck
C.Crushing injury of the arm
D.Contusions and lacerations of the head without loss of consciousness

206.The client is admitted to the unit with the following lab values. Which of the following lab values should be reported immediately?

A.BUN 18 mg/dl
B.PO2 72%
C.Hemoglobin 10 mg/dl
D.White blood cell count of 5500

207.Which of the following findings is consistent with a diagnosis of cardiac overload?

A.Central venous pressure reading of 15
B.Carbon dioxide reading of 30
C.Hemoglobin of 18
D.Potassium level of 5.5

208.A 28-year-old primigravida with pregestational diabetes visits the clinic six weeks gestation. Which of the following statements indicates that she understands the nurse’s teaching regarding her insulin needs during pregnancy?

A.“As the baby grows, I will need more insulin because the baby will not be able to make insulin.”
B.“Changes in hormone levels will make my body more resistant to insulin, so I will need more insulin as the pregnancy progresses.”
C.“As the baby grows, I will need less insulin because the baby uses up any extra glucose.”
D.“If I maintain an adequate balance of diet and exercise, my insulin requirements will be the same.”

209.Which of the following positions is best for a client with preeclampsia who is in labor?

A.Left Sims’
B.High Fowler’s

210.A symptom of impending cardiac decompensation in a pregnant client with heart disease is:

A.Increasing dyspnea
B.Transient palpitations
C.Occasional activity intolerance
D.Periodic shortness of breath

211.A client with acute pancreatitis is experiencing severe abdominal pain. Which of the following orders should be questioned by the nurse?

A.Meperidine 100 mg IM q 4 hours PRN pain
B.Mylanta 30 ccs q 4 hours via NG
C.Cimetadine 300 mg PO q.i.d.
D.Morphine 8 mg IM q 4 hours PRN pain

212.A client is admitted, and an order for continuous observation is written. The nurse is aware of this order because he knows that hallucinogenic drugs differ from other drugs of abuse in their capacity to:

A.Create both stimulant and depressant effects
B.Induce states of altered perception
C.Produce severe respiratory depression
D.Induce rapid physical dependence

213.A client with a history of abusing amphetamines abruptly stops her drug use. The nurse should give priority to assessing the client for:

A.Depression and suicidal ideation
B.Diaphoresis and tachypnea
C.Muscle cramping and abdominal pain
D.Tachycardia and euphoric mood

214.During the assessment of a laboring client, the nurse notes that the FHT are loudest in the upper left quadrant. The infant is most likely in which position?

A.Left mentum anterior
B.Left occipital anterior
C.Left sacral anterior
D.Left occipital transverse

215.The primary physiological alteration in the development of asthma is:

A.Bronchiolar inflammation and dyspnea
B.Hypersecretion of abnormally viscous mucus
C.Induction of histamine mucosal edema
D.Spasm of bronchiolar smooth muscle

216.A client with mania is busy investigating the unit and overseeing the activities of others. She is unable to finish her dinner. To help her maintain sufficient nourishment, the nurse should:

A.Serve high-calorie foods she can carry with her.
B.Encourage her appetite by sending out for her favorite foods.
C.Serve her small, attractively arranged portions.
D.Allow her in the unit kitchen for extra food whenever she pleases.

217.To maintain Bryant’s traction, the nurse must make certain that the child’s:

A.Hips are resting on the bed with the legs suspended at a right angle to the bed
B.Hips are slightly elevated above the bed with the legs suspended at a right angle to the bed
C.Hips are elevated above the level of the body on a pillow with the legs suspended parallel to the bed
D.Hips and legs are flat on the bed with the traction positioned at the foot of the bed

218.Which of the following signs is highly suggestive of impaired hearing in an infant?

A.The absence of the Moro reflex
B.The absence of babbling by age 7 months
C.A lack of eye contact when spoken to
D.A lack of hand gesture to indicate wants

219.After four days of extreme anxiety, a hospitalized toddler appears to settle in. He seems unconcerned when his parents come to visit. The nurse knows that:

A.He is experiencing detachment.
B.He has successfully adjusted to the hospital environment.
C.He has accepted hospitalization and seeing his parents too frequently will only renew his anxiety.
D.He has transferred his attachment to the nursing staff.

220.An order is written for a peak to be drawn on a client receiving Garamycin. The nurse is aware that he should contact the lab for them to draw the blood:

A.15 minutes after the infusion
B.30 minutes after the infusion
C.1 hour after the infusion
D.2 hours after the infusion

221.A client with an embolus is started on a continuous heparin infusion to run at 1,200 units per hour. The solution contains 12,500 units of heparin per 250 ml of normal saline. The IV set should be regulated to deliver how many milliliters per hour?


222.A client using a diaphragm should be instructed to:

A.Refrain from keeping the diaphragm in longer than eight hours.
B.Keep the diaphragm in a warm location.
C.Have the diaphragm resized if she gains five pounds.
D.Have the diaphragm resized if she has any surgery.

223.The nurse is providing postpartum teaching for a non-nursing mother. Which of the client’s statements indicates the need for additional teaching?

A.“I’m wearing a support bra.”
B.“I’m expressing milk from my breast.”
C.“I’m drinking four glasses of fluid during a 24-hour period.”
D.“While I’m in the shower, I’ll keep the water from running over my breasts.”

224.Damage to the VIII cranial nerve results in:

A.Air conduction loss
B.Sensorineural loss
C.Mixed hearing disorders

225.A client is receiving vincristine. The client should be taught that the medication can:

A.Cause diarrhea
B.Change the color of her urine
C.Cause mental confusion
D.Cause changes in taste

226.Which of the following nursing interventions is essential when caring for a client who is receiving cyclophosphamide?

A.Monitoring vital signs q 1 hour
B.Carefully monitoring of urine output
C.Monitoring apical pulse
D.Assessing for signs of increased intracranial pressure

227.A client with AIDS has lesions from herpes simplex virus. He is receiving intravenous acyclovir. Which nursing intervention is most critical during the administration of acyclovir?

A.Limit the client’s activity.
B.Encourage a high-carbohydrate diet.
C.Utilize an incentive spirometer to improve respiratory function.
D.Encourage fluids.

228.A danger following bone marrow transplantation is graft-host disease. The first sign of graft-host disease is:

A.Chest pain
C.ECG changes

229.A client is admitted for an MRI, a CT scan, and a myelogram. Which of the following medication orders should be questioned for the client who is to have a myelogram?

A.Ampicillin 250 mg PO q 6 hours
B.Motrin 400 mg PO q 4 hours PRN for headache
C.Seconal 50 mg HS PRN sleep
D.Darvon 65 mg PO q 4 hours for pain

230.A client admitted with a severe head injury following an MVA is placed on a ventilator and hyperventilation is maintained. The primary reason for maintaining hyperventilation is:

A.To increase oxygen to the brain
B.To dilate the cerebral blood volume
C.To increase the cerebral blood volume
D.To promote cerebral vasoconstriction and decrease cerebral blood flow

231.While monitoring the urine specific gravity of a client with a head injury, the nurse notes that the client’s specific gravity is decreasing and is currently 1.004. The most likely explanation for this finding is:

A.The client is well hydrated.
B.The client is experiencing renal failure.
C.The client has adequate ADH secretion.
D.The client is experiencing diabetes insipidus.

232.The nurse should visit which of the following clients first?

A.The client with diabetes with a blood glucose of 95 mg/dl
B.The client with hypertension being maintained on Lisinopril
C.The client with chest pain and a history of angina
D.The client with Raynaud’s disease

233.Following a stroke, a client is found to have receptive aphasia. This finding is consistent with damage to:

A.The frontal lobe
B.The parietal lobe
C.The temporal lobe
D.The occipital lobe

234.During the first 72 hours post CVA, the nurse should position the client:

A.Flat in bed with the head elevated on a small pillow
B.With the head of the bed elevated at 30° and the client’s head in a midline neutral position
C.In semi-Fowler’s and the knee gatch elevated
D.Flat in bed and lying on the side

235.A client has undergone a lumbar puncture for examination of the CSF. Which of the following findings should be considered abnormal?

A.Total protein 40 mg/100 ml
B.Glucose 60 mg/100 ml
C.Clear, colorless appearance
D.White blood cells 100/cu. mm

236.Which of the following interventions is appropriate when caring for a client who has lost function of cranial nerve V on the left side?

A.Helping the client select foods that are easy to swallow
B.Speaking to the client on his right side
C.Applying an eye patch to the left eye
D.Speaking to the client on his left side

237.Following a CT scan with contrast medium, the nurse should give attention to:

A.Maintaining bed rest for eight hours
B.Forcing fluids
C.Observing the puncture site for hemorrhage
D.Administering pain medication

238.A client whose father died from Huntington’s chorea asks what the chances are that he will develop the disease. The nurse knows that the chances of the client developing the disease are:


239.Cataracts result in opacity of the crystalline lens. Which of the following best explains the functions of the lens?

A.The lens controls stimulation of the retina.
B.The lens orchestrates eye movement.
C.The lens focuses light rays on the retina.
D.The lens magnifies small objects.

240.A client scheduled for a fluorescein angiography is to have mydriatic eye drops instilled in both eyes one hour prior to the test. The nurse knows that the purpose of the medication is:

A.To anesthetize the cornea
B.To dilate the pupils
C.To constrict the pupils
D.To paralyze the muscles of accommodation

241.A client with a severe corneal ulcer has an order for Gentamycin gtt q 4 hours and Neomycin 1 gtt q 4 hours. Which of the following schedules should be used when administering the drops?

A.Allow five minutes between the two medications.
B.The medications can be used together.
C.The medications should be separated by a cycloplegic drug.
D.The medications should not be used in the same client.

242.While assessing a client with AIDS, the nurse notes a reddish-purple discoloration on the client’s eyelid. This finding is most consistent with:

A.Cytomegalovirus retinitis
B.AIDS entropion
C.Retinitis pigmentosa
D.Kaposi’s sarcoma

243.An elderly client has difficulty distinguishing colors. Which colors are often misinterpreted by elderly clients?


244.The rationale for refrigerating urine specimens that cannot be analyzed immediately is:

A.Urine becomes more acidic and kills bacteria that might be present.
B.Urea breaks down into ammonia, causing urine to become more alkaline and promoting cellular breakdown.
C.Components in the urine become consolidated so that the urine cannot be analyzed.
D.Red cells appear in stagnant urine.

245.The client with enuresis is being taught regarding bladder retraining. The ability to remain continent depends on the:

A.Sympathetic nervous system
B.Parasympathetic nervous system
C.Central nervous system
D.Lower motor neurons

246.A client with a history of renal calculi passes a stone made up of calcium oxalate. Which of the following diet instructions should be given to the client?

A.Increase intake of meats, eggs, fish, plums, and cranberries.
B.Avoid citrus fruits and juices.
C.Avoid dark green, leafy vegetables.
D.Increase intake of dairy products.

247.Which of the following drugs would be least helpful for a client who is experiencing an acute attack of bronchial asthma?

A.Cromolyn sodium

248.Which of the following interventions is most helpful in determining the need for oxygen therapy for a client with COPD?

A.Asking the client whether he needs O2
B.Assessing the client’s level of fatigue
C.Evaluating the hemoglobin level
D.Using a pulse oximeter on the client’s ear lobe

249.The nurse is evaluating the security of the client’s tracheostomy ties. Which of the following methods is used to assess for tie tightness?

A.The nurse places one finger between the tie and the neck.
B.The tracheostomy can be pulled slightly away from the neck.
C.There are no tie marks present.
D.The nurse uses a Velcro fastener instead of a tie.

250.Which of the following clients is at highest risk for developing sarcordosis?

A.A 40-year-old Caucasian with a history of bronchitis atrial tachycardia
B.A 30-year-old African American who is pregnant
C.A 50-year-old Asian male with emphysema
D.A 60-year-old Hispanic male with cancer


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