1.A patient requires tracheal suctioning through the  A.

 High pitched cry

nose. Which of the following nursing action would  B. Harsh heart murmur
be incorrect?  C. Bradycardia
 A. Lubricating the catheter with sterile water  D. Hypertension
 B. Applying suction while withdrawing the
catheter from the nose 7. The administration of which of the following
 C. Applying suction for a minimum of 30 types of parenteral fluids would result in a lowering
seconds of the osmotic pressure and cause the fluid to
 D. Rotating the catheter while withdrawing move into the cells?
it
 A. Hypotonic
2.Pain management for terminally ill patients is  B. Isotonic
most effective when analgesics are given:  C. Hypertonic
 D. Colloid
 A. Around the clock
 B. Only when clearly needed 8. Nursing management of the patient with external
 C. After non-pharmacological methods fail otitis includes:
 D. As the patient requests them
 A. Irrigating the ear canal with warm saline
3. A patient is admitted to a hospital with acute several hours after instilling lubricating ear
renal failure. The patient wakes up complaining of drops
abdominal pain. On assessment, the nurse observes  B. Inserting an ear wick into the external canal
edema to the patient's ankles and distended neck before instilling the ear drops to disperse the
veins. The patient is dyspneic with a blood pressure medication
of 200/96 mmHg. The proper nursing diagnosis for  C. Teaching the patient how to instill antibiotic
this patient is: drops into the ear canal before swimming
 D. Instilling ear drops without the dropper
 A. Deficient fluid volume related to disease touching the auricle and positioning the ear
process upward for 2 minutes afterwards
 B. Excess fluid volume related to decreased
glomerular filtration rate 9. The correct way to trim the toe nails of a patient
 C. Knowledge deficit related to proper with diabetes is to:
medication regimen
 D. Acute pain related to renal edema  A. Cut the nails in a curve and then file
 B. Cut the nails straight across and then file
4.The nurse knows that the greatest risk for a  C. File the nails straight across and square only
patient with a ruptured ectopic pregnancy is:  D. File the nails in a curved arch with low sides
only
 A. Hemorrhage leading to hypovolemic shock
 B. Strictures and scarring of the fallopian tube
 C. Adhesions and scarring from blood in the 10.Salem has Alzheimers disease. He is agitated
abdomen and repeatedly asks to go home. The most
 D. Infertility resulting from treatment with a appropriate nursing intervention for him is to:
salpingectomy
 A. Isolate him in a single room
5.A trauma patient with open wounds arrives in the  B. Find activities to keep him occupied
emergency department. The nurse would know that  C. Ask the physician to discharge him
a tetanus injection is needed if the patient has:  D. Administer a minor tranquillizer

 A. Only received 3 doses of tetanus toxoid 11. During the initial pain assessment process, the
 B. Received less than 3 doses of tetanus nurse should:
toxoid
 C. Not had a dose of tetanus toxoid in the past  A. Perform pain relief measures
4 years  B. Teach the patient about pain therapies
 D. Not had a dose of tetanus toxoid in the  C. Conduct a comprehensive pain assessment
past 10 years  D. Provide appropriate treatment and evaluate
its effect
6.A 3-month-old infant is admitted with a diagnosis
of ventricular septal defect. The physical assessment
for this infant would reveal:
12. The immediate treatment for ventricular 18. What would be the expected response of the
fibrillation is: nurse to this request?

 A. Precordial blow  A. "I will go to the unit and hopefully the

 B. Defibrillation behavioral health staff members will assist me
 C. Bolus of lidocaine with my assignment."
 D. Ventricular pacing  B. "I cannot go. I have no previous behavioral
health experience. I do not want to reduce the
13. The purpose of a cardiac pacemaker is to: quality of patient care."
 C. "I have no previous behavioral health
 A. Initiate and maintain the heart rate when SA experience. I am willing to go and help with
node is unable to do so any duties that are similar to those I perform
 B. Stabilize the heart rate when it is above 100 on my unit."
beats per minute  D. "I should not be expected to float to
 C. Stabilize the heart when the patient has had another unit without a proper orientation. I
a heart attack will fill out an incident report if I am sent
 D. Regulate the heart when the patient is there."
going for open heart surgery
18. A patient is to receive 25mg/hr of an
aminophylline infusion. The solution prepared by
14. When taking care of a patient who has the pharmacy contains 500mg of aminophylline in
undergone open reduction and internal fixation of a 1000ml of D5W. How many milligrams are available
fractured left tibia, the nurse should keep the leg: per ml?

 A. Straight to reduce flexion deformities  A. 0.25 mg/ml

 B. Immobilized to enhance bone healing  B. 0.5 mg/ml
 C. Adducted to attain alignment  C. 1 mg/ml
 D. Elevated to minimize venous stasis  D. 2 mg/ml

15. A nurse prepares to set up a secondary

intravenous (IV) cannula. The primary IV infusing is 19. A patient with pneumonia is coughing up
normal saline. In order for the secondary cannula to purulent thick sputum. Which one of the following
infuse correctly, the nurse should set up the primary nursing measures is most likely helpful to loosen
IV to: the secretions?

 A. Hang higher than the secondary IV  A. Postural drainage

 B. Hang at the same level as the secondary IV  B. Breathing humidified air
 C. Hang lower than the secondary IV  C. Percussion over the affected lung
 D. Discontinue before the secondary IV starts  D. Coughing and deep breathing exercises

16. The best dietary advice a nurse can give to a

woman diagnosed with mild pregnancy- induced 20. A 21 year old woman is being treated for
hypertension is to: injuries sustained in a car accident. The patient has
a central venous pressure (CVP) line insitu. The
 A. Follow a strict low salt diet nurse recognizes that CVP measurements:
 B. Restrict fluid intake
 C. Increase protein intake  A. Estimate Cardiac output
 D. Maintain a well-balanced diet  B. Assess myocardial workload
 C. Determine need for fluid replacement
 D. Determine ventilation - perfusion mismatch

17. A nurse has been working in a general hospital 21. A construction worker was brought to the
on the same medical unit for 6 years. The emergency department and admitted with the
Behavioral Unit is desperately short staffed and the diagnosis of heat stroke due to strenuous physical
nurse is asked to work her shift in this other unit. activity during hot weather conditions.
Which action should the nurse take?
  A. Immediately immerse the patient in cold  C. Trendelenberg
water to reduce the patient's temperature  D. Fowler's
 B. Administer an antipyretic such as aspirin or
acetaminophen 27. When the post-operative patient returns to the
 C. Place ice packs to the neck, axillae, scalp surgical unit, the priority is to:
and groin
 D. Encourage foods and oral fluids that  A. Assess the patient's pain
contain carbohydrates and electrolytes  B. Measure the patient’s vital signs
 C. Monitor the rate of the IV infusion
22. Thirty minutes after starting a blood  D. Check the physician’s post-operative orders
transfusion a patient develops tachycardia and
tachypnea and complains of chills and low back 28. When taking routine post-operative
pain. The nurse recognizes these symptoms as observations on a patient who underwent an
characteristic of: exploratory laparotomy, the nurse plans to monitor
which important finding over the next hour?
 A. Circulatory overload
 B. Mild allergy  A. Serosanguinous drainage on the surgical
 C. Febrile response dressing
 D. Hemolytic reaction  B. Blood pressure of 105/65 mmHg
 C. Urinary output of 20 mls in the last hour
23. As a part of the treatment given to a child with  D. Temperature of 37.6 °C
leukemia the child is placed on reverse barrier
isolation to: 29. A patient has been taking Aluminum Hydroxide
daily for 3 weeks. The nurse should be alert for
 A. Protect the child from injury which of the following side effects?
 B. Protect the child from infectious agents
 C. Provide the child with a quiet environment  A. Constipation
 D. Keep the child away from other children  B. Flatulence
 C. Nausea
24. The rationale for having the patient void before  D. Vomiting
an abdominal paracentesis procedure is to:
30. A patient with severe, protracted vomiting will
 A. Minimize discomfort often have what electrolyte abnormality?
 B. Avoid abdominal distention
 C. Prevent bladder puncture  A. Decreased potassium and decreased
 D. Reduce infection rate chloride
 B. Increased sodium and decreased chloride
25. The best time for the nurse to teach an anxious  C. Increased potassium and increased sodium
patient about the patient controlled analgesic (PCA)  D. Decreased sodium and increased chloride
pump would be during which of the following
stages of patient care?

 A. Post-operative
 B. Pre-operative
 C. Intraoperative
 D. Post anesthesia

31. A 13-year old girl with manifestations of

π26. To maintain the airway and promote rheumatic heart disease is admitted to hospital.
respiratory function, the best position for the nurse Which of the following laboratory blood findings
to place the unconscious patient in the Post would confirm that she likely has had a
Anesthesia Care Unit (PACU) is: streptococcal infection within the past two weeks?

 A. Supine  A. Decreased leukocyte count

 B. Lateral  B. Elevated hemoglobin count
  C. Elevated ASO titer 38. The best example of documentation of patient
 D. Decreased ESR teaching regarding wound care is:

32. To prevent post-operative thrombophlebitis,  A. "The patient was instructed about care of
which one of the following measures is effective? wound and dressing changes"
 B. "The patient demonstrated correct
 A. Elevation of the leg on two pillows technique of wound care following instruction"
 B. Using of compression stocking at night  C. "The patient and family verbalize that they
 C. Massage the calf muscle frequently understand the purposes of wound care"
 D. Performing leg exercises  D. "Written instructions regarding wound care
and dressing changes were given to the
33. The mother of a child with nephrotic syndrome patient"
asks why her child must be weighed each morning.
The nurse's response should be based on the fact 39. The nurse teaches a patient recovering from a
that this is important to determine the: total hip replacement that it is important to avoid:

 A. Nutritional status  A. Putting a pillow between the legs while

 B. Water retention sleeping
 C. Medication doses  B. Sitting with the legs crossed
 D. Blood volume  C. Abduction exercises of the affected leg
 D. Bearing weight exercises on the affected
34. A deficiency of which of the following vitamins leg for 6 weeks
can affect the absorption of calcium?
40. Which of the following actions is the most
 A. Vitamin C appropriate when the nurse is responding to a
 B. Vitamin B6 patient during a tonic-clonic seizure?
 C. Vitamin D
 D. Vitamin B12  A. Restrain the patient
 B. Protect the patient from harm
35. The nurse should place the automatic external  C. Minimize noise and light stimulus
defibrillator (AED) electrodes on the patient's  D. Apply oxygen by mask or nasal cannula
anterior chest with one electrode placed:
41. The patient did not sleep well last night and is
 A. Below the left clavicle and one below the anxious about having a bronchoscopy later this
right nipple morning. The priority nursing intervention would be
 B. On the right mid-axillary line and the other to:
at mid-sternum
 C. Below the right clavicle and one below the  A. Reassure and encourage expression of
left nipple feelings
 D. On the mid-axillary line and one at the  B. Administer the premedication a little earlier
sternal notch  C. Keep the patient occupied until the
procedure
36. When caring for a patient with hepatic  D. Explain the purpose of the bronchoscopy
encephalopathy the nurse may carry out the
following orders: give enemas, provide a low
protein diet, and limit physical activities.
These measures are performed to:
42. The nurse should suspect that a patient has
 A. Minimize edema bleeding in the upper gastrointestinal tract when
 B. Decrease portal pressure the color of the patient's stool is:
 C. Reduce hyperkalemia
 D. Decrease serum ammonia  A. Yellow
 B. Black
37. Collection urine bag should be emptied as  C. Clay
necessary and at least every 8 - 9 hours to prevent:  D. Red

 A. Pooling of urine in the tube 43. The police bring a prisoner into the emergency
 B. Reflux of urine into the bladder department who is in severe pain. When the nurse
 C. Pulling on catheter is assigned to this patient, the nurse should:
 D. Bacterial contamination
  A. Ignore the prisoner because he deserves to 48. An elderly patient is admitted to the hospital
be in pain with swollen ankles. The best way to limit edema
 B. Give the prisoner the minimum amount of of the feet is for the nurse to:
pain medication ordered
 C. Tell the prisoner to be quiet, as he is  A. Restrict fluids
disturbing the other patients  B. Apply bandages
 D. Implement nursing interventions to relieve  C. Elevate the legs
the prisoner's pain  D. Do passive range of motion exercises
(ROM)
44. The nurse is preparing teaching plans for several
patients. The nurse should recognize which of the 49. A patient is diagnosed with diabetic
following patients is at greatest risk for fluid and ketoacidosis. The nurse would expect the physician
electrolyte imbalance? to prescribe:

 A. A 2-year-old patient who is receiving  A. Regular insulin IV

gastrostomy feedings  B. NPH insulin SC
 B. A 20-year-old patient with a sigmoid  C. Glucagon IM
colostomy  D. Mixed insulin SC
 C. A 40-year-old patient who is 3 days post-
operative with an ileostomy 50. A newborn infant is assessed using the Apgar
 D. A 60-year-old patient who is 8 hours post- assessment tool and scores 6. The infant has a heart
renal arteriography rate of 95, slow and irregular respiratory effort, and
some flexion of extremities.
45. The patient with liver cirrhosis receives 100 ml The infant is pink, but has a weak cry. The nurse
of 25% serum albumin intravenously. Which of the should know that this Apgar score along with the
following findings would best indicate that the additional symptoms indicates the neonate is:
albumin is having its desired effect?
 A. Functioning normally
 A. Decreased blood pressure  B. Needing immediate life-sustaining
 B. Increased serum albumin level measures
 C. Increased urine output  C. Needing special assistance
 D. Improved breathing pattern  D. Needing to be warmed

46. The apical pulse can be best auscultated at the: 51. To promote accuracy of self-monitoring blood
glucose by patients the nurse should:
 A. Left 2nd intercostal space lateral to the mid
clavicular line  A. Retrain patients periodically
 B. Left 2nd intercostal space at the left sternal  B. Direct patients to rotate testing sites
border  C. Advise patients to buy new strips routinely
 C. Left 5th intercostal space at the mid  D. Compare results from patient's meter
clavicular line against lab results
 D. Left 5th intercostal space at the mid axillary
line

47. Which of the following tasks requires

specialized education and should be performed by 52. A nurse can ensure she maintains her
the nurse only after the training has been competency to practice through:
completed?
 A. Being involved in continuing education
 A. Administering a dose of promethazine programs
(Phenergan) via intravenous push (IVP)  B. Making sure that what was learnt at nursing
 B. Applying a transdermal fentanyl (Duragesic) school is strictly followed
 C. Instilling tobramycin (Tobrex) ophthalmic  C. Closely carrying out instructions given by
solution the Charge Nurse
 D. Beginning an intravenous infusion of  D. Working on the same ward for at least 2
cyclophosphamide (Cytoxan) years
53. When checking the capillary refill time of a  C. Ask anesthesiologist what type of
patient's extremity, the color returns in 7 seconds. anesthesia patient received and last dose of
The nurse recognizes this finding as indicative of: pain medication
 D. Note location, intensity and duration of
 A. A normal response pain and last dose and time of pain
 B. Thrombus formation in the veins medication
 C. Lymphatic obstruction of venous return
 D. Impaired arterial flow to the extremities 58. An 85-year-old man is admitted with dementia.
He continuously attempts to remove his nasogastric
54. In caring for a woman and baby day 3 tube. The nurse applies cloth wrist restraints as
postnatally, she tells you that her baby has not had ordered. Which of the following actions by the
a bowel action since delivery. Your appropriate nurse is most appropriate?
response would be:
 A. Evaluate the need to restrain by observing
 A. Reassure the mother that it is quite normal patient's behavior once every 24 hrs
for a baby to not move their bowels until day  B. Perform circulation checks to the
5 after a few days of milk feeding extremities every two hours
 B. Start a bowel chart, document all findings,  C. Remove the restraints when the patient is
and wait another 48 hours before reporting to sleeping
the physician  D. Instruct family to limit physical contact with
 C. Encourage more frequent warm baths for the patient
the neonate with gentle abdomen massages
 D. Tell the mother that you will let the 59. A patient with deep partial-thickness and full-
physician know, so the baby can be checked thickness burns of the face and chest is admitted to
for any obstruction the emergency department. The nurse must be
particularly alert for:
55. When caring for a patient with acute
pancreatitis, the patient is most likely to complain  A. Paralytic ileus
of pain which is:  B. Respiratory distress
 C. Severity of pain
 A. Severe and located in the left lower  D. Strong burn odor
quadrant and radiating to the groin
 B. Burning and located in the epigastric area 60. A patient becomes angry and threatens to leave
and radiating to the groin the hospital unless the physician reviews the reason
 C. Severe and located in the epigastric area for the patient's delay in discharge. The patient has
and radiating to the back a medication order for agitation available p.m.. but
 D. Burning and located in the left lower refuses the medication and requests a drink of
quadrant and radiating to the back orange juice instead. What should the nurse do?

56. The patient with iron deficiency anemia should  A. Secretly slip the p.r.n. medication into the
be encouraged to eat which of the following foods orange juice and give it to the patient
high in iron?  B. Give the patient the orange juice and tell
the patient that a staff member is attempting
 A. Eggs to call the physician
 B. Lettuce  C. Inform the patient that staff is unable to
 C. Citrus fruits force anyone to stay in the hospital
 D. Cheese  D. Inform the patient that nothing can be
done until the morning
57. A patient arrived to the Post Anesthesia Care
Unit (PACU) complaining of pain after undergoing a 61. A patient requires tracheal suctioning through
right total hip arthroplasty. Which of the following the nose. Which of the following nursing action
should the nurse do to assess the patient's level of would be incorrect?
pain?
 A. Lubricating the catheter with sterile water
 A. Determine the patient's position during  B. Applying suction while withdrawing the
surgery and how long the patient was in this catheter from the nose
position  C. Applying suction for a minimum of 30
 B. Inspect the dressing, note type and amount seconds
of drainage, and insure bandage adhesive is  D. Rotating the catheter while withdrawing it
not pulling on skin
62. Pain management for terminally ill patients is  A. Hypotonic
most effective when analgesics are given:  B. Isotonic
 C. Hypertonic
 A. Around the clock  D. Colloid
 B. Only when clearly needed
 C. After non-pharmacological methods fail 68. Nursing management of the patient with
 D. As the patient requests them external otitis includes:

63. A patient is admitted to a hospital with acute  A. Irrigating the ear canal with warm saline
renal failure. The patient wakes up complaining of several hours after instilling lubricating ear
abdominal pain. On assessment, the nurse observes drops
edema to the patient's ankles and distended neck  B. Inserting an ear wick into the external canal
veins. The patient is dyspneic with a blood pressure before instilling the ear drops to disperse the
of 200/96 mmHg. The proper nursing diagnosis for medication
this patient is:  C. Teaching the patient how to instill antibiotic
drops into the ear canal before swimming
 A. Deficient fluid volume related to disease  D. Instilling ear drops without the dropper
process touching the auricle and positioning the ear
 B. Excess fluid volume related to decreased upward for 2 minutes afterwards
glomerular filtration rate
 C. Knowledge deficit related to proper 69. The correct way to trim the toe nails of a patient
medication regimen with diabetes is to:
 D. Acute pain related to renal edema
 A. Cut the nails in a curve and then file
64. The nurse knows that the greatest risk for a  B. Cut the nails straight across and then file
patient with a ruptured ectopic pregnancy is:  C. File the nails straight across and square only
 D. File the nails in a curved arch with low sides
 A. Hemorrhage leading to hypovolemic shock only
 B. Strictures and scarring of the fallopian tube
 C. Adhesions and scarring from blood in the 70. Salem has Alzheimers disease. He is agitated
abdomen and repeatedly asks to go home. The most
 D. Infertility resulting from treatment with a appropriate nursing intervention for him is to:
salpingectomy
 A. Isolate him in a single room
65. A trauma patient with open wounds arrives in  B. Find activities to keep him occupied
the emergency department. The nurse would know  C. Ask the physician to discharge him
that a tetanus injection is needed if the patient has:  D. Administer a minor tranquillizer

 A. Only received 3 doses of tetanus toxoid 71. During the initial pain assessment process, the
 B. Received less than 3 doses of tetanus nurse should:
toxoid
 C. Not had a dose of tetanus toxoid in the past  A. Perform pain relief measures
4 years  B. Teach the patient about pain therapies
 D. Not had a dose of tetanus toxoid in the  C. Conduct a comprehensive pain assessment
past 10 years  D. Provide appropriate treatment and evaluate
its effect
66. A 3-month-old infant is admitted with a
diagnosis of ventricular septal defect. The physical 72. The immediate treatment for ventricular
assessment for this infant would reveal: fibrillation is:

 A. High pitched cry  A. Precordial blow

 B. Harsh heart murmur  B. Defibrillation
 C. Bradycardia  C. Bolus of lidocaine
 D. Hypertension  D. Ventricular pacing

67. The administration of which of the following

types of parenteral fluids would result in a lowering 73. The purpose of a cardiac pacemaker is to:
of the osmotic pressure and cause the fluid to
move into the cells?  A. Initiate and maintain the heart rate when SA
node is unable to do so
  B. Stabilize the heart rate when it is above 100  A. 0.5 tablet
beats per minute  B. 1.5 tablets
 C. Stabilize the heart when the patient has had  C. 2 tablets
a heart attack  D. 2.5 tablets
 D. Regulate the heart when the patient is
going for open heart surgery 80. In preparing the patient for
electroencephalogram (EEG), the nurse should:
74. When taking care of a patient who has
undergone open reduction and internal fixation of a  A. Withhold breakfast
fractured left tibia, the nurse should keep the leg:  B. Give sleeping pills the night before
 C. Shave the hair
 A. Straight to reduce flexion deformities  D. Restrict intake of coffee
 B. Immobilized to enhance bone healing
 C. Adducted to attain alignment 81. The patient's pre-operative blood pressure was
 D. Elevated to minimize venous stasis 120/68 mmHg. On admission to the Post
Anesthesia Care Unit, the blood pressure was
75. A nurse prepares to set up a secondary 124/70 mmHg. Thirty minutes after admission, the
intravenous (IV) cannula. The primary IV infusing is patient's blood pressure falls to 112/60 mmHg,
normal saline. In order for the secondary cannula to pulse to 72 BPM, and the skin appears warm and
infuse correctly, the nurse should set up the primary dry. The most appropriate action by the nurse at
IV to: this time is to:

 A. Hang higher than the secondary IV  A. Raise the head of the bed
 B. Hang at the same level as the secondary IV  B. Notify the anesthetist immediately
 C. Hang lower than the secondary IV  C. Increase the rate of IV fluid replacement
 D. Discontinue before the secondary IV starts  D. Continue to monitor the patient

76. A young patient is extremely irritable due to 82. The nurse notes that there are no physician's
meningitis. It would be most important for the orders regarding Fatima's post operative daily
nurse to: insulin dose. The most appropriate action by the
nurse is to:
 A. Use low-level lighting in the room
 B. Ventilate the room  A. Withhold any insulin dose since none is
 C. Eliminate strong odors ordered and the patient is NPO
 D. Allow frequent visitors  B. Call the physician to clarify whether insulin
should be given and at what dose
77. Which of the following actions is the most  C. Give half the usual daily insulin dose since
effective measure to reduce hospital acquired she will not be eating in the morning
infections?  D. Give the patient her usual daily insulin dose
since the stress of surgery will increase her
 A. Double bagging of all contaminated blood glucose
laundry
 B. Restricting visitors of infectious patients 83. Which of the following interventions should the
 C. Using disposable supplies nurse implement if a patient complains of cramps
 D. Correct hand washing while irrigating the colostomy?

 A. Reduce the flow of solution

78. The coronary care nurse draws an Arterial Blood  B. Have the patient sit up in bed
Gas (ABG) sample to assess a patient for acidosis. A  C. Remove the irrigation tube
normal pH for arterial blood is:  D. Insert the tube further into the colon

 A. 7.0 - 7.24
 B. 7.25 - 7.34
 C. 7.35 - 7.45
 D. 7.5 - 7.6

79. Order: Allopurinol 450 mg p.o. daily. Drug

availablE.Allopurinol 300 mg scored tablets.
Which of the following will you administer?
84. A nurse is not familiar with a particular solution 89. You have started work on a new ward. One of
ordered to irrigate a patient's wound. The the patient's allocated to you has been on the ward
appropriate action would be to: for the last 7 months since she had a
cerebrovascular accident (CVA). You notice that her
 A. Check if the solution is available on the nursing care plan says strict bed rest, but on
ward, and if so, use it to clean the wound assessment you can not see any reason why this
 B. Put a neat line through the order and re- patient can not sit out of bed for short periods.
write the solution more commonly used Your nursing action would be:
 C. Check with the Pharmacist about the uses
of the solution ordered  A. Check with the other nursing staff as to
 D. Ask the patient what solution he would reasons behind the nursing care plan then
prefer to be used update the plan based on your assessment
 B. Follow the nursing care plan strictly as this
85. While assessing an 84-year-old post-operative would have been developed after a detailed
patient, the nurse observes that the patient and collaborative assessment
suddenly becomes very anxious, appears cyanotic  C. Seek physician's orders so that you have
and has severe dyspnea. The nurse recognizes these permission to move the patient
symptoms to be consistent with:  D. Try and move the patient without
consulting with anyone to see how she
 A. Congestive heart failure manages
 B. Pulmonary embolism
 C. COPD exacerbation 90. A patient is admitted to the emergency
 D. Myocardial infarction department with a possible allergic reaction to a
bee sting. What is the first action the nurse should
86. When preparing an eye medication, the nurse take?
reads the order "OS". Medication is given into:
 A. Quickly use tweezers to remove the stinger
 A. Both eyes  B. Observe the patient for signs of anaphylaxis
 B. Left eye  C. Apply warm compresses to the site of local
 C. Right eye reaction
 D. Infected eye  D. Squeeze the venom sac to remove
additional venom
87. A patient with allergic rhinitis reports severe
nasal congestion, sneezing, and watery eyes at 91. The physician orders heparin 40 000 U in 1 liter
various times of the year. To teach the patient to of D5W IV to infuse at 1000 U/hr. What is the flow
control these symptoms the nurse advises the rate in milliliters per hour?
patient to:
 A. 250 mls/hr
 A. Avoid all over the counter intranasal sprays  B. 25 mls/hr
 B. Limit the use of nasal decongestant sprays  C. 2.5 mls/hr
to 10 days  D. 0.25 mls/hr
 C. Use oral decongestants at bedtime to
prevent symptoms during the night 92. The nurse plans the care for a patient with
 D. Keep a diary of when an allergic reaction increased intracranial pressure, she knows that the
occurs and what precipitates it best way to position the patient is to:

88. The urinary catheter is kept securely in the  A. Keep patient in a supine position until
bladder by: stable
 B. Elevate the head of the bed to 30 degrees
 A. Taping the urinary catheter to the leg  C. Maintain patient on right side with head
 B. Securing catheter and collection bag supported on a pillow
connections  D. Keep patient in a semi-sitting position
 C. Inflating the balloon of the catheter
 D. Anchoring the catheter bag to the bed
93. During balloon inflation of an indwelling urinary  C. Prone, with the head of the bed flat
catheter, the patient complains of pain and  D. Supine, with the head of the bed elevated
discomfort. The nurse should: 30-45 degrees

 A. Continue the procedure and assure the 99. A patient who presents with acute weight loss,
patient dry skin and mucous membranes and decreased
 B. Aspirate the fluid and remove the catheter urine output is most likely be suffering from:
 C. Withdraw the fluid and reinsert the catheter
 D. Decrease the amount of injected fluid and  A. Fluid volume deficit
secure  B. Acute renal failure
 C. Acute heart failure
94. To remove soft contact lenses from the eyes of  D. Urinary tract infection
an unconscious patient the nurse should:
100. A patient with duodenal peptic ulcer would
 A. Uses a small suction cup placed on the describe his pain as:
lenses
 B. Pinches the lens off the eye then slides it off  A. Generalized burning sensation
the cornea  B. Intermittent colicky pain
 C. Lifts the lenses with a dry cotton ball that  C. Gnawing sensation relieved by food
adheres to the lenses  D. Colicky pain intensified by food
 D. Tenses the lateral canthus while stimulating
a blink reflex by the patient 101. Which of the following techniques should the
nurse implement to prevent the patient's mucous
95. After administration of penicillin, a patient membranes from drying when the oxygen flow
develops respiratory distress and severe rate is higher than 4 liters per minute?
bronchospasm. The nurse should:
 A. Use a non rebreather mask
 A. Contact the physician  B. Add humidity to the delivery system
 B. Apply ice packs to the axilla  C. Use a high flow oxygen delivery system
 C. Assess the patient for orthostatic  D. Ensure that the prongs are in the nares
hypotension correctly
 D. Encourage the patient to take slow deep
breaths 102. Extrapyramidal adverse effects and symptoms
are most often associated with which of the
96. Which of the following laboratory blood values following drug classes?
is expected to be decreased in hepatic dysfunction?
 A. Antidepressants
 A. Albumin  B. Antipsychotics
 B. Bilirubin  C. Antihypertensives
 C. Ammonia  D. Antidysrhythmics
 D. ALT and AST
103. While preparing the midday medications, the
97. Whilst recovering from surgery a patient nurse finds difficulty reading the label on a
develops deep vein thrombosis. The sign that medicine bottle. The best action by the nurse is to:
would indicate this complication to the nurse would
be:  A. Document that it could not be given due
to difficulty in reading the label
 A. Intermittent claudication  B. Make out a new label with clear
 B. Pitting edema of the area handwriting using adhesive tape to attach it
 C. Severe pain when raising the legs  C. Ask the pharmacist to replace it with a
 D. Localized warmth and tenderness of the clearly labeled bottle
site  D. Give the medication if it is similar to a
bottle present on the trolley
98. During the acute phase of a cerebrovascular
accident (CVA) the nurse should maintain the 104. One factor affecting the pharmokinetics of
patient in which of the following positions? older patients' drug absorption is:

 A. Semi-prone with the head of the bed  A. Decreased gastrointestinal motility

elevated 60-90 degrees  B. A difficulty in swallowing
 B. Lateral, with the head of the bed flat  C. A prevalence of obesity
  D. Numerous medications  B. Drawing blood samples from the AV
fistula
105. Elevated levels of amylase and lipase in the  C. Massaging the AV fistula
blood are common in:  D. Palpating the AV fistula for a thrill

 A. Diabetes mellitus 111. The patient is receiving piperacillin (Pipril) I.V.

 B. Esophagitis Which of the following should the nurse consider
 C. Pancreatitis when administering the medication to the patient?
 D. Hepatitis
 A. Assess for Stevens-Johnson Syndrome
106. Which of the following correctly describes  B. Be alert for the possibility of
wound packing in a wet to dry dressing? hypersensitivity
 C. Watch for signs of increasing severity of
 A. Pack gauze into the wound tightly infection
 B. Overlap the wound edges with wet  D. Instruct patient to increase the intake of
packing protein-rich foods
 C. Pack the wound with slightly moistened
gauze 112. Which of the following indicates the nurse is
 D. Use gauze well saturated with saline for engaging in a therapeutic nurse-patient
packing the wound relationship?

107. A patient who sustained a chest injury has a  A. The nurse establishes a relationship that
chest tube inserted which is connected to an is mutually beneficial
under water seal drainage system. When caring  B. The nurse demonstrates sympathetic
for this patient the nurse will: feelings toward the patient
 C. The nurse commits to helping the patient
 A. Instruct the patient to limit movement of find ways to help self
the affected shoulder  D. The nurse utilizes therapeutic touch to
 B. Observe for fluctuation of the water level convey acceptance of the patient
 C. Clamp the tube when needed
 D. Administer hourly analgesia 113. Order: Compazine 8 mg IM stat. Drug
availablE.10 mg/ 2mL in vial.
108. When preparing to administer a medication How many mLs would you give?
the nurse should first:
 A. 0.6 mL
 A. Ensure that the medication is on the  B. 1.6 mL
medication cart  C. 2.6 mL
 B. Determine the expiry date of the  D. 3.6 mL
medication
 C. Check the patient's identification 114. A newborn is diagnosed with ventricular septal
armband defect. The baby is discharged with a prescription
 D. Verify the physician order for accuracy for digoxin syrup 20 micrograms bid. The bottle of
digoxin is labeled as 0.05 mg/ml. The nurse should
109. Immediately after a craniotomy for head teach the mother to administer on each dose:
trauma, the nurse must monitor the drainage on
the dressing. Which of the following should be  A. 0.1 ml
reported?  B. 0.2 ml
 C. 0.4 ml
 A. Blood tinged  D. 0.8 ml
 B. Straw colored
 C. Clotted 115. When the nurse is caring for a patient placed
 D. Foul-smelling on droplet precautions, the nurse should:

110. The nurse is caring for a patient who is  A. Have the patient wear a high-efficiency
receiving dialysis. The patient has an arteriovenous particulate air (HEPA) mask
(AV) fistula. Appropriate care for this patient  B. Wear a surgical mask when standing
would include which one of the following options? within 3 feet (1 meter) of the patient
 C. Assign the patient to a room with
 A. Infusing medications through the AV monitored negative air pressure
fistula
  D. Apply a disposable gown when entering 122. To ensure safe practice during defibrillation,
the patient's room the nurse must:

116. A nursing measure that is helpful in  A. Cover paddles with electrode gel
communicating with a hearing-impaired patient is  B. Avoid touching the patient's bed
to:  C. Remove paddles after the shock
 D. Synchronize prior to shock delivery
 A. Use simple sentences
 B. Talk while close to patient's ear 123. Which of the following statements accurately
 C. Raise the voice describes the occurrence of dyspnea in patients
 D. Write out all questions and responses who are receiving end of life care?

117.The patient has a nursing diagnosis of altered  A. Dyspnea is only experienced by patients
cerebral tissue perfusion related to cerebral edema. who have primary diagnoses that involve
An appropriate nursing intervention for this the lungs
problem is to:  B. Dyspnea occurs in less than 50% of the
patients who are receiving end of life care
 A. Elevate the head of the bed 30 degrees  C. Dyspnea that is caused by increased fluid
 B. Provide a position of comfort with knee volume may be improved by diuretics
flexion  D. Dyspnea may be caused by antibiotic
 C. Provide uninterrupted periods of rest therapy used over a long period of time
 D. Ensure adequate hydration with mannitol
124. A patient admitted to the hospital in
118. Nursing management of a patient with hypertensive crisis is ordered to receive
pulmonary embolism would focus on which of the hydralazine
following actions? (Apresoline) 20mg IV stat for blood pressure
greater than 190/100 mmHg. The best response of
 A. Assessing oxygenation status the nurse to this order is to:
 B. Assessing signs of DVT in legs
 C. Monitoring for other sources of clots  A. Give the dose immediately and once
 D. Monitoring patient for cardiogenic shock  B. Give medication if patient's blood
pressure is > 190/100 mmHg
119. The physician orders 20 u of U-100 regular  C. Call the physician because the order is
insulin. The only syringe on hand is a 1 ml not clear
tuberculin syringe. How many milliliters should be  D. Administer the dose and repeat as
administered? necessary

 A. 0.02 ml 125. The nurse manager has just prepared a

 B. 0.2 ml medication for a patient and she asked you to give
 C. 1 ml the medication. Which of the following is the best
 D. 2 ml response to the nurse manager's request?

120. The nurse should be aware that tetracycline is  A. Give the patient his medication and
contraindicated in children under 12 years of age record it on the chart
because:  B. Ask another nursing colleague to give
and record the medication
 A. Minimal doses are needed to control  C. Explain that you cannot give a medication
infection that you did not prepare
 B. Immunosuppression is a common side  D. Give the medication and ask the nurse
effect manager to record it on the chart
 C. Staining of the teeth is an adverse effect
 D. They are prone to develop renal failure 126. A patient is to receive 2.5mg of morphine
sulfate. The ampoule contains l000mcg/mL.
121. The nurse should administer nasogastric tube How much morphine should the nurse
(NGT) feeding slowly to reduce the hazard of: administer?

 A. Distention  A. 0.25 ml
 B. Abdominal cramps  B. 1 ml
 C. Diarrhea  C. 1.5 ml
 D. Regurgitation  D. 2.5 ml
127. A patient has had a total hip joint signs/symptoms of shortness of breath, audible
replacement. Which of the following actions wheezing, nasal flaring and mild lip cyanosis. Your
should the nurse consider for the patient's daily immediate nursing action is to:
recommended exercise program?
 A. Assess respiratory distress and peak
 A. Administering an analgesic before expiratory flow rate
exercising  B. Take a blood sample to assess COlevels
 B. Discontinuing the program if the patient  C. Instruct the parents to take the child
dislikes it immediately to hospital
 C. Continuing exercises inspire of severe  D. Sit the child comfortably and offer 2 puffs
pain of ventolin stat
 D. Evaluating effectiveness of exercise based
on pain scale 133. Which of the following interventions is most
significant in the prevention of pressure sores?
128. A patient presents to the emergency
department with diminished and thready pulses,  A. Increasing fluid intake
hypotension and an increased pulse rate. The  B. Changing soiled linen
patient reports weight loss, lethargy, and  C. Regular changing of position
decreased urine output. The lab work reveals  D. Use of a water mattress
increased urine specific gravity. The nurse should
suspect: 134. A patient complains of pain in his right arm.
The physician orders codeine 45 mg and aspirin 650
 A. Renal failure mgs every 4 hours PRN. Each codeine tablet
 B. Sepsis contains 15mg of codeine and each aspirin tablet
 C. Pneumonia contains 325mg of aspirin. What should the nurse
 D. Dehydration administer?

129. A registered nurse delegates care to a  A. 2 codeine tablets and 4 aspirin tablets
practical nurse. The person most responsible for  B. 4 codeine tablets and 3 ½ aspirin tablets
the safe performance of the care is the:  C. 3 codeine tablets and 2 aspirin tablets
 D. 3 codeine tablets and 3 aspirin tablets
 A. Head nurse who is in-charge of the unit
 B. The practical nurse assigned to provide 135. A patient on diuretics has had vomiting and
the care diarrhea for the past 3 days. Which of the
 C. The registered nurse who delegated the following is this patient most at risk for
care to the practical nurse developing?
 D. The nursing care coordinator who is the
supervisor of the unit  A. Hypokalemia and cardiac arrhythmias
 B. Hypercalcemia and polyuria
130. Symptoms of alcohol withdrawal include:  C. Dehydration and hyperglycemia
 D. Hyperalimentation and heart block
 A. Euphoria, hyperactivity and insomnia
 B. Depression, suicidal ideation and 136. The patient is to receive 100 ml/hr of D5W
hypersomnia through a micro drip. How many drops per minute
 C. Diaphoresis, nausea and vomiting and should the patient receive?
tremors
 D. Unsteady gait, nystagmus and profound  A. 25 gtts/min
disorientation  B. 30 gtts/min
 C. 100 gtts/min
131. What two behaviors are important when  D. 200 gtts/min
documenting the depth of the patients’
depression? 137. Which of the following is the most
appropriate first action for the nurse to take for a
 A. Orientation and appearance pre- schooler who has fallen and has a hematoma
 B. Helplessness and hopelessness formed on the temporal bone?
 C. Affect and thought processes
 D. Mood and impulse control  A. Encourage a nap
 B. Give pain medication
132. An 11 year old girl with a history of asthma  C. Apply ice and monitor vital signs
arrives at the primary health clinic with  D. Allow the child to continue activities
138. A patient undergoes laminectomy. In the  B. Allow child to keep sleeping and record
immediate post-operative period, the nurse shoulD. observations
 C. Wake him and offer some ice chips to
 A. Monitor the patient’s vital signs and log suck
roll him to prone position  D. Check inside his mouth for any signs of
 B. Monitor the patient’s vital signs and bleeding and notify the physician
encourage him to ambulate
 C. Monitor the patient’s vital signs and 144. A 65-year-old patient is admitted with
auscultate his bowel sounds ischemic stroke. Which of the following would be
 D. Monitor the patient’s vital signs, check initially assessed by the nurse to determine the
sensation and motor power of the feet patients level of consciousness?

139. A nurse is making rounds taking vital signs.  A. Visual fields

Which of the following vital signs is abnormal?  B. Deep tendon reflexes
 C. Auditory acuity
 A. 11 year old male – 90 b.p.m, 22 resp/min.  D. Verbal response
, 100/70 mm Hg
 B. 13 year old female – 105 b.p.m., 22 145. A nurse prepares a narcotic analgesic for
resp/min., 105/60 mm Hg administration, but the patient refuses to take it.
 C. 5 year old male- 102 b.p.m, 24 resp/min., Which of the following actions by the nurse is most
90/65 mm Hg appropriate?
 D. 6 year old female- 100 b.p.m., 26
resp/min., 90/70mm Hg  A. Encourage the patient to reconsider
taking the medication
140. An early sign of acute respiratory failure is:  B. Label the medication and replace it for
use at a later time
 A. Diaphoresis  C. Discard the medication in the presence of
 B. Cyanosis a witness and chart the action
 C. Restlessness  D. Call the physician with the patient's
 D. Orthopnea refusal to take the prescribed medication

141. A medication was ordered by a physician. The 146. Whenever a child with thalassemia comes for
nurse believes the medication dose is incorrect. blood transfusion, he is administered
What should the nurse do next? Desferoxamine (Desferal). The action of this drug is
to:
 A. Clarify the order with another physician
who is available on the unit  A. Inhibit the inflammatory process
 B. Ask the nurse in charge if the order is  B. Enhance iron excretion
correct  C. Antagonize the effect of vitamin C
 C. Contact the pharmacy department  D. Increase red blood cell production
 D. Call the physician who prescribed the
medication 147.A patient arrives at the emergency department
with slurred speech and a right facial droop.
142. The priority nursing diagnosis for a The patient's relative states the patient "is not
hospitalized patient with a Stage IV pressure ulcer himself." Upon assessment, the nurse finds
on the hip would be: paresthesia to the right side of the body, receptive
aphasia, hemianopia and altered cognitive abilities.
 A. Altered body image The nurse should suspect:
 B. Acute pain
 C. Risk for infection  A. A narcotic overdose
 D. Altered nutrition  B. Parkinson's disease
 C. Alcohol withdrawal
143. You are the nurse providing post-operative  D. A cerebrovascular accident (CVA)
care for a 9 year old boy who is 6 hours post-
tonsillectomy. He is sleeping, but on routine
observation you notice that his pulse has increased,
he seems to be restless and trying to swallow
frequently. Your immediate action would be:

 A. Apply an ice collar to reduce discomfort

148. An 8-month-old infant is diagnosed with
communicating hydrocephalus. The nurse notices
that his intracranial pressure is increasing from the
following changes in his vital signs:

 A. Bradycardia, hypotension and

hypothermia
 B. Bradycardia, hypertension and
hyperthermia
 C. Tachycardia, hypotension and
hyperthermia
 D. Tachycardia, hypertension and
hypothermia

149. When inserting a rectal suppository for a

patient the nurse should?

 A. Insert the suppository while the patient

performs the 'valsava maneuver'
 B. Place the patient in a supine position
 C. Position the suppository beyond the
muscle sphincter of the rectum
 D. Insert the suppository 1/2 inch into the
rectum

150. A patient with a history of angina pectoris

arrives in emergency complaining of headache,
visual disturbances and feeling dizzy. Your nursing
assessment also notes he looks flushed, is
perspiring perfusely and is experiencing
palpitations. You should suspect:

 A. An overdose of sublingual nitroglycerin

 B. The onset of a myocardial infarction
 C. The patient has been over exercising
 D. The beginning of a severe chest infection
Answers.

1.