Mr.

James, a 62-year-old man with a history of angina, is admitted to the hospital for a scheduled left-
sided cardiac catheterization. He is anxious about the procedure and has several questions.

1. The nurse explains to Mr. James that:

0/1

A. Cardiac catheterization is usually done to assess how blocked or open a patients coronary arteries are.

B. Cardiac catheterization is most commonly done to detect how efficiently a patients heart muscle
contracts.

C. Cardiac catheterization is usually done to evaluate cardiovascular response to stress.

D. Cardiac catheterization is most commonly done to evaluate cardiac electrical activity.

2. Before proceeding, the nurse prioritizes Mr. James' safety by checking:

0/1

A. Client’s airway clearance

B. Ability to turn self in bed

C. Cardiac rhythm and heart rate

D. Allergies to iodine-based agents

3. Knowing Mr. James might experience discomfort, the nurse educates him beforehand that:

0/1

A. it will be important to lie completely still during the procedure.

B. a flushed feeling may be noted when the contrast dye is injected.

C. monitored anesthesia care will be provided during the procedure.

D. arterial pressure monitoring will be required for 24 hours after the test.

4. Following the procedure, the nurse assesses Mr. James closely. She prioritizes checking _________ as
a potential sign of a more serious complication of left-sided cardiac catheterization.
0/1

A. Urinary output less than intake

B. Bruising at the insertion site

C. Slurred speech and confusion

D. Discomfort in the left leg

5. Since Mr. James has a history of renal insufficiency, the nurse focuses on actions to protect his kidneys
before the procedure. These include: (Select all that apply.)

1. Assess for allergies to iodine.

2. Administer intravenous fluids.

3. Assess blood urea nitrogen (BUN) and creatinine results.

4. Insert a Foley catheter.

5. Administer a prophylactic antibiotic.

6. Insert a central venous catheter.

0/1

A. 1, 2, 3

B. 1, 2, 3, 4

C. 1, 2, 3, 4, 5

D. 1, 2, 3, 4, 5, 6

Situation

4 of 5 points

A 55-year-old male patient, Mr. Alex, with a history of hypertension managed by a diuretic and an ACE
inhibitor, arrives at the emergency department (ED) complaining of a sudden, severe headache and
nausea. His blood pressure is a dangerously high 238/128 mmHg.

6. The nurse immediately asks Mr. Alex:

···/1
A. Did you take any acetaminophen (Tylenol) today?

B. Have you been consistently taking your medications?

C. Have there been any recent stressful events in your life?

D. Have you recently taken any antihistamine medications?

7. Mr. Alex’s symptoms and elevated blood pressure suggest a hypertensive crisis. The nurse understands
that hypertensive emergencies, unlike urgency, involve:

1/1

A. The BP is always higher in a hypertensive emergency.

B. Vigilant hemodynamic monitoring is required during treatment of hypertensive emergencies.

C. Hypertensive urgency is treated with rest and benzodiazepines to lower BP.

D. Hypertensive emergencies are associated with evidence of target organ damage.

8. Given the severity, the nurse anticipates Mr. Alex will be administered:

1/1

A. Warfarin (Coumadin)

B. Furosemide (Lasix)

C. Sodium nitroprusside (Nitropress)

D. Ramipril (Altace)

9. Given the severity, the nurse anticipates Mr. Alex will require intravenous medications. The primary
goal, as the nurse remembers, is to:

1/1

A. Lower the BP to reduce onset of neurologic symptoms, such as headache and vision changes.

B. Decrease the BP to a normal level based on the patients age.

C. Decrease the mean arterial pressure between 20% and 25% in the first hour of treatment.
D. Reduce the BP to 120/75 mm Hg as quickly as possible.

10. While all the listed findings are important, the most critical for the nurse to report to the healthcare
provider is:

1/1

A. Urine output over 8 hours is 250 mL less than the fluid intake.

B. The patient cannot move the left arm and leg when asked to do so.

C. Tremors are noted in the fingers when the patient extends the arms.

D. The patient complains of a headache with pain at level 8/10 (0 to 10 scale).

Situation

5 of 5 points

A frantic family rushes 80-year-old Mr. Smith into the emergency department (ED). He has a history of
a diagnosed abdominal aortic aneurysm and is now experiencing clinical manifestations of the
disease.

11. Given the potential for an impending rupture, the most critical action is to immediately:

1/1

A. Obtain the blood pressure.

B. Obtain blood for laboratory testing.

C. Assess for the presence of an abdominal bruit.

D. Determine any family history of kidney disease.

12. While other assessments are important, the nurse continues to closely monitor Mr. Smith for signs of
impending rupture, with which symptom?

1/1

A. Sudden increase in blood pressure and a decrease in heart rate

B. Cessation of pulsating in an aneurysm that has previously been pulsating visibly

C. Sudden onset of severe back or abdominal pain

D. New onset of hemoptysis

13. Emergency endovascular repair surgery for the aneurysm was performed. Which nursing action
should be included in the plan of care after the procedure?

1/1

A. Record hourly chest tube drainage.

B. Monitor fluid intake and urine output.

C. Check the abdominal incision for any redness.

D. Teach the reason for a prolonged recovery period.

14. A few hours after surgery, the nurse finds Mr. Smith has absent pulses in his legs, which are also cool
and mottled. Recognizing the potential for vascular compromise, what is the most important nursing
action?

1/1

A. Notify the surgeon and anesthesiologist.

B. Wrap both the legs in a warming blanket.

C. Document the findings and recheck in 15 minutes.

D. Compare findings to the preoperative assessment of the pulses.

15. When preparing Mr. Smith for discharge, the nurse focuses on education regarding risk factor
modification?

1/1

A. Male gender

B. Turner syndrome

C. Abdominal trauma history

D. Uncontrolled hypertension
Situation

2 of 5 points

Mrs. Auring is preparing for coronary artery bypass graft (CABG) surgery using the internal mammary
artery. Throughout her journey, the nurse plays a vital role in ensuring her understanding and
recovery.

16. The nurse educator emphasizes the functions of cardiopulmonary bypass during CABG surgery.
Which of the following statements should the nurse exclude in the discussion?

0/1

A. “The client’s demand for oxygen is lowered.”

B. “Motion of the heart ceases.”

C. “Rewarming of the client takes place.”

D. “Blood flow to the heart is stopped.”

17. The nurse evaluates Mrs. Auring's understanding of the surgery. Which statement suggests a need for
further explanation?

0/1

A. “They will circulate my blood with a machine during the surgery.”

B. “I will have small incisions in my leg where they will remove the vein.”

C. “They will use an artery near my heart to go around the area that is blocked.”

D. “I will need to take an aspirin every day after the surgery to keep the graft open.”

18. Following surgery, Mrs. Auring has a chest tube to drain fluids. The drainage stops suddenly. What
action by the nurse is most important?

1/1

A. Increase the setting on the suction.

B. Notify the primary health care provider immediately.

C. Reposition the chest tube.

D. Take the tubing apart to assess for clots.

19. Four hours post-surgery, the client is able to inspire 200 mL with the incentive spirometer, then
declines to try to cough because of fatigue and pain. Which of the following actions should the nurse
take?

1/1

A. Allow the client to rest, and return in 1 hr.

B. Administer IV bolus analgesic, and return in 15 min.

C. Document the 200 mL as an appropriate inspired volume.

D. Tell the client coughing after incentive spirometry is required.

20. Before discharge, the nurse assesses Mrs. Auring's understanding of wound care for her unhealed
sternal incision. What statement by the client most indicates a higher risk of developing sepsis after
discharge?

0/1

A. “All my friends and neighbors are planning a party for me.”

B. “I hope I can get my water turned back on when I get home.”

C. “I am going to have my daughter scoop the cat litter box.”

D. “My grandkids are so excited to have me coming home!”

Situation

5 of 5 points

Pharmacology knowledge is crucial for cardiovascular nurses because it allows them to safely
administer medications, recognize drug interactions, and ensure the best possible outcomes for their
patients with heart conditions.

21. The physician is discussing treatment options for high blood pressure with a patient. However, the
patient also experiences symptoms of depression that need medication. Which of the listed medications
would be the worst for this patient?
1/1

A. Reserpine (Serpalan)

B. Captopril (Capoten)

C. Hydralazine (Apresoline)

D. Eplerenone (Inspra)

22. A nurse is monitoring a patient after they received nifedipine. Nifedipine can cause a rapid
heartbeat. Recognizing the adverse effects of the drug, the nurse should be prepared to administer
which drug?

1/1

A. Prazosin (Minipress)

B. Doxazosin (Cardura)

C. Propranolol (Inderal)

D. Enalapril (Vasotec)

23. A patient has a very low urine output and a decreased kidney function. Why might a nurse question
the use of hydrochlorothiazide (a diuretic) for this patient?

1/1

A. the drug can cause hypoglycemia in patients who have a low urine output

B. the drug doesn't reduce blood pressure for patients who have a low urine output

C. the drug can increase the risk of pulmonary edema for patients who have renal insufficiency

D. the drug does not promote diuresis for patients who have renal insufficiency

24. A patient will start taking ethacrynic acid for heart failure. What potential side effect should the
nurse warn the patient about and tell them to report?

1/1

A. shortness of breath
B. hearing loss

C. swelling in the lungs

D. blurred vision

25. A patient will start taking losartan for high blood pressure. What potential side effect should the
nurse warn the patient about and tell them to report?

1/1

A. facial edema

B. sleepiness

C. peripheral edema

D. constipation

Situation

4 of 5 points

Ms. Cassie, a 35-year-old patient, arrives in the emergency department in acute respiratory distress.
The nurse recognizes the urgency of the situation.

26. The nurse prioritizes assessing which of the data?

1/1

A. PaO2 is 45 mm Hg.

B. PaCO2 is 33 mm Hg.

C. Respirations are shallow.

D. Respiratory rate is 32 breaths/minute.

27. Since Ms. Cassie has right lower lobe pneumonia, the nurse positions her:

0/1

A. On the left side

B. On the right side

C. In the tripod position

D. In the high-Fowlers position

28. While monitoring Ms. Cassie with a possible respiratory failure with a high PaCO2. Which change
requires immediate reporting to the healthcare provider?

1/1

A. Somnolence

B. Complains of weakness.

C. Blood pressure of 164/98.

D. Oxygen saturation of 90%.

29. Ms. Cassie's respiratory rate drops to 6 breaths per minute, with lethargy and an oxygen saturation of
88%. These signs indicate respiratory failure. The nurse anticipates which intervention?

1/1

A. Administration of 100% oxygen by non-rebreather mask

B. Endotracheal intubation and positive pressure ventilation

C. Insertion of a mini-tracheostomy with frequent suctioning

D. Initiation of continuous positive pressure ventilation (CPAP)

30. As part of the plan of care for Ms. Cassie's ineffective airway clearance due to thick secretions, the
nurse prioritizes which intervention?

1/1

A. Encourage use of the incentive spirometer.

B. Offer the patient fluids at frequent intervals.

C. Teach the patient the importance of ambulation.

D. Titrate oxygen level to keep O2 saturation >93%.

Situation

4 of 5 points

Mr. Ginto experiences sudden chest pain and shortness of breath shortly after a central venous line
insertion. The nurse suspects a pneumothorax.

31. Which action should the nurse take first?

1/1

A. Notify the health care provider.

B. Offer reassurance to the patient.

C. Auscultate the patients breath sounds.

D. Give the prescribed PRN morphine sulfate IV.

32. During assessment, the nurse observes a crucial finding. Which of these warrants immediate action?

1/1

A. The client rates pain as a 5/10 at the site of the procedure.

B. A small amount of drainage from the site is noted.

C. Pulse oximetry is 93% on 2 L of oxygen.

D. The trachea is shifted toward the opposite side of the neck.

33. Following confirmation of pneumothorax, the surgeon inserts a chest tube. The nurse explains to Mr.
Ginto's family that the primary purpose of the chest tube is to:

1/1

A. To remove air from the pleural space

B. To drain copious sputum secretions

C. To monitor bleeding around the lungs

D. To assist with mechanical ventilation

34. While monitoring the chest tube drainage system, the nurse observes continuous bubbling in the
suction-control chamber. Which is the best action by the nurse?

0/1

A. Document the presence of a large air leak.

B. Notify the surgeon of a possible pneumothorax.

C. Take no further action with the collection device.

D. Adjust the dial on the wall regulator to decrease suction.

35. If the chest tube becomes dislodged, the nurse prioritizes which intervention?

1/1

A. Assess for drainage from the site.

B. Cover the insertion site with sterile gauze.

C. Contact the primary health care provider.

D. Reinsert the tube using sterile technique.

Situation

3 of 5 points

Mrs. Monica is battling Acute Respiratory Distress Syndrome (ARDS) and a recent complication - acute
kidney injury. The nurse plays a crucial role in managing her care.

36. The nurse discusses which medication with the healthcare provider to ensure patient safety?

1/1

A. Pantoprazole 40 mg IV

B. Gentamicin 60 mg IV

C. Sucralfate 1 g per nasogastric tube

D. Methylprednisolone (Solu-Medrol)

37. To confirm ARDS and differentiate it from heart failure-induced pulmonary edema, the nurse assists
with which procedure?

1/1

A. obtaining a ventilation-perfusion scan.

B. drawing blood for arterial blood gases.

C. insertion of a pulmonary artery catheter.

D. positioning the patient for a chest x-ray.

38. Mrs. Monica is on mechanical ventilation with high levels of Positive End-Expiratory Pressure (PEEP)
to keep her lungs open. The nurse might anticipate a reduction in PEEP due to which assessment
finding?

0/1

A. Mrs. Monica’s PaO2 is 50 mm Hg and the SaO2 is 88%.

B. Mrs. Monica has subcutaneous emphysema on the upper thorax.

C. Mrs. Monica has bronchial breath sounds in both the lung fields.

D. Mrs. Monica has a first-degree atrioventricular heart block with a rate of 58.

39. When explaining PEEP to Mrs. Monica's family, the nurse emphasizes that it:

1/1

A. will push more air into the lungs during inhalation.

B. prevents the lung air sacs from collapsing during exhalation.

C. will prevent lung damage while the patient is on the ventilator.

D. allows the breathing machine to deliver 100% oxygen to the lungs.

40. If a right pneumothorax develops, the nurse anticipates which action?

0/1

A. Increase the tidal volume and respiratory rate.

B. Increase the fraction of inspired oxygen (FIO2 ).

C. Perform endotracheal suctioning more frequently.

D. Lower the positive end-expiratory pressure (PEEP).

Situation

5 of 5 points

Mr. Jack, a smoker with a 60-pack-year history, is suspected to have lung cancer.

41. The nurse prioritizes which nursing action when interviewing Mr. Jack?

1/1

A. Tell the client that he or she needs to quit smoking to stop further cancer development.

B. Encourage the client to be completely honest about both tobacco and marijuana use.

C. Maintain a nonjudgmental attitude to avoid causing the client to feel guilty.

D. Avoid giving the client false hope regarding cancer treatment and prognosis.

42. The nurse educates Mr. Jack about the significant risk associated with his smoking history. What
statement by the nurse is the most accurate?

1/1

A. The younger you are when you start smoking, the higher your risk of lung cancer.

B. The risk for lung cancer never decreases once you have smoked, which is why smokers need annual
chest x-rays.

C. The risk for lung cancer is determined mostly by what type of cigarettes you smoke.

D. The risk for lung cancer depends primarily on the other risk factors for cancer that you have.

43. Given the patient history, which statement by Mr. Jack prompts the nurse to refer him for further
evaluation?
1/1

A. Lately, I have this cough that just never seems to go away.

B. I find that I don't have nearly the stamina that I used to.

C. I seem to get nearly every cold and flu that goes around my workplace.

D. I never used to have any allergies, but now I think Im developing allergies to dust and pet hair.

44. Mr. Jack is given the diagnosis of early-stage, non-small cell lung cancer. The nurse knows that which
is the preferred treatment method for Mr. Jack?

1/1

A. Chemotherapy

B. Radiation

C. Surgical resection

D. Bronchoscopic opening of the airway

45. After undergoing radiation therapy, Mr. Jack experiences esophagitis. The nurse provides Mr. Jack,
which type of diet?

1/1

A. Spaghetti with meat sauce, ice cream

B. Chicken soup, grilled cheese sandwich

C. Omelet, soft whole-wheat bread

D. Pasta salad, custard, orange juice

Situation

4 of 5 points

The nurse is working in a busy medical-surgical unit and is caring for several patients with different
electrolyte imbalances.
46. A 68-year-old patient with hypertension taking a bumetanide complains of generalized weakness.
What is the most appropriate initial action for the nurse?

1/1

A. Assess for facial muscle spasms.

B. Ask the patient about loose stools.

C. Suggest that the patient avoid orange juice with meals.

D. Ask the health care provider to order a basic metabolic panel.

47. A 42-year-old patient with chronic kidney disease has a calcium level of 7.0 mEq/L. Which
assessment finding should the nurse prioritize reporting to the doctor?

1/1

A. The patient is experiencing laryngeal stridor.

B. The patient complains of generalized fatigue.

C. The patients bowels have not moved for 4 days.

D. The patient has numbness and tingling of the lips.

48. A patient with renal failure is on a low phosphate diet. Which food item should the nurse instruct the
nursing aide to remove?

0/1

A. Grape juice

B. Milk carton

C. Mixed green salad

D. Fried chicken breast

49. A 30-year-old woman has a magnesium level of 1.3 mg/dL. What is the most important assessment
question for the nurse to ask the patient?

1/1
A. Daily alcohol intake

B. Intake of dietary protein

C. Multivitamin/mineral use

D. Use of over-the-counter (OTC) laxatives

50. The nurse checks on a 55-year-old patient who has a calcium level of 12.1 mg/dL. Which
intervention should the nurse prioritize including in the patient's care plan?

1/1

A. Maintain the patient on bed rest.

B. Auscultate lung sounds every 4 hours.

C. Monitor for Trousseaus and Chvosteks signs.

D. Encourage fluid intake up to 4000 mL every day.

Situation

4 of 5 points

Juan, a 42-year-old patient, has been admitted to the hospital with suspected acute kidney injury (AKI)
caused by dehydration. The nurse is working to understand Juan's condition and develop a
comprehensive care plan.

51. A urine dipstick test shows a small amount of protein in Juan's urine. What is the most appropriate
next step for the nurse?

1/1

A. Send a urine specimen to the laboratory to test for ketones.

B. Obtain a clean-catch urine for culture and sensitivity testing.

C. Inquire about which medications the patient is currently taking.

D. Ask the patient about any family history of chronic renal failure.
52. While educating a new graduate nurse about Juan's condition, the nurse explain that his kidneys are
less able to regulate his pH. What is the main reason for this?

1/1

A. The kidneys regulate and reabsorb carbonic acid to change and maintain pH.

B. The kidneys buffer acids through electrolyte changes.

C. The kidneys regenerate and reabsorb bicarbonate to maintain a stable pH.

D. The kidneys combine carbonic acid and bicarbonate to maintain a stable pH.

53. Juan has been in the hospital for 8 days. The nurse identifies a critical finding in Juan's labs. Which
finding should be reported to the healthcare provider immediately?

0/1

A. The creatinine level is 3.0 mg/dL.

B. Urine output over an 8-hour period is 2500 mL.

C. The blood urea nitrogen (BUN) level is 67 mg/dL.

D. The glomerular filtration rate is <30 mL/min/1.73m2.

54. Juan's recent ECG shows prolonged QRS complexes. Before taking any other actions, what should the
nurse prioritize?

1/1

A. Notify the patient’s health care provider.

B. Document the QRS interval measurement.

C. Check the medical record for most recent potassium level.

D. Check the chart for the patient’s current creatinine level.

55. Given Juan's diagnosis and current symptoms of oliguria, anemia, and hyperkalemia, which of the
following actions should the nurse take first?

1/1
A. Insert a urinary retention catheter.

B. Place the patient on a cardiac monitor.

C. Administer epoetin alfa (Epogen, Procrit).

D. Give sodium polystyrene sulfonate (Kayexalate).

Situation

5 of 5 points

Mr. Keith, a 72-year-old man with a history of benign prostatic hyperplasia (BPH), experiences a
sudden inability to urinate. He is rushed to the emergency room where additional concerning signs are
found - elevated blood urea nitrogen (BUN) and creatinine levels.

56. Mr. Keith is in acute urinary retention. Given his urinary retention and elevated BUN, what is the
most important nursing intervention to initiate?

1/1

A. Insert urethral catheter.

B. Obtain renal ultrasound.

C. Draw a complete blood count.

D. Infuse normal saline at 50 mL/hour.

57. During the initial assessment, what question would be most helpful for the nurse to ask Mr. Keith to
understand the severity of his BPH symptoms?

1/1

A. Have you noticed any unusual discharge from your penis?

B. Has there been any change in your sex life in the last year?

C. Has there been a decrease in the force of your urinary stream?

D. Have you been experiencing any difficulty in achieving an erection?

58. Mr. Keith expresses concerns about potential sexual side effects after discussing transurethral
resection of the prostate (TURP) for his BPH. How should the nurse best address this concern?

1/1

A. Provide teaching about medications for erectile dysfunction (ED).

B. Discuss that TURP does not commonly affect erectile function.

C. Offer reassurance that sperm production is not affected by TURP.

D. Discuss alternative methods of sexual expression besides intercourse.

59. The doctor prescribes Finasteride as part of Mr. Keith's treatment plan. Which potential side effect
should the nurse educate Mr. Keith regarding this medication?

1/1

A. He should change position from lying to standing slowly to avoid dizziness.

B. His interest in sexual activity may decrease while he is taking the medication.

C. Improvement in the obstructive symptoms should occur within about 2 weeks.

D. He will need to monitor his blood pressure frequently to assess for hypertension.

60. Following a successful TURP for his BPH, Mr. Keith is being discharged home. When reviewing post-
operative care instructions, the nurse identifies a statement that suggests Mr. Keith may need further
clarification. Which statement indicates a potential knowledge deficit?

1/1

A. I should call the doctor if I have incontinence at home.

B. I will avoid driving until I get approval from my doctor.

C. I will increase fiber and fluids in my diet to prevent constipation.

D. I should continue to schedule yearly appointments for prostate exams.

Situation

5 of 5 points
Lola Dolores, a 70-year-old woman, experiences sudden, severe pain in her left flank and burning with
urination. She also notices blood in her urine. Based on these symptoms, the nurse suspects the
presence of renal calculi.

61. While gathering information about Lola's condition, which question would be most helpful for the
nurse to ask in regards to her risk factors?

1/1

A. “Do any of your family members have this problem?”

B. “Do you drink any cranberry juice?”

C. “Do you urinate after sexual intercourse?”

D. “Do you experience burning with urination?”

62. Lola is admitted to the hospital with gross hematuria and severe colicky left flank pain. Given her
symptoms, what is the most important initial nursing intervention?

1/1

A. Administer prescribed analgesics.

B. Monitor temperature every 4 hours.

C. Encourage increased oral fluid intake.

D. Give antiemetics as needed for nausea.

63. The doctor suspects Lola Dolores may have a renal calculi lodged in a critical location. Where would
a blockage be most concerning for causing severe pain?

1/1

A. In the ureteropelvic junction

B. In the ureteral segment near the sacroiliac junction

C. In the ureterovesical junction

D. In the urethra
64. Lola Dolores' medical history reveals a diagnosis of oxalate renal calculi. The nurse will be providing
dietary education to help prevent future stones. Which dietary advice should the nurse provide?

1/1

A. Restrict protein intake as ordered.

B. Increase intake of potassium-rich foods.

C. Follow a low-calcium diet.

D. Encourage intake of food containing oxalates.

65. As part of her discharge instructions, the nurse emphasizes strategies to prevent future renal calculi.
Which recommendation would be most helpful for Lola Dolores to prevent recurrence?

1/1

A. Using a filter to strain all urine.

B. Avoiding dietary sources of calcium.

C. Choosing diuretic fluids such as coffee.

D. Drinking 2000 to 3000 mL of fluid a day.

Situation

4 of 5 points

Mr. Davis, a 65-year-old man, requires a blood transfusion due to a low hemoglobin level. The nurse
assigned to his care is familiar with the protocols for safe blood transfusion.

66. Before starting the transfusion, what is the most important action for the nurse to take?

1/1

A. Have the patient identify his or her blood type in writing.

B. Ensure that the patient has granted verbal consent for transfusion.

C. Assess the patient’s vital signs to establish baselines.

D. Facilitate insertion of a central venous catheter.

67. Mr. Davis' transfusion is running slowly due to difficult IV access. Four hours has already passed.
What should the nurse do next?

1/1

A. Apply an icepack to the blood that remains to be infused.

B. Discontinue the remainder of the PRBC transfusion and inform the physician.

C. Disconnect the bag of PRBCs, cool for 30 minutes and then administer.

D. Administer the remaining PRBCs by the IV direct (IV push) route.

68. Preventing transfusion reactions is a top priority. Which action has the greatest impact on reducing
this risk?

1/1

A. Ensure that blood components are never infused at a rate greater than 125 mL/hr.

B. Administer prophylactic antihistamines prior to all blood transfusions.

C. Establish baseline vital signs for all patients receiving transfusions.

D. Be vigilant in identifying the patient and the blood component.

69. During the transfusion, Mr. Davis complains of shortness of breath and new lung sounds. What is the
most appropriate course of action for the nurse?

0/1

A. Slow the infusion rate and monitor the patient closely.

B. Discontinue the transfusion and begin resuscitation.

C. Pause the transfusion and administer a 250 mL bolus of normal saline.

D. Discontinue the transfusion and administer a beta-blocker, as ordered.

70. Mr. Davis needs a transfusion of platelets. Which statement best describes how the nurse should
administer this blood product?
1/1

A. Administer the platelets as rapidly as the patient can tolerate.

B. Establish IV access as soon as the platelets arrive from the blood bank.

C. Ensure that the patient has a patent central venous catheter.

D. Aspirate 10 to 15 mL of blood from the patients IV immediately following the transfusion.

Situation

4 of 5 points

Mr. Jones, a 58-year-old man, recently presented with concerning symptoms suspected with nephrotic
syndrome.

71. Considering his suspected condition, what is the most important nursing diagnosis to address
initially?

1/1

A. Activity intolerance related to rapidly increased weight

B. Excess fluid volume related to low serum protein levels

C. Disturbed body image related to peripheral edema and ascites

D. Altered nutrition: less than required related to protein restriction

72. During Mr. Jones' admission assessment, the nurse will be looking for specific signs and symptoms.
Which finding is most likely to be present with nephrotic syndrome?

1/1

A. Poor skin turgor

B. Recent weight gain

C. Elevated urine ketones

D. Decreased blood pressure

73. Certain lab results are characteristic of nephrotic syndrome. Which finding, along with Mr. Jones'
symptoms, would strongly suggest this diagnosis?

1/1

A. Hypoalbuminemia

B. Low specific gravity

C. Decreased hemoglobin

D. Decreased hematocrit

74. Following a discussion about dietary modifications to manage Mr. Jones' condition, the nurse
assesses his understanding. Which statement demonstrates Mr. Jones has grasped a key concept of the
recommended diet?

0/1

A. “I must decrease my intake of fat.”

B. “I will increase my intake of protein.”

C. “A decreased intake of carbohydrates will be required.”

D. “An increased intake of vitamin C is necessary.”

75. During his hospital stay, Mr. Jones develops flank pain, a potential complication. The nurse
anticipates teaching him about which medication class to manage this possible complication?

1/1

A. Antibiotics.

B. Antifungals.

C. Anticoagulants.

D. Antihypertensives.

Situation

1 of 5 points
Mrs. Tulla, a 76-year-old woman, suffers a fractured humerus while simply picking up her cat. X-rays
reveal the fracture and further testing is ordered due to the unusual nature of the injury. A diagnosis
of multiple myeloma is confirmed.

76. Given Mrs. Tulla's unexplained fracture, what lab test result would most likely point towards multiple
myeloma?

0/1

A. Bence-Jones protein in urine

B. Epstein-Barr virus: positive

C. Hemoglobin: 18 mg/dL (180 mmol/L)

D. Red blood cell count: 8.2 million/mcL (8.2 1012/L)

77. Mrs. Tulla experiences significant bone pain, a common symptom of multiple myeloma. Which
nursing intervention should be prioritized to manage this pain?

0/1

A. Implementing distraction techniques

B. Educating the patient about the effective use of hot and cold packs

C. Teaching the patient to use NSAIDs effectively

D. Helping the patient manage the opioid analgesic regimen

78. As part of Mrs. Tulla's care plan, the nurse identifies which important nursing action?

0/1

A. Monitor fluid intake and output.

B. Administer calcium supplements.

C. Assess lymph nodes for enlargement.

D. Limit weight bearing and ambulation.

79. Diagnostic tests show a decline in Mrs. Tulla's bone density. The doctor prescribes a medication to
address this issue. Which medication would the nurse expect Mrs. Tulla to be taking?

0/1

A. Bortezomib

B. Dexamethasone

C. Thalidomide

D. Zoledronic acid

80. Before discharge, the nurse emphasizes a crucial self-care strategy for Mrs. Tulla to manage her
condition at home. Which advice would be most important for Mrs. Tulla to remember?

1/1

A. Daily performance of weight-bearing exercise to prevent muscle atrophy

B. Close monitoring kidney function and reporting for signs of renal failure

C. Daily administration of warfarin (Coumadin) as ordered

D. Safe use of supplementary oxygen in the home setting

Situation

2 of 4 points

Nurse Sarah is working a busy night shift in the medical-surgical unit. At the beginning of her shift, she
receives change-of-shift report on 16 patients. To prioritize her assessments, she needs to consider
which patients require the most immediate attention.

81. Who among these patients should Sarah assess first?

0/1

A. A 23-year-old patient with cystic fibrosis who has pulmonary function testing scheduled

B. A 46-year-old patient on bed rest who is complaining of sudden onset of shortness of breath

C. A 77-year-old patient with tuberculosis (TB) who has four antitubercular medications due in 15
minutes
D. A 35-year-old patient who was admitted the previous day with pneumonia and has a temperature of
100.2 F (37.8 C)

82. Who among these patients requires the most immediate attention?

0/1

A. 39-year-old with pericarditis who is complaining of sharp, stabbing chest pain

B. 56-year-old with variant angina who is to receive a dose of nifedipine (Procardia)

C. 65-year-old who had a myocardial infarction (MI) 4 days ago and is anxious about the planned
discharge

D. 59-year-old with unstable angina who has just returned to the unit after having a percutaneous
coronary intervention (PCI)

83. After the nurse has received change-of-shift report, which patient should the nurse assess first?

1/1

A. A patient with pneumonia who has crackles in the right lung base

B. A patient with possible lung cancer who has just returned after bronchoscopy

C. A patient with hemoptysis and a 16-mm induration with tuberculin skin testing

D. A patient with chronic obstructive pulmonary disease (COPD) and pulmonary function testing (PFT)
that indicates low forced vital capacity

84. Who among these patients with neutropenic precautions needs to be assessed most urgently?

1/1

A. 56-year-old with frequent explosive diarrhea

B. 33-year-old with a fever of 100.8 F (38.2 C)

C. 66-year-old who has white pharyngeal lesions

D. 23-year-old who is complaining of severe fatigue

Situation
1 of 4 points

Nurse Rica, a seasoned operating room nurse, is teaching a newly hired nurse about proper
positioning in the OR.

85. Nurse Maloi, the newly hired nurse, observed Nurse Rica as she positions the patient for dilatation
and curettage. Which of the following is not expected to be done by Nurse Rica?

1/1

A. Places one leg at a time on the stirrups for accurate placement to prevent nerve damage.

B. Have both arms extended on the arm boards, with the arms positioned not more than 90 degrees,
palms placed upward, fingers extended.

C. Putting adequate linens under the pressure points of the legs on the stirrups.

D. Ensuring that the thighs are not flexed more than 90 degrees.

86. One of your patient’s relative has been worried about complications that may happen during and
after the surgery, particularly deep venous thrombosis (DVT) as her brother has increased risk of
developing it. You assure the relative and patient that proper positioning during surgery can decrease
the risks of DVT and ensured that you will follow them. Which of the following will you expect to see in
the patient’s chart that increased the relative’s worry of DVT?

I. History of previous DVT episode

II. Age: 28 years old

III. Fractured hip

IV. Stroke

V. Heart Failure

VI. Kidney Failure

0/1

A. I, II, III, IV, V

B. I, III, V, VI

C. I, III, IV, V, VI

D. I, II, III, IV, V, VI

87. Aside from nerve injuries, the OR nurse must also be aware of potential skin and soft tissue injury
while positioning the patient especially for lengthy surgeries. Which is NOT an incorrect practice to
prevent skin and tissue injuries during surgery?

0/1

A. Massage the reddened area found on the patient’s skin to prevent numbness and promote circulation
to the affected area.

B. Putting adequate padding on the calcaneus, sacrum, olecranon during a MAST debridement surgery of
L3-L4.

C. Assess for deep tissue injuries, even after 72 hours, as they can go unnoticed immediately after the
surgery.

D. Assess for stage IV pressure ulcers as it begins deep in the tissue and migrates toward the surface.

88. The patient is for surgery this afternoon that involves the lower abdomen and pelvis. The
anesthesiologist, after reviewing the laboratory results of the patient, stated that she has an increased
risk of developing hypovolemic shock. In what position do you expect the patient will be placed later?

0/1

A. Supine with palms upward, arms extended, arm boards positioned less than 90 degrees from the
body.

B. Trendelenburg position with safety features in placed.

C. Prone position with abdomen exposed.

D. Left lateral decubitus position with pegboard.

Situation

4 of 12 points

After correct positioning, the nurse is taught about correct patient skin asepsis to prevent surgical site
infections (SSIs).

89. Above all the safety practices implemented for asepsis by the nurse, what refers to the personal
commitment to adhere strictly to aseptic practice?

0/1
A. Surgical righteousness

B. Surgical integrity

C. Surgical conscience

D. Surgical commitment

90. You are to be assigned as the scrub nurse for a fistulotomy for Patient Roca. Patient Roca asks if the
hair in the surgical site needs to be shaved before the day of surgery. What is the correct response?

0/1

A. Yes, you can shave the hair in the surgical site as it increases the risk of infection.

B. Yes, hair removal will be done by the team if it interferes with the surgical site, but it will be done as
close to the time of surgery as possible.

C. No, hair removal is no longer indicated as it is associated with increased risk of surgical site infection.

D. No, hair removal is associated with creating nicks on the skin that increase the risk for infection during
and after the surgery.

91. Skin preparation antimicrobial agents usually include CHG (chlorhexidine gluconate), iodophors, and
alcohol preparations in concentrations of 60-90%. Which of the following needs further teaching when
done by the new nurse?

0/1

A. Preparing CHG skin prep for the surgery of phacoemulsification with IOL.

B. Preparing CHG skin prep for a laparoscopic cholecystectomy surgery.

C. Preparing povidone iodine skin prep for the surgery of trabeculectomy.

D. Preparing povidone iodine skin prep for an excision of skin tag located at the upper arm.

92. There are several body parts that are considered “dirty” as it harbors microorganisms. Which of the
following demonstrates the correct skin antisepsis for these parts

0/1

A. The umbilicus is cleaned with cotton-tipped applicators after the skin prep is done.
B. In a perineal prep, the vagina and/or anus is prepped second to the last with a separate sponge

C. In a shoulder prep, the axilla is prepped alternating with the shoulder.

D. A colostomy or stoma is covered until the surrounding area is prepped, and then it is prepped with a
separate sponge

93. Which of the following is untrue about the general principles of skin preparation for patient skin
asepsis for surgery?

1/1

A. Skin prep progresses from clean to dirty, beginning with the incision site and working to the periphery
of the area to be prepped.

B. Skin prep progresses from clean to dirty, beginning with the periphery of the area and working
towards the incision site.

C. The prep sponge or applicator cannot be used for more than one stroke.

D. Do not double dip the prep sponge after it is used.

94. Which of the following statement/s is/are TRUE about surgical double gloving?

I. Wearing double gloves reduces skin contact with patient’s blood and/or body fluids during surgery.

II. When double gloving with indicator gloves – the indicator gloves is neutral while the outer gloves are
colored.

III. For double gloving, it is recommended to wear your regular size for the inner gloves and half-size
larger for the outer gloves.

IV. For double gloving, it is recommended to wear half-size larger for the inner gloves and one’s regular
size for the outer gloves.

0/1

A. I, III

B. I, II, IV

C. I, IV

D. I, II, III
95. As a circulating nurse, you are about to pour sterile water for irrigation. How should you pour the
solution to the round basin?

1/1

A. Give the bottle to the scrub nurse with a sterile drape wrapped around the bottle. Let the scrub nurse
pour the solution onto the basin.

B. Carefully reach over the table and pour the solution onto the basin located at the middle of the sterile
table to avoid dropping the basin.

C. Pour all of the solution into the round basin placed near the edge of the table or held by the scrub
nurse.

D. None of the above.

96. You know that the operating room is considered a clean environment. As you learn more about the
operating room environment from your head nurse, which of the following will NOT require further
teaching?

0/1

A. Air in the operating room is maintained under positive pressure to prevent air from the hallway to
enter the OR.

B. To maintain both positive and negative pressures, doors must be kept open at all times.

C. Temperature in the operating room should be maintained between 58ºF and 65ºF.

D. Relative humidity is maintained at 50% to 80% to prevent mold growth and bacteria.

97. You have a patient scheduled for a surgery tomorrow and the secretary of the physician-in-charge
endorsed that the patient has a latex allergy. As the admitting nurse, you suggest that the patient to be
scheduled at which time slot?

1/1

A. Last time slot

B. First time slot

C. Does not matter, as long as the nurse does not use any latex products.
D. Depends on the patient and surgeon availability.

98. Counting of sponges should be done by the scrub nurse and circulating nurse together. When should
the scrub and circulating nurse count the sponges during the surgery?

I. Before the surgery, initial count

II. When new items are added to the sterile field

III. Before closure of a cavity within a cavity

IV. When wound closure begins

V. At skin closure

1/1

A. I, II, IV, V

B. I, II, V

C. I, II, II

D. I, II, III, IV, V

99. You have a patient scheduled for an ORIF of the left elbow. Upon reviewing of the patient’s medical
history and laboratory results, which of the following should be endorsed to the
surgeon/anesthesiologist if a tourniquet device should be used during the surgery? Select all that apply.

I. Sickle cell anemia

II. Hypoxemia

III. Hypertension

IV. Hemoglobin levels

V. DVT

0/1

A. I, II, III, IV, V

B. I, III, V

C. I, II, IV, V

D. I, II, V
100. Tourniquet inflation time duration should be kept to a minimum to prevent complications. Excessive
inflation time duration and pressure can damage underlying tissue and cause injury. For a normal adult,
which of the following is the correct pairing of maximum limit for time and the standard settings for
pressure?

0/1

A. Upper extremity: 1.0 hour; 200-250 mmHg pressure

B. Upper extremity: 1.0-1.5 hours; 300-350 mmHg pressure

C. Lower extremity: 1.0-1.5 hours; 200-250 mmHg pressure

D. Lower extremity: 1.5-2.0 hours; 400-450 mmHg pressure