NCLEX Practical MCQ Test Questions Bank

1. Which of the following diet instructions should be given to the client with recurring urinary tract infections?
A. Increase intake of red meats
B. Avoid citrus fruits
C. Limit the intake of dairy products
D. Drink a glass of cranberry juice every day

2. A client with Parkinson’s disease complains of “choking” when he swallows. Which intervention will improve the client’s ability to swallow?
A. Withholding liquids until after meals
B. Providing semi-liquids when possible
C. Providing a full liquid diet
D. Offering small, more frequent meals

3. During the change of shift report, a nurse writes in her notes that she suspects illegal drug use by a client assigned to her care. During the shift, the notes are found by the client’s daughter. The nurse could be sued for:
A. Libel
B. Slander
C. Malpractice
D. Negligence

4. A nurse is assisting the physician with chest tube removal. Which client instruction is appropriate during removal of the tube?
A. Take a deep breath or hum during removal.
B. Hold the breath for two minutes and exhale slowly.
C. Exhale upon actual removal of the tube.
D. Continually breathe deeply in and out during removal.

5. A client with Hodgkin’s lymphoma is receiving Platinol (cisplatin). To help prevent nephrotoxicity, the nurse should:
A. Slow the infusion rate.
B. Make sure the client is well hydrated.
C. Record the intake and output every shift.
D. Tell the client to report ringing in the ears.

6. After attending a company picnic, several clients are admitted to the emergency room with E. coli food poisoning. The most likely source of infection is:
A. Hamburger
B. Hot dog
C. Potato salad
D. Baked beans

7. A client has been receiving Rheumatrex (methotrexate) for severe rheumatoid arthritis. The nurse should tell the client to avoid taking:
A. Aspirin
B. Multivitamins
C. Omega 3 fish oils
D. Acetaminophen

8. The nurse caring for a client scheduled for an angiogram should prepare the client for the procedure by telling him to expect:
A. Dizziness as the dye is injected
B. Nausea and vomiting after the procedure is completed
C. A decreased heart rate for several hours after the procedure is completed
D. A warm sensation as the dye is injected

9. The nurse is caring for a client with amyotrophic lateral sclerosis (ALS, Lou Gehrig’s disease). The nurse should give priority to:
A. Assessing the client’s respiratory status
B. Providing an alternate means of communication
C. Referring the client and family to community support groups
D. Instituting a routine of active range-of-motion exercises

10. A client receiving chemotherapy for breast cancer has an order for Zofran (ondansetron) 8mg PO to be given 30 minutes before induction of the chemotherapy. The purpose of the medication is to:
A. Prevent anemia
B. Promote relaxation
C. Prevent nausea
D. Increase neutrophil counts

11. A client with psychotic depression is receiving Haldol (haloperidol). Which one of the following adverse effects is associated with the use of haloperidol?
A. Akathisia
B. Cataracts
C. Diaphoresis
D. Polyuria

12. To decrease the likelihood of seizures and visual hallucinations in a client with alcohol withdrawal, the nurse should:
A. Keep the room darkened by pulling the curtains.
B. Keep the light over the bed on at all times.
C. Keep the room quiet and dim the lights.
D. Keep the television or radio turned on.

13. A client with Addison’s disease asks the nurse what he needs to know to manage his condition. The nurse should give priority to:
A. Emphasizing the need for strict adherence to his medication regimen
B. Teaching the client to avoid lotions and skin preparations containing alcohol
C. Explaining the need to avoid extremes of temperature
D. Assisting the client to choose a diet that contains adequate protein, fat, and carbohydrates

14. A client with AIDS asks the nurse why he cannot have a pitcher of water left at his bedside. The nurse should tell the client that:
A. It would be best for him to drink ice water.
B. He should drink several glasses of juice instead.
C. It makes it easier to keep a record of his intake.
D. He should not drink water that has been sitting for a period of time.

15. Which vitamin should be administered with INH (isoniazid) in order to prevent possible nervous system side effects?
A. Thiamine
B. Niacin
C. Pyridoxine
D. Riboflavin

16. A client with schizophrenia is receiving depot injections of Haldol Decanoate (haloperidol decanoate). The client should be told to return for his next injection in:
A. One week
B. Two weeks
C. Four weeks
D. Six weeks

17. A client hospitalized with cirrhosis has developed abdominal ascites. The nurse should provide the client with snacks that provide additional:
A. Sodium
B. Potassium
C. Protein
D. Fat

18. A home health nurse is visiting a client who is receiving diuretic therapy for congestive heart failure. Which medication places the client at risk for the development of hypokalemia?
A. Aldactone (spironolactone)
B. Demadex (torsemide)
C. Dyrenium (triamterene)
D. Midamor (amiloride hydrochloride)

19. A client with schizoaffective disorder is exhibiting Parkinsonian symptoms. Which medication is responsible for the development of Parkinsonian symptoms?
A. Zyprexa (olanzapine)
B. Cogentin (benzatropine mesylate)
C. Benadryl (diphenhydramine)
D. Depakote (divalproex sodium)

20. The physician has prescribed Cognex (tacrine) for a client with dementia. The nurse should monitor the client for adverse reactions, which include:
A. Hypoglycemia
B. Jaundice
C. Urinary retention
D. Tinnitus

21. A client is admitted with symptoms of pseudomembranous colitis. Which finding is associated with Clostridium difficile?
A. Diarrhea containing blood and mucus
B. Cough, fever, and shortness of breath
C. Anorexia, weight loss, and fever
D. Development of ulcers on the lower extremities

22. The most appropriate means of rehydration of a seven-month-old with diarrhea and mild dehydration is:
A. Oral rehydration therapy with an electrolyte solution
B. Replacing milk-based formula with a lactose-free formula
C. Administering intraveneous Dextrose 5% 1/4 normal saline
D. Offering bananas, rice, and applesauce along with oral fluids

23. The nurse is caring for a client with rheumatoid arthritis. The nurse knows that the client’s early morning symptoms will be most improved by:
A. Taking a warm shower upon awakening
B. Applying ice packs to the joints
C. Taking two aspirin before going to bed
D. Going for an early morning walk

24. Which information should be reported to the state Board of Nursing?
A. The facility fails to provide literature in both Spanish and English.
B. The narcotic count has been incorrect on the unit for the past three days.
C. The client fails to receive an itemized account of his bills and services received during his hospital stay.
D. The nursing assistant assigned to the client with hepatitis fails to feed the client and give the bath.

25. The patient is prescribed metronidazole (Flagyl) for adjunct treatment for a duodenal ulcer. When teaching about this medication, the nurse would include:
A. This medication should be taken only until you begin to feel better.
B. This medication should be taken on an empty stomach to increase absorption.
C. While taking this medication, you do not have to be concerned about being in the sun.
D. While taking this medication, alcoholic beverages and products containing alcohol should be avoided.

26. The physician has ordered amphotericin B for a client with histoplasmosis. In order to reduce the risk of nephrotoxicity, the nurse should:
A. Premedicate the patient with diphenhydramine and acetaminophen.
B. Test for hypersensitivity prior to administration.
C. Administer with heparin and hydrocortisone over four to six hours.
D. Hydrate with IV fluids before and after the drug is administered.

27. The home health nurse is visiting a client with autoimmune thrombocytopenic purpura (ATP). The client’s platelet count currently is 80,000. It will be most important to teach the client and family about:
A. Bleeding precautions
B. Prevention of falls
C. Oxygen therapy
D. Conservation of energy

28. A client with leukemia is receiving Trimetrexate. After reviewing the client’s chart, the physician orders Wellcovorin (leucovorin calcium). The rationale for administering leucovorin calcium to a client receiving Trimetrexate is to:
A. Treat iron-deficiency anemia caused by chemotherapeutic agents
B. Create a synergistic effect that shortens treatment time
C. Increase the number of circulating neutrophils
D. Reverse drug toxicity and prevent tissue damage

29. The nurse is caring for a client with an endemic goiter. The nurse recognizes that the client’s condition is related to:
A. Living in an area where the soil is depleted of iodine
B. Eating foods that decrease the thyroxine level
C. Using aluminum cookware to prepare the family’s meals
D. Taking medications that decrease the thyroxine level

30. A client with HIV is taking Zovirax (acyclovir). Which instruction should the nurse give the client taking acyclovir?
A. Limit your activity while taking the medication.
B. Supplement your diet with high-carbohydrate sources.
C. Use an incentive spirometer to improve respiratory function.
D. Increase your fluid intake to eight glasses of water a day.

31. A client with sickle cell anemia is admitted to the labor and delivery unit during the first phase of labor. The nurse should anticipate the client’s need for:
A. Supplemental oxygen
B. Fluid restriction
C. Blood transfusion
D. Delivery by Caesarean section

32. The physician has ordered Zyvox (linezolid) for a patient diagnosed with vancomycin resistant enterococcus. Which food should be avoided?
A. Wheat bread
B. Honey
C. Oranges
D. Aged cheese

33. The physician has ordered an infusion of Osmitrol (mannitol) for a client with increased intracranial pressure. Which finding indicates the direct effectiveness of the drug?
A. Increased pulse rate
B. Increased urinary output
C. Decreased diastolic blood pressure
D. Increased pupil size

34. The nurse is preparing to walk the postpartum client for the first time since delivery. Before walking the client, the nurse should:
A. Give the client pain medication.
B. Assist the client in dangling her legs.
C. Have the client breathe deeply.
D. Provide the client additional fluids.

35. During the initial interview, the client reports that she has a lesion on the perineum. Further investigation reveals a small blister on the vulva that is painful to touch. The nurse is aware that the most likely source of the lesion is:
A. Syphilis
B. Herpes
C. Gonorrhea
D. Condylomata

36. The client is having electroconvulsive therapy for treatment of severe depression. Prior to the ECT, the nurse should:
A. Apply a tourniquet to the client’s arm.
B. Administer an anticonvulsant medication.
C. Ask the client if he is allergic to shellfish.
D. Apply a blood pressure cuff to the arm.

37. A pediatric client is admitted to the hospital for treatment of diarrhea caused by an infection with salmonella. Which of the following most likely contributed to the child’s illness?
A. Brushing the family dog
B. Playing with a turtle
C. Taking a pony ride
D. Feeding the family cat

38. A gravida 3 para 2 is admitted to the labor unit. Vaginal exam reveals that the client’s cervix is 8cm dilated, with complete effacement. The priority nursing diagnosis at this time is:
A. Alteration in coping related to pain
B. Potential for injury related to precipitate delivery
C. Alteration in elimination related to anesthesia
D. Potential for fluid volume deficit related to NPO status

39. A patient with a PCA pump (patient controlled analgesia) asks the nurse if he can become overdosed with pain medication using this machine. Which statement made by the nurse is correct?
A. The machine will administer only the amount of medication needed to control pain without any action from you.
B. The machine has a locking device that prevents overdosing.
C. The machine will administer one large dose every four hours to relieve your pain.
D. The machine is set to deliver medication only if you need it.

40. A client is admitted to the labor and delivery unit in active labor. During examination, the nurse notes a papular lesion on the perineum. Which initial action is most appropriate?
A. Document the finding.
B. Report the finding to the doctor.
C. Prepare the client for a C-section.
D. Continue primary care as prescribed.

41. The nurse is evaluating the client’s pulmonary artery pressure (PAP). The nurse is aware that PAP evaluates:
A. Pressure in the left ventricle
B. Systolic, diastolic, and mean pressure in the pulmonary artery
C. Pressure in the pulmonary veins
D. Pressure in the right ventricle

42. What would the nurse expect the admitting assessment to reveal in a client with glomerulonephritis?
A. Hypertension
B. Lassitude
C. Fatigue
D. Vomiting and diarrhea

43. The nurse is assessing the circulation of a patient in a long leg cast. Which of the following assessments indicate adequate circulation to the extremity?
A. Patient denies pain in the affected leg and foot.
B. Patient is able to wiggle the toes on command.
C. Sensation is reported when the soles of feet are touched.
D. Brisk capillary refill of less than three seconds

44. When assessing the client’s blood pressure, the nurse should use a cuff with a width that is ____% of the circumference of the extremity. (Fill in the blank.)
A. 40
B. 30
C. 20
D. 10

45. A client with angina is being discharged with a prescription for Transderm Nitro (nitroglycerin) patches. The nurse should tell the client to:
A. Shave the area before applying the patch
B. Remove the old patch and clean the skin with alcohol
C. Cover the patch with plastic wrap and tape it in place
D. Avoid cutting the patch because it will alter the dose

46. The nurse is observing the ambulation of a client recently fitted for crutches. Which observation requires nursing intervention?
A. Two finger widths are noted between the axilla and the top of the crutch.
B. The client bears weight on his hands when ambulating.
C. The crutches and the client’s feet move alternately.
D. The client bears weight on his axilla when standing.

47. The physician has ordered injections of Neumega (oprelvekin) for a client receiving chemotherapy for prostate cancer. Which finding suggests that the medication is having its desired effect?
A. Hct 12.8g
B. Platelets 250,000mm^3
C. Neutrophils 4,000mm^3
D. RBC 4.7 million

48. A client is admitted to the hospital in chronic renal failure. A low protein diet is ordered. The rationale for a low protein diet is that:
A. A low protein diet helps reduce blood urea nitrogen and other wastes excreted by the kidneys.
B. A low protein diet increases the sodium and potassium levels.
C. A low protein diet increases albumin production.
D. A low protein diet increases the calcium and phosphorous levels.

49. The client with preeclampsia is admitted to the unit with an order for magnesium sulfate. Which action by the nurse indicates the understanding of magnesium toxicity?
A. The nurse performs a vaginal exam every 30 minutes.
B. The nurse places a padded tongue blade at the bedside.
C. The nurse inserts a Foley catheter.
D. The nurse darkens the room.

50. The nurse calculates the amount of an antibiotic for injection to be given to an infant. The amount of medication to be administered is 1.25mL. The nurse should:
A. Divide the amount into two injections and administer in each vastus lateralis muscle.
B. Give the medication in one injection in the dorsogluteal muscle.
C. Divide the amount in two injections and give one in the ventrogluteal muscle and one in the vastus lateralis muscle.
D. Give the medication in one injection in the ventrogluteal muscle.

51. A client with schizophrenia has been taking Thorazine (chlorpromazine) 200mg four times a day. Which finding should be reported to the doctor immediately?
A. The client complains of thirst.
B. The client has gained four pounds in the past two months.
C. The client complains of a sore throat and fever.
D. The client naps throughout the day.

52. A newborn diagnosed with bilateral choanal atresia is scheduled for surgery soon after delivery. The nurse recognizes the immediate need for surgery because the newborn:
A. Will have difficulty swallowing
B. Will be unable to pass meconium
C. Will regurgitate his feedings
D. Will be unable to breathe through his nose

53. A client with a renal failure is prescribed a low potassium diet. Which food choice would be best for this client?
A. 1 cup beef broth
B. 1 baked potato with the skin
C. 1/2 cup raisins
D. 1 cup rice

54. Four clients are admitted to a medical unit. If only one private room is available, it should be assigned to:
A. The client with ulcerative colitis
B. The client with neutropenia
C. The client with cholecystitis
D. The client with polycythemia vera

55. Which of the following instructions should be included in the teaching for the client with rheumatoid arthritis?
A. Avoid exercise because it fatigues the joints
B. Take prescribed anti-inflammatory medications with meals
C. Alternate hot and cold packs to affected joints
D. Avoid weight-bearing activity

56. The physician has ordered Eskalith (lithium carbonate) 500mg three times a day and Risperdal (risperidone) 2mg twice daily for a client admitted with bipolar disorder, acute manic episodes. The best explanation for the client’s medication regimen is:
A. The client’s symptoms of acute mania are typical of undiagnosed schizophrenia.
B. Antipsychotic medication is used to manage behavioral excitement until mood stabilization occurs.
C. The client will be more compliant with a medication that allows some feelings of hypomania.
D. Antipsychotic medication prevents psychotic symptoms commonly associated with the use of mood stabilizers.

57. The nurse is preparing to give an oral potassium supplement. The nurse should give the medication:
A. Without diluting it
B. With 4oz. of juice
C. With water only
D. On an empty stomach

58. A client with a hemorrhagic stroke has a temperature of 103ºF. Efforts to reduce the temperature have not been effective. The most likely explanation for the elevated temperature is that damage has occurred to the:
A. Hypothalamus
B. Pituitary
C. Carotid baroreceptors
D. Frontal lobe

59. Which client should be assigned to the nursing assistant?
A. The 18-year-old with a fracture to two cervical vertebrae
B. The infant with meningitis with a temperature of 101ºF
C. The elderly client with a thyroidectomy four days ago
D. The client with a thoracotomy two days ago

60. A client with myasthenia gravis is admitted in a cholinergic crisis. Signs of of cholinergic crisis include:
A. Decreased blood pressure and constricted pupils
B. Increased heart rate and increased respirations
C. Increased respirations and increased blood pressure
D. Anoxia and absence of the cough reflex

61. A primigravida, age 42, is six weeks pregnant. Based on the client’s age, her infant is at increased risk for:
A. Down syndrome
B. Respiratory distress syndrome
C. Turner syndrome
D. Pathological jaundice

62. The nurse is caring for a client with acquired immunodeficiency syndrome who has oral candidiasis. The nurse should clean the client’s mouth using:
A. A toothbrush
B. A soft gauze pad
C. Antiseptic mouthwash
D. Lemon and glycerin swabs

63. The nurse is assigning staff for the day. Which client should be assigned to the nursing assistant?
A. A five-month-old with bronchiolitis
B. A 10-year-old who is two-day post-appendectomy
C. A two-year-old with periorbital cellulitis
D. A one-year-old with a fractured tibia

64. The nurse working the organ transplant unit is caring for a client with a white blood cell count of 450. During evening visitation, a visitor brings a basket of fruit. What action should the nurse take?
A. Allow the client to keep the fruit.
B. Place the fruit next to the bed for easy access by the client.
C. Offer to wash the fruit for the client.
D. Ask the family members to take the fruit home.

65. A new diabetic is learning to administer his insulin. He receives 10 units of NPH insulin and 12 units of regular insulin each morning. Which of the following statements reflects understanding of the nurse’s teaching?
A. “When drawing up my insulin, I should draw up the regular insulin first.”
B. “When drawing up my insulin, I should draw up the NPH insulin first.”
C. “It doesn’t matter which insulin I draw up first.”
D. “I cannot mix the two insulins, so I will need two injections.”

66. The nurse is caring for a postoperative patient when suddenly the patient becomes less responsive and pale, with a BP of 70/40. The nurse’s initial action should be to:
A. Increase the rate of IV fluids
B. Lower the head of the bed
C. Notify the physician
D. Obtain a crash cart

67. The doctor has prescribed aspirin 325mg daily for a client with transient ischemic attacks. The nurse explains that aspirin was prescribed to:
A. Prevent headaches
B. Boost coagulation
C. Prevent cerebral anoxia
D. Decrease platelet aggregation

68. Which one of the following situations represents a maturational crisis for the family?
A. A four-year-old entering nursery school
B. Development of preeclampsia during pregnancy
C. Loss of employment and health benefits
D. Hospitalization of a grandfather with a stroke

69. The nurse is using the Glascow coma scale to assess the client’s motor response. The nurse places pressure at the base of the client’s fingernail for 20 seconds. The client’s only response is withdrawal of his hand. The nurse interprets the client’s response as:
A. A score of 6 because he follows commands
B. A score of 5 because he localizes pain
C. A score of 4 because he uses flexion
D. A score of 3 because he uses extension

70. The physician has ordered an IV bolus of Solu-Medrol (methylprednisolone sodium succinate) in normal saline for a client admitted with a spinal cord injury. Solu-Medrol has been shown to be effective in:
A. Preventing spasticity associated with cord injury
B. Decreasing the need for mechanical ventilation
C. Improving motor and sensory functioning
D. Treating post injury urinary tract infections

71. While performing a neurological assessment on a client with a closed head injury, the nurse notes a positive Babinski reflex. The nurse should:
A. Recognize that the client’s condition is improving.
B. Reposition the client and check reflexes again.
C. Do nothing because the finding is an expected one.
D. Notify the physician of the finding.

72. Which finding is associated with Tay Sachs disease?
A. Pallor of the conjunctiva
B. Cherry-red spots on the macula
C. Blue-tinged sclera
D. White flecks in the iris

73. A client with human immunodeficiency syndrome has gastrointestinal symptoms, including diarrhea. The nurse should teach the client to avoid:
A. Calcium-rich foods
B. Canned or frozen vegetables
C. Processed meat
D. Raw fruits and vegetables

74. Which of the following is the best indicator of the diagnosis of HIV?
A. WBC
B. ELISA
C. Western blot
D. CBC

75. A client with breast cancer is returned to the room following a right total mastectomy. The nurse should:
A. Elevate the client’s right arm on pillows.
B. Place the client’s right arm in a dependent sling.
C. Keep the client’s right arm on the bed beside her.
D. Place the client’s right arm across her body.

76. A client with severe anemia is to receive a unit of packed red blood cells. In the event of a transfusion reaction, the first action by the nurse should be to:
A. Notify the physician and the nursing supervisor.
B. Stop the transfusion and maintain an IV of normal saline.
C. Call the lab for verification of type and cross match.
D. Prepare an injection of Benadryl (diphenhydramine).

77. The client is receiving heparin for thrombophlebitis of the left lower extremity. Which of the following drugs reverses the effects of heparin?
A. Cyanocobalamine
B. Protamine sulfate
C. Streptokinase
D. Sodium warfarin

78. Due to a high census, it has been necessary for a number of clients to be transferred to other units within the hospital. Which client should be transferred to the postpartum unit?
A. A 66-year-old female with gastroenteritis
B. A 40-year-old female with a hysterectomy
C. A 27-year-old male with severe depression
D. A 28-year-old male with ulcerative colitis

79. Which of the following nursing interventions has the highest priority for the client scheduled for an intravenous pyelogram?
A. Providing the client with a favorite meal for dinner
B. Asking if the client has allergies to shellfish
C. Encouraging fluids the evening before the test
D. Telling the client what to expect during the test

80. The nurse is assigning staff to care for a number of clients with emotional disorders. Which facet of care is suitable to the skills of the nursing assistant?
A. Obtaining the vital signs of a client admitted for alcohol withdrawal
B. Helping a client with depression with bathing and grooming
C. Monitoring a client who is receiving electroconvulsive therapy
D. Sitting with a client with mania who is in seclusion

81. The nurse is caring for a client admitted with multiple trauma. Fractures include the pelvis, femur, and ulna. Which finding should be reported to the physician immediately?
A. Hematuria
B. Muscle spasms
C. Dizziness
D. Nausea

82. An obstetrical client decides to have epidural anesthesia to relieve pain during labor and delivery. Following administration of the epidural anesthesia, the nurse should monitor the client for:
A. Seizures
B. Postural hypertension
C. Respiratory depression
D. Hematuria

83. An elderly client who experiences nighttime confusion wanders from his room into the room of another client. The nurse can best help with decreasing the client’s confusion by:
A. Assigning a nursing assistant to sit with him until he falls asleep
B. Allowing the client to room with another elderly client
C. Administering a bedtime sedative
D. Leaving a nightlight on during the evening and night shifts

84. A client hospitalized with renal calculi complains of severe pain in the right flank. In addition to complaints of pain, the nurse can expect to see changes in the client’s vital signs that include:
A. Decreased pulse rate
B. Increased blood pressure
C. Decreased respiratory rate
D. Increased temperature

85. The dysrhythmia most commonly seen during tracheal suctioning is:
A. Bradycardia
B. Tachycardia
C. Premature ventricular beats
D. Heart block

86. A client was transferred to the hospital unit as a direct admit. While the nurse is obtaining part of the admission history information, the client suddenly becomes semiconscious. Assessment reveals a systolic BP of 70, heart rate of 130, and respiratory rate of 24. What is the nurse’s best initial action?
A. Lower the head of the client’s bed.
B. Initiate an IV with a large bore needle.
C. Notify the physician of the assessment results.
D. Call for the cardiopulmonary resuscitation team.

87. The nurse is caring for a patient hospitalized with leukopenia. Which of the following assessments should be reported to the physician immediately?
A. The blood pressure is 110/62.
B. The apical pulse is 90.
C. The temperature has increased from 98.6ºF to 99.8ºF.
D. The respiratory rate is 24.

88. Which finding indicates a complication following a parathyroidectomy?
A. Two-inch circle of blood behind the neck
B. Eupnea
C. Absence of carpopedal spasms
D. Negative Chvostek’s sign

89. The physician has ordered a culture for a male patient suspected of having N.gonorrhea. Which information should the nurse give the patient?
A. It will be necessary to obtain a sample of blood for an antibody screen.
B. We will need to obtain a swab of nasopharyngeal secretions.
C. A morning sample of urine will be needed.
D. Emptying the bladder one hour before the test may affect results.

90. The nurse is caring for a client following a transphenoidal hypophysectomy. Post-operatively, the nurse should:
A. Provide the client a toothbrush for mouth care.
B. Check the nasal dressing for the “halo sign.”
C. Tell the client to cough forcibly every two hours.
D. Ambulate the client when he is fully awake.

91. The home health nurse is visiting a client with Paget’s disease. An important part of preventive care for the client with Paget’s disease is:
A. Keeping the environment free of clutter
B. Advising the client to see the dentist regularly
C. Encouraging the client to take the influenza vaccine
D. Telling the client to take a daily multivitamin

92. The nurse in the emergency department is responsible for the triage of four recently admitted clients. Which client should the nurse send directly to the treatment room?
A. A 23-year-old female complaining of headache and nausea
B. A 76-year-old male complaining of dysuria
C. A 56-year-old male complaining of exertional shortness of breath
D. A 42-year-old female complaining of recent sexual assault

93. A client is admitted with a diagnosis of renal calculi. The nurse should give priority to:
A. Initiating an intravenous infusion
B. Encouraging oral fluids
C. Administering pain medication
D. Straining the urine

94. Which task is within the scope of practice of the nursing assistant?
A. Obtaining vital signs on a patient following a craniotomy
B. Obtaining hourly intake and output on a client with preeclampsia
C. Feeding the client with depression
D. Ambulating the client following a hip replacement

95. A client with HELLP syndrome is admitted to the labor and delivery unit for observation. The nurse knows that the client will have elevated:
A. Serum glucose levels
B. Liver enzymes
C. Pancreatic enzymes
D. Plasma protein levels

96. The client arrives in the emergency department after a motor vehicle accident. Nursing assessment findings include BP 80/34, pulse rate 120, and respirations 20. Which is the client’s most appropriate priority nursing diagnosis?
A. Alteration in cerebral tissue perfusion
B. Fluid volume deficit
C. Ineffective airway clearance
D. Alteration in sensory perception

97. The client with a recent liver transplant asks the nurse how long he will have to take an immunosuppressant. Which response is correct?
A. One year
B. Five years
C. 10 years
D. Life

98. The physician has ordered an injection of morphine for a client with post-operative pain. Before administering the medication, it is essential that the nurse assess the client’s:
A. Heart rate
B. Respirations
C. Temperature
D. Blood pressure

99. Skeletal traction is applied to the right femur of a client injured in a fall. The primary purpose of the skeletal traction is to:
A. Realign the tibia and fibula.
B. Provide traction on the muscles.
C. Provide traction on the ligaments.
D. Realign femoral bone fragments.

100. The nurse is caring for a client following a Whipple procedure. The nurse notes that the drainage from the nasogastric tube is bile tinged in appearance and has increased in the past hour. The nurse should:
A. Document the finding and continue to monitor the client.
B. Irrigate the drainage tube with 10mL of normal saline.
C. Decrease the amount of intermittent suction.
D. Notify the physician of the findings.

101. Which finding is associated with secondary syphilis?
A. Painless, papular lesions on the perineum, fingers, and eyelids
B. Absence of lesions
C. Deep asymmetrical granulomatous lesions
D. Well-defined generalized lesions on the palms, soles, and perineum

102. A client with cancer who is receiving chemotherapeutic drugs has been given injections of pegfilgastrim (Neulasta). Which laboratory value reveals that the drug is producing the desired effect?
A. Hemoglobin of 13.5g/dL
B. White blood cells count of 6,000/mm
C. Platelet count of 300,000/mm
D. Hematocrit of 39%

103. Which developmental milestone puts the four-month-old infant at greatest risk for injury?
A. Switching objects from one hand to another
B. Crawling
C. Standing
D. Rolling over

104. Which statement is true regarding the infant’s susceptibility to pertussis?
A. If the mother had pertussis, the infant will have passive immunity.
B. Most infants and children are highly susceptible from birth.
C. The newborn will be immune to pertussis for the first few months of life.
D. Infants under one year of age seldom get pertussis.

105. A client is admitted with a possible bowel obstruction. Which question during the nursing history is least helpful in obtaining information regarding this diagnosis?
A. “Tell me about your pain.”
B. “What does your vomit look like?”
C. “Describe your usual diet.”
D. “Have you noticed an increase in abdominal size?”

106. The nurse is caring for a client following a crushing injury to the chest. Which finding would be most indicative of a tension pneumothorax?
A. Expectoration of moderate amounts of frothy hemoptysis
B. Trachea shift toward the unaffected side of the chest
C. Subcutaneous emphysema noted at the anterior chest
D. Opening chest wound with a whistle sound emitting from the area

107. Which symptom is not associated with glaucoma?
A. Veil-like loss of vision
B. Foggy loss of vision
C. Seeing halos around lights
D. Complaints of eye pain

108. Which aminophylline level is associated with signs of toxicity?
A. 5 micrograms/mL
B. 10 micrograms/mL
C. 20 micrograms/mL
D. 25 micrograms/mL

109. A nurse is caring for a client with a myocardial infarction. The nurse recognizes that the most common complication in the client following a myocardial infarction is:
A. Right ventricular hypertrophy
B. Cardiac dysrhythmia
C. Left ventricular hypertrophy
D. Hyperkalemia

110. The nurse is caring for a client on a ventilator that is set on intermittent mandatory ventilation (IMV). Assessment on the ventilator is IMV mode of eight breaths per minute. The nurse assesses the client’s respiratory rate of 13 per minute. What do these findings indicate?
A. The client is “fighting” the ventilator and needs medication.
B. Pressure support ventilation is being used.
C. Additional breaths are being delivered by the ventilator.
D. The client is breathing five additional breaths on his own.

111. The nurse is caring for an infant receiving intravenous fluid. Signs of fluid overload in an infant include:
A. Swelling of the hands and increased temperature
B. Increased heart rate and increased blood pressure
C. Swelling of the feet and increased temperature
D. Decreased heart rate and decreased blood pressure

112. The home health nurse is planning for the day’s visits. Which client should be seen first?
A. The 78-year-old who had a gastrectomy three weeks ago and has a PEG tube
B. The five-month-old discharged one week ago with pneumonia who is being treated with amoxicillin liquid suspension
C. The 50-year-old with MRSA being treated with Vancomycin via a PICC line
D. The 30-year-old with an exacerbation of multiple sclerosis being treated with cortisone via a centrally placed venous catheter

113. A client with AIDS tells the nurse that he regularly takes echinacea to boost his immune system. The nurse should tell the client that:
A. Herbals can interfere with the action of antiviral medication.
B. Supplements have proven effective in prolonging life.
C. Herbals have been shown to decrease the viral load.
D. Supplements appear to prevent replication of the virus.

114. The physician prescribes captopril (Capoten) 25mg PO bid for the client with hypertension. Which of the following adverse reactions can occur with administration of Capoten?
A. Tinnitus
B. Persistent cough
C. Muscle weakness
D. Diarrhea

115. The nurse is providing postpartum teaching for a mother planning to breastfeed her infant. 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 allow the water to run over my breasts.

116. The doctor has prescribed Cortone (cortisone) for a client with systemic lupus erythematosis. Which instruction should be given to the client?
A. Take the medication 30 minutes before eating.
B. Report changes in appetite and weight.
C. Wear sunglasses to prevent cataracts.
D. Schedule a time to take the influenza vaccine.

117. A client with COPD is in respiratory failure. Which of the following results would be the most sensitive indicator that the client requires a mechanical ventilator?
A. PCO2 58
B. SaO2 90
C. PH 7.23
D. HCO3 30

118. The physician has ordered Vancocin (vancomycin) 500mg IV every six hours for a client with MRSA. The medication should be administered:
A. IV push
B. Over 15 minutes
C. Over 30 minutes
D. Over 60 minutes

119. A client is admitted complaining of chest pain. Which of the following medications is not indicated in the care of the client with chest pain?
A. Nitro-Stat (nitroglycerin)
B. Atropine
C. Inderal (propranolol)
D. Calan (verapamil)

120. To ensure safety while administering a nitroglycerine patch, the nurse should:
A. Wear gloves while applying the patch.
B. Shave the area where the patch will be applied.
C. Wash the area thoroughly with soap and rinse with hot water.
D. Apply the patch to the buttocks.

121. One of the most important criteria for the diagnosis of physical abuse is inconsistency between the appearance of the injury and the history of how the injury occurred. Which one of the following situations should alert the nurse to the possibility of abuse?
A. An 18-month-old with sock and mitten burns from a fall into the bathtub
B. A six-year-old with a fractured clavicle following a fall from her bike
C. An eight-year-old with a concussion from a skateboarding accident
D. A two-year-old with burns to the scalp and face from a grease spill

122. The client with hyperemesis gravidarum is at risk for developing:
A. Respiratory alkalosis without dehydration
B. Metabolic acidosis with dehydration
C. Respiratory acidosis without dehydration
D. Metabolic alkalosis with dehydration

123. The nurse working in the emergency department realizes that it would be contraindicated to induce vomiting if someone had ingested which of the following?
A. Ibuprofen
B. Aspirin
C. Vitamins
D. Gasoline

124. A left-lower lobectomy is performed on a client with lung cancer. The nurse should expect postoperative care to include:
A. A closed chest drainage system
B. Bed rest for 48 hours
C. Positioning supine or right-side lying
D. Chest physiotherapy

125. The primary cause of anemia in a client with chronic renal failure is:
A. Poor iron absorption
B. Destruction of red blood cells
C. Lack of intrinsic factor
D. Insufficient erythropoietin

126. A client with Parkinson’s disease is scheduled for stereotactic surgery. Which finding indicates that the surgery had its intended effect?
A. The client no longer has intractable tremors.
B. The client has sufficient production of dopamine.
C. The client no longer requires any medication.
D. The client will have increased production of serotonin.

127. A three-year-old is immobilized in a hip spica cast. Which discharge instruction should be given to the parents?
A. Keep the bed flat, with a small pillow beneath the cast.
B. Provide crayons and a coloring book for play activity.
C. Increase her intake of high-calorie foods for healing.
D. Tuck a disposable diaper beneath the cast at the perineal opening.

128. Which of the following postpartal clients is at greatest risk for hemorrhage?
A. A gravida 1 para 1 with an uncomplicated delivery of a 7-pound infant
B. A gravida 1 para 0 with a history of polycystic ovarian disease
C. A gravida 3 para 3 with a history of low–birth weight infants
D. A gravida 4 para 3 with a Caesarean section

129. An adolescent client with cystic acne has a prescription for Accutane (isotretinoin). Which lab work is needed before beginning the medication?
A. Complete blood count
B. Clean-catch urinalysis
C. Liver profile
D. Thyroid function test

130. A client with rheumatoid arthritis has Sjogren’s syndrome. The nurse can help relieve the symptoms of Sjogren’s syndrome by:
A. Providing heat to the joints
B. Instilling eyedrops
C. Administering pain medication
D. Providing small, frequent meals

131. The nurse is caring for a client following a myocardial infarction. Which of the following enzymes are specific to cardiac damage?
A. SGOT and LDH
B. SGOT and CK BB
C. LDH and CK MB
D. LDH and CK BB

132. A client with tuberculosis has a prescription for Myambutol (ethambutol HCl). The nurse should tell the client to notify the doctor immediately if he notices:
A. Gastric distress
B. Changes in hearing
C. Red discoloration of body fluids
D. Changes in color vision

133. The nurse is preparing a client for surgery. Which lab finding should be reported to the physician?
A. Potassium 2.5mEq/L
B. Hemoglobin 14.5g/dL
C. Blood glucose 75mg/dL
D. White cell count 8,000mm^3

134. Before administering a client’s morning dose of Lanoxin (digoxin), the nurse checks the apical pulse rate and finds a rate of 54. The appropriate nursing intervention is to:
A. Record the pulse rate and administer the medication
B. Administer the medication and monitor the heart rate
C. Withhold the medication and notify the doctor
D. Withhold the medication until the heart rate increases

135. A client is scheduled to undergo a bone marrow aspiration from the sternum. What position would the nurse assist the client into for this procedure?
A. Dorsal recumbent
B. Supine
C. High Fowler’s
D. Lithotomy

136. A client with obsessive compulsive personality disorder annoys his co-workers with his rigid-perfectionistic attitude and his preoccupation with trivial details. An important nursing intervention for this client would be:
A. Helping the client develop a plan for changing his behavior
B. Contracting with him for the time he spends on a task
C. Avoiding a discussion of his annoying behavior because it will only make him worse
D. Encouraging him to set a time schedule and deadlines for himself

137. The nurse is reviewing the lab results of a client’s arterial blood gases. The PaCO2 indicates effective functioning of the:
A. Kidneys
B. Pancreas
C. Lungs
D. Liver

138. The physician has ordered a blood test for H. pylori. The nurse should prepare the client by:
A. Withholding oral intake after midnight
B. Telling the client that no special preparation is needed
C. Explaining that a small dose of radioactive isotope will be used
D. Giving an oral suspension of glucose one hour before the test

139. A client is admitted to the unit two hours after an explosion causes burns to the face. The nurse would be most concerned with the client developing which of the following?
A. Hypovolemia
B. Laryngeal edema
C. Hypernatremia
D. Hyperkalemia

140. What is the responsibility of the nurse in obtaining an informed consent for surgery?
A. Describing in a clear and simply stated manner what the surgery will involve
B. Explaining the benefits, alternatives, and possible risks and complications of surgery
C. Using the nurse/client relationship to persuade the client to sign the operative permit
D. Providing the informed consent for surgery and witnessing the client’s signature

141. The nurse is performing discharge teaching on a client with polycythemia vera. Which would be included in the teaching plan?
A. Avoid large crowds and exposure to people who are ill.
B. Keep the head of the bed elevated at night.
C. Wear socks and gloves when going outside.
D. Recognize clinical manifestations of thrombosis.

142. The doctor has prescribed a diet high in vitamin B12 for a client with pernicious anemia. Which foods are the best sources of B12?
A. Meat, eggs, dairy products
B. Peanut butter, raisins, molasses
C. Broccoli, cauliflower, cabbage
D. Shrimp, legumes, bran cereals

143. A client has autoimmune thrombocytopenic purpura. To determine the client’s response to treatment, the nurse would monitor:
A. Platelet count
B. White blood cell count
C. Potassium levels
D. Partial prothrombin time (PTT)

144. Which of the following describes the language development of a two-year-old?
A. Doesn’t understand yes and no
B. Understands the meaning of all words
C. Can combine three or four words
D. Repeatedly asks “why?”

145. The nurse at a college campus is preparing to medicate several students who have been exposed to meningococcal meningitis. Which would the nurse most likely administer?
A. Ampicillin (Omnipen)
B. Ciprofoxacin (Cipro)
C. Vancomycin (Vancocin)
D. Piperacillin/Tazobactam (Zosyn)

146. When caring for a ventilator-dependent client who is receiving tube feedings, the nurse can help prevent aspiration of gastric secretions by:
A. Keeping the head of the bed flat
B. Elevating the head of the bed 30–45°
C. Placing the client on his left side
D. Raising the foot of the bed 10–20°

147. The nurse is caring for a patient with suspected diverticulitis. The nurse would be most prudent in questioning an order for which of the following diagnostic tests?
A. Abdominal ultrasound
B. Barium enema
C. Complete blood count
D. Computed tomography (CT) scan

148. A client is admitted to the hospital with seizures. The client has jerking of the right arm and twitching of the face, but is alert and aware of the seizure. This behavior is characteristic of which type of seizure?
A. Absence
B. Complex partial
C. Simple partial
D. Tonic-clonic

149. A client is admitted to the postpartal unit with a large amount of lochia rubra, uterine enlargement, and excessive clots. Which medication will likely be ordered for the client?
A. Fentanyl (sublimaze)
B. Stadol (butorphanol)
C. Prepidil (dinoprostone)
D. Hemabate (carboprost tromethamine)

150. Which infant is exempt from the recommendations of the American Academy of Pediatrics “Back to Sleep” campaign against SIDS?
A. An infant with intussusception
B. An infant with pyloric stenosis
C. An infant with gastroesophageal reflux
D. An infant with a cleft palate

151. A client in the prenatal clinic is assessed to have a blood pressure of 180/96. The nurse should give priority to:
A. Providing a calm environment
B. Obtaining a diet history
C. Administering an analgesic
D. Assessing fetal heart tones

152. The physician has ordered increased oral hydration for a client with renal calculi. Unless contraindicated, the recommended oral intake for helping with the removal of renal calculi is:
A. 75mL per hour
B. 100mL per hour
C. 150mL per hour
D. 200mL per hour

153. The nurse is changing the ties of the client with a tracheostomy. The safest method of changing the tracheostomy ties is to:
A. Apply the new tie before removing the old one
B. Have a helper present in case assistance is needed
C. Hold the tracheostomy tie with the nondominant hand while removing the old tie
D. Ask the client to hold the tracheostomy in place as the ties are changed

154. The physician has ordered Amoxil (amoxicillin) 500mg capsules for a client with esophageal varices. The nurse can best care for the client’s needs by:
A. Giving the medication as ordered
B. Providing extra water with the medication
C. Giving the medication with an antacid
D. Requesting an alternate form of the medication

155. The nurse is teaching the mother regarding treatment for pedicalosis capitis. Which instruction should be given regarding the medication?
A. Treatment is not recommended for children less than 10 years of age.
B. Bed linens should be washed in hot water.
C. Medication therapy will continue for one year.
D. Intravenous antibiotic therapy will be ordered.

156. A client is transferred to the intensive care unit following a coronary artery bypass graft. Which one of the post-surgical assessments should be reported to the physician?
A. Urine output of 50ml in the past hour
B. Temperature of 99°F
C. Strong pedal pulses bilaterally
D. Central venous pressure 15mmH2O

157. A client is admitted with suspected Legionnaires’ disease. Which factor increases the risk of developing Legionnaires’ disease?
A. Treatment of arthritis with steroids
B. Foreign travel
C. Eating fresh shellfish twice a week
D. Doing volunteer work at the local hospital

158. Which of the following would be most appropriate for the nurse to wear when providing direct care to a client with influenza?
A. Mask
B. Gown
C. Gloves
D. Goggles

159. Which medication should be avoided by the client with acute pancreatitis?
A. Demerol (meperidine)
B. Pepcid (famotidine)
C. Zantac (ranitidine)
D. Duramorph (morphine sulfate)

160. The physician has ordered a low-potassium diet for a client with acute glomerulonephritis. Which snack is suitable for the client with potassium restrictions?
A. Raisins
B. Orange
C. Apple
D. Banana

161. Before administering eardrops to a toddler, the nurse should recognize that it is essential to consider which of the following?
A. The age of the child
B. The child’s weight
C. The developmental level of the child
D. The IQ of the child

162. A client has returned from having a bronchoscopy. Before offering the client sips of water, the nurse should assess the client’s:
A. Blood pressure
B. Pupilary response
C. Gag reflex
D. Pulse rate

163. The client has an order for Feosol (ferrous sulfate). To promote absorption, the nurse should administer the medication with:
A. Milk
B. A meal
C. Orange juice
D. Undiluted

164. The client taking glyburide (Diabeta) should be cautioned to:
A. Avoid eating sweets
B. Report changes in urinary pattern
C. Allow three hours for onset
D. Check the glucose daily

165. The nurse is to administer a cleansing enema to a client scheduled for colon surgery. Which client position would be appropriate?
A. Prone
B. Supine
C. Left Sim’s
D. Dorsal recumbent

166. The nurse in the emergency room is caring for a client with multiple rib fractures and a pulmonary contusion. Assessment reveals a respiratory rate of 38, a heart rate of 136, and restlessness. Which associated assessment finding would require immediate intervention?
A. Occasional small amounts of hemoptysis
B. Midline trachea with wheezing on auscultation
C. Subcutaneous air and absent breath sounds
D. Pain when breathing deeply, with rales in the upper lobes

167. The following are all nursing diagnoses appropriate for a gravida 4 para 3 in labor. Which one would be most appropriate for the client as she completes the latent phase of labor?
A. Impaired gas exchange related to hyperventilation
B. Alteration in placental perfusion related to maternal position
C. Impaired physical mobility related to fetal-monitoring equipment
D. Potential fluid volume deficit related to decreased fluid intake

168. The nurse is caring for a client with suspected AIDS dementia complex. The first sign of dementia in the client with AIDS is:
A. Changes in gait
B. Loss of concentration
C. Problems with speech
D. Seizures

169. A client with primary sclerosing cholangitis has received a liver transplant. The nurse should give priority to assessing the client for complications. Which findings are associated with an acute rejection of the new liver?
A. Increased jaundice and prolonged prothrombin time
B. Fever and foul-smelling bile drainage
C. Abdominal distention and clay-colored stools
D. Increased uric acid and increased creatinine

170. The nurse is caring for an obstetrical client in early labor. After the rupture of membranes, the nurse should give priority to:
A. Applying an internal monitor
B. Assessing fetal heart tones
C. Assisting with epidural anesthesia
D. Inserting a Foley catheter

171. The nurse is caring for a client hospitalized with bipolar disorder, manic phase. Which of the following snacks would be best for the client?
A. Potato chips
B. Diet cola
C. Apple
D. Milkshake

172. A child receiving immunosuppressive medication has contracted varicella. The physician will most likely order which of the following medications?
A. Dilantin (phenytoin)
B. ASA (aspirin)
C. Zovirax (acyclovir)
D. Motrin (ibuprofen)

173. A nursing assistant assigned to care for a client receiving linear accelerator radium therapy for laryngeal cancer states, “I don’t want to be assigned to that radioactive patient.” The best response by the nurse is to:
A. Tell the nursing assistant that the client is not radioactive.
B. Tell the nursing assistant to wear a radiation badge to detect the amount of radiation that she is receiving.
C. Instruct her regarding the use of a lead-lined apron.
D. Ask a co-worker to care for the client.

174. The physician has ordered an intravenous infusion of Pitocin (oxytocin) for the induction of labor. When caring for the obstetric client receiving intravenous Pitocin (oxytocin), the nurse should monitor for:
A. Maternal hypoglycemia
B. Fetal bradycardia
C. Maternal hyperreflexia
D. Fetal movement

175. The nurse is completing an assessment history of a client with pernicious anemia. Which complaint differentiates pernicious anemia from other types of anemia?
A. Difficulty in breathing after exertion
B. Numbness and tingling in the extremities
C. A faster than usual heart rate
D. Feelings of lightheadedness

176. The client has elected to have epidural anesthesia to relieve labor pain. If the client experiences hypotension, the nurse would:
A. Place her in Trendelenburg position.
B. Decrease the rate of IV infusion.
C. Administer oxygen per nasal cannula.
D. Increase the rate of the IV infusion.

177. A client with Alzheimer’s disease is in a skilled nursing facility. Which intervention is therapeutic for the client?
A. Placing mirrors in several locations in the facility
B. Placing a picture of the client in her room
C. Placing simple signs to indicate the location of her room, the bathroom, and dining room
D. Alternating healthcare workers to prevent boredom

178. The rationale for inserting a French catheter every hour for the client with epidural anesthesia is:
A. The bladder fills more rapidly because of the medication used for the epidural.
B. Her level of consciousness is such that she is in a trancelike state.
C. The sensation of the bladder filling is diminished or lost.
D. She is embarrassed to ask for the bedpan that frequently.

179. A client is receiving aminophylline IV. The nurse monitors the theophylline blood level and assesses that the level is within therapeutic range at which of the following levels?
A. 5ug/mL
B. 8ug/mL
C. 15ug/mL
D. 25ug/mL

180. Diphenoxylate hydrochloride and atropine sulfate (Lomotil) is prescribed for the client with ulcerative colitis. Which of the following nursing observations indicates that the drug is having a therapeutic effect?
A. There is an absence of peristalsis.
B. The number of diarrhea stools decreases.
C. Cramping in the abdomen has increased.
D. Abdominal girth size increases.

181. The physician has ordered Dilantin (phenytoin) 100mg intra-venously for a client with generalized tonic clonic seizures. The nurse should administer the medication:
A. Rapidly with an IV push
B. With IV dextrose
C. Slowly over 2–3 minutes
D. Through a small vein

182. The nurse is preparing to administer a Meruvax II (rubella) vaccine to an adult client. Which one of the following allergies contraindicates the use of the vaccine?
A. Penicillin
B. Neomycin
C. Acyclovir
D. Tetracycline

183. A five-year-old child is hospitalized for correction of congenital hip dysplasia. During the assessment of the child, the nurse can expect to find the presence of:
A. Scarf sign
B. Harlequin sign
C. Cullen’s sign
D. Trendelenburg sign

184. The physician has prescribed Coumadin (sodium warfarin) for a client having transient ischemic attacks. Which laboratory test measures the therapeutic level of Coumadin?
A. Prothrombin time
B. Clot retraction time
C. Partial thromboplastin time
D. Bleeding time

185. While caring for an elderly patient with hypertension, the nurse notes the following vital signs: BP of 140/40, pulse 120, respirations 36. The nurse’s initial action should be to:
A. Report the findings to the physician
B. Recheck the vital signs in one hour
C. Ask the patient if he is in pain
D. Compare the current vital signs with those on admission

186. The diagnostic work-up of a client hospitalized with complaints of progressive weakness and fatigue confirm a diagnosis of myasthenia gravis. The medication used to treat myasthenia gravis is:
A. Prostigmine (neostigmine)
B. Atropine (atropine sulfate)
C. Didronel (etidronate)
D. Tensilon (edrophonium)

187. When providing care for a client with pancreatitis, the nurse would anticipate which of the following orders?
A. Force fluids to 3,000mL/24 hours.
B. Insert a nasogastric tube to low intermittent suction.
C. Place the client in reverse Trendelenburg position.
D. Place the client in enteric isolation.

188. The nurse is performing an admission history for a client recovering from a stroke. Medication history reveals the drug clopidogrel (Plavix). Which clinical manifestation alerts the nurse to an adverse effect of this drug?
A. Epistaxis
B. Hypothermia
C. Nausea
D. Hyperactivity

189. A client with increased intracranial pressure is placed on mechanical ventilation with hyperventilation. The nurse knows that the purpose of the hyperventilation is to:
A. Prevent the development of acute respiratory failure
B. Decrease cerebral blood flow
C. Increase systemic tissue perfusion
D. Prevent cerebral anoxia

190. Which activity is best suited to the 12-year-old with juvenile rheumatoid arthritis?
A. Playing video games
B. Swimming
C. Working crossword puzzles
D. Playing slow-pitch softball

191. The home health nurse is visiting an elderly client following a hip replacement. Which finding requires further teaching?
A. The client shares her apartment with a cat.
B. The client has a grab bar near the commode.
C. The client usually sits on a soft, low sofa.
D. The client wears supportive shoes with nonskid soles.

192. The nurse is assessing a client who had a colon resection two days ago. The client states, “I feel like my stitches have burst loose.” Upon further assessment, dehiscence of the wound is noted. Which action should the nurse take?
A. Immediately place the client in the prone position.
B. Apply a sterile, saline-moistened dressing to the wound.
C. Administer atropine to decrease abdominal secretions.
D. Wrap the abdomen with an ACE bandage.

193. A client with an esophageal tamponade develops symptoms of respiratory distress, including inspiratory stridor. The nurse should give priority to:
A. Applying oxygen at 4L via nasal cannula
B. Removing the tube after deflating the balloons
C. Elevating the head of the bed to 45°
D. Increasing the pressure in the esophageal balloon

194. The nurse is caring for a client with acromegaly. Following a transphenoidal hypophysectomy, the nurse should:
A. Monitor the client’s blood sugar.
B. Suction the mouth and pharynx every hour.
C. Place the client in low Trendelenburg position.
D. Encourage the client to cough.

195. The nurse is caring for an infant following a cleft lip repair. While comforting the infant, the nurse should avoid:
A. Holding the infant
B. Offering a pacifier
C. Providing a mobile
D. Offering sterile water

196. During a unit card game, a client with acute mania begins to sing loudly as she starts to undress. The nurse should:
A. Ignore the client’s behavior.
B. Exchange the cards for a checker board.
C. Send the other clients to their rooms.
D. Cover the client and walk her to her room.

197. The physician has ordered Dilantin (phenytoin) for a client with generalized seizures. When planning the client’s care, the nurse should:
A. Maintain strict intake and output.
B. Check the pulse before giving the medication.
C. Administer the medication 30 minutes before meals.
D. Provide oral hygiene and gum care every shift.

198. A patient with acute lymphocytic leukemia is receiving intrathecal chemotherapy. Intrathecal chemotherapy is used to:
A. Increase the number circulating neutrophils
B. Prevent systemic effects common to most chemotherapeutic agents
C. Increase the number of mature white blood cells
D. Destroy leukemic cells hiding in the cerebrospinal fluid

199. Which meal selection is most appropriate for a patient with iron deficiency anemia?
A. Roast turkey, gelatin, green beans
B. Chicken salad sandwich, coleslaw, French fries
C. Egg salad on wheat bread, carrot sticks, spinach and kale salad
D. Pork chop, mashed potatoes, green peas

200. The nurse is caring for a patient with a colostomy. The patient asks, “Will I ever be able to swim again?” The nurse’s best response would be:
A. Yes, you should be able to swim again, even with the colostomy.
B. You should avoid immersing the colostomy in water.
C. No, you should avoid getting the colostomy wet.
D. Don’t worry about that. You will be able to live just like you did before.

201. The nurse employed in the emergency room is responsible for triage of four clients injured in a motor vehicle accident. Which of the following clients should receive priority in care?
A. A 10-year-old with lacerations of the face
B. A 15-year-old with sternal bruises
C. A 34-year-old with a fractured femur
D. A 50-year-old with dislocation of the elbow

202. The nurse is discussing meal planning with the mother of a two-year-old. Which of the following statements, if made by the mother, would require a need for further instruction?
A. It is okay to give my child white grape juice for breakfast.
B. My child can have a grilled cheese sandwich for lunch.
C. We are going on a camping trip this weekend, and I have bought hot dogs to grill for his lunch.
D. For a snack, my child can have ice cream.

203. A patient refuses to take his dose of oral medication. The nurse tells the patient that if he does not take the medication that she will administer it by injection. The nurse’s comments can result in a charge of:
A. Malpractice
B. Assault
C. Negligence
D. Battery

204. The registered nurse is making assignments for the day. Which client should be assigned to the pregnant nurse?
A. The client with HIV
B. The client with a radium implant for cervical cancer
C. The client with RSV (respiratory synctial virus)
D. The client with cytomegalovirus

205. Before administering Theo-Dur (theophylline), the nurse should check the patient’s:
A. Urinary output
B. Blood pressure
C. Pulse
D. Temperature

206. The nurse is assessing the arterial blood gases (ABG) of a chest trauma client with the results of pH 7.35, PO2 85, PCO2 55, and HCO3 27. What do these values indicate?
A. Uncompensated respiratory acidosis
B. Uncompensated metabolic acidosis
C. Compensated respiratory acidosis
D. Compensated metabolic acidosis

207. Which one of the following statements is correct when measuring the client for crutches?
A. A distance of five fingerbreadths should exist between the top of the crutch and the axilla.
B. The nurse should measure three inches between the top of the crutch and the axilla.
C. The client’s elbows should be flexed at a 10º angle.
D. The crutches should be extended 8 to 10 inches from the side of the foot.

208. A client with hemophilia has a nosebleed. Which nursing action is most appropriate to control the bleeding?
A. Place the client in a sitting position.
B. Administer acetaminophen (Tylenol).
C. Pinch the soft lower part of the nose.
D. Apply ice packs to the forehead.

209. A client in labor admits to using alcohol throughout the pregnancy. The most recent use was the day before. Based on the client’s history, the nurse should give priority to assessing the newborn for:
A. Respiratory depression
B. Wide-set eyes
C. Jitteriness
D. Low-set ears

210. The mother of a six-month-old asks when her child will have all his baby teeth. The nurse knows that most children have all their primary teeth by age:
A. 12 months
B. 18 months
C. 24 months
D. 30 months

211. Continuous bladder irrigations are ordered for a patient following a TURP. The purpose of continuous bladder irrigations is to:
A. Prevent formation of blood clots
B. Administer intravesical medication
C. Prevent postoperative pain
D. Maintain bladder tone

212. A student nurse is observing a neurological nurse perform an assessment. When the nurse asks the client to “stick out his tongue,” the nurse is assessing the function of which cranial nerve?
A. II optic
B. I olfactory
C. X vagus
D. XII hypoglossal

213. A neurological consult has been ordered for a pediatric client with suspected absence seizures. The client with absence seizures can be expected to have:
A. Short, abrupt muscle contractions
B. Quick, severe bilateral jerking movements
C. Abrupt loss of muscle tone
D. Brief lapse in consciousness

214. A client is admitted with a Ewing’s sarcoma. Which symptom would be expected due to this tumor’s location?
A. Hemiplegia
B. Aphasia
C. Loss of balance
D. Bone pain

215. A high school student returns to school following a three-week absence due to mononucleosis. The school nurse knows it will be important for the client:
A. To drink additional fluids throughout the day
B. To avoid contact sports for 1–2 months
C. To have a snack twice a day to prevent hypoglycemia
D. To continue antibiotic therapy for six months

216. A diabetic multigravida is scheduled for an amniocentesis at 32 weeks gestation to determine the L/S ratio and phosphatidyl glycerol level. The L/S ratio is 1:1 and the presence of phosphatidylglycerol is noted. The nurse’s assessment of this data is:
A. The infant is at low risk for congenital anomalies.
B. The infant is at high risk for intrauterine growth retardation.
C. The infant is at high risk for respiratory distress syndrome.
D. The infant is at high risk for birth trauma.

217. The nurse is assessing a newborn in the well-baby nursery. Which finding should alert the nurse to the possibility of a cardiac anomaly?
A. Diminished femoral pulses
B. Harlequin’s sign
C. Circumoral pallor
D. Acrocyanosis

218. The nurse is planning room assignments for the day. Which client should be assigned to a private room if only one is available?
A. The client with methicillin resistant-staphylococcus aureas (MRSA)
B. The client with diabetes
C. The client with pancreatitis
D. The client with Addison’s disease

219. To decrease the likelihood of seizures and visual hallucinations in a client with alcohol withdrawal, the nurse should:
A. Keep the room darkened by pulling the curtains.
B. Keep the light over the bed on at all times.
C. Keep the room quiet and dim the lights.
D. Keep the television or radio turned on.

220. A client is admitted with a diagnosis of duodenal ulcer. A common complaint of the client with a duodenal ulcer is:
A. Epigastric pain that is relieved by eating
B. Weight loss
C. Epigastric pain that is worse after eating
D. Vomiting after eating

221. The physician has prescribed Zyvox (linezolid) for a patient with VRE. The concurrent use of which medication may result in serotonin syndrome?
A. Nexium (esomeprazole)
B. Zoloft (sertraline)
C. Lipitor (atorvastatin)
D. Zyrtec (cetirizine)

222. A client with Addison’s disease has been receiving glucocorticoid therapy. Which finding indicates a need for dosage adjustment?
A. Dryness of the skin and mucus membranes
B. Dizziness when rising to a standing position
C. A weight gain of six pounds in the past week
D. Difficulty in remaining asleep

223. The physician has ordered Zantac (ranitidine) for a client with reflux. The nurse should administer the medication:
A. Mid afternoon
B. Thirty minutes before eating
C. In a single dose at bedtime
D. Mid-morning

224. When caring for the child with autistic disorder, the nurse should:
A. Take the child to the playroom to be with peers.
B. Assign a consistent caregiver.
C. Place the child in a ward with other children.
D. Assign several staff members to provide care.

225. A neurological consult has been ordered for a pediatric client with suspected absence seizures. The client with absence seizures can be expected to have:
A. Short, abrupt muscle contractions
B. Quick, severe bilateral jerking movements
C. Abrupt loss of muscle tone
D. Brief lapse in consciousness

226. A client with schizophrenia has been taking Clozaril (clozapine) for the past six months. This morning the client’s temperature was elevated to 102°F. The nurse should give priority to:
A. Placing a note in the chart for the doctor
B. Rechecking the temperature in four hours
C. Notifying the physician immediately
D. Asking the client if he has been feeling sick

227. The doctor has ordered Ampicillin 100mg every six hours IV push for an infant weighing 7kg. The suggested dose for infants is 25–50mg/kg/day in equally divided doses. The nurse should:
A. Give the medication as ordered.
B. Give half the amount ordered.
C. Give the ordered amount q 12 hrs.
D. Check the order with the doctor.

228. A client with a diagnosis of HPV is at risk for which of the following?
A. Hodgkin’s lymphoma
B. Cervical cancer
C. Multiple myeloma
D. Ovarian cancer

229. The registered nurse is making shift assignments. Which client should be assigned to the licensed practical nurse (LPN)?
A. A client who is a diabetic with a foot ulcer
B. A client with a deep vein thrombosis receiving intravenous heparin
C. A client being weaned from a tracheostomy
D. A post-operative cholecystectomy with a T-tube

230. Which of the following meal selections is appropriate for the client with celiac disease?
A. Toast, jam, and apple juice
B. Peanut butter cookies and milk
C. Rice Krispies bar and milk
D. Cheese pizza and Kool-Aid

231. The client is admitted after an abdominal cholecystectomy. Montgomery straps are utilized with this client. The nurse is aware that Montgomery straps are utilized on this client because:
A. The client is at risk for evisceration.
B. The client will require frequent dressing changes.
C. The straps provide support for drains that are inserted into the incision.
D. No sutures or clips are used to secure the incision.

232. The physician has ordered Pyridium (phenazopyridine) for a client with urinary urgency. The nurse should tell the client that:
A. The urine will have a strong odor of ammonia.
B. The urinary output will increase in amount.
C. The urine will have a red-orange color.
D. The urinary output will decrease in amount.

233. The client presents to the clinic with a serum cholesterol of 275mg/dL and is placed on rosuvastatin (Crestor). Which instruction should be given to the client taking rosuvastatin (Crestor)?
A. Report muscle weakness to the physician.
B. Allow six months for the drug to take effect.
C. Take the medication with fruit juice.
D. Report difficulty sleeping.

234. The nurse is caring for a client with a diagnosis of cirrhosis who is experiencing pruritis. Which of the following is an appropriate nursing intervention?
A. Suggesting that the client take warm showers twice daily
B. Applying a lotion containing menthol or camphor to the skin after bathing
C. Applying powder to the client’s skin
D. Placing warm compresses on the affected areas

235. A client is diagnosed with emphysema and cor pulmonale. Which findings are characteristic of cor pulmonale?
A. Hypoxia, shortness of breath, and exertional fatigue
B. Weight loss, increased RBC, and fever
C. Rales, edema, and enlarged spleen
D. Edema of the lower extremities and distended neck veins

236. A client with benign prostatic hypertrophy has been started on Proscar (finasteride). The nurse’s discharge teaching should include:
A. Telling the client’s wife not to touch the tablets
B. Explaining that the medication should be taken with meals
C. Telling the client that symptoms will improve in 1–2 weeks
D. Instructing the client to take the medication at bed-time, to prevent nocturia

237. The nurse is observing the respirations of a client when she notes that the respiratory cycle is marked by periods of apnea lasting from 10 seconds to one minute. The apnea is followed by respirations that gradually increase in depth and frequency. The nurse should document that the client is experiencing:
A. Cheyne-Stokes respirations
B. Kussmaul respirations
C. Biot respirations
D. Diaphragmatic respirations

238. Which action by the novice nurse indicates a need for further teaching?
A. The nurse fails to wear gloves consistently when removing a dressing.
B. The nurse applies an oxygen saturation monitor to the ear lobe.
C. The nurse elevates the head of the bed to check the blood pressure.
D. The nurse places the arm in a dependent position to perform a fingerstick.

239. The nurse is caring for a client following a cerebral vascular accident. Which portion of the brain is responsible for changes in the client’s vision?
A. Temporal lobe
B. Frontal lobe
C. Occipital lobe
D. Parietal lobe

240. The physician has ordered aerosol treatments, chest percussion, and postural drainage for a client with cystic fibrosis. The nurse recognizes that the combination of therapies is to:
A. Decrease respiratory effort and mucous production
B. Increase efficiency of the diaphragm and gas exchange
C. Dilate the bronchioles and help remove secretions
D. Stimulate coughing and oxygen consumption

241. The physician has ordered Cortisporin ear drops for a two-year-old. To administer the ear drops, the nurse should:
A. Pull the ear down and back.
B. Pull the ear straight out.
C. Pull the ear up and back.
D. Leave the ear undisturbed.

242. The sputum of a client remains positive for the tubercle bacillus even though the client has been taking Laniazid (isoniazid) in combination with other antituberculars. The nurse recognizes that the client taking isoniazid should have a negative sputum culture within:
A. Two weeks
B. Six weeks
C. Two months
D. Three months

243. A client with a history of schizophrenia is seen in the local health clinic for medication follow-up. To maintain a therapeutic level of medication, the nurse should tell the client to avoid:
A. Taking over-the-counter allergy medication
B. Eating cheese and pickled foods
C. Eating salty foods
D. Taking over-the-counter pain relievers

244. To reduce the possibility of having a baby with a neural tube defect, the client should be told to increase her intake of folic acid. Dietary sources of folic acid include:
A. Meat, liver, eggs
B. Pork, fish, chicken
C. Spinach, beets, cantaloupe
D. Dried beans, sweet potatoes, Brussels sprouts

245. The nurse is caring for a newborn who is on strict intake and output. The used diaper weighs 73.5gm. The diaper’s dry weight was 62gm. The newborn’s urine output is:
A. 10mL
B. 11.5mL
C. 10gm
D. 12gm

246. The nurse notes variable decelerations on the fetal monitor strip. The most appropriate initial action would be to:
A. Notify her doctor
B. Start an IV
C. Reposition the client
D. Readjust the monitor

247. The nurse is caring for a client with laryngeal cancer. Which finding is not associated with laryngeal cancer?
A. Halitosis
B. Dysphagia
C. H. pylori infection
D. Chronic hiccups

248. A client with a missed abortion at 29 weeks gestation is admitted to the hospital. The client will most likely be treated with:
A. Magnesium sulfate
B. Calcium gluconate
C. Dinoprostone (Prostin E.)
D. Bromocriptine (Parlodel)

249. A client develops a temperature of 102°F following coronary artery bypass surgery. The nurse should notify the physician immediately because elevations in temperature:
A. Increase cardiac output
B. Indicate cardiac tamponade
C. Decrease cardiac output
D. Indicate graft rejection

250. A female client with a history of frequent urinary tract infections asks the nurse how she can reduce the risk of recurrence. The nurse should tell the client to:
A. Douche after intercourse
B. Void every three hours
C. Increase her intake of foods containing vitamin C
D. Wipe from back to front after voiding

251. The nurse is providing discharge teaching for the client with leukemia. The client should be told to avoid:
A. Using oils or cream-based soaps
B. Flossing between the teeth
C. The intake of salt
D. Using an electric razor

252. The RN on the oncology unit is preparing to mix and administer amphoteracin B (Fungizone) to a client. Which action is contraindicated for administering this drug IV?
A. Mix the drug with normal saline solution.
B. Administer the drug over 4–6 hours.
C. Hydrate with IV fluids two hours before the infusion is scheduled to begin.
D. Premedicate the client with ordered acetaminophen (Tylenol) and diphenhydramine (Benadryl).

253. The nurse has performed nutritional teaching on a client with gout who is placed on a low-purine diet. Which selection by the client would indicate that teaching has been ineffective?
A. Boiled cabbage
B. Apple
C. Peach cobbler
D. Spinach

254. Which finding is the best indication that a client with ineffective airway clearance needs suctioning?
A. Oxygen saturation
B. Respiratory rate
C. Breath sounds
D. Arterial blood gases

255. The nurse is assisting a client with diverticulitis to select appropriate foods. Which food should be avoided?
A. Bran
B. Fresh peach
C. Tomatoes
D. Dinner roll

256. A patient is diagnosed with secondary syphilis. The nurse can expect the patient to have:
A. “Copper penny” rash on the palms of the hands and soles of the feet
B. Localized tumors in the skin, bones, and liver
C. Chancres and lymphadenopathy
D. General paresis

257. The nurse caring for a client with anemia recognizes which clinical manifestation as the one that is specific for a hemolytic type of anemia?
A. Jaundice
B. Anorexia
C. Tachycardia
D. Fatigue

258. Which skin assessment in a newborn indicates a need for follow-up?
A. Miliaria rubra
B. Erythema toxicum
C. Mongolian spots
D. Jaundice at birth

259. Which medication is often used to treat the client with N.gonorrhea?
A. Sitavig (acyclovir)
B. Vibramycin (doxycycline)
C. Retrovir (zidovudine)
D. Aldara (imiquimod)

260. A client with symptoms of myasthenia gravis is scheduled for a Tensilon (edrophoniun) test. Which medication should be kept available during the test?
A. Atropine sulfate
B. Lasix (furosemide)
C. Prostigmine (neostigmine)
D. Phenergan (promethazine)

261. The nurse caring for a client with a head injury would recognize which assessment finding as the most indicative of increased ICP?
A. Vomiting
B. Headache
C. Dizziness
D. Papilledema

262. The client with confusion says to the nurse, “I haven’t had anything to eat all day long. When are they going to bring breakfast?” The nurse saw the client in the day room eating breakfast with other clients 30 minutes before this conversation. Which response would be best for the nurse to make?
A. You know you had breakfast 30 minutes ago.
B. I am so sorry that they didn’t get you breakfast. I’ll report it to the charge nurse.
C. I’ll get you some juice and toast. Would you like something else?
D. You will have to wait a while; lunch will be here in a little while.

263. The nurse is caring for a client after a motor vehicle accident. The client has a fractured tibia, and bone is noted protruding through the skin. Which action is of priority?
A. Provide manual traction above and below the leg.
B. Cover the bone area with a sterile dressing.
C. Apply an ACE bandage around the entire lower limb.
D. Place the client in the prone position.

264. A client with hypertension has begun an aerobic exercise program. The nurse should tell the client that the recommended exercise regimen should begin slowly and build up to:
A. 20–30 minutes three times a week
B. 45 minutes two times a week
C. One hour four times a week
D. One hour two times a week

265. The nurse is suctioning the tracheostomy of an adult client. The recommended pressure setting for performing tracheostomy suctioning on the adult client is:
A. 40–60mmHg
B. 60–80mmHg
C. 80–120mmHg
D. 120–140mmHg

266. Assuming that all have achieved normal cognitive and emotional development, which of the following children is at greatest risk for accidental poisoning?
A. One-year-old
B. Four-year-old
C. Eight-year-old
D. Twelve-year-old

267. The nurse is discussing breastfeeding with a postpartum client. Breastfeeding is contraindicated in the postpartum client with:
A. Diabetes
B. HIV
C. Hypertension
D. Thyroid disease

268. The physician has ordered Coumadin (sodium warfarin) for a client with a history of clots. The nurse should tell the client to avoid which of the following vegetables?
A. Lettuce
B. Cauliflower
C. Beets
D. Carrots

269. 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 150mL of chest drainage
B. A client two days post-gastrectomy with scant drainage
C. A client with pneumonia with an oral temperature of 102ºF
D. A client with a fractured hip in Buck’s traction

270. The nurse is caring for a client with leukemia who is receiving the drug doxorubicin (Adriamycin). Which toxic effects of this drug would be reported to the physician immediately?
A. Rales and distended neck veins
B. Red discoloration of the urine
C. Nausea and vomiting
D. Elevated BUN and dry, flaky skin

271. A client hospitalized for treatment of congestive heart failure is to be discharged with a prescription for Digitek (digoxin) 0.25mg daily. Which of the following statements indicates that the client needs further teaching?
A. I will need to take the medication at the same time each day.
B. I can prevent stomach upset by taking the medication with an antacid.
C. I can help prevent drug toxicity by eating foods containing fiber.
D. I will need to report visual changes to my doctor.

272. The nurse is infusing total parenteral nutrition (TPN). The primary purpose for closely monitoring the client’s intake and output is:
A. To determine how quickly the client is metabolizing the solution
B. To determine whether the client’s oral intake is sufficient
C. To detect the development of hypovolemia
D. To decrease the risk of fluid overload

273. Which one of the following symptoms is common in the client with duodenal ulcers?
A. Vomiting shortly after eating
B. Epigastric pain following meals
C. Frequent bouts of diarrhea
D. Presence of blood in the stools

274. The nurse is observing a student nurse administering ear drops to a two-year-old. Which observation by the nurse would indicate correct technique?
A. Holds the child’s head up and extended
B. Places the head in chin-tuck position
C. Pulls the pinna down and back
D. Irrigates the ear before administering medication

275. The nurse is obtaining a history on an 80-year-old client. Which statement made by the client might indicate a potential for fluid and electrolyte imbalance?
A. “My skin is always so dry, especially in the winter.”
B. “I have to use laxatives two or three times a week.”
C. “I drink three or four glasses of ice tea during the day.”
D. “I sometimes have a problem with dribbling urine.”

276. The nurse is caring for a client following a right nephrolithotomy. Post-operatively, the client should be positioned:
A. On the right side
B. Supine
C. On the left side
D. Prone

277. A client is admitted to the labor and delivery unit complaining of vaginal bleeding with very little discomfort. The nurse’s first action should be to:
A. Assess the fetal heart tones
B. Check for cervical dilation
C. Check for firmness of the uterus
D. Obtain a detailed history

278. On the second post-operative day after a subtotal thyroidectomy, the client tells the nurse, “I feel numbness and my face is twitching.” What is the nurse’s best initial action?
A. Offer mouth care.
B. Loosen the neck dressing.
C. Notify the physician.
D. Document the finding as the only action.

279. A client with B negative blood requires a blood transfusion during surgery. If no B negative blood is available, the client should be transfused with:
A. A positive blood
B. B positive blood
C. O negative blood
D. AB negative blood

280. A client with asthma has an order to begin an aminophylline IV infusion. Which piece of equipment is essential for the nurse to safely administer the medication?
A. Large bore intravenous catheter
B. IV inline filter
C. IV infusion device
D. Cover to prevent exposure of solution to light

281. The nurse caring for a client with closed chest drainage notes that the collection chamber is full.
A. Add more water to the suction-control chamber.
B. Remove the drainage using a 60mL syringe.
C. Milk the tubing to facilitate drainage.
D. Prepare a new unit for continuing collection.

282. The nurse is preparing a client for cataract surgery. The nurse is aware that:
A. Mydriatics will be used to dilate the pupil.
B. Miotics will be used to constrict the pupil.
C. A laser will be used to smooth and reshape the lens.
D. Silicone oil injections will be used to hold the retina in place.

283. During a change of shift, the oncoming nurse notes a discrepancy in the narcotic count. The nurse’s first action should be to:
A. Notify the hospital pharmacist
B. Notify the nursing supervisor
C. Notify the board of nursing
D. Notify the director of nursing

284. A client is admitted to the emergency department with complaints of crushing chest pain that radiates to the left jaw. After obtaining a stat electrocardiogram the nurse should:
A. Obtain a history of prior cardiac problems
B. Begin an IV using a large-bore catheter
C. Administer oxygen at 2L per minute via nasal cannula
D. Perform pupil checks for size and reaction to light

285. Which nursing intervention is appropriate when caring for a client with herpes zoster?
A. Covering the lesions with a sterile dressing
B. Wearing gloves when providing care
C. Administering aspirin for discomfort
D. Administering Zovirax (acyclovir) within 72 hours of the outbreak

286. A client with a fractured leg is exhibiting shortness of breath, pain upon deep breathing, and hemoptysis. What do these clinical manifestations indicate to the nurse?
A. Congestive heart failure
B. Pulmonary embolus
C. Adult respiratory distress syndrome
D. Tension pneumothorax

287. To correctly assess the oxygen saturation level of an adult client, the pulse oximeter should not be placed on the:
A. Finger
B. Earlobe
C. Extremity with noninvasive BP cuff
D. Nose

288. A client with AIDS complains of a weight loss of 20 pounds in the past month. Which diet is suggested for the client with AIDS?
A. High calorie, high protein, high fat
B. High calorie, high carbohydrate, low protein
C. High calorie, low carbohydrate, high fat
D. High calorie, high protein, low fat

289. The physician has ordered Nitrostat (nitroglycerin SL) tablets for a client with stable angina. The medication:
A. Slows contractions of the heart
B. Dilates coronary blood vessels
C. Increases the ventricular fill time
D. Strengthens contractions of the heart

290. The nurse is assessing the heart sounds of a client with mitral stenosis following a history of rheumatic fever. To hear a mitral murmur, the nurse should place the stethoscope at:
A. The third intercostal space right of the sternum
B. The third intercostal space left of the sternum
C. The fourth intercostal space beneath the sternum
D. The fourth intercostal space mid-clavicular line

291. A client is taking Rifadin(rifampin) 600mg PO daily for pulmonary tuberculosis. The nurse should tell the client to:
A. Take the medication with juice
B. Expect red discoloration of the urine
C. Take the medication before going to bed at night
D. Take the medication only if night sweats occur

292. Which client is best assigned to a newly licensed nurse?
A. A client receiving chemotherapy
B. A clientpostcoronary artery bypass graft
C. A client with a transurethral prostatectomy
D. A client with diverticulosis

293. The nurse is suctioning a tracheostomy, what is the maximum suction pressure the nurse should use?
A. 120mmHg
B. 145mmHg
C. 160mmHg
D. 185mmHg

294. Where is the best site for examining for the presence of petechiae in an African American client?
A. The abdomen
B. The thorax
C. The earlobes
D. The soles of the feet

295. An infant who weighs 8 pounds at birth would be expected to weigh how many pounds at six months?
A. 14 pounds
B. 24 pounds
C. 18 pounds
D. 16 pounds

296. The client has recently been diagnosed with diabetes. Which of the following indicates understanding of the management of diabetes?
A. The client selects a balanced diet from the menu.
B. The client can tell the nurse the normal blood glucose level.
C. The client asks for brochures on the subject of diabetes.
D. The client demonstrates correct insulin injection technique.

297. In preparation for the removal of the client’s chest tubes, the nurse should instruct the client to:
A. Breathe normally
B. Hold his breath and bear down
C. Take deep breaths
D. Take shallow breaths

298. A burn client’s care plan reveals an expected outcome of no localized or systemic infection. Which assessment by the nurse supports this outcome?
A. Wound culture results showing minimal bacteria
B. Cloudy, foul-smelling urine
C. White blood cell count of 14,000/mm3
D. Temperature elevation of 101°F

299. A healthcare worker is referred to the nursing office with a suspected latex allergy. The first symptom of latex allergy is usually:
A. Oral itching after eating bananas
B. Swelling of the eyes and mouth
C. Difficulty in breathing
D. Swelling and itching of the hands

300. A client is admitted with a ruptured spleen following a four-wheeler accident. In preparation for surgery, the nurse suspects that the client is in the compensatory stage of shock because of which clinical manifestation?
A. Blood pressure 120/70, confusion, heart rate 120
B. Crackles on chest auscultation, mottled skin, lethargy
C. Jaundice, urine output less than 30mL in the past hour, heart rate 170
D. Rapid shallow respirations, unconscious, petechiae anterior chest

301. An infant’s Apgar score is 9 at five minutes. The nurse is aware that the most likely cause for the deduction of one point is:
A. The newborn is hypothermic.
B. The newborn is experiencing bradycardia.
C. The newborn has acrocyanosis.
D. The newborn is lethargic.

302. A client is experiencing acute abdominal pain. Which abdominal assessment sequence is appropriate for the nurse to use for examination of the abdomen?
A. Inspect, palpate, auscultate, percuss
B. Inspect, auscultate, percuss, palpate
C. Auscultate, inspect, palpate, percuss
D. Percuss, palpate, auscultate, inspect

303. The nurse is assessing a client recently returned from surgery. The best way to determine the client’s need for pain medication is to:
A. Watch for changes in the client’s vital signs
B. Ask the client to rate his pain on a scale of 0–10
C. Observe the client’s facial expression during dressing changes
D. Wait for the client to request medication for pain relief

304. Which of the following is a late sign associated with oral cancer?
A. Warmth
B. Odor
C. Pain
D. Ulcer with flat edges

305. A client is admitted after a motor vehicle accident. Based on the following results, what physician’s prescription will the nurse anticipate?

A. Blood transfusion
B. Potassium IVPB
C. Mechanical ventilator
D. Platelet transfusion

306. The nurse is caring for a client with a diagnosis of hepatitis who is experiencing pruritis. Which would be the most appropriate nursing intervention?
A. Suggest that the client take warm showers.
B. Add baby oil to the client’s bath water.
C. Apply powder to the client’s skin.
D. Suggest a hot-water rinse after bathing.

307. A client with diabetes insipidus is receiving DDAVP (desmopressin acetate). Which lab finding indicates that the medication is having its intended effect?
A. Blood glucose 92mg/dL
B. Urine specific gravity 1.020
C. White blood count of 7,500
D. Glycosylated hemoglobin 3.5mg/dL

308. The client with dementia is experiencing confusion late in the afternoon and before bedtime. The nurse is aware that the client is experiencing what is known as:
A. Chronic fatigue syndrome
B. Normal aging
C. Sundowning
D. Delusions

309. A 70-year-old male who is recovering from a stroke exhibits signs of unilateral neglect. Which behavior is suggestive of unilateral neglect?
A. The client is observed shaving only one side of his face.
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 side to side.
D. The client is unable to carry out cognitive and motor activity at the same time.

310. The client is admitted for an open reduction internal fixation of a fractured hip. Immediately following surgery, the nurse should give priority to assessing the:
A. Serum collection (Davol) drain
B. Client’s pain
C. Nutritional status
D. Immobilizer

311. The client with a myocardial infarction comes to the nurse’s station stating that he is ready to go home because there is nothing wrong with him. Which defense mechanism is the client using?
A. Rationalization
B. Denial
C. Projection
D. Conversion reaction

312. A dexamethasone-suppression test has been ordered for a client with severe depression. The purpose of the dexamethasone suppression test is to:
A. Determine which social intervention will be best for the client.
B. Help diagnose the seriousness of the client’s clinical symptoms.
C. Determine whether the client will benefit from electroconvulsive therapy.
D. Reverse the depressive symptoms the client is experiencing.

313. A client who delivered this morning tells the nurse that she plans to breastfeed her baby. The nurse is aware that successful breastfeeding is most dependent on the:
A. Mother’s educational level
B. Infant’s birth weight
C. Size of the mother’s breast
D. Mother’s desire to breastfeed

314. The nurse is caring for an obstetrical patient admitted with HELLP syndrome. The nurse anticipates an order for which medication?
A. Yutopar (ritodrine)
B. Brethine (terbutaline)
C. Methergine (methylergonovine)
D. Pitocin (oxytocin)

315. A client with metastatic cancer of the lung has just been told the prognosis by the oncologist. The nurse hears the client state, “I don’t believe the doctor; I think he has me confused with another patient.” This is an example of which of Kubler-Ross’ stages of dying?
A. Denial
B. Anger
C. Depression
D. Bargaining

316. The obstetric client’s fetal heart rate is 80–90 during the contractions. The first action the nurse should take is:
A. Reposition the monitor
B. Turn the client to her left side
C. Ask the client to ambulate
D. Prepare the client for delivery

317. The nurse caring for a client in shock recognizes that the glomerular filtration rate of the kidneys will fail if the client’s mean arterial pressure falls below which of the following levels?
A. 140
B. 120
C. 100
D. 80

318. Which of the following findings would be expected in the infant with biliary atresia?
A. Rapid weight gain and hepatomegaly
B. Dark stools and poor weight gain
C. Abdominal distention and poor weight gain
D. Abdominal distention and rapid weight gain

319. The nurse is teaching the parents of an infant with osteogenesis imperfecta. The nurse should tell the parents:
A. That the infant will need daily calcium supplements
B. That it is best to lift the infant by the buttocks when diapering
C. That the condition is a temporary one
D. That only the bones of the infant are affected by the disease

320. A client with cystic fibrosis is taking pancreatic enzymes. The nurse should administer this medication:
A. Once per day in the morning
B. Three times per day with meals
C. Once per day at bedtime
D. Four times per day

321. A client with pancreatic cancer who is receiving TPN has an order for sliding-scale insulin. The reason for the ordered insulin is:
A. TPN leads to negative nitrogen balance and elevated glucose levels.
B. TPN cannot be managed with oral hypoglycemics.
C. TPN is a high-glucose solution that can elevate the blood glucose levels.
D. TPN use can depress the activity of the beta cells of the islets of Langerhans.

322. A nurse is administering a blood transfusion to a client on the oncology unit. Which clinical manifestation indicates an acute hemolytic reaction to the blood?
A. Low back pain
B. Headache
C. Urticaria
D. Neck vein distention

323. According to Erikson, the developmental task of the infant is to establish trust. Parents and caregivers foster a sense of trust by:
A. Holding the infant during feedings
B. Speaking quietly to the infant
C. Providing sensory stimulation
D. Consistently responding to needs

324. The client with suspected meningitis is admitted to the unit. The doctor is performing an assessment to determine meningeal irritation and spinal nerve root inflammation. A positive Kernig’s sign is charted if the nurse notes:
A. Pain on flexion of the hip and knee
B. Nuchal rigidity on flexion of the neck
C. Pain when the head is turned to the left side
D. Dizziness when changing positions

325. The nurse is caring for a client post-op femoral popliteal bypass graft. Which post-operative assessment finding would require immediate physician notification?
A. Edema of the extremity and pain at the incision site
B. A temperature of 99.6°F and redness of the incision
C. Serous drainage noted at the surgical area
D. A loss of posterior tibial and dorsalis pedis pulses

326. The client has surgery for removal of a Prolactinoma. Which of the following interventions would be appropriate for this client?
A. Place the client in Trendelenburg position for postural drainage.
B. Encourage coughing and deep breathing every two hours.
C. Elevate the head of the bed 30°.
D. Encourage the Valsalva maneuver for bowel movements.

327. The nurse caring for a client with a suspected peptic ulcer recognizes which exam as the one most reliable in diagnosing the disease?
A. Upper-gastrointestinal x-ray
B. Gastric analysis
C. Endoscopy procedure
D. Barium studies x-ray

328. The physician has ordered a paracentesis for a client with severe abdominal ascites. Before the procedure, the nurse should:
A. Provide the client with a urinal
B. Prep the area by shaving the abdomen
C. Encourage the client to drink extra fluids
D. Request an ultrasound of the abdomen

329. A home health nurse is making preparations for morning visits. Which one of the following clients should the nurse visit first?
A. A client with a stroke with tube feedings
B. A client with a history of congestive heart failure complaining of nighttime dyspnea
C. A client with a thoracotomy six months ago
D. A client with Parkinson’s disease

330. A client hospitalized with AIDS tells the nurse that he has been exposed to measles. The nurse should contact the physician regarding an order for:
A. An antibiotic
B. Immune globulin
C. An antiviral
D. Airborne isolation

331. The client is admitted to the postpartum unit with an order to continue the infusion of Pitocin (oxytocin). The nurse is aware that Pitocin is working if the fundus is:
A. Deviated to the left
B. Firm and in the midline
C. Boggy
D. Two finger breadths below the umbilicus

332. A client with sickle cell disease is admitted in active labor. Which nursing intervention would be most helpful in preventing a sickling crisis?
A. Obtaining blood pressures every two hours
B. Administering pain medication every three hours as ordered
C. Monitoring arterial blood gas results
D. Administering IV fluids at ordered rate of 200mL/hr

333. The nurse recognizes which of the following clients as having the highest risk for pulmonary complications after surgery?
A. A 24-year-old with open reduction internal fixation of the ulnar
B. A 45-year-old with an open cholecystectomy
C. A 36-year-old after a hysterectomy
D. A 50-year-old after a lumbar laminectomy

334. The nurse is performing discharge teaching to a client who is on isoniazid (INH). Which diet selection by the client indicates to the nurse that further instruction is needed?
A. Tuna casserole
B. Ham salad sandwich
C. Baked potato
D. Broiled beef roast

335. Which snack selection by a client with osteoporosis indicates that the client understands the dietary management of the disease?
A. A granola bar
B. A bran muffin
C. Yogurt
D. Raisins

336. Which assessment finding in a client with COPD indicates to the nurse that the respiratory problem is chronic?
A. Wheezing on exhalation
B. Productive cough
C. Clubbing of fingers
D. Generalized cyanosis

337. A client is admitted to the medical-surgical unit with a report of severe hematemesis. What is the priority nursing action?
A. Performing an assessment
B. Obtaining a blood permit
C. Initiating an IV
D. Inserting an NG tube

338. A newborn is diagnosed with congenital syphilis. Classic signs of congenital syphilis are:
A. Red papular rash, desquamation, white strawberry tongue
B. Rhinitis, maculopapular rash, hepatosplenomegaly
C. Red edematous cheeks, maculopapular rash on the trunk and extremities
D. Epicanthal folds, low-set ears, protruding tongue

339. The nurse on an oncology unit is caring for a client with neutropenia. During evening visitation, a visitor brings a potted plant to the room. What action should the nurse take?
A. Allow the client to keep the plant.
B. Place the plant by the window.
C. Water the plant for the client.
D. Ask the family to take the plant home.

340. The physician has ordered a trivalent botulism antitoxin for a client with botulism poisoning. Before administering the medication, the nurse should assess the client for a history of allergies to:
A. Eggs
B. Horses
C. Shellfish
D. Pork

341. The client is admitted to the ER with multiple rib fractures on the right. The nurse’s assessment reveals that an area over the right clavicle is puffy and that there is a “crackling” noise with palpation. The nurse should further assess the client for which of the following problems?
A. Flail chest
B. Subcutaneous emphysema
C. Infiltrated subclavian IV
D. Pneumothorax

342. A client visiting a family planning clinic is suspected of having an STI. The best diagnostic test for treponema pallidum is:
A. Venereal Disease Research Lab (VDRL)
B. Rapid plasma reagin (RPR)
C. Fluorescent treponemal antibody (FTA)
D. Thayer-Martin culture (TMC)

343. A client has developed diabetes insipidous after removal of a pituitary tumor. Which finding would the nurse expect?
A. Polyuria
B. Hypertension
C. Polyphagia
D. Hyperkalemia

344. A client with acute alcohol intoxication is being treated for hypomagnesemia. During assessment of the client, the nurse would expect to find:
A. Bradycardia
B. Negative Chvostek’s sign
C. Hypertension
D. Positive Trousseau’s sign

345. Which complaint by the client raises the possibility of compartment syndrome following cast application to the leg?
A. Diffuse aching in the leg
B. Tight burning pain in the calf
C. Localized pain along the shin
D. Throbbing sensation in the toes

346. The client is diagnosed with multiple myeloma. The doctor has ordered cyclophosphamide (Cytoxan). Which instruction should be given to the client?
A. “Walk about a mile a day to prevent calcium loss.”
B. “Increase the fiber in your diet.”
C. “Report nausea to the doctor immediately.”
D. “Drink at least eight large glasses of water a day.”

347. A nurse is teaching a group of teenagers the correct technique for applying a condom. Which point would the nurse include in the teaching plan?
A. The condom can be reused one time.
B. Unroll the condom all the way over the erect penis.
C. Apply petroleum jelly to reduce irritation.
D. Place water in the tip of the condom before use.

348. An adolescent with cystic fibrosis has an order for pancreatic enzyme replacement. The nurse knows that the medication should be given:
A. At bedtime
B. With meals and snacks
C. Twice daily
D. Daily in the morning

349. The physician has ordered Prostin E2 (dinoprostone) gel to induce labor. After inserting the gel, which action should the nurse take?
A. Raise the head of the bed
B. Apply nasal oxygen at 2L/min
C. Help the client to the bathroom
D. Elevate the client’s hips for 30 minutes

350. A child is to receive heparin sodium five units per kilogram of body weight by subcutaneous route every four hours. The child weighs 52.8 lb. How many units should the child receive in a 24-hour period?
A. 300
B. 480
C. 720
D. 960

351. The charge nurse is assigning staff for the day. Staff consists of an RN, an LPN, and a certified nursing assistant. Which client assignment should be given to the nursing assistant?
A. Exploratory laparotomy with a colon resection the previous shift
B. Client with a stroke who has been hospitalized for two days
C. A client with metastatic cancer on PCA morphine
D. A new admission with diverticulitis

352. The nurse is preparing a client for discharge following the removal of a cataract. The nurse should tell the client to:
A. Take aspirin for discomfort
B. Avoid bending over to put on his shoes
C. Remove the eye shield before going to sleep
D. Continue showering as usual

353. Which one of the following clients is most likely to develop acute respiratory distress syndrome?
A. A 20-year-old with fractures of the tibia
B. A 36-year-old who is HIV positive
C. A 40-year-old with duodenal ulcers
D. A 32-year-old with barbiturate overdose

354. Damage to the VII cranial nerve results in:
A. Facial pain
B. Absence of ability to smell
C. Absence of eye movement
D. Tinnitus

355. The physician is preparing to remove a central line. The nurse should tell the client to:
A. Breathe normally
B. Take slow, deep breaths
C. Take a deep breath and hold it
D. Breathe as quickly as possible

356. The complete blood count of a client admitted with anemia reveals that the red blood cells are hypochromic and microcytic. The nurse recognizes that the client has:
A. Aplastic anemia
B. Iron-deficiency anemia
C. Pernicious anemia
D. Hemolytic anemia

357. A toddler with otitis media has just completed antibiotic therapy. A recheck appointment should be made to:
A. Determine whether the ear infection has affected her hearing.
B. Make sure that she has taken all the antibiotic.
C. Document that the infection has completely cleared.
D. Obtain a new prescription, in case the infection recurs.

358. Which statement describes the contagious stage of varicella?
A. The contagious stage is one day before the onset of the rash until the appearance of vesicles.
B. The contagious stage lasts during the vesicular and crusting stages of the lesions.
C. The contagious stage is from the onset of the rash until the rash disappears.
D. The contagious stage is one day before the onset of the rash until all the lesions are crusted.

359. A client with gallstones and obstructive jaundice is experiencing severe itching. The physician has prescribed cholestyramine (Questran). The client asks, “How does this drug work?” What is the nurse’s best response?
A. “It blocks histamine, reducing the allergic response.”
B. “It inhibits the enzyme responsible for bile excretion.”
C. “It decreases the amount of bile in the gallbladder.”
D. “It binds with bile acids and is excreted in bowel movements with stool.”

360. The nurse is caring for a client with uremic frost. The nurse is aware that uremic frost is often seen in clients with:
A. Severe anemia
B. Arteriosclerosis
C. Liver failure
D. Parathyroid disorder

361. The nurse has an order for the administration of intravenous heparin. The medication should be administered using a/an:
A. Metered chamber
B. Infusion controller
C. Intravenous filter
D. Three-way stopcock

362. The client presents to the emergency room with a “bull’s eye” rash, headache, and arthralgia. Which question would be most appropriate for the nurse to ask the client?
A. Have you found any ticks on your body?
B. Have you had any diarrhea in the last 24 hours?
C. Have you been outside the country in the last six months?
D. Have you had any itching for the past few days?

363. A client with tuberculosis who has been on combined therapy with Rifadin (rifampin) and INH (isoniazid) asks the nurse how long he will have to take medication. The nurse should tell the client that:
A. Medication is rarely needed after two weeks.
B. He will need to take medication the rest of his life.
C. The course of combined therapy is usually six months.
D. He will be re-evaluated in one month to see if further medication is needed.

364. Which statement made by the family member caring for the client with a percutaneous gastrostomy tube indicates understanding of the nurse’s teaching?
A. I must flush the tube with water after feedings and clamp the tube.
B. I must check placement four times per day.
C. I will report to the doctor any signs of indigestion.
D. If my father is unable to swallow, I will discontinue the feeding and call the clinic.

365. A client with diverticulitis is admitted with nausea, vomiting, and dehydration. Which finding suggests a complication of diverticulitis?
A. Pain in the left lower quadrant
B. Boardlike abdomen
C. Low-grade fever
D. Abdominal distention

366. As the client reaches 6cm dilation, the nurse notes late decelerations on the fetal monitor. What is the most likely explanation of this pattern?
A. The baby is sleeping.
B. The umbilical cord is compressed.
C. There is head compression.
D. There is uteroplacental insufficiency.

367. The nurse is discharging a client with a prescription of eyedrops. Which observation by the nurse would indicate a need for further client teaching?
A. Shaking of the suspension to mix the medication
B. Administering a second eyedrop medication immediately after the first one was instilled
C. Washing the hands before and after the administration of the drops
D. Holding the lower lid down without pressing the eyeball to instill the drops

368. A client telephones the emergency room stating that she thinks that she is in labor. The nurse should tell the client that labor has probably begun when:
A. Her contractions are two minutes apart.
B. She has back pain and a bloody discharge.
C. She experiences abdominal pain and frequent urination.
D. Her contractions are five minutes apart.

369. The nurse is caring for a client with scalding burns across the face, neck, upper half of the anterior chest, and entire right arm. Using the rule of nines, estimate the percentage of body burned.
A. 18%
B. 23%
C. 32%
D. 36%

370. A client recently started on hemodialysis wants to know how the dialysis will take the place of his kidneys. The nurse’s response is based on the knowledge that hemodialysis works by:
A. Passing water through a dialyzing membrane
B. Eliminating plasma proteins from the blood
C. Lowering the pH by removing nonvolatile acids
D. Filtering waste through a dialyzing membrane

371. The nurse is performing discharge teaching for a client with an implanted defibrillator. What discharge instruction is essential?
A. “You cannot prepare food in a microwave.”
B. “You should avoid shoulder movement on the side of the defibrillator for six weeks.”
C. “You should use your cell phone on your right side.”
D. “You won’t be able to fly on a commercial airliner with an implanted defibrillator.”

372. The physician has ordered a serum aminophylline level for a client with chronic obstructive lung disease. The nurse knows that the therapeutic range for aminophylline is:
A. 1–3 micrograms/mL
B. 4–6 micrograms/mL
C. 7–9 micrograms/mL
D. 10–20 micrograms/mL

373. A client with pneumocystis jiroveci pneumonia is receiving intravenous Pentam (pentamidine). While administering the medication, the nurse should give priority to checking the client’s:
A. Deep tendon reflexes
B. Blood pressure
C. Urine output
D. Tissue turgor

374. Which of the following should be performed before beginning therapy with Accutane (isotretinoin)?
A. Calcium level
B. Pregnancy test
C. Potassium level
D. Creatinine level

375. Which information in the child’s health history is likely related to the diagnosis of plumbism?
A. The child has traveled out of the country in the last six months.
B. The child’s parents are skilled stained glass artists.
C. The child lives in a house built in 1990.
D. The child attends a public daycare facility.

376. An appropriate nursing intervention for the client with borderline personality disorder is:
A. Observing the client for signs of depression or suicidal thinking
B. Allowing the client to lead unit group sessions
C. Restricting the client’s activity to the assigned unit of care throughout hospitalization
D. Allowing the client to select a primary caregiver

377. The physician has ordered intravenous fluid with potassium for a client admitted with gastroenteritis and dehydration. Before adding potassium to the intravenous fluid, the nurse should:
A. Assess the urinary output.
B. Obtain arterial blood gases.
C. Perform a dextrostick.
D. Obtain a stool culture.

378. The chart indicates that a client has expressive aphasia following a stroke. The nurse understands that the client will have difficulty with:
A. Speaking and writing
B. Comprehending spoken words
C. Carrying out purposeful motor activity
D. Recognizing and using an object correctly

379. Which early morning activity helps to reduce the symptoms associated with rheumatoid arthritis?
A. Brushing the teeth
B. Drinking a glass of juice
C. Holding a cup of coffee
D. Brushing the hair

380. Which action by the home health nurse indicates a knowledge of the needs of an elderly client?
A. Teaching regarding availability and services offered by hospice care
B. Speaking in a higher pitched voice tone to facilitate hearing
C. Encouraging fluid restriction to prevent nighttime voiding
D. Reinforcing teaching regarding the prevention of falls

381. The registered nurse is assigning staff for four clients on the 3–11 shift. Which client should be assigned to the LPN?
A. A client with a diagnosis of adult respiratory distress syndrome (ARDS) who was transferred from the critical care unit at 1400
B. A one-hour post-operative colon resection
C. A client with pneumonia expecting discharge in the morning
D. A client with cirrhosis of the liver experiencing bleeding from esophageal varices

382. The nurse is teaching a group of prenatal clients about the effects of cigarette smoke on fetal development. Which characteristic is associated with babies born to mothers who smoked during pregnancy?
A. Low birth weight
B. Large for gestational age
C. Preterm birth, but appropriate size for gestation
D. Growth retardation in weight and length

383. A client suspected of having Alzheimer’s dementia is evaluated using the Mini-Mental State Examination. At the beginning of the evaluation, the examiner names three objects. Later in the evaluation, he asks the client to name the same three objects. The examiner is testing the client’s:
A. Attention
B. Orientation
C. Recall
D. Registration

384. The nurse is reviewing the lab reports of a client who is HIV positive. Which lab report provides information regarding the effectiveness of the client’s medication regimen?
A. ELISA
B. Western Blot
C. Viral load
D. CD4 count

385. A post-operative client has an order for Demerol (meperidine) 75mg and Phenergan (promethazine) 25mg IM every 3–4 hours as needed for pain. The combination of the two medications produces a/an:
A. Agonist effect
B. Synergistic effect
C. Antagonist effect
D. Excitatory effect

386. The nurse observes a group of toddlers at daycare. Which of the following play situations exhibits the characteristics of parallel play?
A. Lindie and Laura sharing clay to make cookies
B. Nick and Matt playing beside each other with trucks
C. Adrienne working a puzzle with Meredith and Ryan
D. Ashley playing with a busy box while sitting in her crib

387. A client being treated with sodium warfarin (Coumadin) has a Protime of 120 seconds. Which intervention would be most important to include in the nursing care plan?
A. Assess for signs of abnormal bleeding.
B. Anticipate an increase in the Coumadin dosage.
C. Instruct the client regarding the drug therapy.
D. Increase the frequency of neurological assessments.

388. A client with adult respiratory distress syndrome has been placed on mechanical ventilation with PEEP. Which finding would indicate to the nurse that the client is experiencing the undesirable effect of an increase in airway and chest pressure?
A. A PO2 of 88
B. Rales on auscultation
C. Blood pressure decrease to 90/48 from 120/70
D. A decrease in spontaneous respirations

389. The home health nurse is visiting an 18-year-old with osteogenesis imperfecta. Which information obtained on the visit would cause the most concern? The client:
A. Likes to play football
B. Drinks carbonated drinks
C. Has two sisters
D. Is taking acetaminophen for pain

390. The client presents to the emergency room with a hyphema. Which action by the nurse would be appropriate?
A. Elevate the head of the bed and apply ice to the eye.
B. Place the client in a supine position and apply heat to the knee.
C. Insert a Foley catheter and measure the intake and output.
D. Perform a vaginal exam and check for a discharge

391. Four days after delivery, a client develops complications of post-partal hemorrhage. The most common cause of late postpartal hemorrhage is:
A. Uterine atony
B. Retained placental fragments
C. Cervical laceration
D. Perineal tears

392. The client with a pacemaker should be taught to:
A. Report ankle edema
B. Check his blood pressure daily
C. Refrain from using a microwave oven
D. Monitor his pulse rate

393. Which observation in the newborn of a diabetic mother would require immediate nursing intervention?
A. Crying
B. Wakefulness
C. Jitteriness
D. Yawning

394. While caring for a client with cervical cancer, the nurse notes that the radioactive implant is lying in the bed. The nurse should:
A. Place the implant in a biohazard bag and return it to the lab.
B. Give the client a pair of gloves and ask her to reinsert the implant.
C. Use tongs to pick up the implant and return it to a lead-lined container.
D. Discard the implant in the commode and double-flush.

395. A client having a colonoscopy is medicated with Versed (midazolam). The nurse recognizes that the client:
A. Will be able to remember the procedure within 2–3 hours
B. Will not be able to remember having the procedure done
C. Will be able to remember the procedure within 2–3 days
D. Will not be able to remember what occurred before the procedure

396. The leukemic client is prescribed a low-bacteria diet. Which does the nurse expect to be included in this diet?
A. Cooked spinach and sautéed celery
B. Lettuce and alfalfa sprouts
C. Fresh strawberries and whipped cream
D. Raw cauliflower or broccoli

397. The nurse is measuring the duration of the client’s contractions. Which statement is true regarding the measurement of the duration of contractions?
A. Duration is measured by timing from the beginning of one contraction to the beginning of the next contraction.
B. Duration is measured by timing from the end of one contraction to the beginning of the next contraction.
C. Duration is measured by timing from the beginning of one contraction to the end of the same contraction.
D. Duration is measured by timing from the peak of one contraction to the end of the same contraction.

398. The nurse is making initial rounds on a client with a C5 fracture. The client is in a halo vest and is receiving O2 at 40% via mask to a tracheostomy. Assessment reveals a respiratory rate of 40 and O2 saturation of 88. The client is restless. Which initial nursing action is most indicated?
A. Notifying the physician
B. Performing tracheal suctioning
C. Repositioning the client to the left side
D. Rechecking the client’s O2 saturation

399. The nurse is performing discharge teaching to the parents of a seven-year-old who has been diagnosed with asthma. Which sports activity would be most appropriate for this client?
A. Baseball
B. Swimming
C. Football
D. Track

400. A client has had diarrhea for the past three days. Which acid/base imbalance would the nurse expect the client to have?
A. Respiratory alkalosis
B. Metabolic acidosis
C. Metabolic alkalosis
D. Respiratory acidosis

401. The chart of a client with schizophrenia states that the client has echolalia. The nurse can expect the client to:
A. Speak using words that rhyme
B. Repeat words or phrases used by others
C. Include irrelevant details in conversation
D. Make up new words with new meanings

402. A female client is admitted for a CAT scan with contrast medium. Which of the following findings would prevent the client from having the ordered test?
A. Pregnancy
B. A titanium hip replacement
C. Allergy to eggs
D. Inability to lie still for 30 minutes

403. The nurse is preparing to discharge a client following a trabeculoplasty for the treatment of glaucoma. The nurse should instruct the client to:
A. Wash her eyes with baby shampoo and water twice a day
B. Take only tub baths for the first month following surgery
C. Begin using her eye makeup again one week after surgery
D. Wear eye protection for several months after surgery

404. A diagnosis of multiple sclerosis is often delayed because of the varied symptoms experienced by those affected with the disease. Which symptom is most common in those with multiple sclerosis?
A. Resting tremors
B. Double vision
C. Flaccid paralysis
D. “Pill-rolling” tremors

405. There is an order for a trough level to be drawn on the client receiving Vancocin (vancomycin). The nurse is aware that the lab should collect the blood:
A. 15 minutes after the infusion
B. Prior to the fourth infusion
C. One hour after the infusion
D. Two hours before the second infusion

406. The nurse is caring for a client with Lyme disease. The nurse should carefully monitor the client for signs of neurological complications, which include:
A. Complaints of a “drawing” sensation and paralysis on one side of the face
B. Presence of an unsteady gait, intention tremor, and facial weakness
C. Complaints of excruciating facial pain brought on by talking, smiling, or eating
D. Presence of fatigue when talking, dysphagia, and involuntary facial twitching

407. The parents of a child with cystic fibrosis ask what determines the prognosis of the disease. The nurse knows that the greatest determinant of the prognosis is:
A. The degree of pulmonary involvement
B. The ability to maintain an ideal weight
C. The secretion of lipase by the pancreas
D. The regulation of sodium and chloride excretion

408. The nurse is educating the lady’s club in self-breast exam. The nurse is aware that most malignant breast masses occur in the tail of Spence. On the diagram, place an X on the tail of Spence.

A. A
B. B
C. C
D. D

409. The nurse is preparing to receive a client from admitting with tumor lysis syndrome (TLS). Which of the following would the nurse expect to find on the laboratory and patient history sections of the chart?

Select all that apply.
I. Low blood pressure
II. Hyperactivity
III. Hyperkalemia
IV. Hyperuricemia
V. Mental changes
A. I, IV and V
B. II, IV and V
C. III, IV, and V
D. All of the Above

410. Which client clinical manifestation during a bone marrow transplantation procedure alerts the nurse to the possibility of an adverse reaction?
A. Fever
B. Red colored urine
C. Hypertension
D. Shortness of breath

411. During the change of shift report, the nurse states that the client’s last pulse strength was a 1+. The oncoming nurse recognizes that the client’s pulse was:
A. Bounding
B. Full
C. Normal
D. Weak

412. A patient with pulmonary tuberculosis is receiving combination therapy. To increase the effects of the medication, the patient may be given:
A. Inderal (propranolol)
B. Dilantin (phenytoin)
C. Benemid (probenecid)
D. Neoral (cyclosporine)

413. The physician has ordered intubation and mechanical ventilation for a client with periods of apnea following a closed head injury. Arterial blood gases reveal a pH of 7.47, PCO2 of 28, and HCO 3 of 23. These findings indicate that the client has:
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis

414. A child with Down syndrome has a developmental age of four years. According to the Denver Developmental Assessment, the four-year-old should be able to:
A. Draw a man in six parts
B. Give his first and last name
C. Dress without supervision
D. Define a list of words

415. A client with advanced Alzheimer’s disease has been prescribed haloperidol (Haldol). What clinical manifestation suggests that the client is experiencing side effects from this medication?
A. Cough
B. Tremors
C. Diarrhea
D. Pitting edema

416. The physician has prescribed tranylcypromine sulfate (Parnate) 10mg bid. The nurse should teach the client to refrain from eating foods containing tyramine because it may cause:
A. Hypertension
B. Hyperthermia
C. Hypotension
D. Urinary retention

417. A mother asks why her newborn has lost weight since his birth one week ago. The best explanation of weight loss in the newborn is:
A. The newborn is dehydrated.
B. The newborn is hypoglycemic.
C. The newborn is not used to the formula.
D. The newborn loses weigh because of the passage of meconium stools and loss of fluid.

418. The client is receiving total parenteral nutrition (TPN). Which lab test should be evaluated while the client is receiving TPN?
A. Hemoglobin
B. Creatinine
C. Blood glucose
D. White cell count

419. During morning assessments, the nurse finds that a client’s nephrostomy tube has been clamped. The nurse’s first action should be to:
A. Assess the drainage bag.
B. Check for bladder distention.
C. Unclamp the tubing.
D. Irrigate the tubing.

420. A client with cancer of the pancreas has undergone a Whipple procedure. The Whipple procedure includes the removal of:
A. The head of the pancreas
B. The proximal third of the small intestine
C. The stomach and duodenum
D. The esophagus and jejunum

421. The nurse is caring for a client with a cerebrovascular accident (CVA) who is complaining of being nauseated and is requesting an emesis basin. Which action would the nurse take first?
A. Administer an ordered antiemetic.
B. Obtain an ice bag and apply to the client’s throat.
C. Turn the client to one side.
D. Notify the physician.

422. Which of the following is an ocular change that may be found in the patient with hyperthyroidism?
A. Ptosis
B. Open angle glaucoma
C. Exophthalmos
D. Presbyopia

423. The doctor accidentally cuts the bowel during surgery. As a result of this action, the client develops an infection and suffers brain damage. The doctor can be charged with:
A. Negligence
B. Tort
C. Assault
D. Malpractice

424. The nurse is conducting a physical assessment on a client with anemia. Which of the following clinical manifestations would be most indicative of the anemia?
A. BP 146/88
B. Respirations 28 shallow
C. Weight gain of 10 pounds in six months
D. Pink complexion

425. The nurse would expect to find which drug prescribed for a patient diagnosed with ALS?
A. Amantadine hydrochloride (Symmetrel)
B. Riluzole (Rilutek)
C. Lisinopril (Zestril)
D. Estrodial (Estrogel)

426. An infant with a ventricular septal defect is discharged with a prescription for Lanoxin (digoxin) elixir 0.01mg PO q 12hrs. The bottle is labeled 0.10mg per 1/2 tsp. The nurse should instruct the mother to:
A. Administer the medication using a nipple.
B. Administer the medication using the calibrated dropper in the bottle.
C. Administer the medication using a plastic baby spoon.
D. Administer the medication in a baby bottle with 1oz. of water.

427. The physician has prescribed imipramine (Tofranil) for a client with depression. The nurse should continue to monitor the client’s affect because the maximal effects of tricyclic antidepressant medication do not occur for:
A. 48–72 hours
B. 5–7 days
C. 2–4 weeks
D. 3–6 months

428. The nurse is caring for the client who has been in a coma for two months. He has signed a donor card, but the wife is opposed to the idea of organ donation. How should the nurse handle the topic of organ donation with the wife?
A. Tell the wife that the hospital will honor her wishes regarding organ donation, but contact the organ-retrieval staff.
B. Tell her that because her husband signed a donor card, the hospital has the right to take the organs upon the death of her husband.
C. Explain that it is necessary for her to donate her husband’s organs because he signed the permit.
D. Refrain from talking about the subject until after the death of her husband.

429. Which statement is true regarding the measurement of fetal heart tones?
A. The normal range for FHT is 100–180 beats per minute.
B. A Doppler ultrasound can detect FHT at 18 to 20 weeks gestation.
C. FHT can be detected at eight weeks gestation using vaginal ultrasound.
D. A TOCO monitor is an invasive means of measuring FHT.

430. A client arrives in the emergency room after a motor vehicle accident. Witnesses tell the nurse that they observed the client’s head hit the side of the car door. Nursing assessment findings include BP 70/34, heart rate 130, and respirations 22. Based on the information provided, which is the priority nursing care focus?
A. Brain tissue perfusion
B. Regaining fluid volume
C. Clearance of the client’s airway
D. Measures to increase sensation

431. The client with enuresis is being taught regarding bladder retraining. The nurse should advise the client to refrain from drinking after:
A. 1900
B. 1200
C. 1000
D. 0700

432. The nurse knows that a 60-year-old female client’s susceptibility to osteoporosis is most likely related to:
A. Lack of exercise
B. Hormonal changes
C. Lack of calcium
D. Genetic predisposition

433. Which statement made by the student nurse indicates the need for further teaching regarding the administration of heparin?
A. I will administer the medication 1–2 inches away from the umbilicus.
B. I will not massage the injection site after administering the heparin.
C. I will check the PTT before administering the heparin.
D. I will need to gently aspirate when I give the heparin.

434. The nurse is caring for a neonate whose mother is diabetic. The nurse will expect the neonate to be:
A. Hypoglycemic, small for gestational age
B. Hyperglycemic, large for gestational age
C. Hypoglycemic, large for gestational age
D. Hyperglycemic, small for gestational age

435. The physician has ordered DDAVP (desmopressin acetate) for a client with diabetes insipidus. Which finding indicates that the medication is having its intended effect?
A. The client’s appetite has improved.
B. The client’s morning blood sugar was 120mg/dL.
C. The client’s urinary output has decreased.
D. The client’s activity level has increased.

436. The nurse is working in the trauma unit of the emergency room when a 24-year-old female is admitted after an MVA. The client is bleeding profusely and a blood transfusion is ordered. Which would the nurse be prepared to administer without a type and crossmatch?
A. AB positive
B. AB negative
C. O positive
D. O negative

437. Which action is contraindicated in the client with epiglottis?
A. Ambulation
B. Oral airway assessment using a tongue blade
C. Placing a blood pressure cuff on the arm
D. Checking the deep tendon reflexes.

438. Which of the following pediatric clients is at greatest risk for latex allergy?
A. The child with a myelomeningocele
B. The child with epispadias
C. The child with coxa plana
D. The child with rheumatic fever

439. A client is being discharged on Coumadin after hospitalization for a deep vein thrombosis. The nurse recognizes that which food would be restricted while the client is on this medication?
A. Lettuce
B. Apples
C. Potatoes
D. Macaroni

440. The teenager with a fiberglass cast asks the nurse if it will be okay to allow his friends to autograph his cast. Which response would be best?
A. It will be alright for your friends to autograph the cast.
B. Because the cast is made of plaster, autographing can weaken the cast.
C. If they don’t use chalk to autograph, it is okay.
D. Autographing or writing on the cast in any form will harm the cast.

441. While reading the progress notes on a client with cancer, the nurse notes a TNM classification of T1, N1, M0. What does this classification indicate?
A. The tumor is in situ, no regional lymph nodes are involved, and there is no metastasis.
B. No evidence of primary tumor exists, lymph nodes can’t be assessed, and metastasis can’t be assessed.
C. The tumor is extended, with regional lymph node involvement and distant metastasis.
D. The tumor is extended and regional lymph nodes are involved, but there is no metastasis.

442. The client admitted with angina is given a prescription for nitroglycerine. The client should be instructed to:
A. Replenish his supply every three months.
B. Take one every 15 minutes if pain occurs.
C. Leave the medication in the brown bottle.
D. Crush the medication and take with water.

443. While obtaining information about the client’s current medication use, the nurse learns that the client takes ginkgo to improve mental alertness. The nurse should tell the client to:
A. Report signs of bruising or bleeding to the doctor.
B. Avoid sun exposure while using the herbal supplement.
C. Purchase only those brands with FDA approval.
D. Increase daily intake of vitamin E.

444. The nurse is assisting the physician with removal of a central venous catheter. To facilitate removal, the nurse should instruct the client to:
A. Take a deep breath, hold it, and bear down as the catheter is withdrawn
B. Turn his head to the left side and hyperextend the neck
C. Take slow, deep breaths as the catheter is removed
D. Turn his head to the right while maintaining a sniffing position

445. The nurse has a preoperative order to administer Valium (diazepam) 10mg and Phenergan (promethazine) 25mg. The correct method of administering these medications is to:
A. Administer the medications together in one syringe
B. Administer the medications separately
C. Administer the Valium, wait five minutes, and then administer the Phenergan
D. Question the order because the medications should not be given to the same patient

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

447. A client seen in the doctor’s office for complaints of nausea and vomiting is sent home with directions to follow a clear-liquid diet for the next 24–48 hours. Which of the following is not permitted on a clear-liquid diet?
A. Sweetened tea
B. Chicken broth
C. Ice cream
D. Orange gelatin

448. A client’s admission history reveals complaints of fatigue, chronic sore throat, and enlarged lymph nodes in the axilla and neck. Which exam would assist the physician to make a tentative diagnosis of leukemia?
A. A complete blood count
B. An x-ray of the chest
C. A bone marrow aspiration
D. A CT scan of the abdomen

449. The home health nurse is visiting a client who plans to deliver her baby at home. Which statement by the client indicates an understanding regarding screening for phenylketonuria (PKU)?
A. "I will need to take the baby to the clinic within 24 hours of delivery to have blood drawn."
B. "I will need to schedule a home visit for PKU screening when the baby is three-days-old."
C. "I will remind the midwife to save a specimen of cord blood for the PKU test."
D. "I will have the PKU test done when I take her for her first immunizations."

450. A client is admitted with suspected abdominal aortic aneurysm (AAA). A common complaint of the client with an abdominal aortic aneurysm is:
A. Loss of sensation in the lower extremities
B. Back pain that lessens when standing
C. Decreased urinary output
D. Pulsations in the periumbilical area

451. The client delivered a nine-pound infant two days ago. An effective means of managing discomfort from an episiotomy is:
A. Medicated suppository
B. Taking a warm shower
C. Sitz baths
D. Ice packs

452. A home health nurse is planning for her daily visits. Which client should the home health nurse visit first?
A. A client with AIDS being treated with Foscavir (foscarnet)
B. A client with a fractured femur in a long leg cast
C. A client with a recent laryngectomy for laryngeal cancer
D. A client with diabetic ulcers to the left foot

453. The nurse is making initial rounds on a client with a C5 fracture stabilized by Crutchfield tongs. Which equipment should be kept at the bedside?
A. Forceps
B. Torque wrench
C. Wire cutters
D. Screwdriver

454. The RN is making assignments for the morning staff. Which client should be cared for by the RN?
A. A client with hemianopsia
B. A client with asterixis
C. A client with akathesia
D. A client with hemoptysis

455. A client with cirrhosis is receiving Cephulac (lactulose). The nurse is aware that Cephulac is given to lower:
A. Blood glucose
B. Uric acid
C. Ammonia
D. Creatinine

456. The nurse is teaching the client with polycythemia vera about prevention of complications of the disease. Which of the following statements by the client indicates a need for further teaching?
A. I will drink 500mL of fluid or less each day.
B. I will wear support hose.
C. I will check my blood pressure regularly.
D. I will report ankle edema.

457. The nurse is preparing to suction the client with a tracheotomy. The nurse notes a previously used bottle of normal saline on the client’s bedside table. There is no label to indicate the date or time of initial use. The nurse should:
A. Lip the bottle and use a pack of sterile 4×4 for the dressing
B. Obtain a new bottle and label it with the date and time of first use
C. Ask the ward secretary when the solution was requested
D. Label the existing bottle with the current date and time

458. A client is admitted to the emergency room with a gunshot wound to the right arm. After dressing the wound and administering the prescribed antibiotic, the nurse should:
A. Ask the client if he has any medication allergies.
B. Check the client’s immunization record.
C. Apply a splint to immobilize the arm.
D. Administer medication for pain.

459. In planning care for the patient with ulcerative colitis, the nurse identifies which nursing diagnosis as a priority?
A. Anxiety
B. Impaired skin integrity
C. Fluid volume deficit
D. Nutrition altered, less than body requirements

460. When assessing a laboring client, the nurse finds a prolapsed cord. The nurse should:
A. Attempt to replace the cord
B. Place the client on her left side
C. Elevate the client’s hips
D. Cover the cord with a dry, sterile gauze

461. A client who is admitted with an above-the-knee amputation tells the nurse that his foot hurts and itches. Which response by the nurse indicates understanding of phantom limb pain?
A. The pain will go away in a few days.
B. The pain is due to peripheral nervous system interruptions. I will get you some pain medication.
C. The pain is psychological because your foot is no longer there.
D. The pain and itching are due to the infection you had before the surgery.

462. The chart of a client hospitalized for a total hip repair reveals that the client is colonized with MRSA. The nurse understands that the client:
A. Will not display symptoms of infection
B. Is less likely to have an infection
C. Can be placed in the room with others
D. Cannot colonize others with MRSA

463. A client with paranoid schizophrenia is brought to the hospital by her elderly parents. During the assessment, the client’s mother states, “Sometimes she is more than we can manage.” Based on the mother’s statement, the most appropriate nursing diagnosis is:
A. Ineffective family coping related to parental role conflict
B. Care-giver role strain related to chronic situational stress
C. Altered family process related to impaired social interaction
D. Altered parenting related to impaired growth and development

464. The client returns to the recovery room following repair of an abdominal aneurysm. Which finding would require further investigation?
A. Pedal pulses regular
B. Urinary output 20mL in the past hour
C. Blood pressure 108/50
D. Oxygen saturation 97%

465. A client is having electroconvulsive therapy for treatment of severe depression. Which of the findings is expected during electroconvulsive therapy?
A. Loss of consciousness
B. Nausea and vomiting
C. Bradycardia
D. Tonic clonic seizure

466. A client with diabetes asks the nurse for advice regarding methods of birth control. Which method of birth control is most suitable for the client with diabetes?
A. Intrauterine device
B. Oral contraceptives
C. Diaphragm
D. Contraceptive sponge

467. A 25-year-old male is brought to the emergency room with a metal fragment in his eye. The first action the nurse should take is:
A. Use a magnet to remove the metal fragment.
B. Rinse the eye thoroughly with sterile saline.
C. Cover both eyes with a cupped object.
D. Place a patch over the affected eye.

468. The physician has ordered Nitrostat (nitroglycerin SL) tablets for a client with stable angina. The medication:
A. Slows contractions of the heart
B. Dilates coronary blood vessels
C. Increases the ventricular fill time
D. Strengthens contractions of the heart

469. The client returns to the unit from surgery with a blood pressure of 90/50, pulse 132, respirations 30. Which action by the nurse should receive priority?
A. Continue to monitor the vital signs
B. Contact the physician
C. Ask the client how he feels
D. Ask the LPN to continue the post-op care

470. The nurse is completing the preoperative checklist on a client scheduled for surgery and finds that the consent form has been signed, but the client is unclear about the surgery and possible complications. Which is the most appropriate action?
A. Call the surgeon and ask him to come see the client to clarify the information.
B. Explain the procedure and complications to the client.
C. Check in the physician’s progress notes to see if understanding has been documented.
D. Check with the client’s family to see if they understand the procedure fully.

471. Which complaint is frequently expressed by a client with macular degeneration?
A. Problems with activities requiring focused vision such as sewing
B. Severe eye and face pain accompanied by nausea and vomiting
C. Seeing halos around lights
D. Veil-like loss of vision

472. A client reports to the nurse that he believes he has an ulcer and wants to be checked for H. pylori. Which of the following medications in the client’s history could make the test invalid?
A. Omeprazole (Prilosec)
B. Furosemide (Lasix)
C. Propoxyphene napsylate (Darvocet)
D. Ibuprofen (Advil)

473. The nurse is teaching basic infant care to a group of first-time parents. The nurse should explain that a sponge bath is recommended for the first two weeks of life because:
A. New parents need time to learn how to hold the baby.
B. The umbilical cord needs time to separate.
C. Newborn skin is easily traumatized by washing.
D. The chance of chilling the baby outweighs the benefits of bathing.

474. A client with a history of diverticulitis complains of abdominal pain, fever, and diarrhea. Which food is most likely responsible for the client’s symptoms?
A. Mashed potatoes
B. Steamed carrots
C. Baked fish
D. Whole-grain cereal

475. An elderly female is admitted with a fractured right femoral neck. Which clinical manifestation would the nurse expect to find?
A. Free movement of the right leg
B. Abduction of the right leg
C. Internal rotation of the right hip
D. Shortening of the right leg

476. Which of the following findings is associated with right-sided heart failure?
A. Shortness of breath
B. Nocturnal polyuria
C. Daytime oliguria
D. Crackles in the lungs

477. A client has ataxia following a cerebral vascular accident. The nurse should:
A. Supervise the client’s ambulation.
B. Measure the client’s intake and output.
C. Request a consult for speech therapy.
D. Provide the client with a magic slate.

478. A client admitted to the psychiatric unit claims to be the Pope and insists that he will not be kept away from his followers. The most likely explanation for the client’s delusion is:
A. A reaction formation
B. A stressful event
C. Low self-esteem
D. Overwhelming anxiety

479. A client has an order to administer cisplatin (Platinol). Which drug would the nurse expect to be ordered to reduce renal toxicity from the cisplatin infusion?
A. Amifostine (Ethyol)
B. Dexrazoxane (Zinecard)
C. Mesna (Mesenex)
D. Pamidronate (Aredia)

480. The nurse on an orthopedic unit is assigned to care for four clients with displaced bone fractures. Which client will not be treated with the use of traction?
A. A client with fractures of the femur
B. A client with fractures of the cervical spine
C. A client with fractures of the humerus
D. A client with fractures of the ankle

481. An obstetrical client has just been diagnosed with cardiac disease. The nurse should give priority to:
A. Instructing the client to remain on strict bed rest
B. Telling the client to monitor her pulse and respirations
C. Instructing the client to check her temperature in the evening
D. Telling the client to weigh herself monthly

482. A client had a total thyroidectomy yesterday. The client is complaining of tingling around the mouth and in the fingers and toes. What would the nurses’ next action be?
A. Obtain a crash cart.
B. Check the calcium level.
C. Assess the dressing for drainage.
D. Assess the blood pressure for hypertension.

483. A client with cancer is experiencing a common side effect of chemotherapy administration. Which laboratory assessment finding would cause the most concern?
A. A sodium level of 50mg/dL
B. A blood glucose of 110mg/dL
C. A platelet count of 125,000/mm3
D. A white cell count of 5,000/mm3

484. The nurse is performing discharge teaching on a client at high risk for the development of skin cancer. Which instruction should be included in the client teaching?
A. “You should see the doctor every six months.”
B. “Sunbathing should be done between the hours of noon and 3 p.m.”
C. “If you have a mole, it should be removed and biopsied.”
D. “You should wear sunscreen when going outside.”

485. Which toy is best suited to the developmental skills of a one-year-old?
A. Pounding board
B. Pull toy
C. Soft books
D. Puzzle with large pieces

486. The nurse is assessing the chart of a client scheduled for surgery in the morning and finds that the consent form has been signed, but the client is unclear about the surgery and possible complications. Which is the most appropriate action?
A. Call the physician and ask him or her to clarify the information with the client.
B. Explain the procedure and complications to the client.
C. Check in the physician’s progress notes to see if client understanding has been documented.
D. Talk with the client’s family to determine if they understand the procedure fully.

487. A client with osteoporosis has a new prescription for alendronate (Fosamax). Which instruction should be given to the client?
A. Rest in bed after taking the medication for at least 30 minutes.
B. Avoid rapid movements after taking the medication.
C. Take the medication with water only.
D. Allow at least one hour between taking the medicine and taking other medications.

488. A client newly diagnosed with diabetes is started on Precose (acarbose). The nurse should tell the client that the medication should be taken:
A. one hour before meals
B. 30 minutes after meals
C. With the first bite of a meal
D. Daily at bedtime

489. A client with increased intracranial pressure is receiving Osmitrol (Mannitol) and Furosemide (Lasix). The nurse recognizes that these two drugs are given to reverse which effect?
A. Energy failure
B. Excessive intracellular calcium
C. Cellular edema
D. Excessive glutamate release

490. The nurse is caring for a client following the removal of a central line catheter when the client suddenly develops dyspnea and complains of substernal chest pain. The client is noticeably confused and fearful. Based on the client’s symptoms, the nurse should suspect which complication of central line use?
A. Myocardial infarction
B. Air embolus
C. Intrathoracic bleeding
D. Vagal response

491. Acticoat (silver nitrate) dressings are applied to the legs of a client with deep partial thickness burns. The nurse should:
A. Change the dressings once per shift.
B. Moisten the dressing with sterile water.
C. Change the dressings only when they become soiled.
D. Moisten the dressing with normal saline.

492. The nurse is caring for a patient following a thyroidectomy. Which of the following is an early symptom of hypocalcemia?
A. Positive Chvostek’s sign
B. 3+ deep tendon reflexes
C. Numbness or tingling of the toes and extremities
D. Prolonged ST and QT intervals

493. The nurse is providing dietary instructions to the mother of a fouryear-old diagnosed with celiac disease. Which food, if selected by the mother, would indicate her understanding of the dietary instructions?
A. Wheat toast
B. Spaghetti
C. Oatmeal
D. Rice

494. The vaginal exam of a laboring patient reveals that she is 3 cm dilated. Which of the following statements would the nurse expect the patient to make?
A. “I can’t decide what to name the baby.”
B. “It feels good to push with each contraction.”
C. “Don’t touch me. I’m trying to concentrate.”
D. “When can I get my epidural?”

495. The RN is planning client assignments. Which is the least appropriate task for the nursing assistant?
A. Assisting a COPD client admitted two days ago to get up in the chair.
B. Feeding a client with bronchitis who is paralyzed on the right side.
C. Accompanying a discharged emphysema client to the transportation area.
D. Assessing an emphysema client complaining of difficulty breathing.

496. The physician has ordered lab work for a client with suspected disseminated intravascular coagulation (DIC). Which lab finding would provide a definitive diagnosis of DIC?
A. Elevated erythrocyte sedimentation rate
B. Prolonged clotting time
C. Presence of fibrin split compound
D. Elevated white cell count

497. An elderly client is hospitalized for a transurethral prostatectomy. Which finding should be reported to the doctor immediately?
A. Hourly urinary output of 40–50mL
B. Bright red urine with many clots
C. Dark red urine with few clots
D. Requests for pain med every four hours

498. The physician ordered Zyprexa (olanzapine) for a patient with schizophrenia. Before administering the medication, the nurse should:
A. Ask the patient to void and measure the amount
B. Check the apical pulse rate
C. Check the temperature
D. Offer additional fluids

499. The mother of a child with chickenpox wants to know if there is a medication that will shorten the course of the illness. Which medication is sometimes used to speed healing of the lesions and shorten the duration of fever and itching?
A. Zovirax (acyclovir)
B. Varivax (varicella vaccine)
C. VZIG (varicella-zoster immune globulin)
D. Periactin (cyproheptadine)

500. The nurse on the neurological unit admits a patient with a newly diagnosed amyotrophic lateral sclerosis (ALS) disorder. Which does the nurse expect to assess in this patient?

Select all that apply.
I. Drooling
II. Weakness
III. Spasticity
IV. Diarrhea
V. Depression
VI. Pain
A. I, II, III, V and VI
B. IV only
C. I, II, III, IV and VI
D. All of the Above

501. A client on a mechanical ventilator begins to fight the ventilator. Which medication will be ordered for the client?
A. Sublimaze (fentanyl)
B. Pavulon (pancuronium bromide)
C. Versed (midazolam)
D. Atarax (hydroxyzine)

502. The nurse is assessing a client hospitalized with a duodenal ulcer. Which finding should be reported to the doctor immediately?
A. BP 82/60, pulse 120
B. Pulse 68, respirations 24
C. BP 110/88, pulse 56
D. Pulse 82, respirations 16

503. Which of the following statements best explains the rationale for placing the client in Trendelenburg position during the insertion of a central line catheter?
A. It will facilitate catheter insertion.
B. It will make the client more comfortable during the insertion.
C. It will prevent the occurrence of ventricular tachycardia.
D. It will prevent the development of pulmonary embolus.

504. A client who has glaucoma is to have miotic eye drops instilled in both eyes. The nurse knows that the purpose of the medication is to:
A. Anesthetize the cornea
B. Dilate the pupils
C. Constrict the pupils
D. Paralyze the muscles of accommodation

505. A client who had major abdominal surgery is having delayed healing of the wound. Which laboratory test result would most closely correlate with this problem?
A. Decreased albumin
B. Decreased creatinine
C. Increased calcium
D. Increased sodium

506. A mother tells the nurse that her daughter has become quite a collector, filling her room with Beanie babies, dolls, and stuffed animals. The nurse recognizes that the child is developing:
A. Object permanence
B. Post-conventional thinking
C. Concrete operational thinking
D. Pre-operational thinking

507. The nurse who is caring for a client with cancer notes a WBC of 500/mm3 on the laboratory results. Which intervention would be most appropriate to include in the client’s plan of care?
A. Assess temperature every four hours because of risk for hypothermia.
B. Instruct the client to avoid large crowds and people who are sick.
C. Instruct in the use of a soft toothbrush.
D. Assess for signs of bleeding.

508. The nurse is teaching circumcision care to the mother of a newborn. Which statement indicates that the mother needs further teaching?
A. I will apply a petroleum gauze to the area with each diaper change.
B. I will clean the area carefully with each diaper change.
C. I can place a heat lamp to the area to speed up the healing process.
D. I should carefully observe the area for signs of infection.

509. A client is admitted with sickle cell crises and sequestration. Upon assessing the client, the nurse would expect to find:
A. Decreased blood pressure
B. Moist mucus membranes
C. Decreased respirations
D. Increased blood pressure

510. A six-month-old is being treated for thrush with Nystatin (mycostatin) oral suspension. The nurse should administer the medication by:
A. Placing it in a small amount of applesauce
B. Using a cotton-tipped swab
C. Adding it to the infant’s formula
D. Placing it in 2–3oz. of water

511. The charge nurse overhears the patient care assistant speaking harshly to the client with dementia. The charge nurse should:
A. Change the nursing assistant’s assignment
B. Explore the interaction with the nursing assistant
C. Discuss the matter with the client’s family
D. Initiate a group session with the nursing assistant

512. The physician has prescribed Cyclogel (cyclopentolate hydrochloride) drops for a client following a scleral buckling. The nurse knows that the purpose of the medication is to:
A. Rest the muscles of accommodation
B. Prevent post-operative infection
C. Constrict the pupils
D. Reduce the production of aqueous humor

513. A nine-year-old is admitted with suspected rheumatic fever. Which finding is suggestive of Sydenham’s chorea?
A. Irregular movements of the extremities and facial grimacing
B. Painless swellings over the extensor surfaces of the joints
C. Faint areas of red demarcation over the back and abdomen
D. Swelling, inflammation, and effusion of the joints

514. A client with a history of phenylketonuria is seen at the local family planning clinic. After completing the client’s intake history, the nurse provides literature for a healthy pregnancy. Which statement indicates that the client needs further teaching?
A. I can help control my weight by switching from sugar to Nutrasweet.
B. I need to resume my old diet before becoming pregnant.
C. Fresh fruits and raw vegetables will make excellent between-meal snacks.
D. I need to eliminate most sources of phenylalanine from my diet.

515. Which clients can be assigned to share a room in the emergency department during a disaster?
A. A client with schizophrenia having visual and auditory hallucinations and the client with ulcerative colitis
B. The client who is six months pregnant with abdominal pain and the client with facial lacerations and fractured arm
C. A child whose pupils are fixed and dilated and his parents, and a client with a frontal head injury
D. The client who arrives with a large puncture wound to the abdomen and the client with chest pain

516. The physician orders lisinopril (Zestril) and furosemide (Lasix) to be administered concomitantly to the client with hypertension. The nurse should:
A. Question the order.
B. Administer the medications.
C. Administer separately.
D. Contact the pharmacy.

517. A client’s lab values reveal Hgb 12.6, WBC 6500cu.mm, K+ 1.9, uric acid 7.0, Na+ 136, and platelets 178,000cu.mm. The nurse evaluates that the client is experiencing which of the following?
A. Hypernatremia
B. Hypokalemia
C. Myelosuppression
D. Leukopenia

518. The client is instructed regarding foods that are low in fat and cholesterol. Which diet selection is lowest in saturated fats?
A. Macaroni and cheese
B. Shrimp with rice
C. Turkey breast
D. Spaghetti with meat sauce

519. The nurse in the ER has received report of four clients en route to the emergency department. Which client should the nurse see first? A client with:
A. Third-degree burns to the face and neck area, with singed nasal hairs
B. Second-degree burns to each leg and thigh area, who is alert and oriented
C. A chemical burn that has been removed and liberally flushed before admission
D. An electrical burn entering and leaving on the same side of the body

520. A client who uses a respiratory inhaler asks the nurse to explain how he can know when half his medication is empty so that he can refill his prescription. The nurse should tell the client to:
A. Shake the inhaler and listen for the contents.
B. Drop the inhaler in water to see if it floats.
C. Check for a hissing sound as the inhaler is used.
D. Press the inhaler and watch for the mist.

521. The physician has prescribed Novalog insulin for a client with diabetes mellitus. Which statement indicates that the client knows when the peak action of the insulin occurs?
A. I will make sure I eat breakfast within 10 minutes of taking my insulin.
B. I will need to carry candy or some form of sugar with me all the time.
C. I will eat a snack around three o’clock each afternoon.
D. I can save my dessert from supper for a bedtime snack.

522. A client with multiple sclerosis has an order to receive Solu Medrol 200mg IV push. The available dose is Solu Medrol 250mg per mL. How much medication will the nurse administer?
A. 0.5 mL
B. 0.8 mL
C. 1.1 mL
D. 1.4 mL

523. The nurse is caring for the client with a mastectomy. Which action would be contraindicated?
A. Taking the blood pressure on the side of the mastectomy
B. Elevating the arm on the side of the mastectomy
C. Positioning the client on the unaffected side
D. Performing a fingerstick on the unaffected side

524. Which instruction should be given to a client who is fitted with a behind-the-ear hearing aid?
A. Remove the ear mold and clean with alcohol
B. Avoid exposing the hearing aid to extremes in temperature
C. Use a cotton-tipped applicator to clean debris from the hole in the middle of the hearing aid
D. Continue to use cosmetics and spray cologne as before

525. The client who is two weeks post-burn with a 40% deep partial-thickness injury still has open wounds. The nurse’s assessment reveals the following findings: temperature 96.5°F, BP 87/40, and severe diarrhea stools. What problem does the nurse most likely suspect?
A. Findings are normal, not suspicious of a problem
B. Systemic gram—positive infection
C. Systemic gram—negative infection
D. Systemic fungal infection

526. The home health nurse is visiting a client with an exacerbation of rheumatoid arthritis. To prevent deformities of the knee joints, the nurse should:
A. Tell the client to walk without bending the knees.
B. Encourage movement within the limits of pain.
C. Instruct the client to sit only in a recliner.
D. Tell the client to remain in bed as long as the joints are painful.

527. The physician has ordered two units of whole blood for a client following surgery. To provide for client safety, the nurse should:
A. Obtain a signed permit for each unit of blood.
B. Use a new administration set for each unit transfused.
C. Administer the blood using a Y connector.
D. Check the blood type and Rh factor three times before initiating the transfusion.

528. 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.

529. The physician has ordered an injection of RhoGAM (Rho[D]immune globulin) for the postpartum client whose blood type is A negative and whose baby is O positive. To provide postpartum prophylaxis, RhoGAM should be administered:
A. Within 72 hours of delivery
B. Within one week of delivery
C. Within two weeks of delivery
D. Within one month of delivery

530. A client with hyperthyroidism is taking Eskalith (lithium carbonate) to inhibit thyroid hormone release. Which complaint by the client should alert the nurse to a problem with the client’s medication?
A. The client complains of blurred vision.
B. The client complains of increased thirst and increased urination.
C. The client complains of increased weight gain over the past year.
D. The client complains of rhinorrhea.

531. Before administering intravenous chemotherapy to the patient being treated, the nurse should:
A. Administer a bolus of IV fluid
B. Administer pain medication
C. Administer an antiemetic
D. Allow the patient a chance to eat

532. An elderly client has a stage II pressure ulcer on her sacrum. During assessment of the client’s skin, the nurse would expect to find:
A. A deep crater with a nonpainful wound base
B. A craterous area with a nonpainful wound base
C. Cracks and blisters with redness and induration
D. Nonblanchable redness with tenderness and pain

533. The client arrives in the emergency department after a motor vehicle accident. Nursing assessment findings include BP 68/34, pulse rate 130, and respirations 18. Which is the client’s most appropriate priority nursing diagnosis?
A. Alteration in cerebral tissue perfusion
B. Fluid volume deficit
C. Ineffective airway clearance
D. Alteration in sensory perception

534. The physician has ordered 50mEq of potassium chloride for a client with a potassium level of 2.5mEq/L. The nurse should administer the medication:
A. Slow, continuous IV push over 10 minutes
B. Continuous infusion over 30 minutes
C. Controlled infusion over five hours
D. Continuous infusion over 24 hours

535. The nurse is working on a neurological unit. If the following events occur simultaneously, which would receive RN priority?
A. A client with a cerebral aneurysm complains of sudden weakness on the right side.
B. A client with a suspected brain tumor complains of a frontal type headache.
C. A client post-op lumbar laminectomy vomits.
D. A client with Guillain-Barré syndrome has a temperature elevation.

536. The nurse is obtaining a history on a 74-year-old client. Which statement made by the client would most alert the nurse to a possible fluid and electrolyte imbalance?
A. “My skin is always so dry.”
B. “I often use a laxative for constipation.”
C. “I have always liked to drink a lot of water.”
D. “I sometimes have a problem with dribbling urine.”

537. The nurse is caring for a client with a closed reduction of a fractured femur. Which finding should the nurse report to the physician?
A. Chest pain and shortness of breath
B. Ecchymosis on the side of the injured leg
C. Oral temperature of 99.2°F
D. Complaints of level two pain on a scale of five

538. During the assessment of a laboring client, the nurse notes that the FHT are loudest in the upper-right quadrant. The infant is most likely in which position?
A. Right breech presentation
B. Right occipital anterior presentation
C. Left sacral anterior presentation
D. Left occipital transverse presentation

539. Which information should be given to the patient undergoing radiation therapy for breast cancer?
A. Avoid exposing radiation areas to sunlight during treatment time and for a year after completion of therapy
B. Moisturize the radiation site with oil-based lotion to prevent blistering
C. Use bath oil when tub bathing to prevent drying and peeling
D. Report redness and soreness of the area to the physician

540. A client has signs of increased intracranial pressure. Which one of the following is an early indicator of deterioration in the client’s condition?
A. Widening pulse pressure
B. Decrease in the pulse rate
C. Dilated, fixed pupils
D. Decrease in level of consciousness

541. The nurse is developing a plan for bowel and bladder retraining for a client with paraplegia. The primary goal of a bowel and bladder retraining program is:
A. Optimal restoration of the client’s elimination pattern
B. Restoration of the client’s neurosensory function
C. Prevention of complications from impaired elimination
D. Promotion of a positive body image

542. The nurse is caring for a client post-myocardial infarction on the cardiac unit. The client is exhibiting symptoms of shock. Which clinical manifestation is the best indicator that the shock is cardiogenic rather than anaphylactic?
A. BP 90/60
B. Chest pain
C. Increased anxiety
D. Temp 98.6°F

543. The nurse is caring for a client who was admitted to the burn unit four hours after the injury with second-degree burns to the trunk and head. Which finding would the nurse least expect to find during this time period?
A. Hypovolemia
B. Laryngeal edema
C. Hypernatremia
D. Hyperkalemia

544. A client who has been receiving Urokinase (uPA) for deep vein thrombosis is noted to have dark brown urine in the urine collection bag. Which action should the nurse take immediately?
A. Prepare an injection of vitamin K
B. Irrigate the urinary catheter with 50 mL of normal saline
C. Offer the client additional oral fluids
D. Withhold the medication and notify the physician

545. The nurse should visit which of the following clients first?
A. The client with diabetes with a blood glucose of 95mg/dL
B. The client with hypertension being maintained on Zestril (lisinopril)
C. The client with chest pain and a history of angina
D. The client with Raynaud’s disease

546. A client diagnosed with COPD is receiving theophylline (Theodur). Morning laboratory values reveal a theophylline level of 38mcg/mL. Which is the most appropriate nursing action?
A. Take no action; this is within normal range.
B. Notify the physician of the level results.
C. Administer Narcan 2mg IV push stat.
D. Give the client an extra dose of the medication.

547. Which information obtained from the mother of a child with cerebral palsy correlates to the diagnosis?
A. She was born at 40 weeks gestation.
B. She had meningitis when she was six months old.
C. She had physiologic jaundice after delivery.
D. She has frequent sore throats.

548. The nurse is caring for a client with a head injury who has increased ICP. The physician plans to reduce the cerebral edema by constricting cerebral blood vessels. Which physician order would serve this purpose?
A. Hyperventilation per mechanical ventilation
B. Insertion of a ventricular shunt
C. Furosemide (Lasix)
D. Solu medrol

549. Which of the following combinations of foods is appropriate for an eight-month-old infant?
A. Cocoa-flavored cereal, orange juice, and strained meat
B. Graham crackers, strained prunes, and pudding
C. Rice cereal, bananas, and strained carrots
D. Mashed potatoes, strained beets, and whole milk

550. A client with hepatitis C who has cirrhosis changes has just returned from a liver biopsy. The nurse will place the client in which position?
A. Trendelenburg
B. Supine
C. Right side-lying
D. Left Sim’s

551. The physician has ordered Pentam (pentamidine) IV for a client with pneumocystis jiroveci. While receiving the medication, the nurse should carefully monitor the client’s:
A. Blood pressure
B. Temperature
C. Heart rate
D. Respirations

552. A client is admitted to the emergency room after falling down a flight of stairs. Initial assessment reveals a large bump on the front of the head and a two-inch laceration above the right eye. Which finding is consistent with injury to the frontal lobe?
A. Complaints of blindness
B. Decreased respiratory rate and depth
C. Failure to recognize touch
D. Inability to identify sweet taste

553. Which type of endotracheal tube is recommended by the Centers for Disease Control (CDC) for reducing the risk of ventilator-associated pneumonia?
A. Uncuffed
B. CASS
C. Fenestrated
D. Nasotracheal

554. A student in a cardiac unit is performing auscultation of a client’s heart. Which stethoscope placement would indicate to the nurse that the student is performing pulmonic auscultation correctly?
A. Between the apex and the sternum
B. At the fifth intercostal space at the left midclavicular line
C. At the second intercostal space, left of the sternum
D. At the manubrium area of the chest

555. A client is being monitored using a central venous pressure monitor. If the CVP is 1 cm of water, the nurse should:
A. Notify the physician immediately
B. Slow the intravenous infusion
C. Auscultate the lungs for rales
D. Administer a diuretic

556. Which nursing assessment indicates that involutional changes have occurred in a client who is three days postpartum?
A. The fundus is firm and three finger widths below the umbilicus.
B. The client has a moderate amount of lochia serosa.
C. The fundus is firm and even with the umbilicus.
D. The uterus is approximately the size of a small grapefruit.

557. Which of the following statements describes Piaget’s stage of concrete operations?
A. Reflex activity proceeds to imitative behavior.
B. The ability to see another’s point of view increases.
C. Thought processes become more logical and coherent.
D. The ability to think abstractly leads to logical conclusion.

558. The mother of a six-year-old with autistic disorder tells the nurse that her son has been much more difficult to care for since the birth of his sister. The best explanation for changes in the child’s behavior is:
A. The child did not want a sibling.
B. The child was not adequately prepared for the baby’s arrival.
C. The child’s daily routine has been upset by the birth of his sister.
D. The child is just trying to get the parent’s attention.

559. A client with a gastrointestinal bleed has an NG tube to low continuous wall suction. Which technique is the correct procedure for the nurse to utilize when assessing bowel sounds?
A. Obtain a sample of the NG drainage and test the pH.
B. Clamp the tube while listening to the abdomen with a stethoscope.
C. Irrigate the tube with 30mL of NS while auscultating the abdomen.
D. Turn the suction on high and auscultate over the naval area.

560. A client receiving Vancocin (vancomycin) has a serum level of 20mcg/mL. The nurse knows that the therapeutic range for vancomycin is:
A. 5–10mcg/mL
B. 10–25mcg/mL
C. 25–40mcg/mL
D. 40–60mcg/mL

561. The nurse is performing a history on a client admitted for surgery in the morning. Which long-term medication in the client’s history would be most important to report to the physician?
A. Prednisone
B. Lisinopril (Zestril)
C. Docusate (Colace)
D. Oscal D

562. Which clinical manifestations would the nurse expect a client with a diagnosis of acute osteomyelitis to exhibit?

Select all that apply.
I. Normal sedimentation rate
II. Pain and fever
III. Low blood count
IV. Tenderness in affected area
V. Edema and pus from the wound
A. I, III and V
B. V only
C. II, III and V
D. II, IV, and V

563. A nurse is triaging in the emergency room when a client enters complaining of muscle cramps and a feeling of exhaustion after a running competition. Which of the following would the nurse suspect?
A. Hypernatremia
B. Hyponatremia
C. Hyperkalemia
D. Hypokalemia

564. Which nursing action is specific to the care of the client in a body cast?
A. Auscultating bowel sounds
B. Assessing the blood pressure
C. Offering pain medication as needed
D. Assessing for swelling in the upper extremities

565. The physician has ordered continuous bladder irrigation for a client following a prostatectomy. The nurse should:
A. Hang the solution 2–3 feet above the client’s abdomen.
B. Allow air from the solution tubing to flow into the catheter.
C. Use a clean technique when attaching the solution tubing to the catheter.
D. Clamp the solution tubing periodically to prevent bladder distention.

566. The surgical nurse is preparing a patient for surgery on the lower abdomen. In which position would the nurse most likely place the client for surgery on this area?
A. Lithotomy
B. Sim’s
C. Prone
D. Trendelenburg

567. A client with in situ bladder cancer is receiving intravesical therapy using BCG. During treatment, the nurse should:
A. Ask the client to remain still after the medication is instilled.
B. Offer the client additional oral fluids.
C. Ask the client to change positions every fifteen minutes.
D. Ask the client to void every hour.

568. The physician has ordered Betoptic (betaxolol) ophthalmic suspension for a patient with open angle glaucoma. Which statement is true regarding the medication?
A. Optic suspensions of Betoptic have no systemic side effects.
B. Betoptic is safe for use by patients who have a history of congestive heart failure.
C. Betoptic decreases the effects of insulin.
D. Betoptic may cause dizziness or vertigo.

569. A two-year-old is being evaluated for hearing loss. Which finding in the child’s history is likely to be a significant factor?
A. Birth at 36 weeks gestation
B. Maternal history of hypertension
C. Birth weight of 6 pounds 6 ounces
D. Meningitis treated with intravenous garamycin

570. The nurse is assessing the client with a total knee replacement two hours post-operative. Which information requires notification of the doctor?
A. Scant bleeding on the dressing
B. Low-grade temperature
C. Hemoglobin of 7gm/dL
D. Urine output of 120mL during the last hour

571. The nurse is preparing a client for cervical uterine radiation implant insertion. Which will be included in the teaching plan?
A. TV or telephone use will not be allowed while the implant is in place.
B. A Foley catheter is usually inserted.
C. A high-fiber diet is recommended.
D. Excretions will be considered radioactive.

572. The physician has ordered Dextrose 5% in normal saline for an infant admitted with gastroenteritis. The advantage of administering the infant’s IV through a scalp vein is:
A. The infant can be held and comforted more easily.
B. Dextrose is best absorbed from the scalp veins.
C. Scalp veins do not infiltrate like peripheral veins.
D. There are few pain receptors in the infant’s scalp.

573. The nurse is caring for a 70-year-old client with hypovolemia who is receiving a blood transfusion. Assessment findings reveal crackles on chest auscultation and distended neck veins. What is the nurse’s initial action?
A. Slow the transfusion.
B. Document the finding as the only action.
C. Stop the blood transfusion and turn on the normal saline.
D. Assess the client’s pupils.

574. A high school student returns to school following a three-week absence due to mononucleosis. The school nurse knows it will be important for the client:
A. To drink additional fluids throughout the day
B. To avoid contact sports for 1–2 months
C. To have a snack twice a day to prevent hypoglycemia
D. To continue antibiotic therapy for six months

575. A client is admitted with a tumor in the parietal lobe. Which symptoms would be expected due to this tumor’s location?
A. Hemiplegia
B. Aphasia
C. Paresthesia
D. Nausea

576. The nurse is performing an assessment on an elderly client who had a total hip repair this morning. Which assessment finding indicates that the patient is in pain?
A. The client’s blood pressure is 130/86.
B. The client is unable to concentrate.
C. The client’s pupils are dilated.
D. The client grimaces during care.

577. The nurse is caring for a client following a laryngectomy. The nurse can best help the client with communication by:
A. Providing a pad and pencil
B. Checking on him every 30 minutes
C. Telling him to use the call light
D. Teaching the client simple sign language

578. A community health nurse is teaching healthful lifestyles to a group of senior citizens. The nurse knows that the leading cause of death in persons 65 and older is:
A. Chronic pulmonary disease
B. Diabetes mellitus
C. Pneumonia
D. Heart disease

579. Which of the following statements is true regarding language development of young children?
A. Infants can discriminate speech from other patterns of sound.
B. Boys are more advanced in language development than girls of the same age.
C. Second-born children develop language earlier than first-born or only children.
D. Using single words for an entire sentence suggests delayed speech development.

580. The nurse is caring for a cognitively impaired client who begins to pull at the tape securing his IV site. To lessen the likelihood of the client dislodging the IV, the nurse should:
A. Place tape completely around the extremity, with taped ends out of the client’s vision.
B. Tell him that if he pulls out the IV, it will have to be restarted.
C. Apply clove hitch restraints to the client’s hands.
D. Wrap the IV site loosely with Kerlix to remove it from his site.

581. When performing Leopold maneuvers on a client at 32 weeks gestation, the nurse would expect to find:
A. No fetal movement
B. Minimal fetal movement
C. Moderate fetal movement
D. Active fetal movement

582. A temporary colostomy is performed on the client with colon cancer. The nurse is aware that the proximal end of a double barrel colostomy:
A. Opens on the left side of the abdomen
B. Will produce only mucus
C. Opens on the right side of the abdomen
D. Will be bluish colored in appearance

583. The nurse is completing admission on a client with possible esophageal cancer. Which finding would not be common for this diagnosis?
A. Foul breath
B. Dysphagia
C. Diarrhea
D. Chronic hiccups

584. The nurse is developing a plan of care for a client with a newly created ileostomy. The priority nursing diagnosis for this client is:
A. Risk for deficient fluid volume related to excessive fluid loss from ostomy
B. Disturbed body image related to presence of ostomy
C. Risk for impaired skin integrity related to irritation from ostomy appliance
D. Deficient knowledge of ostomy care related to unfamiliarity with information resources

585. A client is four hours post-op left carotid endarterectomy. Which assessment finding would cause the nurse the most concern?
A. Temperature 99.4°F, heart rate 110, respiratory rate 24
B. Drowsiness, urinary output of 50mL in the past hour
C. BP 120/60, lethargic, right-sided weakness
D. Alert and oriented, BP 168/96, heart rate 70

586. Vaginal exam of a term gravida 2 para 1 reveals a breech presentation. The nurse should take which action at this time?
A. Prepare the client for a Caesarean section
B. Apply the fetal heart monitor
C. Place the client in the Trendelenburg position
D. Perform an ultrasound exam

587. The primary reason for rapid continuous rewarming of the area affected by frostbite is to:
A. Lessen the amount of cellular damage
B. Prevent the formation of blisters
C. Promote movement
D. Prevent pain and discomfort

588. A burn client begins treatments with silver sulfadiazine (Silvadene) applied to the wounds. The nurse should carefully monitor for which adverse affect associated with this drug?
A. Hypokalemia
B. Leukopenia
C. Hyponatremia
D. Thrombocytopenia

589. A client is caring for a client with irritable bowel syndrome. Irritable bowel syndrome is characterized by:
A. Development of pouches in the wall of the intestine
B. Alternating bouts of constipation and diarrhea
C. Swelling, thickening, and abscess formation
D. Hypocalcemia and iron-deficiency anemia

590. A client with end-stage renal failure receives hemodialysis via an arteriovenous fistula (AV) placed in the right arm. When caring for the client, the nurse should:
A. Take the blood pressure in the right arm above the AV fistula.
B. Flush the AV fistula with IV normal saline to keep it patent.
C. Auscultate the AV fistula for the presence of a bruit.
D. Perform needed venopunctures distal to the AV fistula.

591. A client with cancer and metastasis to the bone is admitted to the hospital. Which symptom of hypercalcemia causes the nurse the most concern?
A. Weakness
B. Anorexia
C. Flaccid muscles
D. Cardiac changes

592. The doctor has prescribed Claritin (loratidine) for a client with seasonal allergies. The feature that separates Claritin from other antihistamines such as Benadryl (diphenhydramine) is that the medication:
A. Is nonsedating
B. Stimulates appetite
C. Is used for motion sickness
D. Is less expensive

593. The client is being evaluated for possible acute leukemia. Which inquiry by the nurse is most important?
A. Have you noticed a change in sleeping habits recently?
B. Have you had a respiratory infection in the last six months?
C. Have you lost weight recently?
D. Have you noticed changes in your alertness?

594. Which of the following assessment findings raises concern for a child with sickle cell anemia?
A. He enjoys playing baseball with the school team.
B. He drinks several carbonated drinks per day.
C. He requires eight to ten hours sleep a night.
D. He occasionally uses ibuprofen to control minor pain.

595. A 65-year-old client is admitted after a stroke. Which nursing intervention would best improve tissue perfusion to prevent skin problems?
A. Assessing the skin daily for breakdown
B. Massaging any erythematous areas on the skin
C. Changing incontinence pads as soon as they become soiled with urine or feces
D. Performing range-of-motion exercises and turning and repositioning the client

596. A home health nurse is visiting a client who is receiving diuretic therapy for congestive heart failure. Which medication places the client at risk for the development of hypokalemia?
A. Aldactone (spironolactone)
B. Demadex (torsemide)
C. Dyrenium (triamterene)
D. Midamor (amiloride hydrochloride)

597. A client is discharged home with a prescription for Coumadin (sodium warfarin). The client should be instructed to:
A. Avoid antihistamines containing diphenhydramine
B. Increase the intake of all vegetables
C. Have a PTT checked monthly
D. Have a CBC drawn every six months

598. A client with acute respiratory distress syndrome (ARDS) is placed on mechanical ventilation. To increase ventilation and perfusion to all areas of the lungs, the nurse should:
A. Tell the client to inhale deeply during the inspiratory cycle.
B. Turn the client every hour.
C. Breathe as quickly as possible
D. Breathe as quickly as possible

599. The initial assessment of a newborn reveals a chest circumference of 34cm and an abdominal circumference of 31cm. The chest is asymmetrical and breath sounds are diminished on the left side. The nurse should give priority to:
A. Providing supplemental oxygen by a ventilated mask
B. Performing auscultation of the abdomen for the presence of active bowel sounds
C. Inserting a nasogastric tube to check for esophageal patency
D. Positioning on the left side with head and chest elevated

600. The nurse is doing bowel and bladder retraining for the client with paraplegia. Which of the following is not a factor for the nurse to consider?
A. Diet pattern
B. Mobility
C. Fluid intake
D. Sexual function

601. Which diet would the nurse expect to see ordered for a patient with nephrotic syndrome?
A. Low carbohydrate potassium
B. Moderate protein
C. Low calcium
D. Increased potassium

602. The nurse is discharging a client with asthma who has a prescription for zafirlukast (Accolate). Which comment by the client would indicate a need for further teaching?
A. “I should take this medication with meals.”
B. “I need to report flu-like symptoms to my doctor.”
C. “My doctor might order liver tests while I’m on this drug.”
D. “If I’m already having an asthma attack, this drug will not stop it.”

603. The nurse is assessing a client with an altered level of consciousness. One of the first signs of altered level of consciousness is:
A. Inability to perform motor activities
B. Complaints of double vision
C. Restlessness
D. Unequal pupil size

604. The blood alcohol concentration of a client admitted following a motor vehicle accident is 460mg/dL. The nurse should give priority to monitoring the client for:
A. Loss of coordination
B. Respiratory depression
C. Visual hallucinations
D. Tachycardia

605. A client with prostate cancer is being treated with iridium seed implants. The nurse’s discharge teaching should include telling the client to:
A. Strain his urine
B. Increase his fluid intake
C. Report urinary frequency
D. Avoid prolonged sitting

606. A client is admitted with suspected Hodgkin’s lymphoma. The diagnosis is confirmed by the:
A. Overproliferation of immature white cells
B. Presence of Reed-Sternberg cells
C. Increased incidence of microcytosis
D. Reduction in the number of platelets

607. A vaginal exam reveals that the cervix is 4 cm dilated, with intact membranes and a fetal heart tone rate of 160–170bpm. The nurse decides to apply an external fetal monitor. The rationale for this implementation is:
A. The cervix is closed.
B. The membranes are still intact.
C. The fetal heart tones are within normal limits.
D. The contractions are intense enough for insertion of an internal monitor.

608. The physician has prescribed Gantrisin (sulfasoxazole) 1gm in divided doses for a client with a urinary tract infection. The nurse should administer the medication:
A. With meals or a snack
B. 30 minutes before meals
C. 30 minutes after meals
D. At bedtime

609. A client with hypertension has begun an aerobic exercise program. The nurse should tell the client that the recommended exercise regimen should begin slowly and build up to:
A. 20–30 minutes three times a week
B. 45 minutes two times a week
C. One hour four times a week
D. One hour two times a week

610. A client with a head injury develops syndrome of inappropriate antidiuretic hormone (SIADH). Which physician prescription would the nurse question?
A. D5W at 200mL/hr
B. Demeclocycline (Declomycin) 150mg Q6h
C. Daily weights
D. Monitor intake and output

611. A client with Alzheimer’s disease has been prescribed donepezil (Aricept). Which information should the nurse include in the teaching plan for a client on Aricept?
A. “Take the medication with meals.”
B. “The medicine can cause dizziness, so rise slowly.”
C. “If a dose is skipped, take two the next time.”
D. “The pill can cause an increase in heart rate.”

612. The client is admitted with left-sided congestive heart failure. In assessing the client for edema, the nurse should check the:
A. Feet
B. Neck
C. Hands
D. Sacrum

613. A client admitted with gastroenteritis and a potassium level of 2.9mEq/dL has been placed on telemetry. Which ECG finding would the nurse expect to find due to the client’s potassium results?
A. A depressed ST segment
B. An elevated T wave
C. An absent P wave
D. A flattened QRS

614. The client is having a cardiac catheterization. During the procedure, the client tells the nurse, “I’m feeling really hot.” What is the correct explanation for the client’s statement?
A. He is having an allergic reaction to the contrast media.
B. A feeling of warmth is normal when the contrast media is injected.
C. “The feeling of warmth” indicates that the clots in the coronary vessels are dissolving.
D. He has increased anxiety due to the invasive procedure.

615. The nurse is assessing a recently admitted newborn. Which finding should be reported to the physician?
A. The umbilical cord contains three vessels.
B. The newborn has a temperature of 98°F.
C. The feet and hands are bluish in color.
D. A large, soft swelling crosses the suture line.

616. The first action that the nurse should take if she finds the client has an Oxygen saturation of 68% is:
A. Elevate the head.
B. Recheck the O2 saturation in 30 minutes.
C. Apply oxygen by mask.
D. Assess the heart rate.

617. A client with suspected leukemia is to undergo a bone marrow aspiration. The nurse plans to include which statement in the teaching session?
A. “You will be lying on your abdomen for the examination procedure.”
B. “Portions of the procedure will cause pain or discomfort.”
C. “You will be given some medication to cause amnesia of the test.”
D. “You will not be able to drink fluids for 24 hours before the study.”

618. The nurse is caring for an adolescent with a five-year history of bulimia. A common clinical finding in the client with bulimia is:
A. Extreme weight loss
B. Dental caries
C. Hair loss
D. Decreased temperature

619. Which roommate would be most suitable for the six-year-old male with a fractured femur in Russell’s traction?
A. Sixteen-year-old male with leukemia
B. Twelve-year-old male with a fractured humerus
C. Ten-year-old male with sarcoma
D. Six-year-old male with osteomyelitis

620. The nurse is caring for a client scheduled for repair of an abdominal aortic aneurysm. Which pre-op assessment is most important?
A. Level of anxiety
B. Exercise tolerance
C. Quality of peripheral pulses
D. Bowel sounds

621. A client is admitted with acute adrenal crisis. During the intake assessment, the nurse can expect to find that the client has:
A. Low blood pressure
B. A slow, regular pulse
C. Warm, flushed skin
D. Increased urination

622. The physician has ordered an amniocentesis to determine the L/S ratio. The L/S ratio is a reliable indicator of:
A. Renal function
B. Rh isoimmunization
C. Fetal lung maturity
D. Anatomical abnormalities

623. While assessing the postpartal client, the nurse notes that the fundus is displaced to the right. Based on this finding, the nurse should:
A. Ask the client to void
B. Assess the blood pressure for hypotension
C. Administer oxytocin
D. Check for vaginal bleeding

624. The physician has made a diagnosis of "shaken child"syndrome for a 13-month-old who was brought to the emergency room after a reported fall from his highchair. Which finding supports the diagnosis of "shaken child"syndrome?
A. Fracture of the clavicle
B. Periorbital bruising
C. Retinal hemorrhages
D. Fracture of the humerus

625. A client is diagnosed with stage II Hodgkin’s lymphoma. The nurse recognizes that the client has involvement:
A. In a single lymph node or single site
B. In more than one node or single organ on the same side of the diaphragm
C. In lymph nodes on both sides of the diaphragm
D. In disseminated organs and tissues

626. The nurse is caring for a client with pancreatitis has been transferred to the intensive care unit. The nurse assesses a pulmonary arterial wedge pressure (PAWP) of 14mmHg. Based on this finding, the nurse would want to further assess for what additional correlating wedge pressure data?
A. A drop in blood pressure
B. Rales on chest auscultation
C. A temperature elevation
D. Dry mucous membranes

627. The RN is making assignments for clients hospitalized on a neurological unit. Which client should be assigned to the LPN?
A. A client with a C3 injury immobilized by Crutchfield tongs
B. A client with exacerbation of multiple sclerosis
C. A client with a lumbar laminectomy
D. A client with hemiplegia and a urinary tract infection

628. A client has recently been diagnosed with primary open-angle glaucoma. The nurse should tell the client to avoid taking:
A. Aleve (naprosyn)
B. Benadryl (diphenhydramine)
C. Tylenol (acetaminophen)
D. Robitussin (guaifenesin)

629. The nurse is caring for an eight-year-old following a routine tonsillectomy. Which finding should be reported immediately?
A. Reluctance to swallow
B. Drooling of blood-tinged saliva
C. An axillary temperature of 99°F
D. Respiratory stridor

630. A 33-year-old male is being evaluated for possible acute leukemia. Which of the following findings is most likely related to the diagnosis of leukemia?
A. The client collects stamps as a hobby.
B. The client recently lost his job as a postal worker.
C. The client had radiation for treatment of Hodgkin’s disease as a teenager.
D. The client’s brother had leukemia as a child.

631. The nurse is assessing the vital signs of a client with pancreatic cancer. In addition to routine vital signs, the nurse assesses the fifth vital sign of:
A. Anorexia
B. Pain
C. Insomnia
D. Fatigue

632. The nurse is assessing the integumentary system of a dark-skinned individual. Which area would be the most likely to show a skin cancer lesion?
A. Chest
B. Arms
C. Face
D. Palms

633. The nurse is performing a breast exam on a client when she discovers a mass. Which characteristic of the mass would best indicate a reason for concern?
A. Tender to the touch
B. Regular shape
C. Moves easily
D. Firm to the touch

634. The effectiveness of the oxygen therapy is best determined by:
A. The rate of respirations
B. The absence of cyanosis
C. Arterial blood gases
D. The level of consciousness

635. Which statement is true regarding therapy with Levemir (insulin detemir)?
A. The onset is 1–2 hours.
B. It may be mixed with regular insulin.
C. It peaks in 2–3 hours.
D. The duration is 24 hours.

636. The client is admitted to the emergency room with shortness of breath, anxiety, and tachycardia. His ECG reveals atrial fibrillation with a ventricular response rate of 130 beats per minute. The doctor orders quinidine sulfate. While he is receiving quinidine, the nurse should monitor his ECG for:
A. Peaked P wave
B. Elevated ST segment
C. Inverted T wave
D. Prolonged QT interval

637. An obstetrical client with diabetes has an amniocentesis at 28 weeks gestation. Which test indicates the degree of fetal lung maturity?
A. Alpha-fetoprotein
B. Estriol level
C. Indirect Coombs
D. Lecithin sphingomyelin ratio

638. Which action by the healthcare worker indicates a need for further teaching?
A. The nursing assistant ambulates the elderly client using a gait belt.
B. The nurse wears goggles while performing a venopuncture.
C. The nurse washes his hands after changing a dressing.
D. The nurse wears gloves to monitor the IV infusion rate.

639. A client with an abdominal aortic aneurysm is admitted in preparation for surgery. Which finding should be reported to the doctor?
A. A WBC of 14,000 cu.mm
B. Auscultation of abdominal bruit
C. Complaints of lower back pain
D. A platelet count of 175,000 cu.mm

640. Which instruction should be given to the client who is self-administering Lovenox (enoxaparin)?
A. Inject the medication into the deltoid muscle
B. Inject the medication into the abdomen
C. Aspirate before administering the medication
D. Clear the air from the syringe before administering the medication

641. The physician has prescribed Oxycontin (oxycodone) for a client following an exploratory laparotomy. Which of the following is an adverse effect associated with the medication?
A. Pulmonary edema
B. Increased blood pressure
C. Nervousness
D. Rapid pulse

642. A client with schizoaffective disorder is exhibiting Parkinsonian symptoms. Which medication is responsible for the development of Parkinsonian symptoms?
A. Zyprexa (olanzapine)
B. Cogentin (benzatropine mesylate)
C. Benadryl (diphenhydramine)
D. Depakote (divalproex sodium)

643. The nurse is preparing to administer regular insulin by continuous IV infusion to a client with diabetic ketoacidosis. The nurse should:
A. Mix the insulin with Dextrose 5% in water.
B. Flush the IV tubing with the insulin solution and discard the first 50mL.
C. Avoid using a pump or controller with the infusion.
D. Mix the insulin with Ringer’s lactate.

644. Physician’s orders for a client with acute pancreatitis include the following: strict NPO and nasogastric tube to low intermittent suction. The nurse recognizes that withholding oral intake will:
A. Reduce the secretion of pancreatic enzymes
B. Decrease the client’s need for insulin
C. Prevent the secretion of gastric acid
D. Eliminate the need for pain medication

645. The doctor has ordered Percocet (oxycodone) for a client following abdominal surgery. The primary objective of nursing care for the client receiving an opiate analgesic is:
A. Preventing addiction
B. Alleviating pain
C. Facilitating mobility
D. Preventing nausea

646. The nurse is making assignments for the day. The staff consists of an RN, an LPN, and a nursing assistant. Which client could the nursing assistant care for?
A. A client with Alzheimer’s disease
B. A client with pneumonia
C. A client with cirrhosis
D. A client with thrombophlebitis

647. A client is admitted with suspected Guillain-Barre syndrome. The nurse would expect the cerebrospinal fluid (CSF) analysis to reveal which of the following to confirm the diagnosis?
A. CSF protein of 10mg/dL and WBC 2 cells/mm3
B. CSF protein of 60mg/dL and WBC 0 cells/mm3
C. CSF protein of 50mg/dL and WBC 20 cells/mm3
D. CSF protein of 5mg/dL and WBC 20 cells/mm3

648. A client has been hospitalized with a diagnosis of laryngeal cancer. Which factor is most significant in the development of laryngeal cancer?
A. A family history of laryngeal cancer
B. Chronic inhalation of noxious fumes
C. Frequent straining of the vocal cords
D. A history of frequent alcohol and tobacco use

649. Which term describes the play activity of the preschool aged child?
A. Cooperative
B. Associative
C. Parallel
D. Solitary

650. A client has just finished her lunch, consisting of shrimp with rice, fruit salad, and a roll. The client calls for the nurse, stating, “My throat feels thick and I’m having trouble breathing.” What action should the nurse implement first?
A. Place the bed in Trendelenburg position and call the physician.
B. Take the client’s vital signs and administer Benadryl 50mg PO.
C. Place the bed in high Fowler’s position and call the physician.
D. Start an Aminophylline drip and call the physician.

651. A home health nurse has several elderly clients in her case load. Which of the following clients is most likely to be a victim of elder abuse?
A. A 76-year-old female with Alzheimer’s dementia
B. A 70-year-old male with diabetes mellitus
C. A 64-year-old female with a hip replacement
D. A 72-year-old male with Parkinson’s disease

652. The nurse is caring for a client with osteoporosis who is being discharged on alendronate (Fosamax). Which statement would indicate a need for further teaching?
A. “I should take the medication immediately before bedtime every night.”
B. “I should remain in an upright position for 30 minutes after taking Fosamax.”
C. “The medication should be taken by mouth with water.”
D. “I should not have any food with this medication.”

653. A client is being discharged after lithotripsy for removal of a kidney stone. Which statement by the client indicates understanding of the nurse’s instructions?
A. “I’ll need to strain my urine starting in the morning.”
B. “I will need to save all my urine.”
C. “I will be careful to strain all the urine and save the stone.”
D. “I won’t need to strain my urine now that the procedure is complete.”

654. A client admitted to the emergency room with multiple injuries develops Cullen’s sign. The nurse is aware that the client has sustained damage to the:
A. Frontal lobe
B. Lungs
C. Abdominal organs
D. Spinal cord

655. A two-year-old is admitted for repair of a fractured femur and is placed in Bryant’s traction. Which finding by the nurse indicates that the traction is working properly?
A. The infant no longer complains of pain.
B. The buttocks are 15º off the bed.
C. The legs are suspended in the traction.
D. The pins are secured within the pulley.

656. The physician has ordered a lumbar puncture for a client with suspected Guillain-Barre syndrome. The spinal fluid of a client with Guillain-Barre syndrome typically shows:
A. Decreased protein concentration with a normal cell count
B. Increased protein concentration with a normal cell count
C. Increased protein concentration with an abnormal cell count
D. Decreased protein concentration with an abnormal cell count

657. Which assignment should not be performed by the nursing assistant?
A. Feeding the client
B. Bathing the client
C. Obtaining a stool
D. Administering a fleet enema

658. Which action by the nurse indicates understanding of the care of a client with a fiberglass leg cast?
A. The nurse handles the cast with the fingertips.
B. The nurse allows 24 hours for the cast to dry.
C. The nurse dries the cast with a blow dryer.
D. The nurse tells the client to wait 30 minutes before bearing weight.

659. The nurse caring for a client receiving intravenous magnesium sulfate must closely observe for side effects associated with drug therapy. An expected side effect of magnesium sulfate is:
A. Decreased urinary output
B. Hypersomnolence
C. Absence of knee jerk reflex
D. Decreased respiratory rate

660. The nurse is performing discharge teaching on a client with ulcerative colitis who has been placed on a low-residue diet. Which food would need to be eliminated from this client’s diet?
A. Roasted chicken
B. Noodles
C. Cooked broccoli
D. Roast beef

661. A dexamethasone-suppression test has been ordered for a client with severe depression. The purpose of the dexamethasone suppression test is to:
A. Determine which social intervention will be best for the client
B. Help diagnose the seriousness of the client’s clinical symptoms
C. Determine whether the client will benefit from electroconvulsive therapy
D. Reverse the depressive symptoms the client is experiencing

662. The nurse is providing dietary teaching for a client with hypertension. Which food should be avoided by the client on a sodium-restricted diet?
A. Dried beans
B. Swiss cheese
C. Peanut butter
D. Colby cheese

663. Which one of the following lab tests should be done periodically if the client is being maintained on warfarin sodium (Coumadin)?
A. Platelet count
B. White blood cell count
C. Neutrophil count
D. Basophil count

664. A five-year-old is admitted to the unit following a tonsillectomy. Which of the following would indicate a complication of the surgery?
A. Decreased appetite
B. A low-grade fever
C. Chest congestion
D. Constant swallowing

665. A client with Crohn’s disease requires TPN to provide adequate nutrition. The nurse finds the TPN bag empty. What fluid would the nurse select to hang until another bag is prepared in the pharmacy?
A. Lactated Ringers
B. Normal saline
C. D10W solution
D. Normosol R

666. A client in labor has been given epidural anesthesia with Marcaine (bupivacaine). To reverse the hypotension associated with epidural anesthesia, the nurse should have which medication available?
A. Narcan (naloxone)
B. Dobutrex (dobutamine)
C. Romazicon (flumazenil)
D. Adrenalin (epinephrine)

667. The client has an order for sliding scale insulin at 1900 hours and Lantus insulin at the same hour. The nurse should:
A. Administer the two medications together.
B. Administer the medications in two injections.
C. Draw up the Lantus insulin and then the regular insulin and administer them together.
D. Contact the doctor because these medications should not be given to the same client.

668. The nurse is formulating a plan of care for a client with a goiter. The priority nursing diagnosis for the client with a goiter is:
A. Body image disturbance related to enlargement of the neck
B. Activity intolerance related to fatigue
C. Nutrition imbalance, less than body requirements, related to increased metabolism
D. Risk for ineffective airway clearance related to pressure of goiter on the trachea

669. The client is admitted following cast application for a fractured ulna. Which finding should be reported to the doctor?
A. Pain at the site
B. Warm fingers
C. Pulses rapid
D. Paresthesia of the fingers

670. The nurse is evaluating the intake and output of a client for the first 12 hours following an abdominal cholecystectomy. Which finding should be reported to the physician?
A. Output of 10mL from the Jackson-Pratt drain
B. Foley catheter output of 285mL
C. Nasogastric tube output of 150mL
D. Absence of stool

671. Which statement by the parent of a child with sickle cell anemia indicates an understanding of the disease?
A. The pain he has is due to the presence of too many red blood cells.
B. He will be able to go snow skiing with his friends as long as he stays warm.
C. He will need extra fluids in summer to prevent dehydration.
D. There is very little chance that his brother will have sickle cell.

672. A newborn weighed seven pounds at birth. At six months of age, the infant could be expected to weigh:
A. 14 pounds
B. 18 pounds
C. 25 pounds
D. 30 pounds

673. A client is admitted with partial thickness burns to the neck, face, and anterior trunk. The nurse would be most concerned about the client developing which of the following?
A. Hypovolemia
B. Laryngeal edema
C. Hypernatremia
D. Oliguria

674. The client with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. The priority intervention for this client is:
A. Measure the urinary output.
B. Check the vital signs.
C. Encourage increased fluid intake.
D. Weigh the client.

675. A client with chronic pain is being treated with opioid administration via epidural route. Which medication would it be most important to have available due to a possible complication of this pain relief procedure?
A. Ketorolac (Toradol)
B. Naloxone (Narcan)
C. Diphenhydramine (Benadryl)
D. Promethazine (Phenergan)

676. In order to reduce the risk of hypotension and “red man syndrome” infusions of Vancocin (vancomycin) should be administered:
A. Within 15 minutes
B. Only after giving Benadryl (diphenhydramine)
C. Over one hour
D. With Zantac (ranitidine) or other histamine blocker

677. The mother of a male child with cystic fibrosis tells the nurse that she hopes her son’s children won’t have the disease. The nurse is aware that:
A. There is a 25% chance that his children will have cystic fibrosis.
B. Most of the males with cystic fibrosis are sterile.
C. There is a 50% chance that his children will be carriers.
D. Most males with cystic fibrosis are capable of having children, so genetic counseling is advised.

678. A client is admitted for suspected bladder cancer. Which one of the following factors is most significant in the client’s diagnosis?
A. Smoking a pack of cigarettes a day for 30 years
B. Use of nonsteroidal anti-inflammatories
C. Eating foods with preservatives
D. Past employment involving asbestos

679. The Joint Commission for Accreditation of Hospital Organizations (JCAHO) specifies that two client identifiers are to be used before administering medication. Which method is best for identifying patients using two patient identifiers?
A. Take the medication administration record (MAR) to the room and compare it with the name and medical number recorded on the armband.
B. Compare the medication administration record (MAR) with the client’s room number and name on the armband.
C. Request that a family member identify the client and then ask the client to state his name.
D. Ask the client to state his full name and then to write his full name.

680. The nurse is assigned to care for a newborn with physiologic jaundice. Which action by the nurse would facilitate elimination of the bilirubin?
A. Offering the newborn water between formula feedings
B. Maintaining the newborn’s temperature at 98.6ºF
C. Minimizing tactile stimulation
D. Decreasing caloric intake

681. The nurse is caring for a child with suspected epiglottitis. Which finding is not associated with epiglottitis?
A. Drooling
B. Brassy cough
C. Muffled phonation
D. Inspiratory stridor

682. A client taking anticoagulant medication has developed a cardiac tamponade. Which finding is associated with cardiac tamponade?
A. A decrease in systolic blood pressure during inspiration
B. An increase in diastolic blood pressure during expiration
C. An increase in systolic blood pressure during inspiration
D. A decrease in diastolic blood pressure during expiration

683. A client with AIDS has a viral load of 200 copies per ml. The nurse should interpret this finding as:
A. The client is at risk for opportunistic diseases.
B. The client is no longer communicable.
C. The client’s viral load is extremely low so he is relatively free of circulating virus.
D. The client’s T-cell count is extremely low.

684. The nurse is assessing the deep tendon reflexes of a client with preeclampsia. Which method is used to elicit the biceps reflex?
A. The nurse places her thumb on the muscle inset in the antecubital space and taps the thumb briskly with the reflex hammer.
B. The nurse loosely suspends the client’s arm in an open hand while tapping the back of the client’s elbow.
C. The nurse instructs the client to dangle her legs as the nurse strikes the area below the patella with the blunt side of the reflex hammer.
D. The nurse instructs the client to place her arms loosely at her side as the nurse strikes the muscle insert just above the wrist.

685. A client on the psychiatric unit is in an uncontrolled rage and is threatening other clients and staff. What is the most appropriate action for the nurse to take?
A. Call security for assistance and prepare to sedate the client.
B. Tell the client to calm down and ask him if he would like to play cards.
C. Tell the client that if he continues his behavior he will be punished.
D. Leave the client alone until he calms down.

686. The nurse has inserted an NG tube for enteral feedings. Which assessment result is the best indicator of the tube’s stomach placement?
A. Aspiration of tan-colored mucus
B. Green aspirate with a pH of 3
C. A swish auscultated with the injection of air
D. Bubbling noted when the end of the tube is placed in liquid

687. The mother calls the clinic to report that her newborn has a rash on his forehead and face. Which action is most appropriate?
A. Tell the mother to wash the face with soap and apply powder.
B. Tell her that 30% of newborns have a rash that will go away by one month of life.
C. Report the rash to the doctor immediately.
D. Ask the mother if anyone else in the family has had a rash in the last six months.

688. The nurse asks the client with an epidural anesthesia to void every hour during labor. The rationale for this intervention is:
A. The bladder fills more rapidly because of the medication used for the epidural.
B. Her level of consciousness is altered.
C. The sensation of the bladder filling is diminished or lost.
D. To allow her to rest uninterrupted after delivery.

689. The nurse should carefully monitor the client for which common dysrhythmia that can occur during suctioning?
A. Bradycardia
B. Tachycardia
C. Ventricular ectopic beats
D. Sick sinus syndrome

690. The nurse is caring for a client with suspected endometrial cancer. Which symptom is associated with endometrial cancer?
A. Frothy vaginal discharge
B. Thick, white vaginal discharge
C. Purulent vaginal discharge
D. Watery vaginal discharge

691. A client with Addison’s disease has been admitted with a history of nausea and vomiting for the past three days. The client is receiving IV glucocorticoids (Solu-Medrol). Which of the following interventions would the nurse implement?
A. Glucometer readings as ordered
B. Intake/output measurements
C. Evaluating the sodium and potassium levels
D. Daily weights

692. The nurse is planning the diet of a client who is recovering from acute pancreatitis. The nurse should select foods that are:
A. High in carbohydrate and protein
B. Low in sodium but high fat
C. High in protein and sodium
D. Low in fat and low protein

693. Which obstetrical client is most likely to have an infant with respiratory distress syndrome?
A. A 28-year-old with a history of alcohol use during the pregnancy
B. A 24-year-old with a history of diabetes mellitus
C. A 30-year-old with a history of smoking during the pregnancy
D. A 32-year-old with a history of pregnancy-induced hypertension

694. A primigravida with diabetes is admitted to the labor and delivery unit at 34 weeks gestation. Which doctor’s order should the nurse question?
A. Magnesium sulfate 4gm (25%) IV
B. Brethine 10mcg IV
C. Stadol 1mg IV push every 4 hours as needed prn for pain
D. Ancef 2gm IVPB every 6 hours

695. A client taking the drug disulfiram (Antabuse) is admitted to the ER. Which clinical manifestations are most indicative of recent alcohol ingestion?
A. Vomiting, heart rate 120, chest pain
B. Nausea, mild headache, bradycardia
C. Respirations 16, heart rate 62, diarrhea
D. Temp 101°F, tachycardia, respirations 20

696. The child with seizure disorder is being treated with phenytoin (Dilantin). Which of the following statements by the patient’s mother indicates to the nurse that the patient is experiencing a side effect of Dilantin therapy?
A. “She is very irritable lately.”
B. “She sleeps quite a bit of the time.”
C. “Her gums look too big for her teeth.”
D. “She has gained about 10 pounds in the last six months.”

697. A 32-year-old mother of three is brought to the clinic. Her pulse is 52, there is a weight gain of 30 pounds in four months, and the client is wearing two sweaters. The client is diagnosed with hypothyroidism. Which of the following nursing diagnoses is of highest priority?
A. Impaired physical mobility related to decreased endurance
B. Hypothermia r/t decreased metabolic rate
C. Disturbed thought processes r/t interstitial edema
D. Decreased cardiac output r/t bradycardia

698. A client with angina is experiencing migraine headaches. The physician has prescribed Sumatriptan succinate (Imitrex). Which nursing action is most appropriate?
A. Call the physician to question the prescription order.
B. Try to obtain samples for the client to take home.
C. Perform discharge teaching regarding this drug.
D. Consult social services for financial assistance with obtaining the drug.

699. Which one of the following infants needs a further assessment of growth?
A. Four-month-old: birth weight 7lb, 6oz; current weight 14lb, 4oz
B. Two-week-old: birth weight 6lb, 10oz; current weight 6lb, 12oz
C. Six-month-old: birth weight 8lb, 8oz; current weight 15lb
D. Two-month-old: birth weight 7lb, 2oz; current weight 9lb, 6oz

700. An 18-month-old is admitted with symptoms of intussusception. Which information is helpful in establishing the diagnosis?
A. When he last ate
B. The characteristic of vomitus
C. A description of his stools
D. The number of times voided in the last eight hours

701. The physician has ordered cultures for cytomegalovirus (CMV). Which statement is true of the collection of cultures for cytomegalovirus?
A. Stool cultures are preferred for definitive diagnosis.
B. Pregnant caregivers may obtain cultures.
C. Collection of one specimen is sufficient.
D. Accurate diagnosis depends on fresh specimens.

702. The nurse is giving an end-of-shift report when a client with a chest tube is noted in the hallway with the tube disconnected. What is the most appropriate action?
A. Clamp the chest tube immediately.
B. Put the end of the chest tube into a cup of sterile normal saline.
C. Assist the client back to the room and place him on his left side.
D. Reconnect the chest tube to the chest tube system.

703. A four-year-old is admitted to the hospital for treatment of Kawasaki’s disease. The medication commonly prescribed for the treatment of Kawasaki’s disease is:
A. Aspirin (acetylsalicylic acid)
B. Benadryl (diphenhydramine)
C. Polycillin (ampicillin)
D. Betaseron (interferon beta)

704. Which person is at greatest risk for developing Lyme disease?
A. Computer programmer
B. Elementary teacher
C. Veterinarian
D. Landscaper

705. The client is admitted with chronic obstructive pulmonary disease. Blood gases reveal pH 7.36, CO 2 45, O 2 84, bicarb 28. The nurse would assess the client to be in:
A. Uncompensated acidosis
B. Compensated alkalosis
C. Compensated respiratory acidosis
D. Uncompensated metabolic acidosis

706. A client is diagnosed with bleeding from the upper gastrointestinal system. The nurse would expect the client’s stools to be:
A. Brown
B. Black
C. Clay colored
D. Green

707. Which client is at greatest risk for a Caesarean section due to cephalopelvic disproportion (CPD)?
A. A 25-year-old gravida 2, para 1
B. A 30-year-old gravida 3, para 2
C. A 17-year-old gravida 1, para 0
D. A 32-year-old gravida 1, para 0

708. The home health nurse is scheduled to visit four clients. Which client should she visit first?
A. A client with acquired immunodeficiency syndrome with a cough and reported temperature of 101°F
B. A client with peripheral vascular disease with an ulcer on the left lower leg
C. A client with diabetes mellitus who needs a diabetic control index drawn
D. A client with an autograft to burns of the chest and trunk

709. A client is receiving Pyridium (phenazopyridine hydrochloride) for a urinary tract infection. The client should be taught that the medication may:
A. Cause diarrhea
B. Change the color of her urine
C. Cause mental confusion
D. Cause changes in taste

710. A trauma client is admitted to the emergency room following a motor vehicle accident. Examination reveals that the left side of the chest moves inward when the client inhales. The finding is suggestive of:
A. Pneumothorax
B. Mediastinal shift
C. Pulmonary contusion
D. Flail chest

711. The nurse knows that a client with right-sided hemiplegia understands teaching regarding ambulation with a cane if she states:
A. I will hold the cane in my right hand.
B. I will advance my cane and my right leg at the same time.
C. I will be able to walk only by using a walker.
D. I will hold the cane in my left hand.”

712. A client is admitted with a two-day history of nausea and vomiting. Which IV fluid is appropriate for the client with moderate dehydration?
A. Lactated Ringer's
B. Dextrose 1% in water
C. Three percent normal saline
D. Dextrose 5% /.45% normal saline

713. The nurse is performing an initial assessment of a newborn delivered at 32 weeks gestation. The nurse can expect to find the presence of:
A. Vernix caseosa
B. Sucking pads
C. Head lag
D. Absence of scarf sign

714. The nurse is caring for a client with chronic hepatitis. Which is the best method to use for determining the degree of early ascites?
A. Inspection of the abdomen for enlargement
B. Bimanual palpation for hepatomegaly
C. Daily measurement of abdominal girth
D. Assessment for peritoneal fluid wave

715. The nurse notes the following on the ECG monitor. The nurse would evaluate the cardiac arrhythmia as:

A. Atrial flutter
B. A sinus rhythm
C. Ventricular tachycardia
D. Atrial fibrillation

716. An obstetrical client arrives at the women’s hospital with abdominal cramping and gross bright red vaginal bleeding. Which action(s) should the nurse take?
A. Perform a vaginal exam
B. Check FHT and notify the physician
C. Request a stat hemoglobin and hematocrit
D. Perform Leopold’s maneuver to check for fetal position

717. The nurse assesses a new order for a blood transfusion. The order is to transfuse one unit of packed red blood cells (contains 250mL) in a two-hour period. What will be the hourly rate of infusion?
A. 50mL/hr
B. 62mL/hr
C. 125mL/hr
D. 137mL/hr

718. Which play activity is best suited to the gross motor skills of a toddler?
A. Coloring book and crayons
B. Ball
C. Building cubes
D. Swing set

719. A client has suffered a severe electrical burn. Which medication would the nurse expect to have ordered for application to the burned area?
A. Mafenide acetate (Sulfamylon)
B. Silver nitrate
C. Povidone-iodine ointment
D. Silver sulfadiazine (Silvadene)

720. The nurse is preparing to teach a client about phenytoin sodium (Dilantin). Which fact would be most important to teach the client regarding why the drug should not be stopped suddenly?
A. Physical dependence can develop over time.
B. Status epilepticus can develop.
C. A hypoglycemic reaction can develop.
D. Heart block can develop.

721. The client using a diaphragm should be instructed to:
A. Refrain from keeping the diaphragm in longer than four hours
B. Store the diaphragm in a cool place
C. Have the diaphragm resized if she gains five pounds
D. Have the diaphragm resized if she has any surgery

722. The nurse is teaching the client regarding use of sodium warfarin. Which statement made by the client would require further teaching?
A. I will have blood drawn every month.
B. I will assess my skin for a rash.
C. I take aspirin for a headache.
D. I will use an electric razor to shave.

723. Which assignment is not within the scope of practice of the registered nurse?
A. Performing a vaginal exam on a patient in labor
B. Removing a PICC line
C. Monitoring central venous pressure
D. Performing wound closure with sutures and clips

724. When assessing deep tendon reflexes, the nurse grades the client’s patellar reflex as a 3+. This reading indicates that the assessed reflex is:
A. Stronger than normal
B. Hypoactive
C. Normal
D. Hyperactive

725. A client is hospitalized with an acute myocardial infarction. Which nursing diagnosis reflects an understanding of the cause of acute myocardial infarction?
A. Decreased cardiac output related to damage to the myocardium
B. Impaired tissue perfusion related to an occlusion in the coronary vessels
C. Acute pain related to cardiac ischemia
D. Ineffective breathing patterns related to decreased oxygen to the tissues

726. After the physician performs an amniotomy, the nurse’s first action should be to assess the:
A. Degree of cervical dilation
B. Fetal heart tones
C. Client’s vital signs
D. Client’s level of discomfort

727. The best method of evaluating the amount of peripheral edema is:
A. Weighing the client daily
B. Measuring the extremity
C. Measuring the intake and output
D. Checking for pitting

728. An elderly client with glaucoma has been prescribed Timoptic (timolol) eyedrops. Timoptic should be used with caution in clients with a history of:
A. Diabetes
B. Gastric ulcers
C. Emphysema
D. Pancreatitis

729. The nurse notes variable decelerations on the fetal monitor strip. The most appropriate initial action would be to:
A. Notify the physician
B. Increase the rate of IV fluid
C. Reposition the client
D. Readjust the monitor

730. The physician has ordered an injection of RhoGAM for a client with blood type A negative. The nurse understands that RhoGAM is given to:
A. Provide immunity against Rh isoenzymes
B. Prevent the formation of Rh antibodies
C. Eliminate circulating Rh antibodies
D. Convert the Rh factor from negative to positive

731. A client has a CVP monitor in place via a central line. Which would be included in the nursing care plan for this client?
A. Notify the physician of readings less than 3cm or more than 8cm of water.
B. Use the clean technique to change the dressing at the insertion site.
C. Elevate the head of the bed to 90° to obtain CVP readings.
D. The 0 mark on the manometer should align with the client’s right clavicle for the readings.

732. In terms of cognitive development, a three-year-old would be expected to:
A. Think abstractly
B. Use magical thinking
C. Understand conservation of matter
D. See things from the perspective of others

733. Which statement made by the nurse describes the inheritance pattern of autosomal recessive disorders?
A. An affected child has unaffected parents.
B. An affected child has one affected parent.
C. Affected parents have a one-in-four chance of passing on the defective gene.
D. Affected parents have unaffected children who are carriers.

734. The elderly client is admitted to the emergency room. Which symptom is the client with a fractured hip most likely to exhibit?
A. Pain
B. Disalignment
C. Cool extremity
D. Absence of pedal pulses

735. The client with Alzheimer’s disease is being assisted with activities of daily living when the nurse notes that the client uses her toothbrush to brush her hair. The nurse is aware that the client is exhibiting:
A. Agnosia
B. Apraxia
C. Anomia
D. Aphasia

736. The suggested diet for a child with cystic fibrosis is one that contains:
A. High calories, high protein, moderate fat
B. High calories, moderate protein, low fat
C. Moderate calories, moderate protein, moderate fat
D. Low calories, high protein, low fat

737. The mother asks the nurse when the “soft spot” on the top of her baby’s head will close. The nurse should tell the mother that the anterior fontanel usually closes by:
A. Three months
B. Six months
C. Twelve months
D. Eighteen months

738. The nurse is planning dietary changes for a client following an episode of acute pancreatitis. Which diet is suitable for the client?
A. Low calorie, low carbohydrate
B. High calorie, low fat
C. High protein, high fat
D. Low protein, high carbohydrate

739. Which finding is expected in a client with a ruptured spleen?
A. Kehr’s sign
B. Chvostek’s sign
C. Kernig’s sign
D. Trendelenburg’s sign

740. An elderly patient has been taking 80mg of furosemide (Lasix) bid. The nurse notes that the patient’s most recent potassium level is 2.5mEq/L. The nurse should:
A. Continue the medication as ordered
B. Administer the morning dose only
C. Give the medication with orange juice
D. Withhold the medication and notify the physician

741. The nurse is caring for a client after a laryngectomy. The client is anxious, with a respiratory rate of 32 and an oxygen saturation of 88. What should be the initial nursing action?
A. Suction the client.
B. Increase the oxygen flow rate.
C. Notify the physician.
D. Recheck the O2 saturation reading.

742. A client with schizophrenia is started on Zyprexa (olanzapine). Three weeks later, the client develops severe muscle rigidity and elevated temperature. The nurse should give priority to:
A. Withholding all morning medications
B. Ordering a CBC and CPK
C. Administering prescribed anti-Parkinsonian medication
D. Transferring the client to a medical unit

743. A gravida 2 para 0 is admitted to the labor and delivery unit. The doctor performs an amniotomy. Which observation would the nurse expect to make immediately after an amniotomy?
A. Fetal heart tones of 160 beats per minute
B. A moderate amount of straw-colored clear vaginal fluid
C. A small amount of greenish vaginal fluid
D. A small segment of the umbilical cord protruding from the vagina

744. The physician orders the removal of an in-dwelling catheter the second post-operative day for a client with a prostatectomy. The client complains of pain and dribbling of urine the first time he voids. The nurse should tell the client that:
A. Using warm compresses over the bladder will lessen the discomfort.
B. Perineal exercises will be started in a few days to help relieve his symptoms.
C. If the symptoms don’t improve, the catheter will have to be reinserted.
D. His complaints are common and will improve over the next few days.

745. A client has been placed on the drug valproic acid (Depakene). Which would indicate to the nurse that the client is experiencing an adverse reaction to this medication?
A. Photophobia
B. Poor skin turgor
C. Lethargy
D. Reported visual disturbances

746. A nurse is observing a local softball game when one of the players is hit in the nose with a ball. The player’s nose is visibly deformed and bleeding. The best way for the nurse to control the bleeding is to:
A. Tilt the head back and pinch the nostrils.
B. Apply a wrapped ice compress to the nose.
C. Pack the nose with soft, clean tissue.
D. Tilt the head forward and pinch the nostrils.

747. The nurse is caring for a client after a burn. Which assessment finding best indicates that the client’s respiratory efforts are currently adequate?
A. The client is able to talk.
B. The client is alert and oriented.
C. The client’s O2 saturation is 97%.
D. The client’s chest movements are uninhibited.

748. A client with osteoarthritis has a prescription for Celebrex (celecoxib). Which instruction should be included in the discharge teaching?
A. Take the medication with milk
B. Report chest pain to the physician
C. Remain upright 30 minutes after taking the medication
D. Allow six weeks for optimal effects

749. The client with cancer refuses to care for herself. Which action by the nurse would be best?
A. Alternate nurses caring for the client so that the staff will not get tired of caring for this client.
B. Talk to the client and explain the need for self-care.
C. Explore the reason for the lack of motivation seen in the client.
D. Talk to the physician about the client’s lack of motivation.

750. At the six-week check-up, the mother asks when she can expect the baby to sleep all night. The nurse should tell the mother that most infants begin to sleep all night by age:
A. One month
B. Two months
C. 3–4 months
D. 5–6 months

751. The nurse is caring for a client with epilepsy who is being treated with carbamazepine (Tegretol). Which laboratory value might indicate a serious side effect of this drug?
A. BUN 10mg/dL
B. Hemoglobin 13.0gm/dL
C. WBC 4,000/mm3
D. Platelets 200,000/mm3

752. After several hospitalizations for respiratory ailments, a six-month-old has been diagnosed as having HIV. The infant’s respiratory ailments were most likely due to:
A. Pneumocystis jiroveci
B. Cytomegalovirus
C. Cryptosporidiosis
D. Herpes simplex

753. Which roommate would be most suitable for a client newly diagnosed with myasthenia gravis?
A. A client with diabetes
B. A client with exacerbation of ulcerative colitis
C. A client with a venous stasis ulcer
D. A client with bronchitis

754. The nurse assesses a client’s fundal height every 15 minutes during the first hour postpartum. What should the height of the fundus be during this hour ?
A. 1–2 fingerbreadths under the umbilicus
B. Four fingerbreadths under the umbilicus
C. One fingerbreadth above the umbilicus
D. Four fingerbreadths above the umbilicus

755. The nurse is caring for the client following a laryngectomy when suddenly the client becomes nonresponsive and pale, with a BP of 90/40. The initial nurse’s action should be to:
A. Place the client in Trendelenburg position.
B. Increase the infusion of normal saline.
C. Administer atropine intravenously.
D. Move the emergency cart to the bedside.

756. The nurse is caring for a client with systemic lupus erythematosus (SLE). The major complication associated with systemic lupus erythematosus is:
A. Nephritis
B. Cardiomegaly
C. Desquamation
D. Meningitis

757. Which would the nurse include in the nursing care plan of a client experiencing severe delirium tremens?
A. Placing the client in a darkened room
B. Keeping the closet and bathroom doors closed
C. Administering a diuretic to decrease fluid excess
D. Checking vital signs every eight hours

758. The nurse is providing dietary instructions for a client with iron-deficiency anemia. Which food is a poor source of iron?
A. Tomatoes
B. Legumes
C. Dried fruits
D. Nuts

759. The nurse is caring for a client with stage III Alzheimer’s disease. A characteristic of this stage is:
A. Memory loss
B. Failing to recognize familiar objects
C. Wandering at night
D. Failing to communicate

760. A newborn is diagnosed with respiratory distress syndrome (RDS). Which position is best for maintaining an open airway?
A. Prone, with his head turned to one side
B. Side-lying, with a towel beneath his shoulders
C. Supine, with his neck slightly flexed
D. Supine, with his neck slightly extended

761. Which statement is true regarding balanced skeletal traction?
A. Uses a Steinman pin
B. Requires that both legs be secured
C. Utilizes Kirschner wires
D. Is used primarily to heal the fractured hips

762. A patient arrives in the ER with a possible Zika virus diagnosis. Which clinical manifestation(s) would the nurse expect the patient to exhibit? Select all that apply.
A. Hypothermia
B. Abdominal pain
C. Waist pain
D. Conjunctivitis

763. A pediatric client with burns to the hands and arms has dressing changes with Sulfamylon (mafenide acetate) cream. The nurse is aware that the medication:
A. Will cause dark staining of the surrounding skin
B. Produces a cooling sensation when applied
C. Can alter the function of the thyroid
D. Produces a burning sensation when applied

764. A 20-year-old female has a prescription for Sumycin (tetracycline). While teaching the client how to take her medicine, the nurse learns that the client is also taking an oral contraceptive. Which instruction should be included in the teaching plan?
A. Oral contraceptives will decrease the effectiveness of the tetracycline.
B. Anorexia often results from taking oral contraceptives with antibiotics.
C. Toxicity can result when taking these antibiotics and an oral contraceptive together.
D. Antibiotics can decrease the effectiveness of oral contraceptives.

765. The nurse is caring for a client with a chronic airway disease. Which of the associated disorders has changes that are reversible?
A. Bronchiectasis
B. Emphysema
C. Asthma
D. Chronic bronchitis

766. A client with burns is admitted and fluid resuscitation has begun. The client’s CVP reading is 14cm/H2O. Which evaluation by the nurse would be most accurate?
A. The client has received enough fluid.
B. The client’s fluid status is unaltered.
C. The client has inadequate fluids.
D. The client has a volume excess.

767. A client is admitted with a blood alcohol level of 180mg/dL. The nurse recognizes that the alcohol in the client’s system should be fully metabolized within:
A. Three hours
B. Five hours
C. Seven hours
D. Nine hours

768. The Mantoux text is used to determine whether a person has been exposed to tuberculosis. If the test is positive, the nurse will find a:
A. Fluid-filled vesicle
B. Sharply demarcated erythema
C. Central area of induration
D. Circular blanched area

769. A client is to receive Dilantin (phenytoin) via a nasogastric (NG) tube. When giving the medication, the nurse should:
A. Flush the NG tube with 2–4mL of water before giving the medication
B. Administer the medication, flush with 5mL of water, and clamp the NG tube
C. Flush the NG tube with 5mL of normal saline and administer the medication
D. Flush the NG tube with 2–4oz of water before and after giving the medication

770. A client with cervical cancer has a radioactive implant. Which statement indicates that the client understands the nurse’s teaching regarding radioactive implants?
A. I won’t be able to have visitors while getting radiation therapy.
B. I will have a urinary catheter while the implant is in place.
C. I can be up to the bedside commode while the implant is in place.
D. I won’t have any side effects from this type of therapy.

771. When assessing the client with acute arterial occlusion, the nurse would expect to find:
A. Peripheral edema in the affected extremity
B. Minute blackened areas on the toes
C. Pain above the level of occlusion
D. Redness and warmth over the affected area

772. In evaluating the effectiveness of IV Pitocin (oxytocin) for a client with secondary dystocia, the nurse should expect:
A. A rapid delivery
B. Cervical effacement
C. Infrequent contractions
D. Progressive cervical dilation

773. The nurse is assessing the abdomen. The nurse knows the best sequence to perform the assessment is:
A. Inspection, auscultation, palpation
B. Auscultation, palpation, inspection
C. Palpation, inspection, auscultation
D. Inspection, palpation, auscultation

774. The physician has prescribed nitroglycerin sublingual tablets as needed for a client with angina. The nurse should tell the client to take the medication:
A. After engaging in strenuous activity
B. Every four hours to prevent chest pain
C. As soon as he notices signs of chest pain
D. At bedtime to prevent nocturnal angina

775. The mother of a one-year-old with sickle cell anemia wants to know why the condition didn’t show up in the nursery. The nurse’s response is based on the knowledge that:
A. There is no test to measure abnormal hemoglobin in newborns.
B. Infants do not have insensible fluid loss before a year of age.
C. Infants rarely have infections that would cause them to have a sickling crises.
D. The presence of fetal hemoglobin protects the infant.

776. The nurse receives a report from the paramedic on four trauma victims. Which client would need to be treated first? A client with:
A. Lower rib fractures and a stable chest wall
B. Bruising on the anterior chest wall and a possible pulmonary contusion
C. Gun shot wound with open pneumothorax unstabilized
D. Dyspnea, stabilized with intubation and manual resuscitator

777. A client with schizophrenia has become disruptive and requires seclusion to help him regain control of his behavior. Which staff member can institute seclusion?
A. The security guard
B. The registered nurse
C. The licensed practical nurse
D. The nursing assistant

778. The nurse is performing discharge instructions for a client with an implantable permanent pacemaker. What discharge instruction is an essential part of the plan?
A. “You cannot eat food prepared in a microwave.”
B. “You should avoid moving the shoulder on the side of the pacemaker site for six weeks.”
C. “You will have to learn to take your own pulse.”
D. “You will not be able to fly on a commercial airliner with the pacemaker in place.”

779. When planning the care for a client after a posterior fossa (infratentorial) craniotomy, which action is contraindicated?
A. Keeping the client flat on one side
B. Elevating the head of the bed 30°
C. Log-rolling or turning as a unit
D. Keeping the neck in a neutral position

780. As the client reaches 8 cm dilation, the nurse notes a pattern on the fetal monitor that shows a drop in the fetal heart rate of 30 beats per minute beginning at the peak of the contraction and ending at the end of the contraction. The FHR baseline is 165–175 beats per minute with a variability of 0–2 beats per minute. What is the most likely explanation of this pattern?
A. The fetus is asleep.
B. The umbilical cord is compressed.
C. There is a vagal response.
D. There is uteroplacental insufficiency.

781. The nurse is evaluating nutritional outcomes for an adolescent with anorexia nervosa. Which observation best indicates that the plan of care is effective?
A. The client selects a balanced diet from the menu.
B. The client is less interested in intense exercise.
C. The client reads magazine articles on food preparation.
D. The client has gained four pounds in the last week.

782. The doctor has ordered neurological checks every 30 minutes for a client injured in a biking accident. Which finding indicates that the client’s condition is satisfactory?
A. A score of 13 on the Glascow coma scale
B. The presence of doll’s eye movement
C. The absence of deep tendon reflexes
D. Decerebrate posturing

783. On a home visit, the nurse finds four young children alone. The youngest of the children has bruises on the face and back and circular burns on the inner aspect of the right forearm. The nurse should:
A. Contact child welfare services
B. Transport the child to the emergency room
C. Take the children to an abuse shelter
D. Stay with the children until an adult arrives

784. While reviewing the chart of a client with a history of hepatitis B, the nurse finds a serologic marker of HB8 AG. The nurse recognizes that the client:
A. Has chronic hepatitis B
B. Has recovered from hepatitis B infection
C. Has immunity to infection with hepatitis C
D. Has no chance of spreading the infection to others

785. The nurse is monitoring a client following a lung resection. The hourly output from the mediastinal tube was 300mL. The nurse should give priority to:
A. Turning the client to the left side
B. Milking the tube to ensure patency
C. Slowing the intravenous infusion
D. Notify the physician of the amount

786. An infant with congenital heart disease is admitted with symptoms of congestive heart failure. Which of the following is a sign of fluid overload in the infant?
A. Bulging fontanels
B. Bradycardia
C. Urine specific gravity of 1.015
D. Bradypnea

787. A new mother tells the nurse that she is getting a new microwave so that her husband can help prepare the baby’s feedings. The nurse should:
A. Explain that a microwave should never be used to warm the baby’s bottles.
B. Tell the mother that microwaving is the best way to prevent bacteria in the formula.
C. Tell the mother to shake the bottle vigorously for one minute after warming in the microwave.
D. Instruct the parents to always leave the top of the bottle open while microwaving so heat can escape.

788. The nurse is planning room assignments for the day. Which client should be assigned to a private room if only one is available?
A. The client with Cushing’s disease
B. The client with diabetes
C. The client with acromegaly
D. The client with myxedema

789. When gathering evidence from a victim of rape, the nurse should place the victim’s clothing in a:
A. Plastic zip-lock bag
B. Rubber tote
C. Paper bag
D. Padded manila envelope

790. Upon admission to the hospital, a client reports having “the worst headache I’ve ever had.” The nurse should give the highest priority to which action?
A. Administering pain medication
B. Starting oxygen
C. Performing neuro checks
D. Inserting a Foley catheter

791. Which selection would provide the most calcium for the client who is four months pregnant?
A. A granola bar
B. A bran muffin
C. A cup of yogurt
D. A glass of fruit juice

792. The nurse is caring for a client with possible cervical cancer. What clinical data would the nurse most likely find in the client’s history?
A. Post-coital vaginal bleeding
B. Nausea and vomiting
C. Foul-smelling vaginal discharge
D. Elevated temperature levels

793. What information should the nurse give a new mother regarding the introduction of solid foods for her infant?
A. Solid foods should not be given until the extrusion reflex disappears at 8–10 months of age.
B. Solid foods should be introduced one at a time, with 4- to 7-day intervals.
C. Solid foods can be mixed in a bottle or infant feeder, to make feeding easier.
D. Solid foods should begin with fruits and vegetables.

794. Which instruction would not be included in the discharge teaching of the client receiving Thorazine (chlorpromazine)?
A. You will need to wear protective clothing or a sunscreen when you are outside.
B. You will need to avoid eating aged cheese.
C. You should carry hard candy with you to decrease dryness of the mouth.
D. You should report a sign of infection immediately.

795. The nurse is caring for a child with a diagnosis of possible hydrocephalus. Which assessment data on the admission history would be the most objective?
A. Anorexia
B. Vomiting
C. Head measurement
D. Temperature reading

796. A client elects to have epidural anesthesia to relieve the discomfort of labor. Following the initiation of epidural anesthesia, the nurse should give priority to:
A. Checking for cervical dilation
B. Placing the client in a supine position
C. Checking the client’s blood pressure
D. Obtaining a fetal heart rate

797. Before administering eye drops, the nurse should recognize that it is essential to consider which of the following?
A. The eye should be cleansed with warm water to remove any exudate before instilling the eye drops.
B. The patient will be more comfortable if allowed to instill his own eye drops.
C. Eye drops should be instilled with the patient looking down.
D. Eye drops should always be warmed before instilling in the patient’s eyes.

798. The charge nurse is making assignments for the day. After accepting the assignment to care for a client with leukemia, the nurse tells the charge nurse that her child has chickenpox. Which initial action should the charge nurse take?
A. Change the nurse’s assignment to another client.
B. Explain to the nurse that there is no risk to the client.
C. Ask the nurse if the chickenpox have crusted.
D. Ask the nurse if she has ever had the chickenpox.

799. A nurse indicates that she is licensed in her new state of residence even though reciprocity has not been granted. The nurse’s action can result in a charge of:
A. Fraud
B. Tort
C. Malpractice
D. Negligence

800. A client with a history of colon cancer is admitted to the oncology unit. Laboratory results reveal a WBC of 1600/mm3 . What plans will the nurse add to the care plan because of the WBC reading?

Select all that apply.
I. No sick visitors
II. Private room necessary
III. No aspirin products
IV. Low bacteria diet
V. Electric razors only
A. All of the Above
B. None of the Above
C. I and V only
D. I, II, IV

801. The charge nurse is formulating a discharge teaching plan for a client with mild preeclampsia. The nurse should give priority to:
A. Teaching the client to report a nosebleed
B. Instructing the client to maintain strict bed rest
C. Telling the client to notify the doctor of pedal edema
D. Advising the client to avoid sodium sources in the diet

802. The mother of a nine-year-old with asthma has brought an electric CD player for her son to listen to while he is receiving oxygen therapy. The nurse should:
A. Explain that he does not need the added stimulation.
B. Allow the CD player, but ask him to wear earphones.
C. Tell the mother that he cannot have items from home.
D. Ask the mother to bring a battery-operated CD instead.

803. An adolescent with cystic fibrosis has an order for pancreatic enzyme replacement. The nurse knows that the medication should be given:
A. At bedtime
B. With meals and snacks
C. Twice daily
D. Daily in the morning

804. Which measure helps reduce nipple soreness associated with breastfeeding?
A. Feeding the baby during the first 48 hours after delivery
B. Placing a finger between the baby’s mouth and the breast to break suction after feeding
C. Applying warm, moist soaks to the breast several times per day
D. Wearing a support bra during the day

805. Which of the following symptoms is associated with Chlamydia?
A. Frequent urination and vaginal discharge
B. Generalized rash
C. Lesions on the perineum
D. Enlarged lymph nodes and pelvic pain

806. The nurse is planning care for a client with adrenal insufficiency. The nurse should give priority to:
A. Monitoring the client for signs of dehydration
B. Promoting sleep and rest
C. Providing high-calorie snacks
D. Promoting a healthy body image

807. The nurse is reviewing the laboratory values of a client with a myocardial infarction. Which laboratory test is used to identify injury to the myocardium and can remain elevated for up to three weeks?
A. Total CK
B. CK-MB
C. Myoglobulin
D. Troponin T or I

808. During an intake assessment, the nurse asks the client if he has an advanced directive. The reason for asking the client this question is:
A. The nursing staff needs to know about funeral arrangements.
B. Much confusion regarding care can occur with the client’s family if there is no advanced directive.
C. An advanced directive allows the medical personnel to make decisions for the client.
D. An advanced directive allows active euthanasia to be carried out.

809. A home health nurse has four clients assigned for morning visits. The nurse should give priority to visiting the client with:
A. Diabetes mellitus with a nongranulated ulcer of the right foot
B. Congestive heart failure who reports coughing up frothy sputum
C. Hemiplegia with tenderness in the right flank and cloudy urine
D. Rheumatoid arthritis with soft tissue swelling behind the right knee

810. A client is scheduled for surgery in the morning. Which of the following is the primary preoperative responsibility of the nurse?
A. Making sure the vital signs are recorded
B. Obtaining a signed permit for surgery
C. Explaining the surgical procedure
D. Answering questions about the surgery

811. The mother of a two-year-old asks the nurse when she should schedule her son’s first dental visit. The nurse’s response is based on the knowledge that most children have all their deciduous teeth by:
A. 15 months
B. 18 months
C. 24 months
D. 30 months

812. A six-month-old is hospitalized with symptoms of botulism. What aspect of the infant’s history is associated with Clostridium botulinum infection?
A. The infant sucks on his fingers and toes.
B. The mother sweetens the infant’s cereal with honey.
C. The infant was switched to soy-based formula.
D. The father recently purchased an aquarium.

813. The nurse is caring for a client in the acute care unit. Initial laboratory values reveal serum sodium of 156mEq/L. What behavior changes would the nurse expect the client to exhibit?
A. Hyporeflexia
B. Manic behavior
C. Depression
D. Muscle cramps

814. A client is admitted with a diagnosis of pernicious anemia. Which of the following signs or symptoms would indicate that the client has been noncompliant with ordered B12 injections?
A. Hyperactivity in the evening hours
B. Weight gain
C. Paresthesia of hands and feet
D. Diarrhea stools

815. The nurse on the oncology unit is caring for a client with a WBC of 1500/mm3. During evening visitation, a visitor brings in a fruit basket. What action should the nurse take?
A. Encourage the client to eat small snacks of the fruit.
B. Remove fruits that are not high in vitamin C.
C. Instruct the client to avoid the high-fiber fruits.
D. Remove the fruits from the client’s room.

816. Which of the following is a characteristic of a reassuring fetal heart rate pattern?
A. A fetal heart rate of 180 beats per minute
B. A baseline variability of 35 beats per minute
C. A fetal heart rate of 90 at the baseline
D. Acceleration of FHR with fetal movements

817. A client is admitted to the labor and delivery unit. The nurse performs a vaginal exam and determines that the client’s cervix is 5cm dilated with 75% effacement. Based on the nurse’s assessment, the client is in which phase of labor?
A. Active
B. Latent
C. Transition
D. Early

818. A client complains of sharp, stabbing pain in the right lower quadrant that is graded as level 8 on a scale of 10. The nurse knows that pain of this severity can best be managed using:
A. Aleve (naproxen sodium)
B. Tylenol with codeine (acetaminophen with codeine)
C. Toradol (ketorolac)
D. Morphine sulfate (morphine sulfate)

819. The nurse is performing an assessment on a client with possible pernicious anemia. Which finding is specific to pernicious anemia?
A. A weight loss of 10 pounds in six months
B. Fatigue
C. Glossitis
D. Pallor

820. A client with cancer received platelet infusions 24 hours ago. Which of the following assessment findings would indicate the most therapeutic effect from the transfusions?
A. Hemoglobin level increase from 8.9 to 10.6mg/dL
B. Temperature reading of 99.4°F
C. White blood cell count of 11,000/mm3
D. Decrease in oozing of blood from IV site

821. A client with a T6 injury six months ago develops facial flushing and a BP of 210/106. After elevating the head of the bed, which is the most appropriate nursing action?
A. Notify the physician.
B. Assess the client for a distended bladder.
C. Apply ordered oxygen via nasal cannula.
D. Increase the IV fluids.

822. A client with Lyme’s disease is being treated with Achromycin (tetracycline HCl). The nurse should tell the client that the medication will be rendered ineffective if taken with:
A. Antacids
B. Salicylates
C. Antihistamines
D. Sedative-hypnotics

823. The nurse discovers a patient care assistant looking through the client’s belongings while the client is out of the room. Which action should be taken by the nurse?
A. Discuss the nursing assistant’s behavior with the family.
B. Report the incident to the charge nurse.
C. Monitor the situation and note whether any items are missing.
D. Ignore the situation until items are reported missing

824. A client with otosclerosis is scheduled for a stapedectomy. Which finding suggests a complication involving the seventh cranial nerve?
A. Diminished hearing
B. Sensation of fullness in the ear
C. Inability to move the tongue side to side
D. Changes in facial sensation

825. A client with a history of cocaine abuse is experiencing tactile hallucinations. This symptom is known as:
A. Dyskinesia
B. Confabulation
C. Formication
D. Dystonia

826. A camp nurse is applying sunscreen to a group of children enrolled in swim classes. Chemical sunscreens are most effective when applied:
A. Just before sun exposure
B. Five minutes before sun exposure
C. 15 minutes before sun exposure
D. 30 minutes before sun exposure

827. The nurse is assigned to care for the client with a Steinman pin. During pin care, she notes that the LPN uses sterile gloves and cotton tipped applicators to clean the pin. Which action should the nurse take at this time?
A. Assist the LPN with opening sterile packages and peroxide
B. Tell the LPN that clean gloves are allowed
C. Tell the LPN that the registered nurse should perform pin care
D. Ask the LPN to clean the weights and pulleys with peroxide

828. The nurse notes the following laboratory test results on a 24-hour post-burn client. Which abnormality should be reported to the physician immediately?
A. Potassium 7.5mEq/L
B. Sodium 131mEq/L
C. Arterial pH 7.34
D. Hematocrit 52%

829. The nurse is caring for a client scheduled for a surgical repair of an abdominal aortic aneurysm. Which assessment is most crucial during the preoperative period?
A. Assessment of the client’s level of anxiety
B. Evaluation of the client’s exercise tolerance
C. Identification of peripheral pulses
D. Assessment of bowel sounds and activity

830. The physician has ordered a low-purine diet for a client with gout. Which protein source is high in purine?
A. Dried beans
B. Nuts
C. Cheese
D. Eggs

831. The client with color blindness will have problems distinguishing which of the following colors?
A. Orange
B. Violet
C. Red
D. Yellow

832. The nurse should be particularly alert for which one of the following problems in a client with barbiturate overdose?
A. Oliguria
B. Cardiac tamponade
C. Apnea
D. Hemorrhage

833. The nurse is caring for a client diagnosed with metastatic cancer of the bone. The client is exhibiting mental confusion and a BP of 150/100. Which laboratory value would correlate with the client’s symptoms reflecting a common complication with this diagnosis?
A. Potassium 5.6 mEq/L
B. Calcium 13mg/dL
C. Inorganic phosphorus 1.7mEq/L
D. Sodium 138mEq/L

834. The physician has ordered the Schilling test for a patient with suspected pernicious anemia. What other vitamin level is often assessed at the same time as the B12 level?
A. Folic acid
B. Pyridoxine
C. Ascorbic acid
D. Thiamine

835. Which of the following characterizes peer group relationships in eight- and nine-year-olds?
A. Activities organized around competitive games
B. Loyalty and strong same-sex friendships
C. Informal socialization between boys and girls
D. Shared activities with one best friend

836. A client arrives in the emergency room with severe burns of the hands, right arm, face, and neck. The nurse needs to start an IV. Which site would be most suitable for this client?
A. Top of client’s right hand
B. Left antecubital fossa
C. Top of either foot
D. Left forearm

837. Which nursing intervention would you expect when working with a hospitalized toddler?
A. Ask the parent to leave the room when assessments are being performed
B. Explain that items from home should not be brought into the hospital
C. Tell the parents that they may stay with the toddler
D. Ask the toddler if he is ready to have his temperature checked

838. A client in labor has an order for Demerol (meperidine) 75mg. IM to be administered 10 minutes before delivery. The nurse should:
A. Wait until the client is placed on the delivery table and administer the medication.
B. Question the order because the medication might cause respiratory depression in the newborn.
C. Give the medication IM during the delivery to prevent pain from the episiotomy.
D. Give the medication as ordered.

839. A client with rheumatoid arthritis is beginning to develop flexion contractures of the knees. The nurse should tell the client to:
A. Lie prone and let her feet hang over the mattress edge
B. Lie supine, with her feet rotated inward
C. Lie on her right side and point her toes downward
D. Lie on her left side and allow her feet to remain in a neutral position

840. A client with iron-deficiency anemia is taking an oral iron supplement. The nurse should tell the client to take the medication with:
A. Orange juice
B. Water only
C. Milk
D. Apple juice

841. An adolescent client hospitalized with anorexia nervosa is described by her parents as “the perfect child.” When planning care for the client, the nurse should:
A. Allow her to choose what foods she will eat
B. Provide activities to foster her self-identity
C. Encourage her to participate in morning exercise
D. Provide a private room near the nurse’s station

842. A client is admitted with disseminated herpes zoster (shingles). According to the Centers for Disease Control Guidelines for Infection Control:
A. Airborne precautions will be needed.
B. No special precautions will be needed.
C. Only contact precautions will be needed.
D. Droplet precautions will be needed.

843. The nurse is caring for a client with a basal cell epithelioma. The primary cause of basal cell epithelioma is:
A. Sun exposure
B. Smoking
C. Ingestion of alcohol
D. Food preservatives

844. The nurse has been asked to present a lecture on the prevention of West Nile virus in the community setting. Which does the nurse include in the teaching plan?
A. Wear protective clothing outside.
B. Avoid being outside in the middle of the day.
C. Avoid the use of insect repellant containing DEET.
D. The virus is more prevalent in people under 18 years old.

845. The nurse is caring for a client with an above-the-knee amputation (AKA). To prevent hip flexion contractures, the nurse should:
A. Place the client in a prone position for 15–30 minutes twice a day.
B. Keep the foot of the bed elevated on shock blocks.
C. Place trochanter rolls on either side of the affected leg.
D. Keep the client’s leg elevated on two pillows.

846. The physician has prescribed a Becloforte (beclomethasone) inhaler two puffs twice a day for a client with asthma. The nurse should tell the client to report:
A. Increased weight
B. A sore throat
C. Difficulty in sleeping
D. Changes in mood

847. A pregnant client, age 32, asks the nurse why her doctor has recommended a serum alpha fetoprotein. The nurse should explain that the doctor has recommended the test:
A. Because it is a state law
B. To detect cardiovascular defects
C. Because of her age
D. To detect neurological defects

848. Which client is at greatest risk for complications following abdominal surgery?
A. A 68-year-old obese client with non-insulin-dependent diabetes
B. A 27-year-old client with a recent history of urinary tract infections
C. A 16-year-old client who smokes a half-pack of cigarettes per day
D. A 40-year-old client who exercises regularly, with no history of medical conditions

849. A client is admitted with Parkinson’s disease who has been taking Carbidopa/levodopa (Sinemet) for one year. Which clinical manifestation would be most important to report?
A. Dry mouth
B. Spasmodic eye winking
C. Dark urine color
D. Complaints of dizziness

850. The home health nurse is planning for the day’s visits. Which client should be seen first?
A. The client with renal insufficiency
B. The client with Alzheimer’s disease
C. The client with diabetes who has a decubitus ulcer
D. The client with multiple sclerosis who is being treated with IV cortisone

851. A client is admitted to the chemical dependency unit for poly-drug abuse. The client states, “I don’t know why you are all so worried; I am in control. I don’t have a problem.” Which defense mechanism is being utilized?
A. Rationalization
B. Projection
C. Dissociation
D. Denial

852. Assessment of a newborn male reveals that the infant has hypospadias. The nurse knows that:
A. The infant should not be circumcised.
B. Surgical correction will be done by six months of age.
C. Surgical correction is delayed until six years of age.
D. The infant should be circumcised to facilitate voiding.

853. The nurse is preparing to discharge a client following a laparoscopic cholecystectomy. The nurse should:
A. Tell the client to avoid a tub bath for 48 hours.
B. Tell the client to expect clay-colored stools.
C. Tell the client that she can expect lower abdominal pain for the next week.
D. Tell the client to report pain in the back or shoulders.

854. Which diet is associated with an increased risk of colorectal cancer?
A. Low protein, complex carbohydrates
B. High protein, simple carbohydrates
C. High fat, refined carbohydrates
D. Low carbohydrates, complex proteins

855. The doctor has ordered antithrombotic stockings to be applied to the legs of a client with peripheral vascular disease. The nurse knows antithrombotic stockings should be applied:
A. Before the client arises in the morning
B. With the client in a standing position
C. After the client has bathed and applied lotion to the legs
D. Before the client retires in the evening

856. The nurse reviewing the lab results of a client receiving Cytoxan (cyclophosphamide) for Hodgkin’s lymphoma finds the following: WBC 4,200, RBC 3,800,000, platelets 25,000, and serum creatinine 1.0mg. The nurse recognizes that the greatest risk for the client at this time is:
A. Overwhelming infection
B. Bleeding
C. Anemia
D. Renal failure

857. The orthopedic nurse should be particularly alert for a fat embolus in which of the following clients having the greatest risk for this complication after a fracture?
A. A 50-year-old with a fractured fibula
B. A 20-year-old female with a wrist fracture
C. A 21-year-old male with a fractured femur
D. An 8-year-old with a fractured arm

858. An elderly client is diagnosed with interstitial cystitis. Which finding differentiates interstitial cystitis from other forms of cystitis?
A. The client is asymptomatic.
B. The urine is free of bacteria.
C. The urine contains blood.
D. Males are affected more often.

859. A client is admitted to the hospital with a temperature of 99.8°F, complaints of blood-tinged hemoptysis, fatigue, and night sweats. The client’s symptoms are consistent with a diagnosis of:
A. Pneumonia
B. Reaction to antiviral medication
C. Tuberculosis
D. Superinfection due to low CD4 count

860. A client with preeclampsia has been receiving an infusion containing magnesium sulfate for a blood pressure that is 160/80. Deep tendon reflexes are 2 plus, and the urinary output for the past hour is 100mL. The nurse should:
A. Continue the infusion of magnesium sulfate while monitoring the client’s blood pressure.
B. Stop the infusion of magnesium sulfate and contact the physician.
C. Slow the infusion rate and turn the client on her left side.
D. Administer calcium gluconate IV push and continue to monitor the blood pressure.

861. A client with hypothyroidism asks the nurse if she will still need to take thyroid medication during the pregnancy. The nurse’s response is based on the knowledge that:
A. There is no need to take thyroid medication because the fetus’s thyroid produces a thyroid-stimulating hormone.
B. Regulation of thyroid medication is more difficult because the thyroid gland increases in size during pregnancy.
C. It is more difficult to maintain thyroid regulation during pregnancy due to a slowing of metabolism.
D. Fetal growth is arrested if thyroid medication is continued during pregnancy.

862. The client admitted two days earlier with a lung resection accidentally pulls out the chest tube. Which action by the nurse indicates understanding of the management of chest tubes?
A. Order a chest x-ray.
B. Reinsert the tube.
C. Cover the insertion site with a Vaseline gauze.
D. Call the doctor.

863. Infants should be restrained in a car seat in a semi-reclined position facing the rear of the car until they weigh:
A. 10 pounds
B. 15 pounds
C. 20 pounds
D. 25 pounds

864. The nurse is assessing a six-year-old following a tonsillectomy. Which one of the following signs is an early indication of hemorrhage?
A. Drooling of bright red secretions
B. Pulse rate of 90
C. Vomiting of dark brown liquid
D. Infrequent swallowing while sleeping

865. The nurse is caring for a client seven days post-burn injury with 60% body surface area involved. What should be the primary focus of nursing care during this time period?
A. Meticulous infection-control measures
B. Fluid-replacement evaluation
C. Psychological adjustment to the wound
D. Measurement and application of a pressure garment

866. A client with B positive blood is scheduled for a transfusion of whole blood. Which finding requires nursing intervention?
A. The available blood has been banked for two weeks.
B. The blood available for transfusion is Rh negative.
C. The client has a peripheral IV of D5 1/2 normal saline.
D. The blood available for transfusion is type O positive.

867. The nurse is admitting a client with a suspected duodenal ulcer. The client will most likely report that his abdominal discomfort decreases when he:
A. Avoids eating
B. Rests in a recumbent position
C. Eats a meal or snack
D. Sits upright after eating

868. A client is admitted with symptoms of vertigo and syncope. Diagnostic tests indicate left subclavian artery obstruction. What additional findings would the nurse expect?
A. Memory loss and disorientation
B. Numbness in the face, mouth, and tongue
C. Radial pulse differences over 10bpm
D. Frontal headache with associated nausea or emesis

869. The nurse is monitoring the progress of a client in labor. Which finding should be reported to the physician immediately?
A. The presence of scant bloody discharge
B. Frequent urination
C. The presence of green-tinged amniotic fluid
D. Moderate uterine contractions

870. A client’s chest tube drainage device has continuous bubbling in the water seal chamber. What is the nurse checking for when she clamps different areas of the tube to find out where the bubbling stops?
A. An air leak in the system
B. The suction being too high
C. The suction being too low
D. A tension pneumothorax

871. The physician has ordered Claforan (cefotaxime) 1g every six hours. The pharmacy sends the medication premixed in 100mL of D5W with instructions to infuse the medication over one hour. The IV set delivers 20 drops per milliliter. The nurse should set the IV rate at:
A. 50 drops per minute
B. 33 drops per minute
C. 25 drops per minute
D. 12 drops per minute

872. Arterial ulcers are best described as ulcers that:
A. Are smooth in texture
B. Have irregular borders
C. Are cool to touch
D. Are painful to touch

873. The client has an order for Garamycin (gentamicin) to be administered. Which lab test should be done before beginning the medication?
A. Hematocrit
B. Serum creatinine
C. White cell count
D. BUN

874. Which of the following post-operative diets is appropriate for the client who has had a hemorrhoidectomy?
A. High fiber
B. Lactose free
C. Bland
D. Clear liquid

875. A client with an abdominal cholecystectomy returns from surgery with a Jackson-Pratt drain. The chief purpose of the Jackson-Pratt drain is:
A. Prevent the need for dressing changes
B. Reduce edema at the incision
C. Provide for wound drainage
D. Keep the common bile duct open

876. A client experienced a major burn over 55% of his body 36 hours ago. The client is restless and anxious, and states, “I am in pain.” There is a physician prescription for intravenous morphine. What should the nurse do first?
A. Administer the morphine.
B. Assess respirations.
C. Assess urine output.
D. Check serum potassium levels.

877. The nurse is caring for a client with bulimia nervosa. The nurse recognizes that the major difference in the client with anorexia nervosa and the client with bulimia nervosa is the client with bulimia:
A. Is usually grossly overweight.
B. Has a distorted body image.
C. Recognizes that she has an eating disorder.
D. Struggles with issues of dependence versus independence.

878. The physician has prescribed Synthroid (levothyroxine) for a client with myxedema. Which statement indicates that the client understands the nurse’s teaching regarding the medication?
A. "I will take the medication each morning after breakfast."
B. "I will check my heart rate before taking the medication."
C. "I will report visual disturbances to my doctor."
D. "I will stop the medication if I develop gastric upset."

879. Which nurse should not be assigned to care for the client with a radium implant for vaginal cancer?
A. The LPN who is six months postpartum
B. The RN who is pregnant
C. The RN who is allergic to iodine
D. The RN with a three-year-old at home

880. A client with emphysema has been receiving oxygen at 3L per minute by nasal cannula. The nurse knows that the goal of the client’s oxygen therapy is achieved when the client’s PaO2 reading is:
A. 50–60mm Hg
B. 70–80mm Hg
C. 80–90mm Hg
D. 90–98mm Hg

881. A client is admitted to the emergency room with multiple injuries. What is the proper sequence for managing the client?
A. Assess for head injuries, control hemorrhage, establish an airway, prevent hypovolemic shock
B. Control hemorrhage, prevent hypovolemic shock, establish an airway, assess for head injuries
C. Establish an airway, control hemorrhage, prevent hypovolemic shock, assess for head injuries
D. Prevent hypovolemic shock, assess for head injuries, establish an airway, control hemorrhage

882. A client is newly diagnosed with diabetes. Which nursing diagnosis is a priority at this time?
A. Fluid volume deficit
B. Anxiety
C. Deficient knowledge
D. Activity intolerance

883. A client with chronic obstructive pulmonary disease (COPD) is admitted to the respiratory unit. Which physician prescription should the nurse question?
A. O2 at 5L/min by nasal cannula
B. Solu Medrol 125mg IV push every six hours
C. Ceftriaxone (Rocephin) 1gram IVPB daily
D. Darvocet N 100 po prn pain

884. A client with a history of depression is treated with Parnate (tranylcypromine), an MAO inhibitor. Ingestion of foods containing tyramine while taking an MAO inhibitor can result in:
A. Extreme elevations in blood pressure
B. Rapidly rising temperature
C. Abnormal movement and muscle spasms
D. Damage to the eighth cranial nerve

885. Which equipment would assist the client with a total hip replacement with activities of daily living?
A. Raised commode
B. Velcro fasteners
C. Hand grip utensils
D. Large button clothing

886. A client is caring for a client with a Brown-Sequard spinal cord injury. The nurse should expect the client to have:
A. Total loss of motor, sensory, and reflex activity
B. Incomplete loss of motor function
C. Loss of sensory function with potential for recovery
D. Loss of sensation on the side opposite the injury

887. The nurse is accessing a venous access port of a client about to receive chemotherapy. Place the following steps in proper sequential order:

I. Apply clean gloves.
II. Clean the skin with antimicrobial and let air dry.
III. Insert needle into port at a 90° angle.
IV. Connect 10mL NS into extension of huber needle and prime.
V. Instill heparin solution.
VI. Stabilize the part by using middle and index fingers.
VII. Wash hands and apply sterile gloves.
VIII. Inject saline and assess for infiltration.
IX. Check placement of needle.
A. I, IV, II, VII, IX, III, VI, VIII, V
B. I, III, IV, VII, VI, II, IX, VIII, V
C. I, II, IV, V, VI, III, IX, VIII, VII
D. I, II, IV, VII, VI, III, IX, VIII, V

888. The nurse is removing a peripherally inserted central catheter (PICC). The nurse should position the patient in which position?
A. Fowlers
B. Right side lying
C. Left side lying
D. Trendelenburg

889. A client scheduled for a carotid endarterectomy requires insertion of an intra-arterial blood pressure-monitoring device. The nurse plans to perform the Allen test. Which observation indicates patency of the ulnar artery?
A. Blanching of the hand on compression and release of the ulnar artery
B. Muscular twitching of the bicep muscle with use of a tourniquet at the wrist
C. Hand turning pink after the nurse releases the pressure on the ulnar artery
D. Flexion of the wrist when tapping the ulnar artery with a reflex hammer

890. The nurse is teaching the client with AIDS regarding needed changes in food preparation. Which statement indicates that the client understands the nurse’s teaching?
A. Adding fresh ground pepper to my food will improve the flavor.
B. Meat should be thoroughly cooked to the proper temperature.
C. Eating cheese and yogurt will prevent AIDS-related diarrhea.
D. It is important to eat four to five servings of fresh fruits and vegetables a day.

891. A behavior-modification program has been started for an adolescent with oppositional defiant disorder. Which statement describes the use of behavior modification?
A. Distractors are used to interrupt repetitive or unpleasant thoughts.
B. Techniques using stressors and exercise are used to increase awareness of body defenses.
C. A system of tokens and rewards is used as positive reinforcement.
D. Appropriate behavior is learned through observing the action of models.

892. The best size cathlon for administration of a blood transfusion to a six-year-old is:
A. 18 gauge
B. 19 gauge
C. 22 gauge
D. 20 gauge

893. The nurse expects that a client with cocaine addiction would most likely be placed on which medication?
A. Bromocriptine (Parlodel)
B. Methadone
C. THC
D. Disulfiram (Antabuse)

894. The nurse is preparing to administer a feeding via a nasogastric tube. The nurse would perform which of the following before initiating the feeding?
A. Assess for tube placement by aspirating stomach content.
B. Place the patient in a left-lying position.
C. Administer feeding with 50% Dextrose.
D. Ensure that the feeding solution has been warmed in a microwave for two minutes.

895. Cystic fibrosis is an exocrine disorder that affects several systems of the body. The earliest sign associated with a diagnosis of cystic fibrosis is:
A. Steatorrhea
B. Frequent respiratory infections
C. Increased sweating
D. Meconium ileus

896. Which of the following statements is true regarding management of the client with multiple sclerosis?
A. Taking a hot bath will decrease stiffness and spasticity.
B. A schedule of strenuous exercise will improve muscle strength.
C. Rest periods should be scheduled throughout the day.
D. Visual disturbances can be corrected with prescription glasses.

897. The physician has ordered Myochrysine (gold sodium thiomalate) for a client with rheumatoid arthritis. Before administering the client’s medication, the nurse should:
A. Check the lab work.
B. Administer an antiemetic.
C. Obtain the blood pressure.
D. Administer a sedative.

898. Which is true regarding the administration of antacids?
A. Antacids should be administered without regard to mealtimes.
B. Antacids should be administered with each meal and snack of the day.
C. Antacids should not be administered with other medications.
D. Antacids should be administered with all other medications, for maximal absorption.

899. An 18-month-old is admitted to the hospital with acute laryngotracheobronchitis. When assessing the respiratory status, the nurse should expect to find:
A. Inspiratory stridor and harsh cough
B. Strident cough and drooling
C. Wheezing and intercostal retractions
D. Expiratory wheezing and nonproductive cough

900. The nurse is caring for a postpartum client two hours post-delivery who is unable to void. Which of the following nursing interventions should be considered first?
A. Insert a straight catheter for residual.
B. Encourage oral intake of fluids.
C. Check perineum for swelling or hematoma.
D. Palpate bladder for distention and position.

901. An adolescent primigravida who is 10 weeks pregnant attends the antepartal clinic for a first check-up. To develop a teaching plan, the nurse should initially assess:
A. The client’s knowledge of the signs of preterm labor
B. The client’s feelings about the pregnancy
C. The client’s method of birth control
D. The client’s plans for continuing school

902. The nurse is preparing a client with an axillopopliteal bypass graft for discharge. The client should be taught to avoid:
A. Using a recliner to rest
B. Resting in supine position
C. Sitting in a straight chair
D. Sleeping in right Sim’s position

903. The nurse is ready to begin an exam on a nine-month-old infant who is sitting quietly on his mother’s lap. Which should the nurse do first?
A. Check the Babinski reflex
B. Listen to the heart and lung sounds
C. Palpate the abdomen
D. Check tympanic membranes

904. A nurse is preparing to mix and administer chemotherapy. What equipment would be unnecessary to obtain?
A. Surgical gloves
B. Luer lok fitting IV tubing
C. Surgical hat cover
D. Disposable long-sleeve gown

905. To decrease the risk of urinary tract infections, a female client should be taught to:
A. Drink citrus fruit juices
B. Avoid using tampons
C. Increase the intake of red meats
D. Clean the perineum from front to back

906. The nurse asks a patient about current medications. Which one of the patient’s medications is most likely to cause abdominal pain?
A. Norco (hydrocodone/APAP)
B. Erythrocin (erythromycin)
C. Zyrtec (cetirizine)
D. Aldactone (spironolactone)

907. A client is admitted with suspected pernicious anemia. Which findings support the diagnosis of pernicious anemia?
A. The client complains of feeling tired and listless.
B. The client has waxy, pale skin.
C. The client exhibits loss of coordination and position sense.
D. The client has a rapid pulse rate and a detectable heart murmur.

908. A client with ascites is scheduled for a paracentesis. Which instruction should be given to the client before the procedure?
A. You will need to lay flat during the procedure.
B. You need to empty your bladder before the procedure.
C. You will be asleep during the procedure.
D. The doctor will inject a medication during the procedure.

909. The nurse is assessing elderly clients at a community center. Which of the following findings would be the most cause for concern?
A. Dry mouth
B. Loss of one inch of height in the last year
C. Stiffened joints
D. Rales bilaterally on chest auscultation

910. The nurse notes that a post-operative client’s respirations have dropped from 14 to 6 breaths per minute. The nurse administers Narcan (naloxone) per standing order. Following administration of the medication, the nurse should assess the client for:
A. Pupillary changes
B. Projectile vomiting
C. Wheezing respirations
D. Sudden, intense pain

911. A client on the postpartum unit has a proctoepisiotomy. The nurse should anticipate administering which medication?
A. Dulcolax suppository
B. Docusate sodium (Colace)
C. Methylergonovine maleate (Methergine)
D. Bromocriptine sulfate (Parlodel)

912. When assessing the urinary output of a client who has had extracorporeal lithotripsy, the nurse can expect to find:
A. Cherry-red urine that gradually becomes clearer
B. Orange-tinged urine containing particles of calculi
C. Dark red urine that becomes cloudy in appearance
D. Dark, smoky-colored urine with high specific gravity

913. The following clients are to be assigned for daily care. The newly licensed nurse should not be assigned to provide primary care for the client with:
A. Full-thickness burns of the abdomen and upper thighs
B. A fractured hip scheduled for hip replacement
C. Ileal reservoir following a cystectomy
D. Noncardiogenic pulmonary edema (ARDS)

914. A client with hypothyroidism frequently complains of feeling cold. The nurse should tell the client that she will be more comfortable if she:
A. Uses an electric blanket at night
B. Dresses in extra layers of clothing
C. Applies a heating pad to her feet
D. Takes a hot bath morning and evening

915. The physician has ordered Activase (alteplase) for a client admitted with a myocardial infarction. The desired effect of Activase is:
A. Prevention of congestive heart failure
B. Stabilization of the clot
C. Increased tissue oxygenation
D. Destruction of the clot

916. A client with terminal lung cancer is admitted to the unit. A family member asks the nurse, “How much longer will it be?” Which response by the nurse is most appropriate?
A. “This must be a terrible situation for you.”
B. “I don’t know. I’ll call the doctor.”
C. “I cannot say exactly. What are your concerns at this time?”
D. “Don’t worry, from the way things look, it will be very soon.”

917. Which information should be given to the client using a TENS unit?
A. Electrocution may occur if you use water with this unit.
B. Skin irritation may occur with prolonged use of the unit.
C. The unit can be placed anywhere on the body without fear of adverse reactions.
D. A cream or lotion should be applied to the skin before applying the unit.

918. A child suspected of having cystic fibrosis is scheduled for a quantitative sweat test. The nurse knows that the quantitative sweat test will be analyzed using:
A. Pilocarpine iontophoresis
B. Chloride iontophoresis
C. Sodium iontophoresis
D. Potassium iontophoresis

919. The client is admitted for observation because of ingestion of a hallucinogenic drug. Which statement is true regarding hallucinogenic drugs?
A. Hallucinogenic drugs create both stimulant and depressant effects.
B. Hallucinogenic drugs induce a state of altered perception.
C. Hallucinogenic drugs produce severe respiratory depression.
D. Hallucinogenic drugs induce rapid physical dependence.

920. A client delivered a nine-pound infant two hours ago. The client has an IV of D5W with oxytocin. The nurse determines that the medication is achieving the desired effect when which of the following is assessed?
A. A rise in blood pressure
B. A decrease in pain
C. An increase in lochia rubra
D. A firm uterine fundus

921. A patient of Greek descent has been prescribed Bactrim (sulfamethoxazole-trimethoprim) for treatment of a urinary tract infection. Before beginning the medication, the patient should be assessed for which of the following disorders?
A. G6PD deficiency
B. ß-thalassemia
C. Sickle cell anemia
D. Von Willebrand disease

922. A client is scheduled to have a cardiac CTA with contrast. Before the procedure, the nurse should assess the patient for:
A. Allergies to shellfish or iodine allergies
B. The ability to lie prone for 30 minutes
C. A history of reaction to nitrates
D. The presence of body tattoos

923. Which of the following would be the priority nursing diagnosis for the adult client with acute leukemia?
A. Oral mucous membrane, altered related to chemotherapy
B. Risk for injury related to thrombocytopenia
C. Fatigue related to the disease process
D. Interrupted family processes related to life-threatening illness of a family member

924. A 21-year-old male with Hodgkin’s lymphoma is a senior at the local university. He is engaged to be married and is to begin a new job upon graduation. Which of the following diagnoses would be a priority for this client?
A. Sexual dysfunction related to radiation therapy
B. Anticipatory grieving related to terminal illness
C. Tissue integrity related to prolonged bed rest
D. Fatigue related to chemotherapy

925. The nurse is the first person to arrive at the scene of a motor vehicle accident. When rendering aid to the victim, the nurse should give priority to:
A. Establishing a patent airway
B. Checking the quality of respirations
C. Observing for signs of active bleeding
D. Determining the level of consciousness

926. A client with nontropical sprue has an exacerbation of symptoms. Which meal selection is responsible for the recurrence of the client’s symptoms?
A. Tossed salad with oil and vinegar dressing
B. Baked potato with sour cream and chives
C. Cream of tomato soup and crackers
D. Mixed fruit and yogurt

927. The nurse has just received the change of shift report. Which client should the nurse assess first?
A. A client with a supratentorial tumor awaiting surgery
B. A client admitted with a suspected subdural hematoma
C. A client recently diagnosed with akinetic seizures
D. A client transferring to the neuro rehabilitation unit

928. A 15-year-old primigravida is admitted with a tentative diagnosis of HELLP syndrome. Which laboratory finding is associated with HELLP syndrome?
A. Elevated blood glucose
B. Elevated platelet count
C. Elevated creatinine clearance
D. Elevated hepatic enzymes

929. When administering a tuberculin skin test, the nurse should insert the needle at a:
A. 15° angle
B. 30° angle
C. 45° angle
D. 90° angle

930. A child is admitted to the emergency room following ingestion of a bottle of medication containing acetaminophen. The antidote for acetaminophen is:
A. Acetylcysteine
B. Deferoxamine
C. Edetate calcium disodium
D. Activated charcoal

931. A four-year-old is scheduled for a routine tonsillectomy. Which of the following lab findings should be reported to the doctor?
A. A hemoglobin of 12Gm
B. A platelet count of 200,000
C. A white blood cell count of 16,000
D. A urine specific gravity of 1.010

932. The nurse is providing dietary teaching for a client with elevated cholesterol levels. Which cooking oil is not suggested for the client on a low-cholesterol diet?
A. Safflower oil
B. Sunflower oil
C. Coconut oil
D. Canola oil

933. A client with a stroke and malnutrition has been placed on Total Parenteral Nutrition (TPN). The nurse notes air entering the client via the central line. Which initial action is most appropriate?
A. Notify the physician.
B. Elevate the head of the bed.
C. Place the client in the left lateral decubitus position.
D. Stop the TPN and hang D5 1/2 NS.

934. A client is being treated for cancer with linear acceleration radiation. The physician has marked the radiation site with a blue marking pen. The nurse should:
A. Remove the unsightly markings with acetone or alcohol.
B. Cover the radiation site with loose gauze dressing.
C. Sprinkle baby powder over the radiated area.
D. Refrain from using soap or lotion on the marked area.

935. A client is brought to the mental health clinic by her sister after the death of their father. Which statement made by the client’s sister suggests the client may have abnormal grieving?
A. “My sister still has episodes of crying, and it’s been three months since Daddy died.”
B. “My sister seems to have forgotten a lot of the bad things that Daddy did in his lifetime.”
C. “My sister has really had a hard time after Daddy’s funeral.”
D. “My sister doesn’t seem sad at all and acts like nothing has happened.”

936. The nurse is performing discharge teaching for a client after a cardiac catheterization. Which statement by the client indicates a need for further teaching?
A. “I should not bend, strain, or lift heavy objects for one day.”
B. “If bleeding occurs, I should place an ice bag on the site for 10 minutes.”
C. “I need to call the doctor if my temperature goes above 101°F.”
D. “I should talk to the doctor to find out when I can go back to work.”

937. When caring for a client with an anterior cervical discectomy, the nurse should give priority to assessing for post-operative bleeding. The nurse should pay particular attention to:
A. Drainage on the surgical dressing
B. Complaints of neck pain
C. Bleeding from the mouth
D. Swelling in the posterior neck

938. Which order would the nurse anticipate for a client hospitalized with acute pancreatitis?
A. Vital signs once per shift
B. Insertion of a nasogastric tube
C. Patient controlled analgesia with Demerol (meperidine)
D. Low-fat diet as tolerated

939. A client with diabetes visits the prenatal clinic at 28 weeks gestation. Which statement is true regarding insulin needs during pregnancy?
A. Insulin requirements moderate as the pregnancy progresses.
B. A decreased need for insulin occurs during the second trimester.
C. Elevations in human chorionic gonadotropin decrease the need for insulin.
D. Fetal development depends on adequate insulin regulation.

940. When the nurse checks the fundus of a client on the first postpartum day, she notes that the fundus is firm, is at the level of the umbilicus, and is displaced to the right. The next action the nurse should take is to:
A. Check the client for bladder distention.
B. Assess the blood pressure for hypotension.
C. Determine whether an oxytocic drug was given.
D. Check for the expulsion of small clots.

941. A client tells the nurse that she takes St. John’s wort (hypericum perforatum) three times a day for mild depression. The nurse should tell the client that:
A. St. John’s wort seldom relieves depression.
B. She should avoid eating aged cheese.
C. Skin reactions increase with the use of sunscreen.
D. The herbal is safe to use with other antidepressants.

942. The nurse is preparing to discharge a client who is taking an MAOI. The nurse should instruct the client to:
A. Wear protective clothing and sunglasses when outside.
B. Avoid over-the-counter cold and hay fever preparations.
C. Drink at least eight glasses of water a day.
D. Increase his intake of high-quality protein.

943. The registered nurse on a pediatric unit is making assignments for the day. Which patient should not be assigned to the nurse who is pregnant?
A. A child with cystic fibrosis who is receiving Nebcin (tobramycin)
B. An infant with respiratory syncytial virus receiving Virazole (ribavirin)
C. A child with Hirschsprung’s disease scheduled for barium enema
D. A child with Meckel’s diverticulum scheduled for radiographic scintigraphy

944. The nurse is teaching the mother of a six-month-old with eczema. Which instruction should be included in the nurse’s teaching?
A. Dress the infant warmly to prevent undue chilling.
B. Cut the infant’s fingernails and toenails regularly.
C. Use bubble bath instead of soap for bathing the infant.
D. Wash the infant’s clothes with mild detergent and fabric softener.

945. A client with essential tremors has been prescribed the drug primidone (Mysoline). Which of the following will the nurse teach the patient about the drug?
A. Avoid alcohol while taking the drug.
B. The drug causes hyperactivity.
C. The drug can be stopped abruptly without effects.
D. Euphoria is a side effect of taking the drug.

946. The nurse is assessing a client upon arrival to the emergency department. Partial airway obstruction is suspected. Which clinical manifestation is a late sign of airway obstruction?
A. Rales in lungs
B. Restless behavior
C. Cyanotic ear lobes
D. Inspiratory stridor

947. Which diet selection by a client with a decubitus ulcer would indicate a clear understanding of the proper diet for healing of the ulcer?
A. Tossed salad, milk, and a slice of caramel cake
B. Vegetable soup and crackers, and a glass of iced tea
C. Baked chicken breast, broccoli, wheat roll, and an orange
D. Hamburger, French fries, and corn on the cob

948. A client with vaginal cancer is being treated with a radioactive vaginal implant. The client’s husband asks the nurse if he can spend the night with his wife. The nurse should explain that:
A. Overnight stays by family members is against hospital policy.
B. There is no need for him to stay because staffing is adequate.
C. His wife will rest much better knowing that he is at home.
D. Visitation is limited to 30 minutes when the implant is in place.

949. The physician prescribes regular insulin, five units subcutaneous. Regular insulin begins to exert an effect:
A. Within 5–10 minutes
B. Within 10–20 minutes
C. Within 30–60 minutes
D. Within 60–90 minutes

950. The client with diabetes is preparing for discharge. During discharge teaching, the nurse assesses the client’s ability to care for himself. Which statement made by the client would indicate a need for follow-up after discharge?
A. I live by myself.
B. I have trouble seeing.
C. I have a cat in the house with me.
D. I usually drive myself to the doctor.

951. A client with rheumatoid arthritis is being discharged with a prescription for etanercept (Enbrel). Which should the nurse teach the client to report immediately?
A. Redness, itching, edema at injection site
B. Exposure to chickenpox or shingles
C. Headache
D. Vomiting

952. The nurse is caring for a client with ß-thalassemia major. Which therapy is used to treat ß-thalassemia major?
A. IV fluids
B. Frequent blood transfusions
C. Oxygen therapy
D. Iron therapy

953. To minimize confusion in the elderly hospitalized client, the nurse should:
A. Provide sensory stimulation by varying the daily routine.
B. Keep the room brightly lit and the television on to provide orientation to time.
C. Encourage visitors to limit visitation to phone calls to avoid overstimulation.
D. Provide explanations in a calm, caring manner to minimize anxiety.

954. The client is seen in the clinic for treatment of migraine headaches. The drug Imitrex (sumatriptan succinate) is prescribed for the client. Which of the following in the client’s history should be reported to the doctor?
A. Diabetes
B. Prinzmetal’s angina
C. Cancer
D. Cluster headaches

955. Which assignment should not be delegated to the licensed practical nurse?
A. Inserting a Foley catheter
B. Discontinuing a nasogastric tube
C. Obtaining a sputum specimen
D. Starting a blood transfusion

956. The physician has ordered Basaljel (aluminum carbonate gel) for a client with recurrent indigestion. The nurse should teach the client common side effects of the medication, which include:
A. Constipation
B. Urinary retention
C. Diarrhea
D. Confusion

957. A client tells the doctor that she is about 20 weeks pregnant. The most definitive sign of pregnancy is:
A. Elevated human chorionic gonadatropin
B. The presence of fetal heart tones
C. Uterine enlargement
D. Breast enlargement and tenderness

958. A newborn with narcotic abstinence syndrome is admitted to the nursery. Nursing care of the newborn should include:
A. Teaching the mother to provide tactile stimulation
B. Wrapping the newborn snugly in a blanket
C. Placing the newborn in the infant seat
D. Initiating an early infant-stimulation program

959. A client with a total knee replacement has a CPM (continuous passive motion) device applied during the post-operative period. Which statement made by the nurse indicates understanding of the care of the client with a CPM device?
A. Use of the CPM device will permit the client to ambulate during the therapy.
B. The CPM device controls should be positioned out of the client’s reach.
C. If the client complains of pain during therapy, I will discontinue use of the device and call the doctor.
D. Use of the CPM device will eliminate the need for physical therapy after the client is discharged.

960. The newly licensed nurse has been asked to perform a procedure that he feels unqualified to perform. The nurse’s best response at this time is to:
A. Attempt to perform the procedure.
B. Refuse to perform the procedure and give a reason for the refusal.
C. Request to observe a similar procedure and then attempt to complete the procedure.
D. Agree to perform the procedure if the client is willing.

961. A client with deep vein thrombosis is receiving a continuous heparin infusion and Coumadin PO. INR lab test result is 8.0. Which intervention would be most important to include in the nursing care plan?
A. Assess for signs of abnormal bleeding.
B. Anticipate an increase in the heparin drip rate.
C. Instruct the client regarding the drug therapy.
D. Increase the frequency of vascular assessments.

962. A 25-year-old client with a goiter is admitted to the unit. What would the nurse expect the admitting assessment to reveal?
A. Slow pulse
B. Anorexia
C. Bulging eyes
D. Weight gain

963. Which set of vital signs would best indicate to the nurse that a client has an increase in intracranial pressure?
A. BP 180/70, pulse 50, respirations 16, temperature 101°F
B. BP 100/70, pulse 64, respirations 20, temperature 98.6°F
C. BP 96/70, pulse 132, respirations 20, temperature 98.6°F
D. BP 130/80, pulse 50, respirations 18, temperature 99.6°F

964. The nurse is teaching the mother of an infant with galactosemia. Which information should be included in the nurse’s teaching?
A. Check food and drug labels for the presence of lactose.
B. Foods containing galactose can be gradually added.
C. Future children will not be affected.
D. Sources of galactose are essential for growth.

965. A child with cystic fibrosis is being treated with inhalation therapy with Pulmozyme (dornase alfa). A side effect of the medication is:
A. Weight gain
B. Hair loss
C. Sore throat
D. Brittle nails

966. The nurse is aware that the best way to prevent post-operative wound infection in the surgical client is to:
A. Administer a prescribed antibiotic
B. Wash her hands for two minutes before care
C. Wear a mask when providing care
D. Ask the client to cover her mouth when she coughs

967. The nurse is developing a plan of care for a client with acromegaly. Which nursing diagnosis should receive priority?
A. Alteration in body image related to change in facial features
B. Risk for immobility related to joint pain
C. Risk for ineffective airway clearance related to obstruction of airway by tongue
D. Sexual dysfunction related to altered hormone secretion

968. The nurse is caring for a client with epilepsy who is being treated with carbamazepine (Tegretol). Which laboratory value indicates an adverse effect of the medication?
A. Uric acid of 5mg/dL
B. Hematocrit of 33%
C. WBC 2000 per cubic millimeter
D. Platelets 150,000 per cubic millimeter

969. A client is admitted to the emergency room with complaints of substernal chest pain radiating to the left jaw. Which ECG finding is suggestive of acute myocardial infarction?
A. Peaked P wave
B. Changes in ST segment
C. Minimal QRS wave
D. Prominent U wave

970. Most parents of infants with Wilms tumor report finding the mass when:
A. The infant is diapered or bathed.
B. The infant is unable to use his arms.
C. The infant is unable to follow a moving object.
D. The infant is unable to vocalize sounds.

971. A client is two days post-operative bowel resection. After a coughing episode, the client’s wound eviscerates. Which nursing action is appropriate?
A. Reinserting the protruding bowel and covering the site with sterile 4×4s
B. Covering the site with a sterile abdominal dressing
C. Covering the site with a sterile saline-soaked dressing
D. Applying an abdominal binder and manual pressure to the site

972. A client scheduled for disc surgery tells the nurse that she frequently uses the herbal supplement kava-kava (piper methysticum). The nurse should notify the doctor because kava-kava:
A. Increases the effects of anesthesia and post-operative analgesia
B. Eliminates the need for antimicrobial therapy following surgery
C. Increases urinary output, so a urinary catheter will be needed post-operatively
D. Depresses the immune system, so infection is more of a problem

973. To prevent deformities of the knee joints in a client with an exacerbation of rheumatoid arthritis, the nurse should:
A. Tell the client to remain on bed rest until swelling subsides.
B. Discourage passive range of motion because it will cause further swelling.
C. Encourage motion of the joint within the limits of pain.
D. Tell the client she will need joint immobilization for 2–3 weeks.

974. A client with AIDS has impaired nutrition due to diarrhea. The nurse teaches the client about the need to avoid certain foods. Which diet selection by the client would indicate a need for further teaching?
A. Tossed salad
B. Baked chicken
C. Broiled fish
D. Steamed rice

975. The nurse is teaching the parents of an infant with osteogenesis imperfecta. The nurse should explain the need for:
A. Additional calcium in the infant’s diet
B. Careful handling to prevent fractures
C. Providing extra sensorimotor stimulation
D. Frequent testing of visual function

976. A client in the family planning clinic asks the nurse about the most likely time for her to conceive. The nurse explains that conception is most likely to occur when:
A. Estrogen levels are low.
B. Luteinizing hormone is high.
C. The endometrial lining is thin.
D. The progesterone level is low.

977. A client is being admitted with syndrome of inappropriate diuretic hormone. Which does the nurse expect to observe?

Select all that apply.
I. Increased thirst
II. Tachycardia
III. Polyuria
IV. Hostility
V. Muscle weakness
A. IV and V only
B. I only
C. II, IV, V
D. None of the Above

978. The nurse is caring for a client with pneumonia who is allergic to penicillin. Which antibiotic is safest to administer to this client?
A. Cefazolin (Ancef)
B. Amoxicillin
C. Erythrocin (Erythromycin)
D. Ceftriaxone (Rocephin)

979. A client with an inguinal hernia asks the nurse why he should have surgery when he has had a hernia for years. The nurse understands that surgery is recommended to:
A. Prevent strangulation of the bowel
B. Prevent malabsorptive disorders
C. Decrease secretion of bile salts
D. Increase intestinal motility

980. Which activity is best suited to the 12-year-old with juvenile rheumatoid arthritis?
A. Playing video games
B. Swimming
C. Working crossword puzzles
D. Playing slow-pitch softball

981. A client is being evaluated for carpel tunnel syndrome. The nurse is observed tapping over the median nerve in the wrist and asking the client if there is pain or tingling. Which assessment is the nurse performing?
A. Phalen’s maneuver
B. Tinel’s sign
C. Kernig’s sign
D. Brudzinski’s sign

982. While caring for a client in the second stage of labor, the nurse notices a pattern of early decelerations. The nurse should:
A. Notify the physician immediately.
B. Turn the client on her left side.
C. Apply oxygen via a tight face mask.
D. Document the finding on the flow sheet.

983. The nurse is caring for a client with epilepsy who is to receive phenytoin sodium (Dilantin) 100mg IV push. The client has an IV of D51/2NS infusing at 100mL/hr. When administering the Dilantin, which is the appropriate initial nursing action?
A. Obtain an ambu bag and put it at bedside.
B. Insert a 16g IV catheter.
C. Flush the IV line with normal saline.
D. Premedicate with promethiazine (phenergan) IV push.

984. The nurse is caring for a client with a radium implant for the treatment of cervical cancer. While caring for the client with a radioactive implant, the nurse should:
A. Provide emotional support by spending additional time with the client.
B. Stand at the foot of the bed when talking to the client.
C. Avoid handling items used by the client.
D. Wear a badge to monitor the amount of time spent in the client’s room.

985. The nurse is reviewing the lab reports on several clients. Which one should be reported to the physician immediately?
A. A serum creatinine of 5.2mg/dL in a client with chronic renal failure
B. A positive C reactive protein in a client with rheumatic fever
C. A hematocrit of 52% in a client with gastroenteritis
D. A white cell count of 2,200cu/mm in a client taking Dilantin (phenytoin)

986. The first exercise that should be performed by the client who had a mastectomy one day earlier is:
A. Walking the hand up the wall
B. Sweeping the floor
C. Combing her hair
D. Squeezing a ball

987. A client is receiving peritoneal dialysis. If the dialysate returns are cloudy, the nurse should:
A. Tell the client that this is a normal occurrence
B. Ask the client about fever or abdominal pain
C. Tell the client that the dialysate should be shaken before use
D. Ask the client how she has been warming the dialysate

988. The physician has inserted an esophageal balloon tamponade in a client with bleeding esophageal varices. The nurse should maintain the esophageal balloon at a pressure of:
A. 5–10mmHg
B. 10–15mmHg
C. 15–20mmHg
D. 20–25mmHg

989. A client with mania 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

990. The client is admitted with a BP of 210/100. Her doctor orders furosemide (Lasix) 40mg IV stat. How should the nurse administer the prescribed furosemide to this client?
A. By giving it over 1–2 minutes
B. By hanging it IV piggyback
C. With normal saline only
D. With a filter

991. A client with cervical cancer is staged as Tis. A staging of Tis indicates that:
A. The cancer stage cannot be assessed.
B. The cancer is localized to the primary site.
C. The cancer shows increasing lymph node involvement.
D. The cancer is accompanied by distant metastasis.

992. The nurse is making room assignments for four obstetrical clients. If only one private room is available, it should be assigned to:
A. A multigravida with diabetes mellitus
B. A primigravida with preeclampsia
C. A multigravida with preterm labor
D. A primigravida with hyperemesis gravidarum

993. When preparing a client for magnetic resonance imaging, the nurse should implement which of the following?
A. Obtain informed consent and administer atropine 0.4mg.
B. Scrub the injection site for 15 minutes.
C. Remove any jewelry and inquire about metal implants.
D. Administer Benadryl 50mg/mL IV.

994. A client with ovarian cancer is receiving fluorouracil (Adrucil) IV. What should the nurse do if she notices crystals in the IV medication?
A. Discard the solution and order a new bag.
B. Warm the solution.
C. Continue the infusion and document the finding.
D. Discontinue the medication.

995. The nurse is responsible for performing a neonatal assessment on a full-term infant. At one minute, the nurse could expect to find:
A. An apical pulse of 100
B. An absence of tonus
C. Cyanosis of the feet and hands
D. Jaundice of the skin and sclera

996. A client who has just undergone a laparoscopic cholecystectomy complains of “free air pain.” What would be your best action?
A. Ambulate the client.
B. Instruct the client to breathe deeply and cough.
C. Maintain the client on bed rest with his legs elevated.
D. Insert an NG tube.

997. The doctor has prescribed Exelon (rivastigmine) for the client with Alzheimer’s disease. Which side effect is most often associated with this drug?
A. Urinary incontinence
B. Headaches
C. Confusion
D. Nausea

998. The nurse identifies ventricular tachycardia on the cardiac monitor. The patient has a pulse rate of 160 with a regular rhythm. The nurse should give priority to:
A. Administering atropine sulfate
B. Requesting a stat potassium level
C. Administering amiodarone
D. Defibrillating at 360 joules

999. The nurse is caring for a client following the reimplantation of the thumb and index finger. Which finding should be reported to the physician immediately?
A. Temperature of 100°F
B. Coolness and discoloration of the digits
C. Complaints of pain
D. Difficulty moving the digits

1000. The nurse is suspected of charting medication administration that he did not give. The nurse can be charged with:
A. Fraud
B. Malpractice
C. Negligence
D. Tort

1001. The amniocentesis reveals that the patient has a high AFP level. The nurse is aware that a high level of AFP is associated with which of the following?
A. Myelomeningocele
B. Esophageal atresia
C. Omphalocele
D. Trisomy 21

1002. A client has an order for vancomycin (Vancocin) 1 gram IVPB in 250 mL normal saline to infuse over 60 minutes. The nurse would set the IV drop rate to deliver how many drops per minute if the IV set delivers 15gtts/mL?

Fill in the blank .... Gtts/minute
A. 63 gtts/minute
B. 17 gtts/minute
C. 54 gtts/minute
D. 3 gtts/minute

1003. A burn client is in the acute phase of burn care. The nurse assesses jugular vein distention, edema, urine output of 20 mL in two hours, and crackles on auscultation. Which order would the nurse anticipate from the physician?
A. Furosemide (Lasix) 40 mg IV push
B. Irrigate the Foley catheter
C. Increase the IV fluids to 200mL/hr
D. Place the client in Trendelenburg position

1004. A client hospitalized with MRSA is placed on contact precautions. Which statement is true regarding precautions for infections spread by contact?
A. The client should be placed in a room with negative pressure.
B. Infection requires close contact; therefore, the door may remain open.
C. Transmission is highly likely, so the client should wear a mask at all times.
D. Infection requires skin-to-skin contact and is prevented by hand washing, gloves, and a gown.

1005. The nurse is evaluating the client who was admitted eight hours ago for induction of labor. The following graph is noted on the monitor. Which action should be taken first by the nurse?

A. Instruct the client to push
B. Perform a vaginal exam
C. Stop the infusion of Pitocin (oxytocin)
D. Place the client in a semi-Fowler’s position

1006. An obstetrical client with a history of stillbirths has an order for a nonstress test. The nurse is aware that a nonstress test is ordered to:
A. Determine lung maturity
B. Measure the fetal activity
C. Show the effect of contractions on fetal heart rate
D. Measure the well-being of the fetus

1007. A client with hepatitis C is scheduled for a liver biopsy. Which would the nurse include in the teaching plan for this client?
A. The client should lie on the left side after the procedure.
B. Cleansing enemas should be given the morning of the procedure.
C. Blood coagulation studies might be done before the biopsy.
D. The procedure is noninvasive and causes no pain.

1008. A client admitted with transient ischemia attacks has returned from a cerebral arteriogram. The nurse performs an assessment and finds a newly formed hematoma in the right groin area. What is the nurse’s initial action?
A. Apply direct pressure to the site.
B. Check the pedal pulses on the right leg.
C. Notify the physician.
D. Turn the client to the prone position.

1009. A client weighing 150 pounds has received burns over 50% of his body at 1200 hours. Using the Parkland formula, calculate the expected amount of fluid that the client should receive by 2000 hours.
A. 3,400
B. 6,800
C. 10,200
D. 13,600

1010. The nurse is planning care for the patient with celiac disease. In teaching about the diet, the nurse should instruct the patient to avoid which of the following for breakfast?
A. Puffed wheat
B. Banana
C. Puffed rice
D. Cornflakes

1011. Which of the following statements by a client with a seizure disorder who is taking topiramate (Topamax) indicates that the client has understood the nurse’s instruction?
A. “I will take the medicine before going to bed.”
B. “I will drink 8 to 10 ten-ounce glasses of water a day.”
C. “I will eat plenty of fresh fruits.”
D. “I must take the medicine with a meal or snack.”

1012. The nurse is performing discharge teaching on a client with diverticulitis who has been placed on a low-roughage diet. Which food would have to be eliminated from this client’s diet?
A. Roasted chicken
B. Noodles
C. Cooked broccoli
D. Custard

1013. A client scheduled for an atherectomy asks the nurse about the procedure. The nurse understands that:
A. Plaque will be removed by rotational or directional catheters.
B. Plaque will be destroyed by a laser.
C. A balloon-tipped catheter will compress fatty lesions against the vessel wall.
D. Medication will be used to dissolve the build-up of plaque.

1014. The RN is making assignments for the day. Which one of the following duties can be assigned to the unlicensed assistive personnel?
A. Notifying the physician of an abnormal lab value
B. Providing routine catheter care with soap and water
C. Administering two aspirin to a client with a headache
D. Setting the rate of an infusion of normal saline

1015. Which of the following techniques is recommended for removing a tick from the skin?
A. Grasping the tick with a tissue and quickly jerking it away from the skin
B. Placing a burning match close the tick and watching for it to release
C. Using tweezers, grasp the tick close to the skin and pull the tick free using a steady, firm motion
D. Covering the tick with petroleum jelly and gently rubbing the area until the tick releases

1016. A pregnant client with a history of alcohol addiction is scheduled for a nonstress test. The nonstress test:
A. Determines the lung maturity of the fetus
B. Measures the activity of the fetus
C. Shows the effect of contractions on the fetal heart rate
D. Measures the neurological well-being of the fetus

1017. The nurse is evaluating cerebral perfusion outcomes for a client with a subdural hematoma. The nurse evaluates which of the following as a favorable outcome for this client?
A. Arterial blood gas PO2 of 98
B. Increase in lethargy
C. Pupils slow to react to light
D. Temperature of 101°F

1018. The home health nurse is visiting a 30-year-old with sickle cell disease. Assessment findings include spleenomegaly. What information obtained on the visit would cause the most concern? The client:
A. Eats fast food daily for lunch
B. Drinks a beer occasionally
C. Sometimes feels fatigued
D. Works as a furniture mover

1019. A client with gestational diabetes has an order for ultrasonography. Preparation for an ultrasound includes:
A. Increasing fluid intake
B. Limiting ambulation
C. Administering an enema
D. Withholding food for eight hours

1020. Which finding is expected in an 18-month-old with normal growth and development?
A. She dresses herself.
B. She pulls a toy behind her.
C. She can build a tower of eight blocks.
D. She can copy a horizontal or vertical line.

1021. The nurse is assessing an adult female client for hypovolemia. Which laboratory result would help the nurse in confirming a volume deficit?
A. Hematocrit 55%
B. Potassium 5.0mEq/L
C. Urine specific gravity 1.016
D. BUN 18mg/dL

1022. The doctor has ordered the removal of a Davol drain. Which of the following instructions should the nurse give to the client before removing the drain?
A. The client should be told to breathe normally.
B. The client should be told to take two or three deep breaths as the drain is being removed.
C. The client should be told to hold his breath as the drain is being removed.
D. The client should breathe slowly as the drain is being removed.

1023. Which of the following can occur with the frequent use of calcium-based antacids?
A. Constipation
B. Hyperperistalsis
C. Delayed gastric emptying
D. Diarrhea

1024. A client has an order for Demerol 75mg and atropine 0.4mg IM as a preoperative medication. The Demerol vial contains 50mg/mL, and atropine is available 0.4mg/mL. How much medication will the nurse administer in total?
A. 1.0mL
B. 1.7mL
C. 2.5mL
D. 3.0 mL

1025. The following are all nursing diagnoses appropriate for a gravida 1 para 0 in labor. Which one would be most appropriate for the primigravida as she completes the early phase of labor?
A. Impaired gas exchange related to hyperventilation
B. Alteration in placental perfusion related to maternal position
C. Impaired physical mobility related to fetal-monitoring equipment
D. Potential fluid volume deficit related to decreased fluid intake

1026. Following eruption of the primary teeth, the mother can promote chewing by giving the toddler:
A. Pieces of hot dog
B. Carrot sticks
C. Pieces of cereal
D. Raisins

1027. A client with AIDS tells the nurse that he has been using herbal supplements in addition to the regimen of drugs prescribed by the physician. The nurse should tell the client that:
A. Most herbals are well suited to use with prescription medications.
B. He should buy only FDA-approved herbal supplements for use.
C. The use of herbals may alter the effect of the medication he is taking.
D. The herbal supplements should be taken at the same time as his medication.

1028. The client is admitted to the hospital with hypertensive crises. Diazoxide (Hyperstat) is ordered. During administration, the nurse should:
A. Utilize an infusion pump.
B. Check the blood glucose level.
C. Place the client in Trendelenburg position.
D. Cover the solution with foil.

1029. The nurse is caring for a client hospitalized with a facial stroke. Which diet selection would be suited to the client?
A. Roast beef sandwich, potato chips, pickle spear, iced tea
B. Split pea soup, mashed potatoes, pudding, milk
C. Tomato soup, cheese toast, Jello, coffee
D. Hamburger, baked beans, fruit cup, iced tea

1030. The nurse is caring for a COPD client who is discharged on p.o. Theophylline. Which of the following statements by the client would indicate a correct understanding of discharge instructions?
A. “A slow, regular pulse could be a side effect.”
B. “Take the pill with antacid or milk and crackers.”
C. “The doctor might order it intravenously if symptoms worsen.”
D. “Hold the drug if symptoms decrease.”

1031. The nurse has just received the change of shift report. The nurse should give priority to assessing the client with:
A. A thoracotomy with 110mL of drainage in the past hour
B. A cholecystectomy with an oral temperature of 100°F
C. A transurethral prostatectomy who complains of urgency to void
D. A stapedectomy who reports diminished hearing in the past hour

1032. A client taking antiretroviral drugs reports his last blood work showed a drop of 3 units in the viral load. The nurse understands that:
A. The virus is no longer detectable.
B. 90% of the viral load has been eliminated.
C. 95% of the viral load has been eliminated.
D. 99% of the viral load has been eliminated.

1033. When preparing a client for admission to the surgical suite, the nurse recognizes that which one of the following items is most important to remove before sending the client to surgery?
A. Hearing aid
B. Contact lenses
C. Wedding ring
D. Dentures

1034. The nurse is caring for a client with myasthenia gravis who is having trouble breathing. The nurse would encourage which of the following positions for maximal lung expansion?
A. Supine with no pillow, to maintain patent airway
B. Side-lying with back support
C. Prone with head turned to one side
D. Sitting or in high Fowler’s

1035. The nurse is teaching the mother of a child with cystic fibrosis how to do chest percussion. The nurse should tell the mother to:
A. Use the heel of her hand during percussion.
B. Change the child’s position every 20 minutes during percussion sessions.
C. Do percussion after the child eats and at bedtime.
D. Use cupped hands during percussion.

1036. The nurse working with another nurse and a patient care assistant. Which of the following clients should be assigned to the registered nurse?
A. A client two days post-appendectomy
B. A client one week post-thyroidectomy
C. A client three days post-splenectomy
D. A client two days post-thoracotomy

1037. The nurse is preparing a teaching plan for a client beginning external radiation treatments. Which of the following will be included in the teaching plan?

Select all that apply.
I. Space activities with rest periods.
II. Avoid spicy and hot foods.
III. Expose radiated areas to sunlight daily.
IV. Wash the skin with plain water.
V. Expect to have difficulty swallowing.
A. III only
B. IV and V only
C. I, II, and IV
D. All of the Above

1038. The physician has ordered a guaiac test for a client with a history of intestinal polyps. Which instruction should be given to the client regarding his diet prior to the test?
A. Increase the intake of whole grains and cereals.
B. Limit the intake of dairy products.
C. Avoid citrus juices and vitamin C.
D. Increase foods containing omega 3 oils.

1039. A client has cancer of the pancreas. The nurse should be most concerned about which nursing diagnosis?
A. Alteration in nutrition
B. Alteration in bowel elimination
C. Alteration in skin integrity
D. Ineffective individual coping

1040. The mother of a one-year-old wants to know when she should begin toilet-training her child. The nurse’s response is based on the knowledge that sufficient sphincter control for toilet training is present by:
A. 12–15 months of age
B. 18–24 months of age
C. 26–30 months of age
D. 32–36 months of age

1041. A client who has been diagnosed with lung cancer is starting a smoking-cessation program. Which of the following drugs would the nurse expect to be included in the program’s plan?
A. Bupropion SR (Zyban)
B. Metaproterenol (Alupent)
C. Oxitropuim (Oxivent)
D. Alprazolam (Xanax)

1042. A child with croup is placed in a cool, high-humidity tent connected to room air. The primary purpose of the high-humidity tent is to:
A. Prevent insensible water loss
B. Provide a moist environment with oxygen at 30%
C. Prevent dehydration and reduce fever
D. Liquefy secretions and relieve laryngeal spasm

1043. The nurse is caring for a client admitted to the emergency room after a fall. X-rays reveal that the client has several fractured bones in the foot. Which treatment should the nurse anticipate for the fractured foot?
A. Application of a walking boot
B. Stabilization with a cast
C. Surgery with Kirschner wire implantation
D. Application of spica cast

1044. A client with breast cancer is returned to the room following a right total mastectomy. The nurse should:
A. Elevate the client’s right arm on pillows.
B. Place the client’s right arm in a dependent sling.
C. Keep the client’s right arm on the bed beside her.
D. Place the client’s right arm across her body.

1045. A two-year-old is hospitalized with a diagnosis of Kawasaki’s disease. A severe complication of Kawasaki’s disease is:
A. The development of Brushfield spots
B. The eruption of Hutchinson’s teeth
C. The development of coxa plana
D. The creation of a giant aneurysm

1046. Which breakfast selection by a client with osteoporosis indicates that the client understands the dietary management of the disease?
A. Scrambled eggs, toast, and coffee
B. Bran muffin with margarine
C. Granola bar and half of a grapefruit
D. Bagel with jam and skim milk

1047. The nurse is caring for a client receiving Capoten (captopril). The nurse should be alert for adverse reactions to the drug, which include:
A. Increased red cell count
B. Decreased sodium level
C. Decreased white cell count
D. Increased calcium level

1048. The doctor suspects that the client has an ectopic pregnancy. Which symptom is consistent with a diagnosis of a ruptured ectopic pregnancy?
A. Painless vaginal bleeding
B. Abdominal cramping
C. Throbbing pain in the upper quadrant
D. Sudden, stabbing pain in the lower quadrant

1049. A five-month-old is diagnosed with atopic dermatitis. Nursing interventions will focus on:
A. Preventing infection
B. Administering antipyretics
C. Keeping the skin free of moisture
D. Limiting oral fluid intake

1050. A school nurse is explaining the dangers of anabolic steroid use to a group of high school athletes. Which organ is adversely affected by the use of anabolic steroids?
A. Kidney
B. Stomach
C. Pancreas
D. Liver

1051. A client has a history of abusing barbiturates. Which of the following is a sign of mild barbiturate intoxication?
A. Rapid speech
B. Nystagmus
C. Anisocoria
D. Polyphagia

1052. A client is admitted with a diagnosis of myxedema. An initial assessment of the client would reveal the symptoms of:
A. Slow pulse rate, weight loss, diarrhea, and cardiac failure
B. Weight gain, lethargy, slowed speech, and decreased respiratory rate
C. Rapid pulse, constipation, and bulging eyes
D. Decreased body temperature, weight loss, and increased respirations

1053. A client with a history of phenylketonuria (PKU) is seen in the local family planning clinic. While completing the intake history, the nurse provides information for a healthy pregnancy. Which statement indicates that the client needs further teaching?
A. I can use artificial sweeteners to keep me from gaining too much weight when I get pregnant.
B. I need to go back on a low-phenylalanine diet before I get pregnant.
C. Fresh fruits and raw vegetables will make good between-meal snacks for me.
D. My baby could be mentally retarded if I don’t stick to a diet eliminating phenylalanine.

1054. Six hours after birth, the newborn is found to have swelling over the right parietal area that does not cross the suture line. The nurse should chart this finding as:
A. Cephalohematoma
B. Molding
C. Subdural hematoma
D. Caput succedaneum

1055. A client is admitted to the acute care unit. Initial laboratory values reveal serum sodium of 170 mEq/L. What behavior changes would be most common for this client?
A. Anger
B. Mania
C. Depression
D. Psychosis

1056. A 60-year-old diabetic is taking glyburide (Diabeta) 1.25mg daily to treat Type II diabetes mellitus. Which statement indicates the need for further teaching?
A. “I will keep candy with me just in case my blood sugar drops.”
B. “I need to stay out of the sun as much as possible.”
C. “I often skip dinner because I don’t feel hungry.”
D. “I always wear my medical identification.”

1057. The physician has ordered an alkaline ash diet for a patient with recurrent cysteine kidney stones. Which of the following should be included in the patient’s diet?
A. Cranberries
B. Grapes
C. Plums
D. Rhubarb

1058. A client treated for depression has developed symptoms of serotonin syndrome. The nurse recognizes that serotonin syndrome might result when the client takes both a prescribed antidepressant and:
A. St. John’s wort
B. Ginko biloba
C. Black cohosh
D. Saw palmetto

1059. The physician has ordered a homocysteine blood level on a client. The nurse recognizes that the results will be increased in a client with a deficiency in which of the following:
A. Vitamin B12
B. Vitamin C
C. Vitamin A
D. Vitamin E

1060. The physician has ordered a minimal-bacteria diet for a client with neutropenia. The client should be taught to avoid using which condiment?
A. Mustard
B. Salt
C. Pepper
D. Ketchup

1061. A client with newly diagnosed epilepsy tells the nurse, “If I keep having seizures, I’m scared my husband will feel differently toward me.” Which response by the nurse would be most appropriate?
A. “You don’t know if you’ll ever have another seizure. Why don’t you wait and see what happens?”
B. “You seem to be concerned that there could be a change in the relationship with your husband.”
C. “You should focus on your children. They need you.”
D. “Let’s see how your husband reacts before getting upset.”

1062. A client diagnosed with tuberculosis asks the nurse when he can return to work. The nurse should tell the client that:
A. He can return to work when he has three negative sputum cultures.
B. He can return to work as soon as he feels well enough.
C. He can return to work after a week of being on the medication.
D. He should think about applying for disability because he will no longer be able to work.

1063. The client with AIDS should be taught to:
A. Avoid warm climates.
B. Refrain from taking herbals.
C. Avoid exercising.
D. Report any changes in skin color.

1064. The nurse is caring for the client receiving Amphotericin B. Which of the following indicates that the client has experienced toxicity to this drug?
A. Changes in vision
B. Nausea
C. Urinary frequency
D. Changes in skin color

1065. Parents of a toddler are dismayed when they learn that their child has Duchenne’s muscular dystrophy. Which statement describes the inheritance pattern of the disorder?
A. An affected gene is located on one of the 21 pairs of autosomes.
B. The disorder is caused by an over-replication of the X chromosome in males.
C. The affected gene is located on the Y chromosome of the father.
D. The affected gene is located on the X chromosome of the mother.

1066. A two-month-old infant has just received her first Tetramune injection. The nurse should tell the mother that the immunization:
A. Will need to be repeated when the child is four years of age
B. Is given to determine whether the child is susceptible to pertussis
C. Is one of a series of injections that protects against diphtheria, pertussis, tetanus, and H.influenzae b
D. Is a one-time injection that protects against measles, mumps, rubella, and varicella

1067. A client with cancer is to undergo a bone scan. The nurse should perform which of the following actions?
A. Force fluids 24 hours before the procedure is scheduled to begin.
B. Ask the client to void immediately before the study.
C. Hold medication that affects the central nervous system for 12 hours pre- and post-test.
D. Cover the client’s reproductive organs with an x-ray shield during the procedure.

1068. Which of the following is considered an intrinsic factor in the development of asthma?
A. Sinusitis
B. Hormonal influences
C. Food additives
D. Psychological stress

1069. A client taking Dilantin (phenytoin) for tonic-clonic seizures is preparing for discharge. Which information should be included in the client’s discharge care plan?
A. The medication can cause dental staining.
B. The client will need to avoid a high-carbohydrate diet.
C. The client will need a regularly scheduled blood work.
D. The medication can cause problems with drowsiness.

1070. The nurse is teaching about irritable bowel syndrome (IBS). Which of the following would be most important?
A. Reinforcing the need for a balanced diet
B. Encouraging the client to drink 16 ounces of fluid with each meal
C. Telling the client to eat a diet low in fiber
D. Instructing the client to limit his intake of fruits and vegetables

1071. The nurse is assessing a trauma client in the emergency room when she notes a penetrating abdominal wound with exposed viscera. The nurse should:
A. Apply a clean dressing to protect the wound.
B. Cover the exposed viscera with a sterile saline gauze.
C. Gently replace the abdominal contents.
D. Cover the area with a petroleum gauze.

1072. The nurse is assessing a client with symptoms of hyperphosphatemia. Which of the following is most likely related to the client’s symptoms?
A. Radiation to the neck
B. Recent orthopedic surgery
C. Minimal physical activity
D. Adherence to a vegan diet

1073. The five-year-old is being tested for enterobiasis (pinworms). Which symptom is associated with enterobiasis?
A. Rectal itching
B. Nausea
C. Oral ulcerations
D. Scalp itching

1074. The nurse is performing fluid resuscitation on a burn client. Which piece of assessment data is the best indicator that it is effective?
A. Respirations 24, unlabored
B. Urine output of 30ml/hr
C. Capillary refill < 4 seconds
D. Apical pulse of 110/min

1075. A client with paranoid schizophrenia has an order for Thorazine (chlorpromazine) 400mg orally twice daily. Which of the following symptoms should be reported to the physician immediately?
A. Fever, sore throat, weakness
B. Dry mouth, constipation, blurred vision
C. Lethargy, slurred speech, thirst
D. Fatigue, drowsiness, photosensitivity

1076. The nurse is caring for a client with a recent laparoscopic hemicolectomy. Which finding should be reported to the physician?
A. Sluggish bowel sounds
B. Pain and tenderness at the umbilicus
C. Passage of small amount of liquid stool
D. Increasing abdominal girth

1077. The patient states, “My stomach hurts about two hours after I eat.” Based upon this information, the nurse suspects the patient likely has a:
A. Gastric ulcer
B. Duodenal ulcer
C. Peptic ulcer
D. Curling’s ulcer

1078. A client with a head injury has an intracranial pressure (ICP) monitor in place. Cerebral perfusion pressure calculations are ordered. If the client’s ICP is 22 and the mean pressure reading is 70, what is the client’s cerebral perfusion pressure?
A. 92
B. 72
C. 58
D. 48

1079. The nurse is caring for a client with cerebral palsy. 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 by rest.

1080. The nurse is assessing the chart of a client with a stroke. MRI results reveal a hemorrhagic stroke to the brain. Which physician prescription would the nurse question?
A. Normal saline IV at 50mL/hr
B. O2 at 3L/min by nasal cannula
C. Heparin infusion per pharmacist protocol
D. Insert a Foley catheter to bedside drainage

1081. A client with a fractured hip is being taught correct use of the walker. The nurse is aware that the correct use of the walker is achieved if the:
A. Palms of the hands rest lightly on the handles.
B. Elbows are extended 0º.
C. Client steps all the way forward to the front of the walker.
D. Client lifts and carries the walker while ambulating.

1082. The nurse is caring for a four-year-old with cerebral palsy. Which nursing intervention will help ready the child for rehabilitative services?
A. Patching one of the eyes to help strengthen the ocular muscles
B. Providing suckers and pinwheels to help strengthen tongue movement
C. Providing musical tapes to provide auditory training
D. Encouraging play with a video game to improve muscle coordination

1083. An elderly client with glaucoma is scheduled for a cholecystectomy. Which medication order should the nurse question?
A. Demerol (meperidine)
B. Tagamet (cimetadine)
C. Atropine (atropine)
D. Phenergan (promethazine)

1084. A client with ankylosing spondylitis is to begin treatment with Cosentyx (secukinumab). Prior to beginning the medication, the physician will most likely order which of the following?
A. Chest x-ray
B. Pregnancy test
C. Allergy testing
D. TB skin test

1085. When checking patellar reflexes, the nurse is unable to elicit a knee-jerk response. To facilitate checking the patellar reflex, the nurse should tell the client to:
A. Pull against her interlocked fingers
B. Shrug her shoulders and hold for a count of five
C. Close her eyes tightly and resist opening
D. Cross her legs at the ankles

1086. The home health nurse is scheduled to visit four clients. Which client should she visit first?
A. A client with acquired immunodeficiency syndrome with a cough and reported temperature of 101°F
B. A client with peripheral vascular disease with an ulcer on the left lower leg
C. A client with diabetes mellitus who needs a diabetic control index drawn
D. A client with an autograft to burns of the chest and trunk

1087. Which statement should be included in the teaching session of a client scheduled for a renal biopsy?
A. “You will be placed in a sitting position for the biopsy.”
B. “You may experience a feeling of pressure or discomfort during aspiration of the biopsy.”
C. “You will be asleep during the procedure.”
D. “You will not be able to drink fluids for 24 hours following the study.”

1088. Four clients are to receive medication. Which client should receive medication first?
A. A client with an apical pulse of 72 receiving Lanoxin (digoxin) PO daily
B. A client with abdominal surgery receiving Phenergan (promethazine) IM every four hours PRN for nausea and vomiting
C. A client with labored respirations receiving a stat dose of IV Lasix (furosemide)
D. A client with pneumonia receiving Polycillin (ampicillin) IVPB every six hours

1089. A client is admitted to the emergency room with partial-thickness burns to his right arm and full-thickness burns to his trunk. According to the Rule of Nines, the nurse calculates that the total body surface area (TBSA) involved is:
A. 20%
B. 35%
C. 45%
D. 60%

1090. A client with congestive heart failure has been receiving digoxin (Laxoxin). Which finding indicates that the medication is having a desired effect?
A. Increased urinary output
B. Stabilized weight
C. Improved appetite
D. Increased pedal edema

1091. Which of the following is the best indication of resolution of a paralytic ileus?
A. Passage of stool
B. Eructation
C. Presence of bowel sounds
D. Decreasing abdominal girth

1092. Nimodipine (Nimotop) is ordered for the client with a ruptured cerebral aneurysm. What does the nurse recognize as a desired effect of this drug?
A. Prevent the influx of calcium into cells.
B. Restore a normal blood pressure reading.
C. Prevent the inflammatory process.
D. Dissolve the clot that has formed.

1093. A client admitted for treatment of bacterial pneumonia has an order for intravenous ampicillin. Which specimen should be obtained prior to administering the medication?
A. Routine urinalysis
B. Complete blood count
C. Serum electrolytes
D. Sputum for culture and sensitivity

1094. The nurse is caring for a 30-year-old male admitted with a stab wound. While in the emergency room, a chest tube is inserted. Which of the following explains the primary rationale for insertion of chest tubes?
A. The tube will allow for equalization of the lung expansion.
B. Chest tubes serve as a method of draining blood and serous fluid and assist in reinflating the lungs.
C. Chest tubes relieve pain associated with a collapsed lung.
D. Chest tubes assist with cardiac function by stabilizing lung expansion.

1095. The doctor has prescribed a diet high in vitamin B12 for a client with pernicious anemia. Which foods are the best sources of B12?
A. Meat, eggs, dairy products
B. Peanut butter, raisins, molasses
C. Broccoli, cauliflower, cabbage
D. Shrimp, legumes, bran cereals

1096. The nurse has just received a report from the previous shift. Which of the following clients should the nurse visit first?
A. A 50-year-old COPD client with a PCO2 of 50
B. A 24-year-old admitted after an MVA complaining of shortness of breath
C. A client with cancer requesting pain medication
D. A one-day post-operative cholecystectomy with a temperature of 100°F

1097. The nurse is assisting in the care of a patient who is two days post-operative from a hemorrhoidectomy. The nurse would be correct in instructing the patient to:
A. Avoid a high-fiber diet
B. Continue to apply ice packs
C. Take a laxative daily to prevent constipation
D. Use a sitz bath after each bowel movement

1098. The intensive care unit is full and the emergency room just called in a report on a ventilator-dependent client who is being admitted to the medical surgical unit. It would be essential that the nurse have which piece of equipment at the client’s bedside?
A. Cardiac monitor
B. Intravenous controller
C. Manual resuscitator
D. Oxygen by nasal cannula

1099. A client is diagnosed with post-traumatic stress disorder following a rape by an unknown assailant. The nurse should give priority to:
A. Providing a supportive environment
B. Controlling the client’s feelings of anger
C. Discussing the details of the attack
D. Administering a hypnotic for sleep

1100. A client is receiving a blood transfusion following surgery. In the event of a transfusion reaction, any unused blood should be:
A. Sealed and discarded in a red bag
B. Flushed down the client’s commode
C. Sealed and discarded in the sharp’s container
D. Returned to the blood bank

1101. The physician has prescribed Nexium (esomeprazole) for a client with erosive gastritis. The nurse should administer the medication:
A. 30 minutes before a meal
B. With each meal
C. In a single dose at bedtime
D. 30 minutes after meals

1102. The nurse is caring for an organ donor client with a severe head injury from an MVA. Which of the following is most important when caring for the organ donor client?
A. Maintenance of the BP at 90mmHg or greater
B. Maintenance of a normal temperature
C. Keeping the hematocrit at less than 28%
D. Ensuring a urinary output of at least 300mL/hr

1103. A toddler is admitted for the repair of a VSD. The nurse is aware that the child with a VSD will:
A. Tire more easily
B. Have normal patterns of growth and development
C. Require more calories
D. Need additional fluids to prevent thrombi

1104. The glycosylated hemoglobin of a 40-year-old client with diabetes mellitus is 2.5%. The nurse understands that:
A. The client can have a higher-calorie diet.
B. The client has good control of her diabetes.
C. The client requires adjustment in her insulin dose.
D. The client has poor control of her diabetes.

1105. A client with a corneal abrasion has an order for Garamycin (gentamicin) ophthalmic drops 1 bid and PredForte (prednisolone) ophthalmic drops 1 bid. Which of the following methods should be used when administering the medications?
A. Allow five minutes between the administration of the two medications
B. Administer the two medications at the same time
C. Allow 30 minutes between the administration of the two medications
D. Separate the administration of the medication by one to two hours

1106. A client with schizophrenia spends much of his time pacing the floor, rocking back and forth, and moving from one foot to another. The client’s behaviors are an example of:
A. Dystonia
B. Tardive dyskinesia
C. Akathisia
D. Oculogyric crisis

1107. Which of the following newborns is at greatest risk for iron deficiency anemia?
A. A newborn who is fed infant formula
B. A newborn delivered at 32 weeks gestation
C. A newborn who is one of a set of quadruplets
D. A newborn who is breastfed

1108. The physician has prescribed NPH insulin for a client with diabetes mellitus. Which statement indicates that the client knows when the peak action of the insulin occurs?
A. I will make sure I eat breakfast within two hours of taking my insulin.
B. I will need to carry candy or some form of sugar with me all the time.
C. I will eat a snack around three o’clock each afternoon.
D. I can save my dessert from supper for a bedtime snack.

1109. The nurse is reviewing the lab results of four clients. Which finding should be reported to the physician?
A. A client with chronic renal failure with a serum creatinine of 5.6mg/dL
B. A client with rheumatic fever with a positive C reactive protein
C. A client with gastroenteritis with a hematocrit of 52%
D. A client with epilepsy with a white cell count of 3,800mm^3

1110. The nurse is assessing a client following a coronary artery bypass graft (CABG). The nurse should give priority to reporting:
A. Chest drainage of 150mL in the past hour
B. Confusion and restlessness
C. Pallor and coolness of skin
D. Urinary output of 40mL per hour

1111. A client with inflammatory bowel disease (IBD) requires an ileostomy. The nurse would instruct the client to do which of the following measures as an essential part of caring for the stoma?
A. Perform massage of the stoma three times a day.
B. Include high-fiber foods in the diet, especially nuts.
C. Limit fluid intake to prevent loose stools.
D. Cleanse the peristomal skin meticulously.

1112. The physician has prescribed Cobex (cyanocobalamin) for a client following a gastric resection. Which lab result indicates that the medication is having its intended effect?
A. Neutrophil count of 4500cu mm
B. Hgb of 14.2g/dL
C. Platelet count of 250,000cu mm
D. Eosinophil count of 200cu mm

1113. The six-month-old client with a ventral septal defect is receiving Digitalis for regulation of his heart rate. Which finding should be reported to the doctor?
A. Blood pressure of 126/80
B. Blood glucose of 110mg/dL
C. Heart rate of 60bpm
D. Respiratory rate of 30 per minute

1114. A client with end stage renal disease is being managed with peritoneal dialysis. If the dialysate return is slowed the nurse should tell the client to:
A. Irrigate the dialyzing catheter with saline.
B. Skip the next scheduled infusion.
C. Gently retract the dialyzing catheter.
D. Change position or turn side to side.

1115. The nurse is performing a physical assessment on a newly admitted client. The last step in the physical assessment is:
A. Inspection
B. Auscultation
C. Percussion
D. Palpation

1116. A client with a right lobectomy is being transported from the intensive care unit to a medical unit. The nurse understands that the client’s chest drainage system:
A. Can be disconnected from suction if the chest tube is clamped
B. Can be disconnected from suction, but the chest tube should remain unclamped
C. Must remain connected by means of a portable suction
D. Must be kept even with the client’s shoulders during the transport

1117. The nurse is caring for a client hospitalized with nephrotic syndrome. Based on the client’s treatment, the nurse should:
A. Limit the number of visitors.
B. Provide a low-protein diet.
C. Discuss the possibility of dialysis.
D. Offer the client additional fluids.

1118. The nurse is caring for a client with leukemia who has received the drug Daunorubicin (Cerubidine). Which of the following common side effects would cause the most concern?
A. Nausea
B. Vomiting
C. Cardiotoxicity
D. Alopecia

1119. The nurse is assessing the laboratory results of a client scheduled to receive phenytoin sodium (Dilantin). The Dilantin level, drawn two hours ago, is 30mcg/mL. What is the appropriate nursing action?
A. Administer the Dilantin as scheduled.
B. Hold the scheduled dose and notify the physician.
C. Decrease the dosage from 100mg to 50mg.
D. Increase the dosage to 200mg from 100mg.

1120. The nurse is assessing an ECG strip of a 42-year-old client and finds a regular rate greater than 100, a normal QRS complex, a normal P wave in front of each QRS, a PR interval between 0.12 and 0.20 seconds, and a P: QRS ratio of 1:1. What is the nurse’s interpretation of this rhythm?
A. Premature atrial complex
B. Sinus tachycardia
C. Atrial flutter
D. Supraventricular tachycardia

1121. A client with chest pain is scheduled for a heart catheterization. Which of the following would the nurse include in the client’s care plan?
A. Keep the client NPO for 12 hours afterward.
B. Inform the client that general anesthesia will be administered throughout the procedure.
C. Assess the site for bleeding or hematoma once per shift.
D. Instruct the client that he might be asked to cough and breathe deeply during the procedure.

1122. The physician has ordered a thyroid scan to confirm the diagnosis of a goiter. Before the procedure, the nurse should:
A. Assess the client for allergies to iodine
B. Bolus the client with IV fluid
C. Administer an anxiolytic
D. Insert a urinary catheter

1123. A 25-year-old client arrives in the emergency room with a possible fracture of the right femur. The nurse should anticipate an order for:
A. Bryant’s traction
B. Ice to the entire extremity
C. Buck’s traction
D. An abduction pillow

1124. A client is hospitalized with signs of transplant rejection following a recent renal transplant. Assessment of the client would be expected to reveal:
A. A weight loss of two pounds in one day
B. A serum creatinine of 1.25mg/dL
C. Urinary output of 50mL/hr
D. Rising blood pressure

1125. A client is admitted to the intensive care unit after falling on an icy sidewalk and striking the right side of the head. An MRI revealed a right-sided epidural hematoma. Which physical force explains the location of the client’s injury?
A. Coup
B. Contrecoup
C. Deceleration
D. Acceleration

1126. The nurse is caring for a client with a closed head injury. A late sign of increased intracranial pressure is:
A. Changes in pupil equality and reactivity
B. Restlessness and irritability
C. Complaints of headache
D. Nausea and vomiting

1127. The nurse is caring for a client admitted with a diagnosis of epilepsy. The client begins to have a seizure. Which action by the nurse is contraindicated?
A. Turning the client to the side-lying position
B. Inserting a padded tongue blade and oral airway
C. Loosening restrictive clothing
D. Removing the pillow and raising padded side rails

1128. The school nurse is assessing an elementary student with hemophilia who fell during recess. Which symptoms indicate hemarthrosis?
A. Pain, coolness, and blue discoloration in the affected joint
B. Tingling and pain without loss of movement in the affected joint
C. Warmth, redness, and decreased movement in the affected joint
D. Stiffness, aching, and decreased movement in the affected joint

1129. Intra-arterial chemotherapy primarily benefits the client by applying greater concentrations of medication directly to the malignant tumor. An additional benefit of intra-arterial chemotherapy is:
A. Prevention of nausea and vomiting
B. Treatment of micro-metastasis
C. Eradication of bone pain
D. Prevention of therapy-induced anemia

1130. The nurse is caring for a child with Down syndrome. Which characteristics are commonly found in the child with Down syndrome?
A. Fragile bones, blue sclera, and brittle teeth
B. Epicanthal folds, broad hands, and transpalmar creases
C. Low posterior hairline, webbed neck, and short stature
D. Developmental regression and cherry-red macula

1131. A client is taking Deltasone(prednisone) each morning to treat his systemic lupus erythematosus. Which statement best explains the reason for taking the prednisone in the morning?
A. There is less chance of forgetting the medication if taken in the morning.
B. There will be less fluid retention if taken in the morning.
C. The medication is absorbed best with the breakfast meal.
D. Morning administration mimics the body’s natural secretion of corticosteroid.

1132. The laboring client is having fetal heart rates of 100–110 beats per minute during contractions. The first action/actions the nurse should take is to:
A. Apply an internal fetal monitor
B. Turn the client on her left side and apply oxygen
C. Get the client up and walk her in the hall
D. Move the client to the delivery room

1133. A five-month-old infant is admitted to the ER with a temperature of 103.6°F and irritability. The mother states that the child has been listless for the past several hours and that he had a seizure on the way to the hospital. A lumbar puncture confirms a diagnosis of bacterial meningitis. The nurse should assess the infant for:
A. Periorbital edema
B. Tenseness of the anterior fontanel
C. Positive Babinski reflex
D. Negative scarf sign

1134. A four-year-old is admitted with acute leukemia. It will be most important to monitor the child for:
A. Abdominal pain and anorexia
B. Fatigue and bruising
C. Bleeding and pallor
D. Petechiae and mucosal ulcers

1135. The nurse is working in the emergency room when a client arrives with severe burns of the face and neck. Which action should receive priority?
A. Starting an IV of Ringer’s lactate
B. Assessing the airway and applying oxygen
C. Obtaining blood gases
D. Administering pain medication

1136. A client is admitted to the emergency department with a loss of consciousness with unknown etiology. The nurse expects to perform which laboratory test to assist in determining etiology?
A. Total cholesterol
B. Alkaline phosphatese
C. Serum glucose
D. Urinalysis

1137. Which of the following is an expected finding in the assessment of a client with bulimia nervosa?
A. Extreme weight loss
B. Presence of lanugo over body
C. Erosion of tooth enamel
D. Muscle wasting

1138. A client with suspected renal cancer is to be scheduled for an intravenous pyelogram. Before the IVP, the nurse should:
A. Offer additional fluids
B. Ask the client to empty his bladder
C. Withhold the client’s medication for 8 hours before the IVP
D. Administer pain medication

1139. The nurse has just admitted a client with emphysema. Arterial blood gas results indicate hypoxia. Which physician prescription would the nurse implement for the best improvement in the client’s hypoxia?
A. Elevate the head of the bed 45°.
B. Encourage diaphragmatic breathing.
C. Initiate an Alupent nebulizer treatment.
D. Start O2 at 2L/min.

1140. The nurse is reviewing the results of a sweat test taken from a child with cystic fibrosis. Which finding supports the client’s diagnosis?
A. A sweat potassium concentration less than 40mEq/L
B. A sweat chloride concentration greater than 60mEq/L
C. A sweat potassium concentration greater than 40mEq/L
D. A sweat chloride concentration less than 40mEq/L

1141. The nurse is suspected of charting medication administration that he did not give. After talking to the nurse, the charge nurse should:
A. Call the Board of Nursing.
B. File a formal reprimand.
C. Terminate the nurse.
D. Charge the nurse with a tort.

1142. The nurse is checking the client’s central venous pressure. The nurse should place the zero of the manometer at the:
A. Phlebostatic axis
B. PMI
C. Erb’s point
D. Tail of Spence

1143. The physician has ordered an MRI as a part of the client’s diagnostic work-up. An MRI should not be done if the client has:
A. The need for oxygen therapy
B. A history of claustrophobia
C. A permanent pacemaker
D. Sensory deafness

1144. The physician has diagnosed a client with cirrhosis characterized by asterixis. If the nurse assesses the client with asterixis, he can expect to find:
A. Irregular movement of the wrist
B. Enlargement of the breasts
C. Dilated veins around the umbilicus
D. Redness of the palmar surfaces

1145. The nurse is preparing a client with gastroesophageal reflux disease (GERD) for discharge. The nurse should tell the client to:
A. Eat a small snack before bedtime
B. Sleep on his right side
C. Avoid carbonated beverages
D. Increase his intake of citrus fruits

1146. The doctor orders 2% nitroglycerin ointment in a 1-inch dose every 12 hours. Proper application of nitroglycerin ointment includes:
A. Rotating application sites
B. Limiting applications to the chest
C. Rubbing it into the skin
D. Covering it with a gauze dressing

1147. The nurse is caring for a client who is recovering from a fractured femur. Which diet selection would be best for this client?
A. Loaded baked potato, fried chicken, and tea
B. Dressed cheeseburger, French fries, and a Diet Coke
C. Tuna fish salad on sourdough bread, potato chips, and skim milk
D. Mandarin orange salad, broiled chicken, and milk

1148. A client has an order for streptokinase. Before administering the medication, the nurse should assess the client for:
A. Allergies to pineapples and bananas
B. A history of streptococcal infections
C. Prior therapy with phenytoin
D. A history of alcohol abuse

1149. A client with cirrhosis has developed signs of hepatorenal syndrome. Which diet is most appropriate for the client at this time?
A. High protein, moderate sodium
B. High carbohydrate, moderate sodium
C. Low protein, low sodium
D. Low carbohydrate, high protein

1150. The physician has ordered Coumadin (sodium warfarin) for a client with thrombophlebitis. The order should be entered to administer the medication at:
A. 0900
B. 1200
C. 1700
D. 2100

1151. The nurse has just received the change of shift report and is preparing to make rounds. Which client should the nurse assess first?
A. A client recovering from a stroke with an oxygen saturation rate of 99%
B. A client three days post-coronary artery bypass graft with an oral temperature of 100.2ºF
C. A client admitted one hour ago with rales and shortness of breath
D. A client being prepared for discharge following a right colectomy

1152. A client with a femoral popliteal bypass graft is assigned to a semiprivate room. The most suitable roommate for this client is the client with:
A. Hypothyroidism
B. Diabetic ulcers
C. Gastroenteritis
D. Bacterial pneumonia

1153. The nurse is aware that a common mode of transmission of clostridium difficile is:
A. Use of unsterile surgical equipment
B. Contamination of objects with sputum
C. Through urinary catheterization
D. Contamination of objects with stool

1154. The nurse is providing discharge teaching for a client taking naltrexone (Revia). The nurse should instruct the client to avoid which over-the-counter medication:
A. Acetaminophen
B. Ibuprofen
C. Cold medicine
D. Antihistamines

1155. The physician has ordered atropine sulfate 0.4milligrams IM before surgery. The medication is supplied in 0.8 milligrams per milliliter. How much medication should the nurse prepare to administer?
A. 0.25mL
B. 0.5mL
C. 1.0mL
D. 1.25mL

1156. Twenty-four hours after an uncomplicated labor and delivery, a client’s WBC is 12,000cu/mm. The elevation in the client’s WBC is most likely an indication of:
A. A normal response to the birth process
B. An acute bacterial infection
C. A sexually transmitted virus
D. Dehydration from being NPO during labor

1157. A priority nursing diagnosis for a child being admitted from surgery following a tonsillectomy is:
A. Altered nutrition
B. Impaired communication
C. Risk for injury/aspiration
D. Altered urinary elimination

1158. A client has sustained a severe head injury and damaged the pre-occipital lobe. The nurse should remain particularly alert for which of the following problems?
A. Visual impairment
B. Swallowing difficulty
C. Impaired judgment
D. Hearing impairment

1159. The nurse is assessing a client following the removal of a pituitary tumor. The nurse notes that the urinary output has increased and that the urine is very dilute. The nurse should give priority to:
A. Notifying the doctor immediately
B. Documenting the finding in the chart
C. Decreasing the rate of IV fluids
D. Administering vasopressive medication

1160. A vaginal exam reveals a footling breech presentation. The nurse should take which of the following actions at this time?
A. Anticipate the need for a Caesarean section
B. Apply an internal fetal monitor
C. Place the client in genupectoral position
D. Perform an ultrasound

1161. The physician has scheduled a Whipple procedure for a client with pancreatic cancer. The nurse recognizes that the client’s cancer is located in:
A. The tail of the pancreas
B. The head of the pancreas
C. The body of the pancreas
D. The entire pancreas

1162. When administering total parenteral nutrition, the nurse should assess the client for signs of rebound hypoglycemia. The nurse knows that rebound hypoglycemia occurs when:
A. The infusion rate is too rapid.
B. The infusion is discontinued without tapering.
C. The solution is infused through a peripheral line.
D. The infusion is administered without a filter.

1163. Which of the following instructions should be included in the nurse’s teaching regarding oral contraceptives?
A. Weight gain should be reported to the physician.
B. An alternate method of birth control is needed when taking antibiotics.
C. If the client misses one or more pills, two pills should be taken per day for one week.
D. Changes in the menstrual flow should be reported to the physician.

1164. Which nursing intervention would be of highest priority when caring for a patient admitted in sickle cell vaso-occlusive crisis?
A. Starting intravenous normal saline
B. Applying oxygen
C. Applying heat to the affected joints
D. Administering pain medication

1165. The nurse is teaching a client with peritoneal dialysis how to manage exchanges at home. The nurse should tell the client to notify the doctor immediately if:
A. The dialysate returns become cloudy in appearance.
B. The return of the dialysate is slower than usual.
C. A “tugging” sensation is noted as the dialysate drains.
D. A feeling of fullness is felt when the dialysate is instilled.

1166. Which of the following statements reflects Kohlberg’s theory of the moral development of the preschool-age child?
A. Obeying adults is seen as correct behavior.
B. Showing respect for parents is seen as important.
C. Pleasing others is viewed as good behavior.
D. Behavior is determined by consequences.

1167. A vaginal exam of a laboring client reveals that the fetus is at 0 station. This assessment means that:
A. The fetus has not descended into the birth canal.
B. The fetus is in a transverse lie.
C. The fetus is level with the ischial spines.
D. The fetus is at increased risk for precipitate delivery.

1168. The nurse has performed discharge teaching to a client in need of a high-iron diet. The nurse recognizes that teaching has been effective when the client selects which meal plan?
A. Hamburger, French fries, and orange juice
B. Sliced veal, spinach salad, and whole-wheat roll
C. Vegetable lasagna, Caesar salad, and toast
D. Bacon, lettuce, and tomato sandwich; potato chips; and tea

1169. Which medication does the nurse expect to be ordered for the postpartal patient with bleeding uncontrolled by Pitocin (oxytocin)?
A. Methergine (methylergonovine maleate)
B. Aquamephyton (phytonadione)
C. Amicar (aminocaproic acid)
D. Celestone (betamethasone)

1170. The nurse is preparing a client for surgery who requests to “go as he is.” Which item is most important for the nurse to remove before sending the client to surgery?
A. Hearing aid
B. Contact lenses
C. Wedding ring
D. Dentures

1171. A nurse is caring for a client in the critical care unit who is complaining of chest pain. Nursing assessment reveals a BP of 78/40, shortness of breath, and third-degree AV block on the heart monitor. What is the most appropriate initial action?
A. Provide trancutaneous pacing.
B. Turn the client on his side.
C. Reassess the blood pressure.
D. Consult with cardiology.

1172. A client tells the nurse that she plans to use the rhythm method of birth control. The nurse is aware that the success of the rhythm method depends on the:
A. Age of the client
B. Frequency of intercourse
C. Regularity of the menses
D. Range of the client’s temperature

1173. Which medication is used to treat iron toxicity?
A. Narcan (naloxone)
B. Digibind (digoxin immune Fab)
C. Desferal (deferoxamine)
D. Zinecard (dexrazoxane)

1174. Which of the following is a characteristic of an ominous periodic change in the fetal heart rate?
A. A fetal heart rate of 120–130bpm
B. A baseline variability of 6–10bpm
C. Accelerations in FHR with fetal movement
D. A recurrent rate of 90–100bpm at the end of the contractions

1175. The nurse is evaluating teaching effectiveness on a client with a gastrointestinal disorder prescribed a gluten-free diet. Which diet choice indicates that the client understands the instructions given?
A. Steamed broccoli
B. Wheat toast
C. Chocolate chip cookie
D. Bran cereal

1176. A nurse is working in an endoscopy recovery area. Many of the clients are administered midazolam (Versed) to provide conscious sedation. Which medication is important to have available as an antidote for Versed?
A. Diazepam (Valium)
B. Naloxone (Narcan)
C. Flumazenil (Romazicon)
D. Florinef (Fludrocortisone)

1177. The nurse is caring for a client with cirrhosis of the liver. Which is the best method to use for determining that the client has ascites?
A. Inspection of the abdomen for enlargement
B. Bimanual palpation for hepatomegaly
C. Daily measurement of abdominal girth
D. Assessment for a fluid wave

1178. A client is admitted with a diagnosis of polycythemia vera. The nurse should closely monitor the client for:
A. Increased blood pressure
B. Decreased respirations
C. Increased urinary output
D. Decreased oxygen saturation

1179. A client with alcoholism has been instructed to increase his intake of thiamine. The nurse knows the client understands the instructions when he selects which food?
A. Roast beef
B. Broiled fish
C. Baked chicken
D. Sliced pork

1180. The autopsy results in SIDS-related death will show the following consistent findings:
A. Abnormal central nervous system development
B. Abnormal cardiovascular development
C. Intraventricular hemorrhage and cerebral edema
D. Pulmonary edema and intrathoracic hemorrhages

1181. Upon arrival to the nursery, Ilotycin (erythromycin) eyedrops are instilled in the newborn’s eyes. The nurse understands that the medication will:
A. Make the eyes less sensitive to light
B. Help prevent neonatal blindness
C. Strengthen the muscles of the eyes
D. Improve accommodation to near objects

1182. Which of the following foods, if selected by the mother with a child with celiac, would indicate her understanding of the dietary instructions?
A. Whole-wheat toast
B. Angel hair pasta
C. Reuben on rye
D. Rice cereal

1183. A client has a tentative diagnosis of myasthenia gravis. The nurse recognizes that myasthenia gravis involves:
A. Loss of the myelin sheath in portions of the brain and spinal cord
B. An interruption in the transmission of impulses from nerve endings to muscles
C. Progressive weakness and loss of sensation that begins in the lower extremities
D. Loss of coordination and stiff “cogwheel” rigidity

1184. The nurse is teaching a pregnant client about nutritional needs during pregnancy. Which menu selection will best meet the nutritional needs of the pregnant client?
A. Hamburger patty, green beans, French fries, and iced tea
B. Roast beef sandwich, potato chips, baked beans, and cola
C. Baked chicken, fruit cup, potato salad, coleslaw, yogurt, and iced tea
D. Fish sandwich, gelatin with fruit, and coffee

1185. The nurse is teaching the mother of a child with attention deficit disorder regarding the use of Ritalin (methylphenidate). The nurse recognizes that the mother understands her teaching when she states the importance of:
A. Offering high-calorie snacks
B. Watching for signs of infection
C. Observing for signs of oversedation
D. Using a sunscreen with an SPF of 30

1186. Which of the following is an adverse effect associated with the use of Adriamycin (doxorubicin)?
A. Ventricular arrhythmias
B. Alopecia
C. Leukopenia
D. Stomatitis

1187. Which observation would the nurse expect to make after an amniotomy?
A. Dark yellow amniotic fluid
B. Clear amniotic fluid
C. Greenish amniotic fluid
D. Red amniotic fluid

1188. The emergency room is flooded with clients injured in a tornado. Which clients can be assigned to share a room in the emergency department during the disaster?
A. A client having auditory hallucinations and the client with ulcerative colitis
B. The client who is pregnant and the client with a broken arm
C. A child who is cyanotic with severe dypsnea and a client with a frontal head injury
D. The client who arrives with a large puncture wound to the abdomen and the client with chest pain

1189. The nurse is caring for a child in a plaster-of-Paris hip spica cast. To facilitate drying, the nurse should:
A. Use a small hand-held hair dryer set on medium heat.
B. Place a small heater near the child’s bed.
C. Turn the child at least every two hours.
D. Allow one side to dry before changing positions.

1190. The nurse would identify which one of the following assessment findings as a normal response in a craniotomy client post-operatively?
A. A decrease in responsiveness the third post-op day
B. Sluggish pupil reaction the first 24–48 hours
C. Dressing changes three to four times a day for the first three days
D. Temperature range of 98.8°F to 99.6°F the first 2–3 days

1191. The nurse is making assignments for the day. Which client should be assigned to the pregnant nurse?
A. The client receiving linear accelerator radiation therapy for lung cancer
B. The client with a radium implant for cervical cancer
C. The client who has just been administered soluble brachytherapy for thyroid cancer
D. The client who returned from placement of iridium seeds for prostate cancer

1192. A four-month-old is brought to the well-baby clinic for immunization. In addition to the DPT and polio vaccines, the baby should receive:
A. Hib titer
B. Mumps vaccine
C. Hepatitis B vaccine
D. MMR

1193. The physician’s notes state that a client with cocaine addiction has formication. The nurse recognizes that the client has:
A. Tactile hallucinations
B. Irregular heart rate
C. Paranoid delusions
D. Methadone tolerance

1194. A client has had a unilateral adrenalectomy to remove a tumor. The most important measurement in the immediate post-operative period for the nurse to take is:
A. The blood pressure
B. The temperature
C. The urinary output
D. The specific gravity of the urine

1195. A pneumonectomy is performed on a client with lung cancer. Which of the following would probably be omitted from the client’s plan of care?
A. Closed chest drainage
B. Pain-control measures
C. Supplemental oxygen administration
D. Coughing and deep-breathing exercises

1196. A client with pregnancy-induced hypertension is scheduled for a C-section. Before surgery, the nurse should keep the client:
A. On her right side
B. Supine with a small pillow
C. On her left side
D. In knee chest position

1197. The nurse is caring for clients on a respiratory unit. Upon receiving the following client reports, which client should be seen first?
A. Client with emphysema expecting discharge
B. Bronchitis client receiving IV antibiotics
C. Bronchitis client with edema and neck vein distention
D. COPD client with abnormal PO2

1198. The physician has ordered Brethine (terbutaline) for a patient with premature labor. The nurse is aware that the medication may cause:
A. Bradycardia
B. Hyperglycemia
C. Decreased muscle tone
D. Hot flashes

1199. The nurse is caring for a client admitted to labor and delivery. Which finding indicates fetal distress?
A. Contractions every three minutes
B. Absent variability
C. Fetal heart tone accelerations with movement
D. Fetal heart tone 120–130 beats per minute

1200. A client sustained a severe head injury to the occipital lobe. The nurse should carefully assess the client for:
A. Changes in vision
B. Difficulty in speaking
C. Impaired judgment
D. Hearing impairment

1201. A two-year-old is hospitalized with suspected intussusception. Which finding is associated with intussusception?
A. "Currant jelly"stools
B. Projectile vomiting
C. "Ribbonlike"stools
D. Palpable mass over the flank

1202. A client is admitted following the repair of a fractured tibia with cast application. Which nursing assessment should be reported to the physician?
A. Pain beneath the cast
B. Warm toes
C. Pedal pulses weak and rapid
D. Paresthesia of the toes

1203. The nurse is presenting a workshop on the Zika virus infection. Which is included in the teaching plan?

Select all that apply.
I. The virus is spread primarily by rodent contact.
II. Sexual transmission can spread the virus.
III. The virus can cause brain defects to the fetus of pregnant women.
IV. There is no specific treatment for Zika.
V. Zika virus should be nationally reported.
A. I, III, IV and V
B. II, III, IV and V
C. II and III only
D. II, IV and V only

1204. The physician has ordered a low-residue diet for a client with Crohn’s disease. Which food is not permitted in a low-residue diet?
A. Mashed potatoes
B. Smooth peanut butter
C. Fried fish
D. Rice

1205. The nurse caring for a client with a closed head injury obtains an intracranial pressure (ICP) reading of 17mmHg. The nurse recognizes that:
A. The ICP is elevated and the doctor should be notified.
B. The ICP is normal; therefore, no further action is needed.
C. The ICP is low and the client needs additional IV fluids.
D. The ICP reading is not as reliable as the Glascow coma scale.

1206. A client with a laryngectomy returns from surgery with a nasogastric tube in place. The primary reason for placement of the nasogastric tube is to:
A. Prevent swelling and dysphagia
B. Decompress the stomach
C. Prevent contamination of the suture line
D. Promote healing of the oral mucosa

1207. A client with an ileostomy is being discharged. Which teaching should be included in the plan of care?
A. Using Karaya powder to seal the bag
B. Irrigating the ileostomy daily
C. Using Stomahesive as a skin protector
D. Using a stool softener as needed

1208. A client being treated with Coumadin (sodium warfarin) has an INR of 8.0. Which intervention is appropriate based on the INR level?
A. Assessing for signs of bleeding
B. Administering intranasal DDAVP
C. Administering an injection of protamine sulfate
D. Limiting the intake of foods rich in vitamin K

1209. While interviewing a client who abuses alcohol, the nurse learns that the client has experienced “blackouts.” The wife asks what this means. What is the nurse’s best response at this time?
A. “Your husband has experienced short-term memory amnesia.”
B. “Your husband has experienced loss of remote memory.”
C. “Your husband has experienced a loss of consciousness.”
D. “Your husband has experienced a fainting spell.”

1210. A client receiving Parnate (tranylcypromine) is admitted in a hypertensive crisis. Which food is most likely to produce a hypertensive crisis when taken with the medication?
A. Processed cheese
B. Cottage cheese
C. Cream cheese
D. Cheddar cheese

1211. A client has a diagnosis of discoid lupus erythematosus (DLE). The nurse recognizes that discoid lupus differs from systemic lupus erythematosus because it:
A. Produces changes in the kidneys
B. Is confined to changes in the skin
C. Results in damage to the heart and lungs
D. Affects both joints and muscles

1212. A client returns from surgery with a total knee replacement. Which of the following findings requires immediate nursing intervention?
A. Bloody drainage of 30mL from the Davol drain is present.
B. The CPM is set on 90° flexion.
C. The client is unable to ambulate to the bathroom.
D. The client is complaining of muscle spasms.

1213. A trauma client is admitted to the emergency room following a motor vehicle accident. Examination reveals that the left side of the chest moves inward when the client inhales. The finding is suggestive of:
A. Pneumothorax
B. Mediastinal shift
C. Pulmonary contusion
D. Flail chest

1214. A client with a deep decubitus ulcer is receiving therapy in the hyperbaric oxygen chamber. Before therapy, the nurse should:
A. Apply a lanolin-based lotion to the skin.
B. Wash the skin with water and pat dry.
C. Cover the area with a petroleum gauze.
D. Apply an occlusive dressing to the site.

1215. A client with glomerulonephritis is placed on a low-sodium diet. Which of the following snacks is suitable for the client with sodium restriction?
A. Peanut butter cookies
B. Grilled cheese sandwich
C. Cottage cheese and fruit
D. Fresh peach

1216. A client arrives from surgery following an abdominal perineal resection with a permanent ileostomy. What should be the priority nursing care during the post-op period?
A. Teaching how to irrigate the ileostomy
B. Stopping electrolyte loss through the stoma
C. Encouraging a high-fiber diet
D. Facilitating perineal wound drainage

1217. Which laboratory test is not included in making the diagnosis of myocardial infarction?
A. AST
B. Troponin
C. CK-MB
D. Myoglobin

1218. Which observation indicates that a student nurse needs further teaching in the proper way to assess central venous pressure?
A. The student places the client in a supine position to read the manometer.
B. The student places the zero reading of the manometer at the phlebostatic axis.
C. The student instructs the client to perform the Valsalva maneuver during the CVP reading.
D. The student records the CVP reading as the level noted at the top of the meniscus

1219. An elderly client refuses to take her daily medication for hypertension. Which action should the nurse take at this time?
A. Administer the medication by injection
B. Obtain help administering the medication
C. Skip the dose of medication and attempt to give it later
D. Explore the reason for the client’s refusal to take the medication

1220. The nurse has given instructions on pursed-lip breathing to a client with COPD. Which statement by the client would indicate effective teaching?
A. “I should inhale through my mouth very deeply.”
B. “I should tighten my abdominal muscles with inhalation.”
C. “I should contract my abdominal muscles with exhalation.”
D. “I should make inhalation twice as long as exhalation.”

1221. Lidocaine is a medication frequently ordered for the client experiencing:
A. Atrial tachycardia
B. Ventricular tachycardia
C. Heart block
D. Ventricular bradycardia

1222. The glycosylated hemoglobin of a 40-year-old client with diabetes mellitus is 2.5%. The nurse understands that:
A. The client can have a higher-calorie diet.
B. The client has good control of her diabetes.
C. The client requires adjustment in her insulin dose.
D. The client has poor control of her diabetes.

1223. The nurse is discussing cigarette smoking with an emphysema client. The client states, “I don’t know why I should worry about smoking.” The nurse’s response is based on the fact that smoking has which of the following negative effects to the emphysematous lung?
A. Affects peripheral blood vessels
B. Causes vasoconstriction to occur
C. Destroys the lung parenchyma
D. Paralyzes ciliary activity

1224. The nurse is preparing to administer an injection to a six-month-old when she notices a white dot in the infant’s right pupil. The nurse should:
A. Report the finding to the physician immediately.
B. Record the finding and give the infant’s injection.
C. Recognize that the finding is a variation of normal.
D. Check both eyes for the presence of the red reflex.

1225. The RN is making assignments on a 12-bed unit. Staff consists of one RN and two certified nursing assistants. Which client should be self-assigned?
A. A client receiving decadron for emphysema
B. A client with chest trauma and a new onset of hemoptysis
C. A client with rib fractures and an O2 saturation of 93%
D. A client two days post-operative lung surgery with a pulse oximetry of 92%

1226. The nurse is evaluating nutritional outcomes for a client with anorexia nervosa. Which one of the following is the most objective favorable outcome for the client?
A. The client eats all the food on her tray.
B. The client requests that family bring special foods.
C. The client’s weight has increased.
D. The client weighs herself each morning.

1227. A client with a C3 spinal cord injury experiences autonomic hyperreflexia. After placing the client in high Fowler’s position, the nurse’s next action should be to:
A. Notify the physician
B. Make sure the catheter is patent
C. Administer an antihypertensive
D. Provide supplemental oxygen

1228. The nurse is assisting a client with diverticulosis to select appropriate foods. Which food should be avoided?
A. Bran flakes
B. Peaches
C. Cucumber and tomato salad
D. Whole wheat bread

1229. The local health clinic recommends vaccination against influenza for all its employees. The influenza vaccine is usually given annually in:
A. November
B. December
C. January
D. February

1230. The charge nurse witnesses the nursing assistant hitting an elderly client in the long-term care facility. The nursing assistant can be charged with:
A. Negligence
B. Tort
C. Assault
D. Malpractice

1231. A four-year-old with cystic fibrosis has a prescription for Creon (pancrelipase). The medication is given to:
A. Thin respiratory secretions
B. Promote clotting
C. Assist with digestion
D. Shrink nasal polyps

1232. The nurse is caring for a 12-year-old who requires a blood transfusion for life-threatening injuries sustained in an automobile accident. The child’s mother refuses to sign the blood permit based on her religious beliefs. What nursing action is appropriate?
A. Administer the blood transfusion without a signed permit.
B. Encourage the mother to reconsider her decision.
C. Explain the consequences if he does not receive a transfusion.
D. Notify the physician of the mother’s refusal to sign the permit.

1233. Why is Phytonadione (vitamin K) administered to a newborn shortly after birth?
A. To stop hemorrhage
B. To treat infection
C. To replace electrolytes
D. To facilitate clotting

1234. A client with preeclampsia is admitted with an order for intravenous magnesium sulfate. Which statement is true regarding the administration of magnesium sulfate?
A. A 4 gram loading dose is administered over 20–30 minutes via infusion pump.
B. Side effects include feeling cold and tremulous.
C. IV infusion rate is adjusted to maintain urine output of 20 to 30 mL per hour.
D. The brachial reflex is checked prior to initiation of medication

1235. Which clinical manifestation is most indicative to the nurse that a possible carbon monoxide poisoning has occurred?
A. Pulse oximetry reading of 80%
B. Expiratory stridor and nasal flaring
C. Cherry red color to the mucous membranes
D. Presence of carbonaceous particles in the sputum

1236. The nurse is preparing a client for mammography. To prepare the client for a mammogram, the nurse should tell the client:
A. To restrict her fat intake for one week before the test
B. To omit creams, powders, or deodorants before the exam
C. That mammography replaces the need for self-breast exams
D. That mammography requires a higher dose of radiation than x-rays

1237. The nurse is assessing a client for tactile fremitus. Which of the following diagnoses would most likely reveal a decrease in tactile fremitus?
A. Emphysema
B. Bronchial pneumonia
C. Tuberculosis
D. Lung tumor

1238. Which woman is not a candidate for RhoGAM?
A. A gravida 4 para 3 that is Rh negative with an Rh-positive baby
B. A gravida 1 para 1 that is Rh negative with an Rh-positive baby
C. A gravida 2 para 0 that is Rh negative admitted after a stillbirth delivery
D. A gravida 4 para 2 that is Rh negative with an Rh-negative baby

1239. The physician has prescribed Vermox (mebendazole) for a child with pinworms. Which statement is true regarding the medication?
A. Medication is administered intramuscularly.
B. The entire family will need to take the medication.
C. Medication will be repeated in two months.
D. Intravenous antibiotic therapy will be ordered.

1240. The nurse is caring for a client admitted with congestive heart failure. Which finding would the nurse expect if the failure was on the right side of the heart?
A. Jugular vein distention
B. Dry, nonproductive cough
C. Dyspneic when supine
D. Crackles on chest auscultation

1241. The nurse can help alleviate the discomfort the client is experiencing associated with xerostomia by:
A. Limiting fluid intake
B. Administering an analgesic
C. Splinting swollen joints
D. Providing sugarless hard candy

1242. If the school-age child is not given the opportunity to engage in tasks and activities he can carry through to completion, he is likely to develop feelings of:
A. Guilt
B. Shame
C. Stagnation
D. Inferiority

1243. The nurse is caring for a client with a closed head injury. Fluid is assessed leaking from the ear. What is the nurse’s first action?
A. Irrigate the ear canal gently.
B. Notify the physician.
C. Test the drainage for glucose.
D. Apply an occlusive dressing.

1244. The nurse is teaching a client with Parkinson’s disease ways to prevent curvatures of the spine associated with the disease. To prevent spinal flexion, the nurse should tell the client to:
A. Periodically lie prone without a neck pillow.
B. Sleep only in dorsal recumbent position.
C. Rest in supine position with his head elevated.
D. Sleep on either side, but keep his back straight.

1245. A client is admitted with suspected acute pancreatitis. Which lab finding confirms the diagnosis?
A. Blood glucose of 260mg/dL
B. White cell count of 21,000cu/mm
C. Platelet count of 250,000cu/mm
D. Serum amylase level of 600 units/dL

1246. The nurse is caring for a client with a head injury who has an intracranial pressure monitor in place. Assessment reveals an ICP reading of 66. What is the nurse’s best action?
A. Notify the physician.
B. Record the reading as the only action.
C. Turn the client and recheck the reading.
D. Place the client supine.

1247. A client with a C4 spinal cord injury has been placed in traction with cervical tongs. Nursing care should include:
A. Releasing the traction for five minutes each shift
B. Loosening the pins if the client complains of headache
C. Elevating the head of the bed 90°
D. Performing sterile pin care as ordered

1248. The nurse is performing a neurological assessment on a client admitted with TIAs. Assessment findings reveal an absence of the gag reflex. The nurse suspects injury to which of the following cranial nerves?
A. XII (hypoglossal)
B. X (vagus)
C. IX (glossopharyngeal)
D. VII (facial)

1249. A client with bipolar disorder is discharged with a prescription for Depakote (divalproex sodium). The nurse should remind the client of the need for:
A. Frequent dental visits
B. Frequent lab work
C. Additional fluids
D. Additional sodium

1250. Which statement is true regarding the care of the patient in skeletal traction?
A. The nurse may remove the weights for bathing.
B. Blocks should be placed beneath the head of the bed.
C. The weights must hang freely to be effective.
D. The nurse should massage reddened areas to prevent skin breakdown.