Questions

1.    Walter, teenage patient is admitted to the hospital because of acetaminophen (Tylenol)

overdose. Overdoses of acetaminophen can precipitate life-threatening abnormalities in which

of the following organs?

a.    Lungs

b.    Liver

c.    Kidney

d.    Adrenal Glands

2.    A contraindication for topical corticosteroid usage in a male patient with atopic dermatitis

(eczema) is:

a.    Parasite infection.

b.    Viral infection.

c.    Bacterial infection.

d.    Spirochete infection.

3.    In infants and children, the side effects of first generation over-the-counter (OTC)

antihistamines, such as diphenhydramine (Benadryl) and hydroxyzine (Atarax) include:

a.    Reye’s syndrome.

b.    Cholinergic effects.

c.    Paradoxical CNS stimulation.

d.    Nausea and diarrhea.

4.    Reye’s syndrome, a potentially fatal illness associated with liver failure and encephalopathy

is associated with the administration of which over-the-counter (OTC) medication?

a.    acetaminophen (Tylenol)

b.    ibuprofen (Motrin)

c.    aspirin

d.    brompheniramine/psudoephedrine (Dimetapp)

5.    The nurse is aware that the patients who are allergic to intravenous contrast media are

usually also allergic to which of the following products?

a.    Eggs

b.    Shellfish

c.    Soy

d.    acidic fruits

6.    A 13-month-old child recently arrived in the United States from a foreign country with his

parents and needs childhood immunizations. His mother reports that he is allergic to eggs.

Upon further questioning, you determine that the allergy to eggs is anaphylaxis. Which of the

following vaccines should he not receive?

a.    Hepatitis B

b.    inactivated polio

c.    diphtheria, acellular pertussis, tetanus (DTaP)

d.    mumps, measles, rubella (MMR)

7.    The cell and Coombs classification system categorizes allergic reactions and is useful in

describing and classifying patient reactions to drugs. Type I reactions are immediate

hypersensitivity reactions and are mediated by:

a.    immunoglobulin E (IgE).

b.    immunoglobulin G (IgG).

c.    immunoglobulin A (IgA).

d.    immunoglobulin M (IgM).

8.    Drugs can cause adverse events in a patient. Bone marrow toxicity is one of the most

frequent types of drug-induced toxicity. The most serious form of bone marrow toxicity is:

a.    aplastic anemia.

b.    thrombocytosis.

c.    leukocytosis.

d.    granulocytosis.

9.    Serious adverse effects of oral contraceptives include:

a.    Increase in skin oil followed by acne.

b.    Headache and dizziness.

c.    Early or mid-cycle bleeding.

d.    Thromboembolic complications.

10.    The most serious adverse effect of Alprostadil (Prostin VR pediatric injection)

administration in neonates is:

a.    Apnea.

b.    Bleeding tendencies.

c.    Hypotension.

d.    Pyrexia.

11.    Mandy, a patient calls the clinic today because he is taking atrovastatin (Lipitor) to treat his

high cholesterol and is having pain in both of his legs. You instruct him to:

a.    Stop taking the drug and make an appointment to be seen next week.

b.    Continue taking the drug and make an appointment to be seen next week.

c.    Stop taking the drug and come to the clinic to be seen today.

d.    Walk for at least 30 minutes and call if symptoms continue.

12.    Which of the following adverse effects is associated with levothyroxine (Synthroid)

therapy?

a.    Tachycardia

b.    Bradycardia

c.    Hypotension

d.    Constipation

13.    Which of the following adverse effects is specific to the biguanide diabetic drug metformin

(Glucophage) therapy?

a.    Hypoglycemia

b.    GI distress

c.    Lactic acidosis

d.    Somulence

14.    The most serious adverse effect of tricyclic antidepressant (TCA) overdose is:

a.    Seizures.

b.    Hyperpyrexia.

c.    Metabolic acidosis.

d.    Cardiac arrhythmias.

15.    The nurse is aware that the following solutions is routinely used to flush an IV device

before and after the administration of blood to a patient is:

a.    0.9 percent sodium chloride

b.    5 percent dextrose in water solution

c.    Sterile water

d.    Heparin sodium

16.    Cris asks the nurse whether all donor blood products are cross-matched with the recipient

to prevent a transfusion reaction. Which of the following always require cross-matching?

a.    packed red blood cells

b.    platelets

c.    plasma

d.    granulocytes

17.   A month after receiving a blood transfusion an immunocompromised male patient develops

fever, liver abnormalities, a rash, and diarrhea. The nurse would suspect this patient has:

a.    Nothing related to the blood transfusion.

b.    Graft-versus-host disease (GVHD).

c.    Myelosuppression.

d.    An allergic response to a recent medication.

18.    Jonas comes into the local blood donation center. He says he is here to donate platelets

only today. The nurse knows this process is called:

a.    Directed donation.

b.    Autologous donation.

c.    Allogenic donation.

d.    Apheresis.

19.    Nurse Bryan knows that the age group that uses the most units of blood and blood

products is:

a.    Premature infants.

b.    Children ages 1-20 years.

c.    Adults ages 21-64 years.

d.    The elderly above age 65 years.

20.    A child is admitted with a serious infection. After two days of antibiotics, he is severely

neutropenic. The physician orders granulocyte transfusions for the next four days. The mother

asks the nurse why? The nurse responds:

a.    “This is the only treatment left to offer the child.”

b.    “This therapy is fast and reliable in treating infections in children.”

c.    “The physician will have to explain his rationale to you.”

d.    “Granulocyte transfusions replenish the low white blood cells until the body can produce its

own.”

21.    A neighbor tells nurse Maureen he has to have surgery and is reluctant to have any blood

product transfusions because of a fear of contracting an infection. He asks the nurse what are

his options. The nurse teaches the person that the safest blood product is:

a.    An allogenic product.

b.    A directed donation product.

c.    An autologous product.

d.    A cross-matched product.

22.    A severely immunocompromised female patient requires a blood transfusion. To prevent

GVHD, the physician will order:

a.    Diphenhydramine hydrochloride (Benadryl).

b.    The transfusion to be administered slowly over several hours.

c.    Irradiation of the donor blood.

d.    Acetaminophen (Tylenol).

23.    Louie who is to receive a blood transfusion asks the nurse what is the most common type

of infection he could receive from the transfusion. The nurse teaches him that approximately 1

in 250,000 patients contract:

a.    Human immunodeficiency disease (HIV).

b.    Hepatitis C infection.

c.    Hepatitis B infection.

d.    West Nile viral disease.

24.    A male patient with blood type AB, Rh factor positive needs a blood transfusion. The

Transfusion Service (blood bank) sends type O, Rh factor negative blood to the unit for the

nurse to infuse into this patient. The nurse knows that:

a.    This donor blood is incompatible with the patient’s blood.

b.    Premedicating the patient with diphenhydramine hydrochloride (Benadryl) and

acetaminophen (Tylenol) will prevent any transfusion reactions or side effects.

c.    This is a compatible match.

d.    The patient is at minimal risk receiving this product since it is the first time he has been

transfused with type O, Rh negative blood.

25.    Dr. Rodriguez orders 250 milliliters of packed red blood cells (RBC) for a patient. This

therapy is administered for treatment of:

a.    Thrombocytopenia.

b.    Anemia.

c.    Leukopenia.

d.    Hypoalbuminemia.

26.    A female patient needs a whole blood transfusion. In order for transfusion services (the

blood bank) to prepare the correct product a sample of the patient’s blood must be obtained for:

a.    A complete blood count and differential.

b.    A blood type and cross-match.

c.    A blood culture and sensitivity.

d.    A blood type and antibody screen.

27.    A male patient needs to receive a unit of whole blood. What type of intravenous (IV)

device should the nurse consider starting?

a.    A small catheter to decrease patient discomfort

b.    The type of IV device the patient has had in the past, which worked well

c.    A large bore catheter

d.    The type of device the physician prefers

28.    Dr. Smith orders a gram of human salt poor albumin product for a patient. The product is

available in a 50 milliliter vial with a concentration of 25 percent. What dosage will the nurse

administer?

a.    The nurse should use the entire 50 milliliter vial.

b.    The nurse should determine the volume to administer from the physician.

c.    This concentration of product should not be used.

d.    The nurse will administer 4 milliliters.

29.    Central venous access devices (CVADs) are frequently utilized to administer

chemotherapy. What is a distinct advantage of using the CVAD for chemotherapeutic agent

administration?

a.    CVADs are less expensive than a peripheral IV.

b.    Once a week administration is possible.

c.    Caustic agents in small veins can be avoided.

d.    The patient or his family can administer the drug at home.

30.    A female patient’s central venous access device (CVAD) becomes infected. Why would

the physician order antibiotics to be given through the line rather than through a peripheral IV

line?

a.    To prevent infiltration of the peripheral line

b.    To reduce the pain and discomfort associated with antibiotic administration in a small vein

c.    To lessen the chance of an allergic reaction to the antibiotic

d.    To attempt to sterilize the catheter and prevent having to remove it

1. Answer B. Acetaminophen is extensively metabolized by pathways in the liver. Toxic

doses of acetaminophen deplete hepatic glutathione, resulting in accumulation of the

intermediate agent, quinine, which leads to hepatic necrosis. Prolonged use of

acetaminophen may result in an increased risk of renal dysfunction, but a single overdose

does not precipitate life-threatening problems in the respiratory system, renal system, or

adrenal glands.

2. Answer B. Topical agents produce a localized, rather than systemic effect. When

treating atopic dermatitis with a steroidal preparation, the site is vulnerable to invasion by

organisms. Viruses, such as herpes simplex or varicella-zoster, present a risk of

disseminated infection. Educate the patient using topical corticosteroids to avoid crowds or

people known to have infections and to report even minor signs of an infection. Topical

corticosteroid usage results in little danger of concurrent infection with these agents.

3. Answer C. Typically, first generation OTC antihistamines have a sedating effect because

of passage into the CNS. However, in some individuals, especially infants and children,

paradoxical CNS stimulation occurs and is manifested by excitement, euphoria,

restlessness, and confusion. For this reason, use of first generation OTC antihistamines has

declined, and second generation product usage has increased. Reye’s syndrome is a

systemic response to a virus. First generation OTC antihistamines do not exhibit a

cholinergic effect. Nausea and diarrhea are uncommon when first generation

OTC antihistamines are taken.

4. Answer C. Virus-infected children who are given aspirin to manage pain, fever, and

inflammation are at an increased risk of developing Reye’s syndrome. Use of

acetaminophen has not been associated with Reye’s syndrome and can be safely given to

patients with fever due to viral illnesses. Ibuprofen adverse effects include GI irritation and

bleeding, and in toxic doses, both renal and hepatic failure are reported. However, ibuprofen

has not been associated with the onset of Reye’s disease.

Brompheniramine/psudoephedrine contains a first generation OTC antihistamine and a

decongestant. Neither agent has been associated with the development of Reye’s

syndrome.

5. Answer B. Some types of contrast media contain iodine as an ingredient. Shellfish also

contain significant amounts of iodine. Therefore, a patient who is allergic to iodine will exhibit

an allergic response to both iodine containing contrast media and shellfish. These products

do not contain iodine.

6. Answer D. The measles portion of the MMR vaccine is grown in chick embryo cells. The

current MMR vaccine does not contain a significant amount of egg proteins, and even

children with dramatic egg allergies are extremely unlikely to have an anaphylactic reaction.

However, patients that do respond to egg contact with anaphylaxis should be in a medically

controlled setting where full resuscitation efforts can be administered if anaphylaxis results.

The vaccines in options a,b and c do not contain egg protein.

7. Answer A. IgE, the least common serum immunoglobulin (Ig) binds very tightly to

receptors on basophils and mast cells and is involved in allergic reactions. Binding of the

allergen to the IgE on the cells results in the release of various pharmacological mediators

that result in allergic symptoms. IgG is the major Ig (75 percent of serum Ig is IgG). Most

versatile Ig because it is capable of carrying out all of the functions of Ig molecules. IgG is

the only class of Ig that crosses the placenta. It is an opsonin, a substance that enhances

phagocytosis. IgA, the second most common serum Ig is found in secretions (tears, saliva,

colostrum, and mucus). It is important in local (mucosal) immunity. IgM, the third most

common serum Ig, is the first Ig to be made by the fetus and the first Ig to be made by a

virgin B cell when it is stimulated by antigen. IgM antibodies are very efficient in leading to

the lysis of microorganisms.

8. Answer A. Aplastic anemia is the result of a hypersensitivity reaction and is often

irreversible. It leads to pancytopenia, a severe decrease in all cell types: red blood cells,

white blood cells, and platelets. A reduced number of red blood cells causes hemoglobin to

drop. A reduced number of white blood cells make the patientsusceptible to infection. And, a

reduced number of platelets cause the blood not to clot as easily. Treatment for mild cases

is supportive. Transfusions may be necessary. Severe cases require a bone marrow

transplant. Option 2 is an elevated platelet count. Option 3 is an elevated white count.

Option 4 is an elevated granulocyte count. A granulocyte is a type of white blood cell.

9. Answer D. Oral contraceptives have been associated with an increased risk of stroke,

myocardial infarction, and deep vein thrombosis. These risks are increased in women who

smoke. Increased skin oil and acne are effects of progestin excess. Headache and dizziness

are effects of estrogen excess. Early or mid-cycle bleeding are effects of estrogen

deficiency.

10. Answer A. All items are adverse reactions of the drug. However, apnea appearing during

the first hour of drug infusion occurs in 10-12 percent of neonates with congenital heart

defects. Clinicians deciding to utilize alprostadil must be prepared to intubate and

mechanically ventilate the infant. Careful monitoring for apnea or respiratory depression is

mandatory. In some institutions, elective intubation occurs prior to initiation of the

medication.

11. Answer C. Muscle aches, soreness, and weakness may be early signs of myopathy

such as rhabdomyolysis associated with the HMG-CoA reducatase class of antilipemic

agents. This patient will need an immediate evaluation to rule out myopathy. Additional

doses may exacerbate the problem. Exercise will not reverse myopathy and delays

diagnosis.

12. Answer A. Levothyroxine, especially in higher doses, can induce hyperthyroid-like

symptoms including tachycardia. An agent that increases the basal metabolic rate would not

be expected to induce a slow heart rate. Hypotension would be a side effect of bradycardia.

Constipation is a symptom of hypothyroid disease.

13. Answer C. Lactic acidosis is the most dangerous adverse effect of metformin

administration with death resulting in approximately 50 percent of individuals who develop

lactic acidosis while on this drug. Metformin does not induce insulin production; thus,

administration does not result in hypoglycemic events. Some nausea, vomiting, and diarrhea

may develop but is usually not severe. NVD is not specific for metformin. Metformin does not

induce sleepiness.

14. Answer D. Excessive ingestion of TCAs result in life-threatening wide QRS complex

tachycardia. TCA overdose can induce seizures, but they are typically not life-threatening.

TCAs do not cause an elevation in body temperature. TCAs do not cause metabolic

acidosis.

15. Answer A. 0.9 percent sodium chloride is normal saline. This solution has the same

osmolarity as blood. Its use prevents red cell lysis. The solutions given in options 2 and 3 are

hypotonic solutions and can cause red cell lysis. The solution in option 4 may

anticoagulate the patient and result in bleeding.

16. Answer A. Red blood cells contain antigens and antibodies that must be matched

between donor and recipient. The blood products in options 2-4 do not contain red cells.

Thus, they require no cross-match.

17. Answer B. GVHD occurs when white blood cells in donor blood attack the tissues of an

immunocompromised recipient. This process can occur within a month of the transfusion.

Options 1 and 4 may be a thought, but the nurse must remember that immunocompromised

transfusion recipients are at risk for GVHD.

18. Answer D. The process of apheresis involves removal of whole blood from a donor.

Within an instrument that is essentially designed as a centrifuge, the components of whole

blood are separated. One of the separated portions is then withdrawn, and the remaining

components are retransfused into the donor. Directed donation is collected from a blood

donor other than the recipient, but the donor is known to the recipient and is usually a family

member or friend. Autologous donation is the collection and reinfusion of the patient’s own

blood. Allogenic donation is collected from a blood donor other than the recipient.

19. Answer D. People older than 65 years use 43 percent of donated blood. This number is

expected to increase as the population ages.

20. Answer D. Granulocyte (neutrophil) replacement therapy is given until the patient’s blood

values are normal and he is able to fight the infection himself. Options 1 and 3 are not

therapeutic responses. The treatment in option 2 takes days and is not always able to

prevent morbidity and mortality.

21. Answer C. This process is the collection and reinfusion of the patient’s own blood. It is

recommended by the American Medical Association’s Council on Scientific Affairs as the

safest product since it eliminates recipient incompatibility and infection. The product in option

1 is collected from a blood donor other than the recipient. The process in option 2 is also

collected from a blood donor other than the recipient, but the donor is known to the recipient

and is usually a family member or friend. Cross-matching significantly enhances

compatibility. It does not detect infection.

22. Answer C. This process eliminates white blood cell functioning, thus, preventing GVHD.

Diphenhydramine HCl is an antihistamine. It’s use prior to a blood transfusion decreases the

likelihood of a transfusion reaction. Option 2 will not prevent GVHD. Use of acetaminophen

prevents and treats the common side effects of blood administration caused by the presence

of white blood cells in the transfusion product: fever, headache, and chills.

23. Answer C. Hepatitis B is the most common infection spread via blood transfusion.

Donors are screened by a questionnaire that includes symptoms. The donated blood is also

tested for infection. The risk of infection with the agents in options 2 and 3 has decreased to

approximately 1 in 2 million secondary to donor questioning and donor blood testing. The

incidence of West Nile viral transmission is unknown, but donor infection is still relatively

rare.

24. Answer C. Type O, Rh negative blood has none of the major antigens and is safely

administered to patients of all blood types. It is also known as the universal donor.

Premedicating with these agents will not prevent a major transfusion reaction if the blood

type and Rh factors of the donor blood are incompatible with the recipient’s blood.

25. Answer B. A red blood cell transfusion is used to correct anemia in patients in which the

low red blood cell count must be rapidly corrected. RBC transfusion will not correct a low

platelet count. RBC transfusion will not correct a low white blood cell count. Packed RBCs

contain very little plasma and, thus, only a small amount of albumin. This amount will not

correct low albumin levels.

26. Answer B. This is needed to utilize the correct type of donor blood and to match the

donor product with the patient. Incompatible matches would result in severe adverse events

and possible death. The tests in options 1 and 3 are unnecessary. The test in option 4 is

utilized to determine the patient’s blood type and presence of antibodies to blood antigens. It

does not determine donor blood compatibility with the patient.

27. Answer C. Large bore catheters prevent damage to blood components and are less

likely to develop clotting problems than a small bore catheter. The nurse should determine

the correct device without asking the patient what type has been used before or asking the

physician which type he prefers and start the IV.

28. Answer D. A 25 percent solution contains one quarter of a gram per milliliter. Thus, the

nurse will administer 4 milliliters to provide a complete gram of albumin. The volume in

option 1 would provide 12.5 grams of albumin. The nurse should determine the volume. It is

unnecessary to seek the answer from the physician. A 25 percent solution is an acceptable

product and can safely be used.

29. Answer C. Many chemotherapeutic drugs are vesicants (highly active corrosive

materials that can produce tissue damage even in low concentrations). Extravasations of a

vesicant can result in significant tissue necrosis. Administration into a large vein is optimal.

CVADs are more expensive than a peripheral IV. Dosing depends on the drug. IV

chemotherapeutic agents are not administered at home. They are given in an outpatient or

clinic setting if not given during hospitalization.

30. Answer D. Microorganisms that infect CVADs are often coagulase-negative

staphylococci, which can be eliminated by antibiotic administration through the catheter. If

unsuccessful in eliminating the microorganism, the CVAD must be removed. CVAD use

lessens the need for peripheral IV lines and, thus, the risk of infiltration. In this case

however, the antibiotics are given to eradicate microorganisms from the CVAD. CVAD use

has this effect, but in this case, the antibiotics are given through the CVAD to eliminate the

infective agent. The third option would not occur.

1.    Nurse Brenda is teaching a patient about a newly prescribed drug. What could cause a

geriatric patient to have difficulty retaining knowledge about prescribed medications?

a.    Decreased plasma drug levels

b.    Sensory deficits

c.    Lack of family support

d.    History of Tourette syndrome

2.    When examining a patient with abdominal pain the nurse in charge should assess:

a.    Any quadrant first

b.    The symptomatic quadrant first

c.    The symptomatic quadrant last

d.    The symptomatic quadrant either second or third

3.    The nurse is assessing a postoperative adult patient. Which of the following should the

nurse document as subjective data?

a.    Vital signs

b.    Laboratory test result

c.    Patient’s description of pain

d.    Electrocardiographic (ECG) waveforms

4.    A male patient has a soft wrist-safety device. Which assessment finding should the nurse

consider abnormal?

a.    A palpable radial pulse

b.    A palpable ulnar pulse

c.    Cool, pale fingers

d.    Pink nail beds

5.    Which of the following planes divides the body longitudinally into anterior and posterior

regions?

a.    Frontal plane

b.    Sagittal plane

c.    Midsagittal plane

d.    Transverse plane

6.    A female patient with a terminal illness is in denial. Indicators of denial include:

a.    Shock dismay

b.    Numbness

c.    Stoicism

d.    Preparatory grief

7.    The nurse in charge is transferring a patient from the bed to a chair. Which action does the

nurse take during this patient transfer?

a.    Position the head of the bed flat

b.    Helps the patient dangle the legs

c.    Stands behind the patient

d.    Places the chair facing away from the bed

8.    A female patient who speaks a little English has emergency gallbladder surgery, during

discharge preparation, which nursing action would best help this patient understand wound care

instruction?

a.    Asking frequently if the patient understands the instruction

b.    Asking an interpreter to replay the instructions to the patient.

c.    Writing out the instructions and having a family member read them to the patient

d.    Demonstrating the procedure and having the patient return the demonstration

9.    Before administering the evening dose of a prescribed medication, the nurse on the

evening shift finds an unlabeled, filled syringe in the patient’s medication drawer. What should

the nurse in charge do?

a.    Discard the syringe to avoid a medication error

b.    Obtain a label for the syringe from the pharmacy

c.    Use the syringe because it looks like it contains the same medication the nurse was

prepared to give

d.    Call the day nurse to verify the contents of the syringe

10.    When administering drug therapy to a male geriatric patient, the nurse must stay

especially alert for adverse effects. Which factor makes geriatric patients to adverse drug

effects?

a.    Faster drug clearance

b.    Aging-related physiological changes

c.    Increased amount of neurons

d.    Enhanced blood flow to the GI tract

11.    A female patient is being discharged after cataract surgery. After providing medication

teaching, the nurse asks the patient to repeat the instructions. The nurse is performing which

professional role?

a.    Manager

b.    Educator

c.    Caregiver

d.    Patient advocate

12.    A female patient exhibits signs of heightened anxiety. Which response by the nurse is

most likely to reduce the patient’s anxiety?

a.    “Everything will be fine. Don’t worry.”

b.    “Read this manual and then ask me any questions you may have.”

c.    “Why don’t you listen to the radio?”

d.    “Let’s talk about what’s bothering you.”

13.    A scrub nurse in the operating room has which responsibility?

a.    Positioning the patient

b.    Assisting with gowning and gloving

c.    Handling surgical instruments to the surgeon

d.    Applying surgical drapes

14.    A patient is in the bathroom when the nurse enters to give a prescribed medication. What

should the nurse in charge do?

a.    Leave the medication at the patient’s bedside

b.    Tell the patient to be sure to take the medication. And then leave it at the bedside

c.    Return shortly to the patient’s room and remain there until the patient takes the medication

d.    Wait for the patient to return to bed, and then leave the medication at the bedside

15.    The physician orders heparin, 7,500 units, to be administered subcutaneously every 6

hours. The vial reads 10,000 units per milliliter. The nurse should anticipate giving how much

heparin for each dose?

a.    ¼ ml

b.    ½ ml

c.    ¾ ml

d.    1 ¼ ml

16.    The nurse in charge measures a patient’s temperature at 102 degrees F. what is the

equivalent Centigrade temperature?

a.    39 degrees C

b.    47 degrees C

c.    38.9 degrees C

d.    40.1 degrees C

17.    To evaluate a patient for hypoxia, the physician is most likely to order which laboratory

test?

a.    Red blood cell count

b.    Sputum culture

c.    Total hemoglobin

d.    Arterial blood gas (ABG) analysis

18.    The nurse uses a stethoscope to auscultate a male patient’s chest. Which statement

about a stethoscope with a bell and diaphragm is true?

a.    The bell detects high-pitched sounds best

b.    The diaphragm detects high-pitched sounds best

c.    The bell detects thrills best

d.    The diaphragm detects low-pitched sounds best

19.    A male patient is to be discharged with a prescription for an analgesic that is a controlled

substance. During discharge teaching, the nurse should explain that the patient must fill this

prescription how soon after the date on which it was written?

a.    Within 1 month

b.    Within 3 months

c.    Within 6 months

d.    Within 12 months

20.    Which human element considered by the nurse in charge during assessmentcan affect

drug administration?

a.    The patient’s ability to recover

b.    The patient’s occupational hazards

c.    The patient’s socioeconomic status

d.    The patient’s cognitive abilities

21.    An employer establishes a physical exercise area in the workplace and encourages all

employees to use it. This is an example of which level of health promotion?

a.    Primary prevention

b.    Secondary prevention

c.    Tertiary prevention

d.    Passive prevention

22.    What does the nurse in charge do when making a surgical bed?

a.    Leaves the bed in the high position when finished

b.    Places the pillow at the head of the bed

c.    Rolls the patient to the far side of the bed

d.    Tucks the top sheet and blanket under the bottom of the bed

23.    The physician prescribes 250 mg of a drug. The drug vial reads 500 mg/ml. how much of

the drug should the nurse give?

a.    2 ml

b.    1 ml

c.    ½ ml

d.    ¼ ml

24.    Nurse Mackey is monitoring a patient for adverse reactions during barbiturate therapy.

What is the major disadvantage of barbiturate use?

a.    Prolonged half-life

b.    Poor absorption

c.    Potential for drug dependence

d.    Potential for hepatotoxicity

25.    Which nursing action is essential when providing continuous enteral feeding?

a.    Elevating the head of the bed

b.    Positioning the patient on the left side

c.    Warming the formula before administering it

d.    Hanging a full day’s worth of formula at one time

26.    When teaching a female patient how to take a sublingual tablet, the nurse should

instruct the patient to place the table on the:

a.    Top of the tongue

b.    Roof of the mouth

c.    Floor of the mouth

d.    Inside of the cheek

27.    Which action by the nurse in charge is essential when cleaning the area around a

Jackson-Pratt wound drain?

a.    Cleaning from the center outward in a circular motion

b.    Removing the drain before cleaning the skin

c.    Cleaning briskly around the site with alcohol

d.    Wearing sterile gloves and a mask

28.    The doctor orders dextrose 5% in water, 1,000 ml to be infused over 8 hours. The I.V.

tubing delivers 15 drops per milliliter. The nurse in charge should run the I.V. infusion at a rate

of:

a.    15 drop per minute

b.    21 drop per minute

c.    32 drop per minute

d.    125 drops per minute

29.    A male patient undergoes a total abdominal hysterectomy. When assessing the patient 10

hours later, the nurse identifies which finding as an early sign of shock?

a.    Restlessness

b.    Pale, warm, dry skin

c.    Heart rate of 110 beats/minute

d.    Urine output of 30 ml/hour

30.    Which pulse should the nurse palpate during rapid assessment of an unconscious male

adult?

a.    Radial

b.    Brachial

c.    Femoral

d.    Carotid

1. Answer B. Sensory deficits could cause a geriatric patient to have difficulty retaining

knowledge about prescribed medications. Decreased plasma drug levels do not alter the

patient’s knowledge about the drug. A lack of family support may affect compliance, not

knowledge retention. Toilette syndrome is unrelated to knowledge retention.

2. Answer C. The nurse should systematically assess all areas of the abdomen, if time and

the patient’s condition permit, concluding with the symptomatic area. Otherwise, the nurse

may elicit pain in the symptomatic area, causing the muscles in other areas to tighten. This

would interfere with further assessment.

3. Answer C. Subjective data come directly from the patient and usually are recorded as

direct quotations that reflect the patient’s opinions or feelings about a situation. Vital signs,

laboratory test result, and ECG waveforms are examples of objective data.

4. Answer C. A safety device on the wrist may impair circulation and restrict blood supply to

body tissues. Therefore, the nurse should assess the patient for signs of impaired

circulation, such as cool, pale fingers. A palpable radial or lunar pulse and pink nail beds are

normal findings.

5. Answer A. Frontal or coronal plane runs longitudinally at a right angle to a sagittal plane

dividing the body in anterior and posterior regions. A sagittal plane runs longitudinally

dividing the body into right and left regions; if exactly midline, it is called a midsagittal plane.

A transverse plane runs horizontally at a right angle to the vertical axis, dividing the structure

into superior and inferior regions.

6. Answer A. Shock and dismay are early signs of denial-the first stage of grief. The other

options are associated with depression—a later stage of grief.

7. Answer B. After placing the patient in high Fowler’s position and moving the patient to

the side of the bed, the nurse helps the patient sit on the edge of the bed and dangle the

legs; the nurse then faces the patient and places the chair next to and facing the head of the

bed.

8. Answer D. Demonstrating by the nurse with a return demonstration by the

patientensures that the patient can perform wound care correctly. Patients may claim to

understand discharge instruction when they do not. An interpreter of family member may

communicate verbal or written instructions inaccurately.

9. Answer A.  As a safety precaution, the nurse should discard an unlabeled syringe that

contains medication. The other options are considered unsafe because they promote error.

10. Answer B. Aging-related physiological changes account for the increased frequency of

adverse drug reactions in geriatric patients. Renal and hepatic changes cause drugs to clear

more slowly in these patients. With increasing age, neurons are lost and blood flow to the GI

tract decreases.

11. Answer B. When teaching a patient about medications before discharge, the nurse is

acting as an educator. The nurse acts as a manager when performing such activities

as scheduling and making patient care assignments. The nurse performs the care giving role

when providing direct care, including bathing patients and administering medications and

prescribed treatments. The nurse acts as a patient advocate when making the patient’s

wishes known to the doctor.

12. Answer D. Anxiety may result from feeling of helplessness, isolation, or insecurity. This

response helps reduce anxiety by encouraging the patient to express feelings. The nurse

should be supportive and develop goals together withthe patient to give the patient some

control over an anxiety-inducing situation. Because the other options ignore the patient’s

feeling and block communication, they would not reduce anxiety.

13. Answer C. The scrub nurse assist the surgeon by providing appropriate surgical

instruments and supplies, maintaining strict surgical asepsis and, with the circulating nurse,

accounting for all gauze, sponges, needles, and instruments. The circulating nurse assists

the surgeon and scrub nurse, positions the patient, applies appropriate equipment and

surgical drapes, assists with gowning and gloving, and provides the surgeon and scrub

nurse with supplies.

14. Answer C. The nurse should return shortly to the patient’s room and remain there until

the patient takes the medication to verify that it was taken as directed. The nurse should

never leave medication at the patient’s bedside unless specifically requested to do so.

15. Answer C. The nurse solves the problem as follows:

10,000 units/7,500 units = 1 ml/X

10,000 X = 7,500

X= 7,500/10,000 or ¾ ml

16. Answer C. To convert Fahrenheit degrees to centigrade, use this formula:

C degrees = (F degrees – 32) x 5/9

C degrees = (102 – 32) 5/9

+ 70 x 5/9

38.9 degrees C

17. Answer D. All of these test help evaluate a patient with respiratory problems. However,

ABG analysis is the only test evaluates gas exchange in the lungs, providing information

about patient’s oxygenation status.

18. Answer B. The diaphragm of a stethoscope detects high-pitched sound best; the bell

detects low pitched sounds best. Palpation detects thrills best.

19. Answer C. In most cases, an outpatient must fill a prescription for a controlled substance

within 6 months of the date on which the prescription was written.

20. Answer D. The nurse must consider the patient’s cognitive abilities to understand drug

instructions. If not, the nurse must find a family member or significant other to take on the

responsibility of administering medications in the home setting. The patient’s ability to

recover, occupational hazards, and socioeconomic status do not affect drug administration.

21. Answer A. Primary prevention precedes disease and applies to health patients.

Secondary prevention focuses on patients who have health problems and are at risk for

developing complications. Tertiary prevention enables patients to gain health from others’

activities without doing anything themselves.

22. Answer A. When making a surgical bed, the nurse leaves the bed in the high position

when finished. After placing the top linens on the bed without pouching them, the nurse

fanfolds these linens to the side opposite from where the patientwill enter and places the

pillow on the bedside chair. All these actions promote transfer of the postoperative patient

from the stretcher to the bed. When making an occupied bed or unoccupied bed, the nurse

places the pillow at the head of the bed and tucks the top sheet and blanket under the

bottom of the bed. When making an occupied bed, the nurse rolls the patient to the far side

of the bed.

23. Answer C. The nurse should give ½ ml of the drug. The dosage is calculated as follows:

250 mg/X=500 mg/1 ml

500x=250

X=1/2 ml

24. Answer C. Patients can become dependent on barbiturates, especially with prolonged

use. Because of the rapid distribution of some barbiturates, no correlation exists between

duration of action and half-life. Barbiturates are absorbed well and do not cause

hepatotoxicity, although existing hepatic damage does require cautions use of the drug

because barbiturates are metabolized in the liver.

25. Answer A. Elevating the head of the bed during enteral feeding minimizes the risk of

aspiration and allows the formula to flow in the patient’s intestines. When such elevation is

contraindicated, the patient should be positioned on the right side. The nurse should give

enteral feeding at room temperature to minimize GI distress. To limit microbial growth, the

nurse should hang only the amount of formula that can be infused in 3 hours.

26. Answer C. The nurse should instruct the patient to touch the tip of the tongue to the roof

of the mouth and then place the sublingual tablet on the floor of the mouth. Sublingual

medications are absorbed directly into the bloodstream form the oral mucosa, bypassing the

GI and hepatic systems. No drug is administered on top of the tongue or on the roof of the

mouth. With the buccal route, the tablet is placed between the gum and the cheek.

27. Answer A. The nurse always should clean around a wound drain, moving from center

outward in ever-larger circles, because the skin near the drain site is more contaminated

than the site itself. The nurse should never remove the drain before cleaning the skin.

Alcohol should never be used to clean around a drain; it may irritate the skin and has no

lasting effect on bacteria because it evaporates. The nurse should wear sterile gloves to

prevent contamination, but a mask is not necessary.

28. Answer C. Giving 1,000 ml over 8 hours is the same as giving 125 ml over 1 hour (60

minutes) to find the number of milliliters per minute:

125/60 min = X/1 minute

60X = 125X = 2.1 ml/minute

To find the number of drops/minute:

2.1 ml/X gtts = 1 ml/15 gtts

X = 32 gtts/minute, or 32 drops/minute

29. Answer A. Early in shock, hyperactivity of the sympathetic nervous system causes

increased epinephrine secretion, which typically makes the patient restless, anxious,

nervous, and irritable. It also decreases tissue perfusion to the skin, causing pale, cool

clammy skin. An above-normal heart rate is a late sign of shock. A urine output of 30 ml/hour

is within normal limits.

30. Answer D. During a rapid assessment, the nurse’s first priority is to check the patient’s

vital functions by assessing his airway, breathing, and circulation. To check a patient’s

circulation, the nurse must assess his heart and vascular network function. This is done by

checking his skin color, temperature, mental status and, most importantly, his pulse. The

nurse should use the carotid artery to check a patient’s circulation. In a patient with a

circulatory problems or a history of compromised circulation, the radial pulse may not be

palpable. The brachial pulse is palpated during rapid assessment of an infant.

B besides high blood pressure values, what other signs and symptoms

may the nurse observe if hypertension is present?

A) Unexplained pain and hyperactivity

B) Headache, flushing of the face, and nosebleed

C) Dizziness, mental confusion, and mottled extremities

D) Restlessness and dusky or cyanotic skin that is cool to the touch

D Which of the following vlues for vital signs would the nurse address

first?

A) Heart rate = 72 beats per minute

B) Respiration rate = 28 breaths per minute

C) Blood pressure = 160/86

D) Oxygen saturation by pulse oximetry = 89%

E) Temperature = 37.2° C (99° F), tympanic

D An 82-year-old widower brought via ambulance is admitted to the

emergency department with complaints of shortness of 

breath, anorexia, and malaise. He recently visited his health care

provider and was put on an antibiotic for pneumonia. The client

indicates that he also takes a diuretic and a beta blocker, which helps

his "high blood." Which vital sign value would take priority in

initiating care?

A) Respiration rate = 20 breaths per minute

B) Oxygen saturation by pulse oximetry = 92%

C) Blood pressure = 138/84

D) Temperature = 39° C (102° F), tympanic

C The client, who has been on bed rest for 2 days, asks to get out of bed

to go to the bathroom. He has new orders for "up ad lib." What action

should the nurse take?

A) Give him some slippers and tell him where the bathroom is

located.

B) Ask the nursing assistant to assist him to the bathroom.

C) Obtain orthostatic blood pressure measurements.

D) Tell him it is not a good idea and provide a urinal.

A Using an oral electronic thermometer, the nurse checks the early

morning temperature of a client. The client's temperature is 36.1° C

(97° F). The client's remaining vital signs are in the normally

acceptable range. What should the nurse do next?

A) Check the client's temperature history.

B) Document the results; temperature is normal.

C) Recheck the temperature every 15 minutes until it is normal.

D) Get another thermometer; the temperature is obviously an error.

B The nurse decides to take an apical pulse instead of a radial pulse.

Which of the following client conditions influenced the nurse's

decision?

A) The client is in shock.

B) The client has an arrhythmia.

C) The client underwent surgery 18 hours earlier.

D) The client showed a response to orthostatic changes.

D The nurse is to measure vital signs as part of the preparation for a test.

The client is talking with a visiting pastor. How should the nurse

handle measuring the rate of respiration?

A) Count respirations during the time the client is not talking to the

visitor.

B) Wait at the client's bedside until the visit is over and then count

respirations.

C) Tell the client it is very important to end the conversation so the

nurse can count respirations.

D) Document the respiration rate as "deferred" and measure the rate

later, since the talking client is obviously not in respiratory distress.

D Delegation of some tasks may become one of the decisions the nurse

will make while on duty. For which of the following clients would it

be most appropriate for unlicensed assistive personnel to measure the

client's vital signs?

A) A client who recently started taking an antiarrhythmic medication

B) A client with a history of transfusion reactions who is receiving a

blood transfusion

C) A client who has frequently been admitted to the unit with asthma

attacks

D) A client who is being admitted for elective surgery who has a

history of stable hypertension

D The client has an oral temperature of 39.2° C (102.6° F). What are the

most appropriate nursing interventions?

A) Provide an alcohol sponge bath and monitor laboratory results.

B) Remove excess clothing, provide a tepid sponge bath, and

administer an analgesic.

C) Provide fluids and nutrition, keep the client's room warm, and

administer an analgesic.

D) Reduce external coverings and keep clothing and bed linens dry;

administer antipyretics as ordered.

D The hypothalamus controls body temperature. The anterior

hypothalamus controls heat loss, and the posterior hypothalamus

controls heat production. What heat conservation mechanisms will the

posterior hypothalamus initiate when it senses that the client's body

temperature is lower than comfortable?

A) Vasodilation and redistribution of blood to surface vessels

B) Sweating, vasodilation, and redistribution of blood to surface

vessels

C) Vasoconstriction, sweating, and reduction of blood flow to

extremities

D) Vasoconstriction, reduction of blood flow to extremities, and

shivering

C The nurse's documentation indicates that a client has a pulse deficit of

14 beats. The pulse deficit is measured by:

A) Subtracting 60 (bradycardia) from the client's pulse rate and

reporting the difference

B) Subtracting the client's pulse rate from 100 (tachycardia) and

reporting the difference

C) Assessing the apical pulse and the radial pulse for the same minute

and subtracting the difference

D) Assessing the apical pulse and 30 minutes later assessing the

carotid pulse and subtracting the difference

D The nurse observes that a client's breathing pattern represents

Cheyne-Stokes respiration. Which statement best describes the

Cheyne-Stokes pattern?

A) Respirations cease for several seconds.

B) Respirations are abnormally shallow for two to three breaths

followed by irregular periods of apnea.

C) Respirations are labored, with an increase in depth and rate (more

than 20 breaths per minute); the condition occurs normally during

exercise.

D) Respiration rate and depth are irregular, with alternating periods of

apnea and hyperventilation; the cycle begins with slow breaths and

climaxes in apnea.

D The nurse finds that the systolic blood pressure of an adult client is 88

mm Hg. What are the appropriate nursing interventions?

A) Check other vital signs.

B) Recheck the blood pressure and give the client orange juice.

C) Recheck the blood pressure after ambulating the client safely.

D) Recheck the blood pressure, make sure the client is safe, and

report the findings.

C 52 year old woman admitted with dyspnea and discomfort in her left

chest with deep breaths. SHe smoked for 35 years and recently lost

over 10 pounds. What vital sign should not be delegated to a nursing

assistant:

a) temperature

b) radial pulse

c) respiratory rate

d) oxygen saturation

1,

5,

2,

4,

3

Place the vital signs in order of priority for your nursing

interventions:

1) SpO2= 89%

2) BP= 160/86 mmHG

3) Temperature= 37.3 (99.4)

4) HR= 72 BPM

5) RR= 28 BrPM

1,

2,

4,

7

82 yr old admitted via ambulance to ER with shortness of breath,

anorexia, and malaise. He recently visited the health care center and is

on antibiotic for pneumonia. He is also on a diuretic, beta-adrergic

blocker, which helps his "high blood".

He has a temperature of 38.2 (100.8) via temporal artery. What

additional assessment data is needed in planning intervention for the

patients infection ? (choose all that apply)

1. HR

2. Skin turgor

3. Smoking history

4. Allergies to antibiotics

5. Recent BM's

6. BP in right arm

7. Client's normal temperature

8. BP in distal extremity