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3. A nurse is instilling an otic solution into an adult client’s left ear. The nurse avoids doing which of the following as part of this procedure? A. warming the solution to room temperature B. placing the client in a side lying position with the ear facing up C. pulling the auricle backward and upward D. placing the tip of the dropper on the edge of the ear canal 4. 40 y/o Toni who works as a bank executive has undergone surgery for glaucoma. The nurse provides which discharge instructions to the clients? A. wound healing usually takes 12 weeks B. expected the vision will be permanently impaired C. a shield or eye patch should be worn to protect the eye D. the sutures are removed after 1 week 5. Which assessment findings provide the best evidence that a client with acute angleclosure glaucoma is responding to drug therapy? A. swelling of the eyelids decreases B. redness of the sclera is reduced C. eye pain is reduced or eliminated D. peripheral vision is diminished 6. At the time of retinal detachment, a client most likely describes which symptoms? A. a seeing flashes of light B. being unable to see light C. feeling discomfort in light D. seeing poorly in daylight 7. The most important health teaching nurse John can provide to the client with conjunctivitis is to: A. eat a well balanced, nutritious diet B. wear sunglasses in bright light C. cease sharing towels and washcloths D. avoid products containing aspirin 9. A nurse is reviewing the record of the client with a disorder involving the inner ear. Which of the following would the nurse expect to see documented as an assessment finding in this client? A. severe hearing loss B. complaints of severe pain in the affected ear C. complaints of burning in the ear D. complaints of tinnitus 10. A client with a conduction hearing loss asks the nurse how a hearing aid improves hearing. The nurse most accurately informs the client that a hearing aid: A. amplifies sound heard B. makes sounds sharper and clearer C. produces more distinct, crisp, speech D. eliminates garbled background sounds 11. Which nursing action is best for controlling the client’s nosebleed? A. have the client lay down slowly and swallow frequently B. have the client lay down and breathe through his mouth C. have the client lean forward and apply direct pressure D. have the client lean forward and clench his teeth Situation: Benjie 59 years old male was admitted to the hospital complaining of nausea, vomiting, weight loss of 20 lbs, constipation and diarrhea. A diagnosis of carcinoma of the colon was made. 77. What method would a nurse use to most accurately assess the effectiveness of a weight loss diet for an obese client? A. daily weights B. serum protein levels C. daily caloric counts D. daily intake and output 90. Which of these maybe used to her post operatively? A. pleural drainage B. hemovac C. prevent infection D. improve coping ability 91. Which of the following is not a post operative complication A. bronchopneumonia B. pneumonia C. atelectasis D. decubitus ulcer 92. Allowing her to do deep breathing exercise every 2 hours would prevent: A. bronchopneumonia B. atelectasis C. bronchitis D. pneumonia 2. A client has been diagnosed with thromboangitis obliterans. The nurse is considering measures to help the client cope up with lifestyle changes needed to control the disease process. The nurse plans to refer the client to a: A. medical social worker B. dietician C. smoking cessation program D. pain management clinic 3. The nurse is implementing a plan of care for a client with deep pain thrombosis of the right leg. Which of the following interventions does the nurse avoid when delivering care to this client? A. elevation of the right leg B. ambulation in the hall twice per shift C. application of moist heat to the right leg D. administration of acetaminophen (Tylenol) D. sexual dysnfunction 80. The nurse is reviewing the record of the client with Crohn’s disease. Which of the following stool characteristic does the nurse expect to note in this client? A. bloody stool B. diarrhea C. constipation alternating with diarrhea D. stool constantly oozing from the rectum 81. The client with cirrhosis has ascites and a fluid volume excess. Which measure will the nurse include in the plan of care for this client? A. increase the amount of sodium in diet B. restrict the amount of fluids consumed C. encourage ambulation frequently D. administer magnesium antacids 82. The client with ascites is schedule for a paracentesis. The nurse is assisting the physician in performing the procedure. Which of the following positions will the nurse assist the client to assume for this procedure? A. supine C. right side lying B. left side lying D. upright 83. An ultrasound of the gallbladder is schedule for the client with a suspect diagnosis of cholecystitis. The nurse explain to the client that this test: A. requires the client to lie still for short intervals B. requires that the client be NPO C. requires the administration of oral tables D. is uncomfortable 84. The nurse is providing preoperative teaching to a client scheduled for a cholecystectomy. Which of the following interventions is of highest priority in the preoperative teaching plan? A. teaching coughing and deep breathing exercises B. teaching leg exercises C. instructions regarding fluid restrictions D. frequent need to work overtime on short notice 85. A client with peptic ulcer states that stress frequently causes exacerbation of the disease. The nurse interprets that which of the following items mentioned by the client is most likely responsible for the exacerbations? A. sleeping 8 hours a night B. eating 5 to 6 small meals per day C. ability to work at home periodically D. frequent need to work overtime on short notice 86. The client with peptic ulcer disease needs dietary modification to reduce episode of epigastric pain. The nurse plans to teach the client that which of the following items, which the client enjoys, does not need to be limited or eliminated with this disease? A. wine C. coffee B. baked chicken D. fresh fruit 87. The medication history of a client with peptic ulcer disease reveals intermittent use of the following medications. The nurse teaches the client to avoid which of these medications altogether because of the irritating effects on the lining of the GI tract? A. (Prilosec) B. ibuprofen (Motrin) C. sucralfate (Carafate) D. Nizatidine (Axid) 88. The nurse instructs the ileostomy client to do which of the following as part of essential care of the stoma? A. cleanse the peristomal skin meticulously B. take in high-fiber foods such as nuts C. massage the area below the stoma D. limit fluid intake to prevent diarrhea 89. The client who has undergone creation of a colostomy has a nursing diagnosis of Body Image disturbance. The nurse evaluates that he client is making the most significant progress toward identified goals if the client: A. watches the nurse empty the ostomy bag B. looks at the ostomy site C. reads the ostomy product literature D. practices cutting the ostomy appliance 90. The client with a new colostomy is concerned about odor from stool in the ostomy drainage bag. The nurse should teach the client to include which of the following foods in the diet to reduce odor? A. yogurt B. broccoli C. cucumbers D. eggs 91. The nurse is giving dietary instruction for the client who has a new colostomy. The nurse encourages the client to eat foods representing which of the following diets for the first 4 to 6 weeks postoperatively? A. high protein C. low calorie B. high carbohydrates D. low residue 92. The nurse has given instructions to the client with an ileostomy about foods to eat to thicken the stool. The nurse evaluates that the client did not fully understand the instructions if the client stated that eating which of the following foods makes the stool less watery? A. pasta C. bran B. boiled rice D. low-fat cheese 93. The client has just had surgery to create an ileostomy. The nurse assesses the client in the immediate postoperatively period for which of the following most frequent complications of this type of surgery? A. intestinal obstruction B. fluid and electrolyte imbalance C. malabsorption of fat D. folate deficiency 94. The client with acute pancreatitis is experiencing severe pain from the disorder. The nurse teaches the client to avoid which of the following positions that could aggravate the pain? A. sitting up C. leaning forward B. lying flat D. flexing the left leg 95. The nurse is evaluating the effect of dietary counseling on the client with cholecystitis. The nurse evaluates that the client understands the instructions given if the client stated that which of the following food items is acceptable in the diet? A. baked scrod C. fried chicken B. sauces and gravies D. fresh whipped cream 96. The nurse assesses the client experiencing an acute episode of cholecystitis for pain that is located in the right: A. upper quadrant and radiates to the left scapula and shoulder B. upper quadrant and radiates to the right scapula and shoulder C. lower quadrant and radiates to the umbilicus D. lower quadrant and radiates to the back 97. The client is beginning to show signs of hepatic encephalopathy. The nurse plans a dietary consult to limit the amount of which of the following ingredients in the client’s diet? A. fat C. protein B. carbohydrates D. minerals 98. The client with Crohn’s disease has an order to begin taking antispasmodic medication. The nurse should time the medication so that each dose is taken: A. 30 minutes before meals B. during meals C. 60 minutes after meals D. upon arising and at bedtime 99. The client with ulcerative colitis is diagnosed with mild case of the disease. The nurse doing dietary teaching gives the client examples of foods to eat that represent which of the following therapeutic diets? A. high-fat with milk B. high-protein without milk C. low-roughage without milk D. low-roughage with milk 100. It has been determined that the client with hepatitis has contracted the infection from contaminated food. What type of hepatitis is this client most likely experiencing? A. hepatitis A B. hepatitis B C. hepatitis C D. hepatitis D AM-CARE Review Academy for Nurses 1. Normal visual acuity as measured with a Snellen eye chart is 20/20. What does a visual acuity of 20/30 indicate? A at 20 feet, an individual can only read letters large enough to be read at 30 feet B. at 30 feet, an individual can read letters large enough to be read at 20 feet C. an individual can read 20 out of 30 total letters on the chart D. an individual can read 30 out of 50 total letters on the chart at 20 feet 2. Damage to the visual area of the occipital love of cerebrum, on the left side, would produce what type of visual loss? A. left eye only B. right eye only C. medial half of the right eye and lateral half of the left eye D. medial half of the left eye and lateral half of the right eye 3. An anterior chamber of the eye refers to all the space in what area? A. anterior to the retina B. between the iris and the cornea C. between the lens and the cornea D. between the lens and the iris 4. What condition results when rays of light are focused in front of the retina? A. myopia B. hyperopia C. presbyopia D. emmetropia 5. As the person grows older, the lens losses its elasticity, causing which kind of farsightedness? A. emmetropia B. presbyopia C. diplopia D. myopia 6. If a person has a foreign object of unknown material that is not readily seen in one eye, what would the first action be? A. irrigate the eye with a boric acid solution B. examine the lower eyelid and then the upper eyelid C. irrigate the eye with opious amounts of water D. shield the eye from pressure, and seek medical help 7. A sudden loss of an area of vision, as if a curtain were being drawn, is a principal symptom of? A. retinal detachment B. glaucoma C. cataracts D. keratitis 8. Postoperative care following stapedectomy would not include which of the following A. out of bed as desired B. no moisture in the affected ear C. avoid sneezing D. no bending over or lifting 9. Dimenhydrinate (Dramamine) is given after a stapedectomy A. to accelerate the auditory process B. to dull the pain experienced with the semicircular canal is disturbed C. to minimize the sensations of equilibrium disturbances and imbalance D. to prevent an increase tendency toward nausea 10. A client with Meniere’s syndrome is extremely uncomfortable because of which of these? A. severe earache B. many perceptual difficulties C. vertigo and resultant nausea D. facial paralysis 11. What is the cataract of the eyes? A. opacity of the cornea B. clouding of the aqueous humor C. opacity of the lens D. papilledema 12. Treating a cataract primarily involves which of the following? A. instillation of miotics B. installation of mydriatics C. removal of the lens D. enucleation 13. Preoperative instruction will not need to include A. type of surgery B. how to use the call bell C. how to prevent paralytic illeus D. how to prevent respiratory infetins 14. In preparing to teach patient about adjustment to cataract lenses, the nurse needs to know that the lenses will. A. magnify objects by one-third- with central vision B. magnify objects by one-third with peripheral vision C. reduce objects by one-third with central vision D. reduce objects by one-third with peripheral vision 15. In the immediate postoperative period the one action that is contraindicated for patient compared with clients after most other operations is which of the following? A. coughing B. turning on the unoperative side C. measures to control nausea and vomiting D. eating after nausea passes 16. Immediate nursing care following cataract extraction is directed primarily toward preventing A. Atelectasis B. infection of the cornea C. hemorrhage D. prolapse of the iris 17. The patient is confused during her first night after eye surgery. What would the nurse do? A. tell her to stay in bed B. apply restraints to keep her in bed C. explain why she cannot get out of bed, keep side rails up, and check her frequently D. sedate her 18. Discharge teaching would probably not need to include A. staying in a darkened room as much as possible B. avoiding alcoholic drinks,; limiting the use of tea and coffee C. using no eye washes or drops unless they were prescribed by the physician D. avoiding being excessively sedentary 19. Patient also needs to be instructed to limit. A. sewing B. watching TV C. walking D. weeding her garden Situation: Lea visit her ophthalmologist and receives a mydriatic drug in order to facilitate the examination. After returning home, she experiences severe pain, nausea and vomiting, and blurred vision. During a visit to the emergency room, a diagnosis of acute glaucoma is made. 20. Lea’s glaucoma has been caused by the dilation of the pupil. A. blockage of he outflow of aqueous humor by the dilation of the pupil B. blockage of the outflow of aqueous humor by the constriction of the pupil C. increase intraocular pressure resulting from the increased production of aqueous humor D. decrease intraocular pressure resulting from decrease production of aqueous humor 21. Intraocular pressure is measured clinically by tonometer. What tonometer reading would be indicative of glaucoma? A. pressure of 10 mmHg B. pressure of 15 mmHg C. pressure of 20 mmHg D. pressure of 25 mmHg 22. Which cranial nerve transmits visual impulses? A. I (olfactory) B. II (optic) C. III (oculomotor) D. IV (abducens) 23. Untreated or uncontrolled glaucoma damages the optic nerve. Three of the following signs and symptoms result from optic nerve atrophy; which one does not? A. colored halos around lights B. severe pain in the eye C. dilated and fixed pupils D. opacity of the lens 24. Glaucoma is conservatively managed with miotic eye drops. Mydriatic eye drops are contraindicated for glaucoma. Which of the following drugs is a mydriatic? A. neostigmine B. pilocarpine C. physostigmatine D. atropine 25. Glaucoma may require surgical treatment. Preoperatively, the client would be taught to expect which of the following postoperatively? A. cough and deep-breathing qh. B. turn only to the unaffected side C. medication for severe eye pain D. restriction of fluids for the first 24 hours Situation: Roy, a 55-year-old man, is admitted to the hospital with wide-angle glaucoma 26. What was the symptom that probably brought Roy to the ophthalmologist initially? A. decreasing vision B. extreme pain in eye C. redness and tearing of the eye D. seeing colored flashes of light 27. The teaching plan for Roy would include which of the following? A. reduce fluid intake B. add extra lighting in the home C. wear dark glasses/during the day D. avoid exercise 28. Miotics are used in the treatment of glaucoma. What is an example of a commonly used miotic? A. atropine B. pilocarpine C. acetazolamide (Diamox) D. scopolamine 29. What is the rationale for using miotics in the treatment of glaucoma? A. they decrease the rate of aqueous humor production B. pupil constriction increases outflow of aqueous humor C. increased pupil size relaxes the ciliary muscles D. the blood flow to the conjunctiva is increased 30. When instilling eye drops for a client with glaucoma, what procedure would the nurse follow? A. place the medication in the middle of the lower lid, and put pressure on the lacrimal duct after instillation. B. Instill the drug to the outer angle of the eye, have client tilt head back C. instill the drug at the innermost angle; wipe with cotton away from inner aspect D. instill medication in middle eye, have client blink for better absorption 31. Carbonic anhydrase inhibitors are sometimes used in the treatment of glaucoma because they: A. depress secretion of a aqueous humor B. dilate the pupil C. paralyze the power of accommodation D. increase the power of accommodation 32. Teaching a client with glaucoma will not include which of the following? A. vision can be restored only if the client remains under a physician’s care B. avoid stimulant (eg., caffeine) C. take all medications conscientiously D. prevent constipation and avid heavy lifting and emotional excitement 33. Glaucoma is a progressive disease that can lead to blindness. It can be managed if diagnosed early. Preventive health teaching would best include which of the points? A. early surgical action may be necessary B. all clients over 40 years of age should have an annual tonometry exam C. the use of contract lances in older clients is not advisable D. clients should seek early treatment for eye infections 34. A client with progressive glaucoma may be experiencing sensory deprivation. Which of the following actions would best minimize this problem? A. speak in a louder voice B. ensure that a sedative is ordered C. orient the client to time, place, and person D. use touch frequently when providing care Situation: 5-Gary is seen in the emergency room with the diagnosis of epitaxis. 35. It is unlikely that Gary’s history will include A. minor trauma to the nose B. a deviated septum C. acute sinusitis D. hypotension 36. Which of the following medications would be used with in order to promote vasoconstriction and control bleeding? A. epinephrine B. lidocaine C. pilovarpine D. cylospentolate 37. Which of the following positions would be most desirable for Gary? A. trendelenburg’s to control shock B. a sitting position, unless he is hypotensive C. side-lying, to prevent aspiration D. prone, to prevent aspiration 38. The physician decides to insert nasal packing. Of the following nursing actions, which would have the highest priority? A. encourage Gary to breath through his mouth, because he may feel panicky after the insertion. B. advice Gary to expectorate the blood in the nasopharynx gently and not to swallow it C. periodically check the position of the nasal packing, because airway obstruction can occur if the packing accidentally slip out of place D. take rectal temperature, because he must rely on mouth breathing and would be unable to keep his mouth closed on the thermometer. 39. After bleeding has been controlled, Gary taken to surgery to correct a deviated nasal septum. Which of the following is likely complication of this surgery? A. loss of the ability to smell B. inability to breath through the nose C. infection D. hemorrhage 40. Upon his discharge, the nurse instructs Gary on the use of vasoconstrictive nose drops and cautions him to avoid too frequent, and excessive use to these drugs, which of the following provides the best rationale for this caution A. A rebound effect occurs in which stuffness worsens after each successive dose B. cocaine, a frequent ingredient in nose drops, may lead to psychological addiction C. these medications may be absorbed systematically, causing severe hypotension D. persistent vasoconstriction of the nasal mucosa can lead to alterations in the olfactory nerve Situation: Brix had redial and neck surgery for cancer of the larynx. 41. Brix has tracheostomy. When suctioning and suctioning through laryngectomy tube. When doing these two procedures at the same time, the nurse would not do which of the ff: A. Use sterile technique B. turn head to right to suction left bronchus C. suction for no longer then 10 to 15 seconds D. observe for tachycardia 42. Brix requires both nasopharyngeal suctioning and suctioning through laryngectomy tube. When doing these two procedures at the same time, the nurse would not do which of the ff: A. use a sterile suction setup B. suction the nose first, then the laryngectomy tube C. suction the laryngectomy tube first, then the nose D. lubricate the catheter with saline 43. A nasogastric tube is used to provide Brix with fluids and nutrient for approximately 10 days, for which of the following reasons? A. to prevent pain while swallowing B. to prevent contamination of the suture line C. to decrease need for swallowing D. to prevent need for holding head up to ear 44. Brix’s children are concerned about their own risk of developing cancer. All but one of the following are facts that describe malignant neoplasia and must be considered by the nurse in her responses. Which one is correct? A. family factors may influence an individual’s susceptibility to neoplasia B. long-term use of corticosteroids enhances the body’s defense C. Sexual differences influence an individuals susceptibility to specific neoplasm D. living in industrialized areas increase an individual’s susceptibility to a malignant neoplasm 45. When would Brix best begin speech rehabilitation? A. when he leaves the hospital B. when the esophageal suture line is healed C. three months after surgery D. when he regains all his strength 46. The nurse is complaining the initial morning assessment on the client. Which physical examination technique would be used first when assessing the abdomen? A. inspection B. light palpation C. auscultation D. percussion 47. The client has orders for a nasogastric (NG) tube insertion. During the procedure, instruction that will assist in insertion would be: A. instruct the client to tilt his head back for insertion into the nostril, then flex his neck for final insertion B. after insertion into the nostril, instruct the client to extend his neck C. introduce the tube with the client’s head tilted back, then instruct him to keep his head upright for final insertion D. instruct the client to hold his chin down, then back for insertion of the tube 48. The most important pathophysiologic factor contributing to the formation of esophageal varices is: A. decreased prothrombin formation B. decreased albumin formation by the liver C. portal hypertension D. increased central venous pressure 49. The nurse analyzes the results of the blood chemistry tests done on a client with acute pancreatitis. Which of the following results would the nurse expect to find? A. low glucose B. low alkaline phosphatase C. elevated amylase D. elevated creatinine 50. A client being treated for esophageal varices has a Sengstaken-Blakemore tube inserted to control the bleeding. The most important assessment is for the nurse to: A. check that a hemostat is at the bedside B. monitor IV fluids for the shift C. regularly assess respiratory status D. check that the balloon is deflated on a regular basis 51. A female client complains of gnawing midepigastric pain for a few hours after meals. At times, when the pain is severe, vomiting occurs. Specific tests are indicated to rule out: A. cancer of the stomach B. peptic ulcer disease C. chronic gastritis D. pylorospasm 52. When a client has peptic ulcer disease, the nurse would expect a priority intervention to be: A. assisting in inserting a Miller-Abbott tube B. assisting in inserting an atrial pressure line C. inserting a nasogastric tube D. inserting an IV 53. A 40-year-old male client has been hospitalized with peptic ulcer disease. He is being treated with a histamine receptor antagonists (cimetidine), antacids, and diet. The nurse doing discharge planning will teach him that the action of cimetidine is to: A. reduce gastric acid output B. protect the ulcer surface C. inhibit the production of hydrochloric acid (HCl) D. inhibit vagal nerve stimulation 54. The nurse is admitting a client with Crohn’s disease who is scheduled for intestinal surgery. Which surgical procedure would the nurse anticipate for the treatment of this condition: A. ileostomy with total colectomy B. sigmoid colostomy with mucous fistula C. intestinal resection with end-to-end anastomosis D. colonoscopy with biopsy and polypectomy 55. A client who has just returned home following ileostomy surgery will need a diet that is supplemented: A. potassium B. vitamin B12 C. sodium D. fiber 56. A client scheduled for colostomy surgery. An appropriate preoperative diet will include: preoperative diet will include: A. broiled chicken, baked potato, and wheat bread B. ground hamburger, rice, and salad C. broiled fish, rice, squash, and tea D. steak, mashed potatoes, raw carrots, and celery 57. As the nurse is completing evening care for a client, he observes that the client is upset, quiet, and withdrawn. The nurse knows that the client is scheduled for diagnostic tests the following day. An important assessment question to ask the client is: A. “would you like to go to the dayroom to watch TV?” B. “are you prepared for the test tomorrow?” C. “have you talked with anyone about the test tomorrow?” D. “have you asked your physician to give you a sleeping pill tonight?” 58. Following abdominal surgery, a client complaining of “gas pains” will have a rectal tube inserted. The client should be positioned on his: A. left side, recumbent B. left side, sims C. right side, semi-fowler’s D. left side, semi-Fowler’s 59. Which of the following statements is most correct regarding colostomy irrigations? A. the solution temperature should be 100 deg. F B. 1000 ml is the usual amount of solution for the irrigation C. the solution container should be placed 10 inches above the stoma D. the irrigation cone is inserted in an upward direction in relation to the stoma 60. The nurse is teaching a client with a new colostomy how to apply an appliance to a colostomy. How much skin should remain exposed between the stoma and the ring of the appliance? A. 1/8 inch B. ½ inch C. ¾ inch D. 1 inch 61. Following a liver biopsy, the highest priority assessment of the client’s condition is to check for: A. pulmonary edema B. uneven respiratory pattern C. hemorrhage D. pain 62. A client has a bile duct obstruction and is jaundiced. Which intervention will be most effective in controlling the itching associated with his jaundice? A. keep the client’s nails clean and short B. maintain the client’s room temperature at 72 to 75 deg. F C. provide tepid water for bathing D. use alcohol for back rubs 63. When a client is in liver failure, which of the following behavioral changes is the most important assessment to report? A. shortness of breath B. lethargy C. fatigue D. nausea 64. A client with a history of cholecystitis is now being admitted to the hospital for possible surgical intervention. The orders include NPO, IV therapy, and bed rest. In addition to assessing for nausea, vomiting and anorexia, the nurse should observe for pain: A. in the right lower quadrant B. after ingesting food C. radiating to the left shoulder D. in the upper quadrant 65. The nurse taking a nursing history from a newly admitted client learns that he has a Denver shunt. This suggest that he has a history of: A. hydrocephalus B. renal failure C. peripheral occlusive disease D. cirrhosis 66. A female client had a laparoscopic cholecystectomy this morning. She is now complaining of right shoulder pain. The nurse would explain to the client this symptom is: A. common following this operation B. expected after general anesthesia C. unusual and will be reported to the surgeon D. indicative of a need to use the incentive spirometer 67. For a client with the diagnosis of acute pancreatitis, the nurse would plan for which critical component of his care? A. testing for Homan’s sign B. measuring the abdominal girth C. performing a glucometer test D. straining the urine 68. After removing a fecal impaction, the client complains of feeling lightheaded and the pulse rate is 44. The priority intervention is: A. monitoring vital signs B. place in shock position C. call the physician D. begin CPR 69. Peritoneal reaction to acute pancreatitis results in a shift of fluid from the vascular space into the peritoneal cavity. If this occurs, the nurse would evaluate for: A. decreased serum albumin B. abdominal pain C. oliguria D. peritonitis 70. The assessment finding should be reported immediately should it develop in the client with acute pancreatitis is: A. nausea and vomiting B. abdominal pain C. decreased bowel sounds D. shortness of breath 71. Following brain surgery, the client suddenly exhibits polyuria and begins voiding 15 to 20 L/day. Specific gravity of the urine is 1.006. The nurse will recognize these symptoms as the possible development of: A. diabetes insipidus B. diabetes, type 1 C. diabetes, type 2 D. Addison’s disease 72. A person with a diagnosis of adult Diabetes, type 2, should understand the symptoms of a hyperglycemic reaction. The nurse will know this client understands if she says these symptoms are: A. thirst, polyuria and decreased appetite B. flushed cheeks, acetone breath, and increased thirst C. nausea, vomiting and diarrhea D. weight gain, normal breath and thirst 73. The non-insulin dependent diabetic who is obese is best controlled by weight loss because obesity: A. reduces the number of insulin receptors B. causes pancreatic islet cell exhaustion C. reduces insulin binding t receptor sites D. reduces pancreatic insulin production 74. A nursing assessment for initial signs of hypoglycemia will include: A. Pallor, blurred vision, weakness, behavioral changes B. frequent urination, flushed face, pleural friction rub C. abdominal pain, diminished deep tendon reflexes, double vision D. weakness, lassitude, irregular pulse, dilated pupils 75. Which of the following nursing diagnosis would be most appropriate for the client with decreased thyroid function: A. alteration in growth and development related to increased growth hormone production B. alteration in thought processes related to decreased neurologic function C. fluid volume deficit related to polyuria D. hypothermia related to decreased metabolic rate 76. The RN should assess for which of the following clinical manifestations in the client with Cushing’s syndrome? A. hypertension, diaphoresis, nausea and vomiting B. tetany, irritability, dry skin and seizures C. unexplained weight gain, energy loss, and cold intolerance D. water retention, moon face, hirsutism and purple striae 77. The client hyperparathyroidism should have extremities handled gently because: A. decreased calcium bone deposits can lead to pathologic fractures B. edema causes stretched tissue to tear easily C. hypertension can lead to stroke with residual paralysis D. polyuria leads to dry skin and mucous membrane that can breakdown 78. Which of the following priority nursing implementation for a client with a tumor of the posterior lobe of the pituitary gland who has had a urine output of 3 L in the last hour with a specific gravity of 1.002? A. measure and record vital signs each shift B. turn client every 2 hours to prevent skin breakdown C. administer Pitressin Tannate as ordered D. maintain a dark and quiet room 79. A client has a diagnosis of diabetes. His physician has ordered short and long acting insulin. When administering two type of insulin, the nurse would: A. withdraw the long acting insulin into the syringe before the short acting insulin B. withdraw the short acting insulin into the syringe before the long acting insulin C. draw up in two separate syringes, then combine in one syringe D. withdraw long acting insulin, inject air into regular insulin, and withdraw insulin 80. Certain physiological changes will result from the treatment for myxedem. The symptoms that may indicate adverse changes in the body that the nurse should observe for are: A. increased respiratory excursion B. increased the frequency of rest periods C. initiate postural drainage D. continue with routine nursing care 81. A client with myxedema has been in the hospital for 3 days. The nursing assessment reveals the following clinical manifestations: respiratory rate 8/min, diminished breath sounds in the right lower lobe, crackles in the left lower lobe. The most appropriate nursing intervention is to: A. increased the use of ROM, turning, deep breathing exercises B. increased the frequency of rest periods C. initiate postural drainage D. continue with routine nursing care 82. In an individual with the diagnosis of hyperparathyroidism, the nurse will assess for which primary symptom: A. fatigue, muscular weakness B. cardiac arrhytmias C. tetany D. constipation 83. The nurse explains to a client who has just received the diagnosis of type 2 non-insulin dependent diabetes mellitus (NIDDM) that sulfonylureas, one group of oral hypoglycemic agents, as act by: A. stimulating the pancreas to produce or release insulin B. making the insulin that is produce more available for use C. lowering the blood sugar by facilitating the uptake and utilization of glucose D. altering both fat and protein metabolism 84. A client has been admitted to the hospital with a tentative diagnosis of adrenocortical hyperfucntion. In assessing the client, an observable sign the nurse would chart is: A. butterfly rash on the face B. moon face C. positive Chvostek’s sign D. bloated extremities 85. The nurse is teaching a diabetic client to monitor glucose using a glucometer. The nurse will know the client is competent in performing her finger-stick to obtain blood when she: A. uses a ball of a finger as the puncture site B. uses the side of fingertip as the puncture site C. avoid using the fingers of her dominant hand as puncture sites D. avoid using the thumbs as puncture sites 86. A client is scheduled for a voiding cystogram. Which nursing intervention would be essential to carry put several hours before the test? A. maintain NPO status B. medicating with urinary antiseptics C. administering bowel preparations D. forcing fluids 87. A retention catheter for a male client is correctly taped if it is: A. on the lower abdomen B. on the umbilicus C. under the thigh D. on the inner thigh 88. A client with a diagnosis of gout will betaking colchicines and allopurinol BID to prevent recurrence. The most common early sign of colchicines toxicity that the nurse assess for is: A. blurred vision B. anorexia C. diarrhea D. fever 89. A client’s laboratory results have been returned and the creatinine level is 7 mg/dl. This finding would lead the nurse to place the highest priority on assessing: A. temperature B. intake andoutput C. capillary refill D. pupillary reflex 90. After the lungs, the kidneys work to maintain body pH. The best explanation of how the kidneys accomplish regulation of pH is that they: A. secrete hydrogen ions and sodium B. secrete ammonia C. exchange hydrogen and sodium in the kidney tubules D. decrease sodium ions, hold on to the hydrogen ions, and then secrete sodium bicarbonate 91. Conditions known to predispose to renal calculi formation include: A. Polyuria B. dehydration, immobility C. glycosuria D. presence of an indwelling Foley catheter 92. the most appropriate nursing intervention, based on physician’s orders, for treating metabolic acidosis is to: A. replace potassium ions immediately to prevent hypokalemia B. administer oral sodium bicarbonate to act as a buffer C. administer IV cathecholamines (Levophed) to prevent hypertension D. administer fluids to prevent dehydration 93. IV is attached to a controller to maintain the flow rate. If the alarm sounds on the controller: A. ensure that drip chamber is full B. assess that height of IV container is at least 30 inches above venipuncture site C. ensure that the drop sensor is properly placed on the drip chamber D. evaluate the needle and IV tubing to determine if they are patent and positioned appropriately 94. A 76-year-old woman who has been in good health develops urinary incontinence over a period of several days and is admitted to the hospital for a diagnostic workup. The nurse would assess the client for other indicators of: A. renal failure B. urinary tract infection C. fluid volume excess D. dementia 95. A 60-year-old male client’s physician schedules a prostatectomy and orders a straight urinary drainage system to be inserted preoperatively. For the system to be effective, the nurse would: A. coil the tubing above the level of the bladder B. position the collection bag above the level of the bladder C. check that the collection bag is vented and distensible D. determine that the tubing is less that 3 feet in length 96. During a retention catheter insertion or bladder irrigation, the nurse must use: A. sterile equipment and wear sterile gloves B. clean equipment and maintain surgical asepsis C. sterile equipment and maintain medical asepsis D. clean equipment and technique 97. The physician has ordered a 24 hours urine specimen. After explaining the procedure to the client, the nurse collects the first specimen. This specimen. This specimen is the: A. discarded, then collection begins B. saved as part of the 24 hours collection C. tested, then discarded D. placed in a separate container and later added to collection 98. The most common cause of bladder infection in the client with a retention catheter is contamination: A. due to insertion technique B. at the time of the catheter removal C. of the urethral/ catheter interface D. of the internal lumen of the catheter 99. A client in acute renal failure receive an IV infusion of 10 percent dextrose in water with 20 units of regular insulin. The nurse understands that the rational for this therapy is to: A. correct the hyperglycemia that occurs with acute renal failure B. facilitate the intracellular movement of potassium C. provide calories to prevent tissue catabolism and azotemia D. force potassium into cells to prevent arrhythmias 100. A client with chronic renal failure is on continuous ambulatory peritoneal dialysis (CAPD). Which nursing diagnosis should have the highest priority? A. powerlessness B. high risk for infection C. altered nutrition: less than body requirements D. high risk for fluid volume deficit Situation: John Lee is an 18-year old high school student who suffered an injury to his cervical spine in a football game. 1. In directing emergency care until the ambulance arrives, it is most important that the school nurse A. place a small makeshift pillow under his head B. check to see if he can move all of his extremities C. keep him flat and immobilized in a natural position D. cover him with a blanket 2. A primary goal of nursing care when John is brought into the emergency room will be A. prevention of spinal shock B. maintenance of respiration C. maintenance of orientation D provision for pain relief Situation: Crutchfield tongs are used to apply traction to realign the spinal cord. 3. A nursing measure for john while he is in cervical traction should be to A. massage the back of his head B. position him from side to side C. remove the weights at least once a shift D. encourage involvement in his own care Situation: John is found to have a temperature of 36ºC (96.8ºF). 4. The most appropriate initial nursing measure for John in response to his hypothermia would be to A. cover him with additional blankets B. place a hot-water bottle at his feet C. check for signs of shock D. notify his physician Situation: John has a tracheostomy performed and is on assisted ventilation. 5. The alarm on the ventilator sounds. The initial response by the nurse should be to quickly A. notify the respiratory therapist B. check all connections from the respirator C. notify the respiratory therapist to come immediately D. use a self-inflating bag to ventilate John 6. When suctioning John, the nurse should A. ensure that he is able to take a breath between insertions of the catheter B. suction him for at least 30 seconds with each catheter insertion C. apply suction and gently rotate the catheter while inserting it into the bronchial bifurcation D. use clean technique during the suction procedure 7. John suddenly becomes diaphoretic, his blood pressure rises to 190/110, and he complains of a headache. The nurse should assess the patient for signs of A. increased intracranial pressure B. spinal meningitis C. pulmonary congestion D. fecal impaction 8. Upon admission John had a complete loss of motor ability. Within 48 hours he is noted to be having muscle spasms. His family becomes very excited when they notice these movements. Which of the following choices would be the most appropriate response by the nurse? A. at this stage, muscle spasms are expected, but it is too soon to evaluate the extent of the injury or its permanent effects B. I can understand your excitement. These movements are a good sign that he is making progress C. these movements are an indication that he is trying to move and that his will is very strong D. these movements are reflex activities that indicate that his spinal cord is intact Situation: Mark Richards has a compound fracture of the temporal bone. 9. The nurse notices bleeding from the orifice of the ear. Which of the following actions by the nurse can be safely used to determine if the drainage contains cerebrospinal fluid (CSF)? The nurse should A. swab the orifice of the ear with sterile applicator and send the specimen to the laboratory B. blot the drainage with a sterile gauze pad and look for a clear halo or ring around the spot of blood C. gently suction the ear an send the specimen to the laboratory D. test the CSF with a Tes-Tape and get a negative reading for sugar 10. The nursing care plans states “Observe for early signs of increased intracranial pressure (IIP).” Early symptoms of IIP include A. widening pulse pressure and dilated pupils B. rising blood pressure and bradycardia C. elevated temperature and decerebrate posturing D. nausea, vomiting, and restlessness 11. During the initial period after a head injury, nursing intervention for Mr. Richards should include A. packing the ear with cotton balls to stop bleeding B. awakening the patient every 2 hours to determine his level of consciousness C. placing the patient in Trendelenburg’s position D. forcing fluids to restore hydration 12. Before discharge, a computerized axial tomogram will be performed to rule out any intracranial or extracranial bleeding. Mr. Richards should be told that A. the procedure is noninvasive and he will not feel any pain B. he will experience a burning sensation as the dye is being injected C. the procedure is done in the operating room under anesthesia D. local anesthetic is used before injecting air into the ventricles of the brain via the spinal canal Situation: Tonnie Miccio is a 43-year old divorced man who has been rushed to the emergency room with an acute gouty arthritis. 13. While admitting Mr. Miccio to the hospital, the nurse should recognize those factors that can precipitate an acute attack. They include A. excessive smoking B. large alcohol intake C. emotional stress D. improper rest 14. A serum uric acid level is performed by the hospital laboratory. In acute gout, the uric acid level is approximately A. 1.0 mg/100 ml B. 2.1 mg/100 ml C. 6.5 mg/100 ml D. 10 mg/100 ml 15. Colchicine is the standard drug used to treat acute gout: The physician orders colchicines, 1.0 mg every 2 hours. After receiving the third dose, the patient complains of nausea, vomiting, and diarrhea. The nurse should recognize that this is A. a transient side effect and give the next dose B. a sign of toxicity and withhold the medication C. an allergic response to the drug and notify the physician D. a psychogenic response to the severe pain 16. The expected outcome for colchicine is to A. reduce uric acid levels B. relieve joint pain and inflammation C. increase blood flow to the kidney D. detoxify purines in the liver 17. During the night, Mr. Miccio complains of severe pain in his toe and asks the nurse for 2 aspirin tablets. The nurse should A. give the patient the 2 aspirin tablets B. elevate the foot on a pillow C. notify the physician D. offer the patient a cup of tea 18. Some physicians prescribe an alkali-ash diet to enhance the effect of the medications. Which of the following foods are allowed? A. liver, shellfish, and fats B. cranberries, cheese, and whole grain cereals C. milk, vegetables, and most fruits D. eggs, milk, prunes, and plums 19. After the acute attack subsides, the physician orders allopurinol (Zyloprim), 300 mg/day. The expected outcome for this drug is to A. lower the plasma and urinary uric acid level B. reduce inflammation of the affected joints C. produce diuresis D. relieve pain 20. A teaching program for Mr. Miccio should include A. emphasizing that aspirin is contraindicated in patient’s taking allopurinol B. restricting fluid intake to 1,000 ml/day C. explaining that acute gouty attacks often occur during initiation of allopurinol therapy D. stating that a low-purine diet should be followed while taking allopurinol 21. About 2 months after taking the allopurinol, Mr. Miccio develops a skin rash. The nurse should A. recognize this as a minor side effect that will subside B. ask the patient if he has been taking any aspirin while taking the allopurinol C. recognize this is an indication to discontinue the drug D. be aware that concomitant use of colchicines with allopurinol causes this reaction 22. One day, Jennifer asks her roommate, Erin, how her scoliosis was first recognized. Erin replies, “The school health nurse told me that there may be a problem after all the girls in my class were asked to stand erect while she examined our backs.” The nurse suspected scoliosis when she observed that Erin’s shoulder on one side was elevated and her A. head appeared aligned to the opposite side B. leg on the same side appeared shorter C. hip on the opposite side appeared prominent D. arm on the same side appeared longer 23. When Erin’s scoliosis was diagnosed after x-ray examination of her spine, she was fitted with a Milwaukee brace. Erin asks the nurse when it could be removed each day. Which of the following would be the best response? A. only when you are lying flat, either resting or sleeping B. for 1 hour a day when you bathe, shower, or go swimming C. only for special occasions, such as a party D. for 3 hours a day: one in the morning, one in the afternoon, and one in the evening Situation: Erin’s admission to the hospital for spinal fusion was necessary because hr scoliosis did not respond to the Milwaukee brace. 24. Preoperative preparation for Erin includes explaining that for 2 weeks after surgery she will be positioned A. on either side or prone B. sitting upright C. flat and will be logrolled D. on her back 25. When Erin is told that after surgery she will wear a body cast for about 1 year, she begins to sob. She tells the nurse she will look like a football player, not a girl. Which of the following is the best response the nurse can make? A. the people who really care about you won’t even notice your cast B. it only will be for a year. You’re mature enough to wait C. just ignore any comments that people make D. a pretty hairstyle and some loose peasant blouses will keep you looking feminine 26. After surgery, the nurse applies slight pressure to Erin’s toes and asks Erin is he can feel her foot being touched. Erin replies, “No, I don’t feel anything.” The nurse should then A. wait 1 hour and supply pressure again B. record Erin’s expected response C. ask Erin if her toes feel cold D. report Erin’s response to the surgeon Situation: Virginia K is a 25- year old woman who works as a lifeguard at the local beach. On her way to work she is in an automobile accident and is rushed to the hospital by ambulance. A diagnosis of complete transaction of the spinal cord at the third lumbar (L3) level is made. 27. While assess Ms. K for neurologic function, the nurse can expect she will be unable to A. shrug her shoulders B. tighten her abdominal muscles C. bend her elbow D. straighten her legs 28. Long-term goals for Ms. K include developing skills in A. performing wheelchair ambulation B. activating an electric wheelchair C. walking with leg braces and crutches D. walking without aids 29. observing for symptoms of which of the following is the priority of care for Ms. K in the acute stages of complete transaction of the lumbar cord? A. spinal shock B. respiratory insufficiency C. autonomic hyperreflexia D. hypertensive crisis 30. To prevent the complication of urinary tract infections, which of the following measures should be included in the nursing care plan? A. encouraging extra fluid intake B. offering at least two servings of citrus fruit juice per day C. telling the patient to avoid fruit juices such as plum, prune, and cranberry D. notifying the dietician to include a container of milk at all meals Situation: Jim, a 17-year old senior in high school, has sustained a simple fracture of the mandible after falling from his motorbike. 31. Upon admission to the emergency room, which of the following choices should the nurse expect to observe? A. bleeding in the external auditory canal B. dropped prominence of the cheek on the affected side C. edema of the eyes and cheeks D. teeth unevenly lined up Situation: An open reduction with wiring of the lower jaw to the upper jaw has been done by the surgeon. 32. In anticipating the postoperative needs o the patient, which of the following actions has the priority for Jim? A. placing paper and pencil at the bedside B. providing a tracheostomy set for tracheostomy care C. taping a wire cutter to the head of the bed D. inserting a gauze wick in the inside of the cheek 33. While teaching Jim mouth care the nurse should A. show him how to use moistened gauze sponges to clean his mouth and tongue B. demonstrate how an oral irrigation can be performed by inserting the catheter along the inside of the mouth between the teeth and the cheek C. explain to him that mouth care should not be done until the wires are removed D. tell him to use an astringent mouthwash to remove all the debris Mrs. Marian H is a 50-year old woman who has a spinal cord lesion at the fourth thoracic (T4) vertebra. 34. When there are lesions above T4 and T6, the patient may experience autonomic hyperreflexia. This condition can be prevented by A. avoiding bladder distention B. changing the patient’s position hourly C. wearing supportive elastic hose D. doing a neurologic check 35. Mrs. H complains of severe headache and is extremely anxious. The nurse checks her blood pressure and finds it is 210/110. The nurse should then A. check the patency of the urinary catheter B. apply ice packs to her head C. place the patient in a flat position D. sit with the patient until the symptoms subside Situation: Dorothy C, RN, age 35, is at work. After moving a particularly heavy patient, she suddenly develops severe pain in the lumbosacral area that radiates down her right leg. The preliminary diagnosis is rupture of an intervertebral disk. 36. Proper body mechanics may have prevented this injury to Ms. C. If she had adhered to the correct method of turning a patient from the supine position to the left side, she would have crossed the patient’s right arm over chest, and crossed the right leg over the left leg. Then, while standing with her feet A. together at the patient’s right side, she would gently turn the patient by pushing at the shoulder and sacral areas B. apart at the right side of the bed, she would turn the patient by gently pushing at the shoulder and center of the back C. apart at the left side of the bed, she would gently roll the patient toward her while keeping her legs straight D. apart at the left side of the bed, she would gently roll the patient toward her while flexing her knees 37. Instructions for Ms. C’s recuperation at home should include the use of a bed board, firm mattress, and rest in which of the following positions? A. completely flat in bed B. head elevated on a pillow, and knees and feet elevated with pillows C. head elevated with several pillows, and her legs flat D. Head elevated with several pillows, and several pillows under her knees 38. Ms. C should be reminded that if she is turning on her side, it is best if she A. grasps a chair leg by the side of the bed, and slowly pulls herself over, flexing the uppermost knee B. keeps her legs extended while crossing them to the side to which she is turning, and then uses her arms to help turn the upper portion of her body C. crosses her arms, flexes the uppermost knee toward the side to which she is turning, and then rolls over D. crosses her arms, crosses her legs while they are extended to the side toward which she is turning, and then rolls over 39. The physician gives Ms. C a prescription for methocarbamol (Robaxin). Because of her nursing background, Ms. C will know that the mediation is having the desired effects if which of the following occurs? A. She feels drowsy, and is sleeping more B. she has a feeling of euphoria C. there is a decrease in muscle spasms D. there is an increase in the knee-jerk reflex Situation: After a week of bed rest at home, Ms. C’s condition remains about the same. She is admitted to the hospital for further treatment and diagnostic tests. 40. Phenylbutazone (Butazolidin) is ordered for Ms. C. Planning for the administration of this medication should include directions to A. administer it immediately before or after eating B. avoid administering it with dairy products C. administer it at least 2 hours after eating D. administer it at specific time intervals, without regard to meals 41. In addition to the order for phenylbutazone, Ms. C is placed on bed rest and in pelvic traction. To diminish adverse responses to this treatment, the nurse should request an order for A. acetylsalicylic acid (aspirin) B. diphenoxylate hydrochloride (Lomotil) C. prochlorpeazine (Compazine) D. dioctyl sodium sulosuccinate (Colace) 42. A myelogram is performed on Mrs. C with a water-soluble contrast medium. Care after this procedure should include A. limiting fluid intake and elevating the head of the bed to 15 to 30 degrees B. not allowing anything by mouth and keeping the bed flat C. encouraging fluid intake and keeping the bed flat D. encouraging fluid intake and raising the head of the bed to 15 to 30 degrees 43. Ms. C has a laminectomy. Postoperatively, she complains that the pain is no different now than it was before surgery. The nurse should A. administer analgesics as ordered, and explain that the pain is to be expected because of the edema that results from the surgery B. administer the analgesics as ordered, but request that the physician check the patient immediately C. withhold the analgesic and notify the physician D. administer the analgesics as ordered, and tell Ms. C it will give her relief shortly 44. Rehabilitation will be facilitated if Ms. C is encouraged to do which of the following? A. sleep in prone position B. sit up for at least part of he day C. perform abdominal-strengthening exercise D. perform full trunk range-of-motion exercises Situation: Martha S is a 27-year old patient who has experienced increasing generalized stiffness, especially in the morning, fatigue, general malaise, and swelling and pain in the finger joints. She has a tentative diagnosis of rheumatoid arthritis. 45. Upon admission, Mrs. S is noted to have a rectal temperature of 37.7ºC (100ºF). A white blood count is ordered, and the report comes back at 8,500/mm³. The nurse should recognize this as being consistent with rheumatoid arthritis because it is A. within normal limits B. evidence of leukopenia C. only slightly elevated D. indicative of a generalized infectious process 46. Which of the following blood-analysis tests would be consistent with diagnosis of rheumatoid arthritis? A. an elevated erythrocyte sedimentation rate and negative C-reactive protein B. an elevated erythrocyte sedimentation rate and positive C-reactive protein C. a low erythrocyte sedimentation rate and negative C-reactive protein D. a low erythrocyte sedimentation rate and positive C-reactive protein 47. The primary goal of nursing care for Mrs. S during this initial acute phase of rheumatoid arthritis should be to A. prevent deformity and reduce inflammation B. prevent the spread of the inflammation to other joints C. provide for comfort and relief of pain D. assist her to accept the fact that rheumatoid arthritis is a log-term illness 48. During hospitalization, the nurse should explain to Mrs. Samuel that analgesics of choice would be A. codeine B. acetylsalicylic acid (aspirin) C. acetaminophen (Tylenol) D. proppoxyphene hydrochloride (Darvon) 49. During the acute phase of Mrs. S’s illness, which of the following measures would be the most appropriate? A. frequent periods of active exercises B. frequent periods of bed rest C. rest for he affected joints only D. encouragement to perform activities of daily living independently 50. The nurse understands that the main nursing goal in helping Mrs. S adapt to her chronic illness and plan is to A. provide the care she is unable to give herself B. provide guidance so that she will not repress her illness C. plan for social contacts so that she will not feel alone D. arrange for her after-care with the home health aide 51. Mrs. S is given instructions for using paraffin for her hands. The nurse should include the fact that the dips will be most effective if they are performed A. before exercising her hands B. after exercising her hands C. instead of exercising her fingers D. while exercising her fingers 52. Whenever Mrs. S feels pain from her arthritis, she tells the nurse she feels not only the pain but that her “whole body feels threatened.” Which response by the nurse is the most therapeutic? A. I will have someone stay with you so you won’t harm yourself B. I will teach you some relaxing exercises so you won’t be so tense C. you must have some medication to help you gain control D. arthritic pain will lessen if you try to grin and bear it 53. When Mrs. S is discharged, she is instructed to take aspirin at home. It is important that she be told to take the drug A. on a regular basis throughout the day B. only when other measures are not effective C. upon arising and again at bedtime D. between meals to promote its absorption 54. When Mrs. S is discharged, the nursing staff refers her to a nurse therapist who will assist her in dealing with the anxiety over her arthritis and the changes it has made in her life. The nursing team recognizes that the role of the nurse therapist is to A. work in conjunction with a psychiatrist B. provide individual nursing psychotherapy C. lead groups in therapy for those with similar problems D. give family nursing psychotherapy Situation: Twenty years after Mrs. S was first diagnosed with rheumatoid arthritis, she is admitted for a right total hip replacement. She has experienced severe right hip pain that has not responded to treatment for several years, and has had increasing difficulty moving about because of damage to the right hip joint. 55. Preoperative teaching for Mrs. S should include A. isometric exercises of the quadriceps and gluteal muscles B. instructions on the necessity for keeping the right leg perfectly straight after surgery C. the need to flex the involved hip postoperatively to maintain mobility D. the avoidance of aspirin for 4 days prior to surgery 56. Which of the following should the nurse consider to be most significant if noted when checking Mrs. S 3 days postoperatively? A. pain in the operative site B. swelling of the operative sites C. pain and tenderness in the calf D. orthostatic hypotension 57. The physical therapist orders exercises of Mrs. S’s right hip, knee, and foot to gradually increase range of motion to the right hip. The nurse can best assist Mrs. S by A. administering an analgesic before the exercises B. stopping the exercises if Mrs. S experiences pain C. performing the exercises for Mrs. S D. observing Mrs. S’s ability to perform the exercises 58. Mrs. S should be instructed to avoid A. adduction of her right leg B. abduction of hr right leg C. bearing any weight on her right leg D. the prone position in bed 59. The nurse and Mrs. S plan for her rehabilitation. Mrs. S asks the nurse, “What do I have to do in therapy?” Which reply by the nurse most accurately describes the task of the patient in rehabilitation? To A. follow the instructions of the rehabilitation team B. regain some function that was lost C. prevent further loss of your ability to function D. learn to deal realistically with your disability 60. When the rehabilitation therapist tells Mrs. S that the outcome of her therapy depends on “the ability of the nursing staff” as well as on her motivation, Mrs. S questions the nurse on the meaning of this phrase. The nurse should reply that “the nurse’s role in rehabilitation is to A. make the patient as comfortable as possible B. follow the directions of the rehabilitation therapist C. supervise the patient’s therapy appointments and exercise program D. assist the patient in establishing therapy priorities and goals 61. Mrs. S asks the nurse if her new joint will function normally. The nurse can best answer this by saying that A. the new joint will be stronger than the old one B. the new joint won’t function as well as a normal joint, but it will be better than the arthritic joint C. the new joint will function almost as well as a normal joint, particularly if you perform your exercise faithfully D. the doctor will be able to assess your limitations in 6 weeks and then explain them to you Situation: Mr. Lee is a 20-year-old patient who sustains a compound fracture of the right shaft of the femur and a simple fracture of the ulna in a motorcycle accident. 62. While serving as a member of a first aid squad, Mary V, RN, reaches the scene of the motorcycle accident and administers emergency treatment, which includes the application of a splint. It is important that the splint A. be applied while the limb is in good alignment B. be applied to the limb in the position in which it is found C. extend from the fracture site downward D. extend from the fracture site upward 63. While Mr. Lee is being transported in the ambulance to the hospital, he should be positioned with the affected limbs A. elevated B. in a flat position C. lower than his heart D. slightly abducted 64. While taking a history from the patient, the nurse determines that his last booster injection for tetanus immunization was 5 years ago. The nurse should recognize that this information is important because it means that he should receive A. a full tetanus immunization program B. nothing, because he is sufficiently immunized against tetanus C. an additional booster injection D. human tetanus immune globulin Situation: Mr. Lee is taken to the operating room and the wound caused by the fracture of the femur is cleansed and debrided. The fracture is then reduced, and a Steinmann pin for skeletal traction is inserted. A closed reduction of the ulna is performed, and a cast is applied. 65. The most important nursing measure in the immediate postoperative period will be A. encouragement of isometric exercises B. cleansing of the area around the Steinmann pin C. careful observation of vital signs D. massage of pressure areas 66. After Mr. Lee returns to his room, he complains of pain in his right arm. The initial action of the nurse should be to A. administer analgesics as ordered B. check his fingers C. notify his physician immediately D. pad the edges of the cast 67. To maintain proper alignment and immobilization of the femur, the physician has ordered skeletal traction with a Thomas splint. While caring for Mr. Lee, the nurse should explain to him that he A. cannot turn or sit up B. cannot turn but can sit up C. can turn but cannot sit up D. can turn and can sit up 68. In dealing with the weights that are applying the traction, the nurse should A. allow them to hang freely in place B. hold them up if the patient is shifting position in bed C. remove them if the patient is being moved up in bed D. lighten them for short periods if the patient complains of pain 69. Mr. Lee has a Thomas knee splint in place. In addition to the usual measures for a patient in traction, it will be important that the nurse observe A. the groin area for pressure B. for constipation C. his skin for sings of decubiti D. for signs of hypostatic pneumonia 70. If Mr. Lee should show an increase in blood pressure and signs of confusion and increased restlessness, the nurse should suspect A. a concussion B. impending shock C. fat emboli D. anxiety 71. Because of the nature of Mr. Lee’s wound and the insertion of a Steinmann pin, it is especially important that the nurse observe for A. a foul odor B. foot drop C. pulmonary congestion D. fecal impaction 72. Mr. Lee develops an acute localized osteomyelitis. He is placed on intravenous antibiotic therapy. The wound is incised and drained, and neomycin irrigations are ordered four times a day. It is important that these irrigations be performed A. with strict aseptic techniques B. with a warm solution C. for at least 5 minutes D. at equal time intervals Situation: Maria Alfredo is a 30-year old married woman who has systemic lupus erythematosus (SLE). 73. While doing as nursing history on Mrs. Alfredo, the nurse should recognize that the most common initial symptoms of SLE are A. petechiae in the skin, nosebleeds, and pallor B. hematuria, increased blood pressure, and edema C. tachycardia, tremors, and loss of weight D. painful muscles and joints, stiffness, and inflammation of joints 74. Mrs. Afredo is instituted on long-term prednisone therapy. Her daily maintenance dose is 5 mg/day. In the instructions to Mrs. Alfredo, the nurse should emphasize that A. once the symptoms of SLE subside, the medication will be discontinued gradually B. a weight gain 2 pounds per week should be reported to the physician C. the maintenance dose will be the lowest dose that controls symptoms D. if adrenal atrophy occurs, adrenocorticotropic hormone (ACTH) will have to be prescribed 75. Mrs. Alfredo questions the nurse about family planning and birth control. Which of the following choices should the nurse include in her answer? A. oral contraceptives can precipitate an acute exacerbation of your condition B. Intrauterine devices are the recommended brithcontrol measures C. there are no contraindications for pregnancy, as long as the disease is being treated D. studies indicate that the corticosteroids produce fetal damage 76. The nursing care plan states, “Observe for signs of Raynaud’s phenomenon.” The nurse should recognize that this phenomenon A. occurs as a side effect of prednisone B. is aggravated by smoking C. is relieved by application of cold compresses to the hands D. is the priority care 77. Although many abnormal laboratory findings are found in SLE, there is no one specific diagnostic test. The test that is positive in over 95 percent of all patients with SLE is the blood test for A. the lupus erythematosus (LE) factor B. the rheumatoid factor C. antinuclear antibodies (ANA) D. C-reactive protein (CRP) 78. The teaching program for Mrs. Alfredo planned by the nurse should include emphasis on which of the following? A. once the symptoms are controlled, the corticosteroids will be discontinued B. if hair loss occurs, it is irreversible C. overexposure to the sun can produce an exacerbation of symptoms D. a low-potassium, low-protein diet is recommended 79. Mrs. Alfredo tells the nurse that she has had black, tarry stools. The nurse should A. reassure the patient that this is a minor side effect of prednisone B. tell the patient that if she takes the prednisone with milk, black, tarry stools will be avoided C. tell the patient that she will ask the physician to prescribe aluminum hydroxide D. notify the physician because black, tarry stools can be an indication of bleeding peptic ulcer 80. Mrs. Alfredo calls the physician’s office and complains that she has chills, a fever, and a cough. The nurse should A. advise that she remain in bed, drink extra fluids, and take aspirin every 4 hours B. recommended that she increase her dose of prednisone until her temperature is normal C. recommended that she come to the office to be examined by the physician D. tell Mrs. Alfredo to call for an appointment when she is feeling better Situation: Irene P is being treated in the emergency room for an acute attack of Meniere’s syndrome 81. The nurse should recognize that the triad of symptoms associated with Meniere’s syndrome is A. nystagmus, arthralgia, and vertigo B. nausea, vomiting, and arthralgia C. syncope, headache, and hearing loss D. hearing loss, vertigo, and tinnitus 82. Patient teaching for Mrs. P includes helping her to recognize that A. Meniere’s syndrome is psychogenic and is brought on by stress B. most patients can be successfully treated with a low-salt diet and diuretics C. acute infection can precipitate an attack D. a labyrinthectomy is the preferred treatment for relieving symptoms and restoring hearing 83. Nursing intervention during an acute attack includes A. encouraging the patient to walk B. placing the patient in a semi-Fowler’s position C. Having the patient lie flat D. placing the patient in Trendelenburg’s position Situation: Mrs. C, 30 years old, has symptoms of diplopia, fatigue, slight vertigo, and a lack of coordination. After a neurological work-up she is diagnosed as having multiple sclerosis. 84. The main goal of nursing care for Mrs. C during the acute phase of the disease should be to A. promotes rest B. prevent constipation C. maintain normal functioning D. encourage activities of daily living 85. Mrs. C is note d to be having mood swings. In deciding what approach to use with her, the nursing staff should recognize that this A. is probably the result of an underlying mental disorder B. indicates that Mrs. C is having difficulty accepting her diagnosis C. may be a result of pathology and involvement of the limbic system in the disease D. indicates that Mrs. C’s intellectual capacity has been compromised 86. Mrs. C questions the nurse concerning the usual course of multiple sclerosis. Which would be the best reply by the nurse? A. each individual is very different; we cannot tell what will happen B. I know you are worried, but it is too soon to predict what will happen C. usually, acute episodes like this are followed by remissions, which may last a long time D. the future will take care of itself; let’s concentrate on the present 87. As Mrs. C’s condition improves, it is most important that she be given guidance in A. developing a program of exercise B. learning to handle stressful situations C. seeking vocational rehabilitation D. limiting her activities to those that are absolutely necessary Situation: Barbara is a 23-year-old woman who lives with her mother, sister, and brother in a private residence. She is attending the neurological out-patient clinic for the first time. Her health history includes two grand mal seizures./ A diagnosis of idiopathic epilepsy has been made. The physician has ordered an electroencephalogram (EEG) and phenytoin sodium (Dilantin), 300 mg/day 88. While doing a nursing history on Barbara, the nurse should recognize that A. persons with idiopathic epilepsy have a lower intelligence level B. grand mal seizures do not cause mental deterioration C. a common characteristic of idiopathic epilepsy is committing acts of violence D. idiopathic epilepsy is a form of mental illness 89. To prepare Barbara for EEG, the nurse should explain that A. during the test she will experience small electric shocks that feels like pin pricks B. the test measures mental status as well as electrical brain waves C. during the hyperventilation portion of the test, she may experience dizziness D. she will be unconscious during the test 90. Health teaching for Barbara includes ensuring that she understands that A. proper prophylactic medication can control the incidence of seizures B. moderate use of alcohol is permitted C. forcing fluids helps to reduce the incidence of seizures D. the incidence of seizures is related to hyperglycemia 91. During a follow-up clinic visit, Barbara tells the nurse that her urine has had a reddishbrown color. The nurse should A. reassure Barabara that this is a harmless side effect of phenytoin sodium (Dilantin) B. tell Barbara that this is a sign of hepatic toxicity C. recommend that Barbara go to the laboratory for a serum Dilantin concentration test D. notify the physician that Barbara has hematuria 92. A long-term goal for Barbara is to minimize the gingival hyperplasia associated with Dilantin therapy. The nurse should recognize that A. another anticonvulsant will be prescribed if it occurs B. the physician will reduce the dosage at the first sign of hyperplasia C. a regular plan of good oral hygiene is essential D. vitamin C should be taken daily with the Dilantin 93. Barbara’s serum concentration level Dilantin is 15 µg/ml. The nurse should recognize this as A. a desired therapeutic serum level B. below the desired therapeutic level C. above the recommended serum level D. a toxic serum level 94. Family members should be instructed about caring Barbara during a grand mal seizure. Immediate care during a seizure should include A. restraining Barbara’s arms and legs B. forcing the mouth open to insert an airway C. giving orange juice before the clonic stage begins D. turning Barbara’s head to the side 95. The nurse explains to Barbara that safety precautions can be taken by those who have warning symptoms before the seizure. (These symptoms are not part of the seizure, as the aura is.) What warning symptoms should the nurse tell Barbara to be aware of? A. Hot and cold sensations, gastrointestinal problems, anxiety, and mood changes B. Muscle twitching, lapse of consciousness, anxiety, and gastrointestinal problems C. tingling in a local region, anxiety, and lapse of consciousness D. increased tonicity of muscles and autonomic behavior 96. The nurse should tell Barbara’s family that after a seizure she will be in a confused state and will need some supervision. It is most important for the caring one to be calm because the confused state of the epileptic is considered to be A. One mood swings and a feeling of general inadequacy and fatigue that result in a decrease of interest B. an adaptive period, when one slowly learns to cope with the devastating insults to one’s psychological and physical integrity C. a gross impairment in social and intellectual functioning with crude, tactless, and impulsive behavior D. a helpless state, with intellectual deterioration, difficulty in communication, and regression to the infantile state 97. Barbara asks the nurse if it is true that there is an “epileptic personality.” Which of the following choices would be the nurse’s best response/ A. the person must be aware that anxiety over anticipation of a seizure may cause personality problems B. No, deviation in personality is caused by restrictions imposed by society C. Yes, one may learn to induce seizures as a way of getting attention from others D. the person may take on a sick role if mismanaged at home or in the community Situation: Ms. R, a 35-year old woman, has myasthenia gravis. She has been referred to the neurology clinic by her physician. 98. While doing a nursing history on Ms. R, the nurse should expect her to complain of which of the following symptoms? A. passive tremors, cogwheel rigidity, and drooling B. spastic weakness of the limbs, intention tremors, and incontinence C. diplopia, ptosis, and fatigue D. nystagmus, ataxia, and tinnitus 99. In preparing a teaching plan for Ms. R, the nurse should emphasize that A. the anticholinesterase medications cause fewer side effects when taken on an empty stomach B. physical activity should be planned for the late afternoon early evening C. a member of the family should be taught how to use suction for emergency use D. edrophonium chloride (Tensilon) is the drug of choice in the treatment of myasthenia gravis 100. Respiratory distress is common in people with myasthenic crisis? Marked improvement of respirations occurs after the administration of intravenous A. diazepam (Valium) B. hydrocortisone C. atropine sulfate D. edrophonium chloride (Tensilon) 101. The medication used to treat cholinergic crisis A. atropine sulfate B. neostigmine (Prostigmin) C. aminophylline D. hydrocortisone 102. The physician has prescribed pyridostigmine (Mestinon), 180 mg/day. Ms. R tells the nurse that each time she takes the medication she feels nauseated. The nurse should tell Ms. R to A. crush the tablet before taking it B. take the tablet with food or milk C. take the tablet on an empty stomach D. not to take the medication until she notifies the physician Mr. Go, who has had Parkinsosn’s disease for 4 years, visits his wife daily during her hospital stay. His illness is being treated with levodopa (L-dopa). 103. When Mr. Go visits his wife, he is observed to be walking rather slowly. The nurse should recognize that Mr. Go is A. exhibiting a long-range side effect of L-dopa B. exhibiting a symptom that is characteristic of stage II Parkinson’s disease C. beginning to experience atrophy of the cerebral cortex and cellular changes D. probably doing this on purpose as a way of 104. The nurse can help him to be more comfortable by A. discussing this problem and how he handles it, and discussing hygiene measures with him B. opening the windows and providing as much ventilation as possible while he is visiting C. suggesting that he is probably dressing too warmly for the hospital environment D. explaining that this is a side effect of his medication, and encouraging increased intake of fluids Situation: Mr. go has a sudden exacerbation of symptoms. He develops tachycardia, a respiratory rate of 40, and appears extremely anxious. He is hospitalized with a diagnosis of parkinsonian crisis. 105. Planning for Mr. Go’s care should include measures to A. provide a quiet, restful environment B. maintain joint range of motion C. decrease social isolation D. improve his nutritional status 106. Mr. Go responds to treatment, and his condition gradually improves. However, he complains that he feels dizzy whenever he tries to stand up from a lying position. The nurse should A. explain that this is just part of his illness B. tell him that his doctor will be notified of this symptom C. encourage him to change his position slowly D. discuss his feelings about his wife’s hospitalization 107. Mr. Go has problems in dressing himself as a result of tremors, but he refuses all assistance. Which of the following is the best initial action by the nurse in response to this complaint? A. tell him he needs assistance, and gradually help him B. give him more time and encouragement to dress himself C. suggest that for the present he wear only the hospital gown D. listen to his refusal, but give him assistance as needed 108. Mr. Go discusses his work as an accountant with the nurse. He states that he his glad that he will be able to continue working. An appropriate initial response would be based on the nurse’s recognition that he A. should be encouraged to be active B. should be cautioned against overfatigue C. is being unrealistic about his future D. needs to recognize that his situation is unique 109. Mr. Go tells the nurse that someone told him that people with Parkinson’s disease develop early senility. In response, the nurse should explain that A. Parkinson’s disease progresses very slowly over a period of years, and it is only in the late stages that any mental changes might take place B. his information is false, because Parkinson’s disease does not cause any changes in the individual’s intellectual capacities C. he does not have to worry about senility because he is responding so well to treatment D. although Parkinson’s disease does cause mental confusion, this condition is clinically different from senility
