Exercise 21

1). Changes in the renal system of an elderly person might include which of the following?

check all answers that apply

increased kidney size

decreased glomerular filtration rate
decreased residual urine
decreased capacity of the bladder
2). You are caring for a patient who has been admitted to your unit after overdosing on
heroin. After the client has been stabilized she tells you that she does not have an abuse
problem; it’s just that she uses the drugs to cope. What is the best type of response to this
patient?

check all answers that apply

Tell her that you understand how she feels.

Ask her why she thinks that drugs are the answer to her problems.
Just listen. Let her do the talking.
Confront her denial and the placing of blame on circumstances.

3). A nurse is caring for a patient with Graves disease. He observes that there is a sudden
oversecretion of thyroid hormone resulting in thyroid storm, a life-threatening event. He has
also observed fever, hypertension, agitation and anxiety in the patient. His nursing interventions
may include all of the following except

maintaining an airway for adequate aeration

avoiding the administration of propranolol
administering methimazole
administering propylthiouracil
4). The nurse is caring for a 7 year old with tonsillitis. The nurse tells the child's mother that the
viral tonsillitis can be spread for the next

2-3 days
5-7 days
10-14 days
20-30 days
5). The nurse has orders from the physician to insert a catheter. What should the nurse do first?

position the client in the appropriate position

monitor the output of the client
assess the flaccidity of urinary sphincter
place a sterile fenestrated drape over the client's external genitalia
6). A registered nurse that works in a psychiatric unit is able to perform which of the following
duties?

case management
conduct individual psychotherapy
 order medication
diagnosis mental health conditions
7). To prevent medication errors, which of the following examples are all necessary components
of a medication order?

date, time, medication name, dosage, route, frequency of administration, and physician's
signature
date, time, medication name, needle size, classification of medication, and physician's signature
date, time, medication name, route, frequency, and client's signature
date, time, medication name, dosage, and nurse manager's signature
8). Which of the following is most related to controlling the liability of health-care institutions
and their staffs?

check all answers that apply

case management
evidence-based practice
risk management
performance improvement
9). A 15-year-old girl is brought by her mother to see a psychiatric nurse practitioner. The
client's mother demands that her daughter be admitted for treatment of "behavioral problems."
Her mother states that the daughter stays out until 4 a.m. and is hanging out with "bad" kids.
The nurse will recommend which of the following?

Outpatient therapy for the mother and daughter

Therapy for the mother
Therapy for the daughter
Involuntary admission for the daughter

10). A client is undergoing an extensive diagnostic workup for a suspected GI problem. The
nurse discovers that the client has a family history of ulcer disease. Which blood type is a risk
factor for duodenal ulcers?

Type A
Type B
Type AB
Type O
11). The nurse is developing a care plan for a client with hepatitis A. What information should
be included in the teaching plan for the patient regarding the main route of transmission of this
hepatitis virus?

The virus is transmitted via sputum

The virus is transmitted via the feces/oral route
The virus is transmitted via blood and blood products
The virus is transmitted via urine
12). Which of the following is the first step to utilizing any fire extinguisher?

“Sweep the fire from side to side.”

 “Aim at the base of the fire.”
“Pull the pin.”
“Squeeze the handles.”
13). Which of the following clients would most likely experience a problem associated with fluid
volume deficit?

A client with acute vomiting and diarrhea.

A client with a prolonged QT interval.
A client with dysphagia.
A client with vertigo.
14). Elderly clients who fall are most at risk for which injuries?

wrist fractures
humerus fractures
pelvic fractures
cervical spine fractures

15). Which of the following is the generic name for Nizoral?

Ketoconazole.
Isotretinoin.
Nystatin.
Flucinonide.
16). The nurse is caring for a client who is immobile and also has orthostatic hypotension.
Which of the following is an appropriate nursing diagnosis?

Infective Airway Clearance

Risk for infection
Risk for injury
Risk for personal delay
17). A 20 year old client is admitted to the hospital and will undergo a hysterectomy the next
morning. The client told the nurse that she was scared and feeling a little depressed because she
will never be able to have a child. At that moment, the client's mother, father and sister walk
into the client's room. The nurse would take which of the following actions?

ask the family to wait outside so she can finish obtaining the client's vital signs
ask the family to visit the client after the surgery
tell the family they are not allowed to see the client because she is on the critical unit
ask the client if she is up for visitors
18). One of the patients on your floor has a marked change in her condition. You call the doctor
to report this and he gives you orders for specific blood work to be done. What is the most
important safety consideration when taking this order?

writing down the order

reporting the order to the supervising nurse
writing down the order and repeating it back to the doctor
calling the lab technician to draw blood immediately
19). There are good and bad ways to resolve conflict. The mode of resolution used when a
person tries to satisfy the needs of others and neglects his or her needs is which of the
following?

check all answers that apply

avoidance
accommodation
competition
compromise
20). The nurse is caring for a client with coronary heart disease. Which of the following would
most likely play a role in myocardial ischemia?

slow heart rate

high levels of cortisol
excessive physical activity
low red blood cells
21). A 44-year-old male, with a diagnosis of schizophrenia, is admitted to the hospital's
psychiatric unit. Which of the following is the best approach for the nurse to develop trust with
the client?

make eye contact each time the nurse talks to the client
help the client establish emotional contact
tell the client he has no reason to feel distrust
encourage the client to participate in group therapy activities
22). Which of the following classes of drugs commonly ends in –pril?

Angiotension-converting enzyme inhibitors.

Antivirals.
Beta blockers.
Calcium channel blockers.
23). The nurse is discussing listening and communicating with mental health clients in the
therapeutic milieu. Clients are encouraged to express their thoughts and feelings and staff
members are to do what?

Keep the client on task.

Tell the client what he should do to get better.
Hear the client and point out discrepancies in stories.
Hear what the client says without feeling threatened.
24). Which of the following is not scored with the APGAR?

Breathing rate
Pulse rate
Hand/foot size
Muscle tone
25). The nurse provides care for a client receiving oxygen from a nonrebreather mask. Which
nursing intervention has the highest priority?
 Posting a "No smoking" sign over the client's bed.
Applying an oil-based lubricant to the client's mouth and nose.
Assessing the client's respiratory status, orientation, and skin color.
Changing the mask and tubing daily.
26). The nurse is developing a plan of care for the client in a crisis state. When developing the
plan, the nurse considers which of the following?

Presenting symptoms in a crisis situation are similar for all individuals experiencing a crisis.
A client's response to a crisis situation is individualized and what constitutes a crisis for one
person may not constitute a crisis for another person.
A crisis state indicates that the individual is suffering from a mental illness.
A crisis state indicates that the individual is suffering from an emotional illness.
27). A client is undergoing treatment for advanced stages of breast cancer. Which of the
following drugs is mostly used to treat breast cancer?

Coumadin
Tamoxifen
Lupron
Cytotec

28). There are several factors to consider when deciding whether or not a medication is effective
for a particular patient. Which of the following effects is defined as the desired response to the
medication?

Therapeutic effect.
Toxicity.
None of these.
Side effect.
29). A 80 year old client presents to the clinic for a follow up visit. The client has coronary
artery disease and is on 75 mg of Plavix. The nurse understands the Plavix

stimulates platelet formation

prevents blood clotting
promote oxygen desaturation
prevents cardiogenic shock
30). A client with depression is started on Zoloft 50 mg a day. After taking the first dose of
Zoloft, the client told the nurse she felt dizzy, everything she saw looked blurry and she felt
nauseated. Which of the following actions should the nurse take?

contact the physician

ask the client to lie down and rest
instruct the client to always eat something when taking Zoloft
encourage the client to eat a light snack
31). A nurse is caring for a patient who just lost her baby. The woman is in denial telling the
nurse that another nurse will bring the baby in any minute for a feeding. Which of the following
would NOT be an appropriate reply?
 You’ll have to talk to the doctor about that.
Go on . . .
It seems as if you really love that baby.
Are you saying that you are expecting your baby to be brought to you by the nurse?
32). Which of the following plays a role in the development of cholelithiasis?

obstructed urination
biliary stasis
decompressed fecal matter
bacteria in the stool
33). Which of the following is NOT completed during the “Assess and plan” phase of the
delegation process?

Request supervision or more training if necessary.

Consider and prioritize the short and long term care needs of the patient.
Understand the pros and cons of delegating duties.
Determine whether or not the nurse has the ability to immediately intervene if an emergency takes
place.

34). A nurse was discharged from the hospital because of numerous errors made in
administering medication to patients. When you are called for a reference for this nurse who
has applied at another hospital, what should you say?

This nurse was discharged because she made too many mistakes and could not improve.
This nurse was discharged but I don’t know why.
I will have the hospital’s legal staff call you later to answer your questions.
This nurse worked here for three years and was discharged.

35). A client has just returned from 18 months in Iraq on the front lines of battle. Altogether, he
witnessed or was impacted by the death of 9 of his comrades. In fact, one of them died saving his
life. The client may be suffering from which of the following?

OCD.
Trauma syndrome.
Toxic shock syndrome.
Post-traumatic stress disorder.
36). Which of the following comments indicates that an 11-year-old child does NOT understand
the concept of death?

“Death is irreversible and final.”

“Maybe I will see grandma again when she visits at Christmas.”
“My grandma died because she was sick and nothing could be done to make her better.”
“My grandma’s death has been hard to understand.”

37). A client tells the nurse, “I wake up in the morning and feel as if I have not slept all night”.
The nurse would expect not feeling rested after sleeping is a characteristic of

Dementia
Depression
 Delirium
Disassociation
38). The nurse is assigned to care for a new client with glaucoma. The client is scheduled for a
tonometry so the physician can determine the extent of the glaucoma. What should the nurse
anticipate the tonometry test measuring?

the optic fundus

the depth of the anterior chamber
the degree narrowing in the central visual field
intraocular pressure
39). A mother asks the nurse “is it okay to give my 8 month old honey”? Which of the following
is an appropriate nurse response?

“Yes, you can give your 8 month old honey. Honey is good for digestion”
“I recommend you avoid giving your infant honey until age 1 year”
“Before you feed your infant honey, your child needs an allergy test first.”
“Never feed an 8 month old honey. It causes gastric distress”

40). A client had unprotected sex 8 hours ago. The client asks the nurse what she can use to
prevent pregnancy. What should the nurse tell the client?

Don't worry about it as long as your partner used the withdrawal method during sex you won't get
pregnant.
There is nothing available to prevent pregnancy after you have had unprotected sex.
A copper IUD is an option. Let me tell you about it.
You can use a spermicide within 12 hours of having unprotected sexual intercourse and this will
prevent pregnancy.

41). What is the function of cerebrospinal fluid (CSF)?

It cushions the brain and spinal cord.

It acts as an insulator to maintain a constant spinal fluid temperature.
It acts as a barrier to bacteria.
It produces cerebral neurotransmitters.
42). A school nurse is assessing a young boy who is brought to the office complaining of a sever
headache and nausea. As she assesses the boy she notices that he has bruises on his back and
scars that resemble burns on several parts of his body. The nurse suspects that the boy is being
abused. What is the first thing that she should do after assuring that his physiological needs are
taken care of?

Call his parents and set up an appointment to investigate her suspicions.

Call the children’s protective service in her county to report the abuse so that the boy can be
removed from the abusive situation.
Notify the principal of the school who will take the necessary action.
Ask the boy how he got the injuries and scars before taking further action.

43). Which of the following is NOT likely to be a side effect or an adverse effect of loop
diuretics?

check all answers that apply

thrombocytopenia
 edema
hypokalemia
thiamine deficiency
hypercalcemia
44). At which of the following developmental stages does an individual learn best through
experimentation with the environment?

Toddlers

Adolescents
Preschoolers

Babies
45). Which of the following defense mechanisms is when an individual unknowingly blames
external forces for the negative thoughts in his or her head?

Sublimination.
Regression.
Projection.
Intellectualization.
46). A nurse must administer blood to a patient. When the blood arrives from the blood bank
she is busy with another emergency. The nurse must administer the blood within which of the
following time periods?

one hour
30 minutes
15 minutes
10 minutes
47). Which finding is a risk factor for testicular cancer?

Age
A weight gain of more than 10 pounds
Cryptorchidism
A history of cocaine abuse

48). A 35-year-old client is prescribed simvastatin (Zocor) to lower high cholesterol. The nurse
educates the client by stating what?

"Eat more fiber while taking this medication."

"Take the medication with an evening meal."
"Immediately call the doctor if you have light colored stool."
"A side effect of Zocor is constipation."

49). Which of the following matches the definition: Improperly implanted placenta in which the
placenta extends to, partially covers, or completely covers the internal os of the cervix.

Preeclampsia
 Externa Placentae
Multigravida
Placenta Previa
50). Which of the following types of power is based on attraction?

Expert.
Reward.
Legitimate.
Referent.
51). You have a patient who has been diagnosed with chlamydia. You are taking her history and
discussing the implications of STDs with her. Which of the following would not be appropriate
for this discussion?

reassuring the patient that you will not have to report this to any agency
using a nonjudgmental approach in talking to her
obtaining a complete sexual history
encouraging the patient to provide information about all sexual contacts
52). When caring for clients who are immobile, the nurse knows that normal body movement
involves posture and

joint mobility
contraction
energy
flexibility
53). During a routine check up, the nurse assesses a client with AIDS for signs and symptoms of
cancer. What is the most common AIDS-related cancer?

Squamous cell carcinoma.

Multiple myeloma.
Leukemia.
Kaposi's sarcoma.
54). A 9-year-old child typically loses which of the following teeth?

central incisor
second molar
lateral incisor
cuspid
55). Which of the following is defined as an infection that a patient contracts during his or her
stay at a hospital?

Particulate respirator.
Healthcare-associated Infection.
Mode of transmission.
VRE.
56). With Cushing's Syndrome, excessive amounts of cortisol puts a client at risk for which of
the following?
 inflammatory distress
pathologic fractures
urine flow dysfunction
excessive bruising
57). The nurse assesses a client with a rash on her chest and upper arms. Which question is not
relevant?

“Have you recently traveled out of the country?”

“How much do you weigh?”
“When did the rash start?”
“Are you allergic to any medications, foods, or pollen?”
58). Which of the following states of acid-base imbalance is characterized by elevated pH,
elevated pCO2, and elevated bicarbonate?

Respiratory alkalosis.
Metabolic acidosis.
Metabolic alkalosis.
Respiratory acidosis.
59). When it comes to the movement of fluids and electrolytes, osmosis is defined as which of the
following?

None of these.
Liquid movement through semipermeable membrane.
Particle movement across cell membranes.
Random movement of particles of a greater concentration to an area of lesser concentration.
60). Your patient has had a uterine artery embolization to treat a fibroid tumor. She is being
discharged and you will be giving her instructions for home care. Which of the following would
NOT be a part of your instructions?

check all answers that apply

alter diet to eliminate fiber

call the health care provider if you run a fever of 101.1 degrees F or more
do not use tampons for at least four weeks
use douches after intercourse
61). Which of the following is an element of comprehensive planning?

check all answers that apply

initial planning
ongoing planning
pre-operative planning
post-operative planning
discharge planning
62). Which of the following is when an individual forcefully restrains another without privilege
or authority?
 Libel.
Slander.
False imprisonment.
Assault and battery.
63). An RN is assigned to develop a plan of care for a client with constipation that is coming for
prenatal visits at a clinic where the RN works. To assist the client in alleviating this problem the
RN should instruct her to do what?

Use a Fleet enema when the episodes occur.

Take a mild stool softener daily in the evening.
Consume a low-roughage diet.
Drink 8 glasses of water per day.

64). Of the following, which is the most common cause of acute respiratory distress syndrome
(ARDS)?

check all answers that apply

embolism
sepsis
radiation pneumonitis
anaphylaxis
65). The charge nurse is providing an in service to the staff. The nurse identifies an
unintentional tort as which of the following?

Gross negligence.
Manslaughter.
Invasion of privacy.
Battery.
66). The nurse interviews a 28-year-old client with a new medical diagnosis of endometriosis.
Which of the following questions is MOST appropriate?

"Are you having hot flashes?"

"Are you experiencing pain during intercourse?"
"Is a discharge present?"
"Where are you having pain?"
67). Which of the following would be considered a late sign of colorectal cancer?

check all answers that apply

blood in stool
anemia
cachexia
abdominal mass
68). Following fertilization, what hormone does the embryo or blastocyst secrete?

Human Chorionic Gonadotropin

 Oxytocin
Human Growth Hormone
Estrogen
69). Your patient has had a cast applied on his leg. Your interventions for this client would
include all of the following EXCEPT:

check all answers that apply

allowing a wet plaster cast 6 – 8 hours to dry

preparing for bivalving or cutting the cast if circulatory impairment occurs
applying moleskin to the edges of the cast
monitoring for signs of infection

70). A client does not make eye contact with the nurse during an interview. The nurse suspects
that the client's behavior has a cultural basis. What should the nurse do first?

read several articles about the client's culture

ask staff members of a similar culture about the client's behavior
observe how the client and the client's family and friends interact with one another and with other
staff members
accept the client's behavior because it is probably culturally based.