Med Surg I - Final Practice Exam

Question 1

A nurse is caring for a patient who is 12 hours post-op following foot surgery. The nurse assesses the presence of edema in the foot. What nursing measure will the nurse implement to control the edema?

a.) Elevate the foot on several pillows.

b.) Apply warm compresses intermittently to the surgical area.

c.) Administer a loop diuretic as ordered.

d.) Increase circulation through frequent ambulation.

Answer 1

a.) Elevate the foot on several pillows

Question 2

A young patient is being treated for a femoral fracture suffered in a snowboarding accident. The nurse’s most recent assessment reveals that the patient is uncharacteristically confused. What diagnostic test should be performed on the patient?

a.) Electrolyte assessment

b.) Electrocardiogram

c.) Arterial Blood Gases

d.) Abdominal ultrasound

Answer 2

c.) Arterial Blood Gases

Question 3

A patient has sustained a long bone fracture & the nurse is preparing the patient’s care plan. Which of the following should the nurse include in the care plan?

a.) Administer vitamin D & calcium supplements as ordered.

b.) Monitor temperature & pulses of the affected extremity.

c.) Perform passive range of motion exercises as tolerated.

d.) Administer corticosteroids as ordered

Answer 3

b.) Monitor temperature & pulses of the affected extremity

Question 4

An oncology nurse is caring for a patient with multiple myeloma who si experiencing bone destruction. WHen reviewing the patient’s most recent blood tests, the nurse should anticipate what imbalance?

a.) Hypercalcemia

b.) Hyperproteinemia

c.) Elevated serum viscosity

d.) Elevated RBC count

Answer 4

a.) Hypercalcemia

Question 5

A patient has experienced a seizure in which she became rigid & then experienced alternating muscle relaxation & contraction. What type of seizure does the nurse recognize?

a.) Unclassified seizure

b.) Absence seizure

c.) Generalized seizure

d.) Focal seizure

Answer 5

c.) Generalized seizures

Question 6

An older adult woman’s current medication regimen includes alendronate (Fosamax). What outcome would indicate successful therapy?

a.) Increased bone mass

b.) Resolution of infection

c.) Relief of bone pain

d.) Absence of tumor spread

Answer 6

a.) Increased bone mass

Question 7

A patient diagnosed with MS has been admitted to the meidcal unit for treatment of an MS exacerbation. Included in the admission orders is baclofen (Lioresal). What should the nurse identify as an expected outcome of this treatment?

a.) Reduction in the appearance of new lesions on the MRI.

b.) Decreased muscle spasms in the lower extremities.

c.) Increased muscle strength in the upper extremities.

d.) Decreased severity & duration of exacerbations.

Answer 7

b.) Decreased muscle spasms in the lower extremities

Question 8

A patient with renal failure has decreased erythropoietin production. Upon analysis of the patient’s CBC, the nurse will expect which of the following results?

a.) An increased hemoglboin & decreased hematocrit

b.) A decreased hemoglobin & hematocrit

c.) A decreased mean corpuscular volume (MCV) and red cell distribution width (RDW)

d.) An increased MCV & RDW

Answer 8

b.) A decreased hemoglboin & hematocrit

Since the kidneys don’t produce enough erythropoietin when they are in kidney failure, this leads to decreased production of RBCs, decreased levels of hemoglobin & hematocrit & can ultimately lead to anemia

Question 9

You are caring for a 65-year-old male patient admitted to your medical unit 72 hours ago with pyloric stenosis. A nasogastric tube placed upon admission has been on low intermittent suction ever since. Upon review of the morning’s labs, you notice that the patient’s potassium is below reference range. You should recognize that the patient may be at risk for what imbalance?

a.) Hypercalcemia

b.) Metabolic acidosis

c.) Metabolic alkalosis

d.) Respiratory acidosis

Answer 9

c.) Metabolic alkalosis

Question 10

A patient is being discharged home after a hysterectomy. WHen providing discharge education for this patient, the nurse has cautioned the patient against sitting for long periods. This advice addresses the patient’s risk for which surgical complication?

a.) Pudendal nerve damage

b.) Fatigue

c.) Venous thromboembolism

d.) Hemorrhage

Answer 10

c.) Venous thromboembolism

Question 10

A nurse is caring for a patient who is in skeletal traction. To prevent the complication of skin breakdown in a patient with skeletal contraction, what action should be included in the plan of care?

a.) Apply occlusive dressing to the pin sites.

b.) Encourage the patient to push with the elbows when repositioning.

c.) Encourage the patient to perform isometric exercises once a shift.

d.) Assess the pin insertion site every 8 hours.

Answer 10

d.) Assess the pin insertion site every 8 hours.

Question 11

An oncology nurse recognizes a patient’s risk for fluid imbalance while the patient is undergoing treatment for leukemia. What relevant assessments should the nurse include in the plan of care? Select all that apply

a.) Monitoring the patient’s elecrolyte levels.

b.) Monitoring the patient’s hepatic function.

c.) Measuring the patient’s weight on a daily basis.

d.) Measuring & recording the patient’s intake & output.

e.) Auscultating the patient’s lungs frequently

Answer 11

a.) Monitoring the patient’s elecrolytes

c.) Measuring the patient’s weight on a daily basis

d.) Measuring & recording the patient’s intake & output

e.) Auscultating the patient’s lungs frequently

Assessments that relate to fluid balance include monitoring patient elecrolytes, auscultating the patient’s chest for adventitious sounds, weighing the patient daily, & closely monitoring I&Os.

• Liver function is not directly relevant to the patient’s fluid status in most cases

Question 12

A patient was fitted with an arm cast after fracturing her humerus. Twelve hours after the application of the cast, the patient tells the nurse that her arm hurts. Analgesics do not relieve the pain. What would be the most appropriate nursing action?

a.) Prepare the patient for opening or bivalving of the cast.

b.) Obtain an order for a different analgesic.

c.) Encourage the patient to wiggle & move the fingers.

d.) Petal the edges of the patient’s cast.

Answer 12

a.) Prepare the patient for opening or bivalving of the cast

Question 13

A clinic nurse is caring for a patient with a history of osteoporosis. Which of the following diagnostic tests best allows the team to assess the patient’s risk of fracture?

a.) Arthrography

b.) Bone scan

c.) Bone densitometry

d.) Arthroscopy

Answer 13

c.) Bone densitometry

Question 14

The nurse is preparing to administer warfarin (Coumadin) to a patient with deep vein thrombophlebitis (DVT). Which laboratory value would most clearly indicate that the patient’s warfarin is at therapeutic levels?

a.) Partial thromboplastin time (PTT) within normal reference range.

b.) Prothrombin time (PT) 8-10 times the control.

c.) International normalized ratio (INR) between 2 and 3.

d.) Hematocrit of 32%

Answer 14

c.) International normalized ratio (INR) between 2 and 3

Question 15

A patient’s low hemoglobin level has necessitated transfusion of PRBCs. Prior to administration, which action should the nurse perform?

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

b.) Ensure that the patient has granted verbal consent for transfusion.

c.) Assess thepatient’s vital signs to establish baselines.

d.) Facilitate insertion of acentral venous catheter.

Answer 15

c.) Assess the patient’s vital signs to establish baselines.

Question 16

A patient with Parkinson’s disease is undergoing a swallowing assessment because she has recently developed adventitious lung sounds. The patient’s nutritional needs should be met by what method?

a.) Total parenteral nutrition (TPN)

b.) Provision of a low residue diet

c.) Semisolid food with thick liquids

d.) Minced foods & a fluid restriction

Answer 16

c.) Semi-solid food with thick liquids

A semi-solid diet with thick liquids is easier for a patient with swallowing difficulties to consume than is a solid diet.

• Low-residue foods & fluid restriction are unnecessary & counterproductive to the patient’s nutritional status.
• The patient’s status does not warrant TPN

Question 17

You are the clinic nurse caring for a patient with a recent diagnosis of myasthenia gravis. THe patient has begun treatment with pyridostigmine bromide (Mestinon). What change in status would most clearly suggest a therapeutic benefit of this medication?

a.) Increased muscle strength

b.) Decreased pain

c.) Improved GI function

d.) Improved cognition

Answer 17

a.) Increased muscle strength

Question 18

A nurse is caring for a patient who has a leg cast. The nurse observes the patient using a pencil to scratch the skin under the edge of the cast. How should the nurse respond to this observation?

a.) Allow the patient ot continue to scratch inside the cast with a pencil but encourage him to be cautious.

b.) Give the patient a sterile tongue depressor to use for scratching instead of the pencil.

c.) Encourage the patient to avoid scratching, & obtain an order for an antihistamine if severe itching persists.

d.) Obtain an order for a sedative, such as lorazepam (Ativan), to prevent the patient from scratching.

Answer 18

c.) Encourage the patient to avoid scratching, & obtain an order for an antihistamine if severe itching persists.

Question 19

A patient who is scheduled for an open prostatectomy is concerned about the potential effects of the surgery on his sexual function. What aspect of prostate surgery should inform the nurse’s response?

a.) Erectile dysfunction is common after prostatectomy as a result of hromonal change.

b.) All prostatectomies carry a risk of nerve damage & consequent erectile dysfunction.

c.) Erectile dysfunction after prostatectomy is expected, but normally respolves within severeal months.

d.) Modern surgical techniques have eliminated the risk of erectile dysfunction following a prostatectomy.

Answer 19

b.) All prostatectomies carry a risk of nerve damage & consequent erectile dysfunction

Question 20

Six weeks after an above-the-knee amputation (AKA), a patient returns to the outpatient office for a routine post-op checkup. During the nurse’s assessment, the patient reports symptoms of phantom pain. What should the nurse tell the patient to reduce the discomfort of the phantom pain?

a.) Apply intermittent hot compresses to the area of the amputation.

b.) Avoid activity until the pain subsides.

c.) Take opioid analgesics as ordered.

d.) Elevate the level of the amputaion site.

Answer 20

c.) Take opioid analgesics as ordered

Question 21

A patient with angina has been prescribed nitroglycerin. Before administering the drug, the nurse should inform the patient about what potential adverse effects?

a.) Nervousness or paresthesia

b.) Throbbing headache or dizziness

c.) Drowsiness or blurred vision

d.) Tinnitus or diplopia

Answer 21

b.) Throbbing headache or dizziness

Question 22

An older adult is newly diagnosed with primary hypertension & has just been started on a beta-blocker. The nurse’s health education should include which of the following?

a.) Increasing fluids to avoid extracellular volume depletion from the diuretic effect fo the beta-blocker.

b.) Maintain a diet high in dairy to increase protein necessary to prevent organ damage.

c.) Use of strategies to prevent falls stemming from postural hypotension.

d.) Limiting exercise to avoid injury that can be caused by increased intracranial pressure.

Answer 22

c.) Use of strategies to prevent falls stemming from postural hypotension

Question 23

A patient is brought to the emergency department by the paramedics. THe patient is a type 2 diabetic and is experiencing HHS. THe nurse should identify what components of HHS? Select all that apply

a.) Leukocytosis

b.) Glycosuria

c.) Dehydration

d.) Hypernatremia

e.) Hyperglycemia

CHECK ANSWER - Q 24

Answer 23

b.) Glycosuria
c.) Dehydration
d.) Hypernatremia
e.) Hyperglycemia

Glycosuria
Dehydration
Hypernatremia
Hyperglycemia

Question 24

**You are an emergency-room nurse caring for a trauma patient. Your patient has the following arterial blood gas results:** * **pH: 7.26** * **PaCO2: 28** * **HCO3: 11** **How would you interpret these results?** **a.)** Respiratory acidosis with no compensation **b.)** Metabolic alkalosis with a compensatory alkalosis **c.)** Metabolic acidosis with no compensation **d.)** Metabolic acidosis with a compensatory respiratory alkalosis

Answer 24

**d.) Metabolic acidosis with a compensatory respiratory alkalosis**

Question 25

**A nurse is planning the care of an older adult who will soon be discharged hoem after treatment for a fractured hip. In an effort to prevent future fractures, the nurse should encourage which of the following?** *Select all that apply* **a.)** Regular bone density testing. **b.)** A high-calcium diet. **c.)** Use of fall prevention precautions **d.)** Use of corticosteroids as ordered. **e.)** Weight-bearing exercises

Answer 25

**a.) Regular bone density testing** **b.) A high-calcium diet** **c.) Use of falls prevention precautions** **e.) Weight-bearing exercises**

Question 26

**A nurse is writing a care plan for a patient admitted to the emergency department (ED) with an open fracture. The nurse will assign priority to what nursing diagnosis for a patient with an open fracture of the radius?** **a.)** Risk for Infection **b.)** Risk for Ineffective Role Performance **c.)** Risk for Perioperative Positioning Injury **d.)** Risk for Powerlessness

Answer 26

**a.) Risk for Infection** ## Footnote * The patient is at significant risk for developing osteomyelitis & tetanus due to the fracture being open.

Question 27

**A patient's diagnosis of atrial fibrillation has prompted the primary care provider to prescribe warfarin (Coumadin), an anticoagulant. When assessing the therapeutic response to this medication, what is the nurse's most appropriate action?** **a.)** Assess for signs of myelosuppression. **b.)** Review the patient's platelet levels. **c.)** Assess the patient's capillary refill time. **d.)** Review the patient's international normalized ratio (INR).

Answer 27

**d.) Review the patient's international normalized ratio (INR)**

Question 28

**An older adult has encouraged her husband to visit their primary care provider, stating that she is concerned that he may have Parkinson's disease. WHich of the wife's descriptions of her husband's health & function is most suggestive of Parkinson's disease?** **a.)** "Lately he seems to move far more slowly than he ever has in the past." **b.)** "He often complains that his joints are terribly stiff when he wakes up in the morning." **c.)** "He's forgotten the names of some people that we've known for years." **d.)** "He's losoing weight even though he has a ravenous appetite."

Answer 28

**a.) "Lately he seems to move far more slowly than he ever has in the past."**

Question 29

**A patient with Guillain-Barre Syndrome has experienced a sharp decline in vital capacity. What is the nurse's most appropriate action?** **a.)** Administer bronchodilators as ordered. **b.)** Remind the patient of the importance of deep breathing & coughing exercises. **c.)** Prepare to assist with intubation. **d.)** Administer supplemental oxygen by nasal cannula.

Answer 29

**c.) Prepare to assist with intubation**

Question 30

**A patient with a pulmonary embolism is being treated with a heparin infusion. What diagnostic finding suggests to the nurse that the treatment is effective?** **a.)** The patient's PT (prothrombin time) is within reference ranges. **b.)** Arterial blood gas sampling tests positive for the presence of factor XIII. **c.)** The patient's platelet level is below 100,000/mm^3. **d.)** The patient's aPTT (activated partial thromboplastin time) is 1.5 to 2.5 times the control value.

Answer 30

**d.) The patient's aPTT (activated partial thromboplastin time) is 1.5 to 2.5 times the control value.**

Question 31

**A patient is admitted to the orthopedic unit with a fractured femur after a motorcycle accident. The patient has been placed in traction until his femur can be rodded in surgery. What early complications should the nurse monitor this patient for?** *Select all that apply* **a.)** Systemic infection **b.)** Complex regional pain syndrome **c.)** Deep vein thrombosis (DVT) **d.)** Compartment syndrome. **e.)** Fat embolism ## Footnote CHECK ANSWER

Answer 31

**c.) Deep vein thrombosis (DVT)** **d.) Compartment syndrome** **e.) Fat embolism**

Question 32

**A nurse is caring for a patient who has just had an arthroscopy as an outpatient procedure & is getting ready to be discharged home. The nurse should teach the patient to monitor closely for what post-procedural complication?** **a.)** Fever **b.)** Crepitus **c.)** Fasciculations **d.)** Synovial fluid leakage

Answer 32

**a.) Fever** ## Footnote fever = sign of infection

Question 33

**A patient is receiving intravenous heparin to prevent blood clots. The order for heparin is 1200 units per hour. The pharmacy sends 25,000 units of Heparin in a 500 mL bag of D5W. At how many mL per hour will the nurse infuse the solution?** *Round to the nearest whole number* **a.)** 23 **b.)** 24 **c.)** 25 **d.)** 26

Answer 33

**b.) 24** mL ## Footnote **1.)** 1200 units **/** 25,000 units **= 0.048 units** **2.)** 0.048 units **X** 500 mL **= 24 mL**

Question 34

**The nurse is caring for a patient who is hospitalized with an exacerbation of MS. TO ensure the patient's safety, what nursing action should be performed?** **a.)** Ensure that sunction apparatus is set up at the bedside. **b.)** Pad the patient's bed rails. **c.)** Maintain bed rest whenever possible. **d.)** Provide several small meals each day.

Answer 34

**a.) Ensure that suction appratus is set up at the bedside** ## Footnote * Pt has increased risk of aspiration as result of MS

Question 35

**The patient is scheduled for a Syme amputation and is concerned about the ability to eventually stand on the amputated extremity. How should the nurse best respond to the patient's concern?** **a.)** "You will eventually be able to withstand full weight-bearing after the amputation". **b.)** "You will have minimal weight-bearing on this extremity but you'll be taught how to use an assistive device". **c.)** "You likely will not be able to use this extremity but you will receive teachign on use of a wheelchair". **d.)** "You will be fitted for a prosthesis which may or may not allow you to walk".

Answer 35

**a.) "You will eventually be able to withstand full weight-bearing after the amputation."** ## Footnote **Syme Amputation:** modified ankle disarticulation amputation * performed most frequently for extensive foot trauma & produces a painless, durable extremity end that can withstand full weight-bearing.

Question 36

**The nurse is assessing a patient for dietary factors that may influence her risk of osteoporosis. The nurse should question the patient about her intake of which nutrients?** *Select all that apply* **a.)** Calcium **b.)** Simple carbohydrates **c.)** Vitamin D **d.)** Protein **e.)** Soluble fiber

Answer 36

**a.) Calcium** **c.) Vitamin D**

Question 37

**A patient has just been diagnosed with Type 2 Diabetes. The physician has prescribed an oral antidiabetic agent that will inhibit the production of glucose in the liver & thereby aid in the control of blood glucose. What type of oral antidiabetic agent did the physician prescribe for this patient?** **a.)** A sulfonylurea **b.)** A biguanide **c.)** A thiazolidinedione **d.)** An alpha glucosidase inhibitor ## Footnote CHECK ANSWER

Answer 37

**b.) a biguanide** ## Footnote * **Biguanides inhibit the production of glucose in the liver**

Question 38

**An older adult patient with type 2 diabetes is brought to the emergency department by his daughter. The patient is found ot have a blood glucose level of 623 mg/dL. The patient's daughter reports that the patient recently had a GI virus & has been confused for the last 3 hours. The diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is made. What nursing action would be priority?** **a.)** Administration of antihypertensive medications. **b.)** Administering sodium bicarbonate intravenously. **c.)** Reversing acidosis by administering insulin **d.)** Fluid & electrolyte replacement.

Answer 38

**d.) Fluid & electrolyte replacement**

Question 39

**A newly admitted patient with type 1 diabetes asks the nurse what caused her diabetes. When the nurse is explaining to the patient the etiology of type 1 diabetes, what process should the nurse describe?** **a.)** "The tissues in your body are resistant to the action of insulin, making the glucose levels in your body increase". **b.)** "Damage to your pancreas causes an increase in the amount of glucose that it releases, & there is not enough insulin to control it". **c.)** "The amount of glucose that your body makes overwhelms your pancreas & decreases your production of insulin". **d.)** "Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down".

Answer 39

**d.) "Destruction of special cells in the pancras causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it donw".**

Question 40

**A nurse is providing health education to an adolescent newly diagnosed with type 1 diabetes mellitus & her family. The nurse teaches the patient & family that which of the following non-pharmacologic measures will decrease the body's need for insulin?** **a.)** Adequate sleep **b.)** Low stimulation **c.)** Exercise **d.)** Low-fat diet

Answer 40

**c.) Exercise**

Question 41

**A patient is recovering in the hospital following a gastrectomy. The nurse notes that the patient has become increasingly difficult to engage & has had several angry outbursts at various staff members in recent days. The nurse's attempts at therapeutic dialogue have been rebuffed. What is the nurse's most appropriate action?** **a.)** Ask the patient's primary care provider to liaise between the nurse & the patient. **b.)** Delegate care of the patient to a colleague. **c.)** Limit contact with the patient in order to provide privacy. **d.)** Make appropriate referrals to services that provide psychosocial support.

Answer 41

**d.) Make appropriate referrals to services that provide psychosocial support**

Question 42

**A physician has explained to a patient that he has developed diabetic neuropathy in his right foot. Later that day, the patient asks the nurse what causes diabetic neuropathy. What would be the nurse's best response?** **a.)** "Research has shown that diabetic neuropathy is caused by fluctuations in blood sugar that have gone on for years". **b.)** "The cause is not known for sure but it is thought to have something to do with ketoacidosis". **c.)** "The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years". **d.)** "Research has shown that diabetic neuropathy is caused by a combination of elevated glucose levels & elevated ketone levels".

Answer 42

**c.) "The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years"**

Question 43

**A patient with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priority instruction for the nurse to give the patient?** **a.)** Examine the feet weekly for redness, blisters, & abrasions. **b.)** Avoid the use of moisturizing lotions. **c.)** Avoid hot-water bottles and heating pads. **d.)** Dry feet vigorously after each bath.

Answer 43

**c.) Avoid hot-water bottles and heating pads**

Question 44

**A nurse is providing care for a patient who is post-op day 2 following gastric surgery. The nurse's assessment should be planned in light of the possibility of what potential complications?** *Select all that apply* **a.)** Malignant hyperthermia **b.)** Atelectasis **c.)** Pneumonia **d.)** Metabolic imbalances **e.)** Chronic gastritis

Answer 44

**b.) Atelectasis** **c.) Pneumonia** **d.) Metabolic imbalances** ## Footnote * After surgery the nurse assesses the patient fro complications secondary to surgical intervention such as *pneumonia, atelectasis, or metabolic imbalances*.

Question 45

**A patient is post-op day 1 following a vaginal hysterectomy. The nurse notes an increase in the patient's abdominal girth & the patient complains of "bloating". What is the nurse's most appropriate action?** **a.)** Provide the patient with an unsweetened, carbonated beverage. **b.)** Apply warm compresses to the patient's lower abdomen. **c.)** Provide an ice pack to apply to the perineum & suprapubic region. **d.)** Assist the patient into a prone position.

Answer 45

**b.) Apply warm compresses to the patient's lower abdomen**

Question 46

**A 31-year-old patient has returned to the post-surgical unit following a hysterectomy. THe patient's care plan addresses the risk of hemorrhage. How should the nurse best monitor the patient's post-operative blood loss?** **a.)** Have the patient void & have bowel movements using a commode rather than a toilet. **b.)** Count & inspect each perineal pad that the patient uses. **c.)** Swab the patient's perineum for the presence of blood at least once per shift. **d.)** Leave the patient's perineum open to air to facilitate inspection.

Answer 46

**b.) Count & inspect each perineal pad that the patient uses.** ## Footnote * To detect bleeding, the nurse counts the perineal pads used or checks the incision site, assesses the extent of saturation with blood, & monitors vitals

Question 47

**The nurse is caring for a 63-year-old patient with ovarian cancer. The patient is to receive chemotherapy consisting of Taxol & Paraplatin. What adverse effect of this treatment should the nurse monitor the patient for?** **a.)** Leukopenia **b.)** Metabolic acidosis **c.)** Hyperphosphatemia **d.)** Respiratory alkalosis

Answer 47

**a.) Leukopenia**

Question 48

**A patient has just returned to the floor following a transurethral resection of the prostate. A triple-lumen indwelling urinary catheter has been inserted for continuous bladder irrigation. What, in addition to balloon inflation, are the functions of the three lumens?** **a.)** Continuous inflow & outflow of irrigation solution. **b.)** Intermittent inflow & continuous outflow of irrigation solution. **c.)** Continuous inflow & intermittent outflow of irrigation solution. **d.)** Intermittent flow of irrigation solution & prevention of hemorrhage.

Answer 48

**a.) Continuous inflow & outflow of irrigation solution**

Question 49

**A patient who is post-op day 12 & recovering at home following a laparoscopic prostatectomy has reported that he is experiencing occasional "dribbling" of urine. How should the nurse best respond to this patient's concern?** **a.)** Inform the patient that urinary control is likely to return gradually. **b.)** Arrange for the patient to be assessed by his urologist. **c.)** Facilitate the insertion of an indwelling urinary catheter by the home care nurse. **d.)** Teach the patient to perform intermittent self-catheterization.

Answer 49

**a.) Inform the patient that urinary control is likely to return gradually**

Question 50

**A hearing-impaired patient is scheduled to have an MRI. What would be important for the nurse to remember when caring for this patient?** **a.)** The patient is likely unable to hear the nurse during testing. **b.)** A person adept in sign language must be present during the test. **c.)** Lip reading will be the method of communication that is necessary. **d.)** The nurse should interact with the patient like any other patient.

Answer 50

**a.) The patient is likely unable to hear the nurse during testing.**

Question 51

**The physician has ordered Vancomycin 500 mg IVPB every 24 hours. The medication was placed in 200 mL of D5W to infuse over 60 minutes. What is the correct volume to be infused & rate for infusion on the infusion pump?** **a.)** Secondary volume: 200 mL**;** Secondary rate: 100 mL **b.)** Secondary volume: 200 mL**;** Secondary rate: 200 mL **c.)** Secondary volume: 500 mL**;** Secondary rate: 60 minutes **d.)** Secondary volume 500 mL**;** Secondary rate: 200 mL ## Footnote **WRITE NOTES ON FINDING ANSWER**

Answer 51

**b.) Secondary volume: 200 mL; Secondary rate: 200 mL**

Question 52

**A patient scheduled for an MRI has arrived at the radiology department. The nurse who prepares the patient for the MRI should prioritize which of the following actions?** **a.)** Withholding stimulants 24 to 48 hours prior to the test. **b.)** Removing all metal-containing objects. **c.)** Instructing the patient to void prior to the MRI. **d.)** Initiating an IV line for administration of contrast.

Answer 52

**b.) Removing all metal-containing objects**

Question 53

**A patient with primary hypertension comes to the clinic complaining of gradual onset of blurry vision & decreased visual acuity over the past several weeks. The nurse is aware that these symptoms could be indicative of what?** **a.)** Retinal blood vessel damage **b.)** Glaucoma **c.)** Cranial nerve damage **d.)** Hypertensive emergency

Answer 53

**a.) Retinal blood vessel damage** ## Footnote * blurred vision, spots in front of the eyes, & diminished visual acuity can mean retinal blood vessel damage indicative of damage elsewhere in the vascular system as a result of hypertension

Question 54

**An older adult who resides in an assisted living facililty has sought care from the nurse because of recurrent episodes of constipation. Which of the following actions shoudl the nurse perform first?** **a.)** Encourage the patient to take stool softener daily. **b.)** Assess the patient's food & fluid intake. **c.)** Assess the patient's surgical history. **d.)** Encourage the patient ot take fiber supplements.

Answer 54

**b.) Assess the patient's food & fluid intake.**

Question 55

**The physical therapist notifies the nurse that a patient with coronary artery disease (CAD) experiences a much greater-than-average increase in heart rate during physical therapy. The nurse recognizes that an increase in heart rate in a patient with CAD may result in what?** **a.)** Development of an atrial-septal defect. **b.)** Myocardial ischemia **c.)** Formation fo a pulmonary embolism. **d.)** Release of potassium ions from cardiac cells.

Answer 55

**b.) Myocardial ischemia**

Question 56

**A nurse has created a plan of care for an immunodeficient patient, specifying that care providers must take the patient's pulse & respiratory rate for a full minute. What is the rationale for this aspect of care?** **a.)** Respirations affect heart rate in immunodeficient patients. **b.)** The patients' blunted inflammatory response can cause subtle changes in status. **c.)** Hemodynamic instability is one of the main complications of immunodeficiency. **d.)** Immunodeficient patients are prone to ventricular tachycardia & atrial fibrillation.

Answer 56

**b.) These patients' blunted inflammatory responses can cause subtle changes in status.**

Question 57

**A nurse is addressing the indicence & prevalence of HIV infection among older adults. What principle should guide the nurse's choice of educational interventions?** **a.)** Many older adults do not see themselves as being at risk for HIV infection. **b.)** Many older adults are not aware of the difference between HIV and AIDS. **c.)** Older adults tend to have more sex partners than younger adults. **d.)** Older adults have the highest incidence of intravenous drug use.

Answer 57

**a.) Many older adults do not see themselves as being at risk for HIV infection.**

Question 58

**A nurse is caring for a patient who is undergoing preliminary testing for a hematologic disorder. What sign or symptom most likely suggests a potential hematologic disroder?** **a.)** Sudden change in level of consciousness (LOC) **b.)** Recurrent infections **c.)** Anaphylaxis **d.)** Severe fatigue

Answer 58

**d.) Severe fatigue**

Question 59

**A nursing student is caring for a patient with acute myeloid leukemia (AML) who is preparing to undergo induction therapy. In preparing a plan of care for this patient, the student should assign the highest priority to which nursing diagnosis?** **a.)** Activity Intolerance **b.)** Risk for Infection **c.)** Acute Confusion **d.)** Risk for Spiritual Distress

Answer 59

**b.) Risk for Infection**

Question 60

**A patient comes into the clinic complaining of fatigue. Blood work shows an increased bilirubin concentration & an increased reticulocyte count. What would the nurse suspect the patient has?** **a.)** A hypoproliferative anemia **b.)** A leukemia **c.)** Thrombocytopenia **d.)** A hemolytic anemia ## Footnote **Hemolytic Anemia =** premature destruction of erythrocytes causing the liberation of hemoglobin into plasma * hemoglobin is then converted into bilirubin causing increased concentration fo bilirubin * increased production of erythropoetin is seen as an increase in reticulocyte count

Answer 60

**d.) A hemolytic anemia**

Question 61

**A patient with a diagnosis of acute myeloid leukemia (AML) is being treated with induction therapy on the oncology unit. What nursing action should be prioritized in the patient's care plan?** **a.)** Protective isolation & vigilant use of standard precautions. **b.)** Provision of a high-calorie, low-texture diet & appropriate oral hygiene. **c.)** Including the family in planning the patient's activities of daily living. **d.)** Monitoring & treating the patient's pain.

Answer 61

**a.) Protective isolation & vigilant use of standard precautions**

Question 62

**A patient's blood work reveals a platelet level of 17,000 / mm^3. When inspecting the patient's integumentary system, what finding would be most consistent with this platelet level?** **a.)** Dermatitis **b.)** Petechiae **c.)** Urticaria **d.)** Alopecia

Answer 62

**b.) Petechiae**

Question 63

**Since the emergence of HIV/AIDS, there have been significant changes in epidemiologic trends. Members of what group currently have the greatest risk of contracting HIV?** **a.)** Gay, bisexual, & other men who have sex with men. **b.)** Recreational drug users. **c.)** Blood transfusion recipients. **d.)** Healthcare providers

Answer 63

**a.) Gay, bisexual, and other men who have sex with men**

Question 64

**The medical nurse is aware that patients with sickle cell anemia benefit from understanding what situations can precipitate a sickle cell crisis. When teaching a patient with sickle cell anemia about strategies to prevent crises, what measures should the nurse recommend?** **a.)** Using prophylactic antibiotics & performing meticulous hygiene. **b.)** Maximizing physical activity & taking OTC iron supplements. **c.)** Limiting psychosocial stress & eating a high-protein diet. **d.)** Avoiding cold temperatures & ensuring sufficient hydration.

Answer 64

**d.) Avoiding cold temperatures & ensuring sufficient hydration.**

Question 65

**The nurse is applying standard precautions in the care of a patient who has an immunodeficiency. What are key elements of standard precaution?** *Select all that apply* **a.)** Using appropriate personal protective equipment (PPE). **b.)** Placing patients in negative-pressure isolation rooms. **c.)** Placing patients in positive-pressure isolation rooms. **d.)** Using safe injection practices. **e.)** Performing hand hygiene.

Answer 65

**a.) Using approrpiate personal protective equipment (PPE).** **d.) Using safe injection practices.** **e.) Performing hand hygiene.**

Question 66

**A 69-year-old is brought to the ED because a family member found them on the floor disoriented & lethargic. The physician suspects bacterial meningitis and admits the patient to the ICU. THe nurse anticipates which of the following?** *Select all that apply* **a.)** Obtain blood type & cross match **b.)** Administer antipyretics as prescribed **c.)** Perform frequent neuro assessments **d.)** Monitor pain & administer analgesics **e.)** Put the patient in positive pressure isolation

Answer 66

**b.) Administer antipyretics as prescribed** **c.) Perform frequent neuro assessments** **d.) Monitor pain & administer analgesics**

Question 67

**A patient with Gullian-Barre Syndrome has experienced a sharp decline in vital capacity. What is your most appropriate action?** **a.)** Administer bronchodilators as ordered **b.)** Remind the patient of the importance of deep breathing & coughing exercises **c.)** Prepare to assist with intubation **d.)** Administer supplemental oxygen via nasal cannula

Answer 67

**c.) Prepare to assist with intubation**

Question 68

**A patient with a short arm case is suspected to have compartment syndrome. What should the nurse include in the plan of care?** *Select all that apply* **a.)** Elevate the arm above the heart **b.)** Prepare for cast removal **c.)** Provide support to the injured extremity **d.)** Assess neurovascular status every 8 hours

Answer 68

**b.) Prepare for cast removal** **c.) Provide support to the injured extremity**

Question 69

**Your patient has an IVPB order for 1 g of Vancomycin to be given over 6o minutes every 8 hours. THe pharmacy has sent up Vancomycin 1g in 180 mL of dextrose 5% in water. What is the correct volume and rate of infusion?**

Answer 69

**VTBI: 180 mL** **Rate: 180 mL per hour**

Question 70

**A patient with Multiple Sclerosis (MS) has ataxia. Which medication can be used to treat this clinical manifestation?** **a.)** Neurontin **b.)** Baclofen **c.)** Dantrium **d.)** Valium

Answer 70

**a.) Neurontin**

Question 71

**A patient has Parkinson's Disease. The nurse is teachign the patient about dietary issues. WHich of the following is the patient at risk for?** *Select all that apply* **a.)** Fluid volume overload **b.)** Dysphagia **c.)** Choking **d.)** Anorexia **e.)** Constipation

Answer 71

**b.) Dysphagia** **c.) Choking** **e.) Constipation**

Question 72

**A nurse is providing nutritional teachign to a patient who is scheduled for bariatric surgery. Which of the following should the nurse include in the teaching?** *Select all that apply* **a.)** Avoid drinking liquid calories **b.)** Drink frequent, small amounts of liquid **c.)** Drink water with meals **d.)** Drink liquids 30-60 minutes before or after meals **e.)** Be sure to drink plenty of water

Answer 72

**a.) Avoid drinking liquid calories** (you want the patient to get nutrient dense food, not calories from liquids) **b.) Drink frequent, small amounts of liquid** **d.) Drink liquids 30-60 minutes before or after meals** **e.) Be sure to drink plenty of water** (to prevent dehydration)

Question 73

**Which well-recognized sign of meningitis is exhibited when a patient's neck is flexed & flexion of the knee & hips is produced?** **a.)** Positive Kernig's sign **b.)** Photophobia **c.)** Positive Brudzinski's sign **d.)** Headache

Answer 73

**c.) Positive Brudzinski's sign**

Question 74

**A 69-year-old was brought to the ED because their family found them on the floor disoriented, confused, & lethargic. The physician suspects bacterial meningitis & the patient is admitted to the ICU. The nurse knows that risk factors for unfavorable outcomes include which of the following?** *Select all that apply* **a.)** Older age **b.)** HR greater than 120 **c.)** BP greater than 140/90 mmHg **d.)** Low GCS **e.)** Lack of previosu immunizations

Answer 74

**a.) Older age** **b.) HR greater than 120** **d.) Low GCS**

Question 75

**The physician has ordered a Heparin bolus of 60 units/kg & a starting dose of 12 units/kg/hr for Mr. Johnson. Mr. Johnson weighs 176 pounds. What is the bolus dose for Mr. Johnson?**

Answer 75

**4800 units** ## Footnote **1.) Find weight in kg** * 176 lbs **/** 2.2 **= 80 kg** **2.) Find the bolus dose** * 80 kg **x** 60 units **= 4800 units**

Question 76

**The pharmacy sent 10,000 units / 10 mL of heparin for a bolus dose. Based on your previous answer, how many mL of heparin would you draw up?** ## Footnote **The physician has ordered a Heparin bolus of 60 units/kg & a starting dose of 12 units/kg/hr for Mr. Johnson. Mr. Johnson weighs 176 pounds.**

Answer 76

**4.8 mL** | Bolus Dose = 4,800 units ## Footnote **1.) Find units / mL** * 10,000 units **/** 10 mL **=** 1,000 units /mL **2.) Ordered / On Hand** * 4,800 units **/** 1,000 **=** 4.8 mL

Question 77

**The pharmacy delivers Heparin 25,000 units in 250 mL D5W. What is the correct rate of infusion?** *Round to the nearest whole number* ## Footnote **The physician has ordered a Heparin bolus of 60 units/kg & a starting dose of 12 units/kg/hr for Mr. Johnson. Mr. Johnson weighs 176 pounds. Pharmacy sent 10,000 units / 10 mL of Heparin for the bolus dose.** * **Bolus Dose = 4,800 units** * **Draw up 4.8 mL of Heparin** * **Weight = 80 kg**

Answer 77

**10 mL** ## Footnote **1.) Find units/mL of Heparin sent from pharmacy** * 25,000 units **/** 250 mL **=** 100 units/mL **2.) Calculate the weight** * 176 lbs **/** 2.2 **=** 80 kg **3.) Calculate starting dose in units/hr using the patient's weight & the starting dose** * 80 kg **x** 12 units/kg/hr **=** 960 units/hr **4.) Ordered / On Hand** * 960 units/hr **/** 100 mL **= 9.6 --> rounds to 10**

Question 78

**A patient is being transported to the ED. EMS tells the nurse that the patient fell from a 2-story building. He has a large contusion on hsi left chest & a hematoma in the left parietal area. He has a compound fracture of his left femur & is comatose. We intubated him & he's maintaining oxygen at 92% by pulse oximeter with a manual-resuscitation bag. Which intervention by the nurse is the highest priority?** **a.)** Assess the left leg **b.)** Assess the pupils **c.)** Place the patient in trendelenburg position **d.)** Assess level of consciousness

Answer 78

**a.) Assess the left leg**

Question 79

**Your patient has a CT of the brain with IV contrast. Prior to the test, what should the nurse do first?** **a.)** Maintain the patient as NPO for 6 hours before the test. **b.)** Obtain a blood sample for BUN and Creatinine levels. **c.)** Obtain 2 large-bore IV lines. **d.)** Assess the patient for medication allergies.

Answer 79

**d.) Assess the patient for medication allergies**

Question 80

**The physician has ordered Dobutamine 2 mcg/kg/min for a patient who weighs 187 ounds. The pharmacy delivers Dobutamine 400 mg in 250 mL D5W. What is the correct infusion?** *Round to the nearest whole number*

Answer 80

**6 mL** ## Footnote **1.) Convert weight to kg** * 187 lbs **/** 2.2 **=** 85 kg **2.) Convert 400 mg Dobutamine to mcg** * 400 mg **x** 1000 **=** 400,000 mcg **3.) Calculate the concentration of Dobutamine in the bag in mcg/mL** * 400,000 mcg **/** 250 mL **=** 16,000 mcg/mL **4.) Calculate the dose** * 2 mcg/kg/min **x** 85 kg **x** 60 min **= 10,200 mcg/min** * 10,200 mcg **/** 16,000 mcg/mL **= 6.35 --> 6 mL**

Question 81

**A 29-year-old female with a history of Insulin Dependent Diabetes Mellitus (IDDM) was treated with IV antibiotics. 12 days later she has persistent flank pain. She is febrile (39.0 C), HR 100, RR 16, BP 130/70. Her urine output is minimal. She appears moderately ill. Her neck veins are flat and her pulse is weak & thready. The following labs were found:** * Na+ = 127 * WBC = 10,700 * Neutrophils = 70% * K+ = 5.0 * Glucose = 640 * Cl- = 92 * BUN = 32 * Cr = 1.6 * Bicarb = 17 * BC & UC negative * UA = pink/cloudy with 1+ ketones, 2+ glucose, rare bacteria **Identify the following:** **1.) Primary problem & cause** **2.) Potential fluid volume disorder** **3.) Electrolyte disturbances**

Answer 81

**1.) DKA** * *low bicarb, elevated blood suger (over 600), ketones in the urine) **2.) Metabolic Acidosis** * *high HR, flat neck veins, low bicarb* **3.) Hyponatremia (low Na+) & potassium is at the high end of normal**

Question 82

**A 34-year-old male patient, who is an alcoholic, was admitted to the floor after an MVA where he sustained multiple injuries. He has received a total of 8 units of PRBC over the last 24 hours. His ECG is now showing:** * **T-Wave inversion** * **Prolonged QT interval** * **Prolonged ST segments** **As the nurse, what do you suspect is the cause?**

Answer 82

* **Hypocalcemia** (low Ca+) * **Hyperkalemia** (high K+ = peaked T-waves) * **Patient needs platelets** (PRBCs don't have clotting factors) * **At risk for fluid volume overload**

Question 83

**A 75-year-old patient had surgery for a left hip fracture yesterday. When completing the plan of care, the nurse should include an assessment for which of the following complications?** **a.)** Pneumonia **b.)** Necrosis of the humerus **c.)** Skin breakdown **d.)** Sepsis **e.)** Delerium

Answer 83

**a.) Pneumonia** **c.) Skin breakdown** **d.) Sepsis** **e.) Delirium**

Question 84

**A patient with renal failure has decreased erythrocyte production. Upon analysis of the patient's CBC, the nurse will epxect which of the following results?** **a.)** Increased hemoglobin & decreased hematocrit **b.)** Decreased hemoglobin & hematocrit **c.)** A decreased mean corpuscular volume (MCV) and red cell distribution (RDW) **d.)** An increased mean corpuscular volume (MCV) and red cell distribution (RDW)

Answer 84

**b.) Decreased hemoglobin & hematocrit**

Question 85

**A patient with a hemoglobin of 7.7 g/dL has 2 units of packed red blood cells (PRBCs) ordered for transfusion. Which intervention(s) should the nurse implement?** *Select all that apply* **a.)** Obtain signed consent **b.)** Initiate a 22 g IV **c.)** Assess the patient's lungs **d.)** Check for allergies **e.)** Hang a keep open IV of D5W

Answer 85

**a.) Obtain signed consent** **c.) Assess the patient's lungs** **d.) Check for allergies**

Question 86

**The patient receiving a unit of PRBCs begins to chill & develops hives. Which action should be the nurse's first response?** **a.)** Notify the lab & HCP **b.)** Administer the histamine-1 blocker **c.)** Assess the patient for further complications **d.)** Stop the transfusion & change the tubing at the hub

Answer 86

**d.) Stop the transfusion & change the tubing at the hub**

Question 87

**The clinic nurse is caring for a patient admitted with AIDS. The nurse has assessed that the patient is experiencing a progressive decline in cognitive, behavioral, & motor functions. The nurse recognizes that these symptosm are most likely related to the onset of which complication?** **a.)** HIV encephalopathy **b.)** B-cell lymphoma **c.)** Kaposi's sarcoma **d.)** Wasting syndrome

Answer 87

**a.) HIV encephalopathy**

Question 88

**A nurse has experienced percutaneous exposure to an HIV-positive patient's blood as a result of a needle stick injury. The nurse has informed the supervisor & identified the patient. What action should the nurse take next?** **a.)** Flush the wound with Chlorhexidine **b.)** Report to the ED or employee health **c.)** Apply a hydrocolloid dressing to the wound **d.)** Follow up with her primary care provider

Answer 88

**b.) Report to the ED or employee health**

Question 89

**A patient has been diagnosed with AIDS complicated by chronic diarrhea. What nursing intervention would be appropriate for this patient?** **a.)** Position the patient in a high Fowler's position whenever possible. **b.)** Temporarily eliminate food protein in the patient's diet. **c.)** Make sure the patient eats at least 2 servings of raw fruit. **d.)** Obtain a stool culture to identify possible pathogens.

Answer 89

**d.) Obtain a stool culture to identify possible pathogens**

Question 90

**A nurse is caring for a patient who has a diagnosis of acute leukemia. What assessment most directly addresses the most common cause of death among patients with leukemia?** **a.)** Monitoring for infection **b.)** Monitor for nutritional status **c.)** Monitor elecrolyte levels **d.)** Monitor liver function

Answer 90

**a.) Monitor for infection**