Unit 1

Question 1

The nurse is caring for a client who has nephrotic syndrome with severe proteinuria. Which of the following actions is appropriate for the nurse to take?
Administering lisinopril.
Withholding diuretic medications.
Providing a 0.9% sodium chloride (NaCl) bolus. Obtaining a narcotic prescription for flank pain.

Answer 1

*Administering lisinopril.

Question 2

The nurse is reviewing the laboratory results of assigned clients. It is a priority for the nurse to follow up with the primary health care provider (PHCP) if a client who
had an abdominal aortic aneurysm
A. (AAA) repair 2 days ago has a creatinine level that has increased from 0.9 to 2.5 mg/dL.
B.had a mitral (mechanical) valve replacement and taking prescribed warfarin has
an international normalized ratio (INR) that is 3.2.
C. Is receiving prescribed enoxaparin postoperatively from cardiac surgery and has a platelet count that has decreased from 200,000 to 175,000 mm3 over the past 2 days.
D.is receiving prescribed digoxin and has a blood urea nitrogen (BUN) level that has increased from 15 to 19 mg/dL over the past 3 days.

Answer 2

*had an abdominal aortic aneurysm (AAA) repair 2 days ago has a creatinine level that has increased from 0.9 to 2.5 mg/dL.

Question 3

The nurse is caring for a client who has been hospitalized for 8 days with acute kidney injury (AKI) caused by dehydration. Which of the following should the nurse report immediately to the primary health care provider (PHCP)?
A creatinine level of 3 mg/dL.
A rhythm strip reading that has tall, peaked T waves.
A blood urea nitrogen (BUN) level of 67 mg/dL.
A decreased glomerular filtration rate.

Answer 3

*A rhythm strip reading that has tall, peaked T waves.

Question 4

The nurse is caring for a client who is receiving gentamicin intravenously for an infection and has developed oliguria and an increased blood pressure. Which of the following is a priority nursing action?
A.Insert a urethral urinary catheter.
B.Collect a urine sample to check the specific gravity.
C.Collect a specimen for gentamicin peak and trough levels.
D.Raise the head of the bed (HOB) to a 45- degree angle.

Answer 4

*Collect a specimen for gentamicin peak and trough levels.

Question 5

The nurse is caring for a client who has chronic kidney disease (CKD). The client has developed an increase in the rate and depth of respirations. After raising the client’s head of bed (HOB), which of the following actions should the nurse take next?
A.Evaluate the client’s urine output for the past 4 hours.
B.Determine if the client is scheduled to receive hemodialysis.
CReview the most recent serum potassium level.
D. Obtain a blood specimen for arterial blood gases (ABG).

Answer 5

*Obtain a blood specimen for arterial blood gases (ABG).

Question 6

The nurse is talking with a client who has chronic kidney disease (CKD) and is receiving hemodialysis 3 times per week. Which of the following client statements is a priority for follow up by the nurse?
A.“I have noticed that my skin looks like it has a layer of frost on it.”
B.“I make sure that I consume at least 50 grams of protein every day.”
C.I try and limit my intake of dietary sodium to 5 grams per day.”
D.“I have noticed that my breath has developed a very unpleasant odor.”

Answer 6

*“I try and limit my intake of dietary sodium to 5 grams per day.”

Question 7

The nurse is teaching a client who is in the late stage of chronic kidney disease (CKD). Which of the following client statements indicates a correct understanding of the teaching?
A.If I develop any muscle weakness or tremors, I should report it to my doctor.”
B.“I should avoid obtaining much of my protein from meat and eggs.”
C.“Hemodialysis will be performed 2 times per week in an outpatient center.”
D.“I can expect to have an increase in my energy level after a dialysis treatment.

Answer 7

*“If I develop any muscle weakness or tremors, I should report it to my doctor.”

Question 8

The nurse is caring for a client who had a hemodialysis treatment the day before. It requires immediate follow up by the nurse if the client has
A.developed a temperature of 101.4° F.
B.developed a blood pressure of 130/72 mm Hg.
C.reports of feeling tired and no desire to eat.
D.a potassium level that decreased from 6.1 to 5.1 mEq

Answer 8

A.developed a temperature of 101.4° F.

Question 9

The nurse is caring for assigned clients. Which of the
following actions should the nurse take?
A.Apply a pressure dressing on a client’s arteriovenous (AV) fistula between hemodialysis treatments.
B.Place a mask on a client when changing the client’s peritoneal dialysis (PD) catheter dressing.
C.Walk a client to the bathroom during the peritoneal dialysis (PD) infusion cycle.
D.Obtain a blood specimen from a client’s arteriovenous (AV) fistula.

Answer 9

Place a mask on a client when changing the client’s peritoneal dialysis (PD) catheter dressing.

Question 10

The nurse preceptor is observing a newly hired nurse care for a client who is receiving peritoneal dialysis (PD). It indicates correct technique if the newly hired nurse is observed
A.placing the PD dialysate bag in the microwave to warm the solution.
B.starting the dialysis fill prior to cleaning the catheter site.
C.placing the PD dialysate bag on the bed during outflow.
D.repositioning the client during dialysis to improve dialysate flow.

Answer 10

*repositioning the client during dialysis to improve dialysate flow.

Question 11

The nurse is assessing a newly admitted client who has acute pancreatitis. Which of the following should the nurse expect to assess?
A.Hypertension.
B.back pain
C.Spider angiomas.
D.Bradycardia.

Answer 11

back pain

Question 12

The nurse is reviewing laboratory results of a client who has acute pancreatitis. Which of the following results should the nurse expect to find in this client?
A.A white blood cell (WBC) count of 15 mm3.
B.A platelet count of 300,000 mm.
C.A blood glucose level of 65 mg/dL.
D.An increase calcium level of 12 mg/dL.

Answer 12

A white blood cell (WBC) count of 15 mm3.

Question 13

The nurse working on the medical-surgical unit is caring for assigned clients. The nurse should first plan to assess the client who has
A. acute kidney injury (AKI) and has a blood urea nitrogen level of 36 mg/dL.
B.acute pancreatitis and has a pulse of 126 with a blood pressure of 98/54 mm Hg.
cirrhosis of the liver and has c.hand flapping of the wrist and fingers.
D.chronic kidney disease (CKD) and is drinking fluids immediately before hemodialysis.

Answer 13

acute pancreatitis and has a pulse of 126 with a blood pressure of 98/54 mm Hg.
cirrhosis of the liver and has

Question 14

who has chronic pancreatitis. Which of the following statements by the client would indicate a correct understanding of the teaching?
A I will eat 3 meals a day and avoid snacking.”
B I will avoid eating foods that are high in fat.”
C.I will measure my abdominal girth every morning.”
D.I will take my prescribed pancreatic enzymes with my antacids.”

Answer 14

*“I will avoid eating foods that are high in fat.”

Question 15

The nurse is caring for a client who has cirrhosis and is having a paracentesis performed. Which of the following should the nurse take following the procedure?
AlInstruct the client to empty their bladder.
B.Position the client prone for one hour.
C.Place an adhesive bandage to the
paracentesis site.
D.Initiate 0.9% sodium chloride (NaCl) intravenous (IV) fluids.

Answer 15

Place an adhesive bandage to the
paracentesis site.

Question 16

The nurse is providing discharge instructions for a client with cirrhosis. Which of the following statements best indicates that the client has understood the teaching?
A.“I should eat a low-protein, low- carbohydrate diet to provide energy.”
B.”It is safer for me to take acetaminophen for pain rather than aspirin.”
C.I should avoid constipation to decrease my risk of bleeding.”
D.“I will wash my skin with warm water and soap if I develop pruritus

Answer 16

.I should avoid constipation to decrease my risk of bleeding.”

Question 17

The nurse has received a hand-off report for the following assigned clients. Which client should the nurse see first?
A 40-year-old who has chronic pancreatitis and reports gnawing abdominal pain
b.55-year-old who has cirrhosis of the liver and is tachypneic.
C.58-year-old who has cirrhosis of the liver and reports anorexia.
D43-year-old who has hepatic encephalopathy and is confused.

Answer 17

55-year-old who has cirrhosis of the liver and is tachypneic

Question 18

The nurse is caring for a client who has cirrhosis and has been prescribed lactulose. It would indicate that the client is having an expected outcome from this medication if the client experiences a decrease in
A.the potassium level
B.nausea and vomiting. C.abdominal distention.
D.the ammonia level.

Answer 18

D.the ammonia level.

Question 19

The nurse is caring for assigned clients. The nurse should first plan to assess the client who has
A.pancreatitis and has had a temperature of 101.1° F for the past hour.
B.atrial fibrillation (AF) and is requesting acetaminophen for a headache.
Chepatic encephalopathy and has been having a flapping tremor of the hands.
D.returned from hemodialysis and is reporting pain radiating down the left arm.

Answer 19

returned from hemodialysis and is reporting pain radiating down the left arm.

Question 20

The nurse working in a cardiac unit is admitting a client who has unstable angina. Which of the following actions should the nurse take?
A.Prepare to send the client for a cardiac catheterization.
B.Check b-type natriuretic peptide (BNP) levels.
C.Administer oxygen therapy via nasal cannula.
DObtain a stat chest radiography (CXR)

Answer 20

Administer oxygen therapy via nasal cannula.

Question 21

The nurse is caring for a client who was admitted from the emergency department (ED) with chest pain . In the ED the client received sublingual nitroglycerin with relief of the chest pain, a 12-lead electrocardiogram (ECG), and arterial blood gases (ABG). Which of the following should the nurse anticipate the primary health care provider (PHCP) will prescribe?
A.Cardiac catheterization.
B.Echocardiogram.
C.Transesophageal
d.Computed tomography (CT) of the chest.

Answer 21

Echocardiogram.

Question 22

The nurse is caring for a client who experienced an acute myocardial infarction (AMI) 24 hours ago. It would be necessary for the nurse to immediately notify the primary health care provider (PHCP) if the client has
•
A.an elevated troponin level.
B.a white blood cell (WBC) count of 13,000 mm3.
C.two unifocal premature ventricular contractions
(PVCs) per minute.
D.crackles auscultated to the midline of the lung fields.

Answer 22

D.crackles auscultated to the midline of the lung fields.

Question 23

The nurse is caring for a group of clients on the cardiac floor. The nurse should immediately follow up on the client who is
A.being treated for premature ventricular contractions (PVCs) with an infusion of potassium chloride and by mouth (PO) atenolol.
B.receiving diltiazem for atrial fibrillation (AF) and has a decrease in systolic blood pressure from 148 to 123 mmHg.
C.2 days postoperative from a coronary artery bypass graft (CABG) and has a capillary blood glucose of 312 mg/dL.
D.being treated for atrial fibrillation with an amiodarone drip and is assessed to have dysarthria.

Answer 23

being treated for atrial fibrillation with an amiodarone drip and is assessed to have dysarthria

Question 24

The nurse has received a hand-off report for a client who was admitted with chest pain and is receiving nitroglycerin (NTG) 50 mg/250 mL D5W at dose of 20 mcg/min. The client weighs 187 lbs. The nurse observes that the client’s IV pump is set at a rate of 3 mL/hr. Which of the following actions should the nurse take?
A.Request the pharmacy to send NTG 100 mg/500 mL D5W.
B.Continue to infuse the NTG at a rate of 3 mL/hr.
C.Obtain a cardiac rhythm strip and place it in the client’s medical record.
D.Increase the infusion rate to 6 mL/hr.

Answer 24

Increase the infusion rate to 6 mL/hr.

Question 25

The nurse working in the emergency department (ED) is caring for a client who just had a myocardial infarction (MI) and is receiving a continuous infusion of tissue plasminogen activator (tPA). It would be most important for the nurse to notify the primary health care provider (PHCP) if the client develops
A.a feeling of apprehension.
B.oozing of blood at the IV insertion site.
C.an increase in heart rate (HR) from 90 to 106 beats/minute.
D.skin that is diaphoretic.

Answer 25

oozing of blood at the IV insertion site.

Question 26

The nurse working in the emergency department (ED) is caring for a client who was admitted 30 minutes ago with substernal chest discomfort, nausea, and diaphoresis. Which of the following findings would be consistent with a diagnosis of a myocardial infarction (MI)?
A.An electrocardiogram (ECG) revealing ST elevation.
B.A blood pressure of 180/110 mm Hg.
C.An elevated low-density lipoprotein (LDL) level.
D.Muffled heart sounds.

Answer 26

An electrocardiogram (ECG) revealing ST elevation

Question 27

The nurse working in a rehabilitation center is assisting a client who had a myocardial infarction (MI) to increase activity tolerance. Which of the following client symptoms indicates a need to stop the client’s current activity?
A.Oxygen saturation level has decreased from 98% to 95%.
B.Systolic blood pressure has decreased from 126/96 to 106/68 mm Hg.
C.Respirations have increased from 22 to 28.
D.Pulse rate has increased from 86 to 98.

Answer 27

Systolic blood pressure has decreased from 126/96 to 106/68 mm Hg.

Question 28

The nurse has received a prescription to administer a dopamine 200 mg/250 mL D5W at a rate of 5 mcg/kg/min to a client who weighs 180 lbs. At what rate should the nurse set the client’s infusion pump? Round to the nearest whole number.
A.13 mL/hr.
B.31 mL/hr.
C.32 mL/hr.
D,41 mL/hr.

Answer 28

31 mL/hr.

Question 29

The nurse working in the telemetry step down unit is preparing a client who is scheduled for a cardiac catheterization and an angioplasty. Which of the following laboratory findings is most important for the nurse to report to the primary health care provider (PHCP)?
A.White blood cell (WBC) count of 4.9 mm3.
B.Prothrombin time (PT) of 20 seconds.
C.Creatinine level of 0.9 mg/dL.
D.Blood urea nitrogen (BUN) of 12 mg/dL.

Answer 29

Prothrombin time (PT) of 20 seconds.

Question 30

The nurse has instructed a client who is scheduled to have a cardiac catheterization. Which of the following statements by the client would indicate a correct understanding of the teaching?
A.This test will help determine how much plaque has developed in my coronary arteries.”
B.“This test will determine if I need a permanent pacemaker or internal cardiac defibrillator (ICD).”
C.I will need to fast for eight hours before this test.”
D. I will need to drink radiopaque dye one hour before this test.”

Answer 30

This test will help determine how much plaque has developed in my coronary arteries.”

Question 31

The nurse has been made aware of the following client situations. The nurse should initially plan to assess the client who
A.had coronary artery bypass graft (CABG) surgery 24 hours ago and has developed distant muffled heart sounds.
B.has infective endocarditis (IE) with clinical manifestations of splinter hemorrhages and petechiae.
C.is diagnosed with acute kidney injury (AKI) and is scheduled to receive a nonsteroidal anti- inflammatory drug (NSAID).
D.has chronic kidney disease (CKD) and is reporting a metallic taste in their mouth.

Answer 31

*had coronary artery bypass graft (CABG) surgery 24 hours ago and has developed distant muffled heart sounds.

Question 32

The nurse is assessing a client who has a suspected aortic dissection. Which of the following findings should the nurse anticipate the client to have?
A.Bounding peripheral pulses. B.Respirations of 8.
C.A right sternal border heart murmur.
DHemorrhagic splinters in the nailbeds.

Answer 32

C.A right sternal border heart murmur.

Question 33

The nurse is caring for assigned clients. It would be a priority for the nurse to follow up with the primary health care provider (PHCP) if a client who
A.had a myocardial infarction (MI) 4 days ago is anxious about the planned discharge.
B.has a prosthetic valve has an international normalized ratio (INR) level of 3.0.
C.has pericarditis is reporting sharp, stabbing chest pain.
D.has a suspected thoracic aortic aneurysm is reporting the development of back pain.

Answer 33

has a suspected thoracic aortic aneurysm is reporting the development of back pain.

Question 34

The nurse is assessing a client who has developed cardiac tamponade. Which of the following findings should the nurse expect to observe?
A.Bibasilar crackles
B.Sinus tachycardia.
C.A blood pressure (BP) of 190/90 mm Hg.
D.Jugular venous distention with clear lung
sounds.

Answer 34

Jugular venous distention with clear lung
sounds.

Question 35

The nurse has been made aware of the following client situations. The nurse should initially assess the client who

A.has heart failure (HF) and is receiving a continuous infusion of a 0.9% normal saline (NaCl) and the IV pump is infusing at a rate of 250 mL/hr.
B.has atrial fibrillation (AF), has been receiving prescribed digoxin for two days, and has a sub- therapeutic digitalis level.
C.has cirrhosis of the liver with jaundice and reports not having had a bowel movement in three days.
D.has chronic kidney disease (CKD) and is eating food brought in by a family member that is high in potassium.

Answer 35

has heart failure (HF) and is receiving a continuous infusion of a 0.9% normal saline (NaCl) and the IV pump is infusing at a rate of 250 mL/hr.

Question 36

The nurse is caring for a client who was recently diagnosed with pericarditis. It would require follow up by the nurse if the
A.primary health care provider (PHCP) prescribes a nonsteroidal anti-inflammatory drug (NSAID) to relieve the client’s chest pain.
B.unlicensed assistive personnel (UAP) reports that the client is sitting upright in the bed leaning forward to help relieve the chest pain.
C.nurse’s assessment of the client reveals a pericardial friction rub heard on auscultation.
D.nurse’s assessment of the client reveals
muffled heart sounds and a report of fatigue by the client.

Answer 36

.nurse’s assessment of the client reveals
muffled heart sounds and a report of fatigue by the client.

Question 37

The nurse working in the medical-surgical unit is caring for a client who reports a “racing heart” and “feeling anxious.” The client is placed on a heart monitor and displays the heart rhythm indicated below.
• Rhythm strip

Which of the following findings should the nurse correlate to this assessment?
A.The client just had a bowel movement.
B.The client uses an albuterol inhaler daily for asthma.
C.The client has a history of Lyme disease.
D.The client has a low magnesium level.

Answer 37

The client uses an albuterol inhaler daily for asthma.

Question 38

The nurse is caring for a client who reports dizziness, has a blood pressure of 80/49 mm Hg, and has the cardiac rhythm indicated below. Which of the following actions should the nurse take?
• Rhythm strip

A.Prepare the client for synchronized cardioversion.
B.Administer prescribed nitroprusside sodium at a rate of 0.3 mcg/kg/min.
C.Place the client with the head of the bed lower than the foot of the bed.
D.Administer prescribed adenosine 6 mg intravenously (IV).

Answer 38

Prepare the client for synchronized cardioversion.

Question 39

The nurse is caring for a client who develops the cardiac rhythm indicated below. Which of the following actions should the nurse take?
• Rhythm strip

A.Ask the client if they are experiencing palpitations.
B.Prepare to cardiovert the client.
C.Replace the client’s ECG leads.
D.Prepare to administer prescribed amiodaron

Answer 39

A.Ask the client if they are experiencing palpitations.

Question 40

The nurse is caring for a client who has received a prescription to administer a continuous infusion of lidocaine 2 g in 500 mL/D5W at a rate 1 mg/minute. The client weighs 75 kg. At what rate should the nurse set the client’s infusion pump? Round to the nearest whole number.
A.3 mL/minute.
B.30 mL/minute.
C.15 mL/hour.
D.80 mL/hour.

Answer 40

15 mL/hour.

Question 41

The nurse has provided discharge teaching to a client following the insertion of a permanent pacemaker to the left chest area. Which of the following client statements would indicate a correct understanding of the teaching?
A.I will lift my left arm over my head several times a day to prevent any mobility issues.”
B. I will avoid cooking with a microwave oven or around any that are being used.”
“
C.It will be 1 month before I can take a bath or return to my usual activities.”
D..I will notify airport personnel of my pacemaker before going through the metal detector.”

Answer 41

I will notify airport personnel of my pacemaker before going through the metal detector.”

Question 42

who had a mitral valve replacement with a mechanical (prosthetic) valve. Which of the following client statements indicate a need for further teaching?
A.I should use an electric razor when I shave.”
B.I need to report any excessive bruising to my primary health care provider (PHCP).”
C.I should avoid having invasive dental work performed for 6 months.”
D.“I will be able to return to my weight lifting routine after 6 weeks.”

Answer 42

I will be able to return to my weight lifting routine after 6 weeks.”

Question 43

The nurse is providing discharge instructions to a client who had a mitral valve replaced with a biologic (porcine) valve. Which of the following client statements indicates a need for further teaching?
A.I will keep my arm in a sling for 2 weeks while the incision heals.”
B.I will need to have the valve replaced every 7- 10 years.”
C.It will not be necessary for me to take blood thinners for the rest of my life.”
D.I should avoid heavy physical activity involving my upper extremities for the next 3-6 months.”

Answer 43

A.I will keep my arm in a sling for 2 weeks while the incision heals.”

Question 44

The nurse has developed a teaching plan for a client who has dilated cardiomyopathy. Which of the following client statements indicates a need for further teaching?
A.I will need to take a lipid lowering agent to help control my symptoms.”
BI should report any feelings of dizziness to my doctor.”
C.I will need to take diuretic therapy for the rest of my life.”
D.I may need to have a heart transplant if my condition becomes severe.”

Answer 44

.I will need to take a lipid lowering agent to help control my symptoms.”

Question 45

The nurse is caring for the following clients. It would be necessary to schedule an interdisciplinary conference for the client who is
A.42 years old, is single with two teenage children, works as a cashier, and has dilated cardiomyopathy.
B.57 years old, is married, works as an accountant, and is being discharged home to an apartment following coronary artery bypass graft (CABG) surgery.
C.65 years old, lives with a partner, is retired, and was recently diagnosed with an abdominal aortic aneurysm (AAA) that is being medically managed.
D.73 years old, lives with an adult child and grandchildren, and is scheduled to have a mitral

Answer 45

42 years old, is single with two teenage children, works as a cashier, and has dilated cardiomyopathy.

Question 46

The nurse is caring for a client who has right-sided heart failure (HF) and is receiving hemodynamic monitoring which reveals an elevated central venous pressure (CVP) reading. Which of the following assessments is consistent with this finding?
A.Pink, frothy sputum.
B.Jugular venous distention.
C.Weak peripheral pulses. D.Bibasilar crackles in the lungs.

Answer 46

Jugular venous distention.

Question 47

he nurse is assessing the following assigned clients. The nurse should immediately notify the primary health care provider (PHCP) about the client who
A.has hepatic encephalopathy with slow, slurred speech.
B.has chronic pancreatitis with steatorrhea and dark colored urine.
C.has infective endocarditis (IE) and auscultation of a heart murmur that has increased in intensity.
D.had a myocardial infarction (MI) 4 hours ago and has an increase in their current troponin level.

Answer 47

has infective endocarditis (IE) and auscultation of a heart murmur that has increased in intensity.

Question 48

The nurse is reviewing prescriptions for assigned clients. It requires follow up with the primary health care provider (PHCP) if a client who
A.has an abdominal aortic aneurysm (AAA) and is prescribed metoprolol 25 mg PO daily.
B.is newly admitted with a myocardial infarction (MI) and is prescribed a loading dose of clopidogrel.
C.has coronary artery disease (CAD) and has been prescribed isosorbide mononitrate 60 mg PO. *is newly diagnosed with infective endocarditis
D. (IE) and has been prescribed an anticoagulant.

Answer 48

is newly diagnosed with infective endocarditis
(IE) and has been prescribed an anticoagulant.

Question 49

The nurse is caring for a client who has infective endocarditis (IE). Which of the following findings indicates the client is having a complication associated with this disease?
A.An electrocardiogram (EKG) that reveals ST elevation.
B.A persistent elevated temperature.
C.The development of heart failure (HF).
D.Gnawing pain radiating to the back.

Answer 49

C.The development of heart failure (HF).