NCLEX Secrets - Neurology Board Review (21-25)

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NCLEX Secrets - Neurology Board Review

21. The client had undergone hypophysectomy. Which of the following findings should the nurse give highest priority?

a) rhinorrhea
b) body temperature is 99F
c) increased specific gravity of urine
d) urine output of 40 to 50 mls/hr

22. The home health nurse is visiting a client who had spinal cord injury. Which of the following factors should the nurse include when giving health teachings?

a) regular schedule for elimination
b) signs and symptoms of constipation
c) proper technique of massaging the legs
d) use of walker

23. What is the most appropriate nursing action to assess a patient who has spinal cord injury at the level of T6 for possible signs and symptoms of autonomic dysreflexia?

a) check the body temperature
b) check the blood pressure
c) check the pulse rate
d) check the respiratory rate

24. Which of the following problems in a client with Guillain-Barre Syndrome (GBS) should be given highest priority by the nurse?

a) renal problems
b) neurologic problems
c) respiratory problems
d) cardiovascular problems

25. The client has history of seizures. He is on dilantin (phenytoin) therapy. Which of the following side effects should the nurse tell the client to report to the physician?

a) reddish-brown urine
b) overgrowth of gingival tissues
c) drowsiness
d) hyperpigmentation of the skin





NCLEX Secrets - Neurology Board Review:
ANSWERS AND RATIONALE

21) A
- rhinorrhea indicates CSF leakage. Options B, C, and D are normal findings.

22) A
- regular schedule of elimination is very important in a client with spinal cord injury. Bladder distention and fecal impaction may cause autonomic dysreflexia.

23) B
- autonomic dysreflexia is characterized by hypertension. This is the most dangerous effect of the condition. If BP remains uncontrolled CVA may occur.

24) C
- GBS involves paralysis of respiratory muscles that may lead to respiratory arrest.

25) B
- gingival hyperplasia is a common toxic effect of phenytoin. Preventive measures are as follows: good oral care, use soft-bristled toothbrush, and massage the gums.


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NCLEX Review Questions on Cancer (11-15)

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NCLEX Review Questions on Cancer

11. Which of the following should the nurse assess prior to administration of cisplatin?

a) hydration
b) hemoglobin
c) weight
d) ECG

12. The client is receiving internal radiation therapy. What is the appropriate nursing action to minimize radiation contamination?

a) put the soiled linens in double bag
b) keep clients things close to her bedside
c) always wear gloves when entering the client's room
d) minimize contact with the client

13. A client is suspected of having pheochromocytoma. Which of the following signs and symptoms would help support this diagnosis?

a) abdominal pain
b) anuria
c) hypertension
d) weight gain

14. Before uterine radioactive implant is inserted, which of the following physician's orders does the nurse expect?

a) administer analgesic
b) administer sedative
c) administer enema
d) administer antibiotic

15. The nurse is admitting a patient with jaundice, due to pancreatic cancer. Which of the following would the nurse give highest priority?

a) body image
b) nutrition
c) skin integrity
d) anticipatory grieving




NCLEX Review Questions on Cancer:
ANSWERS AND RATIONALE

11) A
- cisplatin, a neoplastic agent is nephrotoxic. The client should be adequately hydrated before administration of the drug.

12) D
- Each contact with the client undergoing internal radiation therapy should last for 5 minutes only, a total of 30 minutes in an 8-hour shift, to minimize radiation contamination. The nurse should wear dosimeter badge to measure radiation exposure.

13) C
- pheochromocytoma is a tumor in the adrenal medulla that stimulates increased secretion of catecholamines (epinephrine/norepinephrine). This causes hypertension.

14) C
- during uterine radioactive implant, the client should be on bedrest. Defecation should be avoided during treatment to prevent dislodgement of the implant. Therefore, enema is usually ordered by the physician before the treatment.

15) C
- give priority to physiologic before psychosocial needs. Jaundice causes severe pruritus. Therefore, maintaining skin integrity is a priority.


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    Test Prep for Nursing Exam about Obstetric Nursing (11-15)

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    11. Which of the following findings by the nurse indicates that Methergine injection to a client, who had delivered 3 hours ago, is effective?

    a) uterus is 2 fingerbreadths below the umbilicus
    b) uterus is boggy and at the level of the umbilicus
    c) uterus is palpated on the right side of the abdomen
    d) uterus is 2 fingerbreadths above the umbilicus

    12. Which of the following statements when made by the premenopausal woman indicates that she understands the health teachings on breast self-examination (BSE)?

    a) I will perform breast self-examination every first day of the month
    b) I will perform breast self-examination 5 days after menstruation
    c) I will perform breast self-examination 2 to 3 days after the cycle
    d) I will perform breast self-examination during menstrual period

    13. Which of the following signs and symptoms indicates amniotic fluid embolism?

    a) sudden onset of respiratory distress, chest pain, BP 90/60 mmHg, RR 26/min, PR 98bpm
    b) restlessness, chest pain, BP 140/80 mmHg, RR 24/min, PR 70 bpm
    c) difficulty of breathing, cold, clammy skin, BP 90/60 mmHg, RR 12/min, PR 70 bpm
    d) chest pain, shortness of breath, BP 160/90 mmHg, RR 28/min, PR 120 bpm

    14. The client is in active labor, cervix is 8 cm dilated, is nauseated, and irritable. Which of the following is appropriate nursing action?

    a) encourage the client to do pant-blow breathing exercises
    b) encourage the client to push with each contractions
    c) encourage the client to walk
    d) encourage the client to turn to the right side

    15. The client is in active labor. She is on oxytocin per IV infusion drip. Which of the following situations would require that the infusion be stopped?

    a) the cervix is 8 cm, dilated, contractions occur every 3-5 minutes
    b) contractions occur at less than 2 minute intervals or last for longer than 90 seconds
    c) the cervix is 6 cm, dilated, partially effaced, duration of contractions is 50 to 60 seconds
    d) contractions occur every 3-5 minutes, last 50 to 60 seconds



    ANSWERS AND RATIONALE

    11) A
    - methergine causes uterine contraction and prevents postpartum bleeding. Option A indicates uterine contraction.

    12) B
    - BSE among premenopausal women is best done after menstruation. BSE is done on the same day of the month, e.g., every first day of the month among postmenopausal women. The procedure should not be done during menstruation and during ovulation, because the tissues in the breast may feel hard during these periods.

    13) A
    - amniotic fluid embolism results to pulmonary embolism and possibly shock. Hypotension, tachypnea, tachycardia characterized early stage of the condition. Onset of symptoms is sudden.

    14) A
    - pant-blow breathing exercises will prevent sudden expulsion of the fetus, thereby preventing cervical laceration and hematoma. Pushing is to be done only when there is full cervical dilatation (10 cm). The client should be on bedrest at this stage of labor. It is best for the client to turn to the left side to relieve compression of the vena cava.

    15) B
    - contractions occurring at less than 2-minute intervals and lasting longer than 90 seconds may lead to tetanic uterine contractions and therefore, uterine rupture. Fetal distress may occur.


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    NCLEX Review about Intestinal Disorders 21-25

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    NCLEX Review about Intestinal Disorders

    16. Which of the following assessment findings should concern the nurse most, when assessing client who had undergone colonoscopy?

    a) abdominal distention
    b) 300 ml of bile-stained vomitus
    c) complaints of anal pain
    d) complaints of drowsiness and fatigue

    17. A client has hepatic cirrhosis and gastric bleeding. Which of the following tasks may be delegated to the nursing assistant?

    a) assist the client in taking a bath
    b) hourly intake and output monitoring
    c) assist the client to sit before changing the bed linen
    d) assist the client in ambulation

    18. A client diagnosed with gastric ulcer is for discharge. Which of the following should be included by the nurse in the health teachings regarding diet?

    a) you must eat bland diet
    b) you can eat most foods as long as they don't bother your stomach
    c) you should refrain from eating fruits and vegetables
    d) you should eat low fiber diet

    19. The client who was diagnosed to have gastric cancer had undergone gastrectomy. Which of the following statements when made by the client indicates that he understands the health teachings

    a) I'll take vitamin K for life
    b) I'll take vitamin B12 for life
    c) I'll take vitamin C for life
    d) I'll take vitamin B6 for life

    20. The client had been diagnosed to have liver cirrhosis and esophageal varices. Which of the following should the nurse include when giving health teachings? Select all that apply

    a) avoid spicy foods
    b) avid straining at stool
    c) increase fluid intake
    d) open mouth if coughing or sneezing could not be avoided
    e) avoid bending or stooping
    f) take acetaminophen instead of aspirin for pain
    g) avoid heavy lifting




    NCLEX REVIEW ABOUT INTESTINAL DISORDERS:
    ANSWERS AND RATIONALE

    16) B
    - bile-stained vomitus is a sign of lower GI obstruction . Options A, C, and D are expected findings after colonoscopy.

    17) B
    - input and output monitoring may be delegated to nursing assistant. the client with hepatic cirrhosis and gastric bleeding should be on bed rest to prevent further bleeding. A, C, and D involve getting the client out of bed, which may cause bleeding.

    18) B
    - food tolerance varies from individual to individual. There is no need for special diet for the client with gastric ulcer during remission.

    19) B
    - if a client had undergone gastrectomy, intrinsic factor is no longer produced. Therefore vitamin B12 will not be absorbed. Post-gastrectomy clients are prone to pernicious anemia. Therefore, the client should take vitamin B12 for life.

    20) A, B, D, E, G
    - to prevent rupture of esophageal varices, the client should avoid spicy foods, straining at stool, bending and stooping, and heavy lifting. The client should open his mouth if coughing and sneezing could not be avoided. Acetaminophen is hepatotoxic; aspirin may cause bleeding and therefore, are contraindicated in the client with liver cirrhosis.




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    NCLEX Preparation Course - Critical Thinking Exercises III (Questions 11-20)

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    Here are the Answers to NCLEX Preparation Course - Critical Thinking III (11-20) -->

    11. Which of the following is a characteristic manifestation of rubeola?

    a) koplik's spot in the mouth
    b) clusters of vesicles in the trunk
    c) desquamation of skin at the tips of the fingers and toes
    d) linear burrows in the skin

    12. Which of the following clients should be given highest priority by the nurse?

    a) the client in the manic phase of bipolar disorder
    b) the client whose severe depression is now resolving
    c) the client with severe anxiety
    d) the client with compulsive behavior

    13. In which of the following may the nurse be charged for negligence?

    a) the client's nasogastric tube feeding has been delayed for one hour
    b) a medication has been delayed because of incomplete physician's order
    c) the client's abdominal binder loosened while he was ambulating along the hallway
    d) the nurse allowed the client to read his chart

    14. The patient is on SaO2 monitor. The nurse should intervene in which of the following situations?

    a) if the finger is wiped with alcohol before placing the sensor
    b) if the sensor is placed on the little finger
    c) if an arm board is kept on the same hand of the client, where the sensor is placed
    d) if the sensor is placed alternately in the second, third, and fourth fingers

    15. The client is on total parenteral nutrition (TPN) therapy at home. Which of the following statements indicates that the client understands the health teachings?

    a) I will check my capillary blood sugar daily
    b) I will check my urine ketones
    c) I will check my pulse daily
    d) I will check my weight daily

    16. The nurse should intervene when she observes the CNA (Certified Nursing Assistant) doing which of the following actions?

    a) the CNA is talking loudly to an elderly client
    b) the CNA checks the temperature of water before bathing an elderly
    c) the CNA assisting an elderly who is ambulating along the hallway
    d) the CNA applies lotion to the skin of an elderly

    17. The hospital is conducting a drill on triage for registered nurses. Which of the following clients should the nurse attend first?

    a) an 80-year old client whose trachea is deviated to the left
    b) a 15-year old with multiple fractures of the right femur
    c) a 45-year old client with active bleeding on the left wrist
    d) a 55-year old client with a closed head injury with fixed and dilated pupils

    18. A female nursing assistant tells the nurse that she is not comfortable about a young adolescent's behavior and will not provide care for him. The adolescent has poor impulse control, but has never "acted out" or assaulted the nursing assistant. Which of these goals should have a priority in the nurse's dealing with the nursing assistant?

    a) to have the assistant care for the client
    b) to have the assistant identify her feelings about aggressive behavior
    c) to have the assistant confront the patient's about his behavior
    d) to have the assistant admit the need for a referral for counseling services

    19. A client with long-term debilitating illness shouts, "Get out of here. You're always bothering me with something." Which response by the nurse is most appropriate?

    a) you don't have to yell. I'm sorry you feel like I've bothered you
    b) Ill go but I'll be back in a little while to find out what is bugging you
    c) I'm going to have to ask you to be quiet as there are other clients in this unit
    d) something is bothering you. I'll be glad to listen if you would like to talk

    20. The nursing assistant reports to the charge nurse that she saw the RN putting opioid in his pocket. Which of the following action is essential for the charge nurse to do?

    a) review the charts of the RN's patients, to check if medications were given
    b) ask more information from the nursing assistant (CNA) about the incident
    c) call the security
    d) ignore what the CNA has informed


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    NCLEX Preparation Course - Critical Thinking Exercises III (Answers 1-10)

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    Here are the Questions to NCLEX Preparation Course - Critical Thinking III (1-10) -->
          

    1) A
    - to assess for tactile fremitus, place the palms of the hands on the anterior and posterior chest. The client is asked to say "nine-nine-nine" or "tres-tres-tres". Increased tactile fremitus indicates consolidation.

    2) C
    - the most effective measure to prevent poisoning especially among children is to throw out old and unused drugs. Choices A, B and D may not necessarily avoid the child from obtaining poisonous substances.

    3) A
    - clostridium difficile is bacterial enterocolitis. It is common among those taking antimicrobial. The client with peptic ulcer disease (PUD) is at high risk to develop the disease.

    4) B
    - providing psychosocial care by making self available to clients in distress is therapeutic.

    5) A
    - MMR, a live virus vaccine is not given to a child who is immunocompromised.

    6) C
    - hematoma on the side of the neck or behind the ear (Battle's sign) indicates basilar head injury. This may cause brainstem compression that may lead to cardiopulmonary arrest.

    7) A
    - a client with Addison's disease experiences decreased secretion of aldosterone. Therefore, there is increased excretion of sodium and water. Dehydration is a problem that becomes more serious if the client is on NPO.

    8) B
    - lateral or prone position will promote drainage from the mouth after tonsillectomy and adenoidectomy and therefore, will prevent aspiration.

    9) B
    - continuous gentle bubbling in the suction control chamber indicates that the machine is functioning well. If there's no bubbling, the nurse must check the suction pressure. If there is no drainage.

    10) C
    - this prevents pooling of venous blood by gravity.


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    NCLEX Preparation Course - Critical Thinking Exercises III (Questions 1-10)

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    Here are the Answers to NCLEX Preparation Course - Critical Thinking III (1-10) -->

    1. The nurse performs assessment in a client. She correctly assesses tactile fremitus by:

    a) using the palm of the hands
    b) using the fingers
    c) using the heel of the hand
    d) using the thumb and fingers

    2. When giving health teachings on prevention of poisoning, which of the following is most effective practice?

    a) keep drugs on cupboard top
    b) keep drugs in a child protective cap container
    c) throw out old and unused drugs
    d) keep drugs in the kitchen cupboards

    3. A nurse is working in a long-term care facility. There is a clostridium difficile outbreak. Which of the following clients is at high risk?

    a) the client with peptic ulcer
    b) the client with cardiac disease
    c) the client with open wound who has tetanus toxoid
    d) the client with renal failure

    4. A woman wishes to see her husband's dead body, who died three hours ago. Which of the following is the most appropriate response by the nurse?

    a) I will ask permission from the health care provider
    b) I will come with you, if you want
    c) I am not allowed to give permission for viewing your husband's dead body
    d) I will ask the nursing assistant to go with you

    5. A nurse should be most concerned when MMR is given

    a) in a child who received immunoglobulin recently
    b) in a child who is 15 month old
    c) in a child who has 9 teeth
    d) in a child who has just started walking

    6. Which of the following patient should the nurse see first?

    a) the 40 year old client with fracture of the tibia and fibula
    b) the 30 year old female client with a fracture of the radius with oozing blood
    c) the 25 year old male client with a closed head injury with hematoma on the side of the neck
    d) the 45 year old female client with a fracture of the lumbar spine

    7. Which of the following is most important to assessed in a client with Addison's disease, who will undergo barium swallow?

    a) hydration
    b) blood pressure
    c) bowel habit
    d) temperature

    8. Which of the following is the best position for the client who had just undergone tonsillectomy and adenoidectomy?

    a) prone with pillow under the chest
    b) trendelenburg position
    c) supine position
    d) modified trendelenburg position

    9. A nurse is assessing a patient with chest tube. Which of the following observations is normal?

    a) continuous gentle bubbling in the water-seal chamber
    b) continuous gentle bubbling in the suction control chamber
    c) intermittent bubbling in the water-seal chamber
    d) absence of bubbling in the suction-control chamber

    10. Which of the following statement made by the client indicates an understanding on the use of anti-embolic stockings?

    a) I will remove the stockings before taking a bath
    b) I will remove the stockings and wear them again for 3 times a day
    c) I will wear the stockings before getting out of bed in the morning
    d) I will remove the stockings when lying in bed


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    NCLEX Secrets - Neurology Board Review (16-20)

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    NCLEX Secrets - Neurology Board Review

    16. Which of the following nursing interventions is best for a patient with Alzheimer's disease?

    a) providing an unstructured environment
    b) providing for an environment with less decision making
    c) providing for flexible environment
    d) providing for stimulating environment

    17. A patient with cerebellar impairment. Which of the following assessment is expected?

    a) ataxia
    b) apraxia
    c) agnosia
    d) agraphia

    18. The client has been diagnosed to have hypertension. Captopril (capoten), an angiotensin-converting-enzyme inhibitor was prescribed by the physician. When is the best time for the client to take the medication?

    a) one hour before meals
    b) with meals
    c) 30 minutes after meals
    d) at bedtime

    19. A nurse should be most concerned with a patient who had closed head injury if she assessed which of the following?

    a) glascow coma scale rating changes from 10 to 14
    b) pupil size changes from 7 mm to 5 mm
    c) blood pressure changes from 120/80 mmHg to 140/60 mmHg
    d) pulse rate changes from 90 per minute to 68 per minute

    20. The client who had cerebrovascular accident is in coma. He has an advance directive which states DNR (do not resuscitate). Which of the following statements by the wife indicates effective coping?

    a) I should have taken him to the hospital for regular check-up
    b) I want to be with him when he dies
    c) I wish, I'm not around when he draws his last breath
    d) I don't want him to suffer any longer




    NCLEX Secrets - Neurology Board Review:
    ANSWERS AND RATIONALE

    16) B
    - Alzheimer's disease is characterized by loss of memory or problem with ability to think. The client with this disease will benefit most in a simple, structured environment. (Structured /routine activities/schedule).

    17) A
    - cerebellum is responsible for balance/equilibrium.
    Ataxia - uncoordinated movement
    Apraxia - inability to perform fine motor activities
    Agnosia - inability to perceive sensory stimuli
    Agraphia - inability to write

    18) A
    - capoten is best taken on an empty stomach to promote adequate absorption.

    19) C
    - widening of pulse pressure (the difference between systolic pressure and diastolic pressure is more than 30 to 40 mmHg) is an indication of increased ICP. Always consider increase in ICP as emergency because it causes cerebral hypoxia.

    20) B
    - the wife exhibits acceptance with her husband's decision. Her presence when the husband is dying will provide great psychological support to him.


    Go to the next page ---> NCLEX Secrets - Neurology Board Review (21-25)  

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    NCLEX Review about Cardiac Nursing (11-15)

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    NCLEX Review about Cardiac Nursing

    11. Which of the following are non-modifiable risk factors for cardiovascular disorders?

    a) age and gender
    b) obesity and hypertension
    c) stress and smoking
    d) caffeine and alcohol

    12. Which of the following laboratory findings is expected in a patient with myocardial infarction?

    a) elevated troponin levels
    b) elevated SGPT (ALT) levels
    c) elevated LDH 2 levels
    d) elevated CK-MM levels

    13. Which of the following is a manifestation of negligence when a client with heart disease is in labor

    a) the client is in lithotomy position with her feet in stirrups
    b) the client's vital signs are monitored closely
    c) the client receives oxygen therapy through face mask
    d) the client has a patent IV access line

    14. The client had undergone cardiac catheterization using femoral artery. Which of the following should be included in the nursing care plan of the client?

    a) keep the affected leg immobile and in extended position for few hours
    b) apply warm compress at the puncture site
    c) allow the client to ambulate once vital signs are stable
    d) maintain NPO status until gag reflex returns

    15. After cardiac catheterization, the client experiences chest pain. Which of the following is the best initial nursing action?

    a) bring the patient back to the cardiac catheterization laboratory
    b) administer analgesic
    c) take an ECG
    d) assist the client to ambulate




    NCLEX Review about Cardiac Nursing:
    ANSWERS AND RATIONALE

    11) A
    - age and gender are non-modifiable or unavoidable risk factors for cardiovascular disorders. The other options are modifiable risk factors.

    12) A
    - elevated troponin levels are the best indicator of M.I. Troponin I of 1.5 mg/ml, Troponin T greater than 0.1 to 0.2 are supportive of MI.

    13) A
    - lithotomy position increases cardiac workload. The client should be placed in semi-fowler's position to decrease cardiac workload and promote oxygenation.

    14) A
    - after cardiac catheterization involving femoral artery, the affected leg should be kept immobile and in extended position for few hours. This is to prevent bleeding and to promote adequate circulation in the leg.

    15)
    - assessment is the first nursing action. ECG may reveal dysrhythmias which cause chest pain after cardiac catheterization. Gather adequate information before implementation.





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    NCLEX Secrets about Musculoskeletal Injuries (21-25)

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    NCLEX Secrets about Musculoskeletal Injuries

    21. Which of the following nursing interventions will best help alleviate the discomfort of the patient with rheumatoid arthritis?

    a) walking a mile each morning
    b) active range-of-motion exercises of joints
    c) application of hot or cold packs on the joints
    d) splinting the joint during waking hours

    22. Which of the following instructions should the nurse include when giving health teachings on prevention of crutch palsy?

    a) assuming a tripod position when using crutches
    b) bearing the weight on the palms of the hands and elbows
    c) bearing the weight on the axillae
    d) placing the crossbar of the crutches so that the elbows are extended

    23. Which of the following should be included when giving client teaching to an obese woman, whose height is 5 feet and 2 inches, on prevention of progression of osteoporosis?

    a) bed rest
    b) avoid sunlight
    c) weight-bearing exercises and weight reduction
    d) limit intake of milk and dairy products

    24. The best position for a child with myelomeningocele is

    a) prone
    b) supine
    c) semi-fowler's
    d) modified trendelenburg

    25. Which of the following complications does the nurse suspect when a client had fracture of the femur and is now experiencing respiratory distress?

    a) sepsis
    b) fat embolism
    c) bleeding
    d) shock






    NCLEX Secrets about Musculoskeletal Injuries
    ANSWERS AND RATIONALE

    21) C
    - during acute phase of pain, cold application is recommended. Cold numbs nerve endings and therefore, relieves pain. After the acute phase of pain, heat application is done. This thins the synovial fluid and relieves joint stiffness. Heat also improves circulation to the area, improves oxygen supply and will relieve pain.

    22) B
    - during crutch-walking, the weight of the body should be borne by the hands and elbows, not by the axillae to prevent crutch palsy.

    23) C
    - weight-bearing exercises promote calcium absorption in he bones. Weight reduction reduces strain at the cartilage of joints. These measures prevent progression of osteoporosis.

    24) A
    - prone position will prevent trauma to the sac at the lumbosacral area in a child with myelomeningocele.

    25) B
    - fat embolism is a common complication of fracture of the long bones, like fracture of the femur. Yellow marrow is released into the circulation and reaches the pulmonary circulation. Acute respiratory distress syndrome may occur.


    Go to the next page ---> NCLEX Secrets about Musculoskeletal Injuries (26-30)  

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    NCLEX Endocrine Questions (15-20)

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    NCLEX Endocrine Questions

    15. Which of the following should the nurse include in the discharge instructions to be given to a client on continuous insulin infusion through insulin pump?

    a) change needle site every 2 to 3 days
    b) check blood sugar level daily
    c) push button on the device to self-administer insulin after each meal
    d) the machine gives continuous small doses of insulin, so there is no need to check blood sugar levels

    16. A client with diabetes mellitus is self-administering NPH insulin from a vial kept at room temperature. The client asks a nurse about the length of time an unrefrigerated vial of insulin will remain its potency. The most appropriate response to the client is which of the following?

    a) two weeks
    b) one month
    c) two months
    d) six months

    17. Which of the following is the appropriate initial action by the nurse when preparing insulin administration?

    a) injecting air into the regular insulin
    b) withdrawing the cloudy insulin first before the clear insulin
    c) injecting air into the cloudy insulin but withdrawing the clear insulin first
    d) withdrawing the clear insulin and cloudy insulin in separate syringes

    18. The client with insulin-dependent diabetes mellitus (IDDM) has been brought to the emergency room. What should the nurse watch for if blood pH is 7.28

    a) lactic acidosis
    b) ketoacidosis
    c) metabolic alkalosis
    d) respiratory acidosis

    19. A client has been diagnosed to have Type II diabetes mellitus. She experiences hypoglycemia. After receiving a glass of orange juice, what should the nurse give next?

    a) peanut butter sandwich
    b) 1 tablespoon sugar
    c) 1 cup skim milk
    d) a cup chocolate drink

    20. Which of the following laboratory test best indicate compliance of the diabetic client and insulin therapy?

    a) 2-hour postprandial blood glucose
    b) fasting blood glucose
    c) glycosylated hemoglobin
    d) oral glucose tolerance test




    NCLEX Endocrine Questions:
    ANSWERS AND RATIONALE

    15) B
    - insulin lowers blood sugar levels. Insulin pump gives small doses of insulin continuously and the patient can bolus himself before each meal.

    16) B
    - insulin, when stored at room temperature is potent for 30 days (1 month).

    17) C
    - this action ensures prevention of contamination of the rapid-acting insulin. In case of emergency (DKA), rapid effect of the clear insulin is maintained. Injecting air into the cloudy insulin will promote easy aspiration of the medication, once the syringe already contains the clear insulin.

    18) B
    - ketoacidosis is characterized by low blood pH. Type I diabetic clients are prone to ketoacidosis.

    19) A
    - orange juice provides quick source of glucose; slices of bread provide sustained supply of glucose. This will be followed with skim milk as source of protein, to inhibit breakdown of fats. This in turn, prevents ketoacidosis.

    20) C
    - glycosylated hemoglobin (HbA1c) is the best indicator of diabetic control. It reflects blood glucose level for the past 3 to 4 months.


    Go to the next page ---> NCLEX Endocrine Questions (21-25)  

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    NCLEX Preparation Course - Critical Thinking Exercises II (Answers 11-20)

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    Here are the Questions to NCLEX Preparation Course - Critical Thinking II (11-20) -->

    11) A
    - hypertension may cause rupture of aneurysm. This leads to internal hemorrhage, shock, and finally death. Therefore this client should be given highest priority.

    12) C
    - remove gloves first to prevent contamination of the face, neck and other parts of the body before removing the other barriers.

    13) A
    - these signs and symptoms indicate alcohol withdrawal. The client is likely to experience alcohol withdrawal syndrome because he had abstained from alcohol from the time he had undergone surgery.

    14) A
    - serum potassium of 3.1 mEq/L indicates hypokalemia, which is a common side effect of potassium-wasting diuretic. The normal serum potassium level is 3.5 to 5.5 mEq/L

    15) A
    - only RN's are allowed to deal with clients receiving narcotic through PCA device. This client requires assessment and evaluation. (B, C and D may be delegated).

    16) B
    - regular pattern of sleep and waking time will most likely promote sleep. Hot tea is a stimulant; taking naps should be avoided so that the client can sleep during the night. To be able to sleep, the client should go to bed only when sleepy.

    17) B
    - a client with problem on breathing should be given highest priority (Principle: ABC's are given highest priority)

    18) D
    - Mormons do not drink alcohol, coffee, or tea. Adult Mormons practice fasting every first Sunday of the week.

    19) C
    -CNA's are not allowed to deal with nasogastric tubes. The LVN should be the one to clamp the NGT.

    20) C
    - this client may go into hypertensive crisis, that may increase the risk for hemorrhagic CVA. The client whose condition may pose life-threatening problem should be given highest priority. (Note: if an intervention to a problem does not achieve an expected outcome, this situation is a priority).


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    NCLEX Review about Gastrointestinal Discomfort 9-15

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    NCLEX Review about Gastrointestinal Discomfort

    9. What diet should the nurse recommend for a child with celiac disease?

    a) wheat and oats
    b) rice and corn
    c) cookies and ice cream
    d) pasta and noodles

    10. Which of the following foods should not be included in the diet of the client with diverticulitis?

    a) rice and steamed chicken
    b) tomato and cucumber
    c) pasta and orange slices
    d) roasted turkey and spaghetti

    11. A client had undergone gastric resection. Which of the following is not to be included in the nursing care plan for the client to prevent dumping syndrome?

    a) small, frequent feeding
    b) high protein, low carbohydrate diet
    c) lying down after meals
    d) taking fluids with meals

    12. When is the best time to administer sucralfate?

    a) one hour before meals
    b) 30 minutes after meals
    c) with meals
    d) 2 hours after meals

    13. Which of the following should the nurse include when giving health teachings in a client with gastroesophageal reflux?

    a) lie down after meals
    b) sleep with the head of bed elevated
    c) eat high carbohydrate diet
    d) eat low protein diet

    14. Which of the following should the nurse advise to a client who had undergone partial gastrectomy?

    a) drink fluid with meals
    b) lie down after meals
    c) increase fats in the diet
    d) assume upright position during and after meals

    15. Which of the following statements when made by the mother of a child with celiac disease indicates that she understands the diet of her child?

    a) my child can eat rice
    b) my child can eat oats
    c) my child can eat biscuits
    d) my child can eat pasta




    NCLEX REVIEW ABOUT GASTROINTESTINAL DISCOMFORT:
    ANSWERS AND RATIONALE

    9) B
    - gluten-free diet is recommended for children with celiac disease. Rice and corn are allowed in the child's diet. Avoid foods that contain barley, rye, oats and wheat.

    10) B
    - foods with seeds like tomato and cucumber should be avoided by the patient with diverticulitis because the seeds may be trapped in the outpouchings.

    11) D
    - to prevent dumping syndrome, measures that slow down gastric emptying should be practiced. Fluids should be taken after meals, not with meals.

    12) A
    - sucralfate is a cytoprotective drug. To coat the ulcer, it should be given on empty stomach.

    13) B
    - the head of bed should be elevated during sleep to prevent gastroesophageal reflux.

    14) B
    - after partial gastrectomy, dumping syndrome may occur . Lying down after meals will inhibit rapid emptying of gastric content.

    15) A
    - celiac disease is gluten-sensitivity enteropathy. The client's diet should be gluten-free. Avoid foods from BROW (barley, rye, oats and wheat). Rice and corn are allowed.


    Go to the next page ---> NCLEX Review about Gastrointestinal Discomfort 16-20  

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    Test Prep for Nursing Exam about Pediatric Nursing (11-15)

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    11. How does the nurse appropriately administer mycostatin suspension in an infant?

    a) have the infant drink water, and then administer mycostatin in a syringe
    b) place mycostatin on the nipple of the feeding bottle and have the infant suck it
    c) mix mycostatin with formula
    d) swab mycostatin on the affected areas

    12. Which of the following actions should concern the nurse most, about a newborn with petechiae delivered 3 hours ago

    a) whether vit. K injection was administered
    b) whether eye drops had been instilled
    c) whether feeding had been started
    d) whether IV fluid had been given

    13. Which of the following signs and symptoms in a newborn indicates syphilis?

    a) diarrhea, vomiting
    b) absent reflex
    c) palmar rash
    d) respiratory distress

    14. What assessment tool would the nurse use first on a sleeping infant?

    a) palpation
    b) percussion
    c) observing the infant as he inhales and exhales
    d) auscultation

    15. Which of the following is the best therapeutic diversional activity for 7-year old client confined in the hospital?

    a) playing checkers with the nurse
    b) watching video
    c) listening to radio
    d) talking over the telephone with friends



    ANSWERS AND RATIONALE

    11) D
    - mycostatin suspension is given as swab. Never mix medications with food and formula.

    12) A
    - petechiae is a sign of bleeding. Vit. K will stop bleeding because it promotes synthesis of prothrombin and other clotting factors. In the absence of bacterial flora in the colon. Vit. K cannot be absorbed. Bacteria in the colon will be present once the child had taken milk.

    13) C
    - palmar rash is a characteristic manifestation of syphilis in an newborn.

    14) C
    - observe infant's respiration first, before touching him. When crying occurs, respiration can't be observed accurately.

    15) B
    - watching video is appropriate for a 7-year old patient. Playing checkers with the nurse is appropriate for an adult client. Listening to radio and talking over the telephone with friends are appropriate for adolescents.


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    NCLEX Preparation Course - Critical Thinking Exercises II (Questions 11-20)

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    Here are the Answers to NCLEX Preparation Course - Critical Thinking II (11-20) -->

    11. After making your nursing rounds, who among the following patients should you refer to the physician first?

    a) a patient with abdominal aneurysm who has blood pressure of 154/96 mmHg
    b) a diabetic patient with blood glucose level of 265 mg/dL
    c) a patient with renal failure whose serum potassium level is 3.4 mEq/L
    d) a client with 18% first and second degree burns in the different parts of body, whose urine output is 35 ml/hour

    12. Which of the following is a correct aseptic technique when caring for a clients with communicable diseases?

    a) wear gown, mask and gloves in all clients with communicable diseases
    b) wear double gown to ensure protection
    c) remove gloves before removing gown
    d) remove gown first, then gloves

    13. A patient was admitted 24 hours ago. Pyloroplasty was done to him 4 hours ago. He is observed by the nurse to have elevated blood pressure, increased pulse rate, tremors, and anxiety. What is more likely the cause of these manifestations?

    a) alcohol withdrawal syndrome
    b) dumping syndrome
    c) postoperative hemorrhage
    d) congestive heart failure

    14. Which of the following laboratory values should you monitor for a client on loop diuretic therapy?

    a) serum potassium of 3.1 mEq/L
    b) serum sodium of 135 mEq/L
    c) serum magnesium of 2 mEq/L
    d) serum calcium of 5 mEq/L

    15. Who among these patients should the charge nurse delegate to the registered nurse?

    a) patient on morphine sulfate administration through patient-controlled analgesia device
    b) patient in insulin
    c) patient with abdominal dressings change
    d) patient for nasogastric tube feeding

    16. Which of the following measures best promotes sleep in a client with insomnia?

    a) offering hot tea to the client at bedtime
    b) waking up same time everyday
    c) taking a 20-minute nap during the day
    d) going to bed an hour earlier before the usual bed time

    17. Who among these clients do you attend first during a disaster?

    a) a 45-year old who is complaining of nausea
    b) a 20-year old who has a chest wound and is complaining of pain on inspiration
    c) a 10-year old with laceration in the head and face with open fracture on the right arm and is bleeding
    d) a 22-year old with open fracture on the right arm and is bleeding


    18. Which of the following is a practice of the client who is a member of the Church of the Latter Day Saints (Mormon).

    a) does not drink milk when eating meat
    b) does not eat scavenger fish
    c) does not dairy products
    d) does not drink coffee or tea

    19. A licensed vocational nurse (LVN) and a certified nursing assistant (CNA) are to be assigned to patients. Which patient is an appropriate assignment for the LVN?

    a) a patient who needs his meal tray to be set
    b) a patient who has asthma for vital sign taking
    c) a patient requiring his NGT to be clamped before ambulating
    d) a patient who will have fleet enema

    20. A home health nurse needs to make return calls to some patients. Who among these patients should the nurse make a return call first?

    a) a patient complaining of abdominal pain
    b) a patient who said that her husband confessed that he has been infected with hepatitis B
    c) a patient whose blood pressure is still elevated even after taking anti hypertensive
    d) a patient who said that her ankle is swollen because she had slipped on the floor one day ago


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    NCLEX Preparation Course - Critical Thinking Exercises II (Answers 1-10)

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    Here are the Questions to NCLEX Preparation Course - Critical Thinking II (1-10) -->

    1) D
    - hypermagnesemia inhibits/reduces acetylcholine release, causing decrease in neuromuscular irritability as manifested by loss of deep tendon reflexes.

    2) B
    - a client will develop hepatitis D only when he/she has hepatitis B

    3) C
    - Hindus are vegetarians.

    4) C
    - use the principle of ABC when setting priorities for caring clients. (The client with problem in Airway, Breathing, and Circulation are at highest risk for morbidity and mortality).

    5) D
    - the client should be able to chew, before giving solid foods. Presence of bowel sounds was assessed before full liquid diet was initiated.

    6) B
    - numbness in the leg with cast indicates that the cast is too tight. This causes circulatory impairment. Among the 4 clients given, this is the client with most immediate danger because tissue hypoxia may lead to necrosis and gangrene formation.

    7) A, C, D, and E
    - peripheral venous access does not require surgical mask and sutures.

    8) C
    - NEVER recap needles to prevent needle stab. Use leak-proof, puncture-proof needle/sharp containers for, not the ordinary trash can.

    9) A, B, C, E
    - sickle cell crisis may be precipitated by: dehydration, hypoxia, fever and stress. Warm application is used to relieve joints pain in sickle cell crisis, not cold application.

    10) C
    - explore feelings. Allow the client to verbalize feelings, fears and concerns.


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    NCLEX Secrets - Neurology Board Review (11-15)

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    NCLEX Secrets - Neurology Board Review

    11. The nurse test for the function of abducens nerve in a client. Which of the following is appropriate nursing action?

    a) have the client push his arm against a resistance
    b) have the client shrug his shoulders
    c) have the client turn his eyes from right to left
    d) have the client smile and frown

    12. Which of the following should the nurse include in the health teachings for the family of a child with meningitis?

    a) meningitis can be prevented by influenza vaccine
    b) meningitis does not pose danger to the family
    c) meningitis can be transferred by droplet
    d) meningitis is always fatal

    13. A patient with cerebrovascular accident is experiencing dysphagia. Which of the following is appropriately included in the diet?

    a) broth
    b) chocolate milk
    c) canned tuna
    d) steamed pork chop

    14. How does the nurse test for cranial nerve VI?

    a) asking the patient to close his eyes
    b) testing the pupillary reflexes using a penlight
    c) asking the patient to read with the use of Snellen chart
    d) with the use of penlight, move it different directions and ask the patient to follow it with his eyes

    15. Which diagnostic test will be routine or regular for a patient with multiple sclerosis?

    a) pulmonary function test
    b) CT scan
    c) ECG
    d) myelography




    NCLEX Secrets - Neurology Board Review:
    ANSWERS AND RATIONALE

    11) C
    - the abducens innervate the lateral rectus muscles of the eyes. These muscles move the eyes from side to side (right <-> left).

    12) C
    - meningococcal infection is readily transmitted by droplet infection from nasopharyngeal secretions.

    13) B
    - thickened liquid diet like chocolate milk or pureed foods are best tolerated by clients with dysphagia

    14)D
    - the CN VI (abducens) innervates the lateral rectus muscles of the eyes. These muscles move the eyes from side to side.

    15) A
    - multiple sclerosis may lead to weakness/paralysis of respiratory muscles. Assessment of pulmonary functions is necessary.


    Go to the next page ---> NCLEX Secrets - Neurology Board Review (16-20)  

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    NCLEX Preparation Course - Critical Thinking Exercises II (Questions 1-10)

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    Here are the Answers to NCLEX Preparation Course - Critical Thinking II (1-10) -->

    1. A nurse is caring for a client whose magnesium level is 3.8 mEq/L. On the basis of this magnesium level, which assessment sign or symptom would the nurse most likely expect to note?

    a) tetany
    b) twiches
    c) positive Trousseau's sign
    d) loss of deep tendon reflexes

    2. Who among the following persons is at risk for hepatitis D?

    a) a person who traveled recently to a country with poor socio-economic conditions
    b) a person who was recently diagnosed for hepatitis B
    c) a person who loves to eat raw foods
    d) a person exposed to a client with hepatitis A

    3. A nurse attended a seminar about values. Which of the following is a correct information?

    a) roman catholic aged 10 years and above do not eat meat on Fridays
    b) Islams do not drink milk
    c) Hindus do not eat meat
    d) Jehovah's witnesses have a special preparation for meat

    4. As a nurse, you have been called to respond at an accident scene. Who among the following victims would you see first?

    a) a patient with fractured arm
    b) a patient with bleeding scalp
    c) a patient who is breathing rapidly
    d) a patient with fracture of the lumbar spine

    5. An elderly postoperative client has been tolerating a full-liquid diet, and a nurse plans to advance the diet to solid food as prescribed. Which assessment is most important for the nurse to make before advancing the diet to solids?

    a) presence of bowel sounds
    b) food preferences
    c) cultural preferences
    d) ability to chew

    6. As a home health care nurse, you will make a home visit to several clients. Who among the following clients should you see first?

    a) an insulin-dependent diabetic client with blood glucose of 365 mg/dl
    b) a client in long-leg cast complaining of numbness
    c) a terminally-ill client with respiratory rate of 14 per minute
    d) a post-cerebrovascular accident client complaining of headache

    7. Which of the following equipment would you prepare for peripheral venous access? Choose all that apply?

    a) sterile glove
    b) surgical mask
    c) tourniquet
    d) alcohols swabs
    e) container for disposing sharps
    f) sutures

    8. Which of the following is not a safe nursing action when handling blood products?

    a) wear gloves, gown, and goggles
    b) discard sharps in leak-proof, puncture-proof containers
    c) recap needles before discarding them in the trash can found in the client's room
    d) wash hands before and after removing the gloves

    9.Which of the following statements are correct about sickle cell crisis? Check all that apply

    a) experiences pain in joints, back, and head
    b) needs intravenous fluid infusion and hydration
    c) usually precipitated by hypoxia
    d) joint pain is best relieved by cold application
    e) may be precipitated by fever
    f) needs strict isolation

    10. A male nurse is caring for a client. The client states, "You know, I've never had a male nurse before." The nurse's best reply would be

    a) does it bother you to have a male nurse?
    b) there aren't many of us, we're a minority
    c) how do you feel about having a male nurse
    d) you sound upset. Would you prefer a female nurse?

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    NCLEX Secrets about Musculoskeletal Injuries (14-20)

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    NCLEX Secrets about Musculoskeletal Injuries

    14. The nurse should include which of the following client teachings for prevention of rapid progression of osteoporosis?

    a) avoid taking skim milk
    b) avoid taking protein-rich foods
    c) avoid calcium supplement
    d) avoid alcohol

    15. A client is brought to the emergency room with compound femur fracture. What is the first action the emergency room nurse should do?

    a) cover the open wound
    b) check the clients blood pressure
    c) assess the client's neurologic status
    d) prepare the client for X-ray

    16. A 3-year old in Bryant's traction is with foot foam. You found the child pulling out the foot foam. What is your most appropriate nursing action?

    a) remove the foot foam and assess the area
    b) reapply the foot foam at once
    c) call another nurse to maintain traction as you reapply the foot foam
    d) tell the child to stop removing the foot foam

    17. How do you position a client with left hip fracture in Buck's traction?

    a) head of bed raised at 45 degree angle
    b) left calf on pillow from knee to ankle
    c) position the left on affected side with pillows between legs
    d) position the left in the center of the bed with the leg extended

    18. A patient had hip surgery. On the second post-op day, the patient is agitated, is tremulous and confused. What should the nurse primarily assess?

    a) the surgical wound
    b) alcohol use before surgery
    c) peripheral circulation
    d) breathing pattern

    19. A nurse is conducting a health screening among females at the mall to assess those who are at risk for developing osteoporosis. Which of the following questions is most appropriate to be asked by the nurse in relation to development of osteoporosis?

    a) at what age did you have your menstruation?
    b) did you have any fracture?
    c) are you taking corticosteroids?
    d) are you on the diet high in vitamin D?

    20. Which of the following will contribute to the development of primary gout?

    a) beer and wine
    b) eggs and milk
    c) vegetables and meat
    d) butter and fruits




    NCLEX Secrets about Musculoskeletal Injuries:
    ANSWERS AND RATIONALE

    14) D
    - avoiding alcohol and cigarette smoking will prevent rapid progression of osteoporosis. Skim milk is indicated among elderly because it is low in fats. Protein foods are necessary for calcium absorption. Calcium supplements help maintain integrity of the bones.

    15) B
    - compound fracture of the femur may cause severe internal bleeding. Internal bleeding is characterized by hypotension.

    16) C
    - maintain the traction as the foot foam is reapplied.

    17) B
    - elevate the leg with pillow to relieve pressure from the heel of the foot and to improve the effectiveness of the countertraction.

    18) B
    - the client's sign and symptoms indicate alcohol withdrawal.

    19) C
    - corticosteroids promote calcium loss. This increases the risk for osteoporosis.

    20) A
    - beer and wine are purine-rich beverages. Gout is a metabolic disorder of purine. Other foods rich in purine are: organ meats, legumes, salted anchovies, shellfish, mushroom, sweetbreads, consomme, hearing fish.




    Go to the next page ---> NCLEX Secrets about Musculoskeletal Injuries (21-25)  

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    Online Nursing Practice Test about Renal Disorders (12-15)

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    12. The client for intermittent self-catheterization is concerned with the cost of materials for the procedure. Which of the following is the most appropriate response by the nurse?

    a) I will refer you to social welfare department
    b) you should be more concerned with your health rather than the cost of materials
    c) the materials can be reused if properly cleaned and safely kept
    d) you better discuss your concern with your primary health care provider

    13. A client has been diagnosed to have chronic renal failure. Sodium polysterene sulfonate (exchange resin kayexalate) is prescribed. The action of the medication is that it releases

    a) bicarbonate in exchange for primarily sodium ions
    b) sodium ions in exchange for primarily bicarbonate ions
    c) sodium ions in exchange for primarily potassium ions
    d) potassium ions in exchange for primarily sodium ions

    14. Which of the following problems is expected in a client who is in end-stage renal failure?

    a) anemia
    b) thalassemia
    c) renal calculi
    d) hypotension

    15. Which of the following client responses shows a correct understanding of continuous ambulatory peritoneal dialysis (CAPD)?

    a) I am expected to perform the procedure at home
    b) the procedure lasts for one hour
    c) I have to sit and raise my legs during the procedure
    d) I have to go to the hospital for this procedure


    ANSWERS AND RATIONALE

    12) C
    - intermittent self-catheterization involves clean technique. The client should wash the catheter with warm soapy water. This catheter can be used repeatedly.

    13) C
    - as sodium is released from exchange resin kayexalate, potassium ions will be excreted. This will lower serum potassium levels.

    14) A
    - the damaged kidney are unable to secrete erythropoietin adequately. There is decreased production of RBC in the bone marrow which leads to severe anemia.

    15) A
    - CAPD is done by the client.


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    NCLEX Review about Cardiac Nursing (6-10)

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    NCLEX Review about Cardiac Nursing

    6. The client undergone cardiac catheterization. His blanket is soaked with blood. What is the best initial nursing action?

    a) notify the physician
    b) monitor vital signs
    c) assess where the site of bleeding is, and apply pressure on that site
    d) transport the client back to the cardiac catheterization laboratory

    7. A client with heart disease is on low-fat diet. A nurse evaluates that the client understands the diet if the client states that a food item to avoid is:

    a) plums
    b) cherries
    c) avocado
    d) peaches

    8. Which of the following best shows effective coping of the client after myocardial infarction?

    a) the patient plans to return to work in 2 to 3 days
    b) the patient ask her husband to bathe and dress her
    c) the patient states that she needs to commit to lifelong lifestyle changes

    9. A client complains of chest pain. What should be the nurse,s priority action?

    a) check vital signs
    b) notify physician
    c) let the client lie down and check if the pain is relieved by rest
    d) administer sublingual nitroglycerine

    10. Which of the following assessment data are the usual manifestations of a client with mitral valve stenosis?

    a) dependent edema
    b) dyspnea on exertion and fatigue
    c) distended neck vein
    d) enlarged liver




    NCLEX Review about Cardiac Nursing:
    ANSWERS AND RATIONALE

    6) C
    - puncture site for catheter insertion may be in the brachial or femoral vein/artery. In case of bleeding, the initial nursing action is to assess and apply pressure to the site.

    7) C

    8) D
    - the client accepts that a lifestyle change is lifetime. This is to promote health and well-being of the person.
    - avocado is high in fats

    9) A
    - gather additional information about the client's condition first. Next action is to notify the physician. (Assessment is done before implementation).

    10) B
    - mitral valve stenosis leads to left-sided heart failure. This produces pulmonary manifestations ("left lung"). Left heart affectation results to lung manifestations like dyspnea on exertion.

    Go tho the next page ---> NCLEX Review about Cardiac Nursing (11-15)  

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    NCLEX Preparation Course - Critical Thinking Exercises I (Questions 31-40)

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    Here are the Answers to NCLEX Preparation Course - Critical thinking I (31-40) -->

    31. If a nurse finds a client unresponsive, her most appropriate next nursing action is:

    a) provide rescue breathing
    b) open airway
    c) start cardiac compression
    d) check the carotid pulse

    32. The charge nurse has a registered nurse (RN) and licensed vocational nurse (LVN) in her team. Who among these clients should the charge nurse assign to the RN?

    a) the client for colostomy irrigation
    b) the client for cleansing of diabetic gangrene
    c) the client who requires change of dressing
    d) the client who needs reinforcement of predischarge teaching

    33. Who among these patients should the nurse prepare for interdisciplinary treatment?

    a) an AIDS patient in a long-term care facility
    b) a post-partum diabetic patient for home health care
    c) a post-operative patient in a surgical unit
    d) a patient admitted for pneumonia

    34. Echinacea has which of the following actions?

    a) immune enhancer
    b) relieves migraine headache
    c) relieves menstrual cramps
    d) lowers cholesterol and triglyceride levels

    35. Arterial blood gases are drawn while the client is breathing room air. The results are as follows. pH=7.32; paO2=70mmHg; paCO2=60mmHg. What conclusion does the nurse safely make from these findings?

    a) the patient is metabolic acidosis
    b) the patient is respiratory acidosis
    c) the patient is metabolic alkalosis
    d) the patient is respiratory alkalosis

    36. The nurse is taking care of a patient immediately before surgery. Before giving the preoperative medications, which of the following actions has the highest priority during this time?

    a) allowing the patient to wear his dentures to surgery
    b) giving the patient gum to moisten his mouth
    c) taping the patient's ring to his fingers
    d) having the patient void before going to surgery

    37. Three hours post-tonsillectomy, a patient vomits 300 ml brown emesis. Which action is priority for the nurse to take?

    a) continue to monitor the patient
    b) document the amount and color of the emesis
    c) report the emesis to the doctor
    d) administer an antiemetic as ordered

    38. Following surgery for a total laryngectomy, the patient tells the nurse that his sense of smell seems to have been altered. Which of these responses by the nurse will be best initially?

    a) your sense of smell will return after your stoma heals
    b) your sense of smell will return after your oxygen is removed
    c) breathing through a stoma has altered your sense of smell
    d) as your appetite returns, your sense of smell will also return

    39. The client has been diagnosed to have SIADH. Which of the following signs and symptoms of the client should be given highest priority by the nurse?

    a) serum Na level is 120 mEq/L
    b) serum K level is 4.8 mEq/L
    c) serum Mg level is 1.8 mEq/L
    d) serum Ca level is 5 mEq/L

    40. The nurse finds himself feeling angry with a patient. Which of these actions by the nurse is most appropriate?

    a) tell the nurse manager to assign the patient to another staff member
    b) suppress the angry feelings
    c) express the anger openly
    d) discuss the anger with a clinician during a supervision session


    To strengthen your knowledge about this topic, we recommend the Online Nursing Classes Fundamentals E-Book


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