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00_0789737043_fm.qxd 10/31/07 11:53 AM Page i NCLEX-RN ® Practice Questions Second Edition Wilda Rinehart...

00_0789737043_fm.qxd 10/31/07 11:53 AM Page i NCLEX-RN ® Practice Questions Second Edition Wilda Rinehart Diann Sloan Clara Hurd 00_0789737043_fm.qxd 10/31/07 11:53 AM Page ii NCLEX-RN® Practice Questions Associate Publisher Second Edition David Dusthimer Copyright © 2008 by Pearson Education, Inc. Acquisitions Editor All rights reserved. No part of this book shall be reproduced, stored in a Betsy Brown retrieval system, or transmitted by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from Senior Development Editor the publisher. No patent liability is assumed with respect to the use of the Christopher Cleveland information contained herein. Although every precaution has been taken in the preparation of this book, the publisher and author assume no Managing Editor responsibility for errors or omissions. Nor is any liability assumed for damages resulting from the use of the information contained herein. Patrick Kanouse ISBN-13: 978-07897-3704-5 Senior Project Editor ISBN-10: 0-7897-3704-3 San Dee Phillips Library of Congress Cataloging-in-Publication Data Rinehart, Wilda. Technical Editor NCLEX-RN practice questions / Wilda Rinehart, Diann Sloan, Clara Dr. Catherine Dearman Hurd. -- 2nd ed. Publishing Coordinator p. ; cm. Vanessa Evans ISBN-13: 978-0-7897-3704-5 (pbk. w/CD) ISBN-10: 0-7897-3704-3 (pbk. w/CD) Multimedia Developer 1. Nursing--Examinations, questions, etc. 2. National Council Licensure Dan Scherf Examination for Registered Nurses--Study guides. I. Sloan, Diann. II. Hurd, Clara. III. Title. Book Designer [DNLM: 1. Nursing--Examination Questions. WY 18.2 R579n 2008] Gary Adair RT55.R565 2008 Page Layout 610.73076--dc22 TnT Design, Inc. 2007042132 Printed in the United States of America First Printing: December 2007 Trademarks All terms mentioned in this book that are known to be trademarks or serv- ice marks have been appropriately capitalized. Que Publishing cannot attest to the accuracy of this information. Use of a term in this book should not be regarded as affecting the validity of any trademark or service mark. NCLEX-RN is a registered trademark of the National Council of State Boards of Nursing, Inc. (NCSBN), which does not sponsor or endorse this product. Warning and Disclaimer Every effort has been made to make this book as complete and as accu- rate as possible, but no warranty or fitness is implied. The information provided is on an “as is” basis. The authors and the publisher shall have neither liability nor responsibility to any person or entity with respect to any loss or damages arising from the information contained in this book or from the use of the CD or programs accompanying it. Bulk Sales Que Publishing offers excellent discounts on this book when ordered in quantity for bulk purchases or special sales. For more information, please contact U.S. Corporate and Government Sales 1-800-382-3419 [email protected] For sales outside the U.S., please contact International Sales [email protected] 00_0789737043_fm.qxd 10/31/07 11:53 AM Page iii 00_0789737043_fm.qxd 10/31/07 11:53 AM Page iv 00_0789737043_fm.qxd 10/31/07 11:53 AM Page v Contents at a Glance Introduction xv CHAPTER 1 Practice Exam 1 and Rationales 1 CHAPTER 2 Practice Exam 2 and Rationales 81 CHAPTER 3 Practice Exam 3 and Rationales 159 CHAPTER 4 Practice Exam 4 and Rationales 241 CHAPTER 5 Practice Exam 5 and Rationales 323 APPENDIX A What’s on the CD-ROM? 403 APPENDIX B Need to Know More? 407 APPENDIX C Alphabetical Listing of Nursing Boards in the United States and Protectorates 415 00_0789737043_fm.qxd 10/31/07 11:53 AM Page vi 00_0789737043_fm.qxd 10/31/07 11:53 AM Page vii Table of Contents Introduction..................................................................................xv Chapter 1 Practice Exam 1 and Rationales...........................................................1 Quick Check Answer Key 52 Answers and Rationales 55 Chapter 2 Practice Exam 2 and Rationales.........................................................81 Quick Check Answer Key 131 Answers and Rationales 134 Chapter 3 Practice Exam 3 and Rationales......................................................159 Quick Check Answer Key 212 Answers and Rationales 215 Chapter 4 Practice Exam 4 and Rationales........................................................241 Quick Check Answer Key 292 Answers and Rationales 295 Chapter 5 Practice Exam 5 and Rationales........................................................323 Quick Check Answer Key 376 Answers and Rationales 379 00_0789737043_fm.qxd 10/31/07 11:53 AM Page viii viii Table of Contents Appendix A What’s on the CD-ROM?.................................................................403 The CramMaster Engine 403 Multiple Test Modes 403 Pretest Mode 403 Adaptive Drill Mode 404 Simulated Exam Mode 404 Installing CramMaster for the NCLEX-RN® Exam 404 Using CramMaster for the NCLEX-RN® Exam 405 Customer Support 405 Appendix B Need to Know More?.....................................................................407 The National Council Exam for Licensed Practical Nurses 407 Pharmacology 407 The Respiratory System 407 The Renal and Genitourinary System 408 The Hematopoietic System 408 Fluid and Electrolyte Balance and Acid/Base Balance 409 Burns 409 Sensorineural Disorders 410 Cancer 410 The Gastrointestinal System 411 The Musculoskeletal System 411 The Endocrine System 412 The Cardiovascular System 413 The Neurological System 413 Psychiatric Disorders 414 Maternal/Infant 414 Pediatrics 414 Cultural Practices Influencing Nursing Care 414 Legal Issues in Nursing Practice 414 Appendix C Alphabetical Listing of Nursing Boards in the United States and Protectorates.........................................................................415 00_0789737043_fm.qxd 10/31/07 11:53 AM Page ix About the Authors Wilda Rinehart received her associate degree in nursing from Northeast Mississippi Community College in Booneville, Mississippi. After working as a staff nurse and charge nurse, she became a public health nurse and served in that capacity for a number of years. In 1975, she received her Nurse Practitioner Certification in obstetric-gynecology from the University of Mississippi Medical Center in Jackson, Mississippi. In 1979, she completed her bachelor of science degree in nursing from Mississippi University for Women and the following year completed her master’s degree in nursing from the same university. In 1980, Ms. Rinehart accepted a faculty position at Northeast Mississippi Community College where she taught medical- surgical nursing and obstetrical nursing. In 1982, she founded Rinehart and Associates Educational Consults. For the past 22 years, she and her associ- ates have worked with nursing graduates and schools of nursing to assist graduates to pass the National Council Licensure Exam for Nursing. She has also worked with faculty who want to improve their item writing skills and as a curriculum consultant. Ms. Rinehart has served as a convention speaker throughout the southeastern United States and as a reviewer of medical- surgical and obstetric texts. She has coauthored NCLEX review materials and is presently working on DVD and CD review programs. As president of Rinehart and Associates, she serves as coordinator of a company dedicated to improving the quality of health through nursing education. Dr. Diann Sloan holds an associate degree in nursing from Northeast Mississippi Community College, a bachelor’s degree in nursing from the University of Mississippi, and a master’s degree in nursing from Mississippi University for Women. In addition to her nursing degrees, she holds a mas- ter of science in education degree in counseling psychology from Georgia State University and a doctor of philosophy degree in counselor education. She has minors in both psychology and educational psychology, from Mississippi State University. She has completed additional graduate studies in healthcare administration at Western New England College and the University of Mississippi. As a nurse educator, Dr. Sloan has taught pediatric nursing, psychiatric men- tal health nursing, and medical surgical nursing in both associate degree and 00_0789737043_fm.qxd 10/31/07 11:53 AM Page x x About the Authors baccalaureate nursing programs. As a member of Rinehart and Associates Nursing Review, Dr. Sloan has conducted test construction workshops for faculty and nursing review seminars for both registered and practical nurse graduates. She has coauthored materials used in the item writing workshops for nursing faculty and Rinehart and Associates Nursing Review. She is a member of Sigma Theta Tau nursing honor society. Clara Hurd is an associate degree nurse graduate of Northeast Mississippi Community College in Booneville, Mississippi (1975). Her experiences in nursing are clinically based, having served as a staff nurse in medical-surgical nursing. She has worked as an oncology, intensive care, orthopedics, neuro- logical, and pediatric nurse. She received her bachelor of science degree in nursing from the University of North Alabama in Florence, Alabama, and her master’s degree in nursing from the Mississippi University for Women in Columbus, Mississippi. She is currently serving as a nurse educator at North- east Mississippi Community College teaching medical-surgical content. Ms. Hurd has taught in both associate degree and baccalaureate nursing programs. She was a faculty member of Mississippi University for Women; Austin Peay State University in Clarksville, Tennessee; and Tennessee State University in Nashville, Tennessee. Ms. Hurd joined Rinehart and Associates in 1993. She has worked with students in preparing for the National Council Licensure Exam and with faculty as a consultant in writing test items. Ms. Hurd has also been a presenter at nursing conventions on various top- ics, including item writing for nursing faculty. Her primary professional goal is to prepare the student and graduate for excellence in the delivery of healthcare. 00_0789737043_fm.qxd 10/31/07 11:53 AM Page xi About the Authors xi Contributing Authors Tammy R. Owens, MSN, RN. Master of Science in Nursing, University of Phoenix Online. Associate degree in Nursing, Paducah Kentucky. Tammy is an assistant professor of nursing at Western Kentucky Community and Technical College in Paducah, Kentucky. Michael W. Rager, MSN, RN. Master of Science in Nursing, University of Southern Indiana. Michael is an assistant professor at Madisonville Community College, a school within West Kentucky Community and Technical College in Paducah, Kentucky. Susan Taylor, MSN, RN. Master of Science in Nursing, University of Evansville; Bachelor of Science in Nursing, Murray State University. Susan is an assistant professor of nursing at Western Kentucky and Technical College in Paducah, Kentucky. Rhonda Payne, MSN, RN. Master of Science in Nursing, University of Alabama Mobile; Bachelor of Science in Nursing, Medical College of Georgia. Rhonda is an assistant professor of nursing at Bainbridge College of Nursing in Bainbridge, Georgia. Linda A. Brown, MSN, RN. Master of Science in Nursing, Seattle Pacific University; Bachelor of Science in Nursing, University of Washington. Linda is a professor of nursing at Southwest Georgia Technical College in Thomasville, Georgia. Rhonda Lansdell, MSN, RN, EdD., University of Mississippi; Higher Education Administration and Student Personnel, Master of Science in Nursing, University of Alabama, Birmingham; Bachelor of Science in Nursing, University of North Alabama. Rhonda is a professor of nursing at Northeast Mississippi Community College in Booneville, Mississippi. Rosemary Marecle, MSN, RN. Master of Science in Nursing, University of Mississippi Medical Center College of Nursing; Bachelor of Science in Nursing, University of Alabama, Huntsville. Rosemary is a professor of nurs- ing at Northeast Mississippi Community College in Booneville, Mississippi. 00_0789737043_fm.qxd 10/31/07 11:53 AM Page xii Dedication We would like to thank our families for tolerating our late nights and long hours. Also, thanks to Gene Sloan for his help without pay. Special thanks to all the graduates who have attended Rinehart and Associates Review Seminars. Thanks for allowing us to be a part of your success. 00_0789737043_fm.qxd 10/31/07 11:53 AM Page xiii We Want to Hear from You! As the reader of this book, you are our most important critic and commenta- tor. We value your opinion and want to know what we’re doing right, what we could do better, what areas you’d like to see us publish in, and any other words of wisdom you’re willing to pass our way. As an associate publisher for Que Publishing, I welcome your comments. You can email or write me directly to let me know what you did or didn’t like about this book—as well as what we can do to make our books better. Please note that I cannot help you with technical problems related to the topic of this book. We do have a User Services group, however, where I will forward specific tech- nical questions related to the book. When you write, please be sure to include this book’s title and author as well as your name, email address, and phone number. I will carefully review your comments and share them with the author and editors who worked on the book. Email: [email protected] Mail: Dave Dusthimer Associate Publisher Pearson Education 800 East 96th Street Indianapolis, IN 46240 USA Reader Services Visit our website and register this book at www.quepublishing.com/register for convenient access to any updates, downloads, or errata that might be available for this book. 00_0789737043_fm.qxd 10/31/07 11:53 AM Page xiv 00_0789737043_fm.qxd 10/31/07 11:53 AM Page xv Introduction Welcome to the NCLEX-RN ® Practice Questions Exam Cram This book helps you get ready to take and pass the Licensure Exam for Registered Nurses. This portion of the book discusses the NCLEX-RN® exam in general and how this Exam Cram can help you prepare for the test. It doesn’t matter whether this is the first time you’re going to take the exam or whether you have taken it previously; this book gives you the necessary information and techniques to obtain licensure. The NCLEX-RN® Practice Questions Exam Cram helps you practice taking questions that are written in the NCLEX® format. Used with the NCLEX- RN® Exam Cram, it will help you understand and appreciate the subjects and materials you need to pass. Both books are aimed at test preparation and review. They do not teach you everything you need to know about the sub- ject of nursing. Instead, they present you with materials that you are likely to encounter on the exam. Using a simple approach, we help you understand the “need to know” information. To be able to pass the NCLEX®, you must understand how the exam is developed. The NCLEX-RN® consists of questions from the cognitive levels of knowledge, comprehension, application, and analysis. The majority of questions are written at the application and analysis level. Questions incorporate the five stages of the Nursing Process (assessment, diagnosis, planning, implementation, and evaluation) and the four categories of Client Needs. Client Needs are divided into subcategories that define the con- tent within each of the four major categories. These categories and subcate- gories are: A. Safe effective care: 8%–14% Management of care: 13%–19% Safety and infection control: 8%–14% 00_0789737043_fm.qxd 10/31/07 11:53 AM Page xvi xvi Introduction B. Health promotion and maintenance: 6%–12% C. Psychosocial integrity: 6%–12% D. Physiological integrity Basic care and comfort: 6%–12% Pharmacological and parenteral therapy: 13%–19% Reduction of risk: 13%–19% Physiological adaptation: 11%–17% Taking the Computerized Adaptive Test Computer-adaptive testing, commonly known as CAT, offers the candidate several advantages. The graduate can schedule the exam at a time that is con- venient for him or her. It’s also possible that you will not be tested on the entire 265-question range; if you answer the beginning questions correctly, the CAT might stop early in the session, with far fewer than the 265 ques- tions you were expecting. The first questions will be difficult and should get easier. When the engine has determined your ability level and is satisfied that you are qualified to be a registered nurse, it will stop. The disadvantage of a CAT is that you cannot go back and change answers. When you make a deci- sion and move on, that’s it—no second guessing like on a paper exam. The Pearson Vue testing group is responsible for administering the exam. You can locate a center nearest you by visiting www.pearsonvue.com. Because you might not be familiar with the Pearson Vue testing centers, we recommend that you arrive at least 30 minutes early. If you are late, you will not be allowed to take the test. Bring two forms of identification with you, one of which must be a picture ID. Be sure that your form of identification matches your application. You will be photographed and fingerprinted upon entering the testing site, so don’t let this increase your stress. The allotted time is 6 hours, and the candidate can receive results within approximately 7 days (in some states, even sooner). Remember, the exam is written at approx- imately the tenth-grade reading level, so keep a good dictionary handy dur- ing your studies. 00_0789737043_fm.qxd 10/31/07 11:53 AM Page xvii Introduction xvii The Cost of the Exam A candidate wanting to write the licensure exam must fill out two applica- tions, one to the National Council and one to the state where he or she wants to be licensed. A separate fee must accompany each application. The fee required by the National Council is $200. State licensing fees vary. Licensure applications can be obtained at www.ncsbn.org. Several states are members of the multistate licensure compact. This means that if you are issued a mul- tistate license, you pay only one fee. This information also can be obtained by visiting the National Council’s website. How to Prepare for the Exam Judicious use of this book and its sister book, the NCLEX-RN® Exam Cram, either alone or with a review seminar such as that provided by Rinehart and Associates, will help you achieve your goal of becoming a registered nurse. As you review for the NCLEX® exam, we suggest that you find a location where you can concentrate on the material each day. A minimum of 2 hours per day for at least 2 weeks is suggested. In the NCLEX-RN® Exam Cram, we provide you with exam alerts, tips, notes, and sample questions, both mul- tiple choice and alternate items. Using both books allows you to practice tak- ing hundreds of questions much like those on the actual licensure exam. We have also formulated a “mock” exam with those difficult management and delegation questions that you can score to determine your readiness to test. Pay particular attention to the helpful hints and the Cram Sheet. Using these will help you gain and retain knowledge, and will help reduce your stress as you prepare to test. 00_0789737043_fm.qxd 10/31/07 11:53 AM Page xviii xviii Introduction What You Will Find in This Book As seems obvious from the title, this book is all about practice questions! There are five full exams in this book, totaling 1,250 questions. Each chap- ter is set up with the questions and their possible answers first; the correct answers and rationales appear at the end of each chapter. In the margins next to each question, you will see a quick key to finding the location of its answer and rationales. Here’s exactly what you will find in the chapters:. Practice Questions—These are the numerous questions that will help you learn, drill, and review.. Quick Check Answers—When you have finished answering the ques- tions, you can quickly grade your exam from this section. Only cor- rect answers are given here—no rationales are offered yet.. Answers and Rationales—This section offers you the correct answers, as well as further explanation about the content posed in that ques- tion. Use this information to learn why an answer is correct and to reinforce the content in your mind for exam day. You will also find a Cram Sheet at the beginning of this book specifically written for this exam. This is a very popular element that is also found in NCLEX_RN® Exam Cram (Que Publishing, ISBN 0-7897-3269-6). This item condenses all the necessary facts found in this exam into one easy-to- handle tearcard. The Cram Sheet is something you can carry with you to the exam location and use as a last-second study aid. Be aware that you can’t take it into the exam room, though. Hints for Using This Book We suggest that you score your exam by subtracting the missed items from the total and then dividing the total answered correctly by the total number of questions. This gives you the percentage answered correctly. We also sug- gest that you achieve a score of at least 77% before you schedule your exam. If you do not, take the exam again until you do. The higher the score, the better your chance to do well on the NCLEX® exam! 00_0789737043_fm.qxd 10/31/07 11:53 AM Page xix Introduction xix You should also take advantage of the CD exam engine; it provides you with a computer-adaptive test, or CAT, very similar to the one you will experience during the NCLEX® exam. Every question in this book is on the CD, including the answer rationales. Aside from being a test-preparation book, this book is useful if you are brushing up on your nursing knowledge. It is an excellent quick reference for the licensed nurse. Need Further Study? If you are having a hard time correctly answering questions, be sure to see the sister book to this one, the NCLEX-RN® Exam Cram (Que Publishing, ISBN 0-7897-3269-6). If you still need further study, you might want to take an NCLEX® review seminar or look at one of the many other books avail- able at your local bookstore. Contact the Author The authors of this text are interested in you and want you to pass on the first attempt. If after reviewing with this text you would like to contact the authors, you may do so at Rinehart and Associates, PO Box 124, Booneville, MS, 38829, or by visiting www.nclexreview.net. You may also contact them by phone at 662-728-4622. 00_0789737043_fm.qxd 10/31/07 11:53 AM Page xx 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 1 1 CHAPTER ONE Practice Exam 1 and Rationales 1. A client with a diagnosis of passive-aggressive personality disorder ✓ Quick Check Quick Answer: 52 is seen at the local mental health clinic. A common characteristic of Detailed Answer: 55 persons with passive-aggressive personality disorder is: ❍ A. Superior intelligence ❍ B. Underlying hostility ❍ C. Dependence on others ❍ D. Ability to share feelings 2. The client is admitted for evaluation of aggressive behavior and Quick Answer: 52 diagnosed with antisocial personality disorder. A key part of the Detailed Answer: 55 care of such clients is: ❍ A. Setting realistic limits ❍ B. Encouraging the client to express remorse for behavior ❍ C. Minimizing interactions with other clients ❍ D. Encouraging the client to act out feelings of rage 3. An important intervention in monitoring the dietary compliance of Quick Answer: 52 a client with bulimia is: Detailed Answer: 55 ❍ A. Allowing the client privacy during mealtimes ❍ B. Praising her for eating all her meal ❍ C. Observing her for 1–2 hours after meals ❍ D. Encouraging her to choose foods she likes and to eat in moderation 4. Assuming that all have achieved normal cognitive and emotional Quick Answer: 52 development, which of the following children is at greatest risk for Detailed Answer: 55 accidental poisoning? ❍ A. A 6-month-old ❍ B. A 4-year-old ❍ C. A 12-year-old ❍ D. A 13-year-old 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 2 2 Chapter 1 5. Which of the following examples represents parallel play? ✓ Quick Check Quick Answer: 52 Detailed Answer: 55 ❍ A. Jenny and Tommy share their toys. ❍ B. Jimmy plays with his car beside Mary, who is playing with her doll. ❍ C. Kevin plays a game of Scrabble with Kathy and Sue. ❍ D. Mary plays with a handheld game while sitting in her mother’s lap. 6. The nurse is ready to begin an exam on a 9-month-old infant. The child Quick Answer: 52 is sitting in his mother’s lap. Which should the nurse do first? Detailed Answer: 55 ❍ A. Check the Babinski reflex ❍ B. Listen to the heart and lung sounds ❍ C. Palpate the abdomen ❍ D. Check tympanic membranes 7. In terms of cognitive development, a 2-year-old would be expected to: Quick Answer: 52 Detailed Answer: 55 ❍ A. Think abstractly ❍ B. Use magical thinking ❍ C. Understand conservation of matter ❍ D. See things from the perspective of others Quick Answer: 52 8. Which of the following best describes the language of a 24-month-old? Detailed Answer: 55 ❍ A. Doesn’t understand yes and no ❍ B. Understands the meaning of words ❍ C. Able to verbalize needs ❍ D. Asks “why?” to most statements 9. A client who has been receiving urokinase has a large bloody bowel move- Quick Answer: 52 ment. Which action would be best for the nurse to take immediately? Detailed Answer: 56 ❍ A. Administer vitamin K IM ❍ B. Stop the urokinase ❍ C. Reduce the urokinase and administer heparin ❍ D. Stop the urokinase and call the doctor 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 3 Practice Exam 1 and Rationales 3 10. The client has a prescription for a calcium carbonate compound to neu- ✓ Quick Check Quick Answer: 52 tralize stomach acid. The nurse should assess the client for: Detailed Answer: 56 ❍ A. Constipation ❍ B. Hyperphosphatemia ❍ C. Hypomagnesemia ❍ D. Diarrhea 11. Heparin has been ordered for a client with pulmonary embolis. Which Quick Answer: 52 statement, if made by the graduate nurse, indicates a lack of understand- Detailed Answer: 56 ing of the medication? ❍ A. “I will administer the medication 1-2 inches away from the umbilicus.” ❍ B. “I will administer the medication in the abdomen.” ❍ C. “I will check the PTT before administering the medication.” ❍ D. “I will need to aspirate when I give Heparin.” 12. The nurse is caring for a client with peripheral vascular disease. To correct- Quick Answer: 52 ly assess the oxygen saturation level, the monitor may be placed on the: Detailed Answer: 56 ❍ A. Hip ❍ B. Ankle ❍ C. Earlobe ❍ D. Chin 13. While caring for a client with hypertension, the nurse notes the following Quick Answer: 52 vital signs: BP of 140/20, pulse 120, respirations 36, temperature Detailed Answer: 56 100.8°F. The nurse’s initial action should be to: ❍ A. Call the doctor ❍ B. Recheck the vital signs ❍ C. Obtain arterial blood gases ❍ D. Obtain an ECG 14. The nurse is preparing a client with an axillo-popliteal bypass graft for Quick Answer: 52 discharge. The client should be taught to avoid: Detailed Answer: 56 ❍ A. Using a recliner to rest ❍ B. Resting in supine position ❍ C. Sitting in a straight chair ❍ D. Sleeping in right Sim’s position 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 4 4 Chapter 1 15. The doctor has ordered antithrombolic stockings to be applied to the ✓ Quick Check Quick Answer: 52 legs of the client with peripheral vascular disease. The nurse knows Detailed Answer: 56 antithrombolic stockings should be applied: ❍ A. Before rising in the morning ❍ B. With the client in a standing position ❍ C. After bathing and applying powder ❍ D. Before retiring in the evening 16. The nurse has just received the shift report and is preparing to make Quick Answer: 52 rounds. Which client should be seen first? Detailed Answer: 56 ❍ A. The client with a history of a cerebral aneurysm with an oxygen saturation rate of 99% ❍ B. The client three days post–coronary artery bypass graft with a temperature of 100.2°F ❍ C. The client admitted 1 hour ago with shortness of breath ❍ D. The client being prepared for discharge following a femoral popliteal bypass graft 17. A client with a femoral popliteal bypass graft is assigned to a semiprivate Quick Answer: 52 room. The most suitable roommate for this client is the client with: Detailed Answer: 57 ❍ A. Hypothyroidism ❍ B. Diabetic ulcers ❍ C. Ulcerative colitis ❍ D. Pneumonia 18. The nurse is teaching the client regarding use of sodium warfarin. Which Quick Answer: 52 statement made by the client would require further teaching? Detailed Answer: 57 ❍ A. “I will have blood drawn every month.” ❍ B. “I will assess my skin for a rash.” ❍ C. “I take aspirin for a headache.” ❍ D. “I will use an electric razor to shave.” Quick Answer: 52 19. The client returns to the recovery room following repair of an abdominal Detailed Answer: 57 aneurysm. Which finding would require further investigation? ❍ A. Pedal pulses regular ❍ B. Urinary output 20mL in the past hour ❍ C. Blood pressure 108/50 ❍ D. Oxygen saturation 97% 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 5 Practice Exam 1 and Rationales 5 20. The nurse is doing bowel and bladder retraining for the client with para- ✓ Quick Check Quick Answer: 52 plegia. Which of the following is not a factor for the nurse to consider? Detailed Answer: 57 ❍ A. Diet pattern ❍ B. Mobility ❍ C. Fluid intake ❍ D. Sexual function 21. A 20-year-old is admitted to the rehabilitation unit following a motorcycle Quick Answer: 52 accident. Which would be the appropriate method for measuring the Detailed Answer: 57 client for crutches? ❍ A. Measure five finger breadths under the axilla ❍ B. Measure 3 inches under the axilla ❍ C. Measure the client with the elbows flexed 10° ❍ D. Measure the client with the crutches 20 inches from the side of the foot 22. The nurse is caring for the client following a cerebral vascular accident. Quick Answer: 52 Which portion of the brain is responsible for taste, smell, and hearing? Detailed Answer: 57 ❍ A. Occipital ❍ B. Frontal ❍ C. Temporal ❍ D. Parietal 23. The client is admitted to the unit after a motor vehicle accident with a Quick Answer: 52 temperature of 102°F rectally. The most likely explanations for the elevat- Detailed Answer: 57 ed temperature is that: ❍ A. There was damage to the hypothalamus. ❍ B. He has an infection from the abrasions to the head and face. ❍ C. He will require a cooling blanket to decrease the temperature. ❍ D. There was damage to the frontal lobe of the brain. 24. The client is admitted to the hospital in chronic renal failure. A diet low in Quick Answer: 52 protein is ordered. The rationale for a low-protein diet is: Detailed Answer: 57 ❍ A. Protein breaks down into blood urea nitrogen and other waste. ❍ B. High protein increases the sodium and potassium levels. ❍ C. A high-protein diet decreases albumin production. ❍ D. A high-protein diet depletes calcium and phosphorous. 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 6 6 Chapter 1 25. The client who is admitted with thrombophlebitis has an order for ✓ Quick Check Quick Answer: 52 heparin. The medication should be administered using a/an: Detailed Answer: 57 ❍ A. Buretrol ❍ B. Infusion controller ❍ C. Intravenous filter ❍ D. Three-way stop-cock 26. The nurse is taking the blood pressure of the obese client. If the blood Quick Answer: 52 pressure cuff is too small, the results will be: Detailed Answer: 57 ❍ A. A false elevation ❍ B. A false low reading ❍ C. A blood pressure reading that is correct ❍ D. A subnormal finding 27. A 4-year-old male is admitted to the unit with nephotic syndrome. He is Quick Answer: 52 extremely edematous. To decrease the discomfort associated with scrotal Detailed Answer: 57 edema, the nurse should: ❍ A. Apply ice to the scrotum ❍ B. Elevate the scrotum on a small pillow ❍ C. Apply heat to the abdominal area ❍ D. Administer an analgesic 28. The client with an abdominal aortic aneurysm is admitted in preparation Quick Answer: 52 for surgery. Which of the following should be reported to the doctor? Detailed Answer: 58 ❍ A. An elevated white blood cell count ❍ B. An abdominal bruit ❍ C. A negative Babinski reflex ❍ D. Pupils that are equal and reactive to light 29. If the nurse is unable to elicit the deep tendon reflexes of the patella, the Quick Answer: 52 nurse should ask the client to: Detailed Answer: 58 ❍ A. Pull against the palms ❍ B. Grimace the facial muscles ❍ C. Cross the legs at the ankles ❍ D. Perform Valsalva maneuver 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 7 Practice Exam 1 and Rationales 7 30. The physician has ordered atropine sulfate 0.4mg IM before surgery. The ✓ Quick Check Quick Answer: 52 medication is supplied in 0.8mg per milliliter. The nurse should adminis- Detailed Answer: 58 ter how many milliliters of the medication? ❍ A. 0.25mL ❍ B. 0.5mL ❍ C. 1.0mL ❍ D. 1.25mL 31. The nurse is evaluating the client’s pulmonary artery pressure. The nurse Quick Answer: 52 is aware that this test evaluates: Detailed Answer: 58 ❍ A. Pressure in the left ventricle ❍ B. The systolic, diastolic, and mean pressure of the pulmonary artery ❍ C. The pressure in the pulmonary veins ❍ D. The pressure in the right ventricle 32. A client is being monitored using a central venous pressure monitor. If Quick Answer: 52 the pressure is 2cm of water, the nurse should: Detailed Answer: 58 ❍ A. Call the doctor immediately ❍ B. Slow the intravenous infusion ❍ C. Listen to the lungs for rales ❍ D. Administer a diuretic 33. The nurse identifies ventricular tachycardia on the heart monitor. The Quick Answer: 52 nurse should immediately: Detailed Answer: 58 ❍ A. Administer atropine sulfate ❍ B. Check the potassium level ❍ C. Prepare to administer an antiarrhythmic such as lidocaine ❍ D. Defibrillate at 360 joules 34. The doctor is preparing to remove chest tubes from the client’s left chest. Quick Answer: 52 In preparation for the removal, the nurse should instruct the client to: Detailed Answer: 58 ❍ A. Breathe normally ❍ B. Hold his breath and bear down ❍ C. Take a deep breath ❍ D. Sneeze on command 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 8 8 Chapter 1 35. The doctor has ordered 80mg of furosemide (Lasix) two times per day. ✓ Quick Check Quick Answer: 52 The nurse notes the patient’s potassium level to be 2.5meq/L. The nurse Detailed Answer: 58 should: ❍ A. Administer the Lasix as ordered ❍ B. Administer half the dose ❍ C. Offer the patient a potassium-rich food ❍ D. Withhold the drug and call the doctor 36. Which of the following lab studies should be done periodically if the Quick Answer: 52 client is taking warfarin sodium (Coumadin)? Detailed Answer: 58 ❍ A. Stool specimen for occult blood ❍ B. White blood cell count ❍ C. Blood glucose ❍ D. Erthyrocyte count 37. The client has an order for heparin to prevent post-surgical thrombi. Quick Answer: 52 Immediately following a heparin injection, the nurse should: Detailed Answer: 58 ❍ A. Aspirate for blood ❍ B. Check the pulse rate ❍ C. Massage the site ❍ D. Check the site for bleeding 38. The client with AIDS tells the nurse that he has been using acupuncture Quick Answer: 52 to help with his pain. The nurse should question the client regarding this Detailed Answer: 59 treatment because acupuncture uses: ❍ A. Pressure from the fingers and hands to stimulate the energy points in the body ❍ B. Oils extracted from plants and herbs ❍ C. Needles to stimulate certain points on the body to treat pain ❍ D. Manipulation of the skeletal muscles to relieve stress and pain 39. The nurse is taking the vital signs of the client admitted with cancer of Quick Answer: 52 the pancreas. The nurse is aware that the fifth vital sign is: Detailed Answer: 59 ❍ A. Anorexia ❍ B. Pain ❍ C. Insomnia ❍ D. Fatigue 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 9 Practice Exam 1 and Rationales 9 40. The 84-year-old male has returned from the recovery room following a ✓ Quick Check Quick Answer: 52 total hip repair. He complains of pain and is medicated with morphine Detailed Answer: 59 sulfate and promethazine. Which medication should be kept available for the client being treated with opoid analgesics? ❍ A. Naloxone (Narcan) ❍ B. Ketorolac (Toradol) ❍ C. Acetylsalicylic acid (aspirin) ❍ D. Atropine sulfate (Atropine) 41. The doctor has ordered a patient-controlled analgesia (PCA) pump for Quick Answer: 52 the client with chronic pain. The client asks the nurse if he can become Detailed Answer: 59 overdosed with pain medication using this machine. The nurse demon- strates understanding of the PCA if she states: ❍ A. “The machine will administer only the amount that you need to control your pain without any action from you.” ❍ B. “The machine has a locking device that prevents overdosing.” ❍ C. The machine will administer one large dose every 4 hours to relieve your pain.” ❍ D. The machine is set to deliver medication only if you need it.” 42. The doctor has ordered a Transcutaneous Electrical Nerve Stimulation Quick Answer: 52 (TENS) unit for the client with chronic back pain. The nurse teaching the Detailed Answer: 59 client with a TENS unit should tell the client: ❍ A. “You may be electrocuted if you use water with this unit.” ❍ B. “Please report skin irritation to the doctor.” ❍ C. “The unit may be used anywhere on the body without fear of adverse reactions.” ❍ D. “A cream should be applied to the skin before applying the unit.” 43. The nurse asked the client if he has an advance directive. The reason for Quick Answer: 52 asking the client this question is: Detailed Answer: 59 ❍ A. She is curious about his plans regarding funeral arrangements. ❍ B. Much confusion can occur with the client’s family if he does not have an advanced directive. ❍ C. An advanced directive allows the medical personnel to make decisions for the client. ❍ D. An advanced directive allows active euthanasia to be carried out if the client is unable to care for himself. 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 10 10 Chapter 1 44. A client who has chosen to breastfeed tells the nurse that her nipples ✓ Quick Check Quick Answer: 52 became very sore while she was breastfeeding her older child. Which Detailed Answer: 59 measure will help her to avoid soreness of the nipples? ❍ A. Feeding the baby during the first 48 hours after delivery ❍ B. Breaking suction by placing a finger between the baby’s mouth and the breast when she terminates the feeding ❍ C. Applying hot, moist soaks to the breast several times per day ❍ D. Wearing a support bra 45. The nurse is performing an assessment of an elderly client with a total Quick Answer: 52 hip repair. Based on this assessment, the nurse decides to medicate the Detailed Answer: 59 client with an analgesic. Which finding most likely prompted the nurse to decide to administer the analgesic? ❍ A. The client’s blood pressure is 130/86. ❍ B. The client is unable to concentrate. ❍ C. The client’s pupils are dilated. ❍ D. The client grimaces during care. 46. An obstetrical client decides to have an epidural anesthetic to relieve pain Quick Answer: 52 during labor. Following administration of the anesthesia, the nurse Detailed Answer: 59 should monitor the client for: ❍ A. Seizures ❍ B. Postural hypertension ❍ C. Respiratory depression ❍ D. Hematuria 47. The nurse is assessing the client admitted for possible oral cancer. The Quick Answer: 52 nurse identifies which of the following to be a late-occurring symptom of Detailed Answer: 60 oral cancer? ❍ A. Warmth ❍ B. Odor ❍ C. Pain ❍ D. Ulcer with flat edges 48. The nurse understands that the diagnosis of oral cancer is confirmed with: Quick Answer: 52 Detailed Answer: 60 ❍ A. Biopsy ❍ B. Gram Stain ❍ C. Oral culture ❍ D. Oral washings for cytology 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 11 Practice Exam 1 and Rationales 11 49. The nurse is caring for the patient following removal of a large posterior ✓ Quick Check Quick Answer: 52 oral lesion. The priority nursing measure would be to: Detailed Answer: 60 ❍ A. Maintain a patent airway ❍ B. Perform meticulous oral care every 2 hours ❍ C. Ensure that the incisional area is kept as dry as possible ❍ D. Assess the client frequently for pain 50. The registered nurse is conducting an in-service for colleagues on the Quick Answer: 52 subject of peptic ulcers. The nurse would be correct in identifying which Detailed Answer: 60 of the following as a causative factor? ❍ A. N. gonorrhea ❍ B. H. influenza ❍ C. H. pylori ❍ D. E. coli 51. The patient states, “My stomach hurts about 2 hours after I eat.” Based Quick Answer: 52 upon this information, the nurse suspects the patient likely has a: Detailed Answer: 60 ❍ A. Gastric ulcer ❍ B. Duodenal ulcer ❍ C. Peptic ulcer ❍ D. Curling’s ulcer 52. The nurse is caring for a patient with suspected diverticulitis. The nurse Quick Answer: 52 would be most prudent in questioning which of the following diagnostic Detailed Answer: 60 tests? ❍ A. Abdominal ultrasound ❍ B. Barium enema ❍ C. Complete blood count ❍ D. Computed tomography (CT) scan 53. The nurse is planning care for the patient with celiac disease. In teaching Quick Answer: 52 about the diet, the nurse should instruct the patient to avoid which of the Detailed Answer: 60 following for breakfast? ❍ A. Puffed wheat ❍ B. Banana ❍ C. Puffed rice ❍ D. Cornflakes 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 12 12 Chapter 1 54. The nurse is teaching about irritable bowel syndrome (IBS). Which of the ✓ Quick Check Quick Answer: 52 following would be most important? Detailed Answer: 60 ❍ A. Reinforcing the need for a balanced diet ❍ B. Encouraging the client to drink 16 ounces of fluid with each meal ❍ C. Telling the client to eat a diet low in fiber ❍ D. Instructing the client to limit his intake of fruits and vegetables 55. In planning care for the patient with ulcerative colitis, the nurse identifies Quick Answer: 52 which nursing diagnosis as a priority? Detailed Answer: 60 ❍ A. Anxiety ❍ B. Impaired skin integrity ❍ C. Fluid volume deficit ❍ D. Nutrition altered, less than body requirements 56. The patient is prescribed metronidazole (Flagyl) for adjunct treatment for Quick Answer: 52 a duodenal ulcer. When teaching about this medication, the nurse would Detailed Answer: 60 include: ❍ A. “This medication should be taken only until you begin to feel better.” ❍ B. “This medication should be taken on an empty stomach to increase absorption.” ❍ C. “While taking this medication, you do not have to be con- cerned about being in the sun.” ❍ D. “While taking this medication, alcoholic beverages and products containing alcohol should be avoided.” 57. The nurse is preparing to administer a feeding via a nasogastric tube. Quick Answer: 52 The nurse would perform which of the following before initiating the Detailed Answer: 60 feeding? ❍ A. Assess for tube placement by aspirating stomach content ❍ B. Place the patient in a left-lying position ❍ C. Administer feeding with 50% Dextrose ❍ D. Ensure that the feeding solution has been warmed in a microwave for 2 minutes 01_0789737043_ch01.qxd 11/2/07 12:56 PM Page 13 Practice Exam 1 and Rationales 13 58. Which is true regarding the administration of antacids? ✓ Quick Check Quick Answer: 52 Detailed Answer: 61 ❍ A. Antacids should be administered without regard to mealtimes. ❍ B. Antacids should be administered with each meal and snack of the day. ❍ C. Antacids should not be administered with other medications. ❍ D. Antacids should be administered with all other medications, for maximal absorption. 59. The nurse is caring for a patient with a colostomy. The patient asks, “Will Quick Answer: 52 I ever be able to swim again?” The nurse’s best response would be: Detailed Answer: 61 ❍ A. “Yes, you should be able to swim again, even with the colostomy.” ❍ B. “You should avoid immersing the colostomy in water.” ❍ C. “No, you should avoid getting the colostomy wet.” ❍ D. “Don’t worry about that. You will be able to live just like you did before.” 60. The nurse is assisting in the care of a patient who is 2 days post-opera- Quick Answer: 52 tive from a hemorroidectomy. The nurse would be correct in instructing Detailed Answer: 61 the patient to: ❍ A. Avoid a high-fiber diet ❍ B. Continue to use ice packs ❍ C. Take a laxative daily to prevent constipation ❍ D. Use a sitz bath after each bowel movement 61. The nurse is assisting in the care of a client with diverticulosis. Which of Quick Answer: 52 the following assessment findings must necessitate an immediate report Detailed Answer: 61 to the doctor? ❍ A. Bowel sounds are present ❍ B. Intermittent left lower-quadrant pain ❍ C. Constipation alternating with diarrhea ❍ D. Hemoglobin 26% and hematocrit 32 62. The client is newly diagnosed with juvenile onset diabetes. Which of the Quick Answer: 52 following nursing diagnoses is a priority? Detailed Answer: 61 ❍ A. Anxiety ❍ B. Pain ❍ C. Knowledge deficit ❍ D. Altered thought process 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 14 14 Chapter 1 63. The nurse is asked by the nurse aide, “Are peptic ulcers really caused by ✓ Quick Check Quick Answer: 52 stress?” The nurse would be correct in replying with the following: Detailed Answer: 61 ❍ A. “Peptic ulcers result from overeating fatty foods.” ❍ B. “Peptic ulcers are always caused from exposure to continual stress.” ❍ C. “Peptic ulcers are like all other ulcers, which all result from stress.” ❍ D. “Peptic ulcers are associated with H. pylori, although there are other ulcers that are associated with stress.” 64. The nurse is assisting in the assessment of the patient admitted with Quick Answer: 52 “extreme abdominal pain.” The nurse asks the client about the medica- Detailed Answer: 61 tion that he has been taking because: ❍ A. Interactions between medications will cause abdominal pain. ❍ B. Various medications taken by mouth can affect the alimentary tract. ❍ C. This will provide an opportunity to educate the patient regarding the medications used. ❍ D. The types of medications might be attributable to an abdomi- nal pathology not already identified. 65. The nurse is assessing the abdomen. The nurse knows the best Quick Answer: 52 sequence to perform the assessment is: Detailed Answer: 61 ❍ A. Inspection, auscultation, palpation ❍ B. Auscultation, palpation, inspection ❍ C. Palpation, inspection, auscultation ❍ D. Inspection, palpation, auscultation 66. The nurse is caring for the client who has been in a coma for 2 months. Quick Answer: 52 He has signed a donor card, but the wife is opposed to the idea of organ Detailed Answer: 61 donation. How should the nurse handle the topic of organ donation with the wife? ❍ A. Tell the wife that the hospital will honor her wishes regarding organ donation, but contact the organ-retrieval staff ❍ B. Tell her that because her husband signed a donor card, the hospital has the right to take the organs upon the death of her husband ❍ C. Explain that it is necessary for her to donate her husband’s organs because he signed the permit ❍ D. Refrain from talking about the subject until after the death of her husband 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 15 Practice Exam 1 and Rationales 15 67. The client with cancer refuses to care for herself. Which action by the ✓ Quick Check Quick Answer: 52 nurse would be best? Detailed Answer: 61 ❍ A. Alternate nurses caring for the client so that the staff will not get tired of caring for this client ❍ B. Talk to the client and explain the need for self-care ❍ C. Explore the reason for the lack of motivation seen in the client ❍ D. Talk to the doctor about the client’s lack of motivation 68. The charge nurse is making assignments for the day. After accepting the Quick Answer: 52 assignment to a client with leukemia, the nurse tells the charge nurse Detailed Answer: 61 that her child has chickenpox. Which initial action should the charge nurse take? ❍ A. Change the nurse’s assignment to another client ❍ B. Explain to the nurse that there is no risk to the client ❍ C. Ask the nurse if the chickenpox have scabbed ❍ D. Ask the nurse if she has ever had the chickenpox 69. The nurse is caring for the client with a mastectomy. Which action would Quick Answer: 52 be contraindicated? Detailed Answer: 62 ❍ A. Taking the blood pressure in the side of the mastectomy ❍ B. Elevating the arm on the side of the mastectomy ❍ C. Positioning the client on the unaffected side ❍ D. Performing a dextrostix on the unaffected side 70. The client has an order for gentamycin to be administered. Which lab Quick Answer: 52 results should be reported to the doctor before beginning the medica- Detailed Answer: 62 tion? ❍ A. Hematocrit ❍ B. Creatinine ❍ C. White blood cell count ❍ D. Erythrocyte count 71. Which of the following is the best indicator of the diagnosis of HIV? Quick Answer: 52 Detailed Answer: 62 ❍ A. White blood cell count ❍ B. ELISA ❍ C. Western Blot ❍ D. Complete blood count 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 16 16 Chapter 1 72. The client presents to the emergency room with a “bull’s eye” rash. Which ✓ Quick Check Quick Answer: 52 question would be most appropriate for the nurse to ask the client? Detailed Answer: 62 ❍ A. “Have you found any ticks on your body?” ❍ B. “Have you had any nausea in the last 24 hours?” ❍ C. “Have you been outside the country in the last 6 months?” ❍ D. “Have you had any fever for the past few days?” 73. Which client should be assigned to the nursing assistant? Quick Answer: 52 Detailed Answer: 62 ❍ A. The 18-year-old with a fracture to two cervical vertebrae ❍ B. The infant with meningitis ❍ C. The elderly client with a thyroidectomy 4 days ago ❍ D. The client with a thoracotomy 2 days ago 74. The client presents to the emergency room with a hyphema. Which Quick Answer: 52 action by the nurse would be best? Detailed Answer: 62 ❍ A. Elevate the head of the bed and apply ice to the eye ❍ B. Place the client in a supine position and apply heat to the knee ❍ C. Insert a Foley catheter and measure the intake and output ❍ D. Perform a vaginal exam and check for a discharge 75. The client has an order for FeSo4 liquid. Which method of administration Quick Answer: 52 would be best? Detailed Answer: 62 ❍ A. Administer the medication with milk ❍ B. Administer the medication with a meal ❍ C. Administer the medication with orange juice ❍ D. Administer the medication undiluted 76. The client with an ileostomy is being discharged. Which teaching should Quick Answer: 52 be included in the plan of care? Detailed Answer: 62 ❍ A. Using Karaya powder to seal the bag. ❍ B. Irrigating the ileostomy daily. ❍ C. Using stomahesive as the best skin protector. ❍ D. Using Neosporin ointment to protect the skin. 77. Vitamin K is administered to the newborn shortly after birth for which of Quick Answer: 52 the following reasons? Detailed Answer: 62 ❍ A. To stop hemorrhage ❍ B. To treat infection ❍ C. To replace electrolytes ❍ D. To facilitate clotting 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 17 Practice Exam 1 and Rationales 17 78. Before administering Methyltrexate orally to the client with cancer, the ✓ Quick Check Quick Answer: 52 nurse should check the: Detailed Answer: 62 ❍ A. IV site ❍ B. Electrolytes ❍ C. Blood gases ❍ D. Vital signs 79. The nurse is teaching a group of new graduates about the safety needs Quick Answer: 52 of the client receiving chemotherapy. Before administering chemothera- Detailed Answer: 63 py, the nurse should: ❍ A. Administer a bolus of IV fluid ❍ B. Administer pain medication ❍ C. Administer an antiemetic ❍ D. Allow the patient a chance to eat 80. The client is admitted to the postpartum unit with an order to continue Quick Answer: 52 the infusion of Pitocin. The nurse is aware that Pitocin is working if the Detailed Answer: 63 fundus is: ❍ A. Deviated to the left. ❍ B. Firm and in the midline. ❍ C. Boggy. ❍ D. Two finger breadths below the umbilicus. 81. A 5-year-old is a family contact to the client with tuberculosis. Isoniazid Quick Answer: 52 (INH) has been prescribed for the client. The nurse is aware that the Detailed Answer: 63 length of time that the medication will be taken is: ❍ A. 6 months ❍ B. 3 months ❍ C. 1 year ❍ D. 2 years 82. A 4-year-old with cystic fibrosis has a prescription for Viokase pancreatic Quick Answer: 53 enzymes to prevent malabsorption. The correct time to give pancreatic Detailed Answer: 63 enzyme is: ❍ A. 1 hour before meals ❍ B. 2 hours after meals ❍ C. With each meal and snack ❍ D. On an empty stomach 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 18 18 Chapter 1 83. A client with osteomylitis has an order for a trough level to be done ✓ Quick Check Quick Answer: 52 because he is taking Gentamycin. When should the nurse call the lab to Detailed Answer: 63 obtain the trough level? ❍ A. Before the first dose ❍ B. 30 minutes before the fourth dose ❍ C. 30 minutes after the first dose ❍ D. 30 minutes before the first dose 84. A new diabetic is learning to administer his insulin. He receives 10U of Quick Answer: 52 NPH and 12U of regular insulin each morning. Which of the following Detailed Answer: 63 statements reflects understanding of the nurse’s teaching? ❍ A. “When drawing up my insulin, I should draw up the regular insulin first.” ❍ B. “When drawing up my insulin, I should draw up the NPH insulin first.” ❍ C. “It doesn’t matter which insulin I draw up first.” ❍ D. “I cannot mix the insulin, so I will need two shots.” 85. The client is scheduled to have an intravenous cholangiogram. Before the Quick Answer: 52 procedure, the nurse should assess the patient for: Detailed Answer: 63 ❍ A. Shellfish allergies ❍ B. Reactions to blood transfusions ❍ C. Gallbladder disease ❍ D. Egg allergies 86. Shortly after the client was admitted to the postpartum unit, the nurse Quick Answer: 52 notes heavy lochia rubra with large clots. The nurse should anticipate an Detailed Answer: 63 order for: ❍ A. Methergine ❍ B. Stadol ❍ C. Magnesium sulfate ❍ D. Phenergan 87. The client with a recent liver transplant asks the nurse how long he will Quick Answer: 52 have to take an immunosuppressant. Which response would be correct? Detailed Answer: 63 ❍ A. 1 year ❍ B. 5 years ❍ C. 10 years ❍ D. The rest of his life 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 19 Practice Exam 1 and Rationales 19 88. The client is admitted from the emergency room with multiple injuries ✓ Quick Check Quick Answer: 52 sustained from an auto accident. His doctor prescribes a histamine Detailed Answer: 63 blocker. The nurse is aware that the reason for this order is to: ❍ A. Treat general discomfort ❍ B. Correct electrolyte imbalances ❍ C. Prevent stress ulcers ❍ D. Treat nausea 89. The physician prescribes regular insulin, 5 units subcutaneous. Regular Quick Answer: 52 insulin begins to exert an effect: Detailed Answer: 63 ❍ A. In 5–10 minutes ❍ B. In 10–20 minutes ❍ C. In 30–60 minutes ❍ D. In 60–120 minutes 90. A 60-year-old diabetic is taking glyburide (Diabeta) 1.25mg daily to treat Quick Answer: 52 Type II diabetes mellitus. Which statement indicates the need for further Detailed Answer: 64 teaching? ❍ A. “I will keep candy with me just in case my blood sugar drops.” ❍ B. “I need to stay out of the sun as much as possible.” ❍ C. “I often skip dinner because I don’t feel hungry.” ❍ D. “I always wear my medical identification.” 91. A 20-year-old female has a prescription for tetracycline. While teaching Quick Answer: 53 the client how to take her medicine, the nurse learns that the client is Detailed Answer: 64 also taking Ortho-Novum oral contraceptive pills. Which instructions should be included in the teaching plan? ❍ A. The oral contraceptives will decrease the effectiveness of the tetracycline. ❍ B. Nausea often results from taking oral contraceptives and antibiotics. ❍ C. Toxicity can result when taking these two medications together. ❍ D. Antibiotics can decrease the effectiveness of oral contracep- tives, so the client should use an alternate method of birth control. 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 20 20 Chapter 1 92. The client is taking prednisone 7.5mg po each morning to treat his sys- ✓ Quick Check Quick Answer: 53 temic lupus erythematosis. Which statement best explains the reason for Detailed Answer: 64 taking the prednisone in the morning? ❍ A. There is less chance of forgetting the medication if taken in the morning. ❍ B. There will be less fluid retention if taken in the morning. ❍ C. Prednisone is absorbed best with the breakfast meal. ❍ D. Morning administration mimics the body’s natural secretion of corticosteroid. 93. The client is taking rifampin 600mg po daily to treat his tuberculosis. Quick Answer: 53 Which action by the nurse indicates understanding of the medication? Detailed Answer: 64 ❍ A. Telling the client that the medication will need to be taken with juice ❍ B. Telling the client that the medication will change the color of the urine ❍ C. Telling the client to take the medication before going to bed at night ❍ D. Telling the client to take the medication if the night sweats occur 94. The client is diagnosed with multiple myloma. The doctor has ordered Quick Answer: 53 cyclophosphamide (Cytoxan). Which instruction should be given to the Detailed Answer: 64 client? ❍ A. “Walk about a mile a day to prevent calcium loss.” ❍ B. “Increase the fiber in your diet.” ❍ C. “Report nausea to the doctor immediately.” ❍ D. “Drink at least eight large glasses of water a day.” 95. An elderly client is diagnosed with ovarian cancer. She has surgery fol- Quick Answer: 53 lowed by chemotherapy with a fluorouracil (Adrucil) IV. What should the Detailed Answer: 64 nurse do if she notices crystals in the IV medication? ❍ A. Discard the solution and order a new bag ❍ B. Warm the solution ❍ C. Continue the infusion and document the finding ❍ D. Discontinue the medication 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 21 Practice Exam 1 and Rationales 21 96. The 10-year-old is being treated for asthma. Before administering ✓ Quick Check Quick Answer: 53 Theodur, the nurse should check the: Detailed Answer: 64 ❍ A. Urinary output ❍ B. Blood pressure ❍ C. Pulse ❍ D. Temperature 97. Which information obtained from the mother of a child with cerebral Quick Answer: 53 palsy correlates to the diagnosis? Detailed Answer: 64 ❍ A. She was born at 40 weeks gestation. ❍ B. She had meningitis when she was 6 months old. ❍ C. She had physiologic jaundice after delivery. ❍ D. She has frequent sore throats. 98. A 6-year-old with cerebral palsy functions at the level of an 18-month- Quick Answer: 53 old. Which finding would support that assessment? Detailed Answer: 64 ❍ A. She dresses herself. ❍ B. She pulls a toy behind her. ❍ C. She can build a tower of eight blocks. ❍ D. She can copy a horizontal or vertical line. 99. A 5-year-old is admitted to the unit following a tonsillectomy. Which of Quick Answer: 53 the following would indicate a complication of the surgery? Detailed Answer: 64 ❍ A. Decreased appetite ❍ B. A low-grade fever ❍ C. Chest congestion ❍ D. Constant swallowing 100. The child with seizure disorder is being treated with phenytoin (Dilantin). Quick Answer: 53 Which of the following statements by the patient’s mother indicates to the Detailed Answer: 64 nurse that the patient is experiencing a side effect of Dilantin therapy? ❍ A. “She is very irritable lately.” ❍ B. “She sleeps quite a bit of the time.” ❍ C. “Her gums look too big for her teeth.” ❍ D. “She has gained about 10 pounds in the last six months.” 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 22 22 Chapter 1 101. The physician has prescribed tranylcypromine sulfate (Parnate) 10mg ✓ Quick Check Quick Answer: 53 bid. The nurse should teach the client to refrain from eating foods con- Detailed Answer: 65 taining tyramine because it may cause: ❍ A. Hypertension ❍ B. Hyperthermia ❍ C. Hypotension ❍ D. Urinary retention 102. The client is admitted to the emergency room with shortness of breath, Quick Answer: 53 anxiety, and tachycardia. His ECG reveals atrial fibrillation with a ventric- Detailed Answer: 65 ular response rate of 130 beats per minute. The doctor orders quinidine sulfate. While he is receiving quinidine, the nurse should monitor his ECG for: ❍ A. Peaked P wave ❍ B. Elevated ST segment ❍ C. Inverted T wave ❍ D. Prolonged QT interval 103. Lidocaine is a medication frequently ordered for the client experiencing: Quick Answer: 53 Detailed Answer: 65 ❍ A. Atrial tachycardia ❍ B. Ventricular tachycardia ❍ C. Heart block ❍ D. Ventricular brachycardia 104. The doctor orders 2% nitroglycerin ointment in a 1-inch dose every 12 Quick Answer: 53 hours. Proper application of nitroglycerin ointment includes: Detailed Answer: 65 ❍ A. Rotating application sites ❍ B. Limiting applications to the chest ❍ C. Rubbing it into the skin ❍ D. Covering it with a gauze dressing 105. The physician prescribes captopril (Capoten) 25mg po tid for the client Quick Answer: 53 with hypertension. Which of the following adverse reactions can occur Detailed Answer: 65 with administration of Capoten? ❍ A. Tinnitus ❍ B. Persistent cough ❍ C. Muscle weakness ❍ D. Diarrhea 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 23 Practice Exam 1 and Rationales 23 106. The client is admitted with a BP of 210/100. Her doctor orders ✓ Quick Check Quick Answer: 53 furosemide (Lasix) 40mg IV stat. How should the nurse administer the Detailed Answer: 65 prescribed furosemide to this client? ❍ A. By giving it over 1–2 minutes ❍ B. By hanging it IV piggyback ❍ C. With normal saline only ❍ D. With a filter 107. The client is receiving heparin for thrombophlebitis of the left lower Quick Answer: 53 extremity. Which of the following drugs reverses the effects of heparin? Detailed Answer: 65 ❍ A. Cyanocobalamine ❍ B. Protamine sulfate ❍ C. Streptokinase ❍ D. Sodium warfarin 108. The nurse is making assignments for the day. Which client should be Quick Answer: 53 assigned to the pregnant nurse? Detailed Answer: 65 ❍ A. The client receiving linear accelerator radiation therapy for lung cancer ❍ B. The client with a radium implant for cervical cancer ❍ C. The client who has just been administered soluble brachytherapy for thyroid cancer ❍ D. The client who returned from placement of iridium seeds for prostate cancer 109. The nurse is planning room assignments for the day. Which client should Quick Answer: 53 be assigned to a private room if only one is available? Detailed Answer: 66 ❍ A. The client with Cushing’s disease ❍ B. The client with diabetes ❍ C. The client with acromegaly ❍ D. The client with myxedema 110. The charge nurse witnesses the nursing assistant hitting the client in the Quick Answer: 53 long-term care facility. The nursing assistant can be charged with: Detailed Answer: 66 ❍ A. Negligence ❍ B. Tort ❍ C. Assault ❍ D. Malpractice 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 24 24 Chapter 1 111. Which assignment should not be performed by the licensed practical nurse? ✓ Quick Check Quick Answer: 53 ❍ A. Inserting a Foley catheter Detailed Answer: 66 ❍ B. Discontinuing a nasogastric tube ❍ C. Obtaining a sputum specimen ❍ D. Starting a blood transfusion 112. The client returns to the unit from surgery with a blood pressure of Quick Answer: 53 90/50, pulse 132, respirations 30. Which action by the nurse should Detailed Answer: 66 receive priority? ❍ A. Continue to monitor the vital signs ❍ B. Contact the physician ❍ C. Ask the client how he feels ❍ D. Ask the LPN to continue the post-op care 113. The nurse is caring for a client with B-Thalassemia major. Which therapy Quick Answer: 53 is used to treat Thalassemia? Detailed Answer: 66 ❍ A. IV fluids ❍ B. Frequent blood transfusions ❍ C. Oxygen therapy ❍ D. Iron therapy 114. The child with a history of respiratory infections has an order for a sweat Quick Answer: 53 test to be done. Which finding would be positive for cystic fibrosis? Detailed Answer: 66 ❍ A. A serum sodium of 135meq/L ❍ B. A sweat analysis of 69 meq/L ❍ C. A potassium of 4.5meq/L ❍ D. A calcium of 8mg/dL 115. The nurse caring for the child with a large meningomylocele is aware that Quick Answer: 53 the priority care for this client is to: Detailed Answer: 66 ❍ A. Cover the defect with a moist, sterile saline gauze ❍ B. Place the infant in a supine position ❍ C. Feed the infant slowly ❍ D. Measure the intake and output 116. The nurse is caring for an infant admitted from the delivery room. Which Quick Answer: 53 finding should be reported? Detailed Answer: 66 ❍ A. Acyanosis ❍ B. Acrocyanosis ❍ C. Halequin sign ❍ D. Absent femoral pulses 01_0789737043_ch01.qxd 10/29/07 3:48 PM Page 25 Practice Exam 1 and Rationales 25 117. The nurse is aware that a common mode of transmission of clostridium ✓ Quick Check Quick Answer: 53 difficile is: Detailed Answer: 66 ❍ A. Use of unsterile surgical equipment ❍ B. Contamination with sputum ❍ C. Through the urinary catheter ❍ D. Contamination with stool 118. The nurse has just received the change of shift report. Which client Quick Answer: 53 should the nurse assess first? Detailed Answer: 67 ❍ A. A client 2 hours post-lobectomy with 150ml drainage ❍ B. A client 2 days post-gastrectomy with scant drainage ❍ C. A client with pneumonia with an oral temperature of 102°F ❍ D. A client with a fractured hip in Buck’s traction 119. A client has been receiving cyanocobalamine (B12) injections for the past Quick Answer: 53 six weeks. Which laboratory finding indicates that the medication is hav- Detailed Answer: 67 ing the desired effect? ❍ A. Neutrophil count of 60% ❍ B. Basophil count of 0.5% ❍ C. Monocyt