A.

“The head of your bed must remain flat

MEDSURG for 24 hours after surgery.”
B. “You should avoid deep breathing and
coughing after surgery.”
C. “You won’t be able to swallow for the
A 78 year old client is first day or two.”
admitted to the emergency D. “You must avoid hyperextending your
neck after surgery.”
department with numbness and
weakness of the left arm and
slurred speech. Which nursing
A nurse in the emergency
intervention is priority? *
department is observing a 4-
1/1
Prepare to administer recombinant tissue year-old child for signs of
plasminogen activator (rt-PA).
Discuss the precipitating factors that
increased intracranial pressure
caused the symptoms. after a fall from a bicycle,
Schedule for A STAT computer
tomography (CT) scan of the head. resulting in head trauma. Which
of the following signs or
Notify the speech pathologist for an
emergency consult.
symptoms would be cause for
concern? *
1/1
Leigh Ann is receiving
Bulging anterior fontanel.
pancrelipase (Viokase) for Repeated vomiting.

chronic pancreatitis. Which

Signs of sleepiness at 10 PM.
observation best indicates the Inability to read short words from a
treatment is effective? * distance of 18 inches.

1/1
A. There is no skin breakdown. For a diabetic male client with
B. Her appetite improves.
C. She loses more than 10 lbs. a foot ulcer, the physician
D. Stools are less fatty and decreased in
frequency. orders bed rest, a wet-to-dry
dressing change every shift, and
blood glucose monitoring before

During preoperative teaching meals and bedtime. Why are

for a female client who will wet-to-dry dressings used for

undergo subtotal thyroidectomy, this client? *

1/1
the nurse should include which
They contain exudate and provide a moist
statement? * wound environment.
They protect the wound from mechanical
1/1 trauma and promote healing.
They debride the wound and promote
Nurse Ruth is assessing a client
healing by secondary intention.
after a thyroidectomy. The
They prevent the entrance of assessment reveals muscle
microorganisms and minimize wound
discomfort. twitching and tingling, along
with numbness in the fingers,
A 22 year old client suffered toes, and mouth area. The
from his first tonic-clonic nurse should suspect which
seizure. Upon awakening the complication? *
client asks the nurse, “What 1/1
A. Tetany
caused me to have a seizure?
Which of the following would B. Hemorrhage
the nurse include in the C. Thyroid storm
D. Laryngeal nerve damage
primary cause of tonic clonic
seizures in adults more the 20
A female client admitted to an
years? *
acute care facility after a car
1/1
accident develops signs and
Electrolyte imbalance
Head trauma symptoms of increased
intracranial pressure (ICP). The
Epilepsy
Congenital defect client is intubated and placed
on mechanical ventilation to
A 38 year old woman returns help reduce ICP. To prevent a
from a subtotal thryroidectomy further rise in ICP caused by
for the treatment of suctioning, the nurse anticipates
hyperthyroidism. Upon administering which drug
assessment, the immediate endotracheally before
priority that the nurse would suctioning? *
include is: * 1/1
Phenytoin (Dilantin)
1/1 Mannitol (Osmitrol)
Assess for pain Lidocaine (Xylocaine)
Assess for neurological status
Assess fluid volume status
Assess for respiratory distress Furosemide (Lasix)
A neurological consult has been Dr. Rodriguez prescribes
ordered for a pediatric client glipizide (Glucotrol), an oral
with suspected petit mal antidiabetic agent, for a male
seizures. The client with petit client with type 2 diabetes
mal seizures can be expected to mellitus who has been having
have: * trouble controlling the blood
0/1 glucose level through diet and
Short, abrupt muscle contraction
exercise. Which medication
instruction should the nurse
Quick, bilateral severe jerking movements
Abrupt loss of muscle tone provide? *
A brief lapse in consciousness
Correct answer 1/1
A brief lapse in consciousness “Be sure to take glipizide 30 minutes
before meals.”

A female adult client with a

“Glipizide may cause a low serum sodium
history of chronic level, so make sure you have your sodium
level checked monthly.”
hyperparathyroidism admits to “You won’t need to check your blood
glucose level after you start taking
being noncompliant. Based on glipizide.”
initial assessment findings, the “Take glipizide after a meal to prevent
heartburn.”
nurse formulates the nursing
diagnosis of Risk for injury. To The nurse is formulating a
complete the nursing diagnosis teaching plan for a client who
statement for this client, which has just experienced a transient
“related-to” phrase should the ischemic attack (TIA). Which
nurse add? * fact should the nurse include in
1/1
the teaching plan? *
A. Related to bone demineralization
resulting in pathologic fractures 1/1
TIA symptoms may last 24 to 48 hours.
Most clients have residual effects after
B. Related to exhaustion secondary to an having a TIA.
accelerated metabolic rate TIA may be a warning that the client may
C. Related to edema and dry skin have cerebrovascular accident (CVA)
secondary to fluid infiltration into the
interstitial spaces
D. Related to tetany secondary to a The most common symptom of TIA is the
decreased serum calcium level inability to speak.
Michael, a 42 y.o. man is
admitted to the med-surg floor A client with type 1 DM calls
with a diagnosis of acute the nurse to report recurrent
pancreatitis. His BP is 136/76, episodes of hypoglycemia with
pulse 96, respirations 22 and exercise. Which statement by
temp 101. His past history the client indicated an
includes hyperlipidemia and inadequate understanding of
alcohol abuse. The doctor the peak action of NPH insulin
prescribes an NG tube. Before and exercise? *
inserting the tube, you explain 1/1
A. “The best time for me to exercise is
the purpose to patient. Which
every afternoon.”
of the following is a most
accurate explanation? * B. “The best time for me to exercise is
right after I eat.”
1/1 C. “The best time for me to exercise is
A. “It empties the stomach of fluids and after breakfast.”
gas.” D. “The best time for me to exercise is
after my morning snack.”

B. “It prevents spasms at the sphincter of

Oddi.”
C. “It prevents air from forming in the The physician orders laboratory
small intestine and large intestine.” tests to confirm
D. “It removes bile from the gallbladder.”
hyperthyroidism in a female
client with classic signs and
After undergoing a subtotal
symptoms of this disorder.
thyroidectomy, a female client
Which test result would confirm
develops hypothyroidism. Dr.
the diagnosis? *
Smith prescribes levothyroxine
1/1
(Levothroid), 25 mcg P.O. daily.
No increase in the thyroid-stimulating
For which condition is hormone (TSH) level after 30 minutes
during the TSH stimulation test
levothyroxine the preferred
agent? * A decreased TSH level
1/1 An increase in the TSH level after 30
minutes during the TSH stimulation test
A. Primary hypothyroidism Below-normal levels of serum
triiodothyronine (T3) and serum thyroxine
(T4) as detected by radioimmunoassay
B. Graves’ disease
C. Thyrotoxicosis
D. Euthyroidism
A client who has undergone a
subtotal thyroidectomy is A client who is regaining
subject to complications in the consciousness after a
first 48 hours after surgery. craniotomy becomes restless
The nurse should obtain and and attempts to pull out her IV
keep at the bedside equipment line. Which nursing intervention
to: * protects the client without
1/1 increasing her ICP? *
A. Begin total parenteral nutrition
B. Start a cutdown infusion 1/1
C. Administer tube feedings Place her in a jacket restraint
D. Perform a tracheostomy Wrap her hands in soft “mitten” restraints

Tuck her arms and hands under the draw

sheet
Apply a wrist restraint to each arm
You assess a patient with
Cushing’s disease. For which
A nurse is preparing a plan of
finding will you notify the
care for a client with DM who
physician immediately? *
1/1 has hyperglycemia. The priority
Purple striae present on abdomen and nursing diagnosis would be: *
thighs
Weight gain of 1 pound since the previous 1/1
day A. High risk for deficient fluid volume
+1 dependent edema in ankles and
calves
Crackles bilaterally in lower lobes of lungs B. Deficient knowledge: disease process
and treatment
C. Imbalanced nutrition: less than body
requirements
D. Disabled family coping: compromised.
Initial treatment for a CSF leak
after transphenoidal The nurse is caring for the
hypophysectomy would most client with increased
likely involve: * intracranial pressure. The nurse
1/1 would note which of the
A. Repacking the nose.
B. Returning the client to surgery. following trends in vital signs if
C. Enforcing bed rest with the head of the
bed elevated. the ICP is rising? *
1/1
D. Administering high-dose corticosteroid
therapy.
Increasing temperature, increasing pulse,
A client with subdural
increasing respirations, decreasing blood
pressure. hematoma was given mannitol
Increasing temperature, decreasing pulse,
decreasing respirations, increasing blood to decrease intracranial
pressure.
pressure (ICP). Which of the
following results would best
Decreasing temperature, decreasing
pulse, increasing respirations, decreasing show the mannitol was
blood pressure.
Decreasing temperature, increasing pulse, effective? *
decreasing respirations, increasing blood
pressure. 1/1
Urine output increases

In a 29-year-old female client Pupils are 8 mm and nonreactive

who is being successfully treated Systolic blood pressure remains at 150
mm Hg
for Cushing’s syndrome, nurse BUN and creatinine levels return to
normal
Angelo would expect a decline
in: *
A male client has recently
1/1
Serum glucose level. undergone surgical removal of a
pituitary tumor. Dr. Wong
Hair loss. prescribes corticotropin
Bone mineralization.
Menstrual flow. (Acthar),20 units I.M. q.i.d. as a
replacement therapy. What is
Which nursing diagnosis takes the mechanism of action of
highest priority for a female corticotropin? *
client with hyperthyroidism? * 1/1
1/1 A. It decreases cyclic adenosine
monophosphate (cAMP) production and
A. Risk for imbalanced nutrition: More affects the metabolic rate of target organs.
than body requirements related to thyroid B. It interacts with plasma membrane
hormone excess receptors to inhibit enzymatic actions.
B. Risk for impaired skin integrity related C. It interacts with plasma membrane
to edema, skin fragility, and poor wound receptors to produce enzymatic actions
healing that affect protein, fat, and carbohydrate
C. Body image disturbance related to
weight gain and edema
D. Imbalanced nutrition: Less than body D. It regulates the threshold for water
requirements related to thyroid hormone resorption in the kidneys.
excess

When a client is first admitted

with hyperglycemic
hyperosmolar nonketotic syndrome of inappropriate
syndrome (HHNS), the nurse’s antidiuretic hormone (SIADH)
priority is to provide: * secretion is experiencing
1/1 complications? *
A. Oxygen
1/1
B. Carbohydrates
C. Fluid replacement A. Tetanic contractions
B. Neck vein distention

D. Dietary instruction
C. Weight loss
D. Polyuria

*
Hyperphosphatemia and
0/1
Give regular insulin by IV
hypocalcemia are indicative of
which of the following
Give NPH by IV disorders? *
Give 10-15 g CHO or Orange juice
Give 1 mg glucagon 1/1
Correct answer A. Grave’s Disease
Give 1 mg glucagon B. Hyperparathyroidism
C. Cushing’s Syndrome
D. Hypoparathyroidism
At a senior citizens meeting a
nurse talks with a client who
has diabetes mellitus Type 1. When a client is in diabetic
Which statement by the client ketoacidosis, the insulin that
during the conversation is most would be administered is: *
predictive of a potential for 1/1
impaired skin integrity? * A. Human NPH insulin
B. Human regular insulin
1/1
“I give my insulin to myself in my thighs.”
“Sometimes when I put my shoes on I C. Insulin lispro injection
don’t know where my toes are.” D. Insulin glargine injection

“Here are my up and down glucose A patient is admitted to the

readings that I wrote on my calendar.”
“If I bathe more than once a week my skin medical unit with possible
feels too dry.”
Graves’ disease
(hyperthyroidism). Which
Which of these signs suggests
that a male client with the
 Decrease the size and vascularity of the
assessment finding supports this
thyroid gland.
diagnosis? *
1/1
Periorbital edema
Bradycardia A client arrives in the
Exophthalmos
emergency department with an
Hoarse voice ischemic stroke and receives
tissue plasminogen activator (t-
A male client with type 1 PA) administration. Which is
diabetes mellitus has a highly the priority nursing
elevated glycosylated assessment? *
hemoglobin (Hb) test result. In 1/1
Current medications.
discussing the result with the Complete physical and history.
Time of onset of current stroke.
client, the nurse would be most
accurate in stating: *
1/1 Upcoming surgical procedures.
“The test needs to be repeated following a A nurse is caring for a client
12-hour fast.”
“It looks like you aren’t following the admitted to the ER with DKA.
prescribed diabetic diet.”
“It tells us about your sugar control for the In the acute phase the priority
last 3 months.”
nursing action is to prepare
to: *
“Your insulin regimen needs to be altered
significantly.” 1/1
A. Administer regular insulin intravenously

Inah, with hyperthyroidism is

B. Administer 5% dextrose intravenously
to receive Lugol’s iodine solution C. Correct the acidosis
D. Apply an electrocardiogram monitor.
before a subtotal thyroidectomy
is performed. The nurse is
Which of the following nursing
aware that this medication is
assessment is the most
given to: *
important in the patient with
1/1
Decrease the total basal metabolic rate. hyperthyroidism and risk for
Maintain the function of the parathyroid
glands. thyrotoxic crisis or thyroid
Block the formation of thyroxine by the storm? *
thyroid gland.
1/1
Intake and output
A male client is having a tonic-
Heart sounds
Bowel sounds clonic seizures. What should the
Vital signs
nurse do first? *
1/1
Elevate the head of the bed.
Restrain the client’s arms and legs.
A male client with primary Place a tongue blade in the client’s mouth.
diabetes insipidus is ready for Take measures to prevent injury.

discharge on desmopressin
(DDAVP). Which instruction
should the nurse provide? * The nurse is admitting a client
1/1 with hypoglycemia. Identify the
“Administer desmopressin while the
signs and symptoms the nurse
suspension is cold.”
“Your condition isn’t chronic, so you won’t should expect. Select all that
need to wear a medical identification
bracelet.” apply. *
“You may not be able to use
1/1
desmopressin nasally if you have nasal
discharge or blockage.” A. Thirst
B. Palpitations

“You won’t need to monitor your fluid

intake and output after you start taking C. Diaphoresis
desmopressin.”

D. Slurred speech
The nurse enters a diabetic
E. Hyperventilation
patient’s room at 11:30 and
notices that the patient is
Nurse Alvin is caring for a
diaphoretic, tachycardic,
female client with type 1
anxious, states she is hungry,
diabetes mellitus who exhibits
and doesn’t remember where
confusion, light-headedness,
she is. This patient is most likely
and aberrant behavior. The
showing signs of what? *
1/1 client is still conscious. The
hyperglycemic nurse should first administer: *
hypoglycemic
1/1
I.M. or subcutaneous glucagon.
diabetic ketoacidosis I.V. bolus of dextrose 50%.
hyperosmolar hyperglycemic noketotic 15 to 20 g of a fast-acting carbohydrate
coma such as orange juice.
10 U of fast-acting insulin.
The nurse is positioning the
female client with increased
The client with a history of
intracranial pressure. Which of
diabetes insipidus is admitted
the following positions would
with polyuria, polydipsia, and
the nurse avoid? *
mental confusion. The priority 1/1
intervention for this client is: * Head mildline
Head turned to the side
1/1
Measure the urinary output
Check the vital signs Neck in neutral position
Head of bed elevated 30 to 45 degrees

Encourage increased fluid intake

Weigh the client
A client who recently had a
cerebrovascular accident/stroke
Paolo with severe head trauma
requires a cane to ambulate.
sustained in a car accident is
When teaching about cane use,
admitted to the intensive care
the rationale for holding a cane
unit. Thirty-six hours later, the
on the uninvolved side is to: *
client’s urine output suddenly 1/1
rises above 200 ml/hour, prevent leaning
distribute weight away from the involved
leading the nurse to suspect side
diabetes insipidus. Which
laboratory findings support the maintain stride length
prevent edema
nurse’s suspicion of diabetes
insipidus? * While working in the ICU, you
0/1
are assigned to care for a
Above-normal urine and serum osmolality
levels patient with a seizure disorder.
Below-normal urine and serum osmolality
levels Which of these nursing actions
will you implement first if the
Above-normal urine osmolality level,
patient has a seizure? *
below-normal serum osmolality level
Below-normal urine osmolality level, 1/1
above-normal serum osmolality level Place the patient on a non-rebreather
Correct answer mask will the oxygen at 15 L/minute.
Below-normal urine osmolality level, Administer lorazepam (Ativan) 1 mg IV.
above-normal serum osmolality level Turn the patient to the side and protect
airway.
 A female client is admitted to
Assess level of consciousness during and the hospital with a diagnosis
immediately after the seizure.
of Guillain-Barre syndrome.
The nurse inquires during the
Pierre who is diagnosed with
nursing admission interview if
acute pancreatitis is under the
the client has a history of: *
care of Nurse Bryan. Which
1/1
intervention should the nurse Seizures or trauma to the brain
include in the care plan for the Respiratory or gastrointestinal infection
during the previous month.
client? *
1/1 Meningitis during the last five (5 years
A. Administration of vasopressin and Back injury or trauma to the spinal cord
insertion of a balloon tamponade
B. Preparation for a paracentesis and
administration of diuretics
Osteomyelitis most commonly
C. Maintenance of nothing-by-mouth
status and insertion of nasogastric (NG) results from which of the
tube with low intermittent suction
following mechanisms? *

D. Dietary plan of a low-fat diet and 0/1

increased fluid intake to 2,000 ml/day IV drug use
Surgery
Questions 51 to 100
36 of 50 points
Trauma
.Immune suppression
A client is admitted to the Correct answer
Trauma
hospital with weakness in the
right extremities and a slight
During a hearing assessment,
speech problem. Vital signs are
the nurse notes that the sound
normal. During the first 24
lateralizes to the clients left ear
hours, the nurse should give
with the Weber test. The nurse
priority to: *
analyzes this result as: *
1/1
1/1
Evaluating the client's motor status
A normal finding
A conductive hearing loss in the right ear
A sensorineural or conductive loss
Checking the client's temperature
Obtaining a urine specimen from the client.
Monitoring the client's blood pressure.
The presence of nystagmus
A nurse would question an
order to irrigate the ear canal After cataract surgery, a client
in which of the following is taught how to self-
circumstances? * administer eyedrops before
1/1 discharge. The nurse approves
Otitis externa
Perforated tympanic membrane the technique when the
client : *
Hearing loss 1/1
. Ear pain
Places the drops on the cornea of the eye.
Holds the dropper tip above the eye.

When assisting the family to

Raises the upper eyelid with gentle
help an aphasic member regain traction
Squeezes the eye shut after instilling the
as much speech function as
eyedrops
possible, the nurse should
instruct them to: * The husband of a client with
0/1
aphasia as a result of a brain
Give positive reinforcement for correct
communication attack (CVA) asks whether his
wife's speech will ever return.
Speak louder than usual during visits.
Encourage the client to speak while being The nurse should respond: *
patient with all attempts. 1/1
Tell the client to use the correct words
"This will probably be the extent of her
when speaking
speech from now on."
Correct answer
"You will have to ask your physician".
Encourage the client to speak while being
"It should return to normal in two or three
patient with all attempts.
months."
"It is hard to say how much improvement
will occur."
On the evening before discharge
from the hospital, a client has a
hypertensive crisis and a brain
The nurse is aware that the
attack (CVA). Initially the nurse
teaching about myasthenic and
should place the client in a: *
cholinergic crises is understood
1/1
High Fowler's position when a client who has been
Slight Trendelenburg position
Side-lying position diagnosed with myasthenia
gravis states that a symptom
Supine position common to both is: *
0/1 plan to instruct the client
diarrhea
abdominal cramping that: *
salivation 0/1
"Both eyes will be bandaged for 24 hours
after surgery."
difficulty breathing
"At night you will be wearing a hard patch
Correct answer
over your operated eye for a month or so."
difficulty breathing
"You may have to remain on bed rest for
three to four days after your surgery."

Postoperative nursing
"You must remember to take deep
assessment for a patient who breaths and cough several times an hour."
has had a mastoidectomy Correct answer
"At night you will be wearing a hard patch
should include observing for: * over your operated eye for a month or so."

1/1
Oculomotor paralysis The most significant initial
Facial paralysis
nursing observations that should
Optic paralysis be made about a client who is
Olfactory paralysis
suspected of having myasthenia
gravis , include the: *
Nursing interventions to treat a
1/1
musculoskeletal injury may Degree of anxiety and concern about the
suspected diagnosis
include cold or heat therapy. Capacity to smile and close the eyelids.
Cold therapy decreases pain by Effectiveness of respiratory exchange and
ability to swallow.
which of the following
actions? * Ability to chew and speak distinctly
1/1
Causes local vasoconstriction and
prevents edema or muscle spasm The nurse is teaching a female
client with multiple sclerosis.
Promotes circulation and reduces muscle When teaching the client how
spasms
Promotes analgesia and circulation to reduce fatigue, the nurse
Numbs the nerves and dilates the vessels
should tell the client to: *
1/1
An older adult has cataracts in Increase the dose of muscle relaxants.
Avoid naps during the day.
both eyes. The left cataract is Rest in an air-conditioned room.
scheduled to be extracted in
several days. The nurse should Take a hot bath.
 Has not voided
Complains of sharp pain in the eye.
When assessing the progress of Becomes confused and restless.
Cannot open the eye.
a client being treated for
myasthenia gravis, the nurse Correct answer
Complains of sharp pain in the eye.
would expect: *
1/1
dramatic worsening in muscle strength After cataract surgery, a client
with anticholinesterase drugs
little or no change in muscle strength complains of feeling nauseated.
regardless of therapy initiated The nurse should: *
fluctuating weakness of muscles
innervated by the cranial nerves 1/1
Explain that this is expected following
surgery
partial improvement of muscle strength Instruct the client to deep-breathe until the
with mild exercise. nausea subsides.
Give the client some crackers to eat.
Administer the antiemetic drug as ordered.
After a left cataract extraction,
a client complains of severe
discomfort in the operated eye.
A client is being prepared for
The nurse recognizes that this is
discharge from an ambulatory
a problem that may be caused
surgical unit following a
by: *
cataract removal with an
1/1
Hemorrhage into the eye. intraocular lens implant. The
statement by the client that
Pressure on the eye from the protective suggests to the nurse that
shield
Expected postoperative discomfort discharge teaching was effective
Isolation related to sensory deprivation
would be: *
1/1
After surgery to repair a retinal "I can't expect to see bright flashes of light
for awhile."
detachment, the client returns "I'm driving home since I feel so good."
to the post anesthesia care unit "I can't wait until I get home to wash my
hair."
with the affected eye patched. "I'll call the surgeon if the analgesic
doesn't relieve the pain."
During the first four hours after
surgery, the nurse should notify
the physician if the client: *
0/1
During the neurological
assessment of a client with a Reassure the client that the glasses worn
before surgery can still be worn.
tentative diagnosis of Guillain- Explain to the client that reading will help
strengthen the eye muscles.
Barre syndrome, the nurse Correct answer
Instruct the client to wear dark glasses
should expect that the client
after the patch is removed.
will manifest: *
1/1
During the immediate post-
Increased muscular weakness
trauma period after injury to
Pronounced muscular atrophy the frontal lobe of the brain,
Impairment in cognitive reasoning
Diminished visual acuity the nurse should pace a client
in the: *
0/1
The nurse identifies that a
Trendelenburg position
client exhibits the characteristic Low-fowler's position
Side-lying position
gait associated with Parkinson's
disease. When recording on the
Supine position
client's chart, the nurse should Correct answer
Low-fowler's position
describe this gait as: *
1/1
Ataxic During the first week after a
Shuffling spinal cord injury at the T3
level, a male client and the
Scissoring
Spastic nurse identify a short term goal.
An appropriate short-term goal
A client who has had a retinal for this client would be, "The
detachment has a scleral client will: *
buckling procedure to attempt 0/1
Perform independent ambulation."
to reattach the retina. Before Consider lifestyle changes."
the client is discharged home,
the nurse should: * Carry out personal hygiene activities."
Understand his limitations".
0/1 Correct answer
Instruct the client to wear dark glasses Carry out personal hygiene activities."
after the patch is removed.
Tell the client that usual activities can be
resumed within two weks.
The nurse might expect a client
with multiple sclerosis to Correct answer
Vertigo, tinnitus, and hearing loss.
complain about the most
common initial symptom,
While assessing a client with
which is: *
Parkinson's disease , the nurse
1/1
Visual disturbances identifies bradykinesia when the
client exhibits: *
Headaches 1/1
Skin infections Paralysis of the limbs
Diarrhea Muscle flaccidity
An intention tremor
A lack of spontaneous movement
The nurse in the neurologic
clinic assesses for damage to the
glossopharyngeal (ninth cranial)
A lumbar puncture is
and vagus (tenth cranial) nerve
performed on a child suspected
by testing the client's ability
of having bacterial meningitis.
to: *
CSF is obtained for analysis. A
1/1
swallow nurse reviews the results of the
CSF analysis and determines
shrug that which of the following
smile
smell results would verify the
diagnosis? *
A female client is admitted to 1/1
Clear CSF, elevated protein, and
the facility for investigation of decreased glucose
Clear CSF, decreased pressure, and
balance and coordination
elevated protein
problems, including possible Cloudy CSF, decreased protein, and
decreased glucose
Ménière’s disease. When Cloudy CSF, elevated protein, and
decreased glucose
assessing this client, the nurse
expects to note: *
0/1
Vertigo, pain, and hearing impairment. A client who has Guillain-Barre
Vertigo, tinnitus, and hearing loss.
Vertigo, vomiting, and nystagmus syndrome asks, "Will I ever got
Vertigo, blurred vision, and fever.
better?" The most appropriate
answer by the nurse would be: * Tinnitus that occurs with aging
A conductive hearing loss that occurs with
0/1 aging.
"You'll notice your strength will improve
each day."
"We are doing everything we can to While performing the history
provide the best care."
and physical examination of a
"Your chances for recovery are very good client with Parkinson's disease ,
but recovery is slow".
"You seem concerned about getting better. the nurse should assess the
What do you think?" client for: *
Correct answer
"Your chances for recovery are very good 0/1
but recovery is slow". Frequent bouts of diarrhea
A low-pitched , monotonous voice
Hyperextension of the neck
Which of the following clinical
manifestations suggest A recent increase in appetite and weight
gain
Amyotrophic Lateral Sclerosis Correct answer
A low-pitched , monotonous voice
(ALS)? *
1/1
Fatigue, progressive muscle weakness, A client asks for an explanation
cramps, fasciculations (twitching), and
incoordination about glaucoma. The nurse
explains that with glaucoma
Paralysis of the facial muscles, increased there is: *
lacrimation (tearing), and painful
sensations in the face, behind the ear, 1/1
and in the eye An opacity of the crystalline lens or its
Tremor, rigidity, bradykinesia (abnormally capsule
slow movements), and postural instability An increase in the pressure within the
Involuntary contraction of the facial eyeball.
muscles causing sudden closing of the
eye or twitching of the mouth
A separation of the neural retina from the
pigmented retina
The nurse has notes that the A curvature of the cornea that becomes
unequal
physician has a diagnosis of
presbycusis on the client’s chart.
A client with Meniere’s disease
The nurse plans care knowing
is experiencing severe vertigo.
the condition is: *
Which instruction would the
1/1
Nystagmus that occurs with aging nurse give to the client to assist
A sensorineural hearing loss that occurs in controlling the vertigo? *
with aging
1/1 this activity the client should be
Lie still and watch the television
Increase sodium in the diet taught: *
. Increase fluid intake to 3000 ml a day 1/1
Avoid sudden head movements
Balancing exercises to promote
equilibrium.
Leg lifts to prevent hip contractures.
Quadriceps-setting exercises to maintain
muscle tone.
A client with gout is Push-ups to strengthen arm muscles.
encouraged to increase fluid
intake. Which of the following
statements best explains why A client who has sustained a
increased fluids are encouraged severe head injury in a diving
for gout? * accident remains unconscious.
0/1 In addition, the nurse observes
.Fluids promote the excretion of uric acid.
Fluids decrease inflammation. bleeding from the left ear, as
Fluids provide a cushion for weakened
bones. well as rhinorrhea. The nurse is
aware that the drainage from
.Fluids increase calcium absorption. the ear and nose indicates: *
Correct answer
.Fluids promote the excretion of uric acid. 1/1
Contusion
Nose fracture
The nurse is aware that a client Concussion
Basilar fracture
with a spinal cord injury is
developing autonomic
dysreflexia when the client
While walking in the hall a
has: *
hospitalized client has a tonic-
1/1
Paroxysmal hypertension and bradycardia. clonic seizure. During the
seizure the nurse's priority
Flaccid paralysis and numbness. should be to: *
Absence of sweating and pyrexia
Escalating tachycardia and shock 1/1
Hold the client's arms and legs firmly.
Attempt to insert an airway between the
A client who is recuperating client's teeth.
Protect the client's head from injury.
from a spinal cord injury at the
T4 level wants to use a Move the client immediately to a soft
surface.
wheelchair. In preparation for
 Primary genetic in origin, triggered by
exposure to meningitis
When obtaining the nursing Primarily genetic in origin, triggered by
exposure to neurotoxins
history from a client who has Unknown, but possibly includes ischemia,
viral infection, or an autoimmune problem
open-angle (chronic) glaucoma,
a complaint that the nurse
should expect is: *
When assisting a client who has
1/1
Seeing floating specks myasthenia gravis with a bath,
Loss of peripheral vision
the nurse notices that the
client's arms become weaker
Intolerance to light
Flashes of light with sustained movement. The
nurse should: *
A nurse is planning care for a 1/1
child with acute bacterial Gradually increase the client's activity
level each day.
meningitis. Based on the mode Administer a dose of pyridostigmine
bromide (Mestinon)
of transmission of this infection, Encourage the client to rest for short
periods of time.
which of the following would be
included in the plan of care? *
Continue the bath while supporting the
1/1 client's arms.
Maintain respiratory isolation precautions
for at least 24 hours after the initiation of
antibiotics After an automobile accident, a
client complains of seeing
Maintain neutropenic precautions
No precautions are required as long as frequent flashes of light. The
antibiotics have been started nurse should suspect: *
Maintain enteric precautions
1/1
Acute glaucoma
A male client with Bell’s Palsy A detached retina

asks the nurse what has caused

Scleroderma
this problem. The nurse’s A cerebral concussion
response is based on an
understanding that the cause A client is admitted to the
is: * hospital after sustaining a head
1/1 injury. The most reliable sign
Unknown, but possibly includes long-term
tissue malnutrition and cellular hypoxia that this client is experiencing
an increase in intracranial completely crushed and whose
pressure would be a slowly: * left leg was traumatically
1/1 amputated above the knee is
Decreasing level of consciousness
admitted to the ICU . When
performing an assessment, the
Rising respiratory rate
Narrowing pulse pressure nurse would expect to find that
Increasing diastolic blood pressure
the client was experiencing: *
1/1
Pathophysiologic changes seen Spastic paralysis of the arms and legs.
with osteoarthritis includes: * Pain in the residual limb
Pain at the level of compression
0/1
Narrowing of the joint space.
All of the above. Difficulty breathing

The formation of bony spurs at the edges

of the joint surfaces. Alvin has a history of peptic
Joint cartilage degeneration.
Correct answer ulcer disease and vomits coffee-
Narrowing of the joint space.
ground emesis. What does this
indicate? *
A female client with a
1/1
suspected brain tumor is A. He has fresh, active upper GI bleeding.
B. He needs immediate saline gastric
scheduled for computed lavage.
tomography (CT). What should C. His gastric bleeding occurred 2 hours
earlier.
the nurse do when preparing
the client for this test? * D. He needs a transfusion of packed
RBC’s.
0/1
Determine whether the client is allergic to
iodine, contrast dyes, or shellfish.
Immobilize the neck before the client is Bethanechol (Urecholine) has
moved onto a stretcher.
been ordered for a client with
gastroesophageal reflux disease
Place a cap on the client’s head.
Administer a sedative as ordered. (GERD). The nurse should assess
Correct answer
Determine whether the client is allergic to the client for which of the
iodine, contrast dyes, or shellfish.
following adverse effects? *
1/1
A client whose vertebral column A. Dry oral mucosa
B. Hypertension
at the level of T6 and T7 was C. Urinary urgency
 nurse position the client for this
D. Constipation test initially? *
1/1
The client being seen in a A. Lying on the right side with legs straight
B. Lying on the left side with knees bent
physician’s office has just been
scheduled for a barium swallow C. Prone with the torso elevated
D. Bent over with hands touching the floor
the next day. The nurse writes
down which of the following
Anna is 45 y.o. and has a
instructions for the client to
bleeding ulcer. Despite multiple
follow before the test? *
blood transfusions, her HGB is
1/1
A. Fast for 8 hours before the test 7.5g/dl and HCT is 27%. Her
doctor determines that surgical
B. Eat a regular supper and breakfast
intervention is necessary and
C. Continue to take all oral medications as
scheduled. she undergoes partial
D. Monitor own bowel movement pattern
for constipation gastrectomy. Postoperative
nursing care includes: *
Before bowel surgery, Lee is to 1/1
A. Giving pain medication Q6H.
administer enemas until clear. B. Flushing the NG tube with sterile water.
During administration, he C. Positioning her in high Fowler’s
position.
complains of intestinal cramps. D. Keeping her NPO until the return of
peristalsis.
What do you do next? *
1/1
A. Discontinue the procedure
B. Lower the height of the enema
container A client who has been
diagnosed with
C. Complete the procedure as quickly as gastroesophageal reflux disease
possible
D. Continue administering the enema (GERD) complains of heartburn.
without making any adjustments
To decrease the heartburn, the
nurse should instruct the client
A male client with a recent
to eliminate which of the
history of rectal bleeding is
following items from the diet? *
being prepared for a
1/1
colonoscopy. How should the A. Lean beef
B. Air popped popcorn
x-rays, the nurse should
C. Raw vegetables
D. Hot chocolate instruct the client to: *
1/1
A. administer an enema
B. take a laxative
Which of the following
instructions should the nurse C. take an antiemetic
D. follow a clear liquid diet
include in the teaching plan for
a client who is experiencing
The nurse is providing discharge
gastroesophageal reflux disease
instructions to a male client
(GERD)? *
following gastrectomy and
1/1
A. Limit caffeine intake to two cups of instructs the client to take
coffee per day.
which measure to assist in
B. Do not lie down for 2 hours after eating.
preventing dumping
C. Follow a low-protein diet. syndrome? *
D. Take medications with milk to decrease
irritation. 1/1
A. Ambulate following a meal
B. Eat high carbohydrate foods
C. Limit the fluid taken with meal
Nurse Gemma is teaching a
group of middle-aged men
D. Sit in a high-Fowler’s position during
about peptic ulcers. When meals

discussing risk factors for peptic

ulcers, the nurse should Your patient has a GI tract that
mention: * is functioning, but has the
1/1 inability to swallow foods.
A. a sedentary lifestyle and smoking.
Which is the preferred method
B. a history of hemorrhoids and smoking.
C. alcohol abuse and a history of acute of feeding for your patient? *
renal failure.
D. alcohol abuse and smoking. 1/1
A. Total Parenteral Nutrition
B. Partial Parenteral Nutrition
C. Nasogastric Feeding

The client is scheduled to have

D. Oral Liquid Supplementation
an upper gastrointestinal tract
series of x-rays. Following the
Which specific data should the
nurse obtain from the client
 D. Vitamin E
who is suspected of having
peptic ulcer disease? *
1/1 The nurse has been assigned to
A. History of side effects experienced care for a client diagnosed with
from all medications
B. Use of non steroidal anti inflammatory peptic ulcer disease. Which
drugs (NSAIDs)
assessment data require further
intervention? *
C. Any known allergies to drugs and
environmental factors 1/1
D. Medical histories of at lease 3 A. Bowel sour s auscultated 15 times in 1
generations minute
B. Belching after eating a heavy and fatty
meal late at night
The client with C. A decrease in systolic BP of 20 mm Hg
from lying to sitting
gastroesophageal reflux disease
(GERD) complains of a chronic D. A decreased frequency of distress
located in the epigastric region
cough. The nurse understands
that in a client with GERD this
The nurse is providing discharge
symptom may be indicative of
instructions to a male client
which of the following
following gastrectomy and
conditions? *
1/1 instructs the client to take
A. development of laryngeal cancer which measure to assist in
B. aspiration of gastric contents
preventing dumping

C. Irritation of the esophagus syndrome? *

D. Esophageal scar tissue formation 1/1
A. Ambulate following a meal
B. Eat high carbohydrate foods
The nurse is caring for a client C. Limit the fluid taken with meal
with chronic gastritis. The nurse
D. Sit in a high-Fowler’s position during
monitors the client, knowing
meals
that this client is at risk for
which of the following vitamin The nurse is caring for a female
deficiencies? * client with active upper GI
1/1
bleeding due to a peptic ulcer.
A.Vitamin A
B. Vitamin B12 What is the appropriate diet for

C. Vitamin C
 A. The clients pain is controlled with the
this client during the first 24
use of NSAIDs
hours after admission? * B. The client maintains lifestyle
modifications
1/1
A. Regular diet
B. Skim milk C. The client has no signs and symptoms
C. Nothing by mouth of hemoptysis
D. The client take s antacids with each
meal
D. Clear liquids

A nurse is inserting a
Which assessment data indicate
nasogastric tube in an adult
to the nurse the clients gastric
male client. During the
ulcer has perforated? *
procedure, the client begins to
1/1
A. Complaints of sudden, sharp, cough and has difficulty
substernal pain breathing. Which of the
B. Rigid, boardlike abdomen with rebound
tenderness following is the appropriate
nursing action? *
C. Frequent, clay-colored, liquid stool
1/1
D. Complaints of vague abdominal pain in
the right upper quadrant A. Quickly insert the tube
B. Notify the physician immediately
C. Remove the tube and reinsert when
the respiratory distress subsides
Which of the following factors D. Pull back on the tube and wait until the
would most likely contribute to respiratory distress subsides

the development of a client's

hiatal hernia? *
1/1 The nurse is obtaining a health
A. having a sedentary desk job history from a client who has a
B. using laxatives frequently
C. being 40 years old sliding hiatal hernia associated
D. being 5 feet 2 inches tall and weighing
200 lbs. with reflux. The nurse should
ask the client about the
presence of which of the

Which expected outcome should following symptoms? *

the nurse include for a client 1/1

A. Jaundice
diagnosed with peptic ulcer B. Anorexia
C. Heartburn
disease? *
1/1
D. Stomatitis
 diagnosis of appendicitis. The
A male client who is recovering client is scheduled for surgery in
from surgery has been 2 hours. The client begins to
advanced from a clear liquid complain of increased
diet to a full liquid diet. The abdominal pain and begins to
client is looking forward to the vomit. On assessment the nurse
diet change because he has been notes that the abdomen is
“bored” with the clear liquid distended and the bowel sounds
diet. The nurse would offer are diminished. Which of the
which full liquid item to the following is the most
client? * appropriate nursing
1/1 intervention? *
A. Tea 1/1
B. Gelatin
A. Administer Dilaudid
C. Custard
B. Notify the physician

D. Popsicle
C. Call and ask the operating room team
to perform the surgery as soon as
possible
The nurse is caring for a male D. Reposition the client and apply a
heating pad on a warm setting to the
client postoperatively following client’s abdomen.
creation of a colostomy. Which
nursing diagnosis should the After a subtotal gastrectomy,
nurse include in the plan of care of the client’s nasogastric
care? * tube and drainage system
1/1
should include which of the
A. Sexual Dysfunction
B. Disturbed Body Image following nursing
interventions? *
C. Fear related to Poor Prognosis 0/1
D. Imbalanced Nutrition: more than body
A. Irrigate the tube with 30 ml of sterile
requirements
water every hour, if needed.
Questions 26 to 50 B. Reposition the tube if it is not draining
20 of 25 points well
C. Monitor the client for nausea and
vomiting, and abdominal distention
D. Turn the machine to high suction of the
A nurse is monitoring a client drainage is sluggish on low suction.
admitted to the hospital with a
Correct answer
C. Monitor the client for nausea and B. Stop the irrigation temporarily
vomiting, and abdominal distention

C. Increase the height of the irrigation

D. Medicate for pain and resume the
The client with GERD complains
irrigation
of a chronic cough. The nurse
understands that in a client A 70-year-old client visits the
with GERD this symptom may clinic and complains of minor
be indicative of which of the soiling with occasional urgency
following conditions? * and loss of control. Further
1/1
assessment reveals that the
A. Development of laryngeal cancer
B. Irritation of the esophagus client has poor control of flatus.
C. Esophageal scar tissue formation
D. Aspiration of gastric contents Based on the presenting
symptoms, you suspect that the
client may have: *

Nursing suggestions to help a 1/1

A. Peptic ulcer disease
person break the constipation B. Constipation
C. Irritable bowel syndrome
habit include all of the following D. Fecal incontinence
except: *
0/1
A. A low-residue, bland diet.
B. A fluid intake of at least 2 L/day. A patient with IBS asks, “How
C. Establishing a regular schedule of
exercise. can I manage abdominal
D. Establishing a regular time for daily
elimination. discomfort?” Your best response
would be: *
Correct answer 1/1
A. A low-residue, bland diet. A. “It is best managed by eating dry
crackers.”
B. “Some patients maintain an
The nurse is performing a antidepressant drugs.”
C. “You will be the one to choose what is
colostomy irrigation on a male best for you.”
D. “Abdominal pain can be reduced by
client. During the irrigation, the avoiding carbonated beverages.”
client begins to complain of
abdominal cramps. What is the
appropriate nursing action? * A client with irritable bowel
1/1
syndrome is being prepared for
A. Notify the physician
discharge. Which of the inflammation, perforation, and
following meal plans should the surgery. What is the rationale
nurse give the client? * for choosing this nursing
1/1 diagnosis? *
A. Low fiber, low-fat
1/1
B. High fiber, low-fat
A. Obstruction of the appendix may
increase venous drainage and cause the
C. Low fiber, high-fat appendix to rupture.
D. High-fiber, high-fat B. Obstruction of the appendix reduces
arterial flow, leading to ischemia,
inflammation, and rupture of the appendix.
A 20 year old college student
was rushed to the ER of C. The appendix may develop gangrene
and rupture, especially in a middle-aged
VSMMC after he fainted during client.
D. Infection of the appendix diminishes
their ROTC drill. He complained necrotic arterial blood flow and increases
venous drainage.
of severe right iliac pain. Upon
palpation of his abdomen, the
The nurse is doing an admission
student jerks even on slight
assessment on a client with a
pressure. Blood test was
history of duodenal ulcer. To
ordered. Diagnosis is acute
determine whether the problem
appendicitis. Pre-anesthetic
is currently active, the nurse
med of Demerol and atrophine
would assess the client for
sulfate were ordered to : *
which of the following most
0/1
A. Allay anxiety and apprehension frequent symptom(s) of
B. Reduce pain
duodenal ulcer? *
1/1
C. Prevent vomiting
A. Pain that is relieved by food intake
D. Relax abdominal muscle
Correct answer
A. Allay anxiety and apprehension
B. Pain that radiated down the right arm
C. Nausea and vomiting
D. Weight loss
When preparing a male client,
age 51, for surgery to treat
Trent has been diagnosed with
appendicitis, the nurse
appendicitis. He develops a fever,
formulates a nursing diagnosis
hypotension and tachycardia.
of Risk for infection related to
The nurse suspects which of the appendicitis. Stat
following complications? * appendectomy was indicated.
1/1 Pre op care would include all of
A. Intestinal obstruction
B. Peritonitis the following except? *
1/1
A. Consent signed by the father
C. Bowel ischemia
B. Enema STAT
D. Deficient fluid volume

C. Skin prep of the area including the

Which of the following are pubis
D. Remove the jewelries
considered as the risk factors of
irritable bowel syndrome?
While caring for a client with
Select all that apply. *
peptic ulcer disease, the client
0/1
A. Gastric resection reports that he has been
B. Stress
nauseated most of the day and
is now feeling lightheaded and
C. Spicy foods
dizzy. Based upon these findings,
D. Celiac disease which nursing actions would be
E. Enteritis
most appropriate for the nurse

F. Smoking
to take? Select all that apply. *
1/1
A. Administering an antacid hourly until
Correct answer nausea subsides.
B. Stress B. Monitoring the client’s vital signs
C. Spicy foods C. Notifying the physician of the client’s
F. Smoking symptoms

A 20 year old college student D. Initiating oxygen therapy

E. Reassessing the client on an hour
was rushed to the ER of
VSMMC after he fainted during
The nurse would monitor for
their ROTC drill. He complained
which of the following adverse
of severe right iliac pain. Upon
reactions to aluminum-
palpation of his abdomen, the
containing antacids such as
student jerks even on slight
aluminum hydroxide
pressure. Blood test was
(Amphojel)? *
ordered. Diagnosis is acute
1/1 B. After the client accepts he had a bowel
movement
A. Diarrhea
C. Before breakfast and morning care
B. Constipation
D. At least 2 hours before visitors arrive

C. GI upset
D. Fluid retention The hospitalized client with
GERD is complaining of chest
How does exercise helps manage discomfort that feels like
IBS? * heartburn following a meal.
1/1 After administering an ordered
A. It increases peristalsis.
antacid, the nurse encourages
the client to lie in which of the
B. It decreases peristalsis.
C. It decreases intestinal motility. following positions? *
D. It relieves abdominal pain.
1/1
A. Supine with the head of the bed flat
Hypokalemia can occur rapidly B. On the stomach with the head flat
C. On the left side with the head of the
in an elderly person who bed elevated 30 degrees

experiences diarrhea. The nurse

D. On the right side with the head of the
should immediately report to bed elevated 30 degrees.
the physician a critical
potassium level of: * When teaching an elderly client
1/1 how to prevent constipation,
A. 3.0 mEq/L
which of the following

B. 4.0 mEq/L instructions should the nurse

C. 4.5 mEq/L
include? *
D. 5.0 mEq/L
0/1
A. “Drink 6 glasses of fluid each day.”
When preparing to teach a
client with colostomy how to B. “Avoid grain products and nuts.”
C. “Add at least 4 grams of bran to your
irrigate his colostomy, the nurse cereal each morning.”
should plan to perform the D. “Be sure to get regular exercise.”
Correct answer
procedure: * D. “Be sure to get regular exercise.”

1/1
A. When the client would have normally Which of the following best
had a bowel movement
describes the method of action
 C. Sitting
of medications, such as
D. Lying with legs drawn up
ranitidine (Zantac), which are
used in the treatment of peptic
ulcer disease? *
The client has been admitted
1/1
A. Neutralize gastric acid with a diagnosis of acute
B. Reduce gastric acid secretions pancreatitis. The nurse would
assess this client for pain that
C. Stimulate gastrin release
D. Protect the mucosal barrier is: *
1/1
A. Severe and unrelenting, located in the
In a client with diarrhea, which epigastric area and radiating to the back.
outcome indicates that fluid
resuscitation is successful? * B. Severe and unrelenting, located in the
left lower quadrant and radiating to the
1/1 groin.
A. The client passes formed stools at C. Burning and aching, located in the
regular intervals epigastric area and radiating to the
B. The client reports a decrease in stool umbilicus.
frequency and liquidity D. Burning and aching, located in the left
C. The client exhibits firm skin turgor lower quadrant and radiating to the hip.
Questions 51 to 75
D. The client no longer experiences 25 of 25 points
perianal burning.

A female client who has just

Angelo is being admitted to a been diagnosed with hepatitis A
hospital unit complaining of asks, “How could I have gotten
severe pain in the lower this disease?” What is the
abdomen. Admission vital signs nurse’s best response? *
reveal an oral temperature of 1/1
38 C. Signs and symptoms “You may have eaten contaminated
restaurant food.”
include pain in the RLQ of the
abdomen that may be localize “You could have gotten it by using I.V.
drugs.”
at McBurney’s point. To relieve
“You must have received an infected
pain, Angelo should assume blood transfusion.”
“You probably got it by engaging in
which position? * unprotected sex.”
1/1
A. Prone
B. Supine, stretched out
. The physician orders intestinal vitamin K absorption caused by
decompression. The primary this hepatic disease? *
purpose of a nasoenteric tube is 1/1
Dyspnea and fatigue
to: * Ascites and orthopnea
1/1 Purpura and petechiae
. Break up the obstruction
Remove fluid and gas from the intestine
Gynecomastia and testicular atrophy

Prevent fluid accumulation in the stomach

Provide an alternative route for drug . For which of the following
administration
positions would be appropriate
for a client with severe
You’re assessing the stoma of a
ascites? *
patient with a healthy, well-
1/1
healed colostomy. You expect Fowler’s
the stoma to appear: *
1/1 Side-lying
Reverse Trendelenburg
Pale, pink and moist
Sims’
Red and moist

Dark or purple colored Nurse Juvy is caring for a client

Dry and black
with cirrhosis of the liver. To
minimize the effects of the
A client with advanced cirrhosis
disorder, the nurse teaches the
has been diagnosed with hepatic
client about foods that are high
encephalopathy. The nurse
in thiamine. The nurse
expects to assess for: *
determines that the client has
1/1
. Malaise the best understanding of the
Stomatitis dietary measures to follow if
Hand tremors
the client states an intention to
Weight loss increase the intake of: *
1/1
Pork
The nurse is caring for a male
client with cirrhosis. Which
Milk
assessment findings indicate Chicken
Broccoli
that the client has deficient
 Jordin is a client with jaundice
Which of the following measures who is experiencing pruritus.
should the nurse focus on for Which nursing intervention
the client with esophageal would be included in the care
varices? * plan for the client? *
1/1 1/1
Recognizing hemorrhage Administering vitamin K subcutaneously
Applying pressure when giving I.M.
injections
Controlling blood pressure Decreasing the client’s dietary protein
Encouraging nutritional intake intake
Teaching the client about varices Keeping the client’s fingernails short and
smooth

You’re discharging Nathaniel

with hepatitis B. Which
. Develop a teaching care plan
statement suggests
for Angie who is about to
understanding by the patient? *
undergo a liver biopsy. Which of
1/1
. “Now I can never get hepatitis again.” the following points do you
“I can safely give blood after 3 months.”
“I’ll never have a problem with my liver include? *
again, even if I drink alcohol.” 1/1
“My family knows that if I get tired and
. “You’ll need to lie on your stomach
start vomiting, I may be getting sick
during the test.”
again.”
“You’ll need to lie on your right side after
the test.”

“During the biopsy you’ll be asked to

Immediately after a liver biopsy, exhale deeply and hold it.”
“The biopsy is performed under general
which of the following anesthesia.”
complications should the client
be closely monitored for? * The most important
1/1 pathophysiologic factor
. Abdominal cramping
Hemorrhage contributing to the formation
of esophageal varices is: *
Nausea and vomiting 1/1
Potential infection
Decreased prothrombin formation
Decreased albumin formation by the liver
Portal hypertension
Increased central venous pressure
obstruction. Which intervention
is priority for her? *
Which of the following will the 1/1
nurse include in the care plan Obtain daily weights.
Measure abdominal girth.
for a client hospitalized with
viral hepatitis? * Keep strict intake and output.
1/1 Encourage her to increase fluids.
. Increase fluid intake to 3000 ml per day
Adequate bed rest
A patient with chronic alcohol

Bland diet abuse is admitted with liver

Administer antibiotics as ordered
failure. You closely monitor the
patient’s blood pressure because
You’re caring for Betty with
of which change that is
liver cirrhosis. Which of the
associated with the liver
following assessment findings
failure? *
leads you to suspect hepatic 1/1
encephalopathy in her? * Hypoalbuminemia
1/1
. Asterixis Increased capillary permeability
Abnormal peripheral vasodilation
Excess rennin release from the kidneys
Chvostek’s sign
Trousseau’s sign
Hepatojugular reflex
A client with cirrhosis begins to
develop ascites. Spironolactone
Which of the following tests
(Aldactone) is prescribed to
confirms that the origin of the
treat the ascites. The nurse
disorder is in the liver? *
should monitor the client closely
1/1
for which of the following drug-
Alanine Aminotransferase (ALT)
Aspartate Aminotransferase (AST) related side effects? *
Gamma-glutamyl Transferase (GGT)
Serum Alkaline Phosphatase 1/1
. Constipation
Hyperkalemia

. Claire, a 33 y.o. is on your Irregular pulse

Dysuria
floor with a possible bowel
 Elevated blood urea nitrogen level
A client is admitted to the
Decreased erythrocyte sedimentation rate
hospital complaining of nausea,
vomiting, and abdominal pain. Which rationale supports
Bowel obstruction is suspected. explaining the placement of an
During the initial assessment, esophageal tamponade tube in a
the nurse hears high-pitched client who is hemorrhaging? *
tinkling bowel sounds on 1/1
auscultation and flat sounds on Allowing the client to help insert the tube
Beginning teaching for home care
percussion. The flat sounds are Maintaining the client’s level of anxiety
and alertness
caused by: * Obtaining cooperation and reducing fear
1/1
Hyperactive peristalsis
Fluid trapped in the intestine

. Sharon has cirrhosis of the

Excessive gas trapped in the intestine
The presence of a mass or tumor in the liver and develops ascites. What
bowel intervention is necessary to
decrease the excessive
Nathaniel has severe pruritus accumulation of serous fluid in
due to having hepatitis B. What her peritoneal cavity? *
is the best intervention for his 1/1
comfort? * Restrict fluids

1/1
Give tepid baths. Encourage ambulation
Increase sodium in the diet
Give antacids as prescribed
Avoid lotions and creams.
Use hot water to increase vasodilation.
Use cold water to decrease the itching. You’re caring for a patient with
a sigmoid colostomy. The stool
A client is suspected of having from this colostomy is? *
hepatitis. Which diagnostic test 1/1
result will assist in confirming . Formed

this diagnosis? *
Semisolid
1/1 Semiliquid
Elevated hemoglobin level Watery
Elevated serum bilirubin level
Questions 76 to 100
17 of 25 points
 Frequency of the medication
Purpose of the medication
When a client is diagnosed with Necessity of the medication
Metabolism of the medication
ulcerative colitis. What
complication would the nurse
be on alert for? *
Immediately before an
1/1
Intestinal obstruction abdominal paracentesis, the
Toxic megacolon nurse should ask the client to
void because a full bladder: *
Malnutrition from malabsorption
Fistula formation 1/1
Decreases the intraabdominal pressure
Decreases the amount of fluid in the
An adult has a sigmoid abdominal cavity
Increases the danger of puncture during
colostomy. The nurse is the procedure

performing peristomal skin care

Increases the presence of urea in the
and changing the stoma pouch. intraabdominal fluid
What is the most appropriate
nursing action? * What is the major dietary
0/1 treatment for ascites> *
Empty the ostomy pouch when it is full
0/1
High protein
Pull flange and pouch off together to Increased potassium
prevent spillage of stomach pouch Restricted sodium
contents. Restricted fluids
Leave 1/4 inch of skin exposed around
stoma when determining size to cut new
sin barrier Correct answer
Apply liquid deodorant to mucous Restricted sodium
membrane of protruding stoma
Correct answer
Leave 1/4 inch of skin exposed around An adult who has 7 year
stoma when determining size to cut new
sin barrier history of hepatic cirrhosis was
brought to the emergency room
Which of the following because he began vomiting large
considerations has highest amounts of dark red blood. A
priority when preparing to Sengstaken-Blakemore tube
administer a medication to a was inserted to tamponade the
client with liver cancer? * bleeding esophageal varices.
1/1
While the balloon tamponade is Which of the following not
in place ,what is given the considered as appropriate
highest priority? * management for a patient
0/1 diagnosed with liver abscess? *
Assessing his stools for occult blood
0/1
Evaluating capillary refill in extremities
Performing frequent mouth care Monitor white blood cell count

Auscultating breath sounds. Administer IV antibiotic

Correct answer Meticulous skin care
Auscultating breath sounds. Open surgical drainage is the treatment of
choice
Correct answer
Open surgical drainage is the treatment of
Early manifestation of a patient choice
with liver cancer includes: *
1/1 What is the primary nursing
Ascites
Hepatomegaly diagnosis for a 4th to 10th day
Continuous dull abdominal pain at RUQ
postoperative liver transplant
patient? *
Jaundice
1/1
. Excess Fluid Volume
A client has choledocholithiasis . Risk for Rejection

During the nursing admission ,

Impaired Skin Integrity
the nurse notes that the client's Decreased Cardiac Output
sclera and skin are jaundiced .
Ehen complaining of abdominal The client with hepatitis may
distention and pain, how is the be anicteric and symptomless.
client most likely to described What sign/symptom is most
this condition? * likely present in the early
1/1 presentation f hepatic
An intermittent, colicky pain in his left
flank. inflammatory disorder? *
Pain which awakens him during the night,
0/1
and is relieved by eating.
A vise-like pressure over his sternum. Dark urine
Right upper quadrant pain that often
radiates to his right shoulder.
Ascites
Occult blood in stools
Anorexia
Correct answer
Anorexia
 asterixis. In developing a two
When preparing a client for part nursing diagnosis for this
liver biopsy, the nurse should condition, what would be the
instruct the client to: * second part following Disturbed
0/1 Thought Processes? *
Turn on the left side after the procedure. 1/1
Breathe normally throughout the
Massive ascites formation
procedure.
Increased serum ammonia level
Hold the breath at the moment of the
actual biopsy
Fluid volume excess
Altered clotting mechanism
Bear down (Valsalva maneuver) during
the insertion of the biopsy needle.
Correct answer
Bear down (Valsalva maneuver) during Which of the following tests is
the insertion of the biopsy needle.
the most accurate for
diagnosing liver cancer? *
A client with ascites is to
1/1
receive IV albumin to replace Abdominal ultrasound
Abdominal flat plate X-ray
each liter of fluid removed via Cholangiogram
paracentesis. The albumin Computed tomography (CT) scan

replacement is expected to
decrease: *
0/1 A client is admitted to the
Capillary perfusion and BP hospital for acute cholecystitis.
Ascites and the blood ammonia level
She is now 6 hours post-op
Venous stasis and the Blood urea abdominal cholecystectomy
Nitrogen level.
Tissue fluid accumulation and the with a choledochostomy and
hematocrit level
has a T-tube in place. What is
Correct answer
Tissue fluid accumulation and the the proper management of the
hematocrit level
T-tube? *
0/1
A client is experiencing Hanging the T-tube drainage below the
advanced hepatic cirrhosis bed

complicated by hepatic
Notifying the physician if T-tube drainage
encephalopathy. He is confused, is 75 ml for the first 24 hours after surgery.
Irrigating the T-tube with sterile normal
restless, and demonstrate saline q 2 hours to prevent obstruction.
Clamping the T-tube if the client develops
sudden severe abdominal pain.
Correct answer Antibiotic agents are used as long-term
Notifying the physician if T-tube drainage therapy to prevent rejection of the
is 75 ml for the first 24 hours after surgery. transplanted liver.
Place patient in Trendelenburg position to
facilitate pulmonary drainage.
Monitor cardiac output, oxygen saturation,
A patient with severe cirrhosis
urine output, heart rate, and blood
of the liver develops pressure every 8 hours to evaluate
hemodynamic status and intravascular
hepatorenal syndrome. Which of fluid volume.
the following nursing
assessment data would support A client returns to the surgical
this? * unit after a liver biopsy. The
1/1 nurse identifies a moderately
Oliguria and azotemia
large amount of bile -colored
drainage on the dressing. The
Metabolic alkalosis
Decreased urinary concentration client also complains of right
Weight gain of less than 1 lb per week
upper quadrant pain. The nurse
Submission ID (skip this field) *
DO NOT EDIT this field or your time will not should: *
be recorded. 1/1
vTxf6nBEcbhxGCW7
Medicate the client for pain as ordered
Ensure that the client remains in the
supine position
Which of the following Monitor the client's vial signs every 15
minutes
assessment findings is expected Notify the physician of the client's status
to a patient with liver immediately.

abscess? *
1/1
weight gain
Which laboratory value would
Liver atrophy
Erythrocytosis the nurse expect to find in a
Abdominal tenderness at RUQ
client as a result of liver
failure? *
1/1
Which of the following Decreased serum creatinine
Decreased sodium
interventions is appropriate Increased ammonia
after liver transplant? *
1/1 Increased calcium
Place patient in an environment free from
bacteria, viruses, and fungi as possible.
 stools become brown in color
Which one of the following
statements regarding pyogenic
colic is absent after ingestion of fats.
liver abscess is false? the serum bilirubin level returns to normal
1/1
Biliary sepsis is the commonest source
Blood culture identifies the organism in Which of the following
50% of cases procedures is likely to be most
Surgery is needed for drainage in
loculated abscess necessary for a client with a
Usually single abscess is seen
small tumor confined to one
liver segment or lobe? *
1/1
The nurse is caring for a client Chemotherapy only
Cryoablation or liver resection
diagnosed with ulcerative colitis.
The nurse has been giving
Liver transplant
dietary instructions to help Radiation therapy only
SAS 1
prevent exacerbation of his
inflammatory bowel disease.
1. You’re performing an abdominal
Which dietary choice indicates assessment on Brent who is 52 y.o. In
which order do you proceed?
that the client understands the A. Observation, percussion, palpation,
auscultation
dietary instructions? *
1/1 A.
Apple
Celery Observation, auscultation,
Refined cereals percussion, palpation

B.
Hard cheeses C.

Percussion, palpation, auscultation,

A client has laparoscopic observation

surgery to remove a stone from D.

the common bile duct. The E.

nurse is aware that the bile Palpation, percussion, observation,

auscultation
flow into the duodenum has
been reestablished after biliary F.
surgery when: *
1/1 2. While palpating a female client’s right
upper quadrant (RUQ), the nurse would
the liver is no longer tender
expect to find which of the following A.
structures?
A. Sigmoid colon Analgesics
B. Appendix
C. Spleen
D. Liver B.
C.
3. A female client being seen in a
physician’s office has just been scheduled Corticosteroids
for a barium swallow the next day. The
nurse writes down which instruction for the
client to follow before the test? D.
A. Fast for 8 hours before the test E.
B. Eat a regular supper and breakfast
C. Continue to take all oral medications as Antipyretics
scheduled
D. Monitor own bowel movement pattern F.
for constipation
G.
4. Which diagnostic test would be used first
to evaluate a client with upper GI bleeding? Antibiotics
A. Endoscopy
B. Upper GI series H.
C. Hemoglobin (Hb) levels and hematocrit
(HCT)
D. Arteriography
7. Which of the following are the possible
causes of sialadenitis? Select all that apply.
5. A patient complains about an inflamed
salivary gland below his right ear. The nurse
documents probable inflammation of which A.
gland/s?
Dehydration
A.
B.
Buccal C.

B. Stress
C.
D.
Parotid E.

D. Dental extraction
E.
F.
Sublingual G.

F. Improper oral hygiene

G.
H.
Submandibular I.

H. Frequent ingestion of cold

beverages

6. Parotitis caused by bacteria is treated with J.

which of the following drug classifications?
 D. Vitamin E
8. A patient asks, “Is surgery always the
treatment of choice for inflamed salivary 5. The nurse is reviewing the medication
glands?” Your best response would be: record of a client with gastritis. Which
A. Yes, surgery is always the answer. medication, if noted on the client’s record,
B. Surgery is only recommended for would the nurse question?
children. A. Amoxicillin (Amoxil)
C. Elderly is not a candidate for B. Indomethacin (Indocin)
parotidectomy. C. Lansoprazole (Prevacid)
D. The procedure is advised for chronic D. Clarithromycin (Biazin)
sialadenitis and uncontrolled pain.
6. Which of the following treatments should
9. Which of the following conditions be included in the immediate management
described as presence of calculi in the of acute gastritis?
salivary glands? A. Reducing work stress
A. Parotitis B. Completing gastric resection
B. Sialolithiasis C. Treating the underlying cause
C. Sialadenitis D. Administering enteral tube feedings
D. Mumps
7. Which of the following risk factors can
10. Which of the following medical lead to chronic gastritis?
management is recommended for salivary A. Young age
calculus? B. Antibiotic usage
A. Lithotripsy C. Gallbladder disease
B. Antibiotic therapy D. Helicobacter pylori infection
C. Nephrectomy
D. Endoscopy 8. Which of the following factors associates
chronic gastritis with pernicious anemia?
SAS 3 A. Chronic blood loss
B. Inability to absorb vitamin B12
C. Overproduction of stomach acid
D. Overproduction of vitamin B12
1. Acute gastritis is often caused by:
A. Ingestion of strong acids
9. Which of the following measures helps
B. Irritating foods
relieve pain to a client with gastritis?
C. Overuse of Aspirin
A. Avoid foods and beverages that may be
D. All of the above
irritating to the gastric mucosa.
B. Monitor fluid intake and output daily to
2. Which of the following definitions best detect early signs of dehydration.
describes gastritis? C. Administer Amoxicillin (Amoxil) twice a
A. Erosion of the gastric mucosa day.
B. Inflammation of a diverticulum D. Start intravenous fluid therapy.
C. Inflammation of the gastric mucosa
D. Reflux of stomach acid into the
10 A patient with gastritis is nauseated and
esophagus
vomited 10 times at home, which of the
following nursing diagnoses is appropriate
3. Which of the following substances is most for this patient? Select all that apply.
likely to cause gastritis? A. Acute pain related to irritated stomach
A. Milk mucosa
B. Bicarbonate of soda, or baking soda B. Anxiety related to treatment
C. Enteric coated aspirin C. Imbalanced nutrition, less than body
D. Nonsteriodal anti-imflammatory drugs requirements related to inadequate intake of
nutrients
4. The nurse is caring for a client with D. Risk for imbalanced fluid volume related
chronic gastritis. The nurse monitors the to insufficient fluid intake and excessive fluid
client, knowing that this client is at risk for loss
which of the following vitamin deficiencies?
A.Vitamin A 11. Michael, a 42 y.o. man is admitted to the
B. Vitamin B12 med-surg floor with a diagnosis of acute
C. Vitamin C pancreatitis. His BP is 136/76, pulse 96,
Resps 22 and temp 101. His past history
includes hyperlipidemia and alcohol abuse.
The doctor prescribes an NG tube. Before SAS 5
inserting the tube, you explain the purpose
to patient. Which of the following is a most
accurate explanation?
1. You’re performing an abdominal
A. “It empties the stomach of fluids and
assessment on Brent who is 52 y.o. In which
gas.”
order do you proceed?
B. “It prevents spasms at the sphincter of
A. Observation, percussion, palpation,
Oddi.”
auscultation
C. “It prevents air from forming in the small
B. Observation, auscultation, percussion,
intestine and large intestine.”
palpation
D. “It removes bile from the gallbladder.”
C. Percussion, palpation, auscultation,
observation
12. Jason, a 22 y.o. accident victim,
D. Palpation, percussion, observation,
requires an NG tube for feeding. What
auscultation
should you immediately do after inserting an
NG tube for liquid enteral feedings?
A. Aspirate for gastric secretions with a
2. When teaching an elderly client how to
syringe.
prevent constipation, which of the following
B. Begin feeding slowly to prevent cramping.
instructions should the nurse include?
C. Get an X-ray of the tip of the tube within
A. “Drink 6 glasses of fluid each day.”
24 hours.
B. “Avoid grain products and nuts.”
D. Clamp off the tube until the feedings
C. “Add at least 4 grams of bran to your
begin.
cereal each morning.”
D. “Be sure to get regular exercise.”
13. Stephanie, a 28 y.o. accident victim,
requires TPN. The rationale for TPN is to
3. The nurse would monitor for which of the
provide:
following adverse reactions to aluminum-
A. Necessary fluids and electrolytes to the
containing antacids such as aluminum
body.
hydroxide (Amphojel)?
B. Complete nutrition by the I.V. route.
A. Diarrhea
C. Tube feedings for nutritional
B. Constipation
supplementation.
C. GI upset
D. Dietary supplementation with liquid
D. Fluid retention
protein given between meals.
4. Nursing suggestions to help a person
14. Your patient has a GI tract that is
break the constipation habit include all of the
functioning, but has the inability to swallow
following except:
foods. Which is the preferred method of
A. A low-residue, bland diet.
feeding for your patient?
B. A fluid intake of at least 2 L/day.
1. TPN
C. Establishing a regular schedule of
2. PPN
exercise.
3. NG feeding
D. Establishing a regular time for daily
4. Oral liquid supplements
elimination.
15. An intubated patient is receiving
5. All of the following are considered
continuous enteral feedings through a
complications of constipation except:
Salem sump tube at a rate of 60ml/hr.
A. Hemorrhoids
Gastric residuals have been 30-40ml when
B. Fecal impaction
monitored Q4H. You check the gastric
C. Hypokalemia
residual and aspirate 220ml. What is your
D. Hypertension
first response to this finding?
1. Notify the doctor immediately.
6. In a client with diarrhea, which outcome
2. Stop the feeding, and clamp the NG tube.
indicates that fluid resuscitation is
3. Discard the 220ml, and clamp the NG
tube. successful?
4. Give a prescribed GI stimulant such as A. The client passes formed stools at regular
intervals
metoclopramide (Reglan).
B. The client reports a decrease in stool A. Fluid volume excess related to fluid
frequency and liquidity retention
C. The client exhibits firm skin turgor
B. Fluid volume deficit related to excessive
D. The client no longer experiences perianal
burning. fluid loss
C. Activity intolerance related to
7. The mechanism of action of diphenoxylate imbalanced oxygen supply and demand
(Lotomil) is: D. Risk for infection related to underlying
inflammatory process
A.

An increase in intestinal excretion of SAS 6

water
1. A client with irritable bowel syndrome is
being prepared for discharge. Which of the
B. following meal plans should the nurse give
C. the client?
A. Low fiber, low-fat
An increase in intestinal motility
B. High fiber, low-fat
D. C. Low fiber, high-fat
E.
D. High-fiber, high-fat

A decrease in peristalsis in the 2. Which of the following disorders

intestinal wall characterized by spasm, distention, and
accumulation of mucus in the intestines.
F. A. Malabsorption syndrome
G. B. Gastritis
C. Constipation
D. Irritable bowel syndrome
A decrease in the reabsorption of
water in the bowel 3. A patient with IBS asks, “How can I
manage abdominal discomfort?” Your best
response would be:
H.
A. “It is best managed by eating dry
8. Hypokalemia can occur rapidly in an crackers.”
B. “Some patients maintain an
elderly person who experiences diarrhea. antidepressant drugs.”
The nurse should immediately report to the C. “You will be the one to choose what is
physician a critical potassium level of: best for you.”
D. “Abdominal pain can be reduced by
A. 3.0 mEq/L avoiding carbonated beverages.”
B. 4.0 mEq/L
C. 4.5 mEq/L
4. Which of the following are considered as
D. 5.0 mEq/L
the risk factors of irritable bowel syndrome?
9. Which of the following drugs may be Select all that apply.
administered to patient with diarrhea? A. Gastric resection
B. Stress
A. Loperamide (Imodium) C. Spicy foods
B. Bisacodyl (Dulcolax) D. Celiac disease
C. Senna Concentrate (Senokot) E. Enteritis
D. Docusate (Colace) F. Smoking

10. Which of the following is the priority 5. How exercise helps manage IBS?
nursing diagnosis to a patient with diarrhea? A. It increases peristalsis.
B. It decreases peristalsis.
C. It decreases intestinal motility.
D. It relieves abdominal pain. SAS 7
6. Which of the following statements best
describes fecal incontinence?
1. Which of the following best describes
A. It is a common disorder that affects the Malabsorption syndrome?
large intestine characterized by cramping, A. Are open sores that develop on the inside
abdominal pain, bloating, gas, and diarrhea lining of your stomach and the upper portion
or constipation, or both. of your small intestine.
B. It is the inability of the digestive system to
B. It is the involuntary passage of stool from absorb one or more of the major vitamins,
the rectum. minerals, and nutrients.
C. It is a digestive disorder that occurs when
C. It is an infrequent bowel movements or
acidic stomach juices, or food and fluids
difficult passage of stools that persists for
back up from the stomach into the
several weeks or longer.
esophagus.
D. It is condition with loose and watery D. An inflammatory disease which can lead
stools during a bowel movement. to abdominal pain, severe diarrhea, fatigue,
and weight loss.

7. Fecal incontinence is most frequently 2. A patient complains of abdominal pain

seen in which of the following conditions? and distention is suspected of having
malabsorption syndrome when he/she has:
A. Trauma
A. A bulky, foul-smelling stools with
B. Inflammation
steatorrhea
C. Fecal impaction
B. Episodes of constipation and diarrhea
D. Laxative abuse
C. Chronic constipation
D. Severe abdominal pain after eating
8. A 70-year-old client visits the clinic and
complains of minor soiling with occasional 3. Which of the following diagnostic tests
urgency and loss of control. Further confirms malabsorption syndrome?
assessment reveals that the client has poor A. Complete blood count
control of flatus. Based on the presenting B. Abdominal ultrasound
symptoms, you suspect that the client may C. Panceatic function test
have: D. Endoscopy with biopsy

A. Peptic ulcer disease 4. Which of the following recommended

B. Constipation to a patient with malabsorption
C. Irritable bowel syndrome syndrome?
D. Fecal incontinence
A. Encourage patient to eat pasta three
9. Which of the following measures helps times a day.
control fecal incontinence? B. Instruct patient to increase milk
consumption.
A. Increase fiber in the diet during episodes
of diarrhea.
C. The patient is advised to limit fluid
B. Initiate a bowel-training program. intake.
C. Encourage use of laxatives 3 times a day. D. Vitamin supplementation is
D. Use incontinence brief/adult diaper. prescribed.
10. Which of the following interventions is 5. Which of the following is a
necessary for fecal incontinence? complication of malabsorption syndrome?
A. Encourage use of incontinence brief. A. Anemia
B. Weigh patient daily, with accurate intake B. Dehydration
and output. C. Fracture
C. Advise to delay the urge to defecate to D. All of the above
control incontinence
.D. Avoid carbonated beverages to control 6. Katrina is diagnosed with lactose
abdominal cramping. intolerance. To avoid complications with
lack of calcium in the diet, which food palpation at Mcburney’s point, which is
should be included in the diet? located in the:
A. Fruit A. Right lower quadrant
B. Whole grains B. Right upper quadrant
C. Milk and cheese products C. Left lower quadrant
D. Dark green, leafy vegetables D. Left upper quadrant

7. A client with gastric cancer can expect to 3. Which of the following complications is
have surgery for resection. Which of the thought to be the most common cause of
following should be the nursing appendicitis?
management priority for the preoperative A. A fecalith
client with gastric cancer? B. Bowel kinking
A. Discharge planning C. Internal bowel occlusion
B. Correction of nutritional deficits D. Abdominal bowel swelling
C. Prevention of DVT
D. Instruction regarding radiation treatment 4. An enema is prescribed for a client with
suspected appendicitis. Which of the
8. Care for the postoperative client after following actions should the nurse take?
gastric resection should focus on which of A. Prepare 750 ml of irrigating solution
the following problems? warmed to 100*F
A. Body image B. Question the physician about the order
B. Nutritional needs C. Provide privacy and explain the
C. Skin care procedure to the client
D. Spiritual needs D. Assist the client to left lateral Sim’s
position
9. A 30-year old client experiences weight
loss, abdominal distention, crampy 5. A client with acute appendicitis develops
abdominal pain, and fever, tachycardia, and hypotension. Based
intermittent diarrhea after birth of her on these assessment findings, the nurse
2nd child. Diagnostic tests reveal gluten- suspects which of the following
induced enteropathy. Which foods must she complications?
eliminate from her diet permanently? A. Peritonitis
A. Milk and dairy products B. Bowel ischemia
B. Protein-containing foods C. Intestinal obstruction
C. Cereal grains (except rice and corn) D. Deficient fluid volume
D. Carbohydrates
6. Eleanor, a 62 y.o. woman with
10. Which of the following conditions diverticulosis is your patient. Which
cause/s malabsorption? Select all that apply. interventions would you expect to include in
A. Celiac disease her care?
B. Lactose intolerance A. Low-fiber diet and fluid restrictions.
C. Gastritis B. Total parenteral nutrition and bed rest.
D. Gastric resection C. High-fiber diet and administration of
E. GERD psyllium.
D. Administration of analgesics and antacids.
SAS 8
7. Which of the following types of diets is
implicated in the development of
1. During assessment, the nurse is looking
diverticulosis?
for positive indicators of appendicitis, which
A. Low-fiber diet
include all of the following except:
B. High-fiber diet
A. vomiting
C. High-protein diet
B. low-grade fever
D. Low-carbohydrate diet
C. Thrombocytopenia
D. Abdominal tenderness upon palpation
ANSWER: ________
8. Donald is a 61 y.o. man with diverticulitis.
Diverticulitis is characterized by:
2. On physical examination, the nurse
A. Periodic rectal hemorrhage.
should be looking for tenderness on
B. Hypertension and tachycardia.
C. Vomiting and elevated temperature.
D. Crampy and lower left quadrant pain and A. Obtain daily weights.
low-grade fever. B. Measure abdominal girth.
C. Keep strict intake and output.
9. Medical management of the client with D. Encourage her to increase fluids.
diverticulitis should include which of the
following treatments? 5. Annabelle is being discharged with a
A. Reduced fluid intake colostomy, and you’re teaching her about
B. Increased fiber in diet colostomy care. Which statement correctly
C. Administration of antibiotics describes a healthy stoma?
D. Exercises to increase intra-abdominal A. “At first, the stoma may bleed slightly
pressure when touched.”
B. “The stoma should appear dark and have
10. Which of the following mechanisms can a bluish hue.”
facilitate the development of diverticulosis C. “A burning sensation under the stoma
into diverticulitis? faceplate is normal.”
A. Treating constipation with chronic D. “The stoma should remain swollen away
laxative use, leading to dependence on from the abdomen.”
laxatives
B. Chronic constipation causing an 6. Five days after undergoing surgery, a
obstruction, reducing forward flow of client develops a small-bowel obstruction. A
intestinal contents Miller-Abbott tube is inserted for bowel
C. Herniation of the intestinal mucosa, decompression. Which nursing diagnosis
rupturing the wall of the intestine takes priority?
D. Undigested food blocking the A. Imbalanced nutrition: Less than body
diverticulum, predisposing the area to requirements
bacterial invasion. B. Acute pain
C. Deficient fluid volume
D. Excess fluid volume

7. The nurse caring for a client with small-

bowel obstruction would plan to implement
which nursing intervention first?
SAS 10 A. Administering pain medication
B. Obtaining a blood sample for laboratory
studies
1. You’re assessing the stoma of a patient
C. Preparing to insert a nasogastric (NG)
with a healthy, well-healed colostomy. You
tube
expect the stoma to appear:
D. Administering I.V. fluids
A. Pale, pink and moist
B. Red and moist
8. A client is admitted to the hospital
C. Dark or purple colored
complaining of nausea, vomiting, and
D. Dry and black
abdominal pain. Bowel obstruction is
suspected. During the initial assessment,
2. You’re caring for a patient with a sigmoid
the nurse hears high-pitched tinkling bowel
colostomy. The stool from this colostomy is?
sounds on auscultationand flat sounds on
A. Formed
percussion. The flat sounds are caused by:
B. Semisolid
A. Hyperactive peristalsis
C. Semiliquid
B. Fluid trapped in the intestine
D. Watery
C. Excessive gas trapped in the intestine
D. The presence of a mass or tumor in the
3. You’re advising a 21 y.o. with a bowel
colostomy who reports problems with flatus.
What food should you recommend?
9. The physician orders intestinal
A. Peas
decompression. The primary purpose of a
B. Cabbage
nasoenteric tube is to:
C. Broccoli
A. Break up the obstruction
D. Yogurt
B. Remove fluid and gas from the intestine
4. Claire, a 33 y.o. is on your floor with a
C. Prevent fluid accumulation in the
possible bowel obstruction. Which
stomach
intervention is priority for her?
D. Provide an alternative route for drug
administration 5. You’re caring for Jane, a 57 y.o. patient
with liver cirrhosis who developed ascites
10. Which of the following nursing and requires paracentesis. Before her
diagnoses would be most appropriate for a paracentesis, you instruct her to:
client with an intestinal obstruction? A. Empty her bladder.
A. Impaired swallowing related to NPO B. Lie supine in bed.
status C. Remain NPO for 4 hours.
B. Chronic pain related to abdominal D. Clean her bowels with an enema.
distention
C. Urinary retention related to deficient fluid 6. Nurse Farrah is providing care for Kristoff
volume who has jaundice. Which statement
D. Deficient volume related to nausea and indicates that the nurse understands the
vomiting rationale for instituting skin care measures
for the client?
SAS 11 A. “Jaundice is associated with pressure
ulcer formation.”
B. “Jaundice impairs urea production, which
produces pruritus.”
1. A 52-year-old man was referred to the C. “Jaundice produces pruritus due to
clinic due to increased abdominal girth. He impaired bile acid excretion.”
is diagnosed with ascites by the presence of D. “Jaundice leads to decreased tissue
a fluid thrill and shifting dullness on perfusion and subsequent breakdown.”
percussion. After administering diuretic
therapy, which nursing action would be most 7. Develop a teaching care plan for Angie
effective in ensuring safe care? who is about to undergo a liver biopsy.
A. Measuring serum potassium for Which of the following points do you include?
hyperkalemia A. “You’ll need to lie on your stomach during
B. Assessing the client for hypervolemia the test.”
C. Measuring the client’s weight weekly B. “You’ll need to lie on your right side after
D. Documenting precise intake and output the test.”
C. “During the biopsy you’ll be asked to
exhale deeply and hold it.”
2. Sharon has cirrhosis of the liver and D. “The biopsy is performed under general
develops ascites. What intervention is anesthesia.”
necessary to decrease the excessive
accumulation of serous fluid in her 8. Immediately after a liver biopsy, which of
peritoneal cavity? the following complications should the client
A. Restrict fluids be closely monitored for?
B. Encourage ambulation A. Abdominal cramping
C. Increase sodium in the diet B. Hemorrhage
D. Give antacids as prescribed C. Nausea and vomiting
D. Potential infection
3. A client with cirrhosis begins to develop
ascites. Spironolactone (Aldactone) is 9. Which of the following tests confirms that
prescribed to treat the ascites. The nurse the origin of the disorder is in the liver?
should monitor the client closely for which of A. Alanine Aminotransferase (ALT)
the following drug-related side effects? B. Aspartate Aminotransferase (AST)
A. Constipation C. Gamma-glutamyl Transferase (GGT)
B. Hyperkalemia D. Serum Alkaline Phosphatase
C. Irregular pulse
D. Dysuria 10. A patient with liver disease may
experience which of the following
4. For which of the following positions would manifestations? Select all that apply.
be appropriate for a client with severe A. Jaundice
ascites? B. Clavicular injury
A. Fowler’s C. Spider angiomas
B. Side-lying D. Chronic hyperglycemia
C. Reverse Trendelenburg E. Ascites
D. Sims’
 F. Making sure the client’s fingernails are
short

SAS 12 6. Jordin is a client with jaundice who is

experiencing pruritus. Which nursing
1. For a client in hepatic coma, which intervention would be included in the care
outcome would be the most appropriate? plan for the client?
A. The client is oriented to time, place, and A. Administering vitamin K subcutaneously
person. B. Applying pressure when giving I.M.
B. The client exhibits no ecchymotic areas. injections
C. The client increases oral intake to 2,000 C. Decreasing the client’s dietary protein
calories/day. intake
D. The client exhibits increased serum D. Keeping the client’s fingernails short and
albumin level. smooth

2. Which assessment finding indicates that 7. Nurse Farrah is providing care for Kristoff
lactulose is effective in decreasing the who has jaundice. Which statement
ammonia level in the client with hepatic indicates that the nurse understands the
encephalopathy? rationale for instituting skin care measures
A. Passage of two or three soft stools daily for the client?
B. Evidence of watery diarrhea A. “Jaundice is associated with pressure
C. Daily deterioration in the client’s ulcer formation.”
handwriting B. “Jaundice impairs urea production, which
D. Appearance of frothy, foul-smelling stools produces pruritus.”
C. “Jaundice produces pruritus due to
3. A client with advanced cirrhosis has been impaired bile acid excretion.”
diagnosed with hepatic encephalopathy. D. “Jaundice leads to decreased tissue
The nurse expects to assess for: perfusion and subsequent breakdown.”
A. Malaise
B. Stomatitis 8. Which rationale supports explaining the
C. Hand tremors placement of an esophageal tamponade
D. Weight loss tube in a client who is hemorrhaging?
A. Allowing the client to help insert the tube
4. A client diagnosed with chronic cirrhosis B. Beginning teaching for home care
who has ascites and pitting peripheral C. Maintaining the client’s level
edema also has hepatic encephalopathy. of anxiety and alertness
Which of the following nursing interventions D. Obtaining cooperation and reducing fear
are appropriate to prevent skin breakdown?
Select all that apply. 9. Which of the following measures should
A. Range of motion every 4 hours the nurse focus on for the client with
B. Turn and reposition every 2 hours esophageal varices?
C. Abdominal and foot massages every 2 A. Recognizing hemorrhage
hours B. Controlling blood pressure
D. Alternating air pressure mattress C. Encouraging nutritional intake
E. Sit in chair for 30 minutes each shift D. Teaching the client about varices

5. Mr. Hasakusa is in end-stage liver failure. 10. The most important pathophysiologic
Which interventions should the nurse factor contributing to the formation of
implement when addressing hepatic esophageal varices is:
encephalopathy? Select all that apply. A. Decreased prothrombin formation
A. Assessing the client’s neurologic status B. Decreased albumin formation by the liver
every 2 hours C. Portal hypertension
B. Monitoring the client’s hemoglobin and D. Increased central venous pressure
hematocrit levels
C. Evaluating the client’s serum ammonia SAS 13
level
D. Monitoring the client’s handwriting daily 1. When planning home care for a client with
E. Preparing to insert an esophageal hepatitis A, which preventive measure
tamponade tube
should be emphasized to protect the client’s A. Severe abdominal pain radiating to the
family? shoulder.
A. Keeping the client in complete isolation B. Anorexia, nausea, and vomiting.
B. Using good sanitation with dishes and C. Eructation and constipation.
shared bathrooms D. Abdominal ascites.
C. Avoiding contact with blood-soiled
clothing or dressing 8. For a client with hepatic cirrhosis who
D. Forbidding the sharing of needles or has altered clotting mechanisms, which
syringes intervention would be most important?
A. Allowing complete independence of
2. Which of the following will the nurse mobility
include in the care plan for a client B. Applying pressure to injection sites
hospitalized with viral hepatitis? C. Administering antibiotics as prescribed
A. Increase fluid intake to 3000 ml per day D. Increasing nutritional intake
B. Adequate bed rest
C. Bland diet 9. A client with advanced cirrhosis has
D. Administer antibiotics as ordered been diagnosed with hepatic
encephalopathy. The nurse expects to
3. Nathaniel has severe pruritus due to assess for:
having hepatitis B. What is the best A. Malaise
intervention for his comfort? B. Stomatitis
A. Give tepid baths. C. Hand tremors
B. Avoid lotions and creams. D. Weight loss
C. Use hot water to increase vasodilation. 10. A client diagnosed with chronic
D. Use cold water to decrease the itching. cirrhosis who has ascites and pitting
peripheral edema also has hepatic
4. You’re discharging Nathaniel with encephalopathy. Which of the following
hepatitis B. Which statement suggests nursing interventions are appropriate to
understanding by the patient? prevent skin breakdown? (Select all that
A. “Now I can never get hepatitis again.” apply.)
B. “I can safely give blood after 3 months.” A. Range of motion every 4 hours
C. “I’ll never have a problem with my liver B. Turn and reposition every 2 hours
again, even if I drink alcohol.” C. Abdominal and foot massages every 2
D. “My family knows that if I get tired and hours
start vomiting, I may be getting sick again.” D. Alternating air pressure mattress
E. Sit in chair for 30 minutes each shift
5. A client is suspected of having hepatitis.
Which diagnostic test result will assist in 11. A patient with chronic alcohol abuse is
confirming this diagnosis? admitted with liver failure. You closely
A. Elevated hemoglobin level monitor the patient’s blood pressure
B. Elevated serum bilirubin level because of which change that is associated
C. Elevated blood urea nitrogen level with the liver failure?
D. Decreased erythrocyte sedimentation rate A. Hypoalbuminemia
B. Increased capillary permeability
6. A female client who has just been C. Abnormal peripheral vasodilation
diagnosed with hepatitis A asks, “How could D. Excess rennin release from the kidneys
I have gotten this disease?” What is the
nurse’s best response? 12. You’re caring for Betty with liver
A. “You may have eaten contaminated cirrhosis. Which of the following assessment
restaurant food.” findings leads you to suspect hepatic
B. “You could have gotten it by using I.V. encephalopathy in her?
drugs.” A. Asterixis
C. “You must have received an infected B. Chvostek’s sign
blood transfusion.” C. Trousseau’s sign
D. “You probably got it by engaging in D. Hepatojugular reflex
unprotected sex.”
13. Nurse Juvy is caring for a client
7. A male client has just been diagnosed with cirrhosis of the liver. To minimize the
with hepatitis A. On assessment, the nurse effects of the disorder, the nurse teaches
expects to note: the client about foods that are high in
thiamine. The nurse determines that the 3. Which of the following
client has the best understanding of the procedures is likely to be most
dietary measures to follow if the client necessary for a client with a small
states an intention to increase the intake tumor confined to one liver segment
of: or lobe?
A. Pork
B. Milk A.Chemotherapy only
C. Chicken B.Cryoablation or liver resection
D. Broccoli C.Liver transplant
14. The nurse is caring for a male client D.Radiation therapy only
with cirrhosis. Which assessment
findings indicate that the client has
deficient vitamin K absorption caused by
this hepatic disease?
A. Dyspnea and fatigue
4.Early manifestation of a patient
B. Ascites and orthopnea
with liver cancer includes:
C. Purpura and petechiae
D. Gynecomastia and testicular atrophy
ANSWER: ________

15. A patient with severe cirrhosis of the A.Ascites

liver develops hepatorenal syndrome. B.Hepatomegaly
Which of the following nursing C.Continuous dull abdominal pain at
assessment data would support this? D.RUQ
A. Oliguria and azotemia Jaundice
B. Metabolic alkalosis 5. What is the primary nursing diagnosis
C. Decreased urinary concentration for a 4th to 10th day postoperative liver
D. Weight gain of less than 1 lb per wee transplant patient?
A. Excess Fluid Volume
B. Risk for Rejection
SAS 14 C. Impaired Skin Integrity
D. Decreased Cardiac Output
1. Which of the following tests is
the most accurate for diagnosing 6. Which of the following are considered as
liver cancer? complications of liver transplant? Select all
that apply.
A.Abdominal ultrasound A. Hemorrhage
B.Abdominal flat plate X-ray B. Hypertension
C.Cholangiogram C. Infection
D.Computed tomography (CT) scan D. Hyperglycemia
E. Rejection

7. Which of the following interventions is

appropriate after liver transplant?
2. Which of the following
A. Place patient in an environment free from
considerations has highest priority
bacteria, viruses, and fungi as possible.
when preparing to administer a
B. Antibiotic agents are used as long-term
medication to a client with liver
therapy to prevent rejection of the
cancer?
transplanted liver.
C. Place patient in Trendelenburg position
A.Frequency of the medication
to facilitate pulmonary drainage.
B.Purpose of the medication
D. Monitor cardiac output, oxygen saturation,
C.Necessity of the medication
urine output, heart rate, and blood pressure
D.Metabolism of the medication
every 8 hours to evaluate hemodynamic
status and intravascular fluid volume.
8. Which one of the following statements
regarding pyogenic liver abscess is false?
A. Biliary sepsis is the commonest source
 B. Blood culture identifies the organism in C. Maintenance of nothing-by-mouth status
50% of cases and insertion of nasogastric (NG) tube with
C. Surgery is needed for drainage in low intermittent suction
loculated abscess D. Dietary plan of a low-fat diet and
D. Usually single abscess is seen increased fluid intake to 2,000 ml/day

9. Which of the following assessment 4. Britney, a 20 y.o. student is admitted with

findings is expected to a patient with liver acute pancreatitis. Which laboratory findings
abscess? do you expect to be abnormal for this
A. weight gain patient?
B. Liver atrophy
C. Erythrocytosis A. Serum creatinine and BUN
D. Abdominal tenderness at RUQ B. Alanine aminotransferase (ALT) and
10. Which of the following not considered as aspartate aminotransferase (AST)
appropriate management for a patient C. Serum amylase and lipase
diagnosed with liver abscess? D. Cardiac enzymes
A. Monitor white blood cell count
B. Administer IV antibiotic 5. Michael, a 42 y.o. man is admitted to the
C. Meticulous skin care med-surg floor with a diagnosis of acute
D. Open surgical drainage is the treatment pancreatitis. His BP is 136/76, pulse 96,
of choice Resps 22 and temp 101. His past history
includes hyperlipidemia and alcohol abuse.
The doctor prescribes an NG tube. Before
inserting the tube, you explain the purpose
to patient. Which of the following is a most
accurate explanation?
SAS 16
A. “It empties the stomach of fluids and
1. When teaching a client about pancreatic gas.”
function, the nurse understands that B. “It prevents spasms at the sphincter of
pancreatic lipase performs which function? Oddi.”
C. “It prevents air from forming in the small
A. Transports fatty acids into the brush intestine and large intestine.”
border D. “It removes bile from the gallbladder.”
B. Breaks down fat into fatty acids and
glycerol 6. Ralph has a history of alcohol abuse and
C. Triggers cholecystokinin to contract the has acute pancreatitis. Which lab value is
gallbladder most likely to be elevated?
D. Breaks down protein into dipeptides and
amino acids A. Calcium
B. Glucose
2. What laboratory finding is the primary C. Magnesium
diagnostic indicator for pancreatitis? D. Potassium
A. Elevated blood urea nitrogen (BUN)
B. Elevated serum lipase 7. For Rico who has chronic pancreatitis,
C. Elevated aspartate aminotransferase which nursing intervention would be most
(AST) helpful?
D. Increased lactate dehydrogenase (LD)
A. Allowing liberalized fluid intake
3. Pierre who is diagnosed with acute B. Counseling to stop alcohol consumption
pancreatitis is under the care of Nurse C. Encouraging daily exercise
Bryan. Which intervention should the nurse D. Modifying dietary protein
include in the care plan for the client?
8. Leigh Ann is receiving pancrelipase
A. Administration of vasopressin and (Viokase) for chronic pancreatitis. Which
insertion of a balloon tamponade observation best indicates the treatment is
B. Preparation for a paracentesis and effective?
administration of diuretics
A. There is no skin breakdown.
B. Her appetite improves. 4. A nurse is caring for a client admitted to
C. She loses more than 10 lbs. the ER with DKA. In the acute phase the
D. Stools are less fatty and decreased in priority nursing action is to prepare to:
frequency.
A. Administer regular insulin intravenously
B. Administer 5% dextrose intravenously
9. To inhibit pancreatic secretions, which
C. Correct the acidosis
pharmacologic agent would you anticipate
D. Apply an electrocardiogram monitor.
administering to a patient with chronic
pancreatitis? 5. A nurse performs a physical assessment
on a client with type 2 DM. Findings include
A. Nitroglycerin a fasting blood glucose of 120mg/dl,
B. Somatostatin temperature of 101, pulse of 88, respirations
C. Pancrelipase of 22, and a bp of 140/84. Which finding
D. Pepcid would be of most concern of the nurse?

10. A clinical manifestation of chronic A. Pulse

pancreatitis is epigastric pain. Your nursing B. BP
intervention to facilitate relief of pain would C. Respiration
place the patient in a: D. Temperature
6. A client with type 1 DM calls the nurse to
A. Knee-chest position report recurrent episodes of hypoglycemia
B. Semi-Fowler’s position with exercise. Which statement by the client
C. Recumbent position indicated an inadequate understanding of
D. Low-Fowler’s position the peak action of NPH insulin and exercise?

SAS 17 A. “The best time for me to exercise is every

afternoon.”
1. A client is taking NPH insulin daily every B. “The best time for me to exercise is right
morning. The nurse instructs the client that after I eat.”
the most likely time for a hypoglycemic C. “The best time for me to exercise is after
reaction to occur is: breakfast.”
D. “The best time for me to exercise is after
A. 2-4 hours after administration my morning snack.”
B. 6-14 hours after administration
C. 16-18 hours after administration 7. Glucose is an important molecule in a
D. 18-24 hours after administration cell because this molecule is primarily used
for:
2. A client with a diagnosis of diabetic
ketoacidosis (DKA) is being treated in the A. Extraction of energy
ER. Which finding would a nurse expect to B. Synthesis of protein
note as confirming this diagnosis? C. Building of genetic material
D. Formation of cell membranes.
A. Elevated blood glucose level and a low
plasma bicarbonate 8. When a client is first admitted with
B. Decreased urine output hyperglycemic hyperosmolar nonketotic
C. Increased respirations and an increase in syndrome (HHNS), the nurse’s priority is to
pH provide:
D. Comatose state A. Oxygen
B. Carbohydrates
3. A nurse is preparing a plan of care for a C. Fluid replacement
client with DM who has hyperglycemia. The D. Dietary instruction
priority nursing diagnosis would be:
A. High risk for deficient fluid volume 9. The nurse is admitting a client with
B. Deficient knowledge: disease process hypoglycemia. Identify the signs and
and treatment symptoms the nurse should expect. Select
C. Imbalanced nutrition: less than body all that apply.
requirements A. Thirst
D. Disabled family coping: compromised. B. Palpitations
C. Diaphoresis 5. Vasopressin is administered to the client
D. Slurred speech with diabetes insipidus (DI) because it:
E. Hyperventilation
A. Decreases blood sugar.
10. When a client is in diabetic ketoacidosis, B. Increases tubular reabsorption of water.
the insulin that would be administered is: C. Increases release of insulin from the
pancreas.
A. Human NPH insulin D. Decreases glucose production within the
B. Human regular insulin liver.
C. Insulin lispro injection
D. Insulin glargine injection 6. A male client is admitted for treatment of
the syndrome of inappropriate antidiuretic
SAS 18 hormone (SIADH). Which nursing
intervention is appropriate?
1. When caring for a male client with A. Infusing I.V. fluids rapidly as ordered
diabetes insipidus, nurse Juliet expects to B. Encouraging increased oral intake
administer: C. Restricting fluids
A. Vasopressin (Pitressin Synthetic). D. Administering glucose-containing I.V.
B. Furosemide (Lasix). fluids as ordered
C. Regular insulin. 7. Which of these signs suggests that a
D. 10% dextrose. male client with the syndrome of
inappropriate antidiuretic hormone (SIADH)
2. Nurse Louie is developing a teaching plan secretion is experiencing complications?
for a male client diagnosed with diabetes
insipidus. The nurse should include A. Tetanic contractions
information about which hormone lacking in B. Neck vein distention
clients with diabetes insipidus? C. Weight loss
D. Polyuria
A. Antidiuretic hormone (ADH).
B. Thyroid-stimulating hormone (TSH). 8. Which of the following conditions is
C. Follicle-stimulating hormone (FSH). caused by excessive secretion of
D. Luteinizing hormone (LH). vasopressin?
3. Which outcome indicates that treatment A. Thyrotoxic crisis
of a male client with diabetes insipidus has B. Diabetes insipidus
been effective? C. Primary adrenocortical insufficiency
D. Syndrome of inappropriate antidiuretic
A. Fluid intake is less than 2,500 ml/day. hormone (SIADH)
B. Urine output measures more than 200
ml/hour. 9. Which of the following manifestations
C. Blood pressure is 90/50 mm Hg. expected to a patient with SIADH? Select all
D. The heart rate is 126 beats/minute. that apply.
4. A male client with primary diabetes A. Weight gain
insipidus is ready for discharge on B. Weight loss
desmopressin (DDAVP). Which instruction C. Hypotension
should nurse Lina provide? D. Hypertension
E. Large volumes of urine
A. “Administer desmopressin while the F. Small amounts of urine
suspension is cold.”
B. “Your condition isn’t chronic, so you won’t 10. The appropriate nursing diagnosis for a
need to wear a medical identification patient with SIADH is:
bracelet.”
C. “You may not be able to use A. Fluid volume deficit related to excessive
desmopressin nasally if you have nasal fluid loss
discharge or blockage.” B. Fluid volume excess related to fluid
D. “You won’t need to monitor your fluid retention
intake and output after you start taking C. Risk for injury related to decreased blood
desmopressin.” pressure
D. Impaired skin integrity related to
dehydration
11. A male client has recently undergone 15. Initial treatment for a CSF leak after
surgical removal of a pituitary tumor. Dr. transphenoidal hypophysectomy would most
Wong prescribes corticotropin (Acthar), 20 likely involve:
units I.M. q.i.d. as a replacement therapy.
What is the mechanism of action of A. Repacking the nose.
corticotropin? B. Returning the client to surgery.
C. Enforcing bed rest with the head of the
A. It decreases cyclic adenosine bed elevated.
monophosphate (cAMP) production and D. Administering high-dose corticosteroid
affects the metabolic rate of target organs. therapy
B. It interacts with plasma membrane
receptors to inhibit enzymatic actions.
C. It interacts with plasma membrane
receptors to produce enzymatic actions that
affect protein, fat, and carbohydrate
metabolism.
D. It regulates the threshold for water
resorption in the kidneys. SAS 19
12. A female client whose physical findings 1. Nurse Oliver should expect a client with
suggest a hyperpituitary condition hypothyroidism to report which health
undergoes an extensive diagnostic workup. concerns?
Test results reveal a pituitary tumor, which
necessitates a transsphenoidal A. Increased appetite and weight loss
hypophysectomy. The evening before the B. Puffiness of the face and hands
surgery, nurse Jacob reviews preoperative C. Nervousness and tremors
and postoperative instructions given to the D. Thyroid gland swelling
client earlier. Which postoperative
instruction should the nurse emphasize? 2. A female client with hypothyroidism
(myxedema) is receiving levothyroxine
A. “You must lie flat for 24 hours after (Synthroid), 25 mcg P.O. daily. Which
surgery.” finding should nurse Hans recognize as an
B. “You must avoid coughing, sneezing, and adverse drug effect?
blowing your nose.”
C. “You must restrict your fluid intake.” A. Dysuria
D. “You must report ringing in your ears B. Leg cramps
immediately.” C. Tachycardia
D. Blurred vision

13. A somatotropin-secreting tumor of which

of the following glands would lead to the 3. An incoherent female client with a history
development of acromegaly, Cushing’s of hypothyroidism is brought to the
syndrome, and hypopituitarism? emergency department by the rescue squad.
Physical and laboratory findings reveal
A. Adrenal gland hypothermia, hypoventilation, respiratory
B. Hypothalamus acidosis, bradycardia, hypotension, and
C. Pituitary gland nonpitting edema of the face and pretibial
D. Thyroid gland area. Knowing that these findings suggest
severe hypothyroidism, nurse Libby
14. Surgical management for large, invasive prepares to take emergency action to
pituitary tumors is a transphenoidal prevent the potential complication of:
hypophysectomy. The nurse would explain
that the surgery will be performed through A. Thyroid storm
an incision in the: B. Cretinism
C. Myxedema coma
A. Nose D. Hashimoto’s thyroiditis
B. Back of the mouth
C. Sinus channel below the right eye 4. After undergoing a subtotal thyroidectomy,
D. Upper gingival mucosa in the space a female client develops hypothyroidism. Dr.
between the upper gums and lip Smith prescribes levothyroxine (Levothroid),
25 mcg P.O. daily. For which condition is
levothyroxine the preferred agent?
A. Primary hypothyroidism 10. Which of the following forms of severe
B. Graves’ disease hyperthyroidism is life threatening and
C. Thyrotoxicosis produces high fever, extreme tachycardia,
D. Euthyroidism and altered mental status?
5. What test should be ordered if A. Hepatic coma
hypothyroidism is suspected? B. Thyroid storm
C. Myxedema coma
A. Liver function tests D. Hyperosmolar hyperglycemic nonketotic
B. Hemoglobin A1c syndrome (HHNS)
C. T4 and thyroid-stimulating hormone
D. 24-hour urine free cortisol measurement 11. During preoperative teaching for a
female client who will undergo subtotal
6. Nurse Ruth is assessing a client after a thyroidectomy, the nurse should include
thyroidectomy. The assessment reveals which statement?
muscle twitching and tingling, along with
numbness in the fingers, toes, and mouth A. “The head of your bed must remain flat
area. The nurse should suspect which for 24 hours after surgery.”
complication? B. “You should avoid deep breathing and
coughing after surgery.”
A. Tetany C. “You won’t be able to swallow for the first
B. Hemorrhage day or two.”
C. Thyroid storm D. “You must avoid hyperextending your
D. Laryngeal nerve damage neck after surgery.”
7. Which nursing diagnosis takes highest
priority for a female client with 12. After undergoing a thyroidectomy, a
hyperthyroidism? client develops hypocalcemia and tetany.
A. Risk for imbalanced nutrition: More than Which of the following medications should
body requirements related to thyroid the nurse anticipate administering?
hormone excess A. Calcium gluconate
B. Risk for impaired skin integrity related to B. Potassium chloride
edema, skin fragility, and poor wound C. Sodium bicarbonate
healing D. Sodium phosphorous
C. Body image disturbance related to weight
gain and edema 13. A client who has undergone a subtotal
D. Imbalanced nutrition: Less than body thyroidectomy is subject to complications in
requirements related to thyroid hormone the first 48 hours after surgery. The nurse
excess should obtain and keep at the bedside
equipment to:
8. A client represents with flushed skin, A. Begin total parenteral nutrition
bulging eyes, and perspiration, and states B. Start a cutdown infusion
that he has been irritable and having C. Administer tube feedings
palpitations. This client is presenting with D. Perform a tracheostomy
symptoms of which disorder?
14. The most common type of goiter is
A. Pancreatitis etiologically related to a deficiency of:
B. Hypothyroidism
C. Hyperthyroidism A. Thyrotropin
D. Diabetes insipidus B. Iodine
C. Thyroxine
9. Which of the following treatments can be D. Calcitonin
used for hyperthyroidism?
15. The nurse should assess for the
A. Amputation common manifestation of recurrent
B. Cholecystectomy laryngeal nerve damage, which is:
C. Irradiation of the thyroid
D. Administration of oral thyroid hormones A. Any voice change
B. The inability to speak
C. Pain while speaking
D. Pain while swallowing
 5. Which of the following laboratory results
SAS 20 supports a diagnosis of primary
hyperparathyroidism?
1. A female adult client with a history of A. High parathyroid hormone and high
chronic hyperparathyroidism admits to being calcium levels
noncompliant. Based on initial assessment B. High magnesium and high thyroid
findings, the nurse formulates the nursing hormone levels
diagnosis of Risk for injury. To complete the C. Low parathyroid hormone and low
nursing diagnosis statement for this client, potassium levels
which “related-to” phrase should the nurse D. Low thyroid-stimulating hormone and
add? high phosphorous levels
A. Related to bone demineralization
resulting in pathologic fractures 6. Following a unilateral adrenalectomy,
B. Related to exhaustion secondary to an nurse Betty would assess for hyperkalemia
accelerated metabolic rate shown by which of the following?
C. Related to edema and dry skin
secondary to fluid infiltration into the A. Muscle weakness
interstitial spaces B. Tremors
D. Related to tetany secondary to a C. Diaphoresis
decreased serum calcium level D. Constipation
2. A 67-year-old male client has been 7. A female client has a serum calcium level
complaining of sleeping more, increased of 7.2 mg/dl. During the physical
urination, anorexia, weakness, irritability, examination, nurse Noah expects to assess:
depression, and bone pain that interferes
with her going outdoors. Based on these A. Trousseau’s sign.
assessment findings, nurse Richard would B. Homans’ sign.
suspect which of the following disorders? C. Hegar’s sign.
D. Goodell’s sign.
A. Diabetes mellitus
B. Diabetes insipidus
C. Hypoparathyroidism
D. Hyperparathyroidism
3. When instructing the female client 8. Nurse Wayne is aware that a positive
diagnosed with hyperparathyroidism about Chvostek’s sign indicate?
diet, nurse Gina should stress the
importance of which of the following? A. Hypocalcemia
B. Hyponatremia
A. Restricting fluids C. Hypokalemia
B. Restricting sodium D. Hypermagnesemia
C. Forcing fluids
D. Restricting potassium 9. Hyperphosphatemia and hypocalcemia
are indicative of which of the following
4. Which nursing diagnosis takes highest disorders?
priority for a female client with
hyperthyroidism? A. Grave’s Disease
B. Hypothyroidism
A. Risk for imbalanced nutrition: More than C. Cushing’s Syndrome
body requirements related to thyroid D. Hypoparathyroidism
hormone excess
B. Risk for impaired skin integrity related to
edema, skin fragility, and poor wound 10. Which of the following symptoms is the
healing chief sign of hypoparathyroidism?
C. Body image disturbance related to weight
gain and edema A. Chest pain
B. Exophthalmos
D. Imbalanced nutrition: Less than body
C. Shortness of breath
requirements related to thyroid hormone
excess D. Tetany
11. Nurse Ronn is assessing a client with
possible Cushing’s syndrome. In a client
with Cushing’s syndrome, the nurse would C. Follicle-stimulating hormone (FSH)
expect to find: D. Thyroid-stimulating hormone (TSH)
A. Hypotension. 17. Laboratory findings indicating decreased
B. Thick, coarse skin. levels of glucose and sodium and increased
C. Deposits of adipose tissue in the trunk levels of potassium and white blood cells
and (WBC) would correlate with which diagnosis?
dorsocervical area.
D. Weight gain in arms and legs. A. Addison’s disease
B. Cushing’s syndrome
12. In a 29-year-old female client who is C. Diabetes mellitus
being successfully treated for Cushing’s D. Hypothyroidism
syndrome, nurse Lyzette would expect a
decline in: 18. An appropriate nursing diagnosis for a
client with Addison’s disease would include
A. Serum glucose level. which of the following assessments?
B. Hair loss.
C. Bone mineralization. A. Risk for injury
D. Menstrual flow. B. Excess fluid volume
C. Impaired gas exchange
D. Ineffective thermoregulation
13. A female client with Cushing’s syndrome
is admitted to the medical-surgical unit.
During the admission assessment, nurse 19. Nursing care for a client with Addison’s
Tyzz notes that the client is agitated and disease may include which of the following
irritable, has poor memory, reports loss of goals?
appetite, and appears disheveled. These A. Limiting fluid intake to 100 mL/day.
findings are consistent with which problem? B. Participating in relaxation techniques.
A. Depression C. Ambulating in the hall five to six times per
B. Neuropathy day.
C. Hypoglycemia D. Knowing which high-sodium foods to
D. Hyperthyroidism avoid.

14. Which of the following nursing

diagnoses is appropriate for a client with
Cushing’s syndrome? 20. Which of the following outcomes are
expected for a client being treated for
A. Risk for infection Addison’s disease?
B. Deficient fluid volume
C. Acute pain with movement A. Avoiding alcohol to decrease abdominal
D. Functional urinary incontinence girth.
B. Avoiding hot and uncomfortable
15. A client has thin extremities but an environments.\
obese truncal area and a “buffalo hump” at C. Reporting absence of postural
the shoulder area. The client also complains hypotension symptoms.
of weakness and disturbed sleep. Which of D. Selecting and eating foods high in protein,
the following disorders is the most likely calcium, and vitamin D
diagnosis?
A. Addison’s disease
B. Cushing’s syndrome SAS 21
C. Grave’s disease 1. The nurse is assessing the motor function
D. Hyperparathyroidism of an unconscious male client. The nurse
would plan to use which plan to use which
16. Adrenal insufficiency develops of the following to test the client’s peripheral
secondary to inadequate secretion of which response to pain?
of the following pituitary hormones? A. Sternal rub
B. Nail bed pressure
A. Corticotropin C. Pressure on the orbital rim
B. Antidiuretic hormone (ADH)
D. Squeezing of the sternocleidomastoid PO daily.
muscle C. Teach patient about the need for good
oral hygiene.
2. A client is at risk for increased ICP. Which D. Develop a discharge plan, including
of the following would be a priority for the physician visits and referral to
nurse to monitor? the Epilepsy Foundation.
A. Unequal pupil size
B. Decreasing systolic blood pressure 8. Shortly after admission to an acute care
C. Tachycardia facility, a male client with a seizure disorder
D. Decreasing body temperature develops status epilepticus. The physician
orders diazepam (Valium) 10 mg I.V. stat.
3. Which of the following nursing How soon can the nurse administer the
interventions is appropriate for a client with second dose of diazepam, if needed and
an ICP of 20 mm Hg? prescribed?
A. Give the client a warming blanket A. In 30 to 45 seconds
B. Administer low-dose barbiturate B. In 10 to 15 minutes
C. Encourage the client to hyperventilate C. In 30 to 45 minutes
D. Restrict fluids D. In 1 to 2 hours

4. A client has signs of increased ICP. 9. A male client is having tonic-clonic

Which of the following is an early indicator seizures. What should the nurse do first?
of deterioration in the client’s condition? A. Elevate the head of the bed.
A. Widening pulse pressure B. Restrain the client’s arms and legs.
B. Decrease in the pulse rate C. Place a tongue blade in the
C. Dilated, fixed pupil client’s mouth.
D. Decrease in LOC D. Take measures to prevent injury.

5. A client who is regaining consciousness 10. The nurse is caring for the male client
after a craniotomy becomes restless and who begins to experience seizure activity
attempts to pull out her IV line. Which while in bed. Which of the following actions
nursing intervention protects the client by the nurse would be contraindicated?
without increasing her ICP? A. Loosening restrictive clothing
A. Place her in a jacket restraint B. Restraining the client’s limbs
B. Wrap her hands in soft “mitten” restraints C. Removing the pillow and raising padded
C. Tuck her arms and hands under the draw side rails
sheet D. Positioning the client to side, if possible,
D. Apply a wrist restraint to each arm with the head flexed forward

6. In planning the care for a client who has SAS 22

had a posterior fossa (infratentorial)
craniotomy, which of the following 1. Regular oral hygiene is an essential
is contraindicated when positioning the intervention for the client who has had a
client? stroke. Which of the following nursing
A. Keeping the client flat on one side or the measures is inappropriate when providing
other oral hygiene?
B. Elevating the head of the bed to 30 A. Placing the client on the back with a
degrees small pillow under the head.
C. Log rolling or turning as a unit when B. Keeping portable suctioning equipment at
turning the bedside.
D. Keeping the head in neutral position C. Opening the client’s mouth with a padded
tongue blade.
7. A 23-year-old patient with a recent history D. Cleaning the client’s mouth and teeth
of encephalitis is admitted to the medical with a toothbrush.
unit with new onset generalized tonic-clonic
seizures. Which nursing activities included 2. A 78-year-old client is admitted to the
in the patient’s care? Select all that apply. emergency department with numbness and
A. Document the onset time, nature weakness of the left arm and slurred speech.
of seizure activity, and postictal behaviors Which nursing intervention is a priority?
for all seizures. A. Prepare to administer recombinant tissue
B. Administer phenytoin (Dilantin) 200 mg plasminogen activator (rt-PA).
B. Discuss the precipitating factors that A. To reduce intraocular pressure
caused the symptoms. B. To prevent acute tubular necrosis
C. Schedule for A STAT computer C. To promote osmotic diuresis to decrease
tomography (CT) scan of the head. ICP
D. Notify the speech pathologist for an D. To draw water into the vascular system
emergency consult. to increase blood pressure

3. A client arrives in the emergency 9. A female client who’s paralyzed on the

department with an ischemic stroke and left side has been receiving physical
receives tissue plasminogen activator (t-PA) therapy and attending teaching sessions
administration. Which is the priority nursing about safety. Which behavior indicates
assessment? that the client accurately understands
A. Current medications. safety measures related to paralysis?
B. Complete physical and history. A. The client leaves the side rails down.
C. Time of onset of current stroke. B. The client uses a mirror to inspect the
D. Upcoming surgical procedures. skin.
C. The client repositions only after being
4. During the first 24 hours after reminded to do so.
thrombolytic therapy for ischemic stroke, the D. The client hangs the left arm over the
primary goal is to control the client’s: side of the wheelchair.
A. Pulse
B. Respirations 10. During recovery from a
C. Blood pressure cerebrovascular accident (CVA), a female
D. Temperature client is given nothing by mouth, to help
prevent aspiration. To determine when the
5. What is a priority nursing assessment in client is ready for a liquid diet, the nurse
the first 24 hours after admission of the assesses the client’s swallowing ability
client with a thrombotic stroke? once each shift. This assessment
A. Cholesterol level evaluates:
B. Pupil size and pupillary response A. Cranial nerves I and II.
C. Bowel sounds B. Cranial nerves III and V.
D. Echocardiogram C. Cranial nerves VI and VIII.
D. Cranial nerves IX and X.
6. Which assessment data would indicate to
the nurse that the client would be at risk for
a hemorrhagic stroke?
A. A blood glucose level of 480 mg/dl. SAS 23
B. A right-sided carotid bruit.
C. A blood pressure of 220/120 mmHg. 1.A male client has an impairment of cranial
D. The presence of bronchogenic carcinoma. nerve II. Specific to this impairment, the
nurse would plan to do which of the
7. A client admitted to the hospital with a following to ensure client to ensure client
subarachnoid hemorrhage has complaints safety?
of severe headache, nuchal rigidity, and A. Speak loudly to the client
projectile vomiting. The nurse knows lumbar B. Test the temperature of the shower water
puncture (LP) would be contraindicated in C. Check the temperature of the food on
this client in which of the following the delivery tray.
circumstances? D. Provide a clear path for ambulation
A. Vomiting continues without obstacles
B. Intracranial pressure (ICP) is increased
C. The client needs mechanical ventilation 2. An 18-year-old client is admitted with a
D. Blood is anticipated in the cerebrospinal closed head injury sustained in a MVA. His
fluid (CSF) intracranial pressure (ICP) shows an
upward trend. Which intervention should
8. A client with a subdural hematoma the nurse perform first?
becomes restless and confused, with A. Reposition the client to avoid neck flexion
dilation of the ipsilateral pupil. The physician B. Administer 1 g Mannitol IV as ordered
orders mannitol for which of the following C. Increase the ventilator’s respiratory rate
reasons? to 20 breaths/minute
D. Administer 100 mg of pentobarbital IV as of the following medications would be used
ordered. to control edema of the spinal cord?
A. Acetazolamide (Diamox)
3. A client comes into the ER after hitting his B. Furosemide (Lasix)
head in an MVA. He’s alert and oriented. C. Methylprednisolone (Solu-Medrol)
Which of the following nursing interventions D. Sodium bicarbonate
should be done first?
A. Assess full ROM to determine extent of 9. A 22-year-old client with quadriplegia is
injuries apprehensive and flushed, with a blood
B. Call for an immediate chest x-ray pressure of 210/100 and a heart rate of 50
C. Immobilize the client’s head and neck bpm. Which of the following nursing
D. Open the airway with the head-tilt-chin-lift interventions should be done first?
maneuver A. Place the client flat in bed
B. Assess patency of the indwelling urinary
4. A 23-year-old client has been hit on the catheter
head with a baseball bat. The nurse notes C. Give one SL nitroglycerin tablet
clear fluid draining from his ears and nose. D. Raise the head of the bed immediately to
Which of the following nursing interventions 90 degrees
should be done first?
A. Position the client flat in bed 10. Which of the following interventions
B. Check the fluid for dextrose with a describes an appropriate bladder program
dipstick for a client in rehabilitation for spinal cord
C. Suction the nose to maintain airway injury?
patency A. Insert an indwelling urinary catheter to
D. Insert nasal and ear packing with sterile straight drainage
gauze B. Schedule
intermittent catheterization every 2 to 4
5. An 18-year-old client was hit in the head hours
with a baseball during practice. When C. Perform a straight catheterization every 8
discharging him to the care of his mother, hours while awake
the nurse gives which of the following D. Perform Crede’s maneuver to the lower
instructions? abdomen before the client voids
A. “Watch him for keyhole pupil the next 24
hours.”
B. “Expect profuse vomiting for 24 hours
SAS 24
after the injury.”
1. lumbar puncture is performed on a child
C. “Wake him every hour and assess his
suspected of having bacterial meningitis.
orientation to person, time, and place.”
CSF is obtained for analysis. A nurse
D. “Notify the physician immediately if he
reviews the results of the CSF analysis and
has a headache.”
determines that which of the following
results would verify the diagnosis?
6. A client has been pronounced brain dead.
A. Cloudy CSF, decreased protein, and
Which findings would the nurse assess?
decreased glucose
Select all that apply.
B. Cloudy CSF, elevated protein, and
A. Decerebrate posturing
decreased glucose
B. Dilated nonreactive pupils
C. Clear CSF, elevated protein, and
C. Deep tendon reflexes
decreased glucose
D. Absent corneal reflex
D. Clear CSF, decreased pressure, and
elevated protein
7. A client with a C6 spinal injury would
most likely have which of the following
symptoms?
2. A nurse is planning care for a child with
A. Aphasia
acute bacterial meningitis. Based on the
B. Hemiparesis
mode of transmission of this infection, which
C. Paraplegia
of the following would be included in the
D. Tetraplegia
plan of care?
A. No precautions are required as long
8. A client is admitted with a spinal cord
as antibiotics have been started
injury at the level of T12. He has limited
B. Maintain enteric precautions
movement of his upper extremities. Which
C. Maintain respiratory isolation precautions C. Tremors at rest
for at least 24 hours after the initiation of D. Flaccid muscles
antibiotics
D. Maintain neutropenic precautions 8. The nurse is teaching a female client
with multiple sclerosis. When teaching
3. Which of the following assessment data the client how to reduce fatigue, the
indicated nuchal rigidity? nurse should tell the client to:
A. Positive Kernig’s sign A. Take a hot bath.
B. Negative Brudzinski’s sign B. Rest in an air-conditioned room.
C. Positive homan’s sign C. Increase the dose of muscle relaxants.
D. Negative Kernig’s sign D. Avoid naps during the day.

4. Which of the following are considered as 9. Which of the following is not a typical
the initial symptoms of HSV-1 encephalitis? clinical manifestation of multiple sclerosis
Select all that apply. (MS)?

A.Double vision
B.Sudden burst of energy
C.Weakness in the extremitie
A.Confusion
D.Muscle tremors
B.Seizure
C.Headache
D.Behavioral changes 10. A physician diagnoses a client with
E.Fever myasthenia gravis, prescribing
pyridostigmine (Mestinon), 60 mg P.O.
every 3 hours. Before administering this
5. All of the following are considered as
anticholinesterase agent, the nurse
preventive measures against arboviral
reviews the client’s history. Which
encephalitis, EXCEPT:
preexisting condition would
contraindicate the use of pyridostigmine?
A. Ulcerative colitis
B. Blood dyscrasia
A.Encourage clothing that provides C. Intestinal obstruction
coverage. D. Spinal cord injury
B.Apply insect repellents on
exposed skin. 11. A female client has experienced an
C.Use of screens at home episode of myasthenic crisis. The nurse
D.Advise flower vase with water at would assess whether the client has
home to get rid of mosquitos. precipitating factors such as:
A. Getting too little exercise
B. Taking excess medication
C. Omitting doses of medication
6.Which of the following is the D. Increasing intake of fatty foods
treatment of choice for fungal
encephalitis? 12. The nurse is teaching the female
client with myasthenia gravis about the
prevention of myasthenic and
cholinergic crises. The nurse tells the
client that this is most effectively done
A.Amphotericin B by:
B.Interferon A. Eating large, well-balanced meals
C.Ribavirin B. Doing muscle-strengthening exercises
D.Acyclovir C. Doing all chores early in the day while
less fatigued
7. The nurse is assessing a 37-year-old D. Taking medications on time to maintain
client diagnosed with multiple sclerosis. therapeutic blood levels
Which of the following symptoms would
the nurse expect to find? 13. A female client with Guillain-Barré
A. Vision changes syndrome has paralysis affecting the
B. Absent deep tendon reflexes respiratory muscles and
requires mechanical ventilation. When the
client asks the nurse about the paralysis, 2.Which of the following drugs is
how should the nurse respond? used for trigeminal neuralgia?
A. “You may have difficulty believing this, Riluzole (Rilutek)
but the paralysis caused by this disease is
temporary.”
B. “You’ll have to accept the fact that you’re
permanently paralyzed. However, you won’t
A.Levodopa (Larodopa)
have any sensory loss.”
B.Carbamazepine (Tegretol)
C. “It must be hard to accept the
C.Ceftriaxone
permanency of your paralysis.”
D. sodium (Rocephin)
D. “You’ll first regain use of your legs and
then your arms.”
3. A male client with Bell’s Palsy asks the
nurse what has caused this problem. The
14. A female client is admitted to the
nurse’s response is based on an
hospital with a diagnosis of Guillain-Barre
understanding that the cause is:
syndrome. The nurse inquires during the A. Unknown, but possibly includes ischemia,
nursing admission interview if the client viral infection, or an autoimmune problem
has a history of:
B. Unknown, but possibly includes long-term
A. Seizures or trauma to the brain
tissue malnutrition and cellular hypoxia
B. Meningitis during the last five (5 years
C. Primary genetic in origin, triggered by
C. Back injury or trauma to the spinal cord
exposure to meningitis
D. Respiratory or gastrointestinal infection D. Primarily genetic in origin, triggered by
during the previous month. exposure to neurotoxins
15. A female client with Guillain-Barre
4. The nurse has given the male client
syndrome has ascending paralysis and
with Bell’s palsy instructions on
is intubated and receiving preserving muscle tone in the face and
mechanical ventilation. Which of the preventing denervation. The nurse
following strategies would the nurse
determines that the client needs
incorporate in the plan of care to help the
additional information if the client states
client cope with this illness?
that he or she will:
A. Giving client full control over care
A. Exposure to cold and drafts
decisions and restricting visitors. B. Massage the face with a gentle upward
B. Providing positive feedback and motion
encouraging active range of motion.
C. Perform facial exercises
C. Providing information, giving positive
D. Wrinkle the forehead, blow out the
feedback and encouraging relaxation.
cheeks, and whistle
D. Providing intravenously administered
sedatives, reducing distractions and limiting
5. The nurse is assessing a child diagnosed
visitors.
with a brain tumor. Which of the following
signs and symptoms would the nurse expect
SAS 25 the child to demonstrate? Select all that
apply.
1.Tic douloureux is characterized by A. Head tilt
paroxysms of pain and burning sensations. B. Vomiting
It is a disorder of which cranial nerve? C. Polydipsia
D. Lethargy
A.Third E. Increased appetite
B.Fifth F. Increased pulse
C.Seventh
D.Eighth 6. A female client with a suspected
brain tumor is scheduled for computed
tomography (CT). What should the nurse
do when preparing the client for this test?
A. Immobilize the neck before the client is
moved onto a stretcher.
B. Determine whether the client is allergic to
iodine, contrast dyes, or shellfish.
C. Place a cap on the client’s head.
D. Administer a sedative as ordered.
7. Which nursing diagnosis takes highest
priority for a client with Parkinson’s SAS 26
crisis?
A. Imbalanced nutrition: Less than body 1. The clinic nurse is preparing to test
requirements the visual acuity of a client using
B. Ineffective airway clearance a Snellen chart. Which of the following
C. Impaired urinary elimination identifies the accurate procedure for
D. Risk for injury this visual acuity test?
A. Both eyes are assessed together,
followed by the assessment of the right and
then the left eye.
B. The right eye is tested followed by the left
8.When evaluating the extent of eye, and then both eyes are tested.
Parkinson’s disease, a nurse C. The client is asked to stand at a distance
observes for which of the following of 40ft. from the chart and is asked to read
conditions? the largest line on the chart.
D. The client is asked to stand at a distance
of 40ft from the chart and to read the line
than can be read 200 ft away by an
individual with unimpaired vision.
A.Bulging eyeballs
B/Diminished distal sensations
2. Tonometry is performed on the client with
C.Increased dopamine levels
a suspected diagnosis of glaucoma. The
D.Muscle rigidity
nurse analyzes the test results as
documented in the client’s chart and
9. A female client with amyotrophic understands that normal intraocular
lateral sclerosis (ALS) tells the nurse, pressure is:
“Sometimes I feel so frustrated. I can’t A. 2-7 mmHg
do anything without help!” This B. 10-21 mmHg
comment best supports which nursing C. 22-30 mmHg
diagnosis? D. 31-35 mmHg
A. Anxiety
B. Powerlessness
3. Which of the following instruments is
C. Ineffective denial
used to record intraocular pressure?
D. Risk for disuse syndrome
A. Goniometer
B. Ophthalmoscope
10. Which of the following clinical C. Slit lamp
manifestations suggest ALS? D. Tonometer

4. Which of the following refractive surgeries

has high success rate?
A.Fatigue, progressive muscle A. Laser Vision Correction Photorefractive
weakness, cramps, fasciculations Keratectomy (PRK)
(twitching), and incoordination B. Laser-Assisted In Situ Keratomileusis
B.Tremor, rigidity, bradykinesia (LASIK)
(abnormally slow movements), and C. Phakic Intraocular Lenses
postural instability D. Conductive Keratoplasty
C.Paralysis of the facial muscles,
increased lacrimation (tearing), and
painful sensations in the face,
D.behind the ear, and in the eye
5. After an eye examination, a male client
Involuntary contraction of the facial
is diagnosed with open-angle glaucoma.
muscles causing sudden closing of
The physician
the eye or twitching of the mouth
prescribes Pilocarpine ophthalmic
solution (Pilocar), 0.25% gtt i, OU q.i.D.
Based on this prescription, the nurse
should teach the client or a family
member to administer the drug by:
A. Instilling one drop of pilocarpine 0.25% discharge teaching, the nurse will instruct
into both eyes daily. the client’s wife to:
B. Instilling one drop of pilocarpine 0.25% A. Feed him soft foods for several days to
into both eyes four times daily. prevent facial movement
C. Instilling one drop of pilocarpine 0.25% B. Keep the eye dressing on for one week
into the right eye daily. C. Have her husband remain in bed for 3
D. Instilling one drop of pilocarpine 0.25% days
into the left eye four times daily. D. Allow him to walk upstairs only with
assistance.

6. The client with glaucoma asks the nurse 11. When obtaining the health history
is complete vision will return. The most from a male client with retinal
appropriate response is: detachment, the nurse expects the client
A. “Although some vision as been lost and to report:
cannot be restored, further loss may be A. Light flashes and floaters in front of
prevented by adhering to the treatment plan. the eye.
B. “Your vision will return as soon as the B. A recent driving accident while changing
medications begin to work.” lanes.
C. “Your vision will never return to normal.” C. Headaches, nausea, and redness of the
D. “Your vision loss is temporary and will eyes.
return in about 3-4 weeks.” D. Frequent episodes of double vision.

7. The nurse is developing a teaching plan

for the client with glaucoma. Which of the
following instructions would the nurse 12. After pneumatic retinopexy,
include in the plan of care? the patient must be placed in:
A. Decrease fluid intake to control the
intraocular pressure A.Side-lying position
B. Avoid overuse of the eyes B.Prone position
C. Decrease the amount of salt in the diet C.Trendelenburg position
D. Eye medications will need to be D.Recumbent position
administered lifelong.

8. The nurse is performing an assessment

in a client with a suspected diagnosis of
cataract. The chief clinical manifestation that
the nurse would expect to note in the early
stages of cataract formation is: 13.The most common cause of
A. Eye pain visual loss in people older than 60
B. Floating spots years of age is:
C. Blurred vision
D. Diplopia

9. The client is being discharged from the A.Macular degeneration

ambulatory care unit following cataract B.Ocular trauma
removal. The nurse provides instructions C.Retinal detachment
regarding home care. Which of the following, D.Conjunctivitis
if stated by the client, indicates an
understanding of the instructions?
A. “I will take Aspirin if I have any
discomfort.”
B. “I will sleep on the side that I was
operated on.” 14. The most common manifestation in dry
C. “I will wear my eye shield at night and my eye syndrome is:
glasses during the day.” A. Excessive mucus secretions
D. “I will not lift anything if it weighs more B. Difficulty moving the lids
that 10 pounds.” C. Burning sensation
D. Scratchy or foreign body sensation
10. A male client has just had a cataract
operation without a lens implant. In
 5.Which of the following manifestations
15.Acute bacterial conjunctivitis is suggest cerumen impaction?
characterized by:

A.Painless blurry vision

B.Elevated intraocular pressure A.Purulent drainage
C.A mucopurulent ocular discharge B.Swelling in the middle ear
C.Otalgia
D.Otorrhea

6.The most common fungus associated with

external ear infection is:

SAS 27
A.Staphylococcus albus
B.Staphylococcus aureus
1. The nurse is performing a voice test to C.Aspergillus
assess hearing. Which of the following D.Pseudomonas
describes the accurate procedure for
performing this test? 7. A nurse would question an order to
A. Stand 4 feet away from the client to irrigate the ear canal in which of the
ensure that the client can hear at this following circumstances?
distance. A. Ear pain
B. Whisper a statement and ask the client to B. Hearing loss
repeat it. C. Otitis externa
C. Whisper a statement with the examiners D. Perforated tympanic membrane
back facing the client
D. Whisper a statement while the client
blocks both ears. 8.Tympanoplasty is surgically performed to:

2. During a hearing assessment, the nurse

notes that the sound lateralizes to the
clients left ear with the Weber test. The A.Close a perforation
nurse analyzes this result as: B.Prevent recurrent infection
A. A normal finding C.Reestablish middle ear function
B. A conductive hearing loss in the right ear D.Accomplish all of the above
C. A sensorineural or conductive loss
D. The presence of nystagmus 10. A myringotomy, the most common
procedure for acute otitis media, is
3. The nurse is caring for a client that is performed primarily to:
hearing impaired. Which of the following
approaches will facilitate communication? A.Drain purulent fluid
A. Speak frequently B.Identify the infecting organism
B. Speak loudly C.Relieve tympanic membrane
C. Speak directly into the impaired ear pressure
D. Speak in a normal tone D.Accomplish all of the above

4. The nurse has notes that the physician

has a diagnosis of presbycusis on the
client’s chart. The nurse plans care knowing
the condition is:
A. A sensorineural hearing loss that occurs 11.Postoperative nursing assessment for a
with aging patient who has had a mastoidectomy
B. A conductive hearing loss that occurs should include observing for:
with aging.
C. Tinnitus that occurs with aging
D. Nystagmus that occurs with aging
 possible Ménière’s disease. When
assessing this client, the nurse expects
A.Facial paralysis to note:
B.Olfactory paralysis
A. Vertigo, tinnitus, and hearing loss.
C.Optic paralysis
B. Vertigo, vomiting, and nystagmus
D.Oculomotor paralysis
C. Vertigo, pain, and hearing impairment.
D. Vertigo, blurred vision, and fever.

15. A client with Meniere’s disease is

experiencing severe vertigo. Which
11. A male client with a conductive instruction would the nurse give to the client
hearing disorder caused by ankylosis of to assist in controlling the vertigo?
the stapes in the oval window undergoes A. Increase fluid intake to 3000 ml a day
a stapedectomy to remove the stapes B. Avoid sudden head movements
and replace the impaired bone with a C. Lie still and watch the television
prosthesis. After the stapedectomy, the D. Increase sodium in the diet
nurse should provide which client
instruction? 16. The nurse is reviewing the physician’s
orders for a client with Meniere’s disease.
A. “Lie in bed with your head elevated, and Which diet will most likely be prescribed?
refrain from blowing your nose for 24 hours.” A. Low-cholesterol diet
B. “Try to ambulate independently after B. Low-sodium diet
about 24 hours.” C. Low-carbohydrate diet
C. “Shampoo your hair every day for ten (10) D. Low-fat diet
days to help prevent ear infection.” 17. Canalith repositioning is performed to
D. “Don’t fly in an airplane, climb to high patients with benign paroxysmal positional
altitudes, make sudden movements, or vertigo to:
expose yourself to loud sounds for 30 days.”

12. The nurse has conducted discharge

teaching for a client who had a fenestration
procedure for the treatment of otosclerosis. A.Relieve nausea and vomiting
Which of the following, if stated by the client, B.Treat vertigo
would indicate that teaching was effective? C.Enhance disequilibrium
A. “I should drink liquids through a straw for D.Suppress vestibular function
the next 2-3 weeks.”
B. “It’s ok to take a shower and wash 18. A client is diagnosed with a disorder
my hair.” involving the inner ear. Which of the
C. “I will take stool softeners as prescribed following is the most common client
by my doctor.” complaint associated with a disorder in this
D. “I can resume my tennis lessons starting part of the ear?
next week.”
A. Hearing loss
B. Pruritus
13. Which of the following medications
C. Tinnitus
relieves motion sickness symptoms?
D. Burning of the ear

19. A client who is complaining of tinnitus is

describing a symptom that is:
A.Corticosteroids A. Objective
B.Antihistamines B. Subjective
C.Diuretic C. Functional
D.Antibiotics D. Prodromal

14. A female client is admitted to the

facility for investigation of balance and
coordination problems, including
20. An acoustic neuroma is a benign tumor D.Fluids provide a cushion for
of which cranial nerve? weakened bones.

A.Fifth
B.Sixth 5. Alendronate (Fosamax) is given to a
C.Seventh client with osteoporosis. The nurse advises
D.Eighth the client to?
A. Take the medication in the morning with
meals.
B. Take the medication 2 hours before
bedtime.
C. Take the medication with a glass of water
SAS 28 after rising in the morning.
D. Take the medication during lunch.

1. A client with osteoarthritis has a

prescription for Celebrex (celecoxib). 6. The nurse knows that a 60-year-old
Which instruction should be included in female client’s susceptibility
the discharge teaching? to osteoporosis is most likely related to:
A. Take the medication with milk. A. Lack of exercise
B. Report chest pain. B. Hormonal disturbances
C. Remain upright after taking for 30 C. Lack of calcium
minutes. D. Genetic predisposition
D. Allow 6 weeks for optimal effects.
7.The most common symptoms of
2. Pathophysiologic changes seen with osteomalacia are:
osteoarthritis include:
A. Joint cartilage degeneration.
B. The formation of bony spurs at the edges
of the joint surfaces. A.Bone fractures and kyphosis
C. Narrowing of the joint space. B.Bone pain and tenderness
D. All of the above. C.Muscle weakness and spasm
D.Softened and compressed
3.A client has been prescribed a diet that vertebrae
limits purine-rich foods. Which of the
following foods would the nurse teach him to
avoid eating?

A.Bananas and dried fruits

B.Milk, ice cream, and yogurt 8.Which of the following dietary
C.Wine, cheese, preserved fruits, management is recommended to patient
meats, and vegetables with osteomalacia associated with diet?
D.Anchovies, sardines, kidneys,
sweetbreads, and lentils

A.Adequate calcium and low protein

intake
4.A client with gout is encouraged to B.Adequate protein and moderate
increase fluid intake. Which of the following vitamin intake
statements best explains why increased C.Restrict calcium and vitamin D
fluids are encouraged for gout? intake
D.Increase calcium and vitamin D
A.Fluids decrease inflammation. intake
B.Fluids increase calcium
absorption.
C.Fluids promote the excretion of
uric acid.
9.Which of the following medications used in D.Arthroscopy
Paget’s disease which facilitates remodeling
of abnormal bone? 4. Mr. Miller has been diagnosed with
bone cancer. You know this type of
cancer is classified as:
A. sarcoma.
A.Plicamycin B. lymphoma.
B.Calcitonin C. carcinoma.
C.Dexamethasone D. melanoma.
D.Atropine sulfate
5. For a client diagnosed with Ewing’s
10.Which of the following diagnostic tests sarcoma, which test is most useful in
confirms Paget’s disease? determining the extent of metastasis?

A.X-ray A.Bone scan

B.Bone scan B.Computerized tomography (CT)
C.Bone biopsy scan
D.Serum alkaline phosphate C.Magnetic resonance imaging
(MRI)
SAS 29 D.Positron emission tomography
(PET)
1.A 20-year-old client developed
osteomyelitis 2 weeks after a fishhook was
removed from his foot. Which of the
following rationales best explains the
expected long-term antibiotic therapy 6.Nursing interventions to treat a
needed? musculoskeletal injury may include cold or
heat therapy. Cold therapy decreases pain
by which of the following actions?

A.Bone has poor circulation.

B.Tissue trauma requires antibiotics.
C.Feet are normally more difficult to A.Promotes analgesia and
treat. circulation
D.Fishhook injuries are highly B.Numbs the nerves and dilates the
contaminated. vessels
C.Promotes circulation and reduces
2.Osteomyelitis most commonly results from muscle spasms
which of the following mechanisms? D.Causes local vasoconstriction
and prevents edema or muscle
spasm

A.Immune suppression
B.IV drug use
C.Surgery
D.Trauma 7.Management for a patient with sprain
includes RICE? Which of the following is the
3.Which of the following is the primary correct meaning of RICE?
treatment of septic arthritis?

A.Aspiration of joint fluid

B.Arhtrotomy
A.Rise, Ice, Compression, and
C.Antibiotics
Elevation
 B.Rest, Ice, Compression, and A.Axillae
Elevation B.Elbows
C.Rinse, Immobilize, Cast, and C.Upper arms
Elevation D.Hands
D.Rest, Immobilize, Compression,
and Elevation

SAS 30

8.Which of the following interventions is

appropriate immediately after a patient is
suspected with joint dislocation? 1.A client is admitted to the emergency
department with a foot fracture. Which of the
following reasons explains why the foot is
placed in a brace?
A.Provide range of motion exercises
immediately.
B.Immobilize the joint and maintain
in a stable position. A.To act as a splint
C.Place the affected extremity B.To prevent infection
above the level of the heart. C.To allow for movement
D.Prepare the patient for traction as D.To encourage direct contact
the treatment of choice.

2.A client describes a foul odor from his cast.

9.A client has above-the-knee amputation 4 Which of the following responses or
days after a traumatic injury. Which nursing interventions would be the most appropriate?
diagnosis is most appropriate?

A.Assess further because this may

A.Risk for impaired skin integrity be a sign of infection.
related to decreased peripheral B.Teach him proper cast care,
circulation including hygiene measures.
B.Impaired gas exchange: Fat C.This is normal, especially when a
embolism related to surgical cast is in place for a few weeks.
removal of bone and tissue D.Assess further because this may
C.Acute pain: Phantom limb pain be a sign of neurovascular
related to surgical removal of leg compromise.
after traumatic injury
D.Decreased cardiac output: Shock
related to decreased fluid volume

3.To reduce the roughness of a cast, which

of the following measures should be used?

10.A client who has an above-the-knee

amputation is to use crutches until the
prosthesis is properly fitted. When teaching A.Petal the edges.
the client about using the crutches, the B.Elevate the limb.
nurse instructs the client to support her C.Break off the rough area.
weight primarily on which of the following D.Distribute pressure evenly.
body areas?
4.Which of the following weight is commonly Which of the following discharge instructions
applied to an extremity for Buck’s traction in should be given to a client after surgery for
and adult? repair of a hip fracture?

1 to 2 lb
1 to 5 lb
5 to 7 lb
8 to 10 lb
“Don’t flex the hip more than 30
degrees, don’t cross your legs, get
help putting on your shoes.”

A client is put in traction before surgery. “Don’t flex the hip more than 60
Which of the following reasons for the degrees, don’t cross your legs, get
traction is correct? help putting on your shoes.”

“Don’t flex the hip more than 90

degrees, don’t cross your legs, get
Prevents skin breakdown help putting on your shoes.”
Aids in turning the client
Helps the client become active “Don’t flex the hip more than 120
Prevents trauma and overcomes degrees, don’t cross your legs, get
muscle spasms help putting on your shoes.”

Which of the following nursing interventions

is appropriate for a client in traction?

Which of the following symptoms are

considered signs of a fracture?
Assess the pin sites every shift and
as needed.
Add and remove weights as the
client wants. Tingling, coolness, loss of pulses
Make sure the knots in the rope Loss of sensation, redness,
catch on the pulley. coolness
Give range of motion to all joints, Coolness, redness, new site of pain
including those immediately Redness, warmth, pain at the site of
proximal and distal to the fracture, injury
every shift.

Which of the following serious complications

After a hip replacement, which of the can occur with long bone fractures?
following activity level is usually ordered?

Bed rest
No restrictions
No weight bearing Bone emboli
Limited weight bearing Fat emboli
Platelet emboli
Serous emboli
Vitamin D is important in the healing of Treatment of compartment
fractures for which of the following reasons? syndrome includes which of the
following measures?

It reduces the excretion of calcium

and phosphorus. Amputation

It increases the excretion of calcium Casting

and phosphorus.
Fasciotomy
It reduces the absorption and use of
calcium and phosphorus. Observation, no treatment is
necessary
It increases the absorption and use
of calcium and phosphorus.

Which of the following areas would be

At the scene of an accident, which of the included in a neurovascular assessment?
following interventions applies to a client
with a suspected fracture?

Orientation, movement, pulses,

warmth
Don’t move the client.
Capillary refill, movement, pulses,
Move the client to safety warmth
immediately.
Orientation, pupillary response,
Sit the client up to facilitate his temperature, pulses
airway.

Immobilize the extremity, and move

the client to safety.
Respiratory pattern, orientation, pulses,
temperature

Which of the following symptoms is an early

sign of compartment syndrome?

Heat

Paresthesia

Skin pallor

Swelling
EXTRA DAILY QUIZ is. This patient is most likely showing signs
of what? *
16 & 17 hyperglycemic
For a diabetic male client with a foot ulcer, hypoglycemic
the physician orders bed rest, a wet-to-dry diabetic ketoacidosis
dressing change every shift, and blood hyperosmolar hyperglycemic noketotic
glucose monitoring before meals and coma
bedtime. Why are wet-to-dry dressings used At a senior citizens meeting a nurse talks
for this client? * with a client who has diabetes mellitus Type
They contain exudate and provide a moist 1. Which statement by the client during the
wound environment. conversation is most predictive of a potential
They protect the wound from mechanical for impaired skin integrity? *
trauma and promote healing. “I give my insulin to myself in my thighs.”
They debride the wound and promote “Sometimes when I put my shoes on I don’t
healing by secondary intention. know where my toes are.”
They prevent the entrance of “Here are my up and down glucose readings
microorganisms and minimize wound that I wrote on my calendar.”
discomfort. “If I bathe more than once a week my skin
Leigh Ann is receiving pancrelipase feels too dry.”
(Viokase) for chronic pancreatitis. Which A male client has just been diagnosed with
observation best indicates the treatment is type 1 diabetes mellitus. When teaching the
effective? * client and family how diet and exercise
A. There is no skin breakdown. affect insulin requirements, Nurse Joy
B. Her appetite improves. should include which guideline? *
C. She loses more than 10 lbs. “You’ll need more insulin when you exercise
D. Stools are less fatty and decreased in or increase your food intake.”
frequency. “You’ll need less insulin when you exercise
Michael, a 42 y.o. man is admitted to the or reduce your food intake.”
med-surg floor with a diagnosis of acute “You’ll need less insulin when you increase
pancreatitis. His BP is 136/76, pulse 96, your food intake.”
respirations 22 and temp 101. His past “You’ll need more insulin when you exercise
history includes hyperlipidemia and alcohol or decrease your food intake.”
abuse. The doctor prescribes an NG tube. Nurse Alvin is caring for a female client with
Before inserting the tube, you explain the type 1 diabetes mellitus who exhibits
purpose to patient. Which of the following is confusion, light-headedness, and aberrant
a most accurate explanation? * behavior. The client is still conscious. The
A. “It empties the stomach of fluids and nurse should first administer: *
gas.” I.M. or subcutaneous glucagon.
B. “It prevents spasms at the sphincter of I.V. bolus of dextrose 50%.
Oddi.” 15 to 20 g of a fast-acting carbohydrate
C. “It prevents air from forming in the small such as orange juice.
intestine and large intestine.” 10 U of fast-acting insulin.
D. “It removes bile from the gallbladder.” A nurse is caring for a client admitted to the
Pierre who is diagnosed with ER with DKA. In the acute phase the priority
acute pancreatitis is under the care of Nurse nursing action is to prepare to: *
Bryan. Which intervention should the nurse A. Administer regular insulin intravenously
include in the care plan for the client? * B. Administer 5% dextrose intravenously
A. Administration of vasopressin and C. Correct the acidosis
insertion of a balloon tamponade D. Apply an electrocardiogram monitor.
B. Preparation for a paracentesis and The nurse is admitting a client with
administration of diuretics hypoglycemia. Identify the signs and
C. Maintenance of nothing-by-mouth status symptoms the nurse should expect. Select
and insertion of nasogastric (NG) tube with all that apply. *
low intermittent suction A. Thirst
D. Dietary plan of a low-fat diet and B. Palpitations
increased fluid intake to 2,000 ml/day C. Diaphoresis
The nurse enters a diabetic patient’s room D. Slurred speech
at 11:30 and notices that the patient is E. Hyperventilation
diaphoretic, tachycardic, anxious, states she A client with type 1 DM calls the nurse to
is hungry, and doesn’t remember where she report recurrent episodes of hypoglycemia
with exercise. Which statement by the client exercise. Which medication instruction
indicated an inadequate understanding of should the nurse provide? *
the peak action of NPH insulin and “Be sure to take glipizide 30 minutes before
exercise? * meals.”
A. “The best time for me to exercise is every “Glipizide may cause a low serum sodium
afternoon.” level, so make sure you have your sodium
B. “The best time for me to exercise is right level checked monthly.”
after I eat.” “You won’t need to check your blood
C. “The best time for me to exercise is after glucose level after you start taking glipizide.”
breakfast.” “Take glipizide after a meal to prevent
D. “The best time for me to exercise is after heartburn.”
my morning snack.”
When a client is in diabetic ketoacidosis, the
insulin that would be administered is: * 18 19 & 20
A. Human NPH insulin
B. Human regular insulin Paolo with severe head trauma sustained in
C. Insulin lispro injection a car accident is admitted to the intensive
D. Insulin glargine injection care unit. Thirty-sixhours later, the client’s
A nurse is preparing a plan of care for a urine output suddenly rises above 200
client with DM who has hyperglycemia. The ml/hour, leading the nurse to suspect
priority nursing diagnosis would be: * diabetes insipidus. Which laboratory
A. High risk for deficient fluid volume findings support the nurse’s suspicion of
B. Deficient knowledge: disease process diabetes insipidus? *
and treatment Above-normal urine and serum osmolality
C. Imbalanced nutrition: less than body levels
requirements Below-normal urine and serum osmolality
D. Disabled family coping: compromised. levels
A patient with severe hypoglycemia arrives Above-normal urine osmolality level, below-
at the ED unconscious by ambulance. The normal serum osmolality level
nurse would first… * Below-normal urine osmolality level, above-
Give regular insulin by IV normal serum osmolality level
Give NPH by IV Which of these signs suggests that a male
Give 10-15 g CHO or Orange juice client with the syndrome of inappropriate
Give 1 mg glucagon antidiuretic hormone (SIADH) secretion is
When a client is first admitted with experiencing complications? *
hyperglycemic hyperosmolar nonketotic A. Tetanic contractions
syndrome (HHNS), the nurse’s priority is to B. Neck vein distention
provide: * C. Weight loss
A. Oxygen D. Polyuria
B. Carbohydrates In a 29-year-old female client who is being
C. Fluid replacement successfully treated for Cushing’s syndrome,
D. Dietary instruction nurse Angelo would expect a decline in: *
A male client with type 1 diabetes mellitus Serum glucose level.
has a highly elevated glycosylated Hair loss.
hemoglobin (Hb) test result. In discussing Bone mineralization.
the result with the client, the nurse would be Menstrual flow.
most accurate in stating: * Initial treatment for a CSF leak after
“The test needs to be repeated following a transphenoidal hypophysectomy would most
12-hour fast.” likely involve: *
“It looks like you aren’t following the A. Repacking the nose.
prescribed diabetic diet.” B. Returning the client to surgery.
“It tells us about your sugar control for the C. Enforcing bed rest with the head of the
last 3 months.” bed elevated.
“Your insulin regimen needs to be altered D. Administering high-dose corticosteroid
significantly.” therapy.
Dr. Rodriguez prescribes glipizide You assess a patient with Cushing’s
(Glucotrol), an oral antidiabetic agent, for a disease. For which finding will you notify the
male client with type 2 diabetes mellitus who physician immediately? *
has been having trouble controlling the 1 point
blood glucose level through diet and
Purple striae present on abdomen and What is the mechanism of action of
thighs corticotropin? *
Weight gain of 1 pound since the previous A. It decreases cyclic adenosine
day monophosphate (cAMP) production and
+1 dependent edema in ankles and calves affects the metabolic rate of target organs.
Crackles bilaterally in lower lobes of lungs B. It interacts with plasma membrane
A male client with primary diabetes insipidus receptors to inhibit enzymatic actions.
is ready for discharge on desmopressin C. It interacts with plasma membrane
(DDAVP). Which instruction should the receptors to produce enzymatic actions that
nurse provide? * affect protein, fat, and carbohydrate
D. It regulates the threshold for water
“Administer desmopressin while the resorption in the kidneys
suspension is cold.” Nurse Ruth is assessing a client after a
“Your condition isn’t chronic, so you won’t thyroidectomy. The assessment reveals
need to wear a medical identification muscle twitching and tingling, along with
bracelet.” numbness in the fingers, toes, and mouth
“You may not be able to use desmopressin area. The nurse should suspect which
nasally if you have nasal discharge or complication? *
blockage.”
A. Tetany
“You won’t need to monitor your fluid intake
and output after you start taking B. Hemorrhage
desmopressin.”
Hyperphosphatemia and hypocalcemia are C. Thyroid storm
indicative of which of the following
disorders? * D. Laryngeal nerve damage
A. Grave’s Disease During preoperative teaching for a female
B. Hyperparathyroidism client who will undergo subtotal
C. Cushing’s Syndrome thyroidectomy, the nurse should include
D. Hypoparathyroidism which statement? *
A female adult client with a history of
chronic hyperparathyroidism admits to being A. “The head of your bed must remain flat
noncompliant. Based on initial assessment for 24 hours after surgery.”
findings, the nurse formulates the nursing
diagnosis of Risk for injury. To complete the B. “You should avoid deep breathing and
nursing diagnosis statement for this client, coughing after surgery.”
which “related-to” phrase should the nurse C. “You won’t be able to swallow for the first
add? * day or two.”
1 point
A. Related to bone demineralization D. “You must avoid hyperextending your
resulting in pathologic fractures neck after surgery.”
B. Related to exhaustion secondary to an
accelerated metabolic rate A 38 year old woman returns from a subtotal
C. Related to edema and dry skin thryroidectomy for the treatment of
secondary to fluid infiltration into the hyperthyroidism. Upon assessment, the
interstitial spaces immediate priority that the nurse would
D. Related to tetany secondary to a include is: *
decreased serum calcium level
Assess for pain
The client with a history of diabetes
insipidus is admitted with polyuria, Assess for neurological status
polydipsia, and mental confusion. The
priority intervention for this client is: * Assess fluid volume status
Measure the urinary output
Assess for respiratory distress
Check the vital signs
Encourage increased fluid intake A patient is admitted to the medical unit with
Weigh the client possible Graves’ disease (hyperthyroidism).
A male client has recently undergone Which assessment finding supports this
surgical removal of a pituitary tumor. Dr. diagnosis? *
Wong prescribes corticotropin (Acthar),20
units I.M. q.i.d. as a replacement therapy. Periorbital edema
Bradycardia C. Thyrotoxicosis
Exophthalmos D. Euthyroidism
Hoarse voice A client who has undergone a subtotal
thyroidectomy is subject to complications in
Which of the following nursing assessment the first 48 hours after surgery. The nurse
is the most important in the patient with should obtain and keep at the bedside
hyperthyroidism and risk for thyrotoxic crisis equipment to: *
or thyroid storm? *
A. Begin total parenteral nutrition
Intake and output
B. Start a cutdown infusion
Heart sounds
C. Administer tube feedings
Bowel sounds
D. Perform a tracheostomy
Vital signs
Inah, with hyperthyroidism is to receive
Which nursing diagnosis takes highest Lugol’s iodine solution before a subtotal
priority for a female client with thyroidectomy is performed. The nurse is
hyperthyroidism? * aware that this medication is given to: *
A. Risk for imbalanced nutrition: More than Decrease the total basal metabolic rate.
body requirements related to thyroid
hormone excess Maintain the function of the parathyroid
glands.
B. Risk for impaired skin integrity related to
edema, skin fragility, and poor wound Block the formation of thyroxine by the
healing thyroid gland.
C. Body image disturbance related to weight Decrease the size and vascularity of the
gain and edema thyroid gland.
D. Imbalanced nutrition: Less than body 21 22 & 23
requirements related to thyroid hormone
excess A client who recently had a cerebrovascular
The physician orders laboratory tests to accident/stroke requires a cane to ambulate.
confirm hyperthyroidism in a female client When teaching about cane use, the
with classic signs and symptoms of this rationale for holding a cane on the
disorder. Which test result would confirm the uninvolved side is to: *
diagnosis? * prevent leaning
distribute weight away from the involved
No increase in the thyroid-stimulating side
hormone (TSH) level after 30 minutes maintain stride length
during the TSH stimulation test prevent edema
A client arrives in the emergency
A decreased TSH level department with an ischemic stroke and
receives tissue plasminogen activator (t-PA)
An increase in the TSH level after 30
administration. Which is the priority nursing
minutes during the TSH stimulation test
assessment? *
Below-normal levels of serum Current medications.
triiodothyronine (T3) and serum thyroxine Complete physical and history.
(T4) as detected by radioimmunoassay Time of onset of current stroke.
Upcoming surgical procedures.
After undergoing a subtotal thyroidectomy, a The nurse is formulating a teaching plan for
female client develops hypothyroidism. Dr. a client who has just experienced a transient
Smith prescribes levothyroxine (Levothroid), ischemic attack (TIA). Which fact should the
25 mcg P.O. daily. For which condition is nurse include in the teaching plan? *
levothyroxine the preferred agent? * TIA symptoms may last 24 to 48 hours.
Most clients have residual effects after
A. Primary hypothyroidism having a TIA.
B. Graves’ disease TIA may be a warning that the client may
have cerebrovascular accident (CVA)
The most common symptom of TIA is the administering which drug endotracheally
inability to speak. before suctioning? *
Following a generalized seizure, the nurse
can expect the client to: * Phenytoin (Dilantin)
Be unable to move the extremities Mannitol (Osmitrol)
Be drowsy and prone to sleep
Remember events before the seizure Lidocaine (Xylocaine)
Have a drop in blood pressure
A 78 year old client is admitted to the Furosemide (Lasix)
emergency department with numbness and
A client with subdural hematoma was given
weakness of the left arm and slurred speech.
mannitol to decrease intracranial pressure
Which nursing intervention is priority? *
(ICP). Which of the following results would
Prepare to administer recombinant tissue
best show the mannitol was effective? *
plasminogen activator (rt-PA).
Discuss the precipitating factors that caused Urine output increases
the symptoms.
Schedule for A STAT computer tomography Pupils are 8 mm and nonreactive
(CT) scan of the head.
Notify the speech pathologist for an Systolic blood pressure remains at 150 mm
emergency consult Hg
BUN and creatinine levels return to normal
A neurological consult has been ordered for
a pediatric client with suspected petit mal A client who is regaining consciousness
seizures. The client with petit mal seizures after a craniotomy becomes restless and
can be expected to have: * attempts to pull out her IV line. Which
nursing intervention protects the client
Short, abrupt muscle contraction without increasing her ICP? *
Quick, bilateral severe jerking movements Place her in a jacket restraint
Abrupt loss of muscle tone Wrap her hands in soft “mitten” restraints
A brief lapse in consciousness Tuck her arms and hands under the draw
sheet
The nurse is caring for the client with
increased intracranial pressure. The nurse Apply a wrist restraint to each arm
would note which of the following trends in
vital signs if the ICP is rising? * The nurse is positioning the female client
with increased intracranial pressure. Which
Increasing temperature, increasing pulse, of the following positions would the nurse
increasing respirations, decreasing blood avoid? *
pressure.
Head mildline
Increasing temperature, decreasing pulse,
decreasing respirations, increasing blood Head turned to the side
pressure.
Neck in neutral position
Decreasing temperature, decreasing pulse,
increasing respirations, decreasing blood Head of bed elevated 30 to 45 degrees
pressure. While working in the ICU, you are assigned
Decreasing temperature, increasing pulse, to care for a patient with a seizure disorder.
decreasing respirations, increasing blood Which of these nursing actions will you
pressure. implement first if the patient has a seizure? *

A female client admitted to an acute care Place the patient on a non-rebreather mask
facility after a car accident develops signs will the oxygen at 15 L/minute.
and symptoms of increased intracranial Administer lorazepam (Ativan) 1 mg IV.
pressure (ICP). The client is intubated and
placed on mechanical ventilation to help Turn the patient to the side and protect
reduce ICP. To prevent a further rise in ICP airway.
caused by suctioning, the nurse anticipates
Assess level of consciousness during and The need for mechanical ventilation
immediately after the seizure. A 22-year-old client with quadriplegia is
apprehensive and flushed, with a blood
A nurse in the emergency department is pressure of 210/100 and a heart rate of 50
observing a 4-year-old child for signs of bpm. Which of the following nursing
increased intracranial pressure after a fall interventions should be done first? *
from a bicycle, resulting in head trauma. Place the client flat in bed
Which of the following signs or symptoms Assess patency of the indwelling urinary
would be cause for concern? * catheter
Bulging anterior fontanel. Give one SL nitroglycerin tablet
Raise the head of the bed immediately to 90
Repeated vomiting. degrees
A client comes into the ER after hitting his
Signs of sleepiness at 10 PM. head in an MVA. He’s alert and oriented.
Which of the following nursing interventions
Inability to read short words from a distance
should be done first? *
of 18 inches.
A. Assess full ROM to determine extent of
A 22 year old client suffered from his first injuries
tonic-clonic seizure. Upon awakening the B. Call for an immediate chest x-ray
client asks the nurse, “What caused me to C. Immobilize the client’s head and neck
have a seizure? Which of the following D. Open the airway with the head-tilt-chin-lift
would the nurse include in the primary maneuver
cause of tonic clonic seizures in adults more A 23-year-old client has been hit on the
the 20 years? * head with a baseball bat. The nurse notes
clear fluid draining from his ears and nose.
Electrolyte imbalance Which of the following nursing interventions
should be done first? *
Head trauma
A. Position the client flat in bed
Epilepsy B. Check the fluid for dextrose with a
dipstick
Congenital defect C. Suction the nose to maintain airway
patency
A male client is having a tonic-clonic D. Insert nasal and ear packing with sterile
seizures. What should the nurse do first? * gauze
Elevate the head of the bed. Which of the following respiratory patterns
indicate increasing ICP in the brain stem? *
Restrain the client’s arms and legs. Slow, irregular respirations
Rapid, shallow respirations
Place a tongue blade in the client’s mouth. Asymmetric chest expansion
Nasal flaring
Take measures to prevent injury.
A client is at risk for increased ICP. Which of
A 22-year-old client with quadriplegia is the following would be a priority for the
nurse to monitor? *
apprehensive and flushed, with a blood
Unequal pupil size
pressure of 210/100 and a heart rate of 50
Decreasing systolic blood pressure
bpm. Which of the following nursing
Tachycardia
interventions should be done first? *
A. Place the client flat in bed Decreasing body temperature
B. Assess patency of the indwelling urinary While in the ER, a client with C8 tetraplegia
develops a blood pressure of 80/40, pulse
catheter
48, and RR of 18. The nurse suspects which
C. Give one SL nitroglycerin tablet
of the following conditions? *
D. Raise the head of the bed immediately to
Autonomic dysreflexia
90 degrees
Hemorrhagic shock
A client has a cervical spine injury at the
Neurogenic shock
level of C5. Which of the following
Pulmonary embolism
conditions would the nurse anticipate during
An 18-year-old client was hit in the head
the acute phase? *
with a baseball during practice. When
Absent corneal reflex
discharging him to the care of his mother,
Decerebate posturing
the nurse gives which of the following
Movement of only the right or left half of the
instructions? *
body
A. “Watch him for keyhole pupil the next 24 noted on the client’s record,would
hours.”
B. “Expect profuse vomiting for 24 hours the nurse question? *
after the injury.”
A. Amoxicillin (Amoxil)
C. “Wake him every hour and assess his
orientation to person, time, and place.”
B. Indomethacin (Indocin)
D. “Notify the physician immediately if he C. Lansoprazole (Prevacid)
has a headache.” D. Clarithromycin (Biazin)
A client is admitted with a spinal cord injury An intubated patient is receiving
at the level of T12. He has limited
movement of his upper extremities.Which of continuous enteral feedings
the following medications would be used to
control edema of the spinal cord? *
through a Salem sump tube at a
A. Acetazolamide (Diamox) rate of 60ml/hr. Gastric residuals
B. Furosemide (Lasix)
C. Methylprednisolone (Solu-Medrol) have been 30-40ml when
D. Sodium bicarbonate
monitored Q4H. You check the
gastric residual and aspirate
A female client being seen in a
220ml. What is your first response
physician’s office has just been
to this finding? *
scheduled for a barium swallow
A. Notify the doctor immediately.
the next day. The nurse writes B. Stop the feeding, and clamp the NG
tube.
down which instruction for the
C. Discard the 220ml, and clamp the
client to follow before the test? * NG tube.
D. Give a prescribed GI stimulant such
A. Fast for 8 hours before the test as metoclopramide (Reglan).
B. Eat a regular supper and breakfast
C. Continue to take all oral medications Michael, a 42 y.o. man is admitted
as scheduled
D. Monitor own bowel movement to the med-surg floor with a
pattern for constipation
diagnosis of acute pancreatitis. His
BP is 136/76, pulse 96, Resp 22
Stephanie, a 28 y.o. accident
and temp 101. His past history
victim, requires TPN. The rationale
includes hyperlipidemia and
for TPN is to provide: *
alcohol abuse. The doctor
A. Necessary fluids and electrolytes to
the body. prescribes an NGtube. Before
B. Complete nutrition by the I.V. route.
inserting the tube, you explain the
C. Tube feedings for nutritional
purpose to patient. Which of the
supplementation.
D. Dietary supplementation with liquid following is a most accurate
protein given between meals.
explanation? *
A. “It empties the stomach of fluids and
The nurse is reviewing the gas.”
B. “It prevents spasms at the sphincter
medication record of a client with
of Oddi.”
gastritis. Which medication, if C. “It prevents air from forming in the
small intestine and large intestine.”
D. “It removes bile from the gallbladder.”
 A patient asks, “Is surgery always
A patient with gastritis is the treatment of choice for
nauseated and vomited 10 times inflamed salivary glands?” Your
at home, which of the following best response would be: *
nursing diagnoses is appropriate A. Yes, surgery is always the answer.
B. Surgery is only recommended for
for this patient? Select all that children.
apply. * C. Elderly is not a candidate for
parotidectomy.
A. Acute pain related to irritated
stomach mucosa
B. Anxiety related to treatment D. The procedure is advised for chronic
C. Imbalanced nutrition, less than body sialadenitis and uncontrolled pain.
requirements related to inadequate
intake of nutrients
D. Risk for imbalanced fluid volume While palpating a female client’s
related to insufficient fluid intake and right upper quadrant (RUQ), the
excessive fluid loss
nurse would expect to find which
of the following structures? *
Jason, a 22 y.o. accident victim,
A.Sigmoid colon
requires an NG tube for feeding. B.Appendix
What should you immediately do C. Spleen
D. Liver
after inserting an NG tube for
liquid enteral feedings? *
A. Aspirate for gastric secretions with a
syringe. Which of the following factors
would most likely contribute to the
B. Begin feeding slowly to prevent development of a client's hiatal
cramping.
C. Get an X-ray of the tip of the tube hernia? *
within 24 hours. A. having a sedentary desk job
D. Clamp off the tube until the feedings B. using laxatives frequently
begin. C. being 40 years old
D. being 5 feet 2 inches tall and
weighing 200 lbs.
The nurse is caring for a client
The client with gastroesophageal
with chronic gastritis. The nurse
reflux disease (GERD) complains of
monitors the client, knowing that
a chronic cough. The nurse
this client is at risk for which of
understands that in a client with
the following vitamin
GERD this symptom may be
deficiencies? *
indicative of which of the following
A.Vitamin A
B. Vitamin B12 conditions? *
C. Vitamin C A. development of laryngeal cancer
D. Vitamin E B. aspiration of gastric contents
C. Irritation of the esophagus
D. Esophageal scar tissue formation teaching plan for a client who is
Which specific data should the experiencing gastroesophageal
nurse obtain from the client who is reflux disease (GERD)? *
suspected of having peptic ulcer A. Limit caffeine intake to two cups of
coffee per day.
disease? * B. Do not lie down for 2 hours after
A. History of side effects experienced eating.
from all medications C. Follow a low-protein diet.
B. Use of non steroidal anti D. Take medications with milk to
inflammatory drugs (NSAIDs) decrease irritation.
C. Any known allergies to drugs and
environmental factors
D. Medical histories of at lease 3 A client who has been diagnosed
generations with gastroesophageal reflux
disease (GERD) complains of
The nurse is obtaining a health
heartburn. To decrease the
history from a client who has a
heartburn, the nurse should
sliding hiatal hernia associated
instruct the client to eliminate
with reflux. The nurse should ask
which of the following items from
the client about the presence of
the diet? *
which of the following A. Lean beef
symptoms? * B. Air popped popcorn
C. Raw vegetables
A. Jaundice
D. Hot chocolate
B. Anorexia
C. Heartburn
D. Stomatitis Which expected outcome should
the nurse include for a client
diagnosed with peptic ulcer
disease? *
Bethanechol (Urecholine) has been A. The clients pain is controlled with the
ordered for a client with use of NSAIDs
B. The client maintains lifestyle
gastroesophageal reflux disease modifications
(GERD). The nurse should assess C. The client has no signs and
symptoms of hemoptysis
the client for which of the D. The client take s antacids with each
following adverse effects? * meal
A. Dry oral mucosa The nurse has been assigned to
B. Hypertension care for a client diagnosed with
C. Urinary urgency
D. Constipation peptic ulcer disease. Which
assessment data require further
Which of the following instructions intervention? *
should the nurse include in the A. Bowel sour s auscultated 15 times in
1 minute
B. Belching after eating a heavy and breathing. Which of the following is
fatty meal late at night
C. A decrease in systolic BP of 20 mm the appropriate nursing action? *
Hg from lying to sitting A. Quickly insert the tube
D. A decreased frequency of distress B. Notify the physician immediately
located in the epigastric region C. Remove the tube and reinsert when
the respiratory distress subsides
D. Pull back on the tube and wait until
The client is scheduled to have an
the respiratory distress subsides
upper gastrointestinal tract series
A male client who is recovering
of x-rays. Following the x-rays,
from surgery has been advanced
the nurse should instruct the client
from a clear liquid diet to a full
to: *
liquid diet. The client is looking
A. administer an enema
B. take a laxative forward to the diet change because
C. take an antiemetic he has been “bored” with the clear
D. follow a clear liquid diet
The nurse is providing discharge liquid diet. The nurse would offer

instructions to a male client which full liquid item to the

following gastrectomy and client? *

A. Tea
instructs the client to take which B. Gelatin
measure to assist in preventing C. Custard
D. Popsicle
dumping syndrome? * DAY 2
A. Ambulate following a meal How does exercise helps manage
B. Eat high carbohydrate foods
C. Limit the fluid taken with meal IBS? *
D. Sit in a high-Fowler’s position during A. It increases peristalsis.
meals B. It decreases peristalsis.
C. It decreases intestinal motility.
D. It relieves abdominal pain.
Which assessment data indicate to
the nurse the clients gastric ulcer When teaching an elderly client
has perforated? * how to prevent constipation,
A. Complaints of sudden, sharp, which of the following instructions
substernal pain
B. Rigid, boardlike abdomen with should the nurse include? *
rebound tenderness A. “Drink 6 glasses of fluid each day.”
C. Frequent, clay-colored, liquid stool B. “Avoid grain products and nuts.”
D. Complaints of vague abdominal pain C. “Add at least 4 grams of bran to your
in the right upper quadrant cereal each morning.”
D. “Be sure to get regular exercise.”
A nurse is inserting a nasogastric
tube in an adult male client. Nursing suggestions to help a

During the procedure, the client person break the constipation

begins to cough and has difficulty

habit include all of the following In a client with diarrhea, which
except: * outcome indicates that fluid
A. A low-residue, bland diet. resuscitation is successful? *
B. A fluid intake of at least 2 L/day.
A. The client passes formed stools at
C. Establishing a regular schedule of
regular intervals
exercise.
B. The client reports a decrease in stool
D. Establishing a regular time for daily
frequency and liquidity
elimination.
C. The client exhibits firm skin turgor
D. The client no longer experiences
A client with irritable bowel perianal burning.

syndrome is being prepared for

Which of the following are
discharge. Which of the following
considered as the risk factors of
meal plans should the nurse give
irritable bowel syndrome? Select
the client? *
A. Low fiber, low-fat all that apply. *
B. High fiber, low-fat A. Gastric resection
C. Low fiber, high-fat B. Stress
D. High-fiber, high-fat C. Spicy foods
D. Celiac disease
E. Enteritis
The nurse would monitor for F. Smoking
which of the following adverse
reactions to aluminum-containing A patient with IBS asks, “How can
antacids such as aluminum I manage abdominal discomfort?”
hydroxide (Amphojel)? * Your best response would be: *
A. Diarrhea A. “It is best managed by eating dry
B. Constipation crackers.”
C. GI upset B. “Some patients maintain an
D. Fluid retention antidepressant drugs.”
A 70-year-old client visits the C. “You will be the one to choose what
is best for you.”
clinic and complains of minor D. “Abdominal pain can be reduced by
soiling with occasional urgency and avoiding carbonated beverages.”
Hypokalemia can occur rapidly in
loss of control. Further assessment
an elderly person who experiences
reveals that the client has poor
diarrhea. The nurse should
control of flatus. Based on the
immediately report to the
presenting symptoms, you suspect
physician a critical potassium level
that the client may have: *
A. Peptic ulcer disease of: *
B. Constipation A. 3.0 mEq/L
C. Irritable bowel syndrome B. 4.0 mEq/L
D. Fecal incontinence C. 4.5 mEq/L
D. 5.0 mEq/L
Which of the following should be the patient has Celiac Disease,
included in a plan of care for a what finding will be discovered
client who is lactose intolerant? * with the endoscopy? *
A. Remove all dairy products from the A. Over exaggerated intestinal villi
diet. B. B. Ulcerations in the small intestine,
B. Frozen yogurt can be included in the specifically the Jejunum
C. Flat intestinal villi
diet.
C. Drink small amounts of milk on an D. Cobble-stone appearance
empty stomach. throughout the small intestine
D. Spread out selection of dairy
products throughout the day.
People with celiac disease cannot
A 30-year old client experiences
eat which kind of food? *
weight loss, abdominal distention,
Fruits, especially strawberries
crampy abdominal pain, and Dairy products, especially milk
intermittent diarrhea after birth Peanuts and nuts
Grains, especially wheat, rye, and
of her 2nd child. Diagnostic tests barley
reveal gluten-induced enteropathy.
Which foods must she eliminate Your patient was admitted 3 days
from her diet permanently? * ago for treatment of severe
A. Milk and dairy products malnourishment secondary to
B. Protein-containing foods
C. Cereal grains (except rice and corn) Celiac Disease. The patient is doing
D. Carbohydrates well and will be discharged
tomorrow. When you arrive to the
In planning a treatment and patient's room, the patient's
prevention program of chronic friends and family are visiting and
fecal incontinence for an elderly have brought dinner for the
client, which intervention should patient. Which food item below
you try first? * should the patient avoid
A. Administer a glycerin suppository 15 consuming? *
minutes before evacuation time.
A. Pork barbeque sandwich
B. Insert a rectal tube at specified
B. Steak and steamed broccoli
intervals each day.
C. Braised chicken with carrots
C. Assist the client to the bedpan or
D. Vegetables and rice
toilet 30 minutes after meals.

D. Use incontinence briefs or adult- A patient complains of abdominal

sized diapers. pain and distention is suspected of
A patient is suspected to be having malabsorption syndrome
suffering from Celiac Disease. The when he/she has: *
physician orders an endoscopy. If A. A bulky, foul-smelling stools with
steatorrhea
B. Episodes of constipation and B. Question the physician about the
diarrhea order.
C. Chronic constipation C. Provide privacy and explain the
D. Severe abdominal pain after eating procedure to the client.
D. Assist the client to left lateral Sim’s
position.
Katrina is diagnosed with lactose
intolerance. To avoid complications
Medical management of the client
with lack of calcium in the diet,
with diverticulitis should include
which food should be included in
which of the following
the diet? *
treatments? *
A. Fruit
A. Reduced fluid intake
B. Whole grains
B. Increased fiber in diet
C. Milk and cheese products
D. Dark green, leafy vegetables C. Administration of antibiotics
D. Exercises to increase intra-
abdominal pressure
Which of the following
recommended to a patient with
A client with acute appendicitis
malabsorption syndrome? *
develops fever, tachycardia, and
A. Encourage patient to eat pasta three
times a day. hypotension. Based on these
B. Instruct patient to increase milk assessment findings, the nurse
consumption.
C. The patient is advised to limit fluid suspects which of the following
intake. complications? *
D. Vitamin supplementation is
prescribed. A. Peritonitis
B. Bowel ischemia
C. Intestinal obstruction
Which of the following is the D. Deficient fluid volume

priority nursing diagnosis to a

Before feeding a client via NGT,
patient with diarrhea? *
A. Fluid volume excess related to fluid the nurse checks for residual
retention and obtains a residual amount
B. Fluid volume deficit related to
excessive fluid loss of 90ml. What is the
C. Activity intolerance related to
imbalanced oxygen supply and demand appropriate action for the
D. Risk for infection related to nurse to take? *
underlying inflammatory process
Discard the residual amount.
Hold the due feeding.
An enema is prescribed for a client Skip the feeding and administer the next
feeding due in 4 hours.
with suspected appendicitis. Which Reinstill the amount and continue with
administering the feeding.
of the following actions should the
nurse take? *
A. Prepare 750 ml of irrigating solution
warmed to 100*F.
You're providing care to a 36 tolerate soft diet so the
year old male. The patient physician ordered for the
experienced abdominal trauma removal of it. The nurse would
and recently received 2 units of instruct the client to do which
packed red blood cells. You're of the following before he
assessing the patient's morning removes the tube? *
Inhale and exhale simultaneously.
lab results. Which lab result
Take a long breath and hold it.
below demonstrates that the Do a Valsalva maneuver.
Blow the nose.
blood transfusion was
successful? * What blood type is known as
Hemoglobin level 7 g/dL the “universal donor”? *
Platelets 300,000 µl
Hemoglobin level 15 g/dL Type A
Prothrombin Time 12.5 seconds Type B
Type AB
Type O
A newly RN nurse is about to
insert a nasogastric tube to a Before initiating the blood
client with Guillain-Barre transfusion, you obtain the
Syndrome. To determine the patient's baseline vital signs,
accurate measurement of the which are: heart rate 100,
length of the tube be inserted, blood pressure 115/72,
the nurse should: * respiratory rate 18, and
Place the tube at the tip of the nose, and temperature 100.8'F. Your next
measure by extending the tube to the
earlobe and then down to the top of the action is to:* *
sternum. Administer the blood transfusion as
Place the tube at the tip of the nose, and ordered.
measure by extending the tube to the Hold the blood transfusion and reassess
earlobe and then down to the xiphoid vital signs in 1 hour.
process. Notify the physician before starting the
transfusion.
Place the tube at the tip of the nose, and
measure by extending the tube down to Administer 200 mL of the blood and then
the chin and then down to the top of the reassess the patient's vital signs.
xiphoid process.
Place the tube at the base of the nose,
and measure by extending the tube to the A patient started receiving
earlobe and then down to the top of the
sternum. their first unit of blood at
1000. It is now 1010 and the
A stroke client who was initially
patient is reporting itching,
on NGT feeding was able to
chills, and a headache. In
addition, the patient's
What blood type is known as
temperature is now 99.8'F
the “universal recipient”? *
from 98'F. Your next nursing
Type A
action is: * Type B
Stop the transfusion Type AB
Type O
Notify the physician
Decrease the rate of the transfusion
Reassure the patient that this is normal A client has just arrived in the
and will resolve in 30 minutes.
PACU following a successful
A nurse is checking the tracheostomy procedure. Which
nasogastric tube position of a nursing action must be taken
client receiving a long term first? *
Suction as needed
therapy of Omeprazole (Prisolec)
Clean the tracheostomy inner cannula
by aspirating the stomach and stoma
Listen to lung sounds
contents to check for the PH Change the tracheostomy dressing as
needed
level. The nurse proves that
correct tube placement if the When taking off the gown at
PH level is? * the end of the case, the gloves'
7.75.
7.5. cuffs usually turn down as the
6.5. sleeves pass off the arms. The
5.5.
wearer removes the gloves using
which one of the techniques
The nurse is preparing to give
listed below? *
bolus enteral feedings via a Pull off by fingers of each glove
nasogastric tube to a comatose Glove-to-glove and then skin-to-skin
Open-glove technique
client. Which of the following Scrubbed person's choice if gloves are
not too dirty
actions is an inappropriate
practice by the nurse? * Where should the scrubbed
If bowel sounds are absent, hold the person hold onto his or her
feeding and notify the physician.
Assess tube placement by aspirating gown when lifting it up to don
gastric content and check the PH level.
Warm the feeding to room temperature to it? *
prevent the occurrence of diarrhea and The sterile exterior of the gown
cramps. The inside seams at armpits
Elevate the head of the bed to 45 degrees The inside front of the gown just below the
and maintains for 30 minutes after neckband
instillation of feeding. At the waist
The client who is concerned The closed-glove technique is
about getting a tracheostomy used: *
only when the hands have never passed
says, "I will be ugly, with a hole
through the gown cuffs
in my neck." What is the nurse's when regloving without assistance during
the procedure
best response? * to assist a surgeon in donning sterile attire
"But you know you need this to breathe, as a method for correcting glove
right?" contamination
Do you have a pretty scarf or a large
loose collar that you could place over it?" The sterile areas of the gown
"Your family and friends probably won't
even care." include the: 1. front from two
"It won't take you long to learn to
manage." inches below the neck to waist
or table level 2. gloves and
While changing the tapes on a
gown sleeve to two inches above
tracheostomy tube, the client
the elbow 3. sides from axillae
coughs and the tube is dislodged.
to waist or table level 4. back of
Which is the initial nursing
a wraparound gown *
action? * 1 and 2
Call a respiratory therapist to reinsert the 1 and 3
tracheotomy. 1, 2 and 3
Cover the tracheostomy site with a sterile 1, 2 and 4
dressing.
A patient with a tracheostomy
Call the physician to reinsert the
tracheotomy. needs to be suctioned. What
Grasp the retention sutures to spread the
opening. would you do first before
suctioning the patient? *
A nurse is supervising a student Hyperoxygenate the patient before
nurse who is performing suctioning
Disconnect pulse oximetry
tracheostomy care for a client. Assist the patient into Sim's position
Have the patient bear down
Which of the following actions
by the student should the nurse During gowning, the circulating
intervene? nurse can assist the scrub
Removing the inner cannula and cleaning
person by: *
using universal precaution.
Suctioning the tracheostomy tube before pulling the bottom edge of the front of the
performing tracheostomy care. gown to eliminate blousing
Changing the old tracheotomy ties and helping to get the creases out of the
securing the tube in place. gown's sleeves by pulling the shoulders
Replacing the inner cannula and cleaning up
the site of the stoma. reaching inside the gown and pulling the
inside seam
All of the above
A patient with liver disease for which of the following drug-
may experience which of the related side effects? *
following manifestations? Select 1/1
A. Constipation
all that apply. * B. Hyperkalemia
0/3
A. Jaundice C. Irregular pulse
D. Dysuria
B. Clavicular injury
C. Spider angiomas Mr. Yu is in end-stage liver
D. Chronic hyperglycemia
E. Ascites failure. Which interventions
should the nurse implement
Correct answer
A. Jaundice when addressing
C. Spider angiomas
E. Ascites hepaticencephalopathy? Select
all that apply. *
A 52-year-old man was
3/3
referred to the clinic due to A. Assessing the client’s neurologic status
every 2 hours
increased abdominal girth. He is
diagnosed with ascites by the B. Monitoring the client’s hemoglobin and
hematocrit levels
presence of a fluid thrill and C. Evaluating the client’s serum ammonia
level
shifting dullness on percussion.
After administering diuretic D. Monitoring the client’s handwriting daily

therapy, which nursing action E. Preparing to insert an esophageal

tamponade tube
would be most effective in F. Making sure the client’s fingernails are
ensuring safe care? * short

1/1
For a client in hepatic coma,
A. Measuring serum potassium for
hyperkalemia which outcome would be the
B. Assessing the client for hypervolemia
C. Measuring the client's weight weekly most appropriate? *
D. Documenting precise intake and output
1/1
A. The client is oriented to time, place,
and person.
A client with cirrhosis begins to
B. The client exhibits no ecchymotic areas.
develop ascites. Spironolactone C. The client increases oral intake to
(Aldactone) is prescribed to 2,000 calories/day.
D. The client exhibits increased serum
treat the ascites. The nurse albumin level.

should monitor the client closely

A client with advanced cirrhosis Vanjo is a client with jaundice
has been diagnosed with hepatic who is experiencing pruritus.
encephalopathy. The nurse Which nursing intervention
expects to assess for: * would be included in the care
1/1 plan for the client? *
A. Malaise
1/1
B. Stomatitis
C. Hand tremors A. Administering vitamin K
subcutaneously
D. Weight loss B. Applying pressure when giving I.M.
injections
C. Decreasing the client’s dietary protein
Which rationale supports intake
D. Keeping the client’s fingernails short
explaining the placement of an and smooth
esophageal tamponade tube in a
client who is hemorrhaging? * Nurse Farrah is providing care
1/1
for Kristoff who has jaundice.
A. Allowing the client to help insert the
tube Which statement indicates that
B. Beginning teaching for home care
C. Maintaining the client’s level of anxiety the nurse understands the
and alertness
D. Obtaining cooperation and reducing rationale for instituting skin
fear care measures for the client? *
1/1
A. “Jaundice is associated with pressure
A client diagnosed with chronic
ulcer formation.”
cirrhosis who has ascites and B. “Jaundice impairs urea production,
which produces pruritus.”
pitting peripheral edema also C. “Jaundice produces pruritus due to
impaired bile acid excretion.”
has hepatic encephalopathy.
Which of the following nursing D. “Jaundice leads to decreased tissue
perfusion and subsequent breakdown.”
interventions are appropriate to Questions 11 to 20
prevent skin breakdown? Select 10 of 10 points

all that apply. *

The nurse is caring for a client
2/2
A. Range of motion every 4 hours with cirrhosis of the liver who
B. Turn and reposition every 2 hours has developed esophageal
C. Abdominal and foot massages every 2 varices. The nurse understands
hours
D. Alternating air pressure mattress that the best explanation for
development of esophageal
E. Sit in chair for 30 minutes each shift
varices is which of the asks her to explain why there is
following? * so much emphasis on bleeding
1/1 precautions. Which of the
A. Chronic low serum protein levels result
in inadequate tissue repair, allowing the following provides the most
esophageal wall to weaken. appropriate response? *
B. The enlarged liver presses on the
diaphragm, which in turn presses on the 1/1
esophageal wall, causing collapse of A. “The low protein diet will result in
blood vessels into the esophageal lumen. reduced clotting.”
C. Increased portal pressure causes B. “The increased production of bile
some of the blood that normally circulates decreases clotting factors.”
through the liver to be shunted to the C. “The liver affected by cirrhosis is
esophageal vessels, increasing their unable to produce clotting factors.”
pressure and causing varicosities.
D. “The required medications reduce
D. The enlarged liver displaces the clotting factors.”
esophagus toward the left, tearing the
muscle layer of the esophageal blood
vessels, which allows small aneurysms to A patient contracts hepatitis
form along the lower esophageal vessels.
from contaminated food.
Nurse Vince is caring for a During the acute (icteric) phase
client with cirrhosis of the liver. of the patient's illness, the
To minimize the effects of the nurse would expect serologic
disorder, the nurse teaches the testing to reveal... *
client about foods that are high 1/1
A. hepatitis B surface antigen (HBsAg).
in thiamine. The nurse B. anti-hepatitis B core immunoglobulin M
(anti-HBc IgM).
determines that the client has C. anti-hepatitis A virus immunoglobulin G
the best understanding of the (anti-HAV IgG).
D. anti-hepatitis A virus immunoglobulin M
dietary measures to follow if (anti-HAV IgM)."

the client states an intention to

increase the intake of: * The client is in the preicteric
1/1 phase of hepatitis. Which
A. Pork
signs/symptoms would the
B. Milk nurse expect the client to
C. Chicken
D. Broccoli exhibit during this phase? *
1/1
Nurse Cynthia is providing a A. Clay-colored stools and jaundice
discharge teaching to a client B. Normal appetite and pruritus.
C. Being afebrile and left upper quadrant
with chronic cirrhosis. His wife pain.
D. Complaints of fatigue and diarrhea.
 B. Turn and reposition every 2 hours
C. Abdominal and foot massages every 2
hours
A female client with hepatitis C D. Alternating air pressure mattress
develops liver failure and GI
E. Sit in chair for 30 minutes each shift
hemorrhage. The blood products
that would most likely bring Mr. Rama was admitted to the

about hemostasis in the client hospital with ascites and

are: * jaundice. To rule out cirrhosis of

1/1 the liver:Which laboratory test
A. whole blood and albumin. indicates liver cirrhosis? *
B. platelets and packed red blood cells.
C. fresh frozen plasma and whole blood. 1/1
D. cryoprecipitate and fresh frozen A. Decreased red blood cell count
plasma. B. Decreased serum acid phosphate level
C. Elevated white blood cell count
D. Elevated serum aminotransferase
A female client with viral
hepatitis A is being treated in A man is admitted to the
an acute care facility. Because nursing care unit with a
the client requires enteric diagnosis of cirrhosis. He has a
precautions, the nurse should: * long history of alcohol
1/1
dependence. During the late
A. place the client in a private room.
B. wear a mask when handling the client’s evening following his admission,
bedpan.
C. wash the hands after touching the he becomes increasingly
client.
disoriented and agitated. Which
D. wear a gown when providing personal of the following would the client
care for the client.
be least likely to experience? *
A client diagnosed with chronic 1/1
A. Diaphoresis and tremors.
cirrhosis who has ascites and
B. Increased blood pressure and heart
pitting peripheral edema also rate.
C. Illusions.
has hepatic encephalopathy. D. Delusions of grandeur.

Which of the following nursing

interventions are appropriate to
prevent skin breakdown? Select
all that apply. *
1/1
A. Range of motion every 4 hours
EXTRA is. This patient is most likely showing signs
of what? *
16 & 17 hyperglycemic
For a diabetic male client with a foot ulcer, hypoglycemic
the physician orders bed rest, a wet-to-dry diabetic ketoacidosis
dressing change every shift, and blood hyperosmolar hyperglycemic noketotic
glucose monitoring before meals and coma
bedtime. Why are wet-to-dry dressings used At a senior citizens meeting a nurse talks
for this client? * with a client who has diabetes mellitus Type
They contain exudate and provide a moist 1. Which statement by the client during the
wound environment. conversation is most predictive of a potential
They protect the wound from mechanical for impaired skin integrity? *
trauma and promote healing. “I give my insulin to myself in my thighs.”
They debride the wound and promote “Sometimes when I put my shoes on I don’t
healing by secondary intention. know where my toes are.”
They prevent the entrance of “Here are my up and down glucose readings
microorganisms and minimize wound that I wrote on my calendar.”
discomfort. “If I bathe more than once a week my skin
Leigh Ann is receiving pancrelipase feels too dry.”
(Viokase) for chronic pancreatitis. Which A male client has just been diagnosed with
observation best indicates the treatment is type 1 diabetes mellitus. When teaching the
effective? * client and family how diet and exercise
A. There is no skin breakdown. affect insulin requirements, Nurse Joy
B. Her appetite improves. should include which guideline? *
C. She loses more than 10 lbs. “You’ll need more insulin when you exercise
D. Stools are less fatty and decreased in or increase your food intake.”
frequency. “You’ll need less insulin when you exercise
Michael, a 42 y.o. man is admitted to the or reduce your food intake.”
med-surg floor with a diagnosis of acute “You’ll need less insulin when you increase
pancreatitis. His BP is 136/76, pulse 96, your food intake.”
respirations 22 and temp 101. His past “You’ll need more insulin when you exercise
history includes hyperlipidemia and alcohol or decrease your food intake.”
abuse. The doctor prescribes an NG tube. Nurse Alvin is caring for a female client with
Before inserting the tube, you explain the type 1 diabetes mellitus who exhibits
purpose to patient. Which of the following is confusion, light-headedness, and aberrant
a most accurate explanation? * behavior. The client is still conscious. The
A. “It empties the stomach of fluids and nurse should first administer: *
gas.” I.M. or subcutaneous glucagon.
B. “It prevents spasms at the sphincter of I.V. bolus of dextrose 50%.
Oddi.” 15 to 20 g of a fast-acting carbohydrate
C. “It prevents air from forming in the small such as orange juice.
intestine and large intestine.” 10 U of fast-acting insulin.
D. “It removes bile from the gallbladder.” A nurse is caring for a client admitted to the
Pierre who is diagnosed with ER with DKA. In the acute phase the priority
acute pancreatitis is under the care of Nurse nursing action is to prepare to: *
Bryan. Which intervention should the nurse A. Administer regular insulin intravenously
include in the care plan for the client? * B. Administer 5% dextrose intravenously
A. Administration of vasopressin and C. Correct the acidosis
insertion of a balloon tamponade D. Apply an electrocardiogram monitor.
B. Preparation for a paracentesis and The nurse is admitting a client with
administration of diuretics hypoglycemia. Identify the signs and
C. Maintenance of nothing-by-mouth status symptoms the nurse should expect. Select
and insertion of nasogastric (NG) tube with all that apply. *
low intermittent suction A. Thirst
D. Dietary plan of a low-fat diet and B. Palpitations
increased fluid intake to 2,000 ml/day C. Diaphoresis
The nurse enters a diabetic patient’s room D. Slurred speech
at 11:30 and notices that the patient is E. Hyperventilation
diaphoretic, tachycardic, anxious, states she A client with type 1 DM calls the nurse to
is hungry, and doesn’t remember where she report recurrent episodes of hypoglycemia
with exercise. Which statement by the client exercise. Which medication instruction
indicated an inadequate understanding of should the nurse provide? *
the peak action of NPH insulin and “Be sure to take glipizide 30 minutes before
exercise? * meals.”
A. “The best time for me to exercise is every “Glipizide may cause a low serum sodium
afternoon.” level, so make sure you have your sodium
B. “The best time for me to exercise is right level checked monthly.”
after I eat.” “You won’t need to check your blood
C. “The best time for me to exercise is after glucose level after you start taking glipizide.”
breakfast.” “Take glipizide after a meal to prevent
D. “The best time for me to exercise is after heartburn.”
my morning snack.”
When a client is in diabetic ketoacidosis, the
insulin that would be administered is: * 18 19 & 20
A. Human NPH insulin
B. Human regular insulin Paolo with severe head trauma sustained in
C. Insulin lispro injection a car accident is admitted to the intensive
D. Insulin glargine injection care unit. Thirty-sixhours later, the client’s
A nurse is preparing a plan of care for a urine output suddenly rises above 200
client with DM who has hyperglycemia. The ml/hour, leading the nurse to suspect
priority nursing diagnosis would be: * diabetes insipidus. Which laboratory
A. High risk for deficient fluid volume findings support the nurse’s suspicion of
B. Deficient knowledge: disease process diabetes insipidus? *
and treatment Above-normal urine and serum osmolality
C. Imbalanced nutrition: less than body levels
requirements Below-normal urine and serum osmolality
D. Disabled family coping: compromised. levels
A patient with severe hypoglycemia arrives Above-normal urine osmolality level, below-
at the ED unconscious by ambulance. The normal serum osmolality level
nurse would first… * Below-normal urine osmolality level, above-
Give regular insulin by IV normal serum osmolality level
Give NPH by IV Which of these signs suggests that a male
Give 10-15 g CHO or Orange juice client with the syndrome of inappropriate
Give 1 mg glucagon antidiuretic hormone (SIADH) secretion is
When a client is first admitted with experiencing complications? *
hyperglycemic hyperosmolar nonketotic A. Tetanic contractions
syndrome (HHNS), the nurse’s priority is to B. Neck vein distention
provide: * C. Weight loss
A. Oxygen D. Polyuria
B. Carbohydrates In a 29-year-old female client who is being
C. Fluid replacement successfully treated for Cushing’s syndrome,
D. Dietary instruction nurse Angelo would expect a decline in: *
A male client with type 1 diabetes mellitus Serum glucose level.
has a highly elevated glycosylated Hair loss.
hemoglobin (Hb) test result. In discussing Bone mineralization.
the result with the client, the nurse would be Menstrual flow.
most accurate in stating: * Initial treatment for a CSF leak after
“The test needs to be repeated following a transphenoidal hypophysectomy would most
12-hour fast.” likely involve: *
“It looks like you aren’t following the A. Repacking the nose.
prescribed diabetic diet.” B. Returning the client to surgery.
“It tells us about your sugar control for the C. Enforcing bed rest with the head of the
last 3 months.” bed elevated.
“Your insulin regimen needs to be altered D. Administering high-dose corticosteroid
significantly.” therapy.
Dr. Rodriguez prescribes glipizide You assess a patient with Cushing’s
(Glucotrol), an oral antidiabetic agent, for a disease. For which finding will you notify the
male client with type 2 diabetes mellitus who physician immediately? *
has been having trouble controlling the 1 point
blood glucose level through diet and
Purple striae present on abdomen and What is the mechanism of action of
thighs corticotropin? *
Weight gain of 1 pound since the previous 1 point
day A. It decreases cyclic adenosine
+1 dependent edema in ankles and calves monophosphate (cAMP) production and
Crackles bilaterally in lower lobes of lungs affects the metabolic rate of target organs.
A male client with primary diabetes insipidus B. It interacts with plasma membrane
is ready for discharge on desmopressin receptors to inhibit enzymatic actions.
(DDAVP). Which instruction should the C. It interacts with plasma membrane
nurse provide? * receptors to produce enzymatic actions that
1 point affect protein, fat, and carbohydrate
“Administer desmopressin while the D. It regulates the threshold for water
suspension is cold.” resorption in the kidneys
“Your condition isn’t chronic, so you won’t Nurse Ruth is assessing a client after a
need to wear a medical identification thyroidectomy. The assessment reveals
bracelet.” muscle twitching and tingling, along with
“You may not be able to use desmopressin numbness in the fingers, toes, and mouth
nasally if you have nasal discharge or area. The nurse should suspect which
blockage.” complication? *
“You won’t need to monitor your fluid intake
and output after you start taking 1 point
desmopressin.” A. Tetany
Hyperphosphatemia and hypocalcemia are
indicative of which of the following B. Hemorrhage
disorders? *
A. Grave’s Disease C. Thyroid storm
B. Hyperparathyroidism
D. Laryngeal nerve damage
C. Cushing’s Syndrome
D. Hypoparathyroidism During preoperative teaching for a female
A female adult client with a history of client who will undergo subtotal
chronic hyperparathyroidism admits to being thyroidectomy, the nurse should include
noncompliant. Based on initial assessment which statement? *
findings, the nurse formulates the nursing
diagnosis of Risk for injury. To complete the A. “The head of your bed must remain flat
nursing diagnosis statement for this client, for 24 hours after surgery.”
which “related-to” phrase should the nurse
add? * B. “You should avoid deep breathing and
1 point coughing after surgery.”
A. Related to bone demineralization C. “You won’t be able to swallow for the first
resulting in pathologic fractures day or two.”
B. Related to exhaustion secondary to an
accelerated metabolic rate D. “You must avoid hyperextending your
C. Related to edema and dry skin neck after surgery.”
secondary to fluid infiltration into the
interstitial spaces A 38 year old woman returns from a subtotal
D. Related to tetany secondary to a thryroidectomy for the treatment of
decreased serum calcium level hyperthyroidism. Upon assessment, the
The client with a history of diabetes immediate priority that the nurse would
insipidus is admitted with polyuria, include is: *
polydipsia, and mental confusion. The Assess for pain
priority intervention for this client is: *
Measure the urinary output Assess for neurological status
Check the vital signs
Encourage increased fluid intake Assess fluid volume status
Weigh the client
Assess for respiratory distress
A male client has recently undergone
surgical removal of a pituitary tumor. Dr. A patient is admitted to the medical unit with
Wong prescribes corticotropin (Acthar),20 possible Graves’ disease (hyperthyroidism).
units I.M. q.i.d. as a replacement therapy. Which assessment finding supports this
diagnosis? *
1 point A. Primary hypothyroidism
Periorbital edema B. Graves’ disease
Bradycardia C. Thyrotoxicosis
Exophthalmos D. Euthyroidism
Hoarse voice A client who has undergone a subtotal
thyroidectomy is subject to complications in
Which of the following nursing assessment the first 48 hours after surgery. The nurse
is the most important in the patient with should obtain and keep at the bedside
hyperthyroidism and risk for thyrotoxic crisis equipment to: *
or thyroid storm? *
A. Begin total parenteral nutrition
Intake and output
B. Start a cutdown infusion
Heart sounds
C. Administer tube feedings
Bowel sounds
D. Perform a tracheostomy
Vital signs
Inah, with hyperthyroidism is to receive
Which nursing diagnosis takes highest Lugol’s iodine solution before a subtotal
priority for a female client with thyroidectomy is performed. The nurse is
hyperthyroidism? * aware that this medication is given to: *
A. Risk for imbalanced nutrition: More than Decrease the total basal metabolic rate.
body requirements related to thyroid
hormone excess Maintain the function of the parathyroid
glands.
B. Risk for impaired skin integrity related to
edema, skin fragility, and poor wound Block the formation of thyroxine by the
healing thyroid gland.
C. Body image disturbance related to weight Decrease the size and vascularity of the
gain and edema thyroid gland.
D. Imbalanced nutrition: Less than body
requirements related to thyroid hormone
excess 21 22 & 23
The physician orders laboratory tests to
confirm hyperthyroidism in a female client A client who recently had a cerebrovascular
with classic signs and symptoms of this accident/stroke requires a cane to ambulate.
disorder. Which test result would confirm the When teaching about cane use, the
diagnosis? * rationale for holding a cane on the
uninvolved side is to: *
No increase in the thyroid-stimulating prevent leaning
hormone (TSH) level after 30 minutes distribute weight away from the involved
during the TSH stimulation test side
maintain stride length
A decreased TSH level prevent edema
A client arrives in the emergency
An increase in the TSH level after 30
department with an ischemic stroke and
minutes during the TSH stimulation test
receives tissue plasminogen activator (t-PA)
Below-normal levels of serum administration. Which is the priority nursing
triiodothyronine (T3) and serum thyroxine assessment? *
(T4) as detected by radioimmunoassay Current medications.
Complete physical and history.
After undergoing a subtotal thyroidectomy, a Time of onset of current stroke.
female client develops hypothyroidism. Dr. Upcoming surgical procedures.
Smith prescribes levothyroxine (Levothroid), The nurse is formulating a teaching plan for
25 mcg P.O. daily. For which condition is a client who has just experienced a transient
levothyroxine the preferred agent? *
ischemic attack (TIA). Which fact should the A female client admitted to an acute care
nurse include in the teaching plan? * facility after a car accident develops signs
TIA symptoms may last 24 to 48 hours. and symptoms of increased intracranial
Most clients have residual effects after pressure (ICP). The client is intubated and
having a TIA. placed on mechanical ventilation to help
TIA may be a warning that the client may reduce ICP. To prevent a further rise in ICP
have cerebrovascular accident (CVA) caused by suctioning, the nurse anticipates
The most common symptom of TIA is the administering which drug endotracheally
inability to speak. before suctioning? *
Following a generalized seizure, the nurse
can expect the client to: * Phenytoin (Dilantin)
Be unable to move the extremities Mannitol (Osmitrol)
Be drowsy and prone to sleep
Remember events before the seizure Lidocaine (Xylocaine)
Have a drop in blood pressure
A 78 year old client is admitted to the Furosemide (Lasix)
emergency department with numbness and
A client with subdural hematoma was given
weakness of the left arm and slurred speech.
mannitol to decrease intracranial pressure
Which nursing intervention is priority? *
(ICP). Which of the following results would
Prepare to administer recombinant tissue
best show the mannitol was effective? *
plasminogen activator (rt-PA).
Discuss the precipitating factors that caused Urine output increases
the symptoms.
Schedule for A STAT computer tomography Pupils are 8 mm and nonreactive
(CT) scan of the head.
Notify the speech pathologist for an Systolic blood pressure remains at 150 mm
Hg
emergency consult
BUN and creatinine levels return to normal
A neurological consult has been ordered for
a pediatric client with suspected petit mal A client who is regaining consciousness
seizures. The client with petit mal seizures after a craniotomy becomes restless and
can be expected to have: * attempts to pull out her IV line. Which
nursing intervention protects the client
Short, abrupt muscle contraction without increasing her ICP? *
Quick, bilateral severe jerking movements Place her in a jacket restraint
Abrupt loss of muscle tone Wrap her hands in soft “mitten” restraints
A brief lapse in consciousness Tuck her arms and hands under the draw
sheet
The nurse is caring for the client with
increased intracranial pressure. The nurse Apply a wrist restraint to each arm
would note which of the following trends in
vital signs if the ICP is rising? * The nurse is positioning the female client
with increased intracranial pressure. Which
Increasing temperature, increasing pulse, of the following positions would the nurse
increasing respirations, decreasing blood avoid? *
pressure.
Head mildline
Increasing temperature, decreasing pulse,
decreasing respirations, increasing blood Head turned to the side
pressure.
Neck in neutral position
Decreasing temperature, decreasing pulse,
increasing respirations, decreasing blood Head of bed elevated 30 to 45 degrees
pressure. While working in the ICU, you are assigned
Decreasing temperature, increasing pulse, to care for a patient with a seizure disorder.
decreasing respirations, increasing blood Which of these nursing actions will you
pressure. implement first if the patient has a seizure? *
Place the patient on a non-rebreather mask
will the oxygen at 15 L/minute.
Administer lorazepam (Ativan) 1 mg IV. conditions would the nurse anticipate during
the acute phase? *
Turn the patient to the side and protect Absent corneal reflex
airway. Decerebate posturing
Assess level of consciousness during and Movement of only the right or left half of the
immediately after the seizure. body
The need for mechanical ventilation
A nurse in the emergency department is A 22-year-old client with quadriplegia is
observing a 4-year-old child for signs of apprehensive and flushed, with a blood
increased intracranial pressure after a fall pressure of 210/100 and a heart rate of 50
from a bicycle, resulting in head trauma. bpm. Which of the following nursing
Which of the following signs or symptoms interventions should be done first? *
would be cause for concern? * Place the client flat in bed
Assess patency of the indwelling urinary
Bulging anterior fontanel. catheter
Give one SL nitroglycerin tablet
Repeated vomiting.
Raise the head of the bed immediately to 90
Signs of sleepiness at 10 PM. degrees
A client comes into the ER after hitting his
Inability to read short words from a distance head in an MVA. He’s alert and oriented.
of 18 inches. Which of the following nursing interventions
should be done first? *
A 22 year old client suffered from his first
A. Assess full ROM to determine extent of
tonic-clonic seizure. Upon awakening the
injuries
client asks the nurse, “What caused me to B. Call for an immediate chest x-ray
have a seizure? Which of the following C. Immobilize the client’s head and neck
would the nurse include in the primary
D. Open the airway with the head-tilt-chin-lift
cause of tonic clonic seizures in adults more
maneuver
the 20 years? *
A 23-year-old client has been hit on the
Electrolyte imbalance head with a baseball bat. The nurse notes
clear fluid draining from his ears and nose.
Head trauma Which of the following nursing interventions
should be done first? *
Epilepsy A. Position the client flat in bed
Congenital defect B. Check the fluid for dextrose with a
dipstick
A male client is having a tonic-clonic C. Suction the nose to maintain airway
seizures. What should the nurse do first? * patency
D. Insert nasal and ear packing with sterile
Elevate the head of the bed. gauze
Restrain the client’s arms and legs. Which of the following respiratory patterns
indicate increasing ICP in the brain stem? *
Place a tongue blade in the client’s mouth. Slow, irregular respirations
Rapid, shallow respirations
Take measures to prevent injury. Asymmetric chest expansion
Nasal flaring
A 22-year-old client with quadriplegia is A client is at risk for increased ICP. Which of
apprehensive and flushed, with a blood the following would be a priority for the
pressure of 210/100 and a heart rate of 50 nurse to monitor? *
bpm. Which of the following nursing Unequal pupil size
interventions should be done first? * Decreasing systolic blood pressure
A. Place the client flat in bed Tachycardia
B. Assess patency of the indwelling urinary Decreasing body temperature
catheter While in the ER, a client with C8 tetraplegia
C. Give one SL nitroglycerin tablet develops a blood pressure of 80/40, pulse
D. Raise the head of the bed immediately to 48, and RR of 18. The nurse suspects which
90 degrees of the following conditions? *
A client has a cervical spine injury at the Autonomic dysreflexia
level of C5. Which of the following Hemorrhagic shock
Neurogenic shock
Pulmonary embolism C. Hemoglobin (Hb) levels and hematocrit (HCT)
An 18-year-old client was hit in the head D. Arteriography
with a baseball during practice. When
discharging him to the care of his mother, 5. A patient complains about an inflamed
the nurse gives which of the following salivary gland below his right ear. The nurse
instructions? * documents probable inflammation of
A. “Watch him for keyhole pupil the next 24 which gland/s?
hours.”
A. Buccal
B. “Expect profuse vomiting for 24 hours
B. Parotid
after the injury.”
C. Sublingual
D. Submandibular

6. Parotitis caused by bacteria is treated with

which of the following drug classifications?
A. Analgesics
REVISE SAS
B. Corticosteroids
C. Antipyretics
D. Antibiotics
Sas 1
7. Which of the following are the possible
1. You’re performing an abdominal assessment
causes of sialadenitis? Select all that apply.
on Brent who is 52 y.o. In which order do you
A. Dehydration
proceed?
B. Stress
A. Observation, percussion, palpation,
C. Dental extraction
auscultation
D. Improper oral hygiene
A. Observation, auscultation, percussion,
E. Frequent ingestion of cold beverages
palpation
B. Percussion, palpation, auscultation,
8. A patient asks, “Is surgery always the
observation
treatment of choice for inflamed salivary
C. Palpation, percussion, observation,
glands?” Your best response would be:
auscultation
A. Yes, surgery is always the answer.
B. Surgery is only recommended for children.
2. While palpating a female client’s right upper
C. Elderly is not a candidate for parotidectomy.
quadrant (RUQ), the nurse would expect to find
D. The procedure is advised for chronic
which of the following
sialadenitis and uncontrolled pain.
structures?
A.Sigmoid colon
B.Appendix
9. Which of the following conditions described
C. Spleen
as presence of calculi in the salivary glands?
D. Liver
A. Parotitis
B. Sialolithiasis
3. A female client being seen in a physician’s
C. Sialadenitis
office has just been scheduled for a barium
D. Mumps
swallow the next day. The nurse
writes down which instruction for the client to
10. Which of the following medical
follow before the test?
management is recommended for salivary
A. Fast for 8 hours before the test
calculus?
B. Eat a regular supper and breakfast
A. Lithotripsy
C. Continue to take all oral medications as
B. Antibiotic therapy
scheduled
C. Nephrectomy
D. Monitor own bowel movement pattern for
D. Endoscopy
constipation
Sas 2
4. Which diagnostic test would be used first to
1. Acute gastritis is often caused by:
evaluate a client with upper GI bleeding?
A. Ingestion of strong acids
A. Endoscopy
B. Irritating foods
B. Upper GI series
C. Overuse of Aspirin
D. All of the above 9. Which of the following measures helps
relieve pain to a client with gastritis?
2. Which of the following definitions best A. Avoid foods and beverages that may be
describes gastritis? irritating to the gastric mucosa.
A. Erosion of the gastric mucosa B. Monitor fluid intake and output daily to
B. Inflammation of a diverticulum detect early signs of dehydration.
C. Inflammation of the gastric mucosa C. Administer Amoxicillin (Amoxil) twice a day.
D. Reflux of stomach acid into the esophagus D. Start intravenous fluid therapy.

3. Which of the following substances is most 10 A patient with gastritis is nauseated and
likely to cause gastritis? vomited 10 times at home, which of the
A. Milk following nursing diagnoses is
B. Bicarbonate of soda, or baking soda appropriate for this patient? Select all that
C. Enteric coated aspirin apply.
D. Nonsteriodal anti-imflammatory drugs A. Acute pain related to irritated stomach
mucosa
4. The nurse is caring for a client with chronic B. Anxiety related to treatment
gastritis. The nurse monitors the client, knowing C. Imbalanced nutrition, less than body
that this client is at risk for requirements related to inadequate intake of
which of the following vitamin deficiencies? nutrients
A.Vitamin A D. Risk for imbalanced fluid volume related to
B. Vitamin B12 insufficient fluid intake and excessive fluid loss
C. Vitamin C
D. Vitamin E 11. Michael, a 42 y.o. man is admitted to the
med-surg floor with a diagnosis of acute
5. The nurse is reviewing the medication record pancreatitis. His BP is 136/76, pulse
of a client with gastritis. Which medication, if 96, Resps 22 and temp 101. His past history
noted on the client’s record, includes hyperlipidemia and alcohol abuse. The
would the nurse question? doctor prescribes an NG tube.
A. Amoxicillin (Amoxil) Before inserting the tube, you explain the
B. Indomethacin (Indocin) purpose to patient.Which of the following is a
C. Lansoprazole (Prevacid) most accurate explanation?
D. Clarithromycin (Biazin) A. “It empties the stomach of fluids and gas.”
B. “It prevents spasms at the sphincter of Oddi.”
C. “It prevents air from forming in the small
6. Which of the following treatments should be intestine and large intestine.”
included in the immediate management of D. “It removes bile from the gallbladder.”
acute gastritis?
A. Reducing work stress 12. Jason, a 22 y.o. accident victim, requires an
B. Completing gastric resection NG tube for feeding. What should you
C. Treating the underlying cause immediately do after inserting an
D. Administering enteral tube feedings NG tube for liquid enteral feedings?
A. Aspirate for gastric secretions with a syringe.
7. Which of the following risk factors can lead to B. Begin feeding slowly to prevent cramping.
chronic gastritis? C. Get an X-ray of the tip of the tube within 24
A. Young age hours.
B. Antibiotic usage D. Clamp off the tube until the feedings begin.
C. Gallbladder disease
D. Helicobacter pylori infection 13. Stephanie, a 28 y.o. accident victim, requires
TPN. The rationale for TPN is to provide:
8. Which of the following factors associates A. Necessary fluids and electrolytes to the body.
chronic gastritis with pernicious anemia? B. Complete nutrition by the I.V. route.
A. Chronic blood loss C. Tube feedings for nutritional
B. Inability to absorb vitamin B12 supplementation.
C. Overproduction of stomach acid D. Dietary supplementation with liquid protein
D. Overproduction of vitamin B12 given between meals.
14. Your patient has a GI tract that is rushed in the ED complaining of severe
functioning, but has the inability to swallow heartburn, vomiting and pain that radiates to
foods. Which is the preferred method of the flank. The doctor suspects
feeding for your patient? gastric ulcer.
A. TPN 5. What other symptoms will validate the
B. PPN diagnosis of gastric ulcer?
C. NG feeding A. right epigastric pain
D. Oral liquid supplements B. pain occurs when stomach is empty
C. pain occurs immediately after meal
15. An intubated patient is receiving continuous D. pain not relieved by vomiting
enteral feedings through a Salem sump tube at
a rate of 60ml/hr. Gastric 6. What diagnostic test would yield good
residuals have been 30-40ml when monitored visualization of the ulcer crater?
Q4H. You check the gastric residual and aspirate A. Endoscopy
220ml. What is your first B. Gastroscopy
response to this finding? C. Barium Swallow
A. Notify the doctor immediately. D. Histology
B. Stop the feeding, and clamp the NG tube. 7. Peptic ulcer disease particularly gastric ulcer
C. Discard the 220ml, and clamp the NG tube. is thought to be cause by which of the following
D. Give a prescribed GI stimulant such as microorgamisms?
metoclopramide A. E. coli
B. H. pylori
Sas 3 C. S. aureus
1.Based from the symptoms presented, Nurse D. K. pnuemoniae
Melinda might suspect:
A. Esophagitis 8. She is for occult blood test; what specimen
B. Hiatal hernia will you collect?
C. GERD A. Blood
D. Gastric Ulcer B. Urine
C. Stool
2. What diagnostic test would confirm the type D. Gastric Juice
of problem Mrs. Cruz have?
A. barium enema 9.What Diagnostic test will confirm Achalasia?
B. barium swallow A. Barium Swallow
C. colonoscopy B. X- ray Studies
D. lower GI series C. Manometry
D. Barium Enema
3. Mrs. Dela Cruz complained of pain and
difficulty in swallowing. The terms are referred 10. For Sliding Hiatal Hernia, all are clinical
as: manifestations except:
A. Odynophagia A. Heartburn
B. Dysphagia B. Halitosis
C. Pyrosis C. Regurgitation
D. Dyspepsia D. Dysphagia

4. To avoid acid reflux, Nurse Melinda should Sas 4

advice Mrs. Dela Cruz to avoid which type of 1. You’re performing an abdominal assessment
diet? on Brent who is 52 y.o. In which order do you
A. cola, coffee and tea proceed?
B. high fat, carbonated and caffeinated A. Observation, percussion, palpation,
beverages auscultation
C. beer and green tea B. Observation, auscultation, percussion,
D. All of the above palpation
C. Percussion, palpation, auscultation,
Situation: Nurse Marishka is the staff nurse observation
assigned at the Emergency Department. During D. Palpation, percussion, observation,
her shift, a patient was auscultation
 A. It is a common disorder that affects the large
2. When teaching an elderly client how to intestine characterized by cramping, abdominal
prevent constipation, which of the following pain, bloating, gas, and
instructions should the nurse diarrhea or constipation, or both.
include? B. It is the involuntary passage of stool from the
A. “Drink 6 glasses of fluid each day.” rectum.
B. “Avoid grain products and nuts.” C. It is an infrequent bowel movements or
C. “Add at least 4 grams of bran to your cereal difficult passage of stools that persists for
each morning.” several weeks or longer.
D. “Be sure to get regular exercise.” D. It is condition with loose and watery stools
during a bowel movement.
3. The nurse would monitor for which of the
following adverse reactions to aluminum- 9. Which of the following drugs may be
containing antacids such as aluminum administered to patient with diarrhea?
hydroxide (Amphojel)? A. Loperamide (Imodium)
A. Diarrhea B. Bisacodyl (Dulcolax)
B. Constipation C. Senna Concentrate (Senokot)
C. GI upset D. Docusate (Colace)
D. Fluid retention 10. Which of the following measures helps
control fecal incontinence?
4. Nursing suggestions to help a person break A. Increase fiber in the diet during episodes of
the constipation habit include all of the diarrhea.
following except: B. Initiate a bowel-training program.
A. A low-residue, bland diet. C. Encourage use of laxatives 3 times a day.
B. A fluid intake of at least 2 L/day. D. Use incontinence brief/adult diaper.
C. Establishing a regular schedule of exercise.
D. Establishing a regular time for daily
elimination.
Sas 5
5. All of the following are considered 1. Which of the following best describes
complications of constipation except: Malabsorption syndrome?
A. Hemorrhoids A. Are open sores that develop on the inside
B. Fecal impaction lining of your stomach and the upper portion of
C. Hypokalemia your small intestine.
D. Hypertension B. It is the inability of the digestive system to
absorb one or more of the major vitamins,
6. In a client with diarrhea, which outcome minerals, and nutrients.
indicates that fluid resuscitation is successful? C. It is a digestive disorder that occurs when
A. The client passes formed stools at regular acidic stomach juices, or food and fluids back up
intervals from the stomach into the
B. The client reports a decrease in stool esophagus.
frequency and liquidity D. An inflammatory disease which can lead to
C. The client exhibits firm skin turgor abdominal pain, severe diarrhea, fatigue, and
D. The client no longer experiences perianal weight loss.
burning.
2. A patient complains of abdominal pain and
7. The mechanism of action of diphenoxylate distention is suspected of having malabsorption
(Lotomil) is: syndrome when he/she has:
A. An increase in intestinal excretion of water A. A bulky, foul-smelling stools with steatorrhea
B. An increase in intestinal motility B. Episodes of constipation and diarrhea
C. A decrease in peristalsis in the intestinal wall C. Chronic constipation
D. A decrease in the reabsorption of water in D. Severe abdominal pain after eating
the bowel
3. Which of the following diagnostic tests
8. Which of the following statements best confirms malabsorption syndrome?
describes fecal incontinence? A. Complete blood count
B. Abdominal ultrasound
C. Panceatic function test B. Protein-containing foods
D. Endoscopy with biopsy C. Cereal grains (except rice and corn)
D. Carbohydrates

4. Which of the following recommended to a 10. Which of the following conditions cause/s
patient with malabsorption syndrome? malabsorption? Select all that apply.
A. Encourage patient to eat pasta three times a A. Celiac disease
day. B. Lactose intolerance
B. Instruct patient to increase milk consumption. C. Gastritis
C. The patient is advised to limit fluid intake. D. Gastric resection
D. Vitamin supplementation is prescribed. E. GERD

5. A client with irritable bowel syndrome is Sas 6

being prepared for discharge. Which of the 1. During assessment, the nurse is looking for
following meal plans should the positive indicators of appendicitis, which
nurse give the client? include all of the following except:
A. Low fiber, low-fat A. vomiting
B. High fiber, low-fat B. low-grade fever
C. Low fiber, high-fat C. Thrombocytopenia
D. High-fiber, high-fat D. Abdominal tenderness upon palpation

6. Katrina is diagnosed with lactose intolerance. 2. On physical examination, the nurse should be
To avoid complications with lack of calcium in looking for tenderness on palpation at
the diet, which food should Mcburney’s point, which is located
be included in the diet? in the:
A. Fruit A. Right lower quadrant
B. Whole grains B. Right upper quadrant
C. Milk and cheese products C. Left lower quadrant
D. Dark green, leafy vegetables D. Left upper quadrant

7. A patient with IBS asks, “How can I manage 3. Which of the following complications is
abdominal discomfort?” Your best response thought to be the most common cause of
would be: appendicitis?
A. “It is best managed by eating dry crackers.” A. A fecalith
B. “Some patients maintain an antidepressant B. Bowel kinking
drugs.” C. Internal bowel occlusion
C. “You will be the one to choose what is best D. Abdominal bowel swelling
for you.”
D. “Abdominal pain can be reduced by avoiding 4. An enema is prescribed for a client with
carbonated beverages.” suspected appendicitis. Which of the following
actions should the nurse take?
8. Care for the postoperative client after gastric A. Prepare 750 ml of irrigating solution warmed
resection should focus on which of the following to 100*F.
problems? B. Question the physician about the order.
A. Body image C. Provide privacy and explain the procedure to
B. Nutritional needs the client.
C. Skin care D. Assist the client to left lateral Sim’s position.
D. Spiritual needs
5. A client with acute appendicitis develops
9. A 30-year old client experiences weight loss, fever, tachycardia, and hypotension. Based on
abdominal distention, crampy abdominal pain, these assessment findings, the
and intermittent diarrhea after nurse suspects which of the following
birth of her 2nd child. Diagnostic tests reveal complications?
gluten-induced enteropathy. Which foods must A. Peritonitis
she eliminate from her diet B. Bowel ischemia
permanently? C. Intestinal obstruction
A. Milk and dairy products D. Deficient fluid volume
 2. A nurse is preparing to provide care for a
6. Eleanor, a 62 y.o. woman with diverticulosis is patient whose exacerbation of ulcerative colitis
your patient. Which interventions would you has required hospital
expect to include in her care? admission. During an exacerbation of this health
A. Low-fiber diet and fluid restrictions. problem, the nurse would anticipate that the
B. Total parenteral nutrition and bed rest. patients stools will have
C. High-fiber diet and administration of psyllium. what characteristics?
D. Administration of analgesics and antacids. A) Watery with blood and mucus
B) Hard and black or tarry
7. Which of the following types of diets is C) Dry and streaked with blood
implicated in the development of diverticulosis? D) Loose with visible fatty streaks
A. Low-fiber diet
B. High-fiber diet 3. Annabelle is being discharged with a
C. High-protein diet colostomy, and you’re teaching her about
D. Low-carbohydrate diet colostomy care. Which statement correctly
describes a healthy stoma?
8. Donald is a 61 y.o. man with diverticulitis. A. “At first, the stoma may bleed slightly when
Diverticulitis is characterized by: touched.”
A. Periodic rectal hemorrhage. B. “The stoma should appear dark and have a
B. Hypertension and tachycardia. bluish hue.”
C. Vomiting and elevated temperature. C. “A burning sensation under the stoma
D. Crampy and lower left quadrant pain and faceplate is normal.”
low-grade fever. D. “The stoma should remain swollen away
from the abdomen.”
9. Medical management of the client with
diverticulitis should include which of the 4.. You’re advising a 21 y.o. with a colostomy
following treatments? who reports problems with flatus. What food
A. Reduced fluid intake should you recommend?
B. Increased fiber in diet A. Peas
C. Administration of antibiotics B. Cabbage
D. Exercises to increase intra-abdominal C. Broccoli
pressure D. Yogurt

10. Which of the following mechanisms can 5. Claire, a 33 y.o. is on your floor with a
facilitate the development of diverticulosis into possible bowel obstruction. Which intervention
diverticulitis? is priority for her?
A. Treating constipation with chronic laxative A. Obtain daily weights.
use, leading to dependence on laxatives B. Measure abdominal girth.
B. Chronic constipation causing an obstruction, C. Keep strict intake and output.
reducing forward flow of intestinal contents D. Encourage her to increase fluids.
C. Herniation of the intestinal mucosa, rupturing
the wall of the intestine
D. Undigested food blocking the diverticulum,
predisposing the area to bacterial invasion. Sas 8

1. A 52-year-old man was referred to the clinic

Sas 7 due to increased abdominal girth. He is
1. A patient admitted with inflammatory bowel diagnosed with ascites by the
disease asks the nurse for help with menu presence of a fluid thrill and shifting dullness on
selections. What menu selection percussion. After administering diuretic therapy,
is most likely the best choice for this patient? which nursing action would
A) Spinach be most effective in ensuring safe care?
B) Tofu A. Measuring serum potassium for
C) Multigrain bagel hyperkalemia
D) Blueberries B. Assessing the client for hypervolemia
C. Measuring the client’s weight weekly
D. Documenting precise intake and output
 A. “You’ll need to lie on your stomach during
2. Sharon has cirrhosis of the liver and develops the test.”
ascites. What intervention is necessary to B. “You’ll need to lie on your right side after the
decrease the excessive test.”
accumulation of serous fluid in her peritoneal C. “During the biopsy you’ll be asked to exhale
cavity? deeply and hold it.”
D. “The biopsy is performed under general
A. Restrict fluids anesthesia.”
B. Encourage ambulation
C. Increase sodium in the diet 8. Immediately after a liver biopsy, which of the
D. Give antacids as prescribed following complications should the client be
closely monitored for?
3. A client with cirrhosis begins to develop A. Abdominal cramping
ascites. Spironolactone (Aldactone) is B. Hemorrhage
prescribed to treat the ascites. The nurse C. Nausea and vomiting
should monitor the client closely for which of D. Potential infection
the following drug-related side effects?
A. Constipation 9. Which of the following tests confirms that the
B. Hyperkalemia origin of the disorder is in the liver?
C. Irregular pulse A. Alanine Aminotransferase (ALT)
D. Dysuria B. Aspartate Aminotransferase (AST)
C. Gamma-glutamyl Transferase (GGT)
4. For which of the following positions would be D. Serum Alkaline Phosphatase
appropriate for a client with severe ascites?
A. Fowler’s 10. Mr. Hasakusa is in end-stage liver failure.
B. Side-lying Which interventions should the nurse
C. Reverse Trendelenburg implement when addressing hepatic
D. Sims’ encephalopathy? Select all that apply.
A. Assessing the client’s neurologic status every
5. You’re caring for Jane, a 57 y.o. patient with 2 hours
liver cirrhosis who developed ascites and B. Monitoring the client’s hemoglobin and
requires paracentesis. Before her hematocrit levels
paracentesis, you instruct her to: C. Evaluating the client’s serum ammonia level
A. Empty her bladder. D. Monitoring the client’s handwriting daily
B. Lie supine in bed. E. Preparing to insert an esophageal tamponade
C. Remain NPO for 4 hours. tube
D. Clean her bowels with an enema. F. Making sure the client’s fingernails are short

6. Nurse Farrah is providing care for Kristoff

who has jaundice. Which statement indicates Sas 9
that the nurse understands the 1. When planning home care for a client with
rationale for instituting skin care measures for hepatitis A, which preventive measure should
the client? be emphasized to protect the
A. “Jaundice is associated with pressure ulcer client’s family?
formation.” A. Keeping the client in complete isolation.
B. “Jaundice impairs urea production, which B. Using good sanitation with dishes and shared
produces pruritus.” bathrooms.
C. “Jaundice produces pruritus due to impaired C. Avoiding contact with blood-soiled clothing
bile acid excretion.” or dressing.
D. “Jaundice leads to decreased tissue perfusion D. Forbidding the sharing of needles or syringes.
and subsequent breakdown.”
2. Which of the following will the nurse include
7. Develop a teaching care plan for Angie who is in the care plan for a client hospitalized with
about to undergo a liver biopsy. Which of the viral hepatitis?
following points do you A. Increase fluid intake to 3000 ml per day
include? B. Adequate bed rest
C. Bland diet
D. Administer antibiotics as ordered 9. A client with advanced cirrhosis has been
diagnosed with hepatic encephalopathy. The
3. Nathaniel has severe pruritus due to having nurse expects to assess for:
hepatitis B. What is the best intervention for his A. Malaise
comfort? B. Stomatitis
A. Give tepid baths. C. Hand tremors
B. Avoid lotions and creams. D. Weight loss
C. Use hot water to increase vasodilation.
D. Use cold water to decrease the itching. 10. A client diagnosed with chronic cirrhosis
who has ascites and pitting peripheral edema
4. You’re discharging Nathaniel with hepatitis B. also has hepatic encephalopathy.
Which statement suggests understanding by the Which of the following nursing interventions are
patient? appropriate to prevent skin breakdown? Select
A. “Now I can never get hepatitis again.” all that apply.
B. “I can safely give blood after 3 months.” A. Range of motion every 4 hours
C. “I’ll never have a problem with my liver again, B. Turn and reposition every 2 hours
even if I drink alcohol.” C. Abdominal and foot massages every 2 hours
D. “My family knows that if I get tired and start D. Alternating air pressure mattress
vomiting, I may be getting sick again.” E. Sit in chair for 30 minutes each shift

5. A client is suspected of having hepatitis. 11. A patient with chronic alcohol abuse is
Which diagnostic test result will assist in admitted with liver failure. You closely monitor
confirming this diagnosis? the patient’s blood pressure
A. Elevated hemoglobin level because of which change that is associated with
B. Elevated serum bilirubin level the liver failure?
C. Elevated blood urea nitrogen level A. Hypoalbuminemia
D. Decreased erythrocyte sedimentation rate B. Increased capillary permeability
C. Abnormal peripheral vasodilation
6. A female client who has just been diagnosed D. Excess rennin release from the kidneys
with hepatitis A asks, “How could I have gotten
this disease?” What is the 12. You’re caring for Betty with liver cirrhosis.
nurse’s best response? Which of the following assessment findings
A. “You may have eaten contaminated leads you to suspect hepatic
restaurant food.” encephalopathy in her?
B. “You could have gotten it by using I.V. drugs.” A. Asterixis
C. “You must have received an infected blood B. Chvostek’s sign
transfusion.” C. Trousseau’s sign
D. “You probably got it by engaging in D. Hepatojugular reflex
unprotected sex.”
13. Nurse Juvy is caring for a client with cirrhosis
7. A male client has just been diagnosed with of the liver. To minimize the effects of the
hepatitis A. On assessment, the nurse expects disorder, the nurse teaches the
to note: client about foods that are high in thiamine. The
A. Severe abdominal pain radiating to the nurse determines that the client has the best
shoulder. understanding of the dietary
B. Anorexia, nausea, and vomiting. measures to follow if the client states an
C. Eructation and constipation. intention to increase the intake of:
D. Abdominal ascites. A. Pork
B. Milk
8. For a client with hepatic cirrhosis who has C. Chicken
altered clotting mechanisms, which intervention D. Broccoli
would be most important?
A. Allowing complete independence of mobility 14. The nurse is caring for a male client with
B. Applying pressure to injection sites cirrhosis. Which assessment findings indicate
C. Administering antibiotics as prescribed that the client has deficient
D. Increasing nutritional intake vitamin K absorption caused by this hepatic
disease?
A. Dyspnea and fatigue
B. Ascites and orthopnea
C. Purpura and petechiae
D. Gynecomastia and testicular atrophy

15. A patient with severe cirrhosis of the liver

develops hepatorenal syndrome. Which of the
following nursing assessment
data would support this?
A. Oliguria and azotemia
B. Metabolic alkalosis
C. Decreased urinary concentration
D. Weight gain of less than 1 lb. per week