1. A client has just returned from surgery. 20 minutes later the client is seen trying to get out of bed, trailing the IV line and the wound drain. The nurse’s best nursing action is to: a. Put a restraint jacket on the client on put a note in the client’s chart for the physician.b. Call the nursing supervisor to have a sitter assigned to the patient immediatelyc. Reorient the client, make sure the call light is within reach and move the client close to the nurse station as possible.d. Put a restraint jacket on the client and place client in a wheelchair next to the nurse station2. Which client has special risk factor that warrant testing for tuberculosisa. 45 – year old Caucasian man who has been homeless for 2 yearsb. 15 – year old Caucasian woman with asthmac. 72 – year old woman who is a recent immigrant from Russiad. 50 – year old lowa farmer3. A 10 – year old child has juvenile rheumatoid arthritis. Which action taken by the child has understood the nurse’s teaching regarding measures that would reduce the risk for activity intolerance.a. Delaying eating breakfast until the morning medications have been takenb. Increasing fluid intakec. Taking a warm bath before going to schoold. Continuing to participate in ADL’s despite fatigue and persistent pain4. When auscultating for the heart sounds that the heart sound (S1) is best heard:a. Using the bell of the stethoscopeb. With the client lying on the right sidec. At the second intercoastal space, right sterna borderd. At the fifth intercoastal space, ;eft sterna border5. For an adolescent boy, the main life stage task is to:a. Developing a sense of trust in others and to his environmentb. Finalizing his goals and plans for the futurec. Strinving to attain independence and identityd. Resolving inner conflicts and turmoil6. A child lying on a stretcher upon admission suddenly complains of nausea and beings to vomit. The nurse should immediately.a. Turn the child’s head to the sideb. Suction the child’s oropharynxc. Raise the head of the stretcherd. Insert an NG tube7. The nurse can quickly access volume depletion in a client’s ulcerative colitis by:a. Measuring the SP gravity of the client’s urine outputb. Taking the client’s BP supine then sitting and noting any changesc. Comparing the client’s current weight with the weight upon admissiond. Administering the oral water test

OB

1. Which of the following BBT change indentifies the characteristic of ovulationa. Falls slightly the increases by 0.5 Celsiusb. Rises slightly, then falls by 0.5 Celsiusc. Is affected by a surge of FSHd. Is due to an estrogen surge2. When calculating the 1 minute Apgar, the nurse adds the ff. assessment findings: HR – over 100, RR - slow and irregular; muscle tone – poor response to slap on soles on feet; weak cry; coly – body pink; extremeties; blue. In view of theses assessment findings, which Apgar score would the nurse record:a. 5b. 6c. 7d. 83. A newborn infant that weighs 7lbs at birth now weighs 6lbs 8oz. Implementing health teaching, the nurse tells the mother the percentage of birth weight usually lost by normal and healthy babies. Which represents the maximum amount of weight loss for this newborn?a. 6oz (170 g)b. 8oz (227 g)c. 11oz (317 g)d. 16oz (454 g)4. The woman who is pregnant who is likely given the “trial of labor” for vaginal birth after caesarian section is the one who had a:a. CS through a classical incision because of severe fetal distressb. Low transverse CS for breech presentation. This pregnancy is vertex presentationc. CS for fetopelvic disproportiond. Low temperature CS for active vaginal/ perineal infection; culture at 39 weeks, this pregnancy was positive for herpes5. A pregnant woman’s last LMP began on April. Calcute the exact estimation of her EDD. 6. A pregnant woman is told to increase her intake of foods rich in iron. Which food would the nurse suggest as the best source of irona. Lean red meatb. Nuts Shellfishc. Shellfishd. Dairy products7. At which complication of pregnancy does a Rh negative woman is at risk?a. Spontaneous abortionb. Preeclampsiac. Maternal anemiad. Erythroblastosis fetalis8. The nurse manager on a maternity unit is informed that a woman who is 36 weeks pregnant with preeclampsia is to be admitted. Which bed is the best choice?

a. Bed on double room 50 ft away from the nurse station who has a rheumatic heart diseaseb. Bed in a double room next to the nurse station with roommate who is a drug addictc. Bed in a four-bed unit with all other women who post partumd. Bed in a four-bed unit with other women who have pyelonephritis, diabetes and PROM9. The nurse analyzes the following data:A woman in labor who has 6cm dilation, + 1 station(vertex position) with modeling of the baby’s head at + 2 station for 3 hours. The baby’s FHR has increased from a baseline of 140 to 170. The physician orders Pitocin augmentation of labor. The nurse’s correct action would be to:a. Add Pitocin to the IV and label it correctlyb. Start Pitocin drip using an IV pumpc. Accurately chart the Pitocin infusiond. Refuse to carry out order for Pitocin augmentation10. Of the ff. findings in a full term newborn, which is not an expected outcome of maternal hormone influence and therefore should be reported.a. “With’s milk”b. Slight Vaginal Bleedingc. Undescended testiclesd. Linea Nigra11. The nurse is to assign an NA in a postpartum unit to care for clients. The aide has a cold that day but no other problems. Which client the nurse would not want to assign the NA?a. Woman in renal failureb. Woman who has hypertensionc. Woman who had a prolonged labord. Woman who has AIDS12. The Hct decreases an average of 7 – 10% during pregnancy. This is referred to as physiological anemia of pregnancy.a. The total erythrocyte count increases by about 30%, the plasma volume increases by about 50%b. The total erythrocyte count increases by about 50%, The plasma volume increases by about 30%c. The total erythrocyte count decreases by 30%, the plasma volume increases by about 50%d. The erythrocyte count remains the same. The plasma count decreases by 50%

13. A term neonate is to be released from hospital at 2 days of age. The nurse performs a physical examination before discharge.13. Nurse Valerie examines the neonate’s hands and palms. Which of the following findings requires further assessment?a. Many crease across the palm.b. Absence of creases on the palm.c. A single crease on the palm.d. Two large creases across the palm.

14. The mother asks when the “soft spots” close? The nurse explains that the neonate’s anterior fontanel will normally close by age…a. 2 to 3 months.b. 6 to 8 months.c. 12 to 18 months.d. 20 to 24 months.15. When performing the physical assessment, the nurse explains to the mother that in a term neonate, sole creases are…a. Absent near the heels.b. Evident under the heels only,c. Spread over the entire foot.d. Evident only towards the transverse arch.16. When assessing the neonate’s eyes, the nurse notes the following: absence of tears, corneas of unequal size, constriction of the pupils in response to bright light, and the presence of red circles on the pupils on ophthalmic examination. Which of these findings needs further assessment?a. The absence of tears.b. Corneas of unequal size.c. Constriction of the pupils.d. The presence of red circles on the pupils.17. After teaching the mother about the neonate’s positive Babinski reflex, the nurse determines that the mother understands the instructions when she says that a positive Babinski reflex indicates….a. Immature muscle coordination.b. Immature central nervous system.c. Possible lower spinal cord defect.d. Possible injury to nerves that innervate the feet.18. Nurse Kris is responsible for assessing a male neonate approximately 24 hours old. The neonate was delivered vaginally. The nurse should plan to assess the neonate’s physical condition….a. Midway between feedings.b. Immediately after a feeding.c. After the neonate has been NPO for three hours.d. Immediately before a feeding.19. The nurse notes a swelling on the neonate’s scalp that crosses the suture line. The nurse documents this condition as…a. Cephallic hematoma.b. Caput succedaneum.c. Hemorrhage edema.d. Perinatal caput.20. The nurse measures the circumference of the neonate’s heads and chest, and then explains to the mother that when the two measurements are compared, the head is normally about…a. The same size as the chest.b. 2 centimeter larger than the chest.c. 2 centimeter smaller than the chest.d. 4 centimeter larger than chest.

21. After explaining the neonate’s cranial molding, the nurse determines that the mother needs further instructions from which statement?a) “The molding is caused by an overriding of the cranial bones.”b) “The degree of molding is related to the amount of pressure on the head.”c) “The molding will disappear in a few days.”d) “The fontanels maybe damaged if the molding does not resolved quickly.”22. When instructing the mother about the neonate’s need for sensory and visual stimulation, the nurse should plan to explain that the most highly develop sense in the neonate is…a. Taskb. Smellc. Touchd. HearingNurse Joan works in a children’s clinic and helps with the care for well and ill children of various ages.23. A mother brings her 4 month old infant to the clinic. The mother asks the nurse when she should wean the infant from breastfeeding and begin using a cup. Nurse Joan should explain that the infant will show readiness to be weaned by…a. Taking solid foods well.b. Sleeping through the night.c. Shortening the nursing time.d. Eating on a regular schedule.24. Mother Arlene says the infant’s physician recommends certain foods but the infant refuses to eat them after breastfeeding. The nurse should suggest that the mother alter the feeding plan by…a. Offering desert followed by vegetable and meat.b. Offering breast milk as long as the infant refuses to eat solid food.c. Mixing minced food with cow’s milk and feeding it to the infant through a large hole nipple.d. Giving the infant a few minutes of breast and then offering solid food.25. Which of the following abilities would a nurse expect a 4 month old infant to perform?a. Sitting up without support.b. Responding to pleasure with smiles.c. Grasping a rattle when it is offered.d. Turning from either side to the back.26. The nurse plans to administer the Denver Developmental Screening Test(DDST) to a five month old infant. The nurse should explain to the mother that the test measures the infants…a. Intelligence quotient.b. Emotional development.c. Social and physical activities.d. Pre-disposition to genetic and allergic illnesses.27. When discussing a seven month old infant’s mother regarding the motor skill development, the nurse should explain that by age seven months, an infant most likely will be able to…a. Walk with support.b. Eat with a spoon.c. Stand while holding unto a furnitured. Sit alone using the hands for support.

28. A mother brings her one month old infant to the clinic for check-up. Which of the following developmental achievements would the nurse assess for?a. Smiling and laughing out loud.b. Rolling from back to side.c. Holding a rattle briefly.d. Turning the head from side to side.29. A two month old infant is brought to the clinic for the first immunization against DPT. The nurse should administer the vaccine via what route?a. Oral.b. Intramascularc. Subcutaneousd. Intradermal30. The nurse teaches the client’s mother about the normal reaction that the infant might experience 12 to 24 hours after the DPT immunization, which of the following reactions would the nurse discuss?a. Lethargy.b. Mild fever.c. Diarrhead. Nasal Congestion31. An infant is observed to be competent in the following developmental skills: stares at an object, place her hands to the mouth and takes it off, coos and gargles when talk to and sustains part of her own weight when held to in a standing position. The nurse correctly assessed infant’s age as…a. Two months.b. Four monthsc. Six monthsd. Eight months.32. The mother says, “the soft spot near the front of her baby’s head is still big, when will it close?” Nurse Lilibeth’s correct response would be at…a. 2 to 4 months.b. 5 to 8 months.c.. 9 to 12 months.d. 13 to 18 months. prop33. A mother states that she thinks her 9-month old is ‘developing slowly’. When evaluating the infant’s development, the nurse would not expect a normal 9-month old to be able to…a. Creep and crawl.b. Begin to use imitative verbal expressions.c. Put an arm through a sleeve while being dressed.d. Hold a bottle with good hand – mouth coordination.34. The mother of the 9-month old says, “it is difficult to add new foods to his diet, he spits everything out”, she says. The nurse should teach the mother to…a. Mix new foods with formulab. Mix new foods with more familiar foods.c. Offer new foods one at a time.d. Offer new foods after formula has been offered.35. Which of the following tasks is typical for an 18-month old baby?a. Copying a circleb. Pulling toysc. Playing toy with other childrend. Building a tower of eight blocks

36. Mother Riza brings her normally developed 3-year old to the clinic for a check-up. The nurse would expect that the child would be at least skilled in…a. Riding a bicycleb. Tying shoelacesc. Stringing large beadsd. Using blunt scissors37. The mother tells the nurse that she is having problem toilet-training her 2-year old child. The nurse would tell the mother that the number one reason that toilet training in toddlers fails because the…a. Rewards are too limitedb. Training equipment is inappropriatec. Parents ignore “accidents” that occur during trainingd. The child is not develop mentally ready to be trained38.. A child is not developmentally ready to be trained. A 2-1/2 year old child is brought to the clinic by his father who explains that the child is afraid of the dark and says “no” when asked to do something. The nurse would explain that the negativism demonstrated by toddler is frequently an expression of…a. Quest for autonomyb. Hyperactivityc. Separation anxietyd. Sibling rivalry39. The nurse would explain to the father which concept of Piaget’s cognitive development as the basis for the child’s fear of darkness?a. Reversibilityb. Animismc. Conservation of matterd. Object permanence40. Mother asks the nurse for advice about discipline. The nurse would suggest that the mother would first use…a. Structured interactionb. Spankingc. Reasoningd. Scolding41. When a nurse assesses for pain in toddlers, which of the following techniques would be least effective?a. Ask them about the painb. Observe them for restlessnessc. Watch their face for grimnessd. Listen for pain cues in their cries.42. The mother reports that her child creates a quite scene every night at bedtime and asks what she can do to make bedtime a little more pleasant. The nurse should suggest that the mother to…a. Allow the child to stay up later one or two nights a week.b. Establish a set bedtime and follow a routinec. Let the child play toy just before bedtimed. Give the child a cookie if bedtime is pleasant.

43. The mother asks about dental care for her child. She says that she helps brush the child’s teeth daily. Which of the following responses by the nurse would be most appropriate?a. “Since you help brush her teeth, there’s no need to see a dentist now”b. “You should have begun dental appointments last year but it is not too late”c. “Your child does not need to see the dentist until she starts school”d. “A dental check-up is a good idea, even if no noticeable problems are present”44.. The mother says that she will be glad to let her child brush her teeth without help, but at what age should this begin? Nurse Roselyn should respond at…a. 3 yearsb. 5 yearsc. 6 yearsd. 7 years45. The mother tells the nurse that her other child, a 4-year old boy, has developed some “strange eating habits”, including not finishing her meals and eating the same foods for several days in a row. She would like to develop a plan to connect this situation. In developing such a plan, the nurse and mother should consider…a. Deciding on a good reward for finishing a mealb. Allowing him to make some decisions about the foods he eatsc. Requiring him to eat the foods served at meal times.d. Not allowing him to play with friends until he eats all the food she served.46. Nurse Bryan knows that one of the most effective strategies to teach a Four year old about safety is to…a. Show him potential dangers to avoidb. Tell him he is bad when they do something dangerousc. Provide good examples of safety behaviord. Show him pictures of children who have involve with accidents47.. A 9 year old girl is brought to the pediatrician’s office for an annual physical checkup. She has no history of significant health problems. When the nurse asks the girl about her best friend, the nurse is assessing…a. Language developmentb. Motor developmentc. Neurological developmentd. Social development48. The child probably tells the nurse that brushing and flossing her teeth is her responsibility. When responding to this information, the nurse should realize that the child…a. Is too young to be given this responsibilityb. Is most likely quite capable of this responsibilityc. Should have assumed this responsibility much soonerd. Is probably just exaggerating the responsibility49. The mother tells the nurse that the child is continually telling jokes and riddles to the point of driving the other family members crazy. The nurse should explain that this behavior is a sign of…a. Inadequately parental attentionb. Mastery of language ambiguitiesc. Inappropriate peer influenced. Excessive television watching

50. The mother relates that the child is beginning to identify behaviors that pleases others as “good behavior”. The child’s behavior is characteristics of which Kohlberg’s level of moral development?a. Pre-conventional moralityb. Conventional moralityc. Post conventional moralityd. Autonomous morality51. The mother asks the nurse about the child’s apparent need for between-meals snacks, especially after school. The nurse and mother develop a nutritional plan for the child, keeping in mind that the child..a. Does not need to eat between mealsb. Should eat snacks his mother preparesc. Should help prepare own snacksd. Will instinctively select nutritional snacks52. The mother is concerned about the child’s compulsion for collecting things. The nurse explains that this behavior is related to the cognitive ability to perform.a. Concrete operationsb. Formal operationsc. Coordination ofd. Tertiary circular reactions53. The nurse explained to the mother that according to Erickson’s framework of psychosocial development, play as a vehicle of development can help the school age child develop a sense of…a. Initiativeb. Industryc. Identityd. Intimacy54. The school nurse is planning a series of safety and accident prevention classes for a group of third grades. What preventive measures should the nurse stress during the first class, knowing the leading cause of incidental injury and death in this age?a. Flame-retardant clothingb. Life preservesc. Protective eyeweard. Auto seat belts55.. The mother of a 10-year old boy expresses concern that he is overweight. When developing a plan of care with the mother, Nurse Katrina should encourage her to…a. Limit child’s between-,meal snacksb. Prohibit the child from playing outside if he eat snacksc. Include the child in meal planning and preparationd. Limit the child’s calories intake to 1,200kCal/day56.. When assessing an 18-month old, the nurse notes a characteristics protruding abdomen. Which of the following would explain the rationale for this findings?a. Increased food intake owing to ageb. Underdeveloped abdominal musclesc. Bowlegged postured. Linear growth curve57. If parents keep a toddler dependent in areas where he is capable of using skills, the toddler will develop a sense of which of the following?a. Mistrustb. Shame

c. Guiltd. Inferiority58. Which of the following fears would the nurse typically associate with toddlerhood?a. Mutilationb. The darkc. Ghostsd. Going to sleep59. A mother of a 2 year old has just left the hospital to check on her other children. Which of the following would best help the 2 year old who is now crying inconsolably?a. Taking a napb. Peer play groupc. Large cuddly dogd. Favorite blanket60. Which of the following is an appropriate toy for an 18 month old?a. Multiple-piece puzzleb. Miniature Carsc. Finger paintsd. Comic Book61. When teaching parents about typical toddler eating patterns, which of the following should be included?a. Food “jags”b. Preference to eat alonec. Consistent table mannersd. Increase in appetite62. Which of the following toys should the nurse recommend for a 5-month old?a. A big red balloonb. A teddy bear with button eyesc. A push-pull wooden truckd. A colorful busy box63 When teaching parents about typical toddler eating patterns, which of the following should be included?a. Food “jags”b. Preference to eat alonec. Consistent table mannersd. Increase in appetite64. Which of the following toys should the nurse recommend for a 5-month old?a. A big red balloonb. A teddy bear with button eyesc. A push-pull wooden truckd. A colorful busy box

Medical and Surgical

1. After the lungs, the kidneys work to maintain body pH. The best explanation of how the kidneys accomplish regulation of pH is that they a. Secrete hydrogen ions and sodium. b. Secrete ammonia. c. Exchange hydrogen and sodium in the kidney tubules. d. Decrease sodium ions, hold on to hydrogen ions, and then secrete sodium bicarbonate.2. The nurse explains to a client who has just received the diagnosis of Noninsulin-Dependent Diabetes Mellitus (NIDDM) that sulfonylureas, one group of oral hypoglycemic agents, act by: a. Stimulating the pancreas to produce or release insulin b. Making the insulin that is produced more available for use c. Lowering the blood sugar by facilitating the uptake and utilization of glucose d. Altering both fat and protein metabolism3. Myasthenic crisis and cholinergic crisis are the major complications of myasthenia gravis. Which of the following is essential nursing knowledge when caring for a client in crisis?a. Weakness and paralysis of the muscles for swallowing and breathing occur in either crisisb. Cholinergic drugs should be administered to prevent further complications associated with the crisisc. The clinical condition of the client usually improves after several days of treatmentd. Loss of body function creates high levels of anxiety and fear4. A 54-year-old client was put in Quinidine (a drug that decreases myocardial excitability) to prevent atrial fibrillation. He also has kidney disease. The nurse is aware that this drug, when given to a client with kidney disease, may:a. Cause cardiac arrestb. Cause hypotensionc. Produce mild bradycardiad. Be very toxic even in small doses5. A client is about to be discharged on the drug bishydroxycoumarin (Dicumarol). Of the principles below, which one is the most important to teach the client before discharge?a. He should be sure to take the medication before mealsb. He should shave with an electric razorc. If he misses a dose, he should double the dose at the next scheduled timed. It is the responsibility of the physician to do the teaching for this medication6. A cyanotic client with an unknown diagnosis is admitted to the emergency room. In relation to oxygen, the first nursing action would be to:

a. Wait until the client's lab work is doneb. Not administer oxygen unless ordered by the physicianc. Administer oxygen at 2 liters flow per minuted. Administer oxygen at 10 liters flow per minute and check the client's nail beds7. A client with a diagnosis of gout will be taking colchicine and allopurinol bid to prevent recurrence. The most common early sign of colchicine toxicity that the nurse will assess for is:a. Blurred visionb. Anorexiac. Diarrhead. Fever

8. A client has chronic dermatitis involving the neck, face and antecubital creases. She has a strong family history of varied allergy disorders. This type of dermatitis is probably best described as:a. Contact dermatitisb. Atopic dermatitisc. Eczemad. Dermatitis medicamentosa9. The nurse would expect to find an improvement in which of the blood values as a result of dialysis treatment?a. High serum creatinine levelsb. Low hemoglobinc. Hypocalcemiad. Hypokalemia10. A 24-year-old client is admitted to the hospital following an automobile accident. She was brought in unconscious with the following vital signs: BP 130/76, P 100, R 16, T 98F. The nurse observes bleeding from the client's nose. Which of the following interventions will assist in determining the presence of cerebrospinal fluid?a. Obtain a culture of the specimen using sterile swabs and send to the laboratoryb. Allow the drainage to drip on a sterile gauze and observe for a halo or ring around the bloodc. Suction the nose gently with a bulb syringe and send specimen to the laboratoryd. Insert sterile packing into the nares and remove in 24 hours11. A 24-year-old male is admitted with a possible head injury. His arterial blood gases show that his pH is less than 7.3, his PaCO2 is elevated above 60 mmHg, and his PaO2 is less than 45 mmHg. Evaluating this ABG panel, the nurse would conclude that:a. That it is reversibleb. Amnesia will occurc. Loss of consciousness may be transientd. Laceration of the brain may occur12. A client with tuberculosis is given the drug pyrazinamide (Pyrazinamide). Which one of the following diagnostic tests would be inaccurate if the client is receiving the drug?a. Liver function testb. Gall bladder studiesc. Thyroid function studiesd. Blood glucose13. Which one of the following conditions could lead to an inaccurate pulse oximetry reading if the sensor is attached to the client's ear?

a. Artificial nailsb. Vasodilationc. Hypothermiad. Movement of the head14. While on a camping trip, a friend sustains a snake bite from a poisonous snake. The most effective initial intervention would be to:a. Place a restrictive band above the snake biteb. Elevate the bite area above the level of the heartc. Position the client in a supine positiond. Immobilize the limb

15. There is a physician's order to irrigate a client's bladder. Which one of the following nursing measures will ensure patency?a. Use a solution of sterile water for the irrigationb. Apply a small amount of pressure to push the mucus out of the catheter tip if the tube is not patentc. Carefully insert about 100 mL of aqueous Zephiran into the bladder, allow it to remain for 10 hour, and then siphon it outd. Irrigate with 20mL's of normal saline to establish patency16. A female client has orders for an oral cholecystogram. Prior to the test, the nursing intervention would be to:a. Provide a high fat diet for dinner, then NPOb. Explain that diarrhea may result from the dye tabletsc. Administer the dye tablets following a regular diet for dinnerd. Administer enemas until clear17. The physician has just completed a liver biopsy. Immediately following the procedure, the nurse will position the client:a. On his right side to promote hemostasisb. In Fowler's position to facilitate ventilationc. Supine to maintain blood pressured. In Sims' position to prevent aspiration18. When a client has peptic ulcer disease, the nurse would expect a priority intervention to be:a. Assisting in inserting a Miller-Abbott tubeb. Assisting in inserting an arterial pressure linec. Inserting a nasogastric tubed. Inserting an IV19. In preparation for discharge of a client with arterial insufficiency and Raynaud's disease, client teaching instructions should include:a. Walking several times each day as a part of an exercise routineb. Keeping the heat up so that the environment is warmc. Wearing TED hose during the dayd. Using hydrotherapy for increasing oxygenation20. When a client asks the nurse why the physician says he "thinks" he has tuberculosis, the nurse explains to him that diagnosis of tuberculosis can take several weeks to confirm. Which of the following statements supports this answer?a. A positive reaction to a tuberculosis skin test indicates that the client has active tuberculosis, even if one negative sputum is obtained

b. A positive sputum culture takes at least 3 weeks, due to the slow reproduction of the bacillusc. Because small lesions are hard to detect on chest x-rays, x-rays usually need to be repeated during several consecutive weeksd. A client with a positive smear will have to have a positive culture to confirm the diagnosis21. The nurse is counseling a client with the diagnosis of glaucoma. She explains that if left untreated, this condition leads toa. Blindnessb. Myopiac. Retrolental fibroplasiad. Uveitis

22. A nursing assessment for initial signs of hypoglycemia will includea. Pallor, blurred vision, weakness, behavioral changesb. Frequent urination, flushed face, pleural friction rubc. Abdominal pain, diminished deep tendon reflexes, double visiond. Weakness, lassitude, irregular pulse, dilated pupils23. The physician has ordered a 24-hour urine specimen. After explaining the procedure to the client, the nurse collects the first specimen. This specimen is thena. Discarded, then the collection beginsb. Saved as part of the 24-hour collectionc. Tested, then discardedd. Placed in a separate container and later added to the collection24. Following an accident, a client is admitted with a head injury and concurrent cervical spine injury. The physician will use Crutchfield tongs. The purpose of these tongs is to:a. Hypoextend the vertebral columnb. Hyperextend the vertebral columnc. Decompress the spinal nervesd. Allow the client to sit up and move without twisting his spine25. The most appropriate nursing intervention for a client requiring a finger probe pulse oximeter is to:a. Apply the sensor probe over a finger and cover lightly with gauze to prevent skin breakdownb. Set alarms on the oximeter to at least 100 percentc. Identify if the client has had a recent diagnostic test using intravenous dyed. Remove the sensor between oxygen saturation readings26. A client being treated for esophageal varices has a Sengstaken-Blakemore tube inserted to control the bleeding. The most important assessment is for the nurse to:a. Check that a hemostat is at the bedsideb. Monitor IV fluids for the shiftc. Regularly assess respiratory statusd. Check that the balloon is deflated on a regular basis27. A 55-year-old client with sever epigastric pain due to acute pancreatitis has been admitted to the hospital. The client's activity at this time should be:a. Ambulation as desiredb. Bedrest in supine positionc. Up ad lib and right side-lying position in bedd. Bedrest in Fowler's position

28. Of the following blood gas values, the one the nurse would expect to see in the client with acute renal failure isa. pH 7.49, HCO3 24, PCO2 46b. pH 7.49, HCO3 14, PCO2 30c. pH 7.26, HCO3 24, PCO2 46d. pH 7.26, HCO3 14, PCO2 3029. A client in acute renal failure receives an IV infusion of 10% dextrose in water with 20 units of regular insulin. The nurse understands that the rationale for this therapy is to:a. Correct the hyperglycemia that occurs with acute renal failureb. Facilitate the intracellular movement of potassiumc. Provide calories to prevent tissue catabolism and azotemiad. Force potassium into the cells to prevent arrhythmias

30. A client has had a cystectomy and ureteroileostomy (ileal conduit). The nurse observes this client for complications in the postoperative period. Which of the following symptoms indicates an unexpected outcome and requires priority care?a. Edema of the stomab. Mucus in the drainage appliancec. Redness of the stomad. Feces in the drainage appliance31. A nursing care plan for a client with a suprapubic cystostomy would include:a. Placing a urinal bag around the tube insertion to collect the urineb. Clamping the tube and allowing the client to void through the urinary meatus before removing the tubec. Catheter irrigations every 4 hours to prevent formation ofurinary stones d. Limiting fluid intake to 1500 mL per day32. For a client who has ataxia, which of the following tests would be performed to assess the ability to ambulate?a. Kernig'sb. Romberg'sc. Riley-Day'sd. Hoffmann's33. A client admitted to a surgical unit for possible bleeding in the cerebrumhas vital signs taken every hour to monitor to neurological status. Which of the following neurological checks will give the nurse the best information about the extent of bleeding?a. Pupillary checksb. Spinal tapc. Deep tendon reflexesd. Evaluation of extrapyramidal motor system34. Assessing for immediate postoperative complications, the nurse knows that a complication likely to occur following unresolved atelectasis isa. Hemorrhageb. Infectionc. Pneumoniad. Pulmonary embolism

35. A young client is in the hospital with his left leg in Buck's traction. Theteam leader asks the nurse to place a footplate on the affected side at the bottom of the bed. The purpose of this action is toa. Anchor the tractionb. Prevent footdropc. Keep the client from sliding down in bedd. Prevent pressure areas on the foot36. A nurse is reviewing a patient’s medication during shift change. Which of the following medication would be contraindicated if the patient were pregnant? Note: More than one answer may be correct.A: CoumadinB: FinasterideC: CelebrexD: Catapress

37. A nurse is reviewing a patient’s PMH. The history indicates photosensitive reactions to medications.Which of the following drugs has not been associated with photosensitive reactions? Note: More than one answer may be correct.A: CiproB: SulfonamideC: NoroxinD Nitrodur 38. A patient tells you that her urine is starting to look discolored. If you believe this change is due tomedication, which of the following patient’s medication does not cause urine discoloration?A: SulfasalazineB: LevodopaC: PhenolphthaleinD: Aspirin39. You are responsible for reviewing the nursing unit’s refrigerator. If you found the following drug in the refrigerator it should be removed from the refrigerator’s contents?A: CorgardB: Humulin (injection)C: UrokinaseD: Epogen (injection)40. A 34 year old female has recently been diagnosed with an autoimmune disease. She has also recently discovered that she is pregnant. Which of the following is the only immunoglobulin that will provide protection to the fetus in the womb?A: IgAB: IgDC: IgED: IgG41. A second year nursing student has just suffered a needlestick while working with a patient that ispositive for AIDS. Which of the following is the most important action that nursing student should take?A: Immediately see a social workerB: Start prophylactic AZT treatmentC: Start prophylactic Pentamide treatmentD: Seek counseling

42. A thirty five year old male has been an insulin-dependent diabetic for five years and now is unable tourinate. Which of the following would you most likely suspect?A: AtherosclerosisB: Diabetic nephropathyC: Autonomic neuropathyD: Somatic neuropathy42. You are taking the history of a 14 year old girl who has a (BMI) of 18. The girl reports inability to eat,induced vomiting and severe constipation. Which of the following would you most likely suspect?A: Multiple sclerosisB: Anorexia nervosaC: BulimiaD: Systemic sclerosis

43. A 24 year old female is admitted to the ER for confusion. This patient has a history of a myelomadiagnosis, constipation, intense abdominal pain, and polyuria. Which of the following would you mostlikely suspect?A: DiverticulosisB: HypercalcaemiaC: HypocalcaemiaD: Irritable bowel syndrome44. Rho gam is most often used to treat____ mothers that have a ____ infant.A: RH positive, RH positiveB: RH positive, RH negativeC: RH negative, RH positiveD: RH negative, RH negative45. A new mother has some questions about (PKU). Which of the following statements made by a nurseis not correct regarding PKU?A: A Guthrie test can check the necessary lab values.B: The urine has a high concentration of phenylpyruvic acidC: Mental deficits are often present with PKU.D: The effects of PKU are reversible.46. A patient has taken an overdose of aspirin. Which of the following should a nurse most closelymonitor for during acute management of this patient?A: Onset of pulmonary edemaB: Metabolic alkalosisC: Respiratory alkalosisD: Parkinson’s disease type symptoms47. A fifty-year-old blind and deaf patient has been admitted to your floor. As the charge nurse yourprimary responsibility for this patient is?A: Let others know about the patient’s deficits.B: Communicate with your supervisor your patient safety concerns.C: Continuously update the patient on the social environment.

D: Provide a secure environment for the patient.48. A patient is getting discharged from a SNF facility. The patient has a history of severe COPD andPVD. The patient is primarily concerned about their ability to breath easily. Which of the followingwould be the best instruction for this patient?A: Deep breathing techniques to increase O2 levels.B: Cough regularly and deeply to clear airway passages.C: Cough following bronchodilator utilizationD: Decrease CO2 levels by increase oxygen take output during meals.

49. A nurse is caring for an infant that has recently been diagnosed with a congenital heart defect. Whichof the following clinical signs would most likely be present?A: Slow pulse rateB: Weight gainC: Decreased systolic pressureD: Irregular WBC lab values50. A mother has recently been informed that her child has Down’s syndrome. You will be assigned tocare for the child at shift change. Which of the following characteristics is not associated with Down’ssyndrome?A: Simian creaseB: BrachycephalyC: Oily skinD: Hypotonicity51. A patient has recently experienced a (MI) within the last 4 hours. Which of the following medicationswould most like be administered?A: StreptokinaseB: AtropineC: AcetaminophenD: Coumadin52. A patient asks a nurse, “My doctor recommended I increase my intake of folic acid. What type offoods contain the highest concentration of folic acids?”A: Green vegetables and liverB: Yellow vegetables and red meatC: CarrotsD: Milk53. A nurse is putting together a presentation on meningitis. Which of the following microorganisms hasnoted been linked to meningitis in humans?A: S. pneumoniaB: H. influenzaC: N. meningitis

D: Cl. Difficile54. A nurse is administering blood to a patient who has a low hemoglobin count. The patient asks howlong to RBC’s last in my body? The correct response is.A: The life span of RBC is 45 days.B: The life span of RBC is 60 days.C: The life span of RBC is 90 days.D: The life span of RBC is 120 days.

55. A 65 year old man has been admitted to the hospital for spinal stenosis surgery. When does thedischarge training and planning begin for this patient?A: Following surgeryB: Upon admitC: Within 48 hours of dischargeD: Preoperative discussion56. When you are taking a patient’s history, she tells you she has been depressed and is dealing with ananxiety disorder. Which of the following medications would the patient most likely be taking?A: ElavilB: CalcitoninC: PergolideD: Verapamil57. Which of the following conditions would a nurse not administer erythromycin?A: Campylobacterial infectionB: Legionnaire’s diseaseC: PneumoniaD: Multiple Sclerosis58. A patient’s chart indicates a history of hyperkalemia. Which of the following would you not expect tosee with this patient if this condition were acute?A: Decreased HRB: ParesthesiasC: Muscle weakness of the extremitiesD: Migranes59. A patient’s chart indicates a history of ketoacidosis. Which of the following would you not expect tosee with this patient if this condition were acute?A: VomitingB: Extreme ThirstC: Weight gainD: Acetone breath smell60. A patient’s chart indicates a history of meningitis. Which of the following would you not expect tosee with this patient if this condition were acute?A: Increased appetiteB: VomitingC: FeverD: Poor tolerance of light61. A nurse if reviewing a patient’s chart and notices that the patient suffers from conjunctivitis. Which of the following microorganisms is related to this condition?A: Yersinia pestisB: Helicobacter pyroliC: Vibrio choleraD: Hemophilus aegyptius62. A nurse if reviewing a patient’s chart and notices that the patient suffers from Lyme disease. Which of the following microorganisms is related to this condition?A: Borrelia burgdorferiB: Streptococcus pyrogensC: Bacilus anthracisD: Enterococcus faecalis

63. A fragile 87 year-old female has recently been admitted to the hospital with increased confusion andfalls over last 2 weeks. She is also noted to have a mild left hemiparesis. Which of the following tests ismost likely to be performed?A: FBC (full blood count)B: ECG (electrocardiogram)C: Thyroid function testsD: CT scan64. A 84 year-old male has been loosing mobility and gaining weight over the last 2 months. The patientalso has the heater running in his house 24 hours a day, even on warm days. Which of the following testsis most likely to be performed?A: FBC (full blood count)B: ECG (electrocardiogram)C: Thyroid function testsD: CT scan65. A 20 year-old female attending college is found unconscious in her dorm room. She has a fever and anoticeable rash. She has just been admitted to the hospital. Which of the following tests is most likely tobe performed first?A: Blood sugar checkB: CT scanC: Blood culturesD: Arterial blood gases66. A 28 year old male has been found wandering around in a confused pattern. The male is sweaty andpale. Which of the following tests is most likely to be performed first?A: Blood sugar checkB: CT scanC: Blood culturesD: Arterial blood gases67. A parent calls the pediatric clinic and is frantic about the bottle of cleaning fluid her child drank 20minutes. Which of the following is the most important instruction the nurse can give the parent?A: This too shall pass.B: Take the child immediately to the ERC: Contact the Poison Control Center quicklyD: Give the child syrup of ipecac68. A nurse is administering a shot of Vitamin K to a 30 day-old infant. Which of the following targetareas is the most appropriate?A: Gluteus maximusB: Gluteus minimusC: Vastus lateralisD: Vastus medialis69. A nurse has just started her rounds delivering medication. A new patient on her rounds is a 4 year-old boy who is non-verbal. This child does not have on any identification. What should the nurse do?A: Contact the providerB: Ask the child to write their name on paper.C: Ask a co-worker about the identification of the child.D: Ask the father who is in the room the child’s name.

70. A 68-year-old woman is diagnosed with thrombocytopenia due to acute lymphocytic leukemia. She is admitted to the hospital for treatment. The nurse should assign the patientA. to a private room so she will not infect other patients and health care workers. B. to a private room so she will not be infected by other patients and health care workers. C. to a semiprivate room so she will have stimulation during her hospitalization. D. to a semiprivate room so she will have the opportunity to express her feelings about her illness.71. The nurse teaches a group of mothers of toddlers how to prevent accidental poisoning. Which of the following suggestions should the nurse give regarding medications?A. Lock all medications in a cabinet. B. Child proof all the caps to medication bottles. C. Store medications on the highest shelf in a cupboard. D. Place medications in different containers.72. While inserting a nasogastric tube, the nurse should use which of the following protective measures?A. Gloves, gown, goggles, and surgical cap. B. Sterile gloves, mask, plastic bags, and gown. C. Gloves, gown, mask, and goggles. D. Double gloves, goggles, mask, and surgical cap.73. A 6-year-old boy is returned to his room following a tonsillectomy. He remains sleepy from the anesthesia but is easily awakened. The nurse should place the child in which of the following positions?A. Sims’. B. Side-lying. C. Supine. D. Prone.74. A nursing team consists of an RN, an LPN/LVN, and a nursing assistant. The nurse should assign which of the following patients to the LPN/LVN?A. A 72-year-old patient with diabetes who requires a dressing change for a stasis ulcer. B. A 42-year-old patient with cancer of the bone complaining of pain. C. A 55-year-old patient with terminal cancer being transferred to hospice home care.D. A 23-year-old patient with a fracture of the right leg who asks to use the urinal.

Psychiatric1. A child is 5 years old and has been recently admitted into the hospital. According to Erickson whichof the following stages is the child in?A: Trust vs. mistrustB: Initiative vs. guiltC: Autonomy vs. shameD: Intimacy vs. isolation2. A toddler is 16 months old and has been recently admitted into the hospital. According to Ericksonwhich of the following stages is the toddler in?A: Trust vs. mistrustB: Initiative vs. guiltC: Autonomy vs. shameD: Intimacy vs. isolation3. A young adult is 20 years old and has been recently admitted into the hospital. According to Ericksonwhich of the following stages is the adult in?A: Trust vs. mistrustB: Initiative vs. guiltC: Autonomy vs. shameD: Intimacy vs. isolation4. . A mother is inquiring about her child’s ability to potty train. Which of the following factors is themost important aspect of toilet training?A: The age of the childB: The child ability to understand instruction.C: The overall mental and physical abilities of the child.D: Frequent attempts with positive reinforcement.

Fundamentals1. A nurse is making rounds taking vital signs. Which of the following vital signs is abnormal?A: 11 year old male – 90 b.p.m, 22 resp/min. , 100/70 mm HgB: 13 year old female – 105 b.p.m., 22 resp/min., 105/60 mm HgC: 5 year old male- 102 b.p.m, 24 resp/min., 90/65 mm HgD: 6 year old female- 100 b.p.m., 26 resp/min., 90/70mm Hg