A1 PASSERS TRAINING, RESEARCH, REVIEW & DEVELOPMENT COMPANY NURSING PRACTICE III

SITUATION: In the recall of the fluids and electrolytes, the nurse should be able to understand the calculations and other conditions related to loss or retention.

1. When you report on duty, your team leader tells you that Mr. MartineHi accidentally received 1000 ml of fluids in 2 hours and that you are to be alert for signs of circulatory overload. Which of the following signs would not be likely to occur? a. moist gurgling respirations b. Weak, slow pulse

c. Distended neck veinsd. Dyspnea and coughing

2. The dietary practice that will help a client reduce the dietary intake of sodium isa. Increasing the use of dairy products b. Using an artificial sweetener in coffee c. Avoiding the use of carbonated beverages

d. Using catsup for cooking and flavoring foods

3. . When evaluating a client's response to fluid replacement therapy, the observation that indicates adequate tissue perfusion to vital organ is;a. Urinary output of 30 ml in an hourb. Central venous pressure reading of 2 cm H20c. Pulse rates of 120 and 110 in a 15- minute periodd. Blood pressure readings of 50/30 and 70/40 mm Hg within 30 minutes

4. When monitoring for hypernatremia, the nurse should assess the client for:a. Dry skinb. Confusion

c. Tachycardia d. Pale coloring

5. Serum albumin Is to be administered intravenously to client with ascites, The expected outcome of this treatment will be a decrease in:a. Urinary outputb. Abdominal girth

c. Serum ammonia leveld. Hepatic encephalopathy

6. A client with a history of cardiac dysrhythmias is admitted to the hospital with the diagnosis of dehydration. The nurse should anticipate that the physician will order; a. A glass of water every hour until hydrated b. Small frequent intake of juices, broth, or milkc. Short-term NG replacement of fluids and nutrients d. A rapid IV infusion of an electrolyte and glucose solution

7. The nurse, in assessing the adequacy of a client's fluid replacement during the first 2 to 3 days following full-thickness burns to the trunk and right thigh, would be aware that the most significant data would be obtained from recordinga. Weights every day .b. Urinary output every hour

c. Blood pressure every 15 minutesd. Extent of peripheral edema every 4 hours

8. A client with ascites has a paracentesis, and 1500 ml of fluid is removed. Immediately following the procedure it is most important for the nurse to observe for:a. A rapid, thready pulse b. Decreased peristalsis .

c. Respiratory congestiond. An increased in temperature

9. The nurse is aware that the shift of body fluids associated with the intravenous administration of albumin occurs by the process of:a. Filtrationb. Diffusion

c. Osmosisd. Active Transport

10. A client's IV fluid orders for 24 hour's are 1500 ml D5W followed by 1250 ml of NS. The IV tubing has a drop factor of 15 gtt/ml. To administer the required fluids the nurse should set the drip rate at; a. 13 gtt/minb. 16 gtt/min

c. 29 gtt/mind. 32 gtt/min

SITUATION 3: Perioperative Nursing is a special field of nursing that includes a wide variety of nursing functions associated with the patient’s surgical experience during the perioperative period. Perioperative nursing addresses the nursing roles relevant to the three phases of the surgical experience: preoperative, intraoperative, and postoperative.11. The best time to provide preoperative teaching on deep breathing, coughing and turning exercises is:

a. Before administration of preoperative medicationsb. The afternoon or evening prior to surgeryc. Several days prior to surgeryd. Upon admission of the client in the recovery room

12. The following are the appropriate nursing actions before administration of preoperative medications EXCEPT:a. Ascertain the consent has been

signedb. Ensure that NPO has been maintained

c. Instruct patient to empty his bladderd. Shave the skin at the site of surgery

13. The patient has been observed pacing along the hallway goes to the bathroom frequently and asks questions repeatedly during preoperative assessment. The most likely cause of the behavior is:

a. She is anxious about the surgical procedureb. She is worried about separation from the familyc. She has urinary tract infectiond. She has an underlying emotional problem

14. Which of the following nursing actions would help the patient decrease anxiety during the preoperative period?a. Explaining all procedures thoroughly in chronological orderb. Spending time listening to the patient and answering questionsc. Encouraging sleep and limiting interruptionsd. Reassuring the patient that the surgical staff are competent professional

15. Which of the following is the primary purpose of maintaining NPO for 6 to 8 hours before surgery?a. To prevent malnutritionb. B.To prevent electrolyte imbalance

c. To prevent aspiration pneumoniad. To prevent intestinal obstruction

16. Pre-op instructions to the client would include the following EXCEPT:a. Deep breathing and coughing exerciseb. Turning to sidesc. C.Foot and leg exercisesd. reassuring her that narcotics will be given every 4 hours round the clock until she is discharged

17. The client gave her consent for the surgery. To ensure the legality of the consent, the following conditions must be met EXCEPT:

a. She gave her consent freelyb. She must understand the nature of the surgeryc. The consent must be signed by a witness d. Signing should be done after the administration of pre-anesthesia meds

18. .How frequent should the nurse monitor  the VS of the patient in the recovery room?a. Every 15 minutesb. Every 30 mins

c. Every 45 minsd. Every 60 mins

19. Which of the following drugs is given to relieve nausea and vomiting?a. Mepivacaine b. Aquamephyton

c. Nubaind. Plasil

20. The most important factor in the prevention of post-op infection is:a. Proper administration of antibiotics b. Fluid intake of 2-3L/day

c. Practice of strict aseptic techniquesd. Frequent change of wound dressings

SITUATION 4: Subtotal gastrectomy is a procedure that is use to manage clients who are suffering from peptic ulcer disease. This procedure may be done with Bilroth I or Bilroth II anastomosis.

21. A client is scheduled for a subtotal gastrectomy. In anticipation of clarifying information for client education, the nurse knows that vagotomy is done as part of the surgical treatment for peptic ulcers in order to

a. Decrease secretion of hydrochloric acidb. Improve the tone of the GI musclesc. Increase blood supply to the jejunumd. Prevent the transmission of pain impulses

22. Which of the following facts best explains why the duodenum is not removed during a subtotal gastrectomy?a. The head of the pancreas is adherent to the duodenal wallb. The common bile duct empties into the duodenal lumenc. The wall of the jejunum contains no intestinal villid. The jejunum receives its blood supply through the duodenum

23. During the immediate postoperative period following gastric surgery, why must the nurse be particularly conscientious about encouraging a client to cough and deep-breathe at regular intervals?

a. Marked changes in intrathoracic pressure will stimulate gastric drainageb. The high abdominal incision will lead to shallow breathing to avoid painc. The phrenic nerve will have been permanently damaged during the surgical procedured. Deep-breathing will prevent post op vomiting and intestinal distention

24. Prior to having a subtotal gastrectomy, a client is told about the dumping syndrome. The nurse explains that it is:a. The body’s absorption of toxins produced by liquefaction of dead tissueb. Formation of an ulcer at the margin of the gastrojejunal anastomosis c. Obstruction of venous flow from the stomach into the portal systemd. Rapid emptying of food and fluid from the stomach into the jejunum

25. Which of the following statements by a client recovering from a subtotal gastrectomy would indicate a need for additional teaching about the diet protocol for dumping syndrome?

a. “I plan to eat a diet low in carbohydrates and high in protein and fat”b. “I plan to eat a diet high in CHO and low in CHON and fat”c. “I will eat slowly and avoid drinking fluids during meals”d. “I will try to assume a recumbent position after meals for 30 mins to 1 hour to enhance digestion and relieve

symptoms

SITUATION: Surgery, whether elective or emergent, is a stressful, complex event. Today, as a result of advances in surgical techniques and instrumentation as well as in anesthesia, many surgical procedures that were once performed in an inpatient setting now take place in an ambulatory or outpatient setting. Competent care of ambulatory or same-day surgical patients requires a sound knowledge of all aspects of perioperative and perianesthesia nursing practice.

26. The client who is scheduled to have surgery cannot read or write. The surgeon obtaining the consent wants to have the client's spouse sign the consent instead. What is the nurse's best action? A. Nothing; a signed informed consent statement does not need to be obtained from this client. B. Locate the spouse, because the informed consent statement must be signed by the client's closest relative. C. Inform the surgeon that the client may sign the informed consent statement with an X in front of two witnesses. D. Notify the administration because the court must appoint a legal guardian to represent the client's best interests and give consent for all surgical procedures.

27. Twenty minutes after the client has received a preoperative injection of atropine and midazolam (Versed), the client tells the nurse that he must be allergic to the medication because his mouth is dry and his heart seems to be beating faster than normal. What is the nurse's best first action? A. Document the findings as the only action. B. Check the client's pulse and blood pressure. C. Prepare to administer epinephrine and diphenhydramine (Benadryl). D. Explain to the client that these symptoms are normal responses to the medication.

28. Which nursing action or statement is most likely to reduce anxiety in a client being brought to the surgical suite? A. Asking the client if he or she has talked with the hospital chaplain B. Asking the client what specific surgery he or she is having done today C. Asking the client if he or she wants family members to be with them in the holding area D. Explaining to the client that the surgical area is the most technologically advanced in the city29. Who is responsible for accompanying the surgical client to the postanesthesia recovery area after surgery and for giving a report of the client's intraoperative experience to the PACU nurse? A. The surgeon and scrub nurse B. The surgeon and circulating nurse C. The anesthesiologist and scrub nurse D. The anesthesiologist and circulating nurse

30. The nurse has admitted a client to the unit following a modified radical mastectomy for treatment of breast cancer. The nurse plans to place the right arm in which of the following positions?

a. elevated above shoulder levelb. elevated on a pillow

c. level with the right atriumd. dependent to the right atrium

31. Harry underwent lobectomy. Which of following is the purpose of harry’s closed chest drainage post lobectomy:

a. expansion of the remaining lungb. facilitation of coughing

c. prevention of mediastinal shiftd. promotion of wound healing

Situation: Nurse Fiona is assisting a client with Eyes and Ears disorders. She is using her proper judgment in taking care of her patients and sees to it that they are comfortable and recovers in the disease process without complications.

32. Melrose is having a difficulty in her hearing and balance. Upon assessment, nurse Fiona would most likely pay particular attention to the functioning of what cranial nerve?

a. CN 4b. CN 5

c. CN 8d. CN 10

33. Tonometry is performed on the client with suspected diagnosis of glaucoma. The nurse Fiona is aware that the normal intraocular pressure is:

a. 10-20 mmHgb. 2-7 mmHg

c. 22- 30 mmHgd. 31-35 mmHg

34. A client is being discharged after cataract removal and the nurse reinforces instruction regarding home care. Which of the following , if stated by the client indicates understanding of the instruction?

a. “ I will not lift anything if it weighs more than 10 lbsb. “ I will take aspirin if I have any discomfort”c. “ I will wear my eye shield at night and my glasses during the dayd. “ I will wear an eye patch to prevent my affected eye from bleeding”

35. A nurse assigned to care for client hospitalized with Meniere’s disease the nurse expects that which of the following would be most likely be prescribed for the client?

a. low cholesterol dietb. low sodium diet

c. low carbohydrate dietd. low fat diet

36. A client with Meniere’s disease is experiencing severe vertigo. The nurse instructs the client to do which of the following to assist in controlling the vertigo.

a. Increased fluid intake to 3000 mL/day b. avoid sudden head movements c. lie still and listen to rock music d. increase sodium in the diet

37. A client with an acute myocardial infarction is receiving nitroglycerin (Tridil) by continuous IV infusion. Which statement by the client indicates that this drug is producing its therapeutic effect?

a. “I have a bad headache.”b. “My chest pain is decreasing.”c. “I feel a tingling sensation around my mouth.”d. “My blood pressure must be up because my vision is blurred.”

38. A client reports recent onset of chest pain that occurs sporadically with exertion. The client also has fatigue and mild ankle swelling which is most pronounced at the end of the day. The nurse suspects a cardiovascular disorder. When exploring the chief complaint the nurse should find out if the client has any other common cardiovascular symptoms such as:

a. Shortness of breath b. Insomnia

c. Irritability d. Lower substernal abdominal pain

39. A client is admitted for treatment of Prinzmetal’s angina. When developing the plan of care the nurse keeps in mind that this type of angina is triggered by:

a. Activities that increase myocardial demandb. Are unpredictable amount of activity c. Coronary artery spasmd. The same type of activity that caused previous angina episodes

40. Before discharge, which instruction should the nurse give to a client receiving digoxin (Lanoxin)?a. “Take an extra dose of digoxin if you miss one dose.”b. “Call the physician if you have a rapid heart rate.”c. “Call the physician if your pulse drops below 80 beats/minute.”d. “Take digoxin with meals

SITUATION: Cystic Fibrosis is a disease caused by mutations in the CF transmembrane conductance regulator protein, which is a chloride channel found in all exocrine tissues.41. A "sweat test" or newborn screening may be used to detect:

a. Cystic fibrosisb. . Adrenal insufficiency

c. Grave's diseased. Hypothyroidism

42. The most common causes of death in people with cystic fibrosis is:a. Dehydrationb. Opportunistic infection

c. Lung cancerd. Respiratory failure

SITUATION : A client admitted to an acute care facility with pneumonia is receiving supplemental oxygen, 2 liters/minute via nasal cannula. The client's history includes chronic obstructive pulmonary disease (COPD) and coronary artery disease. Because of these history findings, the nurse closely monitors the oxygen flow and the client's respiratory status. 43. Which complication may arise if the client receives a high oxygen concentration? a. Apnea

b. Anginal painc. Respiratory alkalosisd. Metabolic alkalosis

44. A client who takes theophylline for chronic obstructive pulmonary disease is seen in the urgent care center for respiratory distress. Once the client is stabilized, the nurse begins discharge teaching. The nurse would be especially vigilant to include information about complying with medication therapy if the client’s baseline theophylline level was: a. 10 mcg/mL b. 12 mcg/mL

c. 15 mcg/mL d. 18mcg/mL

45.  A nurse is caring for a male client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which of the following would the nurse expect to note on assessment of this client? A.    Hypocapnia B.    A hyperinflated chest noted on the chest x-ray C.    Increase oxygen saturation with exercise D.    A widened diaphragm noted on the chest x-raySITUATION : Nurse Donna is caring for a client with deep vein thrombosis who was admitted to the health care facility. 46. Nurse Donna must be alert for complications such as pulmonary embolism. Which findings suggest pulmonary embolism?

a. Nonproductive cough and abdominal pain b. Hypertension and lack of fever

c. Bradypnea and bradycardia d. Chest pain and dyspnea

47. In case of pulmonary embolism, nurse Donna would anticipate an order for immediate administration of:a. warfarinb. dexamethazone

c. heparin d. protamine sulfate

48. The following are warning signs of cancer. Which one is not? a. Change In bladder and bowel habits b. Indigestion or difficulty in swallowing

c. Weight gaind. Nagging cough or hoarseness

49. Monthly examination (BSE) can help in early detection of breast CA. When do you perform BSE? a. once a month after menstruation b. once a month before menstruation c. every other month after menstruationd. every other month before menstruation

50. The ABCD method offers one way to assess skin lesions for possible skin cancer. What does the A stand for?a. Actinic b. Asymmetry

c. Arcus d. Assessment

51. The nurse is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by:

a. Breast self-examinationb. Mammography

c. Fine needle aspiration d. Chest x-ray

52. A 52-year old female tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. Which assessment finding would strongly suggest that this client’s lump is cancerous?

a. Eversion of the right nipple and mobile massb. Non-mobile mass with irregular edges c. Mobile mass that is soft and easily delineated d. Non palpable right axillary lymph nodes

SITUATION : Cushing’s syndrome results from excessive, rather than deficient, adrenocortical activity. 53. A client is transferred to a rehabilitation center after being treated in the hospital for a cerebrovascular accident (CVA). Because the client has a history of Cushing’s syndrome (hypercortisolism) and chronic obstructive pulmonary disease (COPD), the nurse formulates a nursing diagnosis of:

a. Risk for imbalanced fluid volume related to excessive sodium lossb. Risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion c. Ineffective health maintenance related to frequent hypoglycemic episodes secondary to Cushing’s syndromed. Decreased cardiac output related to hypotension secondary to Cushing’s syndrome

54. All of the following are symptoms of Cushing's syndrome except:a. Severe fatigue and weaknessb. Hypertension and elevated blood glucose

c. A protruding hump between the shouldersd. Hair loss

55. Which of the following conditions is caused by long-term exposure to high levels of cortisol? a. Addison's disease b.. Crohn's disease

c. Adrenal insufficiency d. Cushing's syndrome

56. The client with Cushing's syndrome is undergoing a dexamethasone suppression test. The nurse plans to implement which steps during this test?

a. A. collect a 24-hour urine specimen to measure serum cortisol levelsb. administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morningc. draw blood samples before and after exercise to evaluate the effect of exercise on

serum cortisol leveld. administer an injection of adrenocorticotropic hormone (ACTH) 30 minutes before drawing blood to

measure serum cortisol levels57. In assessing a client with possible Cushing’s syndrome. In a client with Cushing’s syndrome, the nurse would expect to find:

a. hypotensionb. thick, coarse skinc. deposits of adipose tissue in the trunk and dorsocervical aread. weight gain in arms and legs

58. Which laboratory test result best supports a diagnosis of Addison’s disease?a. Blood urea nitrogen (BUN) level of 12

mg/dlb. Blood glucose level of 90 mg/dl

c. Serum sodium level of 134 mEq/Ld. Serum potassium level of 5.8 mEq/L

59. Before discharge, a client with Addison’s disease should be instructed to do which of the following when exposed to period of stress?

a. Administer hydrocortisone IMb. Drink 8oz fluids c. Perform capillary blood glucose monitoring four times dailyd. Continue to take his usual dose of hydrocortisone

60.Select the correct disorder for these symptoms: (1) salt craving; (2) high K+; (3) hypotension; (4) hypoglycemia; (5) collapse due to stress---

a. diabetes, Type I; b. Cushing's disease(syndrome); c. diabetes insipidus; d. Addison's Disease (hypoadrenalism

Situation: A nurse must be aware in her actions in delivering patient care. The bioethical principles are very helpful in helping her attain this. 61. Nurse Bea enters a pts room & finds the pt lying on the floor. Bea checks the pt & calls the nsg supervisor & the

physician to inform them of the occurrence. The nursing supervisor instructs Bea to make an incident report w/c she did, understanding that it allows analysis of adverse pt events through:a. A method of promoting quality care & risk mgtb. Determining the effectiveness of interventions in relation to outcomesc. Appropriate method of reporting to local agenciesd. Providing pts w/ necessary stabilizing treatments

62. Nurse Ann observes that a pt received pain medication 1 hr ago from another nurse, but that the pt still has severe pain. The nurse has previously observed this same occurrence. Nurse Ann plans to do w/c of the ff.?

a. Talk w/ the nurse who gave the medicationb. Talk to the nsg. supervisor c. Call the physiciand. Report the information to the police

63. Which of the following would refer to one’s duty to benefit or promote the good of others?a. Veracity b. Beneficence c. Nonmaleficence d. Ethical Principles

64. A pt has died and a family member is asked about the funeral arrangements. The family member refuses to discuss the issue. The nurse’s most appropriate action is to:

a. Provide info needed for decision making b. Suggest a referral to a mental health professionalc. Show acceptance of lability of feelings d. Remain w/ the family member w/o discussing funeral arrangements

65. Patient Ramon arrives in the ER & is staggering, confused & verbally abusive; complains of a headache from drinking alcohol & is asking for meds. Nurse Ann explains that the physician will need to perform an assessment before administration of medication. When he becomes verbally abusive, Nurse Ann threatens to place him in restraints. Which can the pt legally charge Ann as a result of the nsg action?

a. Assaultb. Battery

c. Negligenced. Invasion of privacy

Situation: Research is indispensable in the practice of nursing; thus, an astute nurse must have a comprehensive grasp of the research process to achieve quality in patient care. 66. Research in nursing is primarily conducted for what purpose;

a. To improve nursing practiceb. To formulate nursing theories

c. To solve nursing problemsd. To test nursing hypothesis

67. A type of research whose purpose is merely to determine the general picture of the population, to get the over-all distribution of respondents;

a. Causalb. Relational

c. Descriptived. Exploratory

68. When the researcher wishes to determine the association of one variable to another, the type of research is;a. Descriptiveb. Relational

c. Causald. Evaluative

69. When the researcher wishes to determine the association of one variable to another, the type of research is;a. Descriptiveb. Relational

c. Causald. Evaluative

70. Facts which are presumed to be true and existing and need not be tested are called?a. Theoryb. Hypothesis

c. Concepts.d. Assumptions

SITUATION Hyperthyroidism is the second most prevalent endocrine disorder second to diabetes mellitus. Treatment of hyperthyroidism is directed toward reducing thyroid hyperactivity to relieve symptoms and remove the cause of important complications. This treatmemt intervention may include both medical and surgical management.71. Which nursing diagnosis takes highest priority for a female client with hyperthyroidism? A. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess B. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing C. Body image disturbance related to weight gain and edema D. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess72. Nurse Ruth is assessing the client after subtotal thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication? A. Tetany B. Hemorrhage

C. Thyroid storm D. Laryngeal nerve damage

73.    After undergoing subtotal thyroidectomy, the client develops hypothyroidism. Dr. Smith prescribes levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent? A. Primary hypothyroidism B. Graves’ disease

C. Thyrotoxicosis D. Euthyroidism 

74. When assessing the client with pheochromocytoma, nurse April is most likely to detect: A. a blood pressure of 130/70 mm Hg.  B. a blood glucose level of 130 mg/dl.

C. bradycardia. D. a blood pressure of 176/88 mm Hg.

75. To reverse hypertensive crisis caused by pheochromocytoma, nurse April expects to administer: A. phentolamine (Regitine) B. methyldopa (Aldomet) C. mannitol (Osmitrol) D. felodipine (Plendil)

Situation : Quality nursing care with a difference is one of the major goals of quality assurance program or total quality management. One of the functions of nurse manager is to target and ensure that quality nursing care is delivered. The succeeding questions pertains to maintaining standards or quality76. Which of the following ensures quality or safe and effective nursing practice?

a. Standardsb. Goals

c. Targetsd. Philosophy

77. If her patient’s responses conform to her plan of care the type of standard used is;a. Outcomeb. Process

c. Structured. Routine

78. Growth and professional development of nursing personnel should be the responsibility of:a. The institution b. The personnel herself

c. The human resource managerd. The supervisors

79. As a nurse manager, Miss Paloc, RN, was often asked to orient the new graduates and other nursing personnel to the organizational structure of the hospital, the primary purpose of which is to:

a. Explain her role in the organizational structure b. Provide information on hospital’s philosophy and goalsc. Provide mechanism for equitable distribution of work loadd. Explain the staff nurse’s role in the organization

80. Which of the following directing activities is the Chief Nurse primarily confirming?a. Communicationb. Delegating

c. Trainingd. Motivating

SITUATION : Margaret O'Hara, a 30-year-old known diabetic, is brought to the emergency department by ambulance. The paramedic team reports symptoms of apparent hyperglycemia. Stat blood glucose is 640.81. The nurse is aware that excess serum glucose acts to draw fluids osmotically with resultant polyuria. In addition to increased urinary output, the nurse should expect to observe which of the following sets of symptoms in Margaret?

a. Polydipsia, diaphoresis, bradycardiab. Thirst, dry mucous membranes, hot dry skinc. Hypotension, bounding pulse, headached. Nervousness, rapid respirations, diarrhea

82. Acarbose (Precose), an alpha-glucosidase inhibitor, is prescribed to client with type 2 diabetes mellitus. During discharge planning, nurse Pauleen would be aware of the client’s need for additional teaching when the client states: a.  “If I have hypoglycemia, I should eat some sugar, not dextrose.” b.  “The drug makes my pancreas release more insulin.” c.   “I should never take insulin while I’m taking this drug.” d.   “It’s best if I take the drug with the first bite of a meal.”83.  Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Which medication instruction should the nurse provide? a. “Be sure to take glipizide 30 minutes before meals.” b. “Glipizide may cause a low serum sodium level, so make sure you have your sodium level checked monthly.” c. “You won’t need to check your blood glucose level after you start taking glipizide.” d. “Take glipizide after a meal to prevent heartburn.”84.  The male client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide (Tolinase). Which of the following is the most important laboratory test for confirming this disorder?

a.   Serum potassium levelb. Serum sodium level

c. Arterial blood gas (ABG) valuesd. Serum osmolarity

85. During a class on exercise for diabetic clients, a female client asks the nurse educator how often to exercise. The nurse educator advises the clients to exercise how often to meet the goals of planned exercise? a.  At least once a week b.     At least three times a week

c. At least five times a week d. Every day

86. During a routine check-up, the nurse evaluates a client with rheumatoid arthritis. To assess for the most obvious disease manifestations first, the nurse checks for:

a. . Muscle weakness b. Joint abnormalities

c. Painful subcutaneous nodules d. Gait disturbances

87. The nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan?

a. Exposure to sunlight will help control skin rashes.b. There are no activity limitations between flare-ups.c. Monitor body temperatured. Corticosteroids may be stopped when symptoms are relieved.

88. A client with rheumatoid arthritis is about to begin aspirin therapy to reduce inflammation. When teaching the client about aspirin, the nurse discusses adverse reactions to prolonged aspirin therapy. These include: a. Weight gain

b. Fine motor tremorsc. Respiratory acidosis d. Bilateral hearing loss

89. A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?

a. “I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear.”b. “I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal.”c. “I will receive parenteral vitamin B12 therapy monthly for 6 months to a year.”d. “I will receive parenteral vitamin B12 therapy for the rest of my life.”

90. A client takes prednisone (Deltasone), as prescribed, for rheumatoid arthritis. During follow-up visits, the nurse should assess the client for common adverse reactions to this drug, such as:

a. Tetany and tremors b. Anorexia and weight loss

c. Fluid retention and weight gain d. None of the above

SITUATION  Arthur, 20 year old college student was rushed to the ER of St. Luke’s Hospital after he fainted during their parade for the opening of the University week celebration. Complained of severe right iliac pain. Upon palpation of his abdomen, Arthur jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis.91. Which of the following result of the laboratory test will be significant to the diagnosis? A. RBC: 4.5 TO 5 Million / cu. mm. B. Hgb: 13 to 14 gm/dl.

C. Platelets: 250,000 to 500,000 cu.mm. D. WBC: 12,000 to 13,000/cu.mm

92. Stat appendectomy was indicated. Pre op care would include all of the following except? A. Consent signed by the father B. Enema STAT C. Skin prep of the area including the pubis D. Remove the jewelries93. Pre-anesthetic med of Demerol and atrophine sulfate were ordered to: A. Allay anxiety and apprehension B. Reduce pain

C. Prevent vomiting D. Relax abdominal muscle

94. Post op care for a client after appendectomy will include the following except: A. Early ambulation B. Diet as tolerated after fully conscious

C. Nasogastric tube connect to suction D. Deep breathing and leg exercise

95. Peritonitis may be a complication that may occur in ruptured appendix and may cause serious problems which are 1. Hypovolemia, electrolyte imbalance2. Elevated temperature, weakness and diaphoresis3. Nausea and vomiting, rigidity of the abdominal wall4. Pallor and eventually shock A. 1 and 2 B. 2 and 3 C. 1,2,3 D. All of the aboveSITUATION : Matthew, a 36 year old, male patient diagnosed with colon cancer was newly put in colostomy.96. Mathew shows the BEST adaptation with the new colostomy if he shows which of the following? A. Look at the ostomy site B. Participate with the nurse in his daily ostomy care C. Ask for leaflets and contact numbers of ostomy support groups D. Talk about his ostomy openly to the nurse and friends97. The nurse plans to teach Matthew about colostomy irrigation. As the nurse prepares the materials needed, which of the following item indicates that the nurse needs further instruction? A. Plain NSS / Normal Saline B. K-Y Jelly C. Tap water D. Irrigation sleeve98 The nurse should insert the colostomy tube for irrigation at approximately how many inches? A. 1-2 inches B. 12-18 inches C. 6-8 inches D. 3-4 inches99. Which of the following behavior of the client indicates the best initial step in learning to care for his colostomy? A. Ask to defer colostomy care to another individual B. Promises he will begin to listen the next day C. States that colostomy care is the function of the nurse while he is in the hospital D. Agrees to look at the colostomy100. The next day, the nurse will assess Matthew’s stoma. The nurse noticed that a prolapsed stoma is evident if she sees which of the following?

A. A sunken and hidden stoma B. A dusky and bluish stoma C. A narrow and flattened stoma D. Protruding stoma with swollen appearance

a

100.