Medical-Surgical RN A Prophecy Relias – 2024/2025: Practice Questions and Answers, Exams of Public Health

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Medical-Surgical RN A Prophecy Relias – 2024/

1. A patient is having a reaction to a skin test for tuberculosis (TB). What size induration would indicate a positive test? A. 1 mm B. 3 mm C. 5 mm D. 10 mm Answer: D. 10 mm
2. You are assessing a patient for signs of dehydration. Which of the following findings would you expect? A. Increased urine output B. Moist mucous membranes C. Decreased skin turgor D. Bradycardia Answer: C. Decreased skin turgor
3. A nurse caring for a patient with hepatitis B must follow which standard precaution? A. Gloves, gown, mask B. Droplet precautions C. Airborne precautions D. Standard precautions Answer: D. Standard precautions
4. The healthcare provider prescribes methylprednisolone for a patient with an autoimmune disease. What is a common side effect of this medication? A. Weight loss B. Hypoglycemia C. Fluid retention D. Bradycardia Answer: C. Fluid retention
5. Which assessment finding should the nurse monitor for a patient who is taking a calcium channel blocker? A. Decreased heart rate B. Decreased blood pressure C. Increased respiratory rate D. Increased blood glucose Answer: B. Decreased blood pressure
6. A patient with chronic pain is started on a pain management regimen that includes opioids. What is a common concern that should be addressed with this patient? A. Decreased appetite B. Risk for dependency C. Increased activity level

D. Enhanced mood Answer: B. Risk for dependency

7. Your patient is at high risk for developing venous thromboembolism (VTE). What preventive measure should you prioritize? A. Ambulation B. Bed rest C. High-protein diet D. Restrict all activities Answer: A. Ambulation
8. A patient newly diagnosed with diabetes asks the nurse how often they should check their blood glucose levels. What is the most appropriate response? A. "Once a day is sufficient." B. "Check it after every meal." C. "It depends on your treatment plan." D. "Only when feeling symptoms." Answer: C. "It depends on your treatment plan."
9. A nurse is caring for a patient with a tracheostomy. What is the priority nursing intervention? A. Suctioning the tracheostomy regularly B. Ensuring the tracheostomy is properly secured C. Keeping the patient positioned at 30 degrees D. Performing daily dressing changes Answer: A. Suctioning the tracheostomy regularly
10. Your patient is under isolation precautions for a bacterial infection. What is an essential part of the nurse's role? A. Provide education on infection control measures B. Avoiding hand hygiene before exiting the room C. Decreasing the frequency of assessments D. Disregarding health care worker recommendations Answer: A. Provide education on infection control measures
11. A post-operative patient is being treated for nausea. Which medication class is commonly used to manage this side effect? A. Antihypertensives B. Antiemetics C. Antipyretics D. Antibiotics Answer: B. Antiemetics
12. A patient has a prescription for clopidogrel. What is the primary reason this medication is used? A. To lower blood pressure B. To prevent platelet aggregation C. To dissolve blood clots

D. To reduce cholesterol levels Answer: B. To prevent platelet aggregation

13. A nurse is caring for a patient recovering from a hip replacement. Which assessment should the nurse prioritize? A. Pain level B. Bowel sounds C. Urine output D. Skin integrity Answer: A. Pain level
14. Your patient shows symptoms of dehydration, including thirst and dry mucous membranes. What is the immediate nursing intervention? A. Administer IV fluids B. Document your findings C. Obtain a urine sample D. Provide oral fluids Answer: A. Administer IV fluids
15. A patient with chronic bronchitis is complaining of shortness of breath. What assessment finding would you expect? A. Barrel chest B. Decreased respiration rate C. Clear lung sounds D. Hypoxia Answer: A. Barrel chest
16. You are explaining the purpose of a CT scan to your patient. Which of the following should you include in your explanation? A. It uses sound waves to create images. B. It provides real-time imaging of organs. C. It uses radiation to produce detailed cross-sectional images of the body. D. It is only used for cancer diagnosis. Answer: C. It uses radiation to produce detailed cross-sectional images of the body.
17. A nurse is caring for a patient with a high fever. Which intervention is appropriate first? A. Administer an antipyretic B. Obtain blood cultures C. Assess the temperature D. Cover with a warm blanket Answer: C. Assess the temperature
18. The nurse is teaching a patient about the importance of vaccinations. What key point should the nurse emphasize? A. "Vaccines are only needed for children." B. "Vaccinations help prevent some diseases by building immunity." C. "Vaccines can cause serious side effects and should be avoided."

D. "Once you have a vaccine, you don’t need any others." Answer: B. "Vaccinations help prevent some diseases by building immunity."

19. You are providing patient education about anti-hypertensive medications. Which statement by the patient indicates understanding? A. "I can stop taking this medication when my blood pressure is normal." B. "I need to monitor my blood pressure regularly.” C. "It is safe to take this medication with any other drugs." D. "I don’t need to make any lifestyle changes." Answer: B. "I need to monitor my blood pressure regularly.”
20. A nurse is monitoring a patient with gout. What dietary modification should be encouraged? A. High protein diet B. Increased hydration and low-purine foods C. Decreased vitamin intake D. Decreased carbohydrate intake Answer: B. Increased hydration and low-purine foods
21. The priority nursing intervention for a patient with a newly diagnosed seizure disorder includes: A. Medications teaching B. Education about seizure triggers C. Ensuring the patient's safety D. Scheduling follow-up appointments Answer: C. Ensuring the patient's safety
22. Your patient is experiencing severe anxiety before a medical procedure. What is the most appropriate nursing intervention? A. Tell the patient to calm down B. Offer to stay with the patient and provide reassurance C. Dismiss the patient’s concerns D. Discuss the procedure details immediately Answer: B. Offer to stay with the patient and provide reassurance
23. When caring for a patient with COPD, which teaching point should be included regarding medication management? A. "You do not need to worry about your inhalers." B. "You should take your bronchodilator before your steroid inhaler." C. "You may stop your medications once you feel better." D. "It’s important to cut back on your physical activity." Answer: B. "You should take your bronchodilator before your steroid inhaler."
24. A nurse is conducting an assessment on a patient with diabetes. What finding would suggest the patient may be experiencing diabetic neuropathy? A. Fluctuating blood glucose levels B. Numbness or tingling in the feet C. Increased thirst

D. Frequent urination Answer: B. Numbness or tingling in the feet

25. A patient with a history of heart failure and a low sodium diet is also diabetic. What intervention is essential for this patient? A. Restricting fluid intake even more B. Monitoring blood glucose levels closely C. Offering high-sodium snacks D. Discouraging weight checks Answer: B. Monitoring blood glucose levels closely
26. A client has been diagnosed with hyperthyroidism and is being treated with methimazole. What is the priority teaching for this client? A. "You will need to limit your cold exposure." B. "This medication will cause early weight gain." C. "Monitor for signs of hypothyroidism such as fatigue." D. "You can stop taking this medication when you feel better." Answer: C. "Monitor for signs of hypothyroidism such as fatigue."
27. 1.2 milligrams is equal to how many micrograms? A. 1200 mcg B. 120 mcg C. 12,000 mcg D. 1,200,000 mcg Answer: A. 1200 mcg
28. Your post-op patient has a Jackson-Pratt (JP) drain in place. How do you ensure effective drain function? A. Keep the drain open B. Compress the drain, then plug the bulb to establish suction C. Leave the bulb disconnected D. Change the bulb every hour Answer: B. Compress the drain, then plug the bulb to establish suction
29. Your male patient complains of discomfort while inflating the balloon during insertion of an indwelling urinary catheter. What would be the MOST appropriate action? A. Deflate the balloon, advance the catheter further, then reinflate the balloon B. Inflate the balloon more C. Remove the catheter and let him rest D. Call the physician Answer: A. Deflate the balloon, advance the catheter further, then reinflate the balloon
30. Your patient has symptomatic anemia but is refusing a blood transfusion for religious reasons. What is an appropriate response? A. Persuade him to take the transfusion

B. Respect his wishes and notify the provider C. Ignore his choice D. Document refusal only Answer: B. Respect his wishes and notify the provider

31. Your patient is admitted with diverticulitis. What type of diet do you expect to be ordered for the patient? A. Clear liquids B. Broth, jello, soft fruit no skin C. Full solid diet D. High fiber diet Answer: B. Broth, jello, soft fruit no skin
32. You were hired to work the medical unit, and when you arrive at work the charge nurse has assigned you to the post-surgical unit since they are understaffed. Which is the MOST appropriate action? A. Refuse to go B. Report to the post-surgical unit C. Wait for another assignment D. Ask for training on the medical unit Answer: B. Report to the post-surgical unit
33. What is a proton pump inhibitor, such as pantoprazole (Protonix), used for? A. Blood pressure regulation B. Acid reduction C. Pain relief D. Cholesterol management Answer: B. Acid reduction
34. Which adaptive equipment would be MOST appropriate to use for a severely contracted patient who is unable to bear weight when transferring from the bed to the chair? A. Walker B. Patient lift (e.g., Hoyer) C. Bed rails D. Wheelchair ramp Answer: B. Patient lift (e.g., Hoyer)
35. Which tool should you use to assess pain in your 80-year-old patient with severe dementia? A. Numeric scale B. FACES scale C. PAINAD scale D. Wong-Baker scale Answer: C. PAINAD scale
36. Your patient is admitted from the ED with failure to thrive and advanced dementia. You note he is extremely underweight, appears unbathed for some time, and has a stage 4 pressure injury to his coccyx. You were told in report that he lives at home with family members. What should you

do? A. Notify the charge nurse and social worker of your concerns B. Document your findings C. Wait for further orders D. Discuss with the family Answer: A. Notify the charge nurse and social worker of your concerns

37. Your 85-year-old patient with atrial fibrillation fell at home 3 days ago. You notice she has been having several episodes of acute confusion since being admitted to your unit. What is the MOST important order you should anticipate from the provider? A. Routine blood work B. Stat CT of head C. MRI of the brain D. X-ray of the pelvis Answer: B. Stat CT of head
38. Your patient has a temp of 102.3 F, HR 122, and has had 15 mL of urine from the indwelling urinary catheter in the last 2 hours. What is your patient MOST likely experiencing? A. Dehydration B. Heart failure C. Sepsis D. Fever Answer: C. Sepsis
39. What type of personal protective equipment (PPE) is applied prior to entering a room for a patient with C. diff? A. Mask and gloves B. Gown and gloves C. Face shield and goggles D. No PPE required Answer: B. Gown and gloves
40. Your patient continues to pull at their IV site located in their left forearm despite verbal reminders and increased observation. The nursing assistant recommends using soft mitt restraints on the patient. What is your recommendation? A. Request an order for soft mitts as they are the least restrictive B. Use hard restraints C. Ignore the recommendation D. Allow the patient to pull at their IV Answer: A. Request an order for soft mitts as they are the least restrictive
41. Your patient was admitted for a hypertensive crisis and has a history of HTN, Parkinson's disease, depression, and alcohol use. On his second hospitalized day, you notice he is more anxious and restless than his baseline. What would be your FIRST nursing intervention? A. Ask the patient when his last drink of alcohol was B. Administer anxiety medication C. Call the psychiatrist

D. Document your observations Answer: A. Ask the patient when his last drink of alcohol was

42. What is the BEST indication of an acute neurological problem? A. Change in level of consciousness B. Severe headache C. Loss of motor function D. Tingling sensations Answer: A. Change in level of consciousness
43. While in a supine position your patient states, "I'm tired and cannot catch my breath." Physical assessment reveals jugular vein distention and a third heart sound (S3). These symptoms are indicative of what condition? A. Myocardial infarction B. Heart failure C. Pulmonary embolism D. Pneumothorax Answer: B. Heart failure
44. Your new admission presents with a cough, unintentional weight loss, frequent night sweats, and bloody sputum. What type of isolation precautions should you initiate, if any? A. Contact precautions B. Droplet precautions C. Airborne precautions D. No isolation required Answer: C. Airborne precautions
45. Patients with diabetes are at high risk for complications from damage to what body areas? A. Lungs and heart B. Skin and muscles C. Nerve and kidney damage D. Liver and pancreas Answer: C. Nerve and kidney damage
46. If your patient with a known history of diabetes is displaying symptoms of diaphoresis, cool skin, lethargy, and shakiness. What is your first action? A. Administer insulin B. Check the patient's blood glucose level C. Call the physician D. Document findings Answer: B. Check the patient's blood glucose level
47. Your patient tells you, "I hope I don't die, but if I do, I don't want to be brought back." You notice on her chart and wristband that she is a full code. What would be the MOST appropriate action? A. Contact a family member B. Discuss code status with the patient and follow up with the provider to ensure the medical

record reflects her wishes C. Ignore her comment D. Reassure her she will be fine Answer: B. Discuss code status with the patient and follow up with the provider to ensure the medical record reflects her wishes

48. Your coworker posted photos on social media from a birthday party they had for her in the unit breakroom. What should be your NEXT course of action? A. Report to HR immediately B. No action is necessary because no PHI was displayed C. Discuss it with the coworker D. Contact the patient’s family Answer: B. No action is necessary because no PHI was displayed
49. Your new patient understands very limited English. How should you communicate with them when completing the admission assessment? A. Use hand gestures B. Speak louder and slower C. Use the organization's interpreter services D. Ask a bilingual staff member to assist Answer: C. Use the organization's interpreter services
50. You are caring for a patient with a history of diabetes mellitus. You walk into the room and find the patient lethargic and diaphoretic. What is your first action? A. Call the physician B. Obtain capillary blood glucose level C. Administer D D. Check vital signs Answer: B. Obtain capillary blood glucose level
51. Your patient is 4 hours post-open appendectomy and has not voided yet. You note his lower abdomen is distended. What should you do NEXT? A. Perform a bladder scan B. Insert a Foley catheter C. Ask the patient to try to void D. Call the physician Answer: A. Perform a bladder scan
52. A patient with peritonitis presents with tachycardia, hypotension, and dehydration. What other assessment finding would you anticipate as part of your physical assessment? A. Severe abdominal pain or rebound tenderness B. Lethargy C. Decreased respiratory rate D. Increased appetite Answer: A. Severe abdominal pain or rebound tenderness

53. What is the EARLIEST sign indicating increased intracranial pressure (ICP)? A. Severe headache B. Level of consciousness C. Vomiting D. Pupillary signs Answer: B. Level of consciousness
54. In addition to pain, pallor, and pulselessness, a neurovascular assessment also includes checking for: A. Swelling B. Paresthesia and paralysis C. Warmth D. Capillary refill Answer: B. Paresthesia and paralysis
55. You received a report on a patient that sustained a right hemisphere CVA 48 hours ago. What do you expect the patient to exhibit? A. Right-sided weakness of the leg, arm, and face B. Left-sided weakness of the leg, arm, and face C. No weakness D. Unilateral vision loss Answer: B. Left-sided weakness of the leg, arm, and face
56. You are ordered to give digoxin (Lanoxin). Your patient's vital signs are: BP 130/70, Temp 97.9F, HR 52, RR 16, O2 Sat 100% on room air. What should you do NEXT? A. Hold digoxin (Lanoxin) and call the provider B. Administer the medication C. Check a potassium level D. Document the patient's status Answer: A. Hold digoxin (Lanoxin) and call the provider
57. Upon entry to your patient's room, you find her sitting in High Fowler's position and complaining of shortness of breath. Her respiratory rate is 34 breaths/min and O2 sat is 84%. Which mode of oxygen delivery would MOST likely reverse these symptoms? A. Nasal cannula B. CPAP C. Non-rebreather mask D. Venturi mask Answer: C. Non-rebreather mask
58. Your patient is on contact precautions for active MRSA. What proper PPE should you use before entering the room? A. Surgical mask B. Gown and gloves C. N95 mask D. No PPE necessary Answer: B. Gown and gloves

59. Your patient recently had a G-tube placed and intermittent enteral feedings have been initiated. What symptoms may indicate intolerance to the feedings? A. Constipation B. Vomiting and diarrhea C. Weight gain D. Abdominal cramps Answer: B. Vomiting and diarrhea
60. Upon entering your patient's room, you note that they are having a seizure. What is your FIRST action? A. Call for help B. Position the patient on their side to maintain the airway C. Restrain the patient D. Document the event Answer: B. Position the patient on their side to maintain the airway
61. Your 18-year-old female patient was admitted with dehydration secondary to anorexia nervosa. During your assessment, you note she has a flat affect and says, "I just want to die. I'm tired of my life." What should be your FIRST intervention? A. Stay with the patient and ask if she has a plan to carry out this wish B. Notify the physician immediately C. Document the statement D. Refer to a psychiatrist Answer: A. Stay with the patient and ask if she has a plan to carry out this wish
62. Your patient has a non-productive cough and presence of secretions in his tracheostomy. Prior to suctioning the patient, what should you do FIRST? A. Suction the tracheostomy B. Hyperoxygenate patient C. Raise the head of the bed D. Call the physician Answer: B. Hyperoxygenate patient
63. Your patient takes 5 mg of warfarin (Coumadin/Jantoven) daily and reports having black colored stool today. What do you most likely suspect? A. Gastrointestinal bleeding B. Iron supplementation C. Hemorrhoids D. Food intolerance Answer: A. Gastrointestinal bleeding
64. Your new patient was admitted with blunt force trauma to the abdomen following a motor vehicle accident (MVA). An NG tube is in place for decompression; however, you note during the assessment that the stomach is rigid and hard during palpation. What condition do you suspect? A. Pneumonia B. Bowel obstruction C. Hemorrhage

D. Gastritis Answer: C. Hemorrhage

65. Which of the following nursing diagnoses is MOST important for a patient with chronic obstructive pulmonary disease (COPD)? A. Impaired gas exchange B. Risk for falls C. Knowledge deficit D. Ineffective tissue perfusion Answer: A. Impaired gas exchange
66. You have a patient going for dialysis. Their medications include lisinopril (Prinivil), ondansetron (Zofran), famotidine (Pepcid), and atorvastatin (Lipitor). Which medication would you possibly hold and seek clarification? A. Lisinopril (Prinivil) B. Ondansetron (Zofran) C. Famotidine (Pepcid) D. Atorvastatin (Lipitor) Answer: C. Famotidine (Pepcid)
67. What is an early symptom that the patient is developing a complication of heart failure? A. Dyspnea on exertion B. Chest pain C. Palpitations D. Edema in the legs and feet Answer: D. Edema in the legs and feet
68. Black and tarry colored stools are CLASSIC symptoms of what condition? A. Diverticulitis B. Gastrointestinal bleeding C. Constipation D. Hemorrhoids Answer: B. Gastrointestinal bleeding
69. You have 4 patients who have high-priority needs. One needs to go to surgery, one needs STAT lab draws from a PICC line, another has chest pain rated 8/10, and another needs toileting. Which patient should you tend to FIRST? A. The patient who needs to go to surgery B. The patient with chest pain C. The patient needs lab draws D. The patient who needs toileting Answer: B. The patient with chest pain
70. Your patient with hepatitis C exhibits signs of jaundice and a distended abdomen. What procedure would you anticipate being performed by the provider at the bedside for this patient? A. ERCP

B. Paracentesis C. Laparoscopy D. Ultrasound Answer: B. Paracentesis

71. What is clubbing of the fingers MOST likely associated with? A. Anemia B. Chronic oxygen deficiency C. Diabetes mellitus D. High blood pressure Answer: B. Chronic oxygen deficiency
72. A patient on warfarin (Coumadin/Jantoven) has an INR of 6. Which medication would you anticipate administering? A. Aspirin B. Heparin C. Vitamin K D. Protamine sulfate Answer: C. Vitamin K
73. To reduce the risk of infection and phlebitis in an adult patient with a peripheral IV, what is the MINIMUM duration the catheter should remain in place before ROUTINE replacement? A. 48 hours B. 72 hours C. 96 hours D. 24 hours Answer: B. 72 hours
74. You are caring for a patient post-lobectomy with a chest tube in place for drainage. What is a priority in care for this patient? A. Monitor vital signs B. Administer analgesics C. Encourage the patient to cough and deep breathe D. Assess the insertion site Answer: C. Encourage the patient to cough and deep breathe
75. What patient population is the pneumococcal vaccine, PPSV23, indicated for? A. Adults aged 18-50 years B. Children under 2 years C. Adults aged 65 years and older D. All adults Answer: C. Adults aged 65 years and older
76. Your patient with stage IV terminal lung cancer continues to experience increasing pain as each day passes. What would you anticipate the provider ordering for this patient? A. Palliative care consult B. Chemotherapy

C. Full code status D. Physical therapy Answer: A. Palliative care consult

77. The provider gives you a telephone order to explain a surgical procedure to your patient and obtain surgical consent. How should you respond? A. Inform the provider that explaining the procedure is outside the nurse's scope of practice B. Proceed to explain the procedure C. Ask the surgeon to come and explain it D. Refer the patient to the charge nurse Answer: A. Inform the provider that explaining the procedure is outside the nurse's scope of practice
78. The patient has diltiazem HCl (Cardizem CD) ordered and is requesting the capsule be mixed into her morning yogurt. How should you respond? A. "Sorry, it is a slow-release medication that cannot be opened or crushed." B. "That's fine, go ahead." C. "You can chew it if you'd like." D. "I will ask the pharmacist." Answer: A. "Sorry, it is a slow-release medication that cannot be opened or crushed."
79. Your 72-year-old male patient is admitted for colon cancer related complications and has a history of CHF, stroke, and a recent knee replacement. Based on your patient's risk assessment, you determine he is at risk for venous thromboembolism (VTE). What is an appropriate VTE prophylaxis order for this patient? A. Compression stockings B. Aspirin C. Enoxaparin (Lovenox) once daily and intermittent pneumatic compressions (IPC) D. Bed Rest Answer: C. Enoxaparin (Lovenox) once daily and intermittent pneumatic compressions (IPC)
80. You receive a provider's order that is not consistent with evidence-based practice. What is your FIRST step? A. Prepare to follow the order B. Clarify the order with the provider C. Document the order D. Refer to the nursing supervisor Answer: B. Clarify the order with the provider
81. When would sucralfate (Carafate) 4 times daily be scheduled for? A. At the same time as other medications B. 1 hour before meals and at bedtime C. After meals D. Whenever the patient remembers Answer: B. 1 hour before meals and at bedtime

82. Your patient's morning labs revealed a hemoglobin level of 6.3 and hematocrit of 18. What blood product do you expect to administer? A. Platelets B. Fresh frozen plasma C. PRBCs D. Whole blood Answer: C. PRBCs
83. Your 68-year-old patient is a Type 1 diabetic with a history of schizophrenia and exhibits signs and symptoms of tardive dyskinesia. What long-term medication is associated with signs and symptoms of tardive dyskinesia? A. Risperidone B. Levothyroxine C. Metformin D. Amlodipine Answer: A. Risperidone
84. Your 80-year-old patient is being discharged home post-CVA. She lives alone, yet still requires assistance with ADLs. What referral is MOST appropriate to ensure her needs are met? A. Case Manager B. Social Worker C. Physical Therapy D. Occupational Therapy Answer: A. Case Manager
85. Central Telemetry calls and tells you your patient is experiencing bradycardia. What is the first thing you should do after entering the room? A. Prepare to administer medications B. Assess the patient and take vital signs C. Document your findings D. Call the physician Answer: B. Assess the patient and take vital signs
86. Your patient is currently under 1:1 observation for suicide precautions. He states he needs to have a bowel movement and would like some privacy to use the bathroom. What is the MOST appropriate response? A. "I can leave the room." B. "I must be within an arm's length view of you at all times for your safety." C. "You can wait until afterward." D. "Go ahead; I will be outside." Answer: B. "I must be within an arm's length view of you at all times for your safety."
87. A female patient requests a female nurse to provide care for her based on her religious beliefs. What is the MOST appropriate action to take? A. Accommodate her request if possible B. Deny the request C. Ask another staff member to assist

D. Document the request Answer: A. Accommodate her request if possible

88. Your patient is a 40-year-old female with a recent history of hair loss, extremely dry skin, and a 20-point weight loss in the last 3 weeks. She also exhibits occasional episodes of tremors in her upper extremities. What condition do these symptoms MOST likely indicate? A. Hypothyroidism B. Hyperthyroidism C. Diabetes D. Anemia Answer: B. Hyperthyroidism
89. Insulin lispro (Humalog) is ordered via sliding scale a.c. for your patient with diabetes. When is the best time to administer insulin lispro (Humalog)? A. 30 minutes after meals B. Immediately after meals C. 15 minutes before the meal arrives D. 1 hour before meals Answer: C. 15 minutes before the meal arrives
90. Which of the following would be used as part of the preop procedure to prevent infection? A. Prophylactic antibiotics B. Preoperative checklist C. Informed consent D. Patient education Answer: A. Prophylactic antibiotics
91. Two days after surgery, your 72-year-old patient is showing signs of agitation and confusion, which is not his baseline. The severity fluctuates throughout the day. His medications include hydromorphone (Dilaudid), amlodipine (Norvasc), alprazolam (Xanax), and carbidopa-levodopa (Sinemet). What condition do you MOST likely suspect? A. Dementia B. Delirium C. Stroke D. Sedation Answer: B. Delirium
92. What is the proper technique when suctioning a tracheostomy? A. Suction continuously while inserting the catheter B. Suction in a circular motion while the catheter is being pulled out C. Suction only while inserting the catheter D. Have the patient take a deep breath before suctioning Answer: B. Suction in a circular motion while the catheter is being pulled out
93. Your new patient admitted for cholecystitis expresses she has a history of anxiety disorder. She is feeling panicked and does not think she can handle staying in the hospital for her surgery. What action is MOST appropriate for you to take?

A. Call security B. Sit calmly next to her and offer her compassion and a sense of security C. Prescribe anti-anxiety medication D. Discuss with the surgeon Answer: B. Sit calmly next to her and offer her compassion and a sense of security

94. The provider orders an IV infusion of D5W 1000 mL to infuse over the next 6 hours. How many mLs per hour should the IV pump be set to? A. 100 mL/hr B. 156 mL/hr C. 167 mL/hr D. 250 mL/hr Answer: C. 167 mL/hr
95. You are assigned a new admission and note a Braden score of 11 after completing your assessment. Which interventions would be MOST appropriate based on your assessment? A. Turn q 2 hours, request nutrition consult, request low air loss mattress B. Increase mobility and hydration C. Ambulate every hour D. Only document findings Answer: A. Turn q 2hours, request nutrition consult, request low air loss mattress
96. Your patient may have tuberculosis (TB) and is placed in airborne precautions. What test would you expect to be ordered? A. Sputum culture B. Acid-fast bacilli sputum C. Chest X-ray D. PPD test Answer: B. Acid-fast bacilli sputum
97. Your patient starts to complain of difficulty breathing while laying down, and states that he has been coughing up pink sputum. While performing your assessment, you notice jugular vein distention and coarse crackles in both lungs on auscultation. What diagnosis do you suspect? A. Pulmonary embolism B. Congestive heart failure C. Pneumonia D. COPD exacerbation Answer: B. Congestive heart failure
98. You received a patient post-op transurethral resection of the prostate (TURP). Which of the following symptoms would cause you the MOST concern? A. Bright red urine B. Low-grade fever C. Abdominal pain D. Urgency to urinate Answer: A. Bright red urine

99. Your patient with C. diff (Clostridioides difficile) has a family member about to leave the room. What education about performing hand hygiene should you give? A. Hand hygiene with soap and water B. Use alcohol-based hand sanitizer C. No hand hygiene is necessary D. It's ok to just wash hands in the restroom Answer: A. Hand hygiene with soap and water
100. Your patient has a diagnosis of urinary tract infection (UTI) and is currently taking medication that has recently made her urine reddish-orange. Which of the following medications would cause this side effect? A. Amoxicillin B. Phenazopyridine (Pyridium) C. Nitrofurantoin D. Levofloxacin Answer: B. Phenazopyridine (Pyridium)
101. Your patient is taking digoxin (Lanoxin) and has a potassium level of 3.0. How might this affect the patient? A. Increase risk of digoxin toxicity B. Decrease effectiveness of digoxin C. No effect on digoxin D. Reduce heart rate Answer: A. Increase risk of digoxin toxicity
102. You are preparing to hang 1 unit PRBCs to administer to your patient. The patient states, "I don't take blood products." What is the MOST appropriate response? A. "You must take the transfusion." B. "You have the right to refuse the blood transfusion. I will inform the provider of your decision." C. "Let me talk to you about it." D. "It's required for your treatment." Answer: B. "You have the right to refuse the blood transfusion. I will inform the provider of your decision."
103. An older adult patient arrives on the unit looking emaciated, disheveled, and with soiled clothes. The patient claims that his daughter cares for him at home. What would you suspect? A. Neglect B. Normal aging process C. Poverty D. Psychological disorders Answer: A. Neglect
104. You just left your patient's room with her husband at bedside. You then receive a phone call from someone who states that she is your patient's mother and demands updates about your patient. What should you do NEXT? A. Inform her of her daughter's condition

B. Verify your patient's consent to release information to her mother C. Deny the request D. Hang up the phone Answer: B. Verify your patient's consent to release information to her mother

105. The provider orders Heparin 4 units/kg SQ. Your patient weighs 176 pounds. How many units should you administer? A. 320 units B. 200 units C. 340 units D. 10 units Answer: A. 320 units
106. What diagnostic finding would support a diagnosis of deep vein thrombosis? A. Positive D-dimer B. Elevated white blood cell count C. Decreased hemoglobin D. Increased platelet count Answer: A. Positive D-dimer
107. You are caring for a combative 85-year-old male with a history of dementia, CHF, UTI, and anemia. The family states he appears to be more confused than his baseline. What tests do you expect the provider to order? A. MRI of the brain B. Urinalysis with cultures, CBC C. Channeling for tests D. CT scan of abdomen Answer: B. Urinalysis with cultures, CBC
108. A patient has recently been diagnosed with terminal cancer. Her responses are caustic and abrasive. What is the BEST way to respond? A. Avoid discussing her feelings B. Acknowledge her feelings, understanding this is expected in the grieving process C. Suggest she talk to a therapist D. Be defensive about her comments Answer: B. Acknowledge her feelings, understanding this is expected in the grieving process
109. You notice your patient who recently had a stroke is coughing intermittently during meals. What is the MOST likely cause of this? A. Aspiration B. GERD C. Allergies D. Normal swallowing Answer: A. Aspiration
110. A patient with acute diverticulitis is MOST likely to complain of abdominal pain with what quadrant?

A. Right upper quadrant B. Left upper quadrant C. Left lower quadrant D. Right lower quadrant Answer: C. Left lower quadrant

111. Which of the following is MOST important in preventing a catheter-associated urinary tract infection (CAUTI)? A. Using sterile technique when inserting the catheter B. Daily cleaning of the external catheter C. Changing the catheter every week D. Collecting urine samples less frequently Answer: A. Using sterile technique when inserting the catheter
112. The provider orders a Heparin infusion of 900 units/hr. Your IV medication on hand has 25,000 units of Heparin in 500 mL of D5W. How many mL/hr will you infuse? A. 40 mL/hr B. 18 mL/hr C. 32 mL/hr D. 72 mL/hr Answer: B. 18 mL/hr
113. Your patient has developed a productive cough and fever. The provider is suspecting influenza. Which actions should you take FIRST? A. Administer antipyretics B. Initiate droplet precautions C. Check vital signs D. Start antiviral medication Answer: B. Initiate droplet precautions
114. What medication would you anticipate being ordered for a patient who has an LDL > 200 mg/dL? A. Antihypertensives B. Statin C. Anticoagulant D. Diuretic Answer: B. Statin
115. Fifteen minutes after starting a blood transfusion, the patient complains of lower back pain, shortness of breath, and chills. What is your FIRST action? A. Stop the transfusion B. Call the physician C. Monitor vital signs D. Document the event Answer: A. Stop the transfusion

116. Your patient had a transurethral resection of the prostate (TURP) 24 hours ago. What signs require further intervention? A. Bright red urine B. Low-grade fever C. Abdominal pain D. Increased urination Answer: A. Bright red urine
117. What condition (not medication related) might cause an elevation in the patient’s PT/INR level? A. Kidney disease B. Liver disease C. Infection D. Diabetes Answer: B. Liver disease
118. Your patient admitted for small bowel obstruction has been vomiting for the last 3 days. What electrolyte imbalance would you expect to be associated with this patient? A. Hypercalcemia B. Hyperkalemia C. Hypokalemia D. Hyponatremia Answer: C. Hypokalemia
119. Digoxin (Lanoxin) 125 mcg is equivalent to how many mg? A. 0.125 mg B. 0.0125 mg C. 1.25 mg D. 0.025 mg Answer: A. 0.125 mg
120. As you are walking down the hallway you overhear your colleague discussing her personal family issues with a patient. What would be the MOST appropriate response? A. Join the conversation B. Remind her later of her responsibility for establishing and maintaining professional boundaries with patients C. Report her to HR D. Ignore the situation Answer: B. Remind her later of her responsibility for establishing and maintaining professional boundaries with patients
121. Your patient, who has soft wrist restraints for safety (non-violent), is working with the occupational therapist at the bedside. The nursing assistant enters and says, "The patient is not allowed to have his restraints untied." How do you respond? A. "Restraints can be temporarily off while directly working with staff. Let me know when the therapy session is finished and I will re-apply them." B. "Keep the restraints on at all times."

C. "You are right; we cannot take them off." D. "Let me consult the nurse manager first." Answer: A. "Restraints can be temporarily off while directly working with staff. Let me know when the therapy session is finished and I will re-apply them."

122. Your patient suddenly develops signs and symptoms of shortness of breath, restlessness, tachypnea, hemoptysis, and decreased oxygen saturation despite being on 2L/min of O2 by nasal cannula. What do you expect is happening? A. Pneumothorax B. Heart failure C. Pulmonary embolism D. Asthma attack Answer: C. Pulmonary embolism
123. The dosage of which drug must be tapered down slowly to prevent acute adrenal insufficiency? A. Ibuprofen B. Prednisone C. Loratadine D. Metformin Answer: B. Prednisone
124. Your patient with CHF states, "I can still eat the same food, I just have to weigh myself every day." Based on this statement, which nursing diagnosis would be appropriate? A. Knowledge Deficit B. Effective coping C. Imbalanced nutrition D. Risk for fluid volume overload Answer: A. Knowledge Deficit
125. A patient arrives on the unit. You do an assessment and notice lice in her hair. What is your first action? A. Discuss treatment options B. Secure a private room C. Notify the physician D. Give the patient shampoo Answer: B. Secure a private room
126. A patient presents with dusky pallor and pulseless. What is your first action? A. Initiate facility code procedure B. Call for help C. Start CPR D. Check for a pulse Answer: A. Initiate facility code procedure
127. Your patient is experiencing severe chest pain, and an EKG shows ST elevation in leads II, III, and aVF. What is the most likely diagnosis?

A. Unstable angina B. Myocardial infarction C. Aortic dissection D. Pericarditis Answer: B. Myocardial infarction

128. A nurse is educating a female patient about urinary tract infections (UTIs). Which statement by the patient indicates a need for further teaching? A. "I should wipe from front to back." B. "I can hold it when I need to urinate." C. "I should drink plenty of water." D. "I should avoid using irritants such as douches." Answer: B. "I can hold it when I need to urinate."
129. Your patient is on a low-sodium diet due to heart failure. Which food item should be avoided? A. Fresh fruits B. Grilled chicken C. Canned soup D. Steamed vegetables Answer: C. Canned soup
130. When assessing a patient with a suspected stroke, what is the FAST acronym used for? A. To assess blood pressure B. To remember the signs of a stroke C. To determine the level of consciousness D. To check vital signs Answer: B. To remember the signs of a stroke
131. A patient presents to the ER with severe abdominal pain and a rigid abdomen following a car accident. What should be your FIRST priority? A. Administer pain medication B. Obtain vital signs C. Prepare the patient for surgery D. Perform a thorough assessment Answer: B. Obtain vital signs
132. Which of the following symptoms is a common side effect of opioids? A. Diarrhea B. Nausea and vomiting C. Hypertension D. Increased energy Answer: B. Nausea and vomiting
133. Your patient is receiving IV antibiotics for an infection and develops a rash and difficulty breathing. What is your immediate action? A. Discontinue the antibiotic infusion

B. Notify the physician C. Administer an antihistamine D. Document the reaction Answer: A. Discontinue the antibiotic infusion

134. Which of the following laboratory values should be monitored in a patient receiving potassium-sparing diuretics? A. Hypernatremia B. Hyperkalemia C. Hyponatremia D. Hypercalcemia Answer: B. Hyperkalemia
135. During a routine examination, a nurse notes that a patient has a heart murmur. The provider orders a transesophageal echocardiogram (TEE). What is the purpose of this test? A. Assess blood flow in the heart chambers B. Evaluate cardiac stress C. Visualize the brain for stroke risk D. Check for gastrointestinal bleeding Answer: A. Assess blood flow in the heart chambers
136. What is the preferred position for a patient experiencing respiratory distress? A. Prone position B. Trendelenburg position C. High Fowler's position D. Supine position Answer: C. High Fowler's position
137. When caring for a patient with chronic kidney disease (CKD), which nutrient should be restricted in their diet? A. Protein B. Carbohydrates C. Vitamins D. Calcium Answer: A. Protein
138. Your patient has been diagnosed with pneumonia and started on antibiotics. What would be a key indicator of improvement? A. Increased heart rate B. Reduction in fever C. Increased respiratory rate D. Decreased appetite Answer: B. Reduction in fever
139. A patient scheduled for a CT scan with contrast dye has a history of contrast dye allergy. What is the best course of action? A. Proceed with the scan as planned

B. Pre-medicate with steroids and antihistamines C. Cancel the CT scan altogether D. Notify the physician and request an order for a different imaging study Answer: B. Pre-medicate with steroids and antihistamines

140. Which of the following is a critical finding in a patient with appendicitis? A. Nausea and vomiting B. Pain relief after defecation C. Rebound tenderness in the right lower quadrant D. Chronic indigestion Answer: C. Rebound tenderness in the right lower quadrant
141. Your newly admitted patient is on anticoagulants. Which nursing intervention is essential? A. Monitor vital signs every 4 hours B. Assess for signs of bleeding C. Perform daily weight checks D. Limit sodium intake Answer: B. Assess for signs of bleeding
142. A patient with heart failure has gained 3 pounds in two days. What is the MOST appropriate nursing action? A. Document the findings B. Encourage fluid intake C. Notify the physician D. Increase diuretics Answer: C. Notify the physician
143. You suspect your patient may be experiencing suicidal thoughts. What is the most appropriate initial question to ask? A. "Why do you feel this way?" B. "Have you thought about harming yourself?" C. "Are you having a bad day?" D. "Do you have a support system?" Answer: B. "Have you thought about harming yourself?"
144. Your patient is receiving a blood transfusion and develops an acute headache. What should you do first? A. Call the physician B. Assess the patient's vital signs C. Stop the transfusion D. Administer pain medication Answer: C. Stop the transfusion
145. What type of exercise is most important in the rehabilitation of a patient who has suffered a stroke? A. Resistance training