NCLEX RN Exam Test Bank, Exams of Nursing

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NCLEX RN Exam Test Bank

1. Which individual is at greatest risk for developing hypertension? A. 45-year-old African American attorney B. 60-year-old Asian American shop owner C. 40-year-old Caucasian nurse D. 55-year-old Hispanic teacher 1. Answer: A: 45-year-old African American attorney The incidence of hypertension is greater among African Americans than other groups in the US. The incidence among the Hispanic population is rising. 2. A child who ingested 15 maximum strength acetaminophen tablets 45 minutes ago is seen in the emergency department. Which of these orders should the nurse do first? A. Gastric lavage PRN B. Acetylcysteine (Mucomyst) for age per pharmacy C. Start an IV Dextrose 5% with 0.33% normal saline to keep vein open D. Activated charcoal per pharmacy 2. Answer: A: Gastric lavage PRN Removing as much of the drug as possible is the first step in treatment for this drug overdose. This is best done by gastric lavage. The next drug to give would be activated charcoal, then mucomyst and lastly the IV fluids. 3. Which complication of cardiac catheterization should the nurse monitor for in the initial 24 hours after the procedure? A. angina at rest B. thrombus formation C. dizziness D. falling blood pressure 3. Answer: B: thrombus formation Thrombus formation in the coronary arteries is a potential problem in the initial 24 hours after a cardiac catheterization. A falling BP occurs along with hemorrhage of the insertion site which is associated with the first 12 hours after the procedure.

4. A client is admitted to the emergency room with renal calculi and is complaining of moderate to severe flank pain and nausea. The client’s temperature is 100. degrees Fahrenheit. The priority nursing goal for this client is: A. Maintain fluid and electrolyte balance B. Control nausea C. Manage pain D. Prevent urinary tract infection 4. Answer: C: Manage pain The immediate goal of therapy is to alleviate the client’s pain. 5. What would the nurse expect to see while assessing the growth of children during their school age years? A. Decreasing amounts of body fat and muscle mass B. Little change in body appearance from year to year C. Progressive height increase of 4 inches each year D. Yearly weight gain of about 5.5 pounds per year 5. Answer: D: Yearly weight gain of about 5.5 pounds per year School age children gain about 5.5 pounds each year and increase about 2 inches in height. 6. At a community health fair, the blood pressure of a 62-year-old client is 160/ mmHg. The client states “My blood pressure is usually much lower.” The nurse should tell the client to A. go get a blood pressure check within the next 48 to 72 hours B. check blood pressure again in two (2) months C. see the health care provider immediately D. visit the health care provider within one (1) week for a BP check 6. Answer: A: go get a blood pressure check within the next 48 to 72 hours The blood pressure reading is moderately high with the need to have it rechecked in a few days. The client states it is ‘usually much lower.’ Thus a concern exists for complications such as stroke. However, immediate check by the provider of care is not warranted. Waiting 2 months or a week for follow-up is too long.

7. The hospital has sounded the call for a disaster drill on the evening shift. Which of these clients would the nurse put first on the list to be discharged in order to make a room available for a new admission? A. A middle-aged client with a history of being ventilator dependent for over seven (7) years and nmjadmitted with bacterial pneumonia five days ago. B. A young adult with diabetes mellitus Type 2 for over ten (10) years and admitted with antibiotic-induced diarrhea 24 hours ago. C. An elderly client with a history of hypertension, hypercholesterolemia, and lupus, and was admitted with Stevens-Johnson syndrome that morning. D. An adolescent with a positive HIV test and admitted for acute cellulitis of the lower leg 48 hours ago. 7. Answer: A: A middle-aged client with a history of being ventilator dependent for over 7 years and admitted with bacterial pneumonia five days ago The best candidate for discharge is one who has had a chronic condition and is most familiar with their care. This client in option A is most likely stable and could continue medication therapy at home. 8. A client has been newly diagnosed with hypothyroidism and will take levothyroxine (Synthroid) 50 mcg/day by mouth. As part of the teaching plan, the nurse emphasizes that this medication: A. Should be taken in the morning B. May decrease the client’s energy level C. Must be stored in a dark container D. Will decrease the client’s heart rate 8. Answer: A: Should be taken in the morning Thyroid supplement should be taken in the morning to minimize the side effects of insomnia 9. A 3-year-old child comes to the pediatric clinic after the sudden onset of findings that include irritability, thick muffled voice, croaking on inspiration, hot to touch, sit leaning fordward, tongue protruding, drooling and suprasternal retractions. What should the nurse do first? A. Prepare the child for X-ray of upper airways B. Examine the child’s throat C. Collect a sputum specimen D. Notify the healthcare provider of the child’s status

9. Answer: D: Notify the health care provider of the child’s status These findings suggest a medical emergency and may be due to epiglottitis. Any child with an acute onset of an inflammatory response in the mouth and throat should receive immediate attention in a facility equipped to perform intubation or a tracheostomy in the event of further or complete obstruction. 10. In children suspected to have a diagnosis of diabetes, which one of the following complaints would be most likely to prompt parents to take their school age child for evaluation? A. Polyphagia B. Dehydration C. Bedwetting D. Weight loss 10. Answer: C: Bedwetting In children, fatigue and bed wetting are the chief complaints that prompt parents to take their child for evaluation. Bed wetting in a school age child is readily detected by the parents. 11. A client comes to the clinic for treatment of recurrent pelvic inflammatory disease. The nurse recognizes that this condition most frequently follows which type of infection? A. Trichomoniasis B. Chlamydia C. Staphylococcus D. Streptococcus 11. Answer: B: Chlamydia Chlamydial infections are one of the most frequent causes of salpingitis or pelvic inflammatory disease. 12. An RN who usually works in a spinal rehabilitation unit is floated to the emergency department. Which of these clients should the charge nurse assign to this RN? A. A middle-aged client who says “I took too many diet pills” and “my heart feels like it is racing out of my chest.” B. A young adult who says “I hear songs from heaven. I need money for beer. I quit drinking two (2) days ago for my family. Why are my arms and legs jerking?” C. An adolescent who has been on pain medications terminal cancer with an initial assessment finding pupils and a relaxed respiratory rate of 10, D. An elderly client who reports having taken a “large crack hit” 10 minutes prior to walking into the emergency room.

12. Answer: C: An adolescent who has been on pain medications for terminal cancer with an initial assessment finding of pinpoint pupils and a relaxed respiratory rate of 10 Nurses who are floated to other units should be assigned to a client who has minimal anticipated immediate complications of their problem. The client in option C exhibits opioid toxicity with the pinpoint pupils and has the least risk of complications to occur in the near future 13. When teaching a client with coronary artery disease about nutrition, the nurse should emphasize A. Eating three (3) balanced meals a day B. Adding complex carbohydrates C. Avoiding very heavy meals D. Limiting sodium to 7 gms per day 13. Answer: C: Avoiding very heavy meals Eating large, heavy meals can pull blood away from the heart for digestion and is dangerous for the client with coronary artery disease. 14. Which of these findings indicate that a pump to deliver a basal rate of 10 ml per hour plus PRN for pain break through for morphine drip is not working? A. The client complains of discomfort at the IV insertion site B. The client states “I just can’t get relief from my pain.” C. The level of drug is 100 ml at 8 AM and is 80 ml at noon D. The level of the drug is 100 ml at 8 AM and is 50 ml at noon 14. Answer: C: The level of drug is 100 mL at 8 AM and is 80 mL at noon The minimal dose of 10 mL per hour which would be 40 mL given in a four (4) hour period. Only 60 mL should be left at noon. The pump is not functioning when more than expected medicine is left in the container. 15. The nurse is speaking at a community meeting about personal responsibility for health promotion. A participant asks about chiropractic treatment for illnesses. What should be the focus of the nurse’s response? A. Electrical energy fields B. Spinal column manipulation C. Mind-body balance D. Exercise of joints

15. Answer: B: Spinal column manipulation The theory underlying chiropractic is that interference with transmission of mental impulses between the brain and body organs produces diseases. Such interference is caused by misalignment of the vertebrae. Manipulation reduces the subluxation. 16. The nurse is performing a neurological assessment on a client post right CVA. Which finding, if observed by the nurse, would warrant immediate attention? A. Decrease in level of consciousness B. Loss of bladder control C. Altered sensation to stimuli D. Emotional ability 16. Answer: A: Decrease in level of consciousness A further decrease in the level of consciousness would be indicative of a further progression of the CVA. 17. A child who has recently been diagnosed with cystic fibrosis is in a pediatric clinic where a nurse is performing an assessment. Which later finding of this disease would the nurse not expect to see at this time? A. Positive sweat test B. Bulky greasy stools C. Moist, productive cough D. Meconium ileus 17. Answer: C: Moist, productive cough Option c is a later sign. Noisy respirations and a dry non-productive cough are commonly the first of the respiratory signs to appear in a newly diagnosed client with cystic fibrosis (CF). The other options are the earliest findings. CF is an inherited (genetic) condition affecting the cells that produce mucus, sweat, saliva and digestive juices. Normally, these secretions are thin and slippery, but in CF, a defective gene causes the secretions to become thick and sticky. Instead of acting as a lubricant, the secretions plug up tubes, ducts, and passageways, especially in the pancreas and lungs. Respiratory failure is the most dangerous consequence of CF. 18. The home health nurse visits a male client to provide wound care and finds the client lethargic and confused. His wife states he fell down the stairs 2 hours ago. The nurse should A. Place a call to the client’s health care provider for instructions B. Send him to the emergency room for evaluation C. Reassure the client’s wife that the symptoms are transient D. Instruct the client’s wife to call the doctor if his symptoms become worse

18. Answer: B: Send him to the emergency room for evaluation This client requires immediate evaluation. A delay in treatment could result in further deterioration and harm. Home care nurses must prioritize interventions based on assessment findings that are in the client’s best interest. 19. Which of the following should the nurse implement to prepare a client for a KUB (Kidney, Ureter, Bladder) radiograph test? A. Client must be NPO before the examination B. Enema to be administered prior to the examination C. Medicate client with Lasix 20 mg IV 30 minutes prior to the examination D. No special orders are necessary for this examination 19. Answer: D: No special orders are necessary for this examination No special preparation is necessary for this examination. 20. The nurse is giving discharge teaching to a client seven (7) days post myocardial infarction. He asks the nurse why he must wait six (6) weeks before having sexual intercourse. What is the best response by the nurse to this question? A. “You need to regain your strength before attempting such exertion.” B. “When you can climb 2 flights of stairs without problems, it is generally safe.” C. “Have a glass of wine to relax you, then you can try to have sex.” D. “If you can maintain an active walking program, you will have less risk.” 20. Answer: B: “When you can climb 2 flights of stairs without problems, it is generally safe.” There is a risk of cardiac rupture at the point of the myocardial infarction for about six (6) weeks. Scar tissue should form about that time. Waiting until the client can tolerate climbing stairs is the usual advice given by health care providers. 21. A triage nurse has these four (4) clients arrive in the emergency department within 15 minutes. Which client should the triage nurse send back to be seen first? A. A 2-month-old infant with a history of rolling off the bed and has bulging fontanels with crying B. A teenager who got a singed beard while camping C. An elderly client with complaints of frequent liquid brown colored stools D. A middle-aged client with intermittent pain behind the right scapula 21. Answer: B: A teenager who got signed beard while camping

This client is in the greatest danger with a potential of respiratory distress. Any client with singed facial hair has been exposed to heat or fire in close range that could have caused serious damage to the interior of the lungs. Note that the interior linings of the lungs have no nerve fibers so the client will not be aware of swelling.

22. While planning care for a toddler, the nurse teaches the parents about the expected developmental changes for this age. Which statement by the mother shows that she understands the child’s developmental needs? A. “I want to protect my child from any falls.” B. “I will set limits on exploring the house.” C. “I understand the need to use those new skills.” D. “I intend to keep control over our child.” 22. Answer: C: “I understand the need to use those new skills.” Erikson describes the stage of the toddler as being the time when there is normally an increase in autonomy. The child needs to use motor skills to explore the environment. 23. The nurse is preparing to administer an enteral feeding to a client via a nasogastric feeding tube. The most important action of the nurse is A. Verify correct placement of the tube B. Check that the feeding solution matches the dietary order C. Aspirate abdominal contents to determine the amount of last feeding remaining in stomach D. Ensure that feeding solution is at room temperature 23. Answer: A: Verify correct placement of the tube Proper placement of the tube prevents aspiration. 24. The nurse is caring for a client with a serum potassium level of 3.5 mEq/L. The client is placed on a cardiac monitor and receives 40 mEq KCL in 1000 ml of 5% dextrose in water IV. Which of the following EKG patterns indicates to the nurse that the infusions should be discontinued? A. Narrowed QRS complex B. Shortened “PR” interval C. Tall peaked “T” waves D. Prominent “U” waves 24. Answer: C: Tall peaked T waves A tall peaked T wave is a sign of hyperkalemia. The health care provider should be notified regarding discontinuing the medication.

25. A nurse prepares to care for a 4-year-old newly admitted for rhabdomyosarcoma. The nurse should alert the staff to pay more attention to the function of which area of the body? A. All striated muscles B. The cerebellum C. The kidneys D. The leg bones 25. Answer: A: All striated muscles Rhabdomyosarcoma is the most common children’s soft tissue sarcoma. It originates in striated (skeletal) muscles and can be found anywhere in the body. The clue is in the middle of the word and is “myo” which typically means muscle. 26. The nurse anticipates that for a family who practices Chinese medicine the priority goal would be to: A. Achieve harmony B. Maintain a balance of energy C. Respect life D. Restore yin and yang 26. Answer: D: Restore yin and yang For followers of Chinese medicine, health is maintained through the balance between the forces of yin and yang. 27. During an assessment of a client with cardiomyopathy, the nurse finds that the systolic blood pressure has decreased from 145 to 110 mm Hg and the heart rate has risen from 72 to 96 beats per minute and the client complains of periodic dizzy spells. The nurse instructs the client to A. Increase fluids that are high in protein B. Restrict fluids C. Force fluids and reassess blood pressure D. Limit fluids to non-caffeine beverages 27. Answer: C: Force fluids and reassess blood pressure Postural hypotension, a decrease in systolic blood pressure of more than 15 mmHg and an increase in heart rate of more than 15 percent usually accompanied by dizziness indicate volume depletion, inadequate vasoconstrictor mechanisms, and autonomic insufficiency.

28. The nurse prepares the client for insertion of a pulmonary artery catheter (Swan- Ganz catheter). The nurse teaches the client that the catheter will be inserted to provide information about: A. Stroke volume B. Cardiac output C. Venous pressure D. Left ventricular functioning 28. Answer: D. Left ventricular functioning The catheter is placed in the pulmonary artery. Information regarding left ventricular function is obtained when the catheter balloon is inflated. 29. A nurse enters a client’s room to discover that the client has no pulse or respirations. After calling for help, the first action the nurse should take is: A. Start a peripheral IV B. Initiate high-quality chest compressions C. Establish an airway D. Obtain the crash cart 29. Answer: B. Initiate high-quality chest compressions As per new guidelines, the American Heart Association recommends beginning CPR with chest compression (rather than checking for the airway first). Start CPR with 30 chest compressions before checking the airway and giving rescue breaths. Starting with chest compressions first applies to adults, children, and infants needing CPR, but not newborns. CPR can keep oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm. 30. A client is receiving digoxin (Lanoxin) 0.25 mg daily. The health care provider has written a new order to give metoprolol (Lopressor) 25 mg B.I.D. In assessing the client prior to administering the medications, which of the following should the nurse report immediately to the health care provider? A. Blood pressure 94/ B. Heart rate 76 C. Urine output 50 ml/hour D. Respiratory rate 16 30. Answer: A: Blood pressure 94/ Both medications decrease the heart rate. Metoprolol affects blood pressure. Therefore, the heart rate and blood pressure must be within normal range (HR 60-100; systolic BP over 100) in order to safely administer both medications.

31. While assessing a 1-month-old infant, which finding should the nurse report immediately? A. Abdominal respirations B. Irregular breathing rate C. Inspiratory grunt D. Increased heart rate with crying 31. Answer: C: Inspiratory grunt Inspiratory grunting is abnormal and may be a sign of respiratory distress in this infant. 32. The nurse practicing in a maternity setting recognizes that the post mature fetus is at risk due to A. Excessive fetal weight B. Low blood sugar levels C. Depletion of subcutaneous fat D. Progressive placental insufficiency 32. Answer: D: Progressive placental insufficiency The placenta functions less efficiently as the pregnancy continues beyond 42 weeks. Immediate and long-term effects may be related to hypoxia. 33. The nurse is caring for a client who had a total hip replacement four (4) days ago. Which assessment requires the nurse’s immediate attention? A. I have bad muscle spasms in my lower leg of the affected extremity. B. “I just can’t ‘catch my breath’ over the past few minutes and I think I am in grave danger.” C. “I have to use the bedpan to pass my water at least every 1 to 2 hours.” D. “It seems that the pain medication is not working as well today.” 33. Answer: B: “I just can’t ”catch my breath” over the past few minutes and I think I am in grave danger.” The nurse would be concerned about all of these comments. However, the most life threatening is option B. Clients who have had hip or knee surgery are at greatest risk for development of postoperative pulmonary embolism. Sudden dyspnea and tachycardia are classic findings of pulmonary embolism. Muscle spasms do not require immediate attention. Option C may indicate a urinary tract infection. And option D requires further investigation and is not life threatening.

34. A client has been taking furosemide (Lasix) for the past week. The nurse recognizes which finding may indicate the client is experiencing a negative side effect from the medication? A. Weight gain of 5 pounds B. Edema of the ankles C. Gastric irritability D. Decreased appetite 34. Answer: D: Decreased appetite Lasix causes a loss of potassium if a supplement is not taken. Signs and symptoms of hypokalemia include anorexia, fatigue, nausea, decreased GI motility, muscle weakness, dysrhythmias. 35. A client who is pregnant comes to the clinic for a first visit. The nurse gathers data about her obstetric history, which includes 3-year-old twins at home and a miscarriage 10 years ago at 12 weeks gestation. How would the nurse accurately document this information? A. Gravida 4 para 2 B. Gravida 2 para 1 C. Gravida 3 para 1 D. Gravida 3 para 2 35. Answer: C: Gravida 3 para 1 Gravida is the number of pregnancies and Parity is the number of pregnancies that reach viability (not the number of fetuses). Thus, for this woman, she is now pregnant, had 2 prior pregnancies, and 1 viable birth (twins). 36. The nurse is caring for a client with a venous stasis ulcer. Which nursing intervention would be most effective in promoting healing? A. Apply dressing using sterile technique B. Improve the client’s nutrition status C. Initiate limb compression therapy D. Begin proteolytic debridement 36. Answer: B: Improve the client’s nutritional status The goal of clinical management in a client with venous stasis ulcers is to promote healing. This only can be accomplished with proper nutrition. The other answers are correct, but without proper nutrition, the other interventions would be of little help.

37. A nurse is to administer meperidine hydrochloride (Demerol) 100 mg, atropine sulfate (Atropisol) 0.4 mg, and promethazine hydrochloride (Phenergan) 50 mg IM to a pre- operative client. Which action should the nurse take first? A. Raise the side rails on the bed B. Place the call bell within reach C. Instruct the client to remain in bed D. Have the client empty bladder 37. Answer: D: Have the client empty bladder The first step in the process is to have the client void prior to administering the pre-operative medication. The other actions follow this initial step in this sequence: D, C, A and then B. 38. Which of these statements best describes the characteristic of an effective reward- feedback system? A. Specific feedback is given as close to the event as possible B. Staff is given feedback in equal amounts over time C. Positive statements are to precede a negative statement D. Performance goals should be higher than what is attainable 38. Answer: A: Specific feedback is given as close to the event as possible Feedback is most useful when given immediately. Positive behavior is strengthened through immediate feedback, and it is easier to modify problem behaviors if the standards are clearly understood. 39. A client with multiple sclerosis plans to begin an exercise program. In addition to discussing the benefits of regular exercise, the nurse should caution the client to avoid activities which A. Increase the heart rate B. Lead to dehydration C. Are considered aerobic D. May be competitive 39. Answer: B: Lead to dehydration The client must take in adequate fluids before and during exercise periods.

40. During the evaluation of the quality of home care for a client with Alzheimer’s disease, the priority for the nurse is to reinforce which statement by a family member? A. At least two (2) full meals a day is eaten. B. We go to a group discussion every week at our community center. C. We have safety bars installed in the bathroom and have 24-hour alarms on the doors. D. The medication is not a problem to have it taken three (3) times a day. 40. Answer: C: We have safety bars installed in the bathroom and have 24-hour alarms on the doors. Ensuring safety of the client with increasing memory loss is a priority of home care. Note all options are correct statements. However, safety is most important to reinforce Part B

1. A nurse is reviewing a patient’s medication during shift change. Which of the following medication would be contraindicated if the patient were pregnant? Select all that apply: A. Warfarin (Coumadin) B. Finasteride (Propecia, Proscar) C. Celecoxib (Celebrex) D. Clonidine (Catapres) E. Transdermal nicotine (Habitrol) F. Clofazimine(Lamprene) 2. A nurse is reviewing a patient’s past medical history (PMH). The history indicates the patient has photosensitive reactions to medications. Which of the following drugs is associated with photosensitive reactions? Select all that apply: A. Ciprofloxacin (Cipro) B. Sulfonamide C. Norfloxacin (Noroxin) D. Sulfamethoxazole and Trimethoprim (Bactrim) E. Isotretinoin (Accutane) F. Nitro-Dur patch 3. A patient tells you that her urine is starting to look discolored. If you believe this change is due to medication, which of the following of the patient’s medication does not cause urine discoloration? A. Sulfasalazine B. Levodopa C. Phenolphthalein D. Aspirin 4. You are responsible for reviewing the nursing unit’s refrigerator. Which of the following drug, if found inside the fridge, should be removed? A. Nadolol (Corgard) B. Opened (in-use) Humulin N injection C. Urokinase (Kinlytic) D. Epoetin alfa IV (Epogen) 5. 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. IgA B. IgD C. IgE D. IgG

6. A second year nursing student has just suffered a needlestick while working with a patient that is positive for AIDS. Which of the following is the most significant action that nursing student should take? A. Immediately see a social worker. B. Start prophylactic AZT treatment. C. Start prophylactic Pentamidine treatment. D. Seek counseling. 7. A thirty-five-year-old male has been an insulin-dependent diabetic for five years and now is unable to urinate. Which of the following would you most likely suspect? A. Atherosclerosis B. Diabetic nephropathy C. Autonomic neuropathy D. Somatic neuropathy 8. 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 sclerosis B. Anorexia nervosa C. Bulimia nervosa D. Systemic sclerosis 9. A 24-year-old female is admitted to the ER for confusion. This patient has a history of a myeloma diagnosis, constipation, intense abdominal pain, and polyuria. Based on the presenting signs and symptoms, which of the following would you most likely suspect? A. Diverticulosis B. Hypercalcaemia C. Hypocalcemia D. Irritable bowel syndrome 10. Rhogam is most often used to treat mothers that have a infant. A. RH positive, RH positive B. RH positive, RH negative C. RH negative, RH positive D. RH negative, RH negative 11. A new mother has some questions about phenylketonuria (PKU). Which of the following statements made by a nurse is not correct regarding PKU?

A. A Guthrie test can check the necessary lab values. B. The urine has a high concentration of phenylpyruvic acid C. Mental deficits are often present with PKU. D. The effects of PKU are reversible.

12. A patient has taken an overdose of aspirin. Which of the following should a nurse most closely monitor for during acute management of this patient? A. Onset of pulmonary edema B. Metabolic alkalosis C. Respiratory alkalosis D. Parkinson’s disease type symptoms 13. A 50-year-old blind and deaf patient have been admitted to your floor. As the charge nurse, your primary 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. 14. A patient is getting discharged from a skilled nursing facility (SNF). The patient has a history of severe COPD and PVD. The patient is primarily concerned about his ability to breathe easily. Which of the following would be the best instruction for this patient? A. Deep breathing techniques to increase oxygen levels. B. Cough regularly and deeply to clear airway passages. C. Cough following bronchodilator utilization. D. Decrease CO2 levels by increased oxygen take output during meals. 15. A nurse is caring for an infant that has recently been diagnosed with a congenital heart defect. Which of the following clinical signs would most likely be present? A. Slow pulse rate B. Weight gain C. Decreased systolic pressure D. Irregular WBC lab values 16. A mother has recently been informed that her child has Down’s syndrome. You will be assigned to care for the child at shift change. Which of the following characteristics is not associated with Down’s syndrome? A. Simian crease B. Brachycephaly C. Oily skin D. Hypotonicity

17. A client with myocardial infarction is receiving tissue plasminogen activator, alteplase (Activase, tPA). While on the therapy, the nurse plans to prioritize which of the following? A. Observe for neurological changes. B. Monitor for any signs of renal failure. C. Check the food diary. D. Observe for signs of bleeding. 18. A patient asks a nurse, “My doctor recommended I increase my intake of folic acid. What type of foods contain the highest concentration of folic acids?” A. Green vegetables and liver B. Yellow vegetables and red meat C. Carrots D. Milk 19. A nurse is putting together a presentation on meningitis. Which of the following microorganisms has not been linked to meningitis in humans? A. S. pneumoniae B. H. influenzae C. N. meningitidis D. Cl. difficile 20. A nurse is administering blood to a patient who has a low hemoglobin count. The patient asks how long 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. 21. A 65-year-old man has been admitted to the hospital for spinal stenosis surgery. When should the discharge training and planning begin for this patient? A. Following surgery B. Upon admit C. Within 48 hours of discharge D. Preoperative discussion 22. A 5-year-old child and has been recently admitted to the hospital. According to Erik Erikson’s psychosocial development stages, the child is in which stage? A. Trust vs. mistrust B. Initiative vs. guilt

C. Autonomy vs. shame and doubt D. Intimacy vs. isolation

23. A toddler is 26 months old and has been recently admitted to the hospital. According to Erikson, which of the following stages is the toddler in? A. Trust vs. mistrust B. Initiative vs. guilt C. Autonomy vs. shame and doubt D. Intimacy vs. isolation 24. A young adult is 20 years old and has been recently admitted to the hospital. According to Erikson, which of the following stages is the adult in? A. Trust vs. mistrust B. Initiative vs. guilt C. Autonomy vs. shame D. Intimacy vs. isolation 25. A nurse is making rounds taking vital signs. Which of the following vital signs is abnormal? A. 11-year-old male: 90 BPM, 22 RPM, 100/70 mmHg B. 13-year-old female: 105 BPM, 22 RPM, 105/ mmHg C. 5-year-old male: 102 BPM, 24 RPM, 90/65 mmHg D. 6-year-old female: 100 BPM, 26 RPM, 90/70 mmHg 26. When you are taking a patient’s history, she tells you she has been depressed and is dealing with an anxiety disorder. Which of the following medications would the patient most likely be taking? A. Amitriptyline (Elavil) B. Calcitonin C. Pergolide mesylate (Permax) D. Verapamil (Calan) 27. Which of the following conditions would a nurse not administer erythromycin? A. Campylobacteriosis infection B. Legionnaire’s disease C. Pneumonia D. Multiple Sclerosis 28. A patient’s chart indicates a history of hyperkalemia. Which of the following would you not expect to see with this patient if this condition were acute?

A. Decreased HR B. Paresthesias C. Muscle weakness of the extremities D. Migraines

29. A patient’s chart indicates a history of ketoacidosis. Which of the following would you not expect to see with this patient if this condition were acute? A. Vomiting B. Extreme Thirst C. Weight gain D. Acetone breath smell 30. A patient’s chart indicates a history of meningitis. Which of the following would you not expect to see with this patient if this condition were acute? A. Increased appetite B. Vomiting C. Fever D. Poor tolerance of light 31. 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 pestis B. Helicobacter pylori C. Vibrio cholerae D. Haemophilus aegyptius 32. 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 burgdorferi B. Streptococcus pyogenes C. Bacillus anthracis D. Enterococcus faecalis 33. A fragile 87-year-old female has recently been admitted to the hospital with increased confusion and falls over last two (2) weeks. She is also noted to have a mild left hemiparesis. Which of the following tests is most likely to be performed? A. FBC (full blood count) B. ECG (electrocardiogram) C. Thyroid function tests D. CT scan

34. An 84-year-old male has been losing mobility and gaining weight over the last two (2) months. The patient also has the heater running in his house 24 hours a day, even on warm days. Which of the following tests is most likely to be performed? A. FBC (full blood count) B. ECG (electrocardiogram) C. Thyroid function tests D. CT scan 35. A 20-year-old female attending college is found unconscious in her dorm room. She has a fever and a noticeable rash. She has just been admitted to the hospital. Which of the following tests is most likely to be performed first? A. Blood sugar check B. CT scan C. Blood cultures D. Arterial blood gases 36. A 28-year-old male has been found wandering around in a confused pattern. The male is sweaty and pale. Which of the following tests is most likely to be performed first? A. Blood sugar check B. CT scan C. Blood cultures D. Arterial blood gases 37. A mother is inquiring about her child’s ability to potty train. Which of the following factors is the most important aspect of toilet training? A. The age of the child B. The child’s ability to understand instruction. C. The overall mental and physical abilities of the child. D. Frequent attempts with positive reinforcement. 38. A parent calls the pediatric clinic and is frantic about the bottle of cleaning fluid her child drank 20 minutes. 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 ER C. Contact the Poison Control Center quickly D. Give the child syrup of ipecac 39. A nurse is administering a shot of Vitamin K to a 30 day-old infant. Which of the following target areas is the most appropriate?

A. Gluteus maximus B. Gluteus minimus C. Vastus lateralis D. Vastus medialis

40. 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 provider B. Ask the child to write their name on paper. C. Ask a coworker about the identification of the child. D. Ask the father who is in the room the child’s name.

Answers and Rationale

1. Answers: A, and B. - A: Warfarin (Coumadin). Has a pregnancy category X and associated with central nervous system defects, spontaneous abortion, stillbirth, prematurity, hemorrhage, and ocular defects when given anytime during pregnancy and a fetal warfarin syndrome when given during the first trimester. - B: Finasteride (Propecia, Proscar). Also has a pregnancy category X which has a high risk of causing permanent damage to the fetus. - C: Celecoxib (Celebrex). Large doses cause birth defects in rabbits; not known if the effect on people is the same. - D: Clonidine (Catapres). Crosses the placenta but no adverse fetal effects have been observed. - E: Transdermal nicotine (Habitrol). Nicotine replacement products have been assigned to pregnancy category C (nicotine gum) and category D (transdermal patches, inhalers, and spray nicotine products). - F: Clofazimine (Lamprene). Clofazimine has been assigned to pregnancy category C. 2. Answers: A, B, C, D, and E. Photosensitivity is an extreme sensitivity to ultraviolet (UV) rays from the sun and other light sources. A type of photosensitivity called Phototoxic reactions are caused when medications in the body interact with UV rays from the sun. Antiinfectives are the most common cause of this type of reaction. 3. Answer: D. Aspirin - D. Aspirin is not known to cause discoloration of the urine. - A: Sulfasalazine may discolor the urine or skin to an orange-yellow color. - B: Levodopa may discolor the urine, saliva, or sweat to a dark brown color. - C: Phenolphthalein can discolor the urine to a red color.

4. Answer: A. Corgard - A: Nadolol (Corgard): Stored at room temperature between 59 to 86 ºF (15 and 30 ºC) away from heat, moisture, and light. Do not store in the bathroom and keep bottle tightly closed. - B: Humulin N injection: If unopened (not in use) store Humulin N in the fridge and use until expiration date; or store at room temperature and use within 31 days. If opened (in- use), store the vial in a refrigerator or at room temperature and use within 31 days. Store the injection pen at room temperature (do not refrigerate) and use within 14 days. Keep it in its original container protected from heat and light. Do not draw insulin from a vial into a syringe until you are ready to give an injection. Do not freeze insulin or store it near the cooling element in a refrigerator. Throw away any insulin that has been frozen. - C: Urokinase (Kinlytic): Refrigerate at 2–8°C. - D: Epoetin alfa IV (Epogen): Vials should be stored at 2°C to 8°C (36°F to 46°F); Do not freeze. Do not shake. Protect from light. 5. Answer: D. IgG - D: IgG is the only immunoglobulin that can cross the placental barrier. - A: IgA antibodies protect body surfaces that are exposed to outside foreign substances. - B: IgD antibodies are found in small amounts in the tissues that line the belly or chest. - C: IgE antibodies cause the body to react against foreign substances such as pollen, spores, animal dander. 6. Answer: B. Start prophylactic AZT treatment - B: Azidothymidine (AZT) treatment is the most critical intervention. It is an antiretroviral medication used to prevent and treat HIV/AIDS by reducing the replication of the virus. - C: Pentamidine is an antimicrobial medication given to prevent and treat pneumocystis pneumonia. - A and D: Other interventions mentioned are to be done later. 7. Answer: C. Autonomic neuropathy - C: Autonomic neuropathy (also known as Diabetic Autonomic Neuropathy) affects the autonomic nerves, which control the bladder, intestinal tract, and genitals, among other organs. Paralysis of the bladder is a common symptom of this type of neuropathy. - A: Atherosclerosis, or hardening of the arteries, is a condition in which plaque builds up inside the arteries. Plaque is made of cholesterol, fatty substances, cellular waste products, calcium and fibrin (a clotting material in the blood). - B: Diabetic nephropathy (DN) is typically defined by macroalbuminuria—that is, a urinary albumin excretion of more than 300 mg in a 24-hour collection—or macroalbuminuria and abnormal renal function as represented by an abnormality in serum creatinine, calculated creatinine clearance, or glomerular filtration rate (GFR). Clinically, diabetic nephropathy is characterized by a progressive increase in proteinuria

and decline in GFR, hypertension, and a high risk of cardiovascular morbidity and mortality.

• D: Somatic neuropathy affects the whole body and presents with diverse clinical pictures, most common is the development of diabetic foot followed by diabetic ulceration and possible amputation. 8. Answer: B. Anorexia nervosa
• B: All of the clinical signs and symptoms point to a condition of anorexia nervosa. The key feature of anorexia nervosa is self-imposed starvation, resulting from a distorted body image and an intense, irrational fear of gaining weight, even when the patient is emaciated. Anorexia nervosa may include refusal to eat accompanied by compulsive exercising, self-induced vomiting, or laxative or diuretic abuse.
• C: On the other hand , bulimia nervosa features binge eating followed by a feeling of guilt, humiliation, and self-deprecation. These feelings cause the patient to engage in self- induced vomiting, use of laxatives or diuretics.
• A: Multiple sclerosis (MS) is a demyelinating disease in which the insulating covers of the nerve cells in the brain and spinal cord are damaged.
• D: Systemic sclerosis or systemic scleroderma is an autoimmune disease of the connective tissue. 9. Answer: B. Hypercalcemia
• B: Hypercalcaemia can cause polyuria, severe abdominal pain, and confusion.
• A: Diverticulosis is a condition that develops when pouches (diverticula) form in the wall of the large intestine; most people don’t have symptoms.
• C: Hypocalcemia is low calcium levels in the blood; it is asymptomatic in mild forms but can cause paresthesia, tetany, muscle cramps, and carpopedal spasms in severe hypocalcemia.
• D: Irritable bowel syndrome is a widespread condition involving recurrent abdominal pain and diarrhea or constipation, often associated with stress, depression, anxiety, or previous intestinal infection. 10. Answer: C. RH negative, RH positive Rhogam prevents the production of anti-RH antibodies in the mother that has a Rh positive fetus. 11. Answer: D. The effects of PKU are reversible. Phenylketonuria (PKU) is an inherited disorder that increases the levels of phenylalanine (a building block of proteins) in the blood. If PKU is not treated, phenylalanine can build up to harmful levels in the body, causing intellectual disability and other serious health problems. The signs and symptoms of PKU vary from mild to severe. The most severe form of this disorder is known as classic PKU. Infants with classic PKU appear normal until they are a few months old. Without treatment, these children develop a permanent intellectual disability. Seizures, delayed development, behavioral problems, and psychiatric disorders are also common. Untreated