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Adult 1 Final Mock Exam
40 Clinically Focused Questions | Answers & Rationales at the End
Instructions: Answer all questions before checking the answer key. Some questions are Select all that apply (SATA). Choose all correct options for SATA items. This exam is intentionally application-level and patient-focused, modeled for final-exam review across renal/GU, GI, hematologic/immune, fluid/electrolyte/acid-base, endocrine, SLE, oncology/palliative, nutrition, surgical nursing, chronic illness, and delegation/prioritization. Topic Map Questions Main Area High-Yield Focus 1-5 Renal/GU UTI, BPH, AKI/CKD, AV fistula, peritoneal dialysis 6-10 GI UC, appendicitis, peritonitis, GERD, gallbladder 11-15 Hematologic/Immune Anemia, leukemia, neutropenia, HIV/CD 16-20 Fluids/Electrolytes/ABGs Fluid overload, hypercalcemia, acid- base interpretation 21-25 Endocrine Diabetes, hypoglycemia, thyroid storm, SIADH 26-30 SLE/Oncology/Palliative SLE, melanoma, hospice/palliative symptoms 31-35 Nutrition/Surgical/Chronic Illness Fat-soluble vitamins, older adults, pre- op, chronic illness 36-40 Prioritization/Delegation RN/LPN/UAP roles and safety priorities
- A 74-year-old client is brought to the clinic by her daughter, who reports the client has been “not herself,” weak, and more confused for 2 days. The client denies burning with urination. Vital signs: T 99.8°F, HR 104, BP 132/78. Urinalysis shows leukocyte esterase and nitrites. Which nursing interpretation is best? A. The client is unlikely to have a UTI because dysuria is absent. B. The client may have a UTI because older adults can present with confusion and weakness. C. The client most likely has pyelonephritis because nitrites confirm kidney infection. D. The client should be taught that confusion is expected with normal aging.
- A male client with BPH reports increasing nocturia, hesitancy, weak stream, and dribbling. This morning he has severe suprapubic discomfort and has not voided for 10 hours. What is the nurse’s priority concern? A. Expected urinary frequency from aging B. Acute urinary retention related to obstruction C. Stress incontinence related to pelvic floor weakness D. Normal effect of increased fluid intake
- A client with AKI has K+ 6.6 mEq/L and new peaked T waves on ECG. Which provider prescription should the nurse anticipate as the most immediate cardiac-protective medication? A. Calcium gluconate IV B. Oral vitamin K C. Furosemide PO once daily D. Epoetin alfa subcutaneous
- The nurse is assessing a client’s new AV fistula before hemodialysis. Which finding requires immediate follow-up? A. Palpable vibration over the access site B. Audible whooshing sound with a stethoscope C. Absence of both thrill and bruit D. Mild healed scar near the access site
- A client receiving peritoneal dialysis reports abdominal pain. The nurse notes cloudy dialysate outflow. Which action is most appropriate? A. Document as expected protein loss during dialysis. B. Warm the dialysate in a microwave for the next exchange. C. Notify the provider because this suggests peritonitis. D. Encourage the client to drink less fluid and reassess tomorrow.
- A client with ulcerative colitis reports 16 bloody stools in 24 hours, dizziness when standing, and increasing fatigue. Which nursing concern is priority? A. Fluid volume deficit and anemia B. Urinary retention from obstruction C. Risk for hypercalcemia D. Metabolic alkalosis from acid loss
- A client with suspected appendicitis states, “The pain suddenly went away.” The client was previously guarding the RLQ. Which response by the nurse is best? A. “That means the inflammation has resolved.” B. “You can now eat before surgery.” C. “I need to reassess you and notify the provider because rupture is possible.” D. “I will give a laxative to clear the bowel.”
C. The symptoms are unrelated to HIV unless oral thrush is present. D. The client should stop ART until symptoms resolve.
- A client asks the difference between CD4 count and viral load. Which response is best? A. CD4 is the amount of virus; viral load is immune strength. B. CD4 reflects immune strength; viral load reflects the amount of virus. C. Both values mean the same thing. D. CD4 only matters in clients without HIV symptoms.
- A client with CKD has gained 5 lb in 3 days, has crackles, dyspnea when lying flat, and pitting edema. What action should the nurse take first? A. Place the client in high Fowler’s position and assess oxygenation. B. Encourage 1 L of oral fluids immediately. C. Prepare a high-sodium meal tray. D. Tell the client weight gain is expected in CKD and requires no follow-up.
- A client with metastatic bone cancer has calcium 12.8 mg/dL, confusion, constipation, and weakness. Which nursing interventions are appropriate? Select all that apply. A. Institute fall precautions. B. Encourage mobility as tolerated. C. Monitor cardiac rhythm if severe/symptomatic. D. Administer calcium supplements to protect bones. E. Encourage hydration if not contraindicated.
- A client with COPD exacerbation has ABGs: pH 7.29, PaCO2 58, HCO3 25. How should the nurse interpret this ABG? A. Uncompensated respiratory acidosis B. Uncompensated metabolic acidosis C. Partially compensated respiratory alkalosis D. Fully compensated metabolic alkalosis
- A client with prolonged vomiting has ABGs: pH 7.50, PaCO2 43, HCO3 31. Which imbalance is present? A. Metabolic alkalosis B. Metabolic acidosis C. Respiratory acidosis D. Respiratory alkalosis
- A client with DKA has deep, rapid respirations and K+ 5.8 mEq/L. Which explanation best connects these findings? A. DKA causes metabolic alkalosis and potassium moves into cells. B. DKA causes metabolic acidosis; Kussmaul respirations compensate and potassium can shift out of cells. C. DKA causes respiratory alkalosis because CO2 is trapped. D. DKA causes hypocalcemia, which explains deep breathing.
- A client with type 2 diabetes takes glipizide before breakfast but then skips the meal to go to a lab appointment. Two hours later the client is shaky, sweaty, hungry, and confused. What should the nurse do first if the client is awake and can swallow? A. Administer 15 g fast-acting carbohydrate.
B. Administer long-acting insulin. C. Encourage vigorous exercise to lower glucose. D. Wait until lunch and reassess.
- A client with hyperthyroidism develops temperature 104°F, HR 152, severe agitation, vomiting, and confusion. Which intervention cluster is most appropriate? A. Warm blankets, increased stimulation, and delayed ECG monitoring B. Cooling measures, cardiac monitoring, beta blocker/antithyroid medications as prescribed, and low-stimulation environment C. Fluid restriction, seizure precautions only, and oral glucose D. High-fiber diet teaching and discharge planning
- A client with SIADH has sodium 118 mEq/L, new confusion, and muscle twitching. Which nursing action is priority? A. Encourage free water intake. B. Implement seizure precautions and notify the provider. C. Administer hypotonic IV fluids rapidly. D. Give high-potassium foods.
- A client with SIADH is prescribed 3% hypertonic saline for severe symptomatic hyponatremia. Which nursing consideration is most important? A. Correct sodium as quickly as possible to prevent thirst. B. Use an IV pump and monitor sodium/neuro status closely because rapid correction can cause neurologic injury. C. Give the solution freely by gravity tubing. D. Hold all neurologic assessments until infusion is complete.
- A client with type 2 diabetes says, “My feet feel numb, so I use a heating pad at night to warm them.” Which response is best? A. “That is a safe way to improve circulation.” B. “Avoid heating pads on your feet because numbness can prevent you from feeling burns.” C. “Only use the heating pad if your glucose is normal.” D. “Foot care is only important for clients who take insulin.”
- A client with SLE asks how to prevent flares. Which teaching is most important? A. Use SPF 30 or greater, avoid UV exposure/tanning beds, and wear protective clothing. B. Increase sun exposure to improve vitamin D without sunscreen. C. Stop corticosteroids abruptly once joint pain improves. D. Report only high fevers above 104°F.
- A client with SLE reports foamy urine, ankle swelling, and higher blood pressure readings. Which complication should the nurse suspect? A. Lupus nephritis B. Expected photosensitivity only C. GERD exacerbation D. Vitamin E toxicity
- A client asks how to monitor a mole. Which finding should the nurse emphasize as most concerning? A. A symmetric mole unchanged for years B. A mole with irregular borders, multiple colors, and recent growth
C. “Stop all medications until you feel worse.” D. “This means the chronic illness cannot be managed.”
- A client scheduled for surgery says, “I signed the consent, but I still do not understand what they are going to remove.” What should the nurse do? A. Explain the full surgical risks and benefits independently. B. Notify the provider to clarify before surgery proceeds. C. Send the client to the OR because the signature is complete. D. Ask the UAP to re-explain the procedure.
- Which task is most appropriate for the RN to delegate to UAP? A. Initial assessment of a new admission with chest pain B. Discharge teaching for a client newly prescribed insulin C. Ambulating a stable postoperative client who has already walked safely twice D. Evaluating whether pain medication relieved incisional pain
- The nurse is assigning clients. Which client is most appropriate for an LPN/LVN, assuming facility policy permits? A. New admission with acute chest pain and diaphoresis B. Fresh postoperative client with BP 84/50 and HR 128 C. Stable client with a chronic wound needing a routine dressing change D. Client requiring initial discharge teaching for peritoneal dialysis
- A UAP reports that a client’s blood pressure is 82/46 and the client “looks pale.” What should the RN do first? A. Ask the UAP to decide whether to call the provider. B. Assess the client immediately. C. Document the value and reassess next shift. D. Ask the UAP to give IV fluids.
- The nurse has four clients. Which should be assessed first? A. A stable client with GERD requesting diet teaching B. A client after TURP with CBI who reports bladder pressure and has suddenly decreased catheter output C. A stable client with chronic anemia asking for an extra blanket D. A client with SLE asking which sunscreen to buy
- Which client should the nurse assess first? A. Client with CKD whose potassium is 6.7 mEq/L B. Client with stable hiatal hernia reporting mild heartburn after lunch C. Client with chronic illness requesting help setting a follow-up appointment D. Client with vitamin A deficiency asking about diet sources
- A nurse delegates routine vital signs on a stable client to UAP. Which instruction best demonstrates right direction/communication? A. “Check on room 10 when you can.” B. “Get Mr. Lee’s vital signs now and report the BP, HR, RR, temperature, and oxygen saturation to me immediately because he was dizzy earlier.” C. “Assess whether Mr. Lee is stable and decide if I need to call the provider.” D. “Teach Mr. Lee to call if he feels worse.”
- A client receiving internal radiation has a sealed implant in place. Which visitor instruction is appropriate? A. Pregnant visitors may stay if they wear gloves. B. Children may visit if they remain 1 foot from the bed. C. Visitors should be limited according to time/distance/shielding precautions, such as short visits and staying several feet away per policy. D. There are no precautions because all radiation clients are nonradioactive.
B. Incorrect. A bruit is expected and indicates blood flow through the fistula. C. Correct. No thrill and no bruit may indicate clotting or loss of access patency. This is urgent because the fistula is the client’s dialysis lifeline. D. Incorrect. A healed scar is not the priority if there are no infection or patency concerns.
- Answer: C A. Incorrect. Protein loss can occur, but cloudy effluent with abdominal pain is not an expected finding to simply document. B. Incorrect. Dialysate should never be microwaved because uneven heating can injure tissue and damage solution integrity. C. Correct. Cloudy outflow plus abdominal pain is peritonitis until proven otherwise. This needs prompt follow-up. D. Incorrect. This delays treatment of a potentially serious infection.
- Answer: A A. Correct. UC causes frequent bloody diarrhea, placing the client at risk for dehydration, electrolyte imbalance, and anemia. B. Incorrect. The symptoms point to GI fluid/blood loss, not urinary obstruction. C. Incorrect. Hypercalcemia is not the priority pattern here. D. Incorrect. Diarrhea causes bicarbonate loss and is associated with metabolic acidosis, not alkalosis.
- Answer: C A. Incorrect. Sudden relief can occur when the appendix ruptures, releasing pressure. It does not automatically mean improvement. B. Incorrect. Suspected appendicitis generally remains NPO for possible surgery. C. Correct. Sudden pain relief in appendicitis is a rupture warning and can lead to peritonitis. D. Incorrect. Laxatives/enemas can increase rupture/perforation risk and are avoided.
- Answer: B A. Incorrect. GERD causes reflux symptoms, not rigid abdomen and rebound tenderness. B. Correct. Rigid/board-like abdomen, rebound tenderness, fever, and tachycardia are classic peritonitis/perforation clues. C. Incorrect. Hiatal hernia causes reflux/dysphagia symptoms; it does not typically cause board-like abdomen. D. Incorrect. Constipation can cause discomfort/distention, but fever, rebound, and rigidity suggest surgical abdomen.
- Answer: B, C, D A. Incorrect. Large late meals worsen reflux by increasing gastric volume before lying down.
B. Correct. HOB elevation helps reduce reflux during sleep. C. Correct. Avoiding meals close to bedtime reduces reflux risk. D. Correct. These are common LES-relaxing or irritating triggers that worsen GERD. E. Incorrect. Lying flat after meals worsens reflux.
- Answer: B A. Incorrect. Fat causes gallbladder contraction and can worsen gallbladder pain. B. Correct. RUQ pain after fatty foods radiating to the right shoulder suggests gallbladder disease. Low-fat teaching is appropriate. C. Incorrect. Nuts/popcorn are not the key teaching for cholecystitis; high-fat triggers are the issue. D. Incorrect. Avoiding all fluids is unsafe and not standard teaching.
- Answer: A A. Correct. Chronic anemia reduces oxygen-carrying capacity. The heart compensates by working harder; chest pressure suggests myocardial oxygen imbalance/angina. B. Incorrect. Vitamin K affects clotting, not anemia-related chest pain. C. Incorrect. SIADH causes water retention/hyponatremia, not exertional chest pressure from anemia. D. Incorrect. Tachycardia is compensation but can worsen cardiac workload; it does not necessarily improve oxygenation enough.
- Answer: C A. Incorrect. Severe neutropenia plus fever can progress rapidly to sepsis; waiting is unsafe. B. Incorrect. Fresh flowers/plants may be restricted for neutropenic clients due to infection risk. C. Correct. ANC under 500 is severe neutropenia. Fever may be the first/only sign of infection and is urgent. D. Incorrect. Raw/undercooked foods increase infection risk in neutropenic clients.
- Answer: A A. Correct. Very low platelets plus severe headache raises concern for intracranial bleeding and requires prompt assessment/intervention. B. Incorrect. Fatigue may occur, but new severe headache with severe thrombocytopenia is more concerning. C. Incorrect. Hyperglycemia is not the best explanation for severe headache with platelets 17,000. D. Incorrect. Vitamin D toxicity causes hypercalcemia-type symptoms; the platelet/headache pattern points to bleeding risk.
- Answer: B A. Incorrect. Normal CD4 is commonly about 500-1500. CD4 below 200 indicates AIDS-level immunosuppression.
C. Incorrect. Respiratory acidosis would have low pH and high PaCO2. D. Incorrect. Respiratory alkalosis would have high pH and low PaCO2.
- Answer: B A. Incorrect. DKA causes metabolic acidosis, not alkalosis. B. Correct. Ketones create metabolic acidosis. Kussmaul respirations blow off CO2. Acidosis can shift potassium out of cells, increasing serum K. C. Incorrect. Respiratory alkalosis is low CO2 from hyperventilation, not CO2 trapping; DKA’s primary disorder is metabolic acidosis. D. Incorrect. Hypocalcemia does not explain DKA/Kussmaul pattern.
- Answer: A A. Correct. Symptoms suggest hypoglycemia. If awake and able to swallow, give 15 g fast-acting carbohydrate and recheck in 15 minutes. B. Incorrect. Insulin would worsen hypoglycemia. C. Incorrect. Exercise can further lower glucose. D. Incorrect. Delaying treatment risks seizures/loss of consciousness.
- Answer: B A. Incorrect. Fever and tachycardia require cooling and cardiac monitoring; stimulation can worsen symptoms. B. Correct. This is thyroid storm/thyrotoxicosis: cool, calm, monitor heart, slow sympathetic response, and block thyroid hormone as ordered. C. Incorrect. This describes SIADH/hypoglycemia concepts, not thyroid storm management. D. Incorrect. This is an emergency, not a teaching/discharge priority.
- Answer: B A. Incorrect. SIADH causes water retention and dilutional hyponatremia; fluid restriction is typically ordered. B. Correct. Severe hyponatremia with neuro symptoms creates seizure risk and requires urgent follow-up. C. Incorrect. Hypotonic fluids worsen hyponatremia. D. Incorrect. Potassium intake does not treat severe hyponatremia or neuro symptoms.
- Answer: B A. Incorrect. Sodium must be corrected carefully. Rapid correction of chronic hyponatremia can cause severe neurologic injury. B. Correct. Hypertonic saline is powerful and requires pump administration, frequent sodium checks, neuro checks, and fluid overload monitoring. C. Incorrect. Hypertonic saline should not be given freely by gravity without close control.
D. Incorrect. Frequent neurologic assessment is essential.
- Answer: B A. Incorrect. Neuropathy increases burn risk; heating pads are unsafe. B. Correct. Diabetic neuropathy decreases sensation, so clients may not feel heat injury. Daily foot inspection and protective footwear are key. C. Incorrect. Normal glucose at the moment does not remove neuropathy burn risk. D. Incorrect. Foot care matters for all clients with diabetes, not only those using insulin.
- Answer: A A. Correct. UV/sun exposure can trigger SLE flares. Sun protection is high-yield discharge teaching. B. Incorrect. Sun exposure can trigger flares. Vitamin D needs should be discussed safely with the provider. C. Incorrect. Steroids must be tapered as prescribed; abrupt stopping can cause adrenal insufficiency. D. Incorrect. Even low-grade fever should be reported because it may indicate infection or flare, especially if immunosuppressed.
- Answer: A A. Correct. Foamy urine suggests proteinuria; edema and hypertension suggest renal involvement/lupus nephritis. B. Incorrect. Photosensitivity causes rash/flares after UV exposure, not proteinuria/edema/HTN. C. Incorrect. GERD causes reflux symptoms, not renal signs. D. Incorrect. Vitamin E toxicity increases bleeding risk; it does not explain foamy urine and edema.
- Answer: B A. Incorrect. Symmetric and unchanged is less concerning. B. Correct. ABCDE warning signs include asymmetry, border irregularity, color variation, diameter >6 mm, and evolution/change. “Changing” is especially concerning. C. Incorrect. Stable longstanding freckles are less concerning than changing lesions. D. Incorrect. Uniform, round, smooth, unchanged lesions are less suspicious.
- Answer: B A. Incorrect. Hospice is active comfort-focused care, not abandonment. B. Correct. Hospice prioritizes quality of life, symptom palliation, psychosocial/spiritual support, dignity, and family support. C. Incorrect. Hospice may include medications, nursing care, social work, chaplaincy, bereavement support, and more. D. Incorrect. Pain management is a major hospice priority.
A. Incorrect. Labeling the client ignores barriers and damages trust. B. Correct. Chronic illness care includes assessing barriers such as cost, transportation, side effects, health literacy, depression, and regimen complexity. C. Incorrect. Stopping medications can worsen disease control and complications. D. Incorrect. Many chronic illnesses can be managed with support and realistic plans.
- Answer: B A. Incorrect. The provider is responsible for explaining procedure, risks, benefits, and alternatives. The nurse reinforces and witnesses, but does not obtain informed consent by explaining provider-only content. B. Correct. If the client does not understand, the nurse must stop and notify provider for clarification before proceeding. C. Incorrect. A signed form is not valid if understanding is absent. D. Incorrect. UAP cannot provide surgical informed consent education.
- Answer: C A. Incorrect. Initial assessment and chest pain require RN judgment. B. Incorrect. Teaching, especially new insulin teaching, is RN responsibility. C. Correct. Ambulating a stable client with predictable outcome is an appropriate UAP task if directions/safety precautions are clear. D. Incorrect. Evaluation of medication effectiveness is RN responsibility.
- Answer: C A. Incorrect. Acute chest pain is unstable and requires RN assessment. B. Incorrect. Fresh postop hypotension/tachycardia may indicate hemorrhage/shock and needs experienced RN. C. Correct. Stable, predictable clients with routine focused care are appropriate for LPN/LVN assignment depending scope/policy. D. Incorrect. Initial teaching is RN responsibility.
- Answer: B A. Incorrect. UAP reports data; RN interprets and decides actions. B. Correct. Hypotension with pallor may indicate shock/bleeding/poor perfusion and requires RN assessment immediately. C. Incorrect. Delaying assessment is unsafe. D. Incorrect. UAP cannot administer IV fluids or make treatment decisions.
- Answer: B A. Incorrect. Teaching can wait when another client has an acute complication.
B. Correct. Bladder pressure plus decreased CBI output suggests catheter obstruction from clots and requires prompt RN assessment/intervention. C. Incorrect. Stable comfort request is not priority. D. Incorrect. SLE sun teaching is important but not priority over acute obstruction.
- Answer: A A. Correct. Potassium 6.7 is a dangerous lab value that can cause fatal dysrhythmias. This is priority. B. Incorrect. Mild expected reflux symptoms are lower priority. C. Incorrect. Follow-up planning is important but not first when life-threatening hyperkalemia is present. D. Incorrect. Diet teaching can wait.
- Answer: B A. Incorrect. This is vague and lacks timing/reporting expectations. B. Correct. It gives task, timing, specific data, what to report, and why. C. Incorrect. UAP does not assess stability or decide provider notification. D. Incorrect. Teaching is RN responsibility.
- Answer: C A. Incorrect. Pregnant visitors are generally restricted from internal radiation exposure. B. Incorrect. Children are generally restricted, and 1 foot is too close. C. Correct. Internal radiation requires time, distance, and shielding precautions. Visitor limits and distance are key. D. Incorrect. External radiation clients are not radioactive after treatment, but internal radiation can require precautions while the source is in place. Last-Minute Safety Locks Rigid abdomen + fever/tachycardia = peritonitis/perforation until proven otherwise. Fever with ANC <500 = neutropenic emergency. K+ >6 or ECG changes = cardiac danger. Low sodium + confusion/twitching/seizure = SIADH danger; correct sodium carefully. CBI stops draining + bladder pressure = catheter obstruction/clots. Cloudy peritoneal dialysis drainage = peritonitis. Absent thrill/bruit = AV fistula access problem. Thyroid storm = fever, extreme tachycardia, altered mental status; cool/calm/cardiac monitor. Hypoglycemia = shaky, sweaty, starving, strange; treat fast. RN keeps assessment, teaching, evaluation, judgment, unstable clients.
