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199. A client with pneumacystis carinii pneumonia is receiving Methotrexate. The rationale for administering leucovorin calcium to a client receiving Methotrexate is to:
❍ A. Treat anemia
❍ B. Create a synergistic effect
❍ C. Increase the number of white blood cells ❍ D. Reverse drug toxicity
200. A client tells the nurse that she is allergic to eggs, dogs, rabbits, and chicken feathers. Which order should the nurse question?
❍ A. TB skin test
❍ B. Rubella vaccine ❍ C. ELISA test
❍ D. Chest x-ray
201. The physician has prescribed ranitidine (Zantac) for a client with erosive gastritis. The nurse should administer the medication:
❍ A. 30 minutes before meals ❍ B. With each meal
❍ C. In a single dose at bedtime ❍ D. 60 minutes after meals
204. A temporary colostomy is performed on the client with colon can-cer. The nurse is aware that the proximal end of a double barrel colostomy:
❍ A. Is the opening on the client’s left side
❍ B. Is the opening on the distal end on the client’s left side ❍ C. Is the opening on the client’s right side
❍ D. Is the opening on the distal right side
205. While assessing the postpartal client, the nurse notes that the fun-dus is displaced to the right. Based on this finding, the nurse should:
❍ A. Ask the client to void.
❍ B. Assess the blood pressure for hypotension. ❍ C. Administer oxytocin.
❍ D. Check for vaginal bleeding.
206. The physician has ordered an MRI for a client with an orthopedic ailment. An MRI should not be done if the client has:
❍ A. The need for oxygen therapy ❍ B. A history of claustrophobia ❍ C. A permanent pacemaker
❍ D. Sensory deafness
207. A six-month-old client is placed on strict bed rest following a her-nia repair. Which toy is best suited to the client?
❍ A. Colorful crib mobile
❍ B. Hand-held electronic games ❍ C. Cars in a plastic container ❍ D. 30-piece jigsaw puzzle
208. The nurse is preparing to discharge a client with a long history of polio. The nurse should tell the client that:
❍ A. Taking a hot bath will decrease stiffness and spasticity.
❍ B. A schedule of strenuous exercise will improve muscle strength.
❍ C. Rest periods should be scheduled throughout the day.
❍ D. Visual disturbances can be corrected with prescription glasses.
209. A client on the postpartum unit has a proctoepisiotomy. The nurse should anticipate administering which medication?
❍ A. Dulcolax suppository
❍ B. Docusate sodium (Colace)
❍ C. Methyergonovine maleate (Methergine) ❍ D. Bromocriptine sulfate (Parlodel)
210. A client with pancreatic cancer has an infusion of TPN (Total Parenteral Nutrition). The doctor has ordered for sliding-scale insulin. The most likely explanation for this order is:
❍ A. Total Parenteral Nutrition leads to negative nitrogen balance and elevated glucose levels.
❍ B. Total Parenteral Nutrition cannot be managed with oral hypoglycemics.
❍ C. Total Parenteral Nutrition is a high-glucose solution that often elevates the blood glucose levels.
❍ D. Total Parenteral Nutrition leads to further pancreatic disease.
211. An adolescent primigravida who is 10 weeks pregnant attends the antepartal clinic for a first check-up. To develop a teaching plan, the nurse should initially assess:
❍ A. The client’s knowledge of the signs of preterm labor ❍ B. The client’s feelings about the pregnancy
❍ C. Whether the client was using a method of birth control ❍ D. The client’s thought about future children
212. An obstetric client is admitted with dehydration. Which IV fluid would be most appropriate for the client?
❍ A. .45 normal saline
❍ B. Dextrose 1% in water ❍ C. Lactated Ringer’s
❍ D. Dextrose 5% in .45 normal saline
213. The physician has ordered a thyroid scan to confirm the diagnosis of a goiter. Before the procedure, the nurse should:
❍ A. Assess the client for allergies. ❍ B. Bolus the client with IV fluid. ❍ C. Tell the client he will be asleep. ❍ D. Insert a urinary catheter.
214. The physician has ordered an injection of RhoGam for a client with blood type A negative. The nurse understands that RhoGam is given to:
❍ A. Provide immunity against Rh isoenzymes ❍ B. Prevent the formation of Rh antibodies ❍ C. Eliminate circulating Rh antibodies
❍ D. Convert the Rh factor from negative to positive
215. The nurse is caring for a client admitted to the emergency room after a fall. X-rays reveal that the client has several fractured bones in the foot. Which treatment should the nurse anticipate for the fractured foot?
❍ A. Application of a short inclusive spica cast ❍ B. Stabilization with a plaster-of-Paris cast ❍ C. Surgery with Kirschner wire implantation ❍ D. A gauze dressing only
216. A client with bladder cancer is being treated with iridium seed implants. The nurse’s discharge teaching should include telling the client to:
❍ A. Strain his urine
❍ B. Increase his fluid intake ❍ C. Report urinary frequency ❍ D. Avoid prolonged sitting
217. Following a heart transplant, a client is started on medication to prevent organ rejection. Which category of medication prevents the formation of antibodies against the new organ?
❍ A. Antivirals ❍ B. Antibiotics
❍ C. Immunosuppressants ❍ D. Analgesics
218. The nurse is preparing a client for cataract surgery. The nurse is aware that the procedure will use:
❍ A. Mydriatics to facilitate removal
❍ B. Miotic medications such as Timoptic ❍ C. A laser to smooth and reshape the lens ❍ D. Silicone oil injections into the eyeball
219. A client with Alzheimer’s disease is awaiting placement in a skilled nursing facility. Which long-term plans would be most therapeutic for the client?
❍ A. Placing mirrors in several locations in the home ❍ B. Placing a picture of herself in her bedroom
❍ C. Placing simple signs to indicate the location of the bedroom, bathroom, and so on
❍ D. Alternating healthcare workers to prevent boredom
220. A client with an abdominal cholecystectomy returns from surgery with a Jackson-Pratt drain. The chief purpose of the Jackson-Pratt drain is to:
❍ A. Prevent the need for dressing changes ❍ B. Reduce edema at the incision
❍ C. Provide for wound drainage
❍ D. Keep the common bile duct open
221. The nurse is performing an initial assessment of a newborn Caucasian male delivered at 32 weeks gestation. The nurse can expect to find the presence of:
❍ A. Mongolian spots ❍ B. Scrotal rugae
❍ C. Head lag
❍ D. Polyhydramnios
222. The nurse is caring for a client admitted with multiple trauma. Fractures include the pelvis, femur, and ulna. Which finding should be reported to the physician immediately?
❍ A. Hematuria
❍ B. Muscle spasms ❍ C. Dizziness
❍ D. Nausea
223. A client is brought to the emergency room by the police. He is combative and yells, “I have to get out of here. They are trying to kill me.” Which assessment is most likely correct in relation to this statement?
❍ A. The client is experiencing an auditory hallucination. ❍ B. The client is having a delusion of grandeur.
❍ C. The client is experiencing paranoid delusions. ❍ D. The client is intoxicated.
224. The nurse is preparing to suction the client with a tracheotomy. The nurse notes a previously used bottle of normal saline on the client’s bedside table. There is no label to indicate the date or time of initial use. The nurse should:
❍ A. Lip the bottle and use a pack of sterile 4×4 for the dressing.
❍ B. Obtain a new bottle and label it with the date and time of first use.
❍ C. Ask the ward secretary when the solution was requested. ❍ D. Label the existing bottle with the current date and time.
225. An infant’s Apgar score is 9 at five minutes. The nurse is aware that the most likely cause for the deduction of one point is:
❍ A. The baby is hypothermic.
❍ B. The baby is experiencing bradycardia. ❍ C. The baby’s hands and feet are blue. ❍ D. The baby is lethargic.
226. The primary reason for rapid continuous rewarming of the area affected by frostbite is to:
❍ A. Lessen the amount of cellular damage ❍ B. Prevent the formation of blisters
❍ C. Promote movement
❍ D. Prevent pain and discomfort
227. A client recently started on hemodialysis wants to know how the dialysis will take the place of his kidneys. The nurse’s response is based on the knowledge that hemodialysis works by:
❍ A. Passing water through a dialyzing membrane ❍ B. Eliminating plasma proteins from the blood
❍ C. Lowering the pH by removing nonvolatile acids ❍ D. Filtering waste through a dialyzing membrane
228. During a home visit, a client with AIDS tells the nurse that he has been exposed to measles. Which action by the nurse is most appropriate?
❍ A. Administer an antibiotic.
❍ B. Contact the physician for an order for immune globulin. ❍ C. Administer an antiviral.
❍ D. Tell the client that he should remain in isolation for two weeks
229. A client hospitalized with MRSA is placed on contact precautions. Which statement is true regarding precautions for infections spread by contact?
❍ A. The client should be placed in a room with negative pressure.
❍ B. Infection requires close contact; therefore, the door may remain open.
❍ C. Transmission is highly likely, so the client should wear a mask at all times.
❍ D. Infection requires skin-to-skin contact and is prevent-ed by hand washing, gloves, and a gown.
230. A client who is admitted with an above-the-knee amputation tells the nurse that his foot hurts and itches. Which response by the nurse indicates understanding of phantom limb pain?
❍ A. “The pain will go away in a few days.”
❍ B. “The pain is due to peripheral nervous system inter-ruptions. I will get you some pain medication.”
❍ C. “The pain is psychological because your foot is no longer there.”
❍ D. “The pain and itching are due to the infection you had before the surgery.”
231. A client with cancer of the pancreas has undergone a Whipple procedure. The nurse is aware that during the Whipple procedure, the doctor will remove the:
❍ A. Head of the pancreas
❍ B. Proximal third section of the small intestines ❍ C. Stomach and duodenum
❍ D. Esophagus and jejunum
232. The physician has ordered a minimal-bacteria diet for a client with neutropenia. The client should be taught to avoid eating:
❍ A. Fruits ❍ B. Salt
❍ C. Pepper ❍ D. Ketchup
233. A client is discharged home with a prescription for Coumadin (sodium warfarin). The client should be instructed to:
❍ A. Have a Protime done monthly. ❍ B. Eat more fruits and vegetables. ❍ C. Drink more liquids.
❍ D. Avoid crowds.
234. The nurse is assisting the physician with removal of a central venous catheter. To facilitate removal, the nurse should instruct the client to:
❍ A. Perform the Valsalva maneuver as the catheter is advanced
❍ B. Turn his head to the left side and hyperextend the neck ❍ C. Take slow, deep breaths as the catheter is removed
❍ D. Turn his head to the right while maintaining a sniffing position
235. A client has an order for streptokinase. Before administering the medication, the nurse should assess the client for:
❍ A. Allergies to pineapples and bananas ❍ B. A history of streptococcal infections ❍ C. Prior therapy with phenytoin
❍ D. A history of alcohol abuse
236. The nurse is providing discharge teaching for the client with leukemia. The client should be told to avoid:
❍ A. Using oil- or cream-based soaps ❍ B. Flossing between the teeth
❍ C. The intake of salt
❍ D. Using an electric razor
237. The nurse is changing the ties of the client with a tracheotomy. The safest method of changing the tracheotomy ties is to:
❍ A. Apply the new tie before removing the old one. ❍ B. Have a helper present.
❍ C. Hold the tracheotomy with the nondominant hand while removing the old tie.
❍ D. Ask the doctor to suture the tracheostomy in place.
219 | ||||||
238. The nurse is monitoring a client following a lung resection. The | Quick✓Check | |||||
Quick Answer: 224 | ||||||
hourly output from the chest tube was 300mL. The nurse should | Detailed Answer: 249 | |||||
give priority to: | ||||||
❍ A. Turning the client to the left side | ||||||
❍ B. Milking the tube to ensure patency | ||||||
❍ C. Slowing the intravenous infusion | ||||||
❍ D. Notifying the physician | ||||||
239. The infant is admitted to the unit with tetralogy of Fallot. The | Quick Answer: 224 | |||||
nurse would anticipate an order for which medication? | Detailed Answer: 249 | |||||
❍ | A. | Digoxin | ||||
❍ | B. | Epinephrine | ||||
❍ | C. | Aminophyline | ||||
❍ | D. Atropine | |||||
240. The nurse is educating the lady’s club in self-breast exam. The | Quick Answer: 224 | |||||
nurse is aware that most malignant breast masses occur in the | Detailed Answer: 249 | |||||
Tail of Spence. On the diagram, place an X on the Tail of Spence. | ||||||
241. The toddler is admitted with a cardiac anomaly. The nurse is aware that the infant with a ventricular septal defect will:
❍ A. Tire easily
❍ B. Grow normally
❍ C. Need more calories
❍ D. Be more susceptible to viral infections
242. The nurse is monitoring a client with a history of stillborn infants. The nurse is aware that a nonstress test can be ordered for this client to:
❍ A. Determine lung maturity ❍ B. Measure the fetal activity
❍ C. Show the effect of contractions on fetal heart rate ❍ D. Measure the well-being of the fetus
243. The nurse is evaluating the client who was admitted eight hours ago for induction of labor. The following graph is noted on the monitor. Which action should be taken first by the nurse?
210
180
B
150
A
120
90
60
30
Fetal Heart Rate
100
80
60
40
20
0
Uterine Contractions
❍ A. Instruct the client to push. ❍ B. Perform a vaginal exam.
❍ C. Turn off the Pitocin infusion.
❍ D. Place the client in a semi-Fowler’s position.
Quick✓Check
244. The nurse notes the following on the ECG monitor. The nurse would evaluate the cardiac arrhythmia as:
❍ A. Atrial flutter
❍ B. A sinus rhythm
❍ C. Ventricular tachycardia ❍ D. Atrial fibrillation
245. A client with clotting disorder has an order to continue Lovenox (enoxaparin) injections after discharge. The nurse should teach the client that Lovenox injections should:
❍ A. Be injected into the deltoid muscle ❍ B. Be injected into the abdomen
❍ C. Aspirate after the injection
❍ D. Clear the air from the syringe before injections
246. The nurse has a preop order to administer Valium (diazepam) 10mg and Phenergan (promethazine) 25mg. The correct method of administering these medications is to:
❍ A. Administer the medications together in one syringe ❍ B. Administer the medication separately
❍ C. Administer the Valium, wait five minutes, and then inject the Phenergan
❍ D. Question the order because they cannot be given at the same time
247. A client with frequent urinary tract infections asks the nurse how she can prevent the reoccurrence. The nurse should teach the client to:
❍ A. Douche after intercourse ❍ B. Void every three hours
❍ C. Obtain a urinalysis monthly
❍ D. Wipe from back to front after voiding
248. Which task should be assigned to the nursing assistant?
❍ A. Placing the client in seclusion
❍ B. Emptying the Foley catheter of the preeclamptic client ❍ C. Feeding the client with dementia
❍ D. Ambulating the client with a fractured hip
249. The client has recently returned from having a thyroidectomy. The nurse should keep which of the following at the bedside?
❍ A. A tracheotomy set
❍ B. A padded tongue blade ❍ C. An endotracheal tube ❍ D. An airway
250. The physician has ordered a histoplasmosis test for the elderly client. The nurse is aware that histoplasmosis is transmitted to humans by:
❍ A. Cats ❍ B. Dogs ❍ C. Turtles ❍ D. Birds
