1.

A 2 year-old child is receiving temporary

total parental nutrition (TPN) through a central
venous line. This is the first day of TPN
therapy. Although all of the following nursing
actions must be included in the plan of care of
this child, which one would be a priority at this
time?
a. Use aseptic technique during dressing changes
b. Maintain central line catheter integrity
c. Monitor serum glucose levels
d. Check results of liver function tests
2. Nurse Jamie is administering the initial total
parenteral nutrition solution to a client. Which
of the following assessments requires the
nurses immediate attention?
a. Temperature of 37.5 degrees Celsius
b. Urine output of 300 cc in 4 hours
c. Poor skin turgor
d. Blood glucose of 350 mg/dl
3. Nurse Susan administered intravenous
gamma globulin to an 18 month-old child with
AIDS. The parent asks why this medication is
being given. What is the nurses best response?
a. It will slow down the replication of the virus.
b. This medication will improve your childs
overall health status.
c. This medication is used to prevent bacterial
infections.
d. It will increase the effectiveness of the other
medications your child receives.
4. When caring for a client with total parenteral
nutrition (TPN), what is the most important
action on the part of the nurse?

1. Answer C.
Monitor serum glucose levels. Hyperglycemia may
occur during the first day or 2 as the child adapts
to the high-glucose load of the TPN solution. Thus,
a chief nursing responsibility is blood glucose
testing.



2. Answer D.
Total parenteral nutrition formulas contain
dextrose in concentrations of 10% or greater to
supply 20% to 50% of the total calories. Blood
glucose levels should be checked every 4 to 6
hours. A sliding scale dose of insulin may be
ordered to maintain the blood glucose level below
200mg/dl.

3. Answer C.
Intravenous gamma globulin is given to help
prevent as well as to fight bacterial infections in
young children with AIDS.



4. Answer C.
Clients receiving TPN are very susceptible to
infection. The concentrated glucose solutions are a
good medium for bacterial growth. Strict sterile
technique is crucial in preventing infection at IV
infusion site.
a. Record the number of stools per day
b. Maintain strict intake and output records
c. Sterile technique for dressing change at IV site
d. Monitor for cardiac arrhythmias
5. The nurse is administering an intravenous
vesicant chemotherapeutic agent to a client.
Which assessment would require the nurses
immediate action?
a. Stomatitis lesion in the mouth
b. Severe nausea and vomiting
c. Complaints of pain at site of infusion
d. A rash on the clients extremities
6. Nurse Celine is caring for a client with
clinical depression who is receiving a MAO
inhibitor. When providing instructions about
precautions with this medication, the nurse
should instruct the client to:
a. Avoid chocolate and cheese
b. Take frequent naps
c. Take the medication with milk
d. Avoid walking without assistance
7. While providing home care to a client with
congestive heart failure, the nurse is asked how
long diuretics must be taken. The BEST
response to this client should be:
a. As you urinate more, you will need less
medication to control fluid.
b. You will have to take this medication for about
a year.
c. The medication must be continued so the fluid
problem is controlled.
d. Please talk to your physician about medications
and treatments.




5. Answer C.
A vesicant is a chemotherapeutic agent capable of
causing blistering of tissues and possible tissue
necrosis if there is extravasation. These agents are
irritants which cause pain along the vein wall, with
or without inflammation.

6. Answer A.
Foods high in tryptophan, tyramine and caffeine,
such as chocolate and cheese may precipitate
hypertensive crisis.



7. Answer C.
This is the most therapeutic response and gives the
client accurate information.





8. George, age 8, is admitted with rheumatic
fever. Which clinical finding indicates to the
nurse that George needs to continue taking the
salicylates he had received at home?
a. Chorea.
b. Polyarthritis.
c. Subcutaneous nodules.
d. Erythema marginatum.
9. An order is written to start an IV on a 74-
year-old client who is getting ready to go to the
operating room for a total hip replacement.
What gauge of catheter would best meet the
needs of this client?
a. 18
b. 20
c. 21 butterfly
d. 25
10. A client with an acute exacerbation of
rheumatoid arthritis is admitted to the hospital
for treatment. Which drug, used to treat clients
with rheumatoid arthritis, has both an anti-
inflammatory and immunosuppressive effect?
a. Gold sodium thiomalate (Myochrysine)
b. Azathioprine (Imuran)
c. Prednisone (Deltasone)
d. Naproxen (Naprosyn)
11. Which of the following is least likely to
influence the potential for a client to comply
with lithium therapy after discharge?
a. The impact of lithium on the clients energy
level and life-style.
b. The need for consistent blood level monitoring.
c. The potential side effects of lithium.

8. Answer B.
Chorea is the restless and sudden aimless and
irregular movements of the extremities suddenly
seen in persons with rheumatic fever, especially
girls. Polyarthritis is characterized by swollen,
painful, hot joints that respond to salicylates.
Subcutaneous nodules are nontender swellings
over bony prominences sometimes seen in persons
with rheumatic fever. Erythema marginatum is a
skin condition characterized by nonpruritic rash,
affecting trunk and proximal extremities, seen in
persons with rheumatic fever.
9. Answer A.
Clients going to the operating room ideally should
have an 18- gauge catheter. This is large enough to
handle blood products safely and to allow rapid
administration of large amounts of fluid if
indicated during the perioperative period. An 18-
gauge catheter is recommended. A 20-gauge
catheter is a second choice. A 21-gauge needle is
too small and a butterfly too unstable for a client
going to surgery. A 25-gauge needle is too small.
10. Answer C.
Gold sodium thiomalate is usually used in
combination with aspirin and nonsteroidal anti-
inflammatory drugs to relieve pain. Gold has an
immunosuppressive affect. Azathioprine is used
for clients with life-threatening rheumatoid
arthritis for its immunosuppressive effects.
Prednisone is used to treat persons with acute
exacerbations of rheumatoid arthritis. This
medication is given for its anti-inflammatory and
immunosuppressive effects. Naproxen is a
nonsteroidal anti-inflammatory drug.
Immunosuppression does not occur.
11. Answer D.
The impact of lithium on the clients energy level
and life style are great determinants to compliance.
d. What the clients friends think of his need to
take medication
12. Which of the following is least likely to
influence the potential for a client to comply
with lithium therapy after discharge?
a. The impact of lithium on the clients energy
level and life-style.
b. The need for consistent blood level monitoring.
c. The potential side effects of lithium.
d. What the clients friends think of his need to
take medication.
13. The nurse is caring for an elderly client who
has been diagnosed as having sundown
syndrome. He is alert and oriented during the
day but becomes disoriented and disruptive
around dinnertime. He is hospitalized for
evaluation. The nurse asks the client and his
family to list all of the medications, prescription
and nonprescription, he is currently taking.
What is the primary reason for this action?
a. Multiple medications can lead to dementia
b. The medications can provide clues regarding his
medical background
c. Ability to recall medications is a good
assessment of the clients level of orientation.
d. Medications taken by a client are part of every
nursing assessment.
14. A 25-year-old woman is in her fifth month
of pregnancy. She has been taking 20 units of
NPH insulin for diabetes mellitus daily for six
years. Her diabetes has been well controlled
with this dosage. She has been coming for
routine prenatal visits, during which diabetic
teaching has been implemented. Which of the
following statements indicates that the woman
The frequent blood level monitoring required is
difficult for clients to follow for a long period of
time. Potential side effects such as fine tremor,
drowsiness, diarrhea, polyuria, thirst, weight gain,
and fatigue can be disturbing to the client. While
the clients social network can influence the client
in terms of compliance, the influence is typically
secondary to that of the other factors listed.
12. Answer D.
The impact of lithium on the clients energy level
and life style are great determinants to compliance.
The frequent blood level monitoring required is
difficult for clients to follow for a long period of
time. Potential side effects such as fine tremor,
drowsiness, diarrhea, polyuria, thirst, weight gain,
and fatigue can be disturbing to the client. While
the clients social network can influence the client
in terms of compliance, the influence is typically
secondary to that of the other factors listed.
13. Answer A.
Drugs commonly used by elderly people,
especially in combination, can lead to dementia.
Assessment of the medication taken may or may
not provide information on the clients medical
background. However, this is not the primary
reason for assessing medications in a client who is
exhibiting sundown syndrome. Ability to recall
medications may indicate short-term memory and
recall. However, that is not the primary reason for
assessing medications in a client with sundown
syndrome. Medication history should be a part of
the nursing assessment. In this client there is an
even more important reason for evaluating the
medications taken.
14. Answer B.
The client starts to need increased insulin in the
second trimester. This statement indicates a lack of
understanding. As a result of placental maturation
understands the teaching regarding her insulin
needs during her pregnancy?
a. Are you sure all this insulin wont hurt my
baby?
b. Ill probably need my daily insulin dose
raised.
c. I will continue to take my regular dose of
insulin.
d. These finger sticks make my hand sore. Can I
do them less frequently?
15. Mrs. Johansons physician has prescribed
tetracycline 500 mg po q6h. While assessing
Mrs. Johansons nursing history for allergies,
the nurse notes that Mrs. Johansons is also
taking oral contraceptives. What is the most
appropriate initial nursing intervention?
a. Administer the dose of tetracycline.
b. Notify the physician that Mrs. Johanson is
taking oral contraceptives.
c. Tell Mrs. Johanson, she should stop taking oral
contraceptives since they are inactivated by
tetracycline.
d. Tell Mrs. Johanson, to use another form of birth
control for at least two months.
16. An adult clients insulin dosage is 10 units of
regular insulin and 15 units of NPH insulin in
the morning. The client should be taught to
expect the first insulin peak:
a. as soon as food is ingested.
b. in two to four hours.
c. in six hours.
d. in ten to twelve hours.
17. An adult is hospitalized for treatment of
deep electrical burns. Burn wound sepsis
develops and mafenide acetate 10%
and placental production of lactogen, insulin
requirements begin increasing in the second
trimester and may double or quadruple by the end
of pregnancy. The client starts to need increased
insulin in the second trimester. This statement
indicates a lack of understanding. Insulin doses
depend on blood glucose levels. Finger sticks for
glucose levels must be continued.

15. Answer B.
The nurse should be aware that tetracyclines
decrease the effectiveness of oral contraceptives.
The physician should be notified. The physician
should be notified. Tetracycline decreases the
effectiveness of oral contraceptives. There may be
an equally effective antibiotic available that can be
prescribed. Note on the clients chart that the
physician was notified. The nurse should be aware
that tetracyclines decrease the effectiveness of oral
contraceptives. The nurse should not tell the client
to stop taking oral contraceptives unless the
physician orders this. The nurse should be aware
that tetracyclines decrease the effectiveness of oral
contraceptives. If the physician chooses to keep the
client on tetracycline, the client should be
encouraged to use another form of birth control.
The first intervention is to notify the physician.
16. Answer B.
The first insulin peak will occur two to four hours
after administration of regular insulin. Regular
insulin is classified as rapid acting and will peak
two to four hours after administration. The second
peak will be eight to twelve hours after the
administration of NPH insulin. This is why a snack
must be eaten mid-morning and also three to four
hours after the evening meal. The first insulin peak
will occur two to four hours after administration of
regular insulin. The first insulin peak will occur
(Sulfamylon) is ordered bid. While applying the
Sulfamylon to the wound, it is important for the
nurse to prepare the client for expected
responses to the topical application, which
include:
a. severe burning pain for a few minutes following
application.
b. possible severe metabolic alkalosis with
continued use.
c. black discoloration of everything that comes in
contact with this drug.
d. chilling due to evaporation of solution from the
moistened dressings.
18. Ms.Clark has hyperthyroidism and is
scheduled for a thyroidectomy. The physician
has ordered Lugols solution for the client. The
nurse understands that the primary reason for
giving Lugols solution preoperatively is to:
a. decrease the risk of agranulocytosis
postoperatively.
b. prevent tetany while the client is under general
anesthesia.
c. reduce the size and vascularity of the thyroid
and prevent hemorrhage.
d. potentiate the effect of the other preoperative
medication so less medicine can be given while the
client is under anesthesia.
19. A two-year-old child with congestive heart
failure has been receiving digoxin for one week.
The nurse needs to recognize that an early sign
of digitalis toxicity is:
a. bradypnea.
b. failure to thrive.
c. tachycardia.
d. vomiting.
two to four hours after administration of regular
insulin. The second peak will occur eight to twelve
hours after the administration of NPH insulin.
17. Answer A.
Mafenide acetate 10% (Sulfamylon) does cause
burning on application. An analgesic may be
required before the ointment is applied. Mafenide
acetate 10% (Sulfamylon) is a strong carbonic
anhydrase inhibitor that affects the renal tubular
buffering system, resulting in metabolic acidosis.
Mafenide acetate 10% (Sulfamylon) does not
cause discoloration. Silver nitrate solution, another
topical antibiotic used to treat burn sepsis, has the
disadvantage of turning everything it touches
black. Mafenide acetate 10% (Sulfamylon) is an
ointment that is applied directly to the wound. It
has the ability to diffuse rapidly through the
eschar. The wound may be left open or dry
dressing may be applied. Silver nitrate solution is
applied by soaking the wound dressings and
keeping them constantly wet, which may cause
chilling and hypotension.
18. Answer C.
Doses of over 30 mg/day may increase the risk of
agranulocytosis. Lugols solution does not act to
prevent tetany. Calcium is used to treat tetany. The
client may receive iodine solution (Lugols
solution) for 10 to 14 days before surgery to
decrease vascularity of the thyroid and thus
prevent excess bleeding. Lugols solution does not
potentiate any other preoperative medication.
19. Answer D.
Bradypnea (slow breathing) is not associated with
digitalis toxicity. Bradycardia is associated with
digitalis toxicity. Although children with
congestive heart failure often have a related
condition of failure to thrive, it is not directly
related to digitalis administration. It is more related
20. Mr. Bates is admitted to the surgical ICU
following a left adrenalectomy. He is sleepy but
easily aroused. An IV containing
hydrocortisone is running. The nurse planning
care for Mr. Bates knows it is essential to
include which of the following nursing
interventions at this time?
a. Monitor blood glucose levels every shift to
detect development of hypo- or hyperglycemia.
b. Keep flat on back with minimal movement to
reduce risk of hemorrhage following surgery.
c. Administer hydrocortisone until vital signs
stabilize, then discontinue the IV.
d. Teach Mr. Bates how to care for his wound
since he is at high risk for developing
postoperative infection.














to chronic hypoxia. Tachycardia is not a sign of
digitalis toxicity. Bradycardia is a sign of digitalis
toxicity. The earliest sign of digitalis toxicity is
vomiting, although one episode does not warrant
discontinuing medication.

20. Answer A.
Hydrocortisone promotes gluconeogenesis and
elevates blood glucose levels. Following
adrenalectomy the normal supply of
hydrocortisone is interrupted and must be replaced
to maintain the blood glucose at normal levels.
Care for the client following adrenalectomy is
similar to that for any abdominal operation. The
client is encouraged to change position, cough, and
deep breathe to prevent postoperative
complications such as pneumonia or
thrombophlebitis. Maintenance doses of
hydrocortisone will be administered IV until the
client is able to take it by mouth and will be
necessary for six months to two years or until the
remaining gland recovers. The client undergoing
an adrenalectomy is at increased risk for infection
and delayed wound healing and will need to learn
about wound care, but not at this time while he is
in the ICU.