NCLEX MASTERY EXAMINATION

1. During an arteriogram, the patient suddenly says, “I am feeling really hot.” Which is the best
response?
A. “You are having an allergic reaction to the dye. I will get an order for Benadryl”.
B. “Let me get your doctor to explain this sensation to you”.
C. “That feeling of warmth is normal when the dye is injected. It will last up to 20 seconds”.
D. “The heat indicates that the clots in the coronary vessels are dissolving”.
2. A female patient complains of abdominal discomfort. Watery stool has been leaking from her
rectum. This could be a sign of:
A. Fecal impaction
B. Diarrhea
C. Bowel incontinence
D. Constipation
3. A patient with chronic hepatitis C is scheduled for liver biopsy. Before the procedure, the nurse
checks the most recent lab results. Which of the following laboratory findings does NOT assess
coagulation?
A. Partial thromboplastin time
B. Platelet count
C. Hematocrit
D. Prothrombin time
4. The healthcare provider is caring for a patient who has septic shock. Which of these should the
healthcare provider administer to the patient first?
A. Vasopressor to increase blood pressure
B. Antibiotics to treat the underlying infection
C. Corticosteroids to reduce inflammation
D. IV fluids to increase intravascular volume
5. Which of these assessment findings should the nurse expect to identify as an early clinical
characteristics of multiple sclerosis?
A. Vision loss
B. Muscle atrophy
C. Bradycardia
D. Myocardial infarction
6. When evaluating the arterial blood gas of a patient with a 20 year history of chronic bronchitis,
which of these would the nurse expect?
A. Respiratory acidosis, compensated
B. Respiratory acidosis, uncompensated
C. Metabolic acidosis, compensated
D. Metabolic alkalosis, compensated
7. When caring for a patient with a cardiac dysrhythmia, which laboratory finding is a priority for
the nurse to monitor?
A. BUN and creatinine
B. ECG readings and blood works
C. Sodium, potassium and calcium
D. PT and PTT
8. The nurse prepares to administer a corticosteroid to a patient with a diagnosis of asthma. What
is the rationale for administering this drug to the patient?
A. Increase heart rate
B. Decreased respiratory rate
C. Decreased airway swelling
D. None is correct
9. During an assessment of a patient experiencing acute hemorrhage, the nurse would most likely
to expect to find?
A. Bradycardia
B. Tachycardia
C. Hypotension
D. Hypertension
10. When assessing a client diagnosed with osteoarthritis, the nurse looks for which characteristics
of this condition?
A. Swelling
B. Joint crepitus
C. Decreased grip strength and bilateral joint swelling
D. Waddling gait
11. When a drug’s effect is increased after a second drug is given, this interaction is called?
A. Antagonism
B. Synergistic
C. Potentiation
D. Added effect
12. A patient who is diagnosed with Parkinson’s disease (PD) states , I cant tie my shoelaces
anymore . “ The healthcare provider recognizes that this patient’s problem is due to a
deficiency in which of thise neurotransmitters?
A . Dopamine
B. Propanolol
C. Lasix
D . Nitrates
13. A patient diagnosed with ulcerative colitis is admitted to the medical unit. When assessing the
patient, which of these findings would be of the most concern?
A. Rebound tenderness
B. Borborygmi
C. Oral temperature of 99.0 F (37.2 C)
D. Bloody diarrhea
14. An unresponsive patient with diabetes is brought to the emergency department with slow, deep
respirations. Additional findings include: blood glucose 450 mg/dL (24.9 mmol/L), arterial pH
7.2, and urinalysis showing presence of ketones and glucose. Which of the following statements
best describes the underlying cause of this patient's presentation?
A. Nocturnal elevation of growth hormone results in hyperglycemia in the morning
B. Lack of insulin causes increased counter-regulatory hormones and ketone release
C. Hyperglycemia causes oxidative stress, renal dysfunction, and acidosis
D. Hypoglycemia causes release of glucagon resulting in glycogenolysis and hyperglycemia
15. A patient presents to the emergency department with a blood pressure of 180/130 mmHg,
headache, and confusion. Which additional finding is consistent with a diagnosis of hypertensive
emergency?
A. Bradycardia
B. Urinary retention
C. Jaundice
D. Retinopathy
16. The healthcare provider is caring for a patient on a ventilator with an endotracheal tube in
place. What assessment data indicate the tube has migrated too far down the trachea?
A. Increased crackles auscultation bilaterally
B. Decreased breath sounds on the left side of the chest
C. Low pressure alarm sounds
D. A high pressure alarm sounds
17. A patient with a diagnosis of lung cancer is receiving chemotherapy and reports nausea and loss
of appetite resulting in decreased food intake. What should the healthcare provider recommend
to promote adequate nutrition? Advise the patient to
A. Eat only when feeling hungry.
B. Eat large meals but less frequently throughout the day.
C. Eat small meals throughout the day.
D. Eat only favorite foods to increase appetite.
18. During an assessment of a patient experiencing acute hemorrhage , the healthcare provider
would most likely expect to find
A. Jaundice
B. Nausea
C. Tachycardia
D. Hypotension
19. Before administering two units of whole blood, what type of intravenous (IV) device should be
used?
A. The smallest possible catheter to prevent pain on insertion.
B. A large bore catheter to allow blood cells to pass easily into the patient.
C. The same IV device as previously used. Consult the patient's chart.
D. Whatever the doctor has ordered. Consult the patient's chart.
20. The healthcare provider is caring for a patient who has septic shock. Which of these should the
healthcare provider administer to the patient first?
A. Antibiotics to treat the underlying infection.
B. Vasopressors to increase blood pressure.
C. Corticosteroids to reduce inflammation.
D. IV fluids to increase intravascular volume.
21. The healthcare provider is seeing four patients at the neighborhood clinic. Which of these
patients should the healthcare provider identify to be most at risk for iron-deficiency anemia?
A. The obese patient with a history of gastric bypass surgery.
B. The woman of childbearing age reporting a craving for ice.
C. The patient who has a diagnosis of chronic renal failure.
D. The patient who follows a strict vegan diet.
22. The safest method of changing a patient's tracheotomy ties is to
A. Ask the doctor to suture the tracheostomy in place
B. Apply the new ties before removing the old ones.
C. Change ties as soon as possible after the patient has eaten.
23. The healthcare provider is reviewing the arterial blood gas report for a child with severe,
persistent asthma. The blood gas is: pH = 7.28, PaCO2 = 50 mmHg, HCO3 = 25. Which of these
assessments are consistent with this child's arterial blood gas?
A. Disorientation, headache, and flushed face
B. Kussmaul respirations and muscle twitching
C. Rapid, deep respirations and paresthesia
D. Slow respirations, nausea, and vomitingNever attempt to change ties alone.
24. A patient is brought to the Emergency Department (ED) by a friend. The patient is unresponsive
and respirations are slow and shallow. Which of the following is the priority intervention?
A. Check the patient's blood glucose level
B. Administer naloxone, per protocol
C. Ask the friend if they were using illicit drugs
D. Administer 100% oxygen per nasal cannula
25. With a stroke patient, what is the best position for insertion of a nasogastric (NG) tube?
A. High Fowler's
B. Supine
C. Trendelenburg
D. Low Fowler's
26. The earliest identifying sign for a developing pressure sore is a localized _______.
A. change in color
B. loss of sensation
C. edema
D. coolness to touch
27. A patient is prescribed a new medication for the treatment of hypertension. While supine, the
patient's blood pressure is 112/70 mmHg and the heart rate is 80/minute. The healthcare
provider assesses the patient when the patient changes to a sitting position. Which of the
following indicates the patient is experiencing orthostatic hypotension?
A. BP 100/66, HR 90
 B. BP 88/60, HR 100
C. BP 90/60, HR 68
D. BP 120/84, HR 82
28. A diabetic patient receives 10 units of Regular insulin and 20 units of NPH insulin each day after
breakfast. After following normal preparation steps for administering insulin, what should the
nurse do next?
A. Administer each type of insulin separately for accuracy
B. Either insulin can be drawn first, as long as 30 units are given
C. Draw up NPH insulin first, because it is clear
D. Draw up Regular insulin first, because it is clear
29. The healthcare provider is assessing a patient recovering from a total knee replacement. Which
of these assessment findings indicates the patient is at risk of developing a complication from
the surgery?
A. Homan's sign negative
B. Hemoglobin 12.5 g/dL
C. Pale toenail beds
D. Incision site edema
30. A patient with a history of atrial fibrillation for three days is admitted to the cardiac unit. Besides
initiating an anti-dysrhythmia medication, which order should the nurse anticipate?
A. Prepare a heparin infusion
B. Immediately give atropine by IV push
C. Obtain consent for AV node ablation
D. Set up for a cardioversion procedure
31. Lyme Disease should be treated promptly. When a patient presents to the Emergency
Department with symptoms related to Lyme Disease, which should be prescribed?
A. Doxycyline
B. Simvastatin
C. Enalapril
D. Famotidine
32. A patient receiving Vancomycin has an order for a trough level to be drawn. When should the
lab collect the blood sample?
A. 1 hour after the infusion
B. 30 minutes before the infusion
C. 30 minutes after the infusion
D. 1 hour before the infusion
33. A male patient with a history of type 1 diabetes is two days post-op following cholecystectomy.
He has complained of nausea and can't tolerate solid foods. The nurse finds the patient
confused and shaky. Which of the following most likely explains the patient's symptoms?
A. Respiratory acidosis
B. Hypoglycemia
C. Hyperglycemia
D. Diabetic ketoacidosis
34. For a patient who is in the late stages of chronic bronchitis, which of the following would
indicate the patient has developed cor pulmonale?
A. Hepatomegaly
B. Venous stasis ulcers
C. Night sweats
D. Hypocapnia
35. Which type of insulin can never be mixed with another?
A. Regular
B. Long-acting
C. Rapid-acting
D. Intermediate
36. The healthcare provider is performing an assessment on a patient who is taking propranolol
(Inderal) for supraventricular tachycardia. Which assessment finding is an indication the patient
is experiencing an adverse effect of this drug?
A. Paresthesia
B. Urinary retention
C. Dry mouth
D. Bradycardia
37. After an argument with her mother, an adolescent female takes an overdose of Tylenol
(acetaminophen). The health care provider knows to watch for complications in which organ?
A. Pancreas
B. Heart
C. Kidney
D. Liver
38. A patient is taking daily low-dose aspirin and experiences prolonged bleeding from a superficial
cut. Which of the following lab results would be expected for this patient?
A. Platelets 150 x 10^9/L
B. Prothrombin time (PT) 14 seconds
C. Activated partial thromboplastin time (aPTT) 30 seconds
D. Bleeding time of 8 minutes
39. The healthcare provider is preparing a patient on the medical-surgical unit for a thoracentesis.
Which of the following is the most appropriate position for the patient during the procedure?
A. Prone, with both arms extended above the head.
B. The head of the bed flat with the patient lying on the unaffected side.
C. The head of bed elevated 45 degrees with the patient lying on the affected side.
D. Sitting up, leaning over a bedside table and feet supported on the ground or stool.
40. The healthcare provider is planning care for four patients. Which patient is most in need of
interventions aimed at preventing anemia? The patient
A. who is a vegetarian.
B. who has been NPO for 3 days.
C. with a Jackson-Pratt drain.
D. with renal failure on hemodialysis.
 41. The healthcare provider is assisting during the insertion of a pulmonary artery catheter. Which
of these, if assessed in the patient, would indicate the patient is experiencing a complication
from the catheter insertion?
A. Diaphragmatic excursion of 3cm
B. Vesicular breath sounds noted on auscultation
C. Tracheal deviation from midline
D. Inspiration phase is greater than expiration
42. The healthcare provider administers NPH insulin at 6:00 AM to a patient with diabetes. How
soon will the patient show any signs hypoglycemia?
A. 10:00 AM
B. 9:00 AM
C. 8:00 AM
D. 7:00 AM

43. When assessing a patient with dysarthria, the best approach is to:

A. Ask yes/no questions

B. Ask information questions

C. Use visual aids to communicate ideas to patient

D. Speak loudly and clearly

44. A legal document that specifically designates someone to make decisions regarding medical and
end-of-life care if a patient is mentally incompetent is a(n):

A. Do-not-resuscitate order

B. Advance directive

C. General power of attorney

D. Durable power of attorney—ends when mentally ill

45. An effective way to adequately provide nourishment to a patient with moderate dementia is:

A. allowing the patient to choose foods from a varied menu.

B. hand feeding the patient's favorite foods.

C. routinely reminding the patient about the need for adequate nutrition.

D. serving soup in a mug, and offering finger foods.

46. A 90-year-old patient comes to the clinic with a family member. During the health
history, the patient is unable to respond to questions in a logical manner. The gerontological
nurse's action is to:

A. ask the family member to answer the questions.

B. ask the same questions in a louder and lower voice.

C. determine if the patient knows the name of the current president.

D. rephrase the questions slightly, and slowly repeat them in a lower voice.

47. An 80-year-old patient, who lives at home with a spouse, is instructed to follow a 2 g
sodium diet. The patient states, "I've always eaten the same way all my life, and I'm not going to
change now." To promote optimal dietary adherence, the gerontological nurse's initial approach
is to:

A. inform the patient about the need to follow the diet.

B. inquire about the patient's current food preferences and eating habits.

C. list the variety of foods that are allowed on the diet.

D. provide dietary instruction to the patient's spouse, who prepares the meals.

48. A 75-year-old patient, whose marriage ended in divorce after two years, has lived alone
for the past 50 years. Feeling as if life has had little meaning, the patient is terrified of living out
the remaining years and of dying. The age-related issue to be resolved is:

A. disengagement vs. activity.

B. ego integrity vs. despair.

C. self-determination vs. resignation.

D. self-esteem vs. self-actualization.

49. Three months ago, an older adult patient, who lives in an apartment in a housing
complex for senior citizens, began residing with an older adult patient from the same complex.
Upon learning of the situation, the patient's adult child expresses concern to the housing
administrator, who reports that both residents have reported satisfaction with the
arrangement. When the child requests advice, the gerontological nurse's initial response is:

50. I can understand why you are upset. Has he or she ever done something like this
before?"

B. "Why don't we all talk to your parent to get his or her side of the story?"
C. "Your parent has the right to do what he or she wants because he or she is mentally
competent."

D. "Your parent seems to be happy with the arrangement. Have you discussed this
situation with him or her?"

51. In assessing the aging client, it is importnat for the nurse to recognize:

A. The client's ability to perform ADLs

B. The financial status of the client

C. The job that the client held prior to aging

D. All components of well-being, including biological function, psychological function, and social
function

52. Medications, slower mobility, lack of proper fluid intake, and poor diet can contribute to
what common symptom in the elder population?

A. Urinary incontinence

B. Skin changes

C. Mental changes

D. Depression

53. The nurse assessing the older population needs to have a basic understanding of which of
the following?

A. The economic status of the area

B. The difference between normal and abnormal for the older age group

C. The signs of sexual dysfunction

D. The signs of cardiac disease

54. Which statement would be most appropriate to ask when assessing an aging adult for
cognitive function?

A. What is today's date?

B. Can you count to 10 for me?

C. Have you noticed anything different about your memory or thinking in the past few months?

D. Who is the president of the United States?

55. Which statement demonstrates normal cognitive function for an aging adult?

A. Occasional memory lapses

B. Unable to recall the names of their children or siblings

C. Unable to recall current address or phone number

D. Unable to count to 10 or repeat a series of consecutive numbers

56. Dementia and depression are strongly related to:

A. Clients over the age of 60

B. Clients over the age of 65

C. A decreased quality of life and functional deficits

D. Past economic status and job performance

57. Which statement reflects the state of drug absorption in the geriatric patient?

A. The rate of absorption is slowed

B. The rate of absorption is faster due to thinning of the mucosa

C. The percentage of the medication that is absorbed is decreased

D. There is a decrease in gastric pH as we age

58. The absorption of medication in the geriatric client is most often affected by:

A. A decrease in body fat

B. An increase in serum albumin

C. A decrease in body water and lean body weight (15%) bet 20-80

D. An increase in body water

59. Which organ is responsible for drug metabolism and must be considered when prescribing
medicaiton for an older adult?

A. Kidneys

B. Pancreas

C. Intestines

D. Liver – water soluble metabolites

60. In assessing the aging client, it is important for the nurse to recognize:

a) The client's ability to perform ADLs

b) The financial status of the client

c) The job that the client held prior to aging

d) All components of well-being, including biological function, psychological function, and social
function

61. Refers to the field of nursing that relates to the assessment, planning, implementation and
evaluation of older people:

A. Aging

B. Gerantology

C. Geriatric Nursing

D. Life process

62. The study of the aging process that draws from biologic, psychological and sociologic
sciences.

A. Geriatrics

B. Gerantology

C. Aging

D. Elderly

63. Allowable sodium intake per day for an older people is only limited to:

A. 7 mgs.

B. 5 mgs

C. 2.5 mgs

D. 0.5 mgs

64. Which of the following are NOT typical signs and symptoms of right-sided heart failure?
Select-all-that-apply:*

A. Jugular venous distention

B. Persistent cough
C. Weight gain

D. Crackles

E. Nocturia

F. Orthopnea

65. A patient is diagnosed with left-sided systolic dysfunction heart failure. Which of the
following are expected findings with this condition?*

A. Echocardiogram shows an ejection fraction of 38%.

B. Heart catheterization shows an ejection fraction of 65%.

C. Patient has frequent episodes of nocturnal paroxysmal dyspnea.

D. Options A and C are both expected findings with left-sided systolic dysfunction heart failure.

66. True or False: Patients with left-sided diastolic dysfunction heart failure usually have a
normal ejection fraction.*

A. True

B. False

67. A patient has a history of heart failure. Which of the following statements by the patient
indicates the patient may be experiencing heart failure exacerbation?*

A. “I’ve noticed that I’ve gain 6 lbs in one week.”

B. “While I sleep I have to prop myself up with a pillow so I can breathe.”

C. “I haven’t noticed any swelling in my feet or hands lately.”

D. Options B and C are correct.

E. Options A and B are correct.

F. Options A, B, and C are all correct.

68. Patients with heart failure can experience episodes of exacerbation. All of the patients below
have a history of heart failure. Which of the following patients are at MOST risk for heart failure
exacerbation?*

A. A 55 year old female who limits sodium and fluid intake regularly.

B. A 73 year old male who r 3eports not taking Amiodarone for one month and is experiencing
atrial fibrillation. ANTIARRYTHYMIC CLASS
C. A 67 year old female who is being discharged home from heart valve replacement surgery.

69. Which of the following tests/procedures are NOT used to diagnose heart failure?*

A. Echocardiogram

B. Brain natriuretic peptide blood test

C. Nuclear stress test

D. Holter monitoring RHYTHM OF THE HEART

70. What type of heart failure does this statement describe? The ventricle is unable to properly
fill with blood because it is too stiff. Therefore, blood backs up into the lungs causing the patient
to experience shortness of breath.*

A. Left ventricular systolic dysfunction

B. Left ventricular ride-sided dysfunction

C. Right ventricular diastolic dysfunction

D. Left ventricular diastolic dysfunction

71. A patient with left-sided heart failure is having difficulty breathing. Which of the following is
the most appropriate nursing intervention?*

A. Encourage the patient to cough and deep breathe.

B. Place the patient in Semi-Fowler's position.

C. Assist the patient into High Fowler's position.

D. Perform chest percussion therapy.

72.You're providing diet discharge teaching to a patient with a history of heart failure. Which of
the following statements made by the patient represents they understood the diet teaching?*

A. "I will limit my sodium intake to 5-6 grams a day."

B. "I will be sure to incorporate canned vegetables and fish into my diet."

C. "I'm glad I can still eat sandwiches because I love bologna and cheese sandwiches."

D. "I will limit my consumption of frozen meals."

73. Select all the correct statements about educating the patient with heart failure:*
A. It is important patients with heart failure notify their physician if they gain more than 6
pounds in a day or 10 pounds in a week.

B. Patients with heart failure should receive an annual influenza vaccine and be up-to-date with
the pneumonia vaccine.

C. Heart failure patients should limit sodium intake to 2-3 grams per day.

D. Heart failure is exacerbated by illness, too much fluid or sodium intake, and arrhythmias.

74.Which of the following is a late sign of heart failure?*

A. Shortness of breath

B. Orthopnea

C. Edema

D. Frothy-blood tinged sputum

75. All of the following are normal age related changes in the cardiovascular system except:

A. Decreased CO,

B. diminished ability to respond to stress;

C. Increased blood pressure

D. There is no exception

76.The term geriatric refers to what type of adult patient?

A. Those in nursing homes

B. Nursing home patients over 65

C. Any adult patient 65 or older

D.Adult patients 85 or older

77.The five major components of a comprehensive nursing assessment of the older adult
patient include which of these (choose the best answer)?

A. Functional, spiritual, financial, physical, cognitive aspects

B. Physical, cognitive, social, spiritual, and family aspects

C. Spiritual, psychological, social, functional, and physical aspects

D. Spiritual, psychological, social, functional, and financials aspects

78. At a community health fair, the blood pressure of a 62-year-old client is 160/96 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 1 week for a BP check

79. 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
admitted 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.

80. During an assessment of an elderly client with cardiomyopathy, the nurse finds that the
systolic blood pressure has decreased from 145 to 110 mmHg 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

81. When developing the plan of care for an older adult who is hospitalized for an acute illness,
the nurse should

A. use a standardized geriatric nursing care plan.

B. plan for likely long-term-care transfer to allow additional time for recovery.

C. consider the preadmission functional abilities when setting patient goals.

D. minimize activity level during hospitalization.

82. Which information obtained by the home health nurse when making a visit to an 88-year-old
with mild forgetfulness is of the most concern?
A. The patient's son uses a marked pillbox to set up the patient's medications weekly.

B. The patient has lost 10 pounds (4.5 kg) during the last month.

C. The patient is cared for by a daughter during the day and stays with a son at night.

D. The patient tells the nurse that a close friend recently died.

83. In reviewing changes in the older adult, the nurse recognizes that which of the following
statements related to cognitive functioning in the older client is true?

A. Delirium is usually easily distinguished from irreversible dementia.

B. Therapeutic drug intoxication is a common cause of senile dementia.

C. Reversible systemic disorders are often implicated as a cause of delirium.

D. Cognitive deterioration is an inevitable outcome of the human aging process.

84. Which of the following interventions should be taken to help an older client to prevent
osteoporosis?

A. Decrease dietary calcium intake.

B. Increase sedentary lifestyles

C. Increase dietary protein intake.

D. Encourage regular exercise.

85. Which of the following statements accurately reflects data that the nurse should use in
planning care to meet the needs of the older adult?

A. 50% of older adults have two chronic health problems.

B. Cancer is the most common cause of death among older adults.

C. Nutritional needs for both younger and older adults are essentially the same.

D. Adults older than 65 years of age are the greatest users of prescription medications.

86. The nurse is aware that the majority of older adults:

A. Live alone

B. Live in institutional settings

C. Are unable to care for themselves

D. Are actively involved in their community

87. The nurse works with elderly clients in a wellness screening clinic on a weekly basis. Which
of the following statements made by the nurse is the most therapeutic regarding their mobility?

A. "Your shoulder pain is normal for your age."

B. "Continue to exercise your joints regularly to your tolerance level."

C. "Why don't you begin walking 3 to 4 miles a day, and we'll evaluate how you feel next week."

D. "Don't worry about taking that combination of medications since your doctor has prescribed
them.

88. A 84 year old male with a history of severe emphysema and a prior myocardial infarction
becomes short of breath with exertion. Physical examination reveals a III/VI holosystolic murmur
at the cardiac apex, an S3 heart sound, and rales in the lower lung fields. No lower extremity
edema is present. Which of the following is the likely diagnosis?

A. Left-sided congestive heart failure

B. Right-sided congestive heart failure

C. Left and right sided congestive heart failure

D.Cor pulmonale

89. An 82 year old male with a history of hypertension and congestive heart failure presents
with palpitations. His heart rate is 140 beats per minute and his physical examination reveals an
irregularly irregular rhythm. He is diagnosed with atrial fibrillation. Which of the following
medications can reduce his heart rate while improving left ventricular systolic function?

A. Propranolol

B. Verapamil

C. Digoxin

D. Amiodarone

90. A 64 years old suffers hypotension after eating meals on lunch. This phenomenon is also
known as:

A. orthostatic hypotension

B. post prandial hypontention

C. Primary hypotension

D. none is correct
91. For the client suffering from the phenomenon in number 47, the nurse should do which of
the following except:

A. eat small frequent feeding.

B. Avoid eating foods high in sodium

C. Giving large 3 meals everyday

D. Only C is correct

92. An effective way to adequately provide nourishment to a patient with moderate dementia
is:

A. allowing the patient to choose foods from a varied menu.

B.hand feeding the patient's favorite foods.

C. routinely reminding the patient about the need for adequate nutrition.

D. serving soup in a mug, and offering finger foods.

93. An 82-year-old patient has a painful, vesicular rash that burns over the left abdomen. The
patient indicates that he or she has tried multiple creams that have not helped. Which question
does the gerontological nurse first ask?

A. "Did you have the pain before the rash appeared?"

B. "Do you have any food or drug allergies?"

C. "Have you been around anyone with a rash?"

D. "Have your grandchildren visited recently?"

94. A pediatric nurse advises a parent how to best convey the circumstances surrounding
the sudden death of an infant to a four-year-old sibling. The nurse anticipates that the sibling:

A. may feel guilty about the infant's death.

B. may mistrust the parent.

C. C. understands the permanence of death.

D. will role-play the infant's death.

95. At which stage of development are children apt to believe in the reversibility of death?

A. Adolescent
B. Preschool age

C. School age

D. Toddler

96. To meet the emotional needs of a 10-year-old patient who is dying, the most appropriate
nursing action is to:

` A. answer questions honestly and frankly.

B. avoid interruptions by coordinating nursing actions.

C. encourage the patient to write in a journal.

D. provide opportunities for the patient to interact with children of the same age.

97. In preparing a preschool-age patient for an injection, the most appropriate nursing
intervention is to:

A. allow the patient to administer an injection to a doll.

B. coordinate the patient watching a peer receive an injection.

C. have the parents explain the process to the patient.

D. suggest diversionary activities like singing.

98. The nurse is aware that age at which the posterior fontannel closes is at:

A. 2 to 3 months

B. 3 to 6 month

C. 6 to 9 month

D. 9 to 12 months

99. Which stage of development is most unstable and challenging regarding developmental of
personal identity?

A. Adolescence

B. Toddler hood

C. Childhood

D. Infancy
100. A maternity nurse is providing instruction to a new mother regarding the psychosocial
development of the newborn infant. Using Erickson’s psychosocial development theory, the
nurse would instruct the mother to:

A. Allow the newborn infant to signal a need

B. Anticipate all of the needs of the newborn infant

C. Avoid the newborn infant during the first 10 minutes of crying

D. Attend to the newborn infant immediately when crying

101. A mother of a 3-year old tells a clinic nurse that the child is rebelling constantly and having
temper tantrums. The nurse most appropriately tells the mother to:

A. Punish the child every time the child says “no” to change the behavior

B. Allow the behavior because this is normal at this age period

C. Set limits on the child’s behavior

D. Ignore the child when this behavior occurs

102. A nurse is evaluating the developmental level of a 2-year old.Which of the following does
the nurse expect to observe in this child?

A. Uses a fork to eat

B. Uses a cup to drink

C. Uses a knife for cutting food

D. Pours own milk into a cup

103. A clinic nurse assesses the communication patterns of a 5-month-old infant. The nurse
determines that the infant is demonstrating the highest level of developmental achievement
expected if the infant:

A. Uses simple words such as "mama"

B. Uses monosyllabic babbling

C. Links syllables together

D. Coos when comforted

104. A nurse is preparing to care for a 5-year-old who has been placed in traction following a
fracture of the femur. The nurse plans care, knowing that which of the following is the most
appropriate activity for this child?
A. Large picture books

B. A radio

C. Crayons and coloring book

D. A sports video

105. A 16-year-old is admitted to the hospital for acute appendicitis, and an appendectomy is
performed. Which of the following nursing interventions is most appropriate to facilitate normal
growth and development?

A. Allow the family to bring in the child's favorite computer games

B. Encourage the parents to room-in with the child

C. Encourage the child to rest and read

D. Allow the child to participate in activities with other individuals in the same age group when
the condition permits

106. The mother of a toddler asks a nurse when it is safe to place the car safety seat in a face-
forward position. The best nursing response is which of the following?

A. When the toddler weighs 20 lbs

B. The seat should not be placed in a face-forward position unless there are safety locks in the
car

C. The seat should never be place in a face-forward position because the risk of the child
unbuckling the harness

D. When the weight of the toddler is greater than 40 lbs

107. A mother calls the pediatrician's office because her infant is "colicky." The helpful measure
the nurse would suggest to the parent is to:

A. Sing songs to the infant in a soft voice.

B. Place the infant in a well-lit room.

C. Walk around and massage

D. Rock the fussy infant slowly and gently.

108. The nurse teaches parents how to help their children learn impulse control and cooperative
behaviors. This would occur during which of the stages of development defined by Erikson?

A. Trust versus mistrust

B. Initiative versus guilt

C. Industry versus inferiority

D. Autonomy vs. Shame and doubt

109. The nurse knows that an infant's birth weight should be tripled by:

A. 9 months.

B. 1 year.

C. 18 months.

D. 2 years.

110. The nurse is aware that the earliest age at which an infant is able to sit steadily alone is
_____ months.

A. 4

B. 5

C. 8

D. 15

111. The nurse is aware that the earliest age at which the infant should be able to walk
independently is _____ months.

A. 8 to 10

B. 12 to 15

C. 15 to 18

D. 18 to 2

112. The parent of a 3-month-old infant asks the nurse, "At what age do infants usually begin
drinking from a cup?" The nurse would reply:

A. 5 months.

B. 9 months.

C. 1 year.

D 2 years.

113. The nurse would expect a 4-month-old to be able to:

A. Hold a cup.

B. Stand with assistance.

C. Lift head and shoulders.

D. Sit with back straight

114. The abnormal finding in an evaluation of growth and development for a 6-month-old infant
would be:

A. Weight gain of 4 to 7 ounces per week.

B. Length increase of 1 inch in 2 months.

C. Head lag present.

D. Can sit alone for a few seconds.

115. A parent brings a 6-month-old infant to the pediatric clinic for her well-baby examination.
Her birth weight was 8 pounds, 2 ounces. The nurse weighing the infant today would expect her
weight to be at least _____ pounds.

A. 12

B. 16

C. 20

D. 24

116. The nurse would advise a parent when introducing solid foods to:

A. Begin with one tablespoon of food.

B. Mix foods together.

C. Eliminate a refused food from the diet.

D. Introduce each new food 4 to 7 days apart

117. When assessing development in a 9-month-old infant, the nurse would expect to observe
the infant:

A. Speaking in 2-word sentences.

B. Grasping objects with palmar grasp.

C. Creeping along the floor.

D. Beginning to use a spoon rather sloppily

118. The statement made by a parent that indicates correct understanding of infant feeding is:

A. "I've been mixing rice cereal and formula in the baby's bottle."

B. "I switched the baby to low-fat milk at 9 months."

C. "The baby really likes little pieces of chocolate."

D. "I give the baby any new foods before he takes his bottle."

119. The nurse observes a 10-month-old infant using her index finger and thumb to pick up
pieces of cereal. This behavior is evidence that the infant has developed:

A. The pincer grasp.

B. A grasp reflex.

C. Apprehension ability.

D. the parachute reflex.

120. The most appropriate activity to recommend to parents to promote sensorimotor

stimulation for a 1-year-old would be to:

A. Ride a tricycle.

B. Spend time in an infant swing.

C. Play with push-pull toys.

D. Read large picture books

121. The nurse explains that by the age of 6 months an iron-rich formula should be offered
because the infant has:

A. Limited ability to produce red blood cells.

B. Ineffective digestive enzymes.

C. Exhausted maternal iron stores.

D. Need of the iron to support dentition.

122. What should the teaching plan include about infant fall precautions? Select all that apply.

A. Remove all unsteady furniture.

B. Keep crib rails up and in locked position.

C. Steady infant with hand when on changing table.

D. Use tray attachment on high chair as restraint.

E. Keep infant seat on the floor.

123. A 3-month-old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her
hands, but she will not voluntarily grasp it. The nurse should interpret this as:

A. Normal development.

B. Significant developmental lag.

C. Slightly delayed development caused by prematurity.

D Suggestive of a neurologic disorder such as cerebral palsy.

124. The nurse is assessing a pregnant client in the second trimester of pregnancy who was
admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which
assessment finding should the nurse expect to note if this condition is present?

A. Soft abdomen

B. Uterine tenderness

C. Absence of abdominal pain

D. Painless, bright red vaginal bleeding

125. The maternity nurse is preparing for the admission of a client in the third trimester of
pregnancy who is experiencing vaginal bleeding and has a suspected diagnosis of placenta
previa. The nurse reviews the health care provider's prescriptions and should question which
prescription?

A. Prepare the client for an ultrasound.

B. Obtain equipment for a manual pelvic examination.

C. Prepare to draw a hemoglobin and hematocrit blood sample

D. Obtain equipment for external electronic fetal heart rate monitoring

126. An ultrasound is performed on a client at term gestation who is experiencing moderate

vaginal bleeding. The results of the ultrasound indicate that abruption placentae is present. On
the basis of these findings, the nurse should prepare the client for which anticipated
prescription?

A. Delivery of the fetus.

B. Strict monitoring of intake and output

C. Complete bed rest for the remainder of the pregnancy

D. The need for weekly monitoring of coagulation studies until the time of delivery

127. The nurse is preforming an initial assessment on a client who has just been told that a
pregnancy test is positive. Which assessment finding indicates that the client is at risk for
preterm labor?

A.The client is a 35 year old primigravida

B. The client has a history of cardiac disease

C. The client's hemoglobin level is 13.5 g/dL

D. The client is a 20 year old primigravida of average weight and height

128. After a precipitous delivery, the nurse notes that the new mother is passive and only
touches her newborn infant briefly with her fingertips. What should the nurse do to help the
woman process the delivery?

A.Encourage the mother to breastfed soon after birth

B. Support the mother in her reaction to the newborn infant

C.Tell the mother that it is important to hold the newborn infant.

D. document a complete account of the mother's reaction on the birth record.

129. The nurse is caring for a client in labor. Which assessment finding indicates to the nurse
that the client is beginning the second stage of labor?

A. The contractions are regular.

B. The membranes have ruptured

C. The cervix is completely dilated

D. The client starts to expel clear vaginal fluid

130. The nurse is preforming an assessment of a client who is scheduled for a cesarean delivery.
Which assessment finding would indicate the need to contact the health care provider?

A. Hemoglobin of 11g/dL

B. Fetal heart rate of 180 beats/minute

C. Maternal pulse rate of 85 beats/minute

D. White blood cell count of 12,000 cells/mm3

131. A nurse is beginning to care for a client in labor. The physician has prescribed an IV infusion
of Pitocin. The nurse ensures that which of the following is implemented before initiating the
infusion?

A. Placing the client on complete bed rest

B. Continuous electronic fetal monitoring

C. An IV infusion of antibiotics

D. Placing a code cart at the client’s bedside

132. A nurse is assessing a pregnant client in the 2nd trimester of pregnancy who was admitted
to the maternity unit with a suspected diagnosis of abruptio placentae. Which of the following
assessment findings would the nurse expect to note if this condition is present?

A. Absence of abdominal pain

B. A soft abdomen

C. Uterine tenderness/pain

D. Painless, bright red vaginal bleeding

133. A client is admitted to the birthing suite in early active labor. The priority nursing
intervention on admission of this client would be:

A. Auscultating the fetal heart

B. Taking an obstetric history

C. Asking the client when she last ate

D. Ascertaining whether the membranes were ruptured

134. A nurse is caring for a client in labor. The nurse determines that the client is beginning in
the 2nd stage of labor when which of the following assessments is noted?

A. The client begins to expel clear vaginal fluid

B. The contractions are regular

C. The membranes have ruptured

D. The cervix is dilated completely

135. A nurse in the labor room is caring for a client in the active phases of labor. The nurse is
assessing the fetal patterns and notes a late deceleration on the monitor strip. The most
appropriate nursing action is to:

A. Place the mother in the supine position

B. Document the findings and continue to monitor the fetal patterns

C. Administer oxygen via face mask

D. Increase the rate of pitocin IV infusion

136. A maternity nurse is preparing to care for a pregnant client in labor who will be delivering
twins. The nurse monitors the fetal heart rates by placing the external fetal monitor:

A. Over the fetus that is most anterior to the mother’s abdomen

B. Over the fetus that is most posterior to the mother’s abdomen

C. So that each fetal heart rate is monitored separately

D. So that one fetus is monitored for a 15-minute period followed by a 15 minute fetal
monitoring period for the second fetus

137. A pregnant client is admitted to the labor room. An assessment is performed, and the nurse
notes that the client’s hemoglobin and hematocrit levels are low, indicating anemia. The nurse
determines that the client is at risk for which of the following?

A. A loud mouth

B. Low self-esteem

C. Hemorrhage

D. Postpartum infections

138. A nurse is developing a plan of care for a client experiencing dystocia and includes several
nursing interventions in the plan of care. The nurse prioritizes the plan of care and selects which
of the following nursing interventions as the highest priority?

A. Keeping the significant other informed of the progress of the labor

B. Providing comfort measures

C. Monitoring fetal heart rate

D. Changing the client’s position frequently

139. A nurse is caring for a client in labor who is receiving Pitocin by IV infusion to stimulate
uterine contractions. Which assessment finding would indicate to the nurse that the infusion
needs to be discontinued?

A. Three contractions occurring within a 10-minute period

B. A fetal heart rate of 90 beats per minute

C. Adequate resting tone of the uterus palpated between contractions

D. Increased urinary output

140. A young pregnant client is seen at the community health center for the first time. The client
asked the nurse about foods to take inorder to prevent pregnancy produced anemia. The nurse
best reply would be:

A. Eat foods like meat because they are very rich in protein and iron

B. Include more sweets in your everday diet

C. Green leafy vegetables, lean and organ meats are good sources of iron

Exclude grains and legumes in your food preferences.

141. A first time mother went to the health center for a well baby check up. The mother asked
the nurse on duty about preventing constipation to her formula-fed 11 months old baby girl.
The nurse would advise all of the following to prevent constipation, except:

A. Give more water to your child every after milk feeding

B. Meat should be given in huge slices to the baby because this helps in digestion

C. Fruits and vegetables are good in order to maintain a good digestion thus preventing
constipation.

D. There is no exception

142. A 26 weeks pregnant client, company secretary, presented to the health center
complaining of easy fatigability and exhaustion and leg cramps. Which among the following
should the nurse include in her health teachings?

A. Wear high heeled shoes when working to prevent discomforts.

B. Have time to walk during working hours to stretch your legs and get enough rest
during off days to regain strength. Take prenatal vitamins and eat balanced diet.

C. Sitting down for longer periods are good to pregnant women.

 D. Take iron supplements to prevent iron deficiency during pregnancy.

143. A registered nurse arrives at work and is told to” float” to the NICU for the day because the
area is understaffed. The nurse has never worked in the NICU. Which of the following is the
most appropriate nursing action?

A. Refuse to float in the NICU

B. Call the hospital lawyer

C. Call the nursing supervisor

D. Report to the NICU and identify tasks that can be safely performed.

144. The nurse working in the labor and delivery is obligated to follow a doctor’s order unless:

A. The order is a verbal order

B. The order is illegible

C. The order has not been transcribed

D. The order is an error, violates hospital policy or would be harmful and detrimental
to client.

145. The registered nurse is planning to delegate task to a certified nursing assistant. Which of
the following should not be assigned to a CAN?

A. A pregnant client who is complaining of nausea and vomiting

B. A pregnant mother with a history of PROM and with 200/100 bp on admission

C. A pregnant woman suffering from SOB on her 36 weeks gestation

D. A mother suspects pregnancy and for ultrasonography

146. The labor and delivery nurse would be helpful to the newly hired registered nurse in the
unit if she will do all of the following except:

A. Orient the newly hired staff about the unit and the procedures being done in the
area.

B. Introduce the staff to other co workers inorder to feel comfortable

C. Ignore the staff since you are busy on charts

D. Allow the staff to ask work related questions

147. In the labor room you are working with the other staff attain safe deliver of the mother
anytime. You are both working effectively if you do one among the following:

A. Procedures should not be discuss to the client to avoid anxiety.

B. Teach the woman effective breathing and pushing and informing her all procedures
that will be done inorder to make her at peace.

C. Tell the client that labor is painless and that she doesn’t need to worry at all.

D. Do not include her husband in the plan of care

148. You are caring for a high risk pregnant client who is in a life threatening situation. The fetus
is also at risk for death. Clinical decisions are being made that concern you because some of
these treatments and life saving measures promote the pregnant woman’s life at the same time
that they significantly jeopardize the fetus’ life and viability. Which role of the nurse is important
at this time?

A. Case manager

B. Collaborator

C. Coordinator of Care

D. Advocacy

150. A good teamwork in the labor and delivery unit is best observed when:

A. The head nurse allows the staff to discuss their concerns about effective client care.

B. The head nurse is authoritarian

C. The head nurse and the staff nurses do their tasks independently without
confirmation

D. All are correct

CRISANTACONSAGARNMAN CRISANTACONSAGARNMAN CRISANTACONSAGARNMAN

02242019