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6 Instructions: No negative marking. Use blue/black ball point pen in OMR sheet. Overwriting
and scribbling will not award any mark.
Q.1 A client recovers from congestive heart failure and is discharged home. His medications
on discharge are KCl (K-Dur) 20 mEq once daily, bumetanide (Bumex) 1 mg once daily. The
nurse prepares to teach the client about his medications and has prepared several
handouts with pertinent information that he will need to know about each drug. Before
beginning discharge teaching, the nurse needs to be aware of:
A. His attitude toward illness C. His past compliance with medical regimen
B. His educational level D. His usual pattern of ADL
Q.2 The nurse suggests that a 68 years old female client might have an iron deficiency. On
which characteristic exhibited by the client does the nurse base this decision?
A. Paresthesia in the lower extremities C. Gingival hemorrhages
B. Spooning of the nails D. Carpopedal spasms
Q.3 A client visits the physician for a checkup. Which complaint is most likely to be associated
with an adverse reaction to KCl?
A. “I have had a headache for the past 2 C. "Noticed my stools were dark and tarry this
days” morning”
B. “I have trouble remembering things D. “I have trouble seeing things up close
lately” lately”
Q.4 An 83 years old female client is admitted to the hospital to determine the cause of her
increasing memory loss, irritability, and decreasing interest in the family. Her son reports
these symptoms have been present for about 2 years but are slowly getting worse. The
nurse explains to the son that normal aging changes of brain tissue include:
A. Increased concentration of C. Lipofuscin deposits and neurofibrillary
acetylcholine tangles
B. Increase gray and white matter D. Increased MAO
Q.5 The most appropriate plan of care for the Alzheimer’s client who has difficulty eating is to:
A. Eliminate distractions from the C. Offer a variety of nourishing foods and
environment allow him to select
B. Place client in the dining room for D. Serve hot foods to stimulate appetite
meals
Q.6 The nursing assistant asks the nurse how to get a client with Alzheimer’s involved in
personal hygiene. The nurse correctly informs the nursing assistant to:
A. Have her follow the hospital C. Provide step-by-step written directions
procedure for bathing
B. Give her short, specific instructions for D. Explain ahead of time what she is expected
what to do next to do
Q.7 A 65 years old client develops a decubitus ulcer. The nurse identifies this superficial ulcer
appearing as a blister as:
A. Stage 1 C. Stage 3
B. Stage 2 D. Stage 4
Q.8 A 76 years old client is being prepared for a cholecysostomy (surgical removal of the gall
bladder). The client is placed on NPO after midnight. The nurse recognizes that the
primary reason NPO is indicated in client receiving general anesthesia for cholecystostomy
surgery is:
A. To prevent gastric distention which C. To prevent diarrhoea following the surgical
would lead to poor lung expansion procedure
during surgery
B. To prevent fluid loss during the D. To prevent vomiting that would lead to
surgical procedure possible aspiration of vomitus during surgery
Q.9 A client with Alzheimer’s is confused during the day, but the confusion becomes much
worse at night, and she calls “mama” in a very loud voice. The most appropriate nursing
action is to:
A. Restraint her at night C. Have the physician order a stronger
sleeping medication
B. Close the door tightly to keep her D. Leave the lights on in the room
from awakening the other clients
Q.10 The increasing irritability and anxiety experienced by dementia clients during the early
evening hours is referred to as:
A. Agnosia C. Sun downer’s syndrome
B. Apraxia D. Phase 3 dementia
Q.11 Which nursing intervention can prevent a client from experiencing autonomic dysreflexia?
Q.81 A young male of 22years present with gradual decrease of visual acuity in both eyes and
change of refractive error on examination with retinoscopy there was high astigmatism.
Give likely diagnosis?
A. keratoglobus C. megalocornea
B. keratoconus D. buphthalmos
Q.82 A patient presented with gross decrease of vision. On torch examination there was
conjunctival congestion and pupil miosed. Which is the probable diagnosis?
A. Anterior uveitis C. Conjunctivitis
B. Acute congestive glaucoma D. Scleritis
Q.83 A client accidentally splashes chemicals into one eye. The nurse knows that eye irrigation
with plain tap water should begin immediately and continue for 15 to 20 minutes. What is
the primary purpose of this first-aid treatment?
A. To hasten formation of scar tissue C. To eliminate the need for medical care
B. To prevent vision loss D. To serve as a stopgap measure until help
arrives
Q.84 A client comes to the clinic for an ophthalmologic screening, which will include
measurement of intraocular pressure (IOP) with a tonometer. When teaching the client
about the test procedure, the nurse should cover which point?
A. The client will direct the gaze forward C. A topical anesthetic will be administered
while the practitioner rests the after the examination.
tonometer on the scleral surface.
B. The tonometer will register the force D. The client should wear dark glasses for
required to indent or flatten the corneal several hours after the procedure.
apex.
Q.85 After an eye examination, a client is diagnosed with open-angle glaucoma. The physician
prescribes pilocarpine ophthalmic solution (Pilocar), 0.25% gtti, OU q.i.d. Based on this
prescription, the nurse should teach the client or a family member to administer the drug
by:
A. instilling one drop of pilocarpine C. instilling one drop of pilocarpine 0.25% into
0.25% into both eyes daily. the right eye daily.
B. instilling one drop of pilocarpine D. instilling one drop of pilocarpine 0.25% into
0.25% into both eyes four times daily. the left eye four times daily.
Q.86 A home health nurse visits a client who's taking pilocarpine, a miotic agent, to treat
glaucoma. The nurse notes that the client's pilocarpine solution is cloudy. What should
the nurse do first?
A. Advise the client to discard the drug C. Observe the client or a family member
because it may have undergone administer the drug to determine possible
chemical changes or become contamination sources.
contaminated.
B. Advise the client to obtain a fresh D. Advise the client to keep the container
container of pilocarpine solution to avoid closed tightly and protected from light.
omitting prescribed doses.
Q.87 A client with an inflammatory ophthalmic disorder has been receiving repeated courses of
a corticosteroid ointment, in the lower conjunctival sac four times a day as directed. The
client reports a headache and blurred vision. The nurse suspects that these symptoms
represent:
A. common adverse reactions to C. incorrect ointment application.
corticosteroid therapy.
B. expected drug effects that should D. increased intraocular pressure (IOP).
diminish over time.
Q.88 The nurse is monitoring a client for adverse reactions to atropine sulfate (Atropine Care)
eye drops. Systemic absorption of atropine sulfate through the conjunctiva can cause
which adverse reaction?
A. Tachycardia C. Hypotension
B. Increased salivation D. Apnea
Q.89 What should the nurse do when administering pilocarpine (Pilocar)?
A. Apply pressure on the inner canthus C. Apply pressure on the outer canthus to
to prevent systemic absorption. prevent adverse reactions.
B. Administer at bedtime to prevent D. Flush the client's eye with normal saline
night blindness. solution to prevent burning.
Q.90 A client complains of periorbital aching, tearing, blurred vision, and photophobia in her
right eye. Ophthalmologic examination reveals a small, irregular, nonreactive pupil a
condition resulting from acute iris inflammation (iritis). As part of the client's therapeutic
regimen, the physician prescribes atropine sulfate (Atropisol), two drops of 0.5% solution
in the right eye twice daily. Atropine sulfate belongs to which drug classification?
A. Para sympathomimetic agent C. Adrenergic blocker
B. Sympatholytic agent D. Cholinergic blocker
Q.91 A 10 year old girl is presented with pain between the eyes, frontal headache, and
discharge from the nose, post nasal drip and high fever. What is the provisional diagnosis?
A. Acute Frontal sinusitis C. Acute Sphenoidal Sinusitis
B. Acute ethmoidal sinusitis D. Chronic ethmoidal sinusitis
Q.92 Regarding deviated nasal septum (DNS), which of the following is false?
A. DNS is a common physical disorder C. mostly treated surgically
B. it is most frequently caused by impact D. septal hematoma is complication of its
trauma correction
Q.93 If the patient can hear a whispered voice 30 cms away from the ear, the patient has:
A. Normal Hearing C. Conductive hearing loss
B. Sensorineural hearing loss D. Mixed hearing loss
Q.94 Commando operation may be used for the treatment of:
A. nasopharyngeal carcinoma C. Hypo-pharyngeal carcinoma
B. Oropharyngeal Carcinoma D. squamous cell carcinomaof larynx
Q.95 Which of the following is not a typical feature of Meniere's Disease?
A. Sensorineural Deafness C. Vertigo
B. Pulsatile Tinnitus D. Fluctuating Deafness
Q.96 Use of Siegel's Speculum during examination of the ear provides all except:
A. Assessment of movement of tympanic C. Removal of foreign body from the ear
membrane
B. Magnification D. As applicator for the powdered antibiotic to
ear
Q.97 Horner syndrome consists of all of the following features except:
A. Ptosis C. Anhidrosis
B. Dilated Pupil D. Endophthalmos
Q.98 Which of the following is common etiological agent in paranasal sinus mycoses?
A. Aspergillus Species C. Candida Albicans
B. Histoplasma D. ConidiobolusCoronatus
Q.99 Trans illumination test was commonly performed to diagnosis infection of:
A. Maxillary sinus C. Sphenoid sinus
B. Frontal sinusitis D. Both A and C
Q.100 A 20 years old boy had running nose followed by severe earache. One day later he had
mucopurulent discharge from the ear. His diagnosis is:
A. Malignant otitis externa C. Eustachian Catarrh
B. Acute Suppurative otitis media D. Baro trauma
Q.101 A female was slapped on her left side of the face by her husband. Ear examination shows
central perforation. What instruction will you give to the patient?
A. To have X ray Mastoid C. Daily cleaning of the ear canal with cotton
bud
B. Immediate pure tone audiometry D. Don’t instill any drops of medication in the
affected ear
Q.102 If the patient can hear a whispered voice 30 cms away from the ear, the patient has:
A. normal Hearing C. conductive hearing loss
B. sensorineural hearing loss D. mixed hearing loss
Q.103 Tonsillectomy is a common procedure done in ENT specialty. What is the commonest
indication for Tonsillectomy?
A. Peritonsillar Abscess C. Recurrent Chronic tonsillitis
B. Rheumatic Heart Disease D. Suspicious of malignancy
Q.104 A patient presented with left sided cervical Lymphadenopathy for 6 months. The
commonest cause is:
A. Infectious mononucleosis C. Tumor of Larynx
B. Tuberculosis D. Actinomycosis
Q.105 A boy developed Bilateral Nasal obstruction one day after he had blow on the nose. What
is most likely diagnosis?
A. Septal Abscess C. Deviated nasal septum
B. Septal Hematoma D. Acute Rhinitis
Q.106 A diabetic patient presented with severe pain in the ear. Examination shows swollen
tender external auditory canal with granulation. What is planned diagnosis?
A. Otitis media C. Labyrinthitis
B. Malignant otitis externa D. Sinusitis
Q.107 A young swimmer complaints of mild pain and irritation, fluffy greyish debris seen in
external auditory canal.
A. Otomycosis C. Otitis externa
B. Otosclerosis D. Otitis media
Q.108 Oral cancers in men who smoke cigarettes and drink heavily are more likely to occur:
A. on the attached gingiva C. on the dorsum of the tongue
B. on the hard palate D. on the lateral tongue and floor of the
mouth
Q.109 Which strain of HPV is most closely connected with cervical cancer and some oral
cancers?
A. HPV-18 C. HPV-40
B. HPV-31 D. HPV-16
Q.110 Which of the following statements is not true of laryngeal papillomas?
A. laryngeal papillomas are caused by C. laryngeal papillomas can compromise the
human papilloma virus types 6 and 22 airway
B. laryngeal papillomas grow quickly and D. laryngeal papillomas may cause stridor
recur after surgical removal
Q.111 The nurse is evaluating a client's cranial nerves during a routine examination. To assess
the function of cranial nerve XII (hypoglossal), the nurse should instruct the client to:
A. Smell and identify a nonirritating, C. Read an eye chart from a distance of 20'.
aromatic odor.
B. Elevate the shoulders, both with and D. Stick out the tongue and move it rapidly
without resistance. from side to side and in and out.
Q.112 After a plane crash, a client is brought to the emergency department with severe burns
and respiratory difficulty. The nurse helps to secure a patent airway and attends to the
client's immediate needs, then prepares to perform a neurologic assessment. Because the
client is unstable and in critical condition, this examination must be brief but should
include:
A. Evaluation of the corneal reflex C. Examination of the fundus of the eye.
response
B. Assessment of the client's gait. D. Evaluation of bowel and bladder functions.
Q.113 A client undergoes cerebral angiography for evaluation after an intracranial computed
tomography scan revealed a subarachnoid hemorrhage. Afterward, the nurse checks
frequently for signs and symptoms of complications associated with this procedure.
Which findings indicate spasm or occlusion of a cerebral vessel by a clot?
A. Nausea, vomiting, and profuse C. Hemiplegia, seizures, and decreased level
sweating of consciousness (LOC)
B. Difficulty breathing or swallowing D. Tachycardia, tachypnea, and hypotension
Q.114 A client who was found unconscious at home is brought to the hospital by a rescue squad.
In the intensive care unit, the nurse checks the client's oculocephalic (doll's eye) response
by:
Shining a bright light into the pupil.
A. Introducing ice water into the external C. Introducing ice water into the external
auditory canal. auditory canal.
B. Shining a bright light into the pupil. D. Turning the client's head suddenly while
holding the eyelids open.
Q.115 When obtaining the vital signs of a client with multiple traumatic injuries, the nurse
detects bradycardia, bradypnea, and systolic hypertension. The nurse must notify the
physician immediately because these findings may reflect which complication?
A. Shock C. Encephalitis
B. Increased intracranial pressure (ICP) D. Status epilepticus
Q.116 A client admitted to an acute care facility after a car accident develops signs and
symptoms of increased intracranial pressure (ICP). The client is intubated and placed on
mechanical ventilation to help reduce ICP. To prevent a further rise in ICP caused by
suctioning, the nurse anticipates administering which drug endotracheally before
suctioning?
A. Phenytoin C. Mannitol
B. Lidocaine D. Furosemide
Q.117 The nurse formulates a nursing diagnosis of Risk for imbalanced body temperature for a
client who suffers a stroke after surgery. When developing expected outcomes, the nurse
incorporates assessment of the client's temperature to detect abnormalities. The
thermoregulatory centers are located in which part of the brain?
A. Pons C. Cerebellum
B. Temporal lobe D. Hypothalamus
Q.118 A white female client is admitted to an acute care facility with a diagnosis of stroke. Her
history reveals bronchial asthma, exogenous obesity, and iron deficiency anemia. Which
history finding is a risk factor for stroke?
A. Caucasian race C. Female gender
B. Obesity D. Bronchial asthma
Q.119 A client recovering from a stroke has right-sided hemiplegia and telegraphic speech and
often seems frustrated and agitated, especially when trying to communicate. However,
the chart indicates that the client's auditory and reading comprehension are intact. The
nurse suspects that the client has:
A. Global aphasia C. Nonfluent aphasia.
B. Fluent aphasia. D. Anomic aphasia
Q.120 A client undergoes a craniotomy with supratentorial surgery to remove a brain tumor. On
the first postoperative day, the nurse notes the absence of a bone flap at the operative
site. How should the nurse position the client's head?
A. Flat C. Turned onto the operative side
B. Elevated no more than 10 degrees D. Elevated 30 degrees
Q.121 When caring for a client with head trauma, the nurse notes a small amount of clear,
watery fluid oozing from the client's nose. What should the nurse do?
A. Test the nasal drainage for glucose. C. Look for a halo sign after the drainage dries.
B. Tell the client blow the nose. D. Keep the client in a supine position
Q.122 Shortly after admission to an acute care facility, a client with a seizure disorder develops
status epilepticus. The physician orders diazepam (Valium) 10 mg I.V. stat. How soon can
the nurse administer a second dose of diazepam, if needed and prescribed?
A. In 30 to 45 seconds C. In 10 to 15 minutes
B. In 30 to 45 minutes D. In 1 to 2 hours
Q.123 A client with seizure disorder comes to the physician's office for a routine checkup.
Knowing that the client takes phenytoin (Dilantin) to control seizures, the nurse assesses
for which common adverse drug effect?
A. Excessive gum tissue growth C. Drowsiness
B. Hypertension D. Tinnitus
Q.124 A client comes to the emergency department complaining of headache, malaise, chills,
fever, and a stiff neck. Vital sign assessment reveals a temperature elevation, increased
heart and respiratory rates, and normal blood pressure. On physical examination, the
nurse notes confusion, a petechial rash, nuchal rigidity, Brudzinski's sign, and Kernig's
sign. What does Brudzinski's sign indicate?
A. Increased intracranial pressure (ICP) C. Cerebral edema
B. Meningeal irritation D. Low cerebrospinal fluid (CSF) pressure
Q.125 A client injured in a train derailment is admitted to an acute care facility with a suspected
dysfunction of the lower brain stem. The nurse should monitor this client closely for:
A. Hypoxia. C. Fever.
B. Visual disturbance. D. Gait alteration.
Q.126 In a client with amyotrophic lateral sclerosis and respiratory distress, which finding is the
earliest sign of reduced oxygenation?
A. Decreased heart rate C. Increased restlessness
B. Increased blood pressure D. Decreased level of consciousness
Q.127 A client with respiratory complications of multiple sclerosis (MS) is admitted to the
medical-surgical unit. Which equipment is most important for the nurse to keep at the
client's bedside?
A. Sphygmomanometer C. Padded tongue blade
B. Nasal cannula and oxygen D. Suction machine with catheters
Q.128 When teaching a client about levodopa-carbidopa (Sinemet) therapy for Parkinson's
disease, the nurse should include which instruction?
A. "Report any eye spasms." C. "Take this medication at bedtime."
B. "Stop taking this drug when your D. Be aware that your urine may appear
symptoms disappear." darker than usual."
Q.129 A client is hospitalized with Guillain-Barr syndrome. Which nursing assessment finding is
most significant?
A. Warm, dry skin C. Urine output of 40 ml/hour
B. Soft, non-distended abdomen D. Even, unlabored respirations
Q.130 A client who's receiving phenytoin (Dilantin) to control seizures is admitted to the health
care facility for observation. The physician orders measurement of the client's serum
phenytoin level. Which serum phenytoin level is therapeutic?
A. level below 5 mcg/ml C. 10 to 20 mcg/ml
B. 25 to 35 mcg/ml D. 40 to 50 mcg/ml
Q.131 Which of the following is not a feature of communication after laryngectomy?
A. the patient breathes through a neck C. the cricopharyngeus muscle in the
stoma esophagus is integral to the production of
esophageal voice
B. an electronic or artificial larynx is not D. a speaking valve directs the pulmonary
used in the days and weeks following airstream into the neck stoma
surgery
Q.132 A professional voice user presents at a voice clinic with severe hoarseness. Examination
reveals severe reddening of the laryngeal mucosa. Further investigation reveals that this is
caused by gastroesophageal reflux. This individual’s voice disorder has:
A. an organic aetiology only C. an organic and functional aetiology
B. a functional aetiology only D. none of the above
Q.133 Along with a sore throat and fever, which of these can be a symptom of an adenoid
infection?
A. snoring during sleep C. breathing mostly through the mouth, rather
than nose
B. ear infections that keep coming back D. All of the above
Q.134 A students responds correct answer asked by teacher when she says High-frequency
hearing loss that occurs over time. Often associated with aging is
A. paranasal sinuses C. Nystagmus
B. uvula D. Presbycusis
Q.135 A virus that is often accompanied by clear vesicles commonly called cold sore or fever
blisters, usually at the junction of the skin and the lip. The vesicles erupt and then crust
and heal within 2 weeks. They usually recur, especially after heavy exposure to bright
sunlight (e.g., after a day at the beach).
A. Herpes Simplex C. smooth tongue
B. Ankyloglossia D. Gingivitis
Q.136 A nasal inflammation usually due to a viral infection or allergy.It is accompanied by a
watery and often copious discharge, sneezing, and congestion (stuffy nose). Acute is
caused by a virus, whereas allergic results from contact with allergens such as pollen and
dust.
A. Rhinitis C. Epistaxis
B. Sinusitis D. Nasal polyps
Q.137 A patient comes to your clinic with the normal sinusitis. You decide to prescribe a
"mucosal shrinking" medication to open up the sinuses. How should the patient hold his
head when administering the medication?
A. Head tilted directly backwards C. Head tilted directly forward while standing
B. Lying down on back while looking D. Lying down, with head hanging over the
directly up side of bed on affected side
Q.138 A patient comes to you with an anterior nose bleed. You remember from medical school
that anterior nose bleeds are from arteries in "Kiesselbach's Area." Which of the following
would be the least likely artery to hemorrhage in the anterior nose bleed?
A. Sphenopalatine Artery C. Ethmoidal Artery
B. Greater Palatine Artery D. Lateral Nasal Artery
Q.139 While the examiner is inspecting the throat of a client with a tongue blade, the client
begins to gag. What does this response indicate to the examiner?
A. the client has nerve damage to the C. the client is nauseated
tongue
B. the client has malfunctioning response D. the client has functioning response
Q.140 The nurse is preparing to use the otoscope to visualize the auditory canal and tympanic
membrane of an adult client. Which of the following is most appropriate?
A. pull the pinna up and back C. Insert the otoscope into the inner two
thirds of the ear canal
B. ask the client to tilt the head toward D. tell the client that the procedure will be
the side to be examined slightly painful
Q.141 A client tells the nurse, have a headache and pressure right above my nose and eyes. My
nose is stuffy too. The nurse knows that these symptoms might indicate:
A. infection or inflammation of the C. infection or inflammation of the columella
interior turbinate
B. infection or inflammation of the D. infection or inflammation of the frontal
maxillary sinuses sinuses
Q.142 A condition in which the eardrum has white patches of scar tissue due to repeated ear
infections.
A. otitis media C. otitis externa
B. Scarred tympanic membrane D. Otosclerosis
Q.143 The nurse is preparing to perform an assessment of the nasal cavity using a nasal
speculum. The nurse considers which of the following to be normal findings?
A. Deviation of the septum C. superior turbinate free of lesions
B. presence of epistaxis on anterior D. dark pink mucosa without discharge
septum
Q.144 When inspecting the mouth and throat of a client, the nurse considers which of the
following to be normal findings? Select all that apply.
A. the tonsils are red with white C. symmetrical rise of the soft palate and
exudates present uvula when the client says "aah"
B. smooth, pink nodules on the lateral D. uvula and mucus membrane is velvety red
side of the tongue
Q.145 A whitish thickening of the mucous membrane in the mouth or tongue. It cannot be
scraped off. Most often associated with heavy smoking or drinking, it can be a
precancerous condition.
A. Gingivitis C. Leukoplakia
B. Herpes Simplex D. Smooth tongue
Q.146 The bony and cartilaginous auditory tube that connects the middle ear with the
nasopharynx. This helps to equalize the air pressure on both sides of the tympanic
membrane
A. Tympanic membrane C. Ossicles
B. Eustachian tube D. Cochlea
Q.147 The nurse is assessing the sinuses of a client. Which of the following is considered a
normal finding?
A. tenderness to palpation or percussion C. Mild swelling over the frontal sinuses
of the sinuses
B. Pink, moist mucus membranes with D. with trans illumination of the maxillary
no lesions sinuses, there is no red glow present under
the eyes.
Q.148 The nurse notes that a client has a smooth, red, shiny tongue with no lesions. Which of
the following is the most appropriate in this situation?
A. look in the client record for a history C. ask the client to describe his diet
of leukoplakia
B. continue with assessment as this is D. ask whether the client has history of
the normal finding for the tongue halitosis
Q.149 During an otoscope assessment, the nurse notes the presence of large amounts of
cerumen in the client's external canal. The nurse knows:
A. this indicates poor hygiene C. cerumen is needed to assist in the
conduction of sound vibrations to the middle
ear
B. the client should clean his ears with D. cerumen helps to lubricate and protect the
cotton swabs ear
Q.150 The nurse is admitting a client in the emergency room with a foreign body in the ear
identified as an insect. Which of the following interventions is a priority for the nurse to
perform?
A. Instill a cortisone ointment in the C. irrigate the affected ear
affected area
B. Instill antibiotic ointment in the D. instill diluted alcohol in the ear
affected area
Q.151 A 79 years old woman has been diagnosed with osteoarthritis. She has been active in the
community and is otherwise in good health. The physician recommends a hip
replacement, and after much consideration, the client agrees. In the preoperative
teaching, the nurse instructs the client that the physician will most likely begin ambulation
on the 3rd postoperative day. The rationale for early ambulation following joint re-
placement is:
A. Prolonged inactivity in an older adult C. Late ambulation fosters dependence on the
increases the chance of venous nursing staff.
thrombosis.
B. Prolonged bed rest increases the D. Early ambulation ensures that the client
chance of developing decubitus ulcers. will return to the baseline functional status.
Q.152 A 79 years old woman who has undergone hip replacement begins physical therapy for
the first time on the 3rd postoperative day. Although she has been resting for 45 minutes
after the active physical therapy session, she continues to have an elevated blood
pressure (162/92) and pulse rate (94). The nurse’s most appropriate nursing action would
be to:
A. Do nothing and revaluate her in an C. Call the physician
hour
B. Order a stat ECG D. Call physical therapy and see if an error was
made in therapy
Q.153 The physician writes an order to change the operative site dressing of a hip replacement
client 4 days postoperatively. In preparing to change the dressing, the nurse knows that
the most important nursing action is:
A. The need to prevent pain C. The need to be supportive
B. The need to prevent infection D. The need to explain the procedure to the
client
Q.154 A post–hip replacement client successfully completes the physical therapy program and is
scheduled to be discharged soon. The nurse begins discharge teaching. The most
important area to assess before discharge is:
A. The ability to take medications as C. Support from family and friends
prescribed
B. The ability to manage ADL D. The ability to properly use the ambulatory
aid (walker)
Q.155 A nursing diagnosis related to alteration in nutrition is developed. The plan of care most
appropriate to assist a client who has Parkinson’s disease with a nursing diagnosis of
alteration in nutrition is to:
A. Encourage liquids when chewing C. Place in an upright position for meals
B. Allow client to feed himself D. Ask family to bring his favorite foods from
home
Q.156 When assessing a 75 years old client, the nurse would recognize that normal age-related
changes in vision could result in:
A. Difficulty in night time driving C. Inability to see a dark color against a yellow
wall
B. Seeing halos around lights D. Ignoring objects placed in the centre of the
visual field
Q.157 A nurse’s friend asks for advice concerning her 75 years old grandmother. She states,
“Grandmother goes to bed at 9 PM, but I can hear her walking around the house and
preparing snacks in the kitchen at 4 AM.” She asks for advice on how to help her
grandmother. The nurse’s best response based on nursing knowledge of the older adult
would be:
A. “Give your grandmother a protein-rich C. “Give her a glass of warm milk and a
snack immediately before going to bed.” sleeping pill at bedtime.”
B. Obtain a comprehensive physical and D. Do nothing unless it worries your
mental examination to determine the grandmother
cause of insomnia.
Q.158 A general rule of thumb for nurses to remember when administering medications to an
older adult is:
A. Except for cardiac drugs, some C. Most medications do more harm than good.
medications should be prescribed in
greater amounts.
B. Drugs are less effective in the older D. Most medications should be given in lower
adult and must be given more frequently dosages
Q.159 An 87 years old man attends a community health centre during the week and receives a
health screening monthly. He relates to the nurse during the health screening that he has
recently been troubled with impotence. The most appropriate nursing action at this time
is to:
A. Listen and respond empathetically C. Do a complete health history, including
medications
B. Do nothing as this is normal D. Refer him to a physician
Q.160 A 67 years old engineer is diagnosed with Parkinson’s disease. The nurse recognizes that
this disease is:
A. Normal in persons older than 65 years C.A musculoskeletal disorder
of age
B. A neurological disorder D. A reversible condition with medical
management
Q.161 A nursing diagnosis related to alteration in nutrition is developed. The plan of care most
appropriate to assist a client who has Parkinson’s disease with a nursing diagnosis of
alteration in nutrition is to:
A. Encourage liquids when chewing C. Place in an upright position for meals
B. Allow client to feed himself D. Ask family to bring his favorite foods from
home
Q.162 A 52 years old female client regularly attends the center for hypertension. She shares with
the nurse the fact that she is concerned about osteoporosis. The nurse informs the client
that individuals most at risk for osteoporosis are:
A. Men who have taken steroid therapy C. Thin, white men
B. Obese women of Asian or Hispanic D. Thin, postmenopausal white women
origin
Q.163 The nursing action most appropriate in assisting an 87 years old male client who is
incontinent of urine at night to remain dry would be to:
A. Place an absorbent garment, such as C. Talk to him to determine the stressors in his
Depends, on him life
B. Provide him with a bedside commode D. Insert a Foley catheter
and leave the night light on
Q.164 An 87 years old male client has surgery to relieve intestinal obstruction. He returns to the
unit with the following physician’s orders: meperidine (Demerol) 50 mg IM q4h prn for
pain, diphenhydramine (Benadryl) 25 mg po q hs prn for sleep, and gentamicin 75 mg IM
8 hr. The nurse notes that his creatinine clearance is 70 mL/min. The most appropriate
action by the nurse should be to:
A. Give his medicine as scheduled C. Hold the gentamicin and inform the
physician of the creatinine results
B. Do nothing as the values are within D. Call the lab to see if this is in error
the normal limits
Q.165 A client has been in a nursing home for 2 weeks. She seems to be having more difficulty
hearing a conversation, and conversations must be repeated several times before she can
hear them. The admission nursing history indicates the client was able to hear a watch
ticking. Her medications include carbamazepine (Tegretol) 300 mg twice daily and aspirin
325 mg once daily. The initial nursing action by the nurse should be to:
A. Talk louder so that she can hear C. Sit facing her so she can more effectively lip
read
B. Inspect the ear canals for blockage D. Call the physician as this is related to CVA
Q.166 The nurse instructs a 60 years old female client on the need for calcium for the prevention
of osteoporosis. The client states, “I drink at least three glasses of milk each day.” The
nurse advises the client:
A. That three glasses of milk does not C. That dietary intake of calcium is not used by
supply enough calcium the body
B. To supplement the milk with vitamin D. To increase daily oral phosphate as well as
C to ensure absorption calcium
Q.167 In planning priority nursing care for a 78 years old client with a CVA, the nurse is aware
that clients with left hemispheric infarctions may have:
A. Dramatic mood swings C. Labile affect
B. Impaired judgment D. Aggressive potential
Q.168 The nurse correctly identifies that the most important need at this time for a client who
has had a recent CVA involving the left hemisphere is:
A. Maintenance of nutritional status C. Prevention from injury
B. Need for diversional activities D. Need for psychological counseling
Q.169 Which nursing plan best demonstrates the nurse’s knowledge of caring for CVA clients?
A. Allow clients to make decisions about C. Encourage clients to attend unit functions.
their care.
B. Provide clients with clock and D. Provide a structured, consistent
calendar to maintain orientation environment.
Q.170 The nurse further instructs a postmenopausal female client on the preventive measures
for osteoporosis. Which statement by the client demonstrates under- standing of
osteoporosis prevention?
A. “I will include citrus juice in my C. “I will decrease fat in my diet”
breakfast menu”
B. “I will begin walking exercises 3–5 D. “I will start swimming as part of my daily
times weekly” exercise regimen”
Q.171 The nurse is caring for a client who underwent a lumbar laminectomy 2 days ago. Which
of the following findings should the nurse consider abnormal?
A. More back pain than the first C. Paresthesia in the dermatomes near the
postoperative day wounds
B. Urine retention or incontinence D. Temperature of 99.2° F (37.3°
C)
Q.172 A client in a nursing home is diagnosed with Alzheimer's disease. He exhibits the following
symptoms: difficulty with recent and remote memory, irritability, depression,
restlessness, difficulty swallowing, and occasional incontinence. This client is in what stage
of Alzheimer's disease?
A. I C. II
B. III D. IV
Q.173 A client with a spinal cord injury and subsequent urine retention receives intermittent
catheterization every 4 hours. The average catheterized urine volume has been 550 ml.
The nurse should plan to:
A. Increase the frequency of the C. Insert an indwelling urinary catheter.
catheterizations
B. Place the client on fluid restrictions. D. Use a condom catheter instead of an
invasive one.
Q.174 After striking his head on a tree while falling from a ladder, a young man is admitted to
the emergency department. He's unconscious and his pupils are nonreactive. Which
intervention would be the most dangerous for the client?
A. Give him a barbiturate C. Place him on mechanical ventilation
B. Perform a lumbar puncture D. Elevate the head of his bed
Q.175 If a client experienced a stroke that damaged the hypothalamus, the nurse would
anticipate that the client has problems with:
A. Body temperature control C. Balance and equilibrium
B. Visual acuity D. Thinking and reasoning
Q.176 A client with a head injury is being monitored for increased intracranial pressure (ICP). His
blood pressure is 90/60 mm Hg and the ICP is 18 mm Hg; therefore his cerebral perfusion
pressure (CPP) is:
A. 52 mm Hg. C. 88 mm Hg.
B. 48 mm Hg D. 68 mm Hg.
Q.177 A young man was running along an ocean pier, tripped on an elevated area of the decking,
and struck his head on the pier railing. According to his friends, "He was unconscious
briefly and then became alert and behaved as though nothing had happened." Shortly
afterward, he began complaining of a headache and asked to be taken to the emergency
department. If the client's intracranial pressure (ICP) is increasing, the nurse would expect
to observe which sign first?
A. Pupillary asymmetry C. Irregular breathing pattern
B. Involuntary posturing D. Declining level of consciousness
Q.178 After a stroke, a 75-year-old client is admitted to the facility. The client has left-sided
weakness and an absent gag reflex. He's incontinent and has a tarry stool. His blood
pressure is 90/50 mm Hg, and his hemoglobin is 10 g. Which of the following is a priority
for this client?
A. Elevating the head of the bed to 30 C. Checking stools for occult blood
degrees
B. Performing range-of-motion (ROM) D. Keeping skin clean and dry
exercises to the left side
Q.179 The nurse is assessing a client with meningitis. The nurse places the client in a supine
position and flexes the client's leg at the hip and knee. The nurse notes resistance when
straightening the knee and the client reports pain. The nurse documents what neurologic
sign as positive?
A. Babinski's reflex C. Kernig's sign
B. Lichtheim's sign D. Brudzinski's sign
Q.180 A client is undergoing testing to confirm a diagnosis of myasthenia gravis. The nurse
explains that a diagnosis of myasthenia gravis is made if muscle function improves after
the client receives an I.V. injection of a medication. What is the medication the nurse tells
the client he'll receive during this test?
A. Cyclosporine (Sandimmune) C. Edrophonium (Enlon)
B. Immunoglobulin G (Iveegam EN) D. Azathioprine (Imuran)
Q.181 The nurse is performing a neurologic assessment on a client. The nurse observes the
client's tongue for symmetry, tremors, and strength, and assesses the client's speech.
Which cranial nerve is the nurse assessing?
A. IV C. IX
B. VI D. XII
Q.182 A 45-year-old client is admitted with excruciating paroxysmal facial pain. He reports that
the episodes occur most often after feeling cold drafts and drinking cold beverages. Based
on these findings, the nurse determines that the client is most likely suffering from which
neurologic disorder?
A. Bell's palsy C. Migraine headache
B. Trigeminal neuralgia D. Angina pectoris
Q.183 A client is diagnosed with a brain tumor. The nurse's assessment reveals that the client
has difficulty interpreting visual stimuli. Based on these findings, the nurse suspects injury
to which lobe of the brain?
A. Frontal C. Occipital
B. Temporal D. Parietal
Q.184 A client is admitted to the hospital after sustaining a closed head injury in a skiing
accident. The physician ordered neurologic assessments to be performed every two
hours. The client's neurologic assessments have been unchanged since admission, and the
client is complaining of a headache. Which intervention by the nurse is best?
A. Administer codeine 30 mg by mouth C. Assess the client's neurologic status for
as prescribed and continue neurologic subtle changes, administer acetaminophen,
assessments as ordered. and then reassess the client in 30 minutes.
B. Reassure the client that headache is D. Notify the physician; headache is an early
expected and will go away without sign of worsening neurologic status
treatment.
Q.185 A client with stage 2 Alzheimer's disease is admitted to the short stay unit after cardiac
catheterization that involved a femoral puncture. The client is reminded to keep his leg
straight. A knee immobilizer is applied, but the client repeatedly attempts to remove it.
The nurse is responsible for three other clients who underwent cardiac catheterization.
What's the best step the nurse can take?
A. Continually remind the client not to C. Sedate the client.
move his leg and leave the immobilizer
alone.
B. Ask the staffing coordinator to assign D. Apply wrist restraints.
a nursing assistant to sit with the client.
Q.186 The nurse is administering dexamethasone (Decadron) 4 mg I.V. to a client diagnosed with
a brain tumor. The nursing assistant informs the nurse that the client's fingerstick glucose
level is 240 mg/dl. A sliding insulin scale hasn't been prescribed. How should the nurse
intervene?
A. Notify the physician of the fingerstick C. Administer dexamethasone as prescribed,
glucose level, inquire about insulin and inform the physician when he makes
therapy, and ask whether the rounds.
dexamethasone should be
administered.
B. Administer dexamethasone as D. Administer the dexamethasone because
prescribed and not be concerned about the client has no history of diabetes.
the finger stick glucose level because it's
common with steroid therapy.
Q.187 The nurse is planning discharge for a client who suffered right-sided weakness caused by a
stroke. During her hospitalization, the client has been receiving physical therapy,
occupational therapy, and speech therapy daily. The family voices their concern about
rehabilitation after discharge. How should the nurse intervene?
A. Contact the appropriate agencies so C. Suggest that the family speak to the
that they can provide care after physician about their concerns.
discharge.
B. Inform the case manager and provide D. The nurse should do nothing because she is
information about the client's current only responsible for inpatient care
clinical status so appropriate resources
can be provided after discharge.
Q.188 A client with an inoperable brain tumor is brought to the hospital because the family can
no longer care for him at home. As the nurse provides care for the client, family members
express their disappointment at not being able care for him at home according to his
wishes. Which response by the nurse is best?
A. "I understand; I take care of clients C. "Have you explored hospice care? I can ask
like every day and don't know how you the case manager to discuss this care option
could do it at home." with you, if you're interested."
B. "It's okay to bring the client back to D. "Having a family member with a terminal
the hospital to die." illness is very difficult."
Q.189 A client admitted with bacterial meningitis must be transported to the radiology
department for a repeat computed tomography scan of the head. His level of
consciousness is decreased, and he requires nasopharyngeal suctioning before transport.
Which infection control measures are best when caring for this client?
A. Use standard precautions, which C. Put on gloves, a mask, and eye protection.
require gloves for suctioning.
B. Put on gloves, a mask, and eye D. Take no special precautions for this client.
protection during suctioning, and then
apply a mask to the client's face for
transport
Q.190 With the diagnosis of ischemic stroke, the nurse should make sure the bed is in which
position?
A. Flat C. Fowlers
B. High fowlers D. Trendelenburg
Q.191 A post CVA client is discharged but will continue with physical and speech therapy daily.
Which statement by the family best demonstrates a supportive environment?
A. “I just don’t know if we can manage C. “We have a sitter who will be staying with
mother at home” mother at night”
B. “We have placed rails in the tub and D. “Mother will be back to her old self in no
widened the bathroom doors for the time once we get her home”
wheelchair”
Q.192 A 71 years old client is admitted to the hospital for observation following a fall from a
ladder. Vital signs on admission are: BP 170/98; P 92; respirations 22. In performing
morning care for the client, the nurse notes a brown pigmentation around both ankles.
The nurse correctly identifies this as suggestive of:
A. Earlier abuse C. Lymphatic disease
B. Aging skin change D. Venous insufficiency
Q.193 A 65 years old female client is diagnosed with presbycusis. The nurse explains to the client
that she may have difficulty in:
A. Hearing high-pitched sounds C. Seeing objects at a distance
B. Ambulating without mechanical aids D. Distinguishing sweet and sour tastes
Q.194 A 60 years old client complains of blurred vision and difficulty in being outside on sunny
days. The nurse identifies this condition to be:
A. Caused by psychotropic drug therapy C. Due to cataracts
B. An excuse to avoid exercise D. Caused by diuretic therapy
Q.195 A 71 years old male client is diagnosed with right-sided congestive heart failure. Which
assessment by the nurse is most reflective of right-sided congestive heart failure?
A. Tachypnea C. Korotkoff sounds
B. Pink frothy sputum D. Distended jugular veins
Q.196 A 71 years old male client with congestive heart failure is placed on furosemide and
digoxin. In addition to monitoring of vital signs, which complaint by the client might alert
the nurse to digoxin toxicity?
A. “I have to hold on to the wall to keep C. “I can’t see clearly and the lights have
from falling” halos”
B. “My ears are ringing” D. “I am itching allover”
Q.197 Lab values reported this morning for a client who is on digoxin and furosemide for
congestive heart failure include serum digoxin level 2.9 mg/mL and potassium 3.2 mEq/L.
The most appropriate nursing action based on these lab values is to:
A. Give an additional dose of digoxin C. Give one half the usual dose of digoxin
B. Do nothing as the digoxin level is D. Call the physician and inform him or her of
within normal limits the lab values
Q.198 In addition to potassium supplements ordered by the physician, the nurse would
encourage the client to choose which of the following menu items to increase potassium
intake?
A. Boiled chicken, baked potato, dried C. Roast beef, carrots, fresh peach
figs
B. Beef tips, rice, banana D. Fried chicken, broccoli, fresh pear
Q.199 The nursing diagnosis identified for a 68 years old client is hypokalemia. The nurse should
assess the client for which symptom:
A. Muscle weakness and weak, irregular C. Positive Trousseau’s sign
pulse
B. Diminished deep tendon reflexes D. Positive Chvostek’s sign
Q.200 A client’s potassium level drops to 2.7 mEg/L. The physician orders potassium bicarbonate
80 mEg in 1000 mL of D5W over 8 hours. The most important nursing action related to IV
potassium administration includes monitoring:
A. Respiratory rate C. Oral potassium intake
B. Urinary output D. The IV site for edema