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Battery Exam

Level 4
1.A nurse is caring for a patient who
requires measurement of specific gravity
every 4 hours. What does this test detect?
A) Nutritional deficit
B) Hyperkalemia
C) Hypercallcemia
D) Fluid volume status
2. Which of the following might the
nurse assess in a patient diagnosed with
hypermagnesemia?
A) Diminished deep tendon reflexes
B) Tachycardia
C) Cool clammy skin
D) Increased serum magnesium
3. A patient is receiving furosemide
(Lasix) 40mg/d IV. What electrolyte value
should be monitored when a patient is
receiving a loop diuretic?
A) Calcium levels
B) Phosphorous levels
C) Potassium levels
D) Magnesium levels
4. The nurse is evaluating a patients
laboratory results. Based upon the
laboratory findings, what results will
cause the release of an antidiuretic
hormone (ADH)?
A) Increased serum sodium
B) Decreased serum sodium
C) Decrease in serum osmolality
D)Decrease in thirst
5. Third spacing occurs when fluid
moves out of the intravascular space but
not into the intracellular space. Based
upon this shift, The nurse will expect the
patient to demonstrate:
A) Hypertension
B)Bradycardia
C) Hypervolemia
D)Hypovolemia
6. The nurse working in the PACU is
aware that which of the following
procedures may
contribute to extracellular losses?
A) Removal of an ingrown toenail
B) Tooth extraction
C) Abdominal surgery
D) Cataract surgery
7. The renin and angiotensin systems
help to maintain the balance of sodium
and water in the body; What other
functions do these systems serve?
A) Regulating hemoglobin levels
B) Maintaining a healthy blood volume
C) Releasing platelets when tissues are
injured
D) Lowering blood volumes
8. A patients lab result show a slight
decrease in potassium. The physician
has declined to treat with drug therapy
but has suggested increasing the
potassium through diet. Which of the
following would be a good source of
potassium?
A) Apples
B) Asparagus
C) Carrots
D) Bananas
9. Your patient has alcoholism, and you
may suspect during your assessment
that his
serum magnesium is low. What will the
nurse potentially expect to assess
related to
hypomagnesemia?
A) Tremor
B) Pruritus
C) Edema
D) Decreased blood pressure
10. The nurse is assessing the patient for
the presence of Chvosteks sign. What
electrolyte imbalance does a positive
Chvosteks sign indicate?
A)Hypermagnesemia
B)Hypomagnesemia
C)Hypocalcemia
D) Hyperkalemia
11. A patient with hypokalemia and
heart failure is admitted to the
tolemetry unit. The
nurse is aware that hypokalemia could
cause which of the following
abnormalities on an
electrocardiogram(ECG)?
A) Shortened P-R interval
B) Inverted T wave
C) Depressed U wave
D) Elevated U wave

12. A patient is in the hospital with


heart failure. The nurse notes during
the evening
assessment that the patients neck
veins are distended and the patient has
dyspnea. What action should the nurse
take?
A) Place the patient in low Fowlers and
notify the physician
B) Increase the patients IV fluid and
auscultate the lungs
C) Place the patient in semi Fowlers
and prepare to give the PRN diuretic as
13. A nurse sees a variety of patients in
the community health clinic. Which of
the
following patients would be at the
greatest risk of dehydration?
A) An 18-year-old basketball player with
a stress fracture of the right foot
B) An infant with diarrhea
C) A 45-year-old with stomach flu
D) An elderly patient living alone
14. A patient with diabetes insipidus is
admitted to the intensive care unit after
a motor vehicle accident that resulted in
head trauma and damage to the
pituitary gland. Diabetes insipidus can
occur when there is a decreased
production of which of the following?
A) ADH
B) Estrogen
C) Aldosterone
D) Renin

15.The nurse is caring for a patient who


is diaphoretic from a fever. The amount
of
sodium excreted in the urine will:
A) Decrease
B) Increase
C) Remain unchanged
D) Fluctuate
16.The triage nurse notes upon
assessment in the emergency room
that the patient with
anxiety is hyperventilating. The nurse is
aware that hyperventilation is the most
common
cause of which acid base imbalance?
A) Respiratory acidosis
B) Respiratory Alkolosis
C)Metabolic Acidosis
D)Metabolic Alkalosis

17.Your patient has the following


arterial blood gas results: Ph 7.26,
PaCO2 28, HCO3
11 mEq/L. How would the nurse
interpret the results?
A) Respiratory acidosis with no
compensation
B) Metabolic alkalosis with a
compensatory alkalosis
C) Metabolic acidosis with no
compensation
D) Metabolic acidosis with a
compensatory respiratory alkalosis.
18.The nurse who assesses the
patients peripheral IV site and notes
edema around the
insertion site will document which
complication related to IV therapy?
A) Air emboli
B) Phlebitis
C) Infiltration
D) Fluid overload
19.What would be the best initial
nursing actions prior to inserting an IV?
A) Have the patient wash the hands
B) Prepare the IV insertion site with
povidone iodine
C) Verify the order for IV therapy
D)Identify a suitable vein

20. The patient asks the nurse if he will


die if air bubbles get into the IV tubing.
What is
the nurses best response?
A) The system is closed and that is
impossible.
B) Only relatively large volumes of air
administered rapidly are dangerous.
C) There is a risk of complication with
IV administration.
D) You watch too many movie.
21. A patient admitted with a
gastrointestinal bleed and anemia is
receiving a blood
transfusion. Based upon the patients
hypotensive blood pressure, The nurse
anticipates an
order for IV fluids from the physician.
Which of the following IV solutions may
be
administered with blood products?
A) D5 and .45% Normal Saline
B) Lactated Ringers
C) 5% dextrose in water
22.The nurse preparing a site for the
insertion of an IV catheter should treat
excess hair at
the site by:
A) Leaving the hair intact
B) Shaving the area
C) Clipping the hair in the area
D) Removing the hair with a depilatory

23. The nurse assessing skin turgor in


an elderly patient should remember
that:
A) Overhydration causes the skin to
tent
B) Dehydration causes the skin to
appear edematous and spongy
C) Inelastic skin turgor is a normal part
of aging
D) Normal skin turgor is moist and
boggy

24.When selecting a site on the hand or


arm for insertion of an IV catheter, The
nurse should:
A) Choose a proximal site
B) Choose a distal site
C) Have the patient hold his arm over
his head
D) Leave the tourniquet on for at least
5 minutes

25.The nurse is admitting a patient with


a suspected fluid imbalance. The most
sensitive indicator of body fluid balance
is:
A) Daily weight
B)Input and output measurment
C) Skin turgor and mobility
D) Night time weight

26. A patient is taking spironolactone


(Aldactone) to control her hypertension.
Her serum potassium level is 6 mEq/L.
For this patient, the nurses priority
would be to assess her;
A) Neuromuscular function
B) Bowel sounds
C) Respiratory rate
D) Electrocardiogram (ECG) results

27.The nurse is caring for a


postthyroidectomy patient at risk for
hypocalcemia. What
action should the nurse take when
assessing for hypocalcemia?
A) Monitor laboratory values daily for
an elevated thyroid-stimulating
hormone
B) Observe for swelling of the neck,
tracheal deviation, and severe pain
C) Evaluate the quality of the patients
voice postoperatively, noting any
drastic changes
28.A patient who is hospitalized with a
possible electrolyte imbalance is
disoriented and weak, has an irregular
pulse, and takes hydrochlorothiazide.
He most likely suffers from:
A) Hypernatremia
B)Hyponatremia
C) Hyperkalemia
D) Hypokalemia
29.A female patient is discharged from the
hospital after having an episode of heart
failure. Shes prescribed daily oral doses of
digoxin (Lanoxin) and furosemide (Lasix).
Two days later, she tells her community
health nurse that she feels weak and her
heart flutters frequently. What action
should the nurse take?
A) Tell the patient to rest more often
B) Tell the patient to stop taking the digoxin,
and call the physician
C) Call the physician, report the symptoms,
and request to draw a blood sample to
determine the patients porassium level
D)tell the patient to avoid foods that contain
30.A nurse in the medical-surgical unit
is giving a patient with low blood
pressure a
hypertonic solution. Which will increase
the number of dissolved particles in his
blood,
creating pressure for fluids in the
tissues to shift into the capillaries and
increase the blood
volume. Which of the following terms is
associated with this process?
A) Hydrostatic pressure
B) Osmosis and osmolality
31.A 73-year-old man who slipped on a small carpet in
his home and fell on his hip is alert and oriented:
PERRLA (pupils equally round and reactive to light and
accommodation) is intact, and he has come by
ambulance to the emergency department(ED). Heart
rate elevated, he is anxious and thirsty. A Foley
catheter is in place and 40mL of urine is present. The
nurses most likely explanation for the urine output is:
A)The man urinated prior to his arrival in the ED and
will probably not need to have the Foley catheter kept
in place
B) The man has a brain injury, lacks ADH, and needs
vasopressin
C) The man is in heart failure and is releasing atrial
natriuretic peptide, which results in decreased urine
output.
D) He is having a sympathetic reaction, which has
32.A nurse is visiting an 84-year-old woman
living at home and recovering from hip
surgery. The woman seems confused and has
poor skin turgor, and she states that she
stops drinking water early in the day because
it is too dificult to get up during the night to
go to the bathroom. The nurse explains to
the woman that:
A) She will need to have her medications
adjusted and be readmitted to the hospital
for a complete workup.
B)Limiting fluids can create imbalances in the
body that can result in confusion; maybe
we need to adjust the timing of your fluids
C) It is normal to be a little confused
33.A nurse in the medical-surgical unit
has a newly admitted patient who is
oliguric; the
acute care nurse practitioner orders a
fluid challenge of 100 to 200 Ml of
normal saline
solution over 15 minutes. The nurse is
aware this intervention will help:
A) Distinguish hyponatremia from
hypernatremia
B) Evaluate pituitary gland function
C) Distinguish reduced renal blood flow
from decreased renal function
34.A nurse is taking care of a 65-year-
old female patient in a medical-surgical
unit who is in renal failure; during the
assessment the patient complaints of
tingling in her lips and fingers. When
the nurse takes her blood pressure, she
has a spasm in her wrist and hand. The
nurse suspects:
A) Hypophosphatemia
B)Hypocalcemia
C)Hypermagnesemia
D) Hyperkalemia
35.A patient who is in renal failure
partially loses ability to regulate
changes in pH
because the kidneys;
A) Regulate and reabsorb carbonic acid
change and maintain pH
B) Buffer acids through electrolyte
changes
C) Regenerate and reabsorb
bicarbonate to maintain a stable pH
D) Combine carbonic acid and
bicarbonate to maintain a stable pH
36.A 65-year-old male patient was
admitted to a medical-surgical unit 72
hours ago with pyloric stenosis; a
nasogastric tube was inserted upon
admission and has been on low
intermittent suction since then. The
nurse taking care of the patient notices
that his potassium is very low and
becomes concerned that the patient
may be at risk for:
A)Hypercalcemia
B) Metabolic acidosis
C) Metabolic alkalosis
37.A nurse admitting a patient with a history
of emphysema reviews her past lab reports
and notes that the patients PaCO2 has been
56 TO 64 mmHg. The nurse will be cautious
administering oxygen because:
A) The patients calcium will rise dramatically
due to pituitary stimulation
B) The oxygen will increase the patients
intracranial pressure and create confusion
C) The oxygen may cause the patient to
hyperventilate and become acidotic
D) Using oxygen may result in the patient
developing carbon dioxide narcosis and
hypoxemia
38.The nurse in the intensive care unit
receives arterial blood gases (ABG) with
a patient who is complaining of being
short of breath. The ABG has the
following values: Ph=7.21, PaCO2=
64Hg, HCO3=42 mmHg. The labs
reflect:
A) Respiratory acidosis
B) Metabolic alkalosis
C) Respiratory alkalosis
D)Metabolic acidosis
39. A nurse preparing to start an IV on
a newly admitted patient teaches the
patient about the procedure and begins
to prepare the site. The nurse should
always start by:
A) Leaving one hand ungloved to asses
the site
B) Preparing the skin with an iodine
solution
C) Asking the patient if he is allergic to
latex or iodine
D) Removing excessive hair at the
selected site.
40.A 37-year-old woman is being
treated aggressively with a
chemotherapeutic regimen to fight
breast cancer. As a result of this
regimen, she has an inability to fight
infection due to the face her bone
marrow is unable to produce a
sufficient amount of:
A) Lymphocytes
B)Cytoblasts
C) Antibodies
D) Capillaries

41.A patient who is exposed to a


mumps outbreak in the midwest has
previously been immunized for mumps.
She possesses which type of immunity?
A) Acquired immunity
B) Natural immunity
C) Phagocytic immunity
D)Humoral immunity
42.A patient is being treated in the
emergency department following an
injury which resulted in a 6cm
laceration of the right antecubital that
was sustained when the patient fell
through the glass of a storm door. The
site of the injury will have an invasion
of:
A)Inferferon
B) Phagocytic cells
C) Apoptosis
D) Cytokines
43.The patient with a severe laceration
has significant bruising around the site.
The
immune response which destroys worn-
out cells is:
A) The phagocytic immune response
B) The humoral or antibody response
C) The cellular immune response
D) Apoptosis
44.A patient who has sustained a deep
laceration while gardening requires
sutures. Her last tetanus shot was more
than 10 years ago. Based on this
information, the patient will receive a
tetanus immunization that will allow for
the release of an:
A) Antibody
B) Antigen
C) Bacteria
D) Virus

45.A patient develops a virulent


staphylococci infection of the right leg.
The circulating lymphocyte containing
the antigenic message returns to the
nearest lymph node. This is known as
the:
A) Recognition stage
B) Proliferation stage
C) Response stage
D) Effector stage
46.A woman who has received a double
lung transplant for cystic fibrosis is
experiencing signs of rejection.The
immune response which predominates
is the:
A)Humoral
B) Nonspecific
C) Cellular
D) Specific

47.An 48-year-old patient suffering from


urosepsis. The immune response which
presominates is the:
A) Mitigated
B) Nonspecific
C) Cellular
D)Humoral

48.A 44-year-old woman is suffering


from bacterial pneumonia. In the first
stages of her illness, she suffered from
chest pain and had a high fever with
diminished breath sounds. Currently
she is feeling better and no longer has
these symptoms. She is in which of the
immune response?
A) Recognition stage
B) Proliferation stage
C) Response stage
D) Effector stage

49.A woman suffers from multiple


sclerosis. To assist in the treatment of
her illness. She
is lobbying her state and local
governments for the legalization and
use of:
A) Embryonic stem cells
B) Bone marrow transplantation
C) Immunopathology
D) Euthanasia
50.A 48-year-old patient suffering from
multiple sclerosis is receiving interferon
injections. The purpose of interferon
injections is to:
A)Modify the immune response by
suppressing antibody production and cellular
immunity
B) Give rise to numerous cell types able to
form tissues in three germ layers
C) Complement receptors and, as a result,
play an important role in the clearance of
antigens
D) Complements components,
prostaglandins, leukotrienes, and other
inflammatory mediators.
51.An elderly patient is more likely to
develop infections than a younger
individual due
to the:
A) Decreased hormone levels
B) Decreased functions of T
lymphocytes
C)Increased functions of B lymphocytes
D) Increased humoral immunity

52.The elderly male patient is at


greater risk for urinary tract infection
related to:
A) Inability to drink sufficient amounts
of fluid
B) Decreased gastric secretions and
slower motility
C) Prostate enlargement or neurogenic
bladder
D) The ineffectiveness of cilia and
decreased circulation

53.A 55-year-old male patient has high


cholesterol and triglycerides. He is at
risk for
infection related to:
A) Protein-calorie deficiency
B) Regulation of cellular proliferation
C) Excess of trace elements
D) Excess fatty acids
54.The infection control nurse
understands that this term is used
when referring to the
clumping effect occurring when an
antibody acts a cross-link between
two antigens?
A) Agglutination
B) Cellular immune response
C)Humoral response
D) Phagocytic immune response
55.Upon evaluation of a patients
laboratory studies, The nurse notes an
increase in several cell counts on the
complete blood count. Which of the
following cell counts increase because
they are the first cells to arrive at the
site of inflammation?
A)Eosinophils
B) Red blood cell
C) Lymphocytes
D) Neutrophils
56. A woman has just delivered a
stillborn baby boy. Which of the
following would be the most
appropriate nursing response?
A) Can I do anything for you?
B) If something was wrong, it's

better this way.


C) Your son is in heaven with God

now.
D) Would you like to hold your

son?
57. Which of the following is an
appropriate intervention for the
nurse to implement with the client
with obsessive-compulsive disorder?
A) Assist the client to practice

relaxation.
B) Encourage the client to practice

distraction.
C) Teach the client to ignore the

symptoms.
D) Teach the client to control

obsessional thinking.
58. Which of the following is
particularly important when
planning care for a client with
bulimia?
A) Daily urine output
B) Good oral hygiene
C) Meticulous skin care
D) Monitoring daily weight
59. Clients with eating disorders are at
risk for which of the following?
A) Electrolyte imbalance
B) Hyperthermia
C) Insomnia
D) Tachypnea
60. T lymphocytes are believed to
have a specific role in:
A) Transplant rejection
B) Allergic hay fever and asthma
C) Anaphylaxis
D) Bacterial infections
61.B cells, which are responsible for
humoral response, have a specific role
in which of
the following?
A) Graft-verses-host disease
B) Anaphylaxis
C) Tumor surveillance or destruction
D) Intracellular infections
62. A nurse reports for work looking unkempt and
disheveled. Her movements are uncoordinated
and her breath smells like mouthwash.
Another nurse suspects this nurse is
intoxicated. What should the nurse do first?
A) Call the supervisor to report the nurse's
behavior.
B) Confront the nurse about her behavior and

relieve her of her responsibilities.


C) Give the nurse some information about the

hospital's employee assistance program.


D) Ignore the situation until someone else

validates the observations.


63.The nurse administers which of the
following substances to provide passive
acquires
immunity to a patient:
A) Gamma globulin
B) Antibiotics
C) Albumin
D) Measles-mumps-rubella vaccine

64. The nurse recognizes that when she


administers this classifications of drugs,
it will
lead to immunosuppression:
A) Antibiotics (in large doses)
B)Nonsteroidal anti-inflammatory drugs
(NSAIDs in lrage doses)
C)Antineoplastics
D)Antithyroids

65.The nurse is performing an


admission assessment on a patient
admitted with cancer who has recently
finished a course of chemotherapy.
Which of the following assessment
findings may indicate that the patient is
possibly experiencing immune
dysfunction?
A)Hypotension
B) Hypoventilation
C)Bradycardia
D) Dry mucous membranes

66.Removal of specific organs may


place the patient at risk for impaired
immune function. During the health
history, the nurse ask the patient if he
had surgical removal of which organ
that may lead to impairment of the
immune system?
A)Lung
B) Spleen
C) Colon
D) Pancreas

67.The nurse who is concerned about a


patients poor nutritional intake and his
risk for infection bases this worry on
the fact that depletion of which nutrient
increases a patients susceptibility to
infection?
A) Vitamin B
B) Fats
C) Proteins
D)Vitamin C

68. Human immunodeficiency virus


(HIV) belongs to a group of viruses
known as retroviruses. Which of the
following patients is at the greatest risk
of contracting HIV?
A) Injecting drug user
B) Female homosexual
C) Blood Transfusion recipient in 1995
D) Health care provider

69. How might the nurse best decrease


the risk of contracting HIV from an
infected patient?
A) Wash hands with an antibacterial
soap
B) Place patients with suspected
exposure on isolation
C) Disinfect environmental surface
D) Implement standard precautions on
all patients

70.An infection control nurse who has


been asked to speak to a group of
adolescents regarding HIV informs
them that HIV-1 can transmitted by:
A) Kissing
B) Hugging
C) Holding hands
D) Sexual intercourse
71.A nurse caring for a patient has
exposed to HIV-infected blood through
an accidental needle stick. According to
the centers for Disease Control and
Prevention (CDC), when does
prophylactic treatment need to start
following exposure to HIV?
A) Within 92 hours
B) Within 72 hours
C) Within 2 months
D) Within 6 months

72.The nurse who has assessed that a


patient admitted with HIV is
experiencing a progressive decline in
cognitive, behavioral, and motor
functions recognizes that these
symptoms are most likely related to the
onset of:
A) HIV encephalopathy
B) B cell lymphoma
C) Kaposis syndrome
D) Wasting syndrome
73.A 20-year-old woman infected with HIV
is seen in an outreach clinic for symptoms
associated with her disease. The patient is
a known IV drug user and has admitted to
several sexual partners in the last year.
Which of the following statements would
indicate that the patient understands the
risk factors related to HIV?
A) I should not share cigarettes with
people
B) I can use a condom lubricated with
petroleum jelly for sexual intercourse
C) I can have unprotected oral sex
D) If I become pregnant, I could pass the
74.A nurse caring for a 28-year-old man
with HIV who has been diagnosed with
pneumonia. In assessing the patient,
which of the following observations
takes immediately priority?
A) Oral temperature of 100 F
B) Tachypnea and restlessness
C) Frequent loose stools
D) Weight loss og 1lb since yesterday
75.The patient is complaining of pain in
the oral mucosa and difficulty with
eating. The nurse inspects the patients
oral cavity and notes creamy-white
patches. These symptoms are most
likely related to:
A) Poor mouth care
B) Herpes zoster
C) Dehydration
D) Candidiasis
76.A nurse teaches the patient
undergoing HIV testing that if
antibodies to the AIDS virus are present
un the blood, This indicates.
A) The patients is immune to HIV
B) AIDS is inactive in the body
C) The patient may have unprotected
intercourse because he or she is not
infected with HIV
D) The patient has been infected with
HIV

77.A hospitalized patient with AIDS is


immunocompromised and is scheduled
for an abdominal radiograph. How
should the nurse safely facilitate the
test?
A) Arrange for a portable x-ray machine
to be used
B) Have a patient wear a mask to the x-
ray department
C) Have the x-ray department
disinfected prior to the patients arrival
D) Send the patients to the x-ray
department, and have the staff in the
78. In planning care for a child diagnosed
with hyperactivity, the nurse would
include which of the following
interventions?
A) Allowing the child space and

autonomy to decrease energy


B) Providing structure in activities
C) Teaching appropriate anger

expression
D) Teaching relaxation exercises
79. A 32-year-old newly diagnosed
patient with AIDS expresses fear of
dying. How should the nurse best
respond to the patient?
A) would you like to talk to someone?
B) everyone dies eventually
C) You are afraid of death; what
concerns you most about death
D) you may live for several years
80. A family member asks the nurse
about safety when visiting a patient
with AIDS. What is the best response
for addressing the family members
fears.
A) Why do you think the family
members fears?
B) Dont worry; you will not contract
the disease from the patient.
C) AIDS is commonly transmitted by
contact with blood and body fluids
D) the patients should be isolated and
have limited visitation
81.The nurse is teaching a group of
college students about correct condom
use. Which of the following is the
correct condom application technique?
A) Attach the condom prior to erection
B) A condom may be reused with the
same partner if ejaculation has not
occurred
C) Hand lotion is an acceptable from of
lubricant
D) Hold the condom by the cuff upon
withdrawal
82. The nurse is working in a support
group for patients with acquired
immunodeficiency syndrome (AIDS).
Which point is most important for the
nurse to discuss with this group?
A) Avoiding the use of recreational
drugs and alcohol
B) Refraining from telling anyone about
the diagnosis
C) Following safer-sex practices
D) Telling potential sex partners about
the diagnosis, as required by law.
83. A patient with acquired
immunodeficiency syndrome (AIDS)
develops Pneumocystis carinii
pneumonia. Which nursing diagnosis
has the highest priority for this patient?
A) Impaired gas exchange
B) Impaired oral mucous membranes
C) Unbalanced nutrition, less than body
requirements
D) Activity intolerance
84. The nurse is providing care for a
patient with acquired
immunodeficiency syndrome and
Pneumocystis carinii pneumonia. The
patient is receiving aerosolized
pentamidine isethionate. What is the
best evidence that the therapy is
working?
A) A sudden gain in lost body weight
B) Whitening of lung fields on the chest
x-ray
C) Improved patient vitality and activity
tolerance
85. The nurse is aware that teaching
related to the prevention of HIV should
focus on:
A) Vaccinating all individuals to
decrease their risk of contracting HIV
B) Providing educational programs that
focus on control and preventions
C)Instructing sexually active individuals
on the proper usage of nonlatex
condoms
D) Instructing sexually active
individuals on the microbicide,
nonoxynol-9(N-9)
86. The nurse working in a homeless
shelter recognizes the recent research
indicates that the best approach for
decreasing the risk of HIV transmission
in the intravenous drug user population
in the shelter focuses on:
A) Teaching abstinence from addicting
drugs
B) Teachings the individuals on
methods to clean their syringes
C) Referring the individuals to a needle
exchange program
D) Referring the individuals to a local
87. The nurse is aware that the
postpartum female patient with HIV
requires additional teaching when she
states:
A) : I will use an intrauterine
contraceptive device (IUD) as my
primary source of contraception
B) I will not breastfeed my child
C) I know that my period may be more
irregular due to my HIV
D) My infant is at risk for HIV and I will
sure we do not miss any appointments
with the pediatrician
88. Upon interpretation of a patient's
laboratory results, The nurse recognizes
that a patient with HIV is considered to
have AIDS when the CD4 T lymphocyte
cell drops below:
A) 200 cells/mm3 of blood
B)300 cells/mm3 of blood
C) 400cells/mm3 of blood
D) 500 cells/mm3 of blood
89. During the assessment of a patient
newly admitted with AIDS, The nurse
carefully assesses for symptoms related
to the most common infection in
patients with AIDS. This most common
infection is:
A) Salmonella
B) Mycobacterium tuberculosis
C) Clostridium difficile
D) Pneumocystis carinii pneumonia
90. The nurse caring for a patient with
AIDS who receives agenerase is
preparing the patient for discharge.
What dietary counseling will the nurse
provide based upon the patients
medication regimen?
A) Avoid high-fat meals while taking
this medication
B) Limit fluid intake to 2L per day
C) Limit sodium intake to 2g per day
D) Avoid meals high in protein while
taking this medication
91. The nurse is performing an
assessment on gastrointestinal
system of a patient with AIDS.
Which of the following is most
likely to be the priority nursing
diagnosis?
A) Unbalanced nutrition, more
than body requirements
B) Diarrhea
C) Bowel incontinence
D) Constipation
92. A patient with AIDS who is
suspected to have Kaposis
sarcoma asks the nurse how she
will know if she definitely has this
form of cancer. The nurse responds
that the condition is diagnosed by:
A) A biopsy of the skin lesions
B) An ultrasound of the skin lesions
C) A series of blood studies
D) Analysis of cerebral spinal fluid
trough a lumbar puncture
93.In an outpatient facility, the nurse obtaining
information on a patient newly diagnosed with HIV is
aware that many patients with HIV utilize various
alternative or complementary therapies. The nurse
addresses complementary or alternative therapy by
stating:
A) Complementary therapies such as acupuncture
or herbal therapy are dangerous to patients with HIV
and we discourage you from exploring them
B) Researchers have not looked at the benefits of
alternative therapy for patients with HIV, so we
suggest that you stay away from these therapies
until there s solid research data available
C) We see many patients with HIV who are using
some type of alternative therapy and there are
benefits and risks. Are there any types of alternative
or complementary therapies that you
D)
94.A psychiatric clinical nurse specialist
presenting a class to nursing students
on treating depression in patients with
HIV discusses treatment options for
depression in this patient population
and informs the students that the
initials treatment approach integrates:
A) Psychotherapy and pharmacology
B) Psychotherapy and electroconvulsive
therapy
C) Pharmacology and vocational
counseling
D) Electroconvulsive therapy and
95. Upon assessment of the patient, the
nurse notes the following data:
decrease in urine output. Decrease in
blood pressure, weak pulse that
increases when the patient stands, and
a urine specific gravity of 1.030. the
priority nursing diagnosis formulated by
the nurse based upon this data is
A) Deficient fluid volume
B) Hyperthermia
C) Unbalance nutrition, less than body
requirements
D) Ineffective protection
96. While counseling a health care
worker who experienced an
occupational exposure to HIV after
being stuck by a scalpel used for
surgery on a patient with HIV, the
occupational health nurse discusses the
window period. During this period of
time, the body has not yet produced
antibodies. The window period may
have a duration of
A) 1 to 2 weeks after exposure
B) 2 to 4 months after exposure
C) 3 weeks to 6 months after exposure
97.Based upon the classification
system for HIV infection and Expanded
AIDS surveillance Case Definition for
Adolescents and Adults criteria, Identify
the clinical category of the patient with
a CD4+T lymphocyte count of 450
cells/mm3 of blood with no symptoms
of an HIV infection.
A) A1
B) A2
C) B1
D) B2

98. Antibodies are detected in a


patients enzyme immunoassay (EIA).
The nurse expects the physician to
order which of the following tests to
confirm the EIA test results?
A) Another EIA test
B) Viral load test
C) Western blot test
D) CD4/CD8 ratio
99. A graduate nurse (GN) is orienting to her
new position on a telemetry floor. The
graduate nurse preceptor identifies that the
novice nurse will need additional instruction
on standard precaution when she observes
which of the following behaviors.
A) The GN wears face protections, gloves,
and a gown when irrigating a wound
B) The GN washes her hands with a waterless
antiseptic agent after removing a pair of
soiled gloves.
C) The GN puts on a second pair of gloves
over her soiled gloves while performing a
bloody procedure
D) The GN places a used needle and syringe
100. It is necessary for the nurse caring
for a patient to understand the
pathophysiology behind shock. Which
of the following statements best
describes the pathophysiologic
rationale for shock?
A) Blood is shunted from vital organs
to peripheral areas of the body
B) Cells lack an adequate blood supply
and are deprived of oxygen and
nutrients
C) Circulating blood volume is
decreased
Battery Exam
Level 4
1.A nurse is caring for a patient who
requires measurement of specific gravity
every 4 hours. What does this test detect?
A) Nutritional deficit
B) Hyperkalemia
C) Hypercallcemia
D) Fluid volume status
2. Which of the following might the
nurse assess in a patient diagnosed with
hypermagnesemia?
A) Diminished deep tendon
reflexes
B) Tachycardia
C) Cool clammy skin
D) Increased serum magnesium
3. A patient is receiving furosemide
(Lasix) 40mg/d IV. What electrolyte value
should be monitored when a patient is
receiving a loop diuretic?
A) Calcium levels
B) Phosphorous levels
C) Potassium levels
D) Magnesium levels
4. The nurse is evaluating a patients
laboratory results. Based upon the
laboratory findings, what results will
cause the release of an antidiuretic
hormone (ADH)?
A) Increased serum sodium
B) Decreased serum sodium
C) Decrease in serum osmolality
D)DecreAse in thirst
5. Third spacing occurs when fluid
moves out of the intravascular space but
not into the intracellular space. Based
upon this shift, The nurse will expect the
patient to demonstrate:
A) Hypertension
B)Bradycardia
C) Hypervolemia
D)Hypovolemia
6. The nurse working in the PACU is
aware that which of the following
procedures may
contribute to extracellular losses?
A) Removal of an ingrown toenail
B) Tooth extraction
C) Abdominal surgery
D) Cataract surgery
7. The renin and angiotensin systems
help to maintain the balance of sodium
and water in the body; What other
functions do these systems serve?
A) Regulating hemoglobin levels
B) Maintaining a healthy blood
volume
C) Releasing platelets when tissues are
injured
D) Lowering blood volumes
8. A patients lab result show a slight
decrease in potassium. The physician
has declined to treat with drug therapy
but has suggested increasing the
potassium through diet. Which of the
following would be a good source of
potassium?
A) Apples
B) Asparagus
C) Carrots
D) Bananas
9. Your patient has alcoholism, and you
may suspect during your assessment
that his
serum magnesium is low. What will the
nurse potentially expect to assess
related to
hypomagnesemia?
A) Tremor
B) Pruritus
C) Edema
D) Decreased blood pressure
10. The nurse is assessing the patient for
the presence of Chvosteks sign. What
electrolyte imbalance does a positive
Chvosteks sign indicate?
A)Hypermagnesemia
B)Hypomagnesemia
C)Hypocalcemia
D) Hyperkalemia
11. A patient with hypokalemia and
heart failure is admitted to the
tolemetry unit. The
nurse is aware that hypokalemia could
cause which of the following
abnormalities on an
electrocardiogram(ECG)?
A) Shortened P-R interval
B) Inverted T wave
C) Depressed U wave
D) Elevated U wave

12. A patient is in the hospital with


heart failure. The nurse notes during
the evening
assessment that the patients neck
veins are distended and the patient has
dyspnea. What action should the nurse
take?
A) Place the patient in low Fowlers and
notify the physician
B) Increase the patients IV fluid and
auscultate the lungs
C) Place the patient in semi
Fowlers and prepare to give the
13. A nurse sees a variety of patients in
the community health clinic. Which of
the
following patients would be at the
greatest risk of dehydration?
A) An 18-year-old basketball player with
a stress fracture of the right foot
B) An infant with diarrhea
C) A 45-year-old with stomach flu
D) An elderly patient living alone
14. A patient with diabetes insipidus is
admitted to the intensive care unit after
a motor vehicle accident that resulted in
head trauma and damage to the
pituitary gland. Diabetes insipidus can
occur when there is a decreased
production of which of the following?
A) ADH
B) Estrogen
C) Aldosterone
D) Renin

15.The nurse is caring for a patient who


is diaphoretic from a fever. The amount
of
sodium excreted in the urine will:
A) Decrease
B) Increase
C) Remain unchanged
D) Fluctuate
16.The triage nurse notes upon
assessment in the emergency room
that the patient with
anxiety is hyperventilating. The nurse is
aware that hyperventilation is the most
common
cause of which acid base imbalance?
A) Respiratory acidosis
B) Respiratory Alkolosis
C)Metabolic Acidosis
D)Metabolic Alkalosis

17.Your patient has the following


arterial blood gas results: Ph 7.26,
PaCO2 28, HCO3
11 mEq/L. How would the nurse
interpret the results?
A) Respiratory acidosis with no
compensation
B) Metabolic alkalosis with a
compensatory alkalosis
C) Metabolic acidosis with no
compensation
D) Metabolic acidosis with a
compensatory respiratory
18.The nurse who assesses the
patients peripheral IV site and notes
edema around the
insertion site will document which
complication related to IV therapy?
A) Air emboli
B) Phlebitis
C) Infiltration
D) Fluid overload
19.What would be the best initial
nursing actions prior to inserting an IV?
A) Have the patient wash the hands
B) Prepare the IV insertion site with
povidone iodine
C) Verify the order for IV therapy
D)Identify a suitable vein

20. The patient asks the nurse if he will


die if air bubbles get into the IV tubing.
What is
the nurses best response?
A) The system is closed and that is
impossible.
B) Only relatively large volumes of
air administered rapidly are
dangerous.
C) There is a risk of complication with
IV administration.
D) You watch too many movie.
21. A patient admitted with a
gastrointestinal bleed and anemia is
receiving a blood
transfusion. Based upon the patients
hypotensive blood pressure, The nurse
anticipates an
order for IV fluids from the physician.
Which of the following IV solutions may
be
administered with blood products?
A) D5 and .45% Normal Saline
B) Lactated Ringers
C) 5% dextrose in water
22.The nurse preparing a site for the
insertion of an IV catheter should treat
excess hair at
the site by:
A) Leaving the hair intact
B) Shaving the area
C) Clipping the hair in the area
D) Removing the hair with a depilatory

23. The nurse assessing skin turgor in


an elderly patient should remember
that:
A) Overhydration causes the skin to
tent
B) Dehydration causes the skin to
appear edematous and spongy
C) Inelastic skin turgor is a normal
part of aging
D) Normal skin turgor is moist and
boggy

24.When selecting a site on the hand or


arm for insertion of an IV catheter, The
nurse should:
A) Choose a proximal site
B) Choose a distal site
C) Have the patient hold his arm over
his head
D) Leave the tourniquet on for at least
5 minutes

25.The nurse is admitting a patient with


a suspected fluid imbalance. The most
sensitive indicator of body fluid balance
is:
A) Daily weight
B)Input and output measurment
C) Skin turgor and mobility
D) Night time weight

26. A patient is taking spironolactone


(Aldactone) to control her hypertension.
Her serum potassium level is 6 mEq/L.
For this patient, the nurses priority
would be to assess her;
A) Neuromuscular function
B) Bowel sounds
C) Respiratory rate
D) Electrocardiogram (ECG) results

27.The nurse is caring for a


postthyroidectomy patient at risk for
hypocalcemia. What
action should the nurse take when
assessing for hypocalcemia?
A) Monitor laboratory values daily for
an elevated thyroid-stimulating
hormone
B) Observe for swelling of the neck,
tracheal deviation, and severe pain
C) Evaluate the quality of the patients
voice postoperatively, noting any
drastic changes
28.A patient who is hospitalized with a
possible electrolyte imbalance is
disoriented and weak, has an irregular
pulse, and takes hydrochlorothiazide.
He most likely suffers from:
A) Hypernatremia
B)Hyponatremia
C) Hyperkalemia
D) Hypokalemia
29.A female patient is discharged from the
hospital after having an episode of heart
failure. Shes prescribed daily oral doses of
digoxin (Lanoxin) and furosemide (Lasix).
Two days later, she tells her community
health nurse that she feels weak and her
heart flutters frequently. What action
should the nurse take?
A) Tell the patient to rest more often
B) Tell the patient to stop taking the digoxin,
and call the physician
C) Call the physician, report the
symptoms, and request to draw a blood
sample to
determine the patients porassium level
30.A nurse in the medical-surgical unit
is giving a patient with low blood
pressure a
hypertonic solution. Which will increase
the number of dissolved particles in his
blood,
creating pressure for fluids in the
tissues to shift into the capillaries and
increase the blood
volume. Which of the following terms is
associated with this process?
A) Hydrostatic pressure
B) Osmosis and osmolality
31.A 73-year-old man who slipped on a small carpet in
his home and fell on his hip is alert and oriented:
PERRLA (pupils equally round and reactive to light and
accommodation) is intact, and he has come by
ambulance to the emergency department(ED). Heart
rate elevated, he is anxious and thirsty. A Foley
catheter is in place and 40mL of urine is present. The
nurses most likely explanation for the urine output is:
A)The man urinated prior to his arrival in the ED and
will probably not need to have the Foley catheter kept
in place
B) The man has a brain injury, lacks ADH, and needs
vasopressin
C) The man is in heart failure and is releasing atrial
natriuretic peptide, which results in decreased urine
output.
D) He is having a sympathetic reaction, which
32.A nurse is visiting an 84-year-old woman
living at home and recovering from hip
surgery. The woman seems confused and has
poor skin turgor, and she states that she
stops drinking water early in the day because
it is too dificult to get up during the night to
go to the bathroom. The nurse explains to
the woman that:
A) She will need to have her medications
adjusted and be readmitted to the hospital
for a complete workup.
B)Limiting fluids can create imbalances
in the body that can result in confusion;
maybe
we need to adjust the timing of your
33.A nurse in the medical-surgical unit
has a newly admitted patient who is
oliguric; the
acute care nurse practitioner orders a
fluid challenge of 100 to 200 Ml of
normal saline
solution over 15 minutes. The nurse is
aware this intervention will help:
A) Distinguish hyponatremia from
hypernatremia
B) Evaluate pituitary gland function
C) Distinguish reduced renal blood
flow from decreased renal function
34.A nurse is taking care of a 65-year-
old female patient in a medical-surgical
unit who is in renal failure; during the
assessment the patient complaints of
tingling in her lips and fingers. When
the nurse takes her blood pressure, she
has a spasm in her wrist and hand. The
nurse suspects:
A) Hypophosphatemia
B)Hypocalcemia
C)Hypermagnesemia
D) Hyperkalemia
35.A patient who is in renal failure
partially loses ability to regulate
changes in pH
because the kidneys;
A) Regulate and reabsorb carbonic acid
change and maintain pH
B) Buffer acids through electrolyte
changes
C) Regenerate and reabsorb
bicarbonate to maintain a stable
pH
D) Combine carbonic acid and
bicarbonate to maintain a stable pH
36.A 65-year-old male patient was
admitted to a medical-surgical unit 72
hours ago with pyloric stenosis; a
nasogastric tube was inserted upon
admission and has been on low
intermittent suction since then. The
nurse taking care of the patient notices
that his potassium is very low and
becomes concerned that the patient
may be at risk for:
A)Hypercalcemia
B) Metabolic acidosis
C) Metabolic alkalosis
37.A nurse admitting a patient with a history
of emphysema reviews her past lab reports
and notes that the patients PaCO2 has been
56 TO 64 mmHg. The nurse will be cautious
administering oxygen because:
A) The patients calcium will rise dramatically
due to pituitary stimulation
B) The oxygen will increase the patients
intracranial pressure and create confusion
C) The oxygen may cause the patient to
hyperventilate and become acidotic
D) Using oxygen may result in the
patient developing carbon dioxide
narcosis and
hypoxemia
38.The nurse in the intensive care unit
receives arterial blood gases (ABG) with
a patient who is complaining of being
short of breath. The ABG has the
following values: Ph=7.21, PaCO2=
64Hg, HCO3=42 mmHg. The labs
reflect:
A) Respiratory acidosis
B) Metabolic alkalosis
C) Respiratory alkalosis
D)Metabolic acidosis
39. A nurse preparing to start an IV on
a newly admitted patient teaches the
patient about the procedure and begins
to prepare the site. The nurse should
always start by:
A) Leaving one hand ungloved to asses
the site
B) Preparing the skin with an iodine
solution
C) Asking the patient if he is
allergic to latex or iodine
D) Removing excessive hair at the
selected site.
40.A 37-year-old woman is being
treated aggressively with a
chemotherapeutic regimen to fight
breast cancer. As a result of this
regimen, she has an inability to fight
infection due to the face her bone
marrow is unable to produce a
sufficient amount of:
A) Lymphocytes
B)Cytoblasts
C) Antibodies
D) Capillaries

41.A patient who is exposed to a


mumps outbreak in the midwest has
previously been immunized for mumps.
She possesses which type of immunity?
A) Acquired immunity
B) Natural immunity
C) Phagocytic immunity
D)Humoral immunity
42.A patient is being treated in the
emergency department following an
injury which resulted in a 6cm
laceration of the right antecubital that
was sustained when the patient fell
through the glass of a storm door. The
site of the injury will have an invasion
of:
A)Inferferon
B) Phagocytic cells
C) Apoptosis
D) Cytokines
43.The patient with a severe laceration
has significant bruising around the site.
The
immune response which destroys worn-
out cells is:
A) The phagocytic immune response
B) The humoral or antibody response
C) The cellular immune response
D) Apoptosis
44.A patient who has sustained a deep
laceration while gardening requires
sutures. Her last tetanus shot was more
than 10 years ago. Based on this
information, the patient will receive a
tetanus immunization that will allow for
the release of an:
A) Antibody
B) Antigen
C) Bacteria
D) Virus

45.A patient develops a virulent


staphylococci infection of the right leg.
The circulating lymphocyte containing
the antigenic message returns to the
nearest lymph node. This is known as
the:
A) Recognition stage
B) Proliferation stage
C) Response stage
D) Effector stage
46.A woman who has received a double
lung transplant for cystic fibrosis is
experiencing signs of rejection.The
immune response which predominates
is the:
A)Humoral
B) Nonspecific
C) Cellular
D)

47.An 48-year-old patient suffering from


urosepsis. The immune response which
presominates is the:
A) Mitigated
B) Nonspecific
C) Cellular
D)Humoral

48.A 44-year-old woman is suffering


from bacterial pneumonia. In the first
stages of her illness, she suffered from
chest pain and had a high fever with
diminished breath sounds. Currently
she is feeling better and no longer has
these symptoms. She is in which of the
immune response?
A) Recognition stage
B) Proliferation stage
C) Response stage
D) Effector stage

49.A woman suffers from multiple


sclerosis. To assist in the treatment of
her illness. She
is lobbying her state and local
governments for the legalization and
use of:
A) Embryonic stem cells
B) Bone marrow transplantation
C) Immunopathology
D) Euthanasia
50.A 48-year-old patient suffering from
multiple sclerosis is receiving interferon
injections. The purpose of interferon
injections is to:
A)Modify the immune response by
suppressing antibody production and
cellular immunity
B) Give rise to numerous cell types able to
form tissues in three germ layers
C) Complement receptors and, as a result,
play an important role in the clearance of
antigens
D) Complements components,
prostaglandins, leukotrienes, and other
inflammatory mediators.
51.An elderly patient is more likely to
develop infections than a younger
individual due
to the:
A) Decreased hormone levels
B) Decreased functions of T
lymphocytes
C)Increased functions of B lymphocytes
D) Increased humoral immunity

52.The elderly male patient is at


greater risk for urinary tract infection
related to:
A) Inability to drink sufficient amounts
of fluid
B) Decreased gastric secretions and
slower motility
C) Prostate enlargement or
neurogenic bladder
D) The ineffectiveness of cilia and
decreased circulation

53.A 55-year-old male patient has high


cholesterol and triglycerides. He is at
risk for
infection related to:
A) Protein-calorie deficiency
B) Regulation of cellular proliferation
C) Excess of trace elements
D) Excess fatty acids
54.The infection control nurse
understands that this term is used
when referring to the
clumping effect occurring when an
antibody acts a cross-link between two
antigens?
A) Agglutination
B) Cellular immune response
C)Humoral response
D) Phagocytic immune response
55.Upon evaluation of a patients
laboratory studies, The nurse notes an
increase in several cell counts on the
complete blood count. Which of the
following cell counts increase because
they are the first cells to arrive at the
site of inflammation?
A)Eosinophils
B) Red blood cell
C) Lymphocytes
D) Neutrophils
56. A woman has just delivered a
stillborn baby boy. Which of the
following would be the most
appropriate nursing response?
A) Can I do anything for you?
B) If something was wrong, it's

better this way.


C) Your son is in heaven with God

now.
D) Would you like to hold your

son?
57. Which of the following is an
appropriate intervention for the
nurse to implement with the client
with obsessive-compulsive disorder?
A) Assist the client to practice

relaxation.
B) Encourage the client to practice

distraction.
C) Teach the client to ignore the

symptoms.
D) Teach the client to control

obsessional thinking.
58. Which of the following is
particularly important when
planning care for a client with
bulimia?
A) Daily urine output
B) Good oral hygiene
C) Meticulous skin care
D) Monitoring daily weight
59. Clients with eating disorders are at
risk for which of the following?
A) Electrolyte imbalance
B) Hyperthermia
C) Insomnia
D) Tachypnea
60. T lymphocytes are believed to
have a specific role in:
A) Transplant rejection
B) Allergic hay fever and asthma
C) Anaphylaxis
D) Bacterial infections
61.B cells, which are responsible for
humoral response, have a specific role
in which of
the following?
A) Graft-verses-host disease
B) Anaphylaxis
C) Tumor surveillance or destruction
D) Intracellular infections
62. A nurse reports for work looking unkempt and
disheveled. Her movements are uncoordinated
and her breath smells like mouthwash.
Another nurse suspects this nurse is
intoxicated. What should the nurse do first?
A) Call the supervisor to report the nurse's
behavior.
B) Confront the nurse about her behavior and

relieve her of her responsibilities.


C) Give the nurse some information about the

hospital's employee assistance program.


D) Ignore the situation until someone else

validates the observations.


63.The nurse administers which of the
following substances to provide passive
acquires
immunity to a patient:
A) Gamma globulin
B) Antibiotics
C) Albumin
D) Measles-mumps-rubella vaccine

64. The nurse recognizes that when she


administers this classifications of drugs,
it will
lead to immunosuppression:
A) Antibiotics (in large doses)
B)Nonsteroidal anti-inflammatory drugs
(NSAIDs in lrage doses)
C)Antineoplastics
D)Antithyroids

65.The nurse is performing an


admission assessment on a patient
admitted with cancer who has recently
finished a course of chemotherapy.
Which of the following assessment
findings may indicate that the patient is
possibly experiencing immune
dysfunction?
A)Hypotension
B) Hypoventilation
C)Bradycardia
D) Dry mucous membranes

66.Removal of specific organs may


place the patient at risk for impaired
immune function. During the health
history, the nurse ask the patient if he
had surgical removal of which organ
that may lead to impairment of the
immune system?
A)Lung
B) Spleen
C) Colon
D) Pancreas

67.The nurse who is concerned about a


patients poor nutritional intake and his
risk for infection bases this worry on
the fact that depletion of which nutrient
increases a patients susceptibility to
infection?
A) Vitamin B
B) Fats
C) Proteins
D)Vitamin C

68. Human immunodeficiency virus


(HIV) belongs to a group of viruses
known as retroviruses. Which of the
following patients is at the greatest risk
of contracting HIV?
A) Injecting drug user
B) Female homosexual
C) Blood Transfusion recipient in 1995
D) Health care provider

69. How might the nurse best decrease


the risk of contracting HIV from an
infected patient?
A) Wash hands with an antibacterial
soap
B) Place patients with suspected
exposure on isolation
C) Disinfect environmental surface
D) Implement standard precautions
on all patients

70.An infection control nurse who has


been asked to speak to a group of
adolescents regarding HIV informs
them that HIV-1 can transmitted by:
A) Kissing
B) Hugging
C) Holding hands
D) Sexual intercourse
71.A nurse caring for a patient has
exposed to HIV-infected blood through
an accidental needle stick. According to
the centers for Disease Control and
Prevention (CDC), when does
prophylactic treatment need to start
following exposure to HIV?
A) Within 92 hours
B) Within 72 hours
C) Within 2 months
D) Within 6 months

72.The nurse who has assessed that a


patient admitted with HIV is
experiencing a progressive decline in
cognitive, behavioral, and motor
functions recognizes that these
symptoms are most likely related to the
onset of:
A) HIV encephalopathy
B) B cell lymphoma
C) Kaposis syndrome
D) Wasting syndrome
73.A 20-year-old woman infected with HIV
is seen in an outreach clinic for symptoms
associated with her disease. The patient is
a known IV drug user and has admitted to
several sexual partners in the last year.
Which of the following statements would
indicate that the patient understands the
risk factors related to HIV?
A) I should not share cigarettes with
people
B) I can use a condom lubricated with
petroleum jelly for sexual intercourse
C) I can have unprotected oral sex
D) If I become pregnant, I could pass
74.A nurse caring for a 28-year-old man
with HIV who has been diagnosed with
pneumonia. In assessing the patient,
which of the following observations
takes immediately priority?
A) Oral temperature of 100 F
B) Tachypnea and restlessness
C) Frequent loose stools
D) Weight loss og 1lb since yesterday
75.The patient is complaining of pain in
the oral mucosa and difficulty with
eating. The nurse inspects the patients
oral cavity and notes creamy-white
patches. These symptoms are most
likely related to:
A) Poor mouth care
B) Herpes zoster
C) Dehydration
D) Candidiasis
76.A nurse teaches the patient
undergoing HIV testing that if
antibodies to the AIDS virus are present
un the blood, This indicates.
A) The patients is immune to HIV
B) AIDS is inactive in the body
C) The patient may have unprotected
intercourse because he or she is not
infected with HIV
D) The patient has been infected
with HIV

77.A hospitalized patient with AIDS is


immunocompromised and is scheduled
for an abdominal radiograph. How
should the nurse safely facilitate the
test?
A) Arrange for a portable x-ray
machine to be used
B) Have a patient wear a mask to the x-
ray department
C) Have the x-ray department
disinfected prior to the patients arrival
D) Send the patients to the x-ray
department, and have the staff in the
78. In planning care for a child diagnosed
with hyperactivity, the nurse would
include which of the following
interventions?
A) Allowing the child space and

autonomy to decrease energy


B) Providing structure in activities
C) Teaching appropriate anger

expression
D) Teaching relaxation exercises
79. A 32-year-old newly diagnosed
patient with AIDS expresses fear of
dying. How should the nurse best
respond to the patient?
A) would you like to talk to someone?
B) everyone dies eventually
C) You are afraid of death; what
concerns you most about death
D) you may live for several years
80. A family member asks the nurse
about safety when visiting a patient
with AIDS. What is the best response
for addressing the family members
fears.
A) Why do you think the family
members fears?
B) Dont worry; you will not contract
the disease from the patient.
C) AIDS is commonly transmitted
by contact with blood and body
fluids
D) the patients should be isolated and
81.The nurse is teaching a group of
college students about correct condom
use. Which of the following is the
correct condom application technique?
A) Attach the condom prior to erection
B) A condom may be reused with the
same partner if ejaculation has not
occurred
C) Hand lotion is an acceptable from of
lubricant
D) Hold the condom by the cuff
upon withdrawal
82. The nurse is working in a support
group for patients with acquired
immunodeficiency syndrome (AIDS).
Which point is most important for the
nurse to discuss with this group?
A) Avoiding the use of recreational
drugs and alcohol
B) Refraining from telling anyone about
the diagnosis
C) Following safer-sex practices
D) Telling potential sex partners about
the diagnosis, as required by law.
83. A patient with acquired
immunodeficiency syndrome (AIDS)
develops Pneumocystis carinii
pneumonia. Which nursing diagnosis
has the highest priority for this patient?
A) Impaired gas exchange
B) Impaired oral mucous membranes
C) Unbalanced nutrition, less than body
requirements
D) Activity intolerance
84. The nurse is providing care for a
patient with acquired
immunodeficiency syndrome and
Pneumocystis carinii pneumonia. The
patient is receiving aerosolized
pentamidine isethionate. What is the
best evidence that the therapy is
working?
A) A sudden gain in lost body weight
B) Whitening of lung fields on the chest
x-ray
C) Improved patient vitality and
activity tolerance
85. The nurse is aware that teaching
related to the prevention of HIV should
focus on:
A) Vaccinating all individuals to
decrease their risk of contracting HIV
B) Providing educational programs
that focus on control and
preventions
C)Instructing sexually active individuals
on the proper usage of nonlatex
condoms
D) Instructing sexually active
individuals on the microbicide,
86. The nurse working in a homeless
shelter recognizes the recent research
indicates that the best approach for
decreasing the risk of HIV transmission
in the intravenous drug user population
in the shelter focuses on:
A) Teaching abstinence from addicting
drugs
B) Teachings the individuals on
methods to clean their syringes
C) Referring the individuals to a
needle exchange program
D) Referring the individuals to a local
87. The nurse is aware that the
postpartum female patient with HIV
requires additional teaching when she
states:
A) : I will use an intrauterine
contraceptive device (IUD) as my
primary source of contraception
B) I will not breastfeed my child
C) I know that my period may be more
irregular due to my HIV
D) My infant is at risk for HIV and I will
sure we do not miss any appointments
with the pediatrician
88. Upon interpretation of a patient's
laboratory results, The nurse recognizes
that a patient with HIV is considered to
have AIDS when the CD4 T lymphocyte
cell drops below:
A) 200 cells/mm3 of blood
B)300 cells/mm3 of blood
C) 400cells/mm3 of blood
D) 500 cells/mm3 of blood
89. During the assessment of a patient
newly admitted with AIDS, The nurse
carefully assesses for symptoms related
to the most common infection in
patients with AIDS. This most common
infection is:
A) Salmonella
B) Mycobacterium tuberculosis
C) Clostridium difficile
D) Pneumocystis carinii pneumonia
90. The nurse caring for a patient with
AIDS who receives agenerase is
preparing the patient for discharge.
What dietary counseling will the nurse
provide based upon the patients
medication regimen?
A) Avoid high-fat meals while
taking this medication
B) Limit fluid intake to 2L per day
C) Limit sodium intake to 2g per day
D) Avoid meals high in protein while
taking this medication
91. The nurse is performing an
assessment on gastrointestinal
system of a patient with AIDS.
Which of the following is most
likely to be the priority nursing
diagnosis?
A) Unbalanced nutrition, more
than body requirements
B) Diarrhea
C) Bowel incontinence
D) Constipation
92. A patient with AIDS who is
suspected to have Kaposis
sarcoma asks the nurse how she
will know if she definitely has this
form of cancer. The nurse responds
that the condition is diagnosed by:
A) A biopsy of the skin lesions
B) An ultrasound of the skin lesions
C) A series of blood studies
D) Analysis of cerebral spinal fluid
trough a lumbar puncture
93.In an outpatient facility, the nurse obtaining
information on a patient newly diagnosed with HIV is
aware that many patients with HIV utilize various
alternative or complementary therapies. The nurse
addresses complementary or alternative therapy by
stating:
A) Complementary therapies such as acupuncture
or herbal therapy are dangerous to patients with HIV
and we discourage you from exploring them
B) Researchers have not looked at the benefits of
alternative therapy for patients with HIV, so we
suggest that you stay away from these therapies
until there s solid research data available
C) We see many patients with HIV who are
using some type of alternative therapy and
there are benefits and risks. Are there any
types of alternative or complementary
therapies that you
94.A psychiatric clinical nurse specialist
presenting a class to nursing students
on treating depression in patients with
HIV discusses treatment options for
depression in this patient population
and informs the students that the
initials treatment approach integrates:
A) Psychotherapy and
pharmacology
B) Psychotherapy and electroconvulsive
therapy
C) Pharmacology and vocational
counseling
95. Upon assessment of the patient, the
nurse notes the following data:
decrease in urine output. Decrease in
blood pressure, weak pulse that
increases when the patient stands, and
a urine specific gravity of 1.030. the
priority nursing diagnosis formulated by
the nurse based upon this data is
A) Deficient fluid volume
B) Hyperthermia
C) Unbalance nutrition, less than body
requirements
D) Ineffective protection
96. While counseling a health care
worker who experienced an
occupational exposure to HIV after
being stuck by a scalpel used for
surgery on a patient with HIV, the
occupational health nurse discusses the
window period. During this period of
time, the body has not yet produced
antibodies. The window period may
have a duration of
A) 1 to 2 weeks after exposure
B) 2 to 4 months after exposure
C) 3 weeks to 6 months after
97.Based upon the classification
system for HIV infection and Expanded
AIDS surveillance Case Definition for
Adolescents and Adults criteria, Identify
the clinical category of the patient with
a CD4+T lymphocyte count of 450
cells/mm3 of blood with no symptoms
of an HIV infection.
A) A1
B) A2
C) B1
D) B2

98. Antibodies are detected in a


patients enzyme immunoassay (EIA).
The nurse expects the physician to
order which of the following tests to
confirm the EIA test results?
A) Another EIA test
B) Viral load test
C) Western blot test
D) CD4/CD8 ratio
99. A graduate nurse (GN) is orienting to her
new position on a telemetry floor. The
graduate nurse preceptor identifies that the
novice nurse will need additional instruction
on standard precaution when she observes
which of the following behaviors.
A) The GN wears face protections, gloves,
and a gown when irrigating a wound
B) The GN washes her hands with a waterless
antiseptic agent after removing a pair of
soiled gloves.
C) The GN puts on a second pair of
gloves over her soiled gloves while
performing a bloody procedure
D) The GN places a used needle and syringe
100. It is necessary for the nurse caring
for a patient to understand the
pathophysiology behind shock. Which
of the following statements best
describes the pathophysiologic
rationale for shock?
A) Blood is shunted from vital organs
to peripheral areas of the body
B) Cells lack an adequate blood
supply and are deprived of oxygen
and nutrients
C) Circulating blood volume is
decreased

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