1. An adult with chronic renal failure is receiving peritoneal dialysis. His acid-base balance and electrolyte levels are now within normal limits. His hemoglobin is 9.2 and his hematocrit is 30. The most likely cause of his anemia is:
a. hemodilution secondary to fluid retention.
b. eating insufficient protein due to taste changes that occur with dialysis.
c. failure of his kidneys to produce the hormone necessary to stimulate bone marrow to produce red blood cells.
d. hemolysis of red blood cells as they move past the membrane containing the dialysis solution.
2. An adult client has a comminuted fracture of the ulnar bone. He asks the nurse what type of fracture this is. The nurse’s response is based on which of these understandings?
a. The ulnar bone has been crushed and broken in several places.
b. The two ends of the fractured ulnar bone are pulled apart and separated from each other.
c. The ulnar bone has been broken in two and one end of the bone broke through the skin.
d. Only one side of the ulnar bone is broken.
3. The nurse is assessing a client admitted in ketoacidosis. The nurse can expect the client’s skin to be:
4. A child has been brought to the emergency room with an asthma attack. What signs and symptoms would the nurse expect to see?
a. A prolonged inspiratory time and a short expiratory time.
b. Frequent productive coughing of clear, frothy, thin mucus progressing to thick, tenacious mucus heard only on auscultation.
c. Hypoinflation of the alveoli with resulting poor gas exchange from increasingly shallow inspirations.
d. Swelling of the bronchial mucosa, with wheezes starting on expiration and spreading to continuous.
5. The nurse is assisting a child with congestive heart failure. Which of the following would the child be least likely to manifest?
a. Weakness and fatigue.
6. A child who is two years and six months old has had one bout of nephrosis (nephrotic syndrome). His mother suspected a recurrence when she observed swelling around his eyes. The nurse helps to confirm this condition by recognizing what additional symptom?
a. Blood pressure of 140/90.
b. Marked proteinuria.
c. Cola-colored urine.
d. A history of positive streptococcal infection.
7. The nurse is caring for a client with cirrhosis of the liver who has developed esophageal varices. The nurse understands that the best explanation for development of esophageal varices is which of the following?
a. Chronic low serum protein levels result in inadequate tissue repair, allowing the esophageal wall to weaken.
b. The enlarged liver presses on the diaphragm, which in turn presses on the esophageal wall, causing collapse of blood vessels into the esophageal lumen.
c. Increased portal pressure causes some of the blood that normally circulates through the liver to be shunted to the esophageal vessels, increasing their pressure and causing varicosities.
d. The enlarged liver displaces the esophagus toward the left, tearing the muscle layer of the esophageal blood vessels, which allows small aneurysms to form along the lower esophageal vessels.
8. A client has a closed head injury. Vital signs are T 103°F rectally; pulse 100; respirations 24; B.P. 110/84. Hourly urine output is 200 ml/hr. What is the best understanding of the cause of these findings?
a. Damage to the hypothalamus resulting in decreased hormone production.
b. Movement of fluid from the tissue into the intravascular space, resulting from sepsis.
c. An increase in antidiuretic hormone (ADH) as a result of injury to the hypothalamus.
d. Fluid shifts from the tissue into the intravascular space due to administration of normal saline used during fluid resuscitation.
9. One of the most important pulmonary treatments in cystic fibrosis is:
a. inhaled beta agonists.
b. inhaled corticosteroids.
c. chest physiotherapy.
d. oral enzymes.
10. The RN is caring for a patient with a chest tube after a right upper lobectomy. On the day of surgery, the RN notes bubbling in the water-seal chamber. What is this, and what should the RN do?
a. air leak, expected finding
b. air leak, notify physician
c. suction control, expected finding
d. suction control, decrease wall suction
11. The RN has finished teaching a patient about treatment of GERD. The RN knows the patient has understood the teaching if she states:
a. “I should eat a small bedtime snack each night.”
b. “I should lie flat in bed.”
c. “I can have red wine with dinner.”
d. “I should eat six small meals daily.”
12. The nurse is caring for a 73-year-old patient with chronic pain being treated with opioids. One complication to be monitored for is:
13. Which order can be associated with the prevention of atelectasis and pneumonia in a client with amyotrophic lateral sclerosis?
a. Active and passive range of motion exercises twice a day
b. Every 4 hours incentive spirometer
c. Chest physiotherapy twice a day
d. Repositioning every 2 hours around the clock
14. A client who had a vasectomy is in the post recovery unit at an outpatient clinic. Which of these points is most important to be reinforced by the nurse?
a. Until the health care provider has determined that your ejaculate doesn’t contain sperm, continue to use another form of contraception.
b. This procedure doesn’t impede the production of male hormones or the production of sperm in the testicles. The sperm can no longer enter your semen and no sperm are in your ejaculate.
c. Involve hard physical labor, you can return to your job as soon as you feel up to it. The stitches generally dissolve in seven to ten days.
d. The health care provider at this clinic recommends rest, ice, an athletic supporter or over-the-counter pain medication to relieve any discomfort.
15. The nurse is performing an assessment on a client in congestive heart failure. Auscultation of the heart is most likely to reveal
a. S3 ventricular gallop
b. Apical click
c. Systolic murmur
d. Split S2
16. A nurse is performing CPR on an adult who went into cardiopulmonary arrest. Another nurse enters the room in response to the call. After checking the client’s pulse and respirations, what should be the function of the second nurse?
a. Relieve the nurse performing CPR
b. Go get the code cart
c. Participate with the compressions or breathing
d. Validate the client’s advanced directive
17. The nurse is caring for a client with uncontrolled hypertension. Which findings require priority nursing action?
a. Lower extremity pitting edema
c. Jugular vein distension
d. Weakness in left arm
18. A client is admitted for first and second degree burns on the face, neck, anterior chest and hands. The nurse’s priority should be
a. Cover the areas with dry sterile dressings
b. Assess for dyspnea or stridor
c. Initiate intravenous therapy
d. Administer pain medication
19. Which these findings would the nurse more closely associate with anemia in a 10 month-old infant?
a. Hemoglobin level of 12 g/dI
b. Pale mucosa of the eyelids and lips
d. A heart rate between 140 to 160
20. A man diagnosed with epididymitis 2 days ago calls the nurse at a health clinic to discuss the problem. What information is most important for the nurse to ask about at this time?
a. What are you taking for pain and does it provide total relief?
b. What does the skin on the testicles look and feel like?
c. Do you have any questions about your care?
d. Did you know a consequence of epididymitis is infertility?