trial question #1: Which of the following manifestations would the nurse expect when assessing a client with

arterial insufficiency? A. warm, erythematous legs B. thin fragile toenails C. muscular atrophy D. bounding arterial pulses Try to pick the best answer. Eliminate the choices that is obviously wrong or out of this world. If you're done in choosing the best answer, point your cursor over the black box with a question mark below to see the correct answer and rationale. Good luck!

Answer:

Trial question again... QUESTION: Primary gain associated with Somatoform Disorders, is referred to as: A. Financial compensation from disability B. Relief from anxiety associated with conflict C. Love & attention from support system D. Financial aid from relatives . ANSWER: B QUESTION: How will you help a patient anticipate and deal with future recurrence of hallucination? A. Stay with the patient all the time B. Examine the patients ways of dealing with hallucinations C. Help patient accept that hallucination is a part of his mental illness D. Assigning permanent staff who knows when the patient hallucinates

ANSWER: B

QUESTION: The nurse has explained the use of neostigmine methylsulfate (Prostigmin) to a client with Myasthenia Gravis. Which comment by the client indicates the need for further instruction? A. I need to take the medication regularly even when I feel strong B. I should take the medication once daily at bedtime C. if I take too much medication, I can become weak and have breathing problems D. I may have difficulty swallowing my saliva if I take too much medication ANSWER: B

Cardiovascular Nursing Questions 11. The nurse is assessing a client with heart failure. The breath sounds commonly auscultated in clients with heart failure are: a. tracheal. b. fine crackles. c. coarse crackles. d. friction rubs. 12. A client is admitted for treatment of Prinzmetal's angina. When developing the plan of care, the nurse keeps in mind that this type of angina is triggered by: a. activities that increase myocardial oxygen demand. b. an unpredictable amount of activity. c. coronary artery spasm. d. the same type of activity that caused previous angina episodes. 13. An elderly client who underwent total hip replacement exhibits a red, painful area on the calf of the affected leg. What test validates presence of thromboembolism? a. Romberg's b. Phalen's c. Rinne d. Homans' 14. When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which statement by the client most strongly suggests angina pectoris?

a. "The pain lasted about 45 minutes." b. "The pain resolved after I ate a sandwich." c. "The pain got worse when I took a deep breath." d. "The pain occurred while I was mowing the lawn." 15. The nurse is caring for a client with acute pulmonary edema. To immediately promote oxygenation and relieve dyspnea, the nurse should: a. administer oxygen. b. have the client take deep breaths and cough. c. place the client in high Fowler's position. d. perform chest physiotherapy.

Cardiovascular Nursing Questions: Answers and Rationale 11) B - Fine crackles are caused by fluid in the alveoli and commonly occur in clients with heart failure. Tracheal breath sounds are auscultated over the trachea. Coarse crackles are caused by secretion accumulation in the airways. Friction rubs occur with pleural inflammation. 12) C - Prinzmetal's angina results from coronary artery spasm. Activities that increase myocardial oxygen demand may trigger angina of effort. An unpredictable amount of activity may precipitate unstable angina. Worsening angina is brought on by the same type or level of activity that caused previous angina episodes; however, anginal pain is increasingly severe. 13) D - A positive Homans' sign, or pain in the calf elicited upon flexion of the ankle with the leg straight, indicates the presence of a thrombus. Romberg's test assesses cerebellar function. Phalen's test assesses carpal tunnel syndrome. The Rinne test compares air and bone conduction in both ears to screen for or confirm hearing loss. 14) D - Angina pectoris is chest pain caused by a decreased oxygen supply to the myocardium. Lawn mowing increases the cardiac workload; this, in turn, increases the heart's need for oxygen and may precipitate angina. Anginal pain typically is self-limiting and lasts 5 to 15 minutes. Food consumption doesn't reduce this pain, although it may ease pain caused by a GI ulcer. Deep breathing has no effect on anginal pain. 15) C - The high Fowler's position will initially promote oxygenation in the client and relieve shortness of breath. Additional measures include administering oxygen to increase content in the blood. Deep breathing and coughing will improve oxygenation postoperatively but may not immediately relieve shortness of breath. Chest physiotherapy results in expectoration of secretions, which isn't the primary problem in pulmonary edema.

Musculoskeletal Test Questions 1. When caring for a client experiencing an acute gout attack, the nurse anticipates administering which medication? a. allopurinol (Zyloprim) b. colchicines c. prednisone (Deltasone) d. propoxyphene hydrochloride (Darvon) 2. During a senior citizen health screening, the nurse observes a 75-year-old female with a severely increased thoracic curve, or "humpback". What is this condition called? a. Lordosis b. Kyphosis c. Scoliosis d. Genus varum 3. Musculoskeletal test questions about a nurse who is caring for a client with lower back pain who is scheduled for myelography using metrizamide (a water-soluble contrast dye). After the test, the nurse should place the client in which position? a. Head of the bed elevated 45 degrees b. Prone c. Supine with feet raised d. Supine with the head lower than the trunk 4. During a scoliosis screening in a college heath center, a student asks the public health nurse about the consequences of untreated scoliosis. The nurse would be accurate by identifying one of the direct complications as: a. osteoporosis of the vertebra. b. impingement on pulmonary function. c. spontaneous spinal cord injury. d. pituitary hyposecretion. 5. A client is on bed rest after sustaining injuries in a car accident. Which nursing action would help the client avoid complications of immobility? a. Decreasing fluid intake to ease dependent edema b. Turning the client every 2 hours and massaging bony prominences c. Raising the head of the bed to maximize the client's lung inflation d. Bathing and feeding the client to decrease energy expenditure Musculoskeletal Test Questions: Answers and Rationale 1) B - The physician usually prescribes colchicine for a client experiencing an acute gout attack. This drug decreases leukocyte motility, phagocytosis, and lactic acid production, thereby reducing urate crystal deposits and relieving inflammation. Allopurinol is used to decrease

uric acid production in clients with chronic gout. Although corticosteroids are prescribed to treat gout, the nurse wouldn't give them because they must be administered interarticularly to this client. Propoxyphene, a narcotic, may be used to treat osteoarthritis. 2) B - Kyphosis refers to an increased thoracic curvature of the spine, or "humpback." Lordosis is an increase in the lumbar curve or swayback. Scoliosis is a lateral deformity of the spine. Genus varum is a bow-legged appearance of the legs. 3) A - After a myelogram, answer to musculoskeletal test questions about positioning will depend on the dye injected. When a water-soluble dye such as metrizamide is injected, the head of the bed is elevated to a 45-degree angle to slow the upward dispersion of the dye. The other positions are contraindicated when a water-soluble contrast dye is used. If an aircontrast study were performed, the client should be positioned supine with the head lower than the trunk. 4) B - As untreated scoliosis progresses, the thoracic spinal curvature can impinge on the lungs and affect pulmonary function. Osteoporosis, spinal cord injury, and pituitary hyposecretion aren't directly attributed to untreated scoliosis. 5) B - To avoid pressure ulcers in an immobilized client, the nurse must assess the skin thoroughly and use such preventive measures as regular turning, massage of bony prominences, a low-air-loss mattress, and a trapeze (if the client's condition allows). The nurse should increase, not decrease, the client's fluid intake to help prevent renal calculi, which may result from immobility. To prevent atelectasis, another complication of immobility, having the client cough, deep breathe, and use an incentive spirometer would be more effective than raising the head of the bed. Instead of bathing and feeding the client, the nurse should promote independent self-care activities whenever possible to prepare the client for a return to the previous health status.

NLE
Nursing Fundamentals Questions 1. A facility has a system for transcribing medication orders to a Kardex as well as a computerized medication administration record (MAR). A physician writes the following order for a client: "Prednisone 5 mg P.O. daily for 3 days." The order is correctly transcribed on the Kardex. However, the nurse who transcribes the order onto the MAR neglects to place the limitation of 3 days on the prescription. On the 4th day after the order was instituted, a nurse administers prednisone 5 mg P.O. During an audit of the chart, the error is identified. The person most responsible for the error is the: a. nurse who transcribed the order incorrectly on the MAR b. nurse who administered the erroneous dose. c. pharmacist who filled the order and provided the erroneous dose. d. facility because of its policy on transcription of medications.

2. To evaluate a client's chief complaint, the nurse performs deep palpation. The purpose of deep palpation is to assess which of the following? a. Skin turgor b. Hydration c. Organs d. Temperature 3. One of the nursing fundamentals questions is about giving an I.M. injection, the nurse should insert the needle into the muscle at an angle of: a. 15 degrees. b. 30 degrees. c. 45 degrees. d. 90 degrees. 4. A client, age 43, has no family history of breast cancer or other risk factors for this disease. The nurse should instruct her to have a mammogram how often a. Once, to establish a baseline b. Once per year c. Every 2 years d. Twice per year 5. When prioritizing a client's plan of care based on Maslow's hierarchy of needs, the nurse's first priority would be: a. allowing the family to see a newly admitted client. b. ambulating the client in the hallway. c. administering pain medication d. placing wrist restraints on the client. Nursing Fundamentals Questions Answers and Rationale 1) B - The nurse administering the dose should have compared the MAR with the Kardex and noted the discrepancy. The transcribing nurse and pharmacist aren't void of responsibility; however, the nurse administering the dose is most responsible. The facility's policy does provide for a system of checks and balances. Therefore, the facility isn't responsible for the error. 2) C - The purpose of deep palpation, in which the nurse indents the client's skin approximately 1" (3.8 cm), is to assess underlying organs and structures, such as the kidneys and spleen. Skin turgor, hydration, and temperature can be assessed by using light touch or light palpation 3) D - When giving an I.M. injection, the nurse inserts the needle into the muscle at a 90-degree angle, using a quick, dartlike motion. A 15-degree angle is appropriate when administering

an intradermal injection. A 30-degree angle isn't used for any type of injection. A 45- or 90degree angle can be used when giving a subcutaneous injection 4) C - A client age 40 to 49 with no family history of breast cancer or other risk factors for this disease should have a mammogram every 2 years. After age 50, the client should have a mammogram every year 5) C - In Maslow's hierarchy of needs, pain relief is on the first layer. Activity (option B) is on the second layer. Safety (option D) is on the third layer. Love and belonging (option A) are on the fourth layer. Fundamentals in Nursing 6-10 6. A 49-year-old client with acute respiratory distress watches everything the staff does and demands full explanations for all procedures and medications. Which of the following actions would best indicate that the client has achieved an increased level of psychological comfort? a. Making decreased eye contact b. Asking to see family members c. Joking about the present condition d. Sleeping undisturbed for 3 hours 7. A hospitalized client who has a living will is being fed through a nasogastric (NG) tube. During a bolus feeding, the client vomits and begins choking. Which of the following actions is most appropriate for the nurse to take? a. Clear the client's airway. b. Make the client comfortable. c. Start cardiopulmonary resuscitation. d. Stop the feeding and remove the NG tube. 8. The nurse is caring for a geriatric client with a pressure ulcer on the sacrum. When teaching the client about fundamentals in nursing on dietary intake, which foods should the nurse plan to emphasize? a. Legumes and cheese b. Whole grain products c. Fruits and vegetables d. Lean meats and low-fat milk 9. A client with chronic renal failure is admitted with a heart rate of 122 beats/minute, a respiratory rate of 32 breaths/minute, a blood pressure of 190/110 mm Hg, neck vein distention, and bibasilar crackles. Which nursing diagnosis takes highest priority for this client? a. Fear b. Urinary retention c. Excessive fluid volume d. Self-care deficient: Toileting

10. A client's blood test results are as follows: white blood cell (WBC) count is 1,000/l; hemoglobin (Hb) level, 14 g/dl; hematocrit (HCT), 42%. Which of the following goals would be most important for this client? a. Promote fluid balance b. Prevent infection. c. Promote rest. d. Prevent injury. Fundamentals in Nursing Answers and Rationale 6) D - Sleeping undisturbed for a period of time would indicate that the client feels more relaxed, comfortable, and trusting and is less anxious. Decreasing eye contact, asking to see family, and joking may also indicate that the client is more relaxed. However, these also could be diversions. 7) A - A living will states that no life-saving measures are to be used in terminal conditions. There is no indication that the client is terminally ill. Furthermore, a living will doesn't apply to nonterminal events such as choking on an enteral feeding device. The nurse should clear the client's airway. Making the client comfortable ignores the life-threatening event. Cardiopulmonary resuscitation isn't indicated, and removing the NG tube would exacerbate the situation 8) D - Although the client should eat a balanced diet with foods from all food groups, the diet should emphasize foods that supply complete protein, such as lean meats and low-fat milk, because protein helps build and repair body tissue, which promotes healing. Fundamentals in nursing teaches that legumes provide incomplete protein. Cheese contains complete protein, but also fat, which should be limited to 30% or less of caloric intake. Whole grain products supply incomplete proteins and carbohydrates. Fruits and vegetables provide mainly carbohydrates. 9) C - A client with renal failure can't eliminate sufficient fluid, increasing the risk of fluid overload and consequent respiratory and electrolyte problems. This client has signs of excessive fluid volume and is acutely ill. Fear and a toileting self-care deficit may be problems, but they take lower priority because they aren't life-threatening. Urinary retention may cause renal failure but is a less urgent concern than fluid imbalance. 10) B - The client is at risk for infection because the WBC count is dangerously low. Hb level and HCT are within normal limits; therefore, fluid balance, rest, and prevention of injury are inappropriate. Jurisprudence Nursing Practice Test 1. The Republic Act that refers to the Magna Carta of Public Health Workers:

a. R.A. 2382 b. R.A. 2644 c. R.A. 7305 d. R.A. 6425 2. Republic Act -7164 knows as the Nursing Act of 1991 embodies the Regulation of Practice of Nursing in the Philippines. A member of the board of Nursing must be: a. Citizens of the Philippines b. RN and holder of Master Degree c. 10 years of continuous practice of the profession d. All of the above 3. A nurse gives a wrong medication to a client. Another nurses employed by the hospitals, as a risk manager will expect to receive which following communications? a. Incident Report b. Oral report from the nurse c. Copy of medication Kardex d. Jurisprudence Nursing 4. Performing a procedure on a client in the absence of informed consent can lead to which of the following charges? a. Fraud b. Harassment c. Assault and battery d. Breach of confidentiality 5. A nurse is witnessing consent from a client before a cardiac catheterization. Which of the following factors is a component of informed consent? a. Freedom from coercion b. Durable power of attorney c. Private insurance coverage d. Disclosure of previous answers given by the client Jurisprudence Nursing Practice Test ANSWERS AND RATIONALE 1) C - R.A. 7305 is the Magna Carta for the Public Health Workers with objectives to promote and improve the social and economic well-being of health workers; develop their skills and capabilities; and encourage those qualified and with abilities to remain in government service.A- Philippine Medical Act B- Midwifery Law D- Dangerous Drug Act 2) D - Qualifications to be a member of the Board of Nursing are;(1) be a citizen and resident of the Philippines; (2) be a member in good standing of the accredited national nurses association; (3) be a RN and holder of a masters degree in Nursing conferred by a college or university duly recognized by the government; (4) have at least 10 years of continuous

practice of nursing prior to appointment; (5) not a holder of a green card or its equivalent; and (6) not have been convicted of any offense involving moral turpitude even if previously extended pardon by the President of the Philippines. 3) A - Incident report is a record of an accident or incident. This report is used to make all facts about an accident available to agency personnel, to contribute to statistical data about accidents and incidents, and to help personnel prevent future accidents. All accidents are usually reported on incident forms. The report should be completed within 24 hours of the incident. 4) C - Before any medical or surgical procedure can be performed on a patient, consent must be obtained from the patient or his authorized representative. It is only in emergency cases that consent requirement does not apply. The intentional touching or unlawful beating of another person without authorization to do so is a legal wrong called battery. 5) A - The essential elements of an informed consent include (1) the consent must be given voluntarily; (2) the consent must be given by an individual with the capacity and competence to understand; (3) the client must be given enough information to be an ultimate decision maker.

RC/NLE Nursing Jurisprudence Practice Test 6. Under the PRC Board of Nursing Resolution No. 08, nurses can be allowed to insert intravenous solution after duly accredited by: a. Department of health b. Philippine Regulation Commission c. Association of Nursing Service Administration of the Philippines (ANSAP) d. Philippine Nursing Act 1991 (RA 7164) 7. Which of the following is the amendment of R.A. 6111 that provides medicare benefits to all government employees regardless of status and appointment: a. R.A. 2382 b. R.A. 1612 c. P.D. 1519 d. R.A. 1082 8. It provides for compulsory basic immunization for infants and children below 8 years of age. a. Presidential Decree No. 539 b. Nursing Jurisprudence Decree c. Presidential Decree No. 996 d. Presidential Decree No. 148

9. Which of the following is NOT a source of a pronounced law? a. the Philippine Constitution b. Letter of Instruction c. Presidential Decrees d. None of the above 10. Which of the following is the Rural Health Act which provides for more employment of physicians, nurses, midwives and sanitary inspectors who will live in the rural areas to help raise health condition of the barrio people? a. R.A. 2382 b. R.A. 1612 c. R.A. 6111 d. R.A. 1082 PRC/NLE Nursing Jurisprudence Practice Test: ANSWERS AND RATIONALE 6) C - Philippine Nursing Act of 1991 section 28 states in the administration of intrave nous injections, special training shall be required according to a protocol established. Nurses should use the Intravenous Nursing Standards of Practice developed by the Association of Nursing Service Administration of the Philippines (ANSAP). 7) C - R.A. 2382 is the Philippine Medical Act that defines the practice of medicine. R.A. 1612 is the Profession Tax or Omnibus Tax that states to pay P50.00 on or before January 31 of every year. Exempted are those working in the government agencies. R.A. 1082 is the Rural Health Act. 8) C - PD 996 requires compulsory immunization for all children below 8 years old against communicable diseases.A- Presidential proclamation of a Nurses Week (last week of October of very year beginning in 1958).B-Seniors Citizens Act D- Amended RA 679 (women and Child Labor Law) stating the employable age shall be 16 years old. It also provided aside from the minimum employable age, the privileges of a working woman. 9) D - Principal sources of these pronouncements are (1) the constitution; (2) the statues or legislations; (3) regulations issued by the Executive branch of the government; (4) case decisions or judicial opinions, (5) Presidential decrees; (6) Letters of instructions 10) D - R.A. 2382-is the Philippine Medical Act that defines the practice of medicine. R.A. 1612 is the Profession Tax or Omnibus Tax that states to pay P50.00 on or before January 31 of every year. Exempted are those working in the government agencies? R.A. 6111 is the Philippine Medical Care Act that states "all government employees covered by SSS and GSIS are given hospitalization privileges. Cardiovascular Nursing Practice Test

1. The nurse should be prepared to manage complications after abdominal aortic aneurysm resection. Which of the following complications is most common postoperatively? a. Renal failure b. Hemorrhage and shock c. Graft occlusion d. Enteric fistula 2. A client reports recent onset of chest pain that occurs sporadically with exertion. The client also has fatigue and mild ankle swelling, which is most pronounced at the end of the day. The nurse suspects a cardiovascular disorder. When exploring the chief complaint, the nurse should find out if the client has any other common cardiovascular symptoms, such as: a. shortness of breath. b. insomnia. c. irritability. d. lower substernal abdominal pain. 3. Cardiovascular nursing questions about a nurse who records a client's history and discovers several risk factors for coronary artery disease. Which cardiac risk factors are considered controllable? a. Diabetes, hypercholesterolemia, and heredity b. Diabetes, age, and gender c. Age, gender, and heredity d. Diabetes, hypercholesterolemia, and hypertension 4. A client with a history of myocardial infarction is admitted with shortness of breath, anxiety, and slight confusion. Assessment findings include a regular heart rate of 120 beats/minute, audible third and fourth heart sounds, blood pressure of 84/64 mm Hg, bibasilar crackles on lung auscultation, and a urine output of 5 ml over the past hour. The nurse anticipates preparing the client for transfer to the intensive care unit and pulmonary artery catheter insertion because: a. the client is experiencing heart failure. b. the client is going into cardiogenic shock. c. the client shows signs of aneurysm rupture. d. the client is in the early stage of right-sided heart failure. 5. The nurse administers furosemide (Lasix) to treat a client with heart failure. Which adverse effect must the nurse watch for most carefully? a. Increase in blood pressure b. Increase in blood volume c. Low serum potassium level d. High serum sodium level Cardiovascular Nursing Questions Answers and Rationale

1) B - Hemorrhage and shock are the most common complications after abdominal aortic aneurysm resection. Renal failure can occur as a result of shock or from injury to the renal arteries during surgery. Graft occlusion and enteric fistula formation are rare complications of abdominal aortic aneurysm repair. 2) A - Common signs and symptoms of cardiovascular dysfunction include shortness of breath, chest pain, dyspnea, palpitations, fainting, fatigue, and peripheral edema. Insomnia seldom indicates a cardiovascular problem. Although irritability may occur if cardiovascular dysfunction leads to cerebral oxygen deprivation, this symptom more commonly reflects a respiratory or neurologic dysfunction. Lower substernal abdominal pain occurs with some GI disorders. 3) D - Answer to this cardiovascular nursing questions - Controllable risk factors include hypertension, hypercholesterolemia, obesity, lack of exercise, smoking, diabetes, stress, alcohol abuse, and use of contraceptives. Uncontrollable risk factors for coronary artery disease include gender, age, and heredity. 4) B - This client's findings indicate cardiogenic shock, which occurs when the heart fails to pump properly, impeding blood supply and oxygen flow to vital organs. Cardiogenic shock also may cause cold, clammy skin and generalized weakness, fatigue, and muscle pain as lactic acid accumulates from poor blood flow, preventing waste removal. Left-sided and rightsided heart failure eventually cause venous congestion with jugular vein distention and edema as the heart fails to pump blood forward. A ruptured aneurysm causes severe hypotension and a quickly deteriorating clinical status from blood loss and circulatory collapse; this client has low but not severely decreased blood pressure. Also, in ruptured aneurysm, deterioration is more rapid and full cardiac arrest is common. 5) C - Furosemide is a potassium-wasting diuretic. The nurse must monitor the serum potassium level and assess for signs of low potassium. As water and sodium are lost in the urine, blood pressure decreases, blood volume decreases, and urine output increases. Cardiovascular Nursing Practice Test 1. The nurse should be prepared to manage complications after abdominal aortic aneurysm resection. Which of the following complications is most common postoperatively? a. Renal failure b. Hemorrhage and shock c. Graft occlusion d. Enteric fistula 2. A client reports recent onset of chest pain that occurs sporadically with exertion. The client also has fatigue and mild ankle swelling, which is most pronounced at the end of the day. The nurse suspects a cardiovascular disorder. When exploring the chief complaint, the nurse should find out if the client has any other common cardiovascular symptoms, such as:

a. shortness of breath. b. insomnia. c. irritability. d. lower substernal abdominal pain. 3. Cardiovascular nursing questions about a nurse who records a client's history and discovers several risk factors for coronary artery disease. Which cardiac risk factors are considered controllable? a. Diabetes, hypercholesterolemia, and heredity b. Diabetes, age, and gender c. Age, gender, and heredity d. Diabetes, hypercholesterolemia, and hypertension 4. A client with a history of myocardial infarction is admitted with shortness of breath, anxiety, and slight confusion. Assessment findings include a regular heart rate of 120 beats/minute, audible third and fourth heart sounds, blood pressure of 84/64 mm Hg, bibasilar crackles on lung auscultation, and a urine output of 5 ml over the past hour. The nurse anticipates preparing the client for transfer to the intensive care unit and pulmonary artery catheter insertion because: a. the client is experiencing heart failure. b. the client is going into cardiogenic shock. c. the client shows signs of aneurysm rupture. d. the client is in the early stage of right-sided heart failure. 5. The nurse administers furosemide (Lasix) to treat a client with heart failure. Which adverse effect must the nurse watch for most carefully? a. Increase in blood pressure b. Increase in blood volume c. Low serum potassium level d. High serum sodium level Cardiovascular Nursing Questions Answers and Rationale 1) B - Hemorrhage and shock are the most common complications after abdominal aortic aneurysm resection. Renal failure can occur as a result of shock or from injury to the renal arteries during surgery. Graft occlusion and enteric fistula formation are rare complications of abdominal aortic aneurysm repair. 2) A - Common signs and symptoms of cardiovascular dysfunction include shortness of breath, chest pain, dyspnea, palpitations, fainting, fatigue, and peripheral edema. Insomnia seldom indicates a cardiovascular problem. Although irritability may occur if cardiovascular dysfunction leads to cerebral oxygen deprivation, this symptom more commonly reflects a respiratory or neurologic dysfunction. Lower substernal abdominal pain occurs with some GI disorders.

3) D - Answer to this cardiovascular nursing questions - Controllable risk factors include hypertension, hypercholesterolemia, obesity, lack of exercise, smoking, diabetes, stress, alcohol abuse, and use of contraceptives. Uncontrollable risk factors for coronary artery disease include gender, age, and heredity. 4) B - This client's findings indicate cardiogenic shock, which occurs when the heart fails to pump properly, impeding blood supply and oxygen flow to vital organs. Cardiogenic shock also may cause cold, clammy skin and generalized weakness, fatigue, and muscle pain as lactic acid accumulates from poor blood flow, preventing waste removal. Left-sided and rightsided heart failure eventually cause venous congestion with jugular vein distention and edema as the heart fails to pump blood forward. A ruptured aneurysm causes severe hypotension and a quickly deteriorating clinical status from blood loss and circulatory collapse; this client has low but not severely decreased blood pressure. Also, in ruptured aneurysm, deterioration is more rapid and full cardiac arrest is common. 5) C - Furosemide is a potassium-wasting diuretic. The nurse must monitor the serum potassium level and assess for signs of low potassium. As water and sodium are lost in the urine, blood pressure decreases, blood volume decreases, and urine output increases. Cardiovascular Nurse Exam 6. A client with left-sided heart failure complains of increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse should recognize these as signs and symptoms of: a. right-sided heart failure. b. acute pulmonary edema. c. pneumonia. d. cardiogenic shock. 7. After experiencing a transient ischemic attack (TIA), a client is prescribed aspirin, 325 mg P.O. daily. The nurse should teach the client that this medication has been prescribed to: a. control headache pain. b. enhance the immune response. c. prevent intracranial bleeding. d. reduce platelet agglutination. 8. A client is recovering from coronary artery bypass graft (CABG) surgery. The nurse exam questions is, which nursing diagnosis takes highest priority at this time? a. Decreased cardiac output related to depressed myocardial function, fluid volume deficit, or impaired electrical conduction b. Anxiety related to an actual threat to health status, invasive procedures, and pain c. Ineffective family coping related to knowledge deficit and a temporary change in family dynamics

d. Hypothermia related to exposure to cold temperatures and a long cardiopulmonary bypass time 9. The nurse is educating a client who's at risk for coronary artery disease (CAD). The nurse tells the client that CAD has many risk factors. Risk factors that can be controlled or modified include: a. gender, obesity, family history, and smoking. b. inactivity, stress, gender, and smoking. c. obesity, inactivity, diet, and smoking. d. stress, family history, and obesity. 10. While receiving a heparin infusion to treat deep vein thrombosis, a client reports that the gums bleed when brushing the teeth. What should the nurse do first? a. Stop the heparin infusion immediately. b. Notify the physician. c. Administer a coumarin derivative, as prescribed, to counteract heparin. d. Reassure the client that bleeding gums are a normal effect of heparin. Cardiovascular Nurse Exam Answers and Rationale 6) B - Because of decreased contractility and increased fluid volume and pressure in clients with heart failure, fluid may be driven from the pulmonary capillary beds into the alveoli, causing pulmonary edema. In right-sided heart failure, the client would exhibit hepatomegaly, jugular vein distention, and peripheral edema. In pneumonia, the client would have a temperature spike and sputum that varies in color. Cardiogenic shock would show signs of hypotension and tachycardia. 7) D - TIAs are considered forerunners of cerebrovascular accident (CVA). Because CVAs may result from clots in cerebral vessels, aspirin is prescribed to prevent clot formation by reducing platelet agglutination. A 325-mg dose of aspirin is inadequate to relieve headache pain in an adult. Aspirin has no effect on the body's immune response. Intracranial bleeding isn't associated with TIAs, and the action of aspirin probably would worsen any bleeding present. 8) A - For a client recovering from CABG surgery, Decreased cardiac output is the most important nursing diagnosis because myocardial function may be depressed from anesthetics or a long cardiopulmonary bypass time, leading to decreased cardiac output. Other possible causes of decreased cardiac output in this client include fluid volume deficit and impaired electrical conduction. The nurse exam other options may be relevant but take lower priority at this time because maintaining cardiac output is essential to sustaining the client's life. 9) C - The risk factors for coronary artery disease that can be controlled or modified include

obesity, inactivity, diet, stress, and smoking. Gender and family history are risk factors that can't be controlled. 10) B - Because bleeding gums are an adverse effect of heparin that may indicate excessive anticoagulation, the nurse should notify the physician, who will evaluate the client's condition. Laboratory tests, such as partial thromboplastin time, should be performed before concluding that the client's bleeding is significant. The prescribed heparin dose may be therapeutic rather than excessive, so the nurse shouldn't discontinue the heparin infusion, unless the physician orders this after evaluating the client. Protamine sulfate, not a coumarin derivative, is given to counteract heparin. Bleeding gums aren't a normal effect of heparin. Oncology Nurse Education 1. A client is undergoing a diagnostic workup for suspected testicular cancer. When obtaining the client's history, the nurse checks for known risk factors for this type of cancer. Testicular cancer has been linked to: a. testosterone therapy during childhood. b. sexually transmitted disease. c. early onset of puberty. d. cryptorchidism. 2. A client with cancer is being evaluated for possible metastasis. Which of the following is one of the most common metastasis sites for cancer cells? a. Liver b. Colon c. Reproductive tract d. White blood cells (WBCs) 3. Oncology nurse education question about a client who seeks care for hoarseness that has lasted for 1 month. To elicit the most appropriate information about this problem, the nurse should ask which question? a. "Do you smoke cigarettes, cigars, or a pipe?" b. "Have you strained your voice recently?" c. "Do you eat a lot of red meat?" d. "Do you eat spicy foods?" 4. A client is undergoing tests for multiple myeloma. Diagnostic study findings in multiple myeloma include: a. a decreased serum creatinine level. b. hypocalcemia. c. Bence Jones protein in the urine. d. a low serum protein level.

5. During a routine checkup, the nurse assesses a client with acquired immunodeficiency syndrome (AIDS) for signs and symptoms of cancer. What is the most common AIDSrelated cancer? a. Squamous cell carcinoma b. Multiple myeloma c. Leukemia d. Kaposi's sarcoma Oncology Nurse Education Answers and Rationale 1) D - Cryptorchidism (failure of one or both testes to descend into the scrotum) appears to play a role in testicular cancer, even when corrected surgically. Other significant history findings for testicular cancer include mumps orchitis, inguinal hernia during childhood, and maternal use of diethylstilbestrol or other estrogen-progestin combinations during pregnancy. Testosterone therapy during childhood, sexually transmitted disease, and early onset of puberty aren't risk factors for testicular cancer. 2) A - The liver is one of the five most common cancer metastasis sites. The others are the lymph nodes, lung, bone, and brain. The colon, reproductive tract, and WBCs are occasional metastasis sites. 3) A - Persistent hoarseness may signal throat cancer, which commonly is associated with tobacco use. To assess the client's risk for throat cancer, the nurse should ask about smoking habits. Although straining the voice may cause hoarseness, it wouldn't cause hoarseness lasting for 1 month. Consumption of red meat or spicy foods isn't associated with persistent hoarseness. 4) C - Presence of Bence Jones protein in the urine almost always confirms the disease, but absence doesn't rule it out. Serum calcium levels are elevated because calcium is lost from the bone and reabsorbed in the serum. Serum protein electrophoresis shows elevated globulin spike. The serum creatinine level may also be increased. 5) D - Kaposi's sarcoma is the most common cancer associated with AIDS. Squamous cell carcinoma, multiple myeloma, and leukemia may occur in anyone and aren't associated specifically with AIDS. Endocrine System Practice Tests 1. The nurse is planning care for a 52-year-old male client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority? a. Risk for infection b. Decreased cardiac output

c. Impaired physical mobility d. Imbalanced nutrition: Less than body requirements 2. When caring for a client who's being treated for hyperthyroidism, it's important to: a. provide extra blankets and clothing to keep the client warm. b. monitor the client for signs of restlessness, sweating, and excessive weight loss during thyroid replacement therapy. c. balance the client's periods of activity and rest. d. encourage the client to be active to prevent constipation. 3. Endocrine System Practice Tests - During a class on exercise for diabetic clients, a client asks the nurse educator how often to exercise. The nurse educator advises the clients to exercise how often to meet the goals of planned exercise? a. At least once a week b. At least three times a week c. At least five times a week d. Every day 4. The nurse is providing dietary instructions to a client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend: a. increasing saturated fat intake and fasting in the afternoon. b. increasing intake of vitamins B and D and taking iron supplements. c. eating a candy bar if light-headedness occurs. d. consuming a low-carbohydrate, high-protein diet and avoiding fasting. 5. A client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which of the following glands? a. Adrenal cortex b. Pancreas c. Adrenal medulla d. Parathyroid Endocrine System Practice Tests Answers and Rationale 1) B - An acute addisonian crisis is a life-threatening event, caused by deficiencies of cortisol and aldosterone. Glucocorticoid insufficiency causes a decrease in cardiac output and vascular tone, leading to hypovolemia. The client becomes tachycardic and hypotensive and may develop shock and circulatory collapse. The client with Addison's disease is at risk for infection; however, reducing infection isn't a priority during an addisonian crisis. Impaired physical mobility is also an appropriate nursing diagnosis for the client with Addison's disease, but it isn't a priority in a crisis. Imbalanced nutrition: Less than body requirements is also an important nursing diagnosis for the client with Addison's disease but not a priority during a crisis.

2) C - A client with hyperthyroidism needs to be encouraged to balance periods of activity and rest. Many clients with hyperthyroidism are hyperactive and complain of feeling very warm. Consequently, it's important to keep the environment cool and to teach the client how to manage his physical reactions to heat. Clients with hypothyroidism not hyperthyroidism complain of being cold and need warm clothing and blankets to maintain a comfortable temperature. They also receive thyroid replacement therapy, often feel lethargic and sluggish, and are prone to constipation. The nurse should encourage clients with hypothyroidism to be more active to prevent constipation. 3) B - Endocrine System Practice Tests Answer - Diabetic clients must exercise at least three times a week to meet the goals of planned exercise lowering the blood glucose level, reducing or maintaining the proper weight, increasing the serum high-density lipoprotein level, decreasing serum triglyceride levels, reducing blood pressure, and minimizing stress. Exercising once a week wouldn't achieve these goals. Exercising more than three times a week, although beneficial, would exceed the minimum requirement. 4) D - To control hypoglycemic episodes, the nurse should instruct the client to consume a lowcarbohydrate, high-protein diet, avoid fasting, and avoid simple sugars. Increasing saturated fat intake and increasing vitamin supplementation wouldn't help control hypoglycemia. 5) A - Excessive secretion of aldosterone in the adrenal cortex is responsible for the client's hypertension. This hormone acts on the renal tubule, where it promotes reabsorption of sodium and excretion of potassium and hydrogen ions. The pancreas mainly secretes hormones involved in fuel metabolism. The adrenal medulla secretes the catecholamines epinephrine and norepinephrine. The parathyroids secrete parathyroid hormone. Nursing Board Exams Questions 6. The nurse is caring for a client with a colostomy. The client tells the nurse that he makes small pin holes in the drainage bag to help relieve gas. The nurse should teach him that this action: a. destroys the odor-proof seal. b. won't affect the colostomy system. c. is appropriate for relieving the gas in a colostomy system. d. destroys the moisture-barrier seal. 7. For a client with cirrhosis, deterioration of hepatic function is best indicated by: a. fatigue and muscle weakness. b. difficulty in arousal. c. nausea and anorexia. d. weight gain. 8. Nursing board exams questions about a client with severe abdominal pain is being evaluated for appendicitis. What is the most common cause of appendicitis?

a. Rupture of the appendix b. Obstruction of the appendix c. A high-fat diet d. A duodenal ulcer 9. A client is scheduled for bowel resection with anastomosis involving the large intestine. Because of the surgical site, the nurse formulates the nursing diagnosis of Risk for infection. To complete the nursing diagnosis statement, the nurse should add which "related-to" phrase? a. Related to major surgery required by bowel resection b. Related to the presence of bacteria at the surgical site c. Related to malnutrition secondary to bowel resection with anastomosis d. Related to the presence of a nasogastric (NG) tube postoperatively 10. A client with advanced cirrhosis has a prothrombin time (PT) of 15 seconds, compared with a control time of 11 seconds. The nurse expects to administer: a. spironolactone (Aldactone). b. phytonadione (Mephyton). c. furosemide (Lasix). d. warfarin (Coumadin). Nursing Board Exam: Answers and Rationale 6) A - Any hole, no matter how small, will destroy the odor-proof seal of a drainage bag. Removing the bag or unclamping it is the only appropriate method for relieving gas. 7) B - Hepatic encephalopathy, a major complication of advanced cirrhosis, occurs when the liver no longer can convert ammonia (a by-product of protein breakdown) into glutamine. This leads to an increased blood level of ammonia a central nervous system toxin which causes a decrease in the level of consciousness. Fatigue, muscle weakness, nausea, anorexia, and weight gain occur during the early stages of cirrhosis. 8) B - Nursing Board Exams Rationale - Appendicitis most commonly results from obstruction of the appendix, which may lead to rupture. A high-fat diet or duodenal ulcer doesn't cause appendicitis; however, a client may require dietary restrictions after an appendectomy. 9) B - The large intestine normally contains bacteria because its alkaline environment permits growth of organisms that putrefy and break down remaining proteins and indigestible residue. These organisms include Escherichia coli, Aerobacter aerogenes, Clostridium perfringens, and Lactobacillus. Although bowel resection with anastomosis is considered major surgery, it poses no greater risk of infection than any other type of major surgery. Malnutrition seldom follows bowel resection with anastomosis because nutritional absorption (except for some water, sodium, and chloride) is completed in the small intestine. An NG

tube is placed through a natural opening, not a wound, and therefore doesn't increase the client's risk of infection. 10) B - Prothrombin synthesis in the liver requires vitamin K. In cirrhosis, vitamin K is lacking, precluding prothrombin synthesis and, in turn, increasing the client's PT. An increased PT, which indicates clotting time, increases the risk of bleeding. Therefore, the nurse should expect to administer phytonadione (vitamin K1) to promote prothrombin synthesis. Spironolactone and furosemide are diuretics and have no effect on bleeding or clotting time. Warfarin is an anticoagulant that prolongs PT. Integumentary Test Questions 1. The nurse is changing a dressing and providing wound care. Which activity should she perform first? a. Assess the drainage in the dressing. b. Slowly remove the soiled dressing. c. Wash hands thoroughly. d. Put on latex gloves. 2. The nurse is caring for a client with skin grafts covering third-degree burns on the arms and legs. During dressing changes, the nurse should be sure to: a. apply maximum bandages to allow for absorption of drainage. b. wrap elastic bandages distally to proximally on dependent areas. c. wrap elastic bandages on the arms and legs, proximally to distally, to promote venous return. d. remove bandages with clean gloves. 3. Integumentary test question for the nurse who is performing wound care. Which of the following practices violates surgical asepsis? a. Holding sterile objects above the waist b. Considering a 1" edge around the sterile field as being contaminated c. Pouring solution onto a sterile field cloth d. Opening the outermost flap of a sterile package away from the body 4. A client with atopic dermatitis is prescribed medication for photochemotherapy. The nurse teaches the client about the importance of protecting the skin from ultraviolet light before drug administration and for 8 hours afterward and stresses the need to protect the eyes. After administering medication for photochemotherapy, the client must protect the eyes for: a. 4 hours. b. 8 hours. c. 24 hours. d. 48 hours. 5. The nurse documents the presence of a scab on a client's deep wound. The nurse identifies this as which phase of wound healing?

a. Inflammatory b. Migratory c. Proliferative d. Maturation Integumentary Test Answers and Rationale 1) C - When caring for a client, the nurse must first wash her hands. Putting on gloves, removing the dressing, and observing the drainage are all parts of performing a dressing change after hand washing is completed. 2) B - Wrapping elastic bandages on dependent areas limits edema formation and bleeding and promotes graft acceptance. The nurse should wrap the client's arms and legs from the distal to proximal ends and use strict sterile technique throughout the dressing change. Maximum bandages should be avoided because bulky dressings limit mobility; instead, the nurse should use enough bandages to absorb wound drainage. Sterile gloves are required throughout all phases of the dressing change to prevent contamination. 3) C - Pouring solution onto a sterile field cloth violates surgical asepsis because moisture penetrating the cloth can carry microorganisms to the sterile field via capillary action. The other options are practices that help ensure surgical asepsis. 4) D - To prevent eye discomfort, the client must protect the eyes for 48 hours after taking medication for photochemotherapy. Protecting the eyes for a shorter period increases the risk of eye injury. 5) B - The scab formation is found in the migratory phase. It is accompanied by migration of epithelial cells, synthesis of scar tissue by fibroblasts, and development of new cells that grow across the wound. In the inflammatory phase, a blood clot forms, epidermis thickens, and an inflammatory reaction occurs in the subcutaneous tissue. During the proliferative phase, the actions of the migratory phase continue and intensify, and granulation tissue fills the wound. In the maturation phase, cells and vessels return to normal and the scab sloughs off. Nursing Board Exam Questions about Integumentary System 6. The physician prescribes an emollient for a client with pruritus of recent onset. The client asks why the emollient should be applied immediately after a bath or shower. How should the nurse respond? a. "This makes the skin feel soft." b. "This prevents evaporation of water from the hydrated epidermis." c. "This minimizes cracking of the dermis." d. "This prevents inflammation of the skin."

7. The nurse discovers scabies when assessing a client who has just been transferred to the medical-surgical unit from the day surgery unit. To prevent scabies infection in other clients, the nurse should: a. wash hands, apply a pediculicide to the client's scalp, and remove any observable mites. b. isolate the client's bed linens until the client is no longer infectious. c. notify the nurse in the day surgery unit of a potential scabies outbreak. d. place the client on enteric precautions. 8. Nursing board exam questions about a client who is diagnosed with gonorrhea. When teaching the client about this disease, the nurse should include which instruction? a. "Avoid sexual intercourse until you've completed treatment, which takes 14 to 21 days." b. "Wash your hands thoroughly to avoid transferring the infection to your eyes." c. "If you have intercourse before treatment ends, tell sexual partners of your status and have them wash well after intercourse." d. "If you don't get treatment, you may develop meningitis and suffer widespread central nervous system (CNS) damage." 9. A client comes to the physician's office for treatment of severe sunburn. The nurse takes this opportunity to discuss the importance of protecting the skin from the sun's damaging rays. Which instruction would best prevent skin damage? a. "Minimize sun exposure from 1 to 4 p.m. when the sun is strongest." b. "Use a sunscreen with a sun protection factor of 6 or higher." c. "Apply sunscreen even on overcast days." d. "When at the beach, sit in the shade to prevent sunburn." 10. Nursing board exam questions when caring for a client with severe impetigo, the nurse should include which intervention in the plan of care? a. Placing mitts on the client's hands b. Administering systemic antibiotics as prescribed c. Applying topical antibiotics as prescribed d. Continuing to administer antibiotics for 21 days as prescribed Nursing Board Exam Questions Answers and Rationale 6) B - Applying an emollient immediately after taking a bath or shower prevents evaporation of water from the hydrated epidermis, the skin's upper layer. Although emollients make the skin feel soft, this effect occurs whether or not the client has just bathed or showered. An emollient minimizes cracking of the epidermis, not the dermis (the layer beneath the epidermis). An emollient doesn't prevent skin inflammation. 7) B - To prevent the spread of scabies in other hospitalized clients, the nurse should isolate the client's bed linens until the client is no longer infectious usually 24 hours after treatment begins. Other required precautions include using good hand-washing technique and wearing gloves when applying the pediculicide and during all contact with the client. Although the

nurse should notify the nurse in the day surgery unit of the client's condition, a scabies epidemic is unlikely because scabies is spread through skin or sexual contact. This client doesn't require enteric precautions because the mites aren't found on feces. 8) B - Answer to nursing board exam questions - Adults and children with gonorrhea may develop gonococcal conjunctivitis by touching the eyes with contaminated hands. The client should avoid sexual intercourse until treatment is completed, which usually takes 4 to 7 days, and a follow-up culture confirms that the infection has been eradicated. A client who doesn't refrain from intercourse before treatment is completed should use a condom in addition to informing sex partners of the client's health status and instructing them to wash well after intercourse. Meningitis and widespread CNS damage are potential complications of untreated syphilis, not gonorrhea. 9) C - Sunscreen should be applied even on overcast days, because the sun's rays are as damaging then as on sunny days. The sun is strongest from 10 a.m. to 2 p.m. (11 a.m. to 3 p.m. daylight saving time) not from 1 to 4 p.m. Sun exposure should be minimized during these hours. The nurse should recommend sunscreen with a sun protection factor of at least 15. Sitting in the shade when at the beach doesn't guarantee protection against sunburn because sand, concrete, and water can reflect more than half the sun's rays onto the skin. 10) B - Answer to nursing board exam questions - Impetigo is a contagious, superficial skin infection caused by beta-hemolytic streptococci. If the condition is severe, the physician typically prescribes systemic antibiotics for 7 to 10 days to prevent glomerulonephritis, a dangerous complication. The client's nails should be kept trimmed to avoid scratching; however, mitts aren't necessary. Topical antibiotics are less effective than systemic antibiotics in treating impetigo.