1. The nurse cares for an elderly client who appears fully alert and oriented.

As it gets later in the day, the

nurse notices the client becoming increasingly confused and agitated. It would be MOST appropriate for the
nurse to take which of the following actions ?

a. reorient the client, pull the shades down, shut the lights and television off, and promote a quiet
environment
b. reorient the client, and then turn on the lights and television to distract the client from his confusion.
c. encourage the clients alert roommate to talk with the client
d. Tell the client he is at home in his own bed to get him to settle down and go to sleep

2. On the evening shift, the nurse is caring for a client who will be undergoing a mastectomy in the morning. A
call from the front desk alerts the nurse that the clients family has arrived. It would be MOST appropriate
for the nurse to take which of the following actions ?

a. invite the family in to offer suppert after confirming with the client
b. Tell the family that they cannot come in because visiting hours are over
c. tell the client you want to make sure she has some alone time to relax
d. tell the nursing assistant to sit with the client who needs company

3. A client is scheduled to have surgery the following day. The client tells the nurse, Im very scared. I have
never had surgery before and am afraid that I might not make it through. Which of the following responses
by the nurse is the MOST appropriate ?

a. Why do you feel this way ?

b. Dont worry, you will be fine
c. Why dont we take some time to explore why you feel this way ?
d. Its completely normal to be scared. You will be taken care of. Tell me how you are feeling

4. The narse is working on a pediatric unit. The client is a 13 month old child diagnosed with failure to thrive.
The parents report that child eries frequently, does not like to be held, and will not eat. The nurse learns
that the childs uncle lives in the house with the family. When the uncle visits in the hospital, the nurse
notices the child acting differently and turning away from the uncle. Sometimes the childs heart rate
increases when the uncle is present. The nurse should take which of the following a actions FIRST ?

a. immediately report the possible situation of abuse to the authorities

b. call the physician, who will probably have more long term knowledge
c. discuss it with other nurses to see which approaches they have taken
d. encourage the team thats caring for the client to have a family meeting including the parents, but not
the uncle, together more information

5. The nurse is working on a busy locked psychiartric unit. The alarm gets tripped when somebody tries to go
through the locked doors without permission from the front desk. Which of the following actions should
the nurse take after the alarm is tripped ?

a. reset the alarm from the front desk after verifying the everybody is safe and nobody has escaped from
the unit
b. reset the alarm from the front desk after verifying that everybody is safe and nobody has escaped
from the unit
c. reset the alarm from a clients room after doing a quick scan of the hallway
d. reset the alarm from the front desk once the receptionist says every bidy is accounted for

6. The client is an intoxicated male on the medical/surgical unit who attempts to get out of bed every few
minutes. He is unsteady on his feet, and the nurse is concerned that he will fall if he does get out of bed.
The doctor writes an order for the nurse to place wrist restraints to maintain the clients safety and prevent
him from falling. The man refuses the restraints, the nurse should take which of the following actions ?

a. the nurse should place the restraints in compliance with hospital policy.this is circum
b. refrain from placing restraints to honor the clients wishes, because he has the right to refuse care.
c. call the physician for advice on how to proceed
d. check on the client every hour to ensure his safety
7. The mother of a teenage client who has permission to be involved in the plan of care is asking the nurse
questions, after it has been explained to herthat her child has bipolar discorder. Which of the following
statements by the mother indicates that further teaching is needed ?
a. my child will be cured after being on medications for a few months
b. my child will require support and encouragement
c. my child will be on psychiatric medications probably for the rest of her life
d. the goal of the medication is to reduce symptoms associated with bipolar disorder and to hopefully
help with the mood swings

8. The nurse is caring for a male client. The client has exhibited some signs of anxiety and hostility. The nurse
is aware that the client is a recently returned combat veteran. The nurse should assess the client for which
of the following conditions ?
a. post traumatic stress disorder (PTSD)
b. bipolar disorder
c. schizophrenia
d. borderline personality disorder (BPD)

9. The nurse is caring a client with a known past medical history for intravenous substance abuse. The client
requests to go outside for a few minutes to smoke a cigarette and promises to come right back. The client
has a peripheral intravenous line in. The nurse should take which of the following actions ?
a. allow the client to go outside but set a time limit in which to return
b. call security to escort the client to on approved smoking area
c. make a behavioral contract with the client that includes an agreement to have the nursing assistant
accompany the client outside
d. watch the client from the window to make sure the IV line stays open

10. The client is a non English speaking elderly woman who is being admitted to the hospital for worrisome
symptoms. She is accompanied by family members who speak English. The nurse admitting the client needs
to ask some general admission questions. It would be MOST appropriate for the nurse to take which of the
following actions ?
a. Call the hospitals interpreter services to assit with asking the client questions in her vative language
b. ask family members the questions and document their responses
c. ask family members to translate and ask the questions for the nurse
d. document unable to obtain answers, patient does not speak English

11. A client with post traumatic stress disorder (PTSD) appears to be having a flashback. It would be MOST
appropriate for the nurse to perform which of the foloowing interventions ?
a. encourage the client to tell the nurse how the client is feeling in that moment
b. calmly reorient the client to the current situation
c. assit the client in acting out the event
d. tell the client loudly that what the client is experiencing is not real

12. The client has had a depressed mood, decreased sleep, poor concentration, and poor appetite for the past
4 months. Which of the following does the nurse expect the physician to prescribe ?
a. quetiapine (seroquel)
b. haloperidol (haldol)
c. mirtazapine (remeron)
d. clonazepam (klonipin)

13. A client with bipolar disorder makes a sexually inappropriate comment to the nurse. The nurse should take
which of the following actions ?
a. ignore the comment because the client has a mental health disorder and cannot help it.
b. report the comment to the nurse manager
c ignore the comment, but tell the incoming nurse to be aware of the clients propensity to make
inappropriate comments
d. tell the client that it is inappropriate fo clients to speak to any nurse that way

14. The nurse makes a home visit to a child with a G-Tube. Upon arrival, the nurse notices that the clients
sibling is wearing dirty clothes that are too small. The nurse also notices that there is no food in the
refrigerator or in the kitchen cabinets. Which of the following MOST appropriately describes how the nurse
should respond to these observations ?
 a. The nurse should not be concerned because the sibling is not her client and the client is being fed
through a G-Tube appropriately
b. the nurse should not be concerned because there are no signs of physical abouse
c. the nurse should be concerned and take action because there is no food ir appropriate clothing
available to the sibling
d. the nurse should not be concerned because her client is well cared for

15. The nurse is taking a history from a client in an outpatient clinic. The client has been taking loeazepam
(Ativan) for 6 months. Which of the following is the MOST likely side effect that the nurse would expect to
see as a result of the client using Ativan for this time period ?
a. excessive appetite
b. physical dependence
c. suicidal ideation
d. seizure activity

16. The nurse on the inpatient psychiatric ward is caring for a client with known suicidal ideation. The 24 hour
observer calls the nurse to report that the client took off down the hall. The nurse is unable to immediately
locate the client. Arrange the following actions by the nurse in the order that is MOST appropriate. All
options must be used.
a. nofity security that the client has eloped, and provide a description of the client
b. nofity the nurse manager
c. nofity other staff in the unit
d. ask the observer in what direction the client headed

17. The physician orders an MRI of the brain for an adult male client, which of the following findings in the
clients history should the nurse report to the physician ?
a. allergy to contrast dye
b. implanted cardiac pacemaker
c. chronic obstructiove pulmonary disease (COPD)
d. hernia repair

18. The nurse is preparing to discharge a elient with rheumatic heart disease who is recorvering from
endocarditis. Which of the following statements from the client indicates that the client understand the
teaching ?
a. Im so glad I dont need any more antibiotics now that Im feeling better
b. Ican restart my exercise program in a day or two
c. I will watch for signs of relapse the first few day after discharge
d. I will inform my dentist should I ever need any dental work

19. The nurse preparing to test a client who has allergies from an unknown cause. Which of the following tests
should the nurse perform ?
a. tzanck test
b. patch test
c. rinne test
d. stress test

20. The nurse is preparing a client with acquired immunodeficiency syndrome (AIDS) for discharge to home.
Which of the following instructions should the nurse include ?
a. avoid sharing articles such as razors and toothbrushes
b. do not share eating untensils with family members
c. limit the time you spend in public places
d. avoid eatung food from serving dishes shared with others

21. The nurse is preparing to administer a unit of PRBCs to an anemic client. After obtaining the blood from the
blood bank, the nurse must begin administering it within which of the following time periods ?
a. 15 minutes
b. 30 minutes
c. 45 minutes
d. 60 minutes

22. The nurse is assessing an elderly client for risk of falls. Which of the following should the nurse collect ?
 a. the facilitys restraint policy
b. gait, balance, and visual impairment information
c. psychosocial history
d. the facilitys environmental safety plan

23. The nurse is administering nightly medications, which include an anticoagulant and a stool softener. Which
of the following should the nurse do FIRST before administering the medications ?
a. scan the medication label and the clients wristband
b. ask the client his or her name to property identify this client as the one for whom the medications were
ordered
c. match the clients date of birth and name on the clients wristband with the same information on the
medication order
d. match the clients name and room number with the medication order

24. Which of the following actions by the nurse is the MOST effective means of preventing infection ?
a. washing hands after client contact
b. washing hands after removing gloves
c. hand hygiene between clients
d. hand hygiene before entry to a clients room and upon exit of clients room

25. The hospitalized client is receiving an infusion and the pump has malfunctioned. Which of the following
actions by the nurse is MOST appropriate once the infusion has been stopped and restarted with a
functioning pump ?
a. place a Broken sticker on the malfunctioning pump according to hospital policy, and place the pump
in the designated malfunctioning equipment area
b. place the malfunctioning pump in the utility room
c. Remove the malfunctioning pump from the clients room and palce with other pumps
d. place the malfunctioning pump to the side in the clients room

26. The client is found on the floor by the nursing assistant. Once the client is safe, which of the following
should the nurse do next ?
a. document the event in the clients medical record and file an incident report
b. file an incident report only
c. document the event in the clients medical record and have the nursing assistant file an incident report
d. document the event in the clients medical record only

27. The medical center encounters a bomb threat. The emergency response team informs the staff that the
threat is legitimate and that clients should start being evacuated. Which of the following clients should the
nurse begin evacuating FIRST to the safe designated area ?
a. Ambulatory clients
b. bedridden client
c. ICU clients
d. infant client

28. The nurse has just administered insulin to a diabetic client. In which of the following ways should the nurse
dispose of the needle ?
a. needles should not be re-capped
b. needles should not be re-capped and should be placed in puncture-resistant containers, not jus any
biohazard container
c. CORRECT : needles and sharps should be placed in the nearest puncture-resistant container
d. needles should not be broken

29. Two nurses are preparing to lift a client up in bed. Which of the following should the nurses do to help
avoid injuring their backs ?
a. when lifting or moving a client, nurses should maintain the natural curve of the spine and not bend at
the waist
b. when lifting or moving a client, nurses should lift with the legs and not the back
c. when lifting or moving a client, place the bed in the Trendelenburg position if the client can tolerate it
d. correct : the bed should be in a reasonably high position so the nurses do not have to lean.
30. In the emergency room, the nurses assesses a 4-years old child suspected of having measles. Which of the
following kinds of precautions should the nurse initiate ?
a. contact precautions are not used for measles
b. droplet precautions are not used for measles
c. correct : airborne precautions are used to prevent the transmission of infectious agents that remain
infectious over long distances when suspended in the air
d. reverse isolation is not used for measles

31. A female client comes to the Emergency Departement complaining of vaginal discharge, irritation of the
vagina, and the need to urinate often. The nurse suspects a sexually transmitted disease (STD), and the
physician order diagnostic testing of the vaginal disharger. Which of the following STDs does the nurse
know must be reported to the Departement of public Health ?
a. genital herpes is not a reportable disease
b. human papillomavirus infection is not a report able disease
c. correct : gonorrhea must be reported to the department of public health
d. Chlamydia is not reportable disease

32. A-14 year old girl newly diagnosed with diabetes is preparing for discharge. Which of the following activities
BEST describesthe nurses role as a client advocate ?
a. arranging for a visit with a home health nurse
b. providing written medication instructions to the clients parents
c. Instructing the client to follow up with her provider in 4 weeks
d. teaching the client how to administer insulin injections

33. The nurse noticed an increase in the prevalence of pressure ulcers among clients in an intersive care unit.
She documented her findings and worked with her manager to develop and implement a new policy using a
pressure ulcer risk assessment scale. Which of the following BEST describer the nurses actions ?
a. quality improvement
b. collaboration
c. advocacy
d. case management

34. The nurse is working on a surgical unit. Which of the following tasks would be appropriate for nurse to
delegate to unlicensed assistive personnel (UAP) ?
a. Assist a new postoperative client to the bathroom
b. set up the clients lunch trays
c. change a central line dressing
d. teach client how to administer discharge medications

35. A 20 years old client with leukemia has consented to a blood transfusion against the wishes of his family,
who are all Jehovahs Witnesses. The nurse knows that which of the following ethical principles BEST
supports this decision ?
a. autonomy
b. beneficence
c. nonmaleficence
d. justice

36. The nurse wants to delegate the task of showering an elderly client in a wheelchair to unlicensed assistive
personnel (UAP). Before delegating a task to UAP, the nurse should FIRST ensure which of the following is
accomplished ?
a. the UAP is supervised at all times
b. the UAP during orientantion
c. the UAP has performed the task before
d. the UAP has received the assignment during report

37. The nurse is caring for a 41 years old man with a new colostomy. As part of the care planning for his client,
the nurse knows a referral to which of the following will be the priority ?
a. a certified wound, ostomy, and continence nurse (CWOCN)
b. social services
c. Physical therapy
d. occupational therapy
38. An RN is in charge of a team on a medical / surgical unit that includes an LPN. The RN understands that
which of the following is an activity that falls within the scope of practice of an LPN ?
a. administer oral medications to a client
b. collaborate with social service to develop a discharge plan
c. formulate a nursing diagnosis
d. develop a policy

39. A client is being treated for uncontrolled hypertension. The nurse knows that the involvement of nursing,
pharmacy, cardiology, and nutritional services is an example of which of the following approaches ?
a. managed care
b. multidisciplinary
c. case management
d. performance improvement

40. A 20 years old client has just given birth the baby looks healthy, with the exception of giving a grimace
instead of a cry. Which of the following would the nurse expect the obstetrician to say ?
a. the APGAR socre is 3
b. the APGAR score is 6
c. the APGAR score is 9
d. the APGAR score is 12

41. The outpatient client is postmenopausal. In discussing breast self examination, which of the following
should the nurse let the client know that she can do ?
a. switch to an annual schedule, because she does not have periods
b. discontinue self examination, because hormone changes decrease her risks
c. wait until her mammogram shows some findings
d. continue to palpate monthly, picking her own meaningful date

42. A client with acne has been using isotretinoin (Accutane). She tells the nurse that she recently learned she
is pregnant. She ask will my pregnancy interfere with the medications effectiveness ? which of the
following is the appropriate responses by the nurse ?
a. the medication is contraindicated for pregnant women
b. you will have to change the route of administration because you are pregnant
c. there is no reason yoy cant continue taking it
d. if the medication helps you look better that will help feel better about yourself

43. The nurse is preparing for a womens health fair. The nurse knows that which of the following is correct
when teaching about the risks and benefits of hormone replacement therapt (HRT) ?
a. HRT is related to a decreased risk of deep vein thrombosis (DVT)
b. HRT is related to an increased risk for coronary artery disease (CAD)
c. HRT is related to an increased risk for osteoporosis related bonc fractures
d. HRT is related to a decreased risk of breast cancer

44. The nurse is designing a diet plan for a 70 years old with poorly fitting dentures who has been recently
diagnosed with type 2 diabetes. The nurse knows that which of the following is the LEAST likely risk to the
client ?
a. malnutrition
b. dehydration
c. hyperglycemia
d. low blood sugar

45. The nurse is providing education at a senior center. Which of the following measures will the nurse say is
MOST effective in attaining normal blood sugar levels in a client with type 2 diabetes ?
a. decreasing sodium intake
b. increasing potassium and calcium intake
c. reaching recommended weight
d. decreasing daily exercise

46. A local high school is having a health fair. Which of the following main courses should the nurse recommend
as most healthful for a teenager whose cholesterol level is 300 mg / dl ?
 a. medium rare hamburger withonly one slice of cheese
b. vegetarian New York style pizza
c. Grilled chicken breast
d. salad with extra dressing

47. The nurse is talking to a client who is still grieving the loss of a parent to stomach cancer. The nurse knows
that which of the following would increase the clients risk of cancer ?
a. keeping a strict high protein diet
b. following a low fat, low carbohydrate diet
c. using considerable spices when cooking
d. smoking cigarettes

48. A 3 month old child accompanies her parents to a seasonal flu clinic. Assuming that the child does not have
a fever, can the nurse give the child a flu shot ?
a. yes, if regular immunizations are up to date
b. no, because the child is not old enough
c. yes, because then the child wont get sick later
d. no, because it would interfere with regular immunizations

49. The nurse gives a 35 year old primigravida client a Rhogam injection in her 28 th week of pregnancy. Which
of the following client situations reguires the nurse to take this action ?
a. lumbar pain b. urinary frequency
c. urinary urgency d. painless testicular enlargement

50. New parents are concerned about an unexpected characteristic of their newborn baby. Which of the
following would cause the nurse to initiate contact with the physician ?
a. swollen genitals and breast
b. high pitched crying
c. misshapen head
d. milia

51. A public health nurse visits a client at home three days after the client gave birth. In which of the following
situations should the nurse instruct the client to report to a clinician ?
a. Vaginal drainage with streaks of bright red blood
b. Some discomfort at the site fo her episiotomy
c. feelings of fatigue late in the afternoon and evening
d. an elevated temperature without other symptoms

52. The prediatric nurse is providing discharge instructions to the parents of newborn. In which of the following
situations would the nurse advise the parents to call a physician ?
a. the infant has a temperature higher than 100.4 0F (380C)
b. the infant vomits more than once in 24 hours
c. the infants respirations are even and unlabored
d. the infant has sunken or swollen soft sport on the head

53. The clients first day of her last period was February 1. which of the following should the nurse tell the client
is her expected date of delivery ?
a. November 8 b. October 8
c. December 1 d. November 20

54. The client is 40 years old and pregnant with her first child. Her obstetrician has asked the nurse to schedule
her for an amniocentesis. The client inquires why she needs that test. The nurse says which of the following
an explanation ?
a. we routinely do an amniocentesis on all oru clients to check the childs gender
b. an amniocentesis is not invasive, so there is less risk than doing an ultrasound
c. The standard for doing an amniocentesis is motherhood over age 35
d. is we know the babys size, you can better count on having a vaginal birth

55. The nurse is educating a mother to be about possible danger sings during the last three montgs of
pregnancy. Which of the following would NOT cause the nurse concern about danger sings ?
a. rectal bleeding b. continuous headaches
 c. marked swelling of hand d. blurred vision

56. A first time parent is discussing developmental miliestones with the nurse. The nurse tells the client that
she can reasonably expect her child to achieve which of the following by the time the child is I year old ?
a. walking
b. rolling from tummpy to side
c. transferring toys from hand to hand
d. beginning to respond selectively to word

57. A parent is discussing the behavior of her 3 years old child with the nurse. At 3 years, the nurse would
expect the clients child to be doing all of the following EXCEPT which activity ?
a. saying no often
b. using a limited vocabulary of 500 3.000 words
c. speaking in 10 word sentences
d. believing that adults know everything

58. The nurse is teaching a group of mothers of toddlers how to prevent accidental poisoning from
medications. The nurse teaches the mothers to store medications in which of the following locations
a. in a secure, locked place
b. in vials with childproff caps
c. on the highest shelf in the room
d. disguaised in different containers

59. The nurse is giving a lecture at the senior center about preventative health activities for people over age 60.
the nurse tells the clients that the Centers for Disease Control and Prevention (CDC) now recommnends
which of the following vaccines for this age group ?
a. shingles (herpes zoster) b. diphtheria
c. pertussis (whoopinh cough) d. meningitis

60. The nurse is teaching about the challenger of smoking cessation. Which of the following factor will the
nurse idenfity as known challenges that clients face when attempting to quit smoking ? select all that apply
a. stress and depression b. low level of income
c. high level ef education d. continued exposure to smoking associated stimuli