his is a multiple-choice type of questions consisting of 30-items.

Each question tests

your knowledge on the basic subjects in nursing such as Fundamentals of Nursing,

Pharmacology, Medical-Surgical Nursing, Oncology, Psychiatric Nursing, Maternal

and Newborn and Pediatric Nursing.

The topics included are the following:

● Nursing assessment

● Nursing procedures

● Labor and Delivery

● Prioritization of Care

● Nurse-Client Relationship

● Jurisprudence

● Musculoskeletal, Endocrine, Cardiac and Respiratory disorders

1.The client presented with complaints of body weakness, dizziness and chest pain.

Upon careful assessment, the nurse suspects Angina Pectoris. Which of the following

statements made by the client can confirm this?

a. “I suddenly felt a pain on my chest which radiates to my back and arms”.

b. “I suddenly felt a sharp pain on my lower abdomen”.

c. “The pain does not subside even if I rest”.

d. “The pain goes all the way down to my stomach”.

2.The client from the OR is transferred to the post-anesthesia care unit after surgical

repair of abdominal aortic aneurysm. Which of the following assessment findings

would indicate that the repair was successful?

a. Urine output of 50 mL/hr.

b. Presence of non-pitting, peripheral edema.

c. Clear sclera.

d. Presence of carotid bruit.

3.The client is scheduled for cardiac catheterization because the physician wants to

view the right side of the heart. Which of the following would the nurse expect to

see in this procedure?

a. A dye is injected to facilitate the viewing of the heart

b. Thallium is injected to facilitate the scintillation camera

c. A probe with a transducer tip is swallowed by the client.

d. A tiny ultrasound probe is inserted into the coronary artery

4.The client is being treated for hypovolemia. To assess the effectiveness of the

treatment, the Central Venous Pressure (CVP) of the client is being monitored.

Which of the following is TRUE about CVP?

a. The CVP is measured with a central venous line in the inferior vena cava.

b. The normal CVP is 7 to 9 mmHg.

c. The zero point on the transducer needs to be at the level of the left atrium.

d. The client needs to be supine, with the head of the bed elevated at 45 degrees.

5.The client’s ECG tracing shows ventricular tachycardia secondary to low

magnesium level. Which of the following electrocardiogram tracing results is

consistent with this finding?

a. The appearance of a U wave

b. Shortened ST segment and a widened T wave.

c. Tall, peaked T waves

d. Tall T waves and depressed ST segment

6.The nurse is teaching the client how to use a dry powder inhaler (DPI). Which of

the following are correct instructions given by the nurse? Select All That Apply.

a. Load the drug first by turning to the next dose of drug, or inserting the capsule

into the device, or inserting the disk or compartment into the device.

b. Never wash or place the inhaler in water.

c. Shake your inhaler prior to use.

d. The drug is a dry powder that is why you will taste the drug as you inhale.

e. Never exhale into the inhaler.

f. Do not remove the inhaler from your mouth as soon as you have breathe in.

7.The nurse is assigned to render care for a client who has a chest tube drainage

system. Which of the following are appropriate nursing actions? Select All That

Apply.

a. Strip the chest tube.

b. Empty collection chamber when the drainage makes contact to the bottom of the

tube.

c. Keep chest tube as straight as possible.

d. Notify the physician of drainage is greater than 70mL/hr.

e. Assess bubbling in the water seal chamber.

f. Keep drainage system at the level of the client’s chest

8.The client with DKA is receiving bicarbonate IV infusion for treatment of severe

metabolic acidosis. The nurse notes that the latest ABG shows a pH of 7.0. What

should the nurse keep in mind in giving the drug?

a. Check vital signs before giving the drug and monitor serum sodium level.

b. Perform a sensitivity test prior to drug administration.

c. Mix the drug with D10W 500 ml IV fluid and infuse for over 4 to 8 hours.

d. Administer the drug slowly and monitor the potassium leve

9.The client with a gunshot wound on the abdomen starts to get lethargic, is

breathing heavily, and the wound dressing is fully soaked with blood. The nurse is

expected to immediately perform which of the following actions?

a. Loosen tight clothing and administer oxygen supply.

b. Apply warm blanket to prevent heat loss.

c. Apply large gauze on the bleeding site to put direct pressure or place a tourniquet

on the artery near the bleeding site.

d. Initiate IV access.

10.The nurse is providing home instructions to a client with increased

adrenocorticotrophic hormone. The nurse is aware that the client with excessive

corticosteroids is suffering from what condition?

a. Cushing’s syndrome
b. Addison’s disease

c. Hypothyroidism

d. SIADH

11.The nurse is assigned to a post-thyroidectomy client and is monitoring for signs

of hypocalcemia. The nurse gently tapped the area below the zygomatic bone just in

front of the ear. This action will elicit:

a. Facial tremor

b. Hyperreflexia

c. Chvostek sign

d. Trousseau sign

12.The nurse is caring for a client with an antineoplastic IV hooked on the right

hand. The nurse notices that IV site is swelling and feels cool when touched. The

nurse recognizes this as extravasation. This predisposes the client to develop which

among the following complications? Select all that apply.

a. Infection

b. Tissue necrosis

c. Disfigurement

d. Loss of function

e. Amputation

f. Delayed healing
13.Nursing interventions commonly performed when the client is experiencing

Autonomic Dysreflexia will include the following. Select all that apply.

a. Use digital stimulation to empty the bowel.

b. Have the client sit up straight and raise his head so that he is looking ahead.

c. Remove client’s stockings or socks.

d. Manually compress or tap the bladder to allow urine to flow down the catheter.

e. Administer prescribed vasodilators.

14.Neurologic conditions can be manifested by changes in breathing patterns. The

client presents with symptom of Cheyne-Stokes respirations. The nurse knows that

this kind of breathing pattern shows:

a. Completely irregular breathing pattern with random deep and shallow respirations

b. Prolonged inspirations with inspiratory and /or expiratory pauses

c. Sustained regular rapid respirations of increased depth

d. Rhythmic waxing and waning of both rate and depth of respiration with brief

periods of interspersed apnea

15.The physician is assessing the client’s sensorium by using the Glasgow Coma

Scale. Which of the following is true about the Glasgow Coma Scale?

a. If the client does not respond to painful stimuli, the score is 0.

b. A score lower than 10 indicates that the client is in a coma.

c. A score of 8 indicates that the client is alert and oriented.

d. A score of 4 indicates that the client sustained severe head trauma.

16.The nurse on duty is caring for a client with Amyotrophic Lateral Sclerosis and is

concerned with the client’s impaired physical mobility. The following nursing

interventions are geared towards maintaining optimal physical mobility EXCEPT:

a. Maintain an exercise program.

b. Encourage participation in activities.

c. Instruct client related safety measures.

d. Schedule activities in the morning.

17.An elderly client had a cerebrovascular accident or stroke. The left brain is

affected and is at risk for impaired verbal communication. The nurse asked a

question and noted that the client has difficulty talking and communicating his

thoughts. Which of the following terms should the nurse use to document the

finding?

a. Receptive Aphasia

b. Expressive Aphasia

c. Global aphasia

d. Apraxia

18.The client diagnosed with Alzheimer’s disease is starting to show signs and

symptoms. The nurse wants to assess for graphesthesia. This is performed by:

a. Testing for the client’s ability to identify an object that is placed on the hand with

eyes closed.
b. Testing for the client’s ability to recognize the written letter or number in the

client’s skin while the eyes are closed.

c. Making the client stand, with the arms at the side, feet together, with the eyes

open and then closed. The client is then observed for any swaying.

d. Testing for the presence of pain once the leg is flexed at the hip, and then

extended.

19.The pediatric client presents with the following signs and symptoms: high fever,

drooling, difficulty of breathing and leaning forward in a tripod position.

Immunization history shows that the client never received any Hib vaccine. Which of

the following is the priority of the healthcare provider?

a. Continuous oxygen therapy and constant monitoring of oxygen saturation rate.

b. A well regulated IV infusion and timely administration of antibiotics.

c. Vaccination of Hib and other remaining vaccines to complete required

immunizations.

d. Avoiding any throat examination or agitation of the child.

20.The physician prescribed Clarithromycin (Biaxin) 250mg BID x 7 days for the

client’s infection. Incorrect drug frequency and duration would cause inaccurate

transfer time of the drug to specific tissues in the body. The nurse explains to the

client that accumulation of the drug in specific tissues is the concept of:

a. Absorption

b. Distribution

c. Metabolism
d. Excretion

21.The nurse is to administer Meperidine (Demerol) 35 mg through the

intramuscular route. Available meperedine is 50mg/mL. Which of the following is the

least favorable injection site for intramuscular medication?

a. Ventrogluteal

b. Vastus lateralis

c. Deltoid muscle

d. Dorsogluteal

22.The client presented with complaint of leg cramps. Upon checking the client’s

chart, the nurse noted that the client is hypertensive and is prescribed with a

Thiazide diuretic. The appropriate nursing intervention for this client is:

a. Stop the Thiazide diuretic

b. Refer to the physician for evaluation of electrolyte level of the client

c. Switch the client to a loop diuretic

d. Give the client a non-steroidal anti-inflammatory drug (NSAID)

23.The client is wheeled into the delivery room and is ready for childbirth. While

crowning occurs, the labor nurse applies gentle pressure over the perineum and fetal

head. The maneuver performed is called:

a. Brandt-Andrew’s maneuver

b. McRobert’s maneuver
c. Schultz mechanism

d. Ritgen’s maneuver

24.The nurse is monitoring the condition of the postpartum client. As a part of the

postpartum adaptations, the nurse monitors for descent of the uterus and expects

the fundus to be:

a. On the same level after delivery

b. Decreased by 1 cm/day

c. Decreased by 1.5 cm/day

d. Decreased by 2 cm/day

25.The granddaughter of the client asked the nurse if it is normal for elderly people

to feel sleepy despite sleeping for long hours. Which of the following conditions

would the nurse suspect?

a. Somatoform Disorder

b. Malingering

c. Anxiety

d. Amnesia

26.Chemotherapy is one of the treatments for uterine cancer. The client asked the

nurse how chemotherapeutic drugs work. Which of the following statements will be

the best explanation?

a. Chemotherapeutic agents alter molecular structure of DNA.

b. Chemotherapeutic agents hasten cell division.

c. Cancer cells are sensitive only to chemotherapeutic agents.

d. Chemotherapeutic agents act on all rapidly dividing cells.

27.Vomiting is one of the most common side effects of chemotherapy. The nurse

should be aware of which acid-base imbalance?

a. Ketoacidosis

b. Metabolic acidosis

c. Metabolic alkalosis

d. Respiratory alkalosis

28.The client develops a 2nd degree skin reaction from radiation therapy. The nurse

should expect the following symptoms EXCEPT:

a. The skin is scaly.

b. There is an itchy feeling.

c. There is dry desquamation present.

d. The skin is reddened.

29.The nurse is assessing the muscle coordination and mobility of the client with

musculoskeletal disorder. The nurse noted impulsive and brief muscle twitching of

the face and the limbs. This finding is called:

a. Tremor
b. Chorea

c. Athetosis

d. Dystonia

30.The nurse is assigned to render care to a client with altered mobility. Which of

the following statements is true regarding body mechanics when moving clients?

a. Stand at arm’s length from the working area.

b. Elevate adjustable beds to hip level.

c. Swivel the body when moving the client.

d. Move the client with wide base and straight knees.

1. Answer: A

Rationale:

Angina pectoris is a substernal pain that radiates to the neck, jaw, back and arms

and is relieved by rest. Lower abdominal pain may indicate other gastrointestinal

problems.

2. Answer: A

Rationale:

50 mL/hr is the normal urine output. A normal urine output indicates that there is a

good renal perfusion, and also connotes that the client is hemodynamically stable,

therefore, the repair is successful.

3. Answer: A
Rationale:

In cardiac catheterization or coronary angiogram, a catheter is inserted into the

heart via a vein to measure the ventricular function. A dye is used to provide further

assessment of the structure and motion of the heart. Thallium is a radioactive

isotope injected parenterally so that the scintillation camera can count the

radioactive uptake. This is observed when a physician requests for a Nuclear

Cardiology test. When performing a Transesophageal Echocardiogram (TEE), a probe

with a transducer tip is swallowed by the client to visualize for valvular

abnormalities, possible thrombus, bacterial endocarditis and any congenital heart

defects. When performing an Intracoronary Ultrasound, a tiny ultrasound probe is

inserted into the coronary artery to evaluate for plaque size and consistency, arterial

walls and effectiveness of the treatment.

4. Answer: D

Rationale:

The central venous pressure is within the superior vena cava. The Normal CVP is 2-6

mmHg. A decrease in the CVP indicates a decrease in the circulating blood volume,

which may be a result of hemorrhage or fluid imbalances. The right atrium is located

at the midaxillary line at the fourth intercostal space, and the zero point on the

transducer needs to be at the level of the right atrium. The client needs to be

supine, with the head of the bed elevated at 45 degrees to correctly assess the CVP.

5. Answer: D

Rationale:

In hypokalemia, the electrocardiogram may show flattening and inversion of the T

wave, the appearance of a U wave, and ST depression. Hypercalcemia can cause a

shortened ST and widened T wave. The electrocardiogram of a hyperkalemic client

shows tall peak T waves, widened QRS complexes, prolonged PR intervals or flat P

waves.

6. Answer: A, B, E

Rationale:

Loading of drug depends on the type of dry powder inhaler. Take note that some dry

powder inhalers do not require loading. Dry powder inhalers are kept dry always and

are place at room temperature. Never shake a dry powder inhaler. It is not a

pressurized container. There is no propellant, only the client’s breath can pull the

drug in. Because the drug is a dry powder and there is no propellant, the client will

not feel, smell, or taste the drug during inhalation. The client’s breath will moisten

the powder causing it to clump and not be delivered accurately. Immediately after

inhalation of drug, the inhaler must be removed from the client’s mouth to prevent

moisture.

7. Answer: C, D, E

Rationale:

Stripping is not allowed. Also when changing the drainage system or when checking

air leaks, clamp the chest tube for short periods only. Emptying of collection

chamber or changing the drainage system should be done before the drainage

comes in contact with the bottom of the tube. Avoid kinks and dependent loops to

allow effective drainage and prevent disrupting the system. Report excessive

drainage that is cloudy or red. Drainage will often increase with position changes or

coughing.

Bubbling is expected and indicates air drainage from the client. Absence of bubbling

may mean that the chest tube is obstructed, the lungs have fully reexpanded and no

more air is leaking into the pleural space. Keep drainage system lower than the level

of the chest to allow effective drainage.

8. Answer: D

Rationale:

Sodium Bicarbonate should be slowly administered because fast infusion may result

to abrupt reduction of serum potassium level which can eventually lead to

arrhythmias. Diluting or mixing the drug with hypotonic solution (i.e. D5W) or

isotonic solution (0.9% NaCl) can be ordered but not with hypertonic solution (I.e

D10W).

9. Answer: D

Rationale:

Loosening tight clothing, applying warm blanket to prevent heat loss, and

administering oxygen supply might help but is not the priority this time. Direct

pressure over the bleeding site is a priority to prevent shock but placing a tourniquet

on the artery is done by a surgeon. Because the client is showing signs of altered

mental status, there is likely less perfusion in the brain, which calls for fluid

resuscitation. At least two IV access allows administration of fluids – crystalloid,

blood or clotting factors as necessary which is vital in correcting acidosis,

hypothermia and coagulopathy, and to restore perfusion rapidly.

10. Answer: A

Rationale:

Cushing’s syndrome is clinically defined as the presence of excessive corticosteroids.

Addison’s disease is clinically defined as adrenocortical insufficiency. Hypothyroidism

is a condition wherein there is insufficient thyroid hormone produced by the thyroid

glands while SIADH is characterized by excessive release of anti-diuretic hormone.

11. Answer: C
Rationale:

Facial tremors will occur even without performing a specific maneuver. Exaggerated

reflexes such as hyperreflexia can be assessed by performing a different maneuver.

Gentle tapping of the area below the zygomatic bone just in front of the ear is used

to elicit Chvostek sign to assess the presence of hypocalcemia. Trousseau sign is

characterized by spasm of the muscles of the hand and forearm upon inflation of a

BP cuff on it.

12. Answer: A, B, C, D, E and F

Rationale:

The leaking of vesicant drugs into surrounding tissue causes local tissue damage like

delayed healing, tissue necrosis, disfigurement, loss of function and even

amputation.

13. Answer: B, C, E

Rationale:

Manual stimulation is recommended to evacuate impacted stool. Having the client sit

up straight and raise his head so that he is looking ahead helps reduce the blood

pressure as it allows gravitational pooling of blood in the lower extremities.

Constrictive clothing may trigger an autonomic reaction that would cause the blood

pressure to go up so this must be removed. Manual compression or tapping the

bladder to allow urine to flow down the catheter should be avoided because this

would trigger an increase in blood pressure. Administration of prescribed

vasodilators is done to reduce high blood pressure.

14. Answer: D

Rationale:
Option A is ataxic breathing. Option B is apneustic breathing. Option C is central

neurogenic hyperventilation. Cheyne-stokes breathing respirations are a pattern of

breathing in which phases of hyperpnea regularly alternate with apnea in a

crescendo-decrescendo pattern.

15. Answer: D

Rationale:

The lowest possible score for any response is 1. If a client is unresponsive to painful

stimuli, the score is 1. A score lower than 8 indicates that the client is in a comatose

state. The highest score for the GCS is 15. A score of 15 indicates an alert and

oriented person. A score of 3-8 indicates severe head injury.

16. Answer: D

Rationale:

Helping the client maintain an exercise program is a therapeutic intervention to

maintain joint mobility and good body alignment. This will also prevent venous stasis

due to impaired mobility. Client encouragement will not only address the physical

aspect of the disease but the client’s emotions and self-esteem as well. The safety of

the client with impaired physical mobility should always be considered. Continuous

physical activity is not recommended. There should be an alternate period of activity

and rest to prevent excessive fatigue.

17. Answer: B

Rationale:

Receptive Aphasia refers to the inability to understand spoken words but can freely

express and verbalize. Expressive Aphasia refers to the inability to speak and

communicate formulated thoughts and sentiments. Global aphasia affects both

expressive ability and auditory comprehension. Apraxia is characterized by loss of

the ability to perform activities that a person is physically able and willing to do.

18. Answer: B

Rationale:

Graphesthesia is the ability to identify the writing on the skin even with the eyes

closed. The client provides a verbal response, identifying the figure that was drawn.

Option A is a test for stereognosis. Option C is a test used to assess the Romberg’s

sign while option D is a test for Kernig’s sign.

19. Answer: D

Rationale:

Any deterioration of oxygen saturation may necessitate intubation. However, the

priority this time is to maintain a patent airway. Infusion of IV fluids and

administration of antibiotics are expected nursing actions but not the top priority this

time. Completing vaccination at this time will not suffice or treat the underlying

respiratory problem. The situation calls for a curative management and not

preventive measures. Airway closure is the top priority. Throat examination is

avoided as this increases the risk of laryngeal obstruction. Aggression or agitation

can also compromise airway and breathing.

20. Answer: B

Rationale:

Absorption is the process when the drug is transferred from the site of origin into the

bloodstream. Distribution occurs when the drug in the blood is distributed to

different parts of the body and accumulates in specific tissues. Metabolism or

biotransformation is the process wherein the drug is broken down into its inactive

form. Excretion is the body’s response to eliminate all the inactive form of the drug.

21. Answer: D

Rationale:

The Ventrogluteal site is safe for most intramuscular injections because it only

involves the gluteus medius and gluteus minimus muscles. The Vastus lateralis

muscle is also a safe injection site for intramuscular medications because there are

no adjacent large blood vessels and nerves. The deltoid muscle is a smaller muscle

and is safe for administration of intramuscular medications less than 1 mL. The

Dorsogluteal muscle is not recommended for intramuscular medications because of

the potential damage to the sciatic nerve. Large blood vessels are also located near

the dorsogluteal muscle and should be avoided.

22. Answer: B

Rationale:

Prescribing or stopping medications is the responsibility of the physician, thus the

nurse must refer this first. Thiazide diuretics cause loss of blood potassium while

conserving blood calcium, thus, the electrolyte level must be evaluated first.

23. Answer: D

The brandt-andrew maneuver is the proper extraction of the umbilical cord and

placenta. McRobert’s maneuver is performed in case of shoulder dystocia during

childbirth. The Schultz mechanism is used to describe placental delivery. The

Ritgen’s maneuver is performed by applying pressure over the perineum and

counter-pressure on the fetal head. The Ritgen’s maneuver controls the exit of the

fetal head and prevents severe damage to maternal tissues.

24. Answer: B

Rationale:

The uterine fundus should start to descend after 24 hours of delivery. The normal

rate of uterine descent is 1 cm/day.

25. Answer: B

Rationale:

In Somatoform Disorder, there is no real organ damage, but the client verbalizes

symptoms of a disease in an unconscious manner. In Malingering, verbalization of

symptoms of a disease is conscious and is used by the client to achieve a secondary

gain or benefit. Anxiety comes in many forms panic attacks, phobia, and social

anxiety and the distinction between a disorder and “normal” anxiety isn’t always

clear. Amnesia refers to the loss of memories, such as facts, information and

experiences.

26. Answer: D

Rationale:

Not all chemotherapeutic agents alter the molecular structure of DNA.

Chemotherapy should slow down cell division not hasten it. All cells are sensitive to

drug toxins. Chemotherapeutic agents act on all rapidly dividing cells – most action

of chemotherapeutic agents is that it affects all rapidly dividing cells including the

normal and cancer cells.

27. Answer: C

Rationale:
Ketoacidosis is associated with high levels of ketone bodies in the body brought by

breakdown of fatty acids and is not related to vomiting. Metabolic acidosis happens

when the body produces excessive quantity of acid. Severe vomiting will result to

loss of HCL and acids coming from extracellular fluids which in turn lead to metabolic

alkalosis. Respiratory alkalosis occurs when there is an increased respiration which

elevates the blood pH beyond the normal range of 7.35-7.45.

28. Answer: D

Rationale:

2nd degree skin reactions are evident by scaly skin, an itchy feeling and dry

desquamation. Reddening of the skin is not seen in 2nd degree skin reaction.

29. Answer: B

Rationale:

Tremor is clinically defined as the rhythmic and repetitive muscle movement. Chorea

is clinically defined as brief and involuntary muscle twitching of the face or limbs

which hinders the client’s mobility. Athetosis is clinically defined as the presence of

irregular and slow twisting motions. Dystonia is similar to the definition of Athetosis

but involves larger muscle areas.

30. Answer: C

Rationale:

Standing close to the working area is a proper body mechanic to prevent muscle

fatigue. The nurse should adjust the bed to waist level in order to prevent stretching

and muscle strain. Proper body mechanic includes turning the body as a whole unit

when moving the client to avoid twisting the back. The knees are bent to support
the body’s center of gravity and maintain body balance. Bending the knees will

provide a wider base of support for effective leverage and use of energy.