RPN Post Review Test (A) 1. A 23-year old primigravida arrives at the clinic for a check up.

She is complaining of nausea and vomiting upon rising and increase urination. She reports that her last menstrual period was 2 months ago. A blood test confirms that she is pregnant. Which of the following finding would be considered abnormal? a. A bluish tinge to the vagina upon cervical exam b. A white, non-malodorous discharge from the vagina c. Mild contractions radiating from the back to the abdomen d. Increase vascularity, sensitivity, and fullness of the breasts Answer: A a bluish tinge to the vagina may indicate bleeding during the early part of pregnancy 2. The doctor wants to perform an amniocentesis on a client. She wants to know what this test is used for. The PN explains: a. It is used to identify chromosomal aberrations b. It is used to confirm position and lie of the fetus c. It is used to identify gestational sacs and number of fetuses present d. It is used to determine gestational diabetes Answer: A- Down syndrome can be detected from the amniotic fluid. 3. A nursing student is working with Labor and Delivery RPNs. During the monitoring of a patient in labor, the student asks, what is the normal range for a fetal heart rate? The RPN responds by saying: a. 160 to 180 BPM b. 100 to 120 BPM c. 120 to 160 BPM d. 80 to 150 BPM Answer: C-this is the normal range of FHT 4. The PN is providing a postpartum patient a teaching session, includes instructions on self-breast exam. Which of the following instructions would not be correct? a. Do not do self-breast exams during lactation. b. Perform self-breast exams while lying flat on back. c. Check breasts in circular motion and assess for lumps or bumps. d. Examine the breast between the 4th and 7th day of menses. Answer: Athe breasts are full during lactation which may affect the exams. 5. During a teaching session with a 16 year old mother, the PN notes that the following statement made by the adolescent confirms her understanding of proper feeding methods. a. I will heat the milk in microwave and shake it well to be sure not to burn the baby. b. I will burp the baby every 10 minutes, during feedings. c. I will let my baby sleep after every 1& ounces of formula. d. I will hold the bottle so that the nipple is always full of formula. Answer: Dprevent the baby to swallow air 6. Which of the following would alert the nurse to call the doctor in a newborn of an Rh-negative mother? a. Negative direct Coombs b. Resting HR of 160 c. Pallor d. RR of 32 Answer: Cpallor is an abnormal finding 7. A 30-year-old, primigravida is in labor and doing well. Her membranes ruptured and she is 3 cm dilated. The fetal heart suddenly drops to 86 BPM and a prolapsed cord is suspected. The most appropriate nursing action would be to:

a. Open up the IV line and give a fluid bolus. b. Place the woman in a knee chest position. c. Give oxygen. d. Call for an emergency C-Section. Answer: Bthis will reduce the pressure on the cord causing good perfusion. 8. A laboring patient has a sudden drop in blood pressure and becomes tachycardic. What is the first action the PN should take? a. Notify MD. b. Open up IV line and bolus with fluids. c. Give oxygen. d. Turn patient to left side. Answer: D the left side promotes perfusion of the fetus. 9. A 16-year-old girl in the adolescent clinic thinks she may be pregnant since her LMP was 8 weeks ago. Which of the following would be considered a probable sign of pregnancy? a. Urinary frequency. b. Morning Sickness. c. A positive pregnancy test. d. Fetal heart tones. Answer: Cthis is a probable sign; urinary frequency is presumptive sign; morning sickness is presumptive; fetal heart tone is positive sign. 10. A 37-year-old Gravida 4, para 3, complains of severe pain and edema of the left leg and thigh the day after a c-section. Which of the following signs would indicate that she might have thrombophlebitis? a. Babinskis sign. b. Trousseaus sign. c. Chvosteks sign. d. Homans sign. Answer: D this is to assess for thromboplebitis; Babinkis is normal in infants and it is a sign of increased ICP in adult; Trousseaus and Chvosteks are signs of hypocalcemia. 11. A client is diagnosed with thrombophlebitis and 5, 000 units of heparin are ordered Q 12h, SQ. The client asks why she is on heparin. The PN explains: a. This will decrease your risk of developing disseminated intravascular coagulation. b. This will prevent additional clot formation. c. This will cause the clot to dissolve. d. This will increase the clotting factors in your blood. Answer: B heparin delays bleeding time and prevent clot formation.

12. A 25-year-old G2P1 decides to breast-feed and asks if it would be a good idea to breast feed right after
the delivery. Which of the following would NOT be a benefit of initiating breast feeding soon after delivery? a. Enhance uterine involution. b. Decreased need for erythromycin eye ointment for the infant, as the immunity from the colostrums will protect the baby from all infections. c. Enhanced maternal-infant bonding. d. Decreased risk of erythroblastosis fetalis. Answer: B this is not related to breast feeding. 13. The patient is breast feeding successfully. During a routine visit, the client tells the PN that she gets strong abdominal pains and milk seeping from her other breast while breast-feeding. The PN explains to the client: a. This is abnormal you should stop breast-feeding. b. You may be breast feeding for too long, reduce the amount of time on each breast to 5 minutes.

During nursing the hormone oxytocin is released and this causes a let down reflex and also causes uterine involution. d. Estrogen release during nursing will cause these harmless symptoms. Answer: C sucking promotes secretion of milk (let-down reflex).

c.

14. A 15-year-old G1P0 is HIV+ has just delivered a pre-term infant. She is asymptomatic and wants to
know how best she can protect her baby from contracting HIV. The PN explains: a. Keep the baby in respiratory isolation for 2 weeks. b. Avoid breast-feeding the baby. c. Wash her hands before and after handling the baby. d. Wear gloves to change the diapers. Answer: B the HIV virus can be transferred via breast milk. 15. A pregnant woman who is HIV+ is receiving retrovir. The PN knows the effects of retrovir are: a. Suppression of bone marrow activity. b. Prevention of viral replication. c. Decrease in production of CD4 cells. d. Increased development of immunodeficiency syndrome. Answer: B this is the action of Retrovir. 16. A 6 lb. 7 oz male neonate is born to a 32 year old G3 P3. The PN assigns an Apgar score of 8 at 1 minute and 9 at 5 minutes. This score indicates: a. The neonate required some resuscitation. b. The neonates muscle tone was flaccid. c. The neonates heart rate was less than 60. d. The neonate had some cyanosis of the hands and feet. Answer: D this is a reflection of acrocyanosis. 17. Upon performing the initial assessment at birth the PN hears a click while abducting the neonates hips. Which of the following is the most appropriate action: a. Notify the MD. b. Double diaper the baby. c. Document findings and continue to monitor. d. Avoid swaddling the baby. Answer: B this is necessary to promote abduction of the hip. 18. A baby girl develops a caput succedaneum. Which of the following nursing actions would you expect to be included in the care of the infant? a. Explanation to the parents about the cause/prognosis. b. Instruct the parents to rub the caput in a clockwise motion to decrease the size. c. Set up for aspiration of the blood from the subdural space. d. Apply warm soaks to the affected area. Answer: A caput succedaneum is self limiting. 19. Encouraging the parents to hold their infant immediately following delivery is appropriate practice because: a. The neonate is usually stable right after birth and therefore it is safe to leave the baby with the parents. b. The neonate is in an alert stat immediately following the birth and bonding can take place. c. The presence of the neonate to the mother will stimulate the release of oxytocin. d. Holding the infant at this time decreases the chance of postpartum depression. Answer: B this promotes bonding. 20. The mother of 6-lb. 2-oz baby girl asks the PN what is the normal weight loss for a newborn. The PN explains:

a. The baby should only lose a few ounces. b. The baby should not lose any weight. c. The baby should lose less than 5% of the birth weight. d. The baby should lose between 5 and 10% of the birth weight. Answer: D -21. A baby is fed 3 hours after delivery. She gags and regurgitates the feeding. The PN recognizes this as a sign of: a. Esophageal atresia. b. Intusseption. c. Spina Bifida. d. Pyloric Stenosis. Answer: A gagging is a symptom of esophageal atresia. 22. A newborn being discharged from the well baby nursery is being given a follow-up appointment to return for immunizations. The baby would be scheduled to return in a. 2 weeks. b. 2 months. c. 4 months. d. 1 year. Answer: Bimmunization starts at age 2 months.

23. A G1P1 mother is caring for her newborn. Which of the following statements made by the mother
would indicate that she understands newborn care? a. Once the cord is dry, my baby can have a tub bath. b. The foreskin for the penis should not be retracted during cleaning. c. When washing the face the outer aspects should be washed first. d. The baby should always be placed on his belly after feeding. Answer: A this is appropriate. 24. To prevent constipation in a pregnant woman who is taking iron supplements the PN would instruct the patient to: a. Eat more raw fruits and vegetables. b. Eat more cooked fruits and vegetables. c. Take Colace (stool softener). d. Eat more bananas. Answer: A Vit C from fruits and vegetables makes iron available for formation of heme. 25. A neonate born to a diabetic mother weighed 9 lbs. 10 oz. One hour after birth the baby begins to tremble. The most likely cause of this symptom is: a. Neurological immaturity. b. Low Potassium. c. Hypoglycemia. d. Cold stress. Answer: C this is a sign of hypoglycemia. 26. During pregnancy a diabetics need for insulin typically: a. Increases during the entire pregnancy. b. Decreases during the entire pregnancy. c. Decreases during the first trimester and increases in the second and third. d. Increases during the first trimester and decreases during the second and third. Answer: C this is the typical pattern of insulin adjustment in pregnancy. 27. As part of a teaching plan for a pregnant diabetic the PN discusses self-monitoring of blood glucose. The goal of monitoring is to:

a. Identify maternal retinopathy. b. Identify potential macrosomia. c. Identify respiratory problems in the neonate. d. Identify the neonatal diabetes. Answer: B high glucose levels may result to big babies (macrosomia). 29. During labor the patient is sometimes catheterized. The rationale for this is: a. To prevent urinary stasis. b. To encourage fetal descent. c. Minimize discomfort. d. Prevent the patient from having to get up and void. Answer: Ba full bladder delays the progress (descent) of labor. 28. One hour after her delivery a woman asks if she can take a shower. She does not want a bed bath and feels that having a bed bath makes her feel like an invalid. The PNs best response would be: a. You cannot get out of bed for at least 24 hours to prevent hemorrhage. b. Showering is not permitted until you have fully recovered from the delivery. c. You can take a shower, but I must stand nearby. d. You must have a bed bath, I will be sure to clean, you well. Answer: C activity is not contraindicated following vaginal delivery. 29. Two days after birth the PN assesses which phase of maternal adaptation a client is in. Which of the following behaviors would indicate the taking hold phase: a. Desire to learn to bathe the infant. b. Talking about her birth experience. c. Asking her husband to buy a certain brand of diapers. d. Asking for assistance with peri-care. Answer: A taking hold phase is when the mother becomes interested in the baby. 30. A type I diabetic client asks the PN why she cant take a pill for her diabetes. Which of the following best describes the action of oral hypoglycemic agents? a. They stimulate beta cells in the pancreas to release endogenous insulin. b. They supply exogenous insulin, which enhances the transfer of glucose into cells. c. They supply exogenous insulin, which restores efficient sugar utilization. d. They stimulate adipose tissue to release endogenous insulin, Answer: A oral hypoglycemic medications stimulate the pancreas to produce more insulin. 32. When teaching insulin self-administration, it is most important that the client learns to: a. Rotate injection sites. b. Wipe the needle with alcohol. c. Hold the hub of the needle. d. Cool the insulin before injecting. Answer: A rotating insulin injection sites promote good absorption of the medication and prevent tissue dystrophy or tissue atrophy. 33. The PN should instruct a woman with diabetes that symptoms of hypoglycemia includes: a. Cool skin, sweating, headache. b. Constipation, increase in weight, hunger. c. Hot, dry skin, rapid pulse, thirst. d. Nausea, fruity breath odor, diarrhea. 34. A 9-day-old infant is diagnosed with phenylketonuria (PKU). Which of the following must be eliminated from the PKU diet? a. Phenylalanine b. Potassium c. Sodium

d. Glucose. Answer: A phenylalanine is a type of protein (amino acid) that must be eliminated in the PKU diet. 35. Which of the following types of insulin is the slowest acting form: a. Regular b. Ultralente c. NPH d. Humulin N Answer: B this is the longest acting type of insulin. 36. What is the primary reason patient with cystic fibrosis have difficulty absorbing nutrients? a. Liver failure b. Pancreatic insufficiency c. Heart overload d. Vitamin deficiency Answer: B in cystic fibrosis, the pancreatic ducts are obstructed by thick, tenacious secretions preventing the pancreatic enzymes to be secreted in the stomach and small intestine affecting digestion and absorption of nutrients. 37. A toddler is brought to the emergency room. She has a history of vomiting and diarrhea for the past 3 days. Which of the following signs and symptoms would most likely be seen? a. Shortness of breath. b. Slow heart rate. c. Sunken eyeballs. d. Tremors. Answer: C sunken eyeball is a sign of dehydration in infants and toddlers. 38. An 80-years-old man is admitted to the hospital to undergo abdominal surgery. His admitting orders include activity as desired, standard bowel prep and an intravenous infusion of 5% Dextrose in water to infuse at 75 cc/hr starting at 6:00 PM on the evening before surgery. The primary purpose of administering intravenous fluids to a patient before surgery is to: a. Have a route for administering medications rapidly. b. Avoid the need for inserting it on the morning of surgery. c. Decrease the patients desire to take fluids by mouth. d. Assure that the patient remains adequately hydrated. Answer: D - adequate hydration will support the BP during induction of anesthetic drugs which usually cause vasodilatation. 39. A child with AIDS is living in a foster home. Which of the following instruction would be important? to give to the foster parents: a. Weight the child daily b. Feed the child on demand c. Wash hands before and after handling the child d. Always wear gloves when handling the child Answer: C Hand washing is the most effective technique in preventing the spread of infection. 40. Children who are abused often: a. Hate their parents b. Protect their parents c. Tell everybody what their parents are doing d. Run away from home Answer: B Abused children often loves their parents and is fearful of separation and will protect the parents when possible. 41. The presence of gonorrhea in a 4-year-old girl is likely due to: a. Immunosuppression b. Physical abuse

c. Accidental transmission d. Sexual Abuse Answer: D Gonorrhea is a sexually transmitted disease. The child must have come in contact with an infected person to contract it. 42. A mother of a 6-month-old wants to begin supplementing breastfeeding. Which of the following would the PN instruct her to use a. Low iron formula b. Formula with iron c. Soy milk d. Cows milk Answer: B By 6 months neonatal iron stores have depleted and must be replaced through diet. 43. A 2-year-old is in the supermarket with his mother and begins to have a tantrum because she wont give him a lollipop. A PN standing behind them on line might suggests the following to the mother. a. Give him the lollipop now and explain to him after that next time he wants something he should ask for it nicely b. Scold the child and refuse his request c. Ignore the childs behavior d. Pick the child up and comfort him but do not give him the lollipop Answer: C Ignoring the behavior decreases the importance of the event. The child is not motivated by the parental response when having a tantrum in early toddlerhood. 44. Carl Churchill, 65 years old, diagnosed with NIDDM, complains of shaky hands. The PN who is sensitive to the needs of the patient would a. Offer the patient orange juice. b. Due to the patients age, safety measure is top priority for the patient. c. Assist the patient when ambulating. d. Do not allow the patient to get out of bed by himself. Answer: A orange juice with sugar is a simple CHO (sugar) which can be easily metabolized by the body. 45. Thomas Ellis, 48 years old, known diabetic complains of dizziness and tremors. Which of the following is an appropriate nursing action? a. Monitor blood glucose. b. Give glucose p.o. c. Check urine for glucose & ketones d. Offer chocolate candy. Answer: B glucose is a simple sugar. 46. A patient with dysphagia may experience difficulty in: a. Writing b. Focusing c. Swallowing d. Understanding Answer: C- dysphagia is difficulty in swallowing. 47. Martha, 62 yrs old had L hemiparesis, with Hx of CVA. She was admitted to the hospital with Pneumonia and she needs to be put up in bed during the day. As a PN, how will you transfer the patient from bed to wheelchair with two persons? a. Place the wheelchair parallel to the bed, facing the foot of the bed, each nurse to place her hand under the patients axilla and lift patient to the wheelchair. b. Place the wheelchair to the foot part of the bed at R angle, 2 nurses to lift the patient simultaneously. c. Place the wheelchair near and parallel to the bed and the nurse to help patient pivot herself in the chair.

d.

Place patient in sitting position, place the w/c close to the bed and locked, instruct patient to stand while you support the affected hand and pivot herself in the wheelchair. Answer: D this offers the best protection to the patient. 48. You are changing the linens of a patient while shes in bed. What is your best nursing action? a. Ask patient to roll to the far side of the bed, grasp the rail, loosen the soiled linens, and place new ones then go to the other side, raise the side rail and do the same procedure. b. Loosen the dirty linens from the head part to the foot part, and put new linen starting from the foot to the head part. c. Ask patient to roll towards you and change the linens on the opposite side and go to the other side doing the same procedure once again. d. Start changing the dirty linens from the foot part and followed by the head part, asking the help of the weak patient. Answer: A this is the most appropriate way of changing bed linens in an occupied bed. 49. The client with DM says, If I could just avoid what you call carbohydrates in my diet, I guess I would be okay. The PN should base the response to this comment on the knowledge that diabetes affects metabolism of which of the following? a. Carbohydrates only b. Fats and carbohydrates only c. Protein and carbohydrates only d. Proteins, fats, and carbohydrates Answer: D DM affects all types of metabolism from lack of insulin. 50. While doing Mrs. Rodriguez admission history, the PN leads to believe that Mrs. Rodriguez can effectively manage possible hypoglycemia by which of the following responses? a. When I feel weak and sweaty I will eat big chocolate candy bar. b. When I feel weak and sweaty I will eat crackers with peanut butter. c. When I feel weak and sweaty I will eat half banana and one piece of toast. d. When I feel weak and sweaty I will drink a can of coke. Answer: D Coca Cola is a simple sugar. 51. Which statement about type 2 DM is correct? a. It develops when the pancreas cant produce insulin. b. Most people with type 2 DM need insulin. c. Its not common as type 1 DM. d. Most people with type 2 DM rely on medications to control blood glucose levels. Answer: D the pancreas produces insulin in type 2 DM and it is usually controlled by medications and diet. 52. Which statement is correct about type I DM? a. The pancreas produces an insufficient amount of insulin. b. The pancreas cant produce any insulin. c. Oral medications can control blood glucose levels. d. The bodys ability to use insulin is impaired. Answer: B in Type DM, the pancreas produces insulin, however, due to increased fat cells, insulin produced is not adequate. 53. When preparing a patient for discharge, the PN should teach the signs of hypothyroidism. The PN would be aware that the patient understands the teaching when the patient says, I should call my physician if I develop a. Dry skin and intolerance to cold. b. Muscle cramping and sluggishness. c. Fatigue and an increased pulse rate. d. Tachycardia and an increase in weight. Answer: A- dry skin and cold intolerance are characteristic adaptations to low serum thyroxine.

54. Joyce is a 37-year-old female who was admitted for thyroidectomy. Post-operatively, the PN in the Recovery Room frequently speaks to Joyce to rule out possible laryngeal nerve damage. Which symptom below indicates that the laryngeal nerve was severed? a. Whisphery voice. b. Tetany c. Painful tingling on finger. d. Painful muscle twitch on the lips. A Hoarseness is a sign of laryngeal damage. 55. Prior to surgery, thyroidectomy, Joyce was constantly on the call bell calling for the PN with her many complaints. Nursing assessment, which confirms the diagnosis will include: a. The patient asks the nurse to turn on the air conditioner in the room. b. The patient feels cold and thus asks for extra blanket. c. The nurse provided skin cream for the patients extremely dry skin. d. The patient complains of abdominal cramps and feeling gassy. Answer: A intolerance to heat a manifestation of hyperthyroidism. 56. The client who came in with hypothyroidism is taking Levothyroxin. The PN would include which of the following important discharge teaching: a. Teach the client how to monitor his heart rate prior to the drug therapy. b. Teach the client how to monitor his respiratory rate prior to administration of the drug. c. Inform the client to call the physician if he experiences anorexia. d. Teach the client how to monitor his BP prior to administering the drug. Answer: A thyroid drugs increases HR. 57. In caring for Mona, the PN should include which of the following in the patients foot care program? a. Soak her feet in warm water with a little bit of salt. b. Cut her toenail straight across. c. Remove calluses as necessary. d. Apply liberal amount of medicated lotion between the patients toes. B the sides of the toenails should not be picked to prevent infection. 58. Caitlin, 28 years old, was admitted with hyperthyroidism. The PN should watch the client for manifestations of thyroid storm which include: a. HR 200 bpm, subnormal temperature. b. RR 30, HR 180 bpm. c. Tremors, HR 48. d. Restlessness, abnormal response to cold. B tachycardia is a sign of hyperthyroidism. 59. Susan Merk, 46 years old, was diagnosed with NIDDM 10 years ago. Due to poor control of her blood glucose, she was switched to a low dose of insulin. She complains to the visiting PN that sometimes she feels faint, weak and sweaty when she jogs with her friends. What should the PN recommend? a. Advise the client to take an alternate exercise. b. Advise the client to monitor her blood sugar before exercising, and avoid exercising if the blood sugar is below normal. c. Advise the client to eat carbohydrate before exercising.

d. Advise the client to bring chocolate bar candies with her and eat it if she feels weak and sweaty. C Exercise enhances the metabolism of carbohydrates. To prevent hypoglycemia when doing physical activity on a diabetic client, carbohydrates must taken. 60. The physician prescribes a 1500-calorie diabetic diet and 30 units of NPH daily for Ms. Cruz. She is to have a mid-afternoon snack of milk and crackers. The client asks the PN why she has had this snack. Which of the following responses by the PN would be best? a. It improves your nutrition. b. It improves your carbohydrate metabolism. c. It prevents insulin reaction. d. It prevents diabetic coma. C insulin enhances carbohydrates metabolism. 61. Dina, 68 yrs old, has a history of eye operation from glaucoma on her R eye. She has an eye drop that shes taking regularly. As a PN, how will you administer eye drops to the patient? a. Administer it in the inner canthus of the eye. b. Administer at the cornea. c. Administer at the outer canthus of the eye. d. Administer in the lower conjunctiva. Answer: D this is the proper way of administering topical eye medication. 62. A rectal suppository has been ordered for Mrs. Abbotts constipation. Which one of the following techniques is important when administering the rectal suppository? a. Place the suppository past the internal sphincter and against the rectal wall. b. Insert the suppository directly into soft-formed stool. c. Place the suppository between the external and internal sphincter. d. Position the client in R lateral or R Sims position. Answer: A 63. During Joans postoperative period, the PN should include in the care plan a diet high in: a. Vitamin C and protein. b. Vitamin D and carbohydrates. c. Iron and magnesium. d. Calcium and phosphorus. Answer: A Vitamin C and protein promote tissue healing. 64. The PN receives an order to give a client iron by deep injection. The PN know that the reason for this route is to a. enhance absorption of the medication b. ensure that the entire dose of medication is given c. provide more even distribution of the drug d. prevent the drug from causing tissue irritation Answer: D - Deep injection or Z-track is a special method of giving medications via the intramuscular route. Use of this technique prevents irritating or staining medications from being tracked through tissue. Use of Z-track does not affect dose, absorption, or distribution of the drug. 65. When performing an adult CPR, the PN is aware that it is essential to provide which of the following breath/compression ratio: a. 2:30 b. 1:5

c. 2:5 d. Check carotid pulse every 4 cycles of CPR Answer: A this is the guideline from the Heart and Stroke Foundation. 66. The patient wants to write a will. His hands are shaking and the patient is having difficulty writing. He asks you to help him write a will. How would you respond? a. Help the patient write the will. b. Tell the patient that he should write the will with his lawyer. c. Ask the patient when his son is coming to help write the will. d. Give a pen to the patient. Answer: B it is not legal to write a will for the patient. 67. How do you give a subcutaneous injection? a. Administer the injection at a 45 angle. b. Clean the site with alcohol. c. Give slowly and steadily. d. All of the above. Answer: D 68. A patient who has a heart disease wants to eat fried foods. How would you respond? a. You cant eat fried foods because you have heart disease. b. Lets review your dietary nutrition plan. c. Its okay as long as you eat less frequently. d. it will be okay as long as you avoid fast food. Answer: B assessment of the patients knowledge about her/his diet is the first step. 69. Which technique is most accurate when changing the colostomy appliance? a. Place the faceplate over the opening of the stoma so it occludes it. b. Cut the appliance 1/8 larger than the stoma. c. Adhere the appliance after the skin has air-dried for 30 minutes. d. Secure the appliance snugly at the waist or beltline. Answer: B the appliance should be bigger than the ostomy to prevent irritation. 70. When cleaning the skin around the clients stoma of his colostomy, the most appropriate nursing technique is to: a. Cleanse the area with betadine. b. Swab it with 70% alcohol. c. Use water and mild soap. d. Scrub it with peroxide. Answer: C soap has a bacteriostatic effect. 71. When implementing the plan of care of a client with colostomy, the best time of day to perform stomal care and to change the appliance is after the client a. Awakens in the morning. b. Has showered after breakfast. c. Has been ambulating in the hall. d. Finishes the evening meal. Answer: D peristalsis is least active at this time. 72. What is the most common method of administering the injectable Vit. D? a. Intravenous b. Intramuscular c. Subcutaneous d. Intradermal Answer: B IM injection promotes better absorption of the medication. 73. What is typically the best intravenous site for children?

a. Antecubital fossa b. Dorsum of the foot c. Scalp vein d. Femoral vein Answer: A 74. What method do you use in administering an injectable iron medication? a. Z tract method at 90 angle. b. Subcutaneously at 45 to 90. c. Intradermally, parallel to the antecubital fossa. d. Intramuscularly at a 45 angle. Answer: A 75. When giving IM Z track injections, you: a. Bunch up skin and give at a 90 angle. b. Spread skin and give at a 45 angle. c. Pull the skin laterally and give at 90 angle. d. Spread skin superiorly and give at 90 angle. Answer: C 76. How do you irrigate the eye? a. Instruct patient to keep eyes closed. b. Irrigate the eye for 5 minutes. c. Irrigate the eye with a hypertonic solution. d. Irrigate the eye from the inner canthus of the eye. Answer: D 77. How do you give medication when someone is on a nasal tube feeding? a. Deliver the medication quickly to prevent air embolism. b. Irrigate the tube by adding 100 mls of water. c. Keep the patient on a supine position after administering medications. d. Place patient on a Fowlers position while administering medications. Answer: D 78. What would the apgar score of the following: HR over 100; strong cry for respiratory effort; active motion for muscle tone; cries for reflex irritability is tested and completely pink in color? a. 10 b. 3 c. 5 d. 7 Answer: A 79. How do you treat a mothers breast engorgement who is also breastfeeding her infant? a. Apply ice pack before feeding. b. Give medications such as aspirin or acetaminophen. c. Use breast pump to bottlefeed the baby. d. Apply warm compress before feeding. Answer: D 80. Sandys pregnancy progressed to term and she had vaginal delivery of a healthy baby boy and is now transferred to the postpartum unit. In addition to vital signs, which of the following are the most important for the practical nurse to assess in the patient immediately? a. Fundus, lochia, perineum b. Breast, hemorrhoids, voiding c. Breast, fundus, voiding d. Perineum, hemorrhoids Answer: A 81. Sandy, the postpartum patient, had decided to breast feed her baby. Which of the following actions by the practical nurse to assess in the patient immediately? a. Encourage Sandys breastfeeding efforts by providing assistance. b. Assure Sandy that she has made the right decision. c. Inform the patient that the public health nurse will provide guidance at home. d. Provide patient with written information on breastfeeding.

Answer: A 82. The patient was prescribed Digoxin (Lanoxin). Which among the following dose would the practical nurse find as most likely correct and appropriate? a. 0.3 mg tablet OD. b. 0.3 mg subcutaneously OD. c. 0.5 mg subcutaneously OD. d. 0.5 mg tablet OD Answer: D 83. What would the RPN do before the patients family view of a dead patient in the hospital? a. Lower the head of the bed and sponge bath the patient. b. Inform the nurse-in charge. c. Label the bag for which the patient is going to be placed. d. Put the arms and hands crossed on the chest of the patient. Answer: A 84. A patient in the nursing home tells the RPN that he is having some problems swallowing medication. What would the RPN plan to do in administering the medications? a. The RPN may crush the medications as appropriate. b. The RPN will call the attending physician to substitute medications to alternative routes. c. The RPN gives water before giving the medication. d. The RPN gives the medications one at a time. Answer: B 85. What is the most appropriate position for a patient with colostomy during changing of the colostomy bag? a. side lying b. upright c. supine position d. standing in the bathroom Answer: B 86. Which among the following is the most appropriate home health teaching for a patient who is going to be discharged with colostomy? a. Refer the patient to some training sessions on colostomy care. b. Refer the patient to a support group for people with colostomy. c. Teach patient to avoid foods that produce gas or flatus. d. Teach the patient to change the colostomy bag when it is half-full. Answer: A 87. A neonate has a rash on his buttocks and the mother asked the RPN what she has to do? What would be the most appropriate response for the RPN to take? a. Give the babys bottom more time in the open air without diaper on. b. Wash the rash with soap and water, apply lotion. c. Wash the rash with an antiseptic. d. Wash the rash with water. Answer: A 88. Mr. Murray Samuel, a 54 year old married man, has been using nitroglycerin tablets for several months for relief of angina pectoris. Which of the following observations made by the PN would relate to Mr. Samuels diagnosis of angina pectoris? a. He experiences shortness of breath when climbing stairs. b. He is very lethargic after eating an unusually heavy meal. c. His fingers are numb and tingle when he is relaxed and resting. d. He complains of sudden pain in the substernal region after disagreement with his wife. Answer: D 89. The PN should understand that the desired effect from Mr. Samuels NTG is to: a. Constrict his peripheral blood vessels. b. Improve his coronary blood flow. c. Produce slower and stronger heartbeats. d. Increase the rate and depth of respirations. Answer: B

90. While Mr. Samuel is receiving the oral anticoagulant, the PN should observe him for the evidence of: a. Hives. b. Difficulty of breathing. c. Hematuria d. Rashes Answer: C 91. Mr. Samuel dies. Which of the following nursing actions are necessary in caring for the body after death? a. Padding body prominences. b. Keeping the body in side-lying position. c. Positioning the body to prevent drainage from the orifices. d. Handling the body to prevent it from disfigurement. Answer: D 92. Mr. Beer has been depressed since the physician told him that this condition is terminal. Which of the following approaches should the PN include in the care plan? a. Ignore Mr. Beers depression. b. Accept Mr. Beers depression. c. Counterbalance Mr. Beers depression. d. Challenge Mr. Beers depression. Answer: B 93. Joan is experiencing phantom-limb sensation. Which of the following nursing measures should be instituted first? a. Exercise the stump. b. Elevate the stump. c. Administer the prescribed analgesic. d. Encourage the patient to talk about her feelings. Answer: C 94. Ms. Miller receives Demerol and atropine sulfate postoperatively. Which of the following should the PN recognize as the expected outcome of these medications? a. The effectiveness of the anesthesia was increased. b. There was no postoperative dehydration. c. The tone of smooth muscle was improved, thus preventing hemorrhage. d. The respiratory secretions were reduced during surgery. Answer: A 95. Mr. Holler is a 45-yr-old who is scheduled to have a bronchoscopy. Cancer of the lungs is suspected. Following the bronchoscopy, which of the following instructions is essential for the PN to give the patient? a. Call me before you take a drink or anything. b. Take deep breaths and cough every hour. c. Tell me when you wish to get out of bed. d. Avoid talking for three hours. Answer: A 96. Mr. Pennington has Parkinsons disease. He is admitted to a long-term care facility. His admission orders include diet as tolerated. In planning the patients daily care, the PN should give the greatest consideration to: a. Completing his care in as short time as possible. b. Organizing his care so that he will not feel unhurried. c. Encouraging him to assume full responsibility of his care. d. Providing long rest periods for him after each of his care activities. Answer: B 97. Mr. Pennington receives levodopa. To evaluate the effectiveness of the drug, the PN would observe for: a. Decreased severity of symptoms. b. Remission from the disease. c. Increased resistance to infection. d. Improvement in nutritional status.

Answer: A 98. A 76- year- old male patient has been in a long-term care facility for about two years now. He is confused at times and has generalized arteriosclerosis. The PN would expect the patient to be most confused and disoriented during which of the following times? a. Upon arising in the morning. b. When ambulating during the day. c. When sitting alone in the afternoon. d. Upon awakening during the night. Answer: D 99. An elderly patient, 80 year old, is on a diet as tolerated. In collecting data about his nutritional needs, the PN should be most concerned about his: a. Age b. Ability to chew c. Activity level d. Food preferences Answer: B 100. In planning the nutritional requirements of the 85 year old patient residing in the long term care facility, the PN should consider that the patient has a decreased need for: a. Vit. B complex b. Calcium c. Protein d. Calories Answer: D 101. In evaluating the sleep patterns of an elderly client, the PN should understand that the elderly: a. Has little change in the sleep pattern. b. Sleep soundly throughout the night. c. Wake frequently during the night. d. Require less sleep at night. Answer: D 102. The purpose of NGT postoperatively would be which of the following? a. Maintain the ability to swallow. b. To stimulate gag reflex. c. To prevent dehydration. d. To stimulate peristalsis. Answer: D 103. In preparation for the lumbar puncture, the PN should place the patient in which of the following positions? a. Side-lying positions. b. Fetal position c. Supine/flat position d. Prone position Answer: B 104. Which of the following observations by the PN would indicate increased ICP? a. Oliguria b. Pallor c. Lethargy d. Hypotension 105. Which of the following nursing actions will promote safety on a patient who is having seizures? a. Place the patient on a side-lying position. b. Restrain the patient. c. Place patient in his abdomen with head to one side. d. Document findings. 106. The patient is using a walker to ambulate. In assisting the patient with a walker, it would be best for the PN to:

a. b. c. d.

Walk directly behind him. Walk in front of patient, guiding the walker. Walk closely behind and slightly to the side of him. Walk beside him.

107. Following cataract extraction, the PN is aware that the patient would require further teaching if the patient states: a. I can sleep on my back and side. b. I can sleep on my side to my affected side. c. Coughing and deep breathing exercises are good for me. d. Feeling nauseous is expected after surgery. 104-108, C< A <C>B 108. If a patient receiving MgSO4 for preeclampsia begins to seizure the most appropriate nursing action would be to: a. Begin chest compressions. b. Assess fetal heart tones. c. Decrease the MgSO4. d. Establish and maintain a patent airway. Answer: D airway must be protected during seizures. 109. Two days after birth the PN assesses which phase of maternal adaptation a client is in. Which of the following behaviors would indicate the taking hold phase: a. Desire to learn to bathe the infant. b. Talking about her birth experience. c. Asking her husband to buy a certain brand of diapers. d. Asking for assistance with peri-care. Answer: A taking hold phase is when the mother becomes interested in the baby. 110. The PN knows that Marie is developing her sense of autonomy. The PN will choose which of the following approaches to foster the childs sense of autonomy? a. Allow the child to sit in the same spot each meal time. b. Inform the child that she is not allowed to make any mess at mealtimes. c. Offer very little help to the child at mealtimes. d. Allow the child to play with the same toy for a certain period of time. 111. Following birth, which one is a normal characteristic of a newborn? a. Acrocyanosis b. Regular, diaphragmatic respirations. c. High-pitch cry. d. Good sucking reflex. 112. Few hours following birth, Vitamin K is administered IM in order to: a. Facilitate formation of clotting factors. b. Prevent pernicious anemia in newborn. c. Promote the growth of bacteria in the GI tract. d. Improve the hemoglobin level of the newborn. 113. Baby Randy, 8 months old, was admitted with severe dehydration. His skin turgor is poor, anterior fontanel is sunken, and he is underweight. Failure to Thrive was the admitting diagnosis. Which of the following best reflect the definition of Failure to Thrive in an infant? a. The weight and the height of the infant is 50% below the average infant b. The infant has a good sucking reflex. c. The infant has poor appetite. d. The infant has an underdeveloped moro reflex. 114. Carlo was brought to the well baby clinic for routine check up. The PN knows that the most

appropriate toy for the child is: a. Rubber ball. b. Bright colored pictures. c. Push-pull toy. d. Plastic hammer. 115. Frequent, watery, mucoid stools are usually associated with which of the following? a. Diarrhea. b. Cystic Fibrosis. c. Mucoviscidosis. d. Pyloric stenosis. 116. Which of the following factors affects premature infants poor intake of milk? a. He does not need a lot of calories due to his small body surface. b. He gets tired very easily. c. He sucks too much air. d. He has not learned the skill. 117. When teaching the mom about accident prevention for a 6-month-old, the PN should emphasized that this age the child can usually: a. Sit up without assistance. b. Roll over. c. Stand while holding the side of the crib. d. Crawl lengthy distances. 118. A toddler who is saying no to everything you say can be best dealt with by which of the following? a. Provide a peg board so the child can verbalize his negativism. b. Distract the childs attention by providing him toys that he likes. c. Create an environment similar to his home environment. d. This is a normal aspect of growth and development wherein the child is trying to develop autonomy. 119.Children with suspected inborn errors of metabolism are routinely screened for Phenyketonuria (PKU) because this disease is highly associated with: a. Mental retardation. b. Low phenylaline levels. c. High pancreatic enzyme levels. d. Low serum protein level. 120. Which of the following foods will best meet the need of the child with diagnosis of PKU? a. Low salt diet. b. Low protein diet. c. High potassium. d. High calcium. 121. Important nursing intervention following circumcision: a. Apply vazelinized gauze dressing very loosely to the site to prevent bleeding. b. Put an oversized diaper to prevent any constant pressure to the site. c. Monitor the infants vital signs every 2 hours. d. Keep the child NPO. 122. Which of the following are characteristics of a normal stool of newborn? a. A minimum of 2-well-formed, brown stools/day. b. Frequent, 6 to 8, loose stools/day. c. Loose, greenish stools. d. Well-formed, yellow stools, 2 to 3 times/day.

123. A normal newborn will have a heart rate of up to: a. 200 beats per minute. b. 175 beats per minute. c. 160 beats per minute. d. 100 beats per minute. 124. Which of the following tools if utilized will best evaluate the language development of a child? a. IQ test. b. Denver development screening test. c. Snellens screening test. d. Monitor the childs ability to speak. 125. An infant is admitted to the pediatric unit with a diagnosis of chickenpox, a highly contagious disease. It is appropriate for the PN to take which of the following precautions? a. Place the child in a semiprivate room. b. Wear gloves when changing the diaper. c. Wear a mask when entering the room. d. Wear gown, mask, and gloves when providing care for the patient. Answers 110-125===C,A,A,A,B,A,B,B,D,A,B,A,B,C,B,D 126. Feeding a child with a cardiac defect is very challenging for the PN because the child can only take small amounts without becoming tired. How could the PN facilitate nutrition for this child? a. Add cereal to the bottle b. Water down the milk to make it easier to swallow c. Use a soft nipple with a larger hole d. Give the child a higher calorie formula Answer: C A soft nipple will allow the child to suck without having to use additional energy and will improve the nutritional intake. 127. The mother of a 14 year old boy states that he is always eating although his weight is appropriate for his height. The PN explains to the mother: a. This is normal behavior because of an increase in body mass b. This is the beginning signs of an eating disorder c. This may be the early signs of a serious medical problem d. This may be an indication of him substituting food for love Answer: A During the adolescent growth spurt the childs appetite will increase significantly. 128. An example of a child displaying the task of autonomy would be? a. Negativism of toddlers b. Stranger anxiety c. Competitive sports d. Peer dressing alike Answer: A Negative behavior allows the child the opportunity to practice gaining control over his environment. 129. A first year nursing student is caring for a child with Non Organic Failure to thrive. He asks the PN what is the cause of this problem. The PN responds with: a. It is a malabsorption syndrome b. It is most commonly caused by a parents lack of knowledge of infant nutrition c. It is most commonly caused by a disruption in the parent-infant attachment d. It is caused by an underlying chronic medical problem Answer: C Failure To Thrive has been associated with altered parent child attachment 130. Tetralogy of Fallot is a defect that results in decreased pulmonary blood flow because: a. Deoxygenated blood is shunted from the right ventricle to the left ventricle through a ventricular septal defect.

b. Deoxygenated blood is shunted from the right atrium to the left atrium and increased pressure from aortic stenosis c. Deoxygenated blood is forced into the left atrium through a patent ductus arteriosis. d. Deoxygenated blood continuously circulates from the right ventricle to the lungs and back to the right ventricle. Answer: A This is a description of the shunting involved in TOF that causes the altered hemodynamics. 131. A child with Tetralogy of Fallot who has not had a surgical repair may assume a posturing position as a compensatory mechanism. The position automatically assumed by the child would be: a. Prone b. Supine c. Squatting d. Kneeling Answer : C Squatting allows for improved venous return of blood from the lower extremities. 132. A 7 year old has been admitter with R/O Acute Glomerulonephritis. During the history the PN is concerned when the mother states that: a. She had chicken pox 2 weeks ago b. She has a history of urinary tract infections c. She had a sore throat 3 weeks ago d. She is allergic to eggs Answer: C AGN is caused by Beta hemolytic strep infection that also causes sore throats. Identifying possible exposure to the organism helps confirm the diagnosis. 133. In assessing an infant for congenital hip dysplacia the PN would observe for: a. Uneven gluteal folds b. Positive Babinski reflex c. Pain when moving the lower extremities d. Weakness on the affected side Answer : A Uneven gluteal folds are an indication that one hip is dislocated. Mrs Czempoyesh, 80 year old is admitted to day surgery for the extraction of a cataract in her left eye. 134. The practical nurse who just started a shift has been assigned to Mrs. C. What the P/N do to most accurately identify this client? a. Refer to the name on the bed. b. Ask a co-worker to identify the pt. c. Check the client on her armband. d. Say Mrs. C name and waited a response. Answer C 135. Which of the following communication technique should the PN use to facilitate Mrs. C understanding of her postoperative care? a. Speak loudly so that Mrs. C can hear and ask if she understands. b. Stand by her left side, speak in a clear and consistent manner and ask her if she has a question. c. Provide her with instruction video on cataract surgery. d. Stand in front of her speak in a clear and concise manner and ask her if she has any questions. Answer D 136. Mrs. C has just returned from the recovery room, she is disoriented and restless. What the PN should do to best promote patient safety. a. Keep Mrs. C bed in the lowest position with the side rails up. b. Turn on the light above C bed to facilitate her vision. c. Keep all C toiletries on her bedside table d. Ensure that C walker remains close to her bed. Answer A 137. Mrs. C is seen at the eye clinic the next day. The PN removes the dressing as ordered and observes increased redness and swelling around the left eye. What should the PN do next?

a. Report the findings immediately. b. Cleanse C eye and repatch. c. Chart the findings in the nurses notes. d. Instruct C to apply ice to her eye when she gets home. Answer A 138. Mrs. C falls when walking down the hall at the eye clinic after assessing her and helping her off the floor. Which of the following actions should the PN take with regarding documentation and safety? a. Help her to a chair, report the fall, and complete the incident report. b. Once she is in a chair, fill out an incident report, and document the fall in the nurse notes. c. Ask another staff member to assist her to a chair, and fill out an incident report. d. Assist her to a chair and immediately document the fall in the nurses notes. Answer A 139. Which of the following assessment indicated the presence of post operative complication of a tonsillectomy. a. Sore throat. b. Mild earache. c. Frequent swallowing. d. Dysphagia. Answer C 140. Following the surgery, Bill returns to the unit conscious and alert. What should the RPN do first? a. Assess Bills throat. b. Offer Bill some crushed ice. c. Check V/S d. Ask the med Nurse for an analgesic for Bill. Answer C 141. What must the RPN do first? a. Immediately report the obvious signs of hemorrhage to the unit nurse. b. Check to see if there is any of bleeding under the right hip. c. Apply a pressure bandage to the operative site. d. Assess the blood flow by noting the color of the nail bed on the right foot. Answer A 142. Harry P, 72 years old, has been successfully bearing to walker following a hip repair. On his way to the dining room he becomes weak and says he can not breathe. What should the RPN do? a. Assist him to a recovery position. b. Give him oxygen by nasal cannula. c. Bring him a glass of warm water. d. Assist him to a sitting position. Answer D 143. The PN observes that a PSW seldom washes her hands before providing care. How should the PN deal with this situation? a. Bring the lack of hand washing to the HCA attention. b. Question why the HCA is using an incorrect technique. c. Role model correct behavior in front of the HCA. d. Report the incident to the appropriate authority. Answer A 144. Which one of the following measures by the PN would be most appropriate when performing oral suctioning on a conscious patient? a. Position the patient in the lateral position prior to inserting the catheter b. Lubricate the catheter with a water soluble lubricant prior to inserting the catheter c. Apply suction while inserting the catheter along the side of the patient mouth. d. Gently rotate the catheter as it is being drawn from the patients mouth. Answer B 145. How should the PN best verify the identity of an aphasic female patient? a. Ask her to write her name. b. Confirm her identity with a staff member. c. Verify her identity with her personal effects.

d. Check her identification band. Answer D 146. The PN discovers a fire in the janitors closet. What should the PN do? a. Call the fire dept. b. Use the fire extinguisher. c. Close all windows and doors. d. Pull the fire alarm. Answer D 147. Mr. Mae, 75 yr old has left hemiparesis. How should the PN remove Mr. M hospital shirt? a. From the right arm first. b. Both arms at once. c. From the left arm first. d. In the manner that Mr. M prefers. Answer A 148. Mrs. D has a colostomy for 2 weeks. She takes care of her colostomy but expressing concerns about slight swelling of her stoma. After examining the moist red stoma, what action should the PN take? a. Recommend the use of cold saline compress. b. Reassure her and encourage her to continue with the same care. c. Recommend the use of cold pack to reduce swelling. d. Reassure her and suggest the use of hydrogen peroxide for cleaning. Answer B 149. Which one of the following actions by the PN demonstrated knowledge of universal precautions related to G tube drainage? a. Check for sterility of the G tube drainage bag. b. Test for patency of the G tube. c. Wear gloves while emptying the G tube drainage bag. d. Washes glove after emptying the G tube drainage bag. Answer C 150. Michelle, 9 months, has respiratory rate of 34 breaths per minute. What should the PN do? a. Reassess the RR. b. Record the rate on V/S graphic sheet. c. Report the rate immediately. d. Document rate in the nurses notes. Answer B 151. Jane, 16 yrs old, has a history of tonic-clonic (grandmal) seizure in the hospital following uncomplicated appendectomy. The PN checks Jane and found out the patient is having a seizure. After calling for help, what should the PN do? a. Remain with her until the seizure is over and record the details of the seizure. b. Observe the seizure, take her v/s q 2 hours and document c. Assist her to a low fowlers position and document details of the seizure. d. Observe the seizures assist her to a lateral position and document details. 152. Mrs. Bennett has an IV in her right wrist. The infusion pump alarm sounds every time she bends her wrist. What is the initial action by the PN? a. Tell her to keep her right arm still. b. Apply an arm board to act as a splint. c. Silence the alarm mechanism. d. Notify the nurse in charge. Answer B 153. Mrs. Ann is 3 days postpartum. During the assessment which of the following findings should PN report as abnormal? a. Lochia rubra. b. Fundus at umbilicus. c. Episiotomy tenderness. d. Colostrum secretion. Answer B

154. Which of the following actions, by the PN, demonstrates an understanding of the principles of routine cleansing of the ear: a. Cleansing the pinna and external canal with a cotton tip swab. b. Gently irrigating the external canal with syringe of warm NS. c. Cleansing the pinna with a washcloth covered finger. d. Gently irrigating the pinna with syringe of warm tap water. Answer C 155. Which one of the following statements is a character of a normal apical radial pulse assessment? a. The apical rate is lower than the radial rate. b. The apical rate equals the radial rate. c. The apical rate is higher than the radial rate. d. The apical rate is weaker than the radial rate. Answer B 156. In which one of the following circumstances must the RPN verify a physicians order for dressing change? a. When the patient says the other nurse never used that solution before for treatment. b. When the RPN is unfamiliar with the procedure. c. When the RPN dislikes the chosen procedure. d. When the patient says, I do not want my dressing changed right now. Answer A Mrs. Lilian Goldstone, 78 yrs old, has been admitted with a diagnosis of varicose veins. Her lower extremities are edematous. 157. What should the PN do to assist Mrs. Goldstone with her personal hygiene? a. Wash the lower extremities from distal to proximal areas. b. Rub the feet dry to promote circulation. c. Do pericare washing from front to backthis prevents possible infection (anus is part of the GI and it is considered non-sterile) d. Apply powder to keep the skin dry. Answer C 158. Mrs. Goldstone asks why her feet are swollen. Which one of the following responses by the PN would be most appropriate? a. Why do you think your feet are swollen? b. Hanging your feet over the side of the bed may have made them swell. c. The circulation from your feet is slowed down, causing the swelling. d. You have a condition called varicose veins. Answer C 159. Which one of the following physicians orders for Mrs. Goldstone should the PN clarify prior to implementing the care? a. Maintain accurate intake and output. b. Initiate an exercise program today. c. Maintain a complete bedrest. d. Remove entiembolic stockings h.s. Answer C 160. Mrs. Goldstone has progressed to activity as tolerated. On her 3rd hospital day, she reports pain in her right calf. On examination, the area feels warm to touch. What should the PN do first? a. Massage Mrs. Goldstones leg gently to relieve the pain. b. Report Mrs. Goldstoness manifestations to the physician immediately. c. Return Mrs. Goldstone to bed and report the observations. d. Assess and report Mrs. Goldstones BP and pulse. Answer C 161. Lynn Borutski, 66 yrs old, has suffered a concussion. What assessment activity is a priority for the PN? a. Monitor level of consciousness. b. Assess respiratory status. c. Collect baseline vital signs.

d. Determine papillary response. Answer A 162. Robert Reed, 86 years old, was found in the floor in the bathroom by the PN. Which of the following entries by the PN would be most appropriate? a. States no pain, no injuries noted; assisted to bed, v/s stable. b. Found on floor, no injuries noted; returned to bed, incident reported. c. After questioning, client stated he has no injuries; v/s checked. d. Found on floor in bathroom, no visible injuries noted; incident reported. Answer D 163. The PN is helping a client who is lying on her side to sit on the edge of the bed. Which of the following hand placements should the PN use? a. Behind the clients neck and under the clients knees. b. Under the clients shoulders and behind the clients knees. c. Under the clients lower arm and behind the clients knees. d. Around the clients waist and under the clients knees. Answer A 164. The PN is caring for Mrs. Kane, 86 yrs old. Which one of the following statements by the PN would best promote Mrs. Kanes self-esteem? a. I would like to see you get out of your room more, Mrs. Kane; well see what we can arrange. b. Mrs. Kane, would you prefer to wear your blue dress or your green dress today? c. You need your hair shampooed. Ill do it for you tomorrow. d. Would you like to call your daughter tonight so that you wont be as lonely? Answer B 165. Which one of the following statements should the PN make when obtaining consent from Mrs. Robinson to check her BP? a. Mrs. Robinson, may I check your BP now? b. Mrs. Robinson, its time for me to check your BP. c. Mrs. Robinson, the doctor has ordered your BP to be checked. d. Mrs. Robinson, if you let me take your BP, I will take you for a walk. Answer A 166. While the client is in his bathroom, the PN accidentally knocks over and breaks the clients antique clock. Which one of the following actions should the PN take next? a. Place the clock back on the clients bedside table. b. Send the clock out for a repair. c. Report the incident to the nurse-in-charge. d. Tell the client how the clock was broken. Answer D 167. While giving Bill Madden a morning bath, the PN notices large bruises on his arms and legs. When should this information be documented by the PN? a. At the end of the shift. b. Before the bath is completed. c. During conference time. d. After completing the morning care. Answer D 168. Which of the following symptoms are characteristics of impending diabetic coma? a. Hyperreflexia, babinski reflex, numbness b. Hot, dry, flushed skin, excessive thirst, rapid pulsedue to dehydration c. Hot flashes, severe hunger, restlessness, bradycardia. d. Profuse diaphoresis, headache, bradycardia. Answer B 169. The maximum safe height at which container of fluid can be held when administering an enema is: a. 30 cm (12 inches) b. 37 cm (15 inches) c. 45 cm (18 inches) d. 66 cm (26 inches) Answer C

170. During administration of an enema a client complains of intestinal cramps. The PN should: a. Give it at a slower rate b. Discontinue the procedure c. Stops until cramps are gone d. Lower the height of the container Answer C 171. An 18-year-old is admitted with an acute onset of right lower quadrant pain. Appendicitis is suspected. To determine the etiology of the pain, the client should be assessed for: a. Urinary retention b. Gastric hyperacidity c. Rebound tenderness d. Increased lower bowel motility Answer C 172. The PN is aware that the characteristics behavior in the initial stage of coping with the dying includes: a. Crying uncontrollably b. Informing relatives about the sad news c. Refusing to receive visitors d. Asking for an additional medical consultation Answer D 173. A client with cancer of the lungs says to the PN, If I could just free of pain for a few days, I might be able to eat more and regain strength. In reference to the stages of dying, the client`s statement indicates: a. Frustration b. Bargaining c. Depression d. Rationalization Answer B 174. Upon admission of a 3-year-old child with Sickle Cell Anemia, vaso-occlusive crisis, the priority nursing care would be: a. Provide a nutritious diet b. Facilitate fecal elimination c. Remove environmental hazards d. Encourage fluid intake Answer D 175. A 5-year-old child is going for surgery. What development concept will she have regarding surgery? a. Fear of death b. Fear of bodily harm c. Separation from loved ones d. Disapproval of peers Answer B 175. Mr. Artex was admitted with liver cirrhosis. He is complaining of difficulty of breathing and he is also dyspneic. The informed PN would know that the best position for the client who is dyspneic would be one of the following? a. Supine b. High Fowlers c. Low Fowlers d. Position of comfort. Answer B 176. Matthew is a 2 year-old boy who came in to the doctors clinic for his immunization shot. The PN in the clinic is aware that one of the following can be performed by a toddler: a. Play with push pull toy. b. Can dress up and tie his shoelaces. c. Is an average reader. d. Can ride a bicycle. Answer A

177. Three days following Ms. Ls C-section delivery, she was complaining of breast tenderness, pain, and engorgement. The well-informed PN will take one of the following actions: a. Apply warm and cold compresses alternately since Ms. L is not planning to breast-feed. b. Apply warm compresses every 30 minutes to both breasts, around the clock for 24 hours, since Ms. L is not planning to breast-feed. c. Apply cold compresses every 30 minutes to both breasts, around the clock for 24 hours, since Ms. L is not planning to breast-feed. d. Instruct her to take Tylenol #3 for pain as ordered and apply warm compresses to both breasts since she is not planning to breast-feed. Answer C 179. After surgical repair of a hip, which of the following positions is best for the patients legs and hips? a. Abduction b. Adduction c. Prone d. Subluxated Answer A 180. Following modified radical mastectomy, the nurse should position the client`s arm on her affected side to a. Increase circulation b. Relieve pressure on her wound c. Prevent edema d. Decrease pain Answer: C elevating the affected hand will prevent lympedema post mastectomy. 181. A post-cholecystectomy patient was transferred to the floor from the surgical intensive care unit. She was complaining of pain from the incision site where the T- tube is still in place. She has taken the pain medication just three hours ago and the pain medication is scheduled every four hourly when needed. What is your best nursing action? a. Give the pain medication. b. Call the doctor. c. Explain to the patient it is not still due for pain medication. d. Divert the patients attention by giving a magazine. Answer B 181. During a home visit, the mother asks the PN how often she should burp her infant during bottlefeeding. Recognizing that the baby has a strong sucking reflex and no physical problems, the PN could best responded: a. Burp the baby 5 to 6 times during each feeding for the first month. b. You should burp your baby at the end of the feeding only. Babies can become confused at having their feeding stopped. c. Burp your baby periodically; usually in the middle and at the end of a feeding. If the baby has been crying, you can burp before starting. d. With new infants we recommend burping every 5 to 10 minutes. That gets your baby used to a routine and lets you see how much formula is being taken. Answer: C- this is usually sufficient if no problems exist with sucking or palate; too frequent burping is confusing. 182. During the postpartum period following a C-section birth, the PN examines the patient and identifies the presence of lochia serosa and feels the fundus four fingerbreadths below the umbilicus. This indicates that the time elapsed is: a. 1 to 3 days postpartum. b. 4 to 5 days postpartum. c. 6 to 7 days postpartum. d. 8 to 9 days postpartum. Answer: B fundus descends one fingerbreadth per day from the day after delivery; lochia serosa begins to flow on the 5th day.

184. Appropriate breathing technique for COPD patient a. Inhale through the nose, hold breath for 2 seconds, exhale slowly with pursed-lip. b. Breathe and blow through the mouth. c. Inhale through the nose with swooping sound and exhale through the mouth. d. Inhale through the mouth and exhale through the nose. Answer A 185. A woman delivered a set of twins two hours ago via C-section and is now in the recovery room. The following fundal assessment findings would be expected: a. Fundus at umbilicus hard and midline b. Fundus 1-2 finger breaths above umbilicus, hard and midline c. Fundus 1-2 finger breaths below umbilicus, hard and midline d. Fundus would not be assessed because of the C-section Answer: B 186. A 52-year-old client is admitted through the emergency room with a bleeding duodenal ulcer. The client has been vomiting bright red blood. Which statement by the client should cause the practical nurse the most concern? a. I feel very cold and chilly b. I feel like I am about to pass out c. Please give me something to drink, I am very thirsty d. I feel very tired and I would like to sleep Answer B 187. Due to prolonged bedrest, Mrs. Cox is very prone to skin breakdown. Which of the following nursing action will promote the patients skin integrity? a. Massage the patients bony prominences with cream b. Apply liberal amount of talcum powder and alcohol to the patients dry skin c. Turn the patient every 2 hours and avoid wrinkles on the bed sheets d. Wash the patients skin daily with soap and warm water and keep it dry at all times Answer C 188. Following delivery, which of the following indicates post partum bleeding? a. Lochia, using 6 to 8 pads/day. b. Boggy uterus. c. Uterus is displaced to the right side. d. BP 100/60 Answer B 189. When performing newborn assessment, the nurse should measure the vital signs in the following sequence: a. Pulse, respiration, temperature. b. Temperature, pulse, respirations. c. Respirations, temperature, pulse. d. Respirations, pulse, temperature. Answer D 190. Lochia rubra is defined as: a. Bright red vaginal bleeding on the first 3 days following delivery; using 5 to 7 perineal pads/day. b. Vaginal bleeding on the first 3 weeks following delivery; using 5 to 7 perineal pads/day. c. Vaginal bleeding on the first 3 weeks following delivery; using 5 to 7 perineal pads/day. d. Scanty vaginal bleeding on the first 3 days; using 5 to 7 perineal pads/day. Answer A 191. The best injection site for the toddlers immunization would be: a. Deltoid b. Gluteus maximus c. Vastus lateralis d. Abdomen Answer A

Mrs. White, a 65 year-old married, was brought to the hospital after a fall. On admission, she was confused, complained of pain in her right hip, and was unable to move her right leg. X-rays indicate that she has a fracture of her right femur. 192. An observation of Mrs. White that would likely indicate a fracture of the right hip would be that the right leg is: a. rotated internally b. held in a flexed position c. moved away from the body midline d. shorter than the leg on the affected side this is symptom of leg fracture. Answer D 193. Mrs. White is slightly confused and anxious. The best nursing approach would be to: a. Call Mrs. White by her first name -orientation b. Explain to Mrs. White what is expected of her c. Visit Mrs. White frequently d. Listen to what Mrs. White has to say Answer A 194. During the night Mrs. While wakes up and does not remember her daughter had visited her early in the evening. She asks, Why has my daughter not been to see me. Didnt you call her? The best reply would be a. Are you afraid she wont come to visit you? b. Im sure you will hear from her soon. c. Youre confused, she was here earlier tonight. d. Your daughter was here just after supper this evening. Answer D 195. What measures should the RPN carry out to teach Mrs. White about breathing exercises before her surgery? a. Present small amounts of information at a slow pace b. Explain the necessity of following the breathing exercises c. Ask her daughter to be present when pre-operative teaching is done d. Leave a diagram at the bedside which shows the various steps of the exercises Answer A 196. Which of the following would provide Mrs. White with balanced, nutritious lunch? a. Milk, cheese omelette, whole wheat toast b. Tuna sandwich, milk, sliced tomato, banana c. Fried chicken, beef bouillon, peas, herbal tea d. Macaroni and cheese, tomato and lettuce salad, apple, coffee Answer B Ray Black is a 25-year-old who as a compound fracture of the femur of the right leg and a simple fracture of the right ulna as a result of a motorcycle accident. 197. At the accident site a splint is applied. It is important that the splint a. be applied to the right leg in the position of good alignment b. be applied to the right leg in the position in which it is found c. extend from the fracture site downward d. extend from the fracture site upward Answer B 198. When Mr. Black is being transported in the ambulance to the hospital, he should be positioned with affected limbs a. Elevated to minimize edema b. in a low flat position c. lower than his heart d. slightly abducted Answer A

Mr. Black is taken to the operating room. The wound caused by the fractured femur is cleansed and debrided. The fracture is then reduced and a Steimann pin for skeletal traction is inserted. A closed reduction of the ulna is performed and a cast applied. 199. The most important nursing measure in the immediate postoperative period will be: a. Encouragement of isometric exercises b. Cleansing of the area around the Steimann pin c. Observation of vital signs to rule out possible post op complications d. Massage of pressure areas Answer C 200. After Mr. Black returns to his room, he complains of pain in his right arm. The initial action of the RPN should be to a. administer analgesics as ordered b. check his fingers pain is a sign of possible circulation problem and/or nerve damage c. notify the doctor immediately d. pad the edges of the cast Answer B 201. To maintain proper alignment and immobilization of the femur, the doctor has ordered balanced skeletal traction with a Thomas splint. While caring for Mr. Black, the RPN should explain to him that he a. cannot turn or sit up b. cannot turn but can sit up c. can turn but cannot sit up d. can turn and sit up the traction immobilizes the affected limb Answer D 202. In dealing with the weights that are applied to the traction, the RPN should a. Allow them to hang freely in place the weights should hang freely b. Hold them up if the client is shifting position in bed c. Remove them if the client is being moved up in bed d. Lighten them for short periods if the client complains of pain Answer A 203. Mr. Black has a Thomas splint in place. In addition to the usual nursing procedures for a client in traction, it will be important that the RPN observe a. the groin area for pressure b. for constipation patients who are bed rest are prone to constipation c. his skin for signs of infection d. for signs if hypostatic pneumonia Answer B 204. In caring for a wet cast, the RPN should a. use a hair dryer to help dry the cast b. cover the cast to prevent the client from feeling chilled c. use a fan in the room to help dry the cast d. move the cast using only finger tips to lift it to prevent indentation on the cast that may affects circulation Answer D 205. If Mr. Black should show an increase in blood pressure, signs of confusion, and increased restlessness the RPN should suspect a. a concussion b. impending shock c. fat emboli embolism is a known lethal complication of fracture. The patients clinical manifestations are indication of pulmonary embolism d. anxiety Answer C 206. Because of the nature of Mr. Blacks wound and the insertion of a Steimann pin, it is specially important that the RPN observe for a. a foul odor this is a sign of infection

b. foot drop c. pulmonary congestion d. fecal impaction Answer A 207. Mr. Ishmael Ali is a 70-year-old male patient who was admitted due to urinary problems. He is now scheduled for a needle biopsy. Ishmael is a Muslim. Ishmael has already signed the surgical consent but verbalized to the RPN that he does not understand the implication of the surgical procedure. What course of action should the RPN takes? a. Review consent form with him b. Inform him of the complications of the procedure c. Teach him about the role of the kidneys d. Report to the nurse-in-charge that he does not understand the surgery Answer D 208. The biopsy confirms cancer of the prostate. The tumor was removed. On the 3rd post operative day, Ishmaels foley catheter was removed. Which one of the following nursing interventions should be documented in his plan of care? a. limit perineal exercises b. measure the volume of voiding assess for possible urine retention c. record 24-hours intake and output d. teach intermittent self-catheterization Answer B 209. On discharge, the patient was given three different types of eye drops, to be taken QID daily. The patient asked the RPN, I what order do I have to put the drops in. The RPN should reply: a. It really does not matter, you can put the drops in at any time. b. The order you follow does not matter, but wait at least two minutes between drops. c. You can use your judgment as long as you put them in on time. d. Put the three drops in then close your eyes for two minutes. Answer B 210. A patient was admitted with chronic pain. He was diagnosed with cancer of the liver. Narcotic agonists, like Morphine and Demerol, relieve pain by binding specific receptors. The major site of narcotic action is: a. The central nervous system the brainstem is the specific part of the brain causing depression from narcotic b. The upper portion of the brain c. The peripheral nervous system d. The autonomic nervous system Answer A 211. An example of a pure narcotic antagonist is: a. Demerol b. Gravol c. Narcan d. Codeine Answer C Joanne H, is a 15-year-old teen-ager who was admitted to the hospital due to diabetic acidosis. Her parents brought her to the nearest hospital because she has been drinking and voiding large quantities of urine; was becoming very weak and had a funny smell of her breath. They thought she have the flu or perhaps a kidney infection. Joanne was treated with IV fluids, electrolytes and regular insulin for two days until acidosis was corrected. 212. Regular insulin rather than NPH was used during the first two days while Joanne was receiving IV therapy because: a. A person is less likely to develop overdose from insulin when given regular insulin. b. Although regular and NPH insulin act in the same period of time, regular is the preferred one for IV administration c. Regular insulin exerts, per unit, a greater carbohydrate-regulating effect than does NPH

d.

Regular insulin acts in a much shorter period of time and can be given IV diabetic acidosis requires prompt treatment with short acting insulin

Answer D Today Joannes IV has been discontinued, she is being started on subcutaneous injections of regular (Humulin R) and NPH (Humulin N) insulins twice a day, amount to be determined by glucometer readings four times daily. She is on a 9000 KJ diet daily. 213. Regular insulin is often given in conjunction with NPH insulin because: a. Regular insulin reaches its peak eight hours after administration when NPH insulin begins to work. b. as NPH insulin wears off the regular insulin begins to work. c. both insulins begin to be effective together and have a synergistic action over a 24-hout period. d. Regular insulin will provide immediate coverage while NPH will have its peak effect later in the day combination of short and intermediate acting insulin provide a wide coverage to the patient. Answer D 214. Joanne refuses half her lunch saying it is yukky. You would: a. Replace the uneaten portion with 120 ml of orange juice. b. Tell her that it is okay to eat half lunch as she will be getting a snack later. c. Insists that she eat it all, explaining that she will become hypoglycemic if she does not. d. Make note of what she has not eaten and call the dietician for a substitute the patient is on a special diet with limited calories. Answer D 215. Joannes nurse has decided to have her participate in giving her own insulin as a fist step towards selfmanagement. This is her first subcutaneous injection. The RPN who supervises the patient considers one of the following as an appropriate beginning a. Explain in detail aseptic technique and Joanne a brochure to study. b. Have Joanne push in the plunger once the nurse has inserted the needle. c. Have Joanne complete the whole procedure herself with verbal guidance for each step. d. Explain the types, actions, duration and effects of all of the various kinds of insulin. Answer A 216. The rationale for early involvement of the young patient in insulin administration includes: a. To overcome the tendency to develop a fear about having to inject herself the patient is expected to receive insulin shots lifetime b. To counteract any tendency to over protectiveness by the parents. c. To ensure skill at strict aseptic technique by giving lots of time for practice. d. To motivate the patient to please her parents and nurses with her courage. Answer A 217. At 10:00 AM, you walk into Joannes room accompanied by a nurses aide. Joanne is pale and diaphoretic. Her hands are shaky and her mother stated that Joanne is very cranky at the moment. The most appropriate initial management of this situation is to: a. Instruct the aide to stay with Joanne while you obtain a glass of orange juice and call the doctor. b. Remain with Joanne and ask the aide to quickly obtain the glucometer and a glass of milk the patient is manifesting hypoglycemia. This is the best approach to ensure safety of the patient. c. Instruct the aide to remain with Joanne while you obtain some insulin and report to the team leader. d. Stay with Joanne and try to obtain a urine specimen while the aide reports to the team leader. Answer B 218. Joannes parents are very quiet and withdrawn since they have learned about the diagnosis. Today, Joanne has been alternating between weepiness and clinging to her mother. Joannes behavior indicates: a. An abnormal regression to an earlier, dependent stage of development. b. An immature grief reaction to the diagnosis of diabetes. c. A spoiled child who is obviously very dependent on her mother. d. A normal reaction to the loss of her former self concept there is no known cure for diabetes although it can be controlled. The patient reaction is considered normal.

Answer D 219. Joannes parents ask when she come off insulin and go onto pills. The most appropriate immediate response would be: a. When did the doctor say she cold switch to pills? b. When she has become an adult and is more stable. c. Joanne will always require insulin by injection.- type I DM is managed by insulin because the pancreas does not produce insulin d. Joanne will require injections until her blood sugars are normal. Answer C 220. In providing health teaching for Joanne and her parents, which of the following basic concepts should the RPN ensure that they understand? a. Since her diagnosis was discovered early, Joanne has a better than average chance of preventing complications. b. Because of the difficulty in managing insulin-dependent diabetes, Joanne should be discouraged from active sports programs. c. Management of insulin-dependent diabetes is a family centered activity which should be established as a routine aspect of family life. d. Most of the management of Joannes diabetes will rest with the parents until she has completed adolescence. Answer C 221. Joannes parents ask the RPN why Joanne cannot take insulin by mouth. The RPN should explain that insulin Is not given by mouth because it is: a. Excreted before being absorbed. b. Absorbed too slowly to be effective. c. Too irritating to stomach mucous membrane. d. Rendered inactive by the GI secretions Answer D 222. A combination of NPH and Regular insulin is prescribed for Joanne. Which of the following techniques is most often recommended when preparing the two insulins for injection? a. Premix the insulins in a vial, then withdraw the amount needed in one syringe. b. Use two syringes, one for the regular insulin and one for the NPH insulin. c. Withdraw the regular insulin first, then withdraw the NPH insulin with the dame syringe to prevent dose variation, Regular insulin is withdrawn first followed by the intermediate or long acting insulin d. Withdraw the NP insulin first, then withdraw the regular insulin with the same syringe. Answer C 223. Before preparing to remove insulin from its vial, what step should the RPN teached Joanne and is parents to take first? a. Inject at least two times more air into the vial than the amount of insulin to be removed. b. Inject the same amount of air into the vial as the amount of insulin to be withdrawn air create pressure and makes it easier for insulin to be withdrawn more easily c. Inject approximately half as much air into the vial as the amount of insulin to be withdrawn. d. Be sure the plunger is inserted completely into the barrel of the syringe so that no air can be injected into the vial. Answer B 224. Joanne and her parents should be taught that of the following factors, the one that will most often decrease Joannes need for insulin is: a. an infection b. an emotional experience c. an increase exercise exercise enhances the action of insulin d. preparing for hospitalization Answer C 225. In response to her parents asking why Joannes insulin dosages are being changed so frequently, which of the following would be most appropriate? a. Diabetes which began in childhood is always more severe and harder to regulate. b. It takes time to regulate the amount of insulin required and balance it with food and exercise.

c. d.

She must be cheating on her diet by helping herself to snacks from the ward kitchen. Children of Joannes age are growing so fast that it will be several years before the permanent dose can be determined.

Answer D 226. Joannes parents also want to know why Joannes blood glucose has to be monitored each meal and at bedtime. On which of the following rationale would you base your answer? Checking blood glucose levels this frequently will: a. Determine how much exercise she needs during the day. b. Indicate whether daily insulin dosage is adequate for the prescribed food intake. c. Determine the volume of fluid required daily. d. Establish a lifetime stable pattern to test results. Answer B 227. Mrs. Timothy is a 35-year-old grade school teacher diagnosed 8 months ago with multiple sclerosis. She lives alone in a high rise apartment building. She was admitted last week with an acute exacerbation which was treated with steroid and rest. She has not been able to walk without the assistance of two nurses. Today she says shes feeling much stronger and would like to get up to the bathroom. In order to asses Mrs. Timothys strength today, you would first ask her to a. get herself out of bed and walk across the room. b. obtain a wheelchair and ask her to get herself into it. c. bring a walker for her to try to walking without nurse support. d. try sitting herself up at the edge of the bed - this allows the nurse to appropriately assess the patients strength in a safer way. Answer D 228. Mrs. Timothy asks whether she should quit her job and go on welfare. An appropriate reply should be based on the principle that: a. Remaining employed is nearly impossible for people with multiple sclerosis. b. It is possible for her to continue working but she may need to adjust her schedule of activities due to muscle involvement, the patient with MS needs frequent rest periods between activities c. She should continue with whatever work, play and home activities that she has always done. d. Being unemployed will cause her to have more frequent exacerbations of her multiple sclerosis. Answer B Mrs. Bella is a 77-year-old female patient who was admitted 5 days ago following a stroke. She has left hemiparesis with neglect and left hemianopsia. She responds appropriately to speech and expresses herself clearly. She is frequently incontinent of urine. 229. When Mrs. Bella first makes the first transition from a lying to a sitting position: a. No special care is required. e. She is likely to become hypertensive. f. She should be discouraged from helping. g. The head of the bed should be raised slowly less energy is spend when the head part of the bed is raised when sitting from a lying position Answer G 230. When Mrs. Bella is transferring from bed to chair: a. The chair should be at the head of the bed on her affected side. b. She should be standing and balance before trying to pivot- this provide a stable gait c. The RPN should support him by hanging onto her affected arm. d. She should be dropped into the chair as quickly as possible. Answer B Doris, age four, was involved in a fire accident during her parents barbecue party. She sustained partial thickness burns to her face, neck, anterior chest with an estimated of 20% burn surface area. 231. Why was Doris weighed by the RPN on admission when she was in such extreme discomfort? a. To have information from which to determine her general level of physical development. b. To provide a basis for the physician to calculate the amount of IV fluids she should received. c. To serve as a guide for dietary management in the convalescent phase of her illness. Answer B

232. At 1200 hours, four hours post burn, Doris has voided 5 ml in the last hour. The next action would be to: a. Check again in another hour due to fluid loss, urine output is usually scanty, however, urine output should improve with fluid resuscitation. b. Take vital signs. c. Call MD stat. d. Increase the IV intake and check output in another hour. Answer A 233. Oliguria in the early post- burn period is almost an indication of a. Need for electrolytes. b. Impending septic shock. c. Chronic renal failure. d. Inadequate fluid replacement fluid loss from burn causes oliguria. Fluid replacement must be adequalte. Answer D 234. For over demanding patient, it is essential for the RPN caring for the patient to understand that in order to relate therapeutically with the patient, which approach by the RPN would be best initially? a. Setting firm limits on the patients excessive demands setting limits helps the patient controls his/her unreasonable requests b. Complying with the patients requests while assessing her complaints. c. Teaching the patient that self-help could be of benefit to her. d. Helping the patient recognize that other patients have needs that are often acute than hers. Answer A 235. A plan to modify the care of the patient with over demanding behavior will most certainly require: a. Consistency of approach by the health team. b. Development of insight by the patient into the cause of her symptoms. c. Reorganization of the patients basic personality structure. d. Involvement of the patients significant others in the care. Answer A 236. Mrs. Apple was ordered Demerol 75 mg stat IM for her pain. The Demerol is supplied in ampule containing 100 mg/2 ml. The RPN would draw up and administer: a. 0.66 ml b. 1.25 ml c. 1.5 ml Desired/Available X quantity; 75 mg/100 mg X 2 = 1.5 ml d. 0.75 ml 237. During the first 24 hours after surgery, the RPN should administer the ordered analgesic liberally so that the patient who went for abdominal surgery does not: a. Move about too freely and dislodge the draining tube. b. Irritate the patients throat by excessive coughing. c. Develop gas pains from increased peristalsis. d. Limit respiratory excursion to avoid pain following abdominal surgery, breathing could be painful Answer D 238. Mr. Bay, 75 years old was admitted with Alzheimers disease. Aldomet was given to Mr. Bay in order to: a. Control his hand tremors. b. Promote good night sleep. c. Decrease blood pressure Aldomet is an anti-hypertensive drug d. Enhance memory. Answer C Mr. Cole is a 75-year-old restaurant worker. He has been a heavy smoker since age 15. He has a chronic cough with frequent colds. He visits his doctor complaining that he has had a cold for the last three weeks which he cant seem to get rid of. In the last few days the cough has become productive of thick green sputum and he has experienced dyspnea on moderate exertion.

Physical assessment revealed a temperature of 8.2C, pulse 120 per minute, respirations 26 per minute, blood pressure 130/86 mmHg, increased anteroposterior diameter of the chest, crackles, wheezes, labored expiration, cyanosis of lips and nailbeds, and slight cardiomegaly. Lab results showed PFT study with decreased vital capacity; increased residual air volume. Doctors orders include: complete bedrest; Tetracycline 500 mg po QID; postural drainage TID and Q HS; O2 at 2 to 3 L PRN by nasal prongs; high protein diet. 239. Mr. Coles susceptibility to respiratory infections was due chiefly to: a. Failure of his bone marrow to produce phagocystic white blood cells. b. Retention of tracheobronchial secretions due to bronchospasm and mucosal edema. c. Increased residual air volume due to increased lateral chest diameter. d. Persistent mouth breathing associated with dyspnea and coughing. Answer B 240. The crackles in Mr. Coles chest that were heard by the RPN were produced by: a. Blood surging though capillaries surrounding alveoli. b. Friction between two layers of inflamed pleura. c. Air passing through constricted bronchi. d. Air forced from the lung into the pleural sac. Answer C 241. Oxygen will be given to Mr. Cole at no higher than 2 3 L concentration in order to prevent: a. depression of the respiratory center- patient with COPD uses their peripheral chemoreceptors which are sensitive to low oxygen concentration. b. decrease in RBC. c. rupture of the emphysematous bullae. d. excessive drying of respiratory mucosa. Answer A 242. Bedrest was ordered for Mr. Cole primarily in order to: a. Encourage sleep as a means of alleviating fear and anxiety. b. Facilitate the execution of diagnostic and treatment measures. c. Decrease oxygen demand by decreasing basal metabolic rate. d. Increase tissue oxygen uptake by decreasing residual air volume. Answer C 243. It is necessary that humidification be provided with Mr. Coles nebulizer treatments in order to: a. prevent thickening and crusting of tracheobronchial secretions. b. seal minute air leaks between alveoli. c. facilitate transport to the breathing medication across the capillary membrane. d. inhibit growth of microorganisms in the respiratory passageways. Answer A 244. The primary purpose for Mr. Coles nebulizer treatment is to a. eliminate bronchial infection. b. decrease bronchial irritation. c. increase pulmonary circulation. d. improve pulmonary ventilation nebulizer treatment liquefies secretion promoting open airways. Answer D 245. The PN should provide the following comfort measure for Mr. Cole, following postural drainage: a. a drink of milk. b. oral hygiene pulmonary secretions are brought up to the mouth which necessitates oral hygiene. c. a partial bath. d. a back rub. Answer B 246. Breast self examination before climacteric is best done: a. at the time of ovulation.

b. immediately prior to the menses. c. during menses. d. immediately following the menses breast palpation would be more efficient and effective following menses bec the breasts are no longer tender to palpate Answer D 247. On her first day in hospital, Miss Choma said to the nurse, This lump in my breast is cancer, isnt it? Which of the following responses would be most appropriate? a. Of course not! Whatever gave you a ridiculous idea? b. A positive diagnosis cant be made until surgery is done. c. Yes, the doctor feels that you probably have cancer. d. Youre worried about the outcome of your tests?- reflection is a therapeutic response which allows focus on the patients feelings. Answer D 248. The RPN should frequently check both the operation of the suction apparatus attached to the hemovac and the quantity of fluid aspirated to prevent: a. undetected hemorrhage through hemovac drainage, output is quantified, which detects possible post op bleeding b. displacement of the mediastinum. c. atelectasis d. distention of the pleura. Answer A 249. Before Miss Choma is discharged from the hospital, you would teach her how to care for her healed wound area. You would advise her to: a. bathe the area with soap and water. b. rub the area vigorously in order to tougher the skin. c. gently massage the area with Vaseline or non-perfumed cream massage will decrease scar formation d. disregard any signs of redness or skin irritation as this is expected. Answer C 250. Miss Choma is undergoing radiation therapy. Following treatments, localized erythema occurs on the right chest. The best explanation for this is: a. it indicates radio-sensitivity and should be reported immediately. b. it is an expected reaction redness on the skin exposed to radiation is an expected outcome c. it is a common side effect and should be treated with a protective ointment like Zinc Oxide. d. it indicates an overdose of radiation therapy and should be reported to the therapist. Answer B Randy is a 69-year-old male who has been referred by his physician to a community nursing service for instruction and supervision in the management of peripheral occlusive disease. Randy, who admits to having symptoms for many years, only recently sought medical assistance for his problem. Randy is a retired businessman and lives with his wife is 66 years old, in a comfortable 4 bed-room highrise condominium. 251. From the following list, identify the possible complications which Randy might experience due to decreased blood flow. a. ulceration and infection of the lower extremities; gangrene due poor circulation in the legs, these clinical manifestations are possible b. stabbing pain in the lower extremities; leg edema; joint stiffness. c. loss of sensation in the lower legs; inability to move legs. d. loss of pulses in the legs; foot warm to touch. Answer A 252. Pain in peripheral occlusive disease can be precipitated by: a. smoking; exposure to cold due to vasoconstriction b. drinking coffee; wearing loose clothing. c. eating too much fatty foods; long periods of standing. d. application of heat on the lower extremities and prolonged sitting.

Answer A 253. The nurse who visits Randy for the first time documented the following observation. The RPN who reads the nurses written observation is aware that the following nursing intervention may be required: a. Randy is sitting in his favorite chair with legs crossed sitting with leg crossed impedes circulation in the legs b. Randy is wearing his favorite bath robe. c. Randy is eating toss salad and grilled salmon for dinner. d. Randy is drinking green tea and cookies for snack. Answer A 254. During the discussion with the nurse, the RPN learns Randys daily routine. Which of them will he most probably need to modify because if his illness? a. Randys favorite breakfast include cereal, fresh fruit, and fresh fruit shake. b. Randy resumes his favorite past time painting which requires him hours of long standing long standing causes pooling of blood in the lower extremities resulting to poor circulation c. Randy takes short naps in the morning and late afternoon. d. Randy had been regularly swimming late in the afternoon. Answer B 255. Randys wife tells the RPN that Randy has been complaining of cold feet at night and he has been using heating pads. The RPNs most appropriate response a. Due to Randys circulation problem, heating pads must be used with great care. due to decreased sensation in the lower extremities, application of heat could be dangerous b. If heating pads give you comfort, I strongly recommend that you continue using them. c. Bottle or electric heating pads are equally effective. d. Wet towels can be heated in the microwave for 5 minutes will provide the heat you needed. Answer A 256. Collette was hospitalized for surgical treatment of varicose veins of her right leg. In the first 24 hours post-operatively for varicose vein ligation, the RPN would: a. elevate the affected leg supported by a pillow this promotes venous circulation and minimizes edema formation b. keep the bed flat so as to keep the affected leg straight and promote good circulation. c. apply a horizontal bar at the end of the bed to support the affected foot and prevent foot drop. d. monitor the patients vital signs every hour and report any abnormalities to the nurse in charge. Answer A 257. In order to minimize reoccurrence and prevent varicosities of the left leg, your health teaching should include: a. elevate legs when sitting this promotes venous circulation b. limit exercise. c. drink 6 to 8 glasses of water per day. d. wear tight fitting garments in the lower extremities to promote good circulation. Answer A Rowena is a female patient, 61 years old originally came from the Philippines. Last week she was involved in a motor vehicle accident and sustained multiple fractures involving her lower extremities. A full length cast with her feet exposed was applied. 258. Which of the following nursing actions are appropriate when Rowena arrives on the unit with damp cast a. check pedal pulses; assess the color and warmth of her toes peripheral vascular assessment is an important aspect of care post cast application b. cover the damp cast with dry towel; start full range of motion on the affected legs to ensure good

circulation c. apply electric heating pads to her cold feet. d. encourage the patient to perform breathing exercises every hour. Answer A 259. When providing nursing care to Rowena, the RPN will appropriately include which of the following to prevent development of a complication? a. Constipation and urinary tract infection due to prolonged bedrest, these complications are possible b. Dehydration from diuresis. c. Muscular dystrophy. d. Deminiralization of the bones. Answer A 260. In light of Rowena health condition, she has a special nutrition need and this include a. High protein and high Vit. C diet these are good for tissue healing b. High CHO and moderate fat diet. c. Extra fluid intake. d. Her favorite foods. Answer A A 34-year-old female patient has pain in the left leg and is diagnosed with thrombophlebitis. Hospital admission is arranged. Doctors order includes bed rest and heparin therapy. 261. The RPN understands that activity restrictions help the patient by which of the following: a. Bed rest helps improve blood circulation in both legs. b. Bed rest decreases the oxygen demand of the body. c. Bed rest helps prevent the migration of possible clot in the affected extremity the blood clot can be released with body movement d. Bed rest prevents the formation of a thrombus. Answer C 262. The patient is receiving IV infusion of D5W at 100 ml per hour through an infusion pump. Which of the following actions of the new RPN graduate needs further attention from the RN? a. ensure that the height of the IV bag is high enough to allow the IV fluids flows by gravity the height of the IV pole does not affect the IV flow since the infusion is run by the pump b. ensure that the IV tubing is not pinched or kinked. c. ensure that the IV tubing is free from air bubbles. d. strict I/Os must be monitore Answer A 263.A sputum specimen was ordered, however, the patient was unable to raise sputum specimen. Which of the following measures should the RPN implement to help the patient expectorate? a. Apply heating pads on the patients chest. b. Encourage the patient to drink large amount of warm water 30 minutes prior to the collection fluid is a good liquefier c. Have the patient sit in an upright position then encourage to forcefully cough. d. Perform postural drainage an hour before the sputum collection. Answer B 264. The RN is presenting dietary instructions to mother of infants and toddlers. The RPN, who is with the nurse at the time of the discussion, agrees when the nurse informs the mothers that diets that include milk to the exclusion of other foods may be deficient in: a. Calcium b. Iron milk is deficient with iron

c. Calories d. Fat Answer B 265. The patient has been on antibiotic for the last 24 hours. Which assessment finding indicates that the medication is effective? a. The patients appetite is improved. b. The patient voided 300 ml of highly concentrated urine during the last 24 hours. c. The patients pain has subsided. d. Temperature decreasing to 98.8C. Answer D 266. Few days before discharge, the patient who was taught colostomy irrigation complains difficulty in catheter insertion. The RPN should: a. Perform the procedure for the patient. b. Instruct the patient to apply pressure when inserting the tip of the catheter onto the colostomy. c. Instruct the patient to use gently dilate the stoma with a lubricated gloved finger. d. Encourage the patient to request stool softener from the doctor prior to discharge. Answer C 267. Miss Calista is recovering from a colon resection for a removal of a malignant colon mass in the large bowel. Following breakfast one morning, she told the nurse, I am tired of waiting, I want my bath now. Youre never here when I need you. Which of the following responses by the RPN is most appropriate? a. What do you mean, Im never here? I spent all three hours with you yesterday. b. Im sorry youve been waiting. Lets get you comfortable now and Ill be back in twenty minutes to give a bath. c. I am doing my best. You know I have three other patients to take care of today, besides you. d. I must see Mrs. Jones right now. Shes really sick today. Ill be back as soon as I can. Answer B

A child shortly after chemotherapy has developed stomatitis. What should the nurse do? a. use glycerin swab to clean site b. use Normal saline to clean site c. give patient ice cubes A patient has just returned from surgery 12 hours ago and a colostomy was done on the client. What will the stool look like with a colonostomy? a. liquid stool b. semi-formed stool c. formed stool d. no stool A patient has High sodium, High Chlorine, and potassium 6.0mdl. Which food will you tell him to avoid? a. orange b. pineapple c. bread

d. rice When should you hold Digoxin for a child? a. Brachial pulse below 90 b. Brachial pulse above 90 c. Apical pulse below 90 d. Apical pulse above 90 The father and mother both African American are viewing their child through the window and tells the nurse that my baby has been abused. There is a black spot on his back. How will you respond? a. It is normal for African American babies to have a black spot which is called Magnolian spot How do you position a left femur fracture? a. Abducted legs and elevated on pillows When the nurse steps into the room the child patient shouts at the nurse and says I hate you. How should the nurse respond? a. What do you mean by that? b. Your really dont hate me c. Did I offend you d. ignore response because he is confused A past IV drug user who is currently on Tylenol #3 2 tabs q3-4 hours, complains of pain after 1 hour when giving the maximum dose to the client. What should the nurse do next? a. Inform Doctor to reassess patient for pain b. Do nothing because she is experiencing tolerance c. give another 2 tabs of Tylenol 3# d. tell the patient to wait for another 2 hours A newly admitted client is depressed and states that she is lonely. What should the nurse do to help the client? a. show patient how to use the callbell b. introduce patient to other residents c. introduce client to staff d. move her to the nearest room by the nursing station At breakfast time you observed a diabetic client slumped over her meal unconscious. What is the nurse initial action? a. get a glucometer b. call the doctor c. assess his airway d. give glucagons as per order What position do you put a patient in shock?

a. b. c. d.

Trenlenburgs position Semifowler High fowler Sims position

A patient tells the nurse that I have bought my own enema and I want you to use it. How will the nurse respond? a. I cannot give this enema b. Notify physician for an order c. give patient the enema Wife tells the nurse that I want to stop smoking but the husband smokes. What should the nurse do? a. Set a group with the wife and husband so that she can express her feelings How does the nurse know that she has received informed consent? a. patient raises arm for wound care A recently admitted patient has an ostomy. Upon assessing the stoma, the nurse observes that the colour is blueish-pink. What should the nurse do next? a. inform physician of your findings The nurse is serving the lunch tray to their anorexic patient. How should the nurse assess her input and output? a. monitor input and output by collecting her tray after lunch b. stay with the patient while they eat c. leave patient and attend to other patients and come back later to see what she has eaten A postpartum mother wishes to breastfeed her baby. She requested that she have a sitz bath. When returning to the clients room you noticed that she is on the phone, the food is still on the tray getting cold, and the baby is crying. What is the best action by the nurse? a. tell her the sitz bath is ready b. ask her if she needs any assistance c. feed the baby with a formula d. tell her to get off the phone A patient has and IV set for Blood and Antibiotics. The Antibiotics is readily available with the nurse but the blood is at the collection bank. What should the nurse do first? a. start the antibiotics and get the blood from the blood bank b. get the blood from the bank and start the blood and antibiotics together To be able to work in Canada as a liscence nurse who is their governing party. a. liscence with the provincial government b. liscence with the municipal government c. liscence with the federal government

The patient asks the nurse what are these white spots all over my babies face. How will the nurse responds? a. it is called Cilia which will go away soon A mother brings her child to the hospital for cuts and bruises. The nurse suspects that the child is being abuse. What is the nurse best course of action? a. have doctor assess patient b. report to charge nurse of your findings c. interview the mother 12 hours after the baby has been delivered. The mother wants to take her infant home. What test should be done before the patient leaves with the infant? a. PKU test b. Bilirubin test c. Glucose test What is the side effect of digoxin? a. tremors b. general weakness c. hunger d. numbness A homeless diabetic comes to the hospital asking for help. The nurse assesses the man and notices a foot ulcer. What should the nurse do next? a. lay patient to rest and call physician b. give the patient a shower c. perform wound care on patient An IV has been set up to run at 80ml/hr at 0830. At 1300 the infusion rate is changed to 90ml/hr. What volume has already been infused before the changed order? a. 360ml b. 340ml c. 400ml d. 650ml An order of Acetaminophen (Tylenol) 325mg 1-2 tablets q4-6 hours with a maximum dose of 4000mg in 24 hours. How much tablets can be given in 24 hours a. 12 b. 16 c. 6 d. 14 What is the side effect of Tylenol #3 a. diarrhea b. constipation

c. hunger d. hallucinations A mother is recently pregnant, comes to the clinic for a routine assessment. The nurse collects information that she has one daughter in school and a previous pregnancy that ended at 16 weeks. What is the mothers Gravida and Para? a. Gravida 3, Para 1 b. Gravida 1, Para 3 What is the side effect of meperidine (Demerol)? a. respiratory depression b. hunger c. hallucinations d. diarrhea When do you stop a blood transfusion? a. Infiltration and Phlebitis The nurse is doing an APGAR assessment on a baby with pink skin colour with blue extremities, flexed tone, HR of 140, strong cry, and respiration of 40. What is the score of the infant based on the APGAR score? a. 9 b. 10 c. 7 d. 4 Mr. Pasadena has a right hip fracture. How do you place them in bed? a. Abducted with slight external rotation b. Adducted with slight external rotation You saw a colleague sign for 2 narcotics in the med drawer. The patient that he signed for has just been discharged. As you step outside you see the client leaving from the unit through the elevator. You confront the colleague and he states hes getting the narcotic for the client. What is the nurse best action? a. report to supervisor b. confront colleague of this behaviour In a blood transfusion, what is the side effect of priming with D5W instead of Normal Saline? a. high fever b. hemolysis c. blocked tube d. edema A 2 day old client is recovering from an MI attack. The patient states that he wants to smoke outside. What is the best response by the nurse? a. remind patient of hospital policy

b. tell patient that Doctor wants him on bedrest c. we do not provide cigarettes A patient with traction on right foot needs his linen to be changed. How does the nurse know that the unregulated staff personnel understand how to change his linen? a. tell client to adjust traction so that he can reposition himself b. change linen from top to bottom Client is afraid of ambulating with crutches. What should the nurse do? a. refer to physiotherapist of your findings b. give patient a walker c. tell patient this is only way to get stronger Client is complaining of pain from Cancer. Daughter states that my mother is being overdosed. What should the nurse do next? a. review with family about the clients medication b. refer patient and daughter to physician to review her current medication A client is having a seizure what should the nurse do? a. stay with patient and document everything A teenager talks to the nurse and states that next week I will have a hockey game. Do I need to take my insulin in the morning? What should the nurse do? a. refer patient to physician to readjust his insulin b. skip the insulin in the morning c. eat a big breakfast A patient comes to the hospital for complaints of itchiness and pain. Upon assessing him you notice that he has scabies. What is the nurse best action? a. apply scabicide cream b. report to physician c. report to charge nurse d. report to Public Health What size of needle should be used for the deltoid muscle for an adult male? a. 1 inch b. 2 inch c. 0.5 inch d. 1.5 inch An optic med is given in the ear. What is nurse best action? a. irrigate the ear b. report to the physician and document incident report

A patient with a right femur fracture complains of dyspnea and the nurse assesses increased blood pressure. How do you position a client? a. semifowler b. prone c. supine d. sims A patient requests the nurse to buy alcohol for the wifes b-day. How will the nurse respond to this request? a. No, I cannot go but I will get back with you with someone who can b. No, I cannot go. c. What you are asking me is illegal d. You dont need alcohol, you need flowers A client with a blood transfusion has a slight red mark on the skin with no edema and no pain. What will the nurse do? a. Stop the IV b. Continue and monitor IV How do you transfer a client with a hip fracture from a bed to a stretcher? a. Call two more staff to assist you b. Call another staff to assist you c. Assist client to walk to stretcher What sounds will you auscultate for patient who has COPD? a. Crackles What sound will you percuss for a patient who has COPD? a. dull Your unit is having a multidisciplinary group and is talking about a very aggressive patient. During the meeting you discuss how the patient refuses to have AM care. During the interview you hear 2 nurses stating I dont care what that guy says when he doesnt want a shower. I take him in anyways. What has the nurse stop the client from exercising? a. confidentiality b. patient autonomy c. continuing competence d. accountability What is the best way to take a baby temperature? a. axilla b. sublingual c. rectal d. otic

A female with the husband has come to the hospital for cut and bruises. The nurses suspects that the patient has been abused. What should the nurse do next? a. take client to a private room to conduct an assessment b. interview the client with the husband there c. interview female with multidisciplinary group d. refer her to the physician A patient has a colostomy which is secreting gastric secretions at the site. How do you prevent skin excoriation? a. wash it daily b. apply skin barrier c. change bag everyday A baby has just had a circumcision 30 minutes ago. What would be most important to record and document? a. void after 30 minutes b. no petroleum jelly on perineum c. no blood in diaper d. baby sleeping comfortably What do you take into consideration when auscultating for bowel sounds? a. physical well-being of patient during assessment b. diminished noise c. auscultate after palpation Sandy 13 years old, refuses to talk to the nurse when conducting an assessment because she is depressed from a friend suicide. Who do you get information from? a. parent b. friends c. physician d. hospital chart Sandy states that my parents dont understand me. They will be happy if I am not here. How do you respond? a. What makes you think that they will happy if you are not here b. Can I help by talking to your parents c. That is silly to be talking like that The daughter ask the nurse about mothers diagnosis to the nurse. The nurse must respect the mothers: a. confidentiality b. autonomy c. self determination A patient has a clogged G-tube. What is the nurse best intervention? a. flush with warm water

b. flush with sodium phosphate c. report to the charge nurse d. squeeze tubing A PSW has been working at a company for one year and still is not able to complete her care before the shift is over. How should the nurse instruct the PSW to improve upon skills? a. teach PSW Time management skills b. give constructive criticism c. supervise her care The nurse is making care plans for her unit. How should the nurse compile her care plan for the patients? a. get the input of the PSW working on the floor to make care plan The girlfriend asks the nurse about her boyfriends diagnosis. How should the nurse respond? a. tell girlfriend to talk with the boyfriend The nurse receives a new assignment and notices that one of his patient was an exgirlfriend. What should the nurse do? a. Change assignment with another nurse A nurse is being transferred to the Pediatric Ward and has no experience in pediatrics. What is the most appropriate action by the nurse? a. get info on pediatrics from a seminar b. request for an in-service c. ask colleagues to supervise you d. request for more time to study The floor is short of nurses what should the nurse do? a. report to supervisor and document How do you approach a person who has CVA? a. from their good side A colleague expresses to you that they are burnt and stressed out. What do you do? a. talk to charge nurse and have the colleague sent home How do you talk to a person with a hearing deficit? a. slowly and clearly An aboriginal tells you that they dont want blood transfusion. What will the nurse do? a. inform the doctor 12 year old does not want chemotherapy anymore. What will the nurse do?

a. inform doctor of client wishes b. explore the reasons why c. inform parents of client wishes A Nephrotic patient will have problems with: a. electrolyte balance When your shift ends, you check the MARS before leaving and you have an order of Plavix 40mg has been ordered and you only gave 20mg in the morning. What should the nurse do? a. Give 20mg of plavix and make an incident report b. Inform physician and make an incident report What is a sign of hypothyroidism ? a. oily skin b. loose weight c. tired How do you know a patient has understood about their hypothyroidism medication? a. I will have to take these pills for the rest of my life What is causing pain in angina? a. lack of oxygen to the pericordium A COPD is SOB. What do you advise him to do? a. pursed lip breathing b. hyperventilation c. deep breathing What should you caution a patient when taking iron tablets? a. dark urine b. black tarry stool What do you advise a patient who has thick sputum? a. drink plenty of fluids b. perform postural drainage The patient is stating that they are very anxious. What type of technique will the nurse use to relax the patient? a. guided imagery Patient is crying in the dining room. Which intervention is most therapeutic? a. give Kleenex and touch hand b. touch leg while talking to them c. touch head

Which Erickson stage is an adolescent at? a. role confusion and identity Patient wants a folk healer herbalist to help with the wound healing. How should the nurse respond? a. tell patient only doctor can cure you b. set a meeting with the physician and the folk healer c. its not hospital policy d. inform patient of client request Patient wants an oral tablet of vitamin b12 instead of the injection form. What will you tell the patient? a. inform patient that it cannot be absorbed by their stomach The nurse has a tablet and an EC pill to give the patient via G-tube. How will the nurse administer the medication? a. crush tablet and ask doctor for another order of the EC pill A nurse is performing passive ROM exercises for a patient. How will the nurse perform this action? a. move body parts until resistance is left The patient complains to the nurse that they have trouble sleeping. How will the nurse assist the patient to sleep? a. give warm milk b. play soft music c. give sedative d. use other interventions before giving sedative What do you advise a patient who has Chlamydia when applying a cream in the perineum? a. Wash hands b. Apply gloves What diet should be giving to a post op burn client? a. high in protein b. high in carbohydrate c. high fiber diet d. clear liquid diet You always see your colleague arrive late to work and sleeps most of the shift. He tells you not to tell the charge nurse. What is the most appropriate action by the nurse? a. report to the charge nurse in the morning b. help her complete her work Where would you auscultate for the abdomen first?

a. b. c. d.

RLQ LLQ RUQ RLQ

What is the first action by the nurse before shaving a male client? a. Request the clients permission to perform the facial grooming b. Involve the client in identifying the preferred shaving method type of razor to be used c. Apply moist, warm face cloth to the area of the face to be shaved d. Place the client in the semi-fowlers position A patient has committed suicide in the hospital. Who should be informed? a. inform the coroner of this unexpected death b. get permission from the physician for an autopsy c. get permission from the family for an autopsy A community health nurse visits an elderly man who is a widow. He tells you that for pain he takes her wifes medication and states not to tell any one. How will the nurse respond? a. I am concern about your situation and will inform the physician A diabetic client received Humulin R at 0700 hours. At what time will it take for him to have a hypoglycemic reaction? a. mid morning b. afternoon c. late afternoon d. evening Which insulin to draw first if two kinds of insulin are to be combined in one syringe? a. clear insulin first b. the cloudy first What instruction should the practical nurse provide to the client for caring the clients own dentures? a. use hot water when cleaning b. soak dentures in mouthwash c. use sterile gloves when cleaning d. use clean hands when cleaning What would you expect the location of the fundus of a postpartum mother 12 hours after delivery of the baby? a. two finger breaths below the umbilicus b. one finger breath above the umbilicus c. one finger breath below the umbilicus d. at the level of the umbilicus

A client has just delivered a baby six hours ago and is complaining of havent being able to void yet. What do you assess? a. fundus should be palpable above the umbilicus, left lateral b. fundus should be palpable at the level of the umbilicus c. fundus should be palpable midline between symphysis pubis and umbilicus d. fundus should be palpable at the level of the umbilicus, left lateral A client has just delivered a baby three hours ago and is complaining of being unable to void. What would the practical nurse do? a. palpate the bladder b. check for distention of the bladder c. notify nurse in charge d. encourage patient to force void What is the most appropriate care for the episiotomy when the client is complaining of pain three days after delivery? a. put ice pack on perineum b. sitz bath c. apply topical anesthetics What is the most appropriate care for the episiotomy when the client is complaining of pain 6 hours after delivery? a. put ice pack on perineum b. sitz bath c. apply topical anesthetics Where would the fundus be after third day postpartum? a. fundus is palpated on the median b. fundus is above the umbilicus c. fundus is at the symphysis pubis d. fundus is located halfway between umbilicus and symphysis pubis What is the appropriate care for a patient with swollen perineum with an episiotomy? a. apply ice pack for 30 minutes b. apply ice pack for an hour c. apply ice pack for 20 minutes d. apply ice pack for 5 minutes What should the practical nurse tell the postpartum client when having a sitz bath to maintain safety? a. Call me when you feel some dizziness b. I will set the temperature to 41-43 degrees A 6 month old baby is having diarrhea and vomiting. How would the nurse assess for dehydration?

a. check for sunken fontanel b. check for diluted urine c. check for bradycardia d. check baby respirations How would the nurse control the dehydration of an 8 year old child? a. administer electrolytes or IV of D5W and normal saline b. administer water and 2/3 and1/3 fluid c. administer D10W d. Administer TPN Which of the following would indicate an infectious wound drainage? a. serosanguinous drainage b. small purulent drainage c. sanguineous drainage d. absence of drainage A young lady comes to the community health clinic and ask the practical nurse why she missed her period. What question would the nurse ask? a. are you using birth control? b. could you be pregnant? c. are you experiencing nausea in the morning? d. are you on a strict diet? What site is the best for administering injection to an infant? a. vastus lateralis b. gluteus medius c. gluteus minimus d. restus femoris Which among the following is the best site for administering subcutaneous injection? a. abdominal site b. lower back c. deltoid d. forearms Which among the following is the best site for administering intramuscular injection for an adult? a. vastus lateralis b. ventrogluteal c. dorsogluteal d. deltoid muscle When administering an iron injectable, what angle do you inject the needle after displacing the skin laterally? a. 45 degrees b. 90 degrees

c. parallel to the skin d. 15 degrees What should the practical nurse do is she aspirates blood when administering an IM injection? a. discontinue injection and start the procedure again b. continue injecting the medication c. change the needle and inject slowly How do you perform the Z track method? a. pull skin laterally b. pinch skin c. move skin upwards d. move skin downwards When administering an Iron injection, how should the nurse reduce irritation on the skin during injection? a. change needle after aspirating medication b. wipe needle with sterile gauze c. wipe needle with disinfectant What health teaching would you tell a patient that just had a mastectomy two days ago in regards to exercising? a. Tell her to comb her hair b. tell her to take up cycling c. tell her to skip rope d. tell her to do aerobics Which activity should be avoided for a post op mastectomy patient? a. lifting grocery shopping b. combing her hair How would you transfer a patient who is not weightbearing? a. use the mechanical lift b. ask for assistance in lifting the patient c. notify the nurse in charge d. use a wheelchair in transferring The doctor ordered 2 packs of RBCs to be given to a patient over 5 hours. What should the nurse do first? a. verify the order b. notify charge nurse c. begin infusion d. check bag for cloudiness and sediments

While the practical nurse is getting a blood product for blood transfusion from the blood bank, another nurse ask her to get the blood product for her patient too. What should the practical nurse do? a. get both her patients and her colleagues patients blood products b. ask her colleague for the room and bed number of her colleagues patient c. get the patients blood product first then return to the blood bank to get the other nurse patients blood product d. Tell her to let the laboratory assistant help her in obtaining the blood from the blood How should the practical nurse present to the family the recently deceased relative? a. place a pillow under the head and hands on both sides b. place a pillow under the head and both legs and hands crossed c. place pillow under the head and the body fully covered Which among the following is a correct statement about administering a nitroglycerine patch? a. press patch at each edge firmly b. take patch out after a shower c. take patch out before shower d. leave patch on for 24 hours The patient asks why do I have to receive a nitro patch when I can get it in a spray form. How will the nurse respond? a. patch will deliver continuous dosage of nitroglycerin b. it works better than the spray c. it is doctors order d. only some people can get the nitro spray A patient with a cast on his leg is complaining of pain in his cast. What is the initial area to assess with the patients complaint? a. ask the patient to indicate the exact site and describe the character and intensity of pain b. perform capillary refill test to determine is the pain is dues to decreased tissue perfusion c. determine if the patient wants to have an ice pack applied on the cast to minimize pain and reduce risk for compartment syndrome Which of the following is a side effect of corticosteroids in a female client? a. new growth of hair on the leg b. hypertension c. alopecia d. increased libido A PSW is feeding a patient with Alzheimers disease. You see the patient having difficulty swallowing when the PSW is feeding the patient. How would your respond? a. report to the charge nurse

b. arrange a seminar on alzheimers disease for the PSW c. give charcoal to the patient d. tell the PSW to stop the feeding and demonstrate how to feed the client A patient with Parkinson has their shower day today. How would you approach the client for the shower? a. today is you shower, would you like it now or later b. come with me today is your shower day A patient with Alzheimers has their shower day today. How would you approach the client for the shower? a. today is you shower, would you like it now or later b. come with me today is your shower day Mrs. Garcia a 70 year old Alzheimer patient is resistive when taking him for a shower. How should the nurse respond? a. leave client alone and return in 20 minutes b. have another colleague assist you with the shower c. restrain patient to the chair d. tell them that they must have a bath now and bring them to the shower room When cleansing the skin around the clients stoma of his colostomy, the most appropriate nursing technique is to: a. cleanse the area with betadine b. swab with 70% alcohol c. use water and mild soap d. scrub with peroxide

When is the best time to change the ostomy bag and provide stomal care for the client? a. in the morning b. after a shower and breakfast c. after physiotherapy exercises d. after the dinner meal A pregnant teenager mother tell you not to tell her parents that she is pregnant. How would you respond? a. ask how does she feel about her pregnancy b. refer teenager to a social worker c. tell the patient that you will keep her information confidential d. ask the patient what are some possible reactions her parents would have if they knew she was pregnant How do you give medication when someone is on a nasal tube feeding? a. deliver medication quickly to prevent air embolism

b. irrigate the tube by adding 100ml of water c. keep the patient on a supine position after administering medications d. place patient in fowlers position while administering medications What stage of labour is a cervical dilation of 7-10cm? a. latent phase of the first stage of labour b. active phase pf the first stage of labour c. transition phase of the first stage of labour d. second stage of labour or the expulsive stage When should a calcium tablet be given for best absorption? a. Before meals b. An hour after meals c. In the morning d. Before patient goes to sleep A client is refusing calcium as it upsets his stomach. How would you give the calcium tablet? a. give calcium with yogurt b. give the calcium with green leafy vegetables c. give calcium between meals d. give calcium with bran cereals Which food is contraindicated when taking the medications coumadin (Warfarin)? a. beans b. bread c. orange d. broccoli If a client has a high blood pressure, which of the following should be reduced in the diet? a. sodium b. potassium c. calcium d. iron What kind of toy is appropriate for an 8 month old infant? a. small mobile toys b. teddy bear c. push toys d. shape sorters Which among the following is an appropriate techniques in mixing tow kinds of medication in one syringe?

a. withdraw NPH insulin first before the regular insulin and withdraw medication from the vial first before from the ampule b. withdraw the regular insulin first before the NPH insulin and withdraw medication from the vial first before from the ampule c. withdraw medication from the vial first before from the ampule and withdraw the regular insulin first before the NPH d. withdraw medication from the ampule first before from the vial and withdraw NPH insulin first before the regular insulin Which of the following instructions would be most appropriate for the practical nurse to give to Sandy who is pregnant in regards to nutrition during pregnancy? a. eat a balanced diet that includes foods rich in iron b. it is important to have enough nutrients as you will eating for two c. the goal of your diet is to reduce weight d. you are probably already obtaining the nutrients you need Sandy, the pregnant patient developed pregnancy-related hypertension and is hospitalized. Which of the following responses would be most effective for the practical nurse to do in helping reduce Sandys anxiety about her condition? a. initiate a discussion of her condition b. post a no visitor sign on her door c. reassure her that everything will be alright d. encourage her friends to visit In addition to vital signs, which of the following are the most important for the practical nurse to assess in the patient immediately? a. fundus, lochia, perineum b. breast, hemorrhoids, voiding c. breast, fundus, voiding d. perineum , hemorrhoids Sandy, the post partum patient has decided to breastfeed her baby. Which of the following actions by the practical nurse would most effectively provide emotional support to the patient? a. encourage Sandys breastfeeding efforts by providing assisstance b. assure sandy that she has made the right decision c. inform patient that the public health nurse will provide guidance at home d. provide patient with written information on breastfeeding A patient tells the nurse that his wife died a year ago. Which of the following responses by the practical nurse would be most appropriate? a. I know how you feel, I lost also lost my mother 3 years ago b. thats too bad. Can I get you a coffee of tea c. how have you been coping d. was this your first loss

Janice, an 18 year old woman who has diabetes states I just cant deal with this diabetes anymore. Which of the following would be the most appropriate response for the practical nurse to make? a. did you know that you can lead a normal life with diabetes b. having diabetes is difficult for you. Tell me more about that c. I understand how you are feeling because I have looked after many young people with diabetes d. It is very important that you accept your illness. Learn to live with it. Joni, 9 years old, is admitted from the emergency room following a severe asthma attack. She is sitting upright in bed and has an oxygen running per nasal cannula. Which among the following would best indicate the Joni is still in respiratory distress? a. the use of accessory muscles for breathing b. a respiratory rate of 26 breaths per minutes c. the ability to speak in sentences of 6-8 words d. frequent harsh cough Which of the following defines informed consent? a. it is the responsibility of the person performing the procedure b. consent can be verbal or written, except in emergency c. consent prevents delays in completing diagnostic or surgical procedures d. consent is only requested when the clients are scheduled for surgery Jason is a 3 years old with head injury. What would the practical nurse observe during the initial assessment? a. change in level of consciousness b. change in vital signs c. motor deficits d. changes in pupil size

The glascow coma scale is based on: a. Best verbal, pupil response, best motor b. Sensory function, pupil response, level of consciousness, A patient was admitted to the emergency room whose upper chest suffered a third-degree burn after a barbeque grill explosion at the patients backyard. What should the practical nurse observe as a priority if his situation is deteriorating? a. respiratory rate b. pulse oximetry rates c. level of consciousness d. extend of burn site A 5 year old tells the nurse that he is having trouble swallowing 5 pills. What should the practical nurse do?

a. the practical nurse may crush the medications appropriate b. the practical nurse will the attending physician to substitute medications to alternative routes c. the nurse gives water before giving the medication d. the practical nurse gives the medications one at a time Which among is the most appropriate home health teaching for a patient who is going to be discharged with a colostomy? a. refer the patient to some training session on colostomy care b. refer patient to a support group for people with colostomy c. teach patient to avoid foods that produce gas or flatus d. teach the patient to change the colostomy bag when it is half-full A mother complains to the nurse that her baby has frequent rash on their buttocks. How would the nurse advise the patient? a. give the babys bottom more time in the open air without diapers on b. wash the rash with soap and water, then apply lotion c. wash the rash with an antiseptic d. was the rash with water The hospital ward is very busy. The nurse in charge came and asked the practical nurse to help her out with the vital signs and medications. How should the practical nurse help her out with the vital signs and medications. How should the practical nurse respond? a. take the vital signs and refuse to administer the medication b. refuse to do bother the vital signs and administering medications c. do both the vital signs and administering of medications d. report the situation to the supervisor so this can be avoided in the future

What is the correct way of opening a sterile dressing change equipment box? a. open with a pair of scissors b. open the box by grasping the upper flap of he outer wrap, pulling towards your body c. open the box by grasping the upper flap of the outer wrap, pulling away from your body d. open the box by grasping the upper flap of the outer wrap to any direction desired The practical nurse saw her colleague took some narcotic medication and put them in the colleagues pocket. What should the practical nurse do? a. talk to the colleague and inform the nurse in charge b. talk to the colleague what the practical nurse saw c. inform the nurse in charge d. document what the practical nurse observed in the incident report form

While changing position of a patient on the, the practical nurse smelled alcohol on her colleagues breath. What is the most appropriate action to take? a. talk to the colleague and inform the nurse in charge b. talk to the colleague what the practical nurse saw c. inform the nurse in charge d. document what the practical nurse observed in the incident report form What is the priority action for the practical nurse to take to a patient who just returned from the recovery room to the ward after having a mastectomy? a. check vital signs b. check the respiration of the client c. check the level of consciousness d. check the dressing for the signs for infection You see a male and female patients having and intimate sexual encounter in the nursing home. What will the practical nurse do? a. call both the client and tell them not to co that again b. talk to them and report to the supervisor as appropriate c. leave them alone as this is their own private affair d. encourage them to express their intimacy as desired The nurse is administering medication for a client. The physician ask the nurse to assist him with his wound dressing, another patient is calling to go the washroom, a family member told you that her mother has just fallen down. Who will you prioritize first? a. a family member told you that her mother has just fallen down b. assist physician with his wound dressing c. the patient who is calling to go the washroom d. continue with administering the medication Mrs. Sam delivered a baby boy through normal vaginal delivery. What kind of vaginal discharge will you expect in the next 24 hours? a. small amount of lochia serosa b. medium amount of lochia serosa c. scant amount of lochia rubra d. medium amount of lochia rubra Which of the following is a common side effect of vasodilators? a. orthostatic hypotension b. anorexia c. bradycardia d. weightloss When you come to administer the nitro patch to Mr. Kim, you found that he has rashes on his upper and lower torso. Where are you going to administer the patches?

a. b. c. d.

neck upper chest abdomen thigh

Which among the following would you base it from if you to delegate an assignment to a unregulated PSW? a. the PSWs learning abilities b. the PSWs workload c. the PSWs learning experience d. the PSWs job description Mrs. Lee is in early stage of alzheimers disease. Her son is the one who takes care of her financial needs. Her daughter is the one looking after her personal care. Who should make the decisions for the patient about her care? a. daughter b. son c. daughter and son d. client Which among the following patient would take priority in your care? a. a patient who requires a dressing change b. a patient who requires an enema for an afternoon colonoscopy c. a patient who need AM care for his dialysis appointment at 1000 What is the normal papillary reaction when you penflash in the patients eye? a. pupil will first dilates and then constricts b. pupil will constricts and then dilates A patient is on her 5th pregnancy. She visited the hospital and asked the practical nurse where is the nearest abortion clinic. How should the nurse respond? a. give her all the addresses of the abortion clinics b. tell of give her alternative information c. tell her about your religion 5 units packed RBCs has been ordered by the physician for a client that is of the religion Jehovah witnesses. What is the nurse next best action? a. remind physician the client will refuse blood transfusion b. administer blood transfusion c. administer only half for the first and the rest in another hour d. report to the charge nurse The patient request for a male nurse to attend to him. How will the nurse respond to his request? a. explore the reason why he wants a male nurse b. inform patient that you are capable of doing all care for him

c. change assignment with a male nurse d. ignore patient request and continue to give care. A terminally ill patient is near approaching death as approximated by the attending physician. The family is at the patients bedside. What would the nurse do to show emotional support? a. leave them at the bedside and provide privacy b. allow them to stand at the bedside as long as they want to c. stay with them and participate with the family d. show family how to use the call bell when they need help A new resident is admitted to a long term care center who also have some concern about her only daughter. During the interview, you observed that the clients daughter is not actively participating in the interview. What should the practical nurse do at this point? a. tell the daughter to tour around the facility while she interviews her mother b. ask the daughter in private about her concerns and report to her client c. share your observations to the daughter and offer how you can help What size of a needle and syringe will you use in administering an intramuscular injection to an obese 31 year old patient? a. 2 inch and gauge 23 needle b. 1 inch and gauge 21 c. 2 inch and gauge 18 d. 2 inch and gauge 21 How would you transfer a post operative patient from a stretcher to bed? a. 1 person transfer b. 2 person transfer c. 3 person transfer d. ask patient to transfer himself to the bed A mother brought her 3 year old son to the community health clinic for an immunization appointment and was concerned about her sons eating habits and overreacting behaviour. What is the most appropriate response for the nurse to use? a. lets sit and talk about your concerns now before the registered nurse give your sont the immunization b. Why dont you sit down for a few minutes then I will have the registered nurse give your son the immunization. After immunization, then we will talk about your concerns on your sons behaviour c. I will give the immunization now and I will call you for follow up. d. he has to be immunized now and I will call you up for a follow up A client on palliative care states he is now ready to talk to a clergy. It is about 3 oclock in the morning when the client states this. What would the practical nurse do in support to this client? a. page the clergy on call b. leave a message on the clergys office voicemail

c. wait until the morning to discuss this with the clergy Mrs. Plato, who has breast cancer, is afraid that her pain will increase as she approaches death. How should the practical nurse help address Mrs. Plato fear? a. assess Mrs. Plato pain using a pain scale b. report Mrs. Plato concern to the nurse in charge c. Inform Mrs. Plato that she will be kept pain free d. Assure Mrs. Plato that her level of pain will be assessed frequently A practical nurse is preparing to teach a client how to use crutches. Before initiating the lesson, the nurse performs an assessment on the client. The priority nursing assessment should include which of the following? a. the clients fear related to the use of crutches b. the clients understanding of the need for increased mobility c. the clients muscle strength and previous activity level d. the clients feelings about the restricted mobility A practical nurse is teaching a client with coronary artery disease about dietary measures that should be followed. During the session, the client expresses frustration in learning the dietary regimen. The nurse would initially: a. identify the cause of frustration b. continue with the dietary teaching c. notify physician d. tell the client that the diet needs to be followed A practical nurse is reviewing the plan of care for a child with juvenile rheumatoid arthritis. The nurse determines that which of the following is a priority nursing diagnosis? a. Disturbed Body image b. Risk for bathing/hygiene self care deficit c. risk for injury d. acute pain What is the priority nursing intervention before administering Digoxin? a. take apical pulse for one full minute b. take the blood pressure c. take the respiratory rate for one full minute d. take the radial pulse for one full minute Mrs. Lam, 66 years old, has suffered a concussion from car crash. What assessment activity is a priority for the practical nurse to do? a. monitor level of consciousness b. assess respiratory status c. assess brachial pulse d. assess their airway

A practical nurse is assessing the risk for acquiring pneumonia during hospitalization for a group of clients. The nurse determines that which of the following clients is at lowest risk? a. an bed rest elderly client b. a client with AIDS c. A client with a spinal cord injury who is immobile d. postoperative client who is ambulating Jack Nixon, 16 years old has been admitted to hospital for severe gastroenteritis. He is very upset and angry about not being able to participate in a baseball tournament with his friends. Jack is on enteric precautions. Which suggestion should the practical nurse make to provide diversion for jack? a. Encourage him to play video games b. Encourage him to make crafts c. Allow him to invite another friend for a game of cards d. Allow him to invite his baseball team for a visit A client scheduled for a computerized tomography scan of the abdomen ask the nurse when the results of the test will be available. The practical nurse makes which most appropriate response to the client? a. the results wont be available for atleast one week b. you must ask the CT scan technician for that information c. your physician may have the results in about three days d. every scan is read by a radiologist and this process always takes one week A wrong tray of food was given to a diabetic client. The practical nurse already observes the client eating the wrong tray of food. What should the practical nurse do? a. check clients blood sugar b. ask for another tray of food c. stop the client from eating the food The topic discussion in a health education conducted by the RPN is on routine circumcision of male infants. There are varied opinions about the procedure. Some parents are agreeable and some are opposed. Which among the following statements is appropriate for the nurse to make towards the parents who are opposed to it? a. did you know that circumcision can cause many complications b. you should choose your won physician or surgeon c. nowadays, physicians dont recommend for male infants to be routinely circumcised What is the purpose of ensuring that the uterus has contracted after the mother delivers the baby? a. to prevent hypotension b. to prevent hemorrhage and shock c. to minimize the possible administration of oxytocin d. to prevent compensatory increase in pulse rate

Which measure if of greatest importance to prevent infection when assisting to set up an IV for a dehydrated patient? a. wearing sterile gloves b. shaving the IV site c. clearing the tubing of air bubbles d. using aseptic technique What is the right position for administering a vaginal suppository a. supine with knees flexed b. right side lying c. left side lying d. prone The practical nurse assesses the patients back who was admitted for CVA, and finds areas that is reddened from the pressure lying on his back. Which action by the nurse will help relieve pressure sore formation? a. rub the reddened area with emollient cream b. massage the reddened areas gently with alcohol c. massage the back around the reddened areas d. rub around the reddened areas with alcohol The practical nurse is preparing a client with an IV infusion for ambulation with a portable pole. Which direction should the practical nurse give to this client? a. keep affected limb ear the waist b. keep the affected limb elevated c. raise the pole as the fluid level of the bag lower d. lower the pole as the fluid level of the bag lowers When is the best time to bathe a baby? a. before feeding b. every morning c. every evening d. after feeding the baby Which among the following is the most common sign of phlebitis? a. swollen, warm, red from catheter site along vein b. clogging of infusion site c. burning at the site d. cool, swollen, and blanching of site Which among the following is the most common sign of infiltration? a. swollen, warm, red from catheter site along vein b. clogging of infusion site c. burning at the site d. cool, swollen, and blanching of site

A new mother refuses to breastfeed her baby is complaining of pain in her breast. What should the practical nurse with the patients engorged breast? a. apply cold compress b. use a breast pump c. apply warm compress d. massage breast A new mother who wants to breastfeed her baby is complaining of pain in her breast. What should the practical nurse do with the patients engorged breast? a. apply cold compress b. use a breast pump c. apply warm compress d. massage breast Mr. Bautista tells the practical nurse that he sometimes experience constipation. How should the practical nurse assist Mr. Bautista? a. verify that he is receiving sufficient fluids b. ensure that he is receiving a low fiber diet c. offer him a suppository d. have him sit on the commode once a day Two units of packed red blood cells are ordered for a male client. What should the practical nurse do before the infusion is started? a. ask the client if he knows his blood type b. assess and record the clients vital signs c. administer a prophylactic antipyretic medication d. determine whether the client is HIV positive A code blue has been called and the emergency team is performing the resuscitation. Which action by the nurse is most appropriate during the resuscitation? a. check that oxygen and suction equipment are available b. move laundry hampers or wheelchairs out of the hallways c. offer to transport blood specimens to the laboratory d. provide essential care to the remaining clients on the unit A client is on oxygen per nasal cannula. When coming on your shift which will you assess first on the patient? a. skin integrity of the client nose b. assess oxygen tubing c. change oxygen saturation d. check doctors order of oxygen saturation rate The practical nurse is told by a nurse that Gabriel, 1 year old is to have elbow restraints applied. Which of following must the nurse take first? a. heck Gabriels chart for a physician order

b. explain to Gabriel parents what is to be done c. obtain well padded restraints d. consider alternative approaches to restrain Gabriel Mrs. Fannys pulse is normally between 72 and 88 beats per minutes. When the practical nurse takes Mrs. Fannys radial pulse, it is 104 beats per minute. Mrs. Fanny rhythm is regular and her pulse is difficult to feel unless pressure is applied. What do these changes indicate? a. tachycardia and dysrhythmia b. pulse deficit and orthostatic hypotension c. bradycardia and dyspnea d. tachycardia and thready pulse Metoprolol tartrate has been prescribed for a client with hypertension. Which among the following is correct about the medication? a. the common side effect of it is tachycardia b. it is best taken with meals to enhance absorption c. it can be crushed in apple sauce for clients with dysphagia d. it is best taken with 1oz of aluminum hydroxide What should the practical nurse do to prepare Mr. Rufino for his operation? a. Provide him with the information he needs to make an informed consent for surgery b. Prescribe for him preoperative test and activities c. Provide him with information about postoperative management d. Explain to him the need for the type and the extent of surgery Mr. Bedard reports that the traction device is creating discomfort in his groin area and asks the practical nurse to look at his groin area. Which response by the practical nurse would be most appropriate? a. ill examine the area tomorrow when Im helping you with your bath b. I will get the registered nurse to come in and look at this for you c. Why dont you mention this to the doctor on the next visit d. Describe the discomfort while I examine you Mrs. Smitherman refuses to allow dressing change of her left foot. Which approach should the practical nurse take? a. respect the clients wishes and document the situation b. inform the physician of the clients decision and record the decision in the nursing notes c. seek clarification from the nurse in charge regarding the hospital policy and ask that the physician be notified d. clarify with the client her reason for refusing treatment and notify the nurse in charge of her decision

Mrs. Suka, an 81 year old resident of a long term care facility, has been diagnosed with metastatic cancer of the breast. She has no family or friends. Her physician has informed her that she needs to have a mastectomy and chemotherapy. Mrs. Suka tells the nurse that she does not want any treatment. What should the practical nurse do? a. inform the physician of Msr. Sukas desire for no treatment for the cancer b. tell Mrs. Suka that she needs to talk to her physician about cancer treatment c. contact a local cancer support group regarding treatment options for Mrs. Suka d. Explain to Mrs. Suka the importance of starting the treatment immediately The practical nurse observes a colleague, Jane, slapping a 3 year old client. What is most appropriate initial action for the practical nurse to take? a. suggest to the colleague that she should take some time off b. share the observation with another practical nurse c. report the observation to the CNO d. report the observation to the nurse in charge An aboriginal client wishes to have a sweet grass smudge ceremony in her room before she has surgery. What should the practical nurse do first? a. ask the client to describe the ceremony b. state that this activity is not allowed in the hospital c. invite members of the health care team to come and participate in the ceremony d. encourage her to go ahead and perform the ceremony The practical nurse received cues from Mr. Corales suggesting that he is attracted to her. He has asked her to go out with him when he leaves the hospital and says, I Love you to her. Which response by the practical nurse is most appropriate? a. Mr. Corales, I cannot continue caring for you is are in love with me. YOU must stop expressing these feelings b. I also feel a physical attraction toward you, Mr. Corales. Once you are released from the hospital, perhaps we can go out together c. Mr. Corales, the relationship we have is professional. Please stop this behaviour d. Please do no say that you love me. Someone may hear you and suspect that I am not being professional in my relationship with you The practical nurse takes a telephone call from a clients relative asking for information on Mr. Danushkas injuries. Which response is the most appropriate for the practical nurse to make? a. inform Mr. Danushkas relative that the information is confidential b. tell Mr. Danushkas relative that information can only be given to the family c. suggest that the relative visit Mr. Danushka in hospital Mrs. Babushka, who has just delivered her first child, is having difficulty with breast feeding. She says, I am discouraged, I think I am going to give my baby the bottle. Which statement by the practical nurse is most appropriate? a. Formula feedings are just as good as breast milk

b. Dont be discouraged. You will have a lot of time to learn how to breast feed your baby c. I understand your frustration. Lets position the baby so that this feeding will be better d. Bottle feeding is fine but dont give up so easily Nancy 13 years old, has chlamydial infection and is receiving the appropriate treatment. She decides to discontinue the treatment and inform the practical nurse of he reasons. What should the practical nurse do? a. try to convince Nancy of the importance of the treatment b. explain to Nancy the consequences of stopping the treatment c. inform the physician d. inform the nurse in charge Which among the following client statements would the practical nurse be concerned the most of after a major bowel surgery? a. can you get me a blanket please b. I feel sick sick. Can you pass me a basin? c. Im surprised that Im not the least bit hungry d. I feel dizzy. I think Im going to faint Which among the following would strongly indicate of an adult with hypoglycemic reaction? a. dry, pale skin b. RR 24 breaths per minute c. Dry flushed skin d. Diaphoresis, tremors Mr. Sandoval, 65 years old, multiple sclerosis and is confined to a wheel chair. Which nursing diagnosis should the practical nurse recognize has the highest priority? a. body image disturbance b. impaired verbal communication c. high risk for infection d. risk for impaired skin integrity The practical nurse discovers a client having a seizure and experiencing difficulty breathing. Several members have arrived in the clients room. How should the practical nurse best coordinate this situation? a. designate someone to bring the emergency cart b. instruct someone to report the code and return to the scene c. ask someone to notify physician on call to come immediately d. clear the room an assess the client The practical nurse is answering a call light an discovers that Karen, 12 years old, has just vomited. There is a large amount of gastric contents mixed with bloody streaks on

Karens gown and on the floor. After notifying the nurse in charge, which action should the practical nurse take next? a. collect a specimen of the emesis for the nurse in charge to assess b. gown and glove before providing care to Karen c. Call housekeeping to clean the floor after providing care to Karen d. Gown, Glove, and mask before providing care to Karen