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Mid-Semester Exam

1. A physician has ordered peak and trough levels of a medication. When would
the nurse schedule the trough level specimen?
a. 24 hours after the last dose.
b. Before administering the first dose.
c. 30 minutes before the next dose.
d. Immediately after the first dose.
2. A patient has a stage II pressure ulcer on her right buttock. The ulcer is
covered with dry, yellow slough that tightly adheres to the wound. What is
the best treatment the nurse could recommend for treating this wound?
a. Wet-to-dry dressings changed 3 times a day.
b. Dry gauze dressing changed twice a day.
c. Nonadherent dressing with daily wound care.
d. Hydrocolloid dressing changed as needed.
3. A nurse is teaching a home care patient how to do pursed-lip breathing. What
is the therapeutic effect of this procedure?
a. Prolonging expiration to reduce airway resistance.
b. Reducing the need for PRN pain medications.
c. Using upper chest muscles more effectively.
d. Replacing the use of incentive spirometry.
4. The nurse working in the emergency department is preparing heat therapy
for one of the patients in the unit. Which one is it most likely to be? Choose
all that apply.
a. Is actively bleeding.
b. Has lower back pain.
c. Has swollen, tender insect bite.
d. Has just sprained her ankle.
5. A nurse is teaching an older adult at home about taking newly prescribed
medications. Which of the following would be included?
a. You can identify your medications by their color.
b. I have written the names of your drugs with times to take them.
c. Dont worry if the label comes off; just look at the shapes.
d. You wont forget a medication if you count them every day.
6. A physician has ordered that a medication be given stat for a patient who is
having an anaphylactic drug reaction. At what time would the nurse
administer the medication?
a. Immediately after the order is noted.
b. Whenever the patient asks for it.
c. Not until verifying it with the patient.
d. At the next scheduled medication time.

7. The nurse is caring for a patient who suddenly becomes confused and tries to
remove an IV infusion. The nurse begins to develop a plan of care for the
patient. Which nursing intervention should take priority?
a. Gather restraint supplies.
b. Call the physician for a restraint order.

c. Assess the patient.


d. Try alternatives to restraint.
8. Chest percussion and postural drainage would be an appropriate intervention
for which of the following conditions?
a. Congestive heart failure (CHF)
b. Pulmonary edema
c. Pulmonary embolus
d. Pneumonia
9. A patient had a CVA (stroke) 2 days ago, resulting in decreased mobility to
her left side. During the assessment, the nurse discovers a stage I pressure
area on the patients left heel. What is the initial treatment for this pressure
ulcer?
a. Debridement to the left heel.
b. Elevation of the left heel off of the bed.
c. Antibiotic treatment for 2 weeks.
d. Normal saline irrigation of the ulcer daily.
10.Which of the following healthcare providers have prescription authority?
Select all that apply.
a. Physician
b. Social worker
c. Pharmacist
d. Advanced practice nurse
e. Dentist
f. Licensed practical nurse
11.What assessment findings might the nurse expect to see in a patient
experiencing hypoxia? Select all that apply.
a. Peripheral pitting edema.
b. Cyanosis of skin and mucous membranes.
c. Weak or absent peripheral pulses.
d. Altered level of consciousness.
12.The nurse is aware that patients who are immobile are at increased risk of
developing DTVs. Because of this, the nurse should
a. Make sure that elastic stockings are not removed.
b. Measure both ankles to determine size.
c. Dorisflex the foot while assessing the patient for discomfort.
d. Measure the calf circumference of both legs.

13.A nurse on 5 East at Good Samaritan Hospital is caring for an 84 year old
female patient who came in from and extended care facility after a fall. The
patient experienced a hip fracture and had a right hip replacement three days
ago. The patient is now experiencing shortness of breath, her respiratory rate
is 34 and her oxygen saturation is 86%. The nurse uses the SBAR method to
communicate to the patients provider. Which of the following might be listed
under the B of the acronym?
a. Patients name and location
b. Patients oxygen saturation level

c. Recent fall and hip replacement


d. Further testing
14.A hospitalized patients medical record contains the following medications
orders. The patients name is stamped on the order sheet. Which order is
complete?
a. 5/26/14 digoxin 0.25 IV daily, G. Horowitz, RN
b. Furosemide 40 mg IV daily
c. 5/29/14 metopropol 5 mg IV every 6 hours, Robert Young, MD
d. 5/28/14 0930 KDur 40 mEq PO now, James Hart, MD
15.The nurse receives a lab report that states that her patients digoxin level 1.2
ng/mL; therapeutic rage for this drug is 0.5-2 ng/mL. Which action should the
nurse take?
a. Notify the prescriber to reduce the dose.
b. Withhold the next dose of digoxin.
c. Notify the prescribing healthcare provider to increase the dose.
d. Administer the next does as prescribed.
16.Pressure ulcers are directly caused by which of the following conditions at the
site?
a. Compromised blood flow.
b. Inadequate venous return.
c. Shearing forces
d. Edema
17.Of the following interventions, which is/are likely to reduce the risk of postop
atelectasis? Select all that apply.
a. Apply low-flow oxygen.
b. Administer bronchodilators.
c. Encourage coughing and deep breathing.
d. Administer pain medication.
18.You are admitting a 54 year old patient with COPD. The physician prescribes
O2 at 24% FIO2. What is the most appropriate oxygen delivery method for this
patient?
a. Partial rebreather mask
b. Nonrebreather mask
c. Nasal cannula
d. Venturi mask

19.A 62 year old man with emphysema says, My doctor wants me to quit
smoking. Its too late now, though; I already have lung problems. Which of
the following would be the best response to his statement?
a. You should ask your PCP for a prescription for a nicotine patch so that
you can quit.
b. You should quit so that your family does not get sick from exposure to
secondhand smoke.
c. You will need to use oxygen, but remember it is a fire hazard to smoke
with oxygen in your house.

d. Once you stop smoking, your body will begin to repair some of the
damage to your lungs.
20.A young man who has had a traumatic mid-thigh amputation of his right leg
refuses to look at the wound during dressing changes. Which response by the
nurse is appropriate?
a. I respect your wish not to look at it right now.
b. In understand, but you are going to have to look someday.
c. You really wont be able to go home until you look at it.
d. Oh, it really doesnt look that bad.
21.A patient with COPD asks the nurse why he is having increased difficulty with
his fine motor skills, such as buttoning his shirt. Which response by the nurse
is most therapeutic?
a. Often patients with your disease lose mental status and forgot how to
perform daily tasks.
b. Your disease affects both your lungs and your heart, and not enough
blood is being pumped. So you are losing sensory feedback in your
extremities.
c. Your disease process makes even the smallest tasks seem exhausting.
Try taking a nap before getting dressed.
d. Your body isnt receiving enough oxygen to send down to your fingers;
this causes them to club and makes dexterity difficult.
22.The nurse is admitting to the medical-surgical unit an older adult woman with
a diagnosis of pulmonary hypertension and right-sided heart failure. The
patient is complaining of SOB, and the nurse observes conversational
dyspnea. What is the first action the nurse should take?
a. Continue to gather the health history.
b. Administer oxygen to the patient through a partial rebreather.
c. Obtain a thorough health history from the family instead of the patient.
d. Perform a quick physical examination of breathing, circulation, and
oxygenation.
23.Before administering a mediation, the nurse must verify the rights of
medication administration, which include:
a. Right patient, right drug, right route, right time, right documentation,
and right equipment.
b. Right patient, right room, right drug, right route, right dose, and right
time.
c. Right patient, right drug, right dose, right route, right time, and right
documentation.
d. Right drug, right dose, right route, right time, right physician, and right
documentation.
24.One hour after receiving a dose of lispro insulin (Humalog), a patient begins
sweating and develops tremors and dizziness. His blood glucose level signals
hypoglycemia. Which type of adverse reaction to insulin is this patient most
likely experiencing?
a. Allergic
b. Dose-related
c. Patient sensitivity

d. Anaphylactic
25.A nurse is applying cold therapy to a patient to a patient with a contusion of
the arm. Which of the following is an effect of cold therapy? Select all that
apply.
a. Increases blood flow to tissues.
b. Increases the local release of pain-producing substances
c. Reduces muscle spasms.
d. Alters tissue sensitivity (producing numbness).
e. Reduces the formation of edema and inflammation.
f. Constricts peripheral blood vessels.
26.The patient is admitted with a stroke. The outcome of this disorder is
uncertain, but the patient is unable to move his right arm and leg. The nurse
understands that:
a. Active ROM is the only thing that will prevent contractions from
forming.
b. ROM exercises should primarily be done on major joints.
c. Passive ROM must me instituted to help prevent contracture formation.
d. ROM exercises should be started 2 days after the patient is stable.
27.A patient is hospitalized for an infection of a surgical would following
abdominal surgery. To promote healing and fight wound infection, the nurse
plans to arrange to increase the patients intake of:
a. Calcium and vitamin D
b. Vitamin C and zinc
c. B-complex vitamins
d. Vitamin K and iron
28.The nurse must administer an enema to an adult patient with constipation.
Which of the following would be a safe and effective distance for the nurse to
insert the tubing into the patients rectum? Choose all that apply.
a. 5 inches
b. 4 inches
c. 3 inches
d. 2 inches
29.A patient has an area of nonblanchable erythema on his coccyx. The nurse
has determined this to be a stage I pressure ulcer. What would be the most
important treatment for this patient?
a. Frequent turn schedule.
b. Transparent film dressing,
c. Enzymatic debridement.
d. Sheet hydrogel.
30.The nurse in the hospital has a prescription to administer medication at 0400
to Mr. Sanders. Mr. Sanders is asleep when the nurse enters the room. Mr.
Sanders is difficult to arouse and confused. The nurse known the stage of
sleep Mr. Sanders was likely in when she awakened him was?
a. Stage II
b. REM
c. Stage III
d. Stage IV

31.A nurse is caring for a patient who is having and acute asthmatic attack with
copious mucous and difficulty breathing. The patients skin is cyanotic,
respirations are labored, and pulse is rapid. What nursing diagnosis would
have priority for care of this patient?
a. Excess fluid volume
b. Potential for impaired respiratory function
c. Ineffective airway clearance
d. Anxiety
32.The patient has been diagnosed with diabetes for the past 12 years. When
admitted, the patient is unkempt and is in need for a bath and foot care.
When questioned about his hygiene habits, the patient tells the nurse that
baths are taken once a week where he comes from, although he takes a
sponge bath every other day. To provide ultimate care for this patient, the
nurse understands that:
a. All cultures value cleanliness with some degree of importance.
b. Patients who appear unkempt place little importance on hygiene
practices.
c. The patients illness may require teaching of new hygiene practices.
d. Personal preferences determine hygiene practices and are
unchangeable.
33.A patient is having difficulty voiding into the bedpan but states that she feels
her bladder is full. To stimulate micturition, which nursing intervention should
the nurse try first?
a. Administering the prescribed diuretic medication.
b. Obtaining an order for a Foley catheter.
c. Utilizing the power of suggestion by turning on the faucet and letting
the water run.
d. Exiting the room and informing the patient that the nurse will return in
30 minutes to check on her progress.
34.A man was involved in a motor vehicle accident yesterday. He is to be
sedated for over 2 weeks while breathing with the assistance of a mechanical
ventilator. Which of the following would be an appropriate nursing diagnosis
for him at this time?
a. Risk for infections related to subcutaneous injuries.
b. Risk for impaired skin integrity related to immobility.
c. Impaired skin integrity related to ventilator dependency.
d. Impaired tissue integrity related to ventilator dependency.

Answers:
1. C
2. D
3. A

4. B
5. B
6. A
7. C
8. D
9. B
10.A,
11.B,
12.D
13.C
14.D
15.D
16.A
17.C,
18.A
19.D
20.A
21.D
22.D
23.C
24.C
25.C,
26.C
27.B
28.B,
29.A
30.D
31.C
32.C
33.C
34.B

D, E
C, D

D, E, F
D