Practice Exam #19 - 40 questions

 

1. A home health nurse is at the home of a client with diabetes and arthritis. The client has difficulty drawing up insulin. It would be most appropriate for the nurse to refer the client to
A) A social worker from the local hospital
B) A physical therapist to improve fine motor coordination
C) An activity therapist from the community center
D) Another client with diabetes mellitus and takes insulin

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2. A couple asks the nurse about risks of several birth control methods. What is the most appropriate response by the nurse?
A) Norplant is safe and may be removed easily
B) Oral contraceptives should not be used by smokers
C) Depo-Provera is convenient with few side effects
D) The IUD gives protection from pregnancy and infection

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3. The nurse is caring for a client with a long leg cast. During discharge teaching about appropriate exercises for the affected extremity, the nurse should recommend exercises
A) isometric
B) range of motion
C) aerobic
D) isotonic

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4. Which behavioral characteristic describes the domestic abuser?
A) Alcoholic
B) Over confident
C) High tolerance for frustrations
D) Low self-esteem

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5. A client asks the nurse about including her 2 and 12 year-old sons in the care of their newborn sister. Which of the following is an appropriate initial statement by the nurse?
A) "Focus on your sons' needs during the first days at home."
B) "Tell each child what he can do to help with the baby."
C) "Suggest that your husband spend more time with the boys."
D) "Ask the children what they would like to do for the newborn."

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6. The nurse is caring for a post-surgical client at risk for developing deep vein thrombosis. Which intervention is an effective preventive measure?
A) Place pillows under the knees
B) Use elastic stockings continuously
C) Encourage range of motion and ambulation
D) Massage the legs twice daily

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7. A client is scheduled for a percutaneous transluminal coronary angioplasty (PTCA). The nurse knows that a PTCA is the
A) surgical repair of a diseased coronary artery
B) placement of an automatic internal cardiac defibrillator
C) procedure that compresses plaque against the wall of the diseased coronary artery to improve blood flow
D) non-invasive radiographic examination of the heart

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8. A nurse is caring for a 2 year-old child after corrective surgery for Tetralogy of Fallot. The mother reports that the child has suddenly begun seizing. The nurse recognizes this problem is probably due to
A) a cerebral vascular accident
B) postoperative meningitis
C) medication reaction
D) metabolic alkalosis

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9. A client with asthma has low pitched wheezes present on the final half of exhalation. One hour later the client has high pitched wheezes extending throughout exhalation. This change in assessment indicates to the nurse that the client
A) has increased airway obstruction
B) has improved airway obstruction
C) needs to be suctioned
D) exhibits hyperventilation

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10. Following a diagnosis of acute glomerulonephritis (AGN) in their 6 year-old child, the parents remark: “We just don’t know how he caught the disease!” The nurse’s response is based on an understanding that
A) AGN is a streptococcal infection that involves the kidney tubules
B) the disease is easily transmissible in schools and camps
C) the illness is usually associated with chronic respiratory infections
D) it is not ’’caught” but is a response to a previous B-hemolytic strep infection

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11. During the admission assessment on a client with chronic bilateral glaucoma, which statement by the client would the nurse anticipate since it is associated with this problem?
A) "I have constant blurred vision."
B) "I can't see on my left side."
C) "I have to turn my head to see my room."
D) "I have specks floating in my eyes."

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12. A 19 year-old client is paralyzed in a car accident. Which statement used by the client would indicate to the nurse that the client is using the mechanism of "suppression"?
A) "I don't remember anything about what happened to me."
B) "I'd rather not talk about it right now."
C) "It's all the other guy's fault! He was going too fast."
D) "My mother is heartbroken about this."

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13. A client was admitted to the psychiatric unit after complaining to her friends and family that neighbors have bugged her home in order to hear all of her business. She remains aloof from other clients, paces the floor and believes that the hospital is a house of torture. Nursing interventions for the client should appropriately focus on efforts to
A) convince the client that the hospital staff is trying to help
B) help the client to enter into group recreational activities
C) provide interactions to help the client learn to trust staff
D) arrange the environment to limit the client’s contact with other clients

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14. A client with schizophrenia is receiving haloperidol (Haldol) 5 mg T.I.D. The client’s family is alarmed and calls the clinic when "his eyes rolled upward." The nurse recognizes this as what type of side effect?
A) Oculogyric crisis
B) Tardive dyskinesia
C) Nystagmus
D) Dysphagia

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15. The parents of a newborn male with hypospadias want their child circumcised. The best response by the nurse would be to inform them that
A) circumcision is delayed so the foreskin can be used for the surgical repair
B) this procedure is contraindicated because of the permanent defect
C) there is no medical indication for performing a circumcision on any child
D) the procedure should be performed as soon as the infant is stable

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16. A mother brings her 26 month-old to the well-child clinic. She expresses frustration and anger due to her child’s constantly saying "no" and his refusal to follow her directions. The nurse explains this is normal for his age, as negativism is attempting to meet which developmental need?
A) Trust
B) Initiative
C) Independence
D) Self-esteem

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17. Following mitral valve replacement surgery a client develops PVC’s. The health care provider orders a bolus of Lidocaine followed by a continuous Lidocaine infusion at a rate of 2 mg/minute. The IV solution contains 2 grams of Lidocaine in 500 cc’s of D5W. The infusion pump delivers 60 microdrops/cc. What rate would deliver 4 mg of Lidocaine/minute?
A) 60 microdrops/minute
B) 20 microdrops/minute
C) 30 microdrops/minute
D) 40 microdrops/minute

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18. To prevent a Valsalva maneuver in a client recovering from an acute myocardial infarction, the nurse would
A) assist the client to use the bedside commode
B) administer stool softeners every day as ordered
C) administer antidysrhythmics pm as ordered
D) maintain the client on strict bed rest

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19. A 16 year-old client is admitted to a psychiatric unit with a diagnosis of attempted suicide. The nurse is aware that the most frequent cause for suicide in adolescents is
A) Progressive failure to adapt
B) Feelings of anger or hostility
C) Reunion wish or fantasy
D) Feelings of alienation or isolation

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20. The nurse is caring for a woman 2 hours after a vaginal delivery. Documentation indicates that the membranes were ruptured for 36 hours prior to delivery. What is the priority nursing diagnoses at this time?
A) Altered tissue perfusion
B) Risk for fluid volume deficit
C) High risk for hemorrhage
D) Risk for infection

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21 . The nurse is caring for a 20 lbs (9 kg) 6 month-old with a 3 day history of diarrhea, occasional vomiting and fever. Peripheral intravenous therapy has been initiated, with 5% dextrose in 0.33% normal saline with 20 mEq of potassium per liter infusing at 35 ml/hr. Which finding should be reported to the health care provider immediately?
A) 3 episodes of vomiting in 1 hour
B) Periodic crying and irritability
C) Vigorous sucking on a pacifier
D) No measurable voiding in 4 hours

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22. A client is scheduled for an Intravenous Pyelogram (IVP). In order to prepare the client for this test, the nurse would
A) instruct the client to maintain a regular diet the day prior to the examination
B) restrict the client's fluid intake 4 hours prior to the examination
C) administer a laxative to the client the evening before the examination
D) inform the client that only 1 x-ray of his abdomen is necessary

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23. The nurse is caring for a client in the late stages of amyotrophic lateral sclerosis (ALS). Which finding would the nurse expect?
A) confusion
B) loss of half of visual field
C) shallow respirations
D) tonic-clonic seizures

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24. The nurse is caring for a 13 year-old following spinal fusion for scoliosis. Which of the following interventions is appropriate in the immediate post-operative period?
A) Raise the head of the bed at least 30 degrees
B) Encourage ambulation within 24 hours
C) Maintain in a flat position, logrolling as needed
D) Encourage leg contraction and relaxation after 48 hours

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25. An infant weighed 7 pounds 8 ounces at birth. If growth occurs at a normal rate, what would be the expected weight change at 6 months of age?
A) Double the birth weight
B) Triple the birth weight
C) Gain 6 ounces each week
D) Add 2 pounds each month

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26. A client complained of nausea, a metallic taste in her mouth, and fine hand tremors 2 hours after her first dose of lithium carbonate (Lithane). What is the nurse’s best explanation of these findings?
A) These side effects are common and should subside in a few days
B) The client is probably having an allergic reaction and should discontinue the drug
C) Taking the lithium on an empty stomach should decrease these symptoms
D) Decreasing dietary intake of sodium and fluids should minimize the side effects

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27 Which response by the nurse would best assist the chemically impaired client to deal with issues of guilt?
A) "Addiction usually causes people to feel guilty. Don’t worry, it is a typical response due to your drinking behavior."
B) "What have you done that you feel most guilty about and what steps can you begin to take to help you lessen this guilt?"
C) "Don’t focus on your guilty feelings. These feelings will only lead you to drinking and taking drugs."
D) "You’ve caused a great deal of pain to your family and close friends, so it will take time to undo all the things you’ve done."

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28 . Which statement by the client with chronic obstructive lung disease indicates an understanding of the major reason for the use of occasional pursed-lip breathing
A) "This position of my lips helps to keep my airway open.”
B) "I can expel more when I pucker up my lips to breathe out."
C) "My mouth doesn't get as dry when I breathe with pursed lips."
D) "With prolonging breathing out with pursed lips the little areas in my lungs don't collapse."

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29. A 57 year-old male client has a hemoglobin of 10 mg/dl and a hematocrit of 32%. What would be the most appropriate follow-up by the home care nurse?
A) Ask the client if he has noticed any bleeding or dark stools
B) Tell the client to call 911 and go to the emergency department immediately
C) Schedule a repeat Hemoglobin and Hematocrit in 1 month
D) Tell the client to schedule an appointment with a hematologist

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30. A client experiences post partum hemorrhage eight hours after the birth of twins. Following administration of IV fluids and 500 ml of whole blood, her hemoglobin and hematocrit are within normal limits. She asks the nurse whether she should continue to breast feed the infants. Which of the following is based on sound rationale?
A) "Nursing will help contract the uterus and reduce your risk of bleeding."
B) "Breastfeeding twins will take too much energy after the hemorrhage."
C) "The blood transfusion may increase the risks to you and the babies."
D) "Lactation should be delayed until the "real milk" is secreted."

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31. On admission to the psychiatric unit, the client is trembling and appears fearful. The nurse’s initial response should be to
A) Give the client orientation materials and review the unit rules and regulations
B) Introduce him/herself and accompany the client to the client’s room
C) Take the client to the day room and introduce her to the other clients
D) Ask the nursing assistant to get the client’s vital signs and complete the admission search

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32. While caring for the client during the first hour after delivery, the nurse determines that the uterus is boggy and there is vaginal bleeding. What should be the nurse's first action?
A) Check vital signs
B) Massage the fundus
C) Offer a bedpan
D) Check for perineal lacerations

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33. The nurse is teaching parents about the treatment plan for a 2 weeks-old infant with Tetralogy of Fallot. While awaiting future surgery, the nurse instructs the parents to immediately report
A) loss of consciousness
B) feeding problems
C) poor weight gain
D) fatigue with crying

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34. For a 6 year-old child hospitalized with moderate edema and mild hypertension associated with acute glomerulonephritis (AGN), which one of the following nursing interventions would be appropriate?
A) Institute seizure precautions
B) Weigh the child twice per shift
C) Encourage the child to eat protein-rich foods
D) Relieve boredom through physical activity

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35. A nurse is teaching the parent of a nine month-old infant about diaper dermatitis. Which of the following measures would be appropriate for the nurse to include?
A) Use only cloth diapers that are rinsed in bleach
B) Do not use occlusive ointments on the rash
C) Use commercial baby wipes with each diaper change
D) Discontinue a new food that was added to the infant's diet just prior to the rash

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36. An adolescent client comes to the clinic 3 weeks after the birth of her first baby. She tells the nurse she is concerned because she has not returned to her pre-pregnant weight. Which action should the nurse perform first?
A) Review the client's weight pattern over the year
B) Ask the mother to record her diet for the last 24 hours
C) Encourage her to talk about her view of herself
D) Give her several pamphlets on postpartum nutrition

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37. The nurse is assessing an infant with developmental dysplasia of the hip. Which finding would the nurse anticipate?
A) unequal leg length
B) limited adduction
C) diminished femoral pulses
D) symmetrical gluteal folds

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38. A newborn has been diagnosed with hypothyroidism. In discussing the condition and treatment with the family, the nurse should emphasize
A) they can expect the child will be mentally retarded
B) administration of thyroid hormone will prevent problems
C) this rare problem is always hereditary
D) physical growth/development will be delayed

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39. The nurse understands that a priority goal of involuntary hospitalization of the severely mentally ill client is
A) re-orientation to reality
B) elimination of symptoms
C) protection from harm to self or others
D) return to independent functioning

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40. A 3 year-old had a hip spica cast applied two hours ago. In order to facilitate drying, the nurse should
A) Expose the cast to air and turn the child frequently
B) Use a heat lamp to reduce the drying time
C) Handle the cast with the abductor bar
D) Turn the child as little as possible

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Practice Exam #19 - 40 questions