4.

 The nurse is completing a health history

MS II MT2 on a patient admitted with ovarian cancer.
Which of the following  clinical
manifestations would the nurse expect to
1. While giving care, the nurse finds the
assess?
radiation implant on the bed of a client with
A. Fish-like odor of the vagina
cervical radiation implant? What should she
B. Increased abdominal girth
do next? C. Fever and chills
a. Pick up the implant with long handled forceps D. Lower abdominal pelvic pain
and place it in a lead container
b. Call the physician Clear selection
c. Reinsert the implant onto the vagina
5. The nurse reminds a visitor to a patient
immediately
d. Pick up the implant with gloved hands and who has an internal radiation implant to:
flush it down the toilet 1. Avoid visitation if you are pregnant.
2. Take off all metals, such as your watch and
Clear selection belt.
3. Limit visitation time.
2.   A client with cancer is admitted with
4. Wear a protective mask
fever of 103.4˚F and a platelet count of 5. Stay at least 6 feet away from bedside.
18,000/mm3.  Nurse Hannah can expect in a. 3, 4, 5
doctor’s order to include: b. All of the above
c. 1, 2, 3, 4
A. Aspirin every four hours while febrile d. 1, 3, 5
B. Seizure precautions
C. Restriction in some activities Clear selection
D. Tracheostomy set at bedside
6.  While the patient is receiving vincristine
Clear selection intravenously, Nurse Isabelle should
3. The patient is admitted to the emergency prepare which antidote for extravasation?
room after having been bitten on the hand A. Hyaluronidase
by a black widow spider. The nursing B. Sodium bicarbonate
C. Isotonic sodium thiosulfate
intervention that is indicated is to:
D. Ascorbic acid injection
a. Elevate the patient’s hand above his or her
heart. Clear selection
b. Monitor for respiratory distress.
c. Wrap the hand in a warm compress. 7. A 38 year old woman asks the nurse why
d. Seat the patient upright in a chair. she should have a mammogram. The best
response for the nurse to make is?
Clear selection
a. “Mammograms can diagnose breast cancer
SITUATION: Cancer can occur in any part with nearly 100% accuracy.”
of the female reproductive system – the b. “Every sexually active woman needs to have
a mammogram, since there is a correlation
vulva, vagina, cervix, uterus, fallopian
between sexual intercourse and breast cancer.”
tubes, or ovaries.   These cancers are c. “You are 38 years old. This is the appropriate
called gynecologic cancers.   Gynecologic time to have a baseline mammogram done.”
cancers can directly invade nearby tissues d. “The dye or contrast medium, used when you
have a mammogram helped the radiologist see
and organs or spread (metastasize) through
the difference between a tumor and a cyst.
the lymphatic vessels and lymph nodes
(lymphatic system) or bloodstream to Clear selection
distant parts of the body.
8. While shopping in the mall, the nurse
sees a lady fall suddenly to the floor. On
immediate assessment, the nurse realizes shock.  The best nursing intervention would
this is not a cardiac arrest and she has no be :
need for CPR. The immediate actions by A. provide opportunities for the family to spend
the nurse are to: time with the patient and help them to
understand the irreversible stage of shock.
a. Have someone help place large blankets or
B. inform the patient’s family early that the
coats under the legs and trunk.
patient will likely not survive, which allows the
b. Check pulse and respirations, and call for a
family time to make plans and move forward.
blood pressure cuff.
C. Closely monitor fluid replacement therapy
c. Call for help and check pulse, respiration, and
and inform the family that the patient will
mental status.
probably survive and return to normal life.
d. Check pulse, respirations, skin color, and
D. Protect the patient’s airway, optimize
temperature.
intravascular volume, and support the pumping
Clear selection action of the heart.

9.  When assessing a client for early Clear selection

hypovolemic shock, the nurse observes for 13. Which of the following types of blood is
which of the following? considered safest for trauma victims to
a. Cool, clammy skin receive as an emergency transfusion while
b. Decreased pulse rate the type and cross match is being done?
c. Hemorrhage
d. Warm, flushed skin a. Type O
b. Type B
Clear selection c. Type A
d. Type AB
10. When assisting in the monitoring of a
hospitalized client with hypovolemic shock, Clear selection

you would most need to monitor for which 14. The American Cancer Society
of the following problems when this client is recommends annual mammography for
being given large amounts of isotonic asymptomatic women over age ____ years.
crystalloid intravenous solutions such as
a. Fifty
normal saline or lactated ringers? b. Forty
a. Signs of respiratory distress c. Sixty
b. Diminished or absent bowel sounds d. Sixty-five
c. Thromboemboli
d. Rapid rise in blood pressure Clear selection

Clear selection
15. Which of the following statements, if
made by a patient who is under Doxorubicin
11. The nurse has given activated charcoal hydrochloride (Adriamycin), would indicate
to a client for drug overdose. The nurse to a nurse that the patient needs further
explains to the client that the purpose of instruction about the adverse effects?
activated charcoal is:
a. “My hair is going to fall out.”
a. To cause diarrhea and quick evacuation of b. “My urine will turn red.”
drug fragments c. “I can expect to become constipated.”
b. To decrease the present serum drug level d. “I may develop an irregular heartbeat.”
c. To absorb toxins from the GI tract
d. To induce vomiting and remove remaining Clear selection
pills
16.  A trauma patient arrives to the
Clear selection emergency room and is hemorrhaging.  The
nurse is aware that this patient is at
12.  A patient comes to the emergency
greatest risk for which type of shock?
department in the irreversible stage of
A. Cardiogenic 21. A 45 year old client has just been
B. Hypovolemic
admitted to the hospital for an abdominal
C. Neurogenic
D. Septic hysterectomy following diagnosis of uterine
cancer. Results of the lab tests indicate that
Clear selection
the client’s WBC is 9,800/cu mm. The
17. An X-ray of the left femur shows a nursing intervention is to
fracture that extends through the midshaft a. Call the operating room and cancel the
of the bone and multiple splintering surgery.
b. Take no action as this is a normal value.
fragments. What is this type of fracture
c. Notify the surgeon immediately.
called? d. Call the lab and have the test repeated
a. Compression fracture
b. Greenstick fracture Clear selection
c. Comminuted fracture
22. A client has a diagnosis of acute
d. Impacted fracture
cholecystitis with biliary colic. In addition to
Clear selection pain in the right upper quadrant, the nurse
should expect client to have:
18. The following are interventions for a
client stung with a bee, except: a. Melena and diarrhea
b. Vomiting of coffee-ground emesis
a. Wash wound with soap and water c. An intolerance to foods high in lipids
b. Apply ice to the stung part d. Gnawing pain when the stomach is empty
c. Remove the stinger
d. Scratch the wound 23. After surgery, Mrs. ID’s bile drainage
has been prolonged and she complains of
Clear selection
raw, excoriated skin around the T-tube.
19. The nurse has been assigned to care After assessing the skin, the nurse should
for the following six clients. Which of the plan to:
clients would the nurse NOT expect to be at
A. Reinforce the dressing when they are wet.
risk for development of pulmonary B. Cleanse the area with antiseptic solution
embolism? C. Use a skin barrier around the T-tube site
D. Change the type of adhesive tape used on
a. A client who is on complete bed rest
the dressing
following extensive spinal surgery
b. A client who has a large venous stasis ulcer 24. The nurse is providing first aid to a
on the right ankle area
victim of poisonous snakebite. Which
c. A client who has recently been admitted with
a broken femur and is awaiting surgery should be the nurse’s first action?
d. A client who has a pleural effusion secondary A. Apply the tourniquet to the affected limb
to lung cancer B. Cut an X in across the bite and suck out the
venom
Clear selection
C. Administer a corticosteroid medication
D. Have the client lie still and remove
20. The nurse recognizes that the client has
constrictive items.
a good understanding of the means to
reduce the chances of colon cancer when SITUATION: A cancer is an abnormal
she states: growth of cells (usually derived from a
a. I will exercise daily single cell).  The cells have lost normal
b. I will include more red meat in my diet control mechanisms and thus are able to
c. I will have an annual chest X-ray expand continuously.  Invade adjacent
d. I will include more fruits and vegetables in my tissues, migrate to distant parts of the body,
diet
and promote the growth of new blood
Clear selection vessels from which the cells derive
nutrients.  Cancerous (Malignant) cells can 30. Mrs. ID is to undergo an oral
develop from any tissue within the body. cholecystography. As part of the
preparation, the nurse should tell her:
25. A client with cancer is being evaluated
for possible metastasis. Which of the a. The test will be administered on 2 successive
days
following is one of the most common
b. The contrast medium to be used will cause
metastasis sites for cancer cells? constipation
a. Colon c. Any stone present will be readily visible on
b. Reproductive tract the X-ray film
c. Liver d. A low fat supper should be eaten the night
d. White blood cells (WBCs) before the test

26. What category of 4-Tier System Triage 31. Which sign indicates adequate
where injuries are significant and require intravenous fluid replacement for a client
medical care but can wait hours without with a 30% total body surface area burn?
threat to life or limb. Individuals in this group a. Slowing of a previously rapid pulse
receive first aid treatment. b. Urinary output of 15 to 20 mL/hr
c. Increasing hematocrit level
a. Minimal d. Central venous pressure progressing from 5
b. Delayed to 1mm
c. Expectant
d. Immediate 32.  The rescuer understands that the
compression-to-ventilation ratio for one-
27. A nurse establishes that a client is
rescuer adult CPR is:
unresponsive. After calling for help, which
of the following actions should the nurse a. 5:1
b. 15:1
take first?
c. 30:2
a. Check the client’s pulse and initiate CPR d. 15:2
b. Open the client’s airway and check for
breathing 33. The stages of shock proceed in a
c. Administer abdominal thrusts and back definite sequence. What is the correct
blows to the client order?
d. Position the client on the right side and
sweep the mouth a. Progressive, compensatory, refractory
b. Compensatory, progressive, refractory
28. A nurse notes that a client has dyspnea c. Distributive, compensatory, refractory
and red blotches on the face and arms, d. Refractory, progressive, compensatory
starting to become anxious following 34.  The patient presents in the ER with an
exposure to latex. Which of the emergency evisceration following a knife attack.  The
treatment should be taken fist? best nursing intervention related to the
a. Start oxygenation 1 liter per minute via nasal exposed bowel is to:
cannula
A. gently replace the bowel into the abdominal
b. Administer epinephrine 0.4mL
cavity.
subcutaneously
B. Place a sterile wrapped sandbag on the
c. Start IV access with a large bore catheter
abdomen to prevent further evisceration.
d. Administer Benadryl 25mg intramuscularly
C. Place the patient in a high Fowler’s position
29. A high-protein diet is ordered for a client to allow the bowel to drop back into the
abdominal cavity.
recovering from a fracture. High protein is
D. Cover the bowel with a moist saline dressing.
ordered for which of the following reasons?
35.  A nurse caring for an oncology patient
a. Protein promotes gluconeogenesis
b. Protein has anti-inflammatory properties who develops erythema following radiation
c. Protein promotes cell growth and bone union therapy should instruct the patient to:
d. Protein decreases pain medication
A. apply ice to the area 40.  A patient diagnosed with prostate
B. keep the area cleanly shaven
cancer is scheduled for brachytherapy.  The
C. apply petroleum ointment to the affected
area patient and his wife are unsure of the
D. Avoid using lotions on the area of treatment. procedure’s complications.  They state that
their daughter is 3 months pregnant.  What
36. Chest percussion is ordered for the
teaching should the nurse provide to this
client Q.I.D the primary purpose of the
family?
chest percussion for the client is to:
A. The patient should not be in contact with the
a. Stimulate deeper inhalations
baby when it is born.
b. Improve ciliary action in the bronchioles
B. The patient will be in the hospital for a period
c. Propel secretions along the respiratory tract
of a few days after surgery.
d. Loosen secretions in congested areas of the
C. The patient and his wife can have sexual
lungs
intercourse without difficulty.
D. The patient should avoid close contact with
37. In testing for Prostate Specific Antigen
his daughter for 2 months.
(PSA), the nurse will collect which of the
following specimens? 41. The ER is flood with patients injured in a
a. Blood typhoon. Which patients can be assigned to
b. Feces share a room in the room in ER during the
c. Urine disaster?
d. Prostate fluid
a. A schizophrenic client having visual and
38. Following a cholecystectomy the client auditory evolving and a client with ulcerative
colitis
should be assessed for signs of bleeding or
b. A client who is 6 months pregnant with
hemorrhage. These observations are made abdominal pain and a client with facial
because: lacerations and a broken arm
c. A child whose pupils are fixed and dilated
a. Prostaglandins are released at the surgical
with his parents a client with a frontal head
site
injury
b. The inflammatory process interferes with
d. A child who arrived with puncture wound to
platelet formation
the abdomen and client chest pain
c. Diaphragmatic excursion places pressure on
the suture line
42. Ms. C, receiving external radiation
d. Blood clotting may be hindered by lack of
vitamin K absorption therapy for skin cancer, makes all of the
following statements to her nurse. Which of
39. Mr. A.J, a travel salesman, develops the statements tells the nurse the Miss C
gastric bleeding and is hospitalized. An need further teaching about the care she
important etiologic clue for the nurse to requires because of her radiation therapy?
explore while taking his history would be:
a. “I will check my mouth frequently for signs of
A. The medication he has been taking irritation.”
B. Have recent foreign travel b. “I know that if I get tired easily, it may be form
C. His usual dietary pattern the radiation and doesn’t mean my cancer is
D. The status of family relationship getting worse.”
c. “I will use a good quality lotion on my skin to
SITUATION: Treatment options offered to keep the radiation from burning it.”
cancer patients should be based on realistic d. “I can take ginger root juice if I feel
and achievable goals for each specific type nauseated.”
of cancer.  Multiple modalities are 43. A client is diagnosed with cystitis. Client
commonly used in cancer treatment.  A teaching aimed at preventing a recurrence
variety of approached, including surgery, should include which of the following
radiation therapy, chemotherapy and instructions?
targeted therapies may be used at various
a. Bathe in a tub
times throughout treatment.
b. Wear cotton underpants D. 1:2500 dilution intramuscular
c. Use a feminine hygiene spray
d. Limit your intake of cranberry juice 48. Which of the following serious
complications occur with long bone
44. A client with a 10 year history of
fracture?
emphysema is admitted in acute respiratory
a. Bone emboli
distress. The nurse’s assessment of this
b. Fat emboli
client includes monitoring for: c. Platelet emboli
a. Signs of chest pain d. Serious emboli
b. Use of accessory muscles of respiration
49. After a nurse instills atropine drops into
c. Signs and symptoms of respiratory alkalosis
d. Prolonged inspiration and expenditure of both eyes for a client undergoing an
considerable effort ophthalmic examination, which of the
following instructions would be given to the
45. A nurse manager is reviewing the
client?
nursing staff the purposes for applying wrist
and ankle restraints to client. The manager a. “Be careful because the blink reflex is
paralyzed.”
determines that the staff need further
b. “Avoid wearing your regular glasses when
review when the staff states that use of the driving.”
restraint is to: c. “Be aware that the pupils may be unusually
small.”
a. Limit the movement of a limb
d. “Wear dark glasses in bright light because the
b. Keep the client in bed at night
pupils are dilated.”
c. Prevent the violent client from injuring self
and others 50. A client with Sengstaken-Blakemore
d. Prevent the client from pulling out lines of
tube in place is admitted from the
catheters
emergency room. The nurse understands
46.  Kolin and Joesef are celebrating their that the purpose of this tube is to:
3rd anniversary at Luneta Park.  While
a. Remove ammonia-forming bacteria from the
strolling around the part, Joesef was stung gastro-intestinal tract
by a bee in his left arm.  Kolin should do b. Control ascites
which of the following first? c. Apply pressure to esophageal varices
d. Control bleeding from gastritis
A. Remove the stinger with one quick scrape
using fingernail. 51. Following the surgery for a colostomy,
B. remove the stinger by using a quick pinch the most effective way of helping a client
over the sac.
accept the costomy would be to:
C. immediately apply ice over the site.
D. give Joesef an oral antihistamine. a. Begin to teach self-care of the colostomy
immediately
SITUATION: Nurses in this field provide b. Provide literature containing factual data
care for patients in the critical or emergency about colostomies
phase of an illness or trauma, and must be c. Contact a member of a support group to
come and speak with the client
able to recognize life-threatening problems
d. Point out the number of important people
and rapidly arrange necessary care.  These who have had colostomies
nurses are not limited to only working in the
emergency room of a hospital. 52. Which finding suggests that fluid
resuscitation has been effective:
47.  A patient presents to the emergency
a. Urine output of 15 ml/hour
room in cardiac arrest following a bee sting. b. Urine output of 20 ml/hour
The nurse should have epinephrine: c. Urine output of 25 ml/hour
d. Urine output of 30 ml/hour
A. 1: 1000 dilution in the upper thigh
B. 1:1500 dilution intracardiac
C. 1:2000 dilution intravenous
53. Mr. Mercado is suffering from cancer of 57. As an immediate treatment for epistaxis,
the pancreas. The patient asks the nurse the nurse should give the following
the name of the surgery used to treat his instructions:
cancer. The nurse’s correct response would a. “Sit down on a solid surface, lean your head
be: forward so that you don’t choke on the blood,
and pinch your nose shut for at least 10
a. Whipple procedure
minutes.”
b. Billroth procedure
b. “Sit down on a solid surface, lean your head
c. Hassab’s procedure
forward to let the blood run out, and then pinch
d. Mile’s procedure
your nose closed for at least 30 minutes.”
54. A nurse is assigned to care for a client c. “Stand still, lean your head forward, and pinch
your nose tightly for at least 10 minutes.”
who sustained a burn injury. The nurse
d. “Stand still, lean your head backward so that
reviews the physician’s orders and should the blood won’t get all over everything, and
question the registered nurse about which pinch your nose shut for at least 10 minutes.”
Order?
58. Which of the following statements is
a. Monitor weight daily true about fracture reduction?
b. Monitor urine output hourly
c. Maintain the nasogastric tube with a. All fracture can be reduced
intermittent suction b. Fracture reduction restores alignment
d. Administer morphine sulfate intramuscularly c. Non displaced fractures may be reduced
every 3 hours as needed for pain d. Fracture reduction is usually performed with
minimal discomfort
55. A patient is scheduled for a
59. After the cervical radiation implant is
chemotherapy treatment in about 30
placed, the nurse initiates what appropriate
minutes. Breakfast trays have arrived and
activity order for this client?
are being served on the unit. The nurse’s
best intervention would be to: a. Bed rest
b. Out of bed in a chair only
a. Offer to call the family to come and be c. Out of bed
present after the treatment. Encourage the d. Ambulation to the bathroom only
patient to drink at least all of orange juice and
coffee. 60. What is the first intervention for a client
b. Encourage the patient to eat all his breakfast experiencing myocardial infarction (MI)?
to keep up his strength to fight the cancer.
Remind the patient that breakfast is about one a. Administer morphine
third of daily intake. b. Administer oxygen
c. C. Listen attentively to any concerns that the c. Administer sublingual nitroglycerin
patient voices regarding the treatment. Offer to d. Obtain an electrocardiogram
hold his tray until after the treatment.
d. Suggest that the patient request a dose of 61. The emergency room nurse delivers a
strong analgesic instead of eating, because this report on a patient that’s arriving on the
treatment is very painful. orthopedic floor and states that the patient
56. Skin closure with a heterograft is has a fracture of the nose that has resulted
performed on a client with burn injuries. The in a skin tear and involvement of the
client asks the nurse about this type of mucous membrane of the nasal passages.
graft. The nurse bases the response on the The orthopedic nurse is aware that this
knowledge that a heterograft can be best description likely indicated which type of
described as: fracture?
a. complete
A. Skin from a cadaver
b. Compound
B. Skin from a skin bank
c. Greenstick
c. Skin from another species
d. Comminuted
d. skin from a burned client
62.  The nurse cautions that the most intravenous line and extravasation at the
common site of cancer in adult men is the: site. The nurse avoids doing which of the
A. Colon following in the management of this
B. Lung situation?
C. Pancreas
a. Administering an available antidote as
D. Prostate
prescribed
63. What is the primary reason for b. Applying direct manual pressure to the site
c. Leaving the needle in place and aspirating
administering morphine to a client with a
any residual medication
myocardial infarction? d. Stopping the administration of the
a. To sedate the client medication
b. To decrease the client’s pain
68. Nausea and vomiting are common
c. to decrease the client’s anxiety
d. to decrease the demand on the client’s heart adverse effects of radiation and
chemotherapy, then should a nurse
64. The nurse assesses that the patient is administer antiemetics?
in shock based on the findings of:
a. 30 minute before initiation of therapy
a. Failure of the neurological system, thready b. with the administration of therapy
pulse, decreased respirations, decreased BP, c. immediately after nausea begins
and decreased LOC. d. when the therapy is completed.
b. Failure of the renal system with bounding
pulse, shallow respirations, decreased BP, 300 69. Toxicity from which of the following
mL urine in the last hour, displaying unfounded medications may cause a client to see a
anger.
green halo around lights?
c. Lack of urine output in the last hour, thready
pulse, shallow respirations, decreased BP, and a. Digoxin
patient crying softly. b. Furosemide (Lasix)
d. Unable to arouse patient, temperature 99.2º c. Metoprolol (Lopressor)
F, pulse 100, respiration 30, BP 120/78. d. Enalapril (Vasotec)

65. Which of the following statements 70. Which of the following drugs is most
explains the main difference between commonly used to treat cardiogenic shock?
rheumatoid arthritis and osteoarthritis? A. Depomine (Intropin)
a. Osteoarthritis is gender specific, rheumatoid B. Enalapril (Vasotec)
arthritis isn’t. c. Furosemide (Lasix)
b. Osteoarthritis is a localized disease, d. Metoprolol (Lopressor)
rheumatoid arthritis is systemic.
71. A patient is being sent to the unit from
c. Osteoarthritis is a systemic disease,
rheumatoid arthritis is localized. the ER with a diagnosis of shock. The nurse
d. Osteoarthritis has dislocations subluxations, knows that the types of shock are:
rheumatoid arthritis doesn’t.
a. Hypovolemic, cardiogenic, and distributive
66. During the assessment of the client, shock.
b. Cardiogenic, renal, and hypovolemic shock.
signs of osteoarthritis are noted. Which of
c. Renal, hypervolemic, and distributive shock.
the following assessment findings would d. Multiple organ, cardiogenic, and renal shock.
indicate osteoarthritis:
72. Which of the following nursing
a. Elevated sedimentation rate
assessment findings indicates hypovolemic
b. Multiple subcutaneous nodules
c. Asymmetrical joint involvement shock in a client who has had a 15% blood
d. Signs and symptoms of inflammation such loss?
as heat fever
a. Systolic blood pressure less than 90 mmHg
67. Enchong, who is receiving b. Pupils unequally dilated
c. Respiratory rate of 8 breaths/minute
chemotherapy, has an infiltrated
d. Pulse rate less than 60 bpm
73. A client has a T-tube in place following b. The patient’s long history of a respiratory
problem indicates that he would be unable to
a cholecystectomy and choledochostomy. A
absorb oxygen given at a higher rate.
T-tube is inserted primarily to: c. The cells in the alveoli are so damaged by the
a. Drain bile from the cystic duct patient’s long history of a respiratory problem
b. Keep the common bile duct patent that higher levels of oxygen and reduced levels
c. Prevent abscess formation at the surgical of carbon dioxide are likely to cause the cells to
site burst
d. Provide a port for contrast dye in a d. The patient’s respiratory center is so
cholangiogram accustomed to high carbon dioxide and low
blood oxygen concentrations. That changing
74. When caring for a client 8 hours this concentration with oxygen therapy may
following the surgical creation of a eliminate the patient’s stimulus to breathing.

colostomy, the observation that would be 78. Which of the following diagnostic tools
considered normal is: is most commonly used to determine the
a. The presence of hyperactive bowel sounds location of myocardial infarction?
b. The absence of drainage from the colostomy
A. Cardiac catheterization
c. A dusty-colored edematous appearing stoma
B. Cardiac enzymes
pink moist
c. Echocardiogram
d. Bright bloody drainage from the NGT
d. Electro cardiogram (ECG)
75. A community health nurse is providing a
79.  When performing the Heimlich
cancer prevention class at a local church.
maneuver on a conscious adult victim, the
The nurse informs the class that digital
rescuer delivers inward and upward thrusts
rectal examination (DRE) used to screen for
specifically
cancer of the prostate is recommended for
a. Below the xiphoid process and above the
every man:
umbilicus
A. Abstaining from sexual activity b. Over the victim’s midabdominal area
B. over age 18 c. Above the umbilicus
C. over age 35 d. At the level of the xiphoid process
D. over age 50
80.  Once the airway is unobstructed, the
76. Vambie’s sister is concerned of her nurse emergency should ensure adequate
chance to acquire the same disease as her ventilation is maintained to prevent hypoxia
sister. She is scheduled to have her and hypercapnia. Hypoxia and hypercapnia
mammography. The nurse should tell the can be accurately assessed through
client that:
a. arterial blood gas
a. To avoid the use of deodorant, powders and b. pulse oxymeter
creams on the day of the test c. capnography
b. There is no discomfort associated with the d. all of the above
procedure
c. To maintain an NPO status 8 hours before 81. The meal pattern that would be most
the procedure appropriate once the bleeding is controlled
d. Mammography takes about 1 hour is:
77. Oxygen at the rate of 1.5L/min via usual a. Three meals large enough to supply adequate
cannula is prescribed for the client. Which energy
b. Regular meals and snacks to limit gastric
of the following statements best describes
discomfort
why oxygen therapy is maintained at a c. Limited food and fluid intake when he has
relative low level of concentration? pain
d. A flexible plan according to his appetite
a. Oxygen will be lost at the patient’s nostril if
given at a higher level in nasal cannula. 82. The AMD prescribes Cimetidine and
Maalox. The nurse should administer:
a. One immediate before and other b. Manage vasoconstriction of vascular bed
b. The drugs at least one hour apart c. Manage fluid overload
c. The two drugs simultaneously d. Manage increased cardiac output
d. The drugs together with milk or orange
89. The OPD nurse is planning for the day’s
83.  To combat the most common adverse visits. Which of the following client should
effects of chemotherapy, the nurse would she see first?
administer an:
a. 78 year old who had a gastrectomy 3 weeks
a. antiemetic ago with a PED tube
b. antibiotic b. 5 month old discharged one week with
c. anticoagulant pneumonia who is being treated with
d. antimetabolite amoxicillin liquid suspension
c. 50 year old with MRSA being treated with
84.  A hospitalized patient is place on vancomycin via PICC line
diethylstilbestrol (DES) for prostate cancer. d. 30 year old with an exacerbation of multiple
The nurse explains the possible side effects sclerosis being treated with cortisone via a
centrally placed venous catheter
of the medication, which is:
A. Gynecomastia 90. The nurse arrives for her shift at 6am
B. Pruritus and receives her assignment. Which patient
C. Constipation should the nurse assess first?
D. Tinnitus
a. A diabetic patient whose blood sugar at
85. A client is receiving spironolactone to 5:50am was 40 and who just received 50%
treat hypertension. Which of the following dextrose for a hypoglycaemic episode
b. A patient who was admitted with chest pain
instructions should the nurse provide?
whose troponin I result were 0.6 and 0.8mg/mL
a. “Eat food high in potassium” at 24 and 48 hours after admission and is now
b. “Take daily potassium supplement” complaining of indigestion
c. “Discontinue sodium restrictions.” c. A patient who was treated for a temperature
d. “Avoid salt substitutes” of 39 degrees Celsius at 4am and who has
pneumonia and oxygen saturation of 94% on
86. A client with polycythemia vera is at risk 2LPM
for thrombosis from which of the following d. A patient with peptic ulcer disease who has
conditions? pulled out the peripheral IV catheter and is
scheduled to received a dose of famotidine
a. Thrombocytopenia (Pepcid) at 8am.
b. Increased blood viscosity
c. Increased blood velocity 91. A patient is receiving another course of
d. Chemotherapy treatment chemotherapy as his cancer treatment after
some previous radiation treatments. He
87. The nurse is developing a nursing care
asks about several cancer terms, which he
plan for a patient in shock should include
has heard referring to him. Correct
the nursing diagnosis of:
interpretations of these words for this
a. Decreased cardiac output related to
patient are that:
hypovolemia.
b. Increased cardiac output related to a. Carcinogen refers to some of the materials in
hypertension. his environment such as cigarettes, asbestos,
c. Increased cardiac output related to and mercury.
hypotension. b. Biofeedback refers to special diet foods and
d. Decreased cardiac output related to specific vitamins that he will need to take on a
hypertension. regular basis now.
c. Antineoplastic refers to drugs that increase
88.  Which of the following is the most the spread of his cancer.
important goal of nursing care for a client d. Alopecia refers to the darkening of the skin
who is in shock? over his cancer area

a. Manage inadequate tissue perfusion

92. A patient tells the nurse that she is 97. After a subtotal gastrectomy, a client
afraid of getting cervical cancer because resumed to the surgical unit. The nurse can
her mother died of cervical cancer.  The best prevent pulmonary complications by:
most appropriate response by the nurse a. Keeping an oral airway in place
would be: b. Maintaining a consistent oxygen therapy
c. Promoting frequent turning and deep
A. “You need to have a pelvic examination every
breathing to mobilized secretions
6 months because of your history”
d. Suctioning secretions as necessary
B. “If you have regular Pap smears, cervical
cancer is usually diagnosed early and cured.” 98. If during a colostomy irrigation, a client
C. “There’s no need to worry so much. Cervical
complains of abdominal cramps, the nurse
cancer does not run in families.”
D. “Cervical cancer is sexually transmitted. should:
Don’t switch partners often and you don’t have a. Clamp the catheter for a few minutes
to worry.” b. Discontinue the irrigation
c. Lower the container of the fluid
93. Which of the following symptoms
d. Elevate the container of the fluid
usually signifies rapid expansion and
impending rupture of an abdominal aortic Situation: Nurses in many practice settings
aneurysm? encounter patients with neurologic
function.Emergency situations are
a. Abdominal pain
b. Absent pedal pulse unpredictable events that need prompt
c. Angina intervention. It is vital to every nurse to
d. Lower back pain possess first aid common sense.
94. When assessing a client for an 99.  Persons with 2nd/3rd degree burns in
abdominal aortic aneurysm, which area of excess of 60% of body surface area do
the abdomen is most commonly palpated? belong to what category?
a. Right upper quadrant a. Immediate
b. Directly over the umbilicus b. Delayed
c. Middle lower abdomen to the left of the c. Minimal
midline d. Expectant
d. Middle lower abdomen to the right of the
midline 100. In what 4-Tier System Triage category
belong those patients who obtained
95.  After immediate threats to life have
maxillofacial wounds without airway
been corrected in a patient with multiple
compromise, genitourinary tract disruption,
trauma, the nurse and trauma team will:
and fractures requiring open reduction?
A. Perform a rapid physical assessment
B. Splint fractures a. Immediate
C. Perform a thorough physical examination b. Delayed
D. Establish the patient’s age c. Minimal
d. Expectant
96.  A nurse who is talking to a patient
 
when he begins choking on his lunch and
coughing forcefully should:
A. Stand him up and perform the abdominal
thrust maneuver from behind.
B. Lay him down, straddle him, and perform the
abdominal thrust maneuver
C. Leave him to get assistance
D. Stay with him but not intervene at this time.