Question 1: When caring for a client diagnosed with systemic lupus erythematosus (SLE), the nurse should be particularly vigilant for signs of which significant complication?
A) Inflammation of the heart muscle (Cardiomegaly)
B) Peeling skin (Desquamation)
C) Kidney inflammation (Nephritis)
D) Brain and spinal cord inflammation (Meningitis)
Question 2: A client beginning treatment for benign prostatic hypertrophy with finasteride (Proscar) requires discharge education. Which instruction is critical for the nurse to include?
A) Advise the client’s female partner to avoid handling the medication tablets.
B) Instruct the client to always take the medication with food.
C) Inform the client that symptom improvement will be noticeable within one to two weeks.
D) Counsel the client to take the medication at bedtime to reduce nighttime urination.
Question 3: A five-year-old is hospitalized for surgical correction of congenital hip dysplasia. During a physical examination, the nurse would anticipate finding which specific sign?
A) Scarf sign
B) Harlequin sign
C) Cullen’s sign
D) Trendelenburg sign
Question 4: Consumption of which dietary pattern is most closely linked to an increased likelihood of developing colorectal cancer?
A) Diet low in protein, high in complex carbohydrates
B) Diet high in protein, high in simple carbohydrates
C) Diet high in fat, high in refined carbohydrates
D) Diet low in carbohydrates, high in complex proteins
Question 5: When providing comfort to an infant who has recently undergone cleft lip repair, which action should the nurse avoid?
A) Gently holding the infant
B) Offering a pacifier for soothing
C) Providing a visually stimulating mobile
D) Giving sips of sterile water as ordered
Question 6: A client diagnosed with cirrhosis is exhibiting asterixis. The nurse assessing this client would expect to observe which characteristic symptom?
A) Involuntary, flapping tremors of the hands
B) Enlargement of male breast tissue (Gynecomastia)
C) Visible, dilated veins around the navel (Caput medusae)
D) Reddening of the palms of the hands (Palmar erythema)
Question 7: A client with esophageal varices has a prescription for amoxicillin (Amoxil) 500mg capsules. What is the most appropriate action for the nurse to take regarding this medication order?
A) Administer the medication in capsule form as prescribed.
B) Provide extra water for the client to take with the capsule.
C) Give the medication concurrently with an antacid.
D) Consult with the physician to request an alternative medication form.
Question 8: A client with a long-standing inguinal hernia questions the necessity of surgery, stating he has had it for years without significant issues. The nurse understands that the primary rationale for recommending surgical repair is to:
A) Prevent problems with nutrient absorption.
B) Reduce the production of bile salts.
C) Increase the movement of intestinal contents.
D) Avoid the risk of the bowel becoming trapped or obstructed.
Question 9: When teaching a client with iron-deficiency anemia about dietary iron sources, which food should the nurse identify as having a low iron content?
A) Tomatoes
B) Legumes (beans, lentils)
C) Dried fruits (raisins, apricots)
D) Nuts (almonds, walnuts)
Question 10: A client is admitted with suspected acute pancreatitis. Which laboratory result would strongly support this diagnosis?
A) Blood glucose level of 260 mg/dL
B) White blood cell count of 21,000 cells/mm³
C) Platelet count of 250,000 cells/mm³
D) Serum amylase level of 600 units/dL
Question 11: The nurse is instructing a client with Parkinson’s disease on measures to counteract the spinal curvature often associated with the condition. To help prevent spinal flexion, the nurse should advise the client to:
A) Periodically lie face down without using a pillow under the neck.
B) Sleep exclusively on their back with legs extended.
C) Rest in a supine position with the head elevated on pillows.
D) Sleep on either side while making an effort to keep the back straight.
Question 12: The physician orders phenytoin (Dilantin) 100mg intravenously for a client experiencing generalized tonic-clonic seizures. How should the nurse administer this medication?
A) Administer as a rapid IV push over seconds.
B) Mix and administer with intravenous dextrose solution.
C) Administer slowly over a period of 2 to 3 minutes.
D) Infuse through a peripheral vein with a small gauge catheter.
Question 13: The nurse is planning the diet for a client recovering from an episode of acute pancreatitis. Which dietary approach is most appropriate for this client?
A) Low calorie, low carbohydrate diet
B) High calorie, low fat diet
C) High protein, high fat diet
D) Low protein, high carbohydrate diet
Question 14: A client is admitted with a diagnosis of polycythemia vera. The nurse should prioritize monitoring the client for which potential issue?
A) Decreased oxygen saturation levels
B) Reduced respiratory rate
C) Increased production of urine
D) Elevated blood pressure
Question 15: A client with hypothyroidism frequently reports feeling cold. What is the most practical advice the nurse can give the client to improve their comfort with temperature regulation?
A) Use an electric blanket at night for warmth.
B) Wear several layers of clothing.
C) Apply a heating pad to the feet regularly.
D) Take a hot bath in the morning and evening.
Question 16: The nurse is caring for a client with a closed head injury and obtains an intracranial pressure (ICP) reading of 17 mmHg. The nurse interprets this finding as:
A) The ICP is within the normal range, and no immediate action is required.
B) The ICP is lower than normal, suggesting the need for increased IV fluids.
C) The ICP measurement is less reliable than the Glasgow Coma Scale score.
D) The ICP is elevated and the physician needs to be notified.
Question 17: A client is hospitalized with a diagnosis of laryngeal cancer. Which risk factor is considered the most significant contributor to the development of this type of cancer?
A) A family history of laryngeal cancer
B) Regular exposure to irritating airborne substances
C) Frequent overuse or straining of the vocal cords
D) A history of heavy alcohol consumption and tobacco smoking
Question 18: When collecting a health history from a client diagnosed with pernicious anemia, which specific complaint would help differentiate it from other forms of anemia?
A) Reporting difficulty breathing after physical exertion.
B) Experiencing numbness and tingling sensations in the hands and feet.
C) Noting a heart rate that is faster than usual.
D) Having frequent feelings of lightheadedness.
Question 19: A client with rheumatoid arthritis is beginning to develop contractures causing flexion of the knees. What instruction should the nurse give the client to help prevent or reduce these contractures?
A) Lie on their stomach with their feet extending off the end of the mattress.
B) Lie on their back with their feet turned inward.
C) Lie on their right side and point their toes downwards.
D) Lie on their left side and keep their feet in a neutral position.
Question 20: The chart of a client with schizophrenia indicates the presence of echolalia. The nurse observing this client can expect to hear them:
A) Speak using rhyming words or phrases.
B) Repeatedly say words or phrases spoken by others.
C) Include irrelevant and excessive details in their speech.
D) Create new words with personal, idiosyncratic meanings.
Question 21: The mother of a one-year-old child with sickle cell anemia asks why her child did not show symptoms or get diagnosed immediately after birth in the hospital nursery. The nurse’s explanation should be based on the understanding that:
A) A newborn screening test for abnormal hemoglobin is not available.
B) Infants younger than one year do not experience significant fluid loss.
C) Infants rarely get infections that would trigger a sickling crisis.
D) The presence of fetal hemoglobin helps protect the infant in early life.
Question 22: Which activity performed in the morning is beneficial for reducing stiffness commonly experienced by individuals with rheumatoid arthritis?
A) Brushing their teeth
B) Drinking a glass of juice
C) Holding a warm cup of coffee
D) Gently brushing their hair
Question 23: A client with B negative blood type requires a blood transfusion during surgery. If B negative blood is not immediately accessible, which blood type should be transfused?
A) A positive blood
B) B positive blood
C) O negative blood
D) AB negative blood
Question 24: The nurse observes a post-operative client’s respiratory rate decrease significantly from 14 to 6 breaths per minute. The nurse administers naloxone (Narcan) according to a standing order. After giving the medication, the nurse should closely assess the client for which primary sign of therapeutic effect?
A) Changes in pupil size
B) Forceful vomiting
C) Wheezing breath sounds
D) Sudden, intense pain
Question 25: A newborn infant had a birth weight of seven pounds. At six months of age, approximately what weight would the nurse expect this infant to have?
A) 14 pounds
B) 18 pounds
C) 25 pounds
D) 30 pounds
Question 26: A client with celiac disease (nontropical sprue) experiences a flare-up of symptoms. Which food choice from a meal is the most likely cause for the return of the client’s symptoms?
A) Tossed salad with oil and vinegar dressing
B) Baked potato topped with sour cream and chives
C) Cream of tomato soup served with crackers
D) Mixed fruit and yogurt
Question 27: A client with congestive heart failure has been receiving digoxin (Lanoxin). Which observation by the nurse would indicate that the medication is achieving its intended therapeutic effect?
A) The client’s weight remains stable.
B) The client reports an improved appetite.
C) There is a noticeable reduction in swelling in the feet and ankles.
D) The client’s production of urine has increased.
Question 28: Which type of play activity is most appropriate for promoting the gross motor skill development of a toddler?
A) Using a coloring book and crayons
B) Playing with a ball
C) Stacking building cubes
D) Sitting on a swing set
Question 29: A client in labor admits to using alcohol throughout her pregnancy, with the last use occurring the previous day. Based on this history, the nurse’s highest priority assessment for the newborn immediately after birth should focus on signs of:
A) Low-set ears.
B) Facial features such as wide-set eyes.
C) Respiratory depression.
D) Jitteriness or tremors.
Question 30: A client with recurring indigestion is prescribed aluminum carbonate gel (Basaljel). The nurse should educate the client that a common side effect of this medication is:
A) Diarrhea
B) Difficulty emptying the bladder
C) Constipation
D) Mental confusion
Question 31: A client is admitted with a suspected abdominal aortic aneurysm (AAA). What is a common symptom that the client might report experiencing?
A) Reduced urinary output
B) A palpable pulsing sensation near the navel
C) Back pain that lessens when standing upright
D) Loss of feeling in the lower limbs
Question 32: The nurse is caring for a client hospitalized with nephrotic syndrome. Based on the typical treatment plan for this condition, the nurse should anticipate providing which dietary modification?
A) Offering the client extra fluids.
B) Restricting the client’s protein intake.
C) Limiting the number of visitors allowed.
D) Discussing the potential need for dialysis.
Question 33: A client is admitted with acute adrenal crisis (Addisonian crisis). During the initial assessment, the nurse should expect to find that the client has:
A) Increased frequency of urination.
B) Skin that is warm and flushed.
C) A heart rate that is slow and regular.
D) Blood pressure that is low.
Question 34: A five-month-old infant presents to the emergency room with a high fever (103.6°F), irritability, and lethargy, and experienced a seizure en route. A lumbar puncture confirms bacterial meningitis. When assessing this infant, the nurse should specifically look for:
A) Puffiness around the eyes (Periorbital edema).
B) Firmness or bulging of the soft spot on the head (anterior fontanel).
C) The presence of a positive Babinski reflex.
D) The absence of the scarf sign.
Question 35: A client with Pneumocystis jirovecii pneumonia (PJP) is receiving intravenous pentamidine (Pentam). While administering this medication, the nurse should be prepared to monitor for which potential side effect?
A) Hypertension
B) Hypoglycemia
C) Constipation
D) Bradycardia
Question 36: An order is written for Ampicillin 100mg intravenously every six hours for a 7kg infant. The recommended dosage range for infants is 25–50mg/kg/day divided into equal doses. What is the most appropriate nursing action?
A) Administer the medication as ordered.
B) Administer only half of the ordered dose.
C) Administer the ordered dose every 12 hours.
D) Contact the physician to verify or clarify the order.
Question 37: An elderly client is recovering in the hospital after a transurethral prostatectomy (TURP). Which observation made by the nurse should be reported to the physician immediately?
A) Urinary output consistently between 40–50 mL per hour.
B) The client requesting pain medication every four hours.
C) Urine output that is dark red with some small clots.
D) Urine output that is bright red and contains many large clots.
Question 38: Which statement made by the parent of a child with sickle cell anemia demonstrates a correct understanding of how to manage the disease?
A) “His pain occurs because he has too many red blood cells.”
B) “He can go snow skiing with his friends as long as he dresses warmly.”
C) “He will need to drink extra fluids during the summer to prevent dehydration.”
D) “There is a very low chance that his sibling will also have sickle cell disease.”
Question 39: A toddler has completed a course of antibiotics for otitis media (ear infection). A follow-up appointment should be scheduled for what primary reason?
A) To determine if the child has taken all the prescribed antibiotics.
B) To obtain a new prescription in anticipation of the infection returning.
C) To assess whether the ear infection has caused any hearing impairment.
D) To confirm that the infection has completely cleared.
Question 40: A nine-year-old child is admitted to the hospital with suspected rheumatic fever. Which clinical finding would be most suggestive of Sydenham’s chorea, a potential complication?
A) Swelling, inflammation, and fluid accumulation in the joints.
B) Small, painless lumps located over the bony prominences near joints.
C) Faint, ring-like red marks on the skin, often on the trunk or abdomen.
D) Involuntary, jerky, purposeless movements of the limbs and facial muscles.
Question 41: A child diagnosed with croup is placed in a high-humidity tent supplied with room air. The main purpose of using this high-humidity environment is to:
A) Provide supplemental oxygen at a concentration of 30%.
B) Help prevent excessive loss of body water.
C) Reduce fever and prevent dehydration.
D) Thin respiratory secretions and alleviate spasm of the vocal cords.
Question 42: The nurse is performing tracheostomy suctioning on an adult client. What is the recommended negative pressure range to use for adult tracheostomy suctioning?
A) 40–60 mmHg
B) 60–80 mmHg
C) 80–120 mmHg
D) 120–140 mmHg
Question 43: A client is admitted with a diagnosis of myxedema. An initial assessment of this client would likely reveal a constellation of symptoms including:
A) Rapid heart rate, constipation, and bulging eyes.
B) Weight loss, rapid pulse, diarrhea, and signs of heart failure.
C) Decreased body temperature, weight loss, and increased breathing rate.
D) Weight gain, feeling sluggish, slow speech, and a decreased breathing rate.
Question 44: Which statement accurately describes the period during which varicella (chickenpox) is considered contagious?
A) Contagion begins one day before the rash appears and lasts until vesicles are present.
B) Contagion lasts throughout the vesicular and crusting stages of the lesions.
C) Contagion starts with the appearance of the rash and ends when the rash disappears.
D) Contagion begins one day before the rash appears and continues until all lesions have formed scabs.
Question 45: The nurse is reviewing the results of a sweat test performed on a child suspected of having cystic fibrosis. Which specific finding from the sweat test would support a diagnosis of cystic fibrosis?
A) A sweat chloride concentration less than 40 mEq/L.
B) A sweat potassium concentration greater than 40 mEq/L.
C) A sweat chloride concentration greater than 60 mEq/L.
D) A sweat potassium concentration less than 40 mEq/L.
Question 46: A client in labor has an order for meperidine (Demerol) 75mg intramuscularly to be given 10 minutes before anticipated delivery. What should the nurse do regarding this order?
A) Administer the medication intramuscularly immediately to prepare for delivery.
B) Give the medication as ordered, ensuring it is given exactly 10 minutes before delivery.
C) Give the medication during the delivery to help manage pain from the episiotomy.
D) Contact the physician to question the timing of the medication administration.
Question 47: Which of the following statements best characterizes Piaget’s stage of concrete operational thought?
A) Behavior is based on reflexes and develops into imitation.
B) The ability to understand and consider another person’s perspective increases.
C) Thinking processes become more systematic, logical, and organized.
D) The capacity for abstract thinking leads to the formation of logical conclusions.
Question 48: A client admitted to a psychiatric unit claims to be a famous religious figure and is distressed by being kept from their “followers.” This type of delusion is most likely an expression of:
A) Overwhelming anxiety.
B) A reaction formation defense mechanism.
C) Low self-esteem.
D) A response to a recent stressful event.
Question 49: Which statement aligns with Lawrence Kohlberg’s description of the typical moral reasoning of a preschool-aged child?
A) Good behavior is seen as demonstrating respect for parents.
B) Behavior is determined by avoiding punishment and gaining rewards.
C) Obeying rules is considered the correct action.
D) Pleasing others is viewed as good behavior.
Question 50: The nurse is caring for an eight-year-old child who has recently undergone a routine tonsillectomy. Which assessment finding would be most critical and require immediate reporting to the physician?
A) An axillary temperature of 99°F (37.2°C).
B) Reluctance or refusal to swallow liquids.
C) Slight drooling of saliva that appears tinged with blood.
D) A high-pitched, harsh sound heard during breathing.
Question 51: The nurse is admitting a client with a suspected duodenal ulcer. The client is most likely to report that their abdominal discomfort or pain is reduced when they:
A) Avoid consuming any food.
B) Lie down flat on their back.
C) Consume a meal or a snack.
D) Sit upright immediately after eating.
Question 52: The nurse is performing an assessment on a newborn in the well-baby nursery. Which finding should prompt the nurse to suspect the possibility of a congenital cardiac anomaly?
A) Bluish discoloration of the hands and feet (Acrocyanosis).
B) A temporary color change down the midline of the body (Harlequin sign).
C) Paleness around the mouth (Circumoral pallor).
D) Weak or absent pulses felt in the groin area (Diminished femoral pulses).
Question 53: A two-year-old child is hospitalized with a diagnosis of Kawasaki disease. A severe and potentially life-threatening complication associated with Kawasaki disease is:
A) The formation of small, white spots on the iris (Brushfield spots).
B) The development of notched or pegged-shaped teeth (Hutchinson’s teeth).
C) A condition affecting the hip joint (Coxa plana).
D) The formation of large swellings in the walls of coronary arteries (giant aneurysms).
Question 54: The charge nurse is developing a discharge teaching plan for a client with mild preeclampsia. What instruction should be given the highest priority?
A) Advise the client to follow a strict bed rest regimen at home.
B) Instruct the client to report any occurrence of a nosebleed.
C) Counsel the client to avoid all sources of sodium in her diet.
D) Teach the client to notify the healthcare provider if swelling in her feet worsens.
Question 55: The nurse is preparing a client for discharge who is taking a Monoamine Oxidase Inhibitor (MAOI). Which instruction is essential for the nurse to include in the teaching plan?
A) Increase the intake of high-quality protein sources.
B) Drink a minimum of eight glasses of water daily.
C) Wear protective clothing and sunglasses when exposed to sunlight.
D) Avoid taking over-the-counter cold and allergy medications.
Question 56: Which meal choice is appropriate for a client diagnosed with celiac disease?
A) Peanut butter cookies and milk
B) Toast, jam, and apple juice
C) Cheese pizza and a fruit-flavored drink
D) Rice cereal bar and milk
Question 57: A client with hyperthyroidism is receiving lithium carbonate (Eskalith) to help manage thyroid hormone release. Which complaint from the client should alert the nurse to a potential issue related to the lithium medication?
A) The client reports experiencing blurred vision.
B) The client states they have gained a significant amount of weight in the past year.
C) The client complains of increased thirst and more frequent urination.
D) The client reports having a runny nose.
Question 58: The physician has ordered intravenous fluids containing potassium for a client admitted with gastroenteritis and dehydration. Before adding potassium to the IV fluids, what is the most critical assessment the nurse must perform?
A) Check the client’s blood glucose level.
B) Assess the client’s urinary output.
C) Obtain a sample for a stool culture.
D) Obtain a sample for arterial blood gases.
Question 59: A two-month-old infant has just received the first dose of the Tetramune vaccine. What information should the nurse provide the mother about this immunization?
A) This is a single injection that provides protection against measles, mumps, rubella, and varicella.
B) The immunization helps determine if the child is susceptible to pertussis.
C) This is the first in a series of injections that provides protection against diphtheria, pertussis, tetanus, and Haemophilus influenzae type b.
D) This immunization will need to be repeated when the child is four years old.
Question 60: A client with Addison’s disease is receiving glucocorticoid replacement therapy. Which finding would suggest the need for an adjustment in the client’s glucocorticoid dosage?
A) Dry skin and mucous membranes.
B) Increased blood pressure readings.
C) Reports of feeling unusually tired or weak.
D) A decrease in blood glucose levels.
Question 61: When caring for an expectant mother in the early stages of labor, what is the nurse’s immediate priority action after the client’s membranes rupture?
A) Prepare to insert a urinary catheter.
B) Assist with the initiation of epidural anesthesia.
C) Assess the fetal heart rate and pattern.
D) Apply an internal fetal monitoring device.
Question 62: A client diagnosed with myxedema has been prescribed levothyroxine (Synthroid). Which statement by the client indicates they understand the important aspects of taking this medication as taught by the nurse?
A) “I will stop taking this medicine if my stomach gets upset.”
B) “I will take my heart rate before I take the pill each day.”
C) “I will take the medication every morning right after I eat breakfast.”
D) “I will let my doctor know if my eyesight seems blurry.”
Question 63: The nurse is providing care for a client receiving internal radiation therapy via a radium implant for cervical cancer. What is a crucial safety measure the nurse must adhere to when caring for this client?
A) Avoid touching any items used by the client in the room.
B) Provide emotional support by spending extended periods of time at the client’s bedside.
C) Wear a device that tracks the total amount of radiation exposure received.
D) Stand at the foot of the client’s bed when speaking with them.
Question 64: The nurse is caring for a client hospitalized in the manic phase of bipolar disorder. Which snack option would be most suitable for this client?
A) A milkshake
B) Potato chips
C) A piece of fruit, such as an apple
D) Diet cola
Question 65: A client has been prescribed imipramine (Tofranil) for depression. The nurse understands that the maximum therapeutic benefit of this tricyclic antidepressant medication may take several weeks to develop, requiring continued monitoring of the client’s mood and behavior. How long does it typically take to see the full effects?
A) 5 to 7 days
B) 48 to 72 hours
C) 3 to 6 months
D) 2 to 4 weeks
Question 66: An elderly client with glaucoma is prescribed timolol (Timoptic) eyedrops. Caution should be exercised when using timolol eyedrops in clients with a medical history of which condition?
A) Diabetes mellitus
B) Emphysema
C) Gastric ulcers
D) Pancreatitis
Question 67: A two-year-old child is hospitalized with suspected intussusception. Which characteristic finding is frequently associated with this condition?
A) Palpable mass felt over the flank area.
B) Projectile vomiting after feeding.
C) Stools described as resembling “currant jelly.”
D) Stools that are thin and flattened like a ribbon.
Question 68: Which findings would the nurse most likely expect to observe in an infant diagnosed with biliary atresia?
A) Dark-colored stools and poor weight gain.
B) Abdominal swelling and rapid weight gain.
C) Rapid weight gain and an enlarged liver.
D) Abdominal swelling and poor weight gain.
Question 69: A client is receiving external beam radiation therapy for cancer, with the treatment site marked by the physician using a blue pen. What instruction should the nurse provide to the client regarding the marked area?
A) Gently remove the markings with acetone or alcohol.
B) Cover the radiation treatment site with a loose gauze dressing.
C) Sprinkle baby powder over the radiated skin area.
D) Avoid using soap or lotions on the skin within the marked area.
Question 70: A client admitted following a motor vehicle accident has a very high blood alcohol concentration (BAC) of 460 mg/dL. The nurse’s highest priority for monitoring this client should be focused on detecting:
A) Visual disturbances.
B) Rapid heart rate.
C) Loss of physical coordination.
D) Respiratory depression.
Question 71: The nurse is caring for a client with acromegaly who has undergone a transsphenoidal hypophysectomy (surgical removal of the pituitary gland through the nose). What is an essential post-operative assessment for this client?
A) Encourage the client to cough deeply and frequently.
B) Position the client with the head lower than the body.
C) Suction the mouth and pharynx regularly, such as hourly.
D) Monitor the client’s blood glucose levels.
Question 72: A client newly diagnosed with diabetes is started on acarbose (Precose). The nurse should instruct the client to take this medication at which specific time?
A) Daily at bedtime.
B) 30 minutes after starting a meal.
C) One hour before starting a meal.
D) With the very first bite of each meal.
Question 73: A client with a severe pressure ulcer is receiving hyperbaric oxygen therapy. Before the client enters the hyperbaric chamber for treatment, the nurse should perform which action regarding the client’s skin?
A) Apply a lotion containing petroleum jelly to the wound area.
B) Wash the skin gently with water and dry it thoroughly.
C) Apply a dressing that prevents air and moisture from reaching the wound.
D) Apply a moisturizing lotion that contains lanolin to the skin.
Question 74: The physician has prescribed desmopressin acetate (DDAVP) for a client diagnosed with diabetes insipidus. Which finding would best indicate that the medication is having its desired therapeutic effect?
A) The client’s blood sugar level in the morning is 120 mg/dL.
B) The client reports an increase in their overall activity level.
C) The client’s production of urine has significantly decreased.
D) The client’s appetite shows improvement.
Question 75: A client with pregnancy-induced hypertension is scheduled for a Cesarean section. Before the surgery, how should the nurse position the client?
A) Lying on her right side.
B) Lying flat on her back with a small pillow.
C) Lying flat on her back in a knee-chest position.
D) Lying on her left side.
Question 76: The physician has prescribed sodium warfarin (Coumadin) for a client experiencing transient ischemic attacks (TIAs). Which laboratory test is used to monitor the therapeutic effectiveness of warfarin therapy?
A) Bleeding time
B) Partial thromboplastin time (PTT)
C) Prothrombin time (PT) / International Normalized Ratio (INR)
D) Clot retraction time
Question 77: An adolescent client with severe cystic acne has a prescription for isotretinoin (Accutane). Which laboratory test is necessary before the client begins taking this medication?
A) Thyroid function tests.
B) A complete blood count.
C) A clean-catch urine sample for urinalysis.
D) A liver function panel.
Question 78: Twenty-four hours after an uncomplicated labor and vaginal delivery, a client’s white blood cell (WBC) count is reported as 12,000 cells/mm³. The nurse recognizes that this elevated WBC count is most likely an indication of:
A) Dehydration from not eating or drinking during labor.
B) An acute bacterial infection.
C) A normal physiological response to the stress of labor and birth.
D) A sexually transmitted viral infection.
Question 79: A home health nurse is visiting a client who is planning a home birth. Which statement made by the client demonstrates a correct understanding regarding the timing of the newborn screening for phenylketonuria (PKU)?
A) “I will take the baby to the clinic for the blood test within 24 hours of birth.”
B) “I will have the PKU test done when I take her for her first set of shots.”
C) “I will need to arrange for someone to collect a blood sample for PKU screening at home when the baby is three days old.”
D) “I will remind the midwife to collect a sample of cord blood for the PKU test right after the delivery.”
Question 80: A client with a closed head injury is placed on mechanical ventilation due to periods of apnea. Arterial blood gas results show a pH of 7.47, a PaCO₂ of 28 mmHg, and a bicarbonate (HCO₃⁻) of 23 mEq/L. These blood gas findings indicate that the client is experiencing:
A) Metabolic alkalosis.
B) Respiratory acidosis.
C) Respiratory alkalosis.
D) Metabolic acidosis.
Question 81: A client is diagnosed with emphysema and has developed cor pulmonale. Which clinical findings are characteristic signs of cor pulmonale?
A) Swelling in the lower legs and visible distension of the neck veins.
B) Hypoxia, difficulty breathing, and feeling tired with activity.
C) Crackling sounds in the lungs, generalized swelling, and an enlarged spleen.
D) Weight loss, increased red blood cell count, and fever.
Question 82: A client undergoing a laryngectomy returns from surgery with a nasogastric tube in place. What is the primary purpose of having the nasogastric tube after this type of surgery?
A) To keep the stomach decompressed and empty of air.
B) To prevent infection or breakdown of the surgical stitches.
C) To help promote healing of the lining inside the mouth.
D) To prevent swelling and difficulty swallowing.
Question 83: An indwelling urinary catheter is removed on the second post-operative day for a client who underwent a prostatectomy. The client later reports pain and some urine leakage when first voiding. The nurse should explain to the client that:
A) Applying warm compresses over the bladder area will help reduce the discomfort.
B) Perineal muscle strengthening exercises will be started in a few days to help these symptoms.
C) These sensations are expected after catheter removal and will improve over the next few days.
D) If the symptoms don’t get better, the catheter will likely need to be reinserted.
Question 84: A client who has had a right lower lobe lung removal (lobectomy) is being moved from the intensive care unit to a regular medical floor. The nurse understands that during this transport, the client’s chest drainage system:
A) Can be temporarily disconnected from suction, but the chest tube must not be clamped.
B) Must remain connected to a portable suction device throughout the transport.
C) Can be disconnected from suction if the chest tube is clamped beforehand.
D) Must be held at the level of the client’s shoulders during the transport.
Question 85: The nurse is caring for a client who has experienced a myocardial infarction (MI). The nurse knows that the most frequent complication that occurs in clients after an MI is:
A) Enlargement of the right ventricle.
B) High potassium levels in the blood.
C) Abnormal heart rhythms.
D) Enlargement of the left ventricle.
Okay, I will continue the mock test from where we left off.
Question 86: A client develops a fever of 102°F (38.9°C) after undergoing coronary artery bypass surgery. The nurse should promptly report this temperature elevation to the physician because an increase in body temperature can:
A) Indicate that the body is rejecting the new grafts.
B) Cause a dangerous decrease in the heart’s output.
C) Be a sign of fluid accumulation around the heart (cardiac tamponade).
D) Lead to an undesirable increase in the heart’s output.
Question 87: The client’s medical chart indicates that they have expressive aphasia as a result of a stroke. The nurse understands that this client will primarily have difficulty with:
A) Understanding spoken language.
B) Carrying out voluntary physical movements.
C) Using and recognizing objects correctly.
D) Producing spoken words and writing.
Question 88: A client receiving tranylcypromine (Parnate), a type of MAO inhibitor, is admitted experiencing a hypertensive crisis. Consumption of which type of food is most likely to have triggered this severe reaction when taken with the medication?
A) Cottage cheese
B) Cream cheese
C) Processed cheese
D) Cheddar cheese
Question 89: To help prevent stiffness and deformities in the knee joints of a client experiencing a flare-up of rheumatoid arthritis, what intervention should the nurse encourage?
A) Keep the joint completely immobilized for 2 to 3 weeks.
B) Restrict any movement to avoid causing further swelling.
C) Stay on strict bed rest until the joint swelling has decreased.
D) Gently move the joint through its range of motion as tolerated within pain limits.
Question 90: The nurse is assessing a client in the emergency department who sustained a trauma and notes a penetrating wound to the abdomen with some internal organs visible outside the body (exposed viscera). What is the nurse’s immediate priority action?
A) Gently attempt to push the abdominal contents back inside the wound.
B) Cover the exposed organs with a sterile dressing moistened with saline solution.
C) Apply a non-stick dressing over the wound site for protection.
D) Cover the area with a dressing soaked in petroleum jelly.
Question 91: A client admitted following a major trauma with multiple injuries. What is the most appropriate sequence of priorities for the nurse when managing this client?
A) Control bleeding, prevent shock, establish an open airway, assess for head injuries.
B) Assess for head injuries, control bleeding, establish an open airway, prevent shock.
C) Prevent shock, assess for head injuries, establish an open airway, control bleeding.
D) Establish an open airway, control bleeding, prevent shock, assess for head injuries.
Question 92: The nurse is educating the mother of a child diagnosed with Attention Deficit Disorder (ADD) about the prescribed medication methylphenidate (Ritalin). The nurse will know the mother understands the teaching when she emphasizes the importance of:
A) Monitoring for signs of being overly sleepy.
B) Ensuring the child uses sunscreen with a high SPF.
C) Offering the child calorie-dense snacks frequently.
D) Watching for any indications of infection.
Question 93: A home health nurse manages a caseload of several elderly clients. Which of the following clients is most likely to be vulnerable to becoming a victim of elder abuse?
A) A 70-year-old male with a history of diabetes mellitus.
B) A 64-year-old female who recently had hip replacement surgery.
C) A 72-year-old male diagnosed with Parkinson’s disease.
D) A 76-year-old female diagnosed with Alzheimer’s dementia.
Question 94: A nurse at a summer camp is applying sunscreen to children participating in swimming lessons. Chemical sunscreens provide maximum protection when applied how long before sun exposure?
A) Just before going into the sun.
B) Five minutes prior to sun exposure.
C) 15 minutes prior to sun exposure.
D) 30 minutes prior to sun exposure.
Question 95: The physician suspects “shaken baby syndrome” in a 13-month-old infant brought to the emergency room after a reported fall from a highchair. Which specific finding would strongly support a diagnosis of “shaken baby syndrome”?
A) Bruising around the eyes (Periorbital bruising).
B) A fracture of the collarbone (clavicle).
C) Bleeding in the back of the eyes (Retinal hemorrhages).
D) A fracture in the upper arm bone (humerus).
Question 96: A post-operative client has an order for meperidine (Demerol) 75mg IM and promethazine (Phenergan) 25mg IM every 3–4 hours as needed for pain. The interaction between these two medications when given together results in what type of effect?
A) An opposing effect.
B) An effect where each drug cancels the other out.
C) A combined effect that is greater than the sum of their individual effects.
D) An effect that stimulates the nervous system.
Question 97: Which obstetric client is considered to be at the highest risk for delivering an infant with respiratory distress syndrome (RDS)?
A) A 30-year-old client with a history of smoking during pregnancy.
B) A 24-year-old client with pre-existing diabetes mellitus.
C) A 32-year-old client with pregnancy-induced hypertension.
D) A 28-year-old client with a history of alcohol use during pregnancy.
Question 98: A client with a C4 spinal cord injury is placed in skeletal traction using cervical tongs. What is a key nursing intervention for caring for this client?
A) Loosening the pins slightly if the client reports a headache.
B) Releasing the traction system for five minutes during each nursing shift.
C) Performing meticulous sterile care at the pin insertion sites according to protocol.
D) Elevating the head of the bed to a 90-degree angle.
Question 99: The nurse is assessing a client who has recently undergone coronary artery bypass graft (CABG) surgery. Which finding is the most critical and should be reported to the physician immediately?
A) The client reports feeling confused and restless.
B) The client’s skin appears pale and feels cool to the touch.
C) The amount of drainage from the chest tube is 150 mL over the past hour.
D) The client’s urinary output is 40 mL in the past hour.
Question 100: Before administering a client’s scheduled morning dose of digoxin (Lanoxin), the nurse checks the apical pulse and finds it is 54 beats per minute. What is the most appropriate nursing action?
A) Administer the medication and continue to monitor the client’s heart rate.
B) Withhold the medication until the client’s heart rate increases on its own.
C) Record the pulse rate in the client’s chart and administer the medication as ordered.
D) Withhold the medication and contact the physician to report the finding.
Question 101: What advice should the nurse give a new mother regarding the appropriate timing and method for introducing solid foods into her infant’s diet?
A) Solid foods should not be started until the infant is between 8 and 10 months old, when the tongue-thrust reflex disappears.
B) It is acceptable to mix solid foods into the infant’s bottle or use an infant feeder to make feeding easier.
C) Begin introducing solid foods with pureed fruits and vegetables before other food groups.
D) Introduce one new solid food at a time, waiting 4 to 7 days before introducing another.
Question 102: When performing Leopold maneuvers on a client who is 32 weeks pregnant, the nurse would expect to feel what level of fetal movement?
A) Moderate fetal movement.
B) Minimal fetal movement.
C) Active and vigorous fetal movement.
D) No fetal movement.
Question 103: A client with a history of phenylketonuria (PKU) is attending a family planning clinic. The nurse is providing education for maintaining a healthy pregnancy. Which statement made by the client indicates a need for further teaching?
A) “I should eat plenty of fresh fruits and raw vegetables for snacks.”
B) “My baby could have intellectual disabilities if I don’t follow a low-phenylalanine diet.”
C) “I need to start eating a diet low in phenylalanine before I become pregnant.”
D) “I can use artificial sweeteners to help control my weight during pregnancy.”
Question 104: The nurse is educating the mother of an infant diagnosed with galactosemia. Which piece of information is essential to include in the nurse’s teaching plan?
A) It’s okay to gradually reintroduce foods containing galactose as the child grows older.
B) Foods that contain galactose are necessary for the infant’s healthy growth.
C) Future children in the family will not be affected by this condition.
D) Carefully read all food and medication labels to check for the presence of lactose.
Question 105: Which specific eye finding is a classic sign associated with Tay-Sachs disease?
A) White flecks observed in the iris.
B) Paleness of the tissue lining the eyelids (conjunctiva).
C) A bluish tint to the white part of the eyes (sclera).
D) A distinctive cherry-red spot located on the macula of the retina.
Question 106: A client diagnosed with schizophrenia begins taking olanzapine (Zyprexa). Three weeks later, the client develops severe muscle stiffness and a high fever. What should be the nurse’s highest priority action?
A) Administer any prescribed medication to treat symptoms of Parkinson’s disease.
B) Order laboratory tests including a complete blood count and creatinine phosphokinase.
C) Withhold all scheduled morning medications for the client.
D) Arrange for the client to be transferred to a medical unit for evaluation and management.
Question 107: A client diagnosed with human immunodeficiency virus (HIV) is experiencing gastrointestinal symptoms, including diarrhea. Which type of food should the nurse advise the client to avoid?
A) Foods rich in calcium.
B) Canned or frozen vegetables.
C) Processed meat products.
D) Uncooked fruits and vegetables.
Question 108: A four-year-old child is admitted to the hospital with acute leukemia. What are the most critical complications for which the nurse must closely monitor the child?
A) Abdominal discomfort and loss of appetite.
B) Feeling tired and easily bruising.
C) Pinpoint red spots on the skin and sores in the mouth lining.
D) Bleeding and paleness of the skin.
Question 109: A five-month-old infant is diagnosed with atopic dermatitis (eczema). The nurse’s primary interventions for this infant will focus on:
A) Limiting the infant’s intake of oral fluids.
B) Keeping the infant’s skin as dry as possible.
C) Administering medications to reduce fever.
D) Preventing skin infections.
Question 110: A client who is on a mechanical ventilator begins to actively resist or “fight” the ventilator breaths. Which type of medication would the physician most likely order to help manage this?
A) An antihistamine like hydroxyzine (Atarax).
B) An opioid analgesic like fentanyl (Sublimaze).
C) A paralytic agent like pancuronium bromide (Pavulon).
D) A benzodiazepine like midazolam (Versed).
Question 111: A client with a history of diverticulitis reports experiencing abdominal pain, fever, and diarrhea. Consumption of which food is most likely responsible for triggering these symptoms?
A) Steamed carrots.
B) Baked fish.
C) Mashed potatoes.
D) Whole-grain cereal.
Question 112: The home health nurse is visiting a client diagnosed with Paget’s disease. What is an important component of preventive care for this client?
A) Encouraging the client to take a daily multivitamin supplement.
B) Advising the client about the importance of regular dental check-ups.
C) Recommending that the client get the annual influenza vaccination.
D) Ensuring the client’s home environment is free of clutter to prevent falls.
Question 113: The physician has scheduled a Whipple procedure for a client diagnosed with pancreatic cancer. The nurse understands that the client’s cancer is located in which specific part of the pancreas?
A) The tail of the pancreas.
B) The body of the pancreas.
C) The head of the pancreas.
D) The entire pancreas.
Question 114: A child with cystic fibrosis is receiving dornase alfa (Pulmozyme) via inhalation therapy. Which side effect is commonly associated with this medication?
A) Loss of hair.
B) Brittle fingernails.
C) Sore throat or voice changes.
D) Significant weight gain.
Question 115: Four days after giving birth, a client develops complications related to late postpartum hemorrhage. What is considered the most common cause of late postpartum hemorrhage (hemorrhage occurring 24 hours to 6 weeks after birth)?
A) Tears in the cervix.
B) Uterine atony (uterus fails to contract).
C) Tears or trauma to the perineum.
D) Small pieces of placental tissue remaining in the uterus.
Question 116: During a home health visit, the nurse finds four young children unsupervised. The youngest child has bruises on the face and back and distinct circular burns on the inside of the right forearm. What is the nurse’s immediate and primary responsibility?
A) Take the children immediately to a shelter for victims of abuse.
B) Remain with the children at the home until an adult family member returns.
C) Transport the youngest child to the nearest emergency room for examination.
D) Contact child protective services or the appropriate child welfare authorities.
Okay, I will continue the mock test from where we left off.
Question 117: A client is diagnosed with post-traumatic stress disorder (PTSD) following a traumatic event. The nurse’s initial priority in providing care for this client should be focused on:
A) Discussing the specific details of the traumatic experience.
B) Helping the client manage intense feelings of anger.
C) Administering medication to help the client sleep.
D) Establishing a safe and supportive therapeutic environment.
Question 118: The physician has prescribed oxycodone (Percocet) for a client recovering from abdominal surgery. What is the primary objective of nursing care when a client is receiving an opioid analgesic like Percocet?
A) Preventing dependence or addiction to the medication.
B) Facilitating the client’s ability to move around.
C) Reducing or eliminating the client’s experience of pain.
D) Preventing the client from feeling nauseated.
Question 119: Which specific blood level of aminophylline is associated with signs of potential toxicity?
A) 5 micrograms/mL.
B) 10 micrograms/mL.
C) 20 micrograms/mL.
D) 25 micrograms/mL.
Question 120: What is the best clinical indicator that a client with ineffective airway clearance requires suctioning?
A) The client’s blood oxygen saturation level.
B) The client’s respiratory rate.
C) Abnormal sounds heard when listening to the client’s lungs.
D) Results from the client’s arterial blood gas test.
Question 121: Infants should be positioned in a car safety seat in a semi-reclined orientation, facing the rear of the vehicle. This positioning should be maintained until the infant reaches a minimum weight of:
A. 10 pounds
B. 15 pounds
C. 20 pounds
D. 25 pounds
Question 122: The nurse is caring for a client diagnosed with irritable bowel syndrome (IBS). Which characteristic is typical of irritable bowel syndrome?
A. Swelling, thickening of the intestinal wall, and abscess formation.
B. The development of small pouch-like sacs in the wall of the intestine.
C. Periods of constipation alternating with periods of diarrhea.
D. Low blood calcium levels and anemia due to iron deficiency.
Question 123: A client taking phenytoin (Dilantin) to control tonic-clonic seizures is preparing for hospital discharge. What information should the nurse include in the client’s discharge teaching plan regarding this medication?
A. Advise the client that the medication may cause staining of the teeth.
B. Instruct the client that it is necessary to avoid consuming a diet high in carbohydrates.
C. Inform the client that regular laboratory blood tests will be required.
D. Counsel the client that the medication commonly causes significant drowsiness.
Question 124: Assessment of a newborn male indicates that he has hypospadias. The nurse understands that because of this condition:
A. Surgical correction is typically performed when the infant reaches six years of age.
B. The infant should undergo circumcision to make urination easier.
C. Surgical correction is usually planned to be completed by six months of age.
D. The infant should not be circumcised in the newborn period.
Question 125: The nurse is providing dietary counseling for a client with elevated blood cholesterol levels. Which type of cooking oil is generally NOT recommended as part of a low-cholesterol diet plan?
A. Canola oil.
B. Sunflower oil.
C. Safflower oil.
D. Coconut oil.
Question 126: A client is hospitalized with signs indicating potential rejection following a recent kidney transplant. Which finding would the nurse most likely expect to observe during the client’s assessment if rejection is occurring?
A. The client has lost two pounds in the last 24 hours.
B. A decrease in blood pressure.
C. Urinary output of 50 mL per hour.
D. An increase in the client’s blood pressure.
Question 127: A client admitted after a motor vehicle accident has a blood alcohol level (BAL) of 180 mg/dL. The nurse understands that the alcohol in the client’s system is typically metabolized at a relatively constant rate. Approximately how long should it take for the alcohol to be completely metabolized from this client’s system?
A. Five hours.
B. Seven hours.
C. Three hours.
D. Nine hours.
Question 128: The nurse is providing care for a client diagnosed with Stage III (severe) Alzheimer’s disease. Which characteristic behavior or symptom is most typical of this advanced stage?
A. Experiencing memory loss.
B. Difficulty communicating verbally.
C. Wandering behavior, especially at night.
D. Failing to recognize familiar objects.
Question 129: The doctor has prescribed cortisone (Cortone) for a client with systemic lupus erythematosus (SLE). Which instruction is important for the nurse to give this client regarding the medication?
A. Instruct the client to wear sunglasses outdoors to help prevent cataracts.
B. Advise the client to take the medication 30 minutes before eating a meal.
C. Recommend that the client schedule a time to receive the influenza vaccine.
D. Teach the client to report any noticeable changes in appetite or body weight.
Question 130: The nurse is caring for a client who has undergone an above-the-knee amputation (AKA). To help prevent the development of a hip flexion contracture, what nursing intervention should be implemented?
A. Keep the client’s residual limb elevated on two pillows.
B. Place the client in a prone (lying on the stomach) position for 15-30 minutes a couple of times each day.
C. Elevate the foot of the bed by placing it on shock blocks.
D. Place positioning rolls (trochanter rolls) along either side of the affected leg area.
Question 131: The mother of a six-month-old infant asks the nurse when her child will have all of his primary (“baby”) teeth. The nurse knows that most children typically have completed the eruption of all their primary teeth by approximately what age?
A. 24 months.
B. 18 months.
C. 12 months.
D. 30 months.
Question 132: A client with an esophageal tamponade tube (like a Sengstaken-Blakemore tube) develops signs of respiratory distress, including a high-pitched sound during inhalation (inspiratory stridor). What should be the nurse’s immediate priority action?
A. Deflate the balloons and remove the tube from the client’s airway.
B. Apply oxygen at 4 liters per minute via nasal cannula.
C. Increase the pressure in the esophageal balloon.
D. Elevate the head of the client’s bed to a 45-degree angle.
Question 133: The nurse is assessing the heart sounds of a client diagnosed with mitral stenosis, a condition that often follows rheumatic fever. To best auscultate and hear the characteristic murmur associated with mitral stenosis, where should the nurse place the stethoscope?
A. In the fourth intercostal space at the mid-clavicular line.
B. In the third intercostal space to the left of the sternum.
C. In the third intercostal space to the right of the sternum.
D. In the fourth intercostal space directly below the sternum.
Question 134: While providing care for a client receiving internal radiation therapy for cervical cancer, the nurse observes that the radioactive implant has become dislodged and is lying in the bed. What is the nurse’s immediate and appropriate action?
A. Place the implant in a biohazard bag and return it to the laboratory department.
B. Instruct the client to put on gloves and attempt to reinsert the implant herself.
C. Use long forceps or tongs to pick up the implant and place it in a designated lead-lined container.
D. Discard the implant by flushing it down the toilet twice.
Question 135: The nurse is preparing a client for discharge following a laparoscopic cholecystectomy (gallbladder removal). What information should the nurse include in the discharge teaching?
A. Inform the client that she should expect to have clay-colored stools for several days.
B. Advise the client to avoid taking a bath in a tub for the first 48 hours after surgery.
C. Tell the client to expect to experience pain in the lower part of her abdomen for the next week.
D. Instruct the client to report any pain experienced in her back or shoulders.
Question 136: A client diagnosed with schizophrenia is started on olanzapine (Zyprexa). Three weeks later, the client develops severe muscle rigidity and a high body temperature. The nurse’s highest priority action should be:
A. Order laboratory tests including a complete blood count and creatinine phosphokinase.
B. Administer prescribed medication to treat symptoms of Parkinson’s disease.
C. Arrange for the client to be transferred to a medical unit for comprehensive evaluation.
D. Withhold all scheduled morning medications for the client.
Question 137: A client diagnosed with human immunodeficiency virus (HIV) is experiencing significant gastrointestinal symptoms, including persistent diarrhea. Which type of food should the nurse instruct the client to avoid to minimize the risk of exacerbating symptoms or causing infection?
A. Canned or frozen vegetables.
B. Processed meat products.
C. Uncooked fruits and vegetables.
D. Foods rich in calcium.
Question 138: A four-year-old child is admitted to the hospital with a new diagnosis of acute leukemia. What are the two most important complications for which the nurse should monitor the child closely?
A. Abdominal discomfort and loss of appetite.
B. Feeling tired and easily bruising.
C. Bleeding and paleness of the skin.
D. Pinpoint red spots on the skin and sores in the mouth lining.
Question 139: A five-month-old infant has been diagnosed with atopic dermatitis (eczema). The nursing care plan for this infant will primarily focus on which goal?
A. Limiting the infant’s intake of oral fluids.
B. Keeping the infant’s skin as dry as possible to prevent irritation.
C. Administering medications to reduce any associated fever.
D. Implementing interventions to prevent secondary skin infections.
Question 140: A client who is receiving mechanical ventilation starts to exhibit signs of agitation and is breathing out of sync with the ventilator. Which type of medication is commonly prescribed to help manage this situation?
A. An opioid analgesic, such as fentanyl (Sublimaze).
B. A medication that causes muscle paralysis, such as pancuronium bromide (Pavulon).
C. A sedative medication from the benzodiazepine class, such as midazolam (Versed).
D. An antihistamine with sedative effects, such as hydroxyzine (Atarax).