NAME: _________________________________ AREA/DATE OF ROTATION: _______________________

DATE: _______________________ SECTION/GROUP: _________________________

Instruction: Multiple Choice: Select the letter of the bet answer. Write your answer in the
answer sheet provided for you. No ERASURES of any kind.

Test I. Oncology and Palliative Nursing 10. When a client has a lobectomy, what fills the space
1. Which of the following laboratory values is expected for where the lobe was?
a client just diagnosed with chronic lymphocytic a. The space stays empty.
leukemia? b. The surgeon fills the space with gel
a. Elevated sedimentation rate c. The lung space fills up with serous fluid
b. Uncontrolled proliferation of granulocytes d. The remaining lobe or lobes overexpand to fill the space.
c. Thrombocytopenia and increased lymphocytes 11. Which of the following is the primary goal for surgical
d. Elevated aspartate aminotransferase and alanine resection of lung cancer?
aminotransferase levels. a. To remove the tumor and all surrounding tissue.
2. Which of the following statements is correct about the b. To remove the tumor and as little surrounding tissue as
rate of cell growth in relation to chemotherapy? possible.
a. Faster growing cells are less susceptible to chemotherapy. c. To remove all of the tumor and any collapsed alveoli in the
b. Non-dividing cells are more susceptible to chemotherapy same region.
c. Faster growing cells are more susceptible to chemotherapy d. To remove as much as the tumor as possible, without
d. Slower growing cells are more susceptible to chemotherapy. removing any alveoli.
3. Which of the following foods should a client with 12. The client with a benign lung tumor is treated in which
leukemia avoid? of the following ways?
1. White bread a. The tumor is treated with radiation only.
2. Carrot sticks b. The tumor is treated with chemotherapy only.
3. Stewed apples c. The tumor is left alone unless symptoms are present.
4. Medium rare steak d. The tumor is removed, involving the least possible amount of
4. A client with leukemia has neutropenia. Which of the tissue.
following functions must be frequently assessed? 13. In the client with terminal lung cancer, the focus of
a. Blood pressure nursing care is on which of the following nursing
b. Bowel sounds interventions?
c. Heart sounds a. Provide emotional support
d. Breath sounds b. Provide nutritional support
5. During a routine physical examination, a firm mass is c. Provide pain control
palpated in the right breast of a 35-year-old woman. Which d. Prepare the client’s will
of the following findings or client history would suggest 14. Which of the following complications are three main
cancer of the breast as opposed to fibrocystic disease? consequences of leukemia?
a. History of early menarche a. Bone deformities, spherocytosis, and infection.
b. Cyclic changes in mass size b. Anemia, infection, and bleeding tendencies
c. History of anovulatory cycles c. Lymphocytopoiesis, growth delays, and hirsutism
d. Increased vascularity of the breast d. Polycythemia, decreased clotting time, and infection.
6. The client with which of the following types of lung 15. Which of the following assessment findings in a client
cancer has the best prognosis? with leukemia would indicate that the cancer has invaded
a. Adenocarcinoma the brain?
b. Oat cell a. Headache and vomiting.
c. Squamous cell b. Restlessness and tachycardia
d. Small cell c. Hypervigilant and anxious behavior
7. A centrally located tumor would produce which of the d. Increased heart rate and decreased blood pressure.
following symptoms? 16. Which of the following is the reason to perform a
a. Coughing spinal tap on a client newly diagnosed with leukemia?
b. Hemoptysis a. To rule out meningitis
c. Pleuritic pain b. To decrease intracranial pressure
d. Shoulder pain c. To aid in classification of the leukemia
8. Which of the following interventions is the key to d. To assess for central nervous system infiltration
increasing the survival rates of clients with lung cancer? 17. Which of the following tests in performed on a client
a. Early bronchoscopy with leukemia before initiation of therapy to evaluate the
b. Early detection child’s ability to metabolize chemotherapeutic agents?
c. High-dose chemotherapy a. Lumbar puncture
d. Smoking cessation b. Liver function studies
9. A client has been diagnosed with lung cancer and c. Complete blood count (CBC)
requires a wedge resection. How much of the lung is d. Peripheral blood smear
removed? 18. Which of the following immunizations should not be
a. One entire lung given to a 4-month-old sibling of a client with leukemia?
b. A lobe of the lung a. Diphtheria and tetanus and pertussis (DPT) vaccine.
c. A small, localized area near the surface of the lung. b. Hepatitis B vaccine
d. A segment of the lung, including a bronchiole and its alveoli.
c. Haemophilus influenzae type b vaccines (Hib)
d. Oral poliovirus vaccine (OPV)
19. Nausea and vomiting are common adverse effects of
radiation and chemotherapy. When should a nurse
administer antiemetics?
a. 30 minutes before the initiation of therapy.
b. With the administration of therapy.
c. Immediately after nausea begins.
d. When therapy is completed.
20. The nurse is instructing the client to perform a
testicular self-examination. The nurse tells the client:
a. To examine the testicles while lying down.
b. The best time for the examination is after a shower
c. To gently feel the testicle with one finger to feel for a growth
d. That testicular examination should be done at least every 6
months.
21. The client with cancer is receiving chemotherapy and
develops thrombocytopenia. The nurse identifies which
intervention as the highest priority in the nursing plan of
care?
a. Ambulation three times a day
b. Monitoring temperature
c. Monitoring the platelet count
d. Monitoring for pathological factors
22. The nurse is reviewing the laboratory results of a
client receiving chemotherapy. The platelet count is 10,000
cells/mm. Based on this laboratory value, the priority
nursing assessment is which of the following?
a. Assess level of consciousness
b. Assess temperature
c. Assess bowel sounds
d. Assess skin turgor
23. The nurse is caring for a client following a modified
radical mastectomy. Which assessment finding would
indicate that the client is experiencing a complication
related to this surgery?
a. Sanguineous drainage in the Jackson-Pratt drain
b. Pain at the incisional site
c. Complaints of decreased sensation near the operative site
d. Arm edema on the operative side
24. Which of the following nursing interventions would be
most helpful in making the respiratory effort of a client
with metastatic lung cancer more efficient?
a. Teaching the client diaphragmatic breathing techniques
b. Administering cough suppressants as ordered
c. Teaching and encouraging pursed-lip breathing
d. Placing the client in a low semi-Fowlers position
25. The nurse is teaching a 17-year old client and the
client’s family about what to expect with high-dose
chemotherapy and the effects of neutropenia. What should
the nurse teach as the most reliable early indicator of
infection in a neutropenic client?
a. Fever
b. Chills
c. Tachycardia
d. Dyspnea
26. A 58-year-old man is going to have chemotherapy for
lung cancer. He asks the nurse how the chemotherapeutic
drugs will work. The most accurate explanation the nurse
can give is which of the following?
1. “Chemotherapy affects all rapidly dividing cells.”
2. “The molecular structure of the DNA is altered.”
3. “Cancer cells are susceptible to drug toxins.”
4. “Chemotherapy encourages cancer cells to divide.”
27. A client with stomach cancer is admitted to the
oncology unit after vomiting for 3 days. Physical
assessment findings include irregular pulse, muscle
twitching, and complaints of prickling sensations in the
fingers and hands. Laboratory results include a potassium
level of 2.9 mEq/L, a pH of 7.46, and a bicarbonate level of
29 mEq/L. The client is experiencing:
1. Respiratory alkalosis
2. Respiratory acidosis
3. Metabolic alkalosis
4. Metabolic acidosis
28. A 32-year-old woman meets with the nurse on her first
office visit since undergoing a left mastectomy. When
asked how she is doing, the woman states her appetite is
still not good, she is not getting much sleep because she
doesn’t go to bed until her husband is asleep, and she is
really anxious to get back to work. Which of the following
nursing interventions should the nurse explore to support
the client’s current needs?
a. Call the physician to discuss allowing the client to return to
work earlier.
b. Suggest that the client learn relaxation techniques to help
with her insomnia
c. Perform a nutritional assessment to assess for anorexia
d. Ask open-ended questions about sexuality issues related to
her mastectomy
29. One of the most serious blood coagulation
complications for individuals with cancer and for those
undergoing cancer treatments is disseminated
intravascular coagulation (DIC). The most common cause
of this bleeding disorder is:
a. Underlying liver disease
b. Brain metastasis
c. Intravenous heparin therapy
d. Sepsis
30. A pneumonectomy is a surgical procedure sometimes
indicated for treatment of non-small-cell lung cancer. A
pneumonectomy involves removal of:
a. An entire lung field
b. A small, wedge-shaped lung surface
c. One lobe of a lung
d. One or more segments of a lung lobe
31. A 36-year-old man with lymphoma presents with signs
of impending septic shock 9 days after chemotherapy. The
nurse could expect which of the following to be present?
a. Flushing, decreased oxygen saturation, mild hypotension
b. Low-grade fever, chills, tachycardia
c. Elevated temperature, oliguria, hypotension
d. High-grade fever, normal blood pressure, increased
respirations
32. A 56-year-old woman is currently receiving radiation
therapy to the chest wall for recurrent breast cancer. She
calls her health care provider to report that she has pain
while swallowing and burning and tightness in her chest.
Which of the following complications of radiation therapy
is most likely responsible for her symptoms?
a. Hiatal hernia
b. Stomatitis
c. Radiation enteritis
d. Esophagitis
33. Palliation refers to
a) relief of symptoms associated with cancer.
Palliation is the goal for care in terminal cancer patients.
b) hair loss.
c) the spread of cancer cells from the primary tumor to distant
sites.
d) the lowest point of white blood cell depression after therapy
that has toxic effects on the bone marrow.
34. Regarding oral cancer, the nurse provides health
teaching to inform the patient that
a) many oral cancers produce no symptoms in the early stages.
b) most oral cancers are painful at the outset.
c) Blood testing is used to diagnose oral cancer.
d) a typical lesion is soft and crater-like.
35. Which of the following characteristics are risk factors
for colorectal cancer?
a) Familial polyposis
b) Age younger than 40
c) Low fat, low protein, high fiber diet
d) History of skin cancer
Test II. Emergency Room Exam
1. A patient with a spinal cord injury (SCI) complains about
a severe throbbing headache that suddenly started a short
time ago. Assessment of the patient reveals increased
blood pressure (168/94) and decreased heart rate
(48/minute), diaphoresis, and flushing of the face and
neck. What action should you take first?
a. Administer the ordered acetaminophen (Tylenol).
b. Check the Foley tubing for kinks or obstruction.
c. Adjust the temperature in the patient’s room.
d. Notify the physician about the change in status.
2. Regarding emergency procedures at the burn scene, the
nurse teaches which of the following guidelines?
a) Never wrap burn victims in ice.
b) Apply ice directly to a burn area.
c) Never apply water to a chemical burn.
d) Maintain cold dressings on a burn site at all times.
3. In conducting a primary survey on a trauma patient,
which of the following is considered one of the priority
elements of the primary survey?
a. Complete set of vital signs
b. Palpation and auscultation of the abdomen
c. Brief neurologic assessment
d. Initiation of pulse oximetry
4. A 56-year-old patient presents in triage with left-sided
chest pain, diaphoresis, and dizziness. This patient should
be prioritized into which category?
a. High urgent
b. Urgent
c. Non-urgent
d. Emergent
5. Before the patient diagnosed with a concussion is
released from the Emergency Department, the nurse
teaches the family or friends who will be tending to the
patient to contact the physician or return to the ED if the
patient
a) vomits.
b) complains of headache.
c) complains of generalized weakness.
d) sleeps for short periods of time.
6. It is the summer season, and patients with signs and
symptoms of heat-related illness present in the ED. Which
patient needs attention first?
a. An elderly person complains of dizziness and syncope after
standing in the sun for several hours to view a parade
b. A marathon runner complains of severe leg cramps and
nausea. Tachycardia, diaphoresis, pallor, and weakness are
observed.
c. A previously healthy homemaker reports broken air
conditioner for days. Tachypnea, hypotension, fatigue, and
profuse diaphoresis are observed.
d. A homeless person, poor historian, presents with altered
mental status, poor muscle coordination, and hot, dry, ashen
skin. Duration of exposure is unknown.
7. When the nurse reviews the physician’s progress notes
for the patient who has sustained a head injury and sees
that the physician observed Battle’s sign when the patient
was in the Emergency Department, the nurse knows that
the physician observed
a) an area of bruising over the mastoid bone.
b) a bloodstain surrounded by a yellowish stain on the head
dressing.
c) escape of cerebrospinal fluid (CSF) from the patient’s ear.
d) escape of cerebrospinal fluid (CSF) from the patient’s nose.
8. The emergency medical service (EMS) has transported a
patient with severe chest pain. As the patient is being
transferred to the emergency stretcher, you note
unresponsiveness, cessation of breathing, and no
palpable pulse. Which task is appropriate to delegate to
the nursing assistant?
a. Chest compressions
b. Bag-valve mask ventilation
c. Assisting with oral intubation
d. Placing the defibrillator pads
9. An anxious 24-year-old college student complains of
tingling sensations, palpitations, and chest tightness.
Deep, rapid breathing and carpal spasms are noted. What
priority nursing action should you take?
a. Notify the physician immediately.
b. Administer supplemental oxygen.
c. Have the student breathe into a paper bag.
d. Obtain an order for an anxiolytic medication.
10. An experienced traveling nurse has been assigned to
work in the ED; however, this is the nurse’s first week on
the job. Which area of the ED is the most appropriate
assignment for the nurse?
a. Trauma team
b. Triage
c. Ambulatory or fast track clinic
d. Pediatric medicine team
11. A tearful parent brings a child to the ED for taking an
unknown amount of children’s chewable vitamins at an
unknown time. The child is currently alert
and asymptomatic. What information should be
immediately reported to the physician?
a. The ingested children’s chewable vitamins contain iron.
b. The child has been treated several times for ingestion of
toxic substances.
c. The child has been treated several times for accidental
injuries.
d. The child was nauseated and vomited once at home.
12. Which of the following findings in the patient who has
sustained a head injury indicate increasing intracranial
pressure (ICP)?
a) Widened pulse pressure
b) Increased pulse
c) Decreased respirations
d) Decreased body temperature
13. Which of the following nursing interventions is
appropriate when caring for the awake and oriented head
injury patient?
a) Supply oxygen therapy to keep blood gas values within
normal range.
b) Do not elevate the head of the bed.
c) Encourage the patient to cough every 2 hours.
d) Use restraints if the patient becomes agitated.
14. Of the following stimuli, which is known to trigger an
episode of autonomic hyperreflexia in the patient who has
suffered a spinal cord injury?
a) Applying a blanket over the patient
b) Diarrhea
c) Placing the patient in a sitting position
d) Voiding
15. A 36-year-old patient with a history of seizures and
medication compliance of phenytoin (Dilantin) and
carbamazepine (Tegretol) is brought to the ED by the MS
personnel for repetitive seizure activity that started 45
minutes prior to arrival. You anticipate that the physician
will order which drug for status epilepticus?
a. PO phenytoin and carbamazepine
b. IV lorazepam (Ativan)
c. IV carbamazepine
d. IV magnesium sulfate
16. You are preparing a child for IV conscious sedation
prior to repair of a facial laceration. What information
should you immediately report to the physician?
a. The parent is unsure about the child’s tetanus immunization
status.
b. The child is upset and pulls out the IV.
c. The parent declines the IV conscious sedation.
d. The parent wants information about the IV conscious
sedation.
17. An intoxicated patient presents with slurred speech,
mild confusion, and uncooperative behavior. The patient is
a poor historian but admits to “drinking a few on the
weekend.” What is the priority nursing action for this
patient?
a. Obtain an order for a blood alcohol level.
b. Contact the family to obtain additional history and baseline
information.
c. Administer naloxone (Narcan) 2 – 4 mg as ordered.
d. Administer IV fluid support with supplemental thiamine as
ordered.
18. The nurse assesses the dressing of a patient with a
basal skull fracture and sees the halo sign – a blood stain
surrounded by a yellowish stain. The nurse knows that this
sign
a) is highly suggestive of a cerebrospinal fluid (CSF) leak.
b) may indicate a subdural hematoma..
c) is highly suggestive of a cerebral contusion.
d) normally occurs within 24 hours following a basal skull
fracture.
19. A Glasgow Coma Scale (GCS) score of 7 or less is
generally interpreted as
a) coma.
b) a need for emergency attention.
c) least responsive.
d) most responsive.
20. A teenager arrives by private car. He is alert and
ambulatory, but this shirt and pants are covered with
blood. He and his hysterical friends are yelling and trying
to explain that that they were goofing around and he got
poked in the abdomen with a stick. Which of the following
comments should be given first consideration?
a. “There was a lot of blood and we used three bandages.”
b. “He pulled the stick out, just now, because it was hurting
him.”
c. “The stick was really dirty and covered with mud.”
d. “He’s a diabetic, so he needs attention right away.”
21. A prisoner, with a known history of alcohol abuse, has
been in police custody for 48 hours. Initially, anxiety,
sweating, and tremors were noted. Now, disorientation,
hallucination, and hyper-reactivity are observed. The
medical diagnosis is delirium tremens. What is the priority
nursing diagnosis?
a. Risk for Injury related to seizures
b. Risk for Other-Directed Violence related to hallucinations
c. Risk for Situational Low Self-esteem related to police
custody
d. Risk for Nutritional Deficit related to chronic alcohol abuse
22. You are assigned to telephone triage. A patient who
was stung by a common honey bee calls for advice,
reports pain and localized swelling, but denies
any respiratory distress or other systemic signs of
anaphylaxis. What is the action that you should direct the
caller to perform?
a. Call 911.
b. Remove the stinger by scraping.
c. Apply a cool compress.
d. Take an oral antihistamine.
23. The first step in decontamination is
a) removal of the patient’s clothing and jewelry and then rinsing
the patient with water.
b) a thorough soap and water wash and rinse of the patient.
c) to immediately apply personal protective equipment.
d) to immediately apply a chemical decontamination foam to
the area of contamination.
24. You are assessing a patient who has sustained a cat
bite to the left hand. The cat is up-to-date immunizations.
The date of the patient’s last tetanus shot is unknown.
Which of the following is the priority nursing diagnosis?
a. Risk for Infection related to organisms specific to cat bites
b. Impaired Skin Integrity related to puncture wounds
c. Ineffective Health Maintenance related to immunization
status
d. Risk for Impaired Mobility related to potential tendon damage
25. The Emergency Department nurse teaches patients
with sports injuries to remember the acronym RICE, which
stands for which of the following combinations of
treatment?
a) Rest, ice, compression, elevation
b) Rest, ice, circulation, and examination
c) Rotation, immersion, compression and elevation
d) Rotation, ice, compression, and examination
26. In a multiple-trauma victim, which assessment finding
signals the most serious and life-threatening condition?
a. A deviated trachea
b. Gross deformity in a lower extremity
c. Decreased bowel sounds
d. Hematuria
27. You are giving discharge instructions to a woman who
has been treated for contusions and bruises sustained
during an episode of domestic violence. What is your
priority intervention for this patient?
a. Transportation arrangements to a safe house
b. Referral to a counselor
c. Advice about contacting the police
d. Follow-up appointment for injuries
28-32. You respond to a call for help from the ED waiting
room. There is an elderly patient lying on the floor. List the
order for the actions that you must perform.
a. Perform the chin lift or jaw thrust maneuver.
b. Establish unresponsiveness.
c. Initiate cardiopulmonary resuscitation (CPR).
d. Call for help and activate the code team.
e. Instruct a nursing assistant to get the crash cart.
___b__, ___d__, __a___, ___c__, __e___
33-36. You are working in the triage area of an ED, and four
patients approach the triage desk at the same time. List
the order in which you will assess these patients.
a. An ambulatory, dazed 25-year-old male with a bandaged
head wound
b. An irritable infant with a fever, petechiae, and nuchal rigidity
c. A 35-year-old jogger with a twisted ankle, having pedal pulse
and no deformity
d. A 50-year-old female with moderate abdominal pain and
occasional vomiting a. 100 mg/dl
__b___, __a___, __d___, __c___ b. 150 mg/dl
37-43. A patient in a one-car rollover presents with multiple c. 175 mg/dl
injuries. Prioritize the interventions that must be initiated d. 200 mg/dl
for this patient. 5. Which of the following systems is the most likely origin
a. Secure/start two large-bore IVs with normal saline of pain the client describes as knifelike chest pain that
b. Use the chin lift or jaw thrust method to open the airway. increases in intensity with inspiration?
c. Assess for spontaneous respirations a. Cardiac
d. Give supplemental oxygen per mask. b. Gastrointestinal
e. Obtain a full set of vital signs. c. Musculoskeletal
f. Remove patient’s clothing. d. Pulmonary
g. Insert a Foley catheter if not contraindicated. 6. Which of the following blood tests is most indicative of
__c___, __b___, __d___, __a___, __e__, __f__, __g__ cardiac damage?
444-47. These patients present to the ED complaining of a. Lactate dehydrogenase
acute abdominal pain. Prioritize them in order of severity. b. Complete blood count
a. A 35-year-old male complaining of severe, intermittent c. Troponin I
cramps with three episodes of watery diarrhea, 2 hours after d. Creatine kinase
eating 7. A patient who has been admitted to the medical unit with
b. A 11-year-old boy with a low-grade fever, left lower quadrant new-onset angina. Her husband tells you that he rarely
tenderness, nausea, and anorexia for the past 2 days gets a good night’s sleep because he needs to be sure she
c. A 40-year-old female with moderate left upper quadrant pain, does not wander during the night. He insists on checking
vomiting small amounts of yellow bile, and worsening each of the medications you give her to be sure they are
symptoms over the past week the same as the ones she takes at home. Based on this
d. A 56-year-old male with a pulsating abdominal mass and information, which nursing diagnosis is most appropriate
sudden onset of pressure-like pain in the abdomen and flank for this patient?
within the past hour a. Decreased Cardiac Output related to poor myocardial
__d___, __b___, __c___, __a___ contractility
48-51. Following emergency endotracheal intubation, you b. Caregiver Role Strain related to continuous need for
must verify tube placement and secure the tube. List in providing care
order the steps that are required to perform this function? c. Ineffective Therapeutic Regimen Management related to
a. Obtain an order for a chest x-ray to document tube poor patient memory
placement. d. Risk for Falls related to patient wandering behavior during
b. Secure the tube in place. the night
c. Auscultate the chest during assisted ventilation. 8. A nurse is caring for a patient with a nasogastric tube
d. Confirm that the breath sounds are equal and bilateral. that is attached to low suction. The nurse assesses the
__c___, __d___, __b___, __a___ patient for symptoms of which acid-base disorder?
52-55. You are caring for a victim of frostbite to the feet.
a. Metabolic Acidosis
Place the following interventions in the correct order.
b. Metabolic Alkalosis
a. Apply a loose, sterile, bulky dressing.
c. Respiratory Acidosis
b. Give pain medication.
d. Respiratory Alkalosis
c. Remove the victim from the cold environment.
9. A patient with diabetes mellitus has a blood glucose
d. Immerse the feet in warm water 100o F to 105o F (40.6o C
to 46.1o C) level of 640 mg/dl. The nurse interprets that this patient is
__c___, __b___, __d___, __a___ most at risk of developing which type of acid-base
imbalance?
Test III. Medicine Ward Exam a. Respiratory Acidosis
1. Which of the following conditions most commonly b. Respiratory Alkalosis
results in Coronary Artery Disease? c. Metabolic Acidosis
a. Atherosclerosis d. Metabolic Alkalosis
b. DM 10. A nurse caring for a patient with late stage of salicylate
c. MI poisoning who is experiencing metabolic acidosis, reviews
d. Renal failure the result of the patient’s blood chemistry profile. The
2. Atherosclerosis impedes coronary blood flow by which nurse anticipates that which laboratory value is related to
of the following mechanisms? the patient acid-base disturbance?
a. Plaques obstruct the vein a. Sodium: 145 meg/L
b. Plaques obstruct the artery b. Magnesium: 2.0 meg/L
c. Blood clots form outside the vessel wall c. Potassium: 5.2 meg/L
d. Hardened vessels dilate to allow the blood to flow through d. Phosphorus : 2.3 meg/L
3. Which of the following risk factors for coronary artery 11. A 1000 ml intravenous (IV) solution of normal saline
disease cannot be corrected? 0.9% is prescribed for the patient. The nurse understands
a. Cigarette smoking that this type of IV solution.
b. DM
a. Is isotonic with the plasma and other body fluids
c. Heredity
b. Is hypertonic with the plasma and other body fluids
d. HPN
c. Affects the plasma osmolarity.
4. Exceeding which of the following serum cholesterol
d. Is the same solution as sodium chloride 0.45%
levels significantly increases the risk of coronary artery
disease?
12. A patient who has fallen from a ladder fractured three a. Respiratory Acidosis
ribs has arterial blood gas (ABG) results of ph 7.38, PCO2 b. Respiratory Alkalosis
38 mmHg PO2 86 mmHg. The nurse interprets that the c. Metabolic Acidosis
patients ABG’s indicate which of the following? d. Metabolic Alkalosis
20. A patient has just been diagnosed with acute renal
a. Normal results
failure. The laboratory calls the nurse to report a serum
b. Metabolic Alkalosis
c. Metabolic Acidosis potassium level of 6.1 mEq/L on the client.
d. Respiratory Acidosis a. calls the physician
13. A patient with pulmonary edema is receiving oxygen b. checks the sodium level
via nasal cannula at 6 liters per minute. Arterial blood gas c. encourages an extra 500ml of fluid intake
d. teach the client about foods low in K
results indicate: PH 7.29, PCO2 49 mmHg, PO2 58 mmHg,
21. A nurse reviews the serum laboratory results for a
HCo3 18 meq/L. The nurse anticipates that the physician
patient taking Hydrochlorothiazide (HTZ). The nurse
will order which of the respiratory support?
specifically monitors for which of the ff most frequent
a. Lowering the oxygen to 4 liters per minute via nasal cannula
medication side effect on a regular basis?
b. Keeping the oxygen at 6 liters per minute via nasal cannula
c. Adding a partial re-breather mask to the current order a. Hyperphosphatemia
d. Intubution and mechanical ventilation b. Hypocalcemia
14. A patient with significant Flail Chest has arterial blood c. Hypernatremia
gases ( ABG’s) that reveal a PaO2 of 68 and a PaCO2 of 51. d. Hypokalemia
Two hours ago the PaO2 was 82 and the PaCO2 was 44. 22. A patient having mild panic attack has the ff (ABG)
Based on these changes, the nurse obtains which of the ff results ph 7.49,pc02 31mmHg, Pao2 97 mmHg, HCO3
items? 22meq/L.The nurse reviews the results and determines
a. Injectable Lidocine that the client has w/c acid-base disturbance?
b. Portable Chest X-ray machine a. Respiratory acidosis
c. Intubation tray b. Respiratory alkalosis
d. Chest tube insertion set c. Metabolic Acidosis
15. A patient is admitted to the hospital in metabolic d. Metabolic Alkalosis
acidosis caused by diabetic ketoacidosis (DKA). The nurse 23. A nurse is monitoring for the presence of pitting
prepares to administer w/c of the following medications as edema. The nurse presses the fingertips of the middle and
a primary initial treatment to this problem? index fingers against the skin and holds pressure for 2-3
a. sodium bicarbonate seconds.The nurse notes that the indentation is
b. calcium gluconate approximately 1in deep.The nurse documents that the
c. potassium client has which level of pitting edema?
d. regular insulin a. 1 +
16. A nurse is caring for a client with pneumonia who b. 2+
suddenly becomes restless and has a PaO2 of 60mmHg. c. 3+
Which of the following nursing diagnosis would be most d. 4+
appropriare for this patient? 24. Before extracting blood for ABG analysis, the following
criteria must be considered, EXCEPT:
a. Fatigue related to debilitated state a. assess for collateral blood flow
b. Impaired gas exchange related to increase pulmonary b. tissue surrounding the artery
secretions c. accessibility of the vessel
c. Ineffective airway clearance related to dilated bronchioles d. arteries are adjacent to veins
d. Impaired gas exchange related to pneumonia. 25. The safest, most accessible site for ABG analysis
17. A patient with late – stage of Chronic Obstructive puncture is:
Pulmonary Disease (COPD) is admitted to the hospital with a. radial artery
acute exacerbation. Which of the following blood gas b. brachial artery
results would the nurse most likely expect to note? c. femoral artery
a. PO2 of 68 and PCO2 0f 40 d. popliteal artery
b. PO2 of 55 and PCO2 of 40 26. An Allen’s test should be performed before extracting
c. PO2 of 70 and PCO2 Of 50 blood from:
d. PO2 of 60 and PCO2 of 50 a. carotid artery
18. A nurse provides dietary instructions to the patient b. femoral artery
receiving Spironolactone (aldactone). Which food item c. radial artery
would the nurse instruct the client to avoid while taking d. brachial artery
this medication? 27. The following factor does not affect ABG
a. Crackers measurements:
b. Shrimp a. client who has just awakened
c. Bananas b. unchanged setting of oxygen therapy
d. Popcorn c. immediately after suctioning
19. A patient had arterial blood gases drawn. The results d. none of the above
are ph 7.34 , Paco2 0f 37 mmHg, PaO2 of 79,HCo3 of 19 28. Arterial puncture is NOT contraindicated in clients
meq/L.The nurse interprets that the patient is who:
experiencing, a. are receiving anticoagulant therapy
b. have arterial grafts
c. have no history of hemophilia
d. have severe PVD
SITUATION: Henry Sy, age 58 is admitted with a diagnosis of
COPD. His orders include antibiotics and respiratory therapy,
including intermittent positive pressure breathing, chest
physical therapy and nebulizer therapy.
29. Mr. Sy’s best position for maximum lung expansion
should be:
a. Supine
b. Prone
c. Sims
d. Fowler’s
30. Which rate of oxygen flow per cannula would most
likely be appropriate for Mr. Sy?
a. 1-2 lpm
b. 4-6 lpm
c. 6-8 lpm
d. 8-10 lpm
31. Which is the least reliable sign of adequate ventilation?
a. Patent airway
b. Chest and abdominal movement in each respiration
c. Airflow at mouth or nose
d. Skin color
SITUATION: Mr. Lima an 81 y/o patient has bilateral lobe
pneumonia. His admission orders include an IV infusion and
humidified compressed air by face mask
32. To promote gas exchange, the nurse should maintain
the client in which of these positions?
a. Mid fowlers
b. Prone
c. Supine
d. trendelenburg
33. To determine the effectiveness of the humidified
compressed air for Mr. Lima, the nurse should make which
of these assessments?
a. Are the patient’s respiration deeper?
b. Does the ph have an expiratory wheeze?
c. Has the color of the patient’s sputum changed?
d. Have Mr. Lima’s respiratory secretions liquefied?
34. All but are purposes of incentive spirometry.
a. Encourages Deep Breathing Exercise
b. Increases Lung Volume, Boost Alveolar Inflation
c. Benefits a patient on prolonged bed rest
d. Prevent infection that may result from accumulated
secretions
35. The purpose of chest percussion and vibration is to
loosen secretions in the lungs. The difference between the
procedures is:
A. Percussion uses only one hand while vibration uses both
hands
B. Percussion delivers cushioned blows to the chest with
cupped palms while vibration gently shakes secretion
loose on the exhalation cycle
C. In both percussion and vibration the hands are on top of
each other and hand action is in tune with client’s breath
rhythm.
D. Percussion slaps the chest to loosen secretions while
vibration shakes the secretions along with the inhalation of
air.
Test IV. Computation. Show your solutions at the back of
the paper. (2 pts each)
1. The physician prescribes Vascor 5 mg by mouth
every morning for a client with elevated BP during
pregnancy. The pharmacy dispenses tablets that
contain 10 mg. How many tablets should the nurse
administer in each dose?
2. A 20 year old female weighs 45 kg. The empiric
dose of Paracetamol is 10 mg/kg/dose. If your
preparation reads 100 mg/ml, how much should you
administer per dose?
3. The physician orders 10 mg of valium to administer
to a client. The available drug in the pharmacy is 10
mg/ml in a 2 ml ampule. The nurse prepares how
many ml to administer the exact dose to the client?
4. A physician orders an intravenous dose o 400,000
units of penicillin G benzathine (Bicillin). The label
on the 10 mL ampule sent from the pharmacy reads
penicillin G Benzathine 300,000 units per ampule. A
nurse prepares how much medication to administer
the correct dose?
5. The nurse is caring for a client who has had
extensive abdominal surgery and is critical condition.
The nurse notes that the complete blood count
shows 8 mg/dl hemoglobin and a 30% hematocrit.
Dextrose 5% in half normal saline solution is infusing
through a triple lumen catheter at 125 ml/hour. the
physician orders include: (3 pts)
Gentamicin (Garamycin) 80 mg IV piggyback in
50mL D5W over 30 minutes
Ranitidine 50 mg IV in 50 mL D5W ppiggyback over
30 minutes
One unit of 250 mL of packed RBCs over 3 hours
Flush the nasogastric tube with 30mL normal saline
every 4 hours
How many milliliters should the nurse document as
the intake for an 8 hour shift?
_________________________
Test V. Interpret the following Arterial Blood Gas results.
1. pH = 7.44; CO2= 40; HCO3=25
2. pH= 7.50; CO2= 55; HCO3= 28
3. pH=7.44 ; CO2= 48; HCO3=30
4. pH= 7.33; CO2= 50; HCO3=24
5. pH= 7.5; CO2= 30; HCO3=30