ALL INDIA INSTITUTE OF MEDICAL SCIENCES, RISHIKESH

3 B.Sc.(Hons.) Nursing 3rd Year (Batch 2017)

End Term Examination, Feb. 2019
Medical Surgical Nursing-II (VERSION –B) Time-3 hours
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Instructions: No negative marking. Use blue/black ball point pen in OMR sheet. Overwriting
and scribbling will not award any mark.
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Q.1 A female was slapped on her left side of the face by her husband. Ear examination shows
central perforation. What instruction will you give to the patient?
A. To have X ray Mastoid C. Daily cleaning of the ear canal with cotton
bud
B. Immediate pure tone audiometry D. Don’t instill any drops of medication in the
affected ear
Q.2 If the patient can hear a whispered voice 30 cms away from the ear, the patient has:
A. normal Hearing C. conductive hearing loss
B. sensorineural hearing loss D. mixed hearing loss
Q.3 Tonsillectomy is a common procedure done in ENT specialty. What is the commonest
indication for Tonsillectomy?
A. Peritonsillar Abscess C. Recurrent Chronic tonsillitis
B. Rheumatic Heart Disease D. Suspicious of malignancy
Q.4 A patient presented with left sided cervical Lymphadenopathy for 6 months. The
commonest cause is:
A. Infectious mononucleosis C. Tumor of Larynx
B. Tuberculosis D. Actinomycosis
Q.5 A boy developed Bilateral Nasal obstruction one day after he had blow on the nose. What
is most likely diagnosis?
A. Septal Abscess C. Deviated nasal septum
B. Septal Hematoma D. Acute Rhinitis
Q.6 A diabetic patient presented with severe pain in the ear. Examination shows swollen
tender external auditory canal with granulation. What is planned diagnosis?
A. Otitis media C. Labyrinthitis
B. Malignant otitis externa D. Sinusitis
Q.7 A young swimmer complaints of mild pain and irritation, fluffy greyish debris seen in
external auditory canal.
A. Otomycosis C. Otitis externa
B. Otosclerosis D. Otitis media
Q.8 Oral cancers in men who smoke cigarettes and drink heavily are more likely to occur:
A. on the attached gingiva C. on the dorsum of the tongue
B. on the hard palate D. on the lateral tongue and floor of the
mouth
Q.9 Which strain of HPV is most closely connected with cervical cancer and some oral
cancers?
A. HPV-18 C. HPV-40
 B. HPV-31 D. HPV-16
Q.10 Which of the following statements is not true of laryngeal papillomas?
A. laryngeal papillomas are caused by C. laryngeal papillomas can compromise the
human papilloma virus types 6 and 22 airway
B. laryngeal papillomas grow quickly and D. laryngeal papillomas may cause stridor
recur after surgical removal
Q. 11 The nurse is evaluating a client's cranial nerves during a routine examination. To assess
the function of cranial nerve XII (hypoglossal), the nurse should instruct the client to:
A. Smell and identify a nonirritating, C. Read an eye chart from a distance of 20'.
aromatic odor.
B. Elevate the shoulders, both with and D. Stick out the tongue and move it rapidly
without resistance. from side to side and in and out.
Q. 12 After a plane crash, a client is brought to the emergency department with severe burns
and respiratory difficulty. The nurse helps to secure a patent airway and attends to the
client's immediate needs, then prepares to perform a neurologic assessment. Because the
client is unstable and in critical condition, this examination must be brief but should
include:
A. Evaluation of the corneal reflex C. Examination of the fundus of the eye.
response
B. Assessment of the client's gait. D. Evaluation of bowel and bladder functions.
Q. 13 A client undergoes cerebral angiography for evaluation after an intracranial computed
tomography scan revealed a subarachnoid hemorrhage. Afterward, the nurse checks
frequently for signs and symptoms of complications associated with this procedure.
Which findings indicate spasm or occlusion of a cerebral vessel by a clot?
A. Nausea, vomiting, and profuse C. Hemiplegia, seizures, and decreased level of
sweating consciousness (LOC)
B. Difficulty breathing or swallowing D. Tachycardia, tachypnea, and hypotension
Q.14 A client who was found unconscious at home is brought to the hospital by a rescue squad.
In the intensive care unit, the nurse checks the client's oculocephalic (doll's eye) response
by:
Shining a bright light into the pupil.
A. Introducing ice water into the external C. Introducing ice water into the external
auditory canal. auditory canal.
B. Shining a bright light into the pupil. D. Turning the client's head suddenly while
holding the eyelids open.
Q.15 When obtaining the vital signs of a client with multiple traumatic injuries, the nurse
detects bradycardia, bradypnea, and systolic hypertension. The nurse must notify the
physician immediately because these findings may reflect which complication?
A. Shock C. Encephalitis
B. Increased intracranial pressure (ICP) D. Status epilepticus
Q. 16 A client admitted to an acute care facility after a car accident develops signs and
symptoms of increased intracranial pressure (ICP). The client is intubated and placed on
mechanical ventilation to help reduce ICP. To prevent a further rise in ICP caused by
suctioning, the nurse anticipates administering which drug endotracheally before
suctioning?
A. Phenytoin C. Mannitol
 B. Lidocaine D. Furosemide
Q. 17 The nurse formulates a nursing diagnosis of Risk for imbalanced body temperature for a
client who suffers a stroke after surgery. When developing expected outcomes, the nurse
incorporates assessment of the client's temperature to detect abnormalities. The
thermoregulatory centers are located in which part of the brain?
A. Pons C. Cerebellum
B. Temporal lobe D. Hypothalamus
Q. 18 A white female client is admitted to an acute care facility with a diagnosis of stroke. Her
history reveals bronchial asthma, exogenous obesity, and iron deficiency anemia. Which
history finding is a risk factor for stroke?
A. Caucasian race C. Female gender
B. Obesity D. Bronchial asthma
Q. 19 A client recovering from a stroke has right-sided hemiplegia and telegraphic speech and
often seems frustrated and agitated, especially when trying to communicate. However,
the chart indicates that the client's auditory and reading comprehension are intact. The
nurse suspects that the client has:
A. Global aphasia C. Nonfluent aphasia.
B. Fluent aphasia. D. Anomic aphasia
Q. 20 A client undergoes a craniotomy with supratentorial surgery to remove a brain tumor. On
the first postoperative day, the nurse notes the absence of a bone flap at the operative
site. How should the nurse position the client's head?
A. Flat C. Turned onto the operative side
B. Elevated no more than 10 degrees D. Elevated 30 degrees
Q. 21 When caring for a client with head trauma, the nurse notes a small amount of clear,
watery fluid oozing from the client's nose. What should the nurse do?
A. Test the nasal drainage for glucose. C. Look for a halo sign after the drainage dries.
B. Tell the client blow the nose. D. Keep the client in a supine position
Q. 22 Shortly after admission to an acute care facility, a client with a seizure disorder develops
status epilepticus. The physician orders diazepam (Valium) 10 mg I.V. stat. How soon can
the nurse administer a second dose of diazepam, if needed and prescribed?
A. In 30 to 45 seconds C. In 10 to 15 minutes
B. In 30 to 45 minutes D. In 1 to 2 hours
Q. 23 A client with seizure disorder comes to the physician's office for a routine checkup.
Knowing that the client takes phenytoin (Dilantin) to control seizures, the nurse assesses
for which common adverse drug effect?
A. Excessive gum tissue growth C. Drowsiness
B. Hypertension D. Tinnitus
Q. 24 A client comes to the emergency department complaining of headache, malaise, chills,
fever, and a stiff neck. Vital sign assessment reveals a temperature elevation, increased
heart and respiratory rates, and normal blood pressure. On physical examination, the
nurse notes confusion, a petechial rash, nuchal rigidity, Brudzinski's sign, and Kernig's
sign. What does Brudzinski's sign indicate?
A. Increased intracranial pressure (ICP) C. Cerebral edema
B. Meningeal irritation D. Low cerebrospinal fluid (CSF) pressure
Q. 25 A client injured in a train derailment is admitted to an acute care facility with a suspected
dysfunction of the lower brain stem. The nurse should monitor this client closely for:

A. Hypoxia. C. Fever.
B. Visual disturbance. D. Gait alteration.

Q. 26 In a client with amyotrophic lateral sclerosis and respiratory distress, which finding is the
earliest sign of reduced oxygenation?
A. Decreased heart rate C. Increased restlessness
B. Increased blood pressure D. Decreased level of consciousness
Q. 27 A client with respiratory complications of multiple sclerosis (MS) is admitted to the
medical-surgical unit. Which equipment is most important for the nurse to keep at the
client's bedside?
A. Sphygmomanometer C. Padded tongue blade
B. Nasal cannula and oxygen D. Suction machine with catheters
Q. 28 When teaching a client about levodopa-carbidopa (Sinemet) therapy for Parkinson's
disease, the nurse should include which instruction?
A. "Report any eye spasms." C. "Take this medication at bedtime."
B. "Stop taking this drug when your D. Be aware that your urine may appear
symptoms disappear." darker than usual."
Q. 29 A client is hospitalized with Guillain-Barr syndrome. Which nursing assessment finding is
most significant?
A. Warm, dry skin C. Urine output of 40 ml/hour
B. Soft, nondistended abdomen D. Even, unlabored respirations
Q. 30 A client who's receiving phenytoin (Dilantin) to control seizures is admitted to the health
care facility for observation. The physician orders measurement of the client's serum
phenytoin level. Which serum phenytoin level is therapeutic?
A. level below 5 mcg/ml C. 10 to 20 mcg/ml
B. 25 to 35 mcg/ml D. 40 to 50 mcg/ml
Q.31 Which of the following is not a feature of communication after laryngectomy?
A. the patient breathes through a neck C. the cricopharyngeus muscle in the
stoma esophagus is integral to the production of
esophageal voice
B. an electronic or artificial larynx is not D. a speaking valve directs the pulmonary
used in the days and weeks following airstream into the neck stoma
surgery
Q.32 A professional voice user presents at a voice clinic with severe hoarseness. Examination
reveals severe reddening of the laryngeal mucosa. Further investigation reveals that this is
caused by gastroesophageal reflux. This individual’s voice disorder has:
A. an organic aetiology only C. an organic and functional aetiology
B. a functional aetiology only D. none of the above
Q.33 Along with a sore throat and fever, which of these can be a symptom of an adenoid
infection?
A. snoring during sleep C. breathing mostly through the mouth, rather
than nose
B. ear infections that keep coming back D. All of the above
Q.34 A students responds correct answer asked by teacher when she says High-frequency
hearing loss that occurs over time. Often associated with aging is
A. paranasal sinuses C. Nystagmus
B. uvula D. Presbycusis
Q.35 A virus that is often accompanied by clear vesicles commonly called cold sore or fever
blisters, usually at the junction of the skin and the lip. The vesicles erupt and then crust
and heal within 2 weeks. They usually recur, especially after heavy exposure to bright
sunlight (e.g., after a day at the beach).
A. Herpes Simplex C. smooth tongue
B. Ankyloglossia D. Gingivitis
Q.36 A nasal inflammation usually due to a viral infection or allergy.It is accompanied by a
watery and often copious discharge, sneezing, and congestion (stuffy nose). Acute is
caused by a virus, whereas allergic results from contact with allergens such as pollen and
dust.
A. Rhinitis C. Epistaxis
B. Sinusitis D. Nasal polyps
Q.37 A patient comes to your clinic with the normal sinusitis. You decide to prescribe a
"mucosal shrinking" medication to open up the sinuses. How should the patient hold his
head when administering the medication?
A. Head tilted directly backwards C. Head tilted directly forward while standing
B. Lying down on back while looking D. Lying down, with head hanging over the
directly up side of bed on affected side
Q.38 A patient comes to you with an anterior nose bleed. You remember from medical school
that anterior nose bleeds are from arteries in "Kiesselbach's Area." Which of the following
would be the least likely artery to hemorrhage in the anterior nose bleed?
A. Sphenopalatine Artery C. Ethmoidal Artery
B. Greater Palatine Artery D. Lateral Nasal Artery
Q.39 While the examiner is inspecting the throat of a client with a tongue blade, the client
begins to gag. What does this response indicate to the examiner?
A. the client has nerve damage to the C. the client is nauseated
tongue
B. the client has malfunctioning response D. the client has functioning response
Q.40 The nurse is preparing to use the otoscope to visualize the auditory canal and tympanic
membrane of an adult client. Which of the following is most appropriate?
A. pull the pinna up and back C. Insert the otoscope into the inner two
thirds of the ear canal
B. ask the client to tilt the head toward D. tell the client that the procedure will be
the side to be examined slightly painful
Q.41 A client tells the nurse, have a headache and pressure right above my nose and eyes. My
nose is stuffy too. The nurse knows that these symptoms might indicate:
A. infection or inflammation of the C. infection or inflammation of the columella
interior turbinate
B. infection or inflammation of the D. infection or inflammation of the frontal
maxillary sinuses sinuses
Q.42 A condition in which the eardrum has white patches of scar tissue due to repeated ear
infections.
A. otitis media C. otitis externa
 B. Scarred tympanic membrane D. Otosclerosis
Q.43 The nurse is preparing to perform an assessment of the nasal cavity using a nasal
speculum. The nurse considers which of the following to be normal findings?
A. Deviation of the septum C. superior turbinate free of lesions
B. presence of epistaxis on anterior D. dark pink mucosa without discharge
septum
Q.44 When inspecting the mouth and throat of a client, the nurse considers which of the
following to be normal findings? Select all that apply.
A. the tonsils are red with white C. symmetrical rise of the soft palate and
exudates present uvula when the client says "aah"
B. smooth, pink nodules on the lateral D. uvula and mucus membrane is velvety red
side of the tongue
Q.45 A whitish thickening of the mucous membrane in the mouth or tongue. It cannot be
scraped off. Most often associated with heavy smoking or drinking, it can be a
precancerous condition.
A. Gingivitis C. Leukoplakia
B. Herpes Simplex D. Smooth tongue
Q.46 The bony and cartilaginous auditory tube that connects the middle ear with the
nasopharynx. This helps to equalize the air pressure on both sides of the tympanic
membrane
A. Tympanic membrane C. Ossicles
B. Eustachian tube D. Cochlea
Q.47 The nurse is assessing the sinuses of a client. Which of the following is considered a
normal finding?
A. tenderness to palpation or percussion C. Mild swelling over the frontal sinuses
of the sinuses
B. Pink, moist mucus membranes with no D. with trans illumination of the maxillary
lesions sinuses, there is no red glow present under
the eyes.
Q.48 The nurse notes that a client has a smooth, red, shiny tongue with no lesions. Which of
the following is the most appropriate in this situation?
A. look in the client record for a history C. ask the client to describe his diet
of leukoplakia
B. continue with assessment as this is D. ask whether the client has history of
the normal finding for the tongue halitosis
Q.49 During an otoscope assessment, the nurse notes the presence of large amounts of
cerumen in the client's external canal. The nurse knows:
A. this indicates poor hygiene C. cerumen is needed to assist in the
conduction of sound vibrations to the middle
ear
B. the client should clean his ears with D. cerumen helps to lubricate and protect the
cotton swabs ear
Q.50 The nurse is admitting a client in the emergency room with a foreign body in the ear
identified as an insect. Which of the following interventions is a priority for the nurse to
perform?
A. Instill a cortisone ointment in the C. irrigate the affected ear
affected area
 B. Instill antibiotic ointment in the D. instill diluted alcohol in the ear
affected area
Q.5 1. A 79 years old woman has been diagnosed with osteoarthritis. She has been active in the
community and is otherwise in good health. The physician recommends a hip
replacement, and after much consideration, the client agrees. In the preoperative
teaching, the nurse instructs the client that the physician will most likely begin ambulation
on the 3rd postoperative day. The rationale for early ambulation following joint re-
placement is:
A. Prolonged inactivity in an older adult C. Late ambulation fosters dependence on the
increases the chance of venous nursing staff.
thrombosis.
B. Prolonged bed rest increases the D. Early ambulation ensures that the client
chance of developing decubitus ulcers. will return to the baseline functional status.
Q. 52. A 79 years old woman who has undergone hip replacement begins physical therapy for
the first time on the 3rd postoperative day. Although she has been resting for 45 minutes
after the active physical therapy session, she continues to have an elevated blood
pressure (162/92) and pulse rate (94). The nurse’s most appropriate nursing action would
be to:
A. Do nothing and revaluate her in an C. Call the physician
hour
B. Order a stat ECG D. Call physical therapy and see if an error was
made in therapy
Q. 53. The physician writes an order to change the operative site dressing of a hip replacement
client 4 days postoperatively. In preparing to change the dressing, the nurse knows that
the most important nursing action is:
A. The need to prevent pain C. The need to be supportive
B. The need to prevent infection D. The need to explain the procedure to the
client
Q. 54. A post–hip replacement client successfully completes the physical therapy program and is
scheduled to be discharged soon. The nurse begins discharge teaching. The most
important area to assess before discharge is:
A. The ability to take medications as C. Support from family and friends
prescribed
B. The ability to manage ADL D. The ability to properly use the ambulatory
aid (walker)
Q. 55. A nursing diagnosis related to alteration in nutrition is developed. The plan of care most
appropriate to assist a client who has Parkinson’s disease with a nursing diagnosis of
alteration in nutrition is to:
A. Encourage liquids when chewing C. Place in an upright position for meals
B. Allow client to feed himself D. Ask family to bring his favorite foods from
home
Q. 56. When assessing a 75 years old client, the nurse would recognize that normal age-related
changes in vision could result in:
A. Difficulty in night time driving C. Inability to see a dark color against a yellow
wall
B. Seeing halos around lights D. Ignoring objects placed in the centre of the
visual field
Q. 57. A nurse’s friend asks for advice concerning her 75 years old grandmother. She states,
“Grandmother goes to bed at 9 PM, but I can hear her walking around the house and
preparing snacks in the kitchen at 4 AM.” She asks for advice on how to help her
grandmother. The nurse’s best response based on nursing knowledge of the older adult
would be:
A. “Give your grandmother a protein-rich C. “Give her a glass of warm milk and a
snack immediately before going to bed.” sleeping pill at bedtime.”
B. Obtain a comprehensive physical and D. Do nothing unless it worries your
mental examination to determine the grandmother
cause of insomnia.
Q. 58. A general rule of thumb for nurses to remember when administering medications to an
older adult is:
A. Except for cardiac drugs, some C. Most medications do more harm than
medications should be prescribed in good.
greater amounts.
B. Drugs are less effective in the older D. Most medications should be given in lower
adult and must be given more frequently dosages
Q. 59. An 87 years old man attends a community health centre during the week and receives a
health screening monthly. He relates to the nurse during the health screening that he has
recently been troubled with impotence. The most appropriate nursing action at this time
is to:
A. Listen and respond empathetically C. Do a complete health history, including
medications
B. Do nothing as this is normal D. Refer him to a physician
Q.60 A 67 years old engineer is diagnosed with Parkinson’s disease. The nurse recognizes that
this disease is:
A. Normal in persons older than 65 years C.A musculoskeletal disorder
of age
B. A neurological disorder D. A reversible condition with medical
management
Q.61 A nursing diagnosis related to alteration in nutrition is developed. The plan of care most
appropriate to assist a client who has Parkinson’s disease with a nursing diagnosis of
alteration in nutrition is to:
A. Encourage liquids when chewing C. Place in an upright position for meals
B. Allow client to feed himself D. Ask family to bring his favorite foods from
home
Q.62 A 52 years old female client regularly attends the center for hypertension. She shares with
the nurse the fact that she is concerned about osteoporosis. The nurse informs the client
that individuals most at risk for osteoporosis are:
A. Men who have taken steroid therapy C. Thin, white men
B. Obese women of Asian or Hispanic D. Thin, postmenopausal white women
origin
Q.63 The nursing action most appropriate in assisting an 87 years old male client who is
incontinent of urine at night to remain dry would be to:
A. Place an absorbent garment, such as C. Talk to him to determine the stressors in his
Depends, on him life
 B. Provide him with a bedside commode D. Insert a Foley catheter
and leave the night light on
Q.64 An 87 years old male client has surgery to relieve intestinal obstruction. He returns to the
unit with the following physician’s orders: meperidine (Demerol) 50 mg IM q4h prn for
pain, diphenhydramine (Benadryl) 25 mg po q hs prn for sleep, and gentamicin 75 mg IM
8 hr. The nurse notes that his creatinine clearance is 70 mL/min. The most appropriate
action by the nurse should be to:
A. Give his medicine as scheduled C. Hold the gentamicin and inform the
physician of the creatinine results
B. Do nothing as the values are within D. Call the lab to see if this is in error
the normal limits
Q.65 A client has been in a nursing home for 2 weeks. She seems to be having more difficulty
hearing a conversation, and conversations must be repeated several times before she can
hear them. The admission nursing history indicates the client was able to hear a watch
ticking. Her medications include carbamazepine (Tegretol) 300 mg twice daily and aspirin
325 mg once daily. The initial nursing action by the nurse should be to:
A. Talk louder so that she can hear C. Sit facing her so she can more effectively lip
read
B. Inspect the ear canals for blockage D. Call the physician as this is related to CVA
Q.66 The nurse instructs a 60 years old female client on the need for calcium for the prevention
of osteoporosis. The client states, “I drink at least three glasses of milk each day.” The
nurse advises the client:
A. That three glasses of milk does not C. That dietary intake of calcium is not used by
supply enough calcium the body
B. To supplement the milk with vitamin C D. To increase daily oral phosphate as well as
to ensure absorption calcium
Q.67 In planning priority nursing care for a 78 years old client with a CVA, the nurse is aware
that clients with left hemispheric infarctions may have:
A. Dramatic mood swings C. Labile affect
B. Impaired judgment D. Aggressive potential
Q.68 The nurse correctly identifies that the most important need at this time for a client who
has had a recent CVA involving the left hemisphere is:
A. Maintenance of nutritional status C. Prevention from injury
B. Need for diversional activities D. Need for psychological counseling
Q.69 Which nursing plan best demonstrates the nurse’s knowledge of caring for CVA clients?
A. Allow clients to make decisions about C. Encourage clients to attend unit functions.
their care.
B. Provide clients with clock and calendar D. Provide a structured, consistent
to maintain orientation environment.
Q.70 The nurse further instructs a postmenopausal female client on the preventive measures
for osteoporosis. Which statement by the client demonstrates under- standing of
osteoporosis prevention?
A. “I will include citrus juice in my C. “I will decrease fat in my diet”
breakfast menu”
B. “I will begin walking exercises 3–5 D. “I will start swimming as part of my daily
times weekly” exercise regimen”
Q. 71 The nurse is caring for a client who underwent a lumbar laminectomy 2 days ago. Which
of the following findings should the nurse consider abnormal?
A. More back pain than the first C. Paresthesia in the dermatomes near the
postoperative day wounds
B. Urine retention or incontinence D. Temperature of 99.2° F (37.3°
C)
Q. 72 A client in a nursing home is diagnosed with Alzheimer's disease. He exhibits the following
symptoms: difficulty with recent and remote memory, irritability, depression,
restlessness, difficulty swallowing, and occasional incontinence. This client is in what stage
of Alzheimer's disease?
A. I C. II
B. III D. IV
Q. 73 A client with a spinal cord injury and subsequent urine retention receives intermittent
catheterization every 4 hours. The average catheterized urine volume has been 550 ml.
The nurse should plan to:
A. Increase the frequency of the C. Insert an indwelling urinary catheter.
catheterizations
B. Place the client on fluid restrictions. D. Use a condom catheter instead of an
invasive one.
Q. 74 After striking his head on a tree while falling from a ladder, a young man is admitted to
the emergency department. He's unconscious and his pupils are nonreactive. Which
intervention would be the most dangerous for the client?
A. Give him a barbiturate C. Place him on mechanical ventilation
B. Perform a lumbar puncture D. Elevate the head of his bed
Q. 75 If a client experienced a stroke that damaged the hypothalamus, the nurse would
anticipate that the client has problems with:
A. Body temperature control C. Balance and equilibrium
B. Visual acuity D. Thinking and reasoning
Q. 76 A client with a head injury is being monitored for increased intracranial pressure (ICP). His
blood pressure is 90/60 mm Hg and the ICP is 18 mm Hg; therefore his cerebral perfusion
pressure (CPP) is:
A. 52 mm Hg. C. 88 mm Hg.
B. 48 mm Hg D. 68 mm Hg.
Q. 77 A young man was running along an ocean pier, tripped on an elevated area of the decking,
and struck his head on the pier railing. According to his friends, "He was unconscious
briefly and then became alert and behaved as though nothing had happened." Shortly
afterward, he began complaining of a headache and asked to be taken to the emergency
department. If the client's intracranial pressure (ICP) is increasing, the nurse would expect
to observe which sign first?
A. Pupillary asymmetry C. Irregular breathing pattern
B. Involuntary posturing D. Declining level of consciousness
Q. 78 After a stroke, a 75-year-old client is admitted to the facility. The client has left-sided
weakness and an absent gag reflex. He's incontinent and has a tarry stool. His blood
pressure is 90/50 mm Hg, and his hemoglobin is 10 g. Which of the following is a priority
for this client?
A. Elevating the head of the bed to 30 C. Checking stools for occult blood
degrees
 B. Performing range-of-motion (ROM) D. Keeping skin clean and dry
exercises to the left side
Q. 79 The nurse is assessing a client with meningitis. The nurse places the client in a supine
position and flexes the client's leg at the hip and knee. The nurse notes resistance when
straightening the knee and the client reports pain. The nurse documents what neurologic
sign as positive?
A. Babinski's reflex C. Kernig's sign
B. Lichtheim's sign D. Brudzinski's sign
Q. 80 A client is undergoing testing to confirm a diagnosis of myasthenia gravis. The nurse
explains that a diagnosis of myasthenia gravis is made if muscle function improves after
the client receives an I.V. injection of a medication. What is the medication the nurse tells
the client he'll receive during this test?
A. Cyclosporine (Sandimmune) C. Edrophonium (Enlon)
B. Immunoglobulin G (Iveegam EN) D. Azathioprine (Imuran)
Q. 81 The nurse is performing a neurologic assessment on a client. The nurse observes the
client's tongue for symmetry, tremors, and strength, and assesses the client's speech.
Which cranial nerve is the nurse assessing?
A. IV C. IX
B. VI D. XII
Q. 82 A 45-year-old client is admitted with excruciating paroxysmal facial pain. He reports that
the episodes occur most often after feeling cold drafts and drinking cold beverages. Based
on these findings, the nurse determines that the client is most likely suffering from which
neurologic disorder?
A. Bell's palsy C. Migraine headache
B. Trigeminal neuralgia D. Angina pectoris
Q. 83 A client is diagnosed with a brain tumor. The nurse's assessment reveals that the client
has difficulty interpreting visual stimuli. Based on these findings, the nurse suspects injury
to which lobe of the brain?
A. Frontal C. Occipital
B. Temporal D. Parietal
Q. 84 A client is admitted to the hospital after sustaining a closed head injury in a skiing
accident. The physician ordered neurologic assessments to be performed every two
hours. The client's neurologic assessments have been unchanged since admission, and the
client is complaining of a headache. Which intervention by the nurse is best?
A. Administer codeine 30 mg by mouth C. Assess the client's neurologic status for
as prescribed and continue neurologic subtle changes, administer acetaminophen,
assessments as ordered. and then reassess the client in 30 minutes.
B. Reassure the client that headache is D. Notify the physician; headache is an early
expected and will go away without sign of worsening neurologic status
treatment.
Q. 85 A client with stage 2 Alzheimer's disease is admitted to the short stay unit after cardiac
catheterization that involved a femoral puncture. The client is reminded to keep his leg
straight. A knee immobilizer is applied, but the client repeatedly attempts to remove it.
The nurse is responsible for three other clients who underwent cardiac catheterization.
What's the best step the nurse can take?
 A. Continually remind the client not to C. Sedate the client.
move his leg and leave the immobilizer
alone.
B. Ask the staffing coordinator to assign D. Apply wrist restraints.
a nursing assistant to sit with the client.
Q. 86 The nurse is administering dexamethasone (Decadron) 4 mg I.V. to a client diagnosed with
a brain tumor. The nursing assistant informs the nurse that the client's fingerstick glucose
level is 240 mg/dl. A sliding insulin scale hasn't been prescribed. How should the nurse
intervene?
A. Notify the physician of the fingerstick C. Administer dexamethasone as prescribed,
glucose level, inquire about insulin and inform the physician when he makes
therapy, and ask whether the rounds.
dexamethasone should be administered.
B. Administer dexamethasone as D. Administer the dexamethasone because
prescribed and not be concerned about the client has no history of diabetes.
the finger stick glucose level because it's
common with steroid therapy.
Q. 87 The nurse is planning discharge for a client who suffered right-sided weakness caused by a
stroke. During her hospitalization, the client has been receiving physical therapy,
occupational therapy, and speech therapy daily. The family voices their concern about
rehabilitation after discharge. How should the nurse intervene?
A. Contact the appropriate agencies so C. Suggest that the family speak to the
that they can provide care after physician about their concerns.
discharge.
B. Inform the case manager and provide D. The nurse should do nothing because she is
information about the client's current only responsible for inpatient care
clinical status so appropriate resources
can be provided after discharge.
Q. 88 A client with an inoperable brain tumor is brought to the hospital because the family can
no longer care for him at home. As the nurse provides care for the client, family members
express their disappointment at not being able care for him at home according to his
wishes. Which response by the nurse is best?
A. "I understand; I take care of clients C. "Have you explored hospice care? I can ask
like every day and don't know how you the case manager to discuss this care option
could do it at home." with you, if you're interested."
B. "It's okay to bring the client back to D. "Having a family member with a terminal
the hospital to die." illness is very difficult."
Q. 89 A client admitted with bacterial meningitis must be transported to the radiology
department for a repeat computed tomography scan of the head. His level of
consciousness is decreased, and he requires nasopharyngeal suctioning before transport.
Which infection control measures are best when caring for this client?
A. Use standard precautions, which C. Put on gloves, a mask, and eye protection.
require gloves for suctioning.
B. Put on gloves, a mask, and eye D. Take no special precautions for this client.
protection during suctioning, and then
apply a mask to the client's face for
transport
Q. 90 With the diagnosis of ischemic stroke, the nurse should make sure the bed is in which
position?
A. Flat C. Fowlers
B. High fowlers D. Trendelenburg
Q.91 A post CVA client is discharged but will continue with physical and speech therapy daily.
Which statement by the family best demonstrates a supportive environment?
A. “I just don’t know if we can manage C. “We have a sitter who will be staying with
mother at home” mother at night”
B. “We have placed rails in the tub and D. “Mother will be back to her old self in no
widened the bathroom doors for the time once we get her home”
wheelchair”
Q.92 A 71 years old client is admitted to the hospital for observation following a fall from a
ladder. Vital signs on admission are: BP 170/98; P 92; respirations 22. In performing
morning care for the client, the nurse notes a brown pigmentation around both ankles.
The nurse correctly identifies this as suggestive of:
A. Earlier abuse C. Lymphatic disease
B. Aging skin change D. Venous insufficiency
Q.93 A 65 years old female client is diagnosed with presbycusis. The nurse explains to the client
that she may have difficulty in:
A. Hearing high-pitched sounds C. Seeing objects at a distance
B. Ambulating without mechanical aids D. Distinguishing sweet and sour tastes
Q.94 A 60 years old client complains of blurred vision and difficulty in being outside on sunny
days. The nurse identifies this condition to be:
A. Caused by psychotropic drug therapy C. Due to cataracts
B. An excuse to avoid exercise D. Caused by diuretic therapy
Q.95 A 71 years old male client is diagnosed with right-sided congestive heart failure. Which
assessment by the nurse is most reflective of right-sided congestive heart failure?
A. Tachypnea C. Korotkoff sounds
B. Pink frothy sputum D. Distended jugular veins
Q.96 A 71 years old male client with congestive heart failure is placed on furosemide and
digoxin. In addition to monitoring of vital signs, which complaint by the client might alert
the nurse to digoxin toxicity?
A. “I have to hold on to the wall to keep C. “I can’t see clearly and the lights have
from falling” halos”
B. “My ears are ringing” D. “I am itching allover”
Q.97 Lab values reported this morning for a client who is on digoxin and furosemide for
congestive heart failure include serum digoxin level 2.9 mg/mL and potassium 3.2 mEq/L.
The most appropriate nursing action based on these lab values is to:
A. Give an additional dose of digoxin C. Give one half the usual dose of digoxin
B. Do nothing as the digoxin level is D. Call the physician and inform him or her of
within normal limits the lab values
Q.98 In addition to potassium supplements ordered by the physician, the nurse would
encourage the client to choose which of the following menu items to increase potassium
intake?
A. Boiled chicken, baked potato, dried C. Roast beef, carrots, fresh peach
figs
B. Beef tips, rice, banana D. Fried chicken, broccoli, fresh pear
Q.99 The nursing diagnosis identified for a 68 years old client is hypokalemia. The nurse should
assess the client for which symptom:
A. Muscle weakness and weak, irregular C. Positive Trousseau’s sign
pulse
B. Diminished deep tendon reflexes D. Positive Chvostek’s sign
Q.100 A client’s potassium level drops to 2.7 mEg/L. The physician orders potassium bicarbonate
80 mEg in 1000 mL of D5W over 8 hours. The most important nursing action related to IV
potassium administration includes monitoring:
A. Respiratory rate C. Oral potassium intake
B. Urinary output D. The IV site for edema
Q.101 A client recovers from congestive heart failure and is discharged home. His medications
on discharge are KCl (K-Dur) 20 mEq once daily, bumetanide (Bumex) 1 mg once daily. The
nurse prepares to teach the client about his medications and has prepared several
handouts with pertinent information that he will need to know about each drug. Before
beginning discharge teaching, the nurse needs to be aware of:
A. His attitude toward illness C. His past compliance with medical regimen
B. His educational level D. His usual pattern of ADL
Q.102 The nurse suggests that a 68 years old female client might have an iron deficiency. On
which characteristic exhibited by the client does the nurse base this decision?
A. Paresthesia in the lower extremities C. Gingival hemorrhages
B. Spooning of the nails D. Carpopedal spasms
Q.103 A client visits the physician for a checkup. Which complaint is most likely to be associated
with an adverse reaction to KCl?
A. “I have had a headache for the past 2 C. "Noticed my stools were dark and tarry this
days” morning”
B. “I have trouble remembering things D. “I have trouble seeing things up close
lately” lately”
Q.104 An 83 years old female client is admitted to the hospital to determine the cause of her
increasing memory loss, irritability, and decreasing interest in the family. Her son reports
these symptoms have been present for about 2 years but are slowly getting worse. The
nurse explains to the son that normal aging changes of brain tissue include:
A. Increased concentration of C. Lipofuscin deposits and neurofibrillary
acetylcholine tangles
B. Increase gray and white matter D. Increased MAO
Q.105 The most appropriate plan of care for the Alzheimer’s client who has difficulty eating is to:
A. Eliminate distractions from the C. Offer a variety of nourishing foods and
environment allow him to select
B. Place client in the dining room for D. Serve hot foods to stimulate appetite
meals
Q.106 The nursing assistant asks the nurse how to get a client with Alzheimer’s involved in
personal hygiene. The nurse correctly informs the nursing assistant to:
A. Have her follow the hospital C. Provide step-by-step written directions
procedure for bathing
B. Give her short, specific instructions for D. Explain ahead of time what she is expected
what to do next to do
Q.107 A 65 years old client develops a decubitus ulcer. The nurse identifies this superficial ulcer
appearing as a blister as:
 A. Stage 1 C. Stage 3
B. Stage 2 D. Stage 4
Q.108 A 76 years old client is being prepared for a cholecysostomy (surgical removal of the gall
bladder). The client is placed on NPO after midnight. The nurse recognizes that the
primary reason NPO is indicated in client receiving general anesthesia for
cholecystostomy surgery is:
A. To prevent gastric distention which C. To prevent diarrhoea following the surgical
would lead to poor lung expansion procedure
during surgery
B. To prevent fluid loss during the D. To prevent vomiting that would lead to
surgical procedure possible aspiration of vomitus during surgery
Q.109 A client with Alzheimer’s is confused during the day, but the confusion becomes much
worse at night, and she calls “mama” in a very loud voice. The most appropriate nursing
action is to:
A. Restraint her at night C. Have the physician order a stronger
sleeping medication
B. Close the door tightly to keep her D. Leave the lights on in the room
from awakening the other clients
Q.110 The increasing irritability and anxiety experienced by dementia clients during the early
evening hours is referred to as:
A. Agnosia C. Sun downer’s syndrome
B. Apraxia D. Phase 3 dementia
Q.111 Which nursing intervention can prevent a client from experiencing autonomic dysreflexia?

A. Administering zolpidem tartrate C. Assessing laboratory test results as ordered

(Ambien)
B. Placing the client in Trendelenburg's D. Monitoring the patency of an indwelling
position urinary catheter
Q.112 For a client who has had a stroke, which nursing intervention can help prevent
contractures in the lower legs?
A. Applying slippers to the client's feet C. Crossing the client's ankles every 2 hours
B. Placing hand rolls on the balls of each D. Attaching braces or splints to each foot and
foot leg
Q.113 A client who's paralyzed on the left side has been receiving physical therapy and attending
teaching sessions about safety. Which behavior indicates that the client accurately
understands safety measures related to paralysis?
A. The client leaves the side rails down C. The client uses a mirror to inspect the skin
B. The client repositions only after being D. The client hangs the left arm over the side
reminded to do so. of the wheelchair.
Q.114 A quadriplegic client is experiencing severe muscle spasms. To relieve them, a physician
prescribes baclofen (Lioresal), 5 mg P.O. three times daily. What is the principal indication
for baclofen?
A. Acute, painful musculoskeletal C. Skeletal muscle hyperactivity secondary to
conditions cerebral palsy
B. Spasticity related to cerebrovascular D. Muscle spasms with paraplegia or
accident quadriplegia from spinal cord lesions
Q.115 A physician diagnoses a client with myasthenia gravis, prescribing pyridostigmine
(Mestinon), 60 mg P.O. every 3 hours. Before administering this anticholinesterase agent,
the nurse reviews the client's history. Which preexisting condition would contraindicate
the use of pyridostigmine?
A. Ulcerative colitis C. Blood dyscrasia
B. Intestinal obstruction D. Spinal cord injury
Q.116 A 32-year-old client undergoes transsphenoidal hypophysectomy for removal of a
pituitary tumor. This client should be watched carefully for postoperative hemorrhage.
Which sign most likely indicates hemorrhage?
A. Bloody drainage from the ears C. Frequent swallowing
B. Guaiac-positive stools D. Hematuria
Q.117 While reviewing a client's chart, the nurse notices that the client has myasthenia gravis.
Which statement about neuromuscular blocking agents is true for a client with this
condition?
A. The client may be less sensitive to the C. Succinylcholine shouldn't be used;
effects of a neuromuscular blocking pancuronium may be used in a lower dosage.
agent
B. Pancuronium shouldn't be used; D. Pancuronium and succinylcholine both
succinylcholine may be used in a lower require cautious administration
dosage
Q.118 The nurse is caring for an elderly client who exhibits signs of dementia. The most common
cause of dementia in an elderly client is:
A. Depression. C. Alzheimer's disease.
B. Delirium D. Excessive drug use.
Q.119 The nurse is caring for a client with an acute bleeding cerebral aneurysm. The nurse
should do all of the following except:
A. Position the client to prevent airway C. Keep the client in one position to decrease
obstruction. bleeding.
B. Administer I.V. fluid as ordered and D. Maintain the client in a quiet environment.
monitor the client for signs of fluid
volume excess.
Q.120 A client with epilepsy is having a seizure. During the active seizure phase, the nurse
should:
A. Place the client on his back, remove C. Place the client on his side, remove
dangerous objects, and insert a bite dangerous objects, and insert a bite block.
block.
B. Place the client on his back, remove D. Place the client on his side, remove
dangerous objects, and hold down his dangerous objects, and protect his head.
arms.
Q. 121 The nurse is teaching a client who has facial muscle weakness and has recently been
diagnosed with myasthenia gravis. The nurse should teach the client that myasthenia
gravis is caused by:
A. Genetic dysfunction C. Upper and lower motor neuron lesions.
B. Decreased conduction of impulses in D. A lower motor neuron lesion.
an upper motor neuron lesion.
Q. 122 To encourage adequate nutritional intake for a client with Alzheimer's disease, the nurse
should:
 A. Stay with the client and encourage C. Help the client fill out his menu.
him to eat.
B. Give the client privacy during meals D. Fill out the menu for the client
Q.123 A 78-year-old Alzheimer's client is being treated for malnutrition and dehydration. The
nurse decides to place him closer to the nurses' station because of his tendency to:
A. Forget to eat C. Not change his position often
B. Exhibit acquiescent behavior D. Wander.
Q.124 The nurse is administering neostigmine to a client with myasthenia gravis. Which nursing
intervention should the nurse implement?
A. Warn the client that he'll experience C. Schedule the medication before meals.
mouth dryness.
B. Give the medication on an empty D. Administer the medication for complaints
stomach. of muscle weakness or difficulty swallowing.
Q. 125 A client who recently experienced a stroke tells the nurse that he has double vision.
Which nursing intervention is the most appropriate?
A. Encourage the client to close his eyes C. Alternatively patch one eye every 2 hours.
B. Turn out the lights in the room. D. Instill artificial tears.
Q.126 The nurse is assessing a 38-year-old client diagnosed with multiple sclerosis. Which of the
following symptoms would the nurse expect to find?
A. Vision changes C. Absent deep tendon reflexes
B. Tremors at rest D. Flaccid muscles
Q. 127 The nurse is teaching a client with multiple sclerosis. When teaching the client how to
reduce fatigue, the nurse should tell the client to:
A. Take a hot bath. C. Rest in an air-conditioned room.
B. Increase the dose of muscle relaxants D. Avoid naps during the day.
Q. 128 The nurse is caring for a client who requires intracranial pressure (ICP) monitoring. The
nurse should be alert for what major complication of ICP monitoring?
A. Coma C. Infection
B. High blood pressure D. Apnea
Q. 129 The nurse is planning care for a client who suffered a stroke in the right hemisphere of his
brain. What should the nurse do?
A. Anticipate the client will exhibit some C. Place the wheelchair on his left side when
degree of expressive or receptive transferring the client into a wheelchair.
aphasia.
B. Provide close supervision due to the D. Support the right arm with a sling or pillow
client's impulsiveness and poor to prevent subluxation.
judgment.
Q. 130 The nurse is caring for a client with L1-L2 paraplegia who is undergoing rehabilitation.
Which of the following goals is appropriate?
A. Establishing an intermittent C. Managing spasticity with range-of-motion
catheterization routine every 4 hours exercises and medications
B. Establishing an ambulation program D. Preventing autonomic dysreflexia by
using short leg braces preventing bowel impaction
Q.131 A recurrent bilateral conjunctivitis occurring with the onset of hot weather in young boys
with symptoms of burning, itching, and lacrimation with large flat topped cobble stone
papillae raised areas in the palpebral conjunctiva is:
 A. Trachoma C. Mucopurulent conjunctivitis
B. Phlyctenular conjunctivitis D. Vernal keratoconjunctivitis
Q.132 A 25 year old client is complaint of blepharitis. Blepharitis is caused when the
A. Iris becomes infected C. Conjunctiva becomes inflated
B. Eyelid margins are infected D. Pupils become damaged
Q.133 After 48 hours of a cataract extraction operation, a patient complained of ocular pain and
visual loss. On examination, this eye looked red with ciliary injection, corneal edema and
absent red reflex. The first suspicion must be:
A. Secondary glaucoma C. Bacterial endophthalmitis
B. Anterior uveitis D. Acute conjunctivitis
Q.134 A woman presents to you complaining of a red, watering eye for the past two days with
stinging and some photophobia. Her vision has dropped slightly to 20/30. She has a
history of diabetes and taking drops for glaucoma, but is otherwise healthy. The most
likely cause of her redness is:
A. angle-closure glaucoma C. diabetic retinopathy
B. viral conjunctivitis D. papilledema
Q.135 The nurse is developing a teaching plan for the client with glaucoma. Which of the
following instructions would the nurse include in the plan of care?
A. Decrease fluid intake to control the C. Decrease the amount of salt in the diet
intraocular pressure
B. Avoid overuse of the eyes D. Eye medications will need to be
administered lifelong.
Q.136 The client’s vision is tested with a Snellen’s chart. The results of the tests are documented
as 20/60. The nurse interprets this as:
A. The client can read at a distance of 60 C. The client’s vision is normal
feet what a client with normal vision can
read at 20 feet.
B. The client is legally blind. D. The client can read only at a distance of 20
feet what a client with normal vision can read
at 60 feet.
Q.137 The clinic nurse notes that the following several eye examinations, the physician has
documented a diagnosis of legal blindness in the client’s chart. The nurse reviews the
results of the Snellen’s chart test expecting to note which of the following?
A. 20/20 vision C. 20/60 vision
B. 20/40 vision D. 20/200 vision
Q.138 The client arrives in the emergency room after sustaining a chemical eye injury from a
splash of battery acid. The initial nursing action is to:
A. Begin visual acuity testing C. Swab the eye with antibiotic ointment
B. Irrigate the eye with sterile normal D. Cover the eye with a pressure patch.
saline
Q.139 In preparation for cataract surgery, the nurse is to administer prescribed eye drops. The
nurse reviews the physicians orders, expecting which type of eye drops to be instilled?
A. An osmotic diuretic C. A mydriatic medication
B. A miotic agent D. A thiazide diuretic
Q.140 The nurse is performing an admission assessment on a client with a diagnosis of detached
retina. Which of the following is associated with this eye disorder?
 A. Pain in the affected eye C. A sense of a curtain falling across the field
of vision
B. Total loss of vision D. A yellow discoloration of the sclera.
Q.141 Cataract surgery results in aphakia. Which of the following statements best describes this
term?
A. Absence of the crystalline lens C. Loss of accommodation
B. A “keyhole” pupil D. Retinal detachment
Q.142 After the nurse instills atropine drops into both eyes for a client undergoing ophthalmic
examination, which of the following instructions would be given to the client?
A. “Be careful because the blink reflex is C. “Be aware that the pupils may be unusually
paralyzed.” small.”
B. “Avoid wearing your regular glasses D. “Wear dark glasses in bright light because
when driving.” the pupils are dilated.”
Q.143 The client with glaucoma asks the nurse is complete vision will return. The most
appropriate response is:
A. “Although some vision has been lost C. “Your vision will never return to normal.”
and cannot be restored, further loss may
be prevented by adhering to the
treatment plan.”
B. “Your vision will return as soon as the D. “Your vision loss is temporary and will
medications begin to work.” return in about 3-4 weeks.”
Q.144 A male client has just had a cataract operation without a lens implant. In discharge
teaching, the nurse will instruct the client’s wife to:
A. Feed him soft foods for several days to C. Have her husband remain in bed for 3 days
prevent facial movement
B. Keep the eye dressing on for one week D. Allow him to walk upstairs only with
assistance
Q.145 When developing a teaching session on glaucoma for the community, which of the
following statements would the nurse stress?
A. Glaucoma is easily corrected with C. Yearly screening for people ages 20-40
eyeglasses years is recommended.
B. White and Asian individuals are at the D. Glaucoma can be painless and vision may
highest risk for glaucoma. be lost before the person is aware of a
problem.
Q.146 The client arrives in the emergency room with a penetrating eye injury from wood chips
while cutting wood. The nurse assesses the eye and notes a piece of wood protruding
from the eye, what is the initial nursing action?
A. Remove the piece of wood using a C. Perform visual acuity tests
sterile eye clamp
B. Apply an eye patch D. Irrigate the eye with sterile saline
Q.147 Which of the following symptoms would occur in a client with a detached retina?
A. Flashing lights and floaters C. Loss of central vision
B. Homonymous hemianopia D. Ptosis
Q.148 The nurse is caring for a client following enucleation. The nurse notes the presence of
bright red blood drainage on the dressing. Which nursing action is appropriate?
A. Notify the physician C. Document the finding
 B. Continue to monitor the drainage D. Mark the drainage on the dressing and
monitor for any increase in bleeding.
Q.149 Which of the following procedures or assessments must the nurse perform when
preparing a client for eye surgery?
A. Clipping the client’s eyelashes C. Verifying the client has been NPO since
midnight, or at least 8 hours before surgery.
B. Verifying the affected eye has been D. Obtaining informed consent with the
patched 24 hours before surgery client’s signature and placing the forms on the
chart.
Q.150 For a client having an episode of acute narrow-angle glaucoma, a nurse expects to give
which of the following medications?
A. Acetazolamide (Diamox) C. Furosemide (Lasix)
B. Atropine D. Urokinase (Abbokinase)
Q.151 Tonometry is performed on the client with a suspected diagnosis of glaucoma. The nurse
analyzes the test results as documented in the client's chart and understands that normal
intraocular pressure is:
A. 2-7 mmHg C. 22-30 mmHg
B. 10-21 mmHg D. 31-35 mmHg
Q.152 The nurse is developing a plan of care for the client scheduled for cataract surgery. The
nurse documents which more appropriate nursing diagnosis in the plan of care?
A. Self-care deficit C. Disturbed sensory perception
B. Imbalanced nutrition D. Anxiety
Q.153 The nurse is performing an assessment in a client with a suspected diagnosis of cataract.
The chief clinical manifestation that the nurse would expect to note in the early stages of
cataract formation is
A. Eye pain C. Blurred vision
B. Floating spots D. Diplopia
Q.154 In preparation for cataract surgery. The nurse is to administer prescribed eye drops. The
nurse reviews the physician orders. Expecting which type of eye drops to be instilled?
A. An osmotic diuretic C. A mydriatic medication
B. A miotic agent D. A thiazide diuretic
Q.155 The client is being discharged from the ambulatory care unit following cataract removal.
The nurse provides instructions regarding home care. Which of the following. if stated by
the client. Indicates an understanding of the instructions?
A. I will take Aspirin if I have any C. I will wear my eye shield at night and my
discomfort glasses during the day
B. I will sleep on the side that I was D. I will not lift anything if it weighs more than
operated on 10 pounds
Q.156 A 60 years old male patient has age related cataract in right eye with visual acuity of hand
movements. He is otherwise normal. The best surgical treatment option is
A. Small incision cataract surgery C. Intracapsular Cataract resection
B. Conventional ECCE with Intraocular D. Phacoemulsification with foldable IOL
lens
Q.157 In a patient who has hemorrhage in the vitreous cavity of the eyes , the nurse knows that
the blood is accumulating
A. in the aqueous humour C. between the cornea and the lens
B. between the lens and the retina D. in the space between the Iris and the lens
Q.158 A patient presents with red eye, decreased visual acuity, raised Intraocular pressure &
shallow anterior chamber. The likely diagnosis is
A. cataract C. retinal detachment
B. open angle glaucoma D. acute angle closure glaucoma
Q.159 Female with uncontrolled diabetes presents with painful red eye and visual acuity is also
decreased. On examination there was raised Intraocular Pressure and new blood vessels
on the iris. The treatment includes all except.
A. atropine C. steroids
B. beta blockers D. pilocarpine
Q.160 In Addition to High IOP and High vertical cup-disc ratio, risk factors for Primary Open
Angle Glaucoma include all of the following except
A. Old age C. Retinal nerve fiber defects
B. Hypermetropia D. Parapapillary changes
Q.161 A client is having a tonic-clonic seizures. What should the nurse do first?
A. Elevate the head of the bed. C. Take measures to prevent injury
B. Restrain the client's arms and legs D. Place a tongue blade in the client's mouth
Q.162 A client with a tentative diagnosis of myasthenia gravis is admitted for a diagnostic
workup. Myasthenia gravis is confirmed by:
A. positive edrophonium (Tensilon) test C. Kernig's sign
B. positive sweat chloride test D.Brudzinski's sign
Q.163 A client is suspected of having amyotrophic lateral sclerosis (ALS). To help confirm this
disorder, the nurse prepares the client for various diagnostic tests. The nurse expects the
physician to order:
A. Electromyography (EMG) C. Doppler ultrasonography
B. Doppler scanning. D. Quantitative spectral phonoangiography
Q.164 After a motor vehicle accident, a client is admitted to the medical-surgical unit with a
cervical collar in place. The cervical spinal X-rays haven't been read, so the nurse doesn't
know whether the client has a cervical spinal injury. Until such an injury is ruled out, the
nurse should restrict this client to which position?
A. Flat C. Supine, with the head of the bed elevated
30 degrees
B. Flat, except for logrolling as needed D. A head elevation of 90 degrees to prevent
cerebral swelling
Q.165 A client who has been severely beaten is admitted to the emergency department. The
nurse suspects a basilar skull fracture after assessing:
A. Raccoon's eyes and Battle's sign. C. Nuchal rigidity and Kernig's sign.
B. Motor loss in the legs that exceeds D. Pupillary changes.
that in the arms.
Q.166 A client with Guillain-Barr syndrome has paralysis affecting the respiratory muscles and
requires mechanical ventilation. When the client asks the nurse about the paralysis, how
should the nurse respond?
A. "You may have difficulty believing this, C. "You'll have to accept the fact that you're
but the paralysis caused by this disease is permanently paralyzed. However, you won't
temporary." have any sensory loss."
B. "It must be hard to accept the D. "You'll first regain use of your legs and then
permanency of your paralysis." your arms."
Q.167 A client injures the spinal cord in a diving accident. The nurse knows that the client will be
unable to breathe spontaneously if the injury site is above which vertebral level?
A. C4 C. C5
B. C6 D. C7
Q.168 The physician suspects myasthenia gravis in a client with chronic fatigue, muscle
weakness, and ptosis. Myasthenia gravis is associated with:
A. Thyroid disorders C. Poor nutrition.
B. Chemotherapy. D. A viral infection.
Q.169 Three hours after injuring the spinal cord at the C6 level, a client receives high doses of
methylprednisolone to suppress breakdown of the neurologic tissue membrane at the
injury site. To help prevent adverse effects of methylprednisolone sodium succinate (Solu-
Medrol), the nurse expects the physician to prescribe:
A. Naloxone (Narcan) C. Famotidine (Pepcid).
B. Nitroglycerin (Nitro-Bid). D. Atracurium (Tracrium)
Q.170 Which nursing diagnosis takes highest priority for a client with Parkinson's crisis?
A. Impaired urinary elimination C. Risk for injury
B. Imbalanced nutrition: Less than body D. Ineffective airway clearance
requirements
Q.171 When communicating with a client who has sensory (receptive) aphasia, the nurse should:
A. Allow time for the client to respond C. Speak loudly and articulate clearly.
B. Give the client a writing pad. D. Use short, simple sentences
Q.172 A client who is disoriented and restless after sustaining a concussion during a car accident
is admitted to the hospital. Which nursing diagnosis takes highest priority in this client's
care plan?
A. Disturbed sensory perception (visual) C. Dressing or grooming self-care deficit
B. Impaired verbal communication D. Risk for injury
Q.173 Two days after a client undergoes repair of a ruptured cerebral aneurysm, the physician
prescribes mannitol (Osmitrol), 1.5 mg/kg to be infused over 60 minutes. The client
weighs 175 lb. The nurse should administer how many milligrams of mannitol?
A. 263 C. 120
B. 75 D. 60
Q.174 A client is receiving an I.V. infusion of mannitol (Osmitrol) after undergoing intracranial
surgery to remove a brain tumor. To determine whether this drug is producing its
therapeutic effect, the nurse should consider which finding most significant?
A. Decreased level of consciousness C. Elevated blood pressure
(LOC)
B. Increased urine output D. Decreased heart rate
Q.175 When providing discharge teaching for a client with multiple sclerosis (MS), the nurse
should include which instruction?
A. "Avoid taking daytime naps." C. "Avoid hot baths and showers."
B. "Limit your fruit and vegetable D. "Restrict fluid intake to 1,500 ml/day."
intake."
Q.176 The nurse is preparing a client for a computed tomography (CT) scan that requires
infusion of radiopaque dye. Which question is most important for the nurse to ask?
A. "When did you last have something to C. "When did you last take any medication?"
eat or drink?"
 B. "Are you allergic to seafood or D. "How much do you weigh?"
iodine?"
Q.177 The nurse is assessing a geriatric client with senile dementia. Which neurotransmitter
condition is most likely to contribute to this client's cognitive changes?
A. Decreased acetylcholine level C. Increased acetylcholine level
B. Increased norepinephrine level D. Decreased norepinephrine level
Q.178 Family members would like to bring in birthday cake for a client with nerve damage. What
cranial nerve needs to be functioning so the client can chew?
A. Cranial nerve II C. Cranial nerve V
B. Cranial nerve IX D. Cranial nerve X
Q.179 A client arrives at the emergency department complaining of extreme muscle weakness
after minimal effort. The physician suspects myasthenia gravis. Which drug will be used to
test for this disease?
A. Ambenonium (Mytelase) C. Pyridostigmine (Mestinon)
B. Edrophonium (Tensilon) D. Carbachol (Carboptic)
Q.180 A client asks the nurse, "How does ergotamine (Ergostat) relieve migraine headaches?"
The nurse should respond that it:
A. Dilates cerebral blood vessels. C. Constricts cerebral blood vessels
B. Decreases peripheral vascular D. Decreases the stimulation of baroreceptors
resistance

Q.181 A young male of 22years present with gradual decrease of visual acuity in both eyes and
change of refractive error on examination with retinoscopy there was high astigmatism.
Give likely diagnosis?
A. keratoglobus C. megalocornea
B. keratoconus D. buphthalmos
Q.182 A patient presented with gross decrease of vision. On torch examination there was
conjunctival congestion and pupil miosed. Which is the probable diagnosis?
A. Anterior uveitis C. Conjunctivitis
B. Acute congestive glaucoma D. Scleritis
Q.183 A client accidentally splashes chemicals into one eye. The nurse knows that eye irrigation
with plain tap water should begin immediately and continue for 15 to 20 minutes. What is
the primary purpose of this first-aid treatment?
A. To hasten formation of scar tissue C. To eliminate the need for medical care
B. To prevent vision loss D. To serve as a stopgap measure until help
arrives
Q.184 A client comes to the clinic for an ophthalmologic screening, which will include
measurement of intraocular pressure (IOP) with a tonometer. When teaching the client
about the test procedure, the nurse should cover which point?
A. The client will direct the gaze forward C. A topical anesthetic will be administered
while the practitioner rests the after the examination.
tonometer on the scleral surface.
B. The tonometer will register the force D. The client should wear dark glasses for
required to indent or flatten the corneal several hours after the procedure.
apex.
Q.185 After an eye examination, a client is diagnosed with open-angle glaucoma. The physician
prescribes pilocarpine ophthalmic solution (Pilocar), 0.25% gtti, OU q.i.d. Based on this
prescription, the nurse should teach the client or a family member to administer the drug
by:
A. instilling one drop of pilocarpine C. instilling one drop of pilocarpine 0.25% into
0.25% into both eyes daily. the right eye daily.
B. instilling one drop of pilocarpine D. instilling one drop of pilocarpine 0.25% into
0.25% into both eyes four times daily. the left eye four times daily.
Q.186 A home health nurse visits a client who's taking pilocarpine, a miotic agent, to treat
glaucoma. The nurse notes that the client's pilocarpine solution is cloudy. What should
the nurse do first?
A. Advise the client to discard the drug C. Observe the client or a family member
because it may have undergone administer the drug to determine possible
chemical changes or become contamination sources.
contaminated.
B. Advise the client to obtain a fresh D. Advise the client to keep the container
container of pilocarpine solution to closed tightly and protected from light.
avoid omitting prescribed doses.
Q.187 A client with an inflammatory ophthalmic disorder has been receiving repeated courses of
a corticosteroid ointment, in the lower conjunctival sac four times a day as directed. The
client reports a headache and blurred vision. The nurse suspects that these symptoms
represent:
A. common adverse reactions to C. incorrect ointment application.
corticosteroid therapy.
B. expected drug effects that should D. increased intraocular pressure (IOP).
diminish over time.
Q.188 The nurse is monitoring a client for adverse reactions to atropine sulfate (Atropine Care)
eye drops. Systemic absorption of atropine sulfate through the conjunctiva can cause
which adverse reaction?
A. Tachycardia C. Hypotension
B. Increased salivation D. Apnea
Q.189 What should the nurse do when administering pilocarpine (Pilocar)?
A. Apply pressure on the inner canthus C. Apply pressure on the outer canthus to
to prevent systemic absorption. prevent adverse reactions.
B. Administer at bedtime to prevent D. Flush the client's eye with normal saline
night blindness. solution to prevent burning.
Q.190 A client complains of periorbital aching, tearing, blurred vision, and photophobia in her
right eye. Ophthalmologic examination reveals a small, irregular, nonreactive pupil a
condition resulting from acute iris inflammation (iritis). As part of the client's therapeutic
regimen, the physician prescribes atropine sulfate (Atropisol), two drops of 0.5% solution
in the right eye twice daily. Atropine sulfate belongs to which drug classification?
A. Para sympathomimetic agent C. Adrenergic blocker
B. Sympatholytic agent D. Cholinergic blocker
Q.191 A 10 year old girl is presented with pain between the eyes, frontal headache, and
discharge from the nose, post nasal drip and high fever. What is the provisional diagnosis?
A. Acute Frontal sinusitis C. Acute Sphenoidal Sinusitis
B. Acute ethmoidal sinusitis D. Chronic ethmoidal sinusitis
Q.192 Regarding deviated nasal septum (DNS), which of the following is false?
A. DNS is a common physical disorder C. mostly treated surgically
B. it is most frequently caused by impact D. septal hematoma is complication of its
trauma correction
Q.193 If the patient can hear a whispered voice 30 cms away from the ear, the patient has:
A. Normal Hearing C. Conductive hearing loss
B. Sensorineural hearing loss D. Mixed hearing loss
Q.194 Commando operation may be used for the treatment of:
A. nasopharyngeal carcinoma C. Hypo-pharyngeal carcinoma
B. Oropharyngeal Carcinoma D. squamous cell carcinomaof larynx
Q.195 Which of the following is not a typical feature of Meniere's Disease?
A. Sensorineural Deafness C. Vertigo
B. Pulsatile Tinnitus D. Fluctuating Deafness
Q.196 Use of Siegel's Speculum during examination of the ear provides all except:
A. Assessment of movement of tympanic C. Removal of foreign body from the ear
membrane
B. Magnification D. As applicator for the powdered antibiotic to
ear
Q.197 Horner syndrome consists of all of the following features except:
A. Ptosis C. Anhidrosis
B. Dilated Pupil D. Endophthalmos
Q.198 Which of the following is common etiological agent in paranasal sinus mycoses?
A. Aspergillus Species C. Candida Albicans
B. Histoplasma D. ConidiobolusCoronatus
Q.199 Trans illumination test was commonly performed to diagnosis infection of:
A. Maxillary sinus C. Sphenoid sinus
B. Frontal sinusitis D. Both A and C
Q.200 A 20 years old boy had running nose followed by severe earache. One day later he had
mucopurulent discharge from the ear. His diagnosis is:
A. Malignant otitis externa C. Eustachian Catarrh
B. Acute Suppurative otitis media D. Baro trauma