1.

Walter, teenage patient is admitted to the hospital because of acetaminophen

(Tylenol) overdose. Overdoses of acetaminophen can precipitate life-threatening
abnormalities in which of the following organs?

a.
b.
c.
d.

Lungs
Liver
Kidney
Adrenal Glands

2. A contraindication for topical corticosteroid usage in a male patient with atopic

dermatitis (eczema) is:

a.
b.
c.
d.

Parasite infection.
Viral infection.
Bacterial infection.
Spirochete infection.

3. In infants and children, the side effects of first generation over-the-counter (OTC)
antihistamines, such as diphenhydramine (Benadryl) and hydroxyzine (Atarax)
include:

a.
b.
c.
d.

Reyes syndrome.
Cholinergic effects.
Paradoxical CNS stimulation.
Nausea and diarrhea.

4. Reyes syndrome, a potentially fatal illness associated with liver failure and
encephalopathy is associated with the administration of which over-the-counter
(OTC) medication?

a.
b.
c.
d.

acetaminophen (Tylenol)
ibuprofen (Motrin)
aspirin
brompheniramine/psudoephedrine (Dimetapp)

5. The nurse is aware that the patients who are allergic to intravenous contrast
media are usually also allergic to which of the following products?

a.
b.
c.
d.

Eggs
Shellfish
Soy
acidic fruits

6. A 13-month-old child recently arrived in the United States from a foreign country
with his parents and needs childhood immunizations. His mother reports that he is
allergic to eggs. Upon further questioning, you determine that the allergy to eggs is
anaphylaxis. Which of the following vaccines should he not receive?

a.
b.
c.
d.

Hepatitis B
inactivated polio
diphtheria, acellular pertussis, tetanus (DTaP)
mumps, measles, rubella (MMR)

7. The cell and Coombs classification system categorizes allergic reactions and is
useful in describing and classifying patient reactions to drugs. Type I reactions are
immediate hypersensitivity reactions and are mediated by:

a.
b.
c.
d.

immunoglobulin
immunoglobulin
immunoglobulin
immunoglobulin

E (IgE).
G (IgG).
A (IgA).
M (IgM).

8. Drugs can cause adverse events in a patient. Bone marrow toxicity is one of the
most frequent types of drug-induced toxicity. The most serious form of bone marrow
toxicity is:

a.
b.
c.
d.

aplastic anemia.
thrombocytosis.
leukocytosis.
granulocytosis.

9. Serious adverse effects of oral contraceptives include:

a.
b.
c.
d.

Increase in skin oil followed by acne.

Headache and dizziness.
Early or mid-cycle bleeding.
Thromboembolic complications.

10. The most serious adverse effect of Alprostadil (Prostin VR pediatric injection)
administration in neonates is:

a.
b.
c.
d.

Apnea.
Bleeding tendencies.
Hypotension.
Pyrexia.

11. Mandy, a patient calls the clinic today because he is taking atrovastatin (Lipitor)
to treat his high cholesterol and is having pain in both of his legs. You instruct him
to:

a.
b.
c.
d.

Stop taking the drug and make an appointment to be seen next week.
Continue taking the drug and make an appointment to be seen next week.
Stop taking the drug and come to the clinic to be seen today.
Walk for at least 30 minutes and call if symptoms continue.

12. Which of the following adverse effects is associated with levothyroxine

(Synthroid) therapy?

a.
b.
c.
d.

Tachycardia
Bradycardia
Hypotension
Constipation

13. Which of the following adverse effects is specific to the biguanide diabetic drug
metformin (Glucophage) therapy?

a.
b.
c.
d.

Hypoglycemia
GI distress
Lactic acidosis
Somulence

14. The most serious adverse effect of tricyclic antidepressant (TCA) overdose is:

a.
b.
c.
d.

Seizures.
Hyperpyrexia.
Metabolic acidosis.
Cardiac arrhythmias.

15. The nurse is aware that the following solutions is routinely used to flush an IV
device before and after the administration of blood to a patient is:

a.
b.
c.
d.

0.9 percent sodium chloride

5 percent dextrose in water solution
Sterile water
Heparin sodium

16. Cris asks the nurse whether all donor blood products are cross-matched with the
recipient to prevent a transfusion reaction. Which of the following always require
cross-matching?

a.
b.
c.
d.

packed red blood cells

platelets
plasma
granulocytes

17. A month after receiving a blood transfusion an immunocompromised male

patient develops fever, liver abnormalities, a rash, and diarrhea. The nurse would
suspect this patient has:

a.
b.
c.
d.

Nothing related to the blood transfusion.

Graft-versus-host disease (GVHD).
Myelosuppression.
An allergic response to a recent medication.

18. Jonas comes into the local blood donation center. He says he is here to donate
platelets only today. The nurse knows this process is called:

a.
b.
c.
d.

Directed donation.
Autologous donation.
Allogenic donation.
Apheresis.

19. Nurse Bryan knows that the age group that uses the most units of blood and
blood products is:

a.
b.
c.
d.

Premature infants.
Children ages 1-20 years.
Adults ages 21-64 years.
The elderly above age 65 years.

20. A child is admitted with a serious infection. After two days of antibiotics, he is
severely neutropenic. The physician orders granulocyte transfusions for the next
four days. The mother asks the nurse why? The nurse responds:

a.
b.
c.
d.

This is the only treatment left to offer the child.

This therapy is fast and reliable in treating infections in children.
The physician will have to explain his rationale to you.
Granulocyte transfusions replenish the low white blood cells until the body
can produce its own.

21. A neighbor tells nurse Maureen he has to have surgery and is reluctant to have
any blood product transfusions because of a fear of contracting an infection. He
asks the nurse what are his options. The nurse teaches the person that the safest
blood product is:

a.
b.
c.
d.

An allogenic product.
A directed donation product.
An autologous product.
A cross-matched product.

22. A severely immunocompromised female patient requires a blood transfusion. To

prevent GVHD, the physician will order:

a.
b.
c.
d.

Diphenhydramine hydrochloride (Benadryl).

The transfusion to be administered slowly over several hours.
Irradiation of the donor blood.
Acetaminophen (Tylenol).

23. Louie who is to receive a blood transfusion asks the nurse what is the most
common type of infection he could receive from the transfusion. The nurse teaches
him that approximately 1 in 250,000 patients contract:

a.
b.
c.
d.

Human immunodeficiency disease (HIV).

Hepatitis C infection.
Hepatitis B infection.
West Nile viral disease.

24. A male patient with blood type AB, Rh factor positive needs a blood transfusion.
The Transfusion Service (blood bank) sends type O, Rh factor negative blood to the
unit for the nurse to infuse into this patient. The nurse knows that:

a. This donor blood is incompatible with the patients blood.

b. Premedicating the patient with diphenhydramine hydrochloride (Benadryl)
and acetaminophen (Tylenol) will prevent any transfusion reactions or side
effects.
c. This is a compatible match.
d. The patient is at minimal risk receiving this product since it is the first time he
has been transfused with type O, Rh negative blood.
25. Dr. Rodriguez orders 250 milliliters of packed red blood cells (RBC) for a patient.
This therapy is administered for treatment of:

a.
b.
c.
d.

Thrombocytopenia.
Anemia.
Leukopenia.
Hypoalbuminemia.

26. A female patient needs a whole blood transfusion. In order for transfusion
services (the blood bank) to prepare the correct product a sample of the patients
blood must be obtained for:

a.
b.
c.
d.

A
A
A
A

complete blood count and differential.

blood type and cross-match.
blood culture and sensitivity.
blood type and antibody screen.

27. A male patient needs to receive a unit of whole blood. What type of intravenous
(IV) device should the nurse consider starting?

a.
b.
c.
d.

A small catheter to decrease patient discomfort

The type of IV device the patient has had in the past, which worked well
A large bore catheter
The type of device the physician prefers

28. Dr. Smith orders a gram of human salt poor albumin product for a patient. The
product is available in a 50 milliliter vial with a concentration of 25 percent. What
dosage will the nurse administer?

a.
b.
c.
d.

The nurse should use the entire 50 milliliter vial.

The nurse should determine the volume to administer from the physician.
This concentration of product should not be used.
The nurse will administer 4 milliliters.

29. Central venous access devices (CVADs) are frequently utilized to administer
chemotherapy. What is a distinct advantage of using the CVAD for
chemotherapeutic agent administration?

a.
b.
c.
d.

CVADs are less expensive than a peripheral IV.

Once a week administration is possible.
Caustic agents in small veins can be avoided.
The patient or his family can administer the drug at home.

30. A female patients central venous access device (CVAD) becomes infected. Why
would the physician order antibiotics to be given through the line rather than
through a peripheral IV line?

a. To prevent infiltration of the peripheral line

b. To reduce the pain and discomfort associated with antibiotic administration in
a small vein
c. To lessen the chance of an allergic reaction to the antibiotic
d. To attempt to sterilize the catheter and prevent having to remove it
PART 2: NEUROSENSORY

1. A white female client is admitted to an acute care facility with a diagnosis of

cerebrovascular accident (CVA). Her history reveals bronchial asthma, exogenous
obesity, and iron deficiency anemia. Which history finding is a risk factor for CVA?

a.
b.
c.
d.

Caucasian race
Female sex
Obesity
Bronchial asthma

2. The nurse is teaching a female client with multiple sclerosis. When teaching the
client how to reduce fatigue, the nurse should tell the client to:

a.
b.
c.
d.

take a hot bath.

rest in an air-conditioned room
increase the dose of muscle relaxants.
avoid naps during the day

3. A male client is having a tonic-clonic seizures. What should the nurse do first?

a.
b.
c.
d.

Elevate the head of the bed.

Restrain the clients arms and legs.
Place a tongue blade in the clients mouth.
Take measures to prevent injury.

4. A female 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, but the paralysis caused by this
disease is temporary.
b. Youll have to accept the fact that youre permanently paralyzed. However,
you wont have any sensory loss.
c. It must be hard to accept the permanency of your paralysis.
d. Youll first regain use of your legs and then your arms.
5. The nurse is working on a surgical floor. The nurse must logroll a male client
following a:

a.
b.
c.
d.

laminectomy.
thoracotomy.
hemorrhoidectomy.
cystectomy.

6. A female client with a suspected brain tumor is scheduled for computed

tomography (CT). What should the nurse do when preparing the client for this test?

a.
b.
c.
d.

Immobilize the neck before the client is moved onto a stretcher.

Determine whether the client is allergic to iodine, contrast dyes, or shellfish.
Place a cap over the clients head.
Administer a sedative as ordered.

7. During a routine physical examination to assess a male clients deep tendon

reflexes, the nurse should make sure to:

a.
b.
c.
d.

use the pointed end of the reflex hammer when striking the Achilles tendon.
support the joint where the tendon is being tested.
tap the tendon slowly and softly
hold the reflex hammer tightly.

8. A female client is admitted in a disoriented and restless state after sustaining a

concussion during a car accident. Which nursing diagnosis takes highest priority in
this clients plan of care?

a.
b.
c.
d.

Disturbed sensory perception (visual)

Self-care deficient: Dressing/grooming
Impaired verbal communication
Risk for injury

9. A female client with amyotrophic lateral sclerosis (ALS) tells the nurse,
Sometimes I feel so frustrated. I cant do anything without help! This comment
best supports which nursing diagnosis?

a.
b.
c.
d.

Anxiety
Powerlessness
Ineffective denial
Risk for disuse syndrome

10. For a male client with suspected increased intracranial pressure (ICP), a most
appropriate respiratory goal is to:

a.
b.
c.
d.

prevent respiratory alkalosis.

lower arterial pH.
promote carbon dioxide elimination.
maintain partial pressure of arterial oxygen (PaO2) above 80 mm Hg

11. Nurse Maureen witnesses a neighbors husband sustain a fall from the roof of his
house. The nurse rushes to the victim and determines the need to opens the airway
in this victim by using which method?

a.
b.
c.
d.

Flexed position
Head tilt-chin lift
Jaw thrust maneuver
Modified head tilt-chin lift

12. The nurse is assessing the motor function of an unconscious male client. The
nurse would plan to use which plan to use which of the following to test the clients
peripheral response to pain?

a.
b.
c.
d.

Sternal rub
Nail bed pressure
Pressure on the orbital rim
Squeezing of the sternocleidomastoid muscle

13. A female client admitted to the hospital with a neurological problem asks the
nurse whether magnetic resonance imaging may be done. The nurse interprets that
the client may be ineligible for this diagnostic procedure based on the clients
history of:

a.
b.
c.
d.

Hypertension
Heart failure
Prosthetic valve replacement
Chronic obstructive pulmonary disorder

14. A male client is having a lumbar puncture performed. The nurse would plan to
place the client in which position?

a.
b.
c.
d.

Side-lying, with a pillow under the hip

Prone, with a pillow under the abdomen
Prone, in slight-Trendelenburgs position
Side-lying, with the legs pulled up and head bent down onto chest.

15. The nurse is positioning the female client with increased intracranial pressure.
Which of the following positions would the nurse avoid?

a.
b.
c.
d.

Head mildline
Head turned to the side
Neck in neutral position
Head of bed elevated 30 to 45 degrees

16. A female client has clear fluid leaking from the nose following a basilar skull
fracture. The nurse assesses that this is cerebrospinal fluid if the fluid:

a.
b.
c.
d.

Is clear and tests negative for glucose

Is grossly bloody in appearance and has a pH of 6
Clumps together on the dressing and has a pH of 7
Separates into concentric rings and test positive of glucose

17. A male client with a spinal cord injury is prone to experiencing autonomic
dysreflexia. The nurse would avoid which of the following measures to minimize the
risk of recurrence?

a.
b.
c.
d.

Strict adherence to a bowel retraining program

Keeping the linen wrinkle-free under the client
Preventing unnecessary pressure on the lower limbs
Limiting bladder catheterization to once every 12 hours

18. The nurse is caring for the male client who begins to experience seizure activity
while in bed. Which of the following actions by the nurse would be contraindicated?

a.
b.
c.
d.

Loosening restrictive clothing

Restraining the clients limbs
Removing the pillow and raising padded side rails
Positioning the client to side, if possible, with the head flexed forward

19. The nurse is assigned to care for a female client with complete right-sided
hemiparesis. The nurse plans care knowing that this condition:

a. The client has complete bilateral paralysis of the arms and legs.
b. The client has weakness on the right side of the body, including the face and
tongue.
c. The client has lost the ability to move the right arm but is able to walk
independently.
d. The client has lost the ability to move the right arm but is able to walk
independently.
20. The client with a brain attack (stroke) has residual dysphagia. When a diet order
is initiated, the nurse avoids doing which of the following?

a.
b.
c.
d.

Giving the client thin liquids

Thickening liquids to the consistency of oatmeal
Placing food on the unaffected side of the mouth
Allowing plenty of time for chewing and swallowing

21. The nurse is assessing the adaptation of the female client to changes in
functional status after a brain attack (stroke). The nurse assesses that the client is
adapting most successfully if the client:

a.
b.
c.
d.

Gets angry with family if they interrupt a task

Experiences bouts of depression and irritability
Has difficulty with using modified feeding utensils
Consistently uses adaptive equipment in dressing self

22. Nurse Kristine is trying to communicate with a client with brain attack (stroke)
and aphasia. Which of the following actions by the nurse would be least helpful to
the client?

a.
b.
c.
d.

Speaking to the client at a slower rate

Allowing plenty of time for the client to respond
Completing the sentences that the client cannot finish
Looking directly at the client during attempts at speech

23. A female client has experienced an episode of myasthenic crisis. The nurse
would assess whether the client has precipitating factors such as:

a.
b.
c.
d.

Getting too little exercise

Taking excess medication
Omitting doses of medication
Increasing intake of fatty foods

24. The nurse is teaching the female client with myasthenia gravis about the
prevention of myasthenic and cholinergic crises. The nurse tells the client that this
is most effectively done by:

a.
b.
c.
d.

Eating large, well-balanced meals

Doing muscle-strengthening exercises
Doing all chores early in the day while less fatigued
Taking medications on time to maintain therapeutic blood levels

25. A male client with Bells palsy asks the nurse what has caused this problem. The
nurses response is based on an understanding that the cause is:

a. Unknown, but possibly includes ischemia, viral infection, or an autoimmune

problem
b. Unknown, but possibly includes long-term tissue malnutrition and cellular
hypoxia
c. Primary genetic in origin, triggered by exposure to meningitis
d. Primarily genetic in origin, triggered by exposure to neurotoxins

26. The nurse has given the male client with Bells palsy instructions on preserving
muscle tone in the face and preventing denervation. The nurse determines that the
client needs additional information if the client states that he or she will:

a.
b.
c.
d.

Exposure to cold and drafts

Massage the face with a gentle upward motion
Perform facial exercises
Wrinkle the forehead, blow out the cheeks, and whistle

27. Female client is admitted to the hospital with a diagnosis of Guillain-Barre

syndrome. The nurse inquires during the nursing admission interview if the client
has history of:

a.
b.
c.
d.

Seizures or trauma to the brain

Meningitis during the last 5 years
Back injury or trauma to the spinal cord
Respiratory or gastrointestinal infection during the previous month.

28. A female client with Guillian-Barre syndrome has ascending paralysis and is
intubated and receiving mechanical ventilation. Which of the following strategies
would the nurse incorporate in the plan of care to help the client cope with this
illness?

a.
b.
c.
d.

Giving client full control over care decisions and restricting visitors
Providing positive feedback and encouraging active range of motion
Providing information, giving positive feedback, and encouraging relaxation
Providing intravaneously administered sedatives, reducing distractions and
limiting visitors

29. A male client has an impairment of cranial nerve II. Specific to this impairment,
the nurse would plan to do which of the following to ensure client to ensure client
safety?

a.
b.
c.
d.

Speak loudly to the client

Test the temperature of the shower water
Check the temperature of the food on the delivery tray.
Provide a clear path for ambulation without obstacles

30. A female client has a neurological deficit involving the limbic system. Specific to
this type of deficit, the nurse would document which of the following information
related to the clients behavior.

a. Is disoriented to person, place, and time

b. Affect is flat, with periods of emotional lability

c. Cannot recall what was eaten for breakfast today

d. Demonstrate inability to add and subtract; does not know who is president