COMPILATION OF HAAD ITEMS

Source of compiled questions:

 Memory recall of countless generous HAAD takers and HAAD-RNs whom I’ve had the privilege of
meeting and knowing.

References of rationale:
 Saunders Comprehensive Review NCLEX-RN® Examination 6th edition published 2013

Disclaimer:
 I consulted my Saunders 6th edition book along with reputable online sources in answering this
compilation but please verify my answers for yourself so that you will have the BEST answer. If I
committed errors, kindly edit this compilation accordingly. Salamat po. ^_^

Updated and supplemented last:

 November 15, 2015

1. Which condition is determined by a positive sweat test result?

a. Cystic fibrosis
b. Huntington’s disease
c. Myasthenia gravis
d. Celiac disease

 Quantitative sweat chloride test is the definitive diagnostic test for cystic fibrosis. Production of
sweat is stimulated (pilocarpine iontophoresis), sweat is collected, and sweat electrolytes are
measured (more than 75 mg of sweat is needed). Normally, the sweat chloride concentration is less
than 40 mEq/L. Chloride concentration greater than 60 mEq/L is a positive test result (higher than 40
meQ/L is diagnostic in infants younger than 3 months of age). Chloride concentrations of 40 – 60
meQ/L are highly suggestive of cystic fibrosis and requires a repeat test.

2. Glasgow Coma Scale. Which is not a component of Eye opening assessment?

a. Response to voice
b. Response to touch
c. Response to pain
d. Spontaneous eye movement

GLASGOW COMA SCALE

Motor response
Obeys a simple command 6
 Localizes painful stimuli 5
Normal flexion (withdrawal) 4
Abnormal flexion (decorticate posturing) 3
Abnormal extension (decerebrate posturing) 2
No motor response 1
Verbal response
Oriented 5
Confused conversation 4
Inappropriate words 3
Responds with incomprehensible sounds 2
No verbal response 1
Eye opening
Spontaneous 4
In response to sound/voice 3
In response to pain 2
No response even to painful stimuli 1
Total Score 15 = Normal
3 = Deep coma/Death

3. In which transmission precaution will the door kept closed at all times?

a. Contact
b. Airborne
c. Droplet
d. Spore

 Airborne precautions include the following: Placing the client in a single room that is maintained
under negative pressure; door remains closed except upon entering and exiting. Negative airflow
pressure is used in the room, with a minimum of 6 – 12 air exchanges per hour depending on health
agency protocol. Ultraviolet germicide irradiation or high efficiency particulate air filter is used in the
room. Health care workers wear a mask or personal respiratory protection device. Mask is placed on
the client when the client needs to leave the room; client leaves the room only if necessary.

4. An infant is startled by a loud noise. The nurse understands this reaction to the loud noise is the
result of?

a. Tonic neck reflex

b. Moro reflex
c. Stepping reflex
d. Babinski reflex

 The Moro reflex is used to determine an infant's nervous system maturity. This reflex goes away
when a child reaches 4 months old. Typically, when a child hears a loud noise or reacts to a sudden
change in a position, this reflex occurs.
5. The RN gives the patient’s medications. The PN (Practical Nurse) assists the patient in his ADLs.
Which form of nursing is being implemented?

a. Team nursing
b. Functional nursing
c. Total patient care nursing
d. Case management

 Functional nursing involves a task approach to client care, with tasks being delegated by the charge
nurse to individual members of the team.

6. A patient has DM, which of the following meds increases blood glucose levels?

a. Diuretics
b. ACE inhibitors

 Hyperglycemia is a side effect of diuretic therapy.

7. A patient is taking bisphosphonates, what is your health teaching?

a. patient remains upright

b. take with milk

 Alendronate sodium (Fosamax) is a bisphosphonate given for patients with osteoporosis and/or
Paget’s disease. Milk is taken together with alendronate sodium (Fosamax). This may lead to milk
alkali syndrome. It is taken before meals with distilled/plain water. The patient is instructed to avoid
taking with mineralized water, orange juice, tea or coffee. The patient is instructed to remain upright
after taking the drug.

8. What are the side effects of pilocarpine (Isopto Carpine) drops administration?

a. Watering of mouth and nose

b. Darkening of pupils
c. Hypertension
d. Constipation

 Pilocarpine is a miotic agent, which constricts the pupil and thereby stimulates the ciliary muscles to
pull on the trabecular meshwork surrounding the canal of Schlemm, which ↑ the flow of aqueous
humor and ↓ intraocular pressure. Side effects of pilocarpine (Isopto Carpine) include: salivation,
hypotension, diarrhea, nausea and vomiting, and exacerbation of asthma.

9. A patient has undecompensated heart failure; he is prescribed morphine 3 mg IV, what is the
desired effect?

a. ↓respiratory rate
b. ↑BP

 Opioids lead to respiratory depression evidenced by ↓ in respiratory rate.

10. All of these are signs & symptoms of hypercortisolism? (Cushing’s disease), EXCEPT:

a. Weight loss
b. GI bleeds
c. Hyperglycemia
d. Hypernatremia

 Assessment findings for Cushing’s disease include: generalized muscle wasting and weakness; moon
face, buffalo hump; truncal obesity with thin extremities, supraclavicular fat pads, weight gain;
hirsutism, hyperglycemia, hypernatremia, hypokalemia, hypocalcemia; hypertension; fragile skin
that easily bruises, reddish purple striae on the abdomen and upper thighs.

11. A patient s/p EGD, what will be your nursing intervention?

a. Give fluids once gag reflex returns.

b. Give food and fluids once bowel sounds return.

 Because the throat is anesthetized so that the client can tolerate the endoscope, the client’s gag and
swallow reflexes are temporarily lost during endoscopy. The nurse’s priority is to monitor for return
of these protective airway reflexes.

12. A patient prior to bronchoscopy, which is the best demonstration of safety?

a. Make sure pre-meds are administered.

b. Ensure patient is informed of possible complications.
c. Verify patient’s identity with 2 identifiers.

 To prevent medication errors, always ensure that you are administering medicine to the right client
by using identifiers such as asking the patient his/her name and compare to his/her ID band, bed
tags and other forms of identification. The patient’s name, birth date, medical record number or
telephone number are all unique to the patient and as such may be used as identifiers.

13. A patient will undergo EEG, what will be your nursing intervention?

a. Withhold caffeine products before the test

b. Withhold anticonvulsants 72° prior
c. Place the client on NPO
d. Instruct the client to refrain from washing the hair

 Antidepressants, tranquilizers, and anticonvulsants are generally withheld 24-48 hours before an
EEG. The client does not have to be NPO, but should avoid coffee, tea, cola, alcohol, and cigarettes.
Pre-procedure care for EEG involves teaching that there is no discomfort, and shampooing the hair.

14. Position after fine needle biopsy of the kidneys

a. Side lying
b. Prone
 After renal biopsy, the client is placed in prone position with a pillow under the abdomen and
shoulders.

15. You are alone on the scene, what is the ratio of chest compressions to ventilations for CPR?

a. 30:2
b. 15:1

 During CPR, a compression-to-ventilation ration of 30:2 is recommended.

16. An obese patient is on bed rest. After a few days, his sacral area is red and does not blanch with
external pressure. The area is painful, warm, and tender compared with adjacent tissue.

a. Stage I pressure ulcer

b. Stage II pressure ulcer
c. Contact dermatitis
d. Psoriasis

 Stage I pressure ulcer is characterized as an area that is read and does not blanch with external
pressure. The area is painful, warm, and tender compared with adjacent tissue.

17. Airborne precautions are used for patients with:

a. TB
b. TB & varicella
c. Rubella
d. TB, varicella & rubella

 Airborne precautions are instituted for the following conditions: measles (rubeola), chicken pox
(varicella), severe acute respiratory syndrome (SARS), smallpox, tuberculosis and disseminated
varicella zoster. German measles (rubella) requires droplet precautions instead.

18. A patient is taking FeSO4, which is a common side effect?

a. chalk colored stools

b. GI upset
c. collar bone fracture

 Ferrous sulfate is a hematinic agent indicated for iron deficiency anemia. Side effects include: GI
irritation, diarrhea or constipation.

19. A patient is stung by a bee.

a. Use tweezers to remove stingers

b. Observe patient for anaphylaxis

20. A patient is stung by a bee. Cases of mortality are mainly due to?
 a. Delay in giving oral antihistamines
b. Delay in giving IV epinephrine

21. Client education for repeated bee stings would NOT include which of the following?

a. First aid measures

b. Assurance of ↓ reactions with repeated exposure
c. Use of insect repellants
d. Method of removal of stinger

 Re-exposure to a bee sting may precipitate a more severe reaction and require emergency care. It
would be inappropriate to give the client false information that reactions will ↓.

22. When is 24 – hour urine collection best performed?

a. During midnight
b. After first discarded void

 The 1st specimen contains urine that was in the bladder before the test began, so it should be
discarded. The test begins with the next voided specimen.

23. Which IVF is used during blood transfusion?

a. PNSS
b. D5LRS
c. D10W
d. LRS

 0.9% sodium chloride solution / plain normal saline solution is used in blood transfusion to prevent
coagulation of the donor blood. Solution that contains dextrose will cause coagulation of the donor
blood.

24. What will be seen in a patient with hypophosphatemia?

a. Weakness
b. Polydipsia and nausea
c. Tachypnea
d. ↑ DTR

 Assessment findings for hypophosphatemia include: ↓ cardiac contractility and cardiac output,
slowed peripheral pulses; shallow respirations; neuromuscular weakness, ↓ deep tendon reflexes, ↓
bone density that can cause fractures and alterations in bone shape, rhabdomyolysis

25. What is the earliest sign of ↑ intracranial pressure (ICP)?

a. ↓ level of consciousness
b. Nausea
c. Papilledema
 d. Vomiting

 A change in level of consciousness is the earliest and most sensitive indicator of ↑ intracranial
pressure (ICP). Other indicators include confusion, restlessness, and lethargy, disorientation to time,
place, and person.

26. What is the positioning for a client who underwent liver biopsy?

a. Right side-lying
b. Left side-lying
c. Prone
d. High fowler’s

 After liver biopsy, the client is positioned into a right lateral/ side lying position. A small pillow or
folded towel is placed under the puncture site for at least 3 hours to provide pressure to the site
and prevent bleeding.

27. Which of the following manifests perforation of a gastric ulcer?

a. Rigid abdomen
b. Nausea and vomiting
c. Hypertension

 Assessment findings for perforation and peritonitis are: fever, progressive abdominal distention,
tachycardia and tachypnea, pallor, chills, restlessness, irritability, and abdominal rigidity.

28. What is the antidote for heparin sodium?

a. Vitamin K
b. Protamine sulfate

 Protamine sulfate is the antidote for heparin. Vitamin K is the antidote for warfarin.

29. A patient suffered a motor vehicular accident (MVA). What complication will be a priority?

a. Epidural hematoma
b. Subdural hematoma

 Epidural hematoma is the most severe type of hematoma, forms rapidly and results from arterial
bleeding. Epidural hematoma forms between the dura and skull form a tear in the meningeal artery.
It is often associated with temporary loss of consciousness, followed by a lucid period that rapidly
progresses to coma. Epidural hematoma is a surgical hematoma. Subdural hematoma forms slowly
and results from a venous bleed. Subdural hematoma occurs under the dura as a result of the tears
in the veins crossing the subdural space.

30. Which is not a component of ABCDE assessment of skin cancer?

a. Asymmetry
 b. Border, irregularity
c. Cancer that was previously diagnosed
d. Diameter greater than 6 mm

 When following the ABCD method for assessing skin lesions, the A stands for "asymmetry."
Further, the B in the ABCD method stands for "border irregularity," the C for "color variation,"
and the D for "diameter."

31. Administration of ear drops for a 2 year old

a. Pull the child’s pinna down and back before administering the medication.
b. Pull the child’s pinna up and back before administering the medication.
c. Place the dropper into the child’s ear canal before administering the medication.
d. Tilt the head of the child towards the affected side before administering the medication.

 A child aged less than 3 years of age’s pinna is pulled down and back for administration of otic
solutions. Droppers should never be inserted into the ear canal, and the head is tilted toward the
unaffected side. On the other hand, the auditory canal of children over age 3 is similar to adults,
narrower and more curved; with the pinna pulled up and back.

32. What is an appropriate nursing intervention for a patient with congestive heart failure with bilateral
edema and difficulty of breathing?

a. Administer oxygen
b. Administer furosemide (Lasix) intravenously

 Furosemide (Lasix) is a loop diuretic which eliminates excess fluid volume.

33. What is the initial sign of ↑intracranial pressure (ICP)?

a. Disorientation
b. Nausea and vomiting
c. Elevated temperature

 A change in level of consciousness is the earliest and most sensitive indicator of ↑ intracranial
pressure (ICP). Other indicators include confusion, restlessness, and lethargy, disorientation to time,
place, and person.

34. A patient with fever, dry mucosa, K+ = 6 mEq/L, Na- = 135 mEq/L. What will be part of your nursing
management?

a. limit intake of K+ rich food

b. Administer oral KCL

 The patient’s serum potassium is ↑ hence intake of K+ rich food is limited.

35. Definition of ascites

 Hypoalbuminemia causes fluid to leave the vascular system and enter the peritoneal cavity. Low
albumin in the blood causes a ↓ in plasma colloidal osmotic pressure, causing fluid to escape in the
extravascular compartment

36. What will be your health teaching for a patient with Raynaud’s disease?

a. Avoid cold temperature

b. Eat a healthier diet
c. Decrease smoking to 1 pack per week

 For patients with Raynaud’s disease, the major therapeutic intervention that has the highest priority
is to keep the client’s hands and feet warm as well as free from injury. Their hands and feet must be
kept from exposure to cold which triggers vasospasm. They need to be taught to protect digits from
extreme cold by using warm clothing, gloves, and socks. Smoking should be stopped completely. Diet
is not associated with Raynaud’s disease.

37. What is the most common sign of hypovolemia?

a. Thirst

 Excessive blood loss will result in the development of shock symptoms such as tachycardia, cool,
clammy skin, and changes in mental status, because hypovolemia leads to vasoconstriction and
shunting of blood to the central circulation.

38. What will you do prior to administering a medication?

a. Verify doctor’s order

b. Ask for help with a dosage calculation

 The doctor’s order is always verified prior to implementation. Always double-check the order,
dosage, and medication, and give the client an explanation.

39. Which IVF is used during blood transfusion (BT)?

a. 0.9% sodium chloride

b. 0.45% sodium chloride
c. D5LRS
d. PLRS

 0.9% sodium chloride solution / plain normal saline solution is used in blood transfusion to
prevent coagulation of the donor blood. Solution that contains dextrose will cause coagulation of
the donor blood.

40. Which is a side effect of iron supplements?

a. Tooth discoloration and GI upset

b. Steatorrhea
 c. Diarrhea
d. Hypotension

 Side effects of iron supplements include: constipation, nausea and vomiting, black tarry stool, teeth
staining and skin staining

41. What is the appropriate therapy for a patient with croup?

a. Steam inhalation

 For children with croup, nursing interventions include: instructing parents to take the child into the
bathroom with the door closed, turn on the hot water for steam inhalation; if laryngeal spasm does
not subside, the child is taken to the emergency department; after the spasm subsides, the child is
provided with a cool mist with vaporizer.

42. What is a cause of false ↑ BP reading?

a. Rapid deflation of BP cuff

b. Slow deflation of BP cuff

False ↓ BP reading False ↑ BP reading

Bladder or cuff too wide
Deflating cuff too quickly
Inaccurate inflation level
Cuff wrapped too loosely
Bladder or cuff too narrow
Deflating cuff too slowly
Stopping during inflation then
reinflating cuff to recheck systole
Failure to wait 30 seconds before
repeating BP measurement

43. Which of the following items will you avoid documenting in the medical record after completing an
incident report?

a. Names of witnesses in the incident report

b. Nursing interventions in the medical record
c. Time the physician was called in the in the incident report
d. That an incident report was submitted in the medical record

 The medical record belongs to the client and should contain all the facts related to the client and the
incident. The incident report belongs to the hospital and should contain all the facts and supportive
data related to the client and the incident. The medical record should not refer to the incident report.

44. After a prescriber writes a medication order for a client, the nurse determines that the dose is above
the usual dosage range. The nurse should perform which of the following?

a. Ask another nurse about the dosage order.

b. Contact the prescriber about the dosage.
c. Recognize that the prescriber is qualified to write drug orders.
 d. Document the concern in the client’s record.

 The nurse has a legal and ethical responsibility to assure that the client receives the correct dosage.
Since dosages may sometimes be outside recommended ranges, contacting the prescriber for
clarification is appropriate.

45. A client asks the nurse about the meaning of the term “full-thickness burn.” The nurse should
respond that burns classified as full-thickness involve tissue destruction down to which of the
following levels?

a. Epidermis
b. Subcutaneous tissue
c. Bone
d. Dermis

 A full-thickness burn involves all layers, including the epidermis and dermis, and may extend into the
subcutaneous tissue and fat.

46. Which of the following is the proper assessment for olfactory nerve (CN I)?

a. Tell client to identify different nonirritating aromas such as coffee and vanilla.
b. Tell client to clench teeth and palpate temples.
c. Tell the patient to identify salty or sweet taste on front of tongue.
d. Tell the patient to identify sour or sweet taste on the back of the tongue.

 Option B assesses the trigeminal nerve (CN V). Option C assesses the facial nerve (CN VII). Option D
assesses the glossopharyngeal nerve (CN IX).

47. What is evident in a patient with cerebellar tumors?

a. Disturbances in thermoregulation
b. Disturbances in sensory perception
c. Disturbances in respiration
d. Disturbances in gait and balance

 The cerebellum governs and coordinates smooth muscle movement, posture, gait, equilibrium, and
muscle tone.

48. A patient is diagnosed with Buerger’s disease. Which of the following characterizes intermittent
claudication?

a. Pain felt in the lower extremities after exercise.

b. Pain felt in the lower extremities at rest.

 Intermittent claudication is pain in the muscle resulting from an inadequate blood supply and
occurs at rest.

49. Definition of adverse effect of medications:

 a. Undesired effect of medication
b. Interaction between 2 different medications

 Adverse effect is a harmful or unintended reaction that occurs when an individual takes a drug.

50. What is a diagnostic finding for AIDS?

a. CD4+ cell count < 200

 AIDS is a viral disease caused by HIV, which destroys T cells, thereby ↑ susceptibility to infection
and malignancy. Age adjustment is essential because normal counts are relatively high in infants
and steadily ↓ until 6 years of age. Severe suppression in all age groups is < 15% total
lymphocytes. (<750 cells/L in infants <12 months, <500 cells/L in children 1 – 5 years old, <200
cells/L in children 6 – 12 years old)

51. What is the correct collection of urine specimen in patient with indwelling Foley catheter:

a. Apply alcohol to collection port and drain urine from collection port onto specimen
container.
b. Open the collection bag and allow urine to empty into specimen container.
c. Disconnect drainage tube from IFC and allow urine to flow from tube into specimen
container.

52. A patient is admitted for blunt trauma to his abdomen. Why did the physician order for a plain X-ray
of the abdomen?

a. To rule out rupture of kidneys

b. Assess for pelvic fractures
c. Assess for damage to the urethra

53. A patient is admitted in your ward, when will you start discharge planning?

a. Upon admission
b. Working phase

54. To promote percutaneous absorption of NTG patches, apply in which site?

a. Non hairy
b. Muscular
c. Near the heart

55. A patient is taking beta blockers and calcium channel blockers. What are the therapeutic effects?

a. ↓ heart rate & ↓BP

b. ↑ heart rate & ↑BP
c. ↓heart rate & ↑ BP
d. ↑heart rate & ↓BP
56. A patient is taking beta blockers and calcium channel blockers. Which are the adverse effects?

a. Chest pain, palpitations and weakness of one side of the body

b. Sciatica, headache
c. Dysuria, dizziness

57. Which hormone controls blood glucose levels?

a. Glucagon
b. Glycogen
c. Insulin

58. Which is a manifestation of a patient’s severe biliary colic?

a. Diaphoresis & prostration (severe exhaustion)

b. Dysuria

59. A patient has pulseless ventricular tachycardia. What will be your nursing action?

a. Prepare the defibrillator

b. Prepare for intubation

60. Definition of cataract

a. ↑ intraocular pressure
b. opacity of lens

61. A patient has peritoneal dialysis, which characteristic of the outflow will you report to the physician?

a. Cloudy
b. Serosanguineous

62. In which patient will you use other PPEs besides disposable gloves?

a. Patient with interstitial radiation for throat cancer vomits greenish vomitus.

63. Definition of medication error:

a. Inappropriate use of medication at point of delivery.

b. Inappropriate use of medication at any step in the medication process.

64. Which IVF is given in hypovolemic shock?

a. D5LRS
b. LRS
c. D10W
65. A patient exhibits (-) dyspnea, pH = 7.4, pCO2 = 40 mmHg, O2 sat = 97%

a. No O2 is needed
b. Manually ventilate with bag valve mask
c. Apply O2 via nasal cannula

66. You are taking care of OB patients, which complaint will you address first?

a. Headache and blurred vision

b. Paresthesia
c. Swollen extremities

67. Patient experiences dark spotting.

a. Patient maybe experiencing spontaneous abortion.

68. To prevent needle prick injury, one should:

a. Recap needles
b. Discard in a container

69. Definition of Acute Lymphocytic Leukemia:

a. Proliferation of immature WBCs

70. Which patient can continue to undergo the prescribed diagnostic test?

a. CT scan for a woman whose LMP was 10 days ago.

b. MRI for a patient with artificial atrial valve.
c. Renal angiogram for a patient with ↑ BUN and creatinine.
d. Thyroid scan for a patient allergic to shellfish.

71. In carrying out your nursing care, in which of the following patients will you add extra PPEs besides
disposable gloves?

a. Patient undergoing radiation therapy of the mouth with greenish vomitus.

b. Patient undergoing barium enema with chalky stool.

72. Which of the following is a priority assessment finding for a patient with ulcerative colitis?

a. Petechiae and rashes

b. ↑ fiber diet

73. Which of the following factors places a client at risk for dehiscence?

a. Old age
b. Obesity
74. Definition of subcutaneous emphysema

a. Crepitus under the skin

75. What is the purpose of nurses taking CEUs?

a. They update nursing knowledge about new trends.

76. What is the purpose of nursing licensure?

a. Nursing licensure measures how fit the nurse is to perform a job.

77. What is the appropriate positioning for IFC insertion of a female?

a. Dorsal recumbent
b. Low fowler’s

78. Definition of MUGA scan

a. Use of nuclear medicine to view anatomical structures

79. A pregnant client on bed rest becomes dizzy. What will be your nursing action?

a. Administer oxygen.
b. Place in left side-lying position.

80. What is an appropriate nursing action for a patient with nephrostomy tubes?

a. Ensure that the tubes are free from kinks.

81. What is the pH imbalance of a patient with hyperemesis gravidarum?

a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis

82. What diagnostic test is used for disseminated intravascular coagulation (DIC)?

a. Prothrombin time
b. Activated partial thromboplastin time
c. D – dimer test

83. What is an appropriate nursing action for a client taking Immuran

a. Monitor WBC

84. Definition of myelomeningocele

 a. Protrusion of meninges, cerebrospinal fluid, spinal cord with nerves caused by a defect in
spinal fusion.

85. A cancer patient manifests with hypotension, bradycardia, and confusion. What is the patient
experiencing?
a. SIADH
b. SVC syndrome
c. Cardiac tamponade

86. What are manifestations of pulmonary edema?

a. Bilateral crackles and pink, frothy sputum

87. What are manifestations of Parkinson’s disease

a. Pill rolling, involuntary jerky movements, mask like face

88. What will you do if you made an error during documentation?

a. Draw a straight line and sign.

89. What are manifestations of duodenal ulcer?

a. Pain occurs during meals

b. Pain occurs 2 – 3 hours after meals

90. What is the reason for giving deferoxamine for a patient with Thalassemia?

a. To relieve the toxic effects of iron overload.

91. What is the reason for emptying the bladder regularly?

a. To prevent bacterial contamination.

92. After inserting an NGT, the client becomes cyanotic. What will be your nursing action?

a. Remove NGT immediately and assess the client.

93. During ET intubation, a gurgling sound is heard. What does this mean?

a. ET is placed in the esophagus.

94. You are about to administer a medication but the label is unclear. What will you do?

a. Contact the pharmacist and ask for a brand new medication with a clear label.
95. A client with angina pectoris rushes to the ER complaining of headache, dizziness, and palpitations.
What is the reason for this?

a. Overdose of nitroglycerin

96. What diagnostic finding is used for clients taking warfarin?

a. activated partial thromboplastin time (aPTT)

b. prothrombin time (PT) and international normalized ration (INR)

97. A client is advised to have another laparoscopic procedure. He is anxious and asks why is there a
need for a repeat of the procedure. What will you do next?

a. Contact the attending physician and ask him to explain the reason for a repeat of the
laparoscopic procedure.

98. A patient is on diuretics. What is a priority?

a. Obtain daily weight.

99. A client is undergoing a 24 – hour urine collection. The physician recently ordered for a urinalysis.
What will you do?

a. Obtain the urinalysis after completing the 24 – hour urine collection.

100. What is a priority in taking care of a patient for surgery?

a. Assess patient’s stress level.

101. A client will undergo surgery. Upon admission, BP = 125/77 mmHg. Now, his BP = 112/60 mmHg.
What will you do next?

a. Inform the anesthesiologist of the changes in blood pressure readings.

102. What are manifestations of iron deficiency anemia?

a. Dizziness, easy fatigability, ↓ hemoglobin, ↓ hematocrit

103. What component of the nursing care plan, when mistaken will affect all other components?

a. Assessment
b. Nursing diagnosis
c. Implementation
d. Evaluation

104. A burn patient with burns in his face, mouth, and neck complains of difficulty of breathing. What
will you do next?
 a. Prepare for intubation.

105. What is given to a client taking isoniazid (INH)?

a. Vitamin B6 (Pyridoxine)
b. Vitamin B12 (Cyanocobalamin)

106. Definition of phantom pain

a. A client, who underwent BKA, complains of pain beyond the knee.

107. What is contraindicated for a client with placenta previa?

a. Vaginal examination

108. What is the goal of collaborative management for a client with Alzheimer’s disease?

a. Enhancement of skills and prevention of injury

109. What is used to increase blood glucose levels for a client with hypoglycemia?

a. Glycogen
b. Glucagon
c. Insulin

110. A patient instructs you to avoid divulging any details about his condition to his parents and
relatives when they visit. What will you do?

a. Document patient’s request in the nurse’s notes and endorse to all staff involved in patient
care.

111. Which is appropriate for Pain assessment for children aged 3 years and older?

a. Wong-Baker Pain Scale

b. Numerical Pain Scale
c. Verbal Rating

112. A patient s/p abdominal surgery has ↑ temperature and purulent drainage

a. Remove the dressing and check for infection

113. A pregnant woman is for AFP determination.

a. ↑ or ↓ AFP may indicate chromosomal abnormalities

114. RN will determine that health teachings given to a patient with impaired circulation were
successful when?
 a. Patient states the definition of peripheral circulation
b. Patient demonstrates activities that improve circulation

115. The wife of a post op patient asks the RN how she can help in taking care of her husband. Which
is an appropriate response?

a. Providing instructions about coughing and deep breathing exercises.

b. Assist her husband with meals

116. Which of the following is inappropriate when discussing vaccines to parents?

a. Some vaccines can cause autism

117. A patient with fever, dry mucosa, K+ = 6 mEq/L, Na- = 135 mEq/L. Patient’s condition is due to?

a. Dehydration
b. Infection

118. Nursing care before paracentesis

a. Ask the patient to void

119. Food that prevents bad odor for colostomy

a. Yogurt

120. Initial manifestation of anorexia nervosa

a. Absence of menses

121. What is the first sign of respiratory depression?

a. Restlessness

122. Which of the following is an urgent case?

a. Pneumothorax
b. Closed fracture
c. Open fracture
d. Shock

123. Melena is prominently present in which condition?

a. Anal abscess
b. Colorectal cancer
c. Duodenal cancer
d. Gastroesophageal reflux disease (GERD)
124. A patient is about to undergo a surgical procedure, the informed consent is obtained by which
HCP?

a. Physician
b. Registered nurse
c. Chief of hospital

125. When is the preoperative checklist for a patient for elective surgery accomplished?

a. Upon admission

126. What is an appropriate nursing action if a patient on colostomy irrigation complains of

cramping?

a. Lower the height of the irrigation solution

127. Definition of angina pectoris

a. Sharp, stabbing pain after drinking cold water

128. The husband of a staff nurse in your hospital is confined in your ward. Which is an appropriate
action regarding her request to see her husband’s chart?

a. Because the wife is a fellow staff nurse, she can see her husband’s chart.
b. Being the spouse, she can see her husband’s chart.
c. The husband’s consent is required.

129. What are the components of tetralogy of Fallot

a. pulmonic stenosis, right ventricular hypertrophy, overriding aorta, ventricular septal defect
b. pulmonic stenosis, left ventricular hypertrophy, overriding aorta, atrial septal defect

130. You are to administer heparin subcutaneously, what should you do to improve absorption?

a. Aspirate & massage the site.

b. Aspirate but do not massage the site.
c. Don’t aspirate but you can massage the site.
d. Don’t aspirate and massage the site.

131. Which is evident in end stage kidney disease?

a. Hyperkalemia
b. ↑ creatinine clearance

 Assessment findings of end stage renal disease include: uremia/azotemia (asterixis, leg restlessness,
burning soles of feet), weakness, lethargy, daytime drowsiness, tremors, muscle twitching, ataxia,
seizures, coma; hypertension, congestive heart failure, cardiomyopathy, pitting edema, periorbital
edema, pericardial friction rub, cardiac tamponade, pericardial effusion; kussmaul respirations,
 crackles, tachypnea, shortness of breath, pulmonary edema; anemia, abnormal bleeding, bruising;
GI upset, hiccups, anorexia; amenorrhea, testicular atrophy, infertility, impotence, ↓ libido; muscle
weakness and cramping, loss of muscle strength, renal osteodystrophy, pathological fracture;
uremic frost

132. Patient has Shingles

a. Contagion occurs if there are fluid filled blisters.

b. Contagion occurs if the lesions are dry and crusted.

133. Colostomy

a. 12 – 24 hours
b. 24 – 48 hours
c. 2 – 4 hours
d. 4 – 6 hours

134. O2 delivery system for mixing room air with oxygen:

a. Nasal cannula
b. Face mask
c. Partial rebreather
d. Venturi mask

135. To prevent drying of nasal mucosa when a patient is on nasal cannula, O2 is limited to:

a. 2 lpm
b. 4 lpm
c. 6 lpm
d. 8 lpm

136. A patient has symptomatic bradycardia, which drugs will be administered?

a. Adenosine or Atropine
b. Atropine or Epinephrine
c. Lidocaine or Epinephrine

137. A patient will take Cephalexin. What should you determine?

a. Patient is not allergic to Sulfa drugs

b. Patient is not allergic to penicillin

138. A patient s/p cholecystectomy, NGT is used because?

a. ↓ abdominal distention
b. ↓gastric secretions
139. Inotropics are used for?

a. Hypovolemic shock
b. Cardiogenic shock
c. Metabolic shock
d. Septic shock

140. All of the following are signs and symptoms of pernicious anemia. EXCEPT:

a. Jaundice
b. pruritus
c. paresthesia

141. You are taking care of a postop patient for surgical management of retinal detachment. What is
your priority?

a. Alteration in intraocular pressure

b. Pain
c. Altered nutrition

142. A patient is diagnosed with acute pancreatitis, what is the correct description of pain felt?

a. Pain aggravated by drinking sugary and alcoholic drinks.

b. Pain that radiates to the back.

143. A patient is diagnosed with acute pancreatitis, what will be your pre op nursing action?

a. Keep on NPO
b. Give ice chips
c. Give oral fluids

144. Why is barium sulfate used prior to EGD?

a. X-rays are absorbed by barium for better visualization.

b. Barium emits fluorescence.

145. What is the most common cause of intestinal obstruction in children 3 years old and above?

a. Volvulus
b. Intussusception
c. Adhesions
d. Hernia

146. Correct application of arm sling:

a. Elbow flexion greater than 90°

b. Placed along his/her collar bone and place pad over shoulder
147. As elderly people have decreased absorption of vitamins, which of the following should be
increased?

a. Vitamin A
b. Vitamin A & D
c. Vitamin C
d. Vitamin A, C & D

148. Definition of competence

149. Definition of anaphylaxis

150. Which class of antibiotics will you administer to a patient who is allergic to penicillin?

a. Cyclosporine
b. Macrolides
c. Tetracycline

151. Definition of Transient Ischemic Attack (TIA)?

152. Which is a laboratory finding for bacterial meningitis?

a. ↓ WBC
b. ↓ CSF protein
c. ↓ CSF glucose

153. Definition of debridement

154. Definition of thrombophlebitis:

155. Definition of septic shock

156. Definition of down syndrome

157. What is a laboratory finding for a patient with hemophilia?

a. Normal prothrombin

158. A patient is given regular insulin intravenously at 6 am. When will the hypoglycemic effect
occur?

159. What is an appropriate oxygen therapy for a patient with emphysema and hypercapnia?

a. O2 20% via venturi mask

b. O2 40% via venturi mask
c. O2 facemask 3-5 lpm
d. O2 nasal cannula 1-2 lpm
160. Which of the following is an appropriate nursing intervention for gastrostomy feeding?

a. Heat osteorized feeding at body temperature.

b. Flush tube with saline solution before feeding.

Besides this compilation, the following are helpful references for passing the HAAD-RN Exam:

A. Textbook
1. Saunders Comprehensive Review NCLEX-RN Examination 6th Edition published 2013
– In my opinion, the Best textbook for international nursing licensure exams
– Saunders publishes a brand new edition every 3 years so the 7th edition will be published in
2016 I suppose. It would be best to acquire the latest edition of Saunders because of the
updated content which may be part of the NCSBN test pool.

B. Computer programs
1. Evolve Reach Test by HESI – the most difficult NCLEX computer program I have ever
answered. I along with my friends who passed the actual NCLEX-RN Exam had failing scores
while answering this computer program so it really is a commendable computer program
2. Comprehensive Review for NCLEX-RN by Prentice Hall/Pearson Vue/Mary Ann Hogan
3. Silvestri: Saunders Strategies for Alternate Item Formats on the NCLEX-RN® Exam – Alternate
item formats include: Ordered responses, Select all that apply questions, Audiovisual format

If this compilation helps you in passing the HAAD-RN exam, kindly pay it forward by sharing it so
that other nurses can fulfill their dreams of being HAAD-RNs as well. Please update, proofread,
and edit this compilation every time other HAAD-RNs are kind and generous enough to
supplement it.

Let us all strive to be a blessing to those around us.

God bless you all! Aja!!! ^_^

“For I know the plans I have for you, declares the Lord, plans to prosper you and not to harm
you, plans to give you hope and a future.” — Jeremiah 29:11