ENDOCRINE DISORDERS

1. An agitated, confused female client arrives in the emergency department. Her history includes type
1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and
intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute
hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting:
A. 2 to 5 g of a simple carbohydrate.
B. 10 to 15 g of a simple carbohydrate.
C. 18 to 20 g of a simple carbohydrate.
D. 25 to 30 g of a simple carbohydrate.

2. A female adult client with a history of chronic hyperparathyroidism admits to being noncompliant. Based
on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the
nursing diagnosis statement for this client, which “related-to” phrase should the nurse add?
A. Related to bone demineralization resulting in pathologic fractures
B. Related to exhaustion secondary to an accelerated metabolic rate
C. Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces
D. Related to tetany secondary to a decreased serum calcium level

3. Nurse Joey is assigned to care for a postoperative male client who has diabetes mellitus. During the
assessment interview, the client reports that he’s impotent and says he’s concerned about its effect on his
marriage. In planning this client’s care, the most appropriate intervention would be to:
A. Encourage the client to ask questions about personal sexuality.
B. Provide time for privacy.
C. Provide support for the spouse or significant other.
D. Suggest referral to a sex counselor or other appropriate professional.

4. During a class on exercise for diabetic clients, a female client asks the nurse educator how often to exercise.
The nurse educator advises the clients to exercise how often to meet the goals of planned exercise?
A. At least once a week
B. At least three times a week
C. At least five times a week
D. Every day

5. Nurse Oliver should expect a client with hypothyroidism to report which health concerns?
A. Increased appetite and weight loss
B. Puffiness of the face and hands
C. Nervousness and tremors
D. Thyroid gland swelling

6. A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily.
Which finding should nurse Hans recognize as an adverse drug effect?
A. Dysuria
B. Leg cramps
C. Tachycardia
D. Blurred vision

7. A 67-year-old male client has been complaining of sleeping more, increased urination, anorexia, weakness,
irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment
findings, nurse Richard would suspect which of the following disorders?
A. Diabetes mellitus
B. Diabetes insipidus
C. Hypoparathyroidism
D. Hyperparathyroidism

8. When caring for a male client with diabetes insipidus, nurse Juliet expects to administer:
A. vasopressin (Pitressin Synthetic).
B. furosemide (Lasix).
C. regular insulin.
D. 10% dextrose.

9. The nurse is aware that the following is the most common cause of hyperaldosteronism?
A. Excessive sodium intake
B. A pituitary adenoma
C. Deficient potassium intake
D. An adrenal adenoma

10. A male client with type 1 diabetes mellitus has a highly elevated glycosylated hemoglobin (Hb) test result.
In discussing the result with the client, nurse Sharmaine would be most accurate in stating:
A. “The test needs to be repeated following a 12-hour fast.”
B. “It looks like you aren’t following the prescribed diabetic diet.”
C. “It tells us about your sugar control for the last 3 months.”
D. “Your insulin regimen needs to be altered significantly.”
11. Following a unilateral adrenalectomy, nurse Betty would assess for hyperkalemia shown by which of the
following?
A. Muscle weakness
B. Tremors
C. Diaphoresis
D. Constipation

12. Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse
should include information about which hormone lacking in clients with diabetes insipidus?
A. antidiuretic hormone (ADH).
B. thyroid-stimulating hormone (TSH).
C. follicle-stimulating hormone (FSH).
D. luteinizing hormone (LH).

13. Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, nurse Tina
assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme
restlessness. What is the most likely cause of these signs?
A. Diabetic ketoacidosis
B. Thyroid crisis
C. Hypoglycemia
D. Tetany

14. For a male client with hyperglycemia, which assessment finding best supports a nursing diagnosis
of Deficient fluid volume?
A. Cool, clammy skin
B. Distended neck veins
C. Increased urine osmolarity
D. Decreased serum sodium level

15. When assessing a male client with pheochromocytoma, a tumor of the adrenal medulla that secretes
excessive catecholamine, nurse April is most likely to detect:
A. a blood pressure of 130/70 mm Hg.
B. a blood glucose level of 130 mg/dl.
C. bradycardia.
D. a blood pressure of 176/88 mm Hg.

16. A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH).
Which nursing intervention is appropriate?
A. Infusing I.V. fluids rapidly as ordered
B. Encouraging increased oral intake
C. Restricting fluids
D. Administering glucose-containing I.V. fluids as ordered

17. A female client has a serum calcium level of 7.2 mg/dl. During the physical examination, nurse Noah
expects to assess:
A. Trousseau’s sign.
B. Homans’ sign.
C. Hegar’s sign.
D. Goodell’s sign.

18. Which outcome indicates that treatment of a male client with diabetes insipidus has been effective?
A. Fluid intake is less than 2,500 ml/day.
B. Urine output measures more than 200 ml/hour.
C. Blood pressure is 90/50 mm Hg.
D. The heart rate is 126 beats/minute.

19. Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her
husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large
hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client’s
hyperglycemia?
A. Acromegaly
B. Type 1 diabetes mellitus
C. Hypothyroidism
D. Deficient growth hormone

20. Nurse Kate is providing dietary instructions to a male client with hypoglycemia. To control hypoglycemic
episodes, the nurse should recommend:
A. Increasing saturated fat intake and fasting in the afternoon.
B. Increasing intake of vitamins B and D and taking iron supplements.
C. Eating a candy bar if lightheadedness occurs.
D. Consuming a low-carbohydrate, high protein diet and avoiding fasting.
21. An incoherent female client with a history of hypothyroidism is brought to the emergency department by
the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis,
bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings
suggest severe hypothyroidism, nurse Libby prepares to take emergency action to prevent the potential
complication of:
A. Thyroid storm.
B. Cretinism.
C. myxedema coma.
D. Hashimoto’s thyroiditis.

22. A male client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. Nurse
Jack explains that these medications are only effective if the client:
A. prefers to take insulin orally.
B. has type 2 diabetes.
C. has type 1 diabetes.
D. is pregnant and has type 2 diabetes.

23. When caring for a female client with a history of hypoglycemia, nurse Ruby should avoid administering a
drug that may potentiate hypoglycemia. Which drug fits this description?
A. sulfisoxazole (Gantrisin)
B. mexiletine (Mexitil)
C. prednisone (Orasone)
D. lithium carbonate (Lithobid)

24. After taking glipizide (Glucotrol) for 9 months, a male client experiences secondary failure. Which of the
following would the nurse expect the physician to do?
A. Initiate insulin therapy.
B. Switch the client to a different oral antidiabetic agent.
C. Prescribe an additional oral antidiabetic agent.
D. Restrict carbohydrate intake to less than 30% of the total caloric intake.

25. During preoperative teaching for a female client who will undergo subtotal thyroidectomy, the nurse
should include which statement?
A. “The head of your bed must remain flat for 24 hours after surgery.”
B. “You should avoid deep breathing and coughing after surgery.”
C. “You won’t be able to swallow for the first day or two.”
D. “You must avoid hyperextending your neck after surgery.”

26. Nurse Ronn is assessing a client with possible Cushing’s syndrome. In a client with Cushing’s syndrome,
the nurse would expect to find:
A. Hypotension.
B. Thick, coarse skin.
C. Deposits of adipose tissue in the trunk and dorsocervical area.
D. Weight gain in arms and legs.

27. A male client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which
instruction should nurse Lina provide?
A. “Administer desmopressin while the suspension is cold.”
B. “Your condition isn’t chronic, so you won’t need to wear a medical identification bracelet.”
C. “You may not be able to use desmopressin nasally if you have nasal discharge or blockage.”
D. “You won’t need to monitor your fluid intake and output after you start taking desmopressin.”

28. Nurse Wayne is aware that a positive Chvostek’s sign indicate?

A. Hypocalcemia
B. Hyponatremia
C. Hypokalemia
D. Hypermagnesemia

29. In a 29-year-old female client who is being successfully treated for Cushing’s syndrome, nurse Lyzette
would expect a decline in:
A. Serum glucose level.
B. Hair loss.
C. Bone mineralization.
D. Menstrual flow.

30. A male client has recently undergone surgical removal of a pituitary tumor. Dr. Wong prescribes
corticotropin (Acthar), 20 units I.M. q.i.d. as a replacement therapy. What is the mechanism of action of
corticotropin?
A. It decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target organs.
B. It interacts with plasma membrane receptors to inhibit enzymatic actions.
C. It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and
carbohydrate metabolism.
D. It regulates the threshold for water resorption in the kidneys.

31. Capillary glucose monitoring is being performed every 4 hours for a female client diagnosed with diabetic
ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m., the
client has a capillary glucose level of 250 mg/dl for which he receives 8 U of regular insulin. Nurse Vince
should expect the dose’s:
A. Onset to be at 2 p.m. and its peak to be at 3 p.m.
B. Onset to be at 2:15 p.m. and its peak to be at 3 p.m.
C. Onset to be at 2:30 p.m. and its peak to be at 4 p.m.
D. Onset to be at 4 p.m. and its peak to be at 6 p.m.

32. A female client with Cushing’s syndrome is admitted to the medical-surgical unit. During the admission
assessment, nurse Tyzz notes that the client is agitated and irritable, has poor memory, reports loss of
appetite, and appears disheveled. These findings are consistent with which problem?
A. Depression
B. Neuropathy
C. Hypoglycemia
D. Hyperthyroidism

33. Nurse Ruth is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and
tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which
complication?
A. Tetany
B. Hemorrhage
C. Thyroid storm
D. Laryngeal nerve damage

34. After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism. Dr. Smith prescribes
levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent?
A. Primary hypothyroidism
B. Graves’ disease
C. Thyrotoxicosis
D. Euthyroidism

35. Which of these signs suggests that a male client with the syndrome of inappropriate antidiuretic hormone
(SIADH) secretion is experiencing complications?
A. Tetanic contractions
B. Neck vein distention
C. Weight loss
D. Polyuria

36. A female client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive
crisis. To reverse hypertensive crisis caused by pheochromocytoma, nurse Lyka expects to administer:
A. phentolamine (Regitine).
B. methyldopa (Aldomet).
C. mannitol (Osmitrol).
D. felodipine (Plendil).

37. A male client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis
indicates that the client’s hypertension is caused by excessive hormone secretion from which of the following
glands?
A. Adrenal cortex
B. Pancreas
C. Adrenal medulla
D. Parathyroid

38. Nurse Troy is aware that the most appropriate for a client with Addison’s disease?
A. Risk for infection
B. Excessive fluid volume
C. Urinary retention
D. Hypothermia

39. Acarbose (Precose), an alpha-glucosidase inhibitor, is prescribed for a female client with type 2 diabetes
mellitus. During discharge planning, nurse Pauleen would be aware of the client’s need for additional teaching
when the client states:
A. “If I have hypoglycemia, I should eat some sugar, not dextrose.”
B. “The drug makes my pancreas release more insulin.”
C. “I should never take insulin while I’m taking this drug.”
D. “It’s best if I take the drug with the first bite of a meal.”
40. A female client whose physical findings suggest a hyperpituitary condition undergoes an extensive
diagnostic workup. Test results reveal a pituitary tumor, which necessitates
a transsphenoidal hypophysectomy. The evening before the surgery, nurse Jacob reviews preoperative and
postoperative instructions given to the client earlier. Which postoperative instruction should the nurse
emphasize?
A. “You must lie flat for 24 hours after surgery.”
B. “You must avoid coughing, sneezing, and blowing your nose.”
C. “You must restrict your fluid intake.”
D. “You must report ringing in your ears immediately.”

41. Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2
diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise.
Which medication instruction should the nurse provide?
A. “Be sure to take glipizide 30 minutes before meals.”
B. “Glipizide may cause a low serum sodium level, so make sure you have your sodium level checked monthly.”
C. “You won’t need to check your blood glucose level after you start taking glipizide.”
D. “Take glipizide after a meal to prevent heartburn.”

42. For a diabetic male client with a foot ulcer, the physician orders bed rest, a wet-to-dry dressing change
every shift, and blood glucose monitoring before meals and bedtime. Why are wet-to-dry dressings used for
this client?
A. They contain exudate and provide a moist wound environment.
B. They protect the wound from mechanical trauma and promote healing.
C. They debride the wound and promote healing by secondary intention.
D. They prevent the entrance of microorganisms and minimize wound discomfort.

43. When instructing the female client diagnosed with hyperparathyroidism about diet, nurse Gina should
stress the importance of which of the following?
A. Restricting fluids
B. Restricting sodium
C. Forcing fluids
D. Restricting potassium

44. Which nursing diagnosis takes highest priority for a female client with hyperthyroidism?
A. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess
B. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing
C. Body image disturbance related to weight gain and edema
D. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess

45. A male client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has
a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide (Tolinase). Which
of the following is the most important laboratory test for confirming this disorder?
A. Serum potassium level
B. Serum sodium level
C. Arterial blood gas (ABG) values
D. Serum osmolarity

46. A male client has just been diagnosed with type 1 diabetes mellitus. When teaching the client and family
how diet and exercise affect insulin requirements, Nurse Joy should include which guideline?
A. “You’ll need more insulin when you exercise or increase your food intake.”
B. “You’ll need less insulin when you exercise or reduce your food intake.”
C. “You’ll need less insulin when you increase your food intake.”
D. “You’ll need more insulin when you exercise or decrease your food intake.”

47. Nurse Noemi administers glucagon to her diabetic client, then monitors the client for adverse drug
reactions and interactions. Which type of drug interacts adversely with glucagon?
A. Oral anticoagulants
B. Anabolic steroids
C. Beta-adrenergic blockers
D. Thiazide diuretics

48. Which instruction about insulin administration should nurse Kate give to a client?
A. “Always follow the same order when drawing the different insulins into the syringe.”
B. “Shake the vials before withdrawing the insulin.”
C. “Store unopened vials of insulin in the freezer at temperatures well below freezing.”
D. “Discard the intermediate-acting insulin if it appears cloudy.”

49. Nurse Perry is caring for a female client with type 1 diabetes mellitus who exhibits confusion, light-
headedness, and aberrant behavior. The client is still conscious. The nurse should first administer:
A. I.M. or subcutaneous glucagon.
B. I.V. bolus of dextrose 50%.
C. 15 to 20 g of a fast-acting carbohydrate such as orange juice.
D. 10 U of fast-acting insulin.

50. For the first 72 hours after thyroidectomy surgery, nurse Jamie would assess the female client for
Chvostek’s sign and Trousseau’s sign because they indicate which of the following?
A. Hypocalcemia
B. Hypercalcemia
C. Hypokalemia
D. Hyperkalemia

ENDOCRINE MEDICATIONS
1. Somatropin (Humatrope) is being given to a female patient with turner syndrome. Which of the following
findings is associated with this medication?
A. Decreases ALT and AST level.
B. Mild hyperglycemia.
C. Hypotension.
D. Water intoxication.

2. A nurse provide instructions to a client regarding the administration of the prednisone and instructs the
client that the best time to take the medication is during?
A. Any time of the day.
B. Early morning.
C. Lunch.
D. Before bedtime.

3. A client with diabetes insipidus is taking antidiuretic hormone. Which of the following symptoms would
alert the need to decrease the dosage?
A. Alopecia.
B. Jaundice.
C. Diarrhea.
D. Drowsiness.

4. Which of the following medications decreases their action while taking thyroid hormone?
A. Metformin.
B. Warfarin.
C. Zoloft.
D. Epinephrine.

5. Prednisone is prescribed for a client with diabetes mellitus who is using Humulin 70/30 daily. Which of the
following prescription changes does the nurse expect during the therapy with the prednisone?
A. An addition of an oral hypoglycemic medication.
B. Increased dosage of prednisone.
C. Increased dosage of humulin 70/30.
D. Decreased dosage of humulin 70/30.

6. A nurse is instructing a client regarding intranasal Vasopressin (Pitressin). The nurse tells the client that
which of the following is a side effect specific to the medication?
A. Runny nose.
B. Headache.
C. Flushing.
D. Nausea.

7. A nurse is performing an assessment on a newly admit patient who is taking propylthiouracil (PTU) daily.
The nurse suspects that the client has a history of?
A. Addison’s disease.
B. Cushing’s syndrome.
C. Grave’s disease.
D. Myxedema.

8. A nurse is giving discharge instructions a patient who is taking levothyroxine (Synthroid). The nurse instruct
the client to notify the physician if which of the following occurs?
A. Cold intolerance.
B. Tremors.
C. Coarse, dry hair.
D. Muscle cramps.

9. A nurse is giving instructions a patient who is taking levothyroxine (Synthroid). The nurse tells the client
that the best time to take this medication is?
A. During bedtime.
B. After lunch.
C. Taken with food.
D. Taken on an empty stomach.
10. Desmopressin acetate (DDAVP) is given to a patient with diabetes insipidus. Which of the following
therapeutic response should you expect?
A. Decreased blood pressure.
B. Decreased attention span.
C. Decreased urinary output.
D. Decreased blood sugar.

11. A patient adrenal insufficiency is to be discharged and is given Prednisone as a home medication. The
nurse instruct the patient the following, except?
A. To avoid aspirin-containing products.
B. To avoid foods rich in potassium.
C. To avoid caffeinated drinks.
D. To avoid individuals with respiratory infections.

12. Sildenafil (Viagra) is given to a patient with erectile dysfunction. Which of the following history is
contraindicated with the medication?
A. Blurred vision.
B. Neuralgia.
C. Use of vitamins.
D. Use of nitroprusside.

13. Glipizide (Glucotrol) is prescribed to a patient with diabetes mellitus. The nurse instruct the patient to
avoid which of the following?
A. Soft drinks.
B. Whole grain cereals.
C. Alcohol.
D. Organ meats.

14. A nurse is teaching a patient on how to mix regular insulin and NPH insulin in the same syringe. Which of
the following actions, if performed by the patient , indicates the need for further teaching?
A. Withdraws regular insulin first.
B. Withdraws NPH insulin first.
C. Injects an amount of air equivalent to the desired dose of insulin.
D. Injects air into the NPH insulin first.

15. A patient is taking insulin glargine injection daily. The nurse instruct the client that the onset of action will
likely happen?
A. 2-4 hours after administration.
B. 4-12 hours after administration.
C. 6-12 hours after administration.
D. 18-24 hours after administration.

16. A private nurse visits a client who is taking Humulin NPH insulin daily. The client asks the nurse on how is
the storage of the unopened vials of insulin. The nurse tells the client to:
A. Store it at room temperature.
B. Store it in the freezer.
C. Store it in the refrigerator.
D. Keep the insulin in a sunlight, dry place.

17. A client with diabetes mellitus type I was prescribed with Exenatide (Bydureon). The nurse will take which
of the following appropriate actions?
A. Withdraw the insulin from the prefilled pen into an insulin syringe.
B. Monitor for signs of nausea, vomiting, and gastric upset.
C. Administer the medication twice a day during pre-meals.
D. Hold the medication and call the physician to question the prescription.

18. Which of the following insulin cannot be mixed with any other type of insulin?
A. Insulin glargine.
B. Insulin aspart.
C. Insulin isophane.
D. Insulin lispro.

19. Which of the following medications causes hypoglycemia, except?

A. Salicylates.
B. Oral contraceptives.
C. Sulfonamides.
D. Anticoagulants.

20. A nurse is providing instruction to a client who is prescribed with Repaglinide (Prandin). All of which is
true regarding this medication, except?
A. Do not skip the dose when a meal is not taken.
B. Dizziness may occur while taking it.
C. Has quicker and shorter duration of action.
D. Use to treat type II diabetes mellitus.

HEMATOLOGIC DISORDERS

1. The nurse is preparing to teach a client with microcytic hypochromic anemia about the diet to follow after
discharge. Which of the following foods should be included in the diet?
A. Eggs
B. Lettuce
C. Citrus fruits
D. Cheese

2. The nurse would instruct the client to eat which of the following foods to obtain the best supply of vitamin
B12?
A. Whole grains
B. Green leafy vegetables
C. Meats and dairy products
D. Broccoli and Brussels sprouts

3. The nurse has just admitted a 35-year-old female client who has a serum B12 concentration of 800 pg/ml.
Which of the following laboratory findings would cue the nurse to focus the client history on specific drug or
alcohol abuse?
A. Total bilirubin, 0.3 mg/dL
B. Serum creatinine, 0.5 mg/dL
C. Hemoglobin, 16 g/dL
D. Folate, 1.5 ng/mL

4. The nurse understands that the client with pernicious anemia will have which distinguishing laboratory
findings?
A. Schilling’s test elevated
B. Intrinsic factor, absent.
C. Sedimentation rate, 16 mm/hour
D. RBCs 5.0 million

5. The nurse devises a teaching plan for the patient with aplastic anemia. Which of the following is the most
important concept to teach for health maintenance?
A. Eat animal protein and dark leafy vegetables each day
B. Avoid exposure to others with acute infection
C. Practice yoga and meditation to decrease stress and anxiety
D. Get 8 hours of sleep at night and take naps during the day

6. A client comes into the health clinic 3 years after undergoing a resection of the terminal ileum complaining
of weakness, shortness of breath, and a sore tongue. Which client statement indicates a need for intervention
and client teaching?
A. “I have been drinking plenty of fluids.”
B. “I have been gargling with warm salt water for my sore tongue.”
C. “I have 3 to 4 loose stools per day.”
D. “I take a vitamin B12 tablet every day.”

7. A vegetarian client was referred to a dietitian for nutritional counseling for anemia. Which client outcome
indicates that the client does not understand nutritional counseling? The client:
A. Adds dried fruit to cereal and baked goods
B. Cooks tomato-based foods in iron pots
C. Drinks coffee or tea with meals
D. Adds vitamin C to all meals

8. A client was admitted with iron deficiency anemia and blood-streaked emesis. Which question is most
appropriate for the nurse to ask in determining the extent of the client’s activity intolerance?
A. “What activities were you able to do 6 months ago compared to the present?”
B. “How long have you had this problem?”
C. “Have you been able to keep up with all your usual activities?”
D. “Are you more tired now than you used to be?”

9. The primary purpose of the Schilling test is to measure the client’s ability to:
A. Store vitamin B12
B. Digest vitamin B12
C. Absorb vitamin B12
D. Produce vitamin B12

10. The nurse implements which of the following for the client who is starting a Schilling test?
A. Administering methylcellulose (Citrucel)
B. Starting a 24- to 48 hour urine specimen collection
C. Maintaining NPO status
D. Starting a 72 hour stool specimen collection

11. A client with pernicious anemia asks why she must take vitamin B12 injections for the rest of her life.
What is the nurse’s best response?
A. “The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing
sufficient acid.”
B. “The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing
sufficient intrinsic factor.”
C. “The reason for your vitamin deficiency is an excessive excretion of the vitamin because of kidney dysfunction.”
D. “The reason for your vitamin deficiency is an increased requirement for the vitamin because of rapid red blood cell
production.”

12. The nurse is assessing a client’s activity intolerance by having the client walk on a treadmill for 5 minutes.
Which of the following indicates an abnormal response?
A. Pulse rate increased by 20 bpm immediately after the activity
B. Respiratory rate decreased by 5 breaths/minute
C. Diastolic blood pressure increased by 7 mm Hg
D. Pulse rate within 6 bpm of resting phase after 3 minutes of rest.

13. When comparing the hematocrit levels of a post-op client, the nurse notes that the hematocrit decreased
from 36% to 34% on the third day even though the RBC and hemoglobin values remained stable at 4.5 million
and 11.9 g/dL, respectively. Which nursing intervention is most appropriate?
A. Check the dressing and drains for frank bleeding
B. Call the physician
C. Continue to monitor vital signs
D. Start oxygen at 2L/min per NC

14. A client is to receive epoetin (Epogen) injections. What laboratory value should the nurse assess before
giving the injection?
A. Hematocrit
B. Partial thromboplastin time
C. Hemoglobin concentration
D. Prothrombin time

15. A client states that she is afraid of receiving vitamin B12 injections because of the potential toxic
reactions. What is the nurse’s best response to relieve these fears?
A. “Vitamin B12 will cause ringing in the eats before a toxic level is reached.”
B. “Vitamin B12 may cause a very mild skin rash initially.”
C. “Vitamin B12 may cause mild nausea but nothing toxic.”
D. “Vitamin B12 is generally free of toxicity because it is water soluble.”

16. A client with microcytic anemia is having trouble selecting food items from the hospital menu. Which
food is best for the nurse to suggest for satisfying the client’s nutritional needs and personal preferences?
A. Egg yolks
B. Brown rice
C. Vegetables
D. Tea

17. A client with macrocytic anemia has a burn on her foot and states that she had been watching television
while lying on a heating pad. What is the nurse’s first response?
A. Assess for potential abuse
B. Check for diminished sensations
C. Document the findings
D. Clean and dress the area

18. Which of the following nursing assessments is a late symptom of polycythemia vera?
A. Headache
B. Dizziness
C. Pruritus
D. Shortness of breath

19. The nurse is teaching a client with polycythemia vera about potential complications from this disease.
Which manifestations would the nurse include in the client’s teaching plan? Select all that apply.
A. Hearing loss
B. Visual disturbance
C. Headache
D. Orthopnea
E. Gout
F. Weight loss
20. When a client is diagnosed with aplastic anemia, the nurse monitors for changes in which of the following
physiological functions?
A. Bleeding tendencies
B. Intake and output
C. Peripheral sensation
D. Bowel function

21. Which of the following blood components is decreased in anemia?

A. Erythrocytes
B. Granulocytes
C. Leukocytes
D. Platelets

22. A client with anemia may be tired due to a tissue deficiency of which of the following substances?
A. Carbon dioxide
B. Factor VIII
C. Oxygen
D. T-cell antibodies

23. Which of the following cells is the precursor to the red blood cell (RBC)?
A. B cell
B. Macrophage
C. Stem cell
D. T cell

24. Which of the following symptoms is expected with hemoglobin of 10 g/dl?

A. None
B. Pallor
C. Palpitations
D. Shortness of breath

25. Which of the following diagnostic findings are most likely for a client with aplastic anemia?
A. Decreased production of T-helper cells
B. Decreased levels of white blood cells, red blood cells, and platelets
C. Increased levels of WBCs, RBCs, and platelets
D. Reed-Sternberg cells and lymph node enlargement

26. A client with iron deficiency anemia is scheduled for discharge. Which instruction about prescribed
ferrous gluconate therapy should the nurse include in the teaching plan?
A. “Take the medication with an antacid.”
B. “Take the medication with a glass of milk.”
C. “Take the medication with cereal.”
D. “Take the medication on an empty stomach.”

27. Which of the following disorders results from a deficiency of factor VIII?
A. Sickle cell disease
B. Christmas disease
C. Hemophilia A
D. Hemophilia B

28. The nurse explains to the parents of a 1-year-old child admitted to the hospital in a sickle cell crisis that
the local tissue damage the child has on admission is caused by which of the following?
A. Autoimmune reaction complicated by hypoxia
B. Lack of oxygen in the red blood cells
C. Obstruction to circulation
D. Elevated serum bilirubin concentration.

29. The mothers asks the nurse why her child’s hemoglobin was normal at birth but now the child has S
hemoglobin. Which of the following responses by the nurse is most appropriate?
A. “The placenta bars passage of the hemoglobin S from the mother to the fetus.”
B. “The red bone marrow does not begin to produce hemoglobin S until several months after birth.”
C. “Antibodies transmitted from you to the fetus provide the newborn with temporary immunity.”
D. “The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth.”

30. Which of the following would the nurse identify as the priority nursing diagnosis during a toddler’s vaso-
occlusive sickle cell crisis?
A. Ineffective coping related to the presence of a life-threatening disease
B. Decreased cardiac output related to abnormal hemoglobin formation
C. Pain related to tissue anoxia
D. Excess fluid volume related to infection
31. A mother asks the nurse if her child’s iron deficiency anemia is related to the child’s frequent infections.
The nurse responds based on the understanding of which of the following?
A. Little is known about iron-deficiency anemia and its relationship to infection in children.
B. Children with iron deficiency anemia are more susceptible to infection than are other children.
C. Children with iron-deficiency anemia are less susceptible to infection than are other children.
D. Children with iron-deficient anemia are equally as susceptible to infection as are other children.

32. Which statements by the mother of a toddler would lead the nurse to suspect that the child has iron-
deficiency anemia? Select all that apply.
A. “He drinks over 3 cups of milk per day.”
B. “I can’t keep enough apple juice in the house; he must drink over 10 ounces per day.”
C. “He refuses to eat more than 2 different kinds of vegetables.”
D. “He doesn’t like meat, but he will eat small amounts of it.”
5. “He sleeps 12 hours every night and take a 2-hour nap.”

33. Which of the following foods would the nurse encourage the mother to offer to her child with iron
deficiency anemia?
A. Rice cereal, whole milk, and yellow vegetables
B. Potato, peas, and chicken
C. Macaroni, cheese, and ham
D. Pudding, green vegetables, and rice

34. The physician has ordered several laboratory tests to help diagnose an infant’s bleeding disorder. Which
of the following tests, if abnormal, would the nurse interpret as most likely to indicate hemophilia?
A. Bleeding time
B. Tourniquet test
C. Clot retraction test
D. Partial thromboplastin time (PTT)

35. Which of the following assessments in a child with hemophilia would lead the nurse to suspect early
hemarthrosis?
A. Child’s reluctance to move a body part
B. Cool, pale, clammy extremity
C. Ecchymosis formation around a joint
D. Instability of a long bone in passive movement

36. Because of the risks associated with administration of factor VIII concentrate, the nurse would teach the
client’s family to recognize and report which of the following?
A. Yellowing of the skin
B. Constipation
C. Abdominal distention
D. Puffiness around the eyes

37. A child suspected of having sickle cell disease is seen in a clinic, and laboratory studies are performed. A
nurse checks the lab results, knowing that which of the following would be increased in this disease?
A. Platelet count
B. Hematocrit level
C. Reticulocyte count
D. Hemoglobin level

38. A clinic nurse instructs the mother of a child with sickle cell disease about the precipitating factors related
to pain crisis. Which of the following, if identified by the mother as a precipitating factor, indicates the need
for further instructions?
A. Infection
B. Trauma
C. Fluid overload
D. Stress

39. Laboratory studies are performed for a child suspected of having iron deficiency anemia. The nurse
reviews the laboratory results, knowing that which of the following results would indicate this type of anemia?
A. An elevated hemoglobin level
B. A decreased reticulocyte count
C. An elevated RBC count
D. Red blood cells that are microcytic and hypochromic

40. A pediatric nurse health educator provides a teaching session to the nursing staff regarding hemophilia.
Which of the following information regarding this disorder would the nurse plan to include in the discussion?
A. Hemophilia is a Y linked hereditary disorder
B. Males inherit hemophilia from their fathers
C. Females inherit hemophilia from their mothers
D. Hemophilia A results from a deficiency of factor VIII
RESPIRATORY SYSTEM

1. Dr. Jones prescribes albuterol sulfate (Proventil) for a patient with newly diagnose asthma. When teaching
the patient about this drug, the nurse should explain that it may cause:
A. Nasal congestion
B. Nervousness
C. Lethargy
D. Hyperkalemia
2. Miriam, a college student with acute rhinitis sees the campus nurse because of excessive nasal drainage. The
nurse asks the patient about the color of the drainage. In acute rhinitis, nasal drainage normally is:
A. Yellow
B. Green
C. Clear
D. Gray
3. A male adult patient hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis.
Which clinical findings commonly accompany respiratory alkalosis?
A. Nausea or vomiting
B. Abdominal pain or diarrhea
C. Hallucinations or tinnitus
D. Lightheadedness or paresthesia
4. Before administering ephedrine, Nurse Tony assesses the patient’s history. Because of ephedrine’s
central nervous system (CNS) effects, it is not recommended for:
A. Patients with an acute asthma attack
B. Patients with narcolepsy
C. Patients under age 6
D. Elderly patients
5. A female patient suffers adult respiratory distress syndrome as a consequence of shock. The patient’s
condition deteriorates rapidly, and endotracheal intubation and mechanical ventilation are initiated. When the
high-pressure alarm on the mechanical ventilator, alarm sounds, the nurse starts to check for the cause. Which
condition triggers the high-pressure alarm?
A. Kinking of the ventilator tubing
B. A disconnected ventilator tube
C. An endotracheal cuff leak
D. A change in the oxygen concentration without resetting the oxygen level alarm
6. A male adult patient on mechanical ventilation is receiving pancuronium bromide (Pavulon), 0.01 mg/kg
I.V. as needed. Which assessment finding indicates that the patient needs another pancuronium dose?
A. Leg movement
B. Finger movement
C. Lip movement
D. Fighting the ventilator
7. On auscultation, which finding suggests a right pneumothorax?
A. Bilateral inspiratory and expiratory crackles
B. Absence of breaths sound in the right thorax
C. Inspiratory wheezes in the right thorax
D. Bilateral pleural friction rub.
8. Rhea, confused and short breath, is brought to the emergency department by a family member. The
medical history reveals chronic bronchitis and hypertension. To learn more about the current respiratory
problem, the doctor orders a chest x-ray and arterial blood gas (ABG) analysis. When reviewing the ABG
report, the nurses sees many abbreviations. What does a lowercase “a” in ABG value present?
A. Acid-base balance
B. Arterial Blood
C. Arterial oxygen saturation
D. Alveoli
9. A male patient is admitted to the healthcare facility for treatment of chronic obstructive pulmonary disease.
Which nursing diagnosis is most important for this patient?
A. Activity intolerance related to fatigue
B. Anxiety related to actual threat to health status
C. Risk for infection related to retained secretions
D. Impaired gas exchange related to airflow obstruction
10. Nurse Ruth assessing a patient for tracheal displacement should know that the trachea will deviate toward
the:
A. Contralateral side in a simple pneumothorax
B. Affected side in a hemothorax
C. Affected side in a tension pneumothorax
D. Contralateral side in hemothorax
11. After undergoing a left pneumonectomy, a female patient has a chest tube in place for drainage. When
caring for this patient, the nurse must:
A. Monitor fluctuations in the water-seal chamber
B. Clamp the chest tube once every shift
C. Encourage coughing and deep breathing
D. Milk the chest tube every 2 hours
12. When caring for a male patient who has just had a total laryngectomy, the nurse should plan to:
A. Encourage oral feeding as soon as possible
B. Develop an alternative communication method
C. Keep the tracheostomy cuff fully inflated
D. Keep the patient flat in bed
13. A male patient has a sucking stab wound to the chest. Which action should the nurse take first?
A. Drawing blood for a hematocrit and hemoglobin level
B. Applying a dressing over the wound and taping it on three sides
C. Preparing a chest tube insertion tray
D. Preparing to start an I.V. line
14. For a patient with advanced chronic obstructive pulmonary disease (COPD), which nursing action best
promotes adequate gas exchange?
A. Encouraging the patient to drink three glasses of fluid daily
B. Keeping the patient in semi-Fowler’s position
C. Using a high-flow venture mask to deliver oxygen as prescribe
D. Administering a sedative, as prescribe
15. A male patient’s X-ray result reveals bilateral white-outs, indicating adult respiratory distress syndrome
(ARDS). This syndrome results from:
A. Cardiogenic pulmonary edema
B. Respiratory alkalosis
C. Increased pulmonary capillary permeability
D. Renal failure
16. For a female patient with chronic obstructive pulmonary disease, which nursing intervention would help
maintain a patent airway?
A. Restricting fluid intake to 1,000 ml per day
B. Enforcing absolute bed rest
C. Teaching the patient how to perform controlled coughing
D. Administering prescribe sedatives regularly and in large amounts
17. Nurse Lei caring for a client with a pneumothorax and who has had a chest tube inserted notes continues
gentle bubbling in the suction control chamber. What action is appropriate?
A. Do nothing, because this is an expected finding
B. Immediately clamp the chest tube and notify the physician
C. Check for an air leak because the bubbling should be intermittent
D. Increase the suction pressure so that the bubbling becomes vigorous
18. Nurse Maureen has assisted a physician with the insertion of a chest tube. The nurse monitors the client
and notes fluctuation of the fluid level in the water seal chamber after the tube is inserted. Based on this
assessment, which action would be appropriate?
A. Inform the physician
B. Continue to monitor the client
C. Reinforce the occlusive dressing
D. Encourage the client to deep breathe
19. Nurse Reynolds caring for a client with a chest tube turns the client to the side, and the chest tube
accidentally disconnects. The initial nursing action is to:
A. Call the physician
B. Place the tube in bottle of sterile water
C. Immediately replace the chest tube system
D. Place a sterile dressing over the disconnection site
20. A nurse is assisting a physician with the removal of a chest tube. The nurse should instruct the client to:
A. Exhale slowly
B. Stay very still
C. Inhale and exhale quickly
D. Perform the Valsalva maneuver
21. While changing the tapes on a tracheostomy tube, the male client coughs and tube is dislodged. The initial
nursing action is to:
A. Call the physician to reinsert the tube
B. Grasp the retention sutures to spread the opening
C. Call the respiratory therapy department to reinsert the tracheotomy
D. Cover the tracheostomy site with a sterile dressing to prevent infection
22. Nurse Oliver is caring for a client immediately after removal of the endotracheal tube. The nurse reports
which of the following signs immediately if experienced by the client?
A. Stridor
B. Occasional pink-tinged sputum
C. A few basilar lung crackles on the right
D. Respiratory rate 24 breaths/min
23. An emergency room nurse is assessing a male client who has sustained a blunt injury to the chest wall.
Which of these signs would indicate the presence of a pneumothorax in this client?
A. A low respiratory rate
B. Diminished breath sounds
C. The presence of a barrel chest
D. A sucking sound at the site of injury
24. Nurse Reese is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary
disease. Which of the following would the nurse expect to note on assessment of this client?
A. Hypocapnia
B. A hyperinflated chest noted on the chest x-ray
C. Increased oxygen saturation with exercise
D. A widened diaphragm noted on the chest x-ray
25. An oxygen delivery system is prescribed for a male client with chronic obstructive pulmonary disease to
deliver a precise oxygen concentration. Which of the following types of oxygen delivery systems would the
nurse anticipate to be prescribed?
A. Face tent
B. Venturi mask
C. Aerosol mask
D. Tracheostomy collar
26. Blessy, a community health nurse is conducting an educational session with community members
regarding tuberculosis. The nurse tells the group that one of the first symptoms associated with tuberculosis
is:
A. Dyspnea
B. Chest pain
C. A bloody, productive cough
D. A cough with the expectoration of mucoid sputum
27. A nurse performs an admission assessment on a female client with a diagnosis of tuberculosis. The nurse
reviews the result of which diagnosis test that will confirm this diagnosis?
A. Bronchoscopy
B. Sputum culture
C. Chest x-ray
D. Tuberculin skin test
28. A nurse is caring for a male client with emphysema who is receiving oxygen. The nurse assesses the
oxygen flow rate to ensure that it does not exceed:
A. 1 L/min
B. 2 L/min
C. 6 L/min
D. 10 L/min
29. A nurse instructs a female client to use the pursed-lip method of breathing and the client asks the nurse
about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of
pursed-lip breathing is to:
A. Promote oxygen intake
B. Strengthen the diaphragm
C. Strengthen the intercostal muscles
D. Promote carbon dioxide elimination
30. A nurse is caring for a male client with acute respiratory distress syndrome. Which of the following would
the nurse expect to note in the client?
A. Pallor
B. Low arterial PaO2
C. Elevated arterial PaO2
D. Decreased respiratory rate
31. A nurse is preparing to obtain a sputum specimen from a male client. Which of the following nursing
actions will facilitate obtaining the specimen?
A. Limiting fluid
B. Having the client take deep breaths
C. Asking the client to spit into the collection container
D. Asking the client to obtain the specimen after eating
32. Nurse Joy is caring for a client after a bronchoscopy and biopsy. Which of the following signs, if noticed in
the client, should be reported immediately to the physician?
A. Dry cough
B. Hematuria
C. Bronchospasm
D. Blood-streaked sputum
33. A nurse is suctioning fluids from a male client via a tracheostomy tube. When suctioning, the nurse must
limit the suctioning time to a maximum of:
A. 1 minute
B. 5 seconds
C. 10 seconds
D. 30 seconds
34. A nurse is suctioning fluids from a female client through an endotracheal tube. During the suctioning
procedure, the nurse notes on the monitor that the heart rate is decreasing. Which if the following is the
appropriate nursing intervention?
A. Continue to suction
B. Notify the physician immediately
C. Stop the procedure and reoxygenate the client
D. Ensure that the suction is limited to 15 seconds
35. A male adult client is suspected of having a pulmonary embolus. A nurse assesses the client, knowing that
which of the following is a common clinical manifestation of pulmonary embolism?
A. Dyspnea
B. Bradypnea
C. Bradycardia
D. Decreased respirations
36. A slightly obese female client with a history of allergy-induced asthma, hypertension, and mitral valve
prolapse is admitted to an acute care facility for elective surgery. The nurse obtains a complete history and
performs a thorough physical examination, paying special attention to the cardiovascular and respiratory
systems. When percussing the client’s chest wall, the nurse expects to elicit:
A. Resonant sounds.
B. Hyperresonant sounds.
C. Dull sounds.
D. Flat sounds.
37. A male client who weighs 175 lb (79.4 kg) is receiving aminophylline (Aminophyllin) (400 mg in 500 ml) at
50 ml/hour. The theophylline level is reported as 6 mcg/ml. The nurse calls the physician who instructs the
nurse to change the dosage to 0.45 mg/kg/hour. The nurse should:
A. Question the order because it’s too low.
B. Question the order because it’s too high.
C. Set the pump at 45 ml/hour.
D. Stop the infusion and have the laboratory repeat the theophylline measurement.
38. The nurse is teaching a male client with chronic bronchitis about breathing exercises. Which of the
following should the nurse include in the teaching?
A. Make inhalation longer than exhalation.
B. Exhale through an open mouth.
C. Use diaphragmatic breathing.
D. Use chest breathing.
39. Which phrase is used to describe the volume of air inspired and expired with a normal breath?
A. Total lung capacity
B. Forced vital capacity
C. Tidal volume
D. Residual volume
40. A male client abruptly sits up in bed, reports having difficulty breathing and has an arterial oxygen
saturation of 88%. Which mode of oxygen delivery would most likely reverse the manifestations?
A. Simple mask
B. Non-rebreather mask
C. Face tent
D. Nasal cannula
41. A female client must take streptomycin for tuberculosis. Before therapy begins, the nurse should instruct
the client to notify the physician if which health concern occurs?
A. Impaired color discrimination
B. Increased urinary frequency
C. Decreased hearing acuity
D. Increased appetite
42. A male client is asking the nurse a question regarding the Mantoux test for tuberculosis. The nurse should
base her response on the fact that the:
A. Area of redness is measured in 3 days and determines whether tuberculosis is present.
B. Skin test doesn’t differentiate between active and dormant tuberculosis infection.
C. Presence of a wheal at the injection site in 2 days indicates active tuberculosis.
D. Test stimulates a reddened response in some clients and requires a second test in 3 months.
43. A female adult client has a tracheostomy but doesn’t require continuous mechanical ventilation. When
weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the tube for:
A. 15 to 60 seconds.
B. 5 to 20 minutes.
C. 30 to 40 minutes.
D. 45 to 60 minutes.
44. Nurse Oliver observes constant bubbling in the water-seal chamber of a closed chest drainage system.
What should the nurse conclude?
A. The system is functioning normally
B. The client has a pneumothorax.
C. The system has an air leak.
D. The chest tube is obstructed.
45. A black client with asthma seeks emergency care for acute respiratory distress. Because of this client’s dark
skin, the nurse should assess for cyanosis by inspecting the:
A. Lips.
B. Mucous membranes.
C. Nail beds.
D. Earlobes.
46. For a male client with an endotracheal (ET) tube, which nursing action is most essential?
A. Auscultating the lungs for bilateral breath sounds
B. Turning the client from side to side every 2 hours
C. Monitoring serial blood gas values every 4 hours
D. Providing frequent oral hygiene
47. The nurse assesses a male client’s respiratory status. Which observation indicates that the client is
experiencing difficulty breathing?
A. Diaphragmatic breathing
B. Use of accessory muscles
C. Pursed-lip breathing
D. Controlled breathing
48. A female client is undergoing a complete physical examination as a requirement for college. When
checking the client’s respiratory status, the nurse observes respiratory excursion to help assess:
A. Lung vibrations.
B. Vocal sounds.
C. Breath sounds.
D. Chest movements.
49. A male client comes to the emergency department complaining of sudden onset of diarrhea, anorexia,
malaise, cough, headache, and recurrent chills. Based on the client’s history and physical findings, the
physician suspects legionnaires’ disease. While awaiting diagnostic test results, the client is admitted to the
facility and started on antibiotic therapy. What is the drug of choice for treating legionnaires’ disease?
A. Erythromycin (Erythrocin)
B. Rifampin (Rifadin)
C. Amantadine (Symmetrel)
D. Amphotericin B (Fungizone)
50. A male client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial
infarction. Because the client is extremely weak and can’t produce an effective cough, the nurse should
monitor closely for:
A. Pleural effusion.
B. Pulmonary edema.
C. Atelectasis.
D. Oxygen toxicity.
51. The nurse in charge is teaching a client with emphysema how to perform pursed-lip breathing. The client
asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse
provide?
A. It helps prevent early airway collapse.
B. It increases inspiratory muscle strength.
C. It decreases use of accessory breathing muscles.
D. It prolongs the inspiratory phase of respiration.
52. After receiving an oral dose of codeine for an intractable cough, the male client asks the nurse, “How long
will it take for this drug to work?” How should the nurse respond?
A. In 30 minutes
B. In 1 hour
C. In 2.5 hours
D. In 4 hours
53. A male client suffers adult respiratory distress syndrome as a consequence of shock. The client’s condition
deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the
high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which
condition triggers the high-pressure alarm?
A. Kinking of the ventilator tubing
B. A disconnected ventilator tube
C. An ET cuff leak
D. A change in the oxygen concentration without resetting the oxygen level alarm
54. A female client with chronic obstructive pulmonary disease (COPD) takes anhydrous theophylline, 200 mg
P.O. every 8 hours. During a routine clinic visit, the client asks the nurse how the drug works. What is the
mechanism of action of anhydrous theophylline in treating a nonreversible obstructive airway disease such as
COPD?
A. It makes the central respiratory center more sensitive to carbon dioxide and stimulates the respiratory drive.
B. It inhibits the enzyme phosphodiesterase, decreasing degradation of cyclic adenosine monophosphate, a
bronchodilator.
C. It stimulates adenosine receptors, causing bronchodilation.
D. It alters diaphragm movement, increasing chest expansion and enhancing the lung’s capacity for gas exchange.
55. A male client with pneumococcal pneumonia is admitted to an acute care facility. The client in the next
room is being treated for mycoplasmal pneumonia. Despite the different causes of the various types of
pneumonia, all of them share which feature?
A. Inflamed lung tissue
B. Sudden onset
C. Responsiveness to penicillin.
D. Elevated white blood cell (WBC) count
56. A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar
ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?
A. pH, 5.0; PaCO2 30 mm Hg
B. pH, 7.40; PaCO2 35 mm Hg
C. pH, 7.35; PaCO2 40 mm Hg
D. pH, 7.25; PaCO2 50 mm Hg
57. A male client admitted to an acute care facility with pneumonia is receiving supplemental oxygen, 2
L/minute via nasal cannula. The client’s history includes chronic obstructive pulmonary disease (COPD)
and coronary artery disease. Because of these history findings, the nurse closely monitors the oxygen flow and
the client’s respiratory status. Which complication may arise if the client receives a high oxygen
concentration?
A. Apnea
B. Anginal pain
C. Respiratory alkalosis
D. Metabolic acidosis
58. At 11 p.m., a male client is admitted to the emergency department. He has a respiratory rate of 44
breaths/minute. He’s anxious, and wheezes are audible. The client is immediately given oxygen by face mask
and methylprednisolone (Depo-medrol) I.V. At 11:30 p.m., the client’s arterial blood oxygen saturation is 86%
and he’s still wheezing. The nurse should plan to administer:
A. Alprazolam (Xanax).
B. Propranolol (Inderal)
C. Morphine.
D. Albuterol (Proventil).
59. After undergoing a thoracotomy, a male client is receiving epidural analgesia. Which assessment finding
indicates that the client has developed the most serious complication of epidural analgesia?
A. Heightened alertness
B. Increased heart rate
C. Numbness and tingling of the extremities
D. Respiratory depression
60. The nurse in charge formulates a nursing diagnosis of Activity intolerance related to inadequate
oxygenation and dyspnea for a client with chronic bronchitis. To minimize this problem, the nurse instructs
the client to avoid conditions that increase oxygen demands. Such conditions include:
A. Drinking more than 1,500 ml of fluid daily.
B. Being overweight.
C. Eating a high-protein snack at bedtime.
D. Eating more than three large meals a day.

CARDIOVASCULAR
1. Atherosclerosis impedes coronary blood flow by which of the following mechanisms?
A. Plaques obstruct the vein
B. Plaques obstruct the artery
C. Blood clots form outside the vessel wall
D. Hardened vessels dilate to allow blood to flow through
2. A paradoxical pulse occurs in a client who had a coronary artery bypass graft (CABG) surgery two (2) days
ago. Which of the following surgical complications should the nurse suspect?
1. Left-sided heart failure
2. Aortic regurgitation
3. Complete heart block
4. Pericardial tamponade
3. After cardiac surgery, a client’s blood pressure measures 126/80. The nurse determines that the mean
arterial pressure (MAP) is which of the following?
1. 46 mm Hg
2. 80 mm Hg
3. 95 mm Hg
4. 90 mm Hg
4. A woman with severe mitral stenosis and mitral regurgitation has a pulmonary artery catheter inserted. The
physician orders pulmonary artery pressure monitoring, including pulmonary capillary wedge pressures. The
purpose of this is to help assess the:
1. Degree of coronary artery stenosis
2. Peripheral arterial pressure
3. Pressure from fluid within the left ventricle
4. Oxygen and carbon dioxide concentration is the blood
5. For a client who excretes excessive amounts of calcium during the postoperative period after open heart
surgery, which of the following measures should the nurse institute to help prevent complications associated
with excessive calcium excretion?
1. Ensure a liberal fluid intake
2. Provide an alkaline ash diet
3. Prevent constipation
4. Enrich the client’s diet with dairy products
6. A nurse is assessing the neurovascular of a client who has returned to the surgical nursing unit 4 hours ago
after undergoing aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema.
The pedal pulse is palpable and unchanged from admission. The nurse interprets that the neurovascular status
is:
1. Normal because of increased blood flow through the leg
2. Slightly deteriorating and should be monitored for another hour
3. Moderately impaired, and the surgeon should be called
4. Adequate from an arterial approach, but venous complications are arising.
7. After open-heart surgery, a client develops a temperature of 102*F. The nurse notifies the physician because
elevated temperatures:
1. Increase the cardiac output
2. May indicate cerebral edema
3. May be a forerunner of hemorrhage
4. Are related to diaphoresis and possible chilling
8. During a cardiac catheterization blood samples from the right atrium, right ventricle, and pulmonary artery
are analyzed for their oxygen content. Normally:
1. All contain less CO2 than does pulmonary vein blood
2. All contain more oxygen than does pulmonary vein blood
3. The samples of blood all contain about the same amount of oxygen
4. Pulmonary artery blood contains more oxygen than the other samples
9. The nurse prepares the client for insertion of a pulmonary artery catheter (Swan-Ganz catheter). The nurse
teaches the client that the catheter will be inserted to provide information about:
1. Stroke volume
2. Cardiac output
3. Venous pressure
4. Left ventricular functioning
10. When preparing a client for discharge after surgery for a CABG, the nurse should teach the client that
there will be:
1. No further drainage from the incisions after hospitalizations
2. A mild fever and extreme fatigue for several weeks after surgery
3. Little incisional pain and tenderness after 3 to 4 weeks after surgery
4. Some increase in edema in the leg used for the donor graft when activity increases
11. What is the most important nursing action when measuring a pulmonary capillary wedge pressure
(PCWP)?
1. Have the client bear down when measuring the PCWP
2. Deflate the balloon as soon as the PCWP is measured
3. Place the client in a supine position before measuring the PCWP
4. Flush the catheter with heparin solution after the PCWP is determined.
12. The most important assessment for the nurse to make after a client has had a femoropopliteal bypass for
peripheral vascular disease would be:
1. Incisional pain
2. Pedal pulse rate
3. Capillary refill time
4. Degree of hair growth
13. Which signs cause the nurse to suspect cardiac tamponade after a client has cardiac surgery? Check all that
apply.
1. Tachycardia
2. Hypertension
3. Increased CVP
4. Increased urine output
5. Jugular vein distention
14. A client has the diagnosis of left ventricular failure and a high pulmonary capillary wedge pressure
(PCWP). The physician orders dopamine to improve ventricular function. The nurse will know
the medication is working if the client’s:
1. Blood pressure rises
2. Blood pressure decreases
3. Cardiac index falls
4. PCWP rises
15. A 35-year-old male was knifed in the street fight, admitted through the ER, and is now in the ICU. An
assessment of his condition reveals the following symptoms: respirations shallow and rapid, CVP 15 cm H2O,
BP 90 mm Hg systolic, skin cold and pale, urinary output 60-100 mL/hr for the last 2 hours. Analyzing these
symptoms, the nurse will base a nursing diagnosis on the conclusion that the client has which of the following
conditions?
1. Hypovolemic shock
2. Cardiac tamponade
3. Wound dehiscence
4. Atelectasis

1. A client is scheduled for a cardiac catheterization using a radiopaque dye. Which of the following
assessments is most critical before the procedure?
1. Intake and output
2. Baseline peripheral pulse rates
3. Height and weight
4. Allergy to iodine or shellfish
2. A client with no history of cardiovascular disease comes into the ambulatory clinic with flu-like symptoms.
The client suddenly complains of chest pain. Which of the following questions would best help a nurse to
discriminate pain caused by a non-cardiac problem?
1. “Have you ever had this pain before?”
2. “Can you describe the pain to me?”
3. “Does the pain get worse when you breathe in?”
4. “Can you rate the pain on a scale of 1-10, with ten (10) being the worst?”
3. A client with myocardial infarction has been transferred from a coronary care unit to a general medical unit
with cardiac monitoring via telemetry. A nurse plans to allow for which of the following client activities?
1. Strict bed rest for 24 hours after transfer
2. Bathroom privileges and self-care activities
3. Unsupervised hallway ambulation with distances under 200 feet
4. Ad lib activities because the client is monitored.
4. A nurse notes 2+ bilateral edema in the lower extremities of a client with myocardial infarction who was
admitted two (2) days ago. The nurse would plan to do which of the following next?
1. Review the intake and output records for the last two (2) days
2. Change the time of diuretic administration from morning to evening
3. Request a sodium restriction of one (1) g/day from the physician.
4. Order daily weight starting the following morning.
5. A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no
electrocardiogram complexes on the screen. The first action of the nurse is to:
1. Check the client status and lead placement
2. Press the recorder button on the electrocardiogram console.
3. Call the physician
4. Call a code blue
6. A nurse is assessing the blood pressure of a client diagnosed with primary hypertension. The nurse ensures
accurate measurement by avoiding which of the following?
1. Seating the client with arm bared, supported, and at heart level.
2. Measuring the blood pressure after the client has been seated quietly for 5 minutes.
3. Using a cuff with a rubber bladder that encircles at least 80% of the limb.
4. Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion.
7. IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the
following medications is available on the nursing unit?
1. Vitamin K
2. Aminocaproic acid
3. Potassium chloride
4. Protamine sulfate
8. A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin (Coumadin). The
client’s prothrombin time is 20 seconds, with a control of 11 seconds. The nurse assesses that this result is:
1. The same as the client’s own baseline level
2. Lower than the needed therapeutic level
3. Within the therapeutic range
4. Higher than the therapeutic range
9. A client who has been receiving heparin therapy also is started on warfarin. The client asks a nurse why both
medications are being administered. In formulating a response, the nurse incorporates the understanding that
warfarin:
1. Stimulates the breakdown of specific clotting factors by the liver, and it takes two (2)- three (3) days for this to exert
an anticoagulant effect.
2. Inhibits synthesis of specific clotting factors in the liver, and it takes 3-4 days for this medication to exert an
anticoagulant effect.
3. Stimulates production of the body’s own thrombolytic substances, but it takes 2-4 days for this to begin.
4. Has the same mechanism of action as Heparin, and the crossover time is needed for the serum level of warfarin to
be therapeutic.
10. A 60-year-old male client comes into the emergency department with complaints of crushing chest pain
that radiates to his shoulder and left arm. The admitting diagnosis is acute myocardial infarction. Immediate
admission orders include oxygen by NC at 4L/minute, blood work, chest x-ray, an ECG, and two (2) mg
of morphine given intravenously. The nurse should first:
1. Administer the morphine
2. Obtain a 12-lead ECG
3. Obtain the lab work
4. Order the chest x-ray
11. When administered a thrombolytic drug to the client experiencing an MI, the nurse explains to him that
the purpose of this drug is to:
1. Help keep him well hydrated
2. Dissolve clots he may have
3. Prevent kidney failure
4. Treat potential cardiac arrhythmias.
12. When interpreting an ECG, the nurse would keep in mind which of the following about the P wave? Select
all that apply.
1. Reflects electrical impulse beginning at the SA node
2. Indicated electrical impulse beginning at the AV node
3. Reflects atrial muscle depolarization
4. Identifies ventricular muscle depolarization
5. Has a duration of normally 0.11 seconds or less.
13. A client has driven himself to the ER. He is 50 years old, has a history of hypertension, and informs the
nurse that his father died of a heart attack at 60 years of age. The client is presently complaining of
indigestion. The nurse connects him to an ECG monitor and begins administering oxygen at 2 L/minute per
NC. The nurse’s next action would be to:
1. Call for the doctor
2. Start an intravenous line
3. Obtain a portable chest radiograph
4. Draw blood for laboratory studies
14. The nurse receives emergency laboratory results for a client with chest pain and immediately informs the
physician. An increased myoglobin level suggests which of the following?
1. Cancer
2. Hypertension
3. Liver disease
4. Myocardial infarction
15. When teaching a client about propranolol hydrochloride, the nurse should base the information on the
knowledge that propranolol hydrochloride:
1. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction.
2. Increases norepinephrine secretion and thus decreases blood pressure and heart rate.
3. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure.
4. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of
angiotensin I to angiotensin II.
16. The most important long-term goal for a client with hypertension would be to:
1. Learn how to avoid stress
2. Explore a job change or early retirement
3. Make a commitment to long-term therapy
4. Control high blood pressure
17. Hypertension is known as the silent killer. This phrase is associated with the fact that hypertension often
goes undetected until symptoms of other system failures occur. This may occur in the form of:
1. Cerebrovascular accident
2. Liver disease
3. Myocardial infarction
4. Pulmonary disease
18. During the previous few months, a 56-year-old woman felt brief twinges of chest pain while working in
her garden and has had frequent episodes of indigestion. She comes to the hospital after experiencing severe
anterior chest pain while raking leaves. Her evaluation confirms a diagnosis of stable angina pectoris. After
stabilization and treatment, the client is discharged from the hospital. At her follow-up appointment, she is
discouraged because she is experiencing pain with increasing frequency. She states that she is visiting an
invalid friend twice a week and now cannot walk up the second flight of steps to the friend’s apartment
without pain. Which of the following measures that the nurse could suggest would most likely help the client
deal with this problem?
1. Visit her friend earlier in the day.
2. Rest for at least an hour before climbing the stairs.
3. Take a nitroglycerin tablet before climbing the stairs.
4. Lie down once she reaches the friend’s apartment.
19. Which of the following symptoms should the nurse teach the client with unstable angina to report
immediately to her physician?
1. A change in the pattern of her pain
2. Pain during sex
3. Pain during an argument with her husband
4. Pain during or after an activity such as lawn mowing
20. The physician refers the client with unstable angina for a cardiac catheterization. The nurse explains to the
client that this procedure is being used in this specific case to:
1. Open and dilate the blocked coronary arteries
2. Assess the extent of arterial blockage
3. Bypass obstructed vessels
4. Assess the functional adequacy of the valves and heart muscle.
21. As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3mg
given sublingually. This drug’s principal effects are produced by:
1. Antispasmodic effect on the pericardium
2. Causing an increased myocardial oxygen demand
3. Vasodilation of peripheral vasculature
4. Improved conductivity in the myocardium
22. The nurse teaches the client with angina about the common expected side effects of nitroglycerin,
including:
1. Headache
2. High blood pressure
3. Shortness of breath
4. Stomach cramps
23. Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the nurse instruct the
client to use the drug when chest pain occurs?
1. Take one (1) tablet every two (2) to five (5) minutes until the pain stops.
2. Take one (1) tablet and rest for ten (10) minutes. Call the physician if pain persists after ten (10) minutes.
3. Take one (1) tablet, then an additional tablet every 5 minutes for a total of three (3) tablets. Call the physician if pain
persists after three (3) tablets.
4. Take one (1) tablet. If pain persists after five (5) minutes, take two (2) tablets. If pain persists five (5) minutes later,
call the physician.
24. Which of the following arteries primarily feeds the anterior wall of the heart?
1. Circumflex artery
2. Internal mammary artery
3. Left anterior descending artery
4. Right coronary artery
25. When do coronary arteries primarily receive blood flow?
1. During inspiration
2. During diastolic
3. During expiration
4. During systole
26. Prolonged occlusion of the right coronary artery produces an infarction in which of the following areas of
the heart?
1. Anterior
2. Apical
3. Inferior
4. Lateral
27. A murmur is heard at the second left intercostal space along the left sternal border. Which valve is this?
1. Aortic
2. Mitral
3. Pulmonic
4. Tricuspid
28. Which of the following blood tests is most indicative of cardiac damage?
1. Lactate dehydrogenase
2. Complete blood count (CBC)
3. Troponin I
4. Creatine kinase (CK)
29. Which of the following diagnostic tools is most commonly used to determine the location of myocardial
damage?
1. Cardiac catheterization
2. Cardiac enzymes
3. Echocardiogram
4. Electrocardiogram (ECG)
30. Which of the following types of pain is most characteristic of angina?
1. Knifelike
2. Sharp
3. Shooting
4. Tightness
31. Which of the following parameters is the major determinant of diastolic blood pressure?
1. Baroreceptors
2. Cardiac output
3. Renal function
4. Vascular resistance
32. Which of the following factors can cause blood pressure to drop to normal levels?
1. Kidneys’ excretion of sodium only
2. Kidneys’ retention of sodium and water
3. Kidneys’ excretion of sodium and water
4. Kidneys’ retention of sodium and excretion of water
33. Baroreceptors in the carotid artery walls and aorta respond to which of the following conditions?
1. Changes in blood pressure
2. Changes in arterial oxygen tension
3. Changes in arterial carbon dioxide tension
4. Changes in heart rate
34. Which of the following terms describes the force against which the ventricle must expel blood?
1. Afterload
2. Cardiac output
3. Overload
4. Preload
35. Which of the following terms is used to describe the amount of stretch on the myocardium at the end of
diastole?
1. Afterload
2. Cardiac index
3. Cardiac output
4. Preload
36. A 57-year-old client with a history of asthma is prescribed propranolol (Inderal) to control hypertension.
Before administered propranolol, which of the following actions should the nurse take first?
1. Monitor the apical pulse rate
2. Instruct the client to take medication with food
3. Question the physician about the order
4. Caution the client to rise slowly when standing.
37. One hour after administering IV furosemide (Lasix) to a client with heart failure, a short burst of
ventricular tachycardia appears on the cardiac monitor. Which of the following electrolyte imbalances should
the nurse suspect?
1. Hypocalcemia
2. Hypermagnesemia
3. Hypokalemia
4. Hypernatremia
38. A client is receiving spironolactone to treat hypertension. Which of the following instructions should the
nurse provide?
1. “Eat foods high in potassium.”
2. “Take daily potassium supplements.”
3. “Discontinue sodium restrictions.”
4. “Avoid salt substitutes.”
39. When assessing an ECG, the nurse knows that the P-R interval represents the time it takes for the:
1. Impulse to begin atrial contraction
2. Impulse to transverse the atria to the AV node
3. SA node to discharge the impulse to begin atrial depolarization
4. Impulse to travel to the ventricles
40. Following a treadmill test and cardiac catheterization, the client is found to have coronary artery disease,
which is inoperative. He is referred to the cardiac rehabilitation unit. During his first visit to the unit he says
that he doesn’t understand why he needs to be there because there is nothing that can be done to make him
better. The best nursing response is:
1. “Cardiac rehabilitation is not a cure but can help restore you to many of your former activities.”
2. “Here we teach you to gradually change your lifestyle to accommodate your heart disease.”
3. “You are probably right but we can gradually increase your activities so that you can live a more active life.”
4. “Do you feel that you will have to make some changes in your life now?”
41. To evaluate a client’s condition following cardiac catheterization, the nurse will palpate the pulse:
1. In all extremities
2. At the insertion site
3. Distal to the catheter insertion
4. Above the catheter insertion
42. A client’s physician orders nuclear cardiography and makes an appointment for a thallium scan. The
purpose of injecting radioisotope into the bloodstream is to detect:
1. Normal vs. abnormal tissue
2. Damage in areas of the heart
3. Ventricular function
4. Myocardial scarring and perfusion
43. A client enters the ER complaining of severe chest pain. A myocardial infarction is suspected. A 12 lead
ECG appears normal, but the doctor admits the client for further testing until cardiac enzyme studies are
returned. All of the following will be included in the nursing care plan. Which activity has the highest priority?
1. Monitoring vital signs
2. Completing a physical assessment
3. Maintaining cardiac monitoring
4. Maintaining at least one IV access site
44. A client is experiencing tachycardia. The nurse’s understanding of the physiological basis for this symptom
is explained by which of the following statements?
1. The demand for oxygen is decreased because of pleural involvement
2. The inflammatory process causes the body to demand more oxygen to meet its needs.
3. The heart has to pump faster to meet the demand for oxygen when there is lowered arterial oxygen tension.
4. Respirations are labored.
45. A client enters the ER complaining of chest pressure and severe epigastric distress. His VS are 158/90, 94,
24, and 99*F. The doctor orders cardiac enzymes. If the client were diagnosed with an MI, the nurse would
expect which cardiac enzyme to rise within the next 3 to 8 hours?
1. Creatine kinase (CK or CPK)
2. Lactic dehydrogenase (LDH)
3. LDH-1
4. LDH-2
46. A 45-year-old male client with leg ulcers and arterial insufficiency is admitted to the hospital. The nurse
understands that leg ulcers of this nature are usually caused by:
1. Decreased arterial blood flow secondary to vasoconstriction
2. Decreased arterial blood flow leading to hyperemia
3. Atherosclerotic obstruction of the arteries
4. Trauma to the lower extremities
47. Which of the following instructions should be included in the discharge teaching for a patient discharged
with a transdermal nitroglycerin patch?
1. “Apply the patch to a non hairy, nonfatty area of the upper torso or arms.”
2. “Apply the patch to the same site each day to maintain consistent drug absorption.”
3. “If you get a headache, remove the patch for 4 hours and then reapply.”
4. “If you get chest pain, apply a second patch right next to the first patch.”
48. In order to prevent the development of tolerance, the nurse instructs the patient to:
1. Apply the nitroglycerin patch every other day
2. Switch to sublingual nitroglycerin when the patient’s systolic blood pressure elevates to >140 mm Hg
3. Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at night
4. Use the nitroglycerin patch for acute episodes of angina only

49. Direct-acting vasodilators have which of the following effects on the heart rate?
1. Heart rate decreases
2. Heart rate remains significantly unchanged
3. Heart rate increases
4. Heart rate becomes irregular
50. When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together,
the nurse bases teaching on the knowledge that:
1. Moderate doses of two different types of diuretics are more effective than a large dose of one type
2. This combination promotes diuresis but decreases the risk of hypokalemia
3. This combination prevents dehydration and hypovolemia
4. Using two drugs increases osmolality of plasma and the glomerular filtration rate