1. The client with the flu is prescribed the over-the-counter cough suppressant dextromethorphan.

Which information should the nurse teach regarding this medication?

A. Take the medication every 4-8 hours as needed for cough

B. The medication can cause addiction if taken too long.

C. Do not drive or operate machinery while taking the drug.

D. Do not take a beta blocker while taking this medication.

2. The doctor prescribed amoxicillin (Augmentin), an antibiotic, for a client diagnosed with chronic
obstructive pulmonary disease (COPD) who has a cold, Which intervention should the nurse implement?

A. Discuss the prescription with the doctor because antibiotics do not help viral infections.

B. Teach the client to take all the antibiotics as ordered

C. Encourage the client to seek a second opinion before taking the medication.

D. Ask the client if he or she is allergic to sulfa drugs are shellfish.

3. The male client diagnosed with chronic obstructive pulmonary disease (COPD) tells the nurse that he
has been expectorating "rusty colored" sputum. Which medication should the nurse anticipate the
physician prescribing?

A. Prednisone, a glucocorticoid.

B. Habitrol, a transdermal nicotine system.

C. dextromethorphan (Robitussin), an antitussive.

D. Ceftriaxone (Rocephin), a cephalosporin.

4. The nurse is discharging a client diagnosed with chronic obstructive pulmonary disease (COPD). Which
discharge instructions should the nurse provide regarding the client's prescription for prednisone, a
glucocorticoid?

A. Take all the prednisone as ordered until the prescription is empty.

B. Take the prednisone on an empty stomach with a full glass of water.

C. Stop taking the prednisone if a noticeable weight gain occurs.

D. The medication should never be abruptly discontinued.

5. The client diagnosed with chronic obstructive pulmonary disease is prescribed methylprednisolone
(Solu-Medrol), a glucocorticoid, IVP. Which laboratory test should the nurse monitor?

A. The white blood cell (WBC) count. C. The blood glucose level.

B. The hemoglobin and hematocrit. D. The BUN and creatinine

6. The clinic nurse is teaching the parent of a child with reactive airway disease about nebulizer
treatments. Which treatment indicates the teaching has been effective?

A. I will use half the medication in the nebulizer at each treatment."

B. The nebulizer treatment will take about 30 minutes or longer

C. "I will use a disinfectant solution weekly when cleaning the nebulizer"

D. “I will rinse the nebulizer in clean water after each breathing treatment.”

7. The nurse is preparing to hang the next bag of heparin. The client's current laboratory values are as
follows:

5. INR 1 1. PT 13.4

4. Control 36 2. PTT 92

3. Control 12.9

A Discontinue the heparin infusion

B. Prepare to administer protamine sulfate.

D. Assess the client for bleeding

C. Notify the doctor

8. An emergency department nurse is assessing a 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?

B. Diminished breath sounds

A. A low respiratory rate

D. A sucking sound at the site of injury

C. The presence of a barrel chest

9. A nurse 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?

B. A fryer-inflated chest noted on the chest x-ray

A. Hypocapnia

D. A widened diaphragm noted on the chest x-ray

C. Increased oxygen saturation with exercise

10. A nurse instructs a 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:

B. Strengthen the diaphragm. D. Promote carbon dioxide elimination.

A. Promote oxygen intake. C. Strengthen the intercostal muscles.

11 The low-pressure alarm sounds on a ventilator. A nurse assesses the client and then attempts to
determine the cause of the alarm. The nurse is unsuccessful in determining the cause of the alarm and
takes what initial action?

A. Administers oxygen C. Ventilates the client manually

B. Checks the client's vital signs D. Starts cardiopulmonary resuscitation

12. A nurse is caring for a client after a bronchoscopy and biopsy. Which of the following signs, if noted
in the client, should be reported immediately to the physician?

A. Dry cough B. Hematuria

C. Bronchospasm D. Blood-streaked sputum

13. A nurse is suctioning fluids from a client through an endotracheal tube. During the suctioning
procedure, the nurse pates on the monitor that the heart rate is decreasing. Which of the following is
the appropriate nursing intervention?

B. Notify the physician immediately C. Stop the procedure and reoxygenate the
client.
A. Continue to suction.
D. Ensure that the suction is limited to 15
seconds

14. A client with a chest injury has suffered flail chest. A nurse assesses the client for which most
distinctive sign of flailest?

B. Hypotension C. Paradoxical chest movement

A. Cyanosis D. Dyspnea, especially on exhalation

15. A nurse is assessing a client with chronic airflow limitation and notes that the client has a "barrel
chest." The nurse interprets that this client has which of the following forms of chronic airflow
limitation?

A. Emphysema C. Chronic obstructive bronchitis

B. Bronchial asthma D. Bronchial asthma and bronchitis

16. It has experienced pulmonary embolism. A nurse assesses for which symptom, which is most
commonly related?

A. Hot, flushed feeling C. Chest pain that occurs suddenly

B. Sudden chills and fever D. Dyspnea when deep breaths are taken

17, A client who is human immunodeficiency virus- positive has had a Mantoux skin test, the nurse notes
a 7-mm area of duration at the site of the skin test. The nurse interprets the results as:

A. Positive C. Inconclusive

B. Negative D. Indicating the need for repeat testing

18. An oxygen delivery system is prescribed for a client with chronic obstructive pulmonary disease to
deliver a precise oxygen concentration. Which oxygen delivery system would the nurse anticipate to be
prescribed?

A. Face tent C. Aerosol mask

B. Venturi mask D. Tracheostomy collar

19. 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

20. A nurse performs an admission assessment on a client with a diagnosis of tuberculosis. The nurse
reviews the results of which diagnostic test that will confirm this diagnosis?

A. Chest x-ray C. Sputum culture

B. Bronchoscopy D. Tuberculin skin test

21. Which should the nurse teach a group of girls and parents about the importance of preventing
urinary tract infections (UTIs)?

A. Avoiding constipation has no effect on the occurrence of UTIs.

B. After urinating, always wipe from back to front to prevent fecal contamination.

C. Hygiene is an important preventive measure and can be accomplished with frequent tub baths.

D. Increasing fluids will help prevent and treat UTIs.

22. Which child is at risk for developing glomerulonephritis?

A. A 3-year-old who had impetigo 1 week ago.

B. A 5-year-old with a history of five UTIs in the previous year.

C. A 6-year-old with new-onset type 1 diabetes

D. A 10-year-old recovering from viral pneumonia.

23. Which combination of signs is commonly associated with glomerulonephritis?

A. Massive proteinuria, hematuria, decreased urinary output, and lethargy

B. Mild proteinuria, increased urinary output, and lethargy

C. Mild proteinuria, hematuria, decreased urinary output, and lethargy.

D. Massive proteinuria, decreased urinary output, and hypotension

24. The parent of a child with glomerulonephritis asks the nurse why the urine is such a funny color.
Which is the nurse's best response?

A. "It is not uncommon for the urine to be discolored when children are receiving steroids and blood
pressure medications."

B. There is blood in your child's urine that causes it to be tea-colored.

C. Your child's trine is very concentrated, so it appears to tie discolored.

D. "A ketogenic diet often causes the urine to be tea-colored.”

25. Which finding requires immediate attention for a child with glomerulonephritis?

A. Sleeping most of the day and being very "cranky when awake; blood pressure is 170/90.

B. Urine output is 190 mL in an 8-hour period and is the color of Coca Cola.

C. Complaining of a severe Headache and photophobia.

D. Refusing breakfast and lunch and stating he "Just is not hungry.”

26. The nurse is caring for a newborn with hypospadias. His parents ask if circumcision is an option.
Which is the nurse's best response?

A. "Circumcision is a fading practice and is now contraindicated in most children."

B. "Circumcision in children with hypospadias is recommended because it helps prevent infection."

C. "Circumcision is an option, but it cannot be done at this time."

D. "Circumcision can never be performed in a child with hypospadias.

27. An infant is scheduled for a hypospadias and chordee repair. The parent tells the nurse, "I
understand why the hypospadias repair is necessary, but do they have to fix the chordee as well?"
Which is the nurse’s best response?

A. "I understand your concern; Parents do not want their children to undergo extra surgery."

B. The chordee repair is done strictly for cosmetic reasons that may affect your son as he ages."

C. The repair is done to optimize sexual functioning when he is older."

D. This is the best time to repair the chordee because he will be having surgery anyway."

28. Which would the nurse most likely find in the history of a child with hemolytic uremic syndrome?

A. Frequent UTIs and possible vesicoureteral reflux.

B. Vomiting and diarrhea before admission.

C. Bee sting and localized edema of the site for 3 days.

D. Previously healthy and no signs of illness.

29. A child with hemolytic uremic syndrome Is very pale and lethargic. Stools have progressed from
watery to bloody diarrhea. Blood work indicates low hemoglobin and hematocrit levels. The child has
not had any urine output in 24 Hours. The nurse expects administration of blood products and what else
to be added to the plan of care?

A. Initiation of dialysis.

B. Close observation of the child's hemodynamic status.

C. Diuretic therapy to force urinary output.

D. Monitoring of urinary output.

30. Which causes the clinical manifestations of hydronephronsis?

A. A structural abnormality in the urinary system causes urine to back up and can cause pressure and
cell death.

B. A structural abnormality causes urine to flow too freely through the urinary system, leading to fluid
and electrolyte imbalances.

C. Decreased production of urine in one or both kidneys results in an electrolyte imbalance.

D. With an abnormal electrolyte balance and concentration leads to increased blood pressure and
subsequent eased glomerular filtration rate.

31. In addition to increased blood pressure, which findings would most likely be found in a child with
bydronephrosis?

A. Metabolic alkalosis, polydipsia, and polyuria

B. Metabolic acidosis, and bacterial growth in the urine.

C. Metabolic alkalosis, and bacterial growth in the urine

D. Metabolic acidosis, polydipsia, and polyuria.

32. 1he nurse in a diabetic clinic sees a 10-year-old who is a new diabetic and has had trouble
maintaining blood glucose levels within normal limits. The child's parent states the child has had several
daytime "accidents." The nurse knows that this is referred to as which of the following?

D. Nocturnal enuresis. B. Secondary enuresis

C. Diurnal enuresis A. Primary enuresis

33. An adolescent woke up complaining of intense pain and swelling of the scrotal area and abdominal
pain. He has vomited twice. Which should the nurse suggest?

A. Encourage him to drink clear liquids until the vomiting subsides; if he gets worse, bring him to the
emergency room

B. Bring him to the pediatrician's clinic for evaluation.

C. Jake him to the emergency room immediately

D. Encourage him to rest; apply ice to the scrotal area, and go to the emergency room if the pain does
not improve.
34. Which causes the symptoms in testicular torsion?

A. Twisting of the spermatic cord interrupts the blood supply

B. Swelling of the scrotal sac leads to testicular displacement.

C. Unmanaged undescended testes cause testicular displacement.

D. Microthrombi formation in the vessels of the spermatic cord causes interruption of the blood supply.

35. Which protrusion into the groin of a female most likely causes inguinal hernias?

B. Fallopian tube A. Bowel

D. Muscle tissue. C. Large thrombus formation

36. The parents of a 6-week-old male ask the nurse if there is a difference between an inguinal hernia
and a hydrocele. Which is the nurse's best response?

A. "The terms are used interchangeably and mean the same thing."

B. The symptoms are similar, but an inguinal hernia occurs when tissue protrudes into the groin,
whereas a hydrocele is a fluid-filled mass in the scrotum.

C. “A hydrocele is the term used when an inguinal hernia occurs in females."

D. "A hydrocele presents in a manner similar to that of an inguinal hernia but causes increased concern
because it is often malignant."

37. Which would the nurse expect to find on assessment in a child with Wilms tumor?

A. Decreased blood pressure, increased temperature, and a firm mass located in one flank area.

B. Increased blood pressure, normal temperature, and a firm mass located in one flank area.

C. Increased blood pressure, normal temperature, and a firm mass located on one side of the midline of
the abdomen

D. Decreased blood pressure, normal temperature, and a firm mass located on one side or the other
side of the abdomen.

38. A child diagnosed with a Wilms tumor is scheduled for an MRI scan of the lungs, the parent asks the
nurse the reason for this test as a Wilms tumor involves the kidney, not the lung, Which is the nurse's
best response?

A. “I’m not sure why your child is going for this test. I will check and get back to you"

B. “It sounds like we made a mistake. I will check and get back to you"

C. "The test is done to check to see if the disease has spread to the lungs."

D. "We want to check the lungs to make sure your child is healthy enough to tolerate surgery
39. The nurse is caring for a child due for surgery on a Witms tumor. The child's procedure will consist of
which of the following?

A. Only the affected kidney will be removed.

B. Both the affected kidney and the other kidney will be removed in case of recurrence.

C. The mass will be removed from the affected kidney.

D. The mass will be removed from the affected kidney, and a biopsy of the tissue of the unaffected
kidney will be done

40. The parents of a 7-year old tell the nurse they do not understand the difference between chronic
renal failure (CRF) and acute renal failure (ARF). Which is the nurse's best response?

A. "There really is not much difference because the terms are used interchangeably."

B. "Most children experience ARF. It is highly unusual for a child to experience CRF.

C. "CRF tends to occur suddenly and is irreversible."

D. "ARF is often reversible, whereas CRF results in permanent deterioration of kidney function.”

41. A child had a tonsillectomy 6 days ago and was seen in the emergency room 4 hours ago due to post-
operative hemorrhage. The parent noted that her child was "swallowing a lot and finally began vomiting
large amounts of blood. The child's vital signs are as follows: T 99.5 F (37.5 C), HR 124, BP 84/48, and RR
26. The nurse knows that this child is at risk for which type of renal failure?

A. CRF due to advanced disease process.

B. Prerenal failure due to dehydration.

C. Primary kidney damage due to a lack of urine flowing through the system.

D. Postrenal failure due to a hypotensive state.

42. A child diagnosed with acute renal failure (ARF) complains of "not feeling wel," having "butterflies in
the chest," and arms and legs "feeling like Jell-O." The cardiac monitor shows that the ORS complex is
wider than before and that an occasional premature ventricular contraction (PVC) is seen. Which would
the nurse expect to administer?

A. An isotonic saline solution with 20 mEq KCi/L

B. Sodium bicarbonate via slow intravenous push.

C. Calcium gluconate via slow intravenous push.

D. Oral potassium supplements.

43. A 10-kg toddler is diagnosed with acute renal failure (ARF), is afebrile, and has a 24-hour urine
output of 110 mL. After calculating daily fluid maintenance, which would the nurse expect the toddler's
daily allotment of fluids to be?

A. Clear fluids and ice chips only. C. 1000 mL of oral and intravenous fluids

B. 50 0mL of oral and intravenous fluids D. 2000 mL of oral and intravenous fluids
44. The nurse is caring for a 1-year-old diagnosed with acute renal failure (ARF). Edema is noted
throughout the child's body and the liver is enlarged. The child's urine output is less than 0.5 mL/k8/hr,
and vital signs are as follows: HR 146, BP 176/92, and RR 42. The child is noted to have nasal flaring and
retractions with inspiration. The fung sounds are coarse throughout. Despite receiving oral Kayexalate,
the child's serum potassium continues to rise. Which treatment will provide the most benefit to the
child?

A. Additional rectal Kayexalate.

B. Intravenous furosemide.

C. Endotracheal intubation and ventilatory assistance

D. Placement of a Tenckhoff catheter for peritoneal dialysis

45. The parent of a child diagnosed with acute renal failure (ARF) asks the nurse why peritoneal dialysis
was selected instead of hemodialysis. Which is the nurse's best response?

A. "Hemodialysis is not used in the pediatric population."

B. "Peritoneal dialysis has no complications, so it is a treatment used without hesitation.

C. "Peritoneal dialysis removes fluid at a slower rate than hemodialysis, so many complications are
avoided."

D. "Peritoneal dialysis is much more efficient than hemodialysis.

46. Chronic hypertension in the child who has chronic renal failure (CRF) is due to which of the
following?

A. Retention of sodium and water.

B. Obstruction of the urinary system.

C. Accumulation of waste products in the body.

D. Generalized metabolic alkalosis.

47. Which best describes the electrolyte imbalance that occurs in chronic renal failure (CRF)?

A. Decreased serum phosphorus and calcium levels.

B. Depletion of phosphorus and calcium stores from the bones.

C. Change in the structure of the bones, causing calcium to remain in the bones.

D. Nutritional needs are poorly met, leading to a decrease in many electrolytes such as calcium and
phosphorus.

48. The diet for a child with chronic renal failure (CRF) should be high in calories and include:

A. Low protein, and all minerals and electrolytes.

B. Low protein and minerals.

C. High protein and calcium and low potassium and phosphorus.

D. High protein, phosphorus, and calcium and low potassium and sodium.
49. A renal transplantation is which of the following?

A. A curative procedure that will free the child from any more treatment modalities.

B. An ideal treatment option for families with a history of dialysis noncompliance

C. A treatment option that will free the child from dialysis.

D. A treatment option that is very new to the pediatric population.

50. The nurse is caring for a 12-year-old receiving peritoneal dialysis. The nurse notes the return to be
the child is complaining of abdominal pain. The child's parents ask what the next step will likely be.
Which is the most likely response?

A. We will probably place antibiotics in the dialysis fluid before the next dwell time."

B. "Many children experience cloudy returns. We do not usually worry about it."

C. We will probably give your child some oral antibiotics just to make sure nothing else develops.

D. "The abdominal pain is likely due to the fluid going in too slowly. We will increase the rate of
administration with the next fill."

51. During hemodialysis, the nurse notes that a 10-year-old becomes confused and restless. The child
complains of a headache and nausea and has generalized muscle twitching. This can be prevented by
which of the following?

A. Slowing the rate of solute removal during dialysis

B. Ensuring the patient is warm during dialysis.

C. Administering antibiotics before dialysis.

D. Obtaining an accurate weight the night before dialysis

52. How much fluid should a nurse teach a female patient to consume during 24 hours to maintain
normal fluid balance?

D. 2,200 mL C. 1,500 mL

B. 1,000 mL A. 500 mL

53. A patient who is scheduled for chemotherapy is receiving 1L of fluid over a 2-hour period before
receiving nephrotoxic chemotherapy. The nurse assesses the patient frequently for hypervolemia during
this 2-hour period. For what early sign of hypervolemia should the nurse assess the patient?

B. Crackles in the lungs A. Poor skin turgor

D. Increased urinary output C. Jugular vein distention

54. A nurse is caring for a patient who is receiving a low potassium diet. Which food should the nurse
teach the patient to avoid Select all that apply.

1. Chicken liver 4. Spinach

2.Tomato soup 5. Carrots

3.Lima beans

C. 2,3&4 A. 1&2

B. 2&3 D. 2,3&4

55. A patient receiving Lasix daily is admitted with a diagnosis of dehydration and hypokalemia. The
patient's IV fluid is 2000 mL 0.9 percent normal saline with 20 mEq of potassium chloride infusing at 125
mL/hour. What is most important for the nurse to assess?

C. Intake and output A. Food intake

D. Pulse and respirations B. Intravenous site

56. A nurse in the emergency department is caring for a variety of patients. Which patients should the
nurse identify are at risk for a fluid volume deficit? Select all that apply

1. Man with chronic kidney disease

2. Older adult with perfuse diaphoresis

3. Adolescent experiencing ketoacidosis

4. Infant experiencing diarrhea for 12 hours

5. Woman who is in the 8th month of gestation

A. 1 & 2 C. 2 3 & 4

B. 2&3 D. 2,3,4&5

57. A nurse is caring for a patient who is experiencing fluid volume excess evidenced by significant
dependent edema. The primary health-care provider orders a 1,000 mL fluid restriction. Which nursing
intervention is most important?

A. Offer ice chips frequently C. Assess extent of edema daily.

B. Provide frequent mouth care. D. Keep the legs lower than the heart.

58. A nurse is assessing a patient for fluid volume excess. What questions should the nurse ask the
patient to obtain information concerning this problem? Select all that apply

1. “Do your rings feel tighter lately?” 4. "Have you noticed an increase in thirst?"

2. "How often do you need to urinate?" 5. "Did you gain weight in the last few days?"

3. "How much water do you drink each day”

A. 1&2 B.1&5 C. 1&4 D. 1&3

59. A nurse is caring for a patient with a serum calcium level of 7.5 mEq/L What nursing intervention is
important when caring for this patient?

B. Teach the patient to avoid foods high in calcium.

A. Give the patient the prescribed calcium supplement.

D. Prepare the patient for hemodialysis.

C. Assess the patient for hypoactive reflexes

60. A nurse is caring for a patient admitted to the hospital with a diagnosis of congestive heart failure
and is retaining Haid. For what clinical indicator should the nurse assess the patient that supports the
presence of this condition?

3. Bounding pulse

1. Weight loss

2. Hypotension

4. Hemoconcentration