COLLEGE OF THE IMMACULATE CONCEPTION

REVIEW EDUCATION AND COMPREHENSIVE APPRAISAL PROGRAM

FINAL EXAMS

MEDICAL – SURGICAL NURSING 3 & 4

SITUATION: The Client with Gastrointestinal Disorders
1. The nurse is obtaining the health history of a 54-year-old male client diagnosed with duodenal ulcer. Which of the following findings would the nurse anticipate
from the client in relation to his/her condition?
A. Weight loss occurs about a week ago C. Pain in the right epigastrium that occurs two to three hours after meal
B. Certain type of food increases the distress D. Pain that occurs after meals
2. The nurse is caring for a client following a Billroth II procedure. Which post-operative order should the nurse question and verify?
A. Leg exercises B. Early ambulation C. Irrigating the NGT D. DBCE
3. The nurse is making a teaching plan to prevent dumping syndrome to a client who underwent vagotomy. Which of the following would be necessary for the nurse
to include in the teaching plan?
A. Increase food intake at a time to increase the bulk of food therefore decreasing the risk for dumping syndrome to occur
B. Increase fluid intake with meals to prevent dehydration
C. Lie down for 30 minutes after every meal for rapid gastric evacuation
D. Limit carbohydrates in the diet
4. Nurse Darla is caring for a client with a medical diagnosis of Gastroesophageal Reflux Disease (GERD). The client told the nurse that she often experiences
heart burn. The nurse validates the client’s complaint by basking which of the following?
A. “Do you experience pain below the chest area with burning sensation that tends to move up and down?”
B. “Do you experience pain on the chest and radiate to the left arm, jaw and back?”
C. “Do you experience pain confined to the stomach area that happens before meals?
D. “Do you experience pain after eating fatty food?”
5. As part of the treatment, lifestyle modification plays a n important role in controlling the regurgitation in GERD. The nurse instructs the client on how to control the
reflux. Which of the following statements would indicate that the client fully understood the teaching?
1. “I will eat six small meals a day”
2. “Eating large meals should be avoided”
3. “I will avoid bending, heavy lifting, straining, and working in a bent-over position”
4. “After every meal, I will remain in upright position for 1 to 2 hours”
5. “I need to increase intake of milk and foods containing peppermint or spearmint”
A. All except 2 B. All except 4 C. All except 2 and 5 D. All except 5
6. A client is admitted to the medical ward with abdominal discomfort and headache. After a series of assessment, she was diagnosed with acute gastritis. The
nurse noted the admitting order stating that the client should be placed on NPO. Which of the following would the nurse most likely include when explaining the
oral intake of food and fluids to the client?
A. Oral intake is withheld until manifestations of acute gastritis subside, then clear liquid diet is initiated
B. Oral intake should be resumed once the client is able to expel flatus
C. Oral intake of food and fluids will be withheld until discharged from the facility. This will facilitate complete healing of gastritis
D. Clients with acute gastritis are placed on NPO status for the first four hours after the admission
7. A 43-year-old obese female client presents to the ED with severe right upper abdominal pain. During the assessment, the client also complained itching of the
skin. She was also found to have icteric sclera and both palms appearing yellowish in color. The physician orders UTZ of the upper right abdominal region and
the client was subsequently admitted with diagnosis of Calculous cholecystitis. The client asks the nurse on the ward for the reason she is experiencing
itchiness/pruritus. Which statement best explains the concern of the client?
A. “You experienced itching due to the medication given to you in the ED” C. “Urea builds up to your skin causing some itching”
B. “It is due to the bile salts deposited on your skin” D. “The reason is unknown”
8. Ambo, a client who has been experiencing pain on his right lower quadrant, calls the physician’s office to seek advice. The client told the nurse that his abdomen
became rigid and that he has fever for the past 12 hours. In addition, the client also claims. Based on the manifestations presented by the client, the nurse would
advise the client to:
A. Take Paracetamol (Biogesic) every 4 hours to relieve fever
B. Encourage the client to increase fluid intake to relieve the abdominal rigidity which may be caused by constipation
C. Further monitor his condition
D. Go to the nearest hospital
9. A client with severe abdominal pain was admitted to the emergency department for the evaluation of the possible appendicitis. The diagnosis was confirmed
after physical examination and laboratory findings. With this, the client was scheduled to undergo appendectomy. Which of the following preoperative order by
the physician will prompt the nurse to seek clarification?
A. Administer opioid analgesic C. Cleanse the bowel, give laxative once only
B. Start IV infusion D. Administer prophylactic antibiotic as ordered
10. Nurse Darlalou is caring for various clients in the gastrointestinal unit of the hospital she is working at. One of her clients is a 35-year-old male who was admitted
with a diagnosis of Regional Enteritis three (3) days ago. Nurse Darlalou review’s the client’s medical record and should expect for which stool characteristic?
A. Clay-colored stool
B. Diarrhea accompanied by right lower quadrant abdominal pain
C. Ribbon-like stool
D. Severe diarrhea with passage of mucus and pus accompanied by left lower quadrant pain and intermittent tenesmus
11. Which nursing action will be most effective in treating peptic ulcer disease?
A. Giving alternating doses of magnesium and aluminum antacids every 2-4 hours
B. Giving antibiotics and HCl secretion inhibitors daily as ordered for one week
C. Obtaining information on enrollment in a stress management class
D. Explaining procedure for insertion of Minnesota or Blakemore tube with traction
12. The nurse tells a client who is post-operative after gastrectomy that dumping syndrome is a significant problem for:
A. 70-80% of clients having gastrectomies C. 25% of clients having gastrectomies
B. 50% of clients having gastrectomies D. 5-10% of clients having gastrectomies
13. The nurse will usually ambulate a client post-gastrectomy beginning:
A. The day after surgery C. After 4 days of bed rest
B. 3-4 days after surgery D. Immediately after awakening from anesthesia
14. Which would the nurse expect to see with dumping syndrome:
A. Feeling of hunger B. Constipation x diarrhea C. Increased strength D. Diaphoresis
15. A client is admitted with a diagnosis of duodenal ulcer. During the intake history, the nurse would expect the client to report:
A. Epigastric pain that is relieved by eating C. Epigastric pain that is worse after eating – gastric ulcer
B. Weight loss – gastric ulcer D. Vomiting after eating – gastric ulcer

FINAL EXAMINATIONS 1
16. A client is experiencing peptic ulcer disease by Helicobacter pylori. The nurse should plan to administer which of the following oral drug combinations,
Clarithromycin (Biaxin) with:
A. Tetracycline (Achromycin) with Sodium bicarbonate (baking soda C. Amoxicillin (Amoxil) and Omperazole (Prilosec)
B. Metronidazole (Flagyl) and Aluminum hydroxide (Amphogel) D. Penicillin (Pen-G) and Nizatidine (Axid)
17. The nurse is caring for a client who admits to a 15-year history of gastric ulcers. The nurse instructs this client to take which of the following drugs for minor
aches and pains?
A. Acetaminophen (Tylenol) B. Buffered aspirin C. Plain aspirin D. Ibuprofen (Motrin)
18. After a subtotal gastrectomy for cancer of the stomach, a client develops dumping syndrome. When caring for this client, the nurse understands that dumping
syndrome refers to:
A. Nausea resulting from full stomach C. Passage of osmotic fluid into the jejunum
B. Reflux of intestinal contents into the esophagus D. Build-up of feces and gas within the large intestines
19. A client with gastric tumor is scheduled for a subtotal gastrectomy (Billroth II procedure). The nurse explains the procedure to the client and tells the client that
the:
A. Proximal end of the distal stomach is anastomosed to the duodenum
B. Antrum of the stomach is removed with the remaining portion anastomosed to the duodenum
C. Entire stomach is removed and the esophagus is anastomosed to the duodenum
D. Lower portion of the stomach is removed and the remainder is anastomosed to the jejunum
20. A client who has a history of seizure disorder is newly diagnosed with gastric ulcer. The client has maintained seizure-free status using Phenytoin (Dilantin). The
nurse would question a new order for which of the following drugs to treat symptoms caused by the ulcer?
A. Famotidine (Pepcid) B. Cimetidine (Tagamet) C. Nizatidine (Axid) D. Ranitidine (Zantac)
21. Nurse Darla did her admission assessment. She understands that the pain in cholecystitis is characterized as:
A. A tenderness that is generalized in the upper epigastric area
B. Pain in the upper quadrant radiating to the left shoulder
C. Tenderness and rigidity at the left epigastric area radiating to the back
D. Tenderness and rigidity of the upper right abdomen radiating to the midsternal area
22. To confirm the diagnosis of cholecystitis, the attending physician ordered the procedure that can detect gallstones as small as 1 to 2 cm and inflammation; Nurse
Darla would prepare the client for which specific procedure?
A. Gall bladder series B. Oral cholecystogram C. Cholangiography D. Ultrasonography
23. The diagnosis was confirmed as cholecystitis with gallstones. The doctor prepares the client for removal of his gallbladder. The client asks the nurse how will it
affect digestion, the nurse’s MOST correct response would be:
A. The removal of the gall bladder usually interferes with digestion but can be dietary modification
B. The removal of the gall bladder does not usually interfere with digestion
C. Your body system will adjust in due time
D. The removal of the gall bladder would significantly interfere only with digestion of food
24. Reviewing the laboratory finding of the client, the nurse found which findings are elevated?
1. WBC count 2. Total serum bilirubin 3. Alkaline phosphate 4. RBC count
5. Cholesterol 6. Serum amylase
A. 2,3 and 4 B. 1, 2 and 3 C. 3, 5 and 6 D. 1, 2 and 6
25. A T-tube was inserted and the doctor ordered to monitor amount, color, consistency and odor drainage. Which of the following procedure can be performed by
the nurse without the doctor’s order?
A. A clamping B. Aspirating C. Irrigating D. Emptying the drainage
26. Choledocholithotomy is:
A. The removal of the gall bladder C. The removal of the stones in the common bile duct
B. The removal of the stones in the gall bladder D. The removal of the stones in the kidney
27. The simplest pain-relieving technique is:
A. Distraction B. Deep breathing exercise C. Taking aspirin D. Positioning
28. Which of the following statement on pain is TRUE?
A. Culture and pain are not associated C. Patient’s reaction to pain varies
B. Pain accompanies acute illness D. Pain produces the same reaction such as groaning and moaning
29. In pain assessment, which of the following condition is a more reliable indicator?
A. Pain rating scale of 1 to 10 C. Physiological responses
B. Facial expression and gestures D. Patient’s description of the pain sensation
30. When a client complains of pain, your initial response is:
A. Record the description of pain C. Refer the complaint to the doctor
B. Verbally acknowledge the pain D. Change to a more comfortable position
31. A patient who has had a total gastrectomy is given instructions on measure to prevent the developing of dumping syndrome. Which of the following statements, if
made by the patient, would indicate correct understanding of the instructions?
A. “I will have a bedtime snack” C. “I will avoid concentrated sugar”
B. “I will rest one hour before each meal” D. “I will include high-fiber foods in my diet”
32. Which of the following laboratory values should the nurse expect to be elevated in a patient who has pancreatitis?
A. Red blood cell count B. Blood urea nitrogen C. Glycosylated hemoglobin D. Serum amylase
33. Which of the following statements, if made by a patient who has had a cholecystectomy, would indicate correct understanding of dietary instructions?
A. “I should limit my intake of citrus products” C. “I will increase high-fiber foods in my diet”
B. “I must avoid carbonated beverages” D. “I can eat whatever I can tolerate”
34. The nurse should expect to prepare a patient who has bleeding esophageal varices for which of these procedures initially?
A. Nasogastric tube feeding C. Electrocauterization
B. Normal saline lavage D. Chest x-ray
35. To which of the following measures should a nurse give priority when caring for a patient who has acute hepatitis B?
A. Using disposable dishes for the patient C. Promoting bed rest
B. Placing the patient in a private room D. Limiting fluid intake
36. The initial diagnosis of pancreatitis is confirmed if the client’s blood shows a significant elevation of which of the following serum values?
A. Amylase B. Glucose C. Potassium D. Trypsin
37. Which of the following signs and symptoms would the nurse expect to see in a client with acute pancreatitis?
A. Diarrhea B. Jaundice C. Hypertension D. Ascites
38. The nurse evaluates the client’s most recent laboratory data. Which laboratory finding would be consistent with a diagnosis of acute pancreatitis?
A. Hyperglycemia B. Leukopenia C. Thrombocytopenia D. Hyperkalemia
39. The initial plan for a client most likely would focus on which of the following as a priority?
A. Resting the gastrointestinal tract C. Maintaining fluid and electrolyte balance
B. Ensuring adequate nutrition D. Preventing the development of infection
40. The nurse carefully monitors the client with acute pancreatitis for which of the following complications?
A. Congestive heart failure B. Duodenal ulcer C. Cirrhosis D. Pneumonia

FINAL EXAMINATIONS 2
SITUATION: The Client with Genitourinary Disorders
41. Nurse Karatchina is assessing a client who has just been admitted due to nephrotic syndrome. The nurse notes that the client has generalized edema primarily
affecting the face, abdomen and extremities. Which of the following is the reason for these manifestations?
A. Increased secretion of ADH C. Stimulation of the RAAS in response to hypovolemia
B. Decreased oncotic pressure D. Hyperalbunemia
42. A client was admitted to the emergency room with suspected acute glomerulonephritis. Which of the following questions by the nurse will help confirm the
diagnosis?
A. “Do you have a recurrent abdominal or respiratory viral infection a week before the manifestation of acute glomerulonephritis occurs?”
B. “Have you experienced recurrent throat infection in the past?”
C. “Have you experienced cough, night sweats and low-grade fever?”
D. “Have you experienced continuous fever for 3-4 days a week before you experienced edema?”
43. A client with glomerulonephritis was admitted to the hospital for treatment. Upon initial assessment, the nurse detects one of the classic signs of acute
glomerulonephritis. Which of the following refers to this sign?
A. Moderate to severe hypotension C. Generalized edema, especially on the face and periorbital area
B. Polyuria D. Green-tinged urine
44. The nurse is caring for a client admitted with acute glomerulonephritis. As the nurse assesses the urine of the client, which of the following color changes in the
urine is frequently associated with the diagnosis?
A. Cola-colored urine C. Bluish-green discoloration of the urine
B. Bluish discoloration of the urine D. Orange discoloration of the urine
45. Mr. Mungcal, a client who experiences atrial fibrillation, was admitted to the ICU. As the nurse assesses the client, she found out that his urine output is less than
30 mL/hour for the last two days and serum creatinine level is increased. Based on the client’s current condition, the nurse is correct if he/she categorized Mr.
Mungcal’s renal failure?
A. Pre-renal failure B. Intra-renal failure C. Intrinsic renal failure D. Post-renal failure
46. The nurse is caring for a client with acute renal failure; is reviewing the chart and notes that the client’s urine specific gravity is increased. Sodium level is 15
mEq/L. Based on the laboratory findings; the nurse would suspect that the client is on which phase of renal failure?
A. Diuresis period B. Initiation period C. Oliguria period D. Non-oliguria period
47. A client who experienced urinary frequency, urgency and dysuria associated with fever and suprapubic tenderness comes to the clinic to seek treatment.
Urinalysis was taken and reveals the client has an elevated WBC and RBC level. The physician’s diagnosis is cystitis and advised the client that she needs to
undergo antibiotic therapy. Aside from the pharmacologic management prescribed to the client, the nurse must ensure that some measures are instructed to
prevent recurrent infection and to deal with discomforts. Which of the following should not be included in the nurse’s health teaching?
A. Warm sitz bath should be taken two or three times a day for 20 minutes C. Take 500 mg vitamin C daily to acidify the urine
B. Drink 1 to 3 liters of fluid per day D. Wear nylon underwear and avoid bubble bath
48. A male client is admitted to the hospital with the diagnosis of pyelonephritis. The nurse reviews the client’s medical records and noted the client’s history. Which
of the following information in the client’s record, if noted by the nurse, would be a contributing factor in the occurrence of pyelonephritis?
A. Washing of the perineal area back to front C. Average fluid intake of 2,000 cc/day
B. Ingestion of large quantities of cranberry juice D. A 12-tear history of diabetes mellitus
49. Mr. Chin Chin Mei Fah, a client admitted to the medical unit with diagnosis of Urolithiasis calls the nurse with complaint of pain. Based on this complaint, the
nurse should implement which nursing intervention to provide the most relief from renal colic pain?
A. Administer Meperidine (Demerol) C. Increase protein intake
B. Increase fluid intake at least 2,000 mL daily D. Maintain complete bed rest
50. A client with Urolithiasis is being prepared for discharge after a successful treatment. Before discharging the client, the nurse plans to provide instructions on
ways to prevent recurrence of stone formation. Which of the following instructions should not be included by the nurse?
A. Increase fluid intake 3-4 liters per day C. Avoid extreme temperature
B. Encourage increased physical activity D. To dissolve clots, client should be encouraged to remain on bed
51. A male client receiving hemodialysis undergoes surgery to create an arteriovenous fistula. Before discharge, the nurse discuss care at home with the client and
his wife. Which statement by the client’s wife indicates that further teaching is required?
A. “I must touch the shunt several times a day to feel the bruit”
B. “I have to take his blood pressure every day in the arm with the fistula”
C. “He will have to be very careful at night not to lie on the arm with the fistula”
D. “We really should check the fistula every day for signs of redness and swelling”
52. Which of the following laboratory results should alert the nurse to the presence of glomerular injury and the increased risk of renal failure for a client?
A. Cystitis with urine culture positive for E. coli C. Blood urea nitrogen *BUN) level of 15 mg/dL
B. Presence of red blood cell casts in the urine D. Hypotension and increased volume of very dilute urine
53. The nurse is caring for a client with acute renal failure. Which of the following would indicate to the nurse that the client is uremic?
A. BUN of 32 mg/dL – greater than 150-200 mg/dL C. Serum potassium of 2.8 mg/dL – dapat hyperkalemia
B. Serum calcium of 10.5 mg/dL N = 4.5-5.5 D. Urine specific gravity of 1.030 – lower than normal dapat
54. You are reviewing the client’s morning laboratory results. Which of these results is of most concern to you?
A. Serum potassium 0f 5.2 mEq/L C. Serum calcium level of 10.6 mEq/L
B. Serum sodium level of 134 mEq/L D. Serum magnesium level of 0.8 mEq/L
55. Which of the following indicates the type (s) of acute renal failure?
A. Four types: Hemorrhagic with and without clotting and Non-hemorrhagic with and without clotting
B. One type: Acute
C. Three types: Pre-renal, Intrarenal and Post-renal
D. Two types: Acute and Sub-acute

SITUATION: The Client with Endocrine Disorders

56. A 24-year-old male client in the clinic complains of changes in his facial feature. His lips, nose and shoe size have dramatically increased for the past few
months. His blood glucose is above the normal level. Which rationale would the nurse expect to be the probable cause of the client’s presenting manifestation?
A. Excessive and exaggerated adrenocorticosteroid hormones production C. Excessive release of growth hormones
B. Excessive secretion of aldosterone from the adrenal gland D. Excessive production of T3
57. A client manifesting enlargement of body structures and visual changes came to the clinic for consultation. Various diagnostic exams were done and the results
are consistent with gigantism. The physician suggests hypophysectomy as the surgical management to remove the pituitary gland. Information regarding the
procedure was given by the physician. To ensure effective teaching, which of the following statements made by the client needs reinstruction?
A. “A month or two after the procedure, changes in body appearance as well as visual problems will be resolved”
B. “I will receive a general anesthesia during the procedure”
C. “Post-operatively, I will restrict myself from sneezing, coughing, brushing teeth, blowing of nose and other activities that require me to bend forward”
D. A nasal packing will be inserted post-operatively, in that case, I will be required to breathe through the mouth”
58. The nurse is educating a client regarding growth hormone deficiency in children. During the discussion, the client asks about the characteristics of congenital
growth hormone deficiency. Which of the following responses made by the nurse would be inaccurate?
A. “Clients with congenital growth hormone deficiency usually have below-the-normal length”
B. “Clients with congenital growth hormone deficiency have normal intelligence, short stature, obesity and immature facial features”
FINAL EXAMINATIONS 3
 C. “Puberty of clients with congenital growth hormone deficiency are often delayed”
D. “Decrease in growth rate of clients with growth hormone deficiency can be observed by one to two years of age”
59. The client is admitted to the medical unit after full recovery from head injury sustained in a fatal car crash accident. During his two-day stay in the medical-unit,
the nurse noticed that the client tends to drink at least 5 liters a day. When the nurse reviews the recent urinalysis result, it reveals that the client’s urine specific
gravity is 1.002. The physician was notified and various diagnostic exams were made. Diabetes insipidus is confirmed. The physician prescribed Desmopressin.
The wife of the client asks the nurse about the route of administration. The nurse knows that the route to be used will be which of the following?
A. Intranasal B. Oral C. Intramuscular D. Subcutaneous
60. A client with Bronchogenic carcinoma suddenly develops SIADH. When making a plan of care, the nurse included in the intervention “will assess neurological
status every 2 hours.” The nurse understands that alteration in the neurological status is consistent to which of the following electrolyte imbalances associated to
the client’s diagnosis?
A. Hyponatremia B. Hypomagnesemia C. Hypokalemia D. Hypocalcemia
61. Nurse Darla was assigned to care for a client who was admitted with Cushing’s disease. She plans to monitor him for which complication related to increased
cortisol level?
A. Hypovolemia B. Hypoglycemia C. Infection D. Hypotension
62. The physician is educating a client with chronic Cushing’s disease about a possible unilateral adrenalectomy. Which of the following statements made by the
client would indicate that the teaching has been successful?
A. “After the surgery, I will be receiving a temporary glucocorticoid replacement for 2 years”
B. “Lifelong glucocorticoid and mineralocorticoid replacement therapy are necessary after the procedure”
C. “I will be subjected to receive glucocorticoid replacement therapy for not more than 6 months”
D. “After the surgery, I need to restrict myself from taking medications and food with sugar or salt to prevent adrenal crisis”
63. A nurse is assessing a client with suspected Addison’s disease. Which of the following findings by the nurse would support in confirming the diagnosis?
1. Muscle weakness 2. Dark pigmentation of the skin 3. Hypertension 4. Hypertension
5. High blood glucose level 6. High serum potassium level 7. Hypernatremia
A. 1, 2, 3 and 6 B. 1, 2, 4 and 5 C. All except 3, 4 and 6 D. All of the above
64. A nurse is formulating a pre-operative care plan for a client admitted to the surgical unit with a diagnosis of Pheochromocytoma. He is also scheduled to undergo
adrenalectomy for treatment. The nurse makes sure to diligently assess for which of the following prior to surgery?
A. Neurological status B. Vital signs: BP C. Ketones in urine D. Signs of hypoglycemia
65. A client with muscle weakness, loss of stamina and nocturia is being evaluated in the clinic for suspected Conn’s syndrome. The physician orders various
diagnostic exam including blood chemistry and arterial blood gas analysis. Which of the following laboratory results would be helpful in establishing diagnosis of
Conn’s syndromes?
1. Aldosterone level of 15 mg/dL 2. pH level of 7.49 3. Sodium level of 150 mEq/L 4. Potassium level of 3 mEq/L
5. Aldosterone level of 7 mg/dL 6. Sodium level of 130 mEq/L 7. Potassium level of 5.5 mEq/L
A. 1, 2, 3 and 4 B. 1, 2, 6 and 7 C. 1, 2, 3 and 7 D. 1, 2, 4 and 6
66. A nurse is attending to a client admitted to the medical unit with a diagnosis of Diabetes Mellitus Type 1. During the routine assessment, which of the following
signs and symptoms indicates that the client is experiencing hyperglycemia?
1. Elevated blood sugar level 2. Cold, clammy skin 3. Increased urination 4. Tremors
5. Deep, rapid respirations 6. Excessive thirst 7. Metabolic acidosis
A. 1, 3, 5, 6 and 7 B. All of the above C. All except 2, 5 and 7 D. All except 4
67. The nurse is providing information about the use of insulin to a client newly diagnosed with DM Type 1. The teaching has been effective if which of the following
is stated by the client?
A. “Putting the insulin in the refrigerator at all time is essential to prevent the loss of potency of the medication”
B. “I will increase my insulin dosage if I will engage myself to extraneous exercise to prevent hypoglycemia”
C. “I need to systematically rotate the injection site to prevent lipodystrophy”
D. “If ketones are present to my urine, it is indicative that my blood glucose level is under control”
68. Mr. Chin Chin Mei Fah, a 43-year-old client who was admitted due to uncontrolled blood sugar level is being prepared for discharge. The client asks the nurse
about his exercise regimen. Which of the following statements made by the nurse is accurate about the exercise regimen for a client with DM Type 2?
A. “If your blood glucose level is 250 mg/dL or more and still has ketones on your urine, you may begin your exercise regimen to increase the urine excretion of
ketones, thereby decreases the occurrence of any possible complication” C. “You should exercise at the same time and same amount each day”
B. “Sudden increase in exercise period is fine and is usually prescribed” D. “Sporadic exercise is often encouraged”
69. The nurse is providing an educational guideline to a diabetic client regarding measures to be done in case of getting ill. The following instructions should be
included in the discussion except:
A. Double the dose of the insulin or the oral antidiabetic agent that you are taking
B. If you cannot follow your usual meal plan, substitute soft food six to eight times per day
C. If vomiting, diarrhea and fever persists, take liquids such as regular cola, orange juice, cup broth and Gatorade every 30-60 minutes
D. Test blood glucose level and test urine for ketones every 3 to 4 hours
70. The nurse is preparing a health teaching to a client with peripheral neuropathy regarding foot care. The following measures are considered true regarding foot
care, except:
A. Warm feet using a heating pad with temperature not exceeding 100 F, this intervention helps regenerate peripheral nerve that is damaged because of DM
B. Do not go barefooted
C. Never cut your nails, always have a podiatrist cut your nails
D. Use only leather shoes
71. Hyperglycemic, Hyperosmolar, Non-ketotic Syndrome (HHNS) is a hyperosmolar state caused by hyperglycemia. Although both DKA and HHNS are cause dby
hyperglycemia, HHNS is different from DKA. Which of the following statement is true about HHNS?
A. This condition/syndrome occurs commonly in client with type 1 diabetes
B. The mortality rate of HHNS is higher than DKA
C. Overhydration is one of the causes for HHNS to develop, this limiting the fluid intake is essential part of nursing intervention
D. HHNS develops very rapidly
72. The nurse in the emergency room reviews the order that the physician has made for a client rushed to the emergency department due to HHNS. Among the
following physician’s order listed below, which of the following would lead the nurse to call the physician?
A. “Administer 100 unit of NPH subcutaneously”
B. “Initiate rapid IV infusion of 0.45% normal saline solution and if blood glucose level reaches 250-300 mg/dL, incorporate 5% dextrose in the prescribed IV
fluid”
C. “Administer IV regular insulin as ordered”
D. Monitor the client’s glucose level diligently”
73. The nurse assesses a client with hypothyroidism and notes that the thyroid glands are enlarged. The nurse understands that the occurrence of this finding is
consistent with which of the following explanation?
A. “In hypothyroidism, the lowered metabolism causes the hypothalamus and anterior pituitary gland to make stimulatory hormones, especially thyroid-
stimulating hormones as compensatory mechanism. The TSH binds to thyroid cells and causes the enlargement of the thyroid gland forming a goiter”
B. “In hypothyroidism, the decreased secretion of thyroid hormones causes these hormones to become trapped inside the gland causing enlargement of the
thyroid gland”
C. “This enlargement of thyroid gland is brought about by the increase secretion of non-functional thyroid hormones as the result, the glands enlarge because of
workload they received”
FINAL EXAMINATIONS 4
 D. “It is the inflammation that makes the thyroid glands to enlarge and is commonly seen in thyroiditis”

74. Nurse Darla is formulating a plan of care to a client admitted with hypothyroidism. She formulated a nursing diagnosis of Risk for Imbalanced Body Temperature
and plans to exclude which of the following?
A. Provide extra layer of clothing or extra blanket
B. Provide external heat source such as heating pad, electric or warming blanket
C. Protect the client from exposure to drafts and colds
D. Monitor the client’s body temperature and report decrease from the client’s baseline value
75. A client is said to undergo thyroidectomy for treatment of hyperthyroidism. Prior to the surgical procedure, the client receives iodine preparations. The purpose of
this medication is to prevent:
1. Thyroid storm during surgery 2. Excessive bleeding during surgery 3. Malignant hyperthermia during surgery 4. Infection after surgery
A. All of the above B. 1 and 4 C. 1 and 2 D. 2 and 3
76. The nurse is caring for a client who underwent subtotal thyroidectomy two days ago. During the routine assessment, the nurse would suspect that the client is
not experiencing complication if which of the following is noted?
A. Harsh, high pitched respiratory sound C. Tingling around the mouth or of the toes and fingers
B. Hoarseness and weakness of voice D. Bleeding at the incision site
77. A female client with hyperthyroidism has UTI. During the assessment rounds made by the nurse, VS were taken with temperature 101.3 F, HR 130 bpm,
irregular rhythm and BP 140/90 mmHg. The client is also holding his chest and complaining of chest pain. The nurse suspects presence of thyroid storm and
plans to carry out necessary actions. Which of the following interventions if made by the nurse, would further aggravate the client’s condition?
A. Administer ice packs, hypothermia blanket and aspirin to relieve hyperthermia C. Administer PTU or Methimazole as ordered
B. Administer humidified oxygen as ordered D. Administer Digitalis combined with Propranolol as ordered
78. A client is admitted to the medical unit with diagnosis of Parathyroid carcinoma. The client develops hyperparathyroidism. The nurse formulates a plan of care to
prevent renal calculi. Which of the following should be included in the plan of care?
1. For fluid up to 2,000 mL or more 3. Advise the client to increase mobility as much as possible
2. Administer Thiazide diuretics to increase calcium excretion 4. Administer oral phosphate to lower serum calcium level
A. All of the above B. All except 2 C. 2, 3 and 4 D. 1, 2 and 4
79. After failing to respond to fluid and drug therapy, a client with hyperparathyroidism has undergone parathyroidectomy. During the early post-operative period, the
nurse observes the client who exhibits harsh high-pitched sound which happens when he is breathing. Based on these findings, which of the following would be
the appropriate nursing action?
A. Reassure the client that this finding is normal
B. Notify the client’s attending physician
C. Elevate the client’s head
D. Remove the clip on the incision and inspect the area for swelling and bleeding
80. Following a total surgical removal of the thyroid gland, the client develops acute hypoparathyroidism. The client’s recent serum calcium level is 5.5 mg/dL During
the assessment, which of the following signs and symptoms is likely to be observed?
A. Tetany
B. Hypertension
C. Occurrence of carpopedal spasms when a sharp tap to the facial nerve is made
D. Severe back pain
81. A client at a routine blood glucose screening for diabetes mellitus tells a nurse she has excessive urination and excessive thirsts. The nurse should ask about
which of the following symptoms first?
A. Weakness B. Weight loss C. Vision changes D. Excessive hunger
82. Which of the following factors places a client at greatest risk for developing diabetes mellitus?
A. Obesity C. A grandparent with DM
B. Kapampangan descent D. Delivery of a neonate weighing more than 10 lbs
83. Which of the following blood glucose levels is considerd within normal limits?
A. 70 to 125 mg/dL B. 130 to 135 mg/dL C. 135 to 140 mg/dL D. 1401 to 145 mg/dL
84. A DM client says she slipped on a throw rug while going to a bathroom at night. Which of the following factors needs assessment?
A. If the home is safe C. If the client hit her head
B. If the client is confused D. If the client has a urinary tract infection
85. A client with DM also takes 8 ounces of magnesium sulfate solution. The calibrations on the measuring device are in milliliters. How many milliliters should the
nurse give?
A. 8 mL B. 80 mL C. 240 mL D. 480 mL

SITUATION: The Client with Cellular Aberrations

86. Cancer is a disease process that begins when an abnormal cell is transformed by the genetic mutation of the cellular DNA and proliferates abnormally. In
patterns of cell growth which of the following refers to metaplasia?
A. Cells lack normal cellular characteristics and differ in shape and organization with respect to their cells of origin
B. Bizarre cell growth resulting in cells that differ in size, shape or arrangement from other cells of the same type of tissue
C. Increase in the number of cells of a tissue, most often associated with periods of rapid body growth
D. Conversion of one type of mature cell into another type of cell
87. A student nurse is asked to differentiate benign from a malignant neoplasm. Which of the following descriptions of benign neoplasm should the student nurse
choose?
1. Rate of growth is variable and depends on the level of differentiation
2. Does not spread by metastasis
3. Grows at the periphery and sends out processes that infiltrate and destroy the surrounding tissue
4. Well-differentiated cells that resemble normal cells of the tissue from which the tumor originated
A. 2 only B. 1, 2 and 4 C. 2 and 4 D. All of the above
88. Antineoplastic drugs are used to promote tumor cell destruction. When a client is scheduled to have chemotherapy administration, the client asks about the most
convenient route for the chemo drugs. Which of the following routes would the nurse reply?
A. IV B. IM C. Intrathecal D. Oral
89. A client recently diagnosed with cancer visits the hospital to inquire about his treatment. Which of the following would be the initial step of the nurse during the
health teaching about chemotherapy administration?
A. Obtain informed consent C. Clarify information and correct misconception
B. Perform the appropriate way of gloving and gowning D. Make sure to choose an appropriate venous access device
90. A male client is scheduled to receive his fourth chemotherapy session. The nurse who is assigned for this client should be knowledgeable about the essential
things that must be remembered before, during and after the drug administration. When monitoring for the effects of the treatment, the nurse should stay alert for
which of the following clinical manifestations?
A. Hair loss on scalp C. Fatigue
B. Stomatitis D. Presence of ecchymosis in various sites of the body

FINAL EXAMINATIONS 5
91. A client who recently received chemotherapy is experiencing stomatitis. This condition normally happens few days after the chemo drug administration. Being
knowledgeable about this side effect, the nurse should provide measures on how to promote a more comfortable ambiance. Which of the following should not be
included in the nursing care plan?
A. Provide a soft-bland diet C. Encourage oral hygiene through the use of mouthwash such as Ora-Care
B. Avoid spicy and citrus food D. Children are ought to receive viscous Lidocaine as treatment for stomatitis
92. Weight loss can be very significant and visible in clients who are having chemotherapy sessions. In order to address the client’s nutritional imbalance, which of
the following should not be incorporated in the plan of care?
A. Do not serve the food unattractively
B. Serve according to client’s food choices such as meat, fruits and other nutritious diet
C. Provide good oral hygiene
D. Provide bland diet
93. Chemotherapy can affect a person’s laboratory values dramatically. Because of this phenomenon, the nurse should always stat alert for any significant change
that requires physician’s notice. While reviewing the client’s chart, the nurse noticed that he is neutropenic. Which of the following would be considered
inappropriate?
A. Do not recommend spicy food in the client’s diet C. Advise the client to stay out from persons who are actually ill
B. Sterile technique should be carried out while performing invasive procedures D. Report to the physician if the client’s temperature exceeds 100 F
94. Usually, radiotherapy may be used to cure cancer and/or reduce the size of the tumor. Since exposure to radiation poses a profound effect on the healthcare
provider’s health status, the model “ALARA” has been designed to help achieve minimum radiation exposure. The nurse who is part of the healthcare team
should be well-informed about the procedure, especially when care is being provided to the client. Upon entering the client’s room, which of the following actions
is inappropriate to execute?
A. Distance should be at least 72 inches
B. Lead gown is worn during nursing care
C. 30 minutes is the allowable time for nurse-client interaction
D. Film badge is used to monitor radiation exposure; therefore, the nurse should wear this during the entire shift
95. A client who underwent external radiation therapy should be given health teachings about the important actions to perform after the procedure. Being the nurse
assigned to the client, which of the following statements should be included in the teaching plan?
A. Inform the patient that he is radioactive after the procedure
B. Advise the client to remove the markings
C. Side effects are usually systemic rather than localized
D. Wash the area with warm water

SITUATION: Clients in various clinical settings

96. A patient who has had a total gastrectomy is given instructions o measures to prevent the developing of dumping syndrome. Which of the following statements, if
made by the patient, would indicate a correct understanding of the instructions?
A. “I will have a bedtime snack” C. “I will avoid concentrated sugar”
B. I will rest one hour before each meal” D. “I will include high-fiber food in my diet”
97. When instructing a patient who needs to restrict potassium intake, which of the following food would the nurse identify as being the lowest in potassium?
A. Raisins – 618 mg B. Grapes C. Spinach – 420 mg D. Potato – 515 mg
98. In peritoneal dialysis, the inflow time to allow dialysate to flow into the peritoneal cavity is:
A. 5-10 minutes B. 10-20 minutes C. 10-30 minutes D. 1 hour
99. During the meal, a client with Hepatitis B dislodges her IV line and bleeds on the surface of the over-the-bed table. It could be the most appropriate for the nurse
to instruct the housekeeper to clean the table with:
A. Alcohol B. Acetone C. Ammonia D. Bleach
100. Eileen, 45-year-old is admitted to the hospital with a diagnosis of renal calculi. She is experiencing severe flank pain, nauseated and with a temperature of 39 C.
Based on the assessment, the most immediate goal of the nurse would be which of the following?
A. Prevent complication C. Alleviate pain
B. Maintain fluid and electrolytes D. Alleviating nausea

FINAL EXAMINATIONS 6