2019APRILRENRRV:Patrick McKenzie: All Rights Reserve

1. A cast may be split after application to allow for tissue swelling. The nurse will bivalve a
cast by splitting which surfaces of the cast?
a. Medial and lateral
b. Anterior and medial
c. Anterior and posterior
d. Posterior and lateral

2. The nurse is providing a staff in-service on different forms of arthritis. To differentiate

osteoarthritis from rheumatoid arthritis, the nurse notes has:
a. Asymmetric joint involvement
b. No systematic involvement
c. Frequent remissions and exacerbation
d. Brief periods of stiffness after rest

3. In assessing the hands of a patient with osteoarthritis, the nurse identifies small nodules at
the distal interphalangeal joints of the fingers. The nurse recognizes this as:
a. Swan-neck deformity
b. Heberden’s nodes -nodes are hard or bony swellings that can develop in the distal
interphalangeal joints (DIP) (the joints closest to the end of the fingers and toes)
c. Boutonierre deformity
d. Bouchard’s nodes

4. To help prevent future urinary tract infections, the nurse instructs the client to drink an
adequate amount of fluid each day. If the patient weighs 150lbs, how much fluid should
she drink in a 24hr period?
a. 68 ounces
b. 75 ounces
c. 136 ounces
d. 150 ounces - 1 ounce per lbs of weight

5. According to the above patient’s weight the client should consume how many mls in
24hrs?
a. 2040
b. 4080
c. 2250
d. 4500 - 1ml= 0.03oz or 29.5ml = 1oz
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6. The client returning from surgery has an order for insulin IV. The client is to get
3units/hr. the insulin is supplied as 100units in 50ml NS. At what rate in mls/hr should
the second RN verify the pump to run at?
a. 6
b. 2.5
c. 1.5
d. 3

7. The client has an order for Cefipime 1g to be administered IV. The order reads:
reconstitute in 9mls NS to make 10mls of the medication. Cefipime is supplied as 2g vial.
The nurse should administer how many mls of the medication via IV?
a. 4.5
b. 5
c. 10
d. 20

8. The nurse is caring for a client with a chest tube to evacuate a hemopneumothorax
following a motor vehicle accident. The drainage has been consistently 25-50 ml/hr for
the most of the shift. However, over the past 2 hours there has been no drainage. Which
actions should the nurse take select all that apply.
i. Instruct client to cough and deep breathe
ii. Auscultate breath sounds
iii. Increase amount of suction
iv. Reposition the client
a. I ii iii iv
b. I ii iv
c. 1 ii iii
d. I iii iv

9. An elderly client is brought to the emergency department with lethargy, chills and sharp
chest pain with deep breathing. Pulse oximeter shows 93% on room air and respirations
are 24/br/min. what is the nurse’s initial action?
a. Administer intravenous morphine
b. Auscultate the client’s breath sounds
c. Initiate an IV infusion of normal saline
d. Initiate oxygen 3 liters via nasal cannula

10. The client with a left malignant pleural effusion had a thoracenteses with 900ml of fluid
removed. Which of these manifestations if noted on the post procedure assessment should
the nurse report to the doctor immediately?
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a. Blood pressure100/65mmhg
b. Client complain of 6/10 pain to left side
c. Asymmetrical chest expansion and decrease breath sounds on the left
d. Respiratory of 24 breaths with pulse oximeter of 94%on 2 liters oxygen

11. A previously healthy client with left lower lobe bacterial pneumonia. The nurse assesses
chest pain with productive cough of thick rusty sputum. Fine inspiratory crackles and
wheezes on inspiration. Which of the medication prescribed would the nurse question?
a. Furosemide 40mg IV push every day
b. Ibuprofen 600mg every 6 hours
c. Levofloxacin 500mg IV push daily
d. DPH expectorant every 12 hours

12. A client with asthma exacerbation has been using her rescue inhaler 10-12 times per day
because she cannot take a full breath. What possible side effects of albuterol should the
nurse anticipate the client will report? Select all that apply
i. Tremors
ii. Difficulty sleeping
iii. Hives with pruritus
iv. Palpitation
a. I ii iii iv
b. Ii iii iv
c. I ii iv
d. I iii iv

13. Based on the lung assessment information given to the nurse on the morning report which
client should the nurse see first? Client with
a. 1 day post op abdominal surgery with fine inspiratory crackles at the lung bases
b. right sided pleural effusion who has decrease breath sounds at the right lung base
c. client with chronic bronchitis who has rhonchi in the anterior and posterior chest
d. client with severe acute pancreatitis who has inspiratory crackles at the lung bases

14. The nurse is giving report at the end of the shift. A client was admitted with pneumonia
in the morning. Which information is most important for the nurse to communicate in the
change of shift report?
a. Chest X-ray showed left lung infiltrate and white blood cell count of 11000cellscm3
b. Current respirations are 24/min; pulse oximetry is 93% on 2 liters nasal cannula
c. Intravenous line has been infusing without complication
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d. The client’s family was rude to the nurse earlier

15. The client with obesity has been diagnosed with pulmonary embolism. Which assessment
does the nurse expect to find? Select all that apply
i. Bradycardia
ii. Chest pain
iii. Chills and fever
iv. Tachypnea
a. I ii iv
b. I ii iii
c. I iii iv
d. I ii iii iv

16. The nurse performs the admission history for the 70 yr-old client with newly diagnosed
COPD. Which statements made by the client does the nurse recognize as the most
significant contributing factors to the development of COPD? Select all that apply
i. “ I have been drinking alcohol daily since age 20”
ii. “ I have been overweight for as long as I can remember”
iii. “ was a car mechanic for 40 years”
iv. “I have smoked a pack of cigarette for the past 15 years”
a. I ii
b. Ii iv
c. Iii iv
d. Ii iii

17. The charge nurse in the emergency department is mentoring a new registered nurse. They
are caring for a client with chest tube to wall suction for a pneumothorax. The client is
being transferred from the emergency unit to the surgical unit. Which action by the new
RN would cause the nurse to intervene?
a. Clamping the chest tube at the insertion site during the transfer
b. Disconnecting the suction tubing from the wall suction unit
c. Hanging the chest tube connection unit under the underside of the stretcher
d. Tapping the connections between the chest tube and the suction tubing

18. The nurse determines that further teaching is needed if a client with constipation make
which statement? Select all that apply
i. “I will go to the rest room when I feel the urge”
ii. “ I will increase tea consumption to stimulate the bowel”
iii. “ I will exercise at least 3 times per week”
iv. “ I will use a laxative every other day if needed”
a. I ii
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b. I iii
c. Ii iv
d. Ii iii

19. A client is diagnosed with chronic renal failure and told she will be starting hemodialysis.
Client teaching would include which of the following instructions?
a. Follow a high potassium diet
b. Strictly follow the hemodialysis schedule
c. There will be a few changes in your lifestyle.
d. Use alcohol on the skin and clean it due to integumentary changes.

20. A client is undergoing peritoneal dialysis. The dialysate dwell time is completed, and the
dwell clamp is opened to allow the dialysate to drain. The nurse notes that the drainage
has stopped and only 500 ml has drained; the amount the dialysate instilled was 1,500 ml.
Which of the following interventions would be done first?
a. Change the client’s position.
b. Call the physician.
c. Check the catheter for kinks or obstruction.
d. Clamp the catheter and instill more dialysate at the next exchange time.

21. A client receiving hemodialysis treatment arrives at the hospital with a blood pressure of
200/100, a heart rate of 110, and a respiratory rate of 36. Oxygen saturation on room air
is 89%. He complains of shortness of breath, and +2 pedal edema is noted. His last
hemodialysis treatment was yesterday. Which of the following interventions should be
done first?
a. Administer oxygen
b. Administer the clients captopril as ordered
c. Elevate the bed’s lower half
d. Prepare the client for hemodialysis.

22. A client has a history of chronic renal failure and received hemodialysis treatments three
times per week through an arteriovenous (AV) fistula in the left arm. Which of the
following interventions is included in this client’s plan of care?
a. Keep the AV fistula site dry.
b. Keep the AV fistula wrapped in gauze.
c. Take the blood pressure in the left arm
d. Assess the AV fistula for a bruit and thrill

23. A nurse is assessing the patency of an arteriovenous fistula in the left arm of a client who
is receiving hemodialysis for the treatment of chronic renal failure. Which finding
indicates that the fistula is patent?
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a. Absence of bruit on auscultation of the fistula.

b. Palpation of a thrill over the fistula
c. Presence of a radial pulse in the left wrist
d. Capillary refill time less than 3 seconds in the nail beds of the fingers on the left hand.

24. The nurse is performing an assessment on a client who has returned from the dialysis unit
following hemodialysis. The client is complaining of a headache and nausea and is
extremely restless. Which of the following is the most appropriate nursing action?
a. Notify the physician
b. Monitor the client
c. Elevate the head of the bed
d. Medicate the client for nausea

25. The nurse is reviewing a list of components contained in the peritoneal dialysis solution
with the client. The client asks the nurse about the purpose of the glucose contained in the
solution. The nurse bases the response knowing that the glucose:
a. Decreases risk of peritonitis.
b. Prevents disequilibrium syndrome
c. Increases osmotic pressure to produce ultrafiltration.
d. Prevents excess glucose from being removed from the client.

26. Which of the following medications are the safest to administer to adults needing
assistance in falling asleep?
a. Sedatives
b. Hypnotics
c. Benzodiazepines
d. Anti-anxiety agents

27. A patient is admitted to the emergency department with an overdose of a benzodiazepine.

The nurse immediately prepares to administer which of the following antidotes from the
emergency drug cart?
a. naloxone (Narcan)
b. naltrexone (ReVia)
c. nalmefene (Revex)
d. flumazenil (Romazicon)

28. A mother tells the nurse that she is very worried because her 2-year old child does not
finish his meals. What should the nurse advise the mother?
a. make the child seat with the family in the dining room until he finishes his meal
b. provide quiet environment for the child before meals
c. do not give snacks to the child before meals
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d. put the child on a chair and feed him

29. The nurse answers a call bell and finds a frightened mother whose child, the patient, is
having a seizure. Which of these actions should the nurse take?
a. The nurse should insert a padded tongue blade in the patient’s mouth to prevent the
child from swallowing or choking on his tongue.
b. The nurse should help the mother restrain the child to prevent him from injuring
himself.
c. The nurse should call the operator to page for seizure assistance.
d. The nurse should clear the area and position the client safely.

30. The nurse is drawing blood from the diabetic patient for a glycosylated hemoglobin test
(H1c). She explains to the woman that the test is used to determine:
a. The highest glucose level in the past week.
b. glucose levels over the past several months.
c. Her usual fasting glucose level.
d. Her insulin level.

31. While preparing to discharge an 8-month-old infant who is recovering from

gastroenteritis and dehydration, the nurse teaches the parents about their infant’s dietary
and fluid requirements. The nurse should include which other topic in the teaching
session?
a. Nursery schools
b. Toilet Training
c. Safety guidelines
d. Preparation for surgery

32. When caring for an 11-month-old infant with dehydration and metabolic acidosis, the
nurse expects to see which of the following adaptation?
a. A reduced white blood cell count
b. A decreased platelet count
c. Shallow respirations
d. Tachypnea

33. After the nurse provides dietary restrictions to the parents of a child with celiac disease,
which statement by the parents indicates effective teaching?
a. “Well follow these instructions until our child’s symptoms disappear.”
b. “Our child must maintain these dietary restrictions until adulthood.”
c. “Our child must maintain these dietary restrictions lifelong.”
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d. “We’ll follow these instructions until our child has completely grown and
developed.”

34. The Client Self-Determination requires all hospitals to inform clients of advance
directives. What should Nurse Byron tell the client about such advance directives as
living wills and health care power of attorney?
a. They guide the client’s treatment in certain health care situations
b. They can’t provide do-not-resuscitate (DNR) orders for clients with terminal illnesses
c. They allow physicians to make decisions about treatment
d. They permit physicians to give verbal DNR order

35. Nurse Calvin receives a medication order over the telephone. What is the most
appropriate action for the nurse to take?
a. Tell the physician that the nurse practice act prohibits taking medication orders over
the telephone
b. Request that a second physician repeat the order to the nurse over the telephone
c. Insist that the physician sign the medication order within 1 hour
d. Verify the order by repeating it over the phone

36. The basis for building a strong therapeutic nurse-client relationship begins with the
nurse’s:
a. acceptance of others
b. sincere desire to help others
c. self-awareness and understanding
d. sound knowledge of psychiatric nursing

37. Nurse Carl is concerned about another nurse’s relationship with the members of a family
and their ill preschooler. Which of the following behaviors would be most concerning
and should be brought to the attention of the nurse-manager?
a. The nurse keeps communication channels open among herself, the family, physicians,
and other health care providers.
b. The nurse attempts to influence the family’s decisions by presenting her own thoughts
and opinions.
c. The nurse works with the family members to find ways to decrease their dependence
on health care providers.
d. The nurse has developed teaching skills to instruct the family members so they can
accomplish tasks independently.

38. Nurse Carrol works on a general medical-surgical unit where nurses work on 12-client
pods(cubicle). Each pod is staffed by two registered nurses. When one of the nurses
leaves the unit for any reason, the remaining nurse cares for all 12 clients. If she needs
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help, she can call the agency’s in-house resource nurse. One evening when a coworker
nurse left the unit, the remaining nurse, who was making rounds on the departed nurse’s
clients, found medications left at bedsides and a client with a blood-draw tourniquet
remaining on his arm. In addressing the problems, the nurse should:
a. inform the nurse-supervisor right away
b. correct the problems and submit a written report
c. speak to the coworker when she returns to the unit
d. ask for a meeting with the coworker and a manager

39. A client is being discharged after undergoing abdominal surgery and colostomy
formation to treat colon cancer. Which nursing action is most likely to promote continuity
of care?
a. Notifying the Cancer Society of the client’s diagnosis and discharge
b. Requesting Meals On Wheels to provide adequate nutritional intake
c. Referring the client to community health nurse for follow-up
d. Asking an occupational therapist to evaluate the client at home

40. A client requests his medication at 9 p.m. instead of 10 p.m. so that he can go to sleep
earlier. Which type of nursing intervention is required?
a. Intradependent
b. Interdependent
c. Dependent
d. Independent

41. An agitated client demands to see her chart so she can read what has been written about
her. Which of the following statements is nurse Cedric best response to the client?
a. I’m sorry the chart is the property of the facility. We don’t permit clients to read them
b. You have the right to see your chart. Please discuss this with your doctor
c. You may see your chart after you’re discharged
d. Please discuss this matter with your attorney

42. When prioritizing a client’s plan of care based on Maslow’s hierarchy of needs, nurse
Charles first priority would be:
a. allowing the family to see a newly admitted client
b. ambulating the client in the hallway
c. administering pain medication
d. placing wrist restraints on the client

43. Nurse Chester manages a unit that has four full-time vacant positions, and nurses
volunteer to work extra shifts to cover the staffing shortages. One of the staff nurses
hasn’t volunteered and states, “Forty hours a week of nursing is all I can manage to do. I
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won’t volunteer for overtime.” The nurse-manager says to an attending physician on the
unit, “I’ll adjust her schedule to make her wish she’d volunteered.” The physician to
whom she commented should:
a. ensure that the nurse-manager receives counseling about her comment
b. choose to ignore the comment because it isn’t the physician’s domain
c. report the nurse-manager to the director of nursing
d. tell the staff nurse what the manager said about her

44. A client with mitral valve prolapse is advised to have elective mitral valve replacement.
Because the client is a Jehovah’s Witness, she declares in her advance directive that no
blood products are to be administered. As a result, the consulting cardiac surgeon refuses
to care for the client. It would be most appropriate for nurse Christian who’s caring for
the client to:
a. realize the surgeon has the right to refuse to care for the client
b. advise the surgeon to arrange for an alternate cardiac surgeon
c. tell the client that she can donate her own blood for the procedure
d. inform the client that her decision could shorten her life

45. A newly hired charge nurse assesses the staff nurses as competent individually but
ineffective and nonproductive as a team. In addressing her concern, the charge nurse
should understand that the usual reason for such a situation is:
a. unhappiness about the change in leadership
b. unexpressed feelings and emotions among the staff
c. failure to incorporate staff in decision making
d. fatigue from overwork and understaffing

46. Which statement reflects appropriate documentation in the medical record of a

hospitalized client?
a. Small pressure ulcer noted on left leg
b. Client seems to be mad at the physician
c. Client’s skin is moist and cool
d. Client had a good day

47. Which individual is at greatest risk for developing hypertension?

a. 45 year-old African American attorney
b. 60 year-old Asian American shop owner
c. 40 year-old Caucasian nurse
d. 55 year-old Hispanic teacher
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48. A child who ingested 15 maximum strength acetaminophen tablets 45 minutes ago is
seen in the emergency department. Which of these orders should the nurse do first?
a. Gastric lavage PRN
b. Activated charcoal per pharmacy
c. Acetylcysteine (mucomyst) for age per pharmacy
d. Start an IV Dextrose 5% with 0.33% normal saline to keep vein open

49. A client is 24 hours post long bone fracture. Which complication should the nurse
monitor for?
a. angina at rest
b. dizziness
c. thrombus formation
d. falling blood pressure

50. A client is admitted to the emergency room with renal calculi and is complaining of
moderate to severe flank pain and nausea. The client’s temperature is 100.8 degrees
Fahrenheit. The priority nursing goal for this client
a. Maintain fluid and electrolyte balance
b. Prevent urinary tract infection
c. Control nausea
d. Manage pain

51. The hospital has sounded the call for a disaster drill on the evening shift. Which of these
clients would the nurse put first on the list to be discharged in order to make a room
available for a new admission?
a. A middle aged client with a history of being ventilator dependent for over 7 years and
admitted with bacterial pneumonia five days ago
b. A young adult with diabetes mellitus Type 2 for over 10 years and admitted with
antibiotic induced diarrhea 24 hours ago
c. An elderly client with a history of hypertension, hypercholesterolemia and lupus, and
was admitted with Stevens-Johnson syndrome that morning
d. An adolescent with a positive HIV test and admitted for acute cellulitis of the lower
leg 48 hours ago

52. A client has been newly diagnosed with hypothyroidism and will take levothyroxine
(Synthroid) 50 mcg/day by mouth. As part of the teaching plan, the nurse emphasizes that
this medication:
a. Should be taken in the morning
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b. May decrease the client’s energy level

c. Must be stored in a dark container
d. Will decrease the client’s heart rate

53. A 3 year-old child comes to the pediatric clinic after the sudden onset of findings that
include irritability, thick muffled voice, croaking on inspiration, hot to touch, sit leaning
forward, tongue protruding, drooling and suprasternal retractions. What should the nurse
do first?
a. Examine the child’s throat
b. Collect a sputum specimen
c. Prepare the child for x-ray of upper airways
d. Notify the healthcare provider of the child’s status

54. The nurse anticipates that for a family who practices Chinese medicine the priority goal
would be to
a. Respect life
b. Achieve harmony
c. Restore yin and yang
d. Maintain a balance of energy