PHARMACOLOGY

Session 17

1. The three primary elements that determine the pressure in the cardiovascular system are heart
rate, stroke volume, and:
A. Baroreceptors
B. Peripheral resistance
C. Renin-Angiotensin-Aldosterone System (RAAS)
D. All of the above
ANSWER B.
Peripheral resistance.Small arterioles help regulate blood pressure in a constant basis and are the most
important factor affecting peripheral resistance. When small arterioles constrict, they are almost able to
stop the flow of the blood. Their high responsiveness to sympathetic nervous stimulation cause them to
constrict and increase blood pressure. Baroreceptors are pressure receptors located in the arch of the aorta
and carotid arteries that send information to the brain when pressure increases. RAAS is a compensatory
mechanism activated in the kidney when blood pressure falls.

2. Untreated hypertension can result to which of the following:

A. Stroke
B. Renal failure
C. Loss of vision
D. All of the above
ANSWER D.
All of the above.
The force of the blood propelled against blood vessels can damage their linings, making them susceptible
to atherosclerosis and narrowing. When these happen, tiny vessels in the retina, kidneys, and brain can be
destroyed leading to unresponsiveness of the system

3. A student nurse was asked to take the blood pressure of a patient in the emergency room. The BP reads
140/90 mmHg. She would be correct to say that this BP belongs to ____________ classification.
A. Normal
B. Elevated
C. Stage 1 Hypertension
D. Stage 2 Hypertension
ANSWER D.
Stage 2 Hypertension. A category rating the severity of hypertension has been devised and the
classifications of blood pressure are as follows: Normal – systolic: <120 mmHg; diastolic:
<80 mmHg; Elevated – systolic: 120-129 mmHg; diastolic: <80 mmHg; Stage 1 Hypertension – systolic:
130-139 mmHg; diastolic: 80-89 mmHg; Stage 2 Hypertension – systolic: less than or equal to 140 mmHg;
diastolic: less than or equal to 90 mmHg.

4. Which of the following medications will decrease the therapeutic effects of quinapril (Accupril)?
A. NSAIDs
B. Allopurinol
C. Antacids
D. All of the above
ANSWER A.
NSAIDs. Quinapril belongs to the class ACE inhibitors. NSAIDs are linked to decreased antihypertensive
effects of ACE inhibitors. Allopurinol increases risk of hypersensitivity when combined with ACE inhibitors.

5. A patient receiving nitroprusside begun manifesting headache, distant heart sounds, imperceptible
pulses, and shallow breathing. The nurse knows that these are signs of?
A. Reflex tachycardia
B. Hypothyroidism
C. Cyanide toxicity
D. Severe alteration of blood pressure
ANSWER C.
Cyanide toxicity. Nitroprusside is metabolized into cyanide. Other manifestations of cyanide toxicity include
pink color, loss of consciousness, and absence of reflexes.

6. the nurse is administering antihypertensive drugs to older adults patients. the nurse knows that which
adverse effect is of most concern for these patients?
A. dry mouth
B. hypotension
C. restlessness
D. constipation
ANSWER B Hypotension. A client receiving furosemide (Lasix) as an adjunct to treatment of hypertension
returns for follow-up.

7. Which of the following objective data should the nurse consider when determining the effectiveness of
the drug therapy?
A. Blood pressure log notes blood pressure 120/70-134/88 since discharge.
B. Weight loss of six pounds in the past month
C. Frequency of voiding of at least six times per day
D. Absence of edema in lower extremities
ANSWER A.
Maintenance of blood pressure within normal limits indicates that treatment goals are achieved. Absence
of edema, weight loss, and urinating all indicate that the diuretic has promoted fluid loss, but are not the
best measure of the drug's effectiveness for hypertension.

8. A client receiving HCTZ 25 mg q.d. and digoxin 0.125 mg q.d. complains of nausea and vomiting, and
of seeing halos around lights. The client's serum digoxin level is 2.5 ng. The appropriate nursing
intervention is to:
A. Administer both drugs as ordered.
B. Document the findings; the lab results are within normal limits.
C. Hold the digoxin and HCTZ.
D. Hold the digoxin, and give HCTZ as ordered.
ANSWER C.
Hold the digoxin and HCTZ. Thiazide diuretics increase serum digitalis levels by promoting potassium loss,
which increases the risk of digoxin toxicity. A digitalis level above 2.0 ng is toxic.

9. Nitroprusside (Nitropress) is prescribed for a client admitted with a blood pressure of 220/110. What
action by a new nurse would require intervention by the charge nurse?
A. The nurse inserts a Foley catheter.
B. The nurse documents the IV rate and status of site every 15 minutes.
C. The nurse uses electronic monitoring of blood pressure every hour.
D. The nurse cautions the client to call for assistance before getting out of bed.
ANSWER C.
Nitroprusside decreases blood pressure instantaneously. Vital signs must be monitored very closely—e.g.,
every 5-15 minutes.

10. The nurse reviews the teaching plan with a client receiving nifedipine (Procardia). Which of the
following client behaviors indicates understanding?
A. The client avoids taking the drug with grapefruit juice.
B. The client consumes three servings of alcohol daily.
C. The client breaks an enteric-coated tablet for ease of swallowing.
D. The client monitors blood pressure every week.
ANSWER A.
The client avoids taking the drug with grapefruit juice. Grapefruit juice increases absorption of nifedipine,
resulting in increased serum level. Blood pressure ideally should be monitored more frequently. Alcohol
intake of three times a day is excessive. Breaking enteric tablets will interfere with time release of the
medication.

11. A diuretic is added to the treatment regimen for a client with hypertension. The nurse explains that
diuretics help reduce blood pressure by:
A. Removing serum potassium.
B. Dilating peripheral blood vessels.
C. Reducing sympathetic outflow.
D. Constricting blood vessels.
ANSWER C.
Reducing sympathetic outflow. Diuretics decrease blood volume, which in turn decreases the workload of
the heart and reduces blood pressure. They do not dilate blood vessels. Some diuretics promote potassium
loss, but this does not reduce the blood pressure. Central-acting antihypertensives work by blocking
sympathetic outflow.

12. Atenolol (Tenormin) is prescribed for a client with hypertension. The nurse recognizes that a safe dose
for this drug is:
A. Atenolol (Tenormin) 100 mg b.i.d.
B. Atenolol (Tenormin) 150 mg q.d.
C. Atenolol (Tenormin) 50 mg b.i.d.
D. Atenolol (Tenormin) 75 mg b.i.d.
ANSWER C.
The maximum dosage range for Atenolol (Tenormin) is 100 mg/day.

13. Nifedipine (Procardia) 30 mg p.o. is prescribed for a client. The nurse teaches the side effects and
instructs the client to immediately report:
A. Blood pressure 110/70-114/78 for two successive readings.
B. Dizziness when changing positions.
C. Increased shortness of breath and orthopnea.
D. Weight loss of two pounds per week.
ANSWER C.
Nifedipine (Procardia) is a calcium channel blocker. Calcium channel blockers decrease myocardial
contractility, increasing the risk of heart failure. Dizziness can occur, especially when the medication is
started. The BP is a desired reading.

14. The client is taking atenolol (Tenormin) and doxazosin (Cardura). what is the rationale for combining 2
anti-HT drugs?
A. BP will decrease faster
B. Lower doses of both drugs may be given with fewer adverse effects.
C. There is less daily medication dosing.
D. Combination therapy will treat the patient's other medical conditions.
ANSWER B.
The advantage of using a combo of 2 drugs like atenolol (Tenormin)-a beta blocker and doxazosin
(Cardura) an alpha1 antagonist is that Lower doses of both drugs may be given with fewer adverse effects.

15. What health teaching should the nurse provide for the client receiving nadolol (Corgard)?
A. Increase fluids & fiber to prevent constipation
B. Report weight gain of 1kg / month or more
C. Immediately stop taking meds if sexual dysfunction occurs.
D. Rise slowly after prolonged periods of sitting or lying down.
ANSWER D.
Rise slowly after prolonged periods of sitting or lying down.
Session 18

1. Nursing student Annie was assigned in the cardiovascular unit A wherein all the patients have heart
failure. Ms. Annie is aware that the primary treatment for heart failure (HF) is which of the following?.
A. Increasing the heart rate so the heart can pump more blood
B. Decreasing the heart rate so the heart can rest
C. Increasing contractility so the heart will be able to pump more blood
D. Decreasing contractility to prevent muscle fatigue
ANSWER C.
Increasing contractility so the heart will be able to pump more blood. The complete answer would be to
make the heart beat efficiently, that is to increase its force of contraction without increasing the heart rate.
Through this, more blood is pumped every beat without overwhelming the heart because rate of contraction
is not increased.

2. Which of the following is the most common cause of heart failure?

A. Hypertension
B. Valvular heart diseases
C. Cardiomyopathy
D. Coronary artery disease (CAD)
ANSWER D.
Coronary artery disease (CAD). It accounts for 95% of HF cases. CAD results to insufficient supply of blood
in the heart. This leads to hypoxia and loss of function of heart muscles.

3. Digoxin was prescribed to a patient with ventricular tachycardia. What should the nurse do?
A. Administer the drug as ordered.
B. Discuss the order with the doctor.
C. Discontinue other intravenous medications before administering digoxin.
D. Count apical pulse for one full minute before administering.
ANSWER B.
Discuss the order with the doctor.Digoxin is contraindicated in patients with ventricular tachycardia and
fibrillation because these are potentially fatal arrhythmias and need to be treated with other medications.

4. What is the antidote for digoxin intoxication?

A. Diphenhydramine
B. Atropine sulfate
C. Digoxin immune fab (Digibind, DigiFab).
D. Phosphodiesterase inhibitors
ANSWER C.
Digoxin immune fab (Digibind, DigiFab).Digoxin Immune Fab or DigiFab, DigiBind should be administered
for serum digoxin levels of >10 ng/mL and serum potassium level of >5 mEq/mL.

5. An infant who is receiving cardiac glycosides has an apical pulse of 80 beats per minute. Which is the
best nursing intervention for this assessment finding?
A. Administer drug as ordered.
B. Withdraw the drug and notify doctor.
C. Assess apical pulse every hour for the next five hours.
D. Decrease drug dose and administer.
ANSWER B.
Withdraw the drug and notify doctor.A low apical pulse (less than 90 for infants and less than 60 for adults)
can signal drug toxicity.

6. What signals the novice nurse that intravenous milrinone was combined to furosemide in management
of patients with heart failure?
A. Presence of bubbles
B. Pink discoloration of the solution
C. Formation of precipitates
D. No obvious sign. Solution is clear.
ANSWER C.
Formation of precipitates.
Phosphodiesterase inhibitor-furosemide combination should be avoided. Alternate lines should be used if
both of these drugs are given intravenously.

7. What is the therapeutic level for digoxin?

A. 0.5-2 ng/Ml
B. 1.5-2 ng/mL
C. 0.5-1.5 mg/mL
D. 0.5-2 mg/Ml
ANSWER A. 0.5-2 ng/mL.

8. In severe cardiac glycoside toxicity, all of the following should be in the bedside, except _________.
A. Lidocaine
B. Phenytoin
C. Calcium channel blocker
D. A and B only
ANSWER C.
Calcium channel blockers. Lidocaine and potassium salts are used to treat arrhythmias. Phenytoin is for
treatment of seizures. Other medications and equipment at the bedside include atropine for treatment of
increased heart rate, and a cardiac monitor.

9. Type of angina which involves spasm of the blood vessels

A. Stable angina
B. Pre-infarction angina
C. Unstable angina
D. Prinzmetal angina
ANSWER D.
Prinzmetal angina. It is an unusual type of angina which involves the spasm of blood vessels and not just
by narrowing of vessels. Person with prinzmetal angina has angina at rest and associated ECG changes.

10. Which instruction should be included in the discharge teaching for a patient with a transdermal
nitroglycerin (Nitro-Dur) patch?
A. "If you get chest pain, apply a second patch next to the first patch."
B. "If you get a headache, remove the patch for 4 hours and then reapply."
C. "Make sure to rub a lotion or cream on the skin before putting on a new patch."
D. "Apply the patch to a hairless, nonirritated area of the chest, upper arm, back or shoulder."
ANSWER D.
Do not apply the patch to your arms below the elbows, to your legs below the knees, or to skin folds. Apply
the patch to clean, dry, hairless skin that is not irritated, scarred, burned, broken, or calloused. Choose a
different area each day.

11. Contraction and relaxation in each cardiac cycle is controlled by:

A. autonomic nervous system
B. the heart
C. cranial nerves
D. central nervous system
ANSWER B.
The heart.Contraction and relaxation is controlled by impulses arising spontaneously in the SA node and
transmitted via a specialized conducting system to activate all parts of the muscle almost simultaneously.
These rhythmic and continuous contractions are controlled by the heart itself.
12. All of the following can cause arrhythmia, except:
A. Acidosis
B. respiratory depression
C. hyperkalemia
D. none of the above
ANSWER D.
None of the above. Electrolyte disturbances, hypoxic conditions, acidosis or accumulation of waste
products, and structural damage of the conduction system can lead to arrhythmia.

13. Verapamil and diltiazem belong to which class of antiarrhythmics?

A. Class IV
B. Class III
C. Class Ia
D. Class II
ANSWER A.
Class IV. Verapamil and diltiazem are calcium-channel blockers and belong to Class IV antiarrhythmics.

14. The conduction system of the heart include the following:

A. Sinoatrial node
B. Bundle of Purkinje
C. His Fibers
D. Atriomyocardial node
ANSWER A.
Sinoatrial node. Path of conduction is as follows: SA node -> AV node -> Bundle of His -> Purkinje fibers.

15. The patient states to the nurse, "My friend said nitroglycerin relieves angina pain by reducing preload.
What is preload?" Which statement by the nurse explains preload to this patient?
A. "It is the blood return to the heart."
B. "It is the oxygen demand of the heart."
C. "It is the pressure against which the heart must pump."
D. "It is dilation of arteries and veins “
ANSWER A.
Preload is the return of blood to the heart. Preload, also known as the left ventricular end-diastolic
pressure (LVEDP), is the amount of ventricular stretch at the end of diastole.

Session 19

1. Lipid levels of individuals with coronary artery disease (CAD) is usually high. All of the following are
factors of CAD, except:
A. Men
B. Gout
C. Untreated Chlamydia infections
D. None of the above
ANSWER D.
None of the above. The incidence of CAD in men is higher than premenopausal women. Gout injures the
blood vessels because of accumulation of uric acid. Untreated bacterial infections can also contribute to
CAD.

2. Which assessment finding in a patient taking an HMG-CoA reductase inhibitor will the nurse act on
immediately?
A. Decreased haemoglobin
B. Elevated liver function tests
C. Elevated HDL
D. Elevated LDL
ANSWER B.
HMG-CoA reductase inhibitors (statins) can cause hepatic toxicity; thus, it is necessary to monitor liver
function tests. The nurse should act on this finding immediately. Decreased hemoglobin should be
addressed but not immediately. It is most likely not related to the administration of the HMG-CoA reductase
inhibitor. Also, while an elevated LDL level must be addressed, it is not as high a priority as the elevated
liver function test results. An elevated HDL is a positive finding and an encouraging result.
3. A patient is taking pravastatin sodium. Which assessment finding requires immediate action by the
nurse?
A. Headache
B. Slight nausea
C. Muscle pain
D. Fatigue
ANSWER C.
Patients who experience severe muscle pain while taking pravastatin sodium need to report the findings
right away, as this may be indicative of rhabdomyolysis, a muscle disintegration that can become fatal.

4. Antihyperlipidemic agent that is used to decrease plasma cholesterol levels.

A. HMG-CoA reductase inhibitors
B. Phosphodiesterase inhibitors
C. Bile acid sequestrants
D. Cholesterol absorption inhibitor
ANSWER C.
Bile acid sequestrants. Bile acid contains a lot of cholesterol and bile acid sequestrants bind to them to form
an insoluble complex that is then excreted in the feces.

5. A pregnant woman needs a lipid-lowering agent. What would be the best class of lipid-lowering agent
for pregnant women?
A. HMG-CoA reductase inhibitors
B. Bile acid sequestrants
C. Cholesterol absorption inhibitors
D. Phosphodiesterase inhibitors
ANSWER B.
Bile acid sequestrants.This is the drug of choice for women of childbearing age. HMG-CoA reductase
inhibitor is pregnancy category X.

6. A patient begins taking cholestyramine (Questran) to treat hyperlipidemia. The patient reports abdominal
discomfort and constipation. The nurse will provide which instruction to the patient?
A. Increase fluid and slowly increase fiber intake.
B. Stop the medication.
C. Decrease oral fluids
D. Give stool softeners
ANSWER A.
Cholestyramine can cause gastrointestinal upset and constipation, and these symptoms can be reduced
with increased fluids and foods high in fiber.

7. The only statin with outcome data to show effectiveness in decreasing CAD and incidence of myocardial
infarction.
A. atorvastatin (Lipitor)
B. simvastatin (Zocor)
C. pravastatin (Pravachol)
D. fluvastatin (Lescol)
ANSWER C.
Pravastatin is an HMG-CoA reductase inhibitor that can prevent first MI even in patients who do not have
documented increase in cholesterol concentration.

8. Which organ(s) produce(s) clotting factors?

A. Bone marrow
B. Spleen and other lymphoid tissues
C. Liver
D. Both B and C
ANSWER C.
Liver.The liver produces a cascade of clotting factors which contributes to the process of coagulation by
breaking down fibrinogen into insoluble fibrin threads

9. What is the first reaction to a blood vessel injury?

A. Vasodilation and swelling
B. Vasoconstriction
C. Bleeding
D. Blood coagulation
ANSWER B.
Vasoconstriction. This is especially helpful for very small injuries to the blood vessel because
vasoconstriction can seal off any break and allow the area to heal.

10. Heparin is an anticoagulant. What family of anticoagulant medications does this drug belong to?
A. Direct thrombin inhibitors
B. Indirect thrombin inhibitors
C. Vitamin K antagonists
D. Factor Xa inhibitors
ANSWER B.
Heparin is an anticoagulant that belongs to the Indirect Thrombin Inhibitors family.

11. Which statement below BEST describes how Heparin works as an anticoagulant?
A. “It inhibits clotting factors from synthesizing Vitamin K.”
B. “It inactivates the extrinsic pathways of coagulation.”
C. “It prevents Factor Xa from activating prothrombin to fibrinogen.”
D. “It enhances the activation of antihrombin III, which prevents the activation of thrombin and the
conversion of fibrinogen to fibrin.”
ANSWER D.
Heparin enhances the activation of antihrombin III, which prevents the activation of thrombin and the
conversion of fibrinogen to fibrin. Therefore, this medication INDIRECTLY inhibits thrombin via antithrombin
III.

12. Which patients below would be at a HIGH risk for developing adverse effects of Heparin drug therapy?
Select all that apply:
A. A 55-year-old male patient who is post-op day 1 from brain surgery.
B. A 45-year-old female patient with a pulmonary embolism.
C. A 36-year-old male patient with active peptic ulcer disease.
D. A 43-year-old female with uncontrolled atrial fibrillation.
ANSWER A and C.
These patients are both at risk for major bleeding if placed on an anticoagulant due to their condition (one
patient is post-op from brain surgery and the other patient has ulcers that could bleed). Option B and D are
candidates from Heparin therapy because the patient in option B has a blood clot (Heparin can prevent it
from getting bigger and developing new blood clots), and the patient in option D is at risk for developing a
blood clot.

13. A patient is ordered to start an IV continuous Heparin drip. Prior to starting the medication, the nurse
would ensure what information is gathered correctly before initiating the drip?
A. Vital signs
B. Weight
C. PT/INR level
D. EKG
ANSWER B.
The nurse would want to make sure the documented weight of the patient is current and accurate. This
medication is weight-based. Therefore, for proper dosing to be administered, a correct weight should be
used.

14. What is the approximate NORMAL level range for an activated partial thromboplastin time (aPTT)?
A. 20-25 seconds
B. 2-3 seconds
C. 30-40 seconds
D. 60-80 seconds
ANSWER C.
This is considered a (approximate…varies in labs) normal aPTT level in someone who is NOT on Heparin.

15. A patient, who is receiving continuous IV Heparin, has an aPTT of 105 seconds. What is your next
nursing action per protocol?
A. Continue with the infusion because no change is needed based on this aPTT.
B. Increase the drip rate per protocol because the aPTT is too low.
C. Re-draw the aPTT STAT.
D. Hold the infusion for 1 hour and decrease the rate per protocol because the aPTT is too high.
ANSWER D.
The aPTT is 105 seconds, which is too high. Any aPTT value greater than 80 seconds places the patient
at risk for bleeding. Most Heparin protocols dictate that the nurse would hold the infusion for 1 hour and to
decrease the rate of infusion. If the aPTT is less than 60 seconds, the dose would need to be increased
and a bolus may be needed. aPTT values should be around 60-80 seconds to achieve a therapeutic
response for Heparin.

Session 20

1. As a nurse you know that Ferrous should not be given with:

A. Dairy products
B. Antacids
C. Tetracyclines
D. All of the above.
ANSWER D. Ferrous should not be given with dairy products, antacids and tetracyclines because these
decreases the absorption of the drug.

2. What do you give with Ferrous sulfate, ferrous fumarate, or ferrous gluconate to help promote
absorption?
A. Vitamin C
B. Vitamin D
C. Vitamin E
D. Vitamin B12
ANSWER A.
Ferrous sulfate works best when you take it on an empty stomach. However, if it upsets your stomach, you
can take it with or after food. A doctor (or a pharmacist) may recommend taking ferrous sulfate with orange
juice or a vitamin C supplement. Vitamin C is believed to increase the amount of iron absorbed by the body.

3. The client receives epoetin alfa (Epogen) subcutaneously, and says to the nurse, "My doctor said I
have anemia. Are there little red blood cells in that shot?" What are the best responses by the nurse?
A. "No, we do not give blood for anemia anymore."
B. "No, this medication stimulates your body to make red blood cells."
C. " Yes, this small amount of red blood cells will stimulate your bone marrow to produce more cells in the
kidney."
D. "No, this medication promotes clotting so you will not lose even more red blood cells."
ANSWER B
"No, this medication stimulates your body to make red blood cells." Blood transfusions are given if anemia
is severe. Epoetin alfa (Epogen) is not red blood cells and is not a clot promoter.

4. The nurse is teaching a class on how red blood cell formation is regulated by the body to a group of
clients who have AIDS. The nurse evaluates that learning has occurred when the clients make which
statements?
A. "Red blood cell formation is regulated through chemicals called colony-stimulating factors that come
from white blood cells."
B. "Red blood cell formation is regulated through messages from the hormone, secretin, which is located
in the kidney."
C. "Red blood cell formation is regulated through specific liver enzymes and a process called
hemochromatosis."
D. "Red blood cell formation is regulated through messages from the hormone erythropoietin."
ANSWER D.
Regulation of hematopoiesis occurs through messages from hormones such as erythropoietin.

5. The client receives chemotherapy as therapy for cancer. The physician orders epoetin alfa (Procrit)
subcutaneously. The client asks the nurse if this drug is also chemotherapy. What is the best response
by the nurse?
A. "No, but it works with your chemotherapy to make it more effective."
B. "No, this drug helps to counteract the nausea and vomiting caused by your chemotherapy."
C. "No, it will stimulate your immune system to help you battle the cancer."
D. "No, this drug will help prevent anemia that can be caused by your chemotherapy."
ANSWER D.
Epoetin alfa (Procrit) is given to clients undergoing cancer chemotherapy to counteract the anemia caused
by antineoplastic agents. It is similar to a kidney hormone, erythropoietin, and helps your body make more
red blood cells.
Your kidney makes more erythro-poietin if it doesn’t get enough oxygen. Erythropoietin also helps your
body make hemoglobin.”

6. The client is receiving medication for the treatment of anemia. The nurse has taught the client about
this drug and about anemia. The nurse evaluates that learning has occurred when the client makes
which statement?
A. "My anemia could be caused by blood loss somewhere, but there are other causes too."
B. "My anemia was caused by drinking too many carbonated beverages with caffeine."
C. "There are many causes for anemia; mine was caused by heart failure and fluid overload."
D. "I think my anemia occurred when I started that vegetarian diet."
ANSWER A.
"My anemia could be caused by blood loss somewhere, but there are other causes too."The three
categories of blood loss are hemorrhage, increased erythrocyte destruction, and impaired erythrocyte
production.

7. The client had stomach cancer and a surgical removal of his stomach several years ago. The physician
prescribed cyanocobalamin (Nascobal). The client stopped this drug several months ago. What will the
nurse most likely assess in this client?
A. Memory loss, numbness in the limbs, and depression
B. A gradual decrease in red blood cell count
C. Jaundice and tarry stools
D. Low hemoglobin and hematocrit counts
ANSWER A. The most common cause of vitamin B12 deficiency (pernicious anemia) is absence of intrinsic
factor, a protein secreted by stomach cells. This protein is required for vitamin B12 to be absorbed from the
intestine. Symptoms of pernicious anemia involve the nervous system and include memory loss, confusion,
tingling or numbness in the limbs, and mood disturbances.

8. What is the only potassium-sparing diuretics that can be used in children?

A. Furosemide
B. Spironolactone
C. Amiloride
D. Triamterene
ANSWER B.
Spironolactone. Potassium-sparing diuretics include spironolactone, amiloride, and triamterene. Both
amiloride and triamterene are not for use in children. Use of spironolactone in children would require careful
monitoring of electrolytes.

9. A patient receiving diuretics should alert the nurse if she feels the following:
A. insomnia
B. low-grade fever
C. muscle weakness
D. all of the above
ANSWER C.
Muscle weakness. This is a sign of hypokalemia and would require prompt intervention. Other signs and
symptoms of hypokalemia include arrhythmia and muscle cramps

10. A patient admitted for cerebral swelling complained of feeling light-headed and nauseous while
receiving mannitol. What should the nurse do?
A. Document, withdraw, and notify doctor.
B. Decrease mannitol flow.
C. Provide comfort measures.
D. Increase mannitol flow.
ANSWER A.
Document, withdraw, and notify doctor. A sudden drop in fluid level is one of the most potentially fatal
adverse effects of mannitol. Manifestations include hypotension, lightheadedness, nausea, and confusion.

11. The physician prescribes the patient a loop diuretic. As the nurse you know that this type of diuretic
causes diuresis by mainly affecting what structure in the nephron?
A. Distal convoluted tubule
B. Descending limb of the loop of Henle
C. Proximal convoluted tubule
D. Ascending limb of the loop of Henle
ANSWER D.
Loop diuretics affect the loop of Henle, specifically the ASCENDING limb (the thick part of this limb).

12. Loop diuretics are effective with inhibiting sodium reabsorption within the nephron because it inhibits?
A. the sodium-chloride transporter
B. the effects of aldosterone on the distal convoluted tubule
C. the sodium-potassium-chloride cotransporter
D. the transport of bicarbonate by the proximal convoluted tubule
ANSWER C.
Loop diuretics INHIBIT the sodium-potassium-chloride (NKCC2) cotransporter in the thick ascending limb
of the loop of Henle. This inhibits the amount of sodium that is reabsorbed by the kidneys, which will cause
the nephron to decrease the amount of water it reabsorbs…hence leading to more water leaving the kidneys
via the urine (leading to its diuretics affects). Option A is how thiazide diuretics work, option B is how
potassium-sparing diuretics work, and option D is how carbonic anhydrase inhibitors work.

13. Your patient is ordered a loop diuretic at 1000. Which finding below would require you to hold the dose
and notify the physician for further orders?
A. Calcium level 9 mg/L
B. Potassium level 1.5 mEq/L
C. Blood pressure 102/78
D. Sodium level 144
ANSWER B.
Loop diuretics are known to decrease potassium levels due to the way they affect how the nephron wastes
potassium (this happens in the distal convoluted tubule due to the high concentrated amount of sodium in
the filtrate…this tubule will exchange potassium and hydrogen ions for sodium ions under the influence of
aldosterone, which will lead potassium to enter the filtrate and exit the body as urine.)
14. You’re providing discharge instructions to a patient who will be taking a loop diuretic at home. Which
statement by the patient demonstrates they did NOT understand the teaching material and requires
that you reinforce some of the teaching points?
A. “I will eat a diet rich in potatoes, bananas, avocadoes, strawberries, and spinach.”
B. “I will weight myself daily and report to my physician if I gain more than 3 lbs in 1 day.”
C. “I will change position slowly because I can become dizzy easily while taking this medication.”
D. “This medication can cause dehydration, so I will stay hydrated by consuming at least 2 L or more of
fluid per day.”

ANSWER D.
The patient should be educated on the signs and symptoms of dehydration (excessive thirst, fatigue,
hypotension etc.). However, they should not be taught to consume 2L or more of fluid per day. Many
patients are prescribed loop diuretics to treat issues with fluid volume overload (example heart failure).
These patients must monitor how much fluid they are drinking. If too much fluid is consumed this will cancel
out the effectiveness of the medication.

15. What electrolyte imbalances would the nurse monitor for in the patient who is taking a loop diuretic?
Select all that apply:
A. Hyperkalemia
B. Hypocalcemia
C. Hypernatremia
D. Hypokalemia
ANSWER B & D.
Loop diuretics can cause hypokalemia, hyponatremia, and hypomagnesemia.

Session 21

1. A client is prescribed with Guaifenesin (Mucinex). The nurse determines that the client understands the
proper administration of this medication if the client states that he or she will:
A. Drink extra fluids while taking this medication.
B. Take the medication with meals only.
C. Take an additional dose once fever and cough persist.
D. Limit oral fluid intake.
ANSWER A.
Guaifenesin is an expectorant. Drink extra fluids to help loosen the congestion and lubricate the throat while
taking this medication. Option B: The medication does not have to be taken with meals. Option C: Additional
doses should not be taken without the prescription of the doctor. Option D: Fluids are needed to loosen the
secretions.

2. A nurse is about to administer Albuterol (Ventolin HFA) 2 puff and Budesonide (Pulmicort Turbohaler)
2 puff by metered dose inhaler. The nurse plans to administer by?
A. Alternating with a single puff each, starting with albuterol.
B. Alternating with a single puff each, starting with budesonide.
C. Budesonide inhaler first then the albuterol.
D. Albuterol inhaler first then the budesonide
ANSWER D.
Albuterol inhaler first then the budesonide. If two different inhaled medications are prescribed and one of
the medications contains a corticosteroid, administer the bronchodilator (Albuterol) first and the
corticosteroid (Budesonide) second. This will allow for the widening of the air passages by the
bronchodilator, making the corticosteroids more effective.

3. A nurse is about to administer Naloxone hydrochloride (Narcan) to a client with known opioid overdose.
Which of the following equipment should be readily available at the bedside?
A. Suction machine.
B. Resuscitative equipment.
C. Nasogastric tube.
D. Dressing tray.
ANSWER B.
While administering Narcan, resuscitation equipment, oxygen, mechanical ventilator should be readily
available. Options
A, C, and D are not used during the medication therapy.

4. A client with a chronic obstructive pulmonary disease is prescribed with Ipratropium (Combivent). Upon
reviewing the medical history of the patient, the nurse questions the prescription if which of the following
is noted?
A. History of smoking.
B. History of allergy to egg.
C. History of allergy to peanut.
D. History of a previous infection.
ANSWER C. History of allergy to peanut. The client with a peanut allergy should not take ipratropium
because the product contains soy lecithin, which is in the same plant family as peanuts.

5. Montelukast (Singulair) is prescribed to a client with asthma. During the medication therapy, which of
the following laboratories should be monitored?
A. Complete blood count (CBC).
B. Sodium and Potassium.
C. Calcium and Platelet count.
D. ALT and AST.
ANSWER D.
ALT and AST. Montelukast (Singulair) is a leukotriene receptor and is used with caution in clients with
impaired renal function. Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST) should be
monitor while taking this medication. Options A, B, and C are not related to the use of this medication.

6. The nurse is giving medication teachings to a client receiving theophylline. The nurse instruct the client
to limit the intake of which of the following?
A. Apple and banana.
B. Yogurt and cheese.
C. Tuna and oysters.
D. Cola and chocolate.

ANSWER D.
Cola and chocolate. Theophylline is a methylxanthine bronchodilator. The nurse instructs the client to limit
the intake of xanthine-containing foods such as chocolate, cola, and coffee.

7. A nurse is giving teachings to a client receiving Desloratadine (Clarinex). Which of the following
statements made by the client will need further instructions?
A. “I can eat gum after I drink the medicine”.
B. “I can take the medicine on an empty stomach”.
C. “I should avoid using alcohol”.
D. “I will avoid driving while using this medication”.
ANSWER B.
“I can take the medicine on an empty stomach”. This medicine should be taken with food or milk to minimize
gastrointestinal upset. Option A: Use gum or hard candy to minimize dry mouth. Options C and D: The
medication causes drowsiness so avoid taking alcohol or engaging in activities which require mental
alertness such as driving a car.

8. Antitussives are useful in blocking the cough reflex and preserving the energy associated with
prolonged, nonproductive coughing. Antitussives are best used with the following except:
A. Postoperative patients
B. COPD patients who tire easily
C. Patients with a dry, irritating cough
D. Asthma patients
ANSWER D.
Asthma patients. Option D: Patients with asthma need patent airways which coughing could provide.
Options A, B, and C: These conditions may warrant the use of antitussives.

9. Which of the following pathophysiological mechanisms that occur in the lung parenchyma
allows pneumonia to develop?
A. Atelectasis
B. Bronchiectasis
C. Effusion
D. Inflammation
ANSWER D.
Inflammation. Option D: The common feature of all type of pneumonia is an inflammatory pulmonary
response to the offending organism or agent. Options A and B: Atelectasis and bronchiectasis indicate a
collapse of a portion of the airway that doesn’t occur in pneumonia. Option C: An effusion is an accumulation
of excess pleural fluid in the pleural space, which may be a secondary response to pneumonia.

10. A nurse is giving teachings to a client receiving Desloratadine (Clarinex). Which of the following
statements made by the client will need further instructions?
A. “I can eat gum after I drink the medicine”
B. “I can take the medicine on an empty stomach“
C. “I should avoid using alcohol”
D. “I will avoid driving while using this medication”
ANSWER B.
“I can take the medicine on an empty stomach”. Option B: This medicine should be taken with food or milk
to minimize gastrointestinal upset. Option A: Use gum or hard candy to minimize dry mouth. Options C and
D: The medication causes drowsiness so avoid taking alcohol or engaging in activities which require mental
alertness such as driving a car.

11. Nurse Zeke is giving instructions to her client who is taking antihistamine. Which of the following nurse
teachings is appropriate for the client?
A. Expect a relief in 24 hours
B. Be aware that you may have increased saliva
C. Be aware that you may need to take a decongestant
D. Avoid ingesting alcohol
ANSWER D.
Avoid ingesting alcohol. Option D: Because alcohol and antihistamines have sedating properties,
concurrent administration of these drugs should be avoided. Option A: Not all antihistamines last 24 hours.
Option B: Dry mouth is a common side effect, not increased salivation. Option C: Antihistamines and
decongestants are often given together.

12. Andrew has vertigo, which antihistamine is best for his condition?
A. Terfenadine
B. Guaifenesin
C. Meclizine
D. Hydrocodone
ANSWER C.
Meclizine. Option C: Meclizine (Antivert) is given for vertigo and motion sickness. Option A: Terfenadine is
an antihistamine, but meclizine is the standard drug in the treatment of vertigo. Option B and D: Choices C
and D are not antihistamines.

13. Raul, a 20-year-old student, used to buy OTC drugs whenever he feels sick. Which of the following
statements best describes the danger of self-medication with over-the-counter drugs?
A. Clients are not aware of the action of over-the-counter drugs.
B. Clients are not aware of the side effects of over-the-counter drugs.
C. Clients minimize the effects of over-the-counter drugs because they are available without a prescription.
D. Clients do not realize the effects of over-the-counter drugs.
ANSWER C. Clients minimize the effects of over-the-counter drugs because they are available without a
prescription. Option C: This choice is correct because it includes the other three risks noted in choices A,
B, and D.

14. Which histamine-2 antagonist is associated with the most drug interactions?
A. Prilosec
B. Nizatidine
C. Ranitidine
D. Cimetidine
ANSWER D. C
imetidine. Option D: Cimetidine was the first histamine-2 antagonist developed and is associated with the
most toxic drug interactions of the group.

15. Stephanie will be having her exam in pharmacology tomorrow. She should be aware that antitussive is
indicated to:
A. Encourage removal of secretions through coughing
B. Relieve rhinitis
C. Relieve a dry cough
D. Control a productive cough
ANSWER C.
Relieve a dry cough. Option C: An antitussive is a cough suppressant. Options A and D: Represents the
action of an expectorant. Option B: Describe the action of a decongestant.

Session 22

1. A client has been taking Ibuprofen for some quite time and was given Misoprostol (Cytotec). Which of
the following is exhibiting the therapeutic effect of Cytotec?
A. Relief of gastric ulcer.
B. Relief of diarrhea.
C. Relief of vomiting.
D. Relief of constipation.
ANSWER A.
Relief of gastric ulcer. Misoprostol (Cytotec) is a synthetic (man-made) prostaglandin that is used to reduce
the risk of stomach ulcers in patients treated with nonsteroidal antiinflammatory drugs (NSAIDs, for
example, aspirin, ibuprofen, etc.). Option B: Although a side effect, but it is not the intended therapeutic
effect.
Options C and D are not related to the medication.

2. A geriatric patient is prescribed with Cimetidine (Tagamet) for the treatment of heartburn. Which of the
following is the most frequent CNS side effect?
A. Agitation.
B. Drowsiness.
C. Headache.
D. Somnolence

ANSWER A.
Agitation. Cimetidine an H2-receptor antagonist passes the blood brain barrier, and central nervous system
side effects can happen. Most common serious side effects are confusion, agitation, depression, and
disorientation. Options B, C, and D: They are considered as the less common side effect.

3. A nurse is administering an IV bolus of Cimetidine (Tagamet). Which of the following should the nurse
monitor closely follow the administration?
A. Respiratory rate.
B. Skin turgor.
C. Blood pressure.
D. Temperature.
ANSWER C. Blood pressure. Intravenous administration of Cimetidine causes hypotension. Options A, B,
and D are not related to this medication.

4. A client has been given Loperamide hydrochloride (Imodium). Which of the following situation is the
medication indicated to?
A. Abdominal pain.
B. Patients with an ileostomy.
C. Bloody Diarrhea.
D. Acute dysentery.
ANSWER B.
Patients with an ileostomy.Loperamide hydrochloride is an antidiarrheal agent. It can also be used to reduce
the volume of drainage from an ileostomy. Options A, C, and D: It is contraindicated in patients with
abdominal pain in the absence of diarrhea, and in patients with acute dysentery, which is characterized by
blood in stools and high fever.

5. A client has been given Ondansetron (Zofran). For which condition should the nurse administer this
medication to the postoperative patient?
A. Vomiting.
B. Incisional pain.
C. Abdominal infection.
D. Atelectasis.
ANSWER A.
Vomiting. Ondansetron is used to prevent nausea and vomiting that may be caused by surgery or by
medicine to treat cancer (chemotherapy or radiation). Options B, C, and D, are not related to this medication.

6. A client with a duodenal ulcer is diagnosed with H. pylori infection. The physician prescribed Amoxicillin
(Wymox), Pantoprazole (Prevacid), and Clarithromycin (Biaxin). Which statement made by the nurse
correctly explains the purpose of these medications?
A. “These medicines will minimize acid production and will coat the ulcer”.
B. “These medicines will stop the acid production and will kill the bacteria”.
C. “The ulcer will heal because the medications will kill the bacteria”.
D. “These medicines will control the ulcer and motion sickness”.
ANSWER B.
“These medicines will stop the acid production and will kill the bacteria”. The triple therapy treatment of H-
pylori infection is the includes 2 antibiotics (Clarithromycin and Amoxicillin) and one proton pump inhibitor
such as omeprazole, lansoprazole, pantoprazole, or esomeprazole.

7. A client is prescribed with Omeprazole (Prilosec). The nurse determines that the client is receiving its
therapeutic effect if which of the following is stated by the client:
A. Relief of nausea and vomiting.
B. Decrease diarrheal episodes.
C. The absence of constipation.
D. Relief from GERD.
ANSWER D.
Relief from GERD. Omeprazole is used to treat symptoms of gastroesophageal reflux disease (GERD) and
other conditions caused by excess stomach acid. It is also used to promote healing of erosive esophagitis
(damage to your esophagus caused by stomach acid). Options B, C, and D are not related to this
medication.

8. A client has been prescribed with Pancrelipase (Pancrease). Which of the following symptoms would
prompt the nurse that the medication is having its therapeutic effect if which of the following is noted?
A. Negative abdominal pain.
B. An absence of constipation.
C. An absence of diarrhea.
D. Reduction of excess fat in feces.
ANSWER D.
Reduction of excess fat in feces. Pancrelipase is used to help improve food digestion in certain conditions
(cystic fibrosis, pancreatitis) where the pancreas is not working properly. This medicine minimizes the
amount of steatorrhea (fatty stools). Options A, B, and C are not related to this medication.

9. A nurse is giving a nothing per orem instructions to a malnourished client with diarrhea and frequent
abdominal pain episodes which is about to receive a Total Parenteral Nutrition. Which statement made
by the nurse is the most appropriate?
A. “It will help in your weight loss”.
B. “It can assure you that you feel better after receiving TPN”.
C. “It will decrease your diarrhea and your bowel can rest”.
D. “It will give you less time in the hospital”.
ANSWER C.
“It will decrease your diarrhea, and your bowel can rest”. The priority in this kind of situation is to stop
diarrhea and to provide fluids and electrolyte thru the use of TPN. The bowel is rested so that the abdominal
cramping will also stop.

10. A client is receiving Sulfasalazine (Azulfidine) for the treatment of ulcerative colitis. Which of the
following assessment finding will concern the nurse most?
A. Drowsiness.
B. Decreased urine output.
C. Urine discoloration.
D. Vomiting.
ANSWER B.
Decreased urine output. Sulfasalazine is used to treat bowel inflammation, diarrhea (stool frequency), rectal
bleeding, and abdominal pain in patients with ulcerative colitis. It is nephrotoxic, so a decrease in urine
output is the most serious concern. Options A, C, and D are also side effects but are less serious.

11. A client has been prescribed with Sucralfate (Carafate) for the treatment of gastric ulcer. The nurse
instruct the client that this medication is taken?
A. 1 hour before meals.
B. 1 hour after meals.
C. At the same time with an antacid.
D. Lunch time.
ANSWER A.
One hour before meals. Sucralfate is a gastric protective agent. It works by forming a protective layer on
the ulcer to serve as a barrier against acid, bile salts, and enzymes in the stomach. Taken by mouth on an
empty stomach at least 1 hour before or 2 hours after eating. Options B and D are incorrect. Option C: Do
not take an antacid for at least 30 minutes before or after taking sucralfate.

12. Tincture of opium is given to a patient who is having diarrheal episodes. Which of the following is true
regarding this medication?
A. Opium tincture is not a controlled substance.
B. Opium tincture can be used with medications like naltrexone and buprenorphine.
C. Has an unpleasant taste and it can be diluted with 15-30 ml water.
D. It increases intestinal motility and peristalsis.
ANSWER C.
Has an unpleasant taste and can be diluted with 15-30 ml of water. Opium tincture is an oral liquid
medication used to control diarrhea. It has an unpleasant taste so it should be diluted with 15-30 ml of
water. Option A: Opium tincture contains morphine which is a controlled substance. Option B: Opium
tincture should not be used with medications like naltrexone and buprenorphine because they increase
sedation and lower beneficial effect of opium tincture. Option D: It is an antidiarrheal, so a decrease motility
and peristalsis is expected.
13. A nurse is giving medicine instructions to a client with hemorrhoids who is receiving a Mineral oil. Which
of the following statements made by the client indicates a further teaching?
A. “I can take it at least 2 hours before bedtime”.
B. “It can interfere with the absorption of the vitamin E that I am taking”.
C. “If I miss a dose of mineral oil liquid, I’ll take it as soon as I remember”.
D. “I can use mineral oil liquid for an extended period to prevent further damage”.
ANSWER D.
“I can use mineral oil liquid for an extended period to prevent further damage”. Mineral oil liquid is a lubricant
laxative that works by slowing the absorption of water from the bowel, which softens the stool. The use of
mineral oil liquid for a long time may result in loss of normal bowel function. Options A, B, and C are true
regarding mineral oil.

14. A nurse is giving discharge instructions to a client who is receiving a bulk-forming laxative as part of the
home medications. All of which are examples of bulk-forming laxative, except?
A. Docusate Sodium (Colace).
B. Methylcellulose (Citrucel).
C. Polycarbophil (Fibercon).
D. Psyllium (Metamucil).
ANSWER A.
Docusate Sodium (Colace). Option A is an example of surfactant laxative.

15. What is the priority nursing intervention for a client receiving an antiemetic?
A. Monitor intake and output.
B. Keep items far away from the bed.
C. Give the client privacy by letting him walking around the room.
D. Keep bed in low position with side rails up.
ANSWER D.
Keep bed in low position with side rails up.
Antiemetics can cause drowsiness; hence the priority nursing intervention is to protect the client from injury
such as raising the side rails and keeping the bed in low position. Option A is not the most priority
intervention. Options B and C will risk the client for fall

Session 23

1. Nurse Ejay is assigned to a telephone triage. A client called who was stung by a honeybee and is asking
for help. The client reports of pain and localized swelling but has no respiratory distress or other
symptoms of anaphylactic shock. What is the appropriate initial action that the nurse should direct the
client to perform?
A. Removing the stinger by scraping it.
B. Applying a cold compress.
C. Taking an oral antihistamine.
D. Calling emergency number.
ANSWER A.
Since the stinger will continue to release venom into the skin, removing the stinger should be the first action
that the nurse should direct to the client.Options B and C: After removing the stinger, Antihistamine and
cold compress follow. Option D: The caller should be further advised about symptoms that require
emergency assistance.

2. An osmotic diuretic used in emergency, trauma, critical care, and neurosurgical settings to treat cerebral
edema and to reduce increased intracranial pressure.
A. Mannitol
B. Lidocaine
C. Furosemide
D. Albuterol
ANSWER A.
The most rapid and effective means of decreasing tissue water and brain bulk is osmotherapy . Osmotic
therapy is intended to draw water out of the brain by an osmotic gradient and to decrease blood viscosity.
These changes would decrease ICP and increase cerebral blood flow (CBF). Mannitol is the most popular
osmotic agent. Osmotic therapy using mannitol reduces ICP by mechanisms that remain unclear. Mannitol
is thought to decrease brain volume by decreasing overall water content, to reduce blood volume by
vasoconstriction, to reduce CSF volume by decreasing water content. Mannitol may also improve cerebral
perfusion by decreasing viscosity or altering red blood cell rheology. Lastly, mannitol may exert a protective
effect against biochemical injury

3. A client arrives in the emergency unit and reports that a concentrated household cleaner was splashed
in both eyes. Which of the following nursing actions is a priority?
A. Use Restasis (Allergan) drops in the eye.
B. Flush the eye repeatedly using sterile normal saline.
C. Examine the client’s visual acuity.
D. Patch the eye.
ANSWER B.
Flush the eye repeatedly using sterile normal saline. Initial emergency action during a chemical splash to
the eye includes immediate continuous irrigation of the affected eye with normal saline. Option A: Restasis
(Allergan) drops are used to treat dry eyes. Option C: Patching the eye is not part of the first line treatment
of a chemical splash. Option D: After irrigation, visual acuity then is assessed.

4. A 5-year-old client was admitted to the emergency unit due to ingestion of unknown amount of chewable
vitamins for children at an unknown time. Upon assessment, the child is alert and with no symptoms.
Which of the following information should be reported to the physician immediately?
A. The child has been treated multiple times for injuries caused by accidents.
B. The vitamin that was ingested contains iron.
C. The child was nauseated and vomited once at home.
D. The child has been treated several times for toxic substance ingestion
ANSWER B.
The vitamin that was ingested contains iron. Iron is a toxic substance that can lead to massive hemorrhage,
shock, coma, and kidney failure.

5. Which of the following is a concentrated, high-carbohydrate solution given to treat insulin-induced

hypoglycemia or insulin shock?
A. Dextrose 50%
B. Glocagon
C. Mannitol
D. Sodium bicarbonate
ANSWER A.
Dextrose 50% is given by injection to treat insulin shock (low blood sugar caused by using insulin and
then not eating a meal or eating enough food afterward). This medicine works by quickly increasing the
amount of glucose in your blood

6. Epinephrine is administered to a female patient. The nurse should expect this agent to rapidly affect:
A. Adrenergic receptors.
B. Muscarinic receptors.
C. Cholinergic receptors.
D. Nicotinic receptors.
ANSWER A.
Adrenergic receptors. Epinephrine (adrenaline) rapidly affects both alpha and beta adrenergic receptors
eliciting a sympathetic (fight or flight) response. Muscarinic receptors are cholinergic receptors and are
primarily located at parasympathetic junctions. Cholinergic receptors respond to acetylcholine stimulation.
Cholinergic receptors include muscarinic and nicotinic receptors. Nicotinic receptors are cholinergic
receptors activated by nicotine and found in autonomic ganglia and somatic neuromuscular junctions.
7. An anxious female client complains of chest tightness, tingling sensations, and palpitations. Deep, rapid
breathing, and carpal spasms are noted. Which of the following priority action should the nurse do first?
A. Provide oxygen therapy.
B. Notify the physician immediately.
C. Administer anxiolytic medication as ordered.
D. Have the client breathe into a brown paper bag.
ANSWER D.
Have the client breathe into a brown paper bag. The client is suffering from hyperventilation secondary from
anxiety, the initial action is to let the client breathe in a paper bag that will allow the rebreathing of carbon
dioxide.

8. A nurse is providing discharge instruction to a woman who has been treated for contusions and bruises
due to a domestic violence. What is the priority intervention for this client?
A. Making a referral to a counselor.
B. Making an appointment to follow up on the injuries.
C. Advising the client about contacting the police.
D. Arranging transportation to a safe house.
ANSWER D.
Arranging transportation to a safe house. Safety is a priority for this client and she should not return to a
place where violence could recur. Options A, B, and C: These are important for the long-term management
of this case.

9. In the work setting, what is the primary responsibility of the nurse in preparation for disaster
management, that includes natural disasters and bioterrorism incidents?
A. Being aware of the signs and symptoms of potential agents of bioterrorism.
B. Making ethical decisions regarding exposing self to potentially lethal substances.
C. Being aware of the agency’s emergency response plan.
D. Being aware of what and how to report to the Centers for Disease Control and Prevention.
ANSWER C.
Being aware of the agency’s emergency response plan. In disasters preparedness, the nurse should know
the emergency response plan. This gives guidance that includes the roles of the team members,
responsibilities and mechanism of reporting.

10. Early signs and symptoms of local anesthetic toxicity include ALL BUT ONE of the following. Indicate
the exception:
A. Tinnitus
B. Perioral numbness
C. Dizziness
D. Hypertension
ANSWER D.
Manifestations of local anesthetic toxicity typically appear 1-5 minutes after the injection, but onset may
range from 30 seconds to as long as 60 minutes. Initial manifestations may also vary widely. Classically,
patients experience symptoms of central nervous system (CNS) excitement such as the following:
Circumoral and/or tongue numbness, metallic taste, lightheadedness, dizziness, visual and auditory
disturbances (difficulty focusing and tinnitus), disorientation and drowsiness.

11. Which of the following is used to treat significant ventricular dysrhythmias?

A. Lidocaine
B. Mannitol
C. Naloxone
D. Dopamine
ANSWER A.
Lidocaine is an IV antiarrhythmic agent that has moderate efficacy against ventricular arrhythmias. It is
particularly useful in the setting of myocardial infarction or ischemia. It may be used as an alternative to
amiodarone in the management of recurrent or shock refractory ventricular fibrillation/tachycardia.
Lidocaine blocks cardiac sodium channels shortening the action potential and is used intravenously only
for arrhythmia.

12. A patient presents to the emergency department with severe respiratory distress, hives, and edema
after being stung on the face by a bee. Which are accurate nursing assessments of the situation?
A. Hypotension and bronchospasm will progress rapidly if treatment is delayed.
B. The patient is suffering from anaphylactic shock.
C. Epinephrine and diphenhydramine are the drugs of choice as first-line agents.
D. Prompt treatment with drug therapy will prevent this syndrome from occurring again.
ANSWER A, B & C.
Treatment will not prevent anaphylaxis from occurring again. All other statements are true.

13. Which finding indicates that administration of glucagon has been effective? The patient experiences
A. An improvement in level of consciousness.
B. An elevation in respiratory rate.
C. Suppression of heart rate.
D. Reduction in blood pressure.
ANSWER A. Glucagon is used for treatment of patients with severe hypoglycemia. An improved level of
consciousness indicates elevation of blood sugar. A blood sugar analysis should also be obtained.
14. A patient is experiencing both atrial and ventricular dysrhythmias. The nurse anticipates administration
of which medication?
A. Adenosine
B. Amiodarone
C. Atropine
D. Epinephrine
ANSWER B.
Amiodarone is used for the treatment of atrial and ventricular dysrhythmias. Adenosine is used for the
treatment of PSVT. Atropine is used for the treatment of symptomatic bradycardia. Epinephrine is used for
the treatment of cardiac arrest.

15. A dopamine infusion was started in a patient's antecubital vein during resuscitation after cardiac arrest.
The electronic infusion device is now sounding an alert for an occlusion. What is the most important
immediate concern for the nurse?
A. Infiltration with phentolamine will be necessary if there is extravasation
B. An interruption in the infusion can produce hypotension in the patient.
C. The device will need to be reported to the hospital's clinical engineering department for service
D. The patient could develop hypertension as a result of the alarm.
ANSWER B.
An interruption in the infusion can produce hypotension in the patient. Dopamine agonists can markedly
reduce blood pressure, and precipitous changes can occur even with the first dose. Dopamine agonists
lower blood pressure primarily by venous and arterial dilation through inhibition of the sympathetic nervous
system.

Maternal and Child

Session 17
1.A woman delivered a newborn 12 hours ago. Which of the following assessment would the
nurse expect to find?
A. Lochia alba
B. Soft, boggy fundus
 C. Transient tachycardia
D. Complaints of hunger
ANSWER: D
RATIONALE: After delivery, the nurse would expect to find complaints of hunger and thirst due to some
degree of fluid loss during the delivery process. Additional assessment findings include bloody red
discharge called lochia rubra; a fundus that is firm and midline and transient bradycardia.

2. Lochia serosa is characterized by which of the following?

A. Creamy yellow color
B. No odor
C. Serosanguinous appearance
D. White to colorless
ANSWER: C
RATIONALE: Lochia serosa appears as pink to brownish, serosanguinous discharge with a strong odor
occurring 3 to 10 days after delivery. Lochia alba is almost colorless to creamy yellow occurring from 10
days to 3 weeks after delivery.

3. During lecture of a childbirth class, the nurse explains that in the postpartum period the
process whereby the uterus returns to its pre-pregnancy state is called:
A. Involution
B. Puerperium
C. Uterine atony
D. Lochia rubra
ANSWER: A
RATIONALE: Involution is the process whereby the uterus returns to its pre-pregnancy state.
Puerperium refers to the six-week period after birth called the 4th trimester of pregnancy. Uterine atony is
an abnormal condition where the uterus is soft and boggy. Lochia rubra is a discharge similar to
menstrual flow during the first 2 to 3 days after delivery

4. The labor and delivery experience is frequently reviewed by the mother. During which of the
following periods according to Reva Rubin, is this commonly done?
A. Letting-down
B. Letting go
C. Taking hold
D. Taking in
ANSWER: D
RATIONALE: Rubin identifies 3 stages postpartum: taking in, taking hold and letting go. According to
Rubin, during the taking-in period, the new mother may review her experiences during delivery.

5.Nurse Mara is aware that periodic contraction and relaxation of the uterine muscles cause pains
and cramping after birth. Which of the following patients is more likely to experience severe pain
after giving birth?
A. A gravida 1 para 1001 patient who is bottle feeding
B. A gravida 3 para 2002 patient who is breastfeeding
C. A gravida 3 para 1102 patient who is bottle feeding
D. A gravida 2 para 1001 patient who is breastfeeding
ANSWER: B
RATIONALE: The patient who is a second-time mother and breastfeeding will experience more cramping
after giving birth than first-time moms because in first-time moms the uterine tone is increased so the
uterus remains firm, decreasing the incidence of cramping. Mothers who breastfeed will experience more
pain because breastfeeding stimulates release of oxytocin causing uterine contractions.

6. The nurse is assessing a patient in the fourth stage of labor. She notes that the fundus is firm,
globular and located midline of the abdomen. But she assessed that bleeding is excessive.
Which of the following is the most appropriate initial nursing action?
 A. Massage the fundus
B. Place the patient in Trendelenburg position
C. Notify the physician
D. Document the findings
ANSWER: C
RATIONALE: Excessive bleeding in the postpartum is life-threatening. This has to be reported
immediately. The uterus is contracted therefore there is no need to massage the fundus. The bleeding in
this case may be due to lacerations of the vagina, cervix or perineum.

7. The nurse is assessing a patient in the immediate postpartum period for signs of hemorrhage.
Which of the following assessment findings indicates an early sign of excessive blood loss?
A. An increase in pulse rate from 78 to 106 bpm
B. A blood pressure change from128/88 to 118/80 mm Hg.
C. A body temperature of 37.4C
D. A respiratory rate of 24/min.
ANSWER: A
RATIONALE: An early sign of hemorrhage is tachycardia. The client will experience restlessness. A
rising pulse is an early sign of excessive blood loss because the heart pumps faster to compensate for
the blood loss.

8. Which of the following 1-day postpartum patients should be given the highest priority by the
nurse?
A. The patient with bright red lochia with blood clots greater than 1 cm.
B. The patient who complains of afterpains
C. The client with a pulse rate of 62 bpm
D. the patient with colostrum discharge from both breasts.
ANSWER: A
RATIONALE: The patient with bright red lochia and clots greater than 1 cm is experiencing active
bleeding. Therefore, this patient must be given the highest priority by the nurse.

9. The nurse is providing postpartum instructions to a patient after delivery of a healthy newborn.
Which of the following instructions should be given by the nurse to the patient?
A. Breasts become distended with milk on the third day.
B. Normal bowel elimination returns by the 4th or 5th day
C. Temperature may be elevated after 2 days.
D. Pulse rate of 96 to 110 bpm is normal during the first week.
E. Depressed feelings for the first 4 weeks is to be expected.
ANSWER: A
RATIONALE: These are the instructions to be given to the client after delivery of her newborn. Option E
is incorrect. Postpartum depression may develop if depression is unresolved.

10. The nurse is assessing Homan’s sign on a postpartum patient. Which statement of the
student indicates an understanding of this assessment technique?
A. “I will ask the patient to raise her extended leg and lower her legs slowly.”
B. “I will ask the patient to extend her legs flat on bed and dorsiflex her foot forward.”
C. “I will ask the patient to extend her legs flat on bed and sharply extend her foot backward.”
D. “I will ask the patient to raise her legs against pressure from my hand.”
ANSWER: B
RATIONALE: To assess for Homan’s sign (calf pain), the client is asked to extend her legs flat on bed
and dorsiflex her feet forward. Positive Homan’s sign may indicate thrombophlebitis.
Session 18
1. Which of the following would the nurse identify as a goal of newborn care in the postpartum
period?
A. To facilitate development of a close parent-newborn relationship
B. To assist parents in developing healthy attitudes about childbearing practices
C. To identify actual or potential problems requiring immediate or emergency attention
D. To provide the parents of the newborn with information about well-baby programs
ANSWER: C
RATIONALE: In the initial postpartum period it is essential to identify actual and potential problems that
might require immediate attention in order to prevent complications or worsening of the newborn’s
condition.

2. After birth, which of the following structures receives blood only from the left ventricle?
A. Aorta
B. Inferior vena cava
C. Pulmonary arteries
D. Ductus arteriosus
ANSWER: A
RATIONALE: Before birth, the aorta carries blood from both of the ventricles. After birth, the aorta
receives blood from the left ventricle. The inferior vena cava empties blood into the right auricle. The
pulmonary arteries carry blood to the lungs. The ductus arteriosus is obliterated after birth

3. When assessing the newborn’s heart rate, which of the following would be considered normal if
the baby were sleeping?
A. 80 bpm
B. 100 bpm
C. 120 bpm
D. 140 bpm
ANSWER: B
RATIONALE: The normal heart rate for a newborn that is sleeping is about 100 bpm. If the newborn
were awake, the normal heart rate would range from 120 to 160 bpm

4. The initial respirations of the newborn are a result from which of the following?
A. A rise in temperature
B. A change in pressure gradients
C. Increased blood pH
D. Decreased blood CO2 level
ANSWER: B
RATIONALE: Initial respirations are triggered by physical, sensory and chemical factors. Physical factors
include the change in pressure gradients. Sensory factors include a drop in temperature, noise, light,
touch. Chemical factors include the decrease in oxygen, increased carbon dioxide levels and decreased
pH as a result of the transitory asphyxia that occurs during delivery.

5.Which of the following would the nurse identify as correct about the newborn’s immune
system?
A. The risk of infection in the newborn is relatively low
B. Phagocytosis occurs fairly rapidly in the newborn
C. The newborn is unable to limit the invading organisms at their point of entry.
D. Immunoglobulin A is present in their GI and respiratory tract.
ANSWER: C
RATIONALE: The newborn cannot limit the invading organisms at their point of entry. In addition, the
newborn’s risk of infection is increased significantly because of the immature immune-regulatory systems.
Phagocytosis is sluggish and IgA is absent in the GI and respiratory tracts.

6. Which of the following is true regarding the fontanels of the newborn?

A. The anterior is triangle-shaped, the posterior is diamond-shaped
 B. The posterior closes at 18 months, the anterior closes at 8 to 12 weeks
C. The anterior is larger in size when compared to the posterior.
D. The anterior is bulging and the posterior is sunken
ANSWER: C
RATIONALE: The anterior fontanel is larger than the posterior. The anterior is diamond-shaped’ the
posterior is triangle-shaped. The anterior closes at 18 months, the posterior at 8 to 12 weeks. A bulging
fontanel indicates increased intracranial pressure, a sunken fontanel indicates dehydration

7. The first period of reactivity begins at birth. Which of the following is characteristic of this
period?
A. This period lasts about 30 minutes
B. The infant is asleep.
C. A poor suck is present.
D. Respirations may be increased to 110cpm
ANSWER: A
RATIONALE: Choice A is the only choice that is one of the first period or reactivity

8. Which of the following groups of reflexes are present at birth and remains unchanged through
adulthood?
A. Blink, cough, rooting and gag
B. Blink, cough, sneeze and gag
C. Rooting, sneeze, swallowing and cough
D. Stepping, blink, cough and sneeze
ANSWER: B
RATIONALE: Blink, cough, sneeze, swallowing and gag are all present at birth and remains unchanged
throughout adulthood. Reflexes such as rooting and stepping disappear within the first year.

9. Which of the following when present in the urine may cause a reddish stain on the diaper of a
newborn?
A. Mucus
B. Uric acid crystals
C. Bilirubin
D. Excess iron
ANSWER: B
RATIONALE: Uric acid crystals in the urine may produce the reddish “brick dust” stain on the diapers.
Mucus would not produce a stain. Bilirubin and iron are from hepatic adaptation.

10. Before birth, which of the following structures connects the left and right atria of the heart?
A. Umbilical vein
B. Foramen ovale
C. Ductus arteriosus
D. Ductus venosus
ANSWER: B
RATIONALE: Foramen ovale is an opening between the left and right atria that closes after birth.

Session 19

1. You’re caring for children in a day-care center. According to the theorist Jean Piaget, an infant
who learns about objects by placing them in his mouth is in which stage of development?
 A. Preoperational
B. Sensorimotor
C. Concrete operational
D. Formal operational
ANSWER: B
RATIONALE: In the sensorimotor stage, from birth to age 2 years, the infant is exploring the world by
gaining input through the senses and through motor activity. During the preoperational stage, a 2 to 7
year-old child uses as symbols but hasn’t yet developed logic. During the concrete operational stage, a 7
to 10 year-old learns that matter does not change when its form is altered. (A ball of clay that is flattened
is still clay). The formal operations stage is achieved when an adolescent can think abstractly about
concepts or objects and consider different alternatives or outcomes.

2. When preparing to teach a class in child development, you review the work of a theorist who
postulated that the personality is a structure with three parts, called the id, ego and superego.
The theorist is:
A. Sigmund Freud
B. Erik Erikson
C. Jean Piaget
D. Lawrence Kohlberg
ANSWER: A
RATIONALE: Freud developed a theory that sexual energy is centered on specific parts of the body at
certain ages. He also viewed that personality as a structure with three parts: the id, ego and superego.
Additionally, he postulated that unresolved conflict and unmet needs at a certain stage lead to a fixation
at that stage. Erikson, on the other hand, stresses the importance of culture and society in personality
development. Piaget focused on cognitive development. Kohlberg focused on moral development.

3. Directional trends in growth and development are easily seen in the neonate. Which term
describes development in the head-to-tail direction?
A. Sequential trend
B. Proximodistal pattern
C. Cephalocaudal trend
D. Mass to specific pattern
ANSWER: C
RATIONALE: A cephalocaudal trend describes development from head to tail. Sequential trends
describe growth and development as a specific, predictable sequence, with each child normally passing
through every stage. Proximodistal refers to the midline-to-peripheral growth pattern. Mass to specific
pattern describes development from simple operations to complex operations.

4. According to Erikson, infancy is the age for developing which psychosocial task?
A. Sense of initiative vs. guilt
B. Sense of trust vs. mistrust
C. Sense of identity vs. role diffusion
D. Sense of industry vs. inferiority
ANSWER: B
RATIONALE: The developmental task to be developed during infancy is the sense of trust vs mistrust; in
toddlerhood, the sense of autonomy vs shame and doubt; in preschoolers, initiative vs. guilt; in school
age, the sense of industry vs inferiority; and, in adolescence, the sense of identity vs role confusion

5. To stimulate the senses of infants and provide early mental feeding is to meet the needs of this
cognitive stage of infancy. According to Piaget, which stage is this?
A. preoperational stage
B. sensorimotor stage
C. formal operations
D. concrete operations stage
ANSWER: B
RATIONALE: According to the cognitive theory of growth and development by Jean Piaget, ages 0-2
years corresponds to the sensorimotor stage; ages 2-7 years corresponds to the preoperational stage;
ages 7-12 years corresponds to concrete operations stage; 12 years and above, formal operations stage

6. The most significant person to in infant is ___

A. parents
B. mother
C. father
D. basic family
ANSWER: B
RATIONALE: The primary giver, usually the mother, is the most significant person to the infant. But if the
mother goes to work and is seldom home to meet the needs of the infant consistently, then the primary
caregiver (may be the father, nanny, or grandparent) who is present and meets the needs consistently
become the most significant. The parents are most significant to toddlers and members of the basic
family are significant to the preschooler.

7. In order to foster trust in infants, which of the following measures is most important?
A. The mother should always be at home
B. The infant should be fen whenever he cries.
C. The infant’s needs should be met consistently.
D. All of the above
ANSWER: C
RATIONALE: The best way to promote trust is to meet their expressed needs right away and
consistently.

8. According to Sigmund Freud, the age of infancy corresponds to the _______.

A. Oral stage
B. Pre-Conceptual Stage
C. Stage for development of the self
D. Anal Stage
ANSWER: A
RATIONALE: According to Freud, infancy is the stage of the ‘id’ (all pleasure, primitive instincts and
sexual drives), satisfied through the ORAL route. During infancy, satisfaction or pleasure is derived
primarily from meeting the infant’s oral needs like sucking, licking and biting

9. According to Erikson, 2-year-old Peter, is in which stage of development?

A. Anal
B. Autonomy
C. Pre-conceptual
D. all of the above
ANSWER: B
RATIONALE: Erikson’s theory of development describes the toddler stage as the period of developing
‘autonomy vs shame and doubt.’ The stage is also called ‘anal stage by Sigmund Freud and the
‘cognitive stage preoperative pre-conceptual phase’ by Piaget.

10. Which of the following stages of separation occurs last?

A. Protest
B. Denial
C. Despair
D. Recovery
ANSWER: B
RATIONALE: There are only three stages of separation anxiety: namely, protest, denial and despair.
The absence of protest on admission of the toddler to a treatment facility should warrant further
investigation, as this is a danger sign of child abuse.

Session 20
1. The clinic nurse evaluates a 7-month-old infant for eruption of primary teeth and finds a normal
eruption schedule. At this stage, how many primary teeth are expected?
A. A pair of upper central incisors
B. A pair of lower central incisors
C. A pair of molars
D. two pairs on incisors
ANSWERS: B
RATIONALE: Teething usually starts between 6-7 months with the eruption of two lower central incisors,
followed by the upper central incisors between 7-8 months, then the upper lateral incisors between 9-10
months, and finally the lower lateral incisors at 12 months. The first primary teeth to erupt are the molars.

2. During a well-baby check-up, the nurse weighs Baby Ron, 6 months of age, and identifies that
he is growing normally, because his present weight, compared to his birth weight has ____
A. tripled
B. quadrupled
C. doubled
D. decreased
ANSWERED: C
RATIONALE: The doubling of birth weight is between 6-7 months of age; tripling time is at 12 months,
and quadrupling is at 24 months. A decrease in birth weight is not normally expected at 6 months, but
during the first week (7-10 days) and is termed physiological weight loss.

3. Food allergy is one of the problems in infant feeding. Which of these food items is considered
the most allergenic food?
A. fruits
B. vegetables
C. milk
D. meats
ANSWER: C
RATIONALE: The food considered most allergenic for infants is milk. Another food considered highly
allergenic is whole egg, that is why it must only be given after the child has reached 12 months of age.

4. The clinic nurse instruct the mother on the introduction of solid food to her baby. Which if the
following is the correct sequence of introducing solids?
A. vegetable, fruit, cereal, meat, egg
B. fruit, meat, cereal vegetable, egg
C. cereal, vegetable, fruit, meat, egg
D. cereal, meat, fruit, vegetable, egg
ANSWER: C
RATIONALE: When introducing solids, the following sequence is correct: cereal, vegetables, fruit, meat
and lastly, egg. Rice cereal is the first solid food given because it is iron-rich, easy to digest and
hypoallergenic

5.The following are feeding problems in infancy. Which is the most common?
A. Colic
B. Diarrhea
C. Vomiting
D. Aspiration
ANSWER: A
RATIONALE: Colic is the most common problem due to the fact that young infants have not mastered the
art of swallowing; therefore, swallow even gas. To prevent colic, the infant should be burped or bubbled
well during and after feeding.
6. An infant’s mother asks you, “When should I expect my daughter to begin to walk?” Which of
the following is an appropriate response?
A. “Probably by 9 months.”
B. “Most children walk around 12 months.”
C. “It varies so much I couldn’t even guess.”
D. “Try not to worry. When she’s ready, she’ll walk.”
ANSWER: B
RATIONALE: “Children typically walk by 12 to 15 months”

7. An appropriate toy that the nurse should offer to a 3-month-old infant would be a:
A. Push-pull toy
B. Stuffed animal
C. Metallic mirror
D. Large plastic ball
ANSWER: C
RATIONALE: The 3-month-old child is interested in self-recognition and playing with the baby in the
mirror.

8. The nurse is aware that the play of a 5-month-old infant would probably consist of:
A. Picking up a rattle or toy and putting it in the mouth
B. Exploratory searching when a cuddly toy is hidden from view
C. Simultaneously kicking the legs and batting the hands in the air.
D. Waving and clenching fists and dropping toys placed in the hands
ANSWER: A
RATIONALE: During the oral stage, infants tend to complete the exploration of all objects by putting the
objects in the mouth as a final step. Option B is for infants 9-10 months. Option C and D are for 1-2
months old.

9. A mother tells the nurse that her 7-month-old child has just started sitting without support. The
nurse should inform the mother that this:
A. Its an expected developmental behavior at this stage
B. Activity signifies the upper 10% of physical development
C. Could be a developmental delay that requires further evaluation
D. Behavior is early and indicates that the baby will be walking soon
ANSWER: A
RATIONALE: This behavior s within the expected range; by 8 months, a child should sit steadily
unsupported.

10. The nurse’s developmental assessment of a 9-month-old infant would be expected to reveal:
A. A 2 to 3-word vocabulary
B. An ability to feed self with a spoon
C. The ability to sit steadily without support
D. Closure of both anterior and posterior fontanels
ANSWER: C
RATIONALE: This usually occurs at 8 months. Option A is expected of a 12month-old. Option B is
accomplished by a 2-year-old. The anterior fontanel closes by 12 to 18 months and the posterior
fontanel at 2 months

Session 21
1. A toddler seems unable to remain dry despite toilet training. Which patient teaching should be
included in his plan of care?
A. He probably is not yet physically ready for toilet training.
B. He is reacting to his emotional outbursts, responsible for delaying toilet training.
C. He may need to be examined by a child psychologist to solve this problem.
D. He must be under undue stress to be behaving this way.
ANSWER: A
RATIONALE: He is probably not yet physically ready for toilet training. Children must have both physical
and mental maturity for toilet training. For many children, this point is not reached until they are 2½ or 3-
years old

2. A toddler’s mother is concerned because her toddler takes her blanket everywhere. Which
advice would be most appropriate for her regarding this?
A. Have her daughter evaluated by a child psychologist.
B. Understand that this is probably a normal event.
C. Make subtle efforts to remove the blanket.
D. Destroy the blanket by cutting off a strip from it every day.
ANSWER: B
RATIONALE: Understand that this is probably a normal event. Blankets or favorite toys serve as
transitional objects or security objects.

3. While evaluating nursing care in a community clinic, you find that toddlers are at high risk for
injuries because of their increasing curiosity, advancement in cognition, and improved motor
skills. All these hazards are a concern for this age group except:
A. burns
B. poisoning
C. sports injury
D. falls
ANSWER: C
RATIONALE: Toddlers are at risk for burns, poisoning and falls because of their increasing curiosity,
advancement in cognition, and improved motor skills. Sports injuries are common in adolescents.

4. The public health nurse is conducting a class for mothers of 1-3 years. Which of these
characteristics are least likely to be observed in toddlers?
A. negativistic
B. dawdling
C. exhibits temper tantrums
D. cooperative
ANSWER: D
RATIONALE: The significant characteristics of toddlers are negativism, temper tantrums, ritualism or
rigidity, dawdling and selfishness. The cooperative child is the preschooler

5. In explaining to parents about parallel play in toddlers, which should be excluded by the nurse?
A. It is normal for toddlers not to share.
B. Parents need not encourage their toddlers to share during parallel play.
C. Parallel play is when two toddlers are seated together or side by side, each playing with his toy.
D. Parents should encourage toddlers to cooperate and share during play.
ANSWER: D
RATIONALE: Parallel play is the type of play during the toddler stage. This is described as when two
toddlers are seated together or side by side, each playing with his toy without sharing. The toddler is
normally selfish, so it is alright for him not to cooperate and share during play
6. A previously toilet trained 4-year-old child has many episodes of urinary incontinence while in
the hospital for a fractured femur. Which of the following actions should the nurse implement?
A. Awaken the child every 2 hours through the night to try to use the bedpan.
B. Explain that children will usually quickly regain control over a previously mastered skill once home
again.
C. Send a urine specimen for analysis.
D. Limit consumption of fluids between meals.
ANSWER: B
RATIONALE: Explain that children will usually quickly regain control over a previously mastered skill
once home again. Stressful events may cause a child to regress back from a previously mastered task.
Hospitalization, trauma, and separation from parents are all examples of what may induce this.
7. A 4-year-old boy will not stop throwing sand at his sister. Which of the following punishments
would be most effective with this child?
A. Send him to his room for 15 minutes.
B. Restrict television viewing for a day.
C. Sit him in “time-out” for 4 minutes.
D. Spank him on his bottom.
ANSWER: C
RATIONALE: Sit him in “time-out” for 4 minutes. Trying to correct behavior while allowing the child the
right to his or her opinion works best without use of physical punishment.
8. Which patient education should the nurse provide a mother of a preschooler with broken
fluency?
A. Encourage the preschooler to recite in front of friends.
B. Allow the preschooler to have time to talk.
C. Encourage the preschooler to speak slowly.
C. Stop the preschooler and tell him or her to start over.
ANSWER: B
RATIONALE: Allow the preschooler to have time to talk. Children who do not feel rushed to speak have
less broken fluency.

9. Mrs. Sia expresses concern about her 4-year-old son who still insists on a bottle at bedtime.
Which of the suggestions is most appropriate to give to Mrs. Sia?
A. Allow the bottle if it contains diluted formula
B. Allow the bottle if it contains juice
C. Do not allow the bottle; give a pacifier instead
D. Allow the bottle if it contains water
ANSWER: D
RATIONALE: To prevent bottle mouth caries, the toddler should not be allowed to sleep with the bottle.
If the bottle is allowed in bed, it should contain water, not milk.

10. According to Sigmund Freud’s psychoanalytic theory of development, Tana, age 4, is in the
phallic stage and is having Electra complex. When asked what behavior will be observed in Tana,
the nurse gives the parents which explanation?
A. “Tana will show attachment to her mother and jealousy towards her father.”
B. “Having more independence, Tana will withdraw from her parents.”
C. “Tana will show attachment to her father, and jealousy towards her mother.”
D. “Tana will be extra clingy to both parents.”
ANSWER: C
RATIONALE: According to Freud’s theory, during the phallic stage, the child is attached to the parent of
the opposite sex and jealous of the parent of the same sex. It has 2 types: Oedipus and Electra complex.
In Electra complex, the daughter is attached to her father and jealous of her mother, whereas, in Oedipal
complex, the son is attached to his mother and is jealous of his father.

Session 22
1. An 8-year-old eats lunch daily in the school cafeteria. Which is the best way to feel assured that
he will eat a balanced lunch daily?
A. Encourage him to include a vegetable daily.
B. Help him memorize a list of acceptable foods.
C. Teach him to eat everything on his plate.
D. Use visual aids to demonstrate appropriate food selections
ANSWER: D
RATIONALE: Use visual aids to demonstrate appropriate food selections. School-age children are
concrete thinkers, so they respond best to concrete examples
2. A 10-year-old becomes very upset and expresses sympathy for his friend whose dog has just
died. This kind of reaction is an indication that he has achieved which step in cognitive thought?
A. Conservation
B. Accommodation
C. Comprehension
D. Decentering
ANSWER: D
RATIONALE: Decentering means the ability to project one’s self into other people’s situations and see
the world from their viewpoint.

3. A 10-year-old recently began smoking cigarettes. What patient teaching should the nurse
provide at a health maintenance visit?
A. Cigarette abuse invariably leads to other forms of drug abuse.
B. Cigarette smoking is associated with long-term respiratory and cardiovascular effects.
C. He or she will probably begin stealing to pay for cigarettes.
D. At age 10 years, bone growth is severely retarded by the effect of nicotine
ANSWER: B
RATIONALE: Cigarette smoking is associated with long-term respiratory and cardiovascular effects. It is
difficult for school-age children to appreciate long-term effects of their actions without counseling.

4. The most significant person/s to a school-age child is/are___

A. girl friend or boy friend
B. firemen or policemen
C. teacher and classmates
D. parents
ANSWER: C
RATIONALE: The teacher and classmates are most significant at this stage. Also significant are adults
usually, other than the parents, who are hero-worshipped, like the fireman, or the teacher. The ‘best
friend” stage usually starts at age 9 or 10 years, so the best friend, usually of the same sex. Is also
considered significant. Parents are most significant to the toddler

5. The following are causes of accidents in children. Which one is the leading cause of injuries,
accidents and deaths in the school age?
A. drowning
B. burns
C. motor vehicle accidents
D. aspiration
ANSWER: C
RATIONALE: Drowning, burns and aspiration are common causes of injuries in younger children.

6. If the school age child has an unsuccessful resolution of the psychological crisis according to
Erikson, which of the following may result?
A. Trust-fear conflict and general difficulties relating to people
B. Independence-fear conflict and severe feelings of self-doubt
C. Sense of inferiority and difficulty learning and working
D. Aggression-fear conflict and feelings of inadequacy or guilt
ANSWER: C
RATIONALE: The psychosocial task of the school age according to Erikson, is accomplishing the sense
of industry vs. inferiority. Unsuccessful resolution of this task may result in the sense of inferiority and
difficulty learning and working. Option A is for infants; Option B is for toddlers; Option D is for
preschoolers.

7. Which of the following toys is best for school age?

A. tricycle
B. sorting games and toys
C. painting
D. balls
ANSWER: B
RATIONALE: The school age child has moved from pre-logical thinking to concrete operations. He is
now capable of sorting, classifying and ordering facts. For this reason, the best toy is one that enhances
his cognitive development; thus, sorting games and toys are best. A tricycle is for preschoolers; painting
may be an adult hobby. Balls may be for all ages, depending on the size or color.
8. The clinic nurse provides information to the mother of a school age child about nutrition.
Which of the following is not a component of the information session?
A. The child will normally select nutritious snacks.
B. The child should help in preparing his snacks
C. The child will need to shift to a low-fat snack.
D. The child needs extra money so he can participate in snack selection on school
ANSWER: B
RATIONALE: The school age child has a high energy level in school that he needs healthy snacks. He
may not choose nutritious snacks, does not need to shift to low-fat milk and may not need extra money
for snacks. He needs assistance in the selection and preparation of his snacks to include healthy food
selections that consider his preferences.

9. Which of the following fears is highest in the school age child?

A. fear of image alteration
B. fear of death
C. fear of separation from parents
D. fear of strangers
ANSWER: B
RATIONALE: To the school age child, death is permanent separation from school and friends. Fear of
body image alteration is greatest in preschool; fear of separation, in toddlers; fear of strangers, in infants

10. The school age child is lean because bones grow faster than muscles and ligaments at his
age. This normal pattern of growth tends to predispose the school age child to ___
A. Scoliosis
B. Fractures
C. Hip dislocation
D. Clubfoot
ANSWER: B
RATIONALE: The bones of school age children are not protected with adequate pads in the form of
muscles and ligaments. This, coupled with sports activities in school, often predisposes them to
fractures. Scoliosis is common in adolescents; while hip dislocation and clubfoot are congenital.

Session 23
1. The parents of an adolescent boy are concerned about the amount of sleep he seems to
require. What advice would you give them?
A. “As long as he seems otherwise well, this sounds like a typical teenager.”
B. “Adolescents only need 8 hours of sleep a night; anything over this is excessive.”
C. “Your son is probably engaged in too many activities and is wearing himself out.”
D. “Your son may be taking drugs; the side effect of many drugs is to cause sleepiness.”
ANSWER: A
RATIONALE: “As long as he seems otherwise well, this sounds like a typical teenager.” Many teenagers
feel fatigued from a combination of quick-food diets, many activities, and a rapid growth spurt.

2. The nurse working with adolescents understands which to be the most widely used drug
among adolescents?
A. Alcohol
B. Heroin
C. Cocaine
D. Speed
ANSWER: A
RATIONALE: Alcohol is the most abused drug among adolescents because it is often readily available
and is inexpensive compared to other drugs.

3. When encouraging an adolescent who is hospitalized and physically challenged or chronically

ill to develop and maintain a sense of identity, which is the best nursing action?
A. Providing the opportunity for individual decision making
B. Providing physical comfort to the individual
C. Asking the parents what the adolescent is capable of doing
D. Providing care until the adolescent insists on being independent
ANSWER: A
RATIONALE: Providing the opportunity for individual decision making. Knowing who you are includes
how to make decisions to advance your welfare. Providing opportunities to do this is important.

4. The following is/are fears of adolescents. Which is the LEAST common?

A. hospitalization
B. Acne
C. Obesity
D. Death
ANSWER: A
RATIONALE: The fears of adolescents are related to the task of attaining identity vs role confusion or
diffusion. Acne and obesity are considered alterations in one’s looks and identity therefore, feared. This
stage also has the greatest fear of death, as death is viewed as unfulfilled dreams. If the adolescent child
understands the reasons and values for hospitalization, then he is not likely to fear it. It is when the
reason for confinement will affect his identity (e.g., loss of a breast, limb or hair) that hospitalization will be
feared the most.

5. Fred, age 14, considers which of these persons as most important?

A. girlfriend
B. classmates
C. mother
D. professor
ANSWER: A
RATIONALE: Peers of the opposite sex are important to the adolescent so to him, his girlfriend is
considered the most important. The mother is most significant to an infant. Classmates and professor are
significant to the school age child

6. Fifteen-year-old Janice makes an unprovoked rude gesture to a staff member of the university.
It most likely indicates that she is___
A. manipulative
B. threatening to others
C testing boundaries
D. showing signs of immaturity
ANSWER: C
RATIONALE: Adolescents like Janice often break the rules and test boundaries so as to provoke staff.
She is not manipulating nor threatening. Although it may seem to be a sign of immaturity, Option C best
describes an adolescent behavior

7. The female adolescent will likely show signs of pubertal changes such as menstruation. What
is the term used for the first menses?
A. dysmenorrhea
B. menarche
C. menopause
D. menorrhagia
ANSWER: B
RATIONALE: Menarche refers to the first menses. Menorrhagia refers to excessive menstrual bleeding.
Menopause is the cessation of menses

8. Which is least likely a characteristic of puberty in boys?

A. enlargement of the testes
B. pubic and axillary hair
C. nocturnal emission
D. enlargement of the prostate
ANSWER: D
RATIONALE: Options A, B and C are characteristic changes of puberty in boys. Enlargement of the
prostate is pathologic condition common in older men.
9. Piaget’s cognitive theory in adolescence identifies which of these behaviors?
A. object permanence
B. abstract thinking
C. animism
D. global organization
ANSWER: B
RATIONALE: Formal operation in children 12 years and above are characterized by abstract thinking.
The realization that something out of sight still exists (object permanence) occur during infancy
sensorimotor stage of development. Animism, the realization that all inanimate objects are given life
cones in the preoperational stage (preschool). The realization that if any part of the object change, the
whole thing has changed (global organization) also occurs in the preoperational stage.

10. Which of these statements characterize the formal operations stage according to Piaget?
A. The child develops logical thought.
B. The child begins to understand the environment.
C. The child develops abstract thinking
D. The child has difficulty separating fantasy from reality.
ANSWER: C
RATIONALE: In formal operations, the child is capable of abstraction. He can do abstract thinking and
solve hypotheses. Logical thought is present in concrete operations. Understanding the environment is
identified in the sensorimotor stage. Difficulty separating reality is associated with the preoperational
stage.