Midterm Reviewer

RLE 1ST
Question 11 pts
A myocardial infarction can often be detected by the presence of which of the following
in an ECG tracing?
Group of answer choices
M-shaped P waves
Physiologic Q waves
Pathologic Q waves
Minor P waves

Flag question: Question 2
Question 21 pts
Which of the following are appropriate nursing considerations during ECG?
1. Inform the patient that ECG may take about 10 minutes

2. Inform the patient that ECG may cause discomfort but is not painful
3. Explain that the patient must lie still, relax, breathe normally and remain quiet.
4. Keep in mind that evaluation of the recording will guide further treatment
1, 2, and 4
2, 3, and 4
1, 2, 3, and 4
1, 2, and 3

Question 31 pts
The nurse is determining whether the client’s rhythm strip demonstrates proper firing of
the SA node. Which waveform indicates proper function of the SA node?
The QRS complex is present
P wave precedes every QRS complex
The ST segment is elevated
The PR interval is 0.24 second

Question 41 pts
The nurse identifies the client problem as “excess fluid volume” for the client in liver
failure. Which short-term goal would be most appropriate for this problem?
The client will not gain more than two (2) kg a day.
The client will have no increase in abdominal girth.
The client’s vital signs will remain within normal limits (WNL).
The client will receive a low-sodium diet.

Question 51 pts
The nurse recognizes that a client with diabetes understands the teaching about the
treatment of hypoglycemia when the client says, “If I become hypoglycemic, I should
initially eat:
Chocolate candy and a banana
Peanut butter crackers and a glass of milk
Sugar and a slice of bread
Hard candy and fruit juice

Question 61 pts
Which of the following symptoms indicate acute rejection of a transplanted kidney?
Fever, Anorexia
Increased WBC count, pain with voiding
Edema, Nausea
Weight gain, pain at graft site

Question 71 pts
The client is in end-stage liver failure and has vitamin K deficiency. Which interventions
should the nurse implement? Select all that apply.
Instruct client to use a soft toothbrush.
Monitor the platelet count.
Assess for asterixis.
Avoid obtaining rectal temperatures.
Use small-gauge needles.

Question 81 pts
The primary reason for taping an indwelling catheter laterally to the thigh of a male
client is to:
Eliminate pressure at the penoscrotal angle.
Prevent the catheter from kinking in the urethra.
Prevent accidental catheter removal.

Allow the client to turn without kinking the catheter.

Question 91 pts
Which of the following is a nursing intervention during hemodynamic monitoring?
secure consent
none of the above
insertion of the catheter
provides patient education about the procedure

Question 101 pts
When assessing the laboratory values of a client with type 2 diabetes, the nurse should
expect the results to reveal:
Glucose in the urine but not in the blood
Ketones in the blood but not in urine
Urine negative for ketones and glucose in the blood
Urine and blood positive for both glucose and ketones

Question 111 pts
Which is the best advice regarding foot care to give a client with the diagnosis of
diabetes?
Wear synthetic fiber socks when exercising

Examine the feet weekly to identify any areas that are sore
Remove corns on the feet
Wear shoes that are larger to avoid friction

Question 121 pts
A 17-year-old primigravida client at 28 weeks of gestation takes three-hour glucose
tolerance test. The results indicate a fasting blood sugar of 100mg/dl, and a two-hour
post-load blood sugar of 300mg/dL. Which of the following nursing diagnoses should be
considered the highest priority at this time?
Potential for altered parenting related to disappointment
Potential impaired family coping related to diagnosis of gestational diabetes mellitus
Ineffective family coping related to anticipatory grieving
Potential non-compliance related to lack of knowledge or lack of adequate support

system

Question 131 pts
A client is admitted to the hospital with diabetic ketoacidosis. The nurse understands
that the elevated ketone level present with this disorder is caused by the incomplete
oxidation of:
Protein
Potassium
Fats
Carbohydrates

Question 141 pts
The client diagnosed with liver failure is experiencing pruritus secondary to severe
jaundice. Which action by the unlicensed assistant warrants intervention by the primary
nurse?
Assisting the client to take a hot soapy shower.
Putting mittens on both hands of the client.
Applying an emollient to the client’s legs and back.
Patting the client’s skin dry with a clean towel.

Question 151 pts
The client diagnosed with end-stage renal failure with ascites is scheduled for a
paracentesis. Which client teaching should the nurse discuss with the client?
Instruct the client that a Foley catheter will have to be inserted.
Explain that the procedure will be done in the operating room.
Tell the client that vital signs will be taken frequently after the procedure.
Provide instructions on holding the breath when the HCP inserts the catheter.

Question 161 pts
When a patient has long –term atrial fibrillation , the nurse would expect to include
which drug in the plan of care to minimize the greatest risk that is commonly associated
with atrial fibrillation?
Antiarrhythmics
Anticoagulants
Digitalis
Beta blockers

Question 171 pts
The client diagnosed with end-stage liver failure is admitted to the medical unit
diagnosed with esophageal bleeding. The HCP inserts and inflates a triple-lumen
nasogastric tube (Sengstaken-Blakemore). Which nursing action should the nurse
implement for this treatment?
Administer the laxative lactulose (Chronulac).
Stay with the client at all times.
Monitor the client’s ammonia level.
Assess the gag reflex every shift.

Question 181 pts
When obtaining the health history of a 24-year old graduate student recently diagnosed
with type I diabetes, the nurse would expect to identify the presence of:
Weight loss
Hypoglycemic episodes
Edema
Anorexia

Question 191 pts
It is considered the electrical activation of the muscle cells of the heart.
Diastole
Systole
Repolarization
Depolarization

Question 201 pts
The physician orders daily fasting blood glucose levels for a client with diabetes
mellitus. The goal of treatment is that the client will have glucose levels within the range
of:
40-65mg/dl
70-105mg/dl
150-175mg/dl
110-145mg/dl

Question 211 pts
What management can be done to if the patient has a decreased afterload?
inotropic
beta blockers
vasoconstrictors
vasodilators

Question 221 pts
The nurse should explain to a client with diabetes that self-monitoring of blood glucose
is preferred to urine glucose testing because it is:
Easier to perform
More accurate
Not influenced by drugs
Done by the client

Question 231 pts
Mrs. V. Reyes is undergoing hemodialysis with an internal arteriovenous fistula in place.
What do you do to prevent complications associated with this device?
Report a bruit or thrill over the fistula to the doctor.
Palpate pulses above the fistula.
Avoid taking blood pressures in the arm with the fistula.
Insert I.V. lines above the fistula.

Question 241 pts
The cardiac conduction system initiates and delivers an electrical impulse that begins in
the _______:
Atrioventricular node
Purkinje fibers
Atrioventricular bundle
Sino-atrial node

Question 251 pts
It is the study of forces involved in the flow of blood through the cardiovascular and
circulatory system.
Hemodynamics
Circulatory system
Pre-load
Cardiac output

Question 261 pts
Your patient with chronic renal failure reports pruritus. Which instruction should you
include in this patient’s teaching plan?
Apply alcohol-based emollients to the skin.
Take frequent baths.
Rub the skin vigorously with a towel.
Keep fingernails short and clean.

Question 271 pts
The client is diagnosed with end-stage liver failure. The client asks the nurse, “Why is
my doctor decreasing the doses of my medications?” Which statement is the nurse’s
best response?
“You really should ask your doctor. I am sure there is a good reason.”
“You are worried that your doctor has decreased the dosage.”
“The half-life is altered because the liver is damaged.”
“You may have an overdose of the medication because your liver is damaged.”

Question 281 pts
Which of the following is reflective of the Einthoven’s triangle?
All four limb leads
The three limb leads and the first three chest leads
All six chest leads
The three limb leads

Question 291 pts
The following procedures are correct except:
Instructing the patient to flex the arms put the both palms over the chest.
Pressing of the filter button if the patient has metal implants that cannot be removed
Removing metal accessories prior to placement of the leads.
Instructing the patient to breathe deeply and slowly during the recording

Question 301 pts
To prevent the most common serious complication of PD, what is important for the
nurse to do?
Reposition the patient frequently and promote deep breathing
Infuse the dialysate slowly.
Use strict aseptic technique in the dialysis procedures.
Have the patient empty the bowel before the inflow phase.

Question 311 pts
The client has had a liver biopsy. Which post-procedure intervention should the nurse
implement?
Keep the client NPO for eight (8) hours.
Monitor blood urea nitrogen (BUN) and creatinine level.
Place the client on the right side.
Instruct the client to void immediately.

Question 321 pts
Prior to discharge from the Emergency Dept. the nurse prints a rhythm strip on a patient
and notices that the P wave cannot be detected and the QRS complex is 0.24 seconds.
This is a change in the patient’s condition. What is the best action for the nurse to take?
Notify the physician of the abnormal strip.
Continue to monitor for abnormalities.
Prepare the patient for discharge.
Measure the PR interval

Question 331 pts
The nurse is assessing an ECG strip for a client. The P waves and QRS complexes
measure is 0.08 second. The overall heart rate is 82bpm.The nurse interprets the
cardiac rhythm to be which rhythm?
First degree heart block
Sick sinus syndrome
Sinus bradycardia
Normal sinus rhythm

Question 341 pts
A 21-year -old-female is seen in the Emergency Dept. for vomiting and diarrhea for 3
days. Her BP is 94/64 and her EKG rhythm shows that she is sinus tachycardia. The
best action for the nurse to take initially is to:
Start IV bolus normal saline per protocol
Cardiovert the patient immediately
Request pain medication for the patient.
Give Adenosine 6 mg IV push

Question 351 pts
What does ECG measure?
the pumping action of the heart
blood volume
blood pressure
the electrical activity of the heart

Question 361 pts
The client is in end-stage liver failure. Which gastrointestinal assessment data would the
nurse expect to find when assessing the client?
Clay-colored stools and hemorrhoids.
Dyspnea and caput medusae.
Hypoalbuminemia and muscle wasting.
Oligomenorrhea and decreased body hair.

Question 371 pts
A 38 year –old female is brought to ED with complaints of her ‘’heart beating out of her
chest’’. She is diaphoretic, tachypneic and her BP is 70/40. The cardiac monitor shows
supraventricular tachycardia. Valsalva maneuvers and three doses of Adenosine have
not been successful. The nurse should immediately:
perform unilateral carotid massage
give Adenosine 6 mg IV per protocol
give Epinephrine 1mg. IV and repeat in 3 minutes
prepare the patient for synchronized cardioversion.

Question 381 pts
The patient is complaining of muscle cramps while undergoing hemodialysis. Which
intervention is effective in relieving muscle cramps?
Infuse normal saline solution.
Administer a 5% dextrose solution.
Encourage active ROM exercises.
Increase the rate of dialysis.

Question 391 pts
The nurse is caring for the client diagnosed with ascites from hepatic cirrhosis. What
information should the nurse report to the health-care provider?
A decrease in the serum direct bilirubin to 0.6 mg/dL.
An increase in urine output after administration of a diuretic.
A decrease in the client’s daily weight of one pound.
An increase in abdominal girth of two inches.

Question 401 pts
In which type of dialysis does the patient dialyze during sleep and leave the fluid in the
abdomen during the day?
Long nocturnal HD
Continuous veno-venous hemofiltration (CVVH)
Automated peritoneal dialysis (APD)
Continuous ambulatory peritoneal dialysis (CAPD)

Question 411 pts
When obtaining a health history from a client recently diagnosed with type I diabetes,
the nurse should expect the client to mention symptoms with the classic signs of
diabetes, such as:
Polyphagia, polyuria, diaphoresis
Nocturia, weight loss, polydipsia
Irritability, polydipsia, polyuria
Polyuria, polydipsia, polyphagia

Question 421 pts
When a patient who has diabetes mellitus experiences peripheral neuropathy, the
priority nursing diagnosis should be:
Altered health maintenance
Risk for impaired skin integrity
Non-compliance
Altered urinary elimination

Question 431 pts
31. The client has end-stage liver failure secondary to alcoholic cirrhosis. Which
complication indicates the client is at risk for developing hepatic
encephalopathy?
Gastrointestinal bleeding.
Splenomegaly.
Hypoalbuminemia.
Hyperaldosteronism.

Question 441 pts
The nurse is performing an ECG in a hospital setting. The patient becomes
unresponsive stops breathing, does not have the pulse. Which of the following would be
the first appropriate step?
Perform rescue breathing
Start chest compression
Retrieve the automated external defibrillator
Place the patient to recovery position

Question 451 pts
A client with a first degree heart block has ab ECG taken during an episode of chest
pain. The nurse knows that which ECG finding would be an indication of first degree
heart block?
Tall, peaked T waves
Widened QRS complex
Presence of Q waves
Prolonged PR interval

Question 461 pts
Which assessment question would be priority for the nurse to ask the client diagnosed
with end-stage liver failure secondary to alcoholic cirrhosis?
How many years have you been drinking alcohol?
When did you have your last alcoholic drink?
What foods did you eat at your last meal?
Have you completed an advanced directive?

Question 471 pts
What is the appropriate infusion time for the dialysate for an adult patient with chronic
renal failure undergoing peritoneal dialysis?
2 to 3 hours
1hour
15 minutes
30 minutes

Question 481 pts
The most indicative test for prostate cancer is:
A thorough digital rectal examination
Prostate-specific antigen
Excretory urography
Magnetic resonance imaging (MRI)

Question 491 pts
Which of the following statements is incorrect?
Patients are instructed to remove metal accessories
Patients with metal implants are not allowed to undergo ECG.
Patients are instructed to avoid unnecessary movements during the procedure
Patients with metal implants are allowed to undergo ECG.

Question 501 pts
The patient noticed become restless and tell the nurse she has a headache and feels
nauseous while ongoing hemodialysis. Which complication does the nurse suspect?
Acute hemolysis
Air embolism
Infection
Disequilibrium syndrome

Question 511 pts
Which of the following actions by a student nurse requires further action from the clinical
instructor?
The patient was instructed to relax.
The student instructed the patient to avoid unnecessary movements.
The patient was asked to remove metal accessories.

The student ensures that the feet of the patient are touching the footboard

Question 521 pts
The client is admitted with end-stage liver failure and is prescribed the laxative lactulose
(Chronulac). Which statement indicates the client needs more teaching concerning this
medication?
“If I have diarrhea, I will call my doctor.”
“I must check my ammonia level daily.”
“I should check my stool for any blood.”
“I should have two to three soft stools a day.”

Question 531 pts
Regular insulin by continuous intravenous (IV) infusion is prescribed for a client with a
blood glucose level of 700mg/dL. The nurse plans to:
Immediately prepare D50/50 and IV set
Mix the solution in 5% dextrose
Infuse the medication via an electronic infusion pump
Change the solution every 4 hours

Question 541 pts
A patient with ESRD has an arteriovenous fistula in the left arm for hemodialysis. Which
intervention do you include in his plan of care?
Keep the left arm dry.

Apply pressure to the needle site upon discontinuing hemodialysis.
Keep the head of the bed elevated 45 degrees
Place the left arm on an arm board for at least 30 minutes.

Question 551 pts
Which evaluation measures should the nurse specifically check for the client with end-
stage liver failure who is experiencing hepatic encephalopathy?
Client’s stool has no signs of bleeding.
Absence abdominal fluid wave.
Client’s neurologic status.
Therapeutic response to the administered loop diuretic.

Question 561 pts
The nurse identifies the client problem “alteration in gastrointestinal system” for the
elderly client. Which statement reflects the most appropriate rationale for this diagnosis?
Elderly clients have a better mechanical handling of food with dentures.
Elderly clients have an increased need for laxatives because of a decrease in bile.
Elderly clients have an increase in bacteria in the GI system, resulting in diarrhea.
Elderly clients have an increase in digestive enzymes, which helps with digestion.

Question 571 pts
The client diagnosed with end-stage liver failure is admitted with hepatic
encephalopathy. Which dietary restriction should be implemented by the nurse to
address this complication?
Restrict sodium intake to 2 g/day.
Decrease the daily fat intake.
Limit oral fluids to 1500 mL/day.
Reduce protein intake to 60 to 80 g/day.

Question 581 pts
An adult patient who is diagnosed with Diabetes has been experiencing infectious
diarrhea. His arterial blood gases are pH (7.30); paCO2 (35); and HCO3 (19). Nurse
Adiel would monitor the patient for which of the following?
Answer:
Option 2:
Option 3:
Option 4:
Hypokalemia
Trousseau's Sign
Hyperkalemia
Respiratory Changes

Question 591 pts
The nurse would expect which of the following to be the first choice to treat a stable
patient with ventricular tachycardia?
Amiodarone
Synchronized cardioversion
Atropine
Procainamide

Question 601 pts
Which of the following intervals should be used to determine the regularity of ventricular
depolarization?
R-R interval
QT interval
P-P interval
PR interval

Question 611 pts
A client with diabetic ketoacidosis who is receiving intravenous fluids and insulin
complains of tingling and numbness of the fingers and toes and shortness of breath.
The cardiac monitor shows the appearance of a U wave. The nurse should recognize
that these symptoms indicate:
Hypokalemia
Hypernatremia
Hypoglycemia
Hypercalcemia

Question 621 pts
Which of the following is not true regarding heart?
Tricuspid valve separates the right atrium from the right ventricle
Heart function is to pump blood through the body
Heart is composed of one upper and lower chamber
Mitral valve separates the left atrium from the left ventricle

Question 631 pts
Which of the following is appropriate if performed by the student nurse?
Placing V6 at the anterior axillary line, at the level of V4
Placing the red limb electrode at the right upper extremity
Placing the green chest electrode between the yellow and red chest electrodes
Placing the black limb electrode at the left lower extremity

Question 641 pts
A nurse is preparing a patient for a 12-lead ECG .Which of the following is the correct
placement for lead V4?
The 5th intercostal space at the mid axillary line.
The 5th intercostal space at the midclavicular line.
The 4TH Intercostal space at the mid clavicular line.

The 4th intercostal space at the mid axillary line.

Question 651 pts
The most common early sign of kidney disease is:
Development of metabolic acidosis
Elevated BUN level
Inability to dilute or concentrate urine
Sodium retention

Question 661 pts
What does the dialysate for PD routinely contain?
Electrolytes in an equal concentration to that of the blood
Sodium in a higher concentration than in the blood 308
Dextrose in a higher concentration than in the blood
Calcium in a lower concentration than in the blood

Question 671 pts
The R-R interval on a patient’s tracing has five large boxes. Which of the following is the
patient’s heart rate?
85/mm
40/mm
60/mm
75/mm

Question 681 pts
The patient is asking the nurse if ECG is painful. Which response, if made by the nurse,
is appropriate?
I would appreciate it very much if you will fully cooperate.
It might cause you some discomfort but the procedure is not painful
I will make sure that privacy will be provided
It is painful but I will try my best to minimize the pain.

Question 691 pts
The nurse is watching the cardiac monitor and notices that the rhythm suddenly
changes No P waves or QRS complexes are seen ,instead, the monitor screen shows
an irregular wavy line. The nurse interprets that the client is experiencing which rhythm?
Sinus tachycardia
Ventricular fibrillation
Ventricular tachycardia
Premature ventricular contractions (PVC)

Question 701 pts
What is the primary way that a nurse will evaluate the patency of an AVF?
Evaluate the color and temperature of the extremity.
Auscultate for the presence of a bruit at the site.
Palpate for pulses distal to the graft site.
Assess for the presence of numbness and tingling distal to the site.

Question 711 pts
As a graduating student, you understand that ECG:
is a diagnostic and non-invasive tool that reflects the contractility of the heart.
reflects the electrical conduction system.
determines the size and thickness of the myocardium.
is reflective the ejection fraction.

Question 721 pts
While hospitalized a client with diabetes is observed picking at calluses on the feet. The
nurse should immediately:
Check the client’s shoes for proper fit in the calluses
Warn the client of the danger of infection
Teach the importance of proper foot care to the client
Suggest that the client wear white cotton socks

Question 731 pts
Bea, the nurse assigned to a patient receiving peritoneal dialysis noticed that the return
of fluid draining is very slow. What should be the best thing to do?
Place the patient in a reverse Trendelenburg position.
Raise the drainage bag above the level of the abdomen.
Check for kinks in the outflow tubing.
Ask the patient to cough.

Question 741 pts
A client with rapid rate atrial fibrillation ask a nurse why the physician is going to perform
a carotid massage. The nurse responds t6hat this procedure may stimulate the…
Vagus nerve to increase heart rate
Vagus nerve to decrease the heart rate.
Diaphragmatic nerve to decrease heart rate
Diaphragmatic nerve to overdrive the rhythm

Question 751 pts
A father of a child patient with IDDM says to Nurse Nicole, “Why does my child have to
take insulin by injection? Why can’t he have it by mouth?” Nurse Nicole should give him
which of the following information about taking insulin orally?
Insulin inhibits the secretion and action of the pancreatic digestive enzymes
Insulin is destroyed by GI enzymes
Insulin causes ulcerations of the gastrointestinal tract
Insulin molecules are too large to be absorbed in the GI tract

LEC 1ST
Question 11 pts
You expect a patient in the oliguric phase of renal failure to have a 24hour urine output
less than:
1000ml
200ml
400ml
800ml

Question 21 pts
The client’s telemetry reading shows a P-wave before each QRS complex and the rate
is 78. Which action should the nurse implement?
Document this as normal sinus rhythm.
Prepare to administer the cardiotonic digoxin PO
Assess the client’s cardiac enzymes.

Request a 12-lead electrocardiogram.

Question 31 pts
A patient reports, during a routine check-up, that he is experiencing chest pain and
shortness of breath while performing activities. He states the pain goes away when he
rests. This is known as which of the following?
Unstable angina
Stable angina
None of the given options
Variant angina

Question 41 pts
Which factor/a contribute/s to malnutrition in patients with liver failure? Select all that
apply.
Decreased oral intake
Altered mental status
Altered renal problem
Altered metabolism and storage of nutrients

Question 51 pts
During cardiac catheterization, it is most important for the nurse to:
All of the above

Assess baseline peripheral pulses
ECG leads are placed for ECG and vital signs monitoring
Ask for history of allergy to sea foods

Question 61 pts
After cardiac catheterization, it is most important for the nurse to:
Monitor for hematoma on the groin area
Monitor vital signs every shift
Insert sheath
All of the above

Question 71 pts
A client had a liver transplant yesterday. The client’s son has come to visit. The nurse
should instruct the son to do which of the following? Select all that apply.
Perform good hand washing.
Wear a gown and a mask.
Wear a double mask and gloves.
No special isolation techniques are necessary.

Question 81 pts
A patient reports having crushing chest pain that radiates to the jaw. You administer
sublingual nitroglycerin and obtain a 12 lead EKG. Which of the following EKG findings
confirms your suspicion of a possible myocardial infraction?
absent Q wave
absent P-wave
QRS widening
ST segment elevation

Question 91 pts
What is the priority nursing diagnosis with your patient diagnosed with end-stage renal
disease?
Fluid volume excess
Knowledge deficit
Pain
Activity intolerance

Question 101 pts
The client diagnosed with IBD is prescribed total parental nutrition (TPN). Which
intervention should the nurse implement?
Monitor the client’s oral food intake.
Administer an oral hypoglycemic.
Check the client’s glucose level.
Assess the peripheral intravenous site.

Question 111 pts
The client has chronic atrial fibrillation. Which discharge teaching should the nurse
discuss with the client?
Explain to the client the procedure for synchronized cardioversion.
Teach the client about signs of pacemaker malfunction.
Discuss the importance of getting a monthly partial thromboplastin time (PTT).
Instruct the client to use a soft-bristle toothbrush.

Question 121 pts
The client is admitted to the emergency department, and the nurse suspects a cardiac
problem. Which assessment interventions should the nurse implement? Select all that
apply.
Attach telemetry monitor to the client.
Obtain a mid-stream urine specimen.
Start a saline lock in the right arm.
Request an order for a STAT 12-lead ECG.
Draw a basic metabolic panel (BMP).

Question 131 pts
Which of the following might alert the nurse to consider an alcohol-induced liver problem
problem in a client hospitalized for a physical illness?
Flulike symptoms, diarrhea, night sweats, elevated temperature, decreased deep
tendon reflexes.
Elevated gastric enzymes, cirrhosis, decreased platelets.
Tremors, elevated temperature, complaints of nocturnal leg cramps, complaints of pain
Depression, difficulty falling asleep, decreased concentration.

Question 141 pts
A young adult patient having diabetic nephropathy says, “I have two kidneys and I’m still
young. If I stick to my insulin schedule, I don’t have to worry about kidney damage,
right?” Which of the following statements is the best response?
“Even with insulin, kidney damage is still a concern.”
“You have little to worry about as long as your kidneys keep making urine.”
“You should talk to your doctor because statistics show that you’re being unrealistic.”
“You would be correct if your diabetes could be managed with insulin.”

Question 151 pts
Which drug is indicated for pain related to acute renal calculi?
Nonsteroidal anti-inflammatory drugs (NSAIDS)
Narcotic analgesics
Muscle relaxants
Salicylates

Question 161 pts
When assessing a patient for diabetes insipidus, a nurse should recognize which of the
following symptoms as sign/s of this disorder?
Hypocalcemia
Hyperaldosteronism
Polyuria and Polydipsia
Diminished or absent skin pigmentation

Question 171 pts
Cardiac catheterization will be done to measure the central venous pressure, the nurse
anticipates that the catheter will be inserted into the:
Any of the above
Vein in the arm
Artery in the arm
Artery in the leg

Question 181 pts
The client is exhibiting sinus bradycardia, is complaining of syncope and weakness, and
has a BP of 98/60. Which collaborative treatment should the nurse anticipate being
implemented?
Administer a thrombolytic medication.
Obtain a permit for synchronized cardioversion.
Assess the client’s cardiovascular status.

Prepare for an insertion of a pacemaker.

Question 191 pts
After administering Propranolol to a client with Atrial fibrillation. The nurse evaluates the
effectiveness of propranolol by monitoring the:
Blood pressure
ECG
Respiratory rate
Heart rate

Question 201 pts
Acute tubular necrosis (ATN) is the most common cause of intrarenal AKI. Which
patient is most likely to develop ATN?
Patient who tried to overdose on acetaminophen
Patient with diabetes mellitus
Patient with hypertensive crisis
Patient with major surgery who required a blood transfusion

Question 211 pts
The patient with CKD is brought to the emergency department with Kussmaul
respirations. What does the nurse know about CKD that could cause this patient's
Kussmaul respirations?
There is decreased pulmonary macrophage activity.

They are caused by respiratory compensation for metabolic acidosis.
Pulmonary edema from heart failure and fluid overload is occurring.
Uremic pleuritis is occurring.

Question 221 pts
A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The
nurse informs the client that the doctor will prescribe diuretic therapy. Restrict fluid and
to balance sodium intake to treat the disorder. If the client does not want to comply with
the treatment, which complication may arise?
Cerebral Edema
Hypovolemic Shock
Severe Hyperkalemia
Tetany

Question 231 pts
A patient is receiving treatment for stable coronary artery disease. The doctor
prescribes the patient Plavix. What important information will you include in the patient's
teaching?
1.If you are scheduled for any planned surgical procedures, let your doctor know you
are taking Plavix because this medication will need to be discontinued 5-7 days prior to
the procedure.
2.A normal side effect of this medication is a dry cough.
3.Avoid green leafy vegetables while taking Plavix.
4.Notify the doctor, immediately, if you develop bruising, problems urinating, or fever.
2 and 3
3 and 4
1 and 4
1 and 3

Question 241 pts
The post-anesthesia care nurse is caring for the client diagnosed with lung cancer who
had a thoracotomy and is experiencing frequent premature ventricular contractions
(PVC). Which intervention should the nurse implement first?
Administer lidocaine intravenous push.
Request STAT arterial blood gases.
Request a STAT electrocardiogram (ECG).
Assess for possible causes.

Question 251 pts
The client is diagnosed with peritonitis. Which assessment data indicate the client’s
condition is improving?
The client has had two soft, formed bowel movements.
The client is using more pain medication on a daily basis.
The client’s nasogastric tube is draining coffee-ground material.
The client has a decrease in temperature and a soft abdomen.

Question 261 pts
When providing discharge teaching for a client with uric acid calculi, the nurse should
make an instruction to avoid which type of diet?
Low-calcium
Low-oxalate
High-purine
High-oxalate

Question 271 pts
The client shows ventricular fibrillation on the telemetry at the nurse’s station. Which
action should the telemetry nurse implement first?
Start cardiopulmonary resuscitation.
Call a STAT code.
Administer epinephrine IVP.
Prepare to defibrillate the client.

Question 281 pts
The client is in complete heart block. Which intervention should the nurse implement
first?
Prepare to insert a pacemaker.
Notify the health-care provider.
Obtain a STAT electrocardiogram (ECG).
Administer atropine, an antidysrhythmic.

Question 291 pts
Which of the following needs further assessment?
Cardiac output of 7 Liters/min
BP 130 / 80 mmHg
Pulmonary arterial systolic pressure 25 mmHg
MAP 55 mmHg

Question 301 pts
The client is experiencing multifocal premature ventricular contractions. Which
antidysrhythmic medication would the nurse expect the health-care provider to order for
this client?
Digoxin.
Lidocaine.
Atropine.
Adenosine.

Question 311 pts
In replying to a patient's questions about the seriousness of her chronic kidney disease
(CKD), the nurse knows that the stage of CKD is based on what?
Serum creatinine and urea levels
Degree of altered mental status
Total daily urine output

Glomerular filtration rate (GFR)

Question 321 pts

Question 331 pts
Which of the following measures would a nurse include in the plan of care of a patient
who has syndrome of inappropriate antidiuretic hormone (SIADH)?
To decrease urine output
Increasing sodium intake
To decrease potassium intake
To decrease respiratory function

Question 341 pts
The client with coronary artery disease is prescribed a Holter monitor. Which
Teach the client the importance of decreasing activity while wearing the monitor.
Discuss the need to remove Holter monitor during A.M. care and showering.
Instruct client to keep a diary of activity, especially when having chest pain.
Explain that all medications should be withheld while wearing a Holter monitor.

Question 351 pts
Which of the following assessment findings would alert the nurse to change the
intranasal route for VASOPRESSIN administration?
Severe coughing
Pneumonia
Vaginal Bleeding
Mucus membrane irritation

Question 361 pts
The client’s ECG reading shows a P-wave before each QRS complex and the rate is 78.
P – R interval is 0.20 sec and consistent in all waves. Which action should the nurse
implement?
Call a code
Assess the client’s cardiac enzymes.
Document this as normal sinus rhythm.
Prepare to administer digoxin per orem.

Question 371 pts
Initial management of the patient with upper GI bleeding would include, which of the
following?
Identification of the site of bleeding
Hemodynamic stabilization
Volume resuscitation
Initiation of treatment to control bleeding within 24 hours of admission

Question 381 pts
Metabolic acidosis occurs in the oliguric phase of AKI as a result of impairment of:
excretion of bicarbonate.
excretion of hydrogen ions.
excretion of sodium.
conservation of potassium.

Question 391 pts
Select the most accurate explanation by the nurse to a client who is to have oral
glucose tolerance test and needs to understand the procedure:
“Your blood will be drawn after ingestion of a carbohydrate meal and soda, then your
blood will be drawn again after 2 hours.”
“Your blood will be drawn, you will drink a concentrated glucose solution, and your
blood will be drawn again.”
“After you drink a concentrated glucose solution, you cannot eat for 12 hours until the
next draw of blood.”
“You will go to the laboratory and your blood will be draw by the MedTech and
instructions to be followed.”

Question 401 pts
Nurse Levie should recognize which of the following symptoms considered as a cardinal
sign of Diabetes Mellitus?
Nausea
Hyperactivity
Frequent Urination
Seizure

Question 411 pts
The client that is one-day postoperative coronary artery bypass surgery is exhibiting
sinus tachycardia. Which intervention should the nurse implement?
Determine if the client is having pain.
Assess the apical heart rate for one full minute.
Prepare the client for synchronized cardioversion.
Notify the client’s cardiac surgeon.

Question 421 pts
The client is diagnosed with GI bleeding due to ulcerative colitis. When assessing this
client, which sign/symptom would the nurse expect to find?
Hard, rigid abdomen.
Oral temperature of 102°F
Urinary stress incontinence.
Twenty bloody stools a day.

Question 431 pts
A patient calls the cardiac clinic you are working at and reports that they have taken 3
sublingual doses of Nitroglycerin as prescribed for chest pain, but the chest pain is not
relieved. What do you educate the patient to do next?
Lie down and rest to see if that helps with relieving the pain
Take another dose of Nitroglycerin in 5 minutes.
Call for help or go to the ER

Question 441 pts
A patient who has type 1 diabetes experiences weakness and tremors. Which of the
following actions would a nurse take first?
Obtain urine sample to a patient
Administer the patient’s PRN of insulin as ordered via SQ
Immediately give a concentrated source of glucose and refer to the physician
Check the patient’s most recent blood glucose level

Question 451 pts
Which intervention should the nurse implement when defibrillating a client who is in
ventricular fibrillation?
Shout “all clear” prior to defibrillating the client.
Do not remove the oxygen source during defibrillation.
Defibrillate the client at 50, 100, and 200 joules.
Place petroleum jelly on the defibrillator pads.

Question 461 pts
A patient has a diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH).
For which of the following manifestations would a nurse monitor this patient?
Polyuria and Hyponatremia
Dilutional Hyponatremia
Dysphagia and Dysuria
Hyperglycemic reaction

Question 471 pts
The client is exhibiting ventricular tachycardia. Which intervention should the nurse
implement first?
Start basic cardiopulmonary resuscitation.
Assess the client’s apical pulse and blood pressure.
Prepare to defibrillate the client at 200 joules.
Administer lidocaine, an antidysrhythmic, IVP.

Question 481 pts
After the bleeding is identified and bleeding is controlled, what is the drug of choice to
treat a nonvariceal bleed?
Proton pump inhibitors (PPis)
Octreotide/Somatostatin
Antacids
Histamine receptor antagonists

Question 491 pts
The client diagnosed with lower GI bleeding and is crying and tells the nurse, “I can’t
take it anymore. I never know when I will get sick and end up here in the hospital.”
Which statement would be the nurse’s best response?
“I can see you are very upset. I’ll sit down and we can talk.”
“Are you thinking about doing anything like committing suicide?”
“You must keep thinking about the good things in your life.”
“I understand how frustrating this must be for you.”

Question 501 pts
A client who suffered a brain injury after falling off a ladder has recently developed
syndrome of inappropriate antidiuretic hormone (SIADH). What findings indicate that the
treatment that he’s receiving for SIADH is effective?
1. Decrease in body weight

2. Rise in blood pressure and drop in heart rate
3. Widening pulse pressure
4. Decrease in urine osmolality
5. Decrease reflexes

2, 3, 5 only
All except 3
1 and 4 only
1,4, 5 only

Question 511 pts
Nurse Camille understands that diabetes insipidus is the principal disorder of which of
the following glands?
Posterior Pituitary Hypofunction
Parathyroid Hypofunction
Thyroid Hyperfunction
Pancreas Hyperfunction

Question 521 pts
The client is in ventricular fibrillation. Which interventions should the nurse implement?
Select all that apply.
Start cardiopulmonary resuscitation.
Prepare to administer the antidysrhythmic amiodarone IVP.
Prepare to defibrillate the client.

Bring the crash cart to the bedside.
Prepare to administer the antidysrhythmic adenosine IVP.

Question 531 pts
A senior high, male student is admitted with dark urine, fever, and flank pain and is
diagnosed with acute glomerulonephritis. Which would most likely be in this student’s
health history?
Renal trauma
Renal calculi
Family history of acute glomerulonephritis
Recent sore throat

Question 541 pts
The telemetry nurse is unable to read the telemetry monitor at the nurse’s station.
Which intervention should the telemetry nurse implement first?
Contact the client on the client call system.
Go to the client’s room to check the client.
Request the nursing assistant to take the crash cart to the client’s room.
Instruct the primary nurse to assess the client.

Question 551 pts
The patient with CKD is receiving dialysis, and the nurse observes excoriations on the
patient's skin. All of the following are pathophysiologic changes in CKD most likely occur
that can contribute to this finding? Except one.
Calcium-phosphate skin deposits
Vascular calcifications
Dry skin
Sensory neuropathy

Question 561 pts
The nurse is caring for a vegetarian client diagnosed with upper GI vomiting and a
serum potassium of 3.2mEq/L. Now that the client is able to tolerate oral feeding, which
of the following would the nurse best include in planning meals for the client? Select all
that apply.
Fresh tomato juice
Dried fruits
Mashed potatoes
Fresh vegetable salad with carrots and tomatoes

Question 571 pts
A 57-year-old woman was admitted to the hospital for uncontrolled diabetes. Lab
studies reveal a fasting blood sugar of 310mg/dl. Her admitting diagnosis is Type 1
Diabetes Mellitus. Given the scenario, the client needs to understand that the type of
diabetes she has:
a rarely controlled type of DM
is associated with the destruction of beta cells
often occurs in obese individuals

is usually caused by complete fat metabolism

Question 581 pts
Which serum laboratory value indicates to the nurse that the patient's CKD is getting
worse?
Decreased BUN
Decreased calculated glomerular filtration rate (GFR)
Decreased creatinine
Decreased sodium

Question 591 pts
A man with end-stage renal disease (ESRD) is scheduled for HD following healing of an
arteriovenous fistula (AVF). What should the nurse explain to him that will occur during
dialysis?
He will be able to visit, read, sleep, or watch TV while reclining in a chair.
He will be placed on a cardiac monitor to detect any adverse effects that may occur.
A large catheter with two lumens will be inserted into the fistula to send blood to and
return it from the dialyzer.
The dialyzer will remove and hold part of his blood for 20 to 30 minutes to remove the
waste products.

Question 601 pts
The nurse reads the ECG. Sinus and regular rhythm, R – R interval is 0.08 sec, P – R
interval is 0.10 sec. P: QRS ratio is 1. The nurse interprets the findings as:
Sinus bradycardia
Sinus tachycardia
Normal sinus rhythm
Sinus arrhythmia

Question 611 pts
The patient with CKD asks why she is receiving nifedipine (Procardia) and furosemide
(Lasix). The nurse understands that these drugs are being used to treat the patient's:
mineral and bone disorder.
hypertension.
hyperkalemia.
anemia.

Question 621 pts
What indicates to the nurse that a patient with AKI is in the recovery phase?
A urine output of 3700 mL/day
A return to normal weight
Decreasing sodium and potassium levels
Decreasing blood urea nitrogen (BUN) and creatinine levels

Question 631 pts
A child experienced symptoms of hypoglycemia and has eaten sugar cubes. The nurse
should follow this rapid-releasing sugar cubes. The nurse should follow this rapid
releasing sugar with which of the following foods?
Alkaline ash diet
10 glasses of water
Foods that are high in fats to provide source of energy
Complex carbohydrates and protein

Question 641 pts
Which of the following symptoms are signs of hyperglycemia?
1. Tremors
2. Headache
3. Ashen gray color
4. Thirst or polydipsia
5. Pruritus and Flushed Skin
6. Polyuria and Hot Skin
All except 3 and 5
All except 3 and 4
1, 2, 4, 6 only
4, 5, 6 only

Question 651 pts
During cardiac catheterization, the patient may be asked to cough or deep breathe
because:
Assure patient is awake
Assess circulation in the heart
Prevent hypotension
Assess level of anesthesia

Question 661 pts
Which client problem has priority for the client with a cardiac dysrhythmia?
Decreased cardiac output.
Alteration in comfort.
Impaired gas exchange.
Activity intolerance.

Question 671 pts
The male client has had abdominal surgery and is now diagnosed with peritonitis.
Which assessment data support the client’s diagnosis of peritonitis?
Hard, rigid abdomen and white blood cell count 22,000 mm.
Profuse diarrhea and stool specimen shows Campylobacter.
Absent bowel sounds and potassium level of 3.9 mEq/L.
Abdominal cramping and hemoglobin of 14 gm/dL.

Question 681 pts
Keeping the patient in the previous question in mind: What type of diagnostic tests will
the physician most likely order (at first) for this patient to evaluate the cause of the
patient’s symptoms?
1. ECG
2. Stress test
3. Heart catheterization
4. Balloon angioplasty
1 and 2
1 and 4
3 and 4
2 and 3

Question 691 pts
A 55-year-old diabetic client is admitted with HYPOGLYCEMIA. Which information
should the nurse include in her client teaching?
1. Hypoglycemia can result from excessive alcohol consumption

2. Skipping meals and excessive exercise induces hypoglycemia
3. Symptoms of hypoglycemia include thirst and excessive urine output
4. Strenuous activity may result in hypoglycemia
5. Symptoms of hypoglycemia include shakiness, confusion, headache, and
dizziness
6. Hypoglycemia is relatively harmless situation
2, 3, 4, 5 only
1, 2, 4 only
All except 6
1, 2, 4, 5 only

Question 701 pts
Nurse Joshua is caring for a patient with Diabetes Mellitus (Type I) who is not compliant
with the treatment regimen ordered for him. Nurse Joshua is correct if he states that his
patient is at risk of developing?
Pancreatitis
Anasarca (Generalized Edema)
Diabetic Ketoacidosis
Hyperglycemic Hyperosmolar Non-ketotic Syndrome
Hypoglycemia

Question 711 pts
First degree AV block is characterized by:
Delayed conduction producing a prolonged PR interval
P waves hidden with the QRS
A variable heart rate usually slower than 60 bpm
An irregular rhythm

Question 722 pts
SITUATION: A college student is hospitalized due to hepatitis A infection. The client’s
chart showed no significant medical history of any disorders and/or conditions. His
condition is worsening which prompted a transfer to the intensive care unit.
The nurse will anticipate which of the following physician’s orders to manage the client’s
condition? Select all that apply.
Blood typing and cross-matching
Capillary blood glucose monitoring
Lactulose administration
High protein diet

Question 732 pts
The nurse knows that the following information have raised suspicions of acute liver
failure? Select all that apply.
1st time hospitalization
Hepatitis infection
INR of 2.0
Short attention span

LEC 2ND
Question 11 pts
The male client in ESRD has received the initial dose of erythropoietin, a biologic
response modifier, 1 week ago. Which complaint by the client would indicate the need
to notify the health-care provider?
The client reports an elevation in his blood pressure.
The client reports discomfort in his legs and back.
The client complains of flulike symptoms.
The client complains of being tired all the time.

Question 21 pts
The nurse is developing a plan of care for a client diagnosed with ARF. Which
statement would be an appropriate outcome for the client?
Decrease of pain by 3 levels on a 1–10 scale.
Monitor intake and output every shift.

Administer enemas to decrease hyperkalemia.
Electrolytes are within normal limits.

Question 31 pts
A patient calls the cardiac clinic you are working at and reports that they have taken 3
sublingual doses of Nitroglycerin as prescribed for chest pain, but the chest pain is not
relieved. What do you educate the patient to do next?
Take two doses of Nitroglycerin in 5 minutes
Call 911 immediately
Lie down and rest to see if that helps with relieving the pain
Take another dose of Nitroglycerin in 5 minutes.

Question 41 pts
What is the most important nursing action when measuring a client’s pulmonary
capillary wedge pressure (PCWP)?
Place the client in a supine position before measuring the PCWP
Deflate the balloon as soon as the PCWP is measured
Have the client bear down when measuring the PCWP
Flush the catheter with a heparin solution after the PCWP is determined

Question 51 pts
A patient taking Zocor is reporting muscle pain. You are evaluating the patient’s lab
work and note that which of the following findings could cause muscle pain?
Decreased potassium level
Elevated CPK (creatine kinase level)
Decreased CPK (creatine kinase level)
Elevated potassium level

Question 61 pts
The client diagnosed with ARF is admitted to the intensive care department and placed
on a therapeutic diet. Which diet would be most appropriate for the client?
A low-fat and low-cholesterol diet.
A high-potassium and low-calcium diet.
A regular diet with six (6) small feedings a day.
A high-carbohydrate and restricted-protein diet.

Question 71 pts
The client diagnosed with Type 1 diabetes is found lying unconscious on the floor of the
bathroom. Which intervention should the nurse implement first?
Check the serum glucose level.
Notify the health-care provider.
Administer 50% dextrose IV push.
Move the client to the ICU.

Question 81 pts
The client diagnosed with ARF is experiencing hyperkalemia. Which medication should
the nurse prepare to administer to help decrease the potassium level?
Erythropoietin.
Regular insulin.
Calcium gluconate.
Osmotic diuretic.

Question 91 pts
The home health nurse is completing the admission assessment for a 76-year-old client
diagnosed with Type 2 diabetes that must be controlled with 70/30-combination insulin.
Which intervention should be included in the plan of care?
Assess the client’s ability to read small print.
Monitor the client’s serum PT level.
Instruct the client to check the feet weekly.
Teach the client how to perform a hemoglobin A1c test daily.

Question 101 pts
Which of the following might alert the nurse to consider an alcohol-induced liver problem
problem in a client hospitalized for a physical illness?
Depression, difficulty falling asleep, decreased concentration.
Elevated gastric enzymes, cirrhosis, decreased platelets.

Flulike symptoms, diarrhea, night sweats, elevated temperature, decreased deep
tendon reflexes.
Tremors, elevated temperature, complaints of nocturnal leg cramps, complaints of pain

Question 111 pts
What clinical indicator is the nurse most likely to identify when completing a history and
physical of a client with complete heart block?
Syncope
Tachycardia
Hemiparesis
Cephalalgia

Question 121 pts
The client is diagnosed with Acute renal failure (ARF). Which laboratory values are most
significant for diagnosing ARF?
Potassium and sodium.
BUN and creatinine.
Bilirubin and ammonia level.
WBC and hemoglobin.

Question 131 pts
The nurse prepares a client for insertion of a pulmonary artery catheter (e.g. Swan-
Ganz catheter). The nurse explains to the client that the catheter will be inserted to
provide information about:
Venous pressure
Coronary artery patency
Left ventricular functioning
Stroke volume

Question 141 pts
The client diagnosed with HHS was admitted yesterday with a blood glucose level of
780 mg/dL. The client’s blood glucose level is now 300 mg/dL. Which intervention
should the nurse implement?
Check the client’s urine for urinary ketones.
Provide the client with a therapeutic diabetic meal.
Notify the physician to obtain an order to decrease insulin therapy.
Increase the regular insulin IV drip.

Question 151 pts
The male client has had abdominal surgery and is now diagnosed with peritonitis.
Which assessment data support the client’s diagnosis of peritonitis?
Absent bowel sounds and potassium level of 3.9 mEq/L.
Hard, rigid abdomen and white blood cell count 22,000 mm.
Profuse diarrhea and stool specimen shows Campylobacter.
Abdominal cramping and hemoglobin of 14 gm/dL.

Question 161 pts
The charge nurse is making client assignments in the intensive care department. Which
client should be assigned to the most experienced nurse?
The client with HHS who has a plasma osmolarity of 290 mOsm/L.
The client with Type 2 diabetes who has a blood glucose level of 348 mg/dL.
The client with DKA who has multifocal premature ventricular contractions.
The client diagnosed with Type 1 diabetes who is experiencing hypoglycemia.

Question 171 pts
The left anterior descending coronary artery provides blood supply to the left ventricle,
front of the septum and part of the right ventricle.
True
False
Cannot be determined
No answer text provided.

Question 181 pts
The nurse is caring for a vegetarian client diagnosed with upper GI vomiting and a
serum potassium of 3.2mEq/L. Now that the client is able to tolerate oral feeding, which
of the following would the nurse best include in planning meals for the client? Select all
that apply.
Fresh tomato juice
Mashed potatoes
Fresh vegetable salad with carrots and tomatoes
Dried fruits

Question 191 pts
The client receiving hemodialysis is being discharged home from the dialysis center.
Which instruction should the nurse teach the client?
Notify the physician if oral temperature is 102°F or greater.
Keep fingernails short and try not to scratch the skin.
Apply ice to the access site if it starts bleeding at home.
Encourage significant other to make decisions for the client.

Question 201 pts
The client diagnosed with Type 1 diabetes has a glycosylated hemoglobin (A1c) of
8.1%. Which interpretation should the nurse make based on this result?
This result is below normal levels.
This result is dangerously high.
This result is above recommended levels.
This result is within acceptable levels.

Question 211 pts
Lipitor is prescribed for a patient with a high cholesterol level. As the nurse, how do you
educate the patient on how this drug works on the body?
Lipitor increases HDL levels and decreases LDL, total cholesterol, and triglyceride
levels.
Lipitor increases LDL levels and decreases HDL levels, total cholesterol, and
triglyceride levels.
Lipitor increases HDL levels, total cholesterol, and triglyceride levels.
Lipitor decreases LDL, HDL levels, total cholesterol, and triglyceride levels.

Question 221 pts
The nurse is discussing ways to prevent diabetic ketoacidosis with the client diagnosed
with Type 1 diabetes. Which instruction would be most important to discuss with the
client?
Refer the client to the American Diabetes Association.
Do not take any over-the-counter medications.
Take the prescribed insulin even when unable to eat because of illness.
Be sure to get your annual flu and pneumonia vaccines.

Question 231 pts
Which assessment data indicate that the client diagnosed with diabetic ketoacidosis is
responding to the medical treatment?
The client has tented skin turgor and dry mucous membranes.
The client’s serum potassium level is 3.3 mEq/L.
The client is alert and oriented to date, time, and place.
The client’s ABGs results are pH 7.29, PaCO2 44, HCO3 15.

Question 241 pts

Question 251 pts
When caring for a client after cardiac catheterization, which nursing action is most
important?
Administer oxygen
Check the ECG every 5 to 15 minutes
Provide for rest
Check a pulse distal to the insertion site

Question 261 pts
The client is diagnosed with ARF. Which signs/symptoms would indicate to the nurse
that the client is in the recovery period? Select all that apply.
Increase in hemoglobin and hematocrit.
Denial of nausea and vomiting.
Increased serum creatinine level.

Decreased urine-specific gravity.
Increased alertness and no seizure activity.

Question 271 pts
When taking an admission history of a client with right ventricular heart failure, what
clinical indications will the nurse most likely identify from the client’s complaints?
Syncope, oliguria, increased thirst
Weakness, palpitations, nausea
Fatigue, vertigo, headache
Dyspnea, edema, fatigue

Question 281 pts
The client diagnosed with Type 2 diabetes comes to the emergency department. The
client’s blood glucose is 680 mg/dL and the client is diagnosed with HHS. Which
question should the nurse ask the client to determine the cause of this acute
complication?
When is the last time you took your insulin?
Have you had some type of infection lately?
How long have you had diabetes?
When did you have your last meal?

Question 291 pts
A client had a liver transplant yesterday. The client’s son has come to visit. The nurse
should instruct the son to do which of the following? Select all that apply.
No special isolation techniques are necessary.
Perform good hand washing.
Wear a gown and a mask.
Wear a double mask and gloves.

Question 301 pts
Which coronary artery provides blood to the left atrium and left ventricle?
Posterior descending artery
Right coronary artery
Right marginal artery
Left circumflex artery

Question 311 pts
Which arterial blood gas would the nurse expect in the client diagnosed with diabetic
ketoacidosis?
pH 7.46, PaO2 85, PaCO2 30, HCO3 26.
pH 7.38, PaO2 95, PaCO2 40, HCO3 22.
pH 7.30, PaO2 90, PaCO2 30, HCO3 18.
pH 7.34, PaO2 99, PaCO2 48, HCO3 24.

Question 321 pts
What should the nurse do to help alleviate the distress of a client with heart failure and
pulmonary edema?
Place the client in the orthopneic position
Prepare for modified postural drainage
Elevate the lower extremities
Encourage frequent coughing

Question 331 pts
Which patient(s) are most at risk for developing coronary artery disease? Select all that
apply.
A 45-year-old female that reports her father died at the age of 42 from a myocardial
infraction.
A 29-year-old that has type I diabetes.
A 35-year-old male with a BMI of 30 and reports smoking 2 packs of cigarettes a day.
A 25-year-old patient who exercises 3 times per week for 30 minutes a day and has a
history of cervical cancer.

Question 341 pts
The client, an 18-year-old female, 5’4” tall, weighing 113 kg, comes to the clinic for a
wound on her lower leg that has not healed for the last 2 weeks. Which disease process
would the nurse suspect that the client has developed?
Cannot be determined.
Type 1 diabetes.
Type 2 diabetes.
Gestational diabetes.

Question 351 pts
Which test is used to diagnose CAD?
All of the given options
Electrocardiogram
Cardiac catheterization
Treadmill stress test

Question 361 pts
A patient is receiving treatment for stable coronary artery disease. The doctor
prescribes the patient Plavix. What important information will you include in the patient’s
teaching?
1. If you are scheduled for any planned surgical procedures, let your doctor know
you are taking Plavix because this medication will need to be discontinued 5-7
days prior to the procedure.
2. A normal side effect of this medication is a dry cough.
3. Avoid green leafy vegetables while taking Plavix.
4. Notify the doctor, immediately, if you develop bruising, problems urinating, or
fever.
1,4
1,2
3,4
1,3

Question 371 pts
The nurse caring for a client diagnosed with ESRD writes a client problem of
“noncompliance of dietary restrictions.” Which intervention should be included in the
plan of care?
Explain the importance of eating the proper foods.
Refer the client and significant other to the dietician.
Teach the client the proper diet to eat while undergoing dialysis.
Determine the reason for the client not adhering to the diet.

Question 381 pts
A patient who has diabetes will be started on Metoprolol for medical management of
coronary artery disease. Which of the following will you include in your discharge
teaching about this medication?
Check your blood pressure regularly because this medication can cause hypertension.
Check your heart rate regularly because Metoprolol can cause an irregular heart rate.
Check your glucose regularly because this medication can cause hyperglycemia.
Check your glucose regularly because this medication can mask the typical signs and
symptoms of hypoglycemia.

Question 391 pts
The nurse understands that the client with right ventricular heart failure may develop
ascites. What is the physiologic change underlying this development?
Increased pressure within the circulatory system

Loss of cellular constituents in blood
Rapid osmosis from tissue spaces to cells
Rapid diffusion of solutes and solvents into plasma

Question 401 pts
The nurse assesses a client with heart failure who is receiving bumetanide and digoxin
for symptoms of electrolyte depletion. What does the nurse understand is the cause of
the depletion?
Continuous dyspnea
Sodium restriction
Inadequate oral intake
Diuretic therapy

Question 411 pts
The client diagnosed with ESRD is receiving peritoneal dialysis. Which assessment
data warrant immediate intervention by the nurse?
Inability to auscultate a bruit over the fistula.
The dialysate instilled into the client was 1500 mL and that removed was 1500 mL
The client’s abdomen is soft, is nontender, and has bowel sounds.
The dialysate being removed from the client’s abdomen is clear.

Question 421 pts
When teaching a client with angina how to use nitroglycerin, what should the nurse
instruct the client to do?
Place 1 tablet under the tongue 3 minutes before activity and repeat the dose in 5
minutes if pain occurs
Place 1 tablet under the tongue ans swallow another when pain is intense
Place 1 tablet under the tongue when pain occurs and use an additional tablet after the
attack to prevent recurrence
Place 2 tablets under the tongue when pain occurs

Question 431 pts
Which factor/a contribute/s to malnutrition in patients with liver failure? Select all that
apply.
Altered metabolism and storage of nutrients
Decreased oral intake
Altered renal problem
Altered mental status

Question 441 pts
The nurse is discussing the importance of exercising to a client diagnosed with Type 2
diabetes whose diabetes is well controlled with diet and exercise. Which information
should the nurse include in the teaching about diabetes?
Perform warmup and cooldown exercises.
Eat a simple carbohydrate snack before exercising.

Encourage the client to walk 20 minutes 3 times a week.
Carry peanut butter crackers when exercising.

Question 451 pts
A patient reports having crushing chest pain that radiates to the jaw. You administer
sublingual nitroglycerin and obtain a 12 lead EKG. Which of the following EKG findings
confirms your suspicion of a possible myocardial infraction?
ST segment elevation
QRS widening
absent P-wave
absent Q wave

Question 461 pts
A patient reports during a routine check-up that he is experiencing chest pain and
rests. What type of diagnostic tests will the physician most likely order (at first) for this
patient to evaluate the cause of the patient’s symptoms?
1. EKG
2. Stress test
3. Heart catheterization
4. Balloon angioplasty
3,4
1 only
1,2,3,4
1,2

Question 471 pts
After the bleeding is identified and bleeding is controlled, what is the drug of choice to
treat a nonvariceal bleed?
Antacids
Octreotide/Somatostatin
Histamine receptor antagonists
Proton pump inhibitors (PPIs)

Question 481 pts
The client diagnosed with lower GI bleeding and is crying and tells the nurse, “I can’t
take it anymore. I never know when I will get sick and end up here in the hospital.”
Which statement would be the nurse’s best response?
“I can see you are very upset. I’ll sit down and we can talk.”
“You must keep thinking about the good things in your life.”
“I understand how frustrating this must be for you.”
“Are you thinking about doing anything like committing suicide?”

Question 491 pts
You're providing education to a patient who will be undergoing a heart catheterization.
Which statement by the patient requires you to re-educate the patient about this
procedure?
“Not all patients who have a heart catheterization will need a stent placement.”
“The brachial artery is most commonly used for this procedure.”
“I will not be completely asleep and will be able to breathe on my own during the
procedure.”
“A dye is injected into the coronary arteries to assess for blockages."

Question 501 pts
One possible treatment for CAD is coronary angioplasty. What does it involve?
Medicine is used to expand the artery
A new section of artery replaces the blocked section
A tiny balloon is inflated inside an artery

Question 511 pts
The client diagnosed with ARF is placed on bed rest. The client asks the nurse, “Why
do I have to stay in bed, I don’t feel that bad.” Which scientific rationale would support
the nurse’s response?
Bed rest aids in reduction of peripheral and sacral edema.
Bed rest helps increase the blood return to the renal circulation.
Bed rest reduces the metabolic rate during the acute stage.
Bed rest decreases the workload of the left side of the heart.

Question 521 pts
The nurse is caring for a client with long-term Type 2 diabetes and is assessing the feet.
Which assessment data would warrant immediate intervention by the nurse?
The client has thickened toenails.
The client has athlete’s feet.
The client has a necrotic big toe.
The client has crumbling toenails.

Question 531 pts
The client with Type 2 diabetes controlled with biguanide oral diabetic medication is
scheduled for a computed tomography (CT) with contrast of the abdomen to evaluate
pancreatic function. Which intervention should the nurse implement?
Administer pancreatic enzymes prior to the test.
Obtain an informed consent form for the test.
Provide a high-fat diet 24 hours prior to test.
Hold the biguanide medication for 48 hours prior to test.

Question 541 pts
A client asks what the coronary arteries have to do with angina. When determining the
answer, the nurse should take into consideration that the coronary arteries carry blood:
From the aorta to the myocardium
To the endocardium
From the pulmonary system to the heart
To the lungs

Question 551 pts
The nursing assistant on the medical floor tells the primary nurse that the client
diagnosed with DKA wants something else to eat for lunch. What action should the
nurse implement?
Ask the assistant to obtain a glucometer reading.
Instruct the assistant to get the client additional food.
Notify the dietician about the client’s request.
Tell the assistant that the client cannot have anything else.

Question 561 pts
Which is a symptom of coronary artery disease?
Sleep problems
Diarrhea
Pain or discomfort in the chest, arms or lower jaw
Headache

Question 571 pts
The client is diagnosed with rule out ARF. Which condition would predispose the client
to developing pre-renal failure?
Hypotension.
Benign prostatic hypertrophy.
Intake of aminoglycosides.
Diabetes mellitus.

Question 581 pts
The client is diagnosed with GI bleeding due to ulcerative colitis. When assessing this
client, which sign/symptom would the nurse expect to find?
Twenty bloody stools a day.
Oral temperature of 102°F
Hard, rigid abdomen.
Urinary stress incontinence.

Question 591 pts
During a cardiac catheterization, blood samples from the client’s right atrium, right
ventricle, and pulmonary artery are analyzed for their O 2 Which does the nurse identify
as the expected finding?
The samples of blood all contain about the same amount of O2
Blood from the right atrium has less O2 than the right ventricle blood
All samples contain more O2 than does pulmonary vein
Pulmonary artery blood contains more O2 than the other samples

Question 601 pts
The client diagnosed with end-stage renal disease (ESRD) is experiencing metabolic
acidosis. Which statement best describes the scientific rationale for metabolic acidosis
in this client?
The kidney cannot excrete increased levels of acid because the kidneys cannot excrete
ammonia or cannot reabsorb sodium bicarbonate.
There is an increased excretion of phosphates and organic acids, which leads to an

increase in arterial blood pH.
A shortened life span of red blood cells because of damage secondary to dialysis
treatments. This, in turn, leads to metabolic acidosis.
An increase in nausea and vomiting causes a loss of hydrochloric acid and the
respiratory system cannot compensate adequately.

Question 611 pts
The client receiving dialysis is complaining of being dizzy and light-headed. Which
action should the nurse implement first?
Place the client in the Trendelenburg position.
Bolus the client with 500 mL of normal saline.
Notify the health-care provider as soon as possible.
Turn off the dialysis machine immediately.

Question 621 pts
Initial management of the patient with upper GI bleeding would include, which of the
following?
Identification of the site of bleeding
Hemodynamic stabilization
Initiation of treatment to control bleeding within 24 hours of admission

Volume resuscitation

Question 631 pts
The nurse administered 28 units of Humulin N, an intermediate-acting insulin, to a client
diagnosed with Type 1 diabetes at 1600. Which action should the nurse implement?
Ensure the client eats the bedtime snack.
Perform a glucometer reading at 0700.
Offer the client protein after administering insulin.
Determine how much food the client ate at lunch.

Question 641 pts
The client diagnosed with IBD is prescribed total parental nutrition (TPN). Which
Monitor the client’s oral food intake.
Assess the peripheral intravenous site.
Administer an oral hypoglycemic.
Check the client’s glucose level.

Question 651 pts
What effect does anxiety produce that makes it particularly important for the nurse to
allay the anxiety of a client with heart failure?
Produces an elevation in temperature
Interferes with usual respirations
Decreases the amount of O2 used
Increases the cardiac workload

Question 661 pts
A patient reports during a routine check-up that he is experiencing chest pain and
rests. This is known as:
Stable angina
Unstable angina
Variant angina
Prinzmetal angina

Question 671 pts
Which is one of the more common complications of myocardial infarction identified by
the nurse in the coronary care unit?
Anaphylactic shock
Dysrhythmia
Hypokalemia
Cardiac enlargement

Question 681 pts
The nurse in the dialysis center is initiating the morning dialysis run. Which client should
the nurse assess first?
The client who has hemoglobin of 9.8 mg/dL and hematocrit of 30%.
The client who is complaining of being exhausted and is sleeping.
The client who did not take antihypertensive medication this morning.
The client who does not have a palpable thrill or auscultated bruit.

Question 691 pts
A client is admitted with severe chest pain. What laboratory test should the nurse expect
the physician to order to confirm a diagnosis of myocardial infarction?
Potassium
Troponin
APTT
ALT

Question 701 pts
A client with episodes of a cardiac dysrhythmia is to wear a Holter monitor for 24 hours.
When planning teaching for the client, what information should the nurse include about
the monitor? The monitor:
Will record tracings of abnormal cardiac rhythms during activities of daily living
Can be taken off while bathing
Will assist in determining the size and contours of the heart

Can record activities and manifestations of responses

Question 711 pts
The client diagnosed with ARF has a serum potassium level of 6.8 mEq/L. Which
collaborative treatment would the nurse anticipate for the client?
Assess the client for leg cramps.
Type and cross-match for whole blood.
Administer a phosphate binder.
Prepare the client for dialysis.

Question 722 pts
The nurse knows that the following information have raised suspicions of acute liver
failure? Select all that apply.
INR of 2.0
Hepatitis infection
Short attention span
1st time hospitalization

Question 732 pts
The nurse will anticipate which of the following physician’s orders to manage the client’s
condition? Select all that apply.
Lactulose administration
Capillary blood glucose monitoring
Blood typing and cross-matching
High protein diet
RLE 2ND
Question 11 pts
Lyza, a 60-year-old female, with a diagnosis of diabetic ketoacidosis (DKA) is being
treated in the emergency department. Which findings would the nurse expect to note as
confirming this diagnosis? Select all that apply.
Low plasma bicarbonate level
Decreased urine output
Comatose state
Deep, rapid breathing
Elevated blood glucose level
Increase in pH

Question 21 pts
A nurse notes that a client with sinus rhythm has a premature ventricular contraction
that falls on the T wave of the preceding beat. The client’s rhythm suddenly changes to
one with no P waves or definable QRS complexes. Instead, there are coarse wavy lines
of varying amplitude. The nurse assesses this rhythm to be:
Asystole
Atrial fibrillation

Question 31 pts
A client with rapid rate atrial fibrillation asks a nurse why the physician is going to
perform carotid massage. The nurse responds that this procedure may stimulate the:
Vagus nerve to increase the heart rate; overdriving the rhythm.
Vagus nerve to slow the heart rate.
Diaphragmatic nerve to slow the heart rate.
Diaphragmatic nerve to overdrive the rhythm.

Question 41 pts
A client is diagnosed with an acute myocardial infarction and is receiving tissue
plasminogen activator, alteplase (Activase tPA). Which of the following is a priority
nursing intervention?
Check for liver enzyme

Check for cardiac muscle enzyme
Monitor for signs of bleeding
Monitor for renal failure

Question 51 pts
During hemodialysis, a patient complains of nausea and dizziness. Which action should
the nurse take first?
Check the patient's blood pressure
Check the patient's cardiac rate
Check the patient's respiratory rate
Check the patient's temperature

Question 61 pts
An adult who has 7-year-hidtory of hepatic cirrhosis was brought to the emergency
room because he began vomiting large amounts of dark-red blood. A Sengstaken-
Blakemore tube was inserted to tamponade the bleeding esophageal varices. While the
balloon tamponade is in place, the nurse caring for him gives the highest priority to
which of the following?
Assessing his stools for occult blood
Performing frequent mouth care
Evaluating capillary refill in extremities
Auscultating breath sounds

Question 71 pts
A 56-year-old client with hepatic cirrhosis related to 10-year history of alcohol abuse is
at risk for injury related to portal hypertension. Which of the following is the most
appropriate nursing action to decrease the client's risk of injury?
Offer small, frequent feedings
Keep his fingernails short
Assess for jaundice of skin and sclera
Observe stools for color and consistency

Question 81 pts
A 56 year old male was diagnosed with type 2 diabetes was admitted to the intensive
care unit with hyperosmolar hyperglycemic syndrome (HHS) . Which assessment data
should the nurse expect the client to exhibit?
Ketone breath odor.
Diarrhea and epigastric pain.
Kussmaul's respirations.
Dry mucous membranes.

Question 91 pts
While caring for a client who has sustained an MI, the nurse notes eight PVCs in one
minute on the cardiac monitor. The client is receiving an IV infusion of D5W and oxygen
at 2 L/minute. The nurse’s first course of action should be to:
Notify the physician promptly.
Increase the oxygen concentration.

Administer a prescribed analgesic.
Increase the IV infusion rate.

Question 101 pts
Mr. S, 45 years old, was rushed to ED of FUMC with the complaint of chest pain that
develop slowly patient describe as crushing and squeezing on substernal part.
Immediate management rendered. After 3 days in the hospital the doctor ordered the
patient is for discharge. Take home medications prescribed. Which of the following
medications will be prescribed to control angina?
Clopidogrel, amlodipine, carvedilol, nitrates
Nitroglycerin, amlodipine
All the options are correct
Amiloride, lovetalol, isosorbide, diltiazem

Question 111 pts
A patient with generalized edema is under diuretic therapy. The patient asks the nurse if
the treatment is meeting its goal. The nurse knows that the easiest and the best way to
determine the effectiveness of diuretic therapy is by performing which of the following?
Comparing plasma osmolality to baseline
Measuring the patient's weight
Checking for bipedal edema
Determining her serum sodium level

Question 121 pts
A client is having frequent premature ventricular contractions. A nurse would place a
priority on the assessment of which of the following items?
Blood pressure and peripheral perfusion.
Precipitating factors such as infection.
Sensation of palpitations.
Causative factors such as caffeine.

Question 131 pts
What is the appropriate infusion time for the dialysate in a 40-year-old female patient
with chronic renal failure undergoing peritoneal dialysis?
15 minutes
2 to 3 hours
1 hour
30 minutes

Question 141 pts
Which of the following arterial blood gas results should the nurse expect in the client
diagnosed with diabetic ketoacidosis?
pH 7.34, PaO2=99 mmHg, PaCO2=48 mmHg, HCO3=24 mEq/L.
pH 7.38, PaO2=95 mmHg, PaCO2=40 mmHg, HCO3 =22 mEq/L.

Question 151 pts
The nurse provides discharge instructions for a 64-year-old woman with ascites and
peripheral edema related to cirrhosis. Which statement, if made by the patient, indicates
teaching was effective?
herbs and spices should be used to season my foods instead of salt.
I will eat foods high in potassium while taking spinolactome (aldactone).
it is safe to take acetaminophen up to 4x a day for pain.
lactulose should be taken everyday

Question 161 pts
A patient came in with the following complaints increased urinary frequency, nocturia,
urgency, hesitancy, decreased force of urinary stream and dribbling. The nurse would
suspect which of the following?
Pyelonephritis
Acute glomerulonephritis
Benign prostatic hyperplasia
Honeymoon cystitis

Question 171 pts
A client with no history of heart disease has experienced acute myocardial infarction
and has been given thrombolytic therapy with tissue plasminogen activator. The nurse
identifies which of the following assessment findings as the most likely indicator that the
client is experiencing complications of the therapy.
Nausea and vomiting
Orange-colored urine
Decreased urine output
Tarry stools

Question 181 pts
A client with myocardial infarction has been transferred from the coronary care unit
(CCU) to the general medical ward. The nurse encourages which of the following
activity levels for the client immediately after transfer?
Skip activities because the client will be discharge soon
Unsupervised hallway ambulation for up to 200 feet
Bathroom privileges and self-care activities
Strict bed rest for 24 hours after transfer

Question 191 pts
Which assessment data should nurse Marie indicates the client diagnosed with diabetic
ketoacidosis is responding to the medical treatment?
The client is alert and oriented to date, time, and place.
The client's serum potassium level is 3.3 mEq/L.
The client has tented skin turgor and dry mucous membranes.
The client's ABG results are pH = 7.29, PaCO2 = 44mmHg, HCO3 = 15mEq/L.

Question 201 pts
Which of the following is most likely to result in acute liver failure?
Primary biliary cirrhosis
Primary sclerosing cholangitis
Acetaminophen toxicity
Hepatic cyst

Question 211 pts
A home care nurse has taught a client with a nursing diagnosis of Decreased cardiac
output about helpful lifestyle adaptations to promote health. Which of the following
statement by the client best demonstrates an understanding of the information
provided?
“I will try to exercise vigorously to strengthen my heart muscle”
“I will eat enough daily fiber to prevent straining at stool”
“Drinking 2-3 oz. of liquor each night will promote blood flow”
“I will drink 3000 – 3500 ml of fluid daily to promote good kidney function”

Question 221 pts
A client has developed atrial fibrillation, which has a ventricular rate of 150 beats per
minute. A nurse assesses the client for:
Hypertension and headache
Nausea and vomiting
Flat neck veins

Hypotension and dizziness

Question 231 pts
A 52-year-old client is admitted to the ICU diagnosed with diabetic ketoacidosis (DKA).
Which interventions should the nurse implement? Select all that apply.
Assess fluid volume status.
Maintain adequate ventilation.
Administer intravenous potassium.
Check for urinary ketones.
Monitor intake and output.

Question 241 pts
The nurse is reviewing the record of a client with a diagnosis of cirrhosis and notes that
there is documentation of the presence of asterixis. How should the nurse assess for its
presence?
Ask the patient to extend the arms.
Measure abdominal girth
Instruct patient to lean forward.
Dorsiflex the foot

Question 251 pts
A nurse is viewing the cardiac monitor in a client’s room and notes that the client has
just gone into ventricular tachycardia. The client is awake and alert and has good skin
color. The nurse would prepare to do which of the following?
Administer epinephrine (Adrenaline) intravenously.
Prepare for pacemaker insertion.
Administer amiodarone (Cordarone) intravenously.
Immediately defibrillate.

Question 261 pts
Nurse Theo is discussing ways to prevent diabetic ketoacidosis with the client
diagnosed with type 1 diabetes. Which instruction is most important to discuss with the
client?
Do not take any over-the-counter medications.
Refer the client to the Philippine Diabetes Association.
Explain the need to get the annual flu and pneumonia vaccines.
Take the prescribed insulin even when unable to eat because of illness.

Question 271 pts
Which of the following is the initial diagnostic test of choice for cirrhosis?
Abdominal X-ray
Abdominal ultrasonography
Liver biopsy
Abdominal CT

Question 281 pts
Anna a nurse assistant on the ICU tells the nurse that the client diagnosed with DKA
wants something else to eat for lunch. Which intervention should the nurse implement?
Request the Health Care Provider to increase the client's caloric intake.
Notify the dietitian about the client's request.
Instruct the nurse assistant to get the client additional food.
Tell the nurse assistant that the client cannot have anything else.

Question 291 pts
Acute renal failure (ARF) causes severe nutritional imbalances because nausea and
vomiting contribute to inadequate dietary intake, impaired glucose use and protein
synthesis, and increased tissue catabolism. Which of the following nursing actions
related to nutrition should not be included?
Provide high-carbohydrate meals
Daily measuring of weight
Bananas, citrus fruits and juices, coffee are restricted
Dietary proteins are limited to about 5g/kg

Question 301 pts
Nurse Ken teaches a client with diabetes mellitus about differentiating between
hypoglycemia and ketoacidosis. The client demonstrates an understanding of the
teaching by stating that glucose should be taken if which symptoms develop? Select all
that apply.
Fruity breath odor

Shakiness
Polyuria
Lightheadedness
Palpitations
Blurred vision

Question 311 pts
Patient Vina becomes restless and tells the nurse that she has a headache and feels
nauseous during hemodialysis. As a nurse which complication do you suspect?
Disequilibrium syndrome
Air embolism
Infection
Acute hemolysis

Question 321 pts
The client has end stage liver failure secondary to alcoholic cirrhosis. Which
complication indicates the client is at risk for developing hepatic encephalopathy?
Hypoalbuminemia
Hyperaldosteronism
Splenomegaly
Gastrointestinal bleeding

Question 331 pts
Nurse Jimmy is receiving in transfer from the PACU a client who has had percutaneous
ultrasonic lithotripsy for calculi in the renal pelvis. The nurse anticipates that the client’s
care will involve monitoring which of the following?
Ureteral stent
Nephrostomy tube
Jackson Pratt Drain
Suprapubic tube

Question 341 pts
The client diagnosed with end stage liver failure is admitted with esophageal bleeding.
The doctor inserts and inflates a triple- lumen nasogastric tube. Which nursing
intervention should the nurse implement for this treatment?
Monitor the client’s ammonia level.
Assess the gag reflex every shift.
Administer the laxative lactulose.
Stay with the client at all times.

Question 351 pts
A nurse is assessing an electrocardiogram rhythm strip. The P waves and QRS
complexes are regular. The PR interval is 0.16 second, and QRS complexes measure
0.06 second. The overall heart rate is 64 beats per minute. The nurse assesses the
cardiac rhythm as:
Normal sinus rhythm

Sinus bradycardia
First-degree heart block
Sick sinus syndrome

Question 361 pts
A client is admitted to the visiting nurse service for assessment and follow up after being
discharged from the hospital with new onset congestive heart failure (CHF). The nurse
teaches the client with the dietary restriction required with CHF. Which statement of the
client indicates that further teaching is needed?
“I’m not supposed to eat cold cuts”
“I can have most fresh fruits and fresh vegetables”
“I’m going to have a ham and cheese sandwich and potato chips for lunch”
“I’m going to weigh my weight daily to make sure that I don’t gain too much fluid”

Question 371 pts
What criteria should the nurse use to determine normal sinus rhythm for a client on a
cardiac monitor?
The RR intervals are relatively consistent.
The ST segment is higher than the PR interval.
Four to eight complexes occur in a 6-second strip.
The QRS complex ranges from 0.12 to 0.20 second.
One P wave precedes each QRS complex.

Question 381 pts
A nurse is performing an assessment on a client with the diagnosis of left-sided heart
failure. Which assessment component would elicit specific information regarding the
client’s left sided heart function?
Listening to lung sounds
Monitoring of cardiomegaly
Assessing for jugular vein distention
Assessing for peripheral and sacral edema

Question 391 pts
A nurse is watching the cardiac monitor and notices that the rhythm suddenly changes.
There are no P waves, the QRS complexes are wide, and the ventricular rate is regular
but over 100. The nurse determines that the client is experiencing:
Premature ventricular contractions
Sinus tachycardia

Question 401 pts
The nurse identifies the client problem as “excess fluid volume’’ for the client in liver
failure. Which short-term goal would be the most appropriate for this problem?
The client’s vital sign will remain within normal limits.
The client will receive a low-sodium diet.

The client will not gain more than two kg. a day.
The client will have no increase in abdominal girth.

Question 411 pts
The nurse is trying to determine the ability of the client with myocardial infarction (MI) to
manage independently at home after discharge. Which statement by the client is best
indicator of the potential for difficulty after discharge?
“I don’t have anyone to help me with doing heavy housework at home”
“I think I have good understanding of what all my medications are for”
“I need to start exercising more to improve my health”
“I will be sure to keep my appointment with the cardiologist”

Question 421 pts
Chronic renal failure or end stage renal disease is a progressive deterioration of renal
function which leads to the kidneys inability to metabolize and excrete wastes from the
body. Prompt management and interventions are then necessary to avoid further
aggravation of this disease. Possible complications of this disease are the following
apart from:
Bone diseases and calcifications
Hypokalemia
Anemia
Hypertension

Question 431 pts
Helping the patient attain adequate nutritional intake is very important in cases like
chronic renal failure. Which of the following guidelines should the nurse follow in taking
care of patients with chronic renal failure?
Provide patient’s food preferences and give as much as he wants
Alter schedule of medications so that they are not given immediately before meals
Avoid intake of high-biologic value protein foods
Encourage low-calorie, low-potassium, and low-sodium snacks between meals

Question 441 pts
A nurse notices frequent artifacts on the ECG monitor for a client whose leads are
connected by cable to a console at the bedside. The nurse examines the client to
determine the cause. Which of the following items is unlikely to be responsible for the
artifact?
Frequent movement of the client.
Leads applied over hairy areas.
Tightly secured cable connections.
Leads applied to the limbs.

Question 451 pts
During assessment of a patient with obstructive jaundice, the nurse would expect to
find:
dark urine and stool
clay colored urine

urobilinogen
pyrexia and pruritus

Question 461 pts
Larry a 59-year-old male is brought to the emergency department in FUMC in an
unresponsive state, and was diagnosed of hyperglycemic hyperosmolar state (HHS).
The nurse would immediately prepare to initiate which anticipated health care provider's
prescription?
Endotracheal intubation
100 units of NPH insulin
Intravenous infusion of sodium bicarbonate
Intravenous infusion of normal saline

Question 471 pts
A client with a bundle branch block is on a cardiac monitor. The nurse should expect to
observe:
Absence of P wave configurations.
Inverted T waves following each QRS complex.
Widening of QRS complexes to 0.12 second or greater.
Sagging ST segments.

Question 481 pts
A nurse is caring for a client with unstable ventricular tachycardia. The nurse instructs
the client to do which of the following, if prescribed, during an episode of ventricular
tachycardia?
Lie down flat in bed.
Breathe deeply, regularly, and easily.
Inhale deeply and cough forcefully every 1 to 3 seconds.
Remove any metal jewelry.

Question 491 pts
Patient Allan is receiving a peritoneal dialysis. As a nurse what should you do when you
notice the return fluid is slowly draining?
Place the patient in a reverse Trendelenburg position
Check for kinks in the outflow tubing
Raise the drainage bag above the level of the abdomen
Ask the patient to cough

Question 501 pts
A client with heart failure is to be discharged to home with digoxin (Lanoxin) and
furosemide (Lasix) as daily prescribed medications. The nurse tells the client to report
which of the following as an indication that the medications are not having the intended
effect?
Sudden increase in appetite
Increase urine output during the day
Weight gain of 2-3 lbs. in a few days
Cough accompanied by other signs of respiratory infection

Question 511 pts
Edison, a 60-year-old female is admitted to the intensive care department diagnosed
with severe hyperosmolar hyperglycemic syndrome (HHS). Which collaborative
intervention should the nurse include in the plan of care?
Perform blood glucometer checks daily.
Monitor arterial blood gas results.
Infuse 0.9% normal saline intravenously.
Administer intermediate-acting insulin.

Question 521 pts
Which of the following laboratory value reflects the decreased synthetic function of the
liver?
Hyponatremia
Elevated prothrombin time
Elevated bilirubin
Elevated AST and ALT

Question 531 pts
The client has had a liver biopsy. Which post procedure intervention should the nurse
implement?
Place the client on the right side
Instruct the client to void immediately.

Monitor BUN and creatinine level.
Keep the client NPO eight hours.

Question 541 pts
A 52-year-old is experiencing advanced hepatic cirrhosis now complicated by hepatic
encephalopathy. He is confused, restless, and demonstrating asterixis. Which of the
following completes the nurse's formulated nursing diagnosis of 'Disturbed thought
processes related to _______________________________________' ?
Increased serum ammonia levels
Massive ascites formation
Fluid volume excess
Altered clotting mechanism

Question 551 pts
A client with chronic renal failure has been prescribed calcium carbonate. What is the
rationale for this particular medication?
Increase tubular reabsorption of sodium
Binds with phosphorus to lower concentration
Alleviates constipation
Diminishes incidence of gastric ulcer formation

Question 561 pts
Nurse Abby is aware that the electrolyte replacement she should anticipate being
ordered by the health-care provider in the client diagnosed with DKA who has just been
admitted to the ICU?
Calcium.
Potassium.
Sodium
Glucose.

Question 571 pts
An 87-year-old widow was hospitalized for treatment of chronic renal failure. She lives
with her daughter and son in law and their family who are very supportive. She is now
ready for discharge. The doctor has ordered a high carbohydrate, low protein, and low
sodium diet for her so her family has asked for assistance in planning low sodium
meals. Which of the following choices best reflects the pre-discharge information the
nurse should provide for the client’s family regarding the low sodium diet?
Limit milk and dairy products and cook meals with iodized salt instead and encourage
increased fluid intake.
Use potassium salts in place of table salt when cooking and seasoning foods, read the
labels on packaged foods to determine sodium content and increase “snack” food.
Avoid eating in restaurant, soak vegetables well before cooking to remove sodium, omit
all canned foods and remove salt shakers from the table.
Avoid canned and processed foods, do not use salt replacements, substitute herbs and
spices for salt in cooking, and when seasoning foods, call a dietician for help

Question 581 pts
A client admitted with angina and history of DM type 2 is scheduled for cardiac
catheterization. Which of the following medications would need to be withheld for 48
hours before and after the procedure?
Glipizide
Metformin
Regular insulin
Repaglinide

Question 591 pts
The nurse is teaching an adult client who has type 1 diabetes mellitus about
ketoacidosis. The nurse explains that the primary cause of the development of
ketoacidosis is which of the following?
omitted meals
not taking insulin regularly
insulin overdosage
GI disturbance

Question 601 pts
A nurse is assigned to care for the client with a cardiac disorder and she told that a
client has an alteration in cardiac output. The nurse plans care with the understanding
that the heart normally sends out how many liters of blood per minute sends to the
body?
5 L/min
15 L/min
10 L/min
2 L/min.

Question 611 pts
The client diagnosed with end stage renal failure and ascites is scheduled for
paracentesis. Which client teaching should the nurse discuss with the client?
Explain the procedure will be done in the operating room.
Provide instructions on holding the breath when the doctor inserts the catheter.
Tell the client vital signs will be taken frequently after the procedure.
Instruct a client a Foley catheter will have to be inserted.

Question 621 pts
A 60-year-old patient with chronic renal failure reports pruritus. Which instruction should
the nurse include in this patient’s teaching plan?
Rub and skin vigorously with a towel
Apply alcohol-based emollients to the skin
Take frequent bath
Keep fingernails short and clean

Question 631 pts
A client with chronic renal failure has an internal venous access site for hemodialysis on
her left forearm. What action will the nurse take to protect this access site?
Keep the arm elevated above the level of the heart.

Do not use the left arm to take blood pressure readings.
Irrigate with heparin and NS 8hrs
Apply warm moist packs to the area after hemodialysis

Question 641 pts
The nurse is reviewing the lab. results for a patient with cirrhosis and notes the
ammonia level is elevated. Which diet does the nurse anticipates to be prescribed for
this patient?
Moderate –fat
High protein
Low protein
High-carbohydrate

Question 651 pts
A 71-year-old client is admitted to a hospital with a diagnosis of diabetic ketoacidosis
(DKA). The initial blood glucose level was 850 mg/dL. A continuous intravenous infusion
of short-acting insulin is initiated, along with intravenous rehydration with normal saline.
The serum glucose level is now 200 mg/dL. The nurse would next prepare to administer
which item?
Ampule of 50% dextrose
NPH insulin subcutaneously
Intravenous fluids containing dextrose
Phenytoin (Dilantin) for the prevention of seizures

Question 661 pts
The adaptations of a client with complete heart block would most likely include:
Cephalalgia and blurred vision
Syncope and slow ventricular rate
Flushing and slurred speech
Nausea and vertigo

Question 671 pts
A nurse is watching the cardiac monitor, and a client’s rhythm suddenly changes. There
are no P waves; instead, there are wavy lines. The QRS complexes measure 0.08
second, but they are irregular, with a rate of 120 beats a minute. The nurse interprets
this rhythm as:
Sinus tachycardia
Atrial fibrillation

Question 681 pts
Romeo was rushed to the emergency department and was diagnosed with HHS who
has a blood glucose of 680 mg/dl. Which question should the nurse ask the client to
determine the cause of this acute complication?
"Have you had some type of infection lately?"
"How long have you had diabetes?

"When is the last time you took your insulin?"
"When did you have your last meal?"

Question 691 pts
Martha was diagnosed with HHS was admitted at the ICU with a blood glucose level of
780 mg/dL. The client's blood glucose level is now 300 mg/dL. Which intervention
should the nurse implement?
Check the client's urine for ketones.
Increase the regular insulin IV drip.
Notify the physician to obtain an order to decrease insulin.
Provide the client with a therapeutic diabetic meal.

Question 701 pts
Elderly clients often lack the typical signs and symptoms of UTI. In an elderly client
suspected of having UTI, which of the following is considered as the most common
subjective finding?
Confusion
Hematuria
Decreased force of urinary stream
Generalized fatigue

Question 711 pts
Which of the following describes the best course of action for the management of acute
liver failure?
Supportive care and referral to a liver transplant for evaluation.
Liver Biopsy
Paracentesis
Endoscopy

Question 721 pts
The patient with advanced cirrhosis asks why is abdomen is swollen. The nurse’s best
response is based on the knowledge that:
bile salts in the blood irritate the peritoneal membranes, causing edema and pocketing
of fluid.
portal hypertension and hypoalbuminemia cause fluid shift to peritoneal space.
a lack of clotting factors promotes the collection of blood in the abdominal cavity.
decreased peristalsis in the GI tract contributes to gas formation and distention of the
bowel.

Question 731 pts
When ventricular fibrillation occurs in a CCU, the first person reaching the client should:
Administer oxygen.
Initiate CPR.
Defibrillate the client.
Administer sodium bicarbonate intravenously.

Question 741 pts
When planning care for a patient with cirrhosis, the nurse will give highest priority to
which nursing diagnosis?
ineffective breathing pattern related to pressure on diaphragm and reduced lung

volume.
impaired skin integrity related to edema, ascites and pruritus
imbalanced nutrition less than body requirements related to anorexia.
excess fluid volume related to portal hypertension and hyperaldosteronism.

Question 751 pts
A client has experienced a myocardial infarction. The nurse plans care for the client
knowing that the client’s chest pain is due to tissue hypoxia in which of the following
layers of the heart?
Endocardium
Parietal pericardium
Visceral pericardium
Myocardium

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RLE 1ST

1. Inform the patient that ECG may take about 10 minutes

Group of answer choices

P wave precedes every QRS complex

The ST segment is elevated

The PR interval is 0.24 second

The client will have no increase in abdominal girth.

The client will receive a low-sodium diet.

Chocolate candy and a banana

Peanut butter crackers and a glass of milk

Sugar and a slice of bread

Hard candy and fruit juice

Increased WBC count, pain with voiding

Weight gain, pain at graft site

Instruct client to use a soft toothbrush.

Monitor the platelet count.

Assess for asterixis.

Avoid obtaining rectal temperatures.

Use small-gauge needles.

Eliminate pressure at the penoscrotal angle.

Prevent the catheter from kinking in the urethra.

Prevent accidental catheter removal.

none of the above

insertion of the catheter

provides patient education about the procedure

Glucose in the urine but not in the blood

Ketones in the blood but not in urine

Urine negative for ketones and glucose in the blood

Urine and blood positive for both glucose and ketones

Wear synthetic fiber socks when exercising

Remove corns on the feet

Wear shoes that are larger to avoid friction

Potential for altered parenting related to disappointment

Potential impaired family coping related to diagnosis of gestational diabetes mellitus

Ineffective family coping related to anticipatory grieving

Potential non-compliance related to lack of knowledge or lack of adequate support

Assisting the client to take a hot soapy shower.

Putting mittens on both hands of the client.

Applying an emollient to the client’s legs and back.

Patting the client’s skin dry with a clean towel.

Instruct the client that a Foley catheter will have to be inserted.

Explain that the procedure will be done in the operating room.

Administer the laxative lactulose (Chronulac).

Stay with the client at all times.

Monitor the client’s ammonia level.

Assess the gag reflex every shift.

Not influenced by drugs

Done by the client

Report a bruit or thrill over the fistula to the doctor.

Palpate pulses above the fistula.

Avoid taking blood pressures in the arm with the fistula.

Insert I.V. lines above the fistula.

Apply alcohol-based emollients to the skin.

Take frequent baths.

Rub the skin vigorously with a towel.

Keep fingernails short and clean.

“The half-life is altered because the liver is damaged.”

All four limb leads

All six chest leads

The three limb leads

Removing metal accessories prior to placement of the leads.

Reposition the patient frequently and promote deep breathing

Infuse the dialysate slowly.