The hospice nurse informs the family that their loved one will likely

die within the next few days. Which are signs of the client's
impending death?
scant concentrated urine
gaunt and pale appearance
refusal of protein supplements
increased disorientation and lethargy
Increased dysphagia
decreased heart rate
As death approaches, clients may have an increased pulse and respiratory rate, but cardiac contractions
become weak and the pulse can be irregular. With lack of circulation and oxygenation, muscles weaken,
causing weakness, inability to eat or drink, and kidneys are not perfused. The client can become confused or
disoriented due to lack of oxygen to the brain. A gaunt or pale appearance is the result of poor muscle tone
and poor circulation.
Incorrect
Correct answer: 1,2,4,5

If a client is an Orthodox Jew, which foods are strictly forbidden in

their diet?
Eggs and ham
Black coffee
Boiled shrimp
Strawberries
Turnip greens
Pork chops
Kashrut is the body of Jewish law dealing with what foods can and cannot be eaten and how those foods
must be prepared. Among prohibited foods are: pork, shellfish, scavenger fish, and mammals that do not
chew cud or have cloven hooves. Food combinations are also important. Mixing dairy and meat in the same
meal is prohibited. Fish, eggs, fruits, vegetables, and grains can be eaten with either dairy or meat. Coffee is
allowed.
Incorrect
Correct answer: 1,3,6
HInt: living creatures consider unclean

Pre-op care for an infant is similar to care for other age groups.

The nurse is providing care for a 2-month-old infant scheduled for a

pyloromyotomy. Which of the following pre-operative actions can
the nurse expect to perform? Select all that apply.
Keep NPO as ordered before surgery.
Review coagulation study results.
Allow breastfeeding 1 hr before surgery.
Avoid all pre-operative sedation.
Place NG tube to low suction.
Begin IV fluids at maintenance rate.
Infants undergoing surgery follow similar guidelines to other age groups, except clear liquids may be offered
up to 2-3 hours before the procedure, depending on surgeon's orders. Breast milk can be given 4 hours
before, formula 6 hours before. Starting IV access at a KVO/maintenance rate and inserting an NG tube at low
suction are appropriate. Pre-operative administration of sedatives or analgesics is appropriate and will be
ordered by the surgeon or anesthesiologist. Coagulation studies are not routinely done for this procedure.
Pyloric stenosis is a thickening or swelling of the pylorus muscle that causes severe and forceful vomiting. It
occurs most frequently between 2-8 weeks of age. Surgery (pyloromyotomy) is necessary to treat pyloric
stenosis. The procedure may be performed through a periumbilical incision or laparoscopically. divides the
thickened outer muscle, while leaving the internal layers of the pylorus intact. This opens a wider channel to
allow the contents of the stomach to pass more easily into the intestines.
Incorrect
Correct answer: 1,5,6

When caring for a client with pneumonia, which findings are

consistent with hypoxia?
Cough
Restlessness
Tachypnea
Cyanosis
Use of accessory muscles
Fever
A client's initial response to hypoxia is to appear restless and anxious. The respiration rate increases in an
attempt to breathe in more oxygen. If that doesn't supply adequate oxygen, accessory muscles are
automatically used to increase respiratory volume. A late-stage hypoxia sign is cyanosis. Cough and fever are
related to the pneumonia, not the hypoxia.
Correct
2,3,4,5

Abnormal lab results are related to WBCs.

Following a lumbar puncture, the nurse reviews the results of a
client's cerebrospinal fluid (CSF). Which findings indicate possible
bacterial meningitis?
Elevated glucose
Clear CSF appearance
Turbid CSF appearance
Low glucose
Scant red blood cells
Increased neutrophils
Normal CSF is clear. Turbid or cloudy appearance is related to the WBCs in the CSF. An elevated neutrophil
count indicated infection. The CSF glucose level is low because neutrophils require it to fight the infection.
Correct
3,4,6

A client with a diagnosis of schizophrenia is experiencing active

hallucinations. Choose all the appropriate nursing actions.
Explain others are seeing the same things.
Ask if any voices are telling him to hurt himself.
Distract the client with a movie or game.
Use therapeutic touch to reassure the client.
Administer medications as ordered.
Agree with the client's impressions.
No matter the client or the situation, protecting their safety is the nurse's main concern. Administering
prescribed medications is essential. Determining if the client intends to harm himself or others is important.
Hallucinating client should not be touched or placed in an environment with increased stimulation. Telling
the client that others are experiencing the same thing or agreeing with him does not help the client return to
reality.
Incorrect
Correct answer: 2,5

The goal is to maintain an open airway and to prevent entrapment.

The nurse is preparing a presentation for expectant parents on how
to reduce the risk of Sudden Infant Death Syndrome (SIDS). Which
of the following measures should the nurse include? Select all that
apply.
Place the infant on their back for sleep.
Keep the infant in the parents' bedroom.
Use a rolled blanket or wedge for side-lying.
Avoid offering the infant a pacifier.
Do not allow any smoking in the home.
Install bumper pads on the crib.
The American Academy of Pediatrics 2016 Recommendations for a Safe Infant Sleeping Environment include:
1. Place the infant in the supine sleeping position for every sleep until I year old; 2. Use a firm sleep surface,
with only a fitted sheet. No other bedding or soft objects should be in the sleep area; 3. Sitting devices, such
as car seats, infant carriers, or swings, are not recommended, especially for infants under 4 months; 4.
Breastfeeding is recommended; 5. Infants should sleep in the parents' room, but on a different surface, at
least for the first 6. months; 6. Keep soft objects and loose bedding away from the sleep area: blankets,
pillows, bumper pads, and toys; 7. Offer a pacifier at nap and bedtime; 8. Avoid smoke exposure during
pregnancy and after birth; 9. Avoid alcohol and illicit drug use during pregnancy and after birth; 10. Avoid
overheating and head covering in infants.
Incorrect
Correct answer: 1,2,5

When the nurse tries to assist a patient who just had abdominal
surgery stand, the patient collapses back into bed. Which of the
following indicate that the client might be experiencing orthostatic
hypotension?
Bradycardia
Nausea
Confusion
Blurry vision
Dizziness
Facial flushing
Orthostatic hypotension can happen when a person with normal blood pressure displays symptoms of low
blood pressure when moving to an upright or standing position. Symptoms can include fainting, weakness,
dizziness, lightheadedness, confusion, nausea, blurry vision, or report of seeing spots.
Incorrect
Correct answer: 2,3,4,5

firm
All school-age children want honesty and to be part of the process.
The hospice nurse is caring for a 10-year-old who is terminally ill.
Which of the following nursing interventions meet the
developmental needs of a school-age child? Select all that apply.
Assure them they will feel better soon.
Give honest answers when asked.
Include the child in making decisions.
Use phrases such as "passing away."
Avoid topics that produce anxiety.
Provide the child a sense of control.
School-age children are beginning to understand that death is a final separation. They may fear being alone
or leaving their family behind. They may ask questions about the dying process. The nurse and the child's
family should include the child in making decisions such as what to wear or eat; where to sleep; when to
perform some tasks or procedures. Having a sense of control is important for the child; they don't want to
feel helpless or treated like a baby. Honesty is essential; questions should be answered in a way that the child
understands. False assurances, avoiding uncomfortable topics, and using indirect language are not
appropriate.
Incorrect
Correct answer: 2,3,6

During an outbreak of conjunctivitis (pink eye), the school nurse

sends a communication to parents about preventing further spread
of the condition. Which recommendations are appropriate to
include?
Sanitize all flat surfaces.
Wash hands often.
Wear sunglasses when going out.
Use a clean washcloth daily.
Avoid touching the face and eyes.
Stop using mascara for a week.
Conjunctivitis (pink eye) is very contagious. To avoid spreading it, people should avoid touching their face or
eyes with their hands; wash hands or use an alcohol-based hand sanitizer that is at least 60% alcohol; use a
clean washcloth and towel every day; change pillowcases often; and do not share any personal items with an
infected person. If infected, throw away eye or face makeup used. Clean eyeglasses and cases, discard
contact solutions, and replace or clean contact lenses, if they were used while infected.
Incorrect
Correct answer: 2,4,5
 Recall that Parkinson's disease symptoms are related to a deficient supply of dopamine.

When caring for a client with a diagnosis of Parkinson's disease,

which of the following can the nurse expect to find?
dysphagia
unstable posture
resting tremor
flat affect
big handwriting
hyperkinesia
Dopamine sends messages to the part of the brain that controls movement and coordination. When the
neurotransmitter dopamine level is insufficient, the client may be unable to control muscles, resulting in a
resting tremor (usually unilateral), hypokinesia, bradykinesia, dysphagia, and flat affect. Postural instability is
noted when the client walks in a forward-leaning manner, and a shuffling gait. Handwriting tends to become
small and cramped.
Incorrect
Correct answer: 1,2,3,4

Nitroglycerin causes vasodilation.

When teaching a client about the side effects of nitroglycerin
tablets, which of the following should be included?
Hypertension
Headache
Confusion
Dizziness
Flushing
Sweating
Side effects of nitroglycerin include headache, flushing, hypotension, and dizziness. All are related to the
vasodilation action of the medication.
Incorrect
Correct answer: 2,4,5
Client safety and comfort are priorities.
Following a total knee arthroplasty (TKA), a 79-year-old female
becomes confused and attempts to get out of bed. She has also
pulled out two IVs and was stopped just before pulling out her
Foley catheter. The nurse notifies the provider and receives an
order for soft wrist restraints. Which actions are appropriate for this
client?
Remind the client to behave.
Offer toileting every two hours.
Tie restraints to the bed rail.
Use a quick-release knot.
Assess the skin for redness.
Give fluids frequently.
Wrist restraints are meant to prevent the client from pulling out tubes, not as a punishment. Client safety
and comfort remain priorities. The client should receive fluids, and the skin at her wrists should be assessed
every two hours for redness and integrity. A client without a Foley should be offered toileting every two
hours. The client should be reassured and supported during the period of confusion. Restraints are secured
on the bed frame with a quick-release knot.
Incorrect
Correct answer: 4,5,6

Always follow-up on unusual behavior or signs not consistent with the child's age.
Which nursing assessment findings are consistent with suspicions
that a toddler may have been sexually abused?
The child is too thin for their height.
The child can use a doll to show sexual activity.
The child has new adult words for body parts.
The child shows fear around the perpetrator.
The child has blood stains on their underwear.
The child is unable to sleep all night.
Warning signs of sexual abuse include: Sexual knowledge that is inappropriate for the child's age;
unexplained genital discomfort or signs of genital bleeding; experiencing nightmares or trouble sleeping
through the night, acquiring a sexually-transmitted disease, or displaying fear or not wanting to be alone with
a specific person.
Incorrect
Correct answer: 2,3,4,5,6
An LPN/LVN can generally perform tasks involving oral medication administration, feeding,
elimination, and ADL.
The charge nurse on a pediatric unit is making shift assignments.
Which of the following tasks can be appropriately assigned to an
LPN/LVN? Select all that apply
Administering a medication by IV push
Provide discharge teaching for a simple post-op surgery.
Insert a child's hearing aids
Insert an indwelling urinary catheter.
Contacting the HCP with abnormal lab results
Give gastronomy tube feedings
The LPN/LVN scope of practice includes administering oral medications, as well as tasks that involve feeding
and activities of daily living (ADL). Some facilities may allow for IV push administration, but special training is
necessary. Contacting the HCP with lab results and providing discharge instructions require assessment and
higher level skills, which are beyond the scope of practice for the LPN/LVN.
Incorrect
Correct answer: 3,4,6
While some medications are known to cause constipation, other common drugs can, as well.
At a Senior Center health fair, a 72-year-old woman approaches the
nurse privately to ask for a recommendation for an over-the-
counter laxative. Before the nurse continues, he asks the woman
what medications she's currently taking. Select the types of
medications known to contribute to constipation.
NSAIDs
Iron supplements
Tricyclic antidepressants
Antibiotics
Antacids
Opioids
Constipation is defined as stool frequency of fewer than 3 times/week. NSAIDs (Non-steroidal anti-
inflammatory drugs, including ibuprofen and naproxen, can cause constipation if used daily. Tricyclic
antidepressants (Elavil, Pamelor) are anticholinergics, with a side effect of constipation. Antacids with
aluminum or calcium can contribute to constipation. Opioids and iron supplements are known for causing
constipation. Antibiotics rarely cause constipation.
Incorrect
Correct answer: 1,2,3,5,6

nfirm
Shapes and textures can cause aspiration.

At a community health fair, the nurse gives a presentation on

childhood choking risks. Which foods should parents avoid for
children under 3-years-old?
cooked carrots
ground beef
grapes
popcorn
hot dogs
marshmallows
Foods that are hard, round, compressible, or difficult to chew present a choking risk for children aged 3 and
under. Popcorn and marshmallows can conform to the shape of the child's throat. Hot dogs can be difficult to
chew and obstruct the throat. Whole grapes can obstruct the airway.
Correct
3.4.5.6

rm
D - Diuresis, Delirium / Dizziness, Dehydration K - Kussmaul Breathing, Ketotic Breath A -
Abdominal Pain.
A 20-year-old college student with a known diagnosis of type 1
diabetes is brought to the Emergency Department by his roommate.
The roommate states that the client "seems sick and has been
 acting strange." Which signs and symptoms indicate possible
ketoacidosis?
lack of thirst
abdominal pain
fruity-smelling breath
confusion
Kussmaul breathing
anuria
Diabetic ketoacidosis (DKA) is a serious condition that requires immediate intervention. Common signs and
symptoms include: 1. Kussmaul breathing (characteristic hyperventilation); 2. Extreme thirst; 3. Frequent
urination; 4. Nausea and vomiting; 5. Fruity-smelling breath; 6. Confusion and foggy thinking; 7. Fatigue and
lethargy; 8. Abdominal pain; 9. Tachycardia.
Correct
2345

Consider the consequences of a low fluid volume.

Which of the following signs and symptoms are consistent with a

diagnosis of severe dehydration?
poor skin turgor
dry oral mucosa
bradycardia
decreased hematocrit
dizziness
urine Sp Gr 1.008
Dehydration is indicated by: 1. Increased hemoglobin and hematocrit; 2. Increased urine specific gravity of
>1.028; 3. Poor skin turgor; 4. Dry mouth, lips, and nasal passages; 5. Tachycardia; 6. Dizziness and weakness;
7. Fever; 8. Sunken eyes.
Incorrect
Correct answer: 1,2,5

Tyramine is the enemy.

The provider has ordered isocarboxazid (Marplan) for a client with a
diagnosis of depression. Which foods should the nurse instruct the
client to avoid?
Apples
Broccoli
Bananas
Figs
Sauerkraut
Soybeans
Foods that contain tyramine should be restricted when taking an MAOI medication, to avoid a hypertensive
crisis. Monoamine oxidase is a natural enzyme that breaks down serotonin, epinephrine, and dopamine.
MAOIs block the effects of this enzyme. As a result, the levels of those neurotransmitters might get a boost.
Other foods to avoid include avocados, fermented meats and fish, aged cheeses, yeast extracts, and some
beers and wines.
Incorrect
Correct answer: 3,4,5,6

21/30ProgressHintConfirm
Sickle cell crisis results from hypoxia.
The nurse is caring for a 7-year-old admitted for sickle cell (vaso-
occlusive) crisis. Which of the following orders by the health care
professional (HCP) should the nurse question? Select all that apply.
Warm compresses to affected areas.
Nasal cannula to keep O2 sat at 88%.
Elevate and support affected joints.
Maintain NPO status. Mouth care q 2 hr.
Penicillin 250 mg PO bid.
Acetaminophen PRN for complaint of pain.
Pain from the hypoxia of a sickle сell vaso-occlusive crisis can be excruciating. Morphine is the drug of choice,
administered by parenteral route round the clock—not PRN. Fluids are encouraged to prevent the sickle-
shaped RBCs from clumping. O2 saturation >92% is acceptable, If supplemental O2 is required, delivery by
nasal cannula at 1.5-2L/min is usually prescribed. The other options are appropriate when treating a client
with sickle cell crisis: 1. Elevate and extend affected extremities to reduce swelling and increase blood flow; 2.
Warm compresses relieve pain. (Cold compresses can lead to further sickling.); 3. Penicillin (or other
antibiotic) can prevent infection in children with sickle cell disease. For children > 5 years through
adolescence, a typical prophylactic dose is 250 mg PO bid.
Incorrect
Correct answer: 2,4,6
Signs and symptoms indicate sympathetic nervous system stimulation.
A client comes to the Emergency department complaining of chest
pain. Further assessment reveals the cause of the chest pain is a
panic attack. Which findings support this diagnosis?
Hypotension
Unsteady gait
Constricted pupils
Hypersalivation
Diaphoresis
Tachycardia
Panic attacks are a type of anxiety disorder. Physical symptoms reflect the release of adrenaline, including
tachycardia, palpitations, sweating, an unsteady gait, dizziness, and choking sensations. Sympathetic nervous
system stimulation is also indicated by hypertension , dilated pupils, and a dry mouth. Clients may believe
they are having a heart attack, or even dying.
Incorrect
Correct answer: 2,5,6
Consider why the client might be complaining of "feeling full."
During a tube feeding via gastrostomy, the client tells the nurse that
he already feels full, as well as nauseated. Select the appropriate
nursing actions.
Stop the infusion for an hour.
Place client on his right side.
Try another type of formula.
Administer an antiemetic.
Dilute the formula with water.
Measure the gastric residual.
Feeling full and nauseous are signs of delayed gastric emptying. Stop the feeding for an hour and reassess.
Placing the client on his right side may help the stomach empty and relieve the symptoms. Gastric residual is
measured before the infusion begins. Adding water will only increase the volume. An antiemetic is not
appropriate at this point, nor is changing the type of formula.
Incorrect
Correct answer: 1,2

Consider what can affect both analysis and reporting.

The ICU nurse draws a blood sample to send to the laboratory for
an arterial blood gas (ABG) analysis. Select the appropriate
information that should be included on the lab requisition label.
Known allergies
Site of blood draw
Date/time of draw
Ventilator settings
Client name or ID
Client's temperature
ABG analysis requires several pieces of information to be accurate: the ventilator setting, client's
temperature, and the date/time of the arterial blood draw. Client name, ID, or medical record number are
necessary for proper reporting and documentation. Specimens are labeled at the client's bedside, using an
indelible pen. Hospitals may require additional information, such as client room number, name or initials of
the person doing the blood draw, etc.
Correct
23456
The sudden overactivity of the sympathetic branch of the autonomic nervous system is a
medical emergency.
A client with a T4 spinal cord injury is at risk for autonomic
dysreflexia. Which of the following are signs and symptoms of this
clinical disorder?
Tachycardia
Pale skin
Severe headache
Diarrhea
Extreme hypertension
Blurred vision
Autonomic dysreflexia is an emergency situation in which there is a sudden onset of extreme hypertension,
bradycardia, pounding headache, blurry vision, flushed skin, nasal stuffiness, sweating above the area of
injury, and goose bumps below the area of injury. It is more common in people with spinal cord injuries that
involve the thoracic nerves of the spine or above (T6 or above). It is often triggered by a full bladder or fecal
impaction. It can be life-threatening and requires immediate intervention.
Incorrect
Correct answer: 3,5,6
Ability to decide and full knowledge of what directly impacts the client.
Which of the following are necessary elements of an informed
consent?
method of anesthesia
alternative options
reason for the procedure
length of the procedure
risks and benefits
decision-making capacity
The American Medical Association developed the components for informed consent: 1. Explanation of the
diagnosis; 2. Nature and reason for the treatment or procedure; 3. Risks and benefits; 4. Alternative options,
regardless of cost or insurance coverage; 5. Risks and benefit of alternative options; 6. Risks and benefit of
not having the treatment or procedure. In addition, law and ethics dictate that the client (or surrogate) must
have the capacity or ability to give an informed consent.
Incorrect
Correct answer: 2,3,5,6
The radioisotope that is a glucose transporter. This radioisotope will go to any metabolically
active areas in the body.
The nurse is educating a client who is scheduled for a Positron
Emission Tomography (PET) scan. Which foods or liquids are
avoided for 24 hours prior to the scan?
Eggs
Alcohol
Milk
Sugar
Caffeine
Rice
Clients should eat a low carbohydrate diet. The radioisotope used for the PET scan is a glucose transporter
and will go to any metabolically active areas in the body. If the glucose levels are elevated from food or drink
the patient consumed prior to the test, the level of insulin will increase, causing the muscles to take up the
glucose, rather than the areas of interest that are the reason for the scan. Foods that can be eaten include:
meat, hard cheese, tofu, eggs, butter, and vegetables with no starch. Some foods that are NOT allowed
include: cereal, pasta, milk, breads and other sugars, including alcohol. Caffeine is avoided because it is a
diuretic.
Incorrect
Correct answer: 2,3,4,5,6

Triggers result in lack of sufficient oxygenation.

Which precipitating factors can trigger a sickle cell crisis?
Dehydration
Smoking
Fever
Overexertion
Hypoglycemia
Winter
A sickle cell crisis can be triggered by events that result in insufficient oxygen delivery to the cells. Possible
causes include overexertion, stress, dehydration, cold environments, and smoking.
Incorrect
Correct answer: 1,2,4,6
onfirm
Remember "FIGHT".
The nurse is planning a presentation on Post-Traumatic Stress
Disorder (PTSD) at the Veterans Administration. Which are PTSD
characteristics to include in the presentation?
Difficulty concentrating
Angry outbursts
Easily startled
Recurring nightmares
Auditory hallucinations
Volatile emotions
Post-Traumatic Stress Disorder is an anxiety disorder that develops after exposure to a terrifying or life-
threatening events. Clients with PTSD often re-experience their trauma in ways such as nightmares or
flashbacks. They are easily startled and have difficulty concentrating. Some clients have visual hallucinations.
In addition, clients tend to avoid places, people, and circumstances that trigger reminders of their traumatic
events. A way to remember the criteria for a PTSD diagnosis is FIGHT. F=Flight, or avoidant symptoms,
including people or places that are reminders. I=Intrusive symptoms, such as dreams, memories, and
physiological responses. G= Gloomy cognitions. Negative cognitions and mood associated with the traumatic
event. H=Hypervigilance. Alterations in arousal, such as irritability, angry outbursts, reckless behavior, and
exaggerated startle response. T=Trauma, the exposure to actual or threatened death, injury, or violence.

Incorrect
Correct answer: 1,2,3,4

Kidneys are unable to filter and produce erythropoietin.

Which findings are typical of end-stage renal disease?
increased albumin levels
increased serum calcium
Iron-deficient anemia
decreased creatinine clearance
metabolic acidosis
respiratory alkalosis
ESRD results in the following: 1. Decreased creatinine clearance, secondary to decreased glomerular filtration
rate. Serum creatinine and BUN levels rise. 2. Metabolic acidosis results when kidneys are unable to excrete
ammonia and reabsorb Sodium Bicarbonate (NaHCO3). 3. When kidneys are no longer able to produce
erythropoietin, which stimulates the bone marrow to produce more red blood cells, the result is iron-
deficient anemia. The other options are incorrect.
Incorrect
Correct answer: 3,4,5