Republic of the Philippines

PROFESSIONAL REGULATION COMMISSION

Manila

BOARD OF NURSING

Philippine Nurse Licensure Examination

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NURSING PRACTICE III – CARE OF CLIENTS WITH PHYSIOLOGIC ALTERATIONS A

INSTRUCTION: Select the correct answer for each of the following

questions. Mark only one answer for each item by shading the box
corresponding to the letter of your choice on the answer sheet provided.
STRICTLY NO ERASURES ALLOWED

Situation: To effectively assess and manage patients with pain, you need
to understand the physiologic and psychosocial dimensions of pain.

1. Why does the nurse always ask the client his or her pain level after
taking routine vital signs?
a. To determine whether pain is influencing blood pressure and heart rate
b. To determine the need for more frequent vital sign measurement
c. To ensure that pain assessment occurs on a regular basis
d. To follow McCafferys guidelines on pain management

2. The nurse is caring for a client who was medicated for pain 1 hour ago.
The client states that the medication is not working and the pain is still
present. What is the first action that the nurse will take?
a. Assess the client to determine a pain score.
b. Believe the client’s report of pain.
c. Wait until it is time for the next pain medication dose.
d. Teach the client how to use guided imagery.

3. The physician orders a dose of medication that does not resolve the
client’s chronic pain. When the nurse questions the order, the physician
explains that he or she fears the client will develop an addiction with
higher drug dosages. What is the nurses best response?
a. Administer the medication as ordered.
b. Assist the client to use guided imagery.
c. Consult with the pain control specialist.
d. Explain to the client that lower doses are better.

4. A client who has been taking oxycodone (OxyContin) for an extended

period of time comes to the clinic reporting that the drug is no longer
relieving his pain. Which category would be given to the client’s
complaint?
a. Addiction
b. Physical dependence
c. Pseudoaddiction

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d. Tolerance

5. A home care client who is taking morphine for pain management abruptly
stops taking the medication. Which symptom would indicate physical
dependence?
a. Abdominal cramping
b. Craving for morphine
c. Decreased heart rate
d. Elevated temperature

Situation: Effective nursing interventions require an understanding of the

multiple processes that maintain fluid, electrolyte, and acid–base balance
and an understanding of the causes and treatment of imbalances that occur.

6. The client is taking a medication that inhibits aldosterone secretion

and release. The nurse assesses for what potential complication?
a. Fluid retention
b. Hyperkalemia
c. Hyponatremia
d. Hypervolemia

7. Which assessment does the nurse use to determine the adequacy of

circulation in a client whose blood osmolarity is 250 mOsm/L?
a. Measuring urine output
b. Measuring abdominal girth
c. Monitoring fluid intake
d. Comparing radial versus apical pulses

8. Which assessment finding obtained while taking the history of an older

adult client alerts the nurse that the client needs further assessment for
fluid or electrolyte imbalance?
a. I am often cold and need to wear a sweater.
b. I seem to urinate more when I drink coffee.
c. In the summer, I feel thirsty more often.
d. My rings seem to be tighter this week.

9. Which client is at greatest risk for dehydration?

a. Younger adult client on bedrest
b. Older adult client receiving hypotonic IV fluid
c. Younger adult client receiving hypertonic IV fluid
d. Older adult client with cognitive impairment

10. A client is being treated for dehydration. Which statement made by the
client indicates understanding of this condition?
a. I must drink a quart of water or other liquid each day.
b. I will weigh myself each morning before I eat or drink.
c. I will use a salt substitute when making and eating my meals.
d. I will not drink liquids after 6 PM so I wont have to get up at night.

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Situation: Surgery is an invasive medical procedure performed to diagnose
or treat illness, injury, or deformity. Although surgery is a medical
treatment, the nurse assumes an active role in caring for the patient
before, during, and after surgery.

11. A client voluntarily signed the operative consent form. What is the
nurses next action?
a. Teach the client about the surgery.
b. Have family members witness the signature.
c. Sign under the client’s name as a witness.
d. Call for the physician to sign the form.

12. The nurse is caring for an older adult client with a history of
chronic lung disease who will be undergoing surgery the following day.
When postoperative care is planned, which potential problem is the highest
priority for this client?
a. Maintaining oxygenation
b. Tolerating activity
c. Anxiety and fear
d. Hypovolemia

13. The nurse is completing preoperative teaching for a client, and it

becomes apparent that the client does not understand the surgery that will
be performed. What is the priority action for the nurse?
a. Obtain informed consent from the client.
b. Continue teaching the client about the surgery.
c. Revise the teaching plan for the client.
d. Notify the surgeon and document the finding.

14. During the preoperative assessment, the client tells the nurse that he
smokes three packs of cigarettes daily. Which action by the nurse is best?
a. Call the surgeon to cancel the surgery.
b. Have baseline laboratory studies drawn.
c. Perform a respiratory assessment.
d. Give a nebulizer treatment.

15. When the nurse brings a client’s preoperative medications, the client
responds, I don’t need that. I had a good night sleep last night. What is
the nurses best response?
a. The doctor ordered this medication so you should take it.
b. I will make a note that you refused to take the medication.
c. I will ask your surgeon if you have to take the medication.
d. Let me teach you about your medications for surgery.

16. When examining an adult client’s preoperative laboratory results, the

nurse notes that the potassium level is 2.9 mEq/mL. What is the nurse’s
priority action?
a. Document the finding.
b. Alter the client’s diet to include fruit.

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c. Increase the IV flow rate.
d. Notify the surgeon.

17. What recently learned information about a client who is scheduled to

have surgery within the next 2 hours is the nurse certain to communicate
to the surgical team?
a. An allergy to cats
b. Hearing problem
c. Consumption of a glass of wine 12 hours ago
d. Taking 2000 mg of vitamin C each day

18. A client will be undergoing palliative surgery. The client’s daughter

asks what this means. What is the nurses best response?
a. The surgery will relieve the symptoms but will not cure your father.
b. There are fewer risks with this type of surgery.
c. There is no guarantee of the outcome of the surgery.
d. The surgery must be performed immediately to save your father’s life.

19. A client undergoing preoperative assessment informs the nurse that he

takes medication for high blood pressure and for asthma. What is the
nurses best action?
a. Tell the client not to take the medication on the day of surgery.
b. Notify the surgeon and the anesthesiologist.
c. Document the information in the client’s record.
d. Tell the client to take medications preoperatively with a sip of water.

20. Which action is most appropriate during a preoperative chart review?

a. Ensure that the consent form is signed, dated, and witnessed.
b. Call the surgeon if the client has any food allergies.
c. Make sure all marks are washed off the surgical site.
d. Make sure the client understands the procedure.

Situation: Knowing about the activities that occur when a patient is moved
into the surgical suite allows you to provide explanations and
reassurances, especially to the anxious patient

21. Which observed action indicates that the nurse is performing the
surgical scrub correctly?
a. A small brush is used to scrub under nails and wedding ring.
b. The surgical mask is put on before starting the surgical scrub.
c. The soap is rinsed off so that the water runs down to the hands.
d. A paper towel is used to turn off the faucet handle.

22. Which action indicates to the operating room supervisor that the scrub
nurse requires additional teaching about sterile technique?
a. A small amount of sterile saline is poured out before it is poured into
the basin.
b. The nurse disposes of any equipment packages that are in poor
condition.

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c. Sterile surgical supplies are placed in the center of the sterile
field.
d. The sterile saline bottle cap is placed in the center of the sterile
field.

23. Before a client’s surgery begins, the circulating nurse notes that the
nurse anesthetist did not perform a surgical scrub before coming into the
operating room. Which action by the circulating nurse is most appropriate?
a. Direct the nurse anesthetist to perform the surgical scrub immediately.
b. Proceed with positioning the client on the operating bed.
c. Notify the nursing supervisor that sterile technique has been violated.
d. Proceed with setting up the instruments to be used during surgery.

24. The client is to have a surgical procedure under (moderate) conscious

sedation. The client is anxious and asks the nurse what to expect. What is
the nurses best response?
a. You will be awake and alert during the procedure but you will feel no
pain.
b. You will not be able to move your feet or toes during the procedure.
c. You will not be able to swallow or talk during the procedure.
d. You will be very sleepy and we will monitor you closely.

25. What is the priority action for the scrub person at the conclusion of
a surgical procedure?
a. Assist with transferring the client to the postanesthesia care unit.
b. Document the procedure in the client’s medical record.
c. Set up the sterile field and drape the client appropriately.
d. Document how many sponges and sharps have been utilized.

Situation: During the postoperative period, nursing care focuses on

reestablishing the patient’s physiologic equilibrium, alleviating pain,
preventing complications, and educating the patient about self-care

26. A client has been transferred to the postanesthesia care unit (PACU).
Which action does the receiving nurse perform first?
a. Complete a nursing assessment sheet.
b. Change the client’s arm band.
c. Enter client data into the computer.
d. Participate in a hand-off report.

27. A client who has just been transferred to the postanesthesia care unit
(PACU) from surgery is very restless and confused. What is the nurses
first action?
a. Orient the client and remain with him or her.
b. Call the surgeon for an intraoperative report.
c. Notify the physician on call.
d. Assess the client’s level of pain.

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28. A client had surgical repair of a fractured ankle under local
anesthesia and is being transferred from the postanesthesia care unit
(PACU) to the surgical floor. Once admitted, what is the nurses priority
action?
a. Assess pressure points for breakdown.
b. Assess the client’s pain.
c. Insert an IV for antibiotic therapy.
d. Assess a full set of vital signs.

29. The nurse is assessing a client admitted to the postanesthesia care

unit (PACU) after abdominal surgery. The client’s respiratory rate is 8
breaths/min and breath sounds are decreased in the bases. What is the
nurses priority action?
a. Prepare to administer naloxone (Narcan).
b. Assess oxygen saturation and level of consciousness.
c. Call a code or the Rapid Response Team.
d. Turn the client and perform chest physiotherapy.

30. A client is brought to the postanesthesia care unit (PACU) after

surgery that took place with the client in the lithotomy position. Which
action does the nurse take after assessing vital signs?
a. Assess for sacral decubiti.
b. Assess dorsalis pedis pulses.
c. Turn the client on the left side.
d. Put the client in the Trendelenburg position.

Situation: The nurse is assigned in the care of client’s with

injury/fracture of face and nose. Establishing good assessment is
important in giving adequate and quality care.

31. A high school athlete has suffered a nasal fracture. What is the
priority action of the nurse caring for the client?
a. Assess for pain.
b. Pack the nares to prevent blood loss.
c. Assess for bone displacement.
d. Assess for airway patency.

32. After facial trauma, a client has a nasal fracture and is reporting
constant nasal drainage, a headache, and difficulty with vision. What is
the nurses first action?
a. Collect the nasal drainage on a piece of filter paper.
b. Send the client for a facial x-ray.
c. Perform a vision test.
d. Palpate all facial areas for crepitus.

33. A client has a closed fracture of the nose. Which intervention is best
when encouraging self-care for this client?
a. Advise the client not to eat or drink for 24 hours after sustaining the
fracture.

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b. Teach the client how to apply cold compresses to the area to reduce
swelling.
c. Urge the client to sleep without a pillow to hasten resolution of the
swelling.
d. Reassure the client that his or her appearance will normalize after the
swelling is gone.

34. What is the nurses most important action after a client’s gag reflex
has returned post rhinoplasty?
a. Teach the client to change position every 2 hours.
b. Tell the client to put heating pads on the face.
c. Instruct the client to lay flat.
d. Have the client drink at least 2500 mL/day.

35. Which statement indicates that the client needs more teaching
regarding rhinoplasty?
a. I will take my temperature twice each day and will report any fever to
my doctor.
b. I will wait a few weeks to have my photograph taken, when the swelling
is gone.
c. I will take acetaminophen instead of aspirin for pain to avoid
excessive bleeding.
d. I will drink at least 3 quarts of liquids a day and will use a stool
softener.

Situation: Asthma is a chronic inflammatory disorder of the airways

characterized by recurrent episodes of wheezing, breathlessness, chest
tightness, and coughing. The following questions relate to care of
client’s with asthma.

36. A client with asthma reports not being able to take deep breaths. The
nurse auscultates decreased breath sounds in the bases, and no wheezes.
What is the nurses best action?
a. Encourage the client to stay calm and take deep breaths.
b. Document the findings and continue to monitor.
c. Have the client cough forcefully.
d. Assess the client’s oxygen saturation.

37. A client with asthma has been having frequent asthma attacks. What is
the nurses best action?
a. Teach the client to stay away from pets.
b. Assist the client in using an incentive spirometer.
c. Administer aspirin for its anti-inflammatory properties.
d. Administer montelukast (Singulair).

38. A client diagnosed with asthma has not responded well to medication.
The client is concerned and asks the nurse, What is wrong with me, and why
am I not getting better? What is the nurses best response?
a. You just werent used to the medication yet.

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b. The medication dose has to be increased.
c. It is possible that genetic testing may help.
d. You should try homeopathic medicine.

39. The nurse is caring for an older adult who reports experiencing
frequent asthma attacks and severe arthritic pain. What action by the
nurse is most appropriate?
a. Review pulmonary function test results.
b. Assess use of medication for arthritis.
c. Assess frequency of bronchodilator use.
d. Review arterial blood gas results.

40. The nurse is caring for four client’s with asthma. Which client does
the nurse assess first?
a. Client with a barrel chest and clubbed fingernails
b. Client with an SaO2 level of 92% at rest
c. Client whose expiratory phase is longer than the inspiratory phase
d. Client whose heart rate is 120 beats/min

Situation: Infections and inflammation of the lower respiratory system are

common. The respiratory tree is constantly exposed to the environment as
air moves into and out of the lower respiratory tract

41. A client has acute rhinitis. What is the most important intervention
for the nurse to perform?
a. Assess for symptoms of infection.
b. Ascertain whether the client has allergies.
c. Question the client on the use of nasal sprays.
d. Do blood and urine screenings for drug use.

42. A client has pharyngitis. Which symptom helps the nurse determine
whether the infection is bacterial versus viral?
a. Redness in the back of the throat
b. Enlarged lymph glands in the neck
c. Nasal discharge
d. Skin rash

43. It is suspected that a client has bacterial pharyngitis. What is the

best intervention?
a. Administer a broad-spectrum antibiotic.
b. Have the client produce a sputum specimen.
c. Obtain samples for culture and sensitivity.
d. Assess a rapid antigen test (RAT).

44. The nurse is caring for a client with recurrent bacterial pharyngitis.
Which is the nurses highest priority intervention?
a. Assess for symptoms of human immune deficiency virus (HIV).
b. Ask about exposure to allergens.
c. Perform nasal cultures.

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d. Teach the client about antibiotic therapy.

45. A client who has had acute tonsillitis develops drooling and reports
severe throat pain. What is the nurses priority intervention?
a. Assess the throat for deviation of the uvula.
b. Prepare the client for surgery.
c. Teach the client about antibiotic therapy.
d. Prepare the client for percutaneous needle aspiration.

Situation: Impaired cardiac function, no matter what the underlying cause,

affects the patient’s ability to participate in exercise and activities
and to fulfill life roles. Disruptions in cardiac function affect other
organ systems as well, potentially leading to organ system failure and
death.

46. The nurse is taking the history of a client with suspected coronary
artery disease (CAD). Which situation correlates with stable angina?
a. Chest discomfort at rest and inability to tolerate mowing the lawn
b. Chest discomfort when mowing the lawn and subsiding with rest
c. Indigestion and a choking sensation when mowing the lawn
d. Jaw pain that radiates to the shoulder after mowing the lawn

47. The nurse is assessing a client who has a history of stable angina.
The client describes a recent increase in the number of attacks and in the
intensity of the pain. Which question does the nurse ask to assess the
client’s change in condition?
a. How many cigarettes do you smoke daily?
b. Do you have pain when you are resting?
c. Do you have abdominal pain or nausea?
d. How frequently are you having chest pain?

48. The community health nurse assesses client’s at a health fair. Which
statement assists the nurse to identify modifiable risk factors in
client’s with coronary artery disease?
a. Would you please state your full name and birth date?
b. Have you ever had an exercise tolerance stress test?
c. In what activities do you participate on a daily basis?
d. Does anyone in your family have a history of heart disease?

49. The nurse teaches a client who is newly diagnosed with coronary artery
disease. Which instruction does the nurse include to minimize
complications of this disease?
a. Rest is the best medicine at this time. Do not start an exercise
program.
b. You are a man; therefore there is nothing you can do to minimize your
risks.
c. You should talk to your provider about medications to help you quit
smoking.
d. Decreasing the carbohydrates in your diet will help you lose weight.

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50. The emergency department nurse is assessing an 82-year-old client for
a potential myocardial infarction. Which clinical manifestation does the
nurse monitor for?
a. Pain on inspiration
b. Posterior wall chest pain
c. Disorientation or confusion
d. Numbness and tingling of the arm

Situation: The nurse is caring for a client who had a myocardial

infarction.

51. The client develops increased pulmonary congestion; an increase in

heart rate from 80 to 102 beats/min; and cold, clammy skin. Which action
does the nurse implement before notifying the health care provider?
a. Administer oxygen.
b. Increase the IV flow rate.
c. Place the client in supine position.
d. Prepare the client for surgery.

52. The nurse is assisting a client to walk in the hall on the third day
after a myocardial infarction. Which clinical manifestation indicates to
the nurse that the client is not ready to advance to the next level of
activity?
a. Facial flushing
b. Onset of chest pain
c. Heart rate increase of 10 beats/min at completion of the activity
d. Systolic blood pressure increase of 10 mm Hg at completion of the
activity

53. The nurse is administering thrombolytic therapy to a client who had a

myocardial infarction. Which intervention does the nurse implement to
reduce the risk of complications in this client?
a. Administer prescribed heparin.
b. Apply ice to the injection site.
c. Place the client in Trendelenburg position.
d. Instruct the client to take slow deep breaths.

54. A client who presented with an acute myocardial infarction is

prescribed thrombolytic therapy. The client had a stroke 1 month ago.
Which action does the nurse take?
a. Administer the medication as prescribed.
b. Perform a CT scan before administering the medication.
c. Contact the health care provider to discontinue the prescribed therapy.
d. Administer the therapy with a normal saline bolus.

55. The nurse is assessing a client who has left ventricular failure
secondary to a myocardial infarction. Which clinical manifestation of poor
organ perfusion does the nurse monitor for in this client?

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a. Headache
b. Hypertension
c. Urine output of less than 30 mL/hr
d. Heart rate of 55 to 60 beats/min

Situation: Disorders affecting the blood and blood-forming organs have

effects that range from minor disruptions in daily activities to major
life-threatening crises. Patients with hematologic disorders need holistic
nursing care, including emotional support and care for problems involving
major body systems. For the following questions, focus on anemia.

56. The nurse is obtaining the health history of a client who has iron
deficiency anemia. Which factor in this client’s history does the nurse
correlate with this diagnosis?
a. Eating a meat-free diet
b. Family history of sickle cell disease
c. History of leukemia
d. History of bleeding ulcer

57. The nurse is caring for a client who has a decreased serum iron level.
Which intervention does the nurse prioritize for this client?
a. Dietary consult
b. Family assessment
c. Cardiac assessment
d. Administration of vitamin K

58. A female client is admitted with the medical diagnosis of anemia. The
nurse assesses for which potential cause?
a. Diet high in meat and fat
b. Daily intake of aspirin
c. Heavy menses
d. Smoking history

59. The nurse helps to ambulate a client who has anemia. Which clinical
manifestation indicates that the client is not tolerating the activity?
a. Blood pressure of 120/90 mm Hg
b. Heart rate of 110 beats/min
c. Pulse oximetry reading of 95%
d. Respiratory rate of 20 breaths/min

60. The nurse prepares to administer a blood transfusion to a client.

Which means of identification does the nurse use to ensure that the blood
is administered to the correct client?
a. Ask the client whether his or her name is the one on the blood product
tag.
b. Ask the client’s spouse if the client is supposed to have a
transfusion.
c. Compare the name and ID number on the blood product tag with the name
and ID number on the client’s ID band.

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d. Compare the unit and room number of the client with the unit and room
number listed on the blood product tag.

Situation: When caring for the patient with leukemia, the nurse considers
the chronic and life-threatening nature of the disease as well as the
diagnostics and effects of treatment.

61. The nurse is teaching a client who has undergone a bone marrow biopsy.
Which instruction does the nurse give the client?
a. Wear protective gear when playing contact sports.
b. Monitor the biopsy site for bruising.
c. Remain in bed for at least 12 hours.
d. Use a heating pad for pain at the biopsy site.

62. The nurse is caring for a client who had a bone marrow aspiration. The
client begins to bleed from the aspiration site. Which action does the
nurse perform?
a. Apply external pressure to the site.
b. Elevate the extremities.
c. Cover the site with a dressing.
d. Immobilize the leg.

63. The nurse is preparing a client for a bone biopsy and aspiration. The
client asks, Will this be painful? How does the nurse respond?
a. The procedure is always done under general anesthesia.
b. The biopsy lasts for only 2 minutes.
c. There is a chance that you may have pain.
d. You can relieve pain with guided imagery.

64. The nurse is teaching a client who is being discharged to home after
bone marrow transplantation. The client asks, Why is it so important to
protect myself from injury? How does the nurse respond?
a. Injuries put you at high risk for infection.
b. Platelet recovery is slow, which makes you at risk for bleeding.
c. Severe trauma could result in rejection of the transplant.
d. The medications you are taking will make you bruise easily.

65. The nurse is teaching a client who is scheduled to undergo allogeneic

bone marrow transplantation. Which statements indicate that the client
correctly understands the teaching?
1. The surgeon will insert the marrow into my femur bone.
2. Until the marrow transplant takes, I can have visitors.
3. The transplant does not start working immediately.
4. I will need chemotherapy before my transplant.
5. Radiation treatments will begin 2 days after transplantation.

A. 1, 2
B. 3, 4
C. 1, 3, 4

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 D. 1, 2, 5

Situation: The esophagus plays an essential role in the ingestion of food

and liquids. Because of its location and neighboring organs, the symptoms
of esophageal disorders may mimic those of a variety of other illnesses.

66. Which client does the nurse assess most carefully for the development
of gastroesophageal reflux disease?
a. Client with atrial fibrillation who drinks decaffeinated coffee
b. Client who has lost 20 pounds through diet and exercise
c. Diabetic client taking oral hypoglycemic agents
d. Postoperative client who has a nasogastric (NG) tube

67. A client just experienced an episode of reflux with regurgitation.

What assessment by the nurse is the priority?
a. Auscultate the lungs for crackles.
b. Inspect the oral cavity.
c. Check the oxygen saturation.
d. Teach the client to sleep sitting up.

68. A client is undergoing diagnostic testing for gastroesophageal reflux

disease (GERD). Which test does the nurse tell the client is best for
diagnosing this condition?
a. Endoscopy
b. Schilling test
c. 24-Hour ambulatory pH monitoring
d. Stool testing for occult blood

69. The nurse is teaching a client about self-management of

gastroesophageal reflux. Which statement by the nurse is most appropriate?
a. Eat four to six small meals each day.
b. Eat a small evening snack 1 to 2 hours before bed.
c. No specific foods or spices need to be cut from your diet.
d. You may include orange or tomato juice with your breakfast.

70. The nurse is in the room of a client who is sleeping in bed. The
client experiences an episode of reflux with regurgitation. Which action
does the nurse take first?
a. Have the client roll to the side.
b. Raise the head of the client’s bed.
c. Auscultate the client’s lung sounds.
d. Call the Rapid Response Team.

Situation: Like ulcerative colitis, Crohn’s disease is a chronic,

relapsing inflammatory disorder affecting the gastrointestinal tract.
Crohn’s disease can affect any portion of the GI tract from the mouth to
the anus, but usually affects the terminal ileum and ascending colon.

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71. The nurse is caring for a client with Crohn’s disease and colonic
strictures. Which assessment finding requires the nurse to consult the
health care provider immediately?
a. Distended abdomen
b. Temperature of 100.0 F (37.8 C)
c. Traces of blood in the stool
d. Crampy lower abdominal pain

72. The nurse is caring for a client with Crohn’s disease who has
developed a fistula. Which nursing intervention is the highest priority?
a. Monitor the client’s hematocrit and hemoglobin.
b. Position the client to allow gravity drainage of the fistula.
c. Check and record blood glucose levels every 6 hours.
d. Encourage the client to consume a diet high in protein and calories.

73. A client with Crohn’s disease has a draining fistula. Which finding
leads the nurse to intervene most rapidly?
a. Serum potassium of 2.6 mEq/L
b. The client not wanting to eat anything
c. White blood cell count of 8200/mm3
d. The client losing 3 pounds in a week

74. The nurse reviews a health teaching for a client with Crohn’s disease.
Which instruction does the nurse provide for the client?
a. You should have a colonoscopy every few years.
b. You should eat a diet that is high in protein and fiber.
c. You should avoid heavy lifting and tight-fitting clothes.
d. You should take the Asacol whenever you have loose stools.

75. The nurse is caring for a client who is hospitalized with exacerbation
of Crohn’s disease. What does the nurse expect to find during the physical
assessment?
a. Positive Murphys sign with rebound tenderness
b. Dullness in the lower abdominal quadrants
c. High-pitched, rushing bowel sounds in the right lower quadrant
d. Abdominal cramping that the client says is worse at night

Situation: The liver is a complex organ with multiple metabolic and

regulatory functions. Optimal liver function is essential to health.
Because of the significant amount of blood in the liver at all times, it
is exposed to the effects of pathogens, drugs, toxins, and possibly
malignant cells.

76. The nurse is assessing a client with mild liver disease. Which
assessment does the nurse perform to detect the presence of ascites in
this client?
a. Measure lower extremities to assess for edema.
b. Inspect and palpate the abdomen for distention.
c. Palpate the abdomen in assessing for a fluid wave.

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d. Percuss the liver while listening for dullness.

77. A client has cirrhosis and has developed ascites and edema. Which
laboratory value does the nurse correlate with this condition?
a. Blood glucose, 120 mg/dL
b. Serum sodium, 135 mEq/L
c. Serum albumin, 2.1 g/dL
d. Blood urea nitrogen, 18 mg/dL

78. The client with end-stage cirrhosis presents with GI bleeding,

combativeness, and confusion. The nurse anticipates an order to administer
which medication?
a. Omeprazole (Prilosec)
b. Somatostatin (Octreotide)
c. Propranolol (Inderal)
d. Lactulose (Heptalac)

79. The nurse recognizes that fetor hepaticus is consistent with which
assessment finding?
a. Purpuric lesions on the extremities
b. A fruity or musty breath odor
c. Warm and bright red palms
d. Jaundice of the sclera

80. The nurse is assessing a client for asterixis. Which instruction to

the client is most appropriate?
a. Close your eyes and take turns touching your nose with your fingers.
b. Sit on the edge of the bed and hold your legs straight out for 30
seconds.
c. Extend your arm, flex your wrist upward, and extend your fingers.
d. Say EEEEE while I listen to your lungs in the back on both sides.

Situation: Every nurse should be a good leader and a good follower. Not
everyone should be a manager, however. In fact, new graduates simply are
not ready to take on management responsibilities.

81. Because of rapid turnover and the ongoing hiring of new graduates, the
skill levels of staff in a busy CCU are varied. Senior staff are becoming
burned out with the need to provide mentorship and guidance to new staff.
As the manager, you propose the addition of a nurse in advanced practice
to provide consultation and education for staff. This position is termed
a(n):
a. Hierarchical position.
b. Ancillary.
c. Line position.
d. Staff position.

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82. A hospital is working toward becoming a Magnet hospital. The chief
nursing officer is aware that professional nursing departments of the
future will:
a. Not be directed by nurses.
b. Be virtual organizations.
c. Be designed to maintain nursing standards of practice.
d. Be entitled to have client care departments.

83. The chief nursing officer and the dean of the School of Nursing
believe that by establishing rules and regulations and controlling the
environment, this partnership will:
a. Promote professional medical authority, autonomy, and responsibility.
b. Need a degree of flexibility to engender success.
c. Be essential for self-governance.
d. Provide for the establishment of medical committees.

84. In matrix organizational structures, a nurse manager understands that

this type of structure:
a. Is a simplified organizational structure.
b. Has both a functional manager and a service or product-line manager.
c. Arranges departments strictly according to function.
d. Promotes harmony in organizational decision making.

85. Collaborative partnerships between hospitals and schools of nursing

are examples of hybrid organizational structures. A hybrid organizational
structure:
a. Has many divisions of labor.
b. Best fits long-term care units.
c. Has a mixture of the characteristics of various organizational types.
d. Places the authority for decision making closest to the places where
workers perform.

86. In opening a new dialysis unit, the nurse manager has to develop a
philosophy for the unit. This philosophy needs to:
a. Reflect the culture of the unit and its values.
b. Be developed by the nursing manager on the unit.
c. Identify the client’s that will be served on the unit.
d. Replicate the organizations philosophy.

87. The hospital administration gives approval to the chief nursing

officer to hire clinical nurse specialists in staff positions rather than
in administrative positions. A clinical specialist who has staff authority
but no line authority typically is able to:
a. Function through influence.
b. Take complete responsibility for the care of client’s.
c. Interview and hire staff nurses for designated nursing units.
d. Be granted functional authority to determine standards of nursing care
and enforce them.

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88. A new director of nursing in a small rural hospital wants to make
changes from the traditional model of governance to a shared-governance
model. Select the characteristic below that best describes the traditional
organizational structure in which a staff nurse is assigned to carry out
nursing tasks for client’s but is not given the chance to provide input
into forming the policies and procedures by which care is delivered or the
standards by which care is evaluated:
a. Bureaucratic
b. Decentralized
c. Delegated authority and responsibility
d. Delegated responsibility but no authority

89. The chief nursing officer is given the task of reviewing and revising
the organizations mission, philosophy, and technology. In reviewing them,
the chief nursing officer understands that they should be reflected in:
a. The organizational structure.
b. Line and staff responsibilities.
c. The policies and procedures.
d. Government regulations.

90. The facilities department is experiencing some challenges and is

undergoing reorganization. Because of your familiarity with systems
theory, you:
a. Know that this challenge is their issue and that it has nothing to do
with your unit.
b. Understand that such events are localized and do not have an impact on
the organizational culture.
c. Know that the nature of challenges and reorganization in facilities
will have an impact on other areas.
d. Anticipate that your prior experiences with facilities have no effect
on the current situation.

Situation: Nursing research has a tremendous influence on current and

future professional nursing practice, thus rendering it an essential
component of the educational process.

91. A nurse researcher wants to know how well adolescent mothers can learn
to manage their children’s asthma and develops an initial study to explore
and define perceptions of asthma among this population. Which best
describes this initial study?
a. Correlational research
b. Descriptive research
c. Phenomenological research
d. Outcomes research

92. Which research technique would be used by a nurse researcher who

wishes to compare bonding patterns of neonatal intensive care (NIC)
infants to non-NIC infants to test various theories about infant-parent
bonding?

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a. Experimental
b. Exploratory
c. Grounded-theory
d. Quasi-experimental

93. What type of study design would be used to evaluate patient

satisfaction in an outpatient clinic?
a. Exploratory-descriptive research
b. Outcomes research
c. Qualitative research
d. Phenomenological research

94. The nurse researcher wishes to review a body of qualitative studies

about women’s attitudes toward health care in order to develop an overall
interpretation of these findings. Which type of review will the nurse
researcher use?
a. Meta-analysis
b. Meta-synthesis
c. Mixed-methods systematic review
d. Systematic review

95. Which type of evaluation of research yields the most precise estimates
of treatment effects when describing results?
a. Meta-analysis
b. Meta-synthesis
c. Mixed-methods systematic review
d. Systematic review

96. The nurse serves on a committee to develop a clinical protocol to

guide dressing changes for methicillin-resistant Staphylococcus aureus
(MRSA) abscesses. Which is the most important type of evidence to consider
when formulating this protocol?
a. Assertions from a panel of infectious disease physicians about existing
protocols to treat this organism.
b. A statistical review of experimental studies comparing various dressing
change protocols and patient outcomes.
c. A systematic review of all nursing and medical literature about the
incidence of MRSA infection and various dressing change protocols.
d. Studies identifying the correlations between variables such as dressing
types and subsequent infection rates.

97. What role will a new nurse graduate who has a BSN expect to play in
research?
a. Appraising studies and implementing evidence-based guidelines and
protocols.
b. Developing, evaluating, and revising evidence-based guidelines and
protocols.
c. None, since the BSN affords limited education on the research process.

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 d. Synthesizing findings and leading health care teams to make evidence-
based changes.

98. A researcher conducts a study which outlines the daily habits of women
who are overweight. This study represents what type of research?
a. Correlational
b. Descriptive
c. Experimental
d. Quasi-experimental

99. The researcher wants to learn whether there is a relationship between

parental education and emergency room use among children who have asthma.
Which type of research study will this researcher use?
a. Basic
b. Correlational
c. Historical
d. Phenomenological

100. The nurse evaluates a research study that examines the relationship
between computer and television screen time and obesity. A correlational
analysis reveals a correlation of +0.95. What can the nurse conclude about
the relationship between these two variables?
a. An increase in screen time causes obesity.
b. An increase in obesity leads to increased screen time.
c. Screen time and obesity vary in opposite directions.
d. Screen time and obesity vary together.

***** END OF EXAMINATION *****

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