1) Tranylcypromine sulfate (Parnate) has been prescribed to a client with severe depression.

Which of the following

foods should be avoided to prevent the occurrence of hypertensive crisis? Select all that apply.

1) avocados

2) bananas

3) chicken liver

4) cereals

5) bread

6) red wine

2) The nurse was assigned to provide care to a client with bipolar disorder. The health care provider prescribed lithium
carbonate. When administering this drug, which of the following nursing interventions is the most important to prevent
toxicity?

1) maintaining adequate fluid intake

2) avoiding foods that are rich in sodium

3) consuming adequate fiber intake

4) avoiding fatty and spicy foods

3) Several days after administering lithium carbonate, the nurse checked the serum lithium level of the client and
obtained a result of 0.8 mEq/L. The nurse knows that this result would indicate:

1) intoxication

2) undermedication

3) within therapeutic level

4) retesting

4) A 60-year-old male client was admitted and was diagnosed with hyperthyroidism. The health care provider prescribes
to initiate Propylthiouracil (PTU). The nurse is aware of the common side effects of this medication and should instruct
the client to report immediately if he experiencing any signs of:

1) infection

2) hypercalcemia

3) fluid overload

4) hyperglycemia

5) A 60-year-old male client was hospitalized for the management of congestive heart failure. As part of the treatment
regimen, Digoxin (Lanoxin) has been prescribed and administered intravenously. The nurse recognizes that the main
action of this medication is to:

1) dilate the coronary arteries

2) increase the force of myocardial contractions

3) decrease the occurrence of dysrhythmias

4) inhibit sodium and water excretion

6) A 20-year-old client sought consultation due to persistent diarrhea and was suspected of having hypertonic
dehydration. The nurse knows that hypertonic dehydration occurs when:

1) there is an equal water and electrolyte loss

2) the water loss exceeds the electrolyte loss

3) the electrolyte loss exceeds the water loss

4) there is an inadequate intake of fluids and solutes

7) The nurse was assigned to provide care to a male client with syndrome of inappropriate antidiuretic hormone
(SIADH). During the review of his laboratory results, the nurse noted that his serum sodium level is 130 milliequivalents
per liter (mEq/L). The nurse knows that it is primarily due to:

1) serum sodium dilution

2) reduced sodium absorption

3) increased sodium excretion

4) inadequate sodium intake

8) A 45-year-old male client was rushed to the emergency department complaining of abdominal pain and fever. A
diagnosis of peritonitis has been made. The nurse should educate the client based on the knowledge that peritonitis is
caused by the:

1) escape of pancreatic enzymes into the surrounding tissue

2) outpouching or herniation of the intestinal mucosa

3) leakage of contents from abdominal organs into the abdominal cavity

4) progressive degeneration and destruction of hepatocytes

9) The nurse was assigned to monitor a client who will undergo hemodialysis for the first time. After initiation of
hemodialysis treatment, the client suddenly complains of nausea and vomiting, headache, and muscle cramps. The
nurse suspected the client of disequilibrium syndrome. If disequilibrium syndrome occurs, what would be the immediate
action of the nurse?

1) notify the health care provider

2) stop the hemodialysis

3) reduce the environmental stimuli

4) administer mannitol as prescribed

10) The nurse is monitoring a client who undergoes continuous ambulatory peritoneal dialysis. The nurse knows that
peritoneal dialysis predisposes the client to develop peritonitis. Which of the following assessment findings would
suspect the nurse that the client is experiencing peritonitis? Select all that apply.

1) brown-colored dialysate outflow

2) fever

3) foul-smelling stools

4) rebound abdominal tenderness

5) nausea and vomiting

6) abdominal cramps

11) The newly hired nurse manager in the medical-surgical ward is a relational type of a leader. The nurse identifies that
this type of leadership is based on:

1) the desire to serve others

2) social-exchange theory

3) the leader’s personal belief and characteristics

4) working together as a team

12) The terminally ill male client wants his daughter to make health care decisions on his behalf if he can no longer make
decisions for himself. Which of the following legal documentations is needed in this situation?

1) Durable power of attorney

2) Living will

3) Health care provider’s order

4) Informed consent
13) Which of the following characteristics is commonly observed in a laissez-faire type of leader? Select all that apply.

1) passive and nondirective

2) disperses decision making throughout the group

3) “Talk with the members” style

4) relies on organizational policies and procedures

5) provides little or no direction

6) focused and have a strong control

14) The newly assigned nurse in the medical-surgical unit restrains the client’s arms using pillow cases without any
proper and legal consent so that she can have a long break with her colleagues. The nurse can be accused of:

1) Invasion of privacy

2) Battery

3) False imprisonment

4) Assault

15) The registered nurse (RN) in the pediatric ward is preparing to assign some tasks to the unlicensed assistive
personnel (UAP). The RN can delegate which of the following tasks to the UAP? Select all that apply.

1) Hygiene measures

2) Grooming

3) Nasogastric tube feeding

4) Range-of-motion exercises

5) Colostomy irrigation

6) Assisting with frequent ambulation

16) The nurse is having a conversation with a client who was diagnosed with depression. The client suddenly verbalizes,
“Why did you come here to have this conversation with me? There’s a lot of other individuals there.” What would be the
best response of the nurse?

1) “You’re wondering why I’m having this conversation with you, and not with others?”

2) “I believe in you and I want to help you, I know you have a lot of potential.”

3) “I’m the one who was assigned to take care of you today, if only you will allow me to help you.”

4) “Why, are you not that happy and interested to talk to me about your situation?”

17) A 45-year-old female client sought consultation at the psychiatric clinic complaining of inability to sleep, and feelings
of hopelessness after her supervisor fired her from her work. During the interview, the client says to the nurse, “I had a
perfect supervisor. She was the best supervisor that I have ever had in my life and it was such an honor that I worked
with her for almost 10 years.” In this case, which of the following defense mechanisms does the client use?

1) Suppression

2) Reaction formation

3) Sublimation

4) Repression

18) While having a one-on-one interview with a client suspected of having bipolar disorder, the client unexpectedly tells
the nurse, “The sun is already setting down. I love to eat bananas and apples. Where is my long-lost son? I really love to
play billiards.” The nurse identifies that the client is exhibiting:

1) Flight of ideas

2) Neologism

3) Confabulation

4) Depersonalization
19) In the psychiatric unit, the nurse was assigned to provide care to a male client with bipolar disorder. During the
episodes of mania, which of the following activities would help the client to channel his manic behaviors?

1) encourage him to lead a group activity

2) allow him to exercise as much as possible

3) encourage him to fix and clean his room

4) allow him to read some stories to others

20) A 50-year-old female client with a mental disorder was involuntarily admitted by the court for 60 days in the
psychiatric unit. The nurse should be aware that when a client is involuntarily admitted in a psychiatric unit, the client
loses:

1) his right to leave the unit against medical advice

2) his right to informed consent to any procedures

3) his right refuse treatments or procedures

4) his right to send and receive mail

21) A 30-year-old male health care worker assigned in the medical-surgical unit sought consultation in the hospital clinic
due to a possible exposure to a client with HIV infection. In order to have an accurate HIV antibody test result, the nurse
should advise him to have it done:

1) one month after exposure

2) 6 months after exposure

3) immediately after exposure

4) 12 months after exposure

22) After taking an unprescribed antibiotic, the client was rushed to the emergency department due to anaphylactic
reaction. Which of the following immunoglobulins is responsible for anaphylactic or hypersensitivity reaction?

1) IgG

2) IgE

3) IgM

4) IgA

23) The nurse was assigned to a newly admitted male client diagnosed with Goodpasture’s syndrome. Which of the
following therapeutic procedures would the nurse expect to be prescribed by his HCP?

1) blood transfusion

2) hemodialysis

3) paracentesis

4) plasmapheresis

24) The nurse will assess a client diagnosed with Grave’s disease. During the assessment, the nurse would expect which
clinical manifestations? Select all that apply.

1) diarrhea

2) exophthalmos

3) cold intolerance

4) weight gain

5) hypotension

6) bronzed-skin appearance

7) truncal obesity

8) moon face
25) The nurse was assigned to provide care to a male client who underwent mitral valve replacement. During the
assessment, the nurse noted a persistent bleeding on the surgical site. After calling and informing his health care
provider, which of the following medications should the nurse anticipate to be prescribed and administered?

1) Warfarin sodium

2) Dipyridamole

3) Quinidine sulfate

4) Protamine sulfate

26) A child was admitted and was diagnosed with celiac disease. When formulating a meal plan for this child, the nurse
should include which of the following foods?

1) cookies and cakes

2) cereal and spaghetti

3) breads and macaroni noodles

4) fish and eggs

27) The nurse is demonstrating to the client how to use his newly acquired crutches. When going up the stairs, the nurse
should teach the client to move up:

1) the crutches first

2) the affected leg first

3) both of his legs

4) the unaffected leg first

28) In the orthopedic unit, the nurse was assigned to provide care to a client with cervical skin traction. The nurse knows
that the client should maintain which position?

1) flat on bed

2) prone

3) semi-Fowler’s

4) side-lying

29) The nurse will assist a male client to perform passive range-of-motion exercises. Before assisting the client, the nurse
should explain to him that these types of exercises are mainly performed:

1) to restore joint movement

2) to overstimulate circulation

3) to prevent bone fractures

4) to avoid strengthening the muscles

30) The health care provider prescribed to discontinue the total parenteral nutrition (TPN) therapy of the client. Which
of the following nursing actions is the most appropriate in order to prevent complications associated with the
discontinuation of the TPN therapy?

1) stop the TPN therapy

2) remove the IV catheter immediately

3) record oral intake and body weight

4) slowly decreased the flow rate

31) A 33-year-old female client who is suspected of pregnancy came to the maternity clinic for further evaluation. During
the assessment, which of the following are classified as presumptive signs of pregnancy? Select all that apply.

1) presence of fetal heart sound

2) amenorrhea

3) quickening

4) positive Hegar’s sign

5) discoloration of vaginal mucosa

6) pronounced nipples

32) A 34-year-old pregnant client calls the nurse in the maternity clinic and complains of syncope. To avoid the
occurrence of syncope during pregnancy, it would be best for the nurse to instruct the client to:

1) drink no less than 2L of fluid during the day

2) sit with the feet elevated

3) sleep in side-lying position at night

4) wear a supportive bra

33) A 32-year-old pregnant client at 8 weeks’ gestation tells the nurse that her older sister had a baby that was born
with spina bifida. To reduce her risk of neural tube defects, the nurse should tell her that most of the health care
provider usually prescribe:

1) retinoic acid

2) ferrous sulfate

3) folic acid

4) zinc

34) During the assessment of a client in labor, the health care provider told the nurse that the baby’s presenting part is
at +1 station. The nurse recognizes that the presenting part of the baby is at:

1) 1 cm below the ischial spine

2) 1 inch below the ischial spine

3) 1 cm above the ischial spine

4) 1 inch above the ischial spine

35) A multigravida client visited the maternity clinic and told the nurse that her baby hasn’t been moving that much
during the last 24 hours. When the nurse applies the fetal monitor, the tracing indicates that the fetus is experiencing
cord compression. The nurse knows that the client most likely has a deceleration pattern of:

1) Early deceleration

2) Late deceleration

3) Variable deceleration

4) Acceleration, not deceleration

36) The nurse should know that the use of restraints in most of the mental health unit is usually allowed:

1) for not more than 2 hours

2) as needed to control the client

3) when the client is physically harmful to himself or others

4) only when the client gives his consent

37) When formulating a nursing care plan to a suicidal client, the nurse should include the following nursing
interventions, except:

1) Remove all harmful objects

2) Provide a nonjudgmental, caring attitude

3) Restrict all visitors and phone calls

4) Do not leave the client alone

38) A 55-year-old male client was rushed to the emergency department complaining of crushing substernal pain that
radiates to the jaw and left arm. After a thorough assessment, a diagnosis of acute myocardial infarction has been made.
Which of the following orders made by the health care provider should the nurse must implement first?

1) obtaining a 12-lead ECG

2) obtaining laboratory tests

3) giving of morphine sulfate

4) assisting in chest x-ray

39) When performing cardiopulmonary resuscitation (CPR) to a victim, the rescuer should know that one of the
acceptable reasons to discontinue CPR is:

1) when the rescuer is tired and exhausted

2) after 20 minutes of unsuccessful CPR

3) when the victim is least likely to recover

4) after 10 minutes of ineffective CPR

40) A 40-year-old male client sought consultation in the clinic due to fever and chills, and chest discomfort. The health
care provider suspects the client of anthrax. After explaining anthrax to the client, which of the following statements
made by the client needs further teaching?

1) “It can be transmitted from person to person.”

2) “It is usually treated with antibiotics.”

3) “It is commonly manifested by flu-like symptoms.”

4) “It typically affects domestic and wild animals.”

41) A 45-year-old male client came to the clinic complaining of a severe headache. Which of the following assessment
findings would suggest that the client is experiencing cluster headache?

1) nausea and vomiting

2) light sensitivity

3) periorbital pain in one eye

4) pain behind the cheek bone

42) A child was brought to the emergency department due to fever and cough. After a thorough assessment, the health
care provider diagnosed the child with bronchiolitis. The following are measures to prevent the spread of this type
infection, except:

1) Always perform proper handwashing

2) Avoid close contact, such as shaking hands

3) Clean frequently touched surfaces such as doorknobs

4) Place the client in a room with negative pressure

43) A 60-year-old male client was admitted and was suspected of having liver cirrhosis. The health care provider
prescribes to check the serum albumin of the client. The nurse knows that the normal serum albumin ranges from:

1) 5.5 to 8.5 g/dL

2) 3.4 to 5 g/dL

3) 1.5 to 3.0 g/dL

4) 10 to 15 g/dL

44) Which of the following conditions can significantly increase the serum albumin level of the client? Select all that
apply.

1) Persistent diarrhea

2) Liver cirrhosis

3) Alcoholism

4) Dehydration

5) Malnutrition

6) Acute infection

45) A 20-year-old male client was brought to the emergency department due to severe dehydration resulting from
persistent diarrhea. The nurse knows that the most preferred intravenous (IV) fluid used to treat severe diarrhea is:

1) Lactated Ringer’s

2) 0.9% normal saline

3) 5% sodium chloride

4) 10% dextrose and water

46) A 10-year-old child was brought to the school clinic due to a bee sting. During the assessment, the child shows no
signs of any allergic reaction. As the school nurse in-charge, your primary action would be:

1) to remove the stinger using a tweezers

2) to directly apply a hot compress

3) to remove the stinger using the edge of the needle

4) to give epinephrine intramuscularly as a prophylaxis

47) Anaphylaxis is a serious, life-threatening allergic reaction that could lead to a potentially fatal condition known as
anaphylactic shock and even death. The nurse should be aware that the most common cause of fatality in anaphylaxis is
the delayed administration of:

1) bronchodilators

2) antihistamines

3) corticosteroids

4) epinephrine

48) A 32-year-old female client in her 18 weeks of gestation came to the maternity clinic and was scheduled for alpha-
fetoprotein screening. The nurse should educate the client that this test is usually prescribed to detect:

1) Down syndrome

2) Reye’s syndrome

3) Nephrotic syndrome

4) Tetralogy of Fallot
49) A 50-year-old female client with a blood type of AB positive was admitted to the hospital for blood transfusion of at
least 3 units of packed red blood cells (PRBCs). The nurse knows that the client can receive blood from which blood
type/s? Select all that apply.

1) A positive

2) B negative

3) O negative

4) AB positive

5) O positive

6) AB negative

50) The newly hired nurse was assigned to provide care to a client with an airborne precaution. Which of the following
disorders needs an airborne precaution? Select all that apply.

1) Varicella

2) Infectious mononucleosis

3) MRSA

4) Tuberculosis

5) Measles

6) Botulism

51) The nurse assigned in the mental health unit was assigned to provide care to a client with severe depression. In
formulating a care plan for this client, which of the following nursing diagnoses should be the top priority?

1) Self-Care Deficit

2) Risk For Self-Directed Violence

3) Disturbed Thought Processes

4) Impaired Social Interaction

52) A 45-year-old male client with an ongoing intravenous therapy calls the attention of the nurse because his IV is not
working, and complains of coolness, and pain on the intravenous needle insertion site. Based on this case, the
immediate action of the nurse would be:

1) slow the IV flow rate

2) apply a warm compress

3) elevate the extremity

4) remove the IV device

53) The nurse is preparing the child diagnosed with cystic fibrosis for chest physiotherapy. When performing CPT, the
nurse understands that the best time to perform it is:

1) anytime of the day, 30 minutes after a meal

2) in the morning right after breakfast

3) in the morning 2 to 3 hours after meals

4) at least 1 hour before bedtime

54) A 3-week-old newborn was admitted in the pediatric ward and was diagnosed with pyloric stenosis. The nurse
should explain to the mother based on the knowledge that in pyloric stenosis the affected gastrointestinal parts are
usually the:

1) stomach and esophagus

2) colon and rectum

3) stomach and duodenum

4) cecum and appendix

55) The nurse is preparing to give homecare instructions to a client with Parkinson’s disease who will be discharged this
afternoon. In formulating a meal plan for this client at home, the nurse should recommend serving:

1) Solid foods

2) Liquid foods

3) Semi-solid foods

4) Dry foods

56) A 50-year-old male client was rushed to the emergency department complaining of difficulty breathing. The health
care provider orders to check his arterial blood gas (ABG). The result reveals – pH 7.15, PCO2 of 80 mmHg, and HCO3 of
24 mEq/L. The nurse recognizes that his ABG result indicates:

1) Respiratory alkalosis, compensated

2) Respiratory acidosis, uncompensated

3) Metabolic acidosis, uncompensated

4) Metabolic alkalosis, compensated

57) A 54-year-old male client came to the clinic, and during the assessment, he told the nurse, “You know what, these
past several days, I really had a hard time focusing on my daily job in our company.” What would be the best response of
the nurse?

1) “That’s ok, for sure you’ll be fine soon.”

2) “Really? Why is that so?”

3) “Me too, sometimes it happens to me.”

4) “You’re having difficulty concentrating?”

58) The health care provider prescribes 1 L of D5LR solution to be infused for 8 hours to the newly admitted client. If the
given drip factor is 15 drops per 1 mL, the nurse should set the flow rate at:

Answer: _______ drops per minute

59) The health care provider’s prescription to a child diagnosed with bacterial pneumonia reads: Cefixime 250 mg PO
once a day for 7 days: The stock medication label reads: Cefixime 100 mg / 5 mL. The nurse should prepare to give how
many milliliters per day?

Answer: ________ mL

60) A 70-year-old female client diagnosed with osteoporosis visited the orthopedic clinic due to persistent back pain.
When formulating a care plan for this client, which of the following nursing interventions should be included? Select all
that apply.

1) provide a firm, nonsagging mattress

2) encourage to limit fluid intake to at least 1 L per day

3) instruct to avoid sun exposure

4) encourage to perform isometric exercises

5) instruct to eat a diet high in protein, and calcium

6) prepare to apply a back brace especially during the acute phase

61) A 30-year-old male client visited the clinic to have a general check-up. During the assessment, the client’s weight is
70 kg and his height is 1.7 meters. The body mass index (BMI) of the client is:

Answer: _______
62) The nurse will give a discharge instruction to a client on how to use nitroglycerin transdermal patch at home. After
instructing the client, which of the following client’s statements regarding transdermal patch administration needs
further teaching?

1) “I must apply the patch to a hairless area.”

2) “I should use a new patch and a different site each day.”

3) “I can apply the patch on my lower arm.”

4) “I should remove the patch after 12 to 14 hours.”

63) The health care provider prescribed cefuroxime tablet to a male client diagnosed with pharyngitis. Before
administering this medication, the nurse should assess the client if he has any allergy to:

1) eggs

2) seafood

3) streptomycin

4) penicillin

64) The nurse educator is teaching several nurses about proper handling of sharps in the unit. Which of the following
nursing actions regarding sharps disposal needs further education?

1) Avoid throwing needles and other sharps into the trash bin.

2) Recap the needle after using and before disposal.

3) Dispose the sharps straight after use

4) Always wear gloves when handling sharps.

65) The psychiatric nurse was assigned to provide care to a male client diagnosed with obsessive-compulsive disorder
(OCD). When caring for this client, the nurse should implement the following nursing interventions, except:

1) encourage him to verbalize his feelings and concerns

2) interrupt his compulsive behaviors constantly

3) provide him simple structured activities or games

4) recognize and reinforce his positive nonritualistic behaviors

66) The nurse is caring for a male client with an indwelling urinary catheter. In order to prevent Catheter-Associated
Urinary Tract Infection (CAUTI), the following are appropriate measures, except:

1) Maintain a closed drainage system following insertion.

2) Keep the catheter and collecting tube free from kinking.

3) Keep the collecting bag at the level of the bladder at all times.

4) Empty the collecting bag regularly using a clean collecting container.

67) After assessing the client, the health care provider diagnosed the client with Methicillin Resistant Staphylococcus
Aureus. To control and prevent the spread of infection when rendering care for this client, the nurse should:

1) serve foods with disposable eating utensils

2) clean the client’s wound at least every shift

3) wear gloves and gown when entering the room

4) wear a face shield and N95 mask rendering care

68) The nurse supervisor is creating a plan on how to respond to different kinds of disasters. Which of the following is
the top priority when dealing with code red?

1) Client relocation

2) Infection control

3) Client education

4) Staff orientation
69) A 35-year-old female client came to the maternity clinic and was told that she is pregnant. During the interview, the
client verbalizes, “As much as I want to have my own child, I hope that I am not pregnant”. The nurse identifies this
statement as:

1) Ambivalence

2) Anger

3) Denial

4) Guilt

70) A 32-year-old female client visited the maternity clinic and told the nurse that she missed taking her oral
contraceptive pill for one day. What would be the best response of the nurse?

1) “You need to use a backup contraception, such as a condom, for at least 7 days.”

2) “Take the last pill you missed right now, and take the next pill at the usual time.”

3) “Take two pills right now, then one pill daily at the same usual time.”

4) “You need to change your birth control method as soon as possible.”

71) The nurse educator is discussing the concept of pregnancy and infertility to several couples. Which of the following
statements best describes secondary infertility?

1) “It refers to male infertility.”

2) “A couple that does not conceive.”

3) “Infertility that lasts for more than 5 years.”

4) “It is the inability to conceive after previously giving birth.”

72) The nurse is caring for a postpartum client who just gave birth 2 days ago. During the assessment, the nurse
documented that the client’s perineal pad is saturated with bright red lochia. The next best action of the nurse would be
to:

1) check the vital signs

2) identify the amount of time between pad changes

3) call the health care provider immediately

4) massage the fundus

73) The nurse was assigned to provide care to an infant born with spina bifida. Which of the following complications is
commonly associated with spina bifida?

1) Bell’s palsy

2) Cerebral palsy

3) Hydrocephalus

4) Meningitis

74) A 5-year-old child was brought to the emergency department due to colicky abdominal pain. After assessing the
client, a tentative diagnosis of intussusception has been made. Which of the following diagnostic tests should be
prescribed to help confirm the diagnosis?

1) Ultrasonography

2) Abdominal x-ray

3) Rectal biopsy

4) Gastric analysis
75) A 15-year-old female client was admitted to the hospital and was diagnosed with type 1 diabetes mellitus. After the
health care provider assessed the client, he made some prescriptions. Among the listed prescriptions, which of the
following needs further clarification?

1) Metformin (Glucophage) 500 mg PO

2) Humalog (Lispro) sliding scale before meals

3) Glargine (Lantus) 10 units subcutaneously

4) Dextrose 50% vial IV push for 50 mg/dL blood sugar

76) The nurse is preparing the newly admitted client for peripheral IV insertion. Unfortunately, after two attempts, the
nurse fails to insert the IV cannula. The next best action of the nurse is to:

1) Prepare the client for intrajugular vein catheter insertion

2) Call another nurse who is more experience

3) Ask the health care provider for help

4) Use intraosseous needle

77) A 50-year-old male client was hospitalized for the management and treatment of syndrome of inappropriate
antidiuretic hormone (SIADH). When caring for this client, the top priority nursing intervention is to:

1) Restrict fluid intake to less than 1L per day

2) Monitor intake and output

3) Reposition the client to prevent pressure ulcer

4) Administer Vasopressin tannate (Pitressin)

78) The nurse was assigned to assess a client in the medical-surgical clinic suspected of having abdominal hernia. The
nurse should educate the client that the following factors can significantly aggravate herniation, except which of the
following? Select all that apply.

1) obesity

2) malnutrition

3) ascites

4) pregnancy

5) heavy lifting

6) physical activity

79) The nurse is preparing the client with prostate cancer for transurethral resection of the prostate (TURP) this
afternoon. Following the procedure, the nurse would expect the insertion of which type of urinary catheter?

1) Intermittent catheter

2) Indwelling catheter

3) Triple lumen catheter

4) Single lumen catheter

80) The nurse instructor is reviewing the anatomy and physiology of the brain to a group of newly hired nurses assigned
in the neurological intensive care unit. The nurse instructor should teach them that the main function of pons is to:

1) regulate breathing

2) control motor coordination

3) regulate the stress response

4) relay sensory impulses

81) A 60-year-old male client came to the clinic for further evaluation and management of his hyperthyroidism. After the
assessment, the health care provider orders a medication that would help control his hyperthyroidism by reducing the
thyroid gland vascularity. The nurse would expect the prescription of:

1) Potassium iodide (SSKI)

2) Propylthiouracil (PTU)

3) Methimazole (Tapazole)

4) Propranolol (Inderal)

82) The nurse assigned for the narcotic count in the unit notices and confirms that one of his co-workers gave a wrong
dosage of narcotic medication to her client. As the nurse in-charge, your initial action would be to:

1) Assess the client and notify the health care provider

2) Report the nurse who commit medication error to the nurse manager

3) Explain to the client that a medication error has occurred

4) Document what medication is given and when it was given

83) An intermittent pneumatic compression (IPC) device has been prescribed to a client following an abdominal surgery.
The nurse should explain to the client that this device aims to:

1) loosen pulmonary secretions

2) prevent blood clots

3) promote ambulation

4) facilitate wound healing

84) A 50-year-old male client was admitted to the hospital and was scheduled for an abdominal surgery tomorrow
morning. To relieve the stress and anxiety associated with the upcoming surgery, the nurse discusses guided imagery to
the client. In guided imagery, the nurse should instruct the client to focus on:

1) the mental image

2) the person performing the guiding

3) the picture or drawing

4) any object in front of the client

85) The nurse is formulating a care plan for a client who underwent partial gastrectomy. Nursing interventions for this
client postoperatively would include:

1) withholding fluids by mouth until the peristalsis returns

2) administering pain medication every 8 hours

3) placing the patient in a high-Fowler’s position

4) continuously flushing the NGT every hour

86) A 50-year-old client with chronic kidney failure will undergo organ transplantation tomorrow morning. After the
procedure to prevent graft rejection, the nurse would expect the prescription of:

1) Cyclosporine (Neoral)

2) Peginesatide (Omontys)

3) Trimethroprim (Trimpex)

4) Fosfomycin (Monurol)
87) A 50-year-old male client with chronic kidney failure will undergo arteriovenous fistula (AVF) creation as an access
for hemodialysis tomorrow morning. After providing health education regarding AVF, which of the following statements
made by the client would indicate the need for further teaching? Select all that apply.

1) “AV fistula does not require needle insertion during dialysis.”

2) “It will take about 4 to 6 weeks before it can be used.”

3) “I need to perform hand-flexing exercises such as ball squeezing.”

4) “I should avoid sitting position after the creation.”

5) “It predisposes me more to infection compared to other access.”

6) “The risk of clotting and bleeding is low in AV fistula.”

88) A 50-year-old male client sought consultation at the renal clinic complaining of dull flank pain that radiates to his
groin, and hypertension. A diagnosis of hydronephrosis has been made. The nurse should educate the client based on
the idea that hydronephrosis is:

1) an inflammation of the renal pelvis and the parenchyma caused by bacteria

2) a distention of the renal pelvis and calices caused by an obstruction

3) caused by the damage to the clusters of small blood vessels in the kidneys

4) the formation of numerous cysts and hypertrophy of the kidneys

89) A 55-year-old female client was admitted and was diagnosed with chronic kidney failure. The nurse knows that the
signs and symptoms associated with chronic kidney failure usually becomes noticeable in later stages of the disorder
primarily because of:

1) the great functional reserve of the kidneys

2) the compensation of the adrenal glands for the kidneys decreased functioning

3) the liver masking the symptoms of chronic kidney failure

4) the other body system taking over the function of the kidney

90) The nurse was assigned to provide care to a depressed male client who has not been eating for nearly 24 hours.
Which nursing action can encourage the client to eat after serving his food?

1) Sit beside the client and place the spoon in his hand.

2) Tell the client to eat so that he can easily recover.

3) Tell the client that his meal tastes and looks good.

4) Give the client his tray and leave.

91) A 60-year-old male client was admitted to the hospital because of alcohol abuse. During the assessment, his wife
told the nurse that he consumed about 16 ounces of alcohol just before coming to the hospital. To promote the
oxidation of alcohol in the body, what would be the best action of the nurse?

1) Administer oxygen via face mask

2) Have the client drink a black strong coffee

3) Provide the client a room to rest and sleep

4) Assist the client to walk around

92) A 20-year-old female client was rushed to the emergency department due to attempted suicide. During the
assessment, the nurse noted that the client was unconscious and her mother verbalized and confirmed that she
swallowed a bottle of phenobarbital (Gardenal). Which of the following nursing interventions should the nurse must
implement?

1) Prepare to administer a diuretic

2) Prepare to lavage the stomach

3) Prepare to initiate parenteral nutrition

4) Prepare to force fluids intravenously

93) The nurse is caring for a client admitted to the hospital because of hyperthyroidism. Nursing interventions for clients
with hyperthyroidism would include: (Select all that apply)

1) provide a warm environment

2) prepare to administer iodine preparations

3) provide a high-calorie diet

4) prepare to administer Propylthiouracil (PTU)

5) assess client for constipation

6) avoid administration of stimulants

94) A 40-year-old female client was hospitalized because of a severe headache and sustained hypertension. After several
diagnostic tests, a diagnosis of pheochromocytoma has been made. As the nurse in-charge to this client, which of the
following nursing interventions should you question?

1) offer foods that are high in calories

2) prepare to administer beta-adrenergic blocking agent

3) palpate the abdomen twice every shift for assessment

4) instruct the patient not to change position suddenly

95) The nurse educator is teaching a group of nurses in the medical-surgical ward about ethical and legal issues in
nursing. The following are examples of negligent acts, except: (Select all that apply)

1) Medication error that result in injury to the client

2) Falls that occur as a result of failure to provide safety to the client

3) Intimidating the client verbally

4) Administering a medication to a client after he/she refused

5) Failure to monitor a client’s condition

6) Failure to use sterile technique when indicated

96) The nurse assigned to the orthopedic unit was told to float to the cancer unit for the day due to understaffing. The
nurse has no experience in caring and handling cancer clients who are undergoing chemotherapy. In this case, what
would be the first action of the nurse?

1) recognize the task that can be safely performed in the cancer unit

2) notify the nursing manager or supervisor

3) write a letter of refusal and submit it to the nursing manager or supervisor

4) consult the facility lawyer and explain the situation

97) The nurse will provide care to a client diagnosed with bacterial pneumonia. Which of the following measures is the
most effective way to control and lessen the spread of infection?

1) perform proper and frequent hand washing

2) use disposable equipment as much as possible

3) separate personal items for each client

4) isolate the client with a known infection

98) Which of the following circumstances can significantly predispose an individual to contract hepatitis B virus? Select
all that apply.

1) eating contaminated seafood

2) use of IV drugs

3) excessive alcohol intake

4) frequent use of heroin

5) multiple sexual partners

6) undergoing hemodialysis treatment

99) A 20-year-old male client was rushed to the emergency department due to ingestion of a bottle of drain cleaner.
Which of the following should be the initial plan of action of the nurse?

1) prepare to perform a gastric lavage

2) prepare to administer an emetic

3) prepare to initiate cardiopulmonary resuscitation

4) prepare to assist in a tracheostomy

100) The nurse is caring for a newly admitted client diagnosed with peripheral arterial disease. During the assessment,
which of the following findings are not associated with peripheral arterial disease? Select all that apply.

1) intermittent claudication

2) elevational pallor in the lower extremities

3) loss of hair on the lower extremities

4) warm and tender to touch skin

5) thickened toe nails

6) positive Homan’s sign