1. During assessment of a client with

1. During assessment of a client with a 15-year history of diabetes the nurse notes the client has decreased tactile sensation in both feet. Which action does the nurse take first? a. Perform assessment of the patient’s feet b. Call the provider c. Check the patient’s blood sugar d. Provide diabetic teaching 2. A nurse is monitoring a client who was diagnosed with diabetes mellitus and is being treated with both short acting and long-acting insulins. Which of the following manifestations would alert the nurse of possible hypoglycemia? Select all that apply a. Tremors b. Anorexia c. Hot, dry skin d. Nervousness 3. A client on an intensified insulin regimen consistently has a fasting blood glucose level between 70 to 80 mg/d and a hemoglobin A1c level of 5.5%. Which is the nurse’s interpretation of these findings? a. Good Glucose Control b. Poor Glucose Control c. Increase risk for the development of ketoacidosis d. Need for increase insulin dosage 4. Which of the following manifestations would the nurse expect to see in a client with hypothyroidism? a. Blurred vision, night sweats, and palpitation b. Muscle cramps, parenthesis, and numbness of the fingers and toes c. Heat intolerance, weight loss, and diarrhea d. Weakness, constipation, and cold extremities 5. While assessing a client post-thyroidectomy, the nurse noted the client is rather irritable and c/o a tingling feeling in the lips. What is the nurse’s best response to these findings? a. Plan to administer calcium gluconate b. Provide the client with mouth and lip care c. Administer Synthroid immediately to address symptoms of myxedema d. Document the normal findings 6. The nurse IV notes a diabetic client has fruity smelling breath and respiration 30. Which action should the nurse take immediately? a. Provider the client with crackers and 2 % milk b. Administer glucagon push c. Assess blood glucose level for hyperglycemia and urine foe ketones d. Perform a respiratory assessment 7. A client with Type II diabetes ask the nurse how to prevent complications associated diabetes. Which of the following are appropriate responses from the nurse? Select all that apply a. Manage stress b. Avoid all sugar and carbohydrates c. Be sure to get annual flu vaccine d. Seek care from a podiatrist regularly 8. The nurse is providing teaching to a client newly diagnosed with diabetes type I. which of the following should the nurse include in the discharge teaching? Select all that apply a. Be sure to rotate injection sites to avoid lipodystrophy b. Store unused insulin in the refrigerator c. If you become sick monitor your blood sugar and take oral hypoglycemics d. Be sure to inspect your feet daily using a mirror to view the soles of the feet 9. The client with hyperparathyroidism is admitted to the unit. The client asks the nurse why is she receiving so much IV fluid and a “water pill”? Which of the following is the nurse best response? a. Both are needed to improve your cardiac output b. They work together to help eliminate metabolic waste c. We need to restore your fluid volume d. It will help promote calcium excretion 10. The nurse observes a client with diabetes mellitus walking in the room barefoot, although slippers are at the bedside. Which of the following is the best nursing diagnosis for this client? a. Risk of injury related to potential for falls while walking barefoot b. Risk for infection related to impaired tissue perfusion and walking barefoot c. Risk for impaired cerebral perfusion related to low blood glucose levels d. Risk for injury related to lack of resources to purchase clothing and shoes 11 The nurse is caring for a client newly diagnosed with type 2 diabetes. Which interventions should the nurse implement? a. Assess the client for ketonuria b. Administer oral hypoglycemic medications as ordered c. Monitor the client’s arterial gases d. Administer pancreatic enzymes 12. A nurse is preparing to flush a gastric tube. Which of the following steps are included in this procedure? Select all that apply a. Position client supine or flat in bed b. Insert tip of syringe into the end of the gastric tube and slowly instill flushing solution (water) c. Perform hand hygiene and apply clean gloves d. Identify client and explain procedure 13. A client admits to not taking Synthroid and is diagnosed with myxedema coma. Which of the following is the highest priority of the nurse at this time? a. Promote oxygenation and prevent skin breakdown b. Prevent injury related to mental confusion and elevated blood pressure***wrong answer c. Promote nutrition with low fiber foods d. Monitor for signs and symptoms of decreased cardiac output and airway obstruction 14. The student nurse is caring for a patient who is receiving ismolite feedings continuously via a nasal gastric tube. The supervising nurse intervenes when the student does which of the following? a. Flushes the tube with 30 ml of water between medications b. Places the client supine before stopping the tube feedings c. Obtains a sample of gastric secretions d. Performs a GI assessment 15. A client with hyperthyroidism is recovering from thyroidectomy. The nurse notes the client is speaking in a whisper and reports concern of hoarseness. Which of the following is the nurse’s best response to the findings and the client concerns? a. Tell the client these symptoms should be temporary and continue to monitor b. Call the surgeon, this is a medical emergency c. Encourage client to perform ROM exercises of neck to promote healing d. Administer pain medicine so the client can speak normally 16. A client with diabetes mellitus presents with a blood glucose level of 750 and positive ketones. Which of the following is the likely treatment plan for this client? a. Regular insulin 30 units subcutaneously b. Metformin 500 nmg BID c. Regular insulin at 10 units/hour with 40 mEq of potassium d. Lantus insulin at 20 units/hour with 40 mEq of potassium 17. A home care nurse finds a client who has diabetes awake and alert, clammy skin, shaky, diaphoretic, and weak. The client’s blood sugar is 50. Which of the following should the nurse *** a. Administer regular insulin as ordered per sliding scale b. Give the client a complex carbohydrate c. Administer NPH insulin as ordered d. Call the provider 18. Which of the following signs and symptoms characterize thyroid storm? a. Elevated temperature, tachycardia, and delirium b. Paranoia, delusions, and depression c. Coma, hypothermia, and respiratory acidosis d. Decreased blood pressure, anuria, and edema 19. A client is due to receive 10 units of Novolog due at 12 noon and an additional dose of insulin based on the following sliding scale. 1 unit 150 – 200 mg/dL 2 units regular insulin 201-300 mg/dL 3 units regular insulin 301-400 mg/dL Call the provider for glucose level >400 mg/dL The client’s blood glucose level is 152. How many total units of insulin should the client receive? a. 10 units b. 11 units c. 13 units d. 0 units 20. A client has a nasal gastric tube (NGT) inserted. Before using the tube, which of the following is most important? 21. A client has a nasal gastric tube (NGT) inserted. Before using the tube, which of the following is most important? a. Confirm the type of feeding that will be initiated b. Identify the weight of the patient c. Confirm placement before initiating feedings by installing air in the abdomen and listening for the “swish” sound 22. Your client is on telemetry monitoring. When you assess his rhythm strip you note 7 large blocks between the R waves ( 42 bpm), and multiple spikes that are not followed by a QRS complex. This rhythm is indicative of : 23. A client is having an operation. Which assessment findings concern the nurse the most? (Select all that Apply) 24. Discontinuing a mechanical ventilator from a patient who sustained an irreversible anoxic brain injury after a severe automobile accident is a form of active euthanasia. 25. Based on this 6 second strip, this ECG rhythm can be identified as: 26. Twenty minutes after a client was admitted to the ICU for DKA management, an IV of regular insulin was started with frequent finger sticks to monitor the glucose. His potassium level is 2.5 and IV potassium supplements ordered. What assessment must be made before giving the IV potassium? 26. A client has an arm cast and reports that it feels really tight and the fingers are puffy. What is the nurse’s best response? Neuro assessment/ Notify provider for compartment syndrome. 27. The nurse is providing care for a dying client. The nurse would place highest priority on treating which symptoms? (Select all that apply.) 28. A client is being treated for acute congestive heart failure with intravenously administered bumetanide (Bumex). The vital signs are as follows: blood pressure, 100/60 mm Hg; pulse, 96 beats/min; and respirations, 24 breaths/min. After the initial dose, which of the following is the priority assessment? Monitor blood pressure 29. When should a patient with type 1 diabetes avoid exercise? 30. A client admitted to the intensive care unit with severe dyspnea, fear, noisy respirations, sweating, pink frothy sputum and tachypnea. The nurse would recognize that the client is exhibiting manifestations of. 31. A client has end-stage kidney disease (ESKD). The nurse observes tall, peaked T waves on the client’s cardiac monitor. Which action by the nurse is best? 32. The nurse closely monitors a client receiving a blood transfusion because permanent damage can occur with an infusion as small as: 33. After surgical debridement of diseased bone, a client with acute osteomyelitis asks how long antibiotics will be administered. The nurse should respond that the antibiotic protocol will be 34. A client asks the nurse, “What are the advantages of peritoneal dialysis over hemodialysis?” Which response by the nurse is accurate? (Select all that apply.) 35. A client has a fenestrated tracheostomy tube in place. A tracheostomy plug will be used to allow the client to talk. The intervention by the nurse that would be essential before inserting the plug is. 36. A client with a diagnosis of left sided heart failure would have a positive assessment finding of scattered crackles 37. Based on this 6 second ECG strip, this rhythm is called: 38. A client is receiving Metoprolol (Lopressor) for hypertension. The nurse should ask the client about a history of which of the following: 39. As part of the mechanically ventilated client, the nurse must exercise extreme caution and maintain aseptic techniques to avoid cross contamination. The most critical nursing action that would avoid cross contamination, would be. 39. Which intervention can the nurse delegate to the unlicensed assistive personnel? a. Assist the client with repositioning b. Perform a pain assessment d. Take vital signs every 4 hours Promote the expression of grief and loss 40. In addition to being able to provide care by using skills and procedures. What must the medical surgical nurse also be prepared to utilize when caring for the client? Select all that apply a. Teaching b. Patient advocacy c. Spiritual counseling and support d. administrative scheduling and budgeting 41. A nurse is caring for a client with a newly applied cast to the leg. Which of the following will the nurse be sure to have in the plan of care to prevent compartment syndrome? a. Raised the casted extremity above the heart b. Apply ice throughout the shift c. Administer pain medicine as ordered d. Check pedal pulses Q2hrs 42. The client is being admitted to the hospital for treatment of acute cellulitis of the left leg. The client asks the admitting nurse to explain what cellulitis means. The nurse buses the response on the understanding that the characteristic of cellulitis include: a. An inflammation of the epidermis only b. A skin infection into the dermis and subcutaneous tissue c. An acute superficial infection of the dermis and lymphatics d. An epidermal and lymphatic infection caused by staphylococcus 43. While examine a client the nurse notes that the client’s fingernails are spoon shaped. Which of the following questions would be appropriate to identify a cause? a. So you have any breathing problem b. Have you ever been anemic c. Do you have any heart problem d. Are you taking any medication 44. A client admitted to the unit post right BKA (below the knee amputation). The client reports pain in the right leg rating it a 5. What is the appropriate response of the nurse? a. Document the pain but do not treat b. Call the physician c. Complete a mini mental examination d. Administer pain medication as ordered 45. The nurse is preparing discharge instructions for a client who has sprained their ankle. The nurse using the RICE acronym to teach treatment. What do the I stand for 46. A 86 year old client who is recovering from left hip surgery reports pain of a 5 and grimacing. The nurse will be administering the client’s first dose of pain medicine. Which of the following would be the appropriate action of the nurse? a. Document and wait until the pain is at least a 6 before medicating b. Administer Motrin 400mg PO c. Administer Diluadid 2mg IV d. Administer Morphine 1 mg IV 47. Which nursing action would best help to prevent thrombophlebitis in the postoperative client? a. Massaging the client’s legs b. Assisting the client to sit up in the bed after surgery c. Maintaining the legs in an elevated position d. Ensure that clients compression device is on 48. The nurse is told that a client with tuberculosis is being admitted. Which action by the nurse has been a. Implement contact precautions b. Check negative airflow monitor c. Ensure that hand sanitizer is readily available d. Place the client in a room with another measles client 49. When administering medication in the hospital, the nurse should a. Chart medication before administering them b. Chart only those drugs that she or he personally gave the patient. c. Chart all the medication given for the day at on time d. Determine the best method that the medication should be given 50. The nurse caring for HIV positive client. What assessment finding assists the nurse in confirming progression of the client’s diagnosis to AIDS? Select all that apply. a. Lymphadenopathy b. HIV positive status for 8 years c. Low grade fever for the last 2 days d. Thick white patches on the client’s tongue 51. The nurse is assessing skin turgor of a 65 year old client. What is the correct technique to use? a. pinch the skin over the sternum and observe for tenting and return of the skin to its normal b. observe the skin for a dry, scaly, appearance and compare it to a previous assessment c. pinch the skin over the back of the hand and observe for tenting count the number of seconds for the skin to recover position d. observe the mucous membranes and tongue for cracks, fissures or a pasty coating 52. The nurse notes that a postoperative client is voiding very small amounts of urine. Which of following should the nurse perform first? a. palpate for bladder distension b. force fluids c. obtain a urine specimen for culture d. notify the physician 53. A nurse is caring for a client who has had diarrhea for the past 4 days. When assessing the client, the nurse would expect to find which of the following clinical manifestations? Select all that apply a. Hypertension b. poor skin turgor c. peripheral edema d. hypotension 54. A comatose client is receiving tube feedings. Which of the following actions by the nurse is important to prevent complications from nasogastric feeding? a. check residual volume every 4 hours b. be sure that client is in the supine position c. provide only small amounts every hours d. stimulate the gag reflex every eight hours 55. The client has hypophosphatemia. The nurse knows that the client may have high levels of which electrolyte a. chloride b. magnesium c. potassium d. sodium e. calcium 56. Mr. Beebe has been given preoperative medication. The nurse reviews the preoperative checklist and notices the surgical consent form was not signed and witnessed. The nurse’s next step is to a. Sign the form as a witness to the signature b. Ask the family member to sign the consent form c. Immediately inform the physician of the situation d. Ask the patient to sign another consent form and sign as a witness 57. A client asks the nurse why it is important to be weighed every day if he has right-sided heart failure. What is the nurse’s best response? a. Weight is the best indication that you are gaining or losing fluid b. Daily weights will help us make sure that you are eating properly c. The hospital requires that all impatient be weighed daily d. You need to lose weight to decrease the incidence of heart failure 58. The nurse should assist the client in which position for the greatest degree of ease when inserting a nasal gastric tube? a. High Fowler’s b. side-lying c. Supine d. Lithotomy 59. Mrs. Lonzo has been taught how to self-administer her NPH insulin. Specifically related to prevention of lipohypertrohy, the teaching plan will include information regarding? a. Reduction of triglycerides and foods with high cholesterol intake c. Requirements about the appropriate dietary ADA caloric intake d. injection site rotation 60. The nurse is to be sure to look for the development of which of the following when caring for a client that has severe diarrhea secondary to ulcerative colitis. a. Perineal fistula b. Nephrolithiasis c. Metabolic acidosis d. Metabolic alkolosis 61. A beverage that the nurse should caution a client with peptic ulcer to avoid because of its stimulatory effect on gastric secretions is: A. apple juice b. Water c. Alcohol D. Lemonade 62. Which of the following preoperative activities can be delegated to the nursing assistant? a. Correctly assessing the client’s height and weight preoperatively b. completing the client’s respiratory assessment c. Teaching the client about peristaltic activity Monitoring and documenting the client’s reflexes 63. The nurse documents that ms. D;s gait as short accelerating steps, shuffling forward learning posture, and difficulty stopping and starting when walking. Which of the following disease process identifies with this type of gait? a. Alzheimer’s b. Parkinson’s c. Normal aging d. Guillan Barre syndrom 64. Nurse is assessing and discovered that a patient is taking garlic. What should the nurse do? 65. A client has acute osteomyelitis. What are the clinical manifestation? 66. A patient with tricuspid value disorder. Which blood flow disorder will the patient have 67. Which of the following manifestations would the nurse expect to see in a client with hypothyroidism? a. Weakness, constipation and cold extremities b. Heat intolerance, weight loss and diarrhea c. Muscle cramps parenthesis and numbness of the fingers and toes d. Blurred vision, night sweats and palpitation 68. The nurse would explain to a client started on daily doses of aspirin after a femoral bypass surgery that the purpose of this regimen is to: a. Decrease the PH of the blood b. Decrease postoperative pain c. Decrease platelet aggregation d. Increase vasodilation 69. Non pharmacologic management of GERD includes which of the following? a. lying down and resting after meals and weight reduction b. drinking large amounts of fluid with meals and avoiding alcohol c. Including high energy high caloric intake and avoiding mint, orange juice and milk d. weight reduction and sleep with head of bead elevated 4-6 inches with blocks 70. Which of the following signs and symptoms characteristic thyroid crisis/storm? a. Coma, hypothermia, and respiratory acidosis b. paranoia, delusions, and depression c. Decreased blood pressure, anuria, and edema d. Elevated temperature, tachycardia, and delirium 71. What is the most appropriate action for the nurse to take to relieve a client’s pruritus( intense itching) a. Apply power b. Keep area clean with hydrogen peroxide c. Apply hot compress Apply cool compress 72. The nurse explains that if left untreated, Benign prostate hypertrophy (BPH) will result in a. Prostatic cancer b. Urinary calculi c. Upper urinary tract infection d. Bladder cancer The nurse counseling a client in the prevention of goiter would suggest an increased intake of: Calcium Iodine Potassium Protein 73. An older adult client has become agitated and combative toward health care personnel on the unit. What is the first action that the nurse will take? a. obtain an order for a sedative-hypnotic medication to reduce combative behavior b. attempt to soothe the client’s fear and reorient the client to surroundings c. obtain an oder to place the client’s arms in restraints to protect personnel d. Arrange for the client to be transferred to a mental health facility 74. A. client with cholecystitis has pain in the right shoulder area and asks, what is happening to me? What did I do to my shoulder? What is the nurse’s best response? a. You are weak from staying in bed b. does your other arm hurt too? c. sometimes pain from a certain organ is referred elsewhere in the body d. I am going to hold your medication until we can determine what is happening 75. A client is admitted to the unit with the diagnosis of possible myocardial infarction(MI). which laboratory study result would the nurse expect to be elevated? a. Leukocyte count b. Lactic Dehydrogenase (LDH) c. Alkaline phosphatase (ALP) CPK-MB 76. A female patient decided to have breast augmentation surgery. Which kind of surgery is this? a. Palliative b. Emergent c. Elective 77. A client with a history of diabetes, complains of feeding clammy, week and has a headache that will not go away. The nursing tech reports a blood sugar of 62. What is the most appropriate action of the nurse at this time? a. Administer Tylenol b. Give the client a snack of milk and crackers c. call the physician d. Administer insulin 78. . The client is receiving DS ½ NS at 12ml/hr for the past 6 hours and has eaten the following fro breakfast, calculate the clients total intake in millimeters. 1cup of apple juice, 2 sausages, I boiled egg, ½ cup of coffee, ½ pint of milk.. a. 600ml b. 750ml c. 1300ml d. 1350ml 79. A client is admitted to the hospital after vomiting for three days. Which arterial blood gas result would the nurse expect? a. PH 7.30; PaCO2 50; HCO3-27 b. PH 7.47; PaCO2 43; HCO3-28 c. PH 7.34; PaC02 50; HCO3-28 d. PH 7.48; PaCO2 30; HCO3-23 80. The nurse is assessing a client with a tentative diagnosis of hyperpituitarism. What assessment findings should the nurse observe for in this client? Select all that apply a. short status if onset is in childhood b. large hands and feet with prominent jawbones c. joint changes consistent with arthritis Hypertension 81. which action by the surgical nursing staff indicates that additional teaching is required about nurses’ roles and responsibilities in the operating room? a. The circulating nurse and the anesthesiologist accompany the client to the post anesthesia care unit b. The scrub nurse goes to the blood bank to pick up 2 units of fresh-frozen plasma for the client. c. The scrub nurse assists the surgeon with instruments used during surgery. d. The circulating nurse prepares the surgical site before the client is covered with sterile drapes 82. The nurse is providing disease management education to a client with Raynaud’s disease. What intervention does the nurse suggest to prevent complications of this disease? a. take vasoconstrictive agents when you have symptoms b. Wear warm clothing when exposed to cool temperatures c. Avoid placing alcohol-based lotion on affected extremities d. Check the strength of pulses in your arms and legs daily 83. The nurse is caring for client with Burger’s disease. What client education does the nurse provide to minimize disease progression? a. Keep environmental temperatures warm b. Avoid highly stressful activities c. Use a heating pad on your extremities d. Abstain from smoking 84. The nurse is caring for a client with newly diagnosed hypertension. What statement by the client indicates adequate understanding of his or her diet restrictions? Select all that apply a. I will purchase fresh vegetables instead of canned b. I’m going to miss my evening glass of wine c. I will use salt substitutes for flavoring d. I can have pork sausage only in the morning 85. Before the nurse brings the client to the operating room(OR) for knee surgery, the client reports to the nurse that he did not mark the operative knee with the surgeon. What is the priority action of the nurse? a. Proceed with transferring the client to the OR as planned b. Mark the knee his/herself before taking client to the OR. c. Call the surgeon to mark the site with the client before transfer to the OR d. Have the client’s family member mark the site before transfer to the OR. 86. A client with atherosclerosis asks a nurse which factors are responsible for this condition. What is the nurse’s best response a. Injury to the arteries causes them to spasm, reducing blood flow to the extremities b. Excess fats in your diet are stored in the lining of your arteries, causing them to constrict c. A combination of platelets and fat accumulates, narrowing the artery and reducing blood flow d. Excess sodium causes injury to the arteries, reducing blood flow and eventually causing obstruction 87. We use nursing process to convert data. Three (3) parts in nursing diagnosis? 88. Evidenced based practice according? 89. Patient centered care 90. Proper way to cough….. post-op a. Relax abdomen muscles b. Splits incision when coughing c. Breath in through the mouth and out the nose d. Deep breath after coughing 91. Which statement by the female client indicates that instruction in ways to prevent urinary tract infection (UTI) was understood. Select all that apply a. I should limit tub baths and take showers instead b. I should drink 8 to 10 glasses of fluid a day c. I should only wear nylon panties d. I should use powder to aid in keeping the perinea skin dry 92. The nurse reviewed the domains of palliative care and teaches a colleague about the spiritual religious section. What statement by the colleague tells the nurse if the teaching was effective? a. I don’t think religion has a place in health care b. I know I would feel better if my religions and spiritual beliefs were aspects of care c. Religions/Spiritual needs are important aspects of clients care d. Why is this so important to some client? 93. Determine the flow rate for the following IV being administered by infusion pump. Clindamycin 600mg in 100ml D5W over1/2 hour. 50ml 100ml 150ml 200ml 94. Which end of life intervention must the nurse be prepared to perform for a dying client and his or her family? Select all that apply a. Allow the family to verbalize fears and concerns about the impending loss of their love one b. Listen and acknowledge the legitimacy of the family’s pain c. Minimize the family’s loss by using statements such as don’t be upset d. Assess to determine the family and client spiritual needs 95. Which of the following is a legal document that appoints a person to make decisions regarding healthcare for someone else who becomes unable to make his or her own decision? A. Living will b. Do not resuscitate form c. Patient self Determination Act documentation d. Durable power of attorney for health care 96. The client is ordered vancomycin 500mg in 100ml of 0.9% Ns to infuse over 30 minutes by infusion pump. Provide the infusion rate SCIENCE HEALTH SCIENCE NURSING NURS 323

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