The scope of this Nursing Test V is parallel to the NP5 NLE Coverage: (www.nursingcrib.com)
- Psychiatric Nursing
Showing posts with label Practice Tests. Show all posts
Showing posts with label Practice Tests. Show all posts
Monday, January 18, 2010
Monday, October 12, 2009
2009 NLE: Nursing Test I
1. The registered nurse is planning to delegate tasks to unlicensed assistive personnel (UAP). Which of the following task could the registered nurse safely assigned to a UAP?
2. A nurse manager assigned a registered nurse from telemetry unit to the pediatrics unit. There were three patients assigned to the RN. Which of the following patients should not be assigned to the floated nurse?
3. A nurse in charge in the pediatric unit is absent. The nurse manager decided to assign the nurse in the obstetrics unit to the pediatrics unit. Which of the following patients could the nurse manager safely assign to the float nurse?
4. The registered nurse is planning to delegate task to a certified nursing assistant. Which of the following clients should not be assigned to a CAN?
5. The nurse in the medication unit passes the medications for all the clients on the nursing unit. The head nurse is making rounds with the physician and coordinates clients’ activities with other departments. The nurse assistant changes the bed lines and answers call lights. A second nurse is assigned for changing wound dressings; a licensed practitioner nurse takes vital signs and bathes the clients. This illustrates of what method of nursing care?
6. A registered nurse has been assigned to six clients on the 12-hour shift. The RN is responsible for every aspect of care such as formulating the care of plan, intervention and evaluating the care during her shift. At the end of her shift, the RN will pass this same task to the next RN in charge. This nursing care illustrates of what kind of method?
7. A newly hired nurse on an adult medicine unit with 3 months experience was asked to float to pediatrics. The nurse hesitates to perform pediatric skills and receive an interesting assignment that feels overwhelming. The nurse should:
8. An experienced nurse who voluntarily trained a less experienced nurse with the intention of enhancing the skills and knowledge and promoting professional advancement to the nurse is called a:
9. The pediatrics unit is understaffed and the nurse manager informs the nurses in the obstetrics unit that she is going to assign one nurse to float in the pediatric units. Which statement by the designated float nurse may put her job at risk?
10. The newly hired staff nurse has been working on a medical unit for 3 weeks. The nurse manager has posted the team leader assignments for the following week. The new staff knows that a major responsibility of the team leader is to:
11. A 15-year-old girl just gave birth to a baby boy who needs emergency surgery. The nurse prepared the consent form and it should be signed by:
12. A nurse caring to a client with Alzheimer’s disease overheard a family member say to the client, “if you pee one more time, I won’t give you any more food and drinks”. What initial action is best for the nurse to take?
13. Which is true about informed consent?
14. A mother in labor told the nurse that she was expecting that her baby has no chance to survive and expects that the baby will be born dead. The mother accepts the fate of the baby and informs the nurse that when the baby is born and requires resuscitation, the mother refuses any treatment to her baby and expresses hostility toward the nurse while the pediatric team is taking care of the baby. The nurse is legally obligated to:
15. The hospitalized client with a chronic cough is scheduled for bronchoscopy. The nurse is tasks to bring the informed consent document into the client’s room for a signature. The client asks the nurse for details of the procedure and demands an explanation why the process of informed consent is necessary. The nurse responds that informed consent means:
16. A hospitalized client with severe necrotizing ulcer of the lower leg is schedule for an amputation. The client tells the nurse that he will not sign the consent form and he does not want any surgery or treatment because of religious beliefs about reincarnation. What is the role of the RN?
17. While in the hospital lobby, the RN overhears the three staff discussing the health condition of her client. What would be the appropriate nursing action for the RN to take?
18. A staff nurse has had a serious issue with her colleague. In this situation, it is best to:
19. The nurse is caring to a client who just gave birth to a healthy baby boy. The nurse may not disclose confidential information when:
20. A 17-year-old married client is scheduled for surgery. The nurse taking care of the client realizes that consent has not been signed after preoperative medications were given. What should the nurse do?
21. A 12-year-old client is admitted to the hospital. The physician ordered Dilantin to the client. In administering IV phenytoin (Dilantin) to a child, the nurse would be most correct in mixing it with:
22. The nurse is caring to a client who is hypotensive. Following a large hematemesis, how should the nurse position the client?
23. The client is brought to the emergency department after a serious accident. What would be the initial nursing action of the nurse to the client?
24. A nurse is assigned to care to a client with Parkinson’s disease. What interventions are important if the nurse wants to improve nutrition and promote effective swallowing of the client?
25. During tracheal suctioning, the nurse should implement safety measures. Which of the following should the nurse implements?
26. The nurse is conducting a discharge instructions to a client diagnosed with diabetes. What sign of hypoglycemia should be taught to a client?
27. A client admitted to the hospital and diagnosed with Addison’s disease. What would be the appropriate nursing action to the client?
28. The nurse is to perform tracheal suctioning. During tracheal suctioning, which nursing action is essential to prevent hypoxemia?
29. An infant is admitted and diagnosed with pneumonia and suspicious-looking red marks on the swollen face resembling a handprint. The nurse does further assessment to the client. How would the nurse document the finding?
30. On the evening shift, the triage nurse evaluates several clients who were brought to the emergency department. Which in the following clients should receive highest priority?
31. A 80-year-old female client is brought to the emergency department by her caregiver, on the nurse’s assessment; the following are the manifestations of the client: anorexia, cachexia and multiple bruises. What would be the best nursing intervention?
32. The night shift nurse is making rounds. When the nurse enters a client’s room, the client is on the floor next to the bed. What would be the initial action of the nurse?
33. The nurse on the night shift is about to administer medication to a preschooler client and notes that the child has no ID bracelet. The best way for the nurse to identify the client is to ask:
34. The nurse caring to a client has completed the assessment. Which of the following will be considered to be the most accurate charting of a lump felt in the right breast?
35. The physician instructed the nurse that intravenous pyelogram will be done to the client. The client asks the nurse what is the purpose of the procedure. The appropriate nursing response is to:
36. A client visits the clinic for screening of scoliosis. The nurse should ask the client to:
37. A client with tuberculosis is admitted in the hospital for 2 weeks. When a client’s family members come to visit, they would be adhering to respiratory isolation precautions when they:
38. An infant is brought to the emergency department and diagnosed with pyloric stenosis. The parents of the client ask the nurse, “Why does my baby continue to vomit?” Which of the following would be the best nursing response of the nurse?
39. A 70-year-old client with suspected tuberculosis is brought to the geriatric care facilities. An intradermal tuberculosis test is schedule to be done. The client asks the nurse what is the purpose of the test. Which of the following would be the best rationale for this?
40. The nurse is making a health teaching to the parents of the client. In teaching parents how to measure the area of induration in response to a PPD test, the nurse would be most accurate in advising the parents to measure:
41. A community health nurse is schedule to do home visit. She visits to an elderly person living alone. Which of the following observation would be a concern?
42. After a birth, the physician cut the cord of the baby, and before the baby is given to the mother, what would be the initial nursing action of the nurse?
43. A 2-year-old client is admitted to the hospital with severe eczema lesions on the scalp, face, neck and arms. The client is scratching the affected areas. What would be the best nursing intervention to prevent the client from scratching the affected areas?
44. The parents of the hospitalized client ask the nurse how their baby might have gotten pyloric stenosis. The appropriate nursing response would be:
45. A male client comes to the clinic for check-up. In doing a physical assessment, the nurse should report to the physician the most common symptom of gonorrhea, which is:
46. Which of the following would be the most important goal in the nursing care of an infant client with eczema?
47. The nurse is making a discharge instruction to a client receiving chemotherapy. The client is at risk for bone marrow depression. The nurse gives instructions to the client about how to prevent infection at home. Which of the following health teaching would be included?
48. The nurse is assigned to care the client with infectious disease. The best antimicrobial agent for the nurse to use in handwashing is:
49. The mother of the client tells the nurse, “ I’m not going to have my baby get any immunization”. What would be the best nursing response to the mother?
50. The nurse is teaching the client about breast self-examination. Which observation should the client be taught to recognize when doing the examination for detection of breast cancer?
Saturday, October 11, 2008
Fundamentals of Nursing Practice Test III
1. Which element in the circular chain of infection can be eliminated by preserving skin integrity?
a. Host
b. Reservoir
c. Mode of transmission
d. Portal of entry
2. Which of the following will probably result in a break in sterile technique for respiratory isolation?
a. Opening the patient’s window to the outside environment
b. Turning on the patient’s room ventilator
c. Opening the door of the patient’s room leading into the hospital corridor
d. Failing to wear gloves when administering a bed bath
3. Which of the following patients is at greater risk for contracting an infection?
a. A patient with leukopenia
b. A patient receiving broad-spectrum antibiotics
c. A postoperative patient who has undergone orthopedic surgery
d. A newly diagnosed diabetic patient
4. Effective [1] hand washing requires the use of:
a. Soap or detergent to promote emulsification
b. Hot water to destroy bacteria
c. A disinfectant to increase surface tension
d. All of the above
5. After routine patient contact, [1] hand washing should last at least:
a. 30 seconds
b. 1 minute
c. 2 minute
d. 3 minutes
6. Which of the following procedures always requires surgical asepsis?
a. Vaginal instillation of conjugated estrogen
b. [2] Urinary catheterization
c. [3] Nasogastric tube insertion
d. [4] Colostomy irrigation
7. Sterile technique is used whenever:
a. Strict isolation is required
b. Terminal disinfection is performed
c. Invasive procedures are performed
d. Protective isolation is necessary
8. Which of the following constitutes a break in sterile technique while preparing a sterile field for a dressing change?
a. Using sterile forceps, rather than sterile gloves, to handle a sterile item
b. Touching the outside wrapper of sterilized material without sterile gloves
c. Placing a sterile object on the edge of the sterile field
d. Pouring out a small amount of solution (15 to 30 ml) before pouring the solution into a sterile container
9. A natural body defense that plays an active role in preventing infection is:
a. Yawning
b. Body hair
c. Hiccupping
d. Rapid eye movements
10. All of the following statement are true about [5] donning sterile gloves except:
a. The first glove should be picked up by grasping the inside of the cuff.
b. The second glove should be picked up by inserting the gloved fingers under the cuff outside the glove.
c. The gloves should be adjusted by sliding the gloved fingers under the sterile cuff and pulling the glove over the wrist
d. The inside of the glove is considered sterile
11. When removing a contaminated gown, the nurse should be careful that the first thing she touches is the:
a. Waist tie and neck tie at the back of the gown
b. Waist tie in front of the gown
c. Cuffs of the gown
d. Inside of the gown
12. Which of the following nursing interventions is considered the most effective form or universal precautions?
a. Cap all used needles before removing them from their syringes
b. Discard all used uncapped needles and syringes in an impenetrable protective container
c. Wear gloves when administering IM injections
d. Follow enteric precautions
13. All of the following measures are recommended to prevent pressure ulcers except:
a. Massaging the reddened are with lotion
b. Using a water or air mattress
c. Adhering to a schedule for positioning and turning
d. Providing meticulous skin care
14. Which of the following blood tests should be performed before a blood transfusion?
a. Prothrombin and coagulation time
b. Blood typing and cross-matching
c. Bleeding and clotting time
d. Complete blood count (CBC) and electrolyte levels.
15. The primary purpose of a platelet count is to evaluate the:
a. Potential for clot formation
b. Potential for bleeding
c. Presence of an antigen-antibody response
d. Presence of cardiac enzymes
16. Which of the following white blood cell (WBC) counts clearly indicates leukocytosis?
a. 4,500/mm³
b. 7,000/mm³
c. 10,000/mm³
d. 25,000/mm³
17. After 5 days of diuretic therapy with 20mg of [6] furosemide (Lasix) daily, a patient begins to exhibit fatigue, muscle cramping and muscle weakness. These symptoms probably indicate that the patient is experiencing:
a. Hypokalemia
b. Hyperkalemia
c. Anorexia
d. Dysphagia
18. Which of the following statements about chest X-ray is false?
a. No contradictions exist for this test
b. Before the procedure, the patient should remove all jewelry, metallic objects, and buttons above the waist
c. A signed consent is not required
d. Eating, drinking, and medications are allowed before this test
19. The most appropriate time for the nurse to obtain a sputum specimen for culture is:
a. Early in the morning
b. After the patient eats a light breakfast
c. After aerosol therapy
d. After chest physiotherapy
20. A patient with no known allergies is to receive penicillin every 6 hours. When administering the medication, the nurse observes a fine rash on the patient’s skin. The most appropriate nursing action would be to:
a. Withhold the moderation and notify the physician
b. Administer the medication and notify the physician
c. Administer the medication with an antihistamine
d. Apply corn starch soaks to the rash
21. All of the following nursing interventions are correct when using the Z-track method of drug [7] injection except:
a. Prepare the injection site with alcohol
b. Use a needle that’s a least 1” long
c. Aspirate for blood before injection
d. Rub the site vigorously after the injection to promote absorption
22. The correct method for determining the vastus lateralis site for I.M. injection is to:
a. Locate the upper aspect of the upper outer quadrant of the buttock about 5 to 8 cm below the iliac crest
b. Palpate the lower edge of the acromion process and the midpoint lateral aspect of the arm
c. Palpate a 1” circular area anterior to the umbilicus
d. Divide the area between the greater femoral trochanter and the lateral femoral condyle into thirds, and select the middle third on the anterior of the thigh
23. The mid-deltoid injection site is seldom used for I.M. injections because it:
a. Can accommodate only 1 ml or less of medication
b. Bruises too easily
c. Can be used only when the patient is lying down
d. Does not readily parenteral medication
24. The appropriate needle size for insulin injection is:
a. 18G, 1 ½” long
b. 22G, 1” long
c. 22G, 1 ½” long
d. 25G, 5/8” long
25. The appropriate needle gauge for intradermal injection is:
a. 20G
b. 22G
c. 25G
d. 26G
26. Parenteral penicillin can be administered as an:
a. IM injection or an IV solution
b. IV or an intradermal injection
c. Intradermal or [8] subcutaneous injection
d. IM or a subcutaneous injection
27. The physician orders gr 10 of aspirin for a patient. The equivalent dose in milligrams is:
a. 0.6 mg
b. 10 mg
c. 60 mg
d. 600 mg
28. The physician orders an IV solution of dextrose 5% in water at 100ml/hour. What would the flow rate be if the drop factor is 15 gtt = 1 ml?
a. 5 gtt/minute
b. 13 gtt/minute
c. 25 gtt/minute
d. 50 gtt/minute
29. Which of the following is a sign or symptom of a hemolytic reaction to blood transfusion?
a. Hemoglobinuria
b. Chest pain
c. Urticaria
d. Distended neck veins
30. Which of the following conditions may require fluid restriction?
a. Fever
b. Chronic Obstructive Pulmonary Disease
c. Renal Failure
d. Dehydration
31. All of the following are common signs and symptoms of phlebitis except:
a. Pain or discomfort at the IV insertion site
b. Edema and warmth at the IV insertion site
c. A red streak exiting the IV insertion site
d. Frank bleeding at the insertion site
32. The best way of determining whether a patient has learned to instill ear medication properly is for the nurse to:
a. Ask the patient if he/she has used ear drops before
b. Have the patient repeat the nurse’s instructions using her own words
c. Demonstrate the procedure to the patient and encourage to ask questions
d. Ask the patient to demonstrate the procedure
33. Which of the following types of medications can be administered via gastrostomy tube?
a. Any oral medications
b. Capsules whole contents are dissolve in water
c. Enteric-coated tablets that are thoroughly dissolved in water
d. Most tablets designed for oral use, except for extended-duration compounds
34. A patient who develops hives after receiving an antibiotic is exhibiting drug:
a. Tolerance
b. Idiosyncrasy
c. Synergism
d. Allergy
35. A patient has returned to his room after femoral arteriography. All of the following are appropriate nursing interventions except:
a. Assess femoral, popliteal, and pedal pulses every 15 minutes for 2 hours
b. Check the pressure dressing for sanguineous drainage
c. Assess a vital signs every 15 minutes for 2 hours
d. Order a hemoglobin and hematocrit count 1 hour after the arteriography
36. The nurse explains to a patient that a cough:
a. Is a protective response to clear the respiratory tract of irritants
b. Is primarily a voluntary action
c. Is induced by the administration of an antitussive drug
d. Can be inhibited by “splinting” the abdomen
37. An infected patient has chills and begins shivering. The best nursing intervention is to:
a. Apply iced alcohol sponges
b. Provide increased cool liquids
c. Provide additional bedclothes
d. Provide increased ventilation
38. A clinical nurse specialist is a nurse who has:
a. Been certified by the National League for Nursing
b. Received credentials from the Philippine Nurses’ Association
c. Graduated from an associate degree program and is a registered professional nurse
d. Completed a master’s degree in the prescribed clinical area and is a registered professional nurse.
39. The purpose of increasing urine acidity through dietary means is to:
a. Decrease burning sensations
b. Change the urine’s color
c. Change the urine’s concentration
d. Inhibit the growth of microorganisms
40. Clay colored stools indicate:
a. Upper GI bleeding
b. Impending constipation
c. An effect of medication
d. Bile obstruction
41. In which step of the [9] nursing process would the nurse ask a patient if the medication she administered relieved his pain?
a. [10] Assessment
b. Analysis
c. [11] Planning
d. [12] Evaluation
42. All of the following are good sources of vitamin A except:
a. White potatoes
b. Carrots
c. Apricots
d. Egg yolks
43. Which of the following is a primary nursing intervention necessary for all patients with a Foley Catheter in place?
a. Maintain the drainage tubing and collection bag level with the patient’s bladder
b. Irrigate the patient with 1% Neosporin solution three times a daily
c. Clamp the catheter for 1 hour every 4 hours to maintain the bladder’s elasticity
d. Maintain the drainage tubing and collection bag below bladder level to facilitate drainage by gravity
44. The ELISA test is used to:
a. Screen blood donors for antibodies to human immunodeficiency virus (HIV)
b. Test blood to be used for transfusion for HIV antibodies
c. Aid in diagnosing a patient with AIDS
d. All of the above
45. The two blood vessels most commonly used for TPN infusion are the:
a. Subclavian and jugular veins
b. Brachial and subclavian veins
c. Femoral and subclavian veins
d. Brachial and femoral veins
46. Effective skin disinfection before a surgical procedure includes which of the following methods?
a. Shaving the site on the day before surgery
b. Applying a topical antiseptic to the skin on the evening before surgery
c. Having the patient take a tub bath on the morning of surgery
d. Having the patient shower with an antiseptic soap on the evening v=before and the morning of surgery
47. When transferring a patient from a bed to a chair, the nurse should use which muscles to avoid back injury?
a. Abdominal muscles
b. Back muscles
c. Leg muscles
d. Upper arm muscles
48. Thrombophlebitis typically develops in patients with which of the following conditions?
a. Increases partial thromboplastin time
b. Acute pulsus paradoxus
c. An impaired or traumatized blood vessel wall
d. Chronic Obstructive Pulmonary Disease (COPD)
49. In a recumbent, immobilized patient, lung ventilation can become altered, leading to such respiratory complications as:
a. Respiratory acidosis, ateclectasis, and hypostatic pneumonia
b. Appneustic breathing, atypical pneumonia and respiratory alkalosis
c. Cheyne-Strokes respirations and spontaneous pneumothorax
d. Kussmail’s respirations and hypoventilation
50. Immobility impairs bladder elimination, resulting in such disorders as
a. Increased urine acidity and relaxation of the perineal muscles, causing incontinence
b. Urine retention, bladder distention, and infection
c. Diuresis, natriuresis, and decreased urine specific gravity
d. Decreased calcium and phosphate levels in the urine
a. Host
b. Reservoir
c. Mode of transmission
d. Portal of entry
2. Which of the following will probably result in a break in sterile technique for respiratory isolation?
a. Opening the patient’s window to the outside environment
b. Turning on the patient’s room ventilator
c. Opening the door of the patient’s room leading into the hospital corridor
d. Failing to wear gloves when administering a bed bath
3. Which of the following patients is at greater risk for contracting an infection?
a. A patient with leukopenia
b. A patient receiving broad-spectrum antibiotics
c. A postoperative patient who has undergone orthopedic surgery
d. A newly diagnosed diabetic patient
4. Effective [1] hand washing requires the use of:
a. Soap or detergent to promote emulsification
b. Hot water to destroy bacteria
c. A disinfectant to increase surface tension
d. All of the above
5. After routine patient contact, [1] hand washing should last at least:
a. 30 seconds
b. 1 minute
c. 2 minute
d. 3 minutes
6. Which of the following procedures always requires surgical asepsis?
a. Vaginal instillation of conjugated estrogen
b. [2] Urinary catheterization
c. [3] Nasogastric tube insertion
d. [4] Colostomy irrigation
7. Sterile technique is used whenever:
a. Strict isolation is required
b. Terminal disinfection is performed
c. Invasive procedures are performed
d. Protective isolation is necessary
8. Which of the following constitutes a break in sterile technique while preparing a sterile field for a dressing change?
a. Using sterile forceps, rather than sterile gloves, to handle a sterile item
b. Touching the outside wrapper of sterilized material without sterile gloves
c. Placing a sterile object on the edge of the sterile field
d. Pouring out a small amount of solution (15 to 30 ml) before pouring the solution into a sterile container
9. A natural body defense that plays an active role in preventing infection is:
a. Yawning
b. Body hair
c. Hiccupping
d. Rapid eye movements
10. All of the following statement are true about [5] donning sterile gloves except:
a. The first glove should be picked up by grasping the inside of the cuff.
b. The second glove should be picked up by inserting the gloved fingers under the cuff outside the glove.
c. The gloves should be adjusted by sliding the gloved fingers under the sterile cuff and pulling the glove over the wrist
d. The inside of the glove is considered sterile
11. When removing a contaminated gown, the nurse should be careful that the first thing she touches is the:
a. Waist tie and neck tie at the back of the gown
b. Waist tie in front of the gown
c. Cuffs of the gown
d. Inside of the gown
12. Which of the following nursing interventions is considered the most effective form or universal precautions?
a. Cap all used needles before removing them from their syringes
b. Discard all used uncapped needles and syringes in an impenetrable protective container
c. Wear gloves when administering IM injections
d. Follow enteric precautions
13. All of the following measures are recommended to prevent pressure ulcers except:
a. Massaging the reddened are with lotion
b. Using a water or air mattress
c. Adhering to a schedule for positioning and turning
d. Providing meticulous skin care
14. Which of the following blood tests should be performed before a blood transfusion?
a. Prothrombin and coagulation time
b. Blood typing and cross-matching
c. Bleeding and clotting time
d. Complete blood count (CBC) and electrolyte levels.
15. The primary purpose of a platelet count is to evaluate the:
a. Potential for clot formation
b. Potential for bleeding
c. Presence of an antigen-antibody response
d. Presence of cardiac enzymes
16. Which of the following white blood cell (WBC) counts clearly indicates leukocytosis?
a. 4,500/mm³
b. 7,000/mm³
c. 10,000/mm³
d. 25,000/mm³
17. After 5 days of diuretic therapy with 20mg of [6] furosemide (Lasix) daily, a patient begins to exhibit fatigue, muscle cramping and muscle weakness. These symptoms probably indicate that the patient is experiencing:
a. Hypokalemia
b. Hyperkalemia
c. Anorexia
d. Dysphagia
18. Which of the following statements about chest X-ray is false?
a. No contradictions exist for this test
b. Before the procedure, the patient should remove all jewelry, metallic objects, and buttons above the waist
c. A signed consent is not required
d. Eating, drinking, and medications are allowed before this test
19. The most appropriate time for the nurse to obtain a sputum specimen for culture is:
a. Early in the morning
b. After the patient eats a light breakfast
c. After aerosol therapy
d. After chest physiotherapy
20. A patient with no known allergies is to receive penicillin every 6 hours. When administering the medication, the nurse observes a fine rash on the patient’s skin. The most appropriate nursing action would be to:
a. Withhold the moderation and notify the physician
b. Administer the medication and notify the physician
c. Administer the medication with an antihistamine
d. Apply corn starch soaks to the rash
21. All of the following nursing interventions are correct when using the Z-track method of drug [7] injection except:
a. Prepare the injection site with alcohol
b. Use a needle that’s a least 1” long
c. Aspirate for blood before injection
d. Rub the site vigorously after the injection to promote absorption
22. The correct method for determining the vastus lateralis site for I.M. injection is to:
a. Locate the upper aspect of the upper outer quadrant of the buttock about 5 to 8 cm below the iliac crest
b. Palpate the lower edge of the acromion process and the midpoint lateral aspect of the arm
c. Palpate a 1” circular area anterior to the umbilicus
d. Divide the area between the greater femoral trochanter and the lateral femoral condyle into thirds, and select the middle third on the anterior of the thigh
23. The mid-deltoid injection site is seldom used for I.M. injections because it:
a. Can accommodate only 1 ml or less of medication
b. Bruises too easily
c. Can be used only when the patient is lying down
d. Does not readily parenteral medication
24. The appropriate needle size for insulin injection is:
a. 18G, 1 ½” long
b. 22G, 1” long
c. 22G, 1 ½” long
d. 25G, 5/8” long
25. The appropriate needle gauge for intradermal injection is:
a. 20G
b. 22G
c. 25G
d. 26G
26. Parenteral penicillin can be administered as an:
a. IM injection or an IV solution
b. IV or an intradermal injection
c. Intradermal or [8] subcutaneous injection
d. IM or a subcutaneous injection
27. The physician orders gr 10 of aspirin for a patient. The equivalent dose in milligrams is:
a. 0.6 mg
b. 10 mg
c. 60 mg
d. 600 mg
28. The physician orders an IV solution of dextrose 5% in water at 100ml/hour. What would the flow rate be if the drop factor is 15 gtt = 1 ml?
a. 5 gtt/minute
b. 13 gtt/minute
c. 25 gtt/minute
d. 50 gtt/minute
29. Which of the following is a sign or symptom of a hemolytic reaction to blood transfusion?
a. Hemoglobinuria
b. Chest pain
c. Urticaria
d. Distended neck veins
30. Which of the following conditions may require fluid restriction?
a. Fever
b. Chronic Obstructive Pulmonary Disease
c. Renal Failure
d. Dehydration
31. All of the following are common signs and symptoms of phlebitis except:
a. Pain or discomfort at the IV insertion site
b. Edema and warmth at the IV insertion site
c. A red streak exiting the IV insertion site
d. Frank bleeding at the insertion site
32. The best way of determining whether a patient has learned to instill ear medication properly is for the nurse to:
a. Ask the patient if he/she has used ear drops before
b. Have the patient repeat the nurse’s instructions using her own words
c. Demonstrate the procedure to the patient and encourage to ask questions
d. Ask the patient to demonstrate the procedure
33. Which of the following types of medications can be administered via gastrostomy tube?
a. Any oral medications
b. Capsules whole contents are dissolve in water
c. Enteric-coated tablets that are thoroughly dissolved in water
d. Most tablets designed for oral use, except for extended-duration compounds
34. A patient who develops hives after receiving an antibiotic is exhibiting drug:
a. Tolerance
b. Idiosyncrasy
c. Synergism
d. Allergy
35. A patient has returned to his room after femoral arteriography. All of the following are appropriate nursing interventions except:
a. Assess femoral, popliteal, and pedal pulses every 15 minutes for 2 hours
b. Check the pressure dressing for sanguineous drainage
c. Assess a vital signs every 15 minutes for 2 hours
d. Order a hemoglobin and hematocrit count 1 hour after the arteriography
36. The nurse explains to a patient that a cough:
a. Is a protective response to clear the respiratory tract of irritants
b. Is primarily a voluntary action
c. Is induced by the administration of an antitussive drug
d. Can be inhibited by “splinting” the abdomen
37. An infected patient has chills and begins shivering. The best nursing intervention is to:
a. Apply iced alcohol sponges
b. Provide increased cool liquids
c. Provide additional bedclothes
d. Provide increased ventilation
38. A clinical nurse specialist is a nurse who has:
a. Been certified by the National League for Nursing
b. Received credentials from the Philippine Nurses’ Association
c. Graduated from an associate degree program and is a registered professional nurse
d. Completed a master’s degree in the prescribed clinical area and is a registered professional nurse.
39. The purpose of increasing urine acidity through dietary means is to:
a. Decrease burning sensations
b. Change the urine’s color
c. Change the urine’s concentration
d. Inhibit the growth of microorganisms
40. Clay colored stools indicate:
a. Upper GI bleeding
b. Impending constipation
c. An effect of medication
d. Bile obstruction
41. In which step of the [9] nursing process would the nurse ask a patient if the medication she administered relieved his pain?
a. [10] Assessment
b. Analysis
c. [11] Planning
d. [12] Evaluation
42. All of the following are good sources of vitamin A except:
a. White potatoes
b. Carrots
c. Apricots
d. Egg yolks
43. Which of the following is a primary nursing intervention necessary for all patients with a Foley Catheter in place?
a. Maintain the drainage tubing and collection bag level with the patient’s bladder
b. Irrigate the patient with 1% Neosporin solution three times a daily
c. Clamp the catheter for 1 hour every 4 hours to maintain the bladder’s elasticity
d. Maintain the drainage tubing and collection bag below bladder level to facilitate drainage by gravity
44. The ELISA test is used to:
a. Screen blood donors for antibodies to human immunodeficiency virus (HIV)
b. Test blood to be used for transfusion for HIV antibodies
c. Aid in diagnosing a patient with AIDS
d. All of the above
45. The two blood vessels most commonly used for TPN infusion are the:
a. Subclavian and jugular veins
b. Brachial and subclavian veins
c. Femoral and subclavian veins
d. Brachial and femoral veins
46. Effective skin disinfection before a surgical procedure includes which of the following methods?
a. Shaving the site on the day before surgery
b. Applying a topical antiseptic to the skin on the evening before surgery
c. Having the patient take a tub bath on the morning of surgery
d. Having the patient shower with an antiseptic soap on the evening v=before and the morning of surgery
47. When transferring a patient from a bed to a chair, the nurse should use which muscles to avoid back injury?
a. Abdominal muscles
b. Back muscles
c. Leg muscles
d. Upper arm muscles
48. Thrombophlebitis typically develops in patients with which of the following conditions?
a. Increases partial thromboplastin time
b. Acute pulsus paradoxus
c. An impaired or traumatized blood vessel wall
d. Chronic Obstructive Pulmonary Disease (COPD)
49. In a recumbent, immobilized patient, lung ventilation can become altered, leading to such respiratory complications as:
a. Respiratory acidosis, ateclectasis, and hypostatic pneumonia
b. Appneustic breathing, atypical pneumonia and respiratory alkalosis
c. Cheyne-Strokes respirations and spontaneous pneumothorax
d. Kussmail’s respirations and hypoventilation
50. Immobility impairs bladder elimination, resulting in such disorders as
a. Increased urine acidity and relaxation of the perineal muscles, causing incontinence
b. Urine retention, bladder distention, and infection
c. Diuresis, natriuresis, and decreased urine specific gravity
d. Decreased calcium and phosphate levels in the urine
Fundamentals of Nursing Practice Test II
1. The most appropriate nursing order for a patient who develops dyspnea and shortness of breath would be…
a. Maintain the patient on strict bed rest at all times
b. Maintain the patient in an orthopneic position as needed
c. Administer oxygen by Venturi mask at 24%, as needed
d. Allow a 1 hour rest period between activities
2. The nurse observes that Mr. Adams begins to have increased difficulty breathing. She elevates the head of the bed to the high Fowler position, which decreases his respiratory distress. The nurse documents this breathing as:
a. Tachypnea
b. Eupnca
c. Orthopnea
d. Hyperventilation
3. The physician orders a platelet count to be performed on Mrs. Smith after breakfast. The nurse is responsible for:
a. Instructing the patient about this diagnostic test
b. Writing the order for this test
c. Giving the patient breakfast
d. All of the above
4. Mrs. Mitchell has been given a copy of her diet. The nurse discusses the foods allowed on a 500-mg low sodium diet. These include:
a. A ham and Swiss cheese sandwich on whole wheat bread
b. Mashed potatoes and broiled chicken
c. A tossed salad with oil and vinegar and olives
d. Chicken bouillon
5. The physician orders a maintenance dose of 5,000 units of subcutaneous heparin (an anticoagulant) daily. Nursing responsibilities for Mrs. Mitchell now include:
a. Reviewing daily activated partial thromboplastin time (APTT) and prothrombin time.
b. Reporting an APTT above 45 seconds to the physician
c. Assessing the patient for signs and symptoms of frank and occult bleeding
d. All of the above
6. The four main concepts common to nursing that appear in each of the current conceptual models are:
a. Person, nursing, environment, medicine
b. Person, health, nursing, support systems
c. Person, health, psychology, nursing
d. Person, environment, health, nursing
7. In Maslow’s hierarchy of physiologic needs, the human need of greatest priority is:
a. Love
b. Elimination
c. Nutrition
d. Oxygen
8. The family of an accident victim who has been declared brain-dead seems amenable to organ donation. What should the nurse do?
a. Discourage them from making a decision until their grief has eased
b. Listen to their concerns and answer their questions honestly
c. Encourage them to sign the consent form right away
d. Tell them the body will not be available for a wake or funeral
9. A new head nurse on a unit is distressed about the poor staffing on the 11 p.m. to 7 a.m. shift. What should she do?
a. Complain to her fellow nurses
b. Wait until she knows more about the unit
c. Discuss the problem with her supervisor
d. Inform the staff that they must volunteer to rotate
10. Which of the following principles of primary nursing has proven the most satisfying to the patient and nurse?
a. Continuity of patient care promotes efficient, cost-effective nursing care
b. Autonomy and authority for [1] planning are best delegated to a nurse who knows the patient well
c. Accountability is clearest when one nurse is responsible for the overall plan and its [2] implementation.
d. The holistic approach provides for a therapeutic relationship, continuity, and efficient nursing care.
11. If nurse administers an [3] injection to a patient who refuses that injection, she has committed:
a. Assault and battery
b. Negligence
c. Malpractice
d. None of the above
12. If patient asks the nurse her opinion about a particular physicians and the nurse replies that the physician is incompetent, the nurse could be held liable for:
a. Slander
b. Libel
c. Assault
d. Respondent superior
13. A registered nurse reaches to answer the telephone on a busy pediatric unit, momentarily turning away from a 3 month-old infant she has been weighing. The infant falls off the scale, suffering a skull fracture. The nurse could be charged with:
a. Defamation
b. Assault
c. Battery
d. Malpractice
14. Which of the following is an example of nursing malpractice?
a. The nurse administers penicillin to a patient with a documented history of allergy to the drug. The patient experiences an allergic reaction and has cerebral damage resulting from anoxia.
b. The nurse applies a hot water bottle or a heating pad to the abdomen of a patient with abdominal cramping.
c. The nurse assists a patient out of bed with the bed locked in position; the patient slips and fractures his right humerus.
d. The nurse administers the wrong medication to a patient and the patient vomits. This information is documented and reported to the physician and the nursing supervisor.
15. Which of the following signs and symptoms would the nurse expect to find when assessing an Asian patient for postoperative pain following abdominal surgery?
a. Decreased blood pressure and heart rate and shallow respirations
b. Quiet crying
c. Immobility, diaphoresis, and avoidance of deep breathing or coughing
d. Changing position every 2 hours
16. A patient is admitted to the hospital with complaints of nausea, vomiting, diarrhea, and severe abdominal pain. Which of the following would immediately alert the nurse that the patient has bleeding from the GI tract?
a. Complete blood count
b. Guaiac test
c. Vital signs
d. Abdominal girth
17. The correct sequence for assessing the abdomen is:
a. Tympanic percussion, measurement of abdominal girth, and inspection
b. Assessment for distention, tenderness, and discoloration around the umbilicus.
c. Percussions, palpation, and auscultation
d. Auscultation, percussion, and palpation
18. High-pitched gurgles head over the right lower quadrant are:
a. A sign of increased bowel motility
b. A sign of decreased bowel motility
c. Normal bowel sounds
d. A sign of abdominal cramping
19. A patient about to undergo abdominal inspection is best placed in which of the following positions?
a. Prone
b. Trendelenburg
c. Supine
d. Side-lying
20. For a rectal examination, the patient can be directed to assume which of the following positions?
a. Genupecterol
b. Sims
c. Horizontal recumbent
d. All of the above
21. During a Romberg test, the nurse asks the patient to assume which position?
a. Sitting
b. Standing
c. Genupectoral
d. Trendelenburg
22. If a patient’s blood pressure is 150/96, his pulse pressure is:
a. 54
b. 96
c. 150
d. 246
23. A patient is kept off food and fluids for 10 hours before surgery. His oral temperature at 8 a.m. is 99.8 F (37.7 C) This temperature reading probably indicates:
a. Infection
b. Hypothermia
c. Anxiety
d. Dehydration
24. Which of the following parameters should be checked when assessing respirations?
a. Rate
b. Rhythm
c. Symmetry
d. All of the above
25. A 38-year old patient’s vital signs at 8 a.m. are axillary temperature 99.6 F (37.6 C); pulse rate, 88; respiratory rate, 30. Which findings should be reported?
a. Respiratory rate only
b. Temperature only
c. Pulse rate and temperature
d. Temperature and respiratory rate
26. All of the following can cause tachycardia except:
a. Fever
b. Exercise
c. Sympathetic nervous system stimulation
d. Parasympathetic nervous system stimulation
27. Palpating the midclavicular line is the correct technique for assessing
a. Baseline vital signs
b. Systolic blood pressure
c. Respiratory rate
d. Apical pulse
28. The absence of which pulse may not be a significant finding when a patient is admitted to the hospital?
a. Apical
b. Radial
c. Pedal
d. Femoral
29. Which of the following patients is at greatest risk for developing pressure ulcers?
a. An alert, chronic arthritic patient treated with steroids and aspirin
b. An 88-year old incontinent patient with gastric cancer who is confined to his bed at home
c. An apathetic 63-year old COPD patient receiving nasal oxygen via cannula
d. A confused 78-year old patient with congestive heart failure (CHF) who requires assistance to get out of bed.
30. The physician orders the administration of high-humidity oxygen by face mask and placement of the patient in a high Fowler’s position. After assessing Mrs. Paul, the nurse writes the following nursing diagnosis: Impaired gas exchange related to increased secretions. Which of the following nursing interventions has the greatest potential for improving this situation?
a. Encourage the patient to increase her fluid intake to 200 ml every 2 hours
b. Place a humidifier in the patient’s room.
c. Continue administering oxygen by high humidity face mask
d. Perform chest physiotheraphy on a regular schedule
31. The most common deficiency seen in alcoholics is:
a. Thiamine
b. Riboflavin
c. Pyridoxine
d. Pantothenic acid
32. Which of the following statement is incorrect about a patient with dysphagia?
a. The patient will find pureed or soft foods, such as custards, easier to swallow than water
b. Fowler’s or semi Fowler’s position reduces the risk of aspiration during swallowing
c. The patient should always feed himself
d. The nurse should perform oral hygiene before assisting with feeding.
33. To assess the kidney function of a patient with an indwelling urinary (Foley) catheter, the nurse measures his hourly urine output. She should notify the physician if the urine output is:
a. Less than 30 ml/hour
b. 64 ml in 2 hours
c. 90 ml in 3 hours
d. 125 ml in 4 hours
34. Certain substances increase the amount of urine produced. These include:
a. Caffeine-containing drinks, such as coffee and cola.
b. Beets
c. Urinary analgesics
d. Kaolin with pectin (Kaopectate)
35. A male patient who had surgery 2 days ago for head and neck cancer is about to make his first attempt to ambulate outside his room. The nurse notes that he is steady on his feet and that his vision was unaffected by the surgery. Which of the following nursing interventions would be appropriate?
a. Encourage the patient to walk in the hall alone
b. Discourage the patient from walking in the hall for a few more days
c. Accompany the patient for his walk.
d. Consuit a physical therapist before allowing the patient to ambulate
36. A patient has exacerbation of chronic obstructive pulmonary disease (COPD) manifested by shortness of breath; orthopnea: thick, tenacious secretions; and a dry hacking cough. An appropriate nursing diagnosis would be:
a. Ineffective airway clearance related to thick, tenacious secretions.
b. Ineffective airway clearance related to dry, hacking cough.
c. Ineffective individual coping to COPD.
d. Pain related to immobilization of affected leg.
37. Mrs. Lim begins to cry as the nurse discusses hair loss. The best response would be:
a. “Don’t worry. It’s only temporary”
b. “Why are you crying? I didn’t get to the bad news yet”
c. “Your hair is really pretty”
d. “I know this will be difficult for you, but your hair will grow back after the completion of chemotheraphy”
38. An additional Vitamin C is required during all of the following periods except:
a. Infancy
b. Young adulthood
c. Childhood
d. Pregnancy
39. A prescribed amount of oxygen s needed for a patient with COPD to prevent:
a. Cardiac arrest related to increased partial pressure of carbon dioxide in arterial blood (PaCO2)
b. Circulatory overload due to hypervolemia
c. Respiratory excitement
d. Inhibition of the respiratory hypoxic stimulus
40. After 1 week of hospitalization, Mr. Gray develops hypokalemia. Which of the following is the most significant symptom of his disorder?
a. Lethargy
b. Increased pulse rate and blood pressure
c. Muscle weakness
d. Muscle irritability
41. Which of the following nursing interventions promotes patient safety?
a. Asses the patient’s ability to ambulate and transfer from a bed to a chair
b. Demonstrate the signal system to the patient
c. Check to see that the patient is wearing his identification band
d. All of the above
42. Studies have shown that about 40% of patients fall out of bed despite the use of side rails; this has led to which of the following conclusions?
a. Side rails are ineffective
b. Side rails should not be used
c. Side rails are a deterrent that prevent a patient from falling out of bed.
d. Side rails are a reminder to a patient not to get out of bed
43. Examples of patients suffering from impaired awareness include all of the following except:
a. A semiconscious or over fatigued patient
b. A disoriented or confused patient
c. A patient who cannot care for himself at home
d. A patient demonstrating symptoms of drugs or alcohol withdrawal
44. The most common injury among elderly persons is:
a. Atheroscleotic changes in the blood vessels
b. Increased incidence of gallbladder disease
c. Urinary Tract Infection
d. Hip fracture
45. The most common psychogenic disorder among elderly person is:
a. Depression
b. Sleep disturbances (such as bizarre dreams)
c. Inability to concentrate
d. Decreased appetite
46. Which of the following vascular system changes results from aging?
a. Increased peripheral resistance of the blood vessels
b. Decreased blood flow
c. Increased work load of the left ventricle
d. All of the above
47. Which of the following is the most common cause of dementia among elderly persons?
a. Parkinson’s disease
b. Multiple sclerosis
c. Amyotrophic lateral sclerosis (Lou Gerhig’s disease)
d. Alzheimer’s disease
48. The nurse’s most important legal responsibility after a patient’s death in a hospital is:
a. Obtaining a consent of an autopsy
b. Notifying the coroner or medical examiner
c. Labeling the corpse appropriately
d. Ensuring that the attending physician issues the death certification
49. Before rigor mortis occurs, the nurse is responsible for:
a. Providing a complete bath and dressing change
b. Placing one pillow under the body’s head and shoulders
c. Removing the body’s clothing and wrapping the body in a shroud
d. Allowing the body to relax normally
50. When a patient in the terminal stages of lung cancer begins to exhibit loss of consciousness, a major nursing priority is to:
a. Protect the patient from injury
b. Insert an airway
c. Elevate the head of the bed
d. Withdraw all pain medications
a. Maintain the patient on strict bed rest at all times
b. Maintain the patient in an orthopneic position as needed
c. Administer oxygen by Venturi mask at 24%, as needed
d. Allow a 1 hour rest period between activities
2. The nurse observes that Mr. Adams begins to have increased difficulty breathing. She elevates the head of the bed to the high Fowler position, which decreases his respiratory distress. The nurse documents this breathing as:
a. Tachypnea
b. Eupnca
c. Orthopnea
d. Hyperventilation
3. The physician orders a platelet count to be performed on Mrs. Smith after breakfast. The nurse is responsible for:
a. Instructing the patient about this diagnostic test
b. Writing the order for this test
c. Giving the patient breakfast
d. All of the above
4. Mrs. Mitchell has been given a copy of her diet. The nurse discusses the foods allowed on a 500-mg low sodium diet. These include:
a. A ham and Swiss cheese sandwich on whole wheat bread
b. Mashed potatoes and broiled chicken
c. A tossed salad with oil and vinegar and olives
d. Chicken bouillon
5. The physician orders a maintenance dose of 5,000 units of subcutaneous heparin (an anticoagulant) daily. Nursing responsibilities for Mrs. Mitchell now include:
a. Reviewing daily activated partial thromboplastin time (APTT) and prothrombin time.
b. Reporting an APTT above 45 seconds to the physician
c. Assessing the patient for signs and symptoms of frank and occult bleeding
d. All of the above
6. The four main concepts common to nursing that appear in each of the current conceptual models are:
a. Person, nursing, environment, medicine
b. Person, health, nursing, support systems
c. Person, health, psychology, nursing
d. Person, environment, health, nursing
7. In Maslow’s hierarchy of physiologic needs, the human need of greatest priority is:
a. Love
b. Elimination
c. Nutrition
d. Oxygen
8. The family of an accident victim who has been declared brain-dead seems amenable to organ donation. What should the nurse do?
a. Discourage them from making a decision until their grief has eased
b. Listen to their concerns and answer their questions honestly
c. Encourage them to sign the consent form right away
d. Tell them the body will not be available for a wake or funeral
9. A new head nurse on a unit is distressed about the poor staffing on the 11 p.m. to 7 a.m. shift. What should she do?
a. Complain to her fellow nurses
b. Wait until she knows more about the unit
c. Discuss the problem with her supervisor
d. Inform the staff that they must volunteer to rotate
10. Which of the following principles of primary nursing has proven the most satisfying to the patient and nurse?
a. Continuity of patient care promotes efficient, cost-effective nursing care
b. Autonomy and authority for [1] planning are best delegated to a nurse who knows the patient well
c. Accountability is clearest when one nurse is responsible for the overall plan and its [2] implementation.
d. The holistic approach provides for a therapeutic relationship, continuity, and efficient nursing care.
11. If nurse administers an [3] injection to a patient who refuses that injection, she has committed:
a. Assault and battery
b. Negligence
c. Malpractice
d. None of the above
12. If patient asks the nurse her opinion about a particular physicians and the nurse replies that the physician is incompetent, the nurse could be held liable for:
a. Slander
b. Libel
c. Assault
d. Respondent superior
13. A registered nurse reaches to answer the telephone on a busy pediatric unit, momentarily turning away from a 3 month-old infant she has been weighing. The infant falls off the scale, suffering a skull fracture. The nurse could be charged with:
a. Defamation
b. Assault
c. Battery
d. Malpractice
14. Which of the following is an example of nursing malpractice?
a. The nurse administers penicillin to a patient with a documented history of allergy to the drug. The patient experiences an allergic reaction and has cerebral damage resulting from anoxia.
b. The nurse applies a hot water bottle or a heating pad to the abdomen of a patient with abdominal cramping.
c. The nurse assists a patient out of bed with the bed locked in position; the patient slips and fractures his right humerus.
d. The nurse administers the wrong medication to a patient and the patient vomits. This information is documented and reported to the physician and the nursing supervisor.
15. Which of the following signs and symptoms would the nurse expect to find when assessing an Asian patient for postoperative pain following abdominal surgery?
a. Decreased blood pressure and heart rate and shallow respirations
b. Quiet crying
c. Immobility, diaphoresis, and avoidance of deep breathing or coughing
d. Changing position every 2 hours
16. A patient is admitted to the hospital with complaints of nausea, vomiting, diarrhea, and severe abdominal pain. Which of the following would immediately alert the nurse that the patient has bleeding from the GI tract?
a. Complete blood count
b. Guaiac test
c. Vital signs
d. Abdominal girth
17. The correct sequence for assessing the abdomen is:
a. Tympanic percussion, measurement of abdominal girth, and inspection
b. Assessment for distention, tenderness, and discoloration around the umbilicus.
c. Percussions, palpation, and auscultation
d. Auscultation, percussion, and palpation
18. High-pitched gurgles head over the right lower quadrant are:
a. A sign of increased bowel motility
b. A sign of decreased bowel motility
c. Normal bowel sounds
d. A sign of abdominal cramping
19. A patient about to undergo abdominal inspection is best placed in which of the following positions?
a. Prone
b. Trendelenburg
c. Supine
d. Side-lying
20. For a rectal examination, the patient can be directed to assume which of the following positions?
a. Genupecterol
b. Sims
c. Horizontal recumbent
d. All of the above
21. During a Romberg test, the nurse asks the patient to assume which position?
a. Sitting
b. Standing
c. Genupectoral
d. Trendelenburg
22. If a patient’s blood pressure is 150/96, his pulse pressure is:
a. 54
b. 96
c. 150
d. 246
23. A patient is kept off food and fluids for 10 hours before surgery. His oral temperature at 8 a.m. is 99.8 F (37.7 C) This temperature reading probably indicates:
a. Infection
b. Hypothermia
c. Anxiety
d. Dehydration
24. Which of the following parameters should be checked when assessing respirations?
a. Rate
b. Rhythm
c. Symmetry
d. All of the above
25. A 38-year old patient’s vital signs at 8 a.m. are axillary temperature 99.6 F (37.6 C); pulse rate, 88; respiratory rate, 30. Which findings should be reported?
a. Respiratory rate only
b. Temperature only
c. Pulse rate and temperature
d. Temperature and respiratory rate
26. All of the following can cause tachycardia except:
a. Fever
b. Exercise
c. Sympathetic nervous system stimulation
d. Parasympathetic nervous system stimulation
27. Palpating the midclavicular line is the correct technique for assessing
a. Baseline vital signs
b. Systolic blood pressure
c. Respiratory rate
d. Apical pulse
28. The absence of which pulse may not be a significant finding when a patient is admitted to the hospital?
a. Apical
b. Radial
c. Pedal
d. Femoral
29. Which of the following patients is at greatest risk for developing pressure ulcers?
a. An alert, chronic arthritic patient treated with steroids and aspirin
b. An 88-year old incontinent patient with gastric cancer who is confined to his bed at home
c. An apathetic 63-year old COPD patient receiving nasal oxygen via cannula
d. A confused 78-year old patient with congestive heart failure (CHF) who requires assistance to get out of bed.
30. The physician orders the administration of high-humidity oxygen by face mask and placement of the patient in a high Fowler’s position. After assessing Mrs. Paul, the nurse writes the following nursing diagnosis: Impaired gas exchange related to increased secretions. Which of the following nursing interventions has the greatest potential for improving this situation?
a. Encourage the patient to increase her fluid intake to 200 ml every 2 hours
b. Place a humidifier in the patient’s room.
c. Continue administering oxygen by high humidity face mask
d. Perform chest physiotheraphy on a regular schedule
31. The most common deficiency seen in alcoholics is:
a. Thiamine
b. Riboflavin
c. Pyridoxine
d. Pantothenic acid
32. Which of the following statement is incorrect about a patient with dysphagia?
a. The patient will find pureed or soft foods, such as custards, easier to swallow than water
b. Fowler’s or semi Fowler’s position reduces the risk of aspiration during swallowing
c. The patient should always feed himself
d. The nurse should perform oral hygiene before assisting with feeding.
33. To assess the kidney function of a patient with an indwelling urinary (Foley) catheter, the nurse measures his hourly urine output. She should notify the physician if the urine output is:
a. Less than 30 ml/hour
b. 64 ml in 2 hours
c. 90 ml in 3 hours
d. 125 ml in 4 hours
34. Certain substances increase the amount of urine produced. These include:
a. Caffeine-containing drinks, such as coffee and cola.
b. Beets
c. Urinary analgesics
d. Kaolin with pectin (Kaopectate)
35. A male patient who had surgery 2 days ago for head and neck cancer is about to make his first attempt to ambulate outside his room. The nurse notes that he is steady on his feet and that his vision was unaffected by the surgery. Which of the following nursing interventions would be appropriate?
a. Encourage the patient to walk in the hall alone
b. Discourage the patient from walking in the hall for a few more days
c. Accompany the patient for his walk.
d. Consuit a physical therapist before allowing the patient to ambulate
36. A patient has exacerbation of chronic obstructive pulmonary disease (COPD) manifested by shortness of breath; orthopnea: thick, tenacious secretions; and a dry hacking cough. An appropriate nursing diagnosis would be:
a. Ineffective airway clearance related to thick, tenacious secretions.
b. Ineffective airway clearance related to dry, hacking cough.
c. Ineffective individual coping to COPD.
d. Pain related to immobilization of affected leg.
37. Mrs. Lim begins to cry as the nurse discusses hair loss. The best response would be:
a. “Don’t worry. It’s only temporary”
b. “Why are you crying? I didn’t get to the bad news yet”
c. “Your hair is really pretty”
d. “I know this will be difficult for you, but your hair will grow back after the completion of chemotheraphy”
38. An additional Vitamin C is required during all of the following periods except:
a. Infancy
b. Young adulthood
c. Childhood
d. Pregnancy
39. A prescribed amount of oxygen s needed for a patient with COPD to prevent:
a. Cardiac arrest related to increased partial pressure of carbon dioxide in arterial blood (PaCO2)
b. Circulatory overload due to hypervolemia
c. Respiratory excitement
d. Inhibition of the respiratory hypoxic stimulus
40. After 1 week of hospitalization, Mr. Gray develops hypokalemia. Which of the following is the most significant symptom of his disorder?
a. Lethargy
b. Increased pulse rate and blood pressure
c. Muscle weakness
d. Muscle irritability
41. Which of the following nursing interventions promotes patient safety?
a. Asses the patient’s ability to ambulate and transfer from a bed to a chair
b. Demonstrate the signal system to the patient
c. Check to see that the patient is wearing his identification band
d. All of the above
42. Studies have shown that about 40% of patients fall out of bed despite the use of side rails; this has led to which of the following conclusions?
a. Side rails are ineffective
b. Side rails should not be used
c. Side rails are a deterrent that prevent a patient from falling out of bed.
d. Side rails are a reminder to a patient not to get out of bed
43. Examples of patients suffering from impaired awareness include all of the following except:
a. A semiconscious or over fatigued patient
b. A disoriented or confused patient
c. A patient who cannot care for himself at home
d. A patient demonstrating symptoms of drugs or alcohol withdrawal
44. The most common injury among elderly persons is:
a. Atheroscleotic changes in the blood vessels
b. Increased incidence of gallbladder disease
c. Urinary Tract Infection
d. Hip fracture
45. The most common psychogenic disorder among elderly person is:
a. Depression
b. Sleep disturbances (such as bizarre dreams)
c. Inability to concentrate
d. Decreased appetite
46. Which of the following vascular system changes results from aging?
a. Increased peripheral resistance of the blood vessels
b. Decreased blood flow
c. Increased work load of the left ventricle
d. All of the above
47. Which of the following is the most common cause of dementia among elderly persons?
a. Parkinson’s disease
b. Multiple sclerosis
c. Amyotrophic lateral sclerosis (Lou Gerhig’s disease)
d. Alzheimer’s disease
48. The nurse’s most important legal responsibility after a patient’s death in a hospital is:
a. Obtaining a consent of an autopsy
b. Notifying the coroner or medical examiner
c. Labeling the corpse appropriately
d. Ensuring that the attending physician issues the death certification
49. Before rigor mortis occurs, the nurse is responsible for:
a. Providing a complete bath and dressing change
b. Placing one pillow under the body’s head and shoulders
c. Removing the body’s clothing and wrapping the body in a shroud
d. Allowing the body to relax normally
50. When a patient in the terminal stages of lung cancer begins to exhibit loss of consciousness, a major nursing priority is to:
a. Protect the patient from injury
b. Insert an airway
c. Elevate the head of the bed
d. Withdraw all pain medications
Fundamentals of Nursing Practice Test I
1. Using the principles of standard precautions, the nurse would wear gloves in what nursing interventions?
a. Providing a back massage
b. Feeding a client
c. Providing hair care
d. Providing oral hygiene
2. The nurse is preparing to take vital sign in an alert client admitted to the hospital with dehydration secondary to vomiting and diarrhea. What is the best method used to assess the client’s temperature?
a. Oral
b. Axillary
c. Radial
d. Heat sensitive tape
3. A nurse obtained a client’s pulse and found the rate to be above normal. The nurse document this findings as:
a. Tachypnea
b. Hyper pyrexia
c. Arrythmia
d. Tachycardia
4. Which of the following actions should the nurse take to use a wide base support when assisting a client to get up in a chair?
a. Bend at the waist and place arms under the client’s arms and lift
b. Face the client, bend knees and place hands on client’s forearm and lift
c. Spread his or her feet apart
d. Tighten his or her pelvic muscles
5. A client had oral surgery following a motor vehicle accident. The nurse assessing the client finds the skin flushed and warm. Which of the following would be the best method to take the client’s body temperature?
a. Oral
b. Axillary
c. Arterial line
d. Rectal
6. A client who is unconscious needs frequent mouth care. When performing a mouth care, the best position of a client is:
a. Fowler’s position
b. Side lying
c. Supine
d. Trendelenburg
7. A client is hospitalized for the first time, which of the following actions ensure the safety of the client?
a. Keep unnecessary furniture out of the way
b. Keep the lights on at all time
c. Keep side rails up at all time
d. Keep all equipment out of view
8. A walk-in client enters into the clinic with a chief complaint of abdominal pain and diarrhea. The nurse takes the client’s vital sign hereafter. What phrase of nursing process is being implemented here by the nurse?
a. Assessment
b. Diagnosis
c. [1] Planning
d. [2] Implementation
9. It is best describe as a systematic, rational method of planning and providing nursing care for individual, families, group and community
a. Assessment
b. Nursing Process
c. Diagnosis
d. Implementation
10. Exchange of gases takes place in which of the following organ?
a. Kidney
b. Lungs
c. Liver
d. Heart
11. Chambers of the heart that receives oxygenated blood from the lungs is the?
a. Left atrium
b. Right atrium
c. Left ventricle
d. Right ventricle
12. A muscular enlarge pouch or sac that lies slightly to the left which is used for temporary storage of food…
a. Gallbladder
b. Urinary bladder
c. Stomach
d. Lungs
13. The ability of the body to defend itself against scientific invading agent such as baceria, toxin, viruses and foreign body
a. Hormones
b. Secretion
c. Immunity
d. Glands
14. Hormones secreted by Islets of Langerhans
a. Progesterone
b. Testosterone
c. Insulin
d. Hemoglobin
15. It is a transparent membrane that focuses the light that enters the eyes to the retina.
a. Lens
b. Sclera
c. Cornea
d. Pupils
16. Which of the following is included in Orem’s theory?
a. Maintenance of a sufficient intake of air
b. Self perception
c. Love and belonging
d. Physiologic needs
17. Which of the following cluster of data belong to Maslow’s hierarchy of needs
a. Love and belonging
b. Physiologic needs
c. Self actualization
d. All of the above
18. This is characterized by severe symptoms relatively of short duration.
a. Chronic Illness
b. Acute Illness
c. Pain
d. Syndrome
19. Which of the following is the nurse’s role in the health promotion
a. Health risk appraisal
b. Teach client to be effective health consumer
c. Worksite wellness
d. None of the above
20. It is describe as a collection of people who share some attributes of their lives.
a. Family
b. Illness
c. Community
d. Nursing
21. Five teaspoon is equivalent to how many milliliters (ml)?
a. 30 ml
b. 25 ml
c. 12 ml
d. 22 ml
22. 1800 ml is equal to how many liters?
a. 1.8
b. 18000
c. 180
d. 2800
23. Which of the following is the abbreviation of drops?
a. Gtt.
b. Gtts.
c. Dp.
d. Dr.
24. The abbreviation for micro drop is…
a. µgtt
b. gtt
c. mdr
d. mgts
25. Which of the following is the meaning of PRN?
a. When advice
b. Immediately
c. When necessary
d. Now
26. Which of the following is the appropriate meaning of CBR?
a. Cardiac Board Room
b. Complete Bathroom
c. Complete Bed Rest
d. Complete Board Room
27. 1 tsp is equals to how many drops?
a. 15
b. 60
c. 10
d. 30
28. 20 cc is equal to how many ml?
a. 2
b. 20
c. 2000
d. 20000
29. 1 cup is equals to how many ounces?
a. 8
b. 80
c. 800
d. 8000
30. The nurse must verify the client’s identity before administration of medication. Which of the following is the safest way to identify the client?
a. Ask the client his name
b. Check the client’s identification band
c. State the client’s name aloud and have the client repeat it
d. Check the room number
31. The nurse prepares to administer buccal medication. The medicine should be placed…
a. On the client’s skin
b. Between the client’s cheeks and gums
c. Under the client’s tongue
d. On the client’s conjuctiva
32. The nurse administers cleansing enema. The common position for this procedure is…
a. Sims left lateral
b. Dorsal Recumbent
c. Supine
d. Prone
33. A client complains of difficulty of swallowing, when the nurse try to administer capsule medication. Which of the following measures the nurse should do?
a. Dissolve the capsule in a glass of water
b. Break the capsule and give the content with an applesauce
c. Check the availability of a liquid preparation
d. Crash the capsule and place it under the tongue
34. Which of the following is the appropriate route of administration for insulin?
a. Intramuscular
b. Intradermal
c. Subcutaneous
d. Intravenous
35. The nurse is ordered to administer ampicillin capsule TIP p.o. The nurse shoud give the medication…
a. Three times a day orally
b. Three times a day after meals
c. Two time a day by mouth
d. Two times a day before meals
36. Back Care is best describe as:
a. Caring for the back by means of massage
b. Washing of the back
c. Application of cold compress at the back
d. Application of hot compress at the back
37. It refers to the preparation of the bed with a new set of linens
a. Bed bath
b. Bed making
c. Bed shampoo
d. Bed lining
38. Which of the following is the most important purpose of handwashing
a. To promote hand circulation
b. To prevent the transfer of microorganism
c. To avoid touching the client with a dirty hand
d. To provide comfort
39. What should be done in order to prevent contaminating of the environment in bed making?
a. Avoid funning soiled linens
b. Strip all linens at the same time
c. Finished both sides at the time
d. Embrace soiled linen
40. The most important purpose of cleansing bed bath is:
a. To cleanse, refresh and give comfort to the client who must remain in bed
b. To expose the necessary parts of the body
c. To develop skills in bed bath
d. To check the body temperature of the client in bed
41. Which of the following technique involves the sense of sight?
a. Inspection
b. Palpation
c. Percussion
d. Auscultation
42. The first techniques used examining the abdomen of a client is:
a. Palpation
b. Auscultation
c. Percussion
d. Inspection
43. A technique in physical examination that is use to assess the movement of air through the tracheobronchial tree:
a. Palpation
b. Auscultation
c. Inspection
d. Percussion
44. An instrument used for auscultation is:
a. Percussion-hammer
b. Audiometer
c. Stethoscope
d. Sphygmomanometer
45. Resonance is best describe as:
a. Sounds created by air filled lungs
b. Short, high pitch and thudding
c. Moderately loud with musical quality
d. Drum-like
46. The best position for examining the rectum is:
a. Prone
b. Sim’s
c. Knee-chest
d. Lithotomy
47. It refers to the manner of walking
a. Gait
b. Range of motion
c. Flexion and extension
d. Hopping
48. The nurse asked the client to read the Snellen chart. Which of the following is tested:
a. Optic
b. Olfactory
c. Oculomotor
d. Troclear
49. Another name for knee-chest position is:
a. Genu-dorsal
b. Genu-pectoral
c. Lithotomy
d. Sim’s
50. The nurse prepare IM [3] injection that is irritating to the subcutaneous tissue. Which of the following is the best action in order to prevent tracking of the medication
a. Use a small gauge needle
b. Apply ice on the injection site
c. Administer at a 45° angle
d. Use the Z-track technique
a. Providing a back massage
b. Feeding a client
c. Providing hair care
d. Providing oral hygiene
2. The nurse is preparing to take vital sign in an alert client admitted to the hospital with dehydration secondary to vomiting and diarrhea. What is the best method used to assess the client’s temperature?
a. Oral
b. Axillary
c. Radial
d. Heat sensitive tape
3. A nurse obtained a client’s pulse and found the rate to be above normal. The nurse document this findings as:
a. Tachypnea
b. Hyper pyrexia
c. Arrythmia
d. Tachycardia
4. Which of the following actions should the nurse take to use a wide base support when assisting a client to get up in a chair?
a. Bend at the waist and place arms under the client’s arms and lift
b. Face the client, bend knees and place hands on client’s forearm and lift
c. Spread his or her feet apart
d. Tighten his or her pelvic muscles
5. A client had oral surgery following a motor vehicle accident. The nurse assessing the client finds the skin flushed and warm. Which of the following would be the best method to take the client’s body temperature?
a. Oral
b. Axillary
c. Arterial line
d. Rectal
6. A client who is unconscious needs frequent mouth care. When performing a mouth care, the best position of a client is:
a. Fowler’s position
b. Side lying
c. Supine
d. Trendelenburg
7. A client is hospitalized for the first time, which of the following actions ensure the safety of the client?
a. Keep unnecessary furniture out of the way
b. Keep the lights on at all time
c. Keep side rails up at all time
d. Keep all equipment out of view
8. A walk-in client enters into the clinic with a chief complaint of abdominal pain and diarrhea. The nurse takes the client’s vital sign hereafter. What phrase of nursing process is being implemented here by the nurse?
a. Assessment
b. Diagnosis
c. [1] Planning
d. [2] Implementation
9. It is best describe as a systematic, rational method of planning and providing nursing care for individual, families, group and community
a. Assessment
b. Nursing Process
c. Diagnosis
d. Implementation
10. Exchange of gases takes place in which of the following organ?
a. Kidney
b. Lungs
c. Liver
d. Heart
11. Chambers of the heart that receives oxygenated blood from the lungs is the?
a. Left atrium
b. Right atrium
c. Left ventricle
d. Right ventricle
12. A muscular enlarge pouch or sac that lies slightly to the left which is used for temporary storage of food…
a. Gallbladder
b. Urinary bladder
c. Stomach
d. Lungs
13. The ability of the body to defend itself against scientific invading agent such as baceria, toxin, viruses and foreign body
a. Hormones
b. Secretion
c. Immunity
d. Glands
14. Hormones secreted by Islets of Langerhans
a. Progesterone
b. Testosterone
c. Insulin
d. Hemoglobin
15. It is a transparent membrane that focuses the light that enters the eyes to the retina.
a. Lens
b. Sclera
c. Cornea
d. Pupils
16. Which of the following is included in Orem’s theory?
a. Maintenance of a sufficient intake of air
b. Self perception
c. Love and belonging
d. Physiologic needs
17. Which of the following cluster of data belong to Maslow’s hierarchy of needs
a. Love and belonging
b. Physiologic needs
c. Self actualization
d. All of the above
18. This is characterized by severe symptoms relatively of short duration.
a. Chronic Illness
b. Acute Illness
c. Pain
d. Syndrome
19. Which of the following is the nurse’s role in the health promotion
a. Health risk appraisal
b. Teach client to be effective health consumer
c. Worksite wellness
d. None of the above
20. It is describe as a collection of people who share some attributes of their lives.
a. Family
b. Illness
c. Community
d. Nursing
21. Five teaspoon is equivalent to how many milliliters (ml)?
a. 30 ml
b. 25 ml
c. 12 ml
d. 22 ml
22. 1800 ml is equal to how many liters?
a. 1.8
b. 18000
c. 180
d. 2800
23. Which of the following is the abbreviation of drops?
a. Gtt.
b. Gtts.
c. Dp.
d. Dr.
24. The abbreviation for micro drop is…
a. µgtt
b. gtt
c. mdr
d. mgts
25. Which of the following is the meaning of PRN?
a. When advice
b. Immediately
c. When necessary
d. Now
26. Which of the following is the appropriate meaning of CBR?
a. Cardiac Board Room
b. Complete Bathroom
c. Complete Bed Rest
d. Complete Board Room
27. 1 tsp is equals to how many drops?
a. 15
b. 60
c. 10
d. 30
28. 20 cc is equal to how many ml?
a. 2
b. 20
c. 2000
d. 20000
29. 1 cup is equals to how many ounces?
a. 8
b. 80
c. 800
d. 8000
30. The nurse must verify the client’s identity before administration of medication. Which of the following is the safest way to identify the client?
a. Ask the client his name
b. Check the client’s identification band
c. State the client’s name aloud and have the client repeat it
d. Check the room number
31. The nurse prepares to administer buccal medication. The medicine should be placed…
a. On the client’s skin
b. Between the client’s cheeks and gums
c. Under the client’s tongue
d. On the client’s conjuctiva
32. The nurse administers cleansing enema. The common position for this procedure is…
a. Sims left lateral
b. Dorsal Recumbent
c. Supine
d. Prone
33. A client complains of difficulty of swallowing, when the nurse try to administer capsule medication. Which of the following measures the nurse should do?
a. Dissolve the capsule in a glass of water
b. Break the capsule and give the content with an applesauce
c. Check the availability of a liquid preparation
d. Crash the capsule and place it under the tongue
34. Which of the following is the appropriate route of administration for insulin?
a. Intramuscular
b. Intradermal
c. Subcutaneous
d. Intravenous
35. The nurse is ordered to administer ampicillin capsule TIP p.o. The nurse shoud give the medication…
a. Three times a day orally
b. Three times a day after meals
c. Two time a day by mouth
d. Two times a day before meals
36. Back Care is best describe as:
a. Caring for the back by means of massage
b. Washing of the back
c. Application of cold compress at the back
d. Application of hot compress at the back
37. It refers to the preparation of the bed with a new set of linens
a. Bed bath
b. Bed making
c. Bed shampoo
d. Bed lining
38. Which of the following is the most important purpose of handwashing
a. To promote hand circulation
b. To prevent the transfer of microorganism
c. To avoid touching the client with a dirty hand
d. To provide comfort
39. What should be done in order to prevent contaminating of the environment in bed making?
a. Avoid funning soiled linens
b. Strip all linens at the same time
c. Finished both sides at the time
d. Embrace soiled linen
40. The most important purpose of cleansing bed bath is:
a. To cleanse, refresh and give comfort to the client who must remain in bed
b. To expose the necessary parts of the body
c. To develop skills in bed bath
d. To check the body temperature of the client in bed
41. Which of the following technique involves the sense of sight?
a. Inspection
b. Palpation
c. Percussion
d. Auscultation
42. The first techniques used examining the abdomen of a client is:
a. Palpation
b. Auscultation
c. Percussion
d. Inspection
43. A technique in physical examination that is use to assess the movement of air through the tracheobronchial tree:
a. Palpation
b. Auscultation
c. Inspection
d. Percussion
44. An instrument used for auscultation is:
a. Percussion-hammer
b. Audiometer
c. Stethoscope
d. Sphygmomanometer
45. Resonance is best describe as:
a. Sounds created by air filled lungs
b. Short, high pitch and thudding
c. Moderately loud with musical quality
d. Drum-like
46. The best position for examining the rectum is:
a. Prone
b. Sim’s
c. Knee-chest
d. Lithotomy
47. It refers to the manner of walking
a. Gait
b. Range of motion
c. Flexion and extension
d. Hopping
48. The nurse asked the client to read the Snellen chart. Which of the following is tested:
a. Optic
b. Olfactory
c. Oculomotor
d. Troclear
49. Another name for knee-chest position is:
a. Genu-dorsal
b. Genu-pectoral
c. Lithotomy
d. Sim’s
50. The nurse prepare IM [3] injection that is irritating to the subcutaneous tissue. Which of the following is the best action in order to prevent tracking of the medication
a. Use a small gauge needle
b. Apply ice on the injection site
c. Administer at a 45° angle
d. Use the Z-track technique
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