Test Bank for Introductory Medical-Surgical Nursing 10th Edition by Barbara Timby & Nancy Smith - C

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TEST BANK

2023

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COMPLETE Elaborated Test Bank for

Introductory Medical Surgical Nursing 10th Edition Barbara K.Timby Nancy E.Smith 2023

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Introductory Medical-Surgical Nursing 10th Edition by Barbara K.Timby & Nancy E.Smith.

ISBN-10 1605470643 ISBN-13 978-1605470641

Test bank for Introductory Medical-Surgical Nursing 10th Edition by Barbara K.Timby & Nancy E.Smith

ISBN-10 1605470643 ISBN-13 978-1605470641

THIS IS NOT THE ACTUAL BOOK. YOU ARE BUYING it is the Official Test Bank in e-version INSTANT DOWNLOAD >The test bank is what most professors use as a template when making exams for their students, which means there’s a very high chance that you will see the exact questions in the tests! >The file is either in.pdf, excel, or zipped in the package and can easily be read on PCs and Macs. >Delivery is INSTANT. You can download the files IMMEDIATELY once payment is done.

If you have any questions, please feel free to contact us. Our response is the fastest. All questions will alwaysbe answered in 6 hours, most of the time within 30mins.

We also faced similar difficulties when we were students, and we understand how you feel. But now, with the Official Test Bank, you will be able to * * * * * *

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Know the correct answers to those questions.

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Improve your studying and get a better grade!

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TABLE OF CONTENTS Chapter 1 Nursing Roles and Responsibilities Chapter 2 Psychosocial Aspects of Client Care Chapter 3 Concepts of Health and Illness Chapter 4 Common Medical-Surgical Problems Chapter 5 Caring for Clients with Respiratory Disorders Chapter 6 Caring for Clients with Cardiovascular Disorders Chapter 7 Caring for Clients with Hematopoietic and Lymphatic Disorders Chapter 8 Caring for Clients with Immune Disorders Chapter 9 Caring for Clients with Neurologic Disorders Chapter 10 Caring for Clients with Sensory Problems Chapter 11 Caring for Clients with Gastrointestinal Problems Chapter 12 Caring for Clients with Endocrine Problems Chapter 13 Disturbances of Sexual Structures or Reproductive Function Chapter 14 Caring for Clients with Urinary and Renal Problems Chapter 15 Caring for Clients with Musculoskeletal Problems Chapter 16 Caring for Clients with Integumentary Problems

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Prof.Exams

TEST BANK

2023

Prof.Exams

COMPLETE Elaborated Test Bank for

Introductory Medical Surgical Nursing 10th Edition Barbara K.Timby Nancy E.Smith 2023

Prof.Exams

Introductory Medical-Surgical Nursing 10th Edition by Barbara K.Timby & Nancy E.Smith.

ISBN-10 1605470643 ISBN-13 978-1605470641

Test bank for Introductory Medical-Surgical Nursing 10th Edition by Barbara K.Timby & Nancy E.Smith

ISBN-10 1605470643 ISBN-13 978-1605470641

THIS IS NOT THE ACTUAL BOOK. YOU ARE BUYING it is the Official Test Bank in e-version INSTANT DOWNLOAD >The test bank is what most professors use as a template when making exams for their students, which means there’s a very high chance that you will see the exact questions in the tests! >The file is either in.pdf, excel, or zipped in the package and can easily be read on PCs and Macs. >Delivery is INSTANT. You can download the files IMMEDIATELY once payment is done.

If you have any questions, please feel free to contact us. Our response is the fastest. All questions will alwaysbe answered in 6 hours, most of the time within 30mins.

We also faced similar difficulties when we were students, and we understand how you feel. But now, with the Official Test Bank, you will be able to * * * * * *

Anticipate the type of the questions that will appear in your exam.

Know the correct answers to those questions.

Reduce the hassle and stress of your student life.

Improve your studying and get a better grade!

Get prepared for examination questions.

Save you time and help you understand the material.

Prof.Exams

TABLE OF CONTENTS Chapter 1 Nursing Roles and Responsibilities Chapter 2 Psychosocial Aspects of Client Care Chapter 3 Concepts of Health and Illness Chapter 4 Common Medical-Surgical Problems Chapter 5 Caring for Clients with Respiratory Disorders Chapter 6 Caring for Clients with Cardiovascular Disorders Chapter 7 Caring for Clients with Hematopoietic and Lymphatic Disorders Chapter 8 Caring for Clients with Immune Disorders Chapter 9 Caring for Clients with Neurologic Disorders Chapter 10 Caring for Clients with Sensory Problems Chapter 11 Caring for Clients with Gastrointestinal Problems Chapter 12 Caring for Clients with Endocrine Problems Chapter 13 Disturbances of Sexual Structures or Reproductive Function Chapter 14 Caring for Clients with Urinary and Renal Problems Chapter 15 Caring for Clients with Musculoskeletal Problems Chapter 16 Caring for Clients with Integumentary Problems

Chapter 1 Nursing Roles and Responsibilities MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

1) The nurse is assisting a postoperative client in using an incentive spirometer. Which

of the following postoperative complications is this nurse attempting to avoid with this client? 1) A) Hemorrhage B) Pulmonary embolism

C)Deep vein thrombosis D) Atelectasis 2) A client who is recovering from abdominal surgery has a penrose drain. Which of

the following should the nurse include in the care of this client? 2) A)Make sure there is a safety pin on the end of the drain.

B) Clean the wound with normal saline every two hours.

C) Empty the drain every 30 minutes.

D) Remove the drain four hours postoperatively.

3) A client is in the recovery room. Which of the following members of the healthcare

team should the nurse contact regarding the client's level of pain control? 3) A)The surgeon B) The anesthesiologist C)The scrub nurse D) The circulating nurse 4) During the assessment of a postoperative client's bowel sounds, the nurse

auscultates high-pitched sounds over all four abdominal quadrants. The nurse realizes this finding could indicate: 4) A) Normal bowel function. B) The onset of stool.

C)The onset of flatus. D) Paralytic ileus.

5) A client is being transferred from the operating room to the recovery room. The

nurse in the recovery room will be providing which phase of nursing care? 5) A) Intraoperative B) Preoperative

C)Restorative D) Postoperative 6) A client is being scheduled for surgery. Which of the following should be included

in the preoperative teaching provided by the nurse? 6) A) The credentials of the anesthesiologist B) Information concerning the surgical procedure which will be performed by the

surgeon C) Cost of the procedure D) Planned length of stay at the hospital

7) A client is being positioned for a hip replacement procedure. In which of the

following positions will this client most likely be placed? 7) A)Dorsal recumbent B) Lateral chest C)Semi-sitting D) Prone 8) A postoperative client tells the nurse, "A book I read said that I should not eat after

surgery for at least a week." Which of the following statements would be an appropriate nursing response? 8) A) "You don't need any food to heal anyway."

B) "That's true."

C) "That's not true. You could get an infection in your stomach."

D) "I'll be giving you intravenous feedings anyway."

9) An elderly postoperative client is given an antiemetic for nausea. Which of the

following signs would indicate this client is experiencing a possible reaction to the medication? 9) A) Dry mouth B) Involuntary muscle movements

C)Breakthrough vomiting D)Confusion 10) A client is signing a surgical consent. Afterwards, the nurse also signs the form.

What is the meaning of the nursing signature? 10) A) It means the client was alert and aware of what was being signed.

B) It means there is a likelihood of a successful outcome.

C) It means the client understood the procedure as described by the nurse.

D) It means the surgeon was too busy to wait for the client to sign the form.

11) A client's endotracheal tube is being removed after the surgical procedure. The

intra-operative nurse realizes this client is in which phase of the general anesthesia process? 11) A) Induction B) Maintenance

C)Reduction D) Emergence 12) An elderly client is being prepared for orthopedic surgery. The nurse realizes this

client is at risk for which of the following? 12) A) Prolonged effects of anesthesia because of herbal supplements

B)Decreased tolerance of general anesthesia C)Increased hypotensive effects of anesthesia D)Wound dehiscence

13) The client who is preparing for surgery asks the nurse to keep their glasses and

hearing aid in-place until they are under anesthesia. Which of the following statements by the nurse demonstrates accurate, therapeutic communication? 13) A) "I will contact the surgery department to discuss you requests."

B)"Certainly, you can keep them for that time."

C) "You cannot keep those in."

D) "The policies in the surgery unit will not allow it."

14) A client has just arrived in the recovery room. How often should the nurse assess

the client? 14) A) Every 15 minutes for 30 minutes and then every one hour afterwards.

B) Every 15 minutes for the first hour.

C) Every hour.

D) Every two hours.

15) A client who is being admitted for surgery asks the nurse why information is being

collected about the client's use of herbal and natural supplements. Which of the following statements is an appropriate nursing response? 15) A) "The physician is in charge of medications."

B) "Herbal supplements may interact with anesthesia agents."

C) "Herbal remedies may cause pain relievers to be ineffective."

D) "There is no need to take these preparations."

16) An elderly client is completing preoperative diagnostic testing. The nurse notes

that the client's carbon dioxide level is elevated. Which of the following nursing interventions would be indicated for this client? 16) A) Monitor serum sodium level.

B) Monitor serum potassium level.

C) Monitor respiratory status and arterial blood gases.

D) Monitor intake and output.

17) A client is prescribed patient-controlled analgesia for postoperative pain. Which of

the following should the nurse instruct the client about this analgesia? 17) A)"Use this analgesia every hour on the hour."

B) "Use this analgesia only when the pain is extremely severe."

C) "Avoid the use of this because of the risk of addiction."

D) "Use this analgesia regularly."

18) A client has received conscious sedation for a surgical procedure. The nurse

realizes this client will most likely: 18)

A) Respond to physical and verbal stimuli.

B) Not respond to any stimuli.

C) Need an endotracheal tube inserted.

D) Need blood product replacements.

19) A client is in his fifth postoperative day and has sanguineous drainage with a thick,

reddish appearance. The nurse realizes this client's wound is in which stage of healing?

19) A) Stage III B) Stage IV C) Stage I D) Stage II 20) A recovery room nurse is consulting with a circulating nurse about a client who is

having a surgical procedure. These nurses are most likely in which zone of the surgical department? 20) A) Banned B) Semi-restricted

C)Restricted D) Unrestricted 21) A nurse has delegated the collection of vital signs, including blood pressure

readings, to two unlicensed assistive personnel. The of this work means the nurse is: 21) A) Not accountable for these vital signs.

B)Responsible to re-measure all of the vital signs.

C)Not responsible for these vital signs.

D)Accountable for the care that was delegated.

22) The nurse working on a quality improvement study wants to evaluate a client care

process. Which of the following can the nurse use to evaluate this process? 22) A) Variance analysis B) Critical pathway

C)Evidence-based practice D) Nursing process 23) The new nurse is studying the five core competencies for healthcare providers.

Which of the following are a part of these core competencies? (Select all that apply.)

23) A) Work in interdisciplinary teams.

B) Use informatics to deliver care.

C) Use evidence-based practice.

D) Replace quality improvement initiatives with work redesign methods.

E) Use primary nursing to deliver care.

24) A client tells the nurse, "I have an advance directive that I want you to follow."

Which of the following will this document provide for the nurse? 24) A) A complete plan of care for the client B) The answers to any care dilemmas for the client

C) The client's preferences for healthcare should the client become mentally

incapacitated D) Directions regarding when to use universal precautions for the client 25) Client chart audits provide the nurses with information that impacts the future

outcomes of client care. What should the nurses do with this information? 25) A)Use the information to create an action plan to address any negative findings.

B) Nothing C) Submit it to the agency's accrediting body.

D) Place it in a file to compare with the next set of audits.

26) The nurse is preparing a client to go home. Which of the following skills are the

most important for the nurse to adequately prepare this client? 26) A)Familiarity with adult learning principles B) The ability to support client decision making C) The ability to use critical thinking D) The ability to follow written orders 27) The nurse is implementing a plan of care for a client. After providing care, what

should the nurse do as the final step in the process? 27) A) Reassess the client.

B) Give the charge nurse a report.

C)Document D)Nothing 28) At the completion of an assessment, the nurse chooses a nursing diagnosis that

best defines the client's health problems. Which type of clinical judgment will this nurse use? 28) A) Diagnostic reasoning B) Evidence-based practice

C)Nursing process D) Critical pathway 29) A client tells the nurse, "I have pain in my leg when I stand too long." This

information would be considered: 29) A) Subjective data B) Objective data

C)Evaluative data D) Qualitative data 30) The nurse is consulting a critical pathway to help make client care decisions.

Which type of care delivery model is this nurse most likely using to provide client

care? 30) A) Team nursing B) Primary nursing C)Functional nursing D) Case management 31) While providing care to a client, the nurse stops to assess a new client problem.

The assessment in this situation would be: 31) A) An objective assessment B) An initial assessment

C)A focused assessment D) A subjective assessment 32) A graduate nurse is attending a seminar regarding the role of the nurse as a client

advocate. After the session, the students engage in a discussion. Which of the following statements by the graduate nurse indicates the need for further education?

32) A) "Being a client advocate entails making efforts to improve client outcomes."

B) "Client advocates have the authority to make decisions for the client."

C)"Communicating client needs to the members of the healthcare team is a role of the client advocate."

D)"Providing education to the client and family is a key way to be a positive client advocate."

33) The nurse is using a specific process to plan smoking cessation activities for a

client. Which of the following is this nurse most likely using to plan the care for this client? 33) A) Evidence-based practice B) Nursing process

C)Variance analysis D) Critical pathways 34) The nurse is creating outcome criteria for the nursing diagnoses for a client. Which

of the following should the nurse include when creating the criteria? 34) A)They should be written as psychomotor only.

B) They should be written to address the client, and be time-specific and measurable.

C) They should be written as statements.

D) They should be written as nursing goals.

35) The nurse stops to think about a previous client care situation before providing

care to a current client. This nurse is using what critical thinking skill? 35) A)Divergent thinking B) Reflection C)Reasoning D) Clarifying

36) A client care issue has been raised about the actions taken by a nurse who was

asked to provide care to a client whose healthcare decisions were considered controversial. The unit's nurse manager is concerned that care was not appropriately provided. Which of the following should be consulted to protect the client and to evaluate the care in question? 36) A) Nursing code of ethics B) Hospital quality improvement guidelines C) Critical pathway D) Nurse practice act 37) The nurse is reviewing the outcome of client care that was provided. Which of the

following nursing process steps should the nurse use next? 37) A)Implementation B) Planning C)Assessment D) Evaluation 38) The nurse is preparing to provide client care information to a group of unlicensed

assistive personnel. Which type of care delivery system is this nurse most likely using to provide client care? 38) A) Primary nursing B) Team nursing

C)Functional nursing D) Case management 39) A new nurse tells her mentor "you always seem so poised when you interact with

the client. It is as if you always know what to do. Can you teach me how to do that?"

What characteristic does this mentor possess in relation to critical thinking? 39) A) Independent thinking B) Discipline

C)Empathy D) Self-confidence 40) Which of the following best demonstrates a nurse using critical thinking when

providing client care? 40) A) A nurse checks a laboratory manual before providing care.

B) A nurse lists alternative interventions available to provide client care.

C) A nurse checks every intervention with the charge nurse before providing care.

D) A nurse is confused when the only planned intervention fails to help a client.

SHORT ANSWER. Write the word or phrase that best completes each statement or answers the question.

41) The nurse assesses a client's weight loss as being 22 lbs. How many liters of fluid

did this client lose? 41)

Chapter 2 Psychosocial Aspects of Client Care MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

42) A client is admitted with hypernatremia caused by being stranded on a boat in the Atlantic Ocean for five days without a fresh water source. Which of the following is this client at risk for developing? 42) A) Pulmonary edema B) Stress fractures C)Atrial dysrhythmias D) Cerebral bleeding 43) The blood gases of a client with an acid-base disorder show a blood pH outside of

normal limits. The nurse realizes that this client is: 43) A) Fully compensated.

B) In need of intravenous fluids.

C)Demonstrating anaerobic metabolism.

D)Partially compensated.

44) A client with fluid retention related to renal problems is admitted to the hospital.

The nurse realizes that this client could possibly have which of the following electrolyte imbalances? 44) A) Hypokalemia B) Magnesium C)Carbon dioxide D) Hypernatremia 45) An elderly client who is being medicated for pain had an episode of incontinence.

The nurse realizes that this client is at risk for developing: 45) A) Fecal incontinence. B) Dehydration.

C)Over-hydration. D) A stroke.

46) The nurse is reviewing a client's blood pH level. Which of the systems in the body

regulate blood pH? (Select all that apply.) 46) A) Buffers B) Respiratory

C)Renal D) Cardiac 47) A client is prescribed 20 mEq of potassium chloride. The nurse realizes that the

client is receiving this replacement: 47) A) To help regulate acid-base balance.

B) To keep a vein open.

C) To sustain respiratory function.

D) To encourage urine output.

48) An elderly client with peripheral neuropathy has been taking magnesium

supplements. The nurse realizes that which of the following symptoms can indicate hypermagnesemia? 48) A) Excessive urination

B)Hyper reflexia C)Hypotension, warmth, and sweating D)Nausea and vomiting 49) An elderly client with a history of sodium retention arrives to the clinic with the

complaints of "heart skipping beats" and leg tremors. Which of the following should the nurse ask this client regarding these symptoms? 49) A) "Are you using a salt substitute?"

B) "Were you doing any unusual physical activity?"

C) "Have you stopped taking your digoxin medication?"

D) "When was the last time you had a bowel movement?"

50) A client who is taking digoxin (Lanoxin) is admitted with possible hypokalemia.

Which of the following does the nurse realize might occur with this client? 50) A) A higher dose of digoxin (Lanoxin) may be needed.

B) A diuretic may be needed.

C) Digoxin toxicity D) Fluid volume deficit 51) The nurse is admitting a client who was diagnosed with acute renal failure. Which

of the following electrolytes will be most affected with this disorder? 51) A)Phosphorous B) Calcium C)Potassium D) Magnesium 52) A client is admitted with burns over 50% of his body. The nurse realizes that this

client is at risk for which of the following electrolyte imbalances? 52) A)Hypophosphatemia B) Hypernatremia C)Hypercalcemia D) Hypermagnesemia

53) The nurse observes a client's respirations and notes that the rate is 30 per minute

and the respirations are very deep. The metabolic disorder this client might be demonstrating is: 53) A) Hypertension.

B) Pain.

C) Increasing carbon dioxide in the blood.

D)Hypernatremia.

54) A client is admitted for treatment of hypercalcemia. The nurse realizes that this

client's intravenous fluids will most likely be: 54) A) Dextrose 5% and ½ normal saline.

B) Normal saline.

C) Dextrose 5% and water.

D) Dextrose 5% and ¼ normal saline.

55) An elderly postoperative client is demonstrating lethargy, confusion, and a

respiratory rate of 8 per minute. The nurse sees that the last dose of pain medication administered via a patient controlled anesthesia (PCA) pump was within 30 minutes.

Which of the following acid-base disorders might this client be experiencing? 55) A) Metabolic acidosis B) Respiratory alkalosis

C)Metabolic alkalosis D) Respiratory acidosis 56) A 28-year-old male client is admitted with diabetic ketoacidosis. The nurse

realizes that this client will have a need for which of the following electrolytes? 56) A) Sodium B) Magnesium

C)Calcium D) Potassium 57) An elderly client does not complain of thirst. What should the nurse do to assess

that this client is not dehydrated? 57) A) Ask the physician to order a chest x-ray.

B) Assess the urine for osmolality.

C) Ask the physician for an order to begin intravenous fluid replacement.

D) Ask the physician for an order for a brain scan.

58) An elderly client is at home after being diagnosed with fluid volume overload.

Which of the following should the home care nurse instruct this client to do? 58)

A) Avoid wearing shoes while in the home.

B) Try to sleep without extra pillows.

C) Keep legs in a dependent position.

D) Wear support hose.

59) An elderly client comes into the clinic with the complaint of watery diarrhea for

several days with abdominal and muscle cramping. The nurse realizes that this client is demonstrating: 59) A) Hyponatremia. B) Fluid volume excess.

C)Hyperkalemia. D) Hypernatremia.

60) A client's blood gases show a pH greater of 7.53 and bicarbonate level of 36

mEq/L. The nurse realizes that the acid-base disorder this client is demonstrating is: 60) A) Respiratory acidosis. B) Metabolic alkalosis.

C)Respiratory alkalosis. D) Metabolic acidosis.

61) After abdominal surgery a client has difficulty coughing, saying, "It hurts too

much." The nurse teaches the client to: 61) A) support the abdomen with a pillow during the coughing exercises.

B) ask for pain medication if the pain is severe.

C) turn and deep breathe without coughing.

D) cough without straining the abdomen.

62) The preoperative client asks the nurse for some tea before surgery. The nurse

explains that it is important to have nothing by mouth (NPO) prior to surgery to prevent: 62) A) aspiration.

B) urine formation.

C)hyperglycemia. D) abdominal cramping.

63) A nurse is preparing to discharge a client who has had outpatient surgery. It is

important for the nurse to assess the client's: A) family support at home.

B) food preferences.

C)knowledge of sterile technique.

D)understanding of the surgical procedure.

63)

64) When changing the client's sterile dressings on the second postoperative day, the

nurse notes that the suture line is red and slightly inflamed. The nurse recognizes these findings are: 64) A) abnormal and need to be documented.

B) normal signs of the inflammatory response.

C) abnormal and need to be reported to the charge nurse.

D) signs of infection and need to be reported to the physician.

65) During the preoperative assessment, the nurse learns that the client had gestational

diabetes with her three pregnancies. The nurse will obtain an order for the following test: 65) A) electrolytes.

B)urinalysis.

C) partial thromboplastin time (PTT).

D) blood sugar.

66) After abdominal surgery, a client feels bloated and is unable to pass gas.

Appropriate nursing interventions include:

66)

A) encourage fluid intake of 3000 mL/day.

B)assist with ambulation.

C) restrict foods to reduce gas production.

D) press gently on the abdomen to promote expulsion of gas.

67) A postoperative client complains of dizziness when getting out of bed to ambulate.

The nurse should:

67)

A) have the client use a walker.

B)administer medication for dizziness.

C)return the client to bed.

D)walk alongside the client.

68) The nurse is preparing to obtain a client's signature on an informed consent. It is

the nurse's responsibility to:

68)

A) witness the signature.

B) determine the client's understanding about the procedure.

C)describe surgical risks.

D)explain the procedure.

69) A client is being given 0.6 mg atropine (an anticholinergic) IM preoperatively and

asks the nurse what the medication is for. The nurse explains the medication will prevent: 69) A)nausea. B) pain.

C)anxiety. D) aspiration.

70) When providing preoperative teaching for a client scheduled to have abdominal

surgery, the nurse should include: A) changing the dressings.

70)

B) self-medication using a PCA pump.

C) turning, coughing, and deep breathing (TCDB).

D)assisting with the bed bath.

71) The nurse should watch for which of the following side effects when clients are

receiving NSAIDs, nonsteroidal anti-inflammatory drugs, for pain: A)vertigo and syncope.

71)

B) tarry black stools and epigastric pain.

C) diarrhea and vomiting.

D)confusion and memory loss.

72) The nurse notes a client is crying and holding the operative site, yet continues to

refuse pain medication. The nurse might initially explore the client's: A)socioeconomic status.

72)

B) religious beliefs.

C) beliefs about the frequent use of narcotics.

D) cultural beliefs.

73) The nurse evaluates the effectiveness of a client's intravenous injection of

morphine sulfate, 15 mg, given for pain. How soon can the nurse expect the client to begin to get some relief? 73) A) 1 to 5 minutes

B) 10 to 15 minutes C)20 to 30 minutes D) 1 to 2 hours 74) Nurses can assist clients experiencing pain by stimulating large-diameter A-delta

and A-beta fibers by using techniques such as: 74) A) high-intensity exercise.

B)relaxation and massage.

C)group therapy.

D)electrical stimulation therapy.

75) A 5-year-old client was admitted with severe dog bites and was experiencing pain.

The nurse can best evaluate level of pain intensity by:

75)

A) recognizing the level of intensity cannot be evaluated at that early age.

B)asking the parents about how much pain the client seems to be experiencing.

C) asking the child to rate the pain on a scale of 1 to 10.

D) showing pictures of happy, sad, and crying faces and have the client point to the

one like him.

76) A client feels reluctant to ask for pain medication frequently to keep from

bothering the nurse. The nurse recognizes an appropriate type of pain control for this client would be: 76) A) relaxation exercises.

B) narcotic tablets left at the bedside.

C) transcutaneous electrical nerve stimulation (TENS) unit.

D)patient-controlled analgesia (PCA) pump.

77) A client with a right lower extremity amputation complains of pain in the lost limb.

The nurse plans care of the client based on the understanding that phantom limb pain should be: 77) A) referred to a grief counselor.

B) ignored, as it is not possible to have pain in the lost limb.

C) treated as any other client experiencing pain.

D) given small doses of pain medication to prevent addiction.

78) A client who has just had a heart attack reports experiencing intense pain in the

left shoulder. The nurse explains this type of pain is called: A)referred pain. B) phantom pain.

C)acute pain.

78)

D) chronic pain.

79) A client in hospice care has received large doses of morphine but is still unable to

sleep. The nurse should administer which of the following adjuvant drugs?

79)

A) lisinopril (Zestril)

B) acetaminophen (Tylenol) C)amitriptyline (Elavil) D) meperidine (Demerol) 80) The nurse is caring for a postoperative client who is experiencing sweating,

tachycardia, and increased blood pressure. The nurse recognizes these symptoms are due to: 80)

A) chronic pain.

B) acute pain.

C)postoperative shock. D) phantom pain.

81) A client with a history of lumbar spinal cord nerve compression continues to

complain of burning pain. The nurse realizes that this client is experiencing: 81) A) Phantom limb pain.

B)Myofascial pain syndrome.

C)Complex regional pain syndrome.

D)Chronic post-operative pain.

82) A client with chronic pain is being started on a "patch". Which of the following

should be included when instructing the client about this pain-relieving delivery system? 82) A) Dosing will start with a lower dose.

B) The client will never overdose with this delivery method.

C) The client will never experience breakthrough pain.

D) It will not work as well as oral pain medications.

83) A client is seen talking and laughing in the clinic's waiting room yet complains of

excruciating pain. The nurse realizes this client is most likely demonstrating: 83) A) The desire for narcotics.

B) Inconsistent behavioral response to pain.

C)Fake pain.

D)Denial.

84) A client learns that he has no physical cause for the ongoing back pain he

experiences. The nurse realizes this client might be experiencing: 84) A)Psychogenic pain. B) Central pain.

C)Phantom pain. D) Chronic postoperative pain.

85) A client with a history of chronic pain tells the nurse, "I do a variety of things to

make my body produce its own pain reliever." The nurse realizes that this client is describing: 85) A) A theory of denial.

B) The body's ability to make endorphins.

C) A belief in alternative methods

D) One reason to reduce the amount of pain medication prescribed.

86) The nurse is assessing a client's pain perception. Which of the following methods

of assessment would be useful for this? 86) A) PQRST guide B) Biofeedback rating

C)Psychological evaluation tool D) FACES scale 87) A 47-year-old female client has a history of scoliosis and back pain. Which of the

following types of pain does the nurse realize this client most likely is experiencing?

87) A) Chronic intractable nonmalignant pain syndrome.

B)Recurrent acute pain.

C) Chronic nonmalignant pain.

D) Ongoing time-limited pain.

88) A client is complaining of muscle pain. The nurse realizes that the transmission of

this pain is: 88) A) Over the A-delta fibers. B) Over the C nerve fibers.

C)Over the B nerve fibers. D) Over the D nerve fibers.

89) A client has periodic severe nerve pain that is not being well-controlled with pain

medication. The nurse thinks that this client might benefit from: 89) A) A narcotic.

B) A local anesthetic.

C) An antidepressant.

D) A nonsteroidal anti-inflammatory drug (NSAID).

90) The client complaining of pain has been waiting for medication to relieve the pain.

Which of the following should the nurse realize about this client? 90) A) The client wants attention.

B) The client is demanding.

C) The client's pain is real.

D) The client just wants medication.

91) The nurse is assessing a client's vital signs. Which of the following should be

assessed during this time? 91) A) Pain B) Peripheral pulses

C)Urine output D) Ability to ambulate

92) A client with chronic pain tells the nurse that he "rarely sleeps more than 3 hours a

night." The nurse realizes that this client is at risk for developing: 92) A)Depression.

B) Chronic insomnia.

C) High pain tolerance.

D) Adult attention deficit disorder.

93) A client who is receiving pain medication around the clock complains of an acute

exacerbation of pain. What should the nurse do to help this client? 93) A)Give the client a nonsteroidal anti-inflammatory drug (NSAID).

B)Provide the medication ordered for breakthrough pain.

C)Encourage the client to ignore the pain.

D)Talk the client through the pain.

94) The nurse is helping a client in pain by gently massaging the painful area. The

nurse is utilizing which form of pain control with the client? 94) A)Guided imagery B) Biofeedback C)Cutaneous stimulation D) Acupuncture 95) A client with a long history of pain rarely appears to be in pain and often forgoes

the use of pain medication. The nurse realizes that this client: 95) A) Is addicted to pain medication.

B) Does not really have pain.

C) Has a low pain tolerance.

D) Has a high pain tolerance.

96) A client asks the nurse, "What does it matter what grade the tumor I had in my

stomach?" The best response by the nurse is: 96) A) "It explains if the tumor has spread."

B) "It explains how aggressive the tumor is."

C) "It is a method of explaining the extent of the tumor to your insurance provider."

D) "It is a way to name the tumor."

97) A client with uterine cancer is prescribed a treatment in which radioactive material

will be inserted and maintained within her vagina. Which of the following types of treatment does this describe? 97) A) Extracavitary radiation B) Chemotherapy

C)Brachytherapy D) Teletherapy 98) A client who is newly diagnosed with cancer says to the nurse, "I don't want to

spend my final days on earth in a hospital bed." The best response by the nurse is: 98) A) "Why do you feel so negative about being in the hospital?"

B) "If I were you I would go home and enjoy the life you have left."

C) "Please tell me more about how you are feeling right now."

D) "I know how you feel. It must be hard to know that you are dying."

99) The nurse is preparing to change the postoperative dressing of a client with a

mastectomy. During the dressing change the client looks away. Which of the following should the nurse do to assist this client? 99) A) Recommend that the client receive home care upon discharge because the client

will not be able to provide self dressing changes.

B) Hand the client a mirror so that she can look at the incision while the dressing is

being changed.

C) Suggest that the client identify a family member who will have to do the dressing

since the client refuses to learn.

D) Support the client; however, do not avoid discussing the incision.

100) A client is informed that the tumor removed from his abdomen had well-defined

borders, was encapsulated, and totally removed. The nurse realizes that this client has just learned the tumor was most likely: 100) A) Benign.

B) Malignant.

C) One that would not respond to chemotherapy.

D)Metastatic.

101) A 65-year-old male client is diagnosed with lymphoma while being treated for

bladder cancer. The nurse realizes that this client is demonstrating: 101) A)A weakened immune system.

B)Two unrelated cancers.

C)Identification of the primary cancer.

D)Metastasis.

102) A client who was treated for bladder cancer 15 years ago tells the nurse, "I live

each day like it is my last yet plan for the future." The nurse realizes that this client is

demonstrating which phase of cancer survival? 102) A)Diagnosis and treatment B) Extended survival C)Permanent survival D) Watchful waiting 103) A client is receiving bleomycin (Blenoxane) as part of his chemotherapy cancer

treatment. Which of the following should the nurse do prior to his treatment? 103) A) Evaluate the degree of hair loss since the last treatment.

B) Measure vital signs and cardiovascular status.

C) Assess for diarrhea.

D) Evaluate for motor weakness.

104) A client thinks she has cancer because her last Pap smear identified cervical

dysplasia. The best response by the nurse is: 104) A) "This means the cells of your cervix have lost their useful function."

B) "This confirms that the cells are cancerous."

C) "This means the cells are normal."

D) "This means the cells are abnormal because of irritation."

105) The family of a client with terminal metastatic cancer asks the nurse for

guidelines regarding when to call for help when the client is discharged to home.

Which of the following would indicate this client needs medical intervention? (Select all that apply.) 105) A)Rectal temperature greater than 101.5 F B)Improvement in ankle edema C)Resting comfortably, and reading D)Extreme hunger E)Difficulty breathing F)Onset of bleeding 106) A 30-year-old client has been informed of an abnormal mammogram and is to

return to the radiology department for additional testing. The nurse realizes that this client will most likely need to have a: 106) A) Ultrasound.

B) Chest x-ray.

C) Computed tomography (CT) scan.

D) Nuclear scan.

107) A client is prescribed external radiation as part of his cancer treatment. Which of

the following should be included in this client's instructions? (Select all that apply.)

107) A) Do not wash off the treatment marks.

B) Wash the skin with soap and water.

C) Use an electric razor to shave the treatment area.

D) Avoid applying heat or cold to the area.

108) A client with cancer is diagnosed with pain associated with the cancer treatment.

The nurse realizes that this client is most likely experiencing: 108) A)Metastatic bone pain.

B) Incisional pain.

C) No pain.

D) Pain within a hollow visceral organ.

109) A client who is being treated for cancer says, "I thought the pain that I had before

I was diagnosed with cancer was bad. This is horrible." The nurse's best response is: 109) A) "Pain is a frame of mind."

B) "The treatment for the cancer must not be working."

C) "Pain is the main indication of cancer."

D) "The pain might be worse because of the cancer treatment."

110) A client with abdominal cancer is asking why the physician wants to perform

surgery. An appropriate response for the nurse to make to this client is: 110) A)"Maybe the physician wants to confirm that you don't have cancer."

B) "The physician must think this will help get rid of the cancer."

C) "Surgical resection is used for diagnosis and staging of 90% of all cancers."

D)"That's a good question."

111) The client tells the nurse, "The doctor says my breast tumor was at B stage. What

does that mean?" The nurse explains the staging describes:

111)

A) "Where the tumor tissue first originated."

B) "The size of the tumor and extent of the cancer."

C) "The rate of growth of the cancer cells."

D) "The type of cancer cells."

112) Which of the following statements indicates a need for further teaching by the

nurse for a client with radiation implants?

A)"I might feel unusually fatigued."

112)

B) "I may have nausea and vomiting."

C) "I will spend some time with my grandson and my daughter who is expecting

again."

D) "I need to take good care of the skin around the radiation implant."

113) A client is being prepared for a bone marrow transplant. The nurse knows to

prepare for which of the following administration routes?

A)incision and instillation B) intramuscular

113)

C)intrathecal D) intravenous 114) An 86-year-old client asks the nurse why cancer affects mostly the elderly. An

accurate response would be:

114)

A) "The elderly have a longer time to be affected by all carcinogens."

B) "The cells of the elderly are more fragile and more susceptible to cancer."

C) "It may take 10 to 20 years after damage to the DNA for the cancer to appear."

D) "The elderly have more oncogenes."

115) A client suffers from claustrophobia, the fear of being in enclosed places. The

nurse knows that the client may have difficulty with the following test: A)MRI B) CT scan C)x-ray imaging D) ultrasonography

115)

116) An elderly client told the nurse she had been smoking for 70 years and did not

have lung cancer. The nurse explained that other factors need to be taken into account, such as: 116) A)type of cigarettes smoked. B) genetic predisposition.

C)history of alcohol abuse. D) type of diet.

117) The nurse is caring for a hospitalized cancer client with a radiation implant. The

nurse plans to take the following precautions:

117)

A) Avoid touching the patient.

B) Encourage family involvement with client care.

C)Wear a lead apron when administering care.

D)Organize care to limit exposure.

118) A client with breast cancer who is receiving chemotherapy tells the nurse she

does not care what happens to her anymore, since she cannot work or care for her family. The nurse can assist by: 118) A) finding a helper for her.

B) allowing her to express her feelings, fears, and concerns.

C) telling her that she has the right to feel depressed.

D)referring her to counseling services.

119) An eighth-grade class is taking a field trip to the beach to explore sea life. The

school nurse suggests that the students: 119) A) use SPF 15 lotion on their exposed skin to prevent sunburn.

B) go on the field trip in the evening to avoid exposure to the sun.

C) wear long-sleeved shirts and long pants to protect them from the sun.

D) stay out of the water.

120) A 78-year-old client has been diagnosed with prostate cancer. The nurse should

educate the client about the prevention or treatment of:

120)

A)urinary retention. B) recurrent headaches.

C)constipation. D) urinary incontinence.

121) A client in the outpatient clinic is scheduled to have blood drawn for an iron level.

Recognizing that certain medications will affect the results, the nurse should determine if the client is taking: 121) A)acetaminophen. B) antidepressants.

C)antihypertensives. D) oral contraceptives.

122) When checking laboratory values, the nurse notes the client's platelet count is

100,000 mm3. The nurse should include which of the following actions in the client's plan of care? 122) A)Hold pressure over injection sites to ensure clotting has occurred.

B)Encourage client to increase ambulation to prevent a deep venous thrombosis.

C)Use strict sterile technique with wound care in order to prevent infection.

D)Instruct client to increase intake of vitamin C to assist in blood coagulation.

123) It is reported a client has leukocytosis. When checking the laboratory results, the

nurse will expect to find:

123)

A)white blood cell count is less than 5,000/mm3.

B)neutrophil count is greater than 50%.

C) eosinophil count is less than 5%.

D) white blood cell count is greater than 10,000/mm3.

124) While bathing the client, the nurse observes large purple-colored rashes on the

client's chest. The nurse documents that the client has:

124)

A)purpura. B) eythema.

C)papules. D) petechiae.

125) During the change-of-shift report the nurse learns that an assigned client has a

hemoglobin level of 8 g/dL. Based on this information the nurse plans to:

125)

A) prevent exposure to infectious diseases.

B) keep the client on strict bed rest to restrict activity.

C) space activities in order to conserve energy.

D)encourage ambulation to prevent thrombophlebitis.

126) The nurse checks the results of a client's Schilling's test and notes the excretion of

vitamin B12 is less than 10% in 24 hours. The nurse should plan to:

126)

A)observe client for signs of bleeding tendencies.

B) explain the need and rationale for supplemental vitamin B12.

C) instruct client to increase intake of foods high in iron.

D) measure client's oxygen saturation levels.

127) The physician has informed the parents that the results of a hemoglobin

electrophoresis performed on their child indicate the presence of hemoglobin S. When the parent asks what this means, the nurse explains:

127)

A) "It is indicative of sickle cell disease or trait."

B) "It verifies the presence of hemolytic anemia."

C)"Hemoglobin S is a type of immature red blood cell."

D)Hemoglobin S is found in people with pernicious anemia."

128) The nurse checks the coagulation studies on a client who is not receiving any

type of anticoagulant therapy. Which of the following findings should be reported to the physician? 128) A) Platelet count is 250,000 mm3.

B) APPT is 25 seconds.

C) INR is 2.5.

D) Prothrombin time is 20 seconds.

129) A nurse is bathing a client who had a bone marrow aspiration from the right iliac

crest 5 days ago. Which of the following findings would be of concern to the nurse?

129) A) The client is doing isometric leg exercises.

B) The needle insertion site is scabbed over and without drainage.

C) The needle aspiration site is ecchymotic.

D) The client complains of moderate pain in the right iliac crest.

130) A client being prepared to have a bone marrow transplant expresses concern the

procedure will be painful. The nurse explains:

130)

A) "You will be given some analgesic since it can be painful."

B) "It should not be any more painful than having an injection."

C) "The procedure is very quick and not very painful."

D) "A local anesthetic is given and so you won't feel any pain."

131) When making morning rounds, a client with acute leukemia reports having

nosebleeds off and on throughout the night. Which of the following actions should be taken by the nurse?

131)

A)Determine if client has pain anywhere.

B)Apply a water-soluble lubricant to the nares.

C) Check the client's blood pressure and pulse.

D) Report the findings to the physician.

132) A client with hemophilia A is being prepared to receive a transfusion of clotting

factors and expresses concern about contracting HIV from the transfusion. The best explanation the nurse can provide is: 132) A) "The blood that is donated is screened so you should not worry."

B) "That certainly is always a concern. You can refuse the treatment if you prefer."

C)"Rigorous screening of donors and treatment of donated blood has significantly reduced the risk."

D)"You won't be receiving whole blood so you shouldn't worry about HIV contamination."

133) When caring for a client with a history of alcoholism the nurse recognizes the

client is at increased risk for which of the following conditions?

A)hemolytic anemia B) Von Willibrand's disease C)folic acid deficiency

D) pernicious anemia

133)

134) The nurse is preparing a client recovering from sickle cell crisis for discharge. To

prevent future crises from occurring, the nurse instructs the client to: A)keep well hydrated.

134)

B) avoid doing any types of exercise.

C) eat a high-protein diet.

D) abstain from alcohol use.

135) A client with multiple myeloma has been started on filgrastin (Neupogen) for

treatment of neutropenia. The nurse identifies the drug is being effective when:

135)

A) the client is no longer hypotensive.

B) the hemoglobin level is within normal limits.

C) the client no longer has bone pain.

D) an increase in the white blood cell count occurs.

136) Infectious mononucleosis is suspected in a client being seen in the clinic. In

addition to swollen lymph glands and an increased lymphocyte count, the nurse can expect the client to:

136)

A) have petechiae over the anterior chest.

B) have an enlarged liver.

C) report having insomnia.

D) complain of headaches and malaise.

137) The nurse learns a client with sepsis has developed disseminated intravascular

coagulation (DIC). The nurse should plan to:

137)

A)encourage frequent ambulation in the hallway.

B)restrict fluid intake to prevent vascular fluid overload.

C) keep client in a low-Fowler's position to promote venous return.

D) check peripheral pulses and capillary refill frequently.

138) A client with secondary polycythemia being seen in the clinic informs the nurse

he will be taking a long flight overseas in the near future. The nurse reminds the client: 138) A) to be sure to wear support stockings during the flight.

B) that he will need supplemental oxygen when at a higher altitude.

C) to restrict intake of high-protein foods the day of the flight.

D) that he should start taking an antibiotic 1 week before leaving.

139) A client with chronic lymphangitis of the lower extremities asks the nurse how

often she should wear elastic stockings. The nurse explains:

139)

A) "It is only necessary to wear them if you notice an increase in swelling."

B) "You should wear them at all times, only taking them off to bathe."

C) "You should wear them when your legs feel heavy or are painful for you."

D) "It is best to wear them during the waking hours and remove them when sleeping."

140) When caring for the client with a history of pica the nurse assesses the client for

signs of chronic iron deficiency anemia. These may include: A)chelosis. B) clubbing of the fingernails.

140)

C)jaundice. D) petechiae.

141) A client tells the nurse, "I had this arthritis pain under control but then I learned I

might lose my job." Which of the following should the nurse say in response to this client? 141) A) "Stress can cause an exacerbation of the arthritis."

B) "Well, we better do everything to help you before you lose your health benefits."

C) "I'm sure you'll find another job."

D) "Have you considered going on disability?"

142) During the physical assessment of a client, the nurse wants to include the client's

immunity function. Which of the following techniques would provide the nurse with the best information? 142) A)Auscultation of the heart B) Palpation of the abdomen C)Percussion of the lungs D) Inspection of the skin 143) The client is diagnosed with a type IV hypersensitivity response. The nurse

realizes that this client will most likely need treatment with: 143) A)Renal dialysis. B) Antihistamines.

C)Endotracheal intubation. D) Cardiac output medications.

144) A differential diagnosis for a client is food allergies. The nurse escorts the client

into an examination room and begins to ask questions about what the client has most recently eaten. Which of the following has the nurse observed about this client? 144) A)Cachexia B) Obesity C) Anorexia D) Urticaria 145) An HIV positive client is not adhering to the prescribed medication therapy.

Which of the following actions by the nurse will best improve client compliance and long-term treatment of the disease process? 145) A) Talk with the client about not adhering to the medication schedule.

B) Refer the client to a social worker so that lower-cost medications can be obtained.

C) Suggest that the client take the medication at bedtime to prevent nausea.

D) Confront the client about the noncompliant behavior.

146) The nurse is preparing to instruct a class of young adults about ways to achieve

safe sex. What should be included in the nurse's presentation? (Select all that apply.)

146) A) Only use water-based lubricants with condoms.

B) Be HIV tested if entering into a new monogamous relationship and have the test

repeated in six months.

C) Avoid sexual activity until both partners found HIV negative for two tests.

D) Avoid spermicidal agents.

147) A client who received a kidney transplant six months prior is demonstrating an

alteration in his blood-urea-nitrogen level. The nurse realizes that this client is demonstrating: 147) A) An allergic response.

B) A functional decline as an early indicator of rejection.

C) An expected response.

D) A functional decline as an early indicator of acceptance.

148) An HIV-positive client is being treated for thrush. Client teaching by the nurse

should include which of the following side effects? 148) A) "Hepatitis can develop as a side effect."

B) "Nausea, vomiting, and diarrhea are common side effects."

C) "Skin discoloration is a common side effect."

D) "There are few side effects associated with the medication to treat thrush."

149) A client tells the nurse, "I've never had this before" and exposes an area of

redness, itching, and skin thickness on his left hand. The nurse realizes that this client is demonstrating which of the following? 149) A)A type I allergic response B) A type IV allergic response C)A type II allergic response D) A type III allergic response 150) A client is prescribed a monoclonal antibody after an allograft on his left thigh.

Which of the following should be done for this client? 150) A)Closely observe the client for four hours following the original dose.

B)Encourage the client to have a chest x-ray one week after the first dose.

C)Premedicate with hydrocortisone.

D)Instruct the client that side effects will occur after at least six doses of the medication.

151) A client with an autoimmune disorder tells the nurse, "My family keeps telling

me that I don't look sick." The nurse should utilize which of the following nursing diagnoses to help this client? 151) A)Ineffective Coping B) Activity Intolerance C)Interrupted Family Processes D) Ineffective Protection 152) A young HIV female client tells the nurse she does not want to see the

gynecologist because, "I'm going to die anyway." Which of the following should the nurse say in response to this client? 152) A) "But you still should be on birth control."

B) "The gynecologist will help diagnose any Hodgkin's disease."

C) "Why do you think that you are going to die?"

D) "Having a PAP smear will help detect the onset of cervical cancer."

153) An adolescent client asks the nurse about sexual practices and the onset of HIV.

Which of the following should the nurse instruct this client? 153) A) The only safe sex is no sex.

B) Be sure to be tested for HIV every six months.

C) There is no such thing as safe sex.

D) Always use a condom.

154) An HIV positive client comes into the clinic complaining of increasing pain in

his feet and legs. The nurse realizes that this client is demonstrating: 154) A)A reaction to the medication.

B) A nervous system manifestation of the disease.

C) An opportunistic infection.

D) A secondary cancer.

155) Before a bone marrow transplant, a client is prescribed ganciclovir (Cytovene).

Which of the following should be included in the instructions to the client about this

medication? 155) A) It will maintain cardiac output.

B) It will prevent the development of cytomegaloviral pneumonia.

C) It will prevent the development of herpes pneumonia.

D) It will decrease the onset of bacterial infections.

156) A client is found to be allergic to several allergens from the epicutaneous testing.

Which of the following should be done next to help this client? 156) A)Undergo patch testing.

B) Undergo intradermal testing of the allergens.

C) Keep a food diary.

D)Determine treatment.

157) A client is demonstrating signs of anaphylactic shock. Which of the following

should the nurse do first to assist this client? 157) A) Maintain an airway.

B) Administer subcutaneous epinephrine.

C)Place on a cardiac monitor.

D)Provide calm reassurance.

158) A client is recovering from a skin graft where the thumb of his right hand is

sutured to the skin on his abdomen. The nurse realizes this client has which of the following types of grafts? 158) A)Xenograft. B) Allograft.

C)Autograft. D) Isograft.

159) A client has been given instructions on collection of a sputum specimen for

analysis of mycobacterium tuberculosis. Which statement by the client indicates he understands the directions? 159) A) "I will need to drink a radioactive dye before coughing up secretions."

B) "They will need to collect three specimens."

C) "It is best to collect a specimen after drinking warm liquids."

D) "I will need to take a sedative before the secretions are suctioned."

160) The nurse uses palpation of the chest in order to assess the client for:

A)tactile fremitus. B) retractions and bulging.

C)use of accessory muscles. D) pleural rub.

160)

161) A client scheduled for a pulmonary function test asks what is involved in the test.

The nurse explains:

161)

A) "You will be asked to breathe in breathe in a specific manner and measurements

are taken."

B) "An x-ray of your lungs is taken after a dye is injected into your vein."

C) "You will have blood drawn from an artery in your wrist."

D) "A sensor is placed on your fingertip or earlobe and your oxygen levels will be

measured."

162) The nurse obtains a pulse oximetry reading of 95% on a client 2 days

postoperative. Which of the following actions should be taken by the nurse?

162)

A) Increase level of oxygen delivery by 1 L/min.

B) Document the findings.

C) Encourage client to do more coughing and deep breathing.

D)Recheck the pulse oximetry after ambulating client.

163) A client has blood drawn for an arterial blood gas. When applying pressure to the

puncture site it is important for the nurse to: A) hold the pressure for at least 60 seconds.

163)

B) have a tourniquet available in case bleeding does not stop.

C) keep the extremity elevated above the heart.

D) hold pressure for 2 minutes or longer.

164) The nurse is assessing an elderly client who is 2 days postop abdominal surgery.

The nurse recognizes alterations in the respiratory system of the elderly put the client at risk for: 164) A)increased vital capacity. B) upper respiratory infections.

C)pulmonary embolus. D) rib fractures.

165) When assessing the respiratory status of a client, the nurse auscultates the lungs

by: 165) A)checking breath sounds in the anterior and posterior thorax.

B)listening for air exchange in the bronchus and anterior lobes.

C)checking for adventitious sounds while having client cough.

D)listening to breath sounds in the anterior and posterior lung bases.

166) The nurse caring for a client who has sustained a head trauma closely monitors

respirations because: 166) A)breathing is controlled by the respiratory center in the brain.

B)the client will be unable to cough and clear secretions.

C) the client will be lethargic and forget to breathe.

D) the trauma may cause the client to be disoriented.

167) The nurse observes the serum alpha1-antitrypsin level of a client is 40 mg/dL and

recognizes this reading could be influenced by which of the following client conditions? 167) A)gastroesophageal reflux disease B)cellulitis of a lower extremity C)osteoporosis D)migraine headaches 168) A client scheduled to have blood drawn for a serum alpha1-antitrypsin level asks

the nurse if any special preparation is necessary. Since the client has a history of hyperlipidemia the nurse explains:

168)

A) "A low-fat diet should be eaten for twenty-four hours prior to the test."

B) "A fasting specimen will be necessary."

C) "No special preparation is needed."

D) "Any lipid-lowering medications should be held the day of the test."

169) When assessing a client with streptococcal pharyngitis, the nurse can expect the

client to complain of pain and: A)headache. B) dysphagia.

C)nausea and vomiting.

169)

D) palpitations

170) A postoperative client with a tracheostomy requires tracheal suctioning. The first

intervention in completing this procedure would be to:

170)

A) change the tracheostomy dressing.

B) perform oral or nasal suctioning.

C) provide humidity with a trach mask.

D) deflate the tracheal cuff.

171) When caring for clients who have had a tonsillectomy, the nurse should monitor

closely for which of the following complications: A) hemorrhage.

171)

B) nausea and vomiting.

C) throat pain and headache.

D)temperature elevation of 100.6°F. 172) A postoperative laryngectomy and radical neck dissection client has a nursing

diagnosis of Impaired Verbal Communication. Which of the following interventions should be included in the care plan? 172) A) Instruct the client to speak softly when talking.

B) Provide uninterrupted time for the client to attempt communication with the nurse

and health care team.

C) Provide the client with a pen and paper for writing.

D) Teach the client to read lips.

173) The client with chronic rhinitis asks the nurse why he cannot use his nasal spray

as often as he needs. The nurse's best response is:

173)

A) "Too much medication is absorbed through the mucosa and has a systemic effect

on the circulation."

B) "Continuous use of nasal spray causes nosebleeds."

C)"Prolonged use of nasal spray dries the nasal mucosa."

D)"Continuous use causes rebound congestion, which increases frequency of use."

174) The nurse provides discharge teaching to a client with laryngitis. Which of the

following statements by the client indicates an understanding of the instruction?

174)

A) "I should massage my throat to stimulate the vocal cords."

B) "I should rest my voice by not speaking."

C) "I can whisper but not speak in a regular voice."

D) "I can speak as much as I want as long as it is not painful."

175) A cyanotic client with an unknown diagnosis is admitted to the emergency

department. In relation to oxygen, the first nursing action would be to: A)not administer oxygen unless ordered by the physician.

175)

B)administer oxygen at a flow of 6 L/min and check O2 sats.

C)administer oxygen at a flow of 2 L/min.

D)wait until the client's STAT lab work is completed.

176) The nurse monitors a client with suspected nasal bone fractures for cerebrospinal

fluid leakage by:

176)

A)gently palpating nose for presence of crepitus.

B)determining the amount of postnasal drainage.

C)checking nasal or ear drainage for glucose.

D)checking the nasal drainage for blood.

177) The nurse is preparing a client for discharge who has had endoscopic sinus

surgery for obstruction. The nurse instructs the client:

177)

A)"Irrigate your sinuses with warm saline solution."

B)"Sleep on your back or in a semireclining position only."

C) "Avoid blowing your nose and strenuous exercising for a week."

D) "Sneeze with your mouth closed."

178) The nurse is caring for a patient who develops epistaxis. Which of the following

nursing interventions is advisable?

178)

A) Apply heat to the client's nose.

B) Have the client tilt his head back and hold pressure to the nose by pinching the

nares toward the septum.

C) Have the client lie supine and place ice packs to the forehead.

D) Have the client tilt the head forward and apply pressure by pinching the nares

toward the septum.

179) The nurse assesses a client suspected of having chronic bronchitis. It would be

most important for the nurse to question the client about which of the following?

179) A)pain location B) characteristics of the cough C)medication history D) occupation history 180) A client is brought in with a gunshot wound to the chest. The nurse assesses for

tension pneumothorax. What signs and symptoms of tension pneumothorax can the nurse expect to find? 180) A) high blood pressure B) deviated trachea C) wheezes in all lung fields D) audible sucking sounds on inspiration 181) The nurse auscultates crackles at the bases of the lungs of a client with adult

respiratory distress syndrome (ARDS). The nurse knows that these adventitious lung sounds are due to: 181)

A)hyperinflated alveoli. B) fluid in the alveoli.

C)constriction of the airways. D) mucus in the airways.

182) A client with tuberculosis has been on drug therapy for several months, but his

sputum is still positive for tuberculosis bacilli. It would be most important for the nurse to ask which of the following questions?

182)

A) "Have you had any reaction to your medications?"

B) "Are you feeling better now that you are taking medicine?"

C) "Have you taken all of your medicines as prescribed?"

D) "When did you last take your medications?"

183) The nurse caring for a client admitted with a diagnosis of suspected lung cancer

might expect to find which of the following on assessment?

A)hemoptysis B) cyanosis

183)

C)dysphagia D) night sweats 184) The nurse is caring for a client admitted with pneumonia. Which of the following

assessment findings would pro vide the most accurate information about the type of pneumonia the client has? 184) A) client's complaint of shortness of breath B) productive cough with large amounts of rust-colored sputum

C)client's complaint of chest pain D)temperature of 38.3°C (101°F) 185) The nurse assesses the client's chest tube drainage system. Which of the

following findings should be reported to the physician?

A)serosanguinous drainage in the collection chamber

185)

B) bubbling in the suction control chamber C) bubbling in the water seal chamber when the client coughs D) fluid in the water seal chamber that rises and falls with respirations 186) The nurse instructs the client with chronic obstructive pulmonary disease (COPD)

to practice pursed-lip breathing and explains that this breathing technique is done: 186) A) to prolong exhalation to help remove carbon dioxide from the lungs.

B) to use the abdominal muscles to breathe, giving the diaphragm a rest.

C) to break up mucus that has accumulated in the airway.

D) to prolong inhalation to help bring more oxygen to the lungs.

187) A client informs the nurse he is having pleuritic pain. Before documenting this

complaint, the nurse should verify if the pain:

187)

A)is constant along the costal borders.

B)increases with expiration.

C) subsides when client coughs.

D)increases with deep breathing.

188) A client has just been diagnosed with a pulmonary embolism. The nurse

anticipates the physician will order which of the following medication therapies?

188) A)antibiotic therapy B)nitroglycerin therapy C)heparin therapy D) bronchodilator and nebulizer treatments 189) A client who was diagnosed with the flu is demonstrating rapid, shallow

respirations. Which of the following is this client most at risk for developing? 189) A)Increased tidal volume B) Pneumonia C)Dehydration D) Atelectasis 190) A client tells the nurse, "After I leave here, I need to get to the dentist. My upper

teeth are hurting and I don't know why." Which of the following should the nurse do?

190) A) Tell the client there is nothing wrong with his teeth.

B) End the visit so the client can get to the dentist.

C)Reschedule the appointment at another time.

D)Assess the client for a sinus infection.

191) While eating a meal in the hospital, a client begins to demonstrate difficulty

breathing and signs of choking. The nurse realizes that the client is experiencing: 191) A)An acute myocardial infarction.

B)Pulmonary emboli.

C)Epiglottitis.

D)Laryngeal obstruction.

192) The nurse observes a client's respirations during sleep and notes the absence of

respirations that lasts from 15 to 45 seconds. This finding is consistent with: 192) A)Respiratory acidosis. B) Renal failure.

C)Laryngeal spasm. D) Sleep apnea.

193) A client says, "My nose is always congested and it just seems to get worse with

the nasal spray I've been using." The nurse realizes that this client is describing: 193) A) Rebound nasal congestion.

B) A side effect of the nasal spray.

C) An incorrect use of the nasal spray.

D) An acute sinus infection that needs to be treated with antibiotics.

194) During an assessment, the nurse learns that the only thing that helps a client with

a daily morning headache is "taking a mentholated cough drop" before eating breakfast. The nurse realizes that this client is experiencing: 194) A)Allergic rhinitis. B) Symptoms of sinusitis.

C)Acute rhinitis. D) After-effects from the flu.

195) While recovering at home from a total laryngectomy, a client notices an increase

in left shoulder weakness. This symptom is consistent with: 195) A) Damage to the spinal accessory nerve.

B) Normal recovery.

C)Medication complication.

D)Side effect of neck radiation therapy.

196) The nurse suspects that a client is demonstrating signs of tonsillitis. Which of the

following would be indications of this disorder? (Select all that apply.) 196) A)Thirst B) Pain around the ears C) Low grade fever D) Hoarse voice E) Nucal rigidity 197) A middle-age adult client who is diagnosed with pertussis is complaining of

right-sided thoracic pain. The nurse realizes that this client should be assessed for: (Select all that apply.) 197)

A)Pulmonary emboli. B) Pleural effusion.

C)Rib fractures. D) Pneumothorax.

198) A client tells the nurse he has a "cold" every spring that lasts for a few weeks.

The nurse suspects that the client is experiencing: 198) A)Acute viral rhinitis. B) Atrophic rhinitis.

C)Vasomotor rhinitis. D) Allergic rhinitis.

199) A client with a low red blood cell count is receiving a blood transfusion. The

nurse realizes that the body needs which length of time to create more red blood cells?

199) A)48 hours B) 10 days C)Two weeks D) 3 to 5 days 200) A client is admitted to the hospital with an inflammatory disorder. The nurse

expects that the physician will order which of the following diagnostic tests? 200) A)Sedimentation rate. B) Hemoglobin.

C)Platelet count. D) Red blood cell count.

201) The nurse is preparing to assess a client's hematologic, peripheral vascular, and

lymphatic systems. Which of the following assessment techniques is not typically utilized for this assessment? 201) A)Palpation B) Inspection C)Auscultation D) Percussion 202) A client is diagnosed with a disorder in which deoxygenated blood is having

difficulty returning to the heart and lungs for reoxygenation. In which part of the peripheral vascular system is the origin of this client's disorder? 202) A)Capillaries B) Arteries C)Arterioles D) Venules 203) A client is admitted with an enlarged lymph node. The nurse explains to the

client that the purpose of the lymph system is to: 203) A)Remove infectious organisms.

B)Synthesize lymphocytes.

C) Break down old red blood cells.

D) Filter blood.

204) During the assessment of a client's lower extremities, the nurse notes slight

pitting. This assessment finding should be documented as: 204) A)1+. B) 4+. C) 2+. D) 3+.

205) A client is diagnosed with an abnormally low red blood cell (RBC) count. The

nurse realizes that this disorder is: 205) A) Anemia. B) Bacteremia.

C)Leukemia. D) Polycythemia.

206) A client is diagnosed with an alteration in peripheral vascular resistance. The

nurse realizes that this resistance is determined by: (Select all that apply.) 206) A)Blood flow.

B) Blood pressure.

C) Vessel length.

D) Vessel diameter.

E) Blood viscosity.

207) A client is experiencing a disorder in which large amounts of red blood cells

(RBCs) are being destroyed. An outcome of this disorder can be demonstrated as: 207) A)Nausea. B) Anxiety.

C)Dysphagia. D) Jaundice.

208) A client with some blood loss is maintaining a blood pressure of 100/60 mm Hg.

The nurse interprets this to mean that the client's blood pressure is being maintained through the help of: 208) A)Venules. B) Veins.

C)Arterioles. D) Capillaries.

209) During the assessment, a client's pedal pulses are increased. The nurse should

document this finding as: 209) A)+3. B) +1. C) +4. D) +2.

210) A client who is diagnosed with a blood disorder has a platelet value of

>400,000/ml. The nurse interprets this to mean that this client is exhibiting: 210) A)Thrombocytosis. B) Anemia.

C)Thrombocytopenia. D) Leukemia.

211) A client needs a blood transfusion. The nurse realizes that the function of the

blood includes: (Select all that apply.) 211) A)Regulate fluid and electrolyte balance.

B)Oxygenation of body tissues.

C) Transmit impulses.

D) Aids in joint mobility.

E)Digestion of protein.

212) A client is demonstrating a sign of blood pressure stabilization accompanied by a

decreased urine output. The nurse explains that the body mechanism responsible for this blood pressure stabilization is: 212) A) Change in body temperature.

B) Response to chemoreceptors in the aortic arch.

C) Renal conservation of sodium and water.

D) Intake of dietary fat and protein.

213) A client has an inflammation of his gastrointestinal tract. When interpreting the

labwork for this client, the nurse expects an increase in which of the following types of white blood cells (WBCs)? Select all that apply. 213) A)Neutrophils B) Eosinophils C)Basophils D) Lymphocytes 214) A client who is being treated for malignant lymphoma is experiencing pruritis.

Which of the following interventions would be appropriate for this client? (Select all that apply.) 214) A) Bathe with cool water.

B) Cleanse bedding and clothing in mild detergent with a second rinse cycle.

C)Vigorously rub the skin after bathing.

D) Apply lavender-scented body lotion.

E) Keep room temperature above normal.

215) A client with disseminated intravascular coagulation is not responding to

infusions of fresh frozen plasma and platelets. Which of the following interventions might be indicated for this client? Select all that apply. 215) A) Begin normal saline infusion.

B) Prepare for a bone marrow biopsy.

C) Begin heparin infusion.

D) Begin heparin injections.

216) A client who is undergoing treatment for leukemia is scheduled for a bone

marrow transplant. The nurse determines that this client is in which phase of treatment for the disorder? 216) A)Maintenance B) Rehabilitative C)Postremission D) Induction 217) A college-aged client who is in the hospital for Hodgkin's disease treatment is

visited by friends who bring a pizza and cola to the client's room. Which of the following can the nurse do to ensure the client's comfort? 217) A) Ask the visitors to eat the pizza in the lounge.

B) Ask the visitors to leave.

C) Encourage the client to eat as much pizza as possible.

D) Provide the client with an antiemetic and suggest something else for the client to

eat with the visitors.

218) A client is diagnosed with stage II A Hodgkin's lymphoma. The nurse interprets

this information to mean that the extent of this disorder is limited to: 218) A)An extranodal site involvement with systemic symptoms.

B) A single lymph node with systemic symptoms.

C) Upper abdominal lymph nodes without systemic symptoms.

D) Two or more lymph nodes on the same side without systemic symptoms.

219) A client is being treated for acquired hemolytic anemia. Which of the following

assessment findings would suggest that the condition is severe? 219) A)Jaundice B) Enlarged spleen C) Misshaped limbs due to pathological fractures D)Bradycardia 220) A client with chronic gastritis is experiencing "tingling" in his hands. The nurse

realizes that this client might be demonstrating signs of: 220) A) Iron deficiency anemia.

B) Folic acid deficiency anemia.

C) Vitamin B12 deficiency anemia.

D) Acute blood loss anemia.

221) A client diagnosed with leukemia says, "If I have too many white blood cells and

white blood cells fight infections, why do I have to be careful not to be exposed to germs?" An appropriate response for the nurse to make is: 221) A) "That's not what leukemia is."

B) "Your bone marrow can become infected."

C) "Leukemia means you have the wrong kind of white blood cells."

D)"The white blood cells with leukemia aren't effective to fight infections."

222) Upon analysis, a client's red blood cells (RBCs) appear microcytic and

hypochromic. The nurse interprets this information to mean that this client is demonstrating signs of: 222) A) Iron deficiency anemia.

B) Chronic blood loss anemia.

C) Vitamin B12 deficiency anemia.

D) Acute blood loss anemia.

223) The nurse is preparing an analgesic for a client with leukemia. Which of the

following routes is preferred for this client? 223) A)Intramuscular B) Oral C)Intravenous D) Subcutaneous 224) A client in sickle cell crisis is experiencing edema of the hands and feet. The

nurse realizes that this edema is caused by: 224) A)Fluid overload. B) Small vessel infarction.

C)Poor venous return. D) Dehydration.

225) A client with idiopathic thrombocytopenia purpura continues to experience

symptoms of the disease after completing several courses of prednisone (Meticorten) therapy. The nurse anticipates that which of the following will most likely be indicated for this client? 225) A)Life-long prednisone therapy B)Splenectomy C) Weekly platelet transfusions D) Aspirin therapy 226) The nurse is planning to instruct a client with secondary polycythemia about

ways to prevent blood stasis. Which of the following should be included in these

instructions? 226) A) Black stools are to be expected.

B) Restrict fluids.

C) Elevate feet and legs when sitting.

D) Leg pain is normal.

227) A client who is undergoing chemotherapy for lymphoma says, "I thought I was

ugly before this all started. Now I know for sure I'm disgusting to look at." Which of the following is this client most at risk for developing related to their comments? 227) A) Changed body image perception B) Reduced sexual response C) Inability to cope with the diagnosis and treatment

D)Altered taste sensation 228) The nurse is providing dietary instructions to a vegetarian client with iron

deficiency anemia. Which of the following should be included in these instructions?

228) A) Consider adding animal sources of iron and protein to the diet.

B) Drink at least 12 glasses of water every day.

C) Ensure an adequate intake of vitamin C when consuming non-animal-based

proteins.

D) Avoid exercise at least 30 minutes after completing a meal or snack.

229) A client with chest pain is seen in the emergency department and is scheduled for

blood work to check his heart damage. The nurse anticipates which of the following laboratory studies will be ordered? 229) A) atrial nuturetic factor (ANF)

C)cardiac muscle troponin

B) creatine kinase (CK) D) B-naturetic peptide (BNP)

230) A client has returned to the nursing unit following a transesophageal

echocardiogram (TEE). Nursing responsibilities include: 230) A)encouraging client to drink 8 ounces of water every hour.

B) removing chest electrodes and checking for skin irritation.

C) keeping client sedated for the remainder of the shift.

D) checking for return of a gag reflex.

231) A client with a history of deep venous thrombosis (DVT) is seen in the clinic.

Since the client is planning a long airplane flight, the nurse instructs the client to: 231) A) do deep-breathing exercises every hour while awake.

B) perform isometric exercises of the lower extremities every 2 hours.

C) keep the lower extremities elevated as much as possible during the flight.

D) restrict intake of fluids during the flight.

232) A client is being sent home with a 24-hour Holter monitor device. The nurse

instructs the client to: 232) A) remove the Holter monitor when sleeping.

B) avoid drinking any alcoholic beverages.

C) record any unusual symptoms you may experience.

D) change the chest electrodes every 4 hours.

233) A client tells the nurse his recent blood work indicated his high density lipids

(HDLs) were 40 mg/dL and asks if this is a "good level"? The nurse should respond: 233) A) "You should ask your primary care provider to explain the results."

B) "HDLs should be lower than your cholesterol level."

C) "It is desirable to have a level above 60 mg/dL." D) "That is a good level. You must be eating healthy."

234) Before an electron beam computed tomography (EBCT) study is done, the nurse

needs to determine if the client:

234)

A) has any metal implants.

B) is pregnant.

C) has an allergy to iodine or shellfish.

D) is taking any antihypertensive medications.

235) The nurse is performing a cardiovascular assessment on an elderly client. Which

of the following findings should be reported to the charge nurse?

A)sparse hair growth on lower extremities

235)

B) weak, thready, irregular pulse C) presence of bruising on upper extremities D) thin, pale facial hair 236) A client being seen in the office is scheduled to have an ankle-brachial index test.

When the client asks what the purpose of the test is, the nurse explains that it:

236)

A) measures the pressure of varicose veins.

B) predicts the likelihood of developing hypertension.

C) measures cardiac ejection fraction.

D) will determine if atherosclerosis is present.

237) The nurse instructs the client scheduled to have blood drawn for a C-reactive

protein level to do which of the following prior to the test? 237) A) Hold any cardiac medication for 24 hours prior to the test.

B) Restrict intake of caffeine containing products 24 hours prior to the test.

C) Fast for 8 hours prior to the test.

D) No special fasting or preparation is required.

238) A client being seen in the outpatient clinic has had a radionuclear scan of the

heart. Upon discharge the client should be instructed to:

238)

A) increase fluid intake to 2000 mL in 24 hours.

B) dispose of urine in specially provided containers.

C) avoid close physical contact with others for 24 hours.

D) return in 24 hours for follow up x-rays.

239) A client being discharged following treatment for a deep venous thrombosis

(DVT), will be taking warfarin (Coumadin) at home. The nurse instructs the client to: 239) A) "Use over-the-counter anti-inflammatory drugs for pain or a headache."

B) "Include a lot of dark green leafy vegetables in your diet."

C) "If you miss a dose of the drug, wait until the next day to take the next dose."

D) "Avoid drinking any alcohol while taking this med."

240) In management of a newly diagnosed, low-risk client with hypertension, the

nurse understands that the initial treatment generally consists of:

240)

A)restriction of fluid and sodium intake.

B) lifestyle modification and a diuretic medication.

C) dietary management; exercise regimen; and stress reduction.

D)aggressive treatment with diuretics, beta blockers, and 1,000-calorie diet.

241) The nurse instructs clients with hypertension to drink beverages with caffeine

(coffee, tea, cola drinks) in moderation because caffeine causes: A)accumulation of plaque in blood vessels.

241)

B)constriction of blood vessels.

C)dilation of blood vessels.

D)hardening of the arteries.

242) When caring for a client with Raynaud's disease, the nurse provides the following

instructions: 242) A) Drink red wine because it is a vasodilator and would be helpful.

B) Wear gloves and warm socks during cold weather.

C) Engage in high activity and stressful situations to promote circulation.

D) Restrict your fluid intake to <1,500 mL of liquids daily.

243) During early treatment, the client with hypertension experienced postural

hypotension. The nurse can minimize symptoms of this problem by instructing the client to: 243) A) increase fluid intake.

B) lie down for 1 hour after taking antihypertensive medications.

C) rise slowly when changing from sitting or lying positions.

D) limit Na in the diet.

244) When performing a circulatory system assessment, the nurse suspects the client

has a total arterial occlusion based on the following findings: 244) A)Client complained of absence of sensation or ability to move the extremity.

B)Extremity became deep red and cool to touch.

C)Extremity suddenly became white, cold, and painful.

D)Client complained of pain and numbness in the extremity.

245) A client with PVD tells the nurse that even short walks cause leg pain and muscle

cramps. The nurse recommends to the client:

245)

A) "Stop and rest when your legs start to hurt."

B) "Wear elastic hose to prevent the leg pain."

C) "You might try using an exercise bicycle instead of walking."

D) "Take pain medication before you go walking."

246) A client with surgical repair with synthetic graft of an abdominal aortic aneurysm

develops bruising of the scrotum and penis. The nurse's findings may indicate: A) altered renal perfusion.

B) expected postoperative signs and symptoms.

246)

C) accumulation of fluid in the perineum.

D)disruption of the graft anastomosis.

247) The nursing assessment determines that a client has hypertension risk factors.

The most significant risk factor(s) include:

247)

A) maternal grandmother died of complications related to malignant hypertension.

B) client only exercises three times per weeks and is 15 pounds overweight.

C) client is a manager at Microsoft.

D) client smokes two packs of cigarettes per day and is obese.

248) The nurse prepares to discharge a client with deep venous thrombophlebitis.

Which information does the nurse include in the teaching plan? 248) A)Thromboembolism device (TED) hose should be worn to prevent venous stasis.

B)Bed rest should be maintained to prevent pulmonary emboli.

C) Venous circulation is improved by decreasing activity.

D) Sitting instead of standing relieves pressure on the veins.

249) Two signs that are indicative of heart failure are: 249)

A)S1, S2 and flat neck veins.

B) S5 and flat neck veins.

C) S3 and distended neck veins.

D) S2 is heard the loudest and followed by S1.

250) What is the initial indication of valve disease? 250)

A)A murmur is heard during physical exam.

B) It is discovered only through cardiac catheterization.

C) It is discovered by accident on a chest x-ray.

D) An echocardiography study is done to preventatively check the valves.

251) The client in critical care has an invasive hemodynamic pressure monitoring line.

The appropriate landmark to use when calibrating and leveling hemodynamic monitoring equipment is: 251) A) The second intercostal space, left sternal border.

B) The right atrial position at the fourth intercostal space, midaxillary line.

C) The second intercostal space, right sternal border.

D) The left ventricular position at the third intercostal space, midclavicular line.

252)A client is admitted with acute heart failure. The nurse realizes that acute heart

failure is associated with an abrupt onset of: (Select all that apply.) 252) A)Myocardial infarction (MI).

B)Heart valve disease.

C)Cardiomyopathy.

D)Coronary heart disease (CHD).

253) The nurse is caring for an ICU client whose fluid volume status needs to be

closely watched. The most likely type of monitoring that will be used is: 253) A)Central venous pressure monitoring.

B) Arterial pressure monitoring.

C) Intra-aortic balloon pump monitoring.

D)Pulmonary artery pressure monitoring.

254) Clinical signs and symptoms of pericarditis include: (Select all that apply.) 254)

A)Pericardial friction rub.

B)Chest pain.

C) Bradycardia D) Abdominal discomfort and nausea.

255) When obtaining the health history of a client who is being assessed for possible

congestive heart failure, it is significant when the client says: 255) A) "I break out into a cold sweat when I eat a large meal".

B) "I have to prop myself up on three pillows to sleep at night. I cannot breathe

otherwise".

C) "I am sleepy after I eat lunch each day".

D) "I feel better with my legs down when I sit up in my favorite chair."

256) When caring for a chronic heart failure client with left-sided failure, the nurse

would most likely hear which of the following statements from the physician after a cardiac catheterization? 256) A) "Pressures in the left ventricle and atrium are increased."

B) "Pressures in the right ventricle are reflective of how both sides of the heart are

functioning."

C) "Pressures in the right ventricle and atrium match the left ventricle pressures."

D)"Pressures in the left ventricle and atrium are decreased."

257) A pulmonary artery (PA) catheter is used in critical care clients who: 257)

A) Require evaluation of left ventricular pressures through pulmonary artery wedge

pressure readings.

B) Require a peripheral intravenous catheter for medication administration.

C) Cannot tolerate hemodynamic monitoring.

D) Would benefit from having the right ventricle pressures measured every shift.

258) The elderly client has just returned home from the hospital after treatment for

chronic heart failure. The client experiences a pulse rate increase from 80 beats per minute to 102 beats per minute when walking between the kitchen and the utility room to do laundry. Which of the following are appropriate nursing actions for the home health nurse? 258) A) Recommend that the client ignore the pulse rate and become more active in order to

build stamina.

B) Encourage the client to accomplish tasks like laundry early in the morning before

fatigue is an issue.

C) Encourage the client to keep a chair near the washer/dryer unit and sit to rest when

the client feels their pulse rate increase.

D) Encourage the client to rest for 30 minutes between each load of laundry

completed.

259) The nurse is assessing a client who arrives at the hospital with dyspnea,

orthopnea, cyanosis, clammy skin, a productive cough with pink, frothy sputum, and crackles. The nurse realizes that the client is likely suffering from which of the following conditions? 259) A)Endocarditis B) Pulmonary edema C)Angina D) Chronic heart failure 260) The nurse recognizes which of the following as a sign of decreased cardiac

output and tissue perfusion in a client with heart failure? 260) A)Abdominal distention B) Decreased mental alertness.

C)Strong peripheral pulses D) Increased urine output 261) Cardiac tamponade is treated with: 261)

A)Antidysrhythmic drugs and oxygen.

B) Oxygen and rest.

C) Chest x-ray and antibiotics.

D)Pericardiocentesis.

262) The most important first action the nurse should initiate on a client who arrives to

the hospital in pulmonary edema is: 262) A)Administer oxygen and attach a pulse oximeter.

B)Monitor the blood glucose level.

C) Initiate a peripheral intravenous catheter.

D) Seek an order to medicate for discomfort.

263) The nurse is caring for a client who now has invasive hemodynamic monitoring.

The highest priority of care for this client is: 263) A) Prevent infection at the catheter site by changing the dressing as ordered.

B) Set alarm limits and turn monitor alarms on.

C) Coil IV tubing on the bed.

D) Explain to family members why the monitoring is in use.

264) The nurse is assessing a client who arrives at the hospital with dyspnea,

orthopnea, cyanosis, clammy skin, a productive cough with pink, frothy sputum, and crackles. The nurse realizes that the client is likely suffering from which of the following conditions? 264) A) Endocarditis B) Pulmonary edema C)Angina D) Chronic heart failure 265) What is the initial indication of valve disease? 265)

A)A murmur is heard during physical exam.

B) It is discovered only through cardiac catheterization.

C) It is discovered by accident on a chest x-ray.

D) An echocardiography study is done to preventatively check the valves.

266) A client is admitted with acute heart failure. The nurse realizes that acute heart

failure is associated with an abrupt onset of: (Select all that apply.) 266) A)Cardiomyopathy.

B) Coronary heart disease (CHD).

C) Heart valve disease.

D)Myocardial infarction (MI).

267) The nurse recognizes which of the following as a sign of decreased cardiac

output and tissue perfusion in a client with heart failure? 267) A)Decreased mental alertness. B) Abdominal distention C)Strong peripheral pulses D) Increased urine output

268) Typical medications taken by heart failure clients include: (Select all that apply.)

268) A) Furosemide (Lasix). B) Digoxin (Lanoxin).

C)Promethazine (Phenergan). D) Enalapril (Vasotec).

269) A client on the Pritikin Diet is eating foods high in complex carbohydrates and

fiber, low in cholesterol, and low in fat. The program also includes: 269) A)Supervised exercise twice a week and a daily multivitamin.

B) Aerobic exercise daily for 30 minutes and only organic foods.

C) Walking 45 minutes daily and vitamin supplements including vitamins C, E, and

folate.

D) Exercising three times a week for 30 minutes and eating high-protein red meats.

270) A 52-year-old obese male client who is admitted with elevated triglycerides and a

history of smoking two packs of cigarettes a day for 20 years: 270) A)Possesses all modifiable risk factors for coronary artery disease that can be overcome.

B) Possesses all nonmodifiable risk factors for coronary artery disease that cannot be overcome.

C) Is not at risk for coronary artery disease.

D) Is at risk for coronary artery disease.

271) The nurse is caring for an adult client who is admitted with chest pain that began

four hours ago. Which of the following tests will be most specific in identifying acute heart damage? 271) A)CK-MB B) Troponin C)Cholesterol D) CPK 272) The term pacemaker noncapture requires the nurse to do the following: (Select all

that apply.) 272) A) Contact the physician and describe what is documented on the ECG strip.

B) Assess the client to determine their response to the pacemaker noncapture.

C) Document the event by printing an ECG strip and making it part of the client's

record.

D) Administer nitroglycerin sublingual stat times one dose from standing orders.

273)Drugs used to treat hyperlipidemia: 273)

A) Include lovastatin (Mevacor), which acts by lowering LDL levels.

B) Act by increasing the LDL levels and decreasing the HDL levels.

C) Do not include angiotensin-converting enzyme inhibitors.

D) Include bile acid sequestrants as first-line drugs to lower cholesterol levels.

274) When a client's ECG shows frequent premature ventricular contractions (PVCs),

the nurse expects that the physician will create an order for: (Select all that apply.)

274) A)Oxygen. B) Antidysrhythmic agents.

C)Isoproterenol (Isuprel). D) Beta-blockers.

275) The client has a pacemaker that creates a pacer spike before each QRS on the

ECG when the intrinsic heart rate falls below 70. The nurse realizes that this is: 275) A)Abnormal, because the asynchronous pacemaker is not functioning as designed.

B)Abnormal, because the demand pacemaker is not effectively pacing both the atria and ventricle.

C) Normal, because the asynchronous pacemaker is responding to the heart rate

change as designed.

D) Normal, because the demand pacemaker is responding to the heart rate drop at the

preset level.

276) The following clients come to the clinic for a physical exam. Which client has

signs and symptoms of hypertension that require further assessment? 276) A)A 60-year-old African American female with a blood pressure of 118/60 B) A 30-year-old Hispanic female with a blood pressure of 118/70 C) A 48-year-old Caucasian male with a blood pressure of 124/80 D) A 55-year-old African American male with a blood pressure of 120/100 277) The nurse notes an ECG rhythm with a rate of 80, a regular rhythm, a 1:1

relationship of P:QRS, a PR interval of 0.16, and a QRS complex measurement of 0.8.

The nurse realizes that this rhythm is evidence of: 277) A)Normal sinus rhythm. B) Sinus bradycardia.

C)Ventricular rhythm. D) Sinus tachycardia.

278) Cardiovascular heart disease (CHD) is a large problem in the United States.

Clients with which of the following may require closer evaluation for CHD? (Select all that apply.) 278)

A)Hyperlipidemia B) Hypotension C)Diabetes D) Positive family history 279) The nurse is assessing a client who presents with chest pain. The client has been

previously diagnosed with chest pain and now reports an increase in the frequency and duration of the chest pain. Appropriate nursing care for this type of chest pain includes: 279) A) Atropine (Atropair) 0.4 mg IVP. B) Pepto Bismol 30 cc prn.

C) Bed rest with bathroom privileges.

D) Aspirin 325 mg a day per physician order.

280) The client has a pacemaker with one pacing spike seen on the ECG before every

QRS complex. There is no change in the pacemaker rhythm over time, with rest or with activity. The nurse realizes that this means that the type of pacemaker is: 280) A)Atrial single-chamber pacing.

B)Asynchronous pacing.

C)Dual-chamber pacing.

D)Demand pacing.

281) Sinus bradycardia (rate 56) is identified in a sleeping client on telemetry. The

nurse realizes that the priority is to: 281) A) Call for an immediate 12-lead EKG. B) Call the physician and report the dysrhythmia.

C) Check the medication administration record to see if a drug is ordered prn that will

help slow the heart rate.

D) Awaken the client and see how the heart rate responds.

SHORT ANSWER. Write the word or phrase that best completes each statement or answers the question.

282) The nurse is caring for a client who develops atrial fibrillation with a heart rate

above 100 beats per minute. Place the following nursing actions in sequence from the highest priority to the lowest priority: 1.

2.

Check the patency of an intermittent IV. Assess the client for comfort level and vital signs.

3.

4.

Call the physician to report the dysrhythmia.

Check the client's chart for lab results from today's tests. 282)

Chapter 3 Concepts of Health and Illness MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

283) A client is in sinus tachycardia. The nurse realizes that the needed interventions

are to: (Select all that apply.) 283) A) Observe the client for effects on cardiac function.

B) Administer normal saline 0.9% IV at the ordered rate of 200 ml per hour if hypovolemia is suspected as the cause.

C) Administer two tablets of acetaminophen (Tylenol) per physician order if an

elevated temperature is present.

D) Administer atropine (Atropair) IV push to halt the tachycardia.

284) When caring for a client who has experienced a massive trauma, the nurse

recognizes that the response of the autonomic nervous system to stress correlates with the following assessment finding: 284) A)increased peristalsis B) dilated pupils C)urinary urgency D) decreased pulse 285) The nurse is explaining the preparation needed for a positive emission

tomography (PET) scan. The client is told he will: 285) A) only be allowed to drink water the morning of the test.

B) have an intravenous line inserted just before the test.

C) be given a mild sedative 1 hour before the test.

D) need to drink several glasses of contrast media.

286) During a neurologic examination of the older client the nurse would expect to see

which of the following age-related findings? 286) A)disorientation to person and place B)an increase in deep tendon reflexes C) a depressed mood D) a decreased sense of touch and temperature 287) The nurse notes that a client was treated for labyrinthitis on previous admission.

To determine if the problem has resolved, the nurse asks the client: A)"Are you having difficulty with your balance?"

B) "Are you still having earaches?"

C) "Have you noticed any drainage from your ears?"

287)

D) "Do you ever have ringing in your ears?"

288) A client has sustained damage to the ventral root of the lower thoracic spinal cord.

When the client's wife asks if her husband will be paralyzed, the nurse explains:

288)

A) "He will be able to move his extremities, but he won't be able to feel anything."

B) "He will have flaccid paralysis from the neck down."

C) "Your husband will not have any sensation from the neck down."

D) "His kind of damage will cause flaccid paralysis in the lower extremities."

289) The nurse checks the laboratory report on a client who recently had a spinal tap.

The presence of which of the following cerebral spinal fluid (CSF) contents should be of concern to the nurse? 289) A) high glucose content

B) few white blood cells C)many red blood cells D) high water content 290) A client's CT scan indicates the presence of an abnormal mass near the

hypothalamus. The nurse understands this could affect the client's: A)ability to follow simple directions.

B) problem-solving skills.

C)speech.

290)

D)fluid balance.

291) The nurse is checking results of a neurologic assessment on a client. Abnormal

results to testing of the abducens nerve indicate the client may have difficulty with: 291) A)taste sensation. B) chewing food properly.

C)adequate tear production D) peripheral vision.

292) A client scheduled for an electromyography (EMG) study asks the nurse what the

purpose of the test is. The nurse explains that it:

292)

A) will identify velocity of blood flow in a vessel.

B) records electrical activity of muscles.

C) measures brain electrical activity.

D)stimulates contraction of muscle fibers.

293) The nurse recognizes that a client with a tumor in the temporal lobe may exhibit

which of the following symptoms?

293)

A) personality changes

B) global aphasia C)mood swings D) receptive aphasia 294) The nurse realizes that medication ordered to control migraine headaches will be

aimed at reducing the frequency and severity and to halt a headache in progress.

Prophylactic therapy for migraines includes: 294) A)Propranolol hydrochloride (Inderal).

B) Zolmitriptan (Zomig).

C)Sumatriptan (Imitrex).

D)Acetaminophen (Tylenol).

295) The client was riding in a car that hit a tree. The head hit the windshield (coup)

and then the brain rebounded within the skull toward the opposite side (contrecoup).

This is: 295) A) An acceleration-deceleration injury.

B) An acceleration injury.

C) A deceleration injury.

D) A penetrating head injury.

SHORT ANSWER. Write the word or phrase that best completes each statement or answers the question.

296) Traumatic brain injury (TBI) is the leading cause of death and disability in the

United States. The nurse realizes that all of the following are causes of TBI. Place the answers in order from the most frequent to least frequent cause of TBI: 1.

2.

3.

4.

Elevated blood alcohol.

Motor vehicle accidents.

Riding a motorcycle without a helmet.

Falls. 296)

Chapter 4 Common Medical-Surgical Problems MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

297) The nurse anticipates a medication order to halt status epilepticus. Which of the

following medications is expected? 297) A)Oral glucose B)Lorazepam (Ativan) IV C)Gabapentin (Neurontin) and lamotrigine (Lamictal) D)Phenytoin (Dilantin) orally

298) The nurse is planning a seminar about headaches for a local civic group. The type

of headache that has a strong familial connection, affects females three to one over males, and results in lost productivity is: 298) A)Cluster. B) Migraine.

C)Sinus. D) Stress.

299) After a fall, the client is brought to the emergency department. There was a brief

loss of consciousness, the client complains of headache, has vomited twice, has a dilated pupil on the same side as a hematoma over the temporal area, and now is having a seizure. The nurse anticipates that: 299) A) This is an emergency situation that is likely an epidural hematoma and requires surgery.

B) This is a controlled situation once the seizure stops.

C) This is a serious situation in which a subdural hematoma is developing and requires

surgery.

D) This is a typical situation seen with most clients who fall and will subside with

observation.

300) Brain death is the cessation of all brain functions. The criteria to establish brain

death varies from state to state but generally recognized criteria include: (Select all that apply.) 300) A) No spontaneous respiration.

B) Absent motor and reflex movements.

C) Flat electroencephalogram (EEG) on successive EEGs. D) Pupils are equal and responsive to light.

301) The nurse is caring for a head-injured client with cerebral edema and increased

intracranial pressure (IICP). To prevent further transient increases from occurring, the nurse should implement which of the following interventions? 301) A) Position the client in the supine position with the head of the bed at 30 degrees.

B) Initiate and monitor an IV with normal saline.

C) Initiate oxygen administration.

D) Implement measures to help the client avoid coughing, sneezing, and straining.

302) When assessing an adult after a fall, the nurse in the emergency department notes

a dilated pupil on the right and a hematoma in the right temporal area. The nurse realizes that this likely means that: 302) A) The process affecting the pupil is occurring locally on the right side (ipsilateral

pupil dilation).

B) The process causing the right pupil to dilate is a result of a metabolic process.

C) The process affecting the pupil is occurring on the opposite side and is unrelated to the right temporal hematoma.

D) The process affecting the right pupil is temporary and soon both pupils will be

equal in size.

303) A change in breathing pattern to alternating regular periods of deep, rapid

breathing followed by periods of apnea is called the diencephalon region of the cerebrum. 303)

and is related to damage in

A) Neurogenic hyperventilation B) Cheyne-Stokes respirations

C)Ataxic respirations D) Apneustic respirations SHORT ANSWER. Write the word or phrase that best completes each statement or answers the question.

304) The nurse is caring for a client on a medical unit who begins a tonic-clonic

seizure. After a few minutes the seizure stops but repeats again after a minute. This pattern continues in which the client is having repeated tonic-clonic seizures and has lasted for more than 10 minutes. Place the following nursing actions into order from highest priority to lowest: 1.

Hang an IV of normal saline to keep vein open.

2.

3.

4.

Call respiratory therapy stat.

Call the physician stat.

Initiate oxygen via the nasal cannula at the bedside. 304)

Chapter 5 Caring for Clients with Respiratory Disorders MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

305) The client is hit by a swinging bat. This is an example of: 305)

A)An acceleration-deceleration injury.

B) An acceleration injury.

C) A deceleration injury.

D) A penetrating head injury.

306) In the client with altered level of consciousness (LOC), the most appropriate

intravenous fluid is: 306) A) Dextrose 5% and .45 normal saline.

B) Isotonic or hypertonic.

C).45 normal saline.

D)Dextrose 5% in water.

307) A client is in the emergency department following a head injury. The most

accurate sign of developing increased intracranial pressure is: 307) A)Decreasing respiratory rate.

B)Elevated diastolic blood pressure.

C)Decreasing level of consciousness.

D)Pupils that are equal.

308) The nurse is observing a client who is having a seizure that involves a blank stare,

unresponsiveness to questions, and smacking of the lips. The seizure lasts less than a minute. The nurse categorizes the seizure as: 308) A)Partial. B) Absence.

C)Tonic-clonic. D) Status epilepticus.

309) The medication expected in the care of an Alzheimer's client is: 309)

A)Acetaminophen (Tylenol).

B)Adrenocorticotropic hormone (ACTH).

C)Rivastigmine tartrate (Exelon).

D)Meperidine (Demerol).

310) A client is admitted to the hospital with a suspected case of botulism. The nurse

realizes that the botulism infection was likely caused by which of the following scenarios? 310) A) The client was injected with the poison.

B) The client ate food contaminated with the toxin.

C) The client ate infected dirt.

D) The client had a dirty wound that developed this toxin.

311) An adult woman comes to the clinic complaining of repetitive episodes of sudden

severe pain on the right side of the face. The nurse expects that the diagnosis will be and the medication treatment will be A)Bell's palsy; penicillin

. 311)

B)Myasthenia gravis; acetaminophen (Tylenol) C)Trigeminal neuralgia; phenytoin (Dilantin) D)Parkinson's disease; propranolol (Inderal) 312) An adult client has been diagnosed with Bell's palsy. The client asks if the facial

paralysis and distortion will go away. The nurse should answer: 312) A)"Most people have permanent facial paralysis on both sides of the face."

B) "About 80% of people recover completely within a few weeks to a few months, but

there can be lasting effects."

C) "Everyone recovers from Bell's palsy in three to five weeks."

D) "Most people have permanent facial paralysis on one side of the face."

313) The nurse anticipates the following medication administration for a client with

multiple sclerosis (MS): 313) A)Rivastigmine tartrate (Exelon).

B)Adrenocorticotropic hormone (ACTH).

C)Meperidine (Demerol).

D)MAO inhibitors.

314) The nurse is assessing a client who was just admitted with the diagnosis

Guillain-Barre syndrome. The nurse anticipates that the client will exhibit: 314) A)Increased leg pain.

B)Increased muscular weakness.

C)Increased intolerance to light.

D)Increased confusion.

315) Huntington's disease has no cure and causes progressive chorea, speech problems,

and dementia. When teaching the newly-diagnosed client about the disease, the client asks the nurse whether it can be passed on to future children. The nurse's best response is: 315) A) "Each child will have a 50% chance of inheriting the gene."

B) "There may be genetic concerns that should be discussed with the physician."

C) "The disease is passed on genetically in 75% of offspring."

D)"Children will not be affected by the disease."

316) A client who was diagnosed with Parkinson's disease is demonstrating

bradykinesia. The nurse will likely observe the following actions in this client: 316) A) Very slow talk.

B) A loss of spontaneous movement.

C) An increase in spontaneous movements that occur more slowly.

D) Active exercise and high energy as required to perform activities of daily living.

317) A test that is used to diagnose myasthenia gravis (MG) is ordered by the

physician. Because the test involves an injection of a drug that makes muscle strength improve for about five minutes the nurse realizes that this test likely is: 317) A)A computed tomography (CT) scan of the legs.

B) A Tensilon test.

C) Analysis of antiacetylcholine receptor antibodies.

D) A nerve stimulation study.

318) The nurse understands that tetanus is completely preventable by: 318)

A)Debriding the bite wound.

B)Administering antibiotics immediately after a bite.

C)Passive immunization.

D)Active immunization.

319) The nurse is having a conversation with an older adult with Parkinson's disease.

Which of the following would this client most likely exhibit during conversation with the nurse? 319) A) Jumbled words that do not make sense B) Angry, loud talk C) A low-pitched monotone voice D) Bubbly, spirited discussion 320) The nurse is caring for a client with amyotrophic lateral sclerosis (ALS). The

nurse realizes that the prognosis is: 320) A) Good. The disease will progress over many years but the quality of life will be

good.

B) Good. The disease progresses rapidly but can be halted by drug therapy.

C)Excellent. The disease will progress slowly and can be controlled by medication.

D)Poor. The disease rapidly progresses and is fatal.

321) A surgical option for clients younger than 60 with myasthenia gravis (MG) is

thymectomy. The nurse anticipates that surgery. 321)

will obtain remission with the

A)40% B) 60% C) 30% D) 10% 322) A 30-year-old nurse who works on a busy medical-surgical unit has been

diagnosed with multiple sclerosis (MS). The priority for this client is to: 322)

A) Negotiate a regular schedule of working 8-hour dayshifts and consider applying for

nursing positions that are less stressful and demanding.

B) Continue to work as scheduled without making changes.

C) Work as hard as possible now because later, it may not be possible.

D) Leave employment as a nurse due to the need for complete bed rest.

323) Medication does not stop all symptoms with Parkinson's disease. The nurse notes

tremors and muscle rigidity in an older adult client. Expected medication to combat these symptoms includes: (Select all that apply.) 323) A) Nitroglycerin (Nitrobid). B) Meperidine (Demerol).

C)Acetaminophen (Tylenol). D) Propranolol (Inderal).

324) The family of a client with Alzheimer's disease expresses concern that their

mother is becoming worse. The nurse identifies the following manifestations as indicating the client is advancing to stage 2 of Alzheimer's disease: 324) A)forgets the location and names of objects B) short-term memory loss C) has difficulty learning new information D) has difficulty using objects 325) When planning to discharge a client with multiple sclerosis (MS), the nurse

should teach the client to: 325) A) decrease medication as symptoms improve.

B) perform tasks in the morning.

C) take showers or tub baths in hot water.

D) increase exercises in the afternoon.

326) After administering diazepam (Valium) PO to a client who has a spinal cord

injury the nurse should expect to observe which of these client responses?

326)

A) improved swallowing ability B) improved motor coordination C) a decrease in salivation and sweating D) decrease in muscle spasm and pain 327) When doing a physical assessment of a client, the nurse should expect to find

which symptom related to a diagnosis of Parkinson's disease?

A)dry skin B) elevated blood pressure

327)

C)polyuria D) bradykinesia 328) When teaching the client and family about the disease myasthenia gravis, the

nurse should include which of the following?

328)

A) methods to increase fluid intake B) signs and symptoms of fluid volume excess C) signs and symptoms of cholinergic crisis

D)strategies to improve memory 329) A client diagnosed with Parkinson's disease is prescribed to take levodopa. The

nurse should instruct the client about possible side effects which include:

329)

A)diarrhea.

B)bradycardia.

C)acute hypertension and glycosuria.

D)orthostatic hypotension and confusion.

330) When planning the care for a client who has a spinal cord injury, the nurse should

give priority to which of these treatment measures first?

330)

A)listening for bowel sounds B)testing for motor strength C)monitoring the client's blood pressure D)palpating the client's bladder for fullness 331) When a client has trigeminal neuralgia, the client should be carefully assessed for:

331) A) changes in the level of consciousness.

B) symptoms of acute respiratory distress.

C) signs and symptoms of acute cholinergic crisis.

D) trigger zones that cause pain when stimulated.

332) When caring for a client with herniated disk disease, the nurse's priority of focus

is to: 332) A) take precautions to prevent further injury.

B) teach the client log-rolling techniques.

C) decrease intervertebral disk pressure.

D) assess the degree to which the disease affects daily activities.

333) A client is admitted with the following symptoms: visual changes, muscular

weakness, and numbness and tingling in the extremities. Based on theses findings, the nurse should suspect the client of having which of the following diseases? 333) A)myasthenia gravis B) multiple sclerosis C)amyotrophic lateral sclerosis

D) Guillain-Barraccent(e) syndrome

334) A client is scheduled for diagnostic tests to determine the cause of his hearing

and balance disorder. The diagnostic tests that could be used to help this client include: (Select all that apply.) 334) A)Auditory brainstem response (ABR).

B)Tonometry.

C) Caloric test.

D) Computed tomography (CT) scan.

E) Auditory evoked potentials (AEP).

335) The nurse notes that a client's left eye deviates inward while focusing on an

object. This finding is consistent with: 335) A)Strabismus. B) Presbyopia.

C)Myopia. D) Hyperopia.

336) The nurse notices that a client's pupils constrict when reading the consent form

for medical treatment. This observation is considered: 336) A) Evidence that the client can read.

B) Evidence that the client needs reading glasses.

C) A normal pupillary response.

D) Evidence that the client has normal vision.

337) A client has sustained an injury to the inner layer of his left retina. The nurse

realizes that this client will have difficulty with: 337) A)Peripheral vision and color perception.

B)Tear production.

C) Blinking.

D) Reading.

338) A client who is using atropine eye drops is found to have a poor consensual light

response. The nurse realizes that this finding is considered: 338) A) Normal because of the eye drops.

B) Evidence of optic nerve damage.

C) Abnormal and should be reported to the physician.

D) Evidence of retinal degeneration.

339) While exiting a burning building, a client's eyebrows and lashes were burned.

The nurse realizes that this client might experience: 339) A) Fluid and electrolyte imbalance.

B) Wound infections.

C) Foreign bodies in the eyes.

D)Itchiness as the hair grows back.

340) A client is found to have small, raised lesions on the rim of the ear. This finding

is consistent with: 340) A)Kidney failure. B) Heart disease.

C)Gout. D) Hypertension.

341) The client assessment reveals absence of the fovea centralis. The next

examination that may be anticipated by the nurse is: 341) A)Inspection of the optic disc. B) Inspection of the red reflex.

C)Inspection of the retina. D) Inspection of the macula.

342) A client with a sore throat is complaining of "troubles hearing". The nurse

realizes that this client might be experiencing: 342) A)An inner ear infection. B) Infected tonsils.

C)A sinus infection. D) A middle ear infection.

343) During the assessment of a client's outer eyes, the nurse suspects that the client

has a hair follicle infection and elevated lipid levels. Which of the following did the nurse most likely assess in this client? (Select all that apply.) 343) A)Sty B)Exophthalmos C)Xanthelasma D)Ptosis E)Yellow sclera 344) During a Weber test, a client is found to have increased hearing in the right ear.

The nurse realizes that this finding is consistent with: 344) A) Conductive hearing loss in the left ear.

B) Perforated left ear drum.

C)Normal aging.

D)Possible build-up of cerumen or otitis media in the right ear.

345) While assisting a client with morning care, the client's left cornea was

accidentally touched, which caused the client to blink and create tears. This response is considered: 345) A) A possible side effect of a medication.

B) Unusual but something that would clear up in time.

C)Normal.

D)Abnormal and should be reported to the physician.

346) A client, recovering from a stroke, is demonstrating vision changes. The nurse

realizes that this is because: 346) A) The client is unable to talk because of the stroke.

B) The client is experiencing another stroke.

C) The brain interprets information received through the eyes.

D) The stroke occurred in the optic region of the client's brain.

347) A client with a right eye injury has received an eye patch. The nurse realizes that

this client might experience difficulty with: 347) A)Depth perception. B) Light perception.

C)Reading. D) Color perception.

348) A client is having difficulty maintaining equilibrium. The nurse realizes that the

portion of the ear involved with this symptom is: 348) A) The tympanic membrane.

B) The malleus, incus, and stapes.

C) The labyrinth.

D) The auricles.

349) A client is diagnosed with exudative macular degeneration. The client's primary

recreation is reading. Which of the following can the nurse suggest to this client? 349) A) Spend more time with friends and family.

B) Find another activity that does not require reading.

C) Obtain books on tape or CD. D) Listen to music instead of watching so much television.

350) During an assessment, a client without any health problems explains how his

"ears ring" periodically. The nurse realizes that this assessment finding most likely is: 350) A)Aspirin overdose.

B)A preliminary symptom of a severe disease.

C)Nothing.

D)Pending drug toxicity.

351) A client experiences an increase in ear pain when the auricle is pulled up and

back. The nurse realizes that this client might be experiencing: 351) A)Mastoiditis. B) Otitis interna.

C)Otitis externa. D) Otitis media.

352) A client is learning how to apply and care for a new set of contact lenses.

Instructions for this client should include: (Select all that apply.) 352) A)Wash hands before and after applying the lenses.

B)Distilled water is the best solution for the lenses.

C)Once applied, only remove when cloudy.

D) Contact eye physician if eyes become red or tear.

E) Eye pain is a common complaint and should not be a concern.

353) A client is experiencing a severe episode of Meniere's disease. The medication to

help reduce the sensation of spinning and nausea is: 353) A)Droperidol (Inapsine).

B)Hydrochlorothiazide (HydroDIURIL).

C)Diazepam (Valium).

D)Meclizine hydrochloride (Antivert).

354) An elderly client often responds incorrectly to questions or during general

conversation. The nurse realizes that this client should be assessed for: 354) A)History of strokes. B) Hearing disorder.

C)Cognitive impairment. D) Level of education.

355) A client with COPD is being treated for glaucoma. The medication that will most

likely be prescribed for this client is a(an): 355) A)Antibiotic. B) Adrenergic agonist.

C)Beta—blocker. D) Calcium channel blocker

356) An elderly client with a mobility disorder is being discharged after having a

cataract removed as an outpatient. The nurse should assess this client for their: 356) A) Ability to read discharge instructions.

B) Ability to provide eye drops postprocedure.

C) Ability to ambulate.

D) Ability to drive.

357) A client is seen for hearing loss and odd popping noises in his left ear after

"having a cold". This client is demonstrating signs of: 357) A) Otitis interna. B) Acute otitis media.

C)Serous otitis media. D) Otitis externa.

358) A client with chronic acute otitis media infections is having tympanostomy tubes

placed. Post-tube placement instructions for this client should include: 358) A)Avoid getting any water into the ears.

B) Wash hair only with warm water.

C) Make sure showers are completed within 10 minutes.

D) Avoid gum chewing.

359) The nurse is instructing a client who has a hearing and balance disorder. Which

of the following should be included in these instructions? (Select all that apply.) 359) A) Increase pace of ambulation.

B) Stand very still with the onset of vertigo.

C) Take antivertigo medication only when able to lie down.

D) Change positions slowly.

E) Turn the whole body, rather than just the head.

360) A teenage client is diagnosed with a corneal abrasion. Which of the following

should the nurse instruct this client? 360) A) Do not share or use another person's eye makeup.

B) Use the prescribed eye drops until the symptoms disappear.

C) Gently rub the eyes when itchy.

D) Only share a towel with family members.

361) A client with chronic otitis media is diagnosed with a cholesteatoma. The nurse

realizes that the treatment of choice for this client will be: 361) A)Surgery.

B)Nothing. It will resolve on its own.

C)Antibiotics.

D)Tympanostomy tubes.

362) A client who became blind in his left eye because of an industrial accident says,

"I still have one good eye and I can still do a lot." The nurse realizes that this client is demonstrating signs of: 362) A)Anticipatory grieving. B) Remorse.

C)Denial. D) Acceptance.

363) A client comes into the clinic complaining of "black spots and a curtain

dropping" in his right eye. The nurse realizes that this client is experiencing signs of: 363) A)Conjunctivitis. B) Cataract.

C)Detached retina. D) Sty. 364) A client scheduled to have a urea breath test asks the nurse what the purpose of

the test is. The nurse explains:

364)

A) "It is done to determine the amount of hydrochloric acid secreted by your

stomach."

B) "It measures the acidity of your esophagus and gastric fluids."

C) "It identifies the pressure of the esophageal sphincter."

D) "It detects the presence of bacteria that contribute to formation of peptic ulcer

disease."

365) The nurse is caring for a client being treated for pancreatitis. Which of the

following laboratory studies would best indicate the treatment is being effective: 365) A)normal liver function tests. B) normal lipase level.

C)elevated amylase level. D) decreased bilirubin level.

366) A client is scheduled to have esophageal manometry testing. Prior to the test

nursing responsibilities will include: 366) A) ensure client has not smoked cigarettes in the past 24 hours.

B) keeping client NPO for 12 hours prior to the test.

C)restricting intake to clear liquids for 4 hours prior to the test.

D)medicating client with an antihistamine.

367) The nurse is caring for an elder client with periodontal disease and recognizes

this can be a cause of:

367)

A) tooth loss.

B) excessive dryness in the mouth.

C)furrows in the tongue.

D)excessive craving of salty foods.

368) The nurse is assigned to care for a client with cirrhosis of the liver. The nurse

recognizes the client's impaired liver function will affect:

368)

A)production of digestive enzymes.

B)metabolism of drugs.

C)formation of hydrochloric acid.

D)formation of red blood cells.

369) A client having complaints of right upper quadrant pain is scheduled for an

ultrasound of the gallbladder. The nurse explains the test will help to identify:

369)

A) presence of gallstones.

B) presence of an abdominal aneurysm.

C) blockages in the common bile duct and sphincter of Oddi.

D)ability of the gallbladder to store and excrete bile.

370) A client is admitted with malnutrition. The nurse can expect laboratory studies to

show: 370) A) elevated blood sugar.

B) elevated bilirubin levels.

C)decreased alkaline phosphate level.

D)decreased albumin levels.

371) A client's medical record indicates he has presence of the H. pylori antibody. The

nurse understands the client:

371)

A) has had a recent viral infection.

B) will not need to be medicated for gastric reflux.

C) has a current or past infection with H. pylori.

D) will be at increased risk for diarrhea.

372) An ERCP (endoscopic retrograde cholangiopancreatomy) indicates a client has

an obstruction at the sphincter of Oddi. Which of the following client symptoms does the nurse correlate to this finding? 372) A)complaints of heartburn after eating B)frequent episodes of hiccoughing C)complaints of indigestion after eating D)abdominal distention 373) The nurse is instructing a client in preparation for a colonoscopy. The nurse

explains that the client: 373) A) will be given a soap-suds water enema shortly before the exam.

B) will need to be NPO for 8 to 12 hours prior to the exam.

C) should eat a low-residue meal the evening before the exam.

D) is permitted to drink clear liquids up until the time of the exam.

374) A client has an esophagogastroduodenoscopy (EGD) performed for evaluation of

dysphagia. Which action by the nurse is most important in postprocedure care?

374)

A) Provide mouth care with saline rinses and gargles.

B) Keep the client NPO until her gag reflex returns.

C) Assess for nausea and vomiting.

D) Position the client on the left side.

375) A client is recovering from a gastrojejunostomy (Billroth II) for treatment of

duodenal ulcer. About 20 minutes after lunch, the client develops dizziness, weakness, palpitations, and the urge to defecate. To avoid recurrence of these symptoms, which measures does the nurse teach the client? 375) A) Drink fruit juice after each meal.

B) Eat a high-carbohydrate, low-fat diet in six small feedings a day.

C) Decrease fluid intake with meals and lie down after meals.

D) Increase fluid intake with meals and lie down 30 minutes after meals.

376) The physician ordered Nystatin oral suspension for a client with candidiasis.

Which of the following instructions on the use of Nystatin should the nurse give to the client? 376) A) Swish the medication throughout the mouth and swallow.

B) Dilute the medication with water.

C) Swish the medication throughout the mouth and spit out the excess.

D) Drink the medication through a straw.

377) A client admitted to the emergency department with coffee-grounds emesis and

melena develops sudden, severe upper abdominal pain and calls for the nurse. The client is doubled over in pain and is diaphoretic. The nurse suspects a perforated ulcer.

The nurse should assess for which other signs or symptoms?

A)rigid, boardlike abdomen B)diarrhea

377)

C) bowel sounds increased in frequency and pitch D) fever and respiratory depression 378) When the nurse inspects a client's oral cavity, which of the following findings

would indicate the need to evaluate the client for oral cancer?

A)white, curdlike patches on the mucous membranes

378)

B)velvety red patch on inner cheek C)gingivitis D)presence of dental caries 379) A client following a vegetarian diet asks a nurse what he can do to get more

protein with a meal that consists of a corn tortilla and refried beans. The nurse should suggest complementary protein such as: 379) A) raisin and oatmeal granola bar.

B) cooked spinach.

C) cheese.

D) lettuce and tomato salad.

380) The nurse is teaching a client with a history of upper gastrointestinal bleeding to

check his stool for occult blood. Which information provided by the nurse is most accurate? 380) A) If a client is vomiting blood, stools will not be black and tarry.

B) Acute bleeding in the upper gastrointestinal tract will result in bright red blood in

the stool.

C) Blood is never obvious in the stool and must be detected by guaiac testing.

D) Stools that are black and tarry occur with prolonged bleeding from the stomach or

small intestine.

381) A client undergoes a gastroduodenostomy (Billroth I) for treatment of a

perforated ulcer. Postoperatively the nurse cannot detect bowel sounds and there is

200 mL of bright red blood in the nasogastric (NG) drainage container. What is the most appropriate nursing action? 381) A)Notify the physician. B) Assess the client's pain level.

C)Apply an abdominal binder. D) Irrigate the NG tube.

382) A client visits an urgent care center and tells the nurse he has had nausea and

vomiting for 3 days and thinks he has the flu. The nurse should assess the client for symptoms of: 382) A)adequate carbohydrate intake.

B)dehydration.

C) chronic fatigue.

D) vitamin C deficiency.

383) During assessment of the oral cavity, the nurse notes the presence of swollen

gums. The nurse teaches the client about proper oral hygiene in order to assist the client in meeting which of the following outcomes? 383) A)Maintain balanced nutritional intake.

B)Experience a decrease in dental caries.

C)Maintain healthy oral mucous membranes.

D)Reduce risk factors for periodontal disease.

384) A client who is experiencing difficulty swallowing is diagnosed with esophageal

cancer after having a barium swallow. The nurse realizes that the diagnostic test must have displayed: 384) A)Metastasis. B) A tumor.

C)A narrow esophageal lumen. D) Blood.

385) The nurse is assessing a client with gastrointestinal dysfunction who says, "I was

having chest pain so bad last week I thought I was having a heart attack!" The nurse suspects that the client was experiencing: 385) A)Hiatal hernia. B) Diverticulitis.

C)Constipation. D) Bowel obstruction.

386) A client with chronic gastritis says, "I've stopped taking the medication because I

feel so much better now that I drink ginger tea." The nurse realizes that this client: 386) A) Needs to see the doctor immediately.

B) Is using a complementary therapy for the symptoms.

C) Is in denial of the disease.

D) Cannot afford the medication.

387) A client tells the nurse, "I get these tremendous stomach pains in the middle of

the night and they disappear after I eat something. No wonder I can't lose any weight!" The nurse suspects that this client is experiencing: 387) A) Acute gastritis.

B) Chronic gastritis.

C) Peptic ulcer disease.

D) Gastroesophageal reflux disease (GERD).

388) The nurse is preparing the morning medications for a client with

gastroesophageal reflux disease (GERD). Which of the following nursing interventions would be appropriate for this client's medications? 388) A)Hold the antacids for at least two hours after oral medications are taken.

B) Provide the antacids first and then follow with the oral medications.

C) Provide the antacids only at the hour of sleep.

D) Provide all prescribed medications at 10:00 a.m.

389) The nurse learns that a client who is being treated for peptic ulcer disease is still

"having problems". Which of the following should the nurse instruct this client? 389) A) Have the largest meal of the day at lunchtime.

B) Smoking cessation techniques.

C) Avoid eating breakfast.

D) Make sure the client is eating a bland diet.

390) A client who is recovering from surgery for stomach cancer a month ago

continues to experience dumping syndrome. Which of the following should the nurse instruct this client? 390) A) "Only eat a clear liquid diet."

B) "It will be a problem for the rest of your life."

C) "There's no treatment."

D) "It's usually self-limiting and will resolve within 6 to 12 months."

391) A client who had stomach cancer surgery two years ago comes into the clinic

fearful that the "cancer is back because I'm so tired all of the time". The nurse realizes that this client is likely experiencing: 391)

A)Ineffective coping.

B)Vitamin deficiency.

C)A return of the stomach cancer.

D)Metastasis.

392) A client with a long history of chewing tobacco says, "I've been chewing for

years. I'm not going to get cancer." Which of the following would be an appropriate nursing response? 392) A) "It's not my body."

B) "You are probably one of the lucky ones."

C) "I guess you're right."

D) "Use of smokeless tobacco has been linked to oral cancer."

393) A client who is in need of a radical neck dissection for cancer continues to delay

the surgery. Which of the following nursing diagnoses would best describe the reason for this client's delay? 393) A)Risk for Ineffective Airway Clearance B)Imbalanced Nutrition: Less than Body Requirements C)Disturbed Body Image D)Impaired Verbal Communication 394) A client with peptic ulcer disease says, "I feel so much better now that I've

stopped eating." The nurse realizes that this client is at risk for: 394) A)Pain.

B) Sleep Pattern Disturbance.

C) Imbalanced Nutrition: Less than Body Requirements.

D)Fluid Volume Overload.

395) The nurse learns that an elderly client with ill-fitting dentures has been using an

over-the-counter preparation for a gum sore over the last month. Which of the following should the nurse instruct this client? 395) A) Continue to use the preparation.

B) Change the preparation.

C) Stop wearing the dentures.

D) Make an appointment to see the physician.

396) A client with nausea says, "I'm tired of taking this medication. All it does is make

me nauseated." Which of the following could the nurse instruct this client? 396)

A) Nothing.

B) Suggest that the client take the medication with a heavy meal.

C) Suggest eating a dry cracker to help with the nausea.

D)Encourage the client to stop taking the medication.

397) The nurse is preparing to instruct a client who is newly-diagnosed with

gastroesophageal reflux disease (GERD) about dietary considerations. Which of the following should the nurse include in these instructions? (Select all that apply.) 397) A) "Be sure to eat at least one citrus fruit per day."

B) "Meals should be small and more frequent."

C) "Alcohol should be limited to two drinks per day."

D) "Avoid eating up to three hours before bedtime."

E) "Avoid peppermint."

398) A client who is in the post-gastric surgery stage for cancer is denying that he has

cancer. The nurse should: 398) A) Do not argue with the client, but continue to provide emotional support as needed.

B) Remind the client of the diagnosis.

C) Explain how many people with cancer live long, productive lives.

D) Ask a clinical psychologist to talk with the client.

399) A client who is prescribed lactulose is complaining of "diarrhea with cramps"

throughout most of the day. The nurse realizes that this client is demonstrating: 399) A) An allergy to the medication.

B) An expected outcome from taking the medication.

C) The need to adjust the dose of the medication.

D)Intolerance of the medication and it should be discontinued.

400) A client tells the nurse that his bowel movements are "weird" in that they look

"soapy" and "smell really bad". The nurse realizes that this client might be experiencing: 400) A)An obstructed gallbladder. B) Cullen's sign.

C)Turner's sign. D) Steatorrhea.

401) A client is scheduled for extracorporeal shock wave lithotripsy for gallstones.

Which of the following should be included in the care of this client after the procedure? 401) A) Instruct about the potential for nausea, vomiting, and hematuria postprocedure.

B) Admit to the hospital until the stones have been passed.

C)Nothing.

D)Monitor vital signs for eight hours postprocedure.

402) The family and friends of a liver transplant client is concerned because they have

not been permitted to see the client after the surgery. The nurse realizes that this means: 402) A) The client is prone to developing an infection and is in isolation.

B) The client's condition is not stable.

C) Nothing. This is a common restriction.

D) The client's condition is critical.

403) The family of a client with acute pancreatitis arrives to the care area with a large

bag of personal items and food. What should the nurse instruct this family about the care of the client? 403) A) Avoid bringing food to the client.

B) Bring high-calorie foods to support the client's caloric needs.

C) Only bring foods the client requests.

D) Bring fresh fruits.

404) A client comes into the clinic complaining of "gaining weight only in the

stomach". The nurse realizes that this client is exhibiting signs of: 404) A)Esophageal varices. B) Hepatic encephalopathy.

C)Portal hypertension. D) Splenomegaly.

405) The nurse is preparing to instruct a client with pruritis caused by jaundice about

the care of the skin. Which of the following should be included in these instructions?

(Select all that apply.) 405) A) Apply lotion to keep the skin moist.

B) Take another antihistamine if the itching continues.

C) Bathe with hot water.

D) Alcohol-based products work the best.

E)Use soap when bathing.

F)Scratching is permitted.

406) A client who is being evaluated for liver trauma that was sustained in a motor

vehicle accident is found to have a negative peritoneal lavage. The nurse realizes that this client is demonstrating: 406) A)Clotting factor malfunction. B) No bleeding from the liver.

C)Severe liver lacerations. D) Hematoma formation.

407) During a physical assessment, the nurse learns that a client has pain in the right

shoulder and scapula most evenings after eating dinner. Which of the following should the nurse ask to further assess these findings? 407) A) "Have you been told you have high blood pressure?"

B) "Have you been restricting your diet?"

C) "Have you changed your exercise program?"

D) "How much water do you drink each day?"

408) A client who is admitted to the hospital with an acutely inflamed gallbladder says,

"I suddenly feel better. The pain was really bad but then it completely stopped." The nurse should: 408) A) See when the client last received pain medication.

B) Suggest that the client prepare to be discharged.

C) Contact the physician immediately.

D) Do nothing.

409) A client with hepatic cirrhosis begins to bleed. Which of the following should the

nurse anticipate being included in the physician's orders? 409) A)Administer packed red blood cells (PRBCs).

B)Administer vitamin K. C)Administer nadolol (Corgard).

D)Administer folic acid.

410) While providing care to a client with hepatitis B, the nurse is exposed to this

client's blood. What should the nurse do? 410) A) Report the exposure and prepare to receive immune globulin (IG).

B) Prepare to be treated with interferon.

C) Report the exposure and prepare to receive hepatitis B immune globulin (HBIG).

D)Nothing.

411) A client with hepatitis is complaining of "itchy skin" and "odd colored bowel

movements". The nurse realizes that this client is in which phase of acute hepatitis?

411) A)Posticteric. B) Icteric.

C)Prodromal. D) Preicteric.

412) A client with acute pancreatitis is uncomfortable in bed. Which of the following

positions might improve this client's comfort level? 412) A) Lay on the stomach.

B) Lay flat in bed.

C) Elevate the head 45 degrees.

D) Assist to a standing position and ambulate.

413) A client with acute pancreatitis is being discharged. Which of the following

should the nurse include when providing discharge instructions to this client? 413) A)Limit smoking. B) A fever is common.

C)Avoid all alcohol. D) Resume a regular diet.

414) Following a motor vehicle accident, a client with injuries to the face is tested for

muscle strength. The nurse determines there is adequate strength of the eyes and eyelids when the client is able to: 414) A) blink rapidly.

B) follow the nurse's finger movements with eyes.

C) close eyes tightly.

D) keep eyelids closed for 30 seconds.

415) The nurse is preparing a client scheduled for an arthroscopy of the elbow. When

the client asks if there will be any restrictions after the procedure, the nurse explains: 415) A) "You will need to limit range of motion in the joint until the sutures are removed."

B) "The elbow will be kept in a sling for two weeks."

C) "You will need to keep the elbow elevated for one to two days."

D) "There are no restrictions, unless you have a lot of pain."

416) When checking laboratory values on a client recovering from a fracture of the left

femur, the nurse would expect to find which of the following changes?

A)a positive antinuclear antibody (ANA) B) an increase in alkaline phosphatase

416)

C) an increase in uric acid D) a decrease in erythrocyte sedimentation rate (ESR) 417) The nurse determines a client has understood instructions given following a lung

scan when the client states:

417)

A) "I need to drink a lot of fluids."

B) "I'll avoid close contact with my family for one week."

C) "I won't play with the grandchildren for at least forty-eight hours."

D) "I won't eat foods with any artificial colors or dyes."

418) When assessing a client's lateral flexion of the cervical spine, the nurse asks the

client to:

418)

A) turn the head and look to the left.

B) touch the ear to the shoulder.

C) touch the chin to the chest.

D) look at the ceiling.

419) A client scheduled for a magnetic resonance imaging (MRI) of the shoulder

expresses concern over radiation exposure. The nurse provides the following information: 419) A)"The amount of radiation is no more than when you have a dental x-ray.

B)"Drinking a lot of water after the procedure helps to flush it out of the body."

C)"You will not be exposed to any radiation."

D)"Most of your body will be covered with a lead apron."

420) The nurse determines a client's treatment for hypoparathyroidism has been

effective for correction of electrolyte imbalances when laboratory values indicate the: 420) A) calcium level has decreased from 8.6 mg/dL to 8.0 mg/dL. B) alkaline phosphate is within normal limits.

C) calcium level has increased from 8.2 mg/dL to 8.9 mg/dL.

D)phosphate levels are 3.0 mg/dL. 421) When assessing the musculoskeletal system of an elderly client, it would be

important for the nurse to report which of the following findings?

A)Client complains of numbness in the hands.

B) Client is unable to fully extend arms about the head.

C) Client complains of stiffness and mild pain in the knee joints.

421)

D) Crepitus is heard when bending the knee.

422) The nurse is assisting a client who is having a Thomas test performed. When the

client's left knee is brought to the chest, the nurse recognizes a hip flexion contracture is present when: 422) A) the right leg rises off the bed.

B) the client complains of pain in the lumbar spine.

C) the client complains of sharp pain radiating down the left leg.

D) the right leg externally rotates.

423) Following an arthrocentesis of the right knee in the physician's office, the nurse

gives the following instructions to the client:

423)

A) Apply warm moist heat as needed for pain relief.

B) Limit use of the joint for 2 to 3 days.

C) Begin range-of-motion exercises to the knee in 24 hours.

D) Remove the pressure dressing when you get home.

424) The nurse is providing nutrition education to the residents of a senior center. The

presentation addresses the implication of vitamin D deficiency and low serum levels of phosphorus. Based upon their knowledge, the nurse advises the participants that potential complications include: 424) A)Osteosarcoma; due to lack of nutrients that allows mutation of cells.

B)Tophi formation due to low intake of nutrients needed for bone formation.

C)Osteomyelitis; due to lack of nutrients for muscle cells, which then become inflamed.

D)Osteomalacia; due to low intake of calcium and vitamin D in the diet.

425) Client care of an older adult with osteoporosis should: 425)

A)Focus on research related to causes and the progression of the condition.

B) Focus on slowing or stopping the process and preventing complications.

C) Focus on diagnosis and medical management.

D) Focus on treating the development of complications and client complaints.

426) The nurse is teaching a client about risk factors for osteoporosis that can be

changed, which include: 426) A)Gender. B) Race. C) Lifestyle. D) Age. 427) A client with Paget's disease tells the nurse that she fears falling. The nurse

should: 427) A) Recognize that the fear of falling makes the client more prone to falls and facilitate the client's expression of thoughts.

B) Tell the client not to worry; this fear will go away with results from proper

medication.

C) Tell the client to stay in the house where they will be safer.

D) Recognize that the fear of falling is silly and tell the client to think more positively

about their disease.

428) The nurse is providing information to a client about Paget's disease. Which of the

following statements by the client about pathophysiology of the disease reflects understanding? 428) A) "Because metabolic activity is compromised, excessive bone resorption occurs

followed by no bone formation."

B) "Due to excessive metabolic activity, excessive bone resorption occurs followed by

excessive bone formation."

C) "Metabolic activity remains the same but bone resorption ceases and bones become

larger."

D) "Metabolic activity is enhanced and no bone resorption occurs, followed by

continuing bone formation."

429) Clients with Paget's disease: 429) A) Are often diagnosed early due to a spike in serum alkaline phosphatase.

B) Present with a long history of various areas of bone pain and a history of pain

medication abuse.

C) Are asymptomatic for years but can eventually develop bone pain in affected

bones.

D) Develop symptoms early and are tested by bone biopsy to diagnose the disorder.

430) The following lab results would likely be seen in a client who is diagnosed with

osteomalacia is diagnosed: 430) A) Low or normal serum calcium, and elevated parathyroid hormone and alkaline

phosphatase.

B) Low serum calcium, and normal parathyroid hormone and alkaline phosphatase.

C) Elevated serum calcium, and normal parathyroid hormone and alkaline

phosphatase.

D) High serum calcium, and low parathyroid hormone and alkaline phosphatase.

431) The nurse planning care for a client who was diagnosed with muscular dystrophy

(MD) needs to remember that: 431) A) The pathophysiology of MD involves muscle degeneration, which affects activities

of daily living.

B) The treatment is daily electrical muscle stimulus.

C) The treatment of MD is aimed at eliminating the cause by identifyng the specific

organisms that cause the muscle infection.

D) The cause is related to a lack of blood supply to nerves.

432) The nurse expects to care for clients most often with which of the following types

of arthritis? 432) A)Rheumatoid arthritis B) Osteoarthritis C)Ankylosing spondylitis D) Gouty arthritis 433) A 52-year-old client is prescribed raloxifene (Evista) for the treatment of

osteoporosis. The nurse realizes that this drug is used with postmenopausal women, and that it works by: 433) A)Stimulating osteoblast activity and increasing bone formation.

B)Inhibiting bone breakdown.

C) Inhibiting bone loss.

D) Preventing bone loss by mimicking what estrogen does for bone density.

434) One of the first symptoms of osteoarthritis the nurse expects to note in the

assessment is: 434) A)Crepitus in the joint with movement.

B)Inability to walk long distances due to fatigue.

C)Pain when at rest.

D)Pain and stiffness in one or more joints.

435) The nurse is teaching a 68-year-old female client information about dietary

calcium recommendations. Which dosage should be included in the nurse's teaching?

435) A)750 mg per day B) 1500 mg per day C)1000 mg per day D) 500 mg per day 436) The nurse is teaching a client who has gout. Which of the following should be

included in the teaching?

436)

A) Avoid eating cottage cheese.

B) Avoid drinking bottled water.

C) Avoid drinking milk.

D) Avoid eating shellfish.

437) Impaired physical mobility is a major nursing diagnosis for clients with

osteoarthritis (OA). Nursing activities related to this diagnosis include: 437) A)Encouraging taking care of own self-care needs in order to remain more active.

B)Assessing the need for narcotic analgesics around the clock to prevent pain in activities of daily living.

C) Assessing the range of motion of affected joints in order to plan appropriate

interventions.

D) Encouraging consistently high activity levels in order to prevent other problems

associated with OA. 438) A client has early onset osteoarthritis of the left knee. The nurse expects which

medication will be ordered? 438) A)Prednisone B) Ibuprofen (Motrin) C)Hyaluronan (Synvisc) D) Meperidine (Demerol) 439) When reviewing results of a client's urinalysis, the nurse notes the specific

gravity is 1.050. The nurse is aware this level is: A) could be indicative of diabetes.

439)

B) could be a sign of dehydration.

C) the result of a contaminated specimen.

D) within normal limits.

440) A client is voiding 50 to 100 mL of urine every few hours and reports urgency

with voiding. The nurse reports this as an abnormal finding based on the understanding that: 440) A) urgency is always a sign of a bladder infection.

B) it is normal to void at least 600 to 700 mL with each bladder emptying.

C) it is abnormal to urinate every few hours.

D) the urge to void occurs at 300 to 500 mL in the bladder.

441) The nurse is instructing a female client on the proper method for a midstream

clean-catch urine specimen. The nurse stresses the importance of: 441) A)cleansing the meatus in a circular motion with an antiseptic towelette.

B) using antibacterial foam to cleanse the labia and meatus.

C) wiping the meatus with an antiseptic towelette from front to back.

D) using an iodine solution to cleanse the outer labia.

442) Following a cystoscopy of the bladder the nurse provides the following teaching:

442) A) "It is not unusual to have chills and a fever for a few days."

B) "Avoid taking any laxatives or straining with defecation."

C) "Contact your physician if you experience burning with urination."

D) "Taking a sitz bath may help to ease discomfort."

443) The nurse is preparing to do a portable ultrasonic bladder scan to check for

residual urine in a client who voids very frequently. The nurse should plan to do the scan: 443) A)just before the client is ready to void.

B)immediately after the client has voided.

C)immediately upon awakening in the A.M. D)within 15 minutes of voiding.

444) A client became hypotensive following a surgical procedure. When assessing the

urinary system the nurse should expect to find: A) episodes of frequent urination.

444)

B) presence of blood in the urine.

C) a decrease in urine output.

D) painful urination.

445) The nurse recognizes the client with reduced renal function should also be

assessed for:

445)

A) an increase in white blood cell production.

B) a low blood pressure.

C) a decrease in red blood cell production.

D) signs of dehydration.

446) The nurse is preparing a client for a renal scan. It will be necessary for the nurse

to: 446) A)keep client NPO for 8 hours prior to the procedure.

B)determine if the client has allergies to iodine.

C) instruct the client to drink two to three glasses of water.

D) medicate client with a mild tranquilizer.

447) Following an intravenous pyelogram (IVP) nursing responsibilities will include:

447) A) keeping client NPO for 4 hours.

B) checking injection site for redness and warmth.

C) informing client a warm flushed feeling may occur at the IV site.

D)explaining urine may be pink tinged for 24 hours.

448) A client scheduled to have a uroflometry asks the nurse why the test is being

done. The nurse explains that the test:

448)

A) can identify types of bladder infections.

B) will determine the presence of bladder tumors.

C) can evaluate need for urethral surgery.

D) is used to evaluate urinary retention and incontinence.

449) An adult client is admitted with acute glomerulonephritis with symptoms of

fatigue, anorexia, and blood pressure of 140/94. The nurse identifies the initial goal of treatment as follows: 449) A) energy conservation and bed rest during the acute phase B) to reduce the hypertension C) urinary output of at least 3,000 mL daily

D)providing a 5,000-calorie daily diet 450) The nurse is checking lab values on a client who has just had a hemodialysis

treatment. Which of the following would indicate to the nurse that the client's renal dialysis was effective? 450) A) an increase in serum creatinine B) a decrease in potassium level C) an increase in hemoglobin level D) a decrease in white cell count 451) The nurse monitors a client receiving peritoneal dialysis for signs of peritonitis.

Which of the following assessment findings should be reported to the physician?

451) A)Temperature is 36.8°C. B)Skin is pale and dry.

C) Abdomen is tender to palpation.

D) Dialysate return is cloudy and yellow.

452) A client informs the nurse that he frequently experiences stress incontinence. The

nurse plans the following interventions:

452)

A) Catheterize client every shift for residual urine.

B) Have a bedside commode readily available to the client.

C) Provide client with absorbent pads or panty liners.

D) Toilet client every 2 hours.

453) When caring for a client with chronic renal failure (CRF) the nurse should plan to

administer which of the following medications?

453)

A)opioid analgesics B) antidiarrheals C)folic acid supplements D) antiarrhythmic agents 454) The nurse obtains a urine specimen from the client with glomerulonephritis and

expects to find the urine is: 454) A) clear amber with a foul odor.

B) clear and very dilute.

C) cloudy with some hematuria.

D) dark brown.

455) The nurse is caring for a client who has had a cystectomy for bladder cancer.

Postoperative nursing interventions should include:

455)

A) reduce activity levels and keep client on strict bed rest.

B) secure catheters and stents with tape; keep drainage bags lower than the kidneys.

C) label all catheters and stents; keep drainage bags at kidney level.

D) limit fluid intake to less than 1,000 mL in 24 hours to promote healing.

456) A young female client presents with UTI. Which of the following questions by

the nurse will provide information that might help to prevent future UTI infections?

456) A) "Are you pregnant?"

B) "How long have you been married?"

C) "What kind of bath soap do you use?"

D) "Do you urinate after having sexual intercourse?"

457) Following an intravenous pyelogram (IVP) the nurse encourages fluid intake,

recognizing this is necessary to prevent which of the following renal complications?

457) A) acute renal failure B) glomerulonephritis C)chronic renal failure D) polycystic kidney disease 458) The nurse is giving discharge instructions to a client treated for renal calculi. The

nurse explains that the stones can be prevented in many cases by: A)drinking 8 to 10 glasses of water daily.

458)

B) taking urinary antiseptic agents to prevent urinary tract infections.

C) engaging in frequent aerobic exercise.

D)restricting protein and acid foods in the diet.

459) A client is scheduled for an MRI (magnetic resonance imaging) of the head. Prior

to the procedure the nurse will need to determine if the client:

459)

A) has a history of seizures.

B) has had anything to eat in the past 8 hours.

C) has any metallic implants.

D) is allergic to iodine.

460) A client with type 1 diabetes mellitus has a glycosylated hemoglobin level of 8%.

The nurse recognizes that this indicates the client: A) is well controlled in his diet and insulin.

460)

B) has a low hemoglobin level.

C) needs adjustment in diet and/or medication.

D) has not been taking his insulin.

461) When reading a client's history, the nurse notes the client has exopthalmos,

secondary to hyperthyroidism. An assessment finding the nurse expects to see is: 461) A)ecchymotic areas on the trunk.

B)purple striae over the abdomen.

C) a bronze discoloration of the skin.

D) forward protrusion of the eyeballs.

462) A client seen in the clinic is scheduled to have a radioactive iodine (RAI) uptake

test. In preparation for the test, it is important for the nurse to instruct the client to: 462) A) avoid drinking dairy products 24 hours prior to the test.

B) hold any thyroid medications for 2 weeks prior to the test.

C) bring a fresh voided urine specimen the day of the test.

D) eat a high fat meal the morning of the test.

463) An active elderly client complains of feeling tired all the time and is frequently

constipated. The nurse recognizes that these symptoms:

463)

A) are most likely due to normal changes of aging.

B) are probably a sign of cancer.

C) are frequently signs of dementia.

D) may be indicative of an endocrine imbalance.

464) A client is being evaluated for a disorder of the parathyroid glands. The nurse

anticipates blood work will be ordered to check:

464)

A) TSH (thyroid stimulating hormone).

B) urinary 17-ketosteroids.

C) fasting blood sugar.

D) calcium levels.

465) The nurse can anticipate a client suspected of having Cushing's disease to have

blood levels checked for: 465) A)cortisol. B) calcium.

C)phosphorus.

D) glycosylated hemoglobin.

466) A client has an elevated level of urinary microalbumin. The nurse under stands

this could be an indication of:

466)

A)Addison's disease. B) thyroid cancer.

C)diabetic nephropathy. D) pancreatitis.

467) The physician orders a urinary 17-ketosteroid test on a client with a suspected

adrenal disorder. The nurse is responsible to: 467) A) instruct client to avoid drinking any caffeine products.

B) obtain a catheterized sterile urine specimen.

C) send the first voided urine specimen of the day to the laboratory.

D) keep a 24-hour urine collection on ice.

468) A client scheduled to have a 2-hour glucose tolerance test asks the nurse what is

involved in the test. The nurse explains:

468)

A) "After your breakfast meal, blood will be drawn every thirty minutes for two

hours."

B) "You will drink a glucose solution and not eat anything for two hours."

C) "You will have blood drawn two hours after eating a large meal."

D) "Blood is drawn two hours after eating a high carbohydrate meal."

469) A client with myxedema tells the nurse, "I watch what I eat but my cholesterol

continues to go up." An appropriate response for the nurse to make to this client would be: 469) A) "Maybe you don't realize how much fat is in the foods that you eat."

B) "What are you eating at bedtime?"

C) "It's a normal part of aging."

D) "The thyroid gland malfunction can affect your cholesterol level."

470) A client comes into the emergency department with Addisonian crisis. Which of

the following should the nurse be prepared to administer to assist this client? 470) A)Intravenous fluids B)Blood transfusion C) Warm blankets D) Thyroid replacement hormone 471) A postoperative parathyroidectomy client has a temperature of 103 degrees F

with a rising systolic blood pressure. What should the nurse do for this client? 471) A)Apply a cooling blanket.

B)Administer aspirin as prescribed.

C) Nothing. These are normal postoperative findings.

D) Apply ice to the groin.

472) The family of an elderly client with hypothyroidism says, "I try to keep her clean

but she has all of these open areas on her legs and arms." Which of the following would be appropriate for the nurse to instruct this family? 472) A) "Follow the bath with a rubbing alcohol massage."

B) "Make sure she has a daily bath."

C) "Use firm consistent strokes when bathing."

D) "Use warm water."

473) A client with Cushing's syndrome tells the nurse, "I seem to catch a cold every

couple of weeks." Which of the following nursing interventions would be appropriate

for this client? 473) A)Assess for protein and vitamin intake.

B)Encourage daily weights.

C) Plan for frequent rest periods.

D) Review coping strategies.

474) A client tells the nurse, "I am rarely outside in the sun and I'm getting such a

tan!" Which of the following should the nurse assess in this client? 474) A)Auscultate the client's lung sounds.

B) Palpate the client's thyroid gland.

C) Ask the client what time of day they are outdoors.

D) Ask if the client is still taking the prescribed steroid for her Addison's disease.

475) The nurse is providing care to a client who is postoperative from a bilateral

adrenalectomy. Which of the following interventions would be helpful to assess for the onset of adrenal insufficiency? 475) A) Change dressing using clean technique.

B) Place on fluid restriction.

C) Monitor strict intake and output.

D) Question the order for cortisol administration.

476) A postoperative thyroidectomy client wants to know when her "eyes will go back

to being normal." The nursing diagnosis most appropriate for this client's concern would be: 476) A) Coping.

B) Disturbed sensory perception: visual.

C)Powerlessness.

D)Disturbed body image.

477) A client with hyperthyroidism tells the nurse, "The medicine isn't working

because I'm not feeling any better." Which of the following would be an appropriate response for the nurse to make to this client? 477) A) "You are right. Maybe the medication isn't working."

B) "Be sure to tell the doctor about how you are feeling."

C) "It can take several weeks for the medication to begin working."

D) "It sounds like you need another medication to add to the one you are already

taking."

478) The nurse is providing care to a client with hypoparathyroidism. Which of the

following assessment findings would be consistent with this diagnosis? (Select all that apply.) 478) A) Facial grimacing B) Increased dental caries

C)Arrhythmias D) Smooth, soft skin E)Abdominal cramps F) Hair loss 479) The nurse is preparing a client for a thyroidectomy. Which of the following

instructions should the nurse include during this preparation? 479) A)Remind the client to avoid iodine and salt.

B) Review scar expectations and how the use of plastic surgery is often helpful.

C) Instruct about how to support the neck with the hands.

D) Explain how the bed will need to be flat after surgery.

480) A 35-year-old female client on oral contraceptives is prescribed steroid therapy.

Which of the following should be included when teaching the client about this medication? 480) A) Consider adding another form of contraception B) Avoid salt C) Weigh daily

D)Nothing 481) During the assessment of a client with a hyperthyroidism, the nurse notes smooth,

fine hair and warm, dry skin. These findings are indicative of: 481) A)Inconsistency with the diagnosis of hyperthyroidism.

B) The client has another underlying disease.

C) Nothing. These are normal findings in hyperthyroidism.

D)Misdiagnosis.

482) The nurse is assessing a female client with hyperparathyroidism. Which of the

following assessment findings would be consistent with this diagnosis? 482) A)Hypotension B) Weight gain C)Muscle atrophy D) Diarrhea 483) A client says to the nurse, "I didn't realize this steroid medicine would make me

lose weight in my legs." The nurse realizes that this client is demonstrating signs of: 483) A)Muscle wasting

B)Increased susceptibility to infections C)Poor wound healing D)Risk for compression fractures 484) The father told the nurse that his 11-year-old child with type 1 diabetes has

frequent nightmares and wakes up in the middle of the night. Which of the following is probably the cause of the nightmares? 484) A) The child may be experiencing Somogyi phenomenon, which often occurs at night.

B) The child's nightmares have nothing to do with the diabetes.

C) The child may be experiencing dawn phenomenon with blood sugar elevations.

D) The child is experiencing anxiety related to the diabetes.

485) A client with type 1 diabetes who has the flu calls the nurse asking what to do.

The best advice by the nurse would be: 485) A) "You should not take any insulin until you are well again."

B) "You should increase your insulin dose for five days, then return to the prescribed

dose."

C) "You should be hospitalized whenever you have the flu in case it affects your

diabetes."

D) "Measure your blood sugar and urinary ketones every two to four hours while you

are sick."

486) The nurse instructs a client with type 2 diabetes on foot care. In addition to

keeping the feet clean and dry, the nurse may also offer the following advice:

486)

A) "File your toenails straight across. Avoid using scissors."

B) "Wear nylon socks to keep your feet warm."

C) "Walk on bare feet to promote circulation."

D) "Wear open-toe shoes to avoid pressure around toenails."

487) The client asks the nurse to explain how type 1 diabetes differs from type 2. The

nurse explains that with type 2 diabetes:

487)

A) there is decreased insulin production by the pancreas or cell resistance to the

insulin produced.

B) the client depends entirely on an outside source of insulin.

C) there are insulin antibodies that destroy the beta cells in the pancreas.

D) the liver destroys the C-peptide chain of proinsulin produced by the pancreas.

488) The physician orders 10 units regular and 40 units NPH insulin subcutaneously.

The nurse prepares the injection by:

488)

A) injecting 40 units air into the NPH, 10 units air into the regular, aspirate 10 units of

regular, then aspirate 40 units NPH. B) injecting air into the regular, air into the NPH, aspirating the NPH, then aspirating

the regular.

C) aspirating 10 units regular, then aspirating 40 units NPH. D) injecting air into the regular, aspirating 10 units regular, injecting air into the NPH,

then aspirating 40 units NPH. 489) A diabetic client asks the nurse why it is so important to exercise several times a

week. Which of the following is the best response by the nurse? 489) A)"Exercise helps to increase blood sugar levels, so the body needs less food."

B)"Exercise brings down high sugar levels, so the body needs less food."

C)"Exercise increases the use of insulin in the body, so it requires less insulin."

D)"Exercise helps reduce high ketone levels, so the body stays healthier."

490) A client was diagnosed as having type 2 diabetes and was treated with diet and

exercise. When assisting the client with diet planning, the nurse's instructions include: 490) A) a consistent number of calories are needed each day.

B) no substitutes can be made if using the food exchange plan.

C) the greatest number of calories should be from the protein group.

D) the meal plan can be disregarded if "dietetic" foods are used.

491) A type 1 diabetic was admitted to the emergency room with an elevated

temperature and urinary tract infection. The findings were 31 acetone in the urine and blood glucose of 654 mg/dL. The nurse recognizes the client is probably experiencing: 491) A) a Somogyi reaction.

B) diabetic ketoacidosis.

C) nonketotic hyperosmolar syndrome.

D)hyperinsulinism.

492) The client who is self-injecting insulin was advised by the nurse to rotate

injection sites because:

492)

A) insulin can reach all parts of the body and be used more efficiently.

B) it reduces the danger of nerve damage and decreases absorption.

C) it reduces the chance of infection and increases absorption.

D) it reduces irritation to the tissues and increases absorption.

493) A client hospitalized with diabetic ketoacidosis calls the nurse and reports feeling

hungry, shaky, and anxious. Which action by the nurse is most appropriate?

493)

A) Call the lab to draw blood for a glucose level.

B) Give 6 ounces of orange juice to drink.

C)Administer 10 mg glucagon intramuscularly.

D)Check the client's blood pressure and pulse.

494) A 55-year-old female client thinks she's "losing her mind" because of constant

anxiety, inability to sleep, and headaches. The nurse realizes that this client is describing symptoms of: 494) A)Menopause. B) Chronic fatigue syndrome.

C)Pregnancy. D) Normal menstruation.

495) A client who was just diagnosed with breast cancer is scheduled for a

lumpectomy. The nurse believes that the client is demonstrating signs of anticipatory grieving because the client is: 495) A) Sitting quietly, occasionally crying.

B) Making calls to her girlfriends.

C) Joking with her hospital roommate.

D) Doing a crossword puzzle.

496) The nurse is assisting a client with ways to reduce the severity of the monthly

menstrual discomforts associated with premenstrual syndrome. Information that can be reviewed with this client includes: (Select all that apply.) 496) A) Apply ice packs to the lower abdominal region.

B) Restrict caffeine intake.

C) Balance exercise with rest.

D) Increase sodium intake.

E) Use abdominal breathing.

497) A client is prescribed radiation treatments to the pelvic region after having

surgery for cervical cancer. The nurse should instruct this client to: 497) A)Use an oil-based lotion on the skin area being radiated.

B) Pain is always associated with focused radiation.

C) Preserve the skin markings made for the radiation treatments.

D) Skin burning is expected.

498) A female client is experiencing a reoccurrence of endometrial cancer. The nurse

realizes that this client's treatment might include: 498) A)Radiation therapy after surgery.

B)Partial abdominal hysterectomy.

C)Chemotherapy.

D)Progesterone therapy.

499) A female client is concerned that she will develop ovarian cancer because her

mother's grandmother had the disease. Which of the following factors will most reflect a potential reduction in risk factors for the client? 499) A) Had her first child at the age of 20 B) Has never had long-term antibiotic therapy C) Didn't start menstruating until age 10 D) Has asymptomatic menstrual cycles 500) A female client is recovering from breast cancer surgery that included axillary

node dissection. The nurse realizes that this client is at risk for developing: 500) A)Postoperative wound infection.

B)Anemia.

C)Metastasis.

D)Lymphedema.

501) A client is diagnosed with uterine prolapse into the vagina. The factor that most

likely contributed to this client's disorder is: 501) A)Pelvic inflammatory disease. B) Endometriosis.

C)Multiple pregnancies. D) Tumor.

502) A female client tells the nurse that lately she "isn't interested in sex" but is

concerned that her husband will divorce her. Which of the following would be an appropriate response for the nurse to make to this client? 502) A) "I'm sure it's nothing and will go away in time."

B) "Sex isn't that important in a marriage anyway."

C) "There are other activities you and your husband can do together."

D) "Let's talk more about how you are feeling right now."

503) A female client complains about increasing premenstrual symptoms over the past

few years and thinks "something must be wrong". The nurse realizes that this client is experiencing: 503) A)Normal pattern of premenstrual syndrome.

B)Premenstrual dysphoric disorder.

C)Early menopausal symptoms.

D)Interpersonal relationship difficulties.

504) A female client is diagnosed with "chocolate" cysts. The nurse realizes that these

cysts are caused by: 504) A)Use of oral contraceptives. B) Endometrial overgrowth.

C)Infection. D) Hormone imbalance.

505) A mass is found on a mammogram of a 42-year-old female client. The mass is

diagnosed as a cyst upon ultrasound. The nurse realizes that the best course of action for this client is: 505) A) Apply warm soaks to the cyst.

B) A surgical biopsy is needed to rule out cancer.

C) Suggest the "watch and wait" approach.

D) Reduce caffeine intake.

506) A 25-year-old female is diagnosed with endometriosis. The nurse should include

which of the following when teaching the client about this disorder? (select all that apply) 506) A) It can be treated without any long-term effects.

B) If children are desired, pregnancy should occur before the disease progresses.

C) Leaving it untreated will not result in any long-term health issues.

D) Laser ablation and birth control pills are the treatments for this condition.

507) The mother of a 16-year-old female child voices concern to the nurse. The parent

reports that the teen began menstruating at age 14 but has stopped for at least 5 months. Which of the following responses would be most appropriate for the nurse to make to this mother? 507) A) "Have you noticed any other changes in diet, activity, or weight loss?"

B) "That's normal."

C) "It's probably psychological."

D) "Have you thought about a pregnancy?"

508) A client who is recovering from a complete hysterectomy for endometrial cancer

is concerned that she will not be able to continue a sexual relationship with her husband because of the related activity intolerance. Which of the following would assist this client? 508) A) Suggest that she discuss her fears with a marriage counselor.

B) Suggest that she and her husband coordinate sexual activity with rest periods and

pain-free periods.

C) Remind her that she has successfully survived cancer surgery.

D) Suggest other activities to participate with her spouse.

509) A client comes into the emergency department with complaints of an erection

that has lasted for more than four hours. Which of the following should the nurse include in the client's assessment? 509) A) Number of sexual partners B) Use of medications for erectile dysfunction C) Blood pressure

D)Substance abuse 510) A client who is complaining of heaviness in his scrotum has learned that his

serum lactic acid dehydrogenase level is normal. This information indicates that the client: 510) A) Needs more diagnostic tests for testicular cancer.

B) Has testicular cancer.

C) Does not have testicular cancer.

D) Has a spermatocele.

511) A 55-year-old client with a history of angina and is being treated with

nitroglycerin asks for a prescription to aid with erectile dysfunction. Which of the following should be done to assist this client? 511) A) Suggest a behavioral health consult to analyze the reason for the erectile

dysfunction.

B) Explain why the erectile dysfunction medication is not a good idea with the heart

medication.

C) Provide education about the medication once the prescription is provided.

D) Remind the client to stop taking the heart medication when planning to take the

erectile dysfunction medication.

512) A client was diagnosed with benign prostatic hypertrophy. The nurse realizes that

the blood pressure measurement of this client will be beneficial to determine: 512) A) The dose of finasteride (Proscar).

B) If the client can tolerate doxazosin mesylate (Cardura).

C) The volume of urine being retained in the bladder.

D) If surgery is indicated.

513) A client is recovering from a penile implant procedure. Which of the following

should be included in the care of, and teaching about, the implant? (Select all that apply.) 513) A) Suggest wearing snug-fitting underwear and loose-fitting trousers to conceal the

semi-erection.

B) Suggest wearing loose-fitting underwear.

C) Encourage the client to practice inflating and deflating the device during the

recovery period.

D) Remind the client to not inflate or deflate the device for at least 4 weeks.

E)Encourage the client to resume sexual activity within 3 weeks.

514) A male client is concerned about ongoing premature ejaculation. Which of the

following can the nurse do to assist this client? 514) A) Review any newly-prescribed medications, and check for side effects.

B) Tell the client that the condition is temporary and will disappear in time.

C) Suggest that the client wear a condom with sexual activity.

D) Suggest that the client talk with the physician about medication choices.

515) The nurse is instructing a client with benign prostatic hypertrophy about

techniques to reduce urinary retention. These instructions should include: 515) A)Urinate until all of the urine is drained from the bladder.

B)Over-the-counter cold remedies are permitted with other medications.

C)Avoid alcoholic beverages.

D)Encourage ingesting large amounts of fluids at one time.

516) A male client who presents with the complaint of a "swollen" scrotum is found to

have fluid within his scrotum. The nurse realizes that this finding is consistent with a: 516) A)Variocele. B) Scrotal cancer.

C)Spermatocele. D) Hydrocele.

517) The nurse is planning instructions for a client diagnosed with prostatitis. Which

of the following should be included in these instructions? (Select all that apply.) 517) A) Adhere to a daily bowel movement regime.

B) Withhold voiding for as long as possible.

C) Only take antibiotics when symptoms are present.

D) Remind the client that the condition does not cause cancer.

E) Increase fluid intake up to 3 liters per day.

518) A client is diagnosed with asymptomatic inflammatory prostatitis. The nurse

realizes that this diagnosis was made: 518) A)According to the client's symptoms.

B)After palpating the client's prostate gland.

C) After examining prostate tissue.

D) By testing the serum PSA (prostate-specific antigen) level.

519) A male client reports concern about his recent increase in breast tissue. The nurse

can best assist this client by: 519) A) Recommending a breast biopsy to find out the reason for the increase in breast

tissue.

B) Suggesting that the client has a mammogram to ensure he does not have breast

cancer.

C) Telling him that it is self-limiting and will go away in time.

D)Reviewing the client's health history.

520) A male client is diagnosed with stage 1 testicular cancer. The nurse realizes that

the first step in the treatment for this client is: 520) A)Surgical removal of the testicle.

B)Radiation.

C) Chemotherapy.

D) Aspiration of the enlarged testicle.

521) A male client with type I diabetes mellitus and coronary artery disease is able to

achieve an erection but cannot maintain it. Which of the following could be done to assist this client? 521) A) Provide tadalafil (Cialis) teaching material.

B) Suggest an "O" ring.

C) Provide sildenafil (Viagra) teaching material.

D) Discuss penile implant surgery.

522) A client who is being treated for epididymitis stops taking his antibiotics. The

nurse realizes that this client is at risk for developing: 522) A)Spermatocele. B) Orchitis.

C)Priapism. D) Hydrocele.

523) A female client asks the nurse for help because her husband has not been able to

attain an erection in several months. Which of the following can the nurse do to help this client? 523) A) Provide a prescription for tadalafil (Cialis).

B) Assess for the most recent sexual practices.

C) Suggest that she seek psychiatric counseling.

D) Suggest that they both see a marriage counselor.

524) A female client says that she has been using "the medication for a yeast

infection" but it is not "getting any better". The nurse realizes that this client most likely: 524) A) Might be using a treatment that is not appropriate for the cause.

B) Is not washing her hands before applying the medication.

C) Is not using the medication correctly.

D) Has not used the medication long enough.

525) A male client tells the nurse that he is not concerned about sexually transmitted

diseases because he is in a monogamous relationship. The nurse realizes that this client would benefit from education because: 525) A) Sex means different things to different people.

B) He is having difficulty with sperm production.

C) He currently has a sexually transmitted disease.

D) All sexually active persons are at risk for a sexually transmitted disease.

526) A female client is seen for a recurrence of a vaginal infection. The nurse realizes

that this client might benefit from instruction about: 526) A) Personal hygiene.

B) Avoiding sexual contact until the infection heals.

C) Wearing tight underwear.

D) Saving some of the prescribed medication for use when symptoms return.

527) A male client is "relieved" to learn that he has a sexually transmitted disease and

is not HIV positive. Which of the following would be an appropriate response for the nurse to make to this client? 527) A) "I told you not to be concerned."

B) "You would know if you had HIV." C) "Having a sexually transmitted disease does predispose the body to be infected with

HIV if exposed to the virus."

D) "You are lucky."

528) A female client is seen for a new onset of blisters on the labia majora. The nurse

realizes that this client is experiencing: 528) A) A drug reaction.

B) Latency period of the herpes virus infection.

C)Prodromal symptoms of the herpes virus.

D)First episode of a herpes virus infection.

529) A female client is having difficulty accepting the diagnosis of a sexually

transmitted disease because she has "been on the pill" for years. Information the nurse can provide to aid this client is that: 529) A) She possibly needs to change the type of birth control pill being used.

B) Some diseases are virulent and the pill will not protect her.

C) Skipping doses could have caused the disease.

D) Oral contraceptives do not protect against sexually transmitted diseases.

530) A female client complains of a fever and foul-smelling vaginal discharge. Upon a

gynecological examination, the client has pain when the cervix is palpated. The nurse realizes that this client should have a diagnostic test for: 530) A)Syphilis.

B)Ectopic pregnancy.

C) Yeast infection.

D) Many sexually transmitted diseases.

531) A female client who was just diagnosed with a sexually transmitted disease is

beginning treatment. The nurse should remind the client to: 531) A) Inform all sexual partners about the diagnosis so they can also be treated.

B) Be pleased that she was not diagnosed with HIV. C) Avoid all sexual activity in the future.

D) Begin birth control pills to prevent future disease transmission.

532) A female client is complaining of a "watery" vaginal discharge with a "really

strong fishy" odor. The nurse suspects that this client is experiencing: 532) A)Genital warts. B) Trichomoniasis infection.

C)Yeast infection. D) Bacterial vaginosis.

533) A client has been diagnosed with herpes simplex II. The nurse provides

information to the client about the disorder. Which of the following statements by the nurse indicates the need for further teaching? 533) A) "I can only give this to my partners when my blisters are present."

B) "I will have this disease for life."

C) "It is important to keep the lesions clean and dry."

D) "When I become pregnant, this condition can affect my pregnancy, labor, and

delivery."

534) A male client is diagnosed with epididymitis. The nurse realizes that the sexually

transmitted disease known to cause this disorder is: 534) A)Syphilis. B) Gonorrhea.

C)Chlamydia. D) Genital herpes.

535) A client with genital herpes is experiencing increased pain with urination. The

nurse should suggest that the client: 535) A)Restrict fluids. B) Drink more water.

C)Drink more cranberry juice. D) Drink more orange juice.

536) A female client who was just diagnosed with chlamydia says, "I thought I was

really sick. This isn't anything." Which of the following should the nurse respond to this client? 536) A) "You're lucky that you only need treatment and not your partner."

B) "Most men have this disease anyway."

C) "This is one cause of sterility and ectopic pregnancy in women."

D) "You're right. This is minor."

537) A client who was just diagnosed with syphilis is allergic to penicillin. The nurse

realizes that the first choice of drug to treat this client is: 537) A)Amoxicillin and clavulanate (Augmentin).

B)Doxycycline (Adoxa).

C)Erythromycin (Erythrocin).

D)Amoxicillin (Amoxil).

538) A female client has the complaint of a 'weird rash" on her hands and feet. Which

of the following should the nurse include in the care of this client? (Select all that apply.) 538) A) Ask the client if she uses a public gym for working out.

B) Ask if the client has experienced a foul-smelling vaginal discharge.

C) Conduct a complete sexual history assessment.

D) Ask the client how long the rash has been present.

E) Find out if the client has experienced a chancre sore on her mouth or genital area.

539) A client is admitted with third-degree burns of the upper arms and chest. When

assessing the client, the nurse will expect the skin to be:

539)

A)bluish-purple with blisters.

B)reddened and covered with blisters.

C)diffusely bright red and swollen.

D)white with patches of blackened skin.

540) While bathing an elderly client, the nurse observes the presence of various

age-related skin changes. Which of the following skin changes should be of concern to the nurse? 540) A)seborrheic keratosis B) actinic keratosis C)senile lentigines D) skin tags 541) A client has a patch test done to determine degree of allergic reaction to

suspected allergens. After the patches are applied the nurse instructs the client to: 541) A) return in 1 week to have skin reactions assessed.

B) return in 48 hours to have the patches removed.

C) avoid contact with anyone else for 48 hours.

D) leave patches on until they fall off on their own.

542) When assessing a client of African American descent for jaundice, the nurse

should check the: A) sclera.

542)

B) mucous membranes of the mouth.

C) palms of the hands.

D) abdomen.

543) A client seen in the clinic is being evaluated for a scabies infection. To confirm

the diagnosis, the nurse informs the client he will need to have which of the following tests performed? 543) A)skin scraping B) patch test C)Tzank test D) Wood's light examination 544) The nurse observes that a client has a deep, irregularly shaped area of skin loss

extending into the dermis on the lower extremity. The nurse documents that the client has: 544) A)a fissure. B) a wheal.

C)a macule. D) an ulcer.

545) A client recently started on steroids has been reading about the medication and

asks the nurse: "The book says I could have hirsutism as a side effect. How will I know if this happens?" The nurse explains: 545) A) "You will notice a pinpoint red rash on your chest."

B) "Your breasts will become enlarged and swollen."

C) "Your hair will start to come out in clumps."

D) "You will notice excess facial and body hair."

546) When performing an assessment of the integumentary system on a client, the

nurse should:

546)

A) palpate for edema over the knee.

B) inspect inside of the mouth for skin tags.

C) check color, quantity, and distribution of hair.

D) check for skin turgor on the forearm.

547) Which of the following assessment findings on an African American client

should be reported to the primary nurse?

547)

A) a pustule on the right hand B) red splinter hemorrhages on the nails

C)pigmented bands on the fingernails D)keloid formation over an appendectomy scar 548) The nurse is assisting in the collection of fluid from a client's blister. The nurse

explains the specimen will be sent for a Tzanck test, which is done to:

548)

A)diagnose scabies. B) identify bacterial infections.

C)diagnose fungal infections. D) identify herpes infections.

549) While inspecting a pressure ulcer of a 90-year-old client, the nurse observes new

tissue growth around the area, which is pinkish-red in color. The nurse documents the presence of: 549) A)epithelialization. B) eschar.

C)slough. D) granulation.

550) When taking a history on a client who has had a severe flare-up of psoriasis, the

nurse should determine which of the following factors?

550)

A) age at onset of his psoriasis B) allergy history C) where the symptoms first appeared D) recent changes in work or home environment 551) A nurse is planning to teach about early recognition of malignant melanoma at a

local health fair. A poster using which of the following acronyms would be appropriate? 551) A)Eat RICE. B) Know your ABCDs. C)Watch the SUN. D) Don't be a BRAT. 552) The nurse has instructed an adult client with diabetes about proper foot care. The

nurse determines that the client understood the instructions when the nurse observes the client: 552) A) trimming toenails with scissors.

B) cutting the toenails at the corners.

C) wearing open toe sandals.

D) using a file to trim the toenails.

553) A client has crusty vesicopustular lesions over her face diagnosed as furuncles.

When teaching the client to how prevent reoccurrences, the nurse identifies a common contributing factor: 553) A)impaired immune response B)excessively dry skin C)inadequate personal hygiene D)deficiency in vitamin A in the diet

554) The nurse is preparing to cleanse a pressure ulcer over the sacrum of a client. The

nurse chooses which of the following solutions?

554)

A)normal saline solution B) povidone-iodine (Betadine) C)Dakin's solution D) hydrogen peroxide 555) A dark-skinned client was admitted in respiratory distress. When planning to

assess for cyanosis the nurse recognizes that:

555)

A) cyanosis will blanch with direct pressure to the soles of the feet in dark-skinned

clients.

B) cyanosis in clients with dark skin will need to be checked.

C) it is not possible to assess color changes in clients with dark skin.

D) cyanosis can be seen on the lips and mucous membranes of clients with dark skin.

556) After turning a bedridden client from her side to her back, the nurse observes that

the area over the trochanter is red and does not blanch with finger pressure. The nurse should document this observation as: 556) A)ischemia. B) a stage I pressure ulcer.

C)eschar. D) hyperemia.

557) A female client with acne vulgaris is given a prescription for Retin-A. The client

should be instructed to: 557) A) avoid chocolate, cola drinks, and peanuts.

B) increase intake of vitamin A and calcium.

C) do not take if pregnant and limit exposure to sunlight.

D) take larger doses if acne gets worse before menstrual periods.

558) A client has been treated for pediculosis capitis and is concerned about spreading

the infestation. The nurse explains that it can be spread:

558)

A) through sexual activity.

B) by sharing drinks and eating utensils.

C) by sharing personal hygiene items.

D) through your clothing and bed linens.

559) During the acute stage of burns, nursing interventions should focus on:

A)treatment of respiratory distress.

B)prevention of contractures.

C) application of topical antimicrobial agents.

559)

D) assessment of shock.

560) The client told the nurse that he was thankful that the burns were not bad since

they did not hurt much. The best response by the nurse would be: 560) A)"Your burns are pretty deep and have destroyed some of the pain receptors."

B) "Yes, you are fortunate not have a lot of pain" C) "I'm glad you have such a positive attitude; it's going to be helpful during your

recovery."

D) "I'm afraid you are mistaken. These are severe burns."

561) A burn client experiences excessive fluid in the interstitial spaces causing edema.

Because the fluid accumulation impairs peripheral circulation, the nurse assesses the client for which of the following complications? 561) A)tissue necrosis B) increased diuresis C)increase in cardiac output D) impaired mobility 562) Before applying mafenide acetate (Sulfamylon) to a client's burns, the nurse

should plan to:

562)

A) check client for allergies to codeine.

B) wear protective clothing to avoid staining.

C)premedicate client with pain medication.

D)have client wear a facial mask.

563) A 42-year-old client was admitted with second- and third-degree burns over 45%

of the body. The nurse identifies the initial goal in treatment for these burns as:

563)

A) preventing scarring and infection.

B)preventing hemorrhage and shock.

C)preventing dehydration and infection.

D)combating shock and preventing infection.

564) A client with first- and second-degree burns of the cheek was very concerned

about permanent damage. The nurse might focus the client teaching on: A)prevention of infection to reduce scarring.

B) scrubbing the burned area daily to promote new skin growth.

C)use of plastic surgery to relieve scarring.

D)use of vitamin E to prevent scarring.

564)

565) The nurse is observing a client with major burn injuries for signs of Curling's

ulcer, a common complication. The nurse should assess the client for: A)frequent headaches.

565)

B) hypertension.

C) black, tarry stools.

D) purulent drainage from wound sites.

566) The nurse plans interventions knowing the client with first-degree burns over a

large part of her body surface may experience symptoms such as: A)dehydration and thirst.

566)

B)headache, chills, nausea, and vomiting.

C)chest pain and dyspnea.

D)pain and temporary memory loss.

567) The nurse notices that the burn client develops a dysrhythmia. The nurse

recognizes that the probable cause of this complication is: A)increased cardiac output.

567)

B) increase of intracellular magnesium ions.

C) loss of potassium ion related to cell injury.

D) decrease in sodium levels related to diuresis.

568) The nurse admits a severely burned client who is unconscious, dyspneic, and

cyanotic. The blood test shows decreased levels of oxyhemoglobin, which occur secondary to: 568) A)cardiac arrest. B) carbon monoxide poisoning.

C)pulmonary collapse. D) smoke inhalation.

569) A client is admitted with trauma to the integumentary system. Which of the

following are types of skin trauma? (Select all that apply.) 569) A)Laceration B) Cutaneous C)Contusion D) Abrasion 570) The nurse suspects that a client is a victim of abuse. Which of the following

would provide this indication to the nurse? 570) A)Spontaneously moving all four extremities B)Caring attitude between client and spouse C) Evidence of adequate hydration

D) Injuries that do not correlate with the client's story of the injury 571) A client is going to be evaluated for brain death. Which of the following

diagnostic tests will need to be done to make this evaluation? 571) A)Chest x-ray B) EKG C)Serum carbon dioxide level D) EEG 572) A trauma client needs whole blood transfusions and has a blood type of AB+.

The nurse realizes that this client will need to receive which type of blood? 572) A) Any type. B) O+ only

C)AB+ only D) AB- only 573) A client is diagnosed as being in the warm phase of septic shock. The nurse will

expect to see which of the following signs and symptoms in this client? 573) A)Hypotension B) Tachycardia

C)Alert and anxious D)Urine output less than 30 cc per hour 574) A trauma client has multiple injuries and has lost approximately 25% of

circulating blood volume. The nurse realizes that this client is in which stage of shock?

574) A)Stage III B) Stage I C) Stage II D) Stage IV 575) A trauma client in Stage II shock is demonstrating signs of pulmonary edema.

The nurse realizes that this client is demonstrating: 575) A)Heart failure. B) SARs. C)ARDS. D) Respiratory acidosis.

576) A client is brought into the emergency department with multiple stab wounds.

The nurse realizes that these wounds can be classified as being: 576) A)Intentional B) Related to disease process C)Accidental D) Unintentional 577) The nurse is determining a client's cardiac output. Which of the following

equations can the nurse use to make this assessment? 577) A) Systolic blood pressure x heart rate

B) Heart rate x respiratory rate C) Stroke volume x heart rate D) Mean arterial pressure x heart rate 578) A trauma client has an airway obstruction and needs to be intubated. Which of

the following acronyms can the nurse use to guide the assessment of the difficulty with intubating this client? 578) A)LEMON LAW B) SMART C)APIE D) CAGE 579) A client is prescribed an infusion of nitroprusside sodium (Nipride). Which of the

following should the nurse do to ensure a safe infusion of this medication? 579) A) Mix with dextrose 5% and ½ normal saline.

B) Protect the infusion bag from light by keeping the wrapping provided from the

pharmacy on the bag.

C) Inject furosemide (Lasix) 20 mg into the transfusion bag.

D) Time the drops to infuse at the rate of 20 drops per minute.

580) A client is receiving a blood transfusion. Which of the following should the nurse

do to ensure safe blood administration? 580) A) Stay with the client for the entire transfusion.

B) Inject an intravenous diuretic through the blood tubing line.

C)Administer the blood over eight hours.

D)Return the empty bag and tubing to the blood bank after the infusion is completed.

581) A client in shock is prescribed a vasoconstrictor. Which of the following would

the nurse most likely be administering to this client? 581) A) Isoproterenol (Isuprel) B) Dopamine (Dopastat)

C)Dobutamine (Dobutrex) D) Metaraminol (Aramine) 582) A trauma client is being assessed with the Champion Revised Scoring System.

What are the elements of this scoring system? (Select all that apply.) 582) A)Heart rate B) Respiratory rate

C)Glasgow coma scale D)Systolic blood pressure E)Diastolic blood pressure

583) A trauma client is in hypovolemic shock. The nurse should be prepared to

administer which of the following types of blood products to this client? 583) A)Packed RBCs B) Platelets C)Plasma D) Whole blood 584) A client is being started on buspirone (Buspar), a nonbenzodizepine

antidepressant agent. The client should be given the following information about use of the drug: 584) A) It may cause euphoria in some people.

B) It may take up to 6 weeks to see full effects.

C) It may lead to dependence.

D) It may cause extreme drowsiness initially.

585) The nurse notes that a client has a diagnosis of post-traumatic stress syndrome

(PTSD). When developing a plan of care, the nurse anticipates the client may have the following nursing diagnosis: 585) A) Acute Pain related to nerve damage secondary to torture B) Anxiety related to flashbacks of torture C) Disturbed Body Image related to trauma of imprisonment

D)Self-Care Deficit related to refusal to bathe self 586) A client with obsessive compulsive disorder (OCD) occupies much of the day

with rituals involved with washing hands and frequently misses breakfast because of the behavior. The nurse should:

586)

A) wake the client an hour early, allowing time to complete the ritual.

B) bring the meal to the client's room and allow as much time as needed for washing.

C) allow the client to miss breakfast since the ritual is more important than a missed

meal.

D) make the client stop washing and go to breakfast with the other clients.

587) A friend confides he goes around his house three to four times to check that all

lights are turned off before leaving for work in the morning. He asks the nurse "Do you think I have an obsessive compulsive disorder (OCD)?" To help identify criteria defining the disorder, the nurse should ask: 587) A) "Have you ever considered purchasing an automatic timing device to turn out the lights at a designated time?"

B) "How much time do you spend doing this activity?"

C) "How long have you been doing this?"

D) "Do you do this on the weekends as well?"

588) A client scheduled for an operation later in the day tells the nurse she is anxious

and wants the surgery to be over. The nurse correlates the following physical findings to the client's moderate degree of anxiety:

588)

A)difficulty arousing B)crying uncontrollably C) blood pressure and pulse are elevated from baseline D) pacing in the hall 589) A client on the mental health unit has agoraphobia and refuses to go to the

dayroom for a scheduled unit activity. The nurse can best reduce the client's anxiety by doing which of the following? 589) A)Reinforce that the client knows everyone else on the unit.

B)Premedicate the client with a benzodiazepine.

C) Offer to accompany the client and stay with her.

D) Require the client to go and only stay for 10 minutes.

590) A client just recently diagnosed with having panic disorder asks the nurse if there

is any way to predict when an attack will occur. The nurse explains: 590) A)"People usually experience attacks in surroundings where a previous attack occurred."

B) "Unfortunately attacks can occur at anytime without warning."

C) "If you are stressed in any way you are more likely to have an attack."

D) "Many people will have an aura, such as flashes of light or a strange smell, just

before the attack occurs."

591) A client given a benzodiazepine for general anxiety disorder has a paradoxical

reaction to the medication. When planning to administer the next scheduled dose of the benzodiazepine the nurse should: 591) A) hold the drug and inform the physician of the client's reaction.

B) notify physician and request a lower dose of the benzodiazepine.

C) observe client closely since the reaction may occur a second time.

D) explain to the client the reactions will decrease as the body adjusts to the

medication.

592) The nurse is preparing to draw blood from a client who states, "Oh, I hate needles.

I hope I don't faint this time." The nurse should take the following action:

592)

A) Have another nurse present.

B) Be sure to have aromatic spirits available.

C) Ensure client is in a recumbent position.

D) Keep client distracted while drawing the blood.

593) The nurse initially employs which of the following nursing interventions to

reduce anxiety in a client demonstrating severe anxiety?

A) Allow client to be alone in a quiet environment.

593)

B) Ask the client to verbalize his feelings.

C) Instruct client to do deep-breathing exercises.

D)Encourage client to identify the source of the anxiety.

594) The nurse instructs a client being started on a SSRI for possible side effects. The

nurse explains that the most frequent side effects include:

594)

A) postural hypotension and diarrhea.

B) cardiac arrhythmias and postural hypotension.

C)headaches, nausea, and insomnia.

D)urinary retention, dry mouth, and drowsiness.

595) A client is seen in the emergency department complaining of sudden onset of a

throbbing headache. The client is taking a monoamine oxidase inhibitor (MAOI) and admits to having eaten a lot of aged cheese recently. The nurse should assess the client for which other symptoms? 595) A)stiff neck B) diaphoresis C)abdominal cramping D) hypotension 596) The nurse is caring for a client with bipolar disorder who is experiencing a manic

episode. To assist the client in reducing the hyperactive behavior, the nurse should plan to do which of the following?

596)

A) Allow the client to set her own limits on behavior.

B) Engage the client in a quiet game of cards or puzzle solving.

C)Encourage the client to get involved in a game of volleyball.

D)Provide a calm, quiet area for client to sit or walk around in.

597) A client who was experiencing symptoms of early lithium toxicity has had the

dosage of medication reduced. The nurse determines the dosage reduction was

effective when the client demonstrates: A)a decrease in urine output.

597)

B) a coarse hand tremor.

C) a return of normal speech.

D) a decrease in blood pressure.

598) The nurse has determined that a client with a bipolar disorder has a nursing

diagnosis of hopelessness. Which of the following therapeutic communication skills should the nurse use? 598) A) Arrange for the client to go on a group outing to the mall.

B) Sit quietly with the client and hold her hand.

C) Ask the client how she has overcome obstacles in the past.

D)Encourage the client to engage in a social activity.

599) Which of the following symptoms would a nurse most expect to identify when

assessing a client with bipolar disorder who is in the manic phase?

A)pressured speech B) napping throughout the day C)hallucinations

599)

D) thoughts of inferiority

600) A friend shares with a nurse that her mother has been in a very depressed mood

lately and is concerned she should see a psychiatrist. To best determine if the client might be experiencing a major depressive disorder, the nurse should ask the friend: 600) A) "Has she been depressed for more than a solid week?"

B) "How often does she attend social events outside of the home?"

C) "Does your mother cry a lot or is just quiet and sad most of the time?"

D) "Has her depressed mood caused significant interruption of daily routines?"

601) A client being seen in the mental health clinic is being started on tricyclic

antidepressants for treatment of depression. Which of the following conditions in the client's history should be brought to the attention of the primary care provider?

A) The client lives alone.

B) The client smokes cigarettes.

C) The client has a history of previous suicide attempts.

D) The client was unresponsive to treatment with selective serotonin reuptake

inhibitors (SSRIs).

601)

602) A client being treated for depression with a selective serotonin reuptake inhibitor

(SSRI) becomes agitated, diaphoretic, and complains of muscle spasms and tremors.

The client's sister confides to the nurse her sister has been taking St. John's wort daily for the last 6 months. Which of the following actions should be taken by the nurse?

602) A) Withhold any scheduled doses of the SSRI and notify the physician.

B) Have the laboratory draw blood work for a serotonin level.

C) Ask the client to give the St. John's wort tablets to the staff.

D) Discuss the dangers of taking over-the-counter herbal preparations with the client.

603) A client confides in the nurse that he is going to kill himself. Which of the

following questions should the nurse ask the client?

A) "What has happened to make you feel this way?"

603)

B) "Have you ever attempted suicide before?"

C) "How will you kill yourself?"

D) "Do you think this will solve your problems?"

604) In planning the care of a postoperative client who uses caffeine and nicotine in

large quantities, the nurse may want to observe for signs and symptoms of:

604)

A) physical and psychological withdrawal.

B) lower pain threshold.

C) cardiac arrhythmias.

D)depression.

605) A client who has a history of amphetamine abuse comes to the clinic and informs

the nurse she has stopped taking all drugs. To ensure the client's safety, the nurse informs her withdrawal from amphetamines can cause: 605) A) nausea and vomiting.

B) lethargy and depression.

C) an extreme increase in appetite.

D) life-threatening respiratory depression.

606) The nurse working with clients who have a history of substance abuse

understands that a major reason they are not readily identified or do not seek help from health professionals is: 606) A) fear of health interventions against their will.

B) fear that family members will reject them.

C) denial that they have a problem.

D) fear that they will be subject to legal charges.

607) The nurse understands that the ultimate goals of substance dependence treatment

are abstinence from the drug and:

607)

A)having a close relationship with a counselor.

B)involvement of the entire family in drug rehabilitation.

C) development of coping mechanisms to replace the use of drugs as solutions to

problems.

D) belonging to a support group and maintaining a close affiliation with the members.

608) A client admitted with a long history of alcohol abuse is at risk to go through

withdrawal and suffer delirium tremens (DTs). The nurse knows to assess the client for: 608) A)confusion, delusions, and hallucinations.

B)lethargy and fine tremors.

C) grand mal seizures.

D) fever, diaphoresis, and hyperactivity.

609) In obtaining a history from a male client who abuses codeine, the nurse might

expect the client to describe which of the following symptoms?

A)"I have a persistent cough."

609)

B) "I can no longer maintain an erection."

C) "I can't sleep more than a few hours a day."

D) "I eat at least three meals a day."

610) The nurse is providing an educational seminar at a high school on the abuse of

anabolic steroids. The nurse explains that some dangerous complications can include: 610) A)increased risk of prostate cancer.

B)severe acne.

C)a deepened voice.

D)hypotension.

611) In obtaining a teenage client's history, which of the following would the nurse

consider an early indicator of substance abuse?

A) six absences from school in 1 year B) an increasing tolerance for alcohol

611)

C) a desire to stop drinking D) drinking beer with friends after a football game 612) An alcoholic client is admitted with Wernicke's syndrome (alcoholic

encephalopathy). The nurse prepares to administer: A)vitamin A.

612)

B) vitamin E.

C)vitamin B1. D) vitamin C. 613) The nurse recognizes that the following assessment finding in the alcoholic client

indicates a gastrointestinal complication:

613)

A)tarry, black stools B) dental caries C)nausea and vomiting D) loss of appetite 614) The nurse is working with a group of clients with personality disorders who are

attending a cognitive behavioral therapy session. The nurse recognizes that the clients who are most responsive to this type of therapy have the following personality trait: 614) A)eccentric B) dramatic C)inflexible D) agreeableness 615) A client with a personality disorder has a nursing diagnosis of Disturbed Thought

Processes. The nurse should implement which of the following skills when interacting with the client? 615) A) Ignore suspicions and fears verbalized by the client.

B) Reassure client she is in a safe place.

C) Approach client in a friendly, jovial manner.

D) Allow visitors to stay longer than designated visiting hours.

616) When working with a client with personality disorders the nurse recognizes that

the behavior displayed by the client must have the following characteristics:

616)

A) The behavior is very different from what is expected of the client's culture.

B) It is frequently characterized by psychotic behaviors.

C) Daily functioning is rarely affected by the disorders.

D) It can occur at anytime during adulthood.

617) The nurse is developing a plan of care for a client with an Avoidant Personality

Disorder. The nurse decides an appropriate goal would be for the client to:

617)

A) make a decision about their care.

B) be free from self-harm.

C) improve social skills.

D) refrain from harming others.

618) When caring for a client with a Dependent Personality Disorder, the nurse plans

nursing interventions based on the knowledge that the client: A) has an unrealistic fear of abandonment.

618)

B) has an inflated sense of self-importance.

C) will frequently display attention-seeking behaviors.

D) often engages in self-harm activities.

619) A client admitted with Paranoid Personality Disorder insists the food is

contaminated with pesticides. Which of the following communication techniques should the nurse plan to use to encourage the client to eat? 619) A)Describe how the food is prepared at the institution.

B)Ask client open-ended questions and sit with client.

C)Encourage identification of foods preferred by the client.

D)Identify reasons why the client should eat.

620) A client with an obsessive compulsive personality tells the nurse, "I become so

anxious and stressed and then I start my compulsive ritual. I wish I could stop it." To help the client reduce the anxiety, the nurse offers the following suggestions: 620) A) "Keep distracted by playing the television and radio loudly."

B) "Make a list of things that provoke anxiety for you."

C) "Set a rigid timetable of your daily schedule."

D) "Hold an ice cube in each hand for ten minutes when you are tempted to do a

ritual."

621) The nurse is doing group therapy with a group of clients on a mental health unit.

The nurse determines that a client with Schizotypal Personality Disorder is displaying an inappropriate affect when the client: 621) A) sits off to the side and refuses to participate.

B) cries when another client tells a silly joke.

C) rocks back and forth in the chair throughout the meeting.

D) sings loudly while the other clients are trying to talk.

622) A client with a Histrionic Personality Disorder is admitted to the mental health

unit. The nurse expects the client will display which of the following behaviors?

622) A) being the center of attention B) impulsive and frequently aggressive with others

C)hostile and suspicious of others D)detachment from staff and other clients 623) When developing a plan of care for the client with Paranoid Personality Disorder,

the nurse recognizes that a hallmark of the disorder is the client's: A)difficulty with interpersonal relationships.

B)violation of the rights of others.

C)impulsive behavior.

D)preoccupation with delusions of persecution.

1)D 2)A 3)B 4)D 5)D 6)D 7)B 8)C 9)B 10)A

623)

11)D 12)B 13)A 14)B 15)B 16)C 17)D 18)A 19)D 20)D 21)D 22)D 23)A, B, D 24)C 25)A 26)A 27)C 28)A 29)A

30)D 31)C 32)B 33)B 34)B 35)B 36)A 37)D 38)B 39)D 40)B 41)10 liters 42)D 43)D 44)D 45)B 46)A, B, C 47)A 48)C

49)A 50)C 51)C 52)A 53)C 54)B 55)D 56)B 57)B 58)D 59)A 60)B 61)A 62)A 63)A 64)B 65)D 66)B 67)D

68)A 69)D 70)C 71)B 72)C 73)A 74)B 75)D 76)D 77)C 78)A 79)C 80)B 81)C 82)A 83)B 84)A 85)B 86)A

87)C 88)B 89)C 90)C 91)A 92)A 93)B 94)C 95)D 96)B 97)C 98)C 99)D 100)A 101)A 102)C 103)B 104) D 105) D, E, F

106)A 107)A, C, D 108)B 109)D 110)C 111)B 112)C 113)D 114)C 115)A 116)B 117)D 118)B 119)A 120)A 121)D 122)A 123)D 124)A

125)C 126)B 127)A 128)D 129)D 130)A 131)D 132)C 133)C 134)A 135)D 136)D 137)D 138)A 139)D 140)A 141)A 142)D 143)B

144)D 145)A 146)A, B, C 147)D 148)D 149)B 150)C 151)C 152)D 153)A 154)B 155)B 156)D 157)A 158)C 159)B 160)A 161)A 162)B

163)D 164)B 165)A 166)A 167)B 168)B 169)B 170)B 171)A 172)C 173)D 174)B 175)C 176)C 177)C 178)D 179)B 180)B 181)B

182)C 183)A 184)B 185)C 186)A 187)D 188)C 189)D 190)D 191)D 192)D 193)A 194)B 195)A 196) B, C, D 197) C, D

198)D 199)D 200)A

201)D 202)D 203)A 204)C 205)A 206)C, D, E 207)D 208)C 209)A 210)A 211)A, B 212)C 213) A, C 214) A, B 215) C, D

216)C 217)D 218)D 219)C

220)C 221)D 222)B 223)B 224)B 225)B 226)C 227)A 228)C 229)C 230)D 231)B 232)C 233)C 234)B 235)B 236)D 237)D 238)A

239)D 240)C 241)B 242)B 243)C 244)A 245)A 246)D 247)D 248)A 249)C 250)A 251)B 252)A 253)A 254)A, B 255)B 256)A 257)A

258)C 259)B 260)B 261)D 262)A 263)B 264)B 265)A 266)D 267)A 268)A, B, D 269)C 270)D 271)B 272)A, B, C 273)A 274)A, B, D 275)D 276)D

277)A 278)A, C, D 279)D 280)B 281)D 282)2, 1, 4, 3 283)A, B, C 284)B 285)B 286)D 287)A 288)D 289)C 290)D 291)D 292)C 293)D 294)A 295)A

296)4, 2, 1, 3 297)B 298)B 299)A 300)A, B, C 301)D 302)A 303)B 304)4, 2, 3, 1 305)B 306)B 307)C 308)B 309)C 310)B 311)C 312)B 313)B 314)B

315)B 316)B 317)B 318)D 319)C 320)D 321)A 322)A 323)D 324)D 325)B 326)D 327)D 328)C 329)D 330)C 331)D 332)A 333)B

334)A, C, E 335)A 336)C 337)A 338)A 339)C 340)C 341)D 342)D 343)A, C 344)D 345)C 346)C 347)A 348)C 349)C 350)C 351)C 352)A, D

353)D 354)B 355)B 356)B 357)C 358)A 359)B, D 360)A 361)A 362)D 363)C 364)D 365)C 366)A 367)A 368)B 369)A 370)D 371)C

372)C 373)B 374)B 375)D 376)A 377)A 378)B 379)C 380)D 381)A 382)B 383)D 384)C 385)A 386)B 387)C 388)A 389)B 390)D

391)B 392)D 393)C 394)C 395)D 396)C 397)B, D, E 398)A 399)C 400)D 401)A 402)C 403)A 404)C 405)A 406)B 407)B 408)C 409)A

410)C 411)B 412)C 413)C 414)C 415)C 416)B 417)A 418)B 419)C 420)C 421)A 422)A 423)B 424)D 425)B 426)C 427)A 428)B

429)C 430)A 431)A 432)B 433)D 434)D 435)B 436)D 437)C 438)B 439)B 440)D 441)C 442)D 443)D 444)C 445)C 446)C 447)B

448)D 449)A 450)A 451)D 452)C 453)C 454)C 455)B 456)D 457)A 458)A 459)C 460)C 461)D 462)B 463)D 464)D 465)A 466)C

467)D 468)B 469)D 470)A 471)A 472)D 473)A 474)D 475)C 476)D 477)C 478)A, C, E, F 479)C 480)A 481)C 482)C 483)A 484)A 485)D

486)A 487)A 488)A 489)C 490)A 491)B 492)D 493)B 494)A 495)A 496)B, C, E 497)C 498)D 499)A 500)D 501)C 502)D 503)A 504)B

505)B 506)B, D 507)A 508)B 509)B 510)A 511)B 512)B 513)A, C 514)C 515)C 516)D 517)A, D, E 518)C 519)D 520)A 521)B 522)B 523)B

524)A 525)D 526)B 527)C 528)D 529)D 530)D 531)A 532)D 533)A 534)B 535)B 536)C 537)B 538)C, D, E 539)D 540)B 541)B 542)A

543)A 544)D 545)D 546)C 547)A 548)D 549)D 550)D 551)B 552)D 553)C 554)A 555)D 556)B 557)C 558)C 559)C 560)A 561)A

562)C 563)D 564)A 565)C 566)B 567)C 568)B 569)A, C, D 570)D 571)D 572)A 573)C 574)B 575)C 576)A 577)C 578)A 579)B 580)D

581)D 582)B, C, D 583)D 584)B 585)B 586)A 587)B 588)C 589)C 590)B 591)A 592)C 593)C 594)C 595)A 596)D 597)C 598)C 599)A

600)D 601)C 602)A 603)C 604)A 605)B 606)C 607)C 608)A 609)B 610)A 611)B 612)C 613)A 614)D 615)B 616)A 617)C 618)A

619)B 620)B 621)B 622)A 623)A