We shall be listing out the Schools of Nursing who passed their just concluded NMCN.

1. EKITI STATE UNIVERSITY EKSU RECORDS 100% SUCCESS

2. UNIVERSITY OF MEDICAL SCIENCES ONDO UNIMED RECORDS 100% SUCCESS

3. FCT COLLEGE OF NURSING SCIENCES GWAGWALADA RECORDS 100% SUCCESS

4. OBAFEMI AWOLOWO UNIVERSITY TEACHING HOSPITAL OAUTH COLLEGE OF NURSING RECORDS 100% SUCCESS

5. STANDARD COLLEGE OF NURSING NIGER STATE MINNA RECORDS 100% SUCCESS

6. BOWEN UNIVERSITY OSUN STATE RECORDS 100% SUCCESS

7. EKITI STATE UNIVERSITY TEACHING HOSPITAL
COLLEGE OF NURSING SCIENCES RECORDS 100% SUCCESS

8. ECWA COLLEGE OF NURSING SCIENCES KOGI RECORDS 100% SUCCESS

9. KADUNA STATE COLLEGE OF NURSING SCIENCES TUDUN WADA CAMPUS RECORDS 100% SUCCESS

10. SCHOOL OF NURSING EBONYI (FETHA) RECORDS 100% SUCCESS

11. ALEX EKWUEME FEDERAL UNIVERSITY TEACHING HOSPITAL ABAKALIKI
COLLEGE OF NURSING (CONSAEFUTHA) RECORDS 100% SUCCESS

12. ANAMBRA STATE COLLEGE OF NURSING SCIENCES NKPOR RECORDS 100% SUCCESS

13. OGUN STATE COLLEGE OF NURSING SCIENCES, ILARP RECORDS 100% SUCCESS

14. LADOKE AKINTOLA UNIVERSITY OF TECHNOLOGY OGBOMOSO LAUTECH RECORDS 100% SUCCESS

15. DEPARTMENT OF NURSING SCIENCES OBAFEMI AWOLOWO UNIVERSITY ILE-IFE RECORDS 100% SUCCESS

16. KWARA STATE COLLEGE OF NURSING SCIENCES RECORDS 100% SUCCESS

17. IMO STATE UNIVERSITY RECORDS 98% SUCCESS

18. FEDERAL UNIVERSITY BIRNIN KEBBI RECORDS 100% SUCCESS

19. COLLEGE OF NURSING SCIENCES AMICHI ANAMBRA STATE RECORDS 100% SUCCESS

20. UNIVERSITY OF NIGERIA NSUKKA UNTH RECORDS 100% SUCCESS

21. NIGERIAN AIR FORCE COLLEGE OF NURSING SCIENCES NAF BASE KADUNA RECORDS 100% SUCCESS

22. COLLEGE OF NURSING SCIENCES AMAIGBO, IMO STATE RECORDS 99% SUCCESS RATE

23. OGUN STATE COLLEGE OF NURSING SCIENCES ILARO RECORDS 100% SUCCESS RATE

24. ADELEKE UNIVERSITY OSUN STATE RECORDS 100% SUCCESS

25. MERCY COLLEGE OF NURSING SCIENCES OSUN STATE RECORDS 92.6% SUCCESS RATE

26. LAGOS STATE COLLEGE OF NURSING SCIENCES IGANDO RECORDS 100% SUCCESS

27. ZAMFARA STATE COLLEGE OF NURSING SCIENCES RECORDS AS FOLLOWS:

• General Nursing 94%
• Post Basic Nursing 96%
• Community Nursing 87%

28. ST GERRARD COLLEGE OF NURSING SCIENCES KADUNA RECORD 100% SUCCESS

29. SACRED HEART COLLEGE OF NURSING OGUN RECORDS 100% SUCCESS

30. COLLEGE OF NURSING SCIENCES OSOGBO RECORDS 100% SUCCESS

31. ST. CHARLSE BORROMEO COLLEGE PF NURSING SCIENCES ONITSHA RECORDS 100% SUCCESS

32. AMBROSE ALI UNIVERSITY EKPOMA EDO STATE RECORDS 94.57% SUCCEESS

33. COLLEGE OF NURSING UNIVERSITY OF MAIDUGURI TEACHING HOSPITAL RECORDS 100% SUCCESS

34. ADAMU ADAMU COLLEGE PF NURSING SCIENCES RECORDS 100% SUCCESS

35. RIVER STATE UNIVERSITY
DEPARTMENT OF NURSING RECORDS 100% PASS

36. PRINCESS COLLGE OF NURSING SCIENCES IMO STATE RECORDS 100% PASS

37. COLLEGE OF NURSING SCIENCES IYI ENU MISSION HOSPITAL OGIDI ANAMBRA STATE RECORDS 100% PASS

38. ST. CHARLSE BORROMEO SPECIALIST HOSPITAL ONITSHA COLLEGE OF NURSING SCIENCES ONITSHA RECORDS 100% PASS

39. SHEHU SULE COLLEGE OF NURSING YOBE STATE RECORDS AS FOLLOWS

• HND 97%
• POST BASIC 100%
• COMMUNITY NURSING 100%

40. JIGAWA STATE COLLEGE OF NURSING SCIENCES RECORDS 90% SUCCESS

41. YOBE STATE COLLEGE OF NURSING SCIENCES RECORDS AS FOLLOWS:

• ND/HND 98%
• Post basic nursing 100%
• community NURSING 100%

RECORDS 90% SUCCESS

42. OUR LADY OF LOURDES COLLEGE OF NURSING IHIALA RECORDS 97% SUCCESS

43. ENUGU STATE UNIVERSITY OF SCIENCE AND TECHNOLOGY RECORDS 100% PASS

44. ALIKO DANGOTE COLLEGE OF NURSING SCIENCES BAUCHI RECORDS 95% SUCCESS

45. SCHOOL OF NURSING, FEDERAL TEACHING HOSPITAL iDO EKITI RECORDS 100% SUCCESS

46. UNIVERSITY OF OSUN
DEPARTMENT OF NURSING RECORDS 100% SUCCESS

47. DEPARTMENT OF NURSING EDO STATE UNIVERSITY UZAIRUE RECORDS 97% SUCCESS

48. ST. LUKE COLLEGE OF NURSING SCIENCES WUSASA ZARIA RECORDS 77% PASS

49. TARABA STATE UNIVERSITY TSU DEPARTMENT OF NURSING JALINGO RECORDS 84.21% SUCCESS

50. UNIVERSITY OF CALABAR
DEPARTMENT OF NURSING RECORD AS FOLLOWS:

• GENERAL NURSING 95.6%
• Public health 100%

51. BAYELSA STATE COLLEGE OF NURSING SCIENCES, TOMBIA-EKPETIAMA RECORDS 94.37% SUCCESS

52. REDEEMERS UNIVERSITY
DEPARTMENT OF NURSING RECORDS 100% SUCCESSS

53. NKST COLLEGE OF NURSING SCIENCES MKAR RECORDS 91.4% SUCCESS

54. UNITED EVANGELICAL COLLEGE OF NURSING SCIENCES UEC CONS KOGI RECORDS 96% SUCCESS

55. THOMAS ADEWUMI UNIVERSITY
DEPARTMENT OF NURSING RESULTS RECORDS 100% SUCCESS

56. NASARAWA STATE COLLEGE OF NURSING SCIENCES LAFIA RECORDS 100% SUCCESS

57. THOMAS ADEWUMI UNIVERSITY OKO-IRESE KWARA STATE RECORDS 100 % PASS

58. COLLEGE OF NURSING SCIENCES EZEALA UMUSEKE OKWUDOR IMO STATE RECORDS 100% SUCCESS

59. UNIVERSITY OF ILORIN
DEPARTMENT OF NURSING RECORDS 100% SUCCESS

60. UNIVERSITY OF ILORIN
DEPARTMENT OF NURSING RECORDS 100% SUCCESS

Congratulations to you all; you should go and excel!

Today, we shall be looking at medical-surgical nursing questions and answers. The aim is to prepare us ahead of any professional exam.

1. The nurse counts an adult’s apical heartbeat at 110 beats per minute. The nurse describes this as:

1. asystole.
2. bigeminy.
3. tachycardia.
4. bradycardia.

2. A client has an elevated AST 24 hours following chest pain and shortness of breath. This is suggestive of which of the following?

1. Gallbladder disease
2. Liver disease
3. Myocardial infarction
4. Skeletal muscle injury

3. An adult has a coagulation time of 20 minutes. The nurse should observe the client for which of the following?

1. Blood clots
2. Ecchymotic areas
3. Jaundice
4. Infection

4. A prothrombin time test should be performed regularly on persons who are taking which medication?

1. Heparin
2. Warfarin
3. Phenobarbital
4. Digoxin

5. Which prothrombin time value would be considered normal for a client who is receiving warfarin (Coumadin)?

1. 12 seconds
2. 20 seconds
3. 60 seconds
4. 98 seconds

6. The nurse is caring for a client who is receiving heparin. What drug should be readily available? 1. Vitamin K

2. Caffeine
3. Calcium gluconate
4. Protamine sulfate

7. An adult who is receiving heparin asks the nurse why it cannot be given by mouth. The nurse responds that heparin is given parenterally because:

1. it is destroyed by gastric secretions.
2. it irritates the gastric mucosa.
3. it irritates the intestinal lining.
4. therapeutic levels can be achieved more quickly.

8. An adult who is admitted for a cardiac catheterization asks the nurse if she will be asleep during the cardiac catheterization. What is the best initial response for the nurse to make?

1. “You will be given a general anesthesia.”
2. “You will be sedated but not asleep.”
3. “The doctor will give you an anesthetic if you
   are having too much pain.”
4. “Why do you want to be asleep?”

9. During the admission interview, a client who is admitted for a cardiac catheterization says, “Every time I eat shrimp I get a rash.” What action is essential for the nurse to take at this time?

1. Notify the physician.
2. Ask the client if she gets a rash from any other
   foods.
3. Instruct the dietary department not to give the
   client shrimp.
4. Teach the client the dangers of eating shrimp and other shellfish.

10. The nurse is preparing a client for a cardiac catheterization. Which action would the nurse expect to take?

1. Administer a radioisotope as ordered.
2. Give the client a cleansing enema.
3. Locate and mark peripheral pulses.
4. Encourage high fluid intake before the test.

11. A young adult with a history of rheumatic fever as a child is to have a cardiac catheterization. She asks the nurse why she must have a cardiac catheterization. The nurse’s response
is based on the understanding that cardiac catheterization can accomplish all of the following EXCEPT:

1. assessing heart structures.
2. determining oxygen levels in the heart chambers.
3. evaluating cardiac output.
4. obtaining a biopsy specimen.

12. When a client returns from undergoing a cardiac catheterization, it is most essential for the nurse to:

1. check peripheral pulses.
2. maintain NPO.
3. apply heat to the insertion site.
4. start range of motion exercises immediately.

13. A male client with angina pectoris has been having an increased number of episodes of pain recently. He is admitted for observation. During the admission interview, he tells the nurse that he has been having chest pain during the last week. Which statement by the client would be of greatest concern to the nurse?

1. “I had chest pain while I was walking in the snow on Thursday.”
2. “We went out for a big dinner to celebrate my wife’s birthday, but I couldn’t enjoy it because I got the pain before we got home from the restaurant”
3. “I had chest pain yesterday while I was sitting in the living room watching television.”
4. “I felt pain all the way down my left arm after I was playing with my grandson on Monday.”

14. The nurse responds to the call light of a client who has a history of angina pectoris. He tells the nurse that he has just taken a nitroglycerin tablet sublingually for anginal pain. What action should the nurse take next?

1. If the pain does not subside within five minutes, place a second tablet under his tongue
2. Position him with head lower than feet
3. Administer a narcotic as needed (PRN) for pain if he still has pain in 10 minutes
4. Call his physician and alert the code team for possible intervention.

15. The nurse is teaching an adult who has angina about taking nitroglycerin. The nurse tells him he will know the nitroglycerin is effective when:

1. he experiences tingling under the tongue.
2. his pulse rate increases.
3. his pain subsides.
4. his activity tolerance increases.

16. A client with angina will have to make lifestyle modifications. Which of the following statements by the client would indicate that he understands the necessary modifications in lifestyle to prevent angina attacks?

1. “I know that I will need to eat less, so I will only eat one meal a day.”
2. “I will need to stay in bed all the time so I won’t have the pain.”
3. “I’ll stop what I’m doing whenever I have pain and take a pill.”
4. “I will need to walk more slowly and rest frequently to avoid the angina.”

17. A client who has been treated for angina is discharged in stable condition. At a clinic visit, he tells the nurse he has anginal pain when he has sexual intercourse with his wife. What is the best response for the nurse to make?

1. “Do you have ambivalent feelings toward your wife?”
2. “Many persons with angina have less pain when their partner assumes the top position.”
3. “Be sure that you attempt intercourse only when you are well rested and relaxed.”
4. “You might try having a cocktail before sexual activity to help you relax.”

18. A low-sodium, low-cholesterol, weight-reducing diet is prescribed for an adult with heart disease. The nurse knows that he understands his diet when he chooses which of the following meals?

1. Baked skinless chicken and mashed potatoes
2. Stir-fried Chinese vegetables and rice
3. Tuna fish salad with celery sticks
4. Grilled lean steak with carrots

19. An adult client is admitted with a diagnosis of left-sided congestive heart failure. Which assessment finding would most likely be present?

1. Distended neck veins

2. Dyspnea
3. Hepatomegaly
4. Pitting edema

20. Digoxin (Lanoxin) and furosemide (Lasix) are ordered for a client who has congestive heart failure. Which of the following would the nurse also expect to be ordered for this client?

1. Potassium
2. Calcium
3. Aspirin
4. Coumadin

21. When the nurse is about to administer digoxin to a client, the client says, “I think I need to see the eye doctor. Things seem to look kind of green today.” The nurse takes his vital signs, which are blood pressure = 150/94, pulse = 60 bpm, and respirations = 28. What is the most appropriate initial action for the nurse to take?

1. Administer the medication and record the findings on his chart
2. Withhold the digoxin and report to the charge nurse
3. Request an appointment with the ophthalmologist
4. Reassure the client that he is having a normal reaction to his medication

22. An adult client is admitted to the hospital with peripheral vascular disease of the lower extremities. He has several ischemic ulcers on each ankle and lower leg area. Other parts of his skin are shiny and taut with loss of hair. A primary nursing goal for this client should be to do which of the following?

1. Increase activity tolerance
2. Relieve anxiety
3. Protect from injury
4. Help build a positive body image

23. An adult client who has peripheral vascular disease of the lower extremities was observed smoking in the waiting area. What is the most appropriate response for the nurse to make regarding the client’s smoking?

1. “Smoking is not allowed for patients with blood diseases.”
2. “Smoking causes the blood vessels in your legs to constrict and reduces the blood supply.”
3. “Smoking increases your blood pressure and strains your heart.”
4. “Smoking causes your body to be under greater stress”

24. An adult client with peripheral vascular disease tells the nurse he is afraid his left leg is not improving and may need to be amputated. How should the nurse respond?

1. “You and your wife should discuss your feelings before surgery.”
2. “You sound concerned about your leg and possible surgery.”
3. “It is better to have an amputation when the ulcers are not improving.”
4. “You don’t need to be afraid of surgery.”

25. An adult is diagnosed with hypertension. He is prescribed chlorothiazide (Diuril) 500 mg PO. What nursing instruction is essential for him?

1. Drink at least two quarts of liquid daily.

2. Avoid hard cheeses.
3. Drink orange juice or eat a banana daily.
4. Do not take aspirin

26. A low-sodium diet has been ordered for an adult client. The nurse knows that the client understands his low-sodium diet when the client selects which menu?

1. Tossed salad, carrot sticks, and steak
2. Baked chicken, mashed potatoes, and green beans
3. Hot dog, roll, and coleslaw
4. Chicken noodle soup, applesauce, and cottage cheese

27. A female client is admitted to the hospital with obesity and deep vein thrombophlebitis (DVT) of the right leg. She weighs 275 pounds. Which of the following factors is least related to her diagnosis?

1. She has been taking oral estrogens for the last three years.
2. She smokes two packs of cigarettes daily.
3. Her right femur was fractured recently.
4. She is 30 years old.

28. Which assessment finding would most likely indicate that a client has thrombophlebitis in the leg?

1. Diminished pedal pulses
2. Color changes in the extremities when elevated
3. Red, shiny skin
4. Coolness and pallor in the leg

29. What should be included in the teaching plan for an adult who has hypertension?

1. Reduce dietary calcium.
2. Avoid aerobic exercise.
3. Reduce alcohol intake.
4. Limit fluid intake.

30. The nurse is caring for an elderly client who has congestive heart failure and is taking digoxin. The client should be monitored for which of the following signs of toxicity?

1. Disorientation
2. Weight gain
3. Constipation
4. Dyspnea

31. The licensed practical nurse (LPN) is assisting the registered nurse (RN) in developing the nursing care plan for an older adult who has congestive heart failure. Which nursing diagnosis is most likely to be included?

1. Deficient fluid volume
2. Impaired verbal communication
3. Chronic pain
4. Activity intolerance

32. The nurse is caring for a client who is being evaluated for arteriosclerosis obliterans. Which complaint is the client most likely to have?

1. Burning pain in the legs that wakens him or her at night
2. Numbness of the feet and ankles with exercise
3. Leg pain while walking that becomes severe enough to force him or her to stop
4. Increasing warmth and redness of the legs when they are elevated

33. An adult is admitted with venous thromboembolism. What treatment should the nurse expect during the acute stage?

1. Application of an elastic stocking
2. Ambulation three times a day
3. Passive range of motion exercises to the legs
4. Use of ice packs to control pain

34. The nurse is observing a client who is learning to perform Buerger-Allen exercises. The nurse knows that the client is performing these exercises correctly when the client is observed doing what? Alternately dorsiflexing and plantar flexing the feet while the legs are elevated

2. Massaging the legs beginning at the feet and moving toward the heart
3. Alternately walking short distances and resting with the legs elevated
4. Elevating the legs, then dangling them, and then lying flat for three minutes in each position

35. What should be included in foot care for the client who has a peripheral vascular disorder?

1. Soaking the feet for 20 minutes before washing
   them
2. Walking barefoot only on carpeted floors
3. Applying lotion between the toes to avoid cracking of the skin
4. Avoiding exposure of the legs and feet to the sun

36. An adult male is being evaluated for possible dysrhythmia and is to be placed on a Holter monitor. What instructions should the nurse give him to ensure that this test provides a comprehensive picture of his cardiac status?

1. Remove the electrodes intermittently for hygiene measures.
2. Exercise frequently while the monitor is in place.
3. Keep a diary of all your activities while being monitored.
4. Refrain from activities that precipitate
   symptoms.

37. An older adult is scheduled for coronary arteriography during a cardiac catheterization. Which nursing intervention will be essential as she recovers from the diagnostic procedure on the hospital unit?

1. Encouraging frequent ambulation to prevent deep vein thrombosis
2. Limiting fluid intake to prevent fluid overload
3. Limiting dietary fiber to prevent diarrhea
4. Assessing the arterial puncture site when taking vital signs

38. An older adult is admitted to the hospital with symptoms of severe dyspnea, orthopnea, dia- phoresis, bubbling respirations, and cyanosis. He states that he is afraid “something bad is about
to happen.” How should the nurse position this client?

1. Sitting upright
2. Head lower than feet
3. Supine
4. Prone

39. An adult male has a high level of high-density lipoproteins (HDL) in proportion to low-density lipoproteins (LDL). How does this relate to his risk of developing coronary artery disease (CAD)?

1. His risk for CAD is low.
2. There is no direct correlation.
3. His risk may increase with exercise.
4. His risk will increase with age.

40. A 72-year-old man had a total hip arthroplasty eight days ago. He suddenly develops tenderness in his left calf, a slight temperature elevation, and a positive Homan’s sign. Which of the following will be included in the initial care of this man?

1. Warm packs to the left leg
2. Vigorous massage of the left leg
3. Placing the left leg in a dependent position
4. Performing range of motion exercises to the left leg.

ANSWERS AND RATIONALES

1. 3. Tachycardia in an adult is defined as a heart rate above 100 beats per minute. Asystole is cardiac arrest. There is no heartbeat. Bigeminy means that the heartbeats are coming in pairs.
   Bradycardia in an adult is defined as a heart rate of 60 beats or less per minute.
2. 3. AST is an enzyme released in response to tissue damage. The symptoms are suggestive of myocardial damage. AST rises 24 hours after
   a myocardial infarction. It will also rise when there is liver damage and skeletal muscle injury. This client has symptoms typical of myocardial infarction. Gallbladder disease may present with pain in the right scapula (shoulder blade) region but would not have an elevated AST.
3. 2 The normal clotting time is 9 to 12 minutes. A prolonged clotting time would suggest a bleeding tendency; the client should be observed for signs of bleeding, such as ecchymotic areas. Blood clots would occur with a clotting time of less than normal. Jaundice occurs with liver damage or rapid breakdown of red blood cells, such as is seen in sickle cell anemia. Infection occurs when there are too few white blood cells.
4. 2. A prothrombin time test is done to determine the effectiveness of warfarin. A partial thromboplastin time test is done for persons taking heparin. Phenobarbital and digoxin do not require regular clotting tests. Serum levels of these drugs may be done if the client is on long-term therapy.
5. 2. When a client is receiving Coumadin, the prothrombin time should be 1.5 to 2 times the normal value, which is 11 to 12.5 seconds. Twenty seconds falls within that range. Twelve seconds
   is normal for someone who is not receiving Coumadin. Sixty seconds is normal for a partial thromboplastin time (PTT) test. Ninety-eight seconds on a PTT would be acceptable for a client who is receiving heparin. It should be 1.5 to 2 times the normal range of 60 to 70 seconds.
6. 4. The antidote for heparin is protamine sulfate. Vitamin K is the antidote for Coumadin. Calcium gluconate is the antidote for magnesium sulfate. Caffeine is a central nervous system stimulant and will increase alertness and heart rate.
7. Heparin is a protein and is destroyed by gastric secretions. It is given either intravenously or subcutaneously for that reason.
8. Persons who are undergoing cardiac catheterization will receive a sedative but are not put to sleep. Their cooperation is needed during the procedure. Asking “why” makes the client defensive and is not appropriate for this client at this time. Give the client the information asked for.
9. Allergy to shellfish is indicative of an allergy to iodine. The dye used in a cardiac catheterization is an iodine dye. Anaphylactic reactions can occur. Because the exam is scheduled for the morning, the nurse should notify the physician immediately. The other actions might have relevance but are not essential (safety related) at this time.
10. 3. It is essential to monitor peripheral pulses after the procedure. They should be assessed before the procedure to determine location and baseline levels. An iodine dye is used during a cardiac catheterization, not a radioisotope. There is no need to give the client an enema. Fluids may be encouraged after the test. The client will be NPO for eight hours before the test.
11. 4. A biopsy specimen cannot be obtained during a cardiac catheterization. Heart structures can be assessed, oxygen levels in the heart chambers can be determined, and cardiac output can be measured during a cardiac catheterization.
12. 1. Checking peripheral pulses is of highest priority. The complications most likely to occur are hemorrhage and obstruction of the vessel. The client is NPO before the procedure, not after. Cold may be applied to the insertion site to vasoconstrict. Heat vasodilates and is contraindicated because it might cause bleeding. Range of motion exercises might cause bleeding. The extremity used for the insertion site is
    kept quiet immediately following a cardiac catheterization.
13. 3. This answer indicates pain at rest, which suggests a progression of the angina. The other answers all indicate pain with known causes of angina, such as exercise, cold environment, or eating.
14. 1. Nitroglycerin can be given at five-minute intervals for up to three doses if the pain is not relieved. Positioning with head lower than feet increases cardiac workload and would make the client worse. PRN narcotics are not usually ordered for clients who have anginal pain. Nitroglycerin, a vasodilator, is usually the medication of choice. At some point, the physician will need to be called, but there is no need to alert the code team for possible intervention.
15. 3. Pain relief is the expected outcome when taking nitroglycerin. Vasodilation of coronary vessels will increase the blood supply to the heart muscle, decreasing pain caused by ischemia. Tingling under the tongue and a headache indicate that
    the medication is potent. His pulse rate should decrease when the pain is relieved. Increase in activity tolerance is nice, but nitroglycerin is given to relieve anginal pain.
16. 4. Walking more slowly and resting decreases energy expenditure and prevents an attack. Answer 3 treats an attack. By the time he has pain, he is experiencing angina. To prevent angina,
    he needs to walk slowly and rest frequently. He should eat small, frequent meals—not one large meal. He should exercise within his tolerance level. Staying in bed predisposes the client to the complications of immobility, such as clots and pneumonia.
17. 2. Reducing his physical activity reduces the cardiac workload. This response suggests a
    way that he can engage in sexual activity with minimum strain on the heart. Ambivalent feelings toward his wife are unlikely to cause anginal pain. There is some truth to being well rested and relaxed, but telling him that this is the only time he should have intercourse is not realistic. The nurse should not advise the client to have an alcoholic beverage before sexual activity.
18. 1. Chicken is lower in sodium than beef or seafood. Baking adds no sodium to the chicken. Barbecuing adds sodium and fat, and frying adds fat and usually sodium. Mashed potatoes contain little sodium. Chinese food is usually high in sodium. Tuna fish and celery are high in sodium. Steak and carrots are high in sodium.
19. 2. Dyspnea occurs with left-sided heart failure. Distended neck veins, hepatomegaly, and pitting edema are signs of right-sided heart failure.
20. 1. Lasix is a potassium-depleting diuretic. Digoxin toxicity occurs more quickly in the presence of a low serum potassium. Potassium supplements are usually ordered when the client is on a potassium- depleting diuretic. There is no indication for supplemental calcium. Aspirin and Coumadin are anticoagulants and are not indicated because the client is taking Lasix and digoxin.
21. 2. Disturbance in green and yellow vision is a sign of digoxin toxicity. A pulse of 60 is borderline for digoxin toxicity. When there is any possibility
    of digoxin toxicity, withhold the medication and report to the charge nurse. Once a person takes digoxin, it stays in the system for nearly a week. The LPN will of course record the findings, but withholding the medication is essential. The client needs to have serum digoxin levels done and does not need to be seen by an ophthalmologist. Visual disturbances are a sign of digoxin toxicity, but these are not normal.
22. 3. Because the client has such poor blood supply to his legs, the nurse must be very careful to protect him from injury. Increasing activity tolerance might be desirable but is certainly not the primary nursing goal. Note that the question does not indicate that he has poor exercise tolerance. There are no data in the question to indicate that the client is anxious. He may need help in building a positive body image because his legs are disfigured, but this is certainly not a high priority.
23. 2. This is an accurate answer that relates his behavior to his illness. All of the other statements are true about smoking but do not relate to his current health problem.
24. 2. This response opens communication and allows him to talk about his feelings. The other answers do not allow him to discuss his feelings with the nurse now.
25. 3. Chlorothiazide (Diuril) is a potassium-depleting diuretic. Orange juice and bananas are good sources of potassium. It is not necessary to increase fluids to two quarts when the client is taking a diuretic. Hard cheeses should be avoided when the client is taking monoamine oxidase inhibitors (MAOIs). MAOIs are antidepressants. People who take Coumadin should not take aspirin.
26. 2. Chicken is low in sodium, as are mashed potatoes and green beans. Carrot sticks, steak, hot dogs, soup, and cottage cheese are all high in sodium.
27. 4. Age is least related to DVT. Oral estrogens, smoking, and a broken leg are all risk factors for DVT.
28. 3. Red, shiny skin suggests inflammation. Diminished pedal pulses and color changes in the extremities when elevated are indicative of arterial insufficiency, not a clot in the vein. Coolness and pallor do not suggest inflammation; redness and warmth suggest inflammation.
29. 3. High alcohol intake contributes to increases in blood pressure. Hypertensive clients are usually advised to limit alcohol intake to the equivalent of two glasses of wine or less per day. Dietary sodium should be limited in people with hypertension; however, dietary calcium is not a contributing factor in hypertension. Aerobic exercise is helpful in controlling high blood pressure. It may also contribute to weight reduction, which can help decrease blood pressure. Restriction of fluid intake is a medical order and is not appropriate advice for a nurse to give. Fluid restriction is avoided unless other measures are not successful.
30. 1. Disorientation and confusion are often the first signs of digitalis toxicity in the elderly. Weight gain and dyspnea are not signs of digoxin toxicity.
    They might indicate exacerbation of congestive heart failure. Diarrhea, not constipation, is a sign of digoxin toxicity. Constipation could occur if the client has restricted activity.
31. 4. Dyspnea and impaired oxygenation of tissues reduce the client’s ability to tolerate exercise. Excess fluid volume, manifested by edema,
    is much more likely to occur with congestive heart failure (CHF) than deficient fluid volume. Impaired verbal communication would describe dysphasia, which occurs with cerebrovascular accident (CVA), not CHF. Acute pain may occur with CHF when exacerbations occur. Chronic pain does not usually occur with CHF.
32. 3. Severe leg pain while walking describes intermittent claudication, which is the most common symptom of arteriosclerosis obliterans. Pain at rest develops in the late stages of the disease. Pain is much more likely than numbness with exercise. Paresthesias (including numbness) do occur, but they are likely at rest. The legs and feet of the client with arteriosclerosis obliterans become cool and pale when elevated
    because there is not enough blood flow to the extremities.
33. 1. Compression bandages or stockings help prevent edema and promote adequate venous blood flow and are a major element in the treatment of venous thromboembolism. Bed
    rest is appropriate in the acute stage of venous thromboembolism. Any form of exercise of the legs would increase the risk of pulmonary emboli. Heat is appropriate in the treatment of venous thromboembolism. Ice causes vasoconstriction, which decreases blood flow to the extremities.
34. 4. In Buerger-Allen exercises, the feet are elevated until they blanch, then dangled until they redden, and then stretched out while the client is lying flat. This promotes arterial circulation to the feet. Dorsiflexing and plantar flexing the feet help to maintain range of motion but are not Buerger- Allen exercises. The client with peripheral vascular disease should never massage the legs because of the high risk of dislodging a thrombus if one is present. Walking promotes venous circulation but is not a Buerger-Allen exercise.
35. 4. Sunburn would damage the already fragile skin, increasing the risk of ulceration and infection. Feet should not be soaked. Soaking leads to maceration, predisposing to skin breakdown or infection. The client with a peripheral vascular disorder should never walk barefoot. Small sharp objects such as pins may not be visible in carpet and could be stepped on. Lotion may be applied to dry areas of the legs and feet but must be avoided between the toes, where the excess moisture causes maceration. Ingredients in lotion provide a nutrient source for bacteria and fungi, increasing the infection risk if cracks in the skin occur.
36. 3. The client should function according to his normal daily schedule unless directed to do otherwise by the physician. Keeping a diary or log of these daily activities is necessary so that it can be correlated with the continuous ECG monitor strip to determine whether the dysrhythmia occurs during a certain activity or at a particular time of day. The Holter monitor is usually worn for only 24 hours, so it is not necessary to change the leads. Activities that precipitate symptoms may be correlated with a dysrhythmia that can be treated, preventing further symptoms from occurring. Therefore, it would be helpful if the client were symptomatic while attached to the Holter monitor.
37. 4. Following a cardiac catheterization in which an arterial site is used for access, the puncture
    or cutdown site should be assessed at least as often as vital signs are monitored. The client is
    at risk for development of bleeding, hemorrhage, hematoma formation, and arterial insufficiency
    of the affected extremity. When the arterial access site is used, the client is on strict bed rest for at least several hours. Fluids are encouraged after catheterization to increase urinary output and flush out the dye used during the procedure. There is no need to restrict dietary fiber. In fact, constipation can be dangerous for cardiac clients if they strain at stool (Valsalva maneuver.)
38. 1. The client’s symptoms suggest pulmonary edema. Any client with severe dyspnea,
    orthopnea, and bubbling respirations needs to be in an upright position. An upright position decreases venous return to the heart by allowing blood to pool in the extremities. Decreasing venous return lowers the output of the right ventricle and decreases lung congestion. Sitting upright also allows the abdominal organs to fall away from the diaphragm, easing breathing. Positioned with head lower than feet would not promote venous pooling in the extremities and would increase venous return and pulmonary congestion. The supine position also would contribute to increased pulmonary congestion. The prone position, lying on the abdomen, does not decrease venous return, which is what this client desperately needs.
39. 1. Although elevated LDL levels in proportion to HDL levels are positively correlated with CAD, elevated HDL levels in proportion to LDL levels may decrease the risk of developing CAD. HDL levels may increase with exercise, thereby decreasing a client’s risk of CAD. Age is not a predictor of HDL and LDL levels.
40. 1. Warm, moist heat applied to the extremity reduces the discomfort associated with thrombophlebitis. Vigorous massage of the leg is contraindicated in any client because it may cause a thrombus to become dislodged and possibly cause a pulmonary embolus. The leg should be elevated to prevent venous stasis. Leg exercises are used to prevent thrombophlebitis; once a client has thrombophlebitis, the leg is not exercised to prevent the thrombus from becoming an embolus.

I want to clear the air by answering so many questions from candidates who have been asking me questions.

Is there any school of nursing selling form now?

Truthful saying, there are a few or no school of nursings selling admission forms presently. If there are, they could not be your preferred school of choice.

Can I apply for school of nursing without Jamb?

This depends on your choice of school.

Yes, there are so many schools of nursing you can apply without Jamb. Here is the list of the schools of nursing without Jamb.

Can I apply for nursing school now?

The question is; what nursing school do you have in mind to apply to? Because there are several schools of nursing whose admission forms are no longer on sale.

Can I apply for school of nursing without jamb scores 140, 160, etc

Yes, although it depends on your choice, there are schools of nursing you can actually apply to with the Jamb scores below 140.

Can I still gain admission into school of nursing now?

Yes, you can gain admission provided that you purchased the admission form and applied for admission. Admissions are in batches, if you are not in Batch A, you may be in the subsequent Batches.

Which school of nursing is currently available that does not require Jamb?

Only private schools of nursing are currently available and do not require Jamb. If you can afford it, why not? Are you ready to go to the state where the school is located? If yes and show interest, I will list them in the comment section.

When will they start selling forms for midwifery?

Various schools of midwifery in different states have different periods during which they sell their admission forms depending on their academic calendar. But mostly, admission forms commence between the 2nd quarter of the year for most schools of midwifery whereas few start at the beginning of the year. Always visit this site, we do keep students updated.

Can I study Nursing sciences with Jamb scores of 240, 250, etc.?

We have many universities offering nursing sciences with their Jamb cut-off marks for nursing sciences. Check the list of schools and their cut-off marks here

What are the school fees for schools of nursing in Nigeria?

Studying nursing in Nigeria is very expensive, and if you can’t afford it please kindly back out now. Approximately, school fees for nursing range from #200,000 and above for entrance. This also includes federal universities.

When is the form going to be on sale again?

We shall update you whenever any school of nursing starts selling their admission forms. Just keep visiting this site for updates on the admission process.

Which school of nursing is selling form in Nigeria now?

At this time of writing this, there are few or no schools of nursing except private schools of nursing.

I am pleased to inform you that the Coordinating Honourable Minister of Health and Social Welfare has approved the release of results of the Professional Examination in Midwifery September 2024.

2. Summary of the results indicated that four thousand, seven hundred and Fifty-three (4,753) candidates were successful representing 88% with the breakdown as follows:

a) Post Basic Midwifery: Two thousand, one hundred and thirty-seven (2,137) candidates were successful, representing 92% pass

b) i. Basic Midwifery: One thousand, eight hundred and thirty-five (1,835) candidates were successful, representing 72% pass..

ii. Basic Midwifery (Refresher): Sixteen (16) candidates were successful, representing 100% pass

c) Community Midwifery: Seven hundred and sixty-five (765) candidates were successful, representing 89% pass.

3. Heads of the training institutions are hereby directed to check the result of their institution(s) on-line as from Monday 16th September, 2024.
4. Successful candidates are hereby directed to visit the Nursing and Midwifery Council of Nigeria Portal (portal.nmen.gov.ng) to apply on-line for registration and licensing with effect from 16th September, 2024
5. Please note that on-line registration formalities including payment of registration fee should be completed within ninety (90) days. Furthermore, any application for registration initiated and not completed within thirty (30) days will be automatically deleted by the portal
6. Late registration attracts a penalty fee of Sixteen thousand, two hundred and fifty Naira (16,250.00) only, per applicant after ninety (90) days. Additionally, a penalty fee of six thousand, five hundred and sixty-two Naira (N6,562.00) only will be charged per year in default of first licensing.
7. The next Professional Examination in Midwifery is to he held from Tuesday 11 Friday 14th March, 2025.
8. Heads of nursing training institutions are hereby requested to send statistics of eligible candidates for March, 2025 Professional Examination in Midwifery to exams@nmen.gov.ng on or before 31st December, 2024 using Examination Application Checklist (EAC). Kindly note that Examination Application Checklist received after this date will be rejected outrightly.
9. Please acknowledge receipt of the result and contact the Registrar/CEO immediately for rectification of any error. Council will not entertain any complaint after thirty (30) days of release of result.
10. All correspondences should be addressed to the Registrar/CEO, Nursing and Midwifery Council of Nigeria, Headquarters Office, Plot 713, Cadastral Zone, Life Camp, Abuja.
11. On behalf of the Management of the Nursing and Midwifery Council of

Nigeria, I extend our sincere congratulations to all successful candidates and

wish them success in their future endeavor.

12. Thank you for your support and cooperation in promoting and maintaining Excellence in Nursing Education and Practice in Nigeria in line with global best practices.

Release Of Results Of The Professional Examinations In Midwifery, November 2024.

Click below to check your November Professional Examination Results.

ANATOMY AND PHYSIOLOGY OF THE RESPIRATORY SYSTEM 

SECTION 1

1. Question

Aminophylline (theophylline) is prescribed for a client with acute bronchitis. A nurse administers the medication, knowing that the primary action of this medication is to:

A. Promote expectoration.

B. Suppress the cough.

C. Relax smooth muscles of the bronchial airway.

D. Prevent infection.

Incorrect

Correct Answer: C. Relax smooth muscles of the bronchial airway.

2. Question

A client is receiving isoetharine hydrochloride (Bronkosol) via a nebulizer. The nurse monitors the client for which side effect of this medication?

A. Constipation

B. Diarrhea

C. Bradycardia

D. Tachycardia

Correct

Correct Answer: D. Tachycardia

3. Question

A nurse teaches a client about the use of a respiratory inhaler. Which action by the client indicated a need for further teaching?

A. Removes the cap and shakes the inhaler well before use.

B. Press the canister down with your finger as he breathes in.

C. Inhales the mist and quickly exhales.

D. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed.

Incorrect

Correct Answer: C. Inhales the mist and quickly exhales.

4. Question

A female client is scheduled to have a chest radiograph. Which of the following questions is of most importance to the nurse assessing this client?

A. “Is there any possibility that you could be pregnant?”

B. “Are you wearing any metal chains or jewelry?”

C. “Can you hold your breath easily?”

D. “Are you able to hold your arms above your head?”

Incorrect

Correct Answer: A. “Is there any possibility that you could be pregnant?”

5. Question

A client has just returned to a nursing unit following bronchoscopy. A nurse would implement which of the following nursing interventions for this client?

A. Encouraging additional fluids for the next 24 hours

B. Ensuring the return of the gag reflex before offering foods or fluids

C. Administering atropine intravenously

D. Administering small doses of midazolam (Versed).

Incorrect

Correct Answer: B. Ensuring the return of the gag reflex before offering foods or fluids

6. Question

A client has an order to have radial ABG drawn. Before drawing the sample, a nurse occludes the:

A. Brachial and radial arteries, and then releases them and observes the circulation of the hand.

B. Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the process with the other artery.

C. Radial artery and observes for color changes in the affected hand.

D. Ulnar artery and observes for color changes in the affected hand.

Incorrect

Correct Answer: B. Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the process with the other artery.

7. Question

A nurse is assessing a client with chronic airflow limitation and notes that the client has a “barrel chest.” The nurse interprets that this client has which of the following forms of chronic airflow limitation?

A. Chronic obstructive bronchitis

B. Emphysema

C. Bronchial asthma

D. Bronchial asthma and bronchitis

Incorrect

Correct Answer: B. Emphysema

8. Question

A client has been taking benzonatate (Tessalon Perles) as prescribed. A nurse concludes that the medication is having the intended effect if the client experiences:

A. Decreased anxiety level.

B. Increased comfort level.

C. Reduction of N/V.

D. Decreased frequency and intensity of cough.

Correct

Correct Answer: D. Decreased frequency and intensity of cough.

9. Question

Which of the following would be an expected outcome for a client recovering from an upper respiratory tract infection? The client will:

A. Maintain a fluid intake of 800 ml every 24 hours.

B. Experience chills only once a day.

C. Cough productively without chest discomfort.

D. Experience less nasal obstruction and discharge.

Correct

Correct Answer: D. Experience less nasal obstruction and discharge.

10. Question

Which of the following individuals would the nurse consider to have the highest priority for receiving an influenza vaccination?

A. A 60-year-old man with a hiatal hernia.

B. A 36-year-old woman with 3 children.

C. A 50-year-old woman caring for a spouse with cancer.

D. A 60-year-old woman with osteoarthritis.

Incorrect

Correct Answer: C. A 50-year-old woman caring for a spouse with cancer.

11. Question

A client with allergic rhinitis asks the nurse what he should do to decrease his symptoms. Which of the following instructions would be appropriate for the nurse to give the client?

A. “Use your nasal decongestant spray regularly to help clear your nasal passages.”

B. “Ask the doctor for antibiotics. Antibiotics will help decrease the secretion.”

C. “It is important to increase your activity. A daily brisk walk will help promote drainage.”

D. “Keep a diary when your symptoms occur. This can help you identify what precipitates your attacks.”

Incorrect

Correct Answer: D. “Keep a diary when your symptoms occur. This can help you identify what precipitates your attacks.”

12. Question

An elderly client has been ill with the flu, experiencing headache, fever, and chills. After 3 days, she developed a cough productive of yellow sputum. The nurse auscultates her lungs and hears diffuse crackles. How would the nurse best interpret these assessment findings?

A. It is likely that the client is developing a secondary bacterial pneumonia.

B. The assessment findings are consistent with influenza and are to be expected.

C. The client is getting dehydrated and needs to increase her fluid intake to decrease secretions

D. The client has not been taking her decongestants and bronchodilators as prescribed.

Incorrect

Correct Answer: A. It is likely that the client is developing a secondary bacterial pneumonia.

13. Question

Guaifenesin 300 mg four times daily has been ordered as an expectorant. The dosage strength of the liquid is 200mg/5ml. How many mL should the nurse administer each dose? Fill in the blank and record your final answer using one decimal place.

Answer:  mL

Correct

Correct Answer: 7.5 ml

14. Question

Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant. Which of the following is a possible side effect of this drug?

A. Constipation

B. Bradycardia

C. Diplopia

D. Restlessness

Correct

Correct Answer: D. Restlessness

15. Question

A client with COPD reports steady weight loss and being “too tired from just breathing to eat.” Which of the following nursing diagnoses would be most appropriate when planning nutritional interventions for this client?

A. Altered nutrition: Less than body requirements related to fatigue.

B. Activity intolerance related to dyspnea.

C. Weight loss related to COPD.

D. Ineffective breathing pattern related to alveolar hypoventilation.

Incorrect

Correct Answer: A. Altered nutrition: Less than body requirements related to fatigue.

16. Question

When developing a discharge plan to manage the care of a client with COPD, the nurse should anticipate that the client will do which of the following?

A. Develop infections easily.

B. Maintain current status.

C. Require less supplemental oxygen.

D. Show permanent improvement.

Incorrect

Correct Answer: A. Develop infections easily.

17. Question

Which of the following outcomes would be appropriate for a client with COPD who has been discharged to home? The client:

A. Promises to do pursed lip breathing at home.

B. States actions to reduce pain.

C. States that he will use oxygen via a nasal cannula at 5 L/minute.

D. Agrees to call the physician if dyspnea on exertion increases.

Correct

Correct Answer: D. Agrees to call the physician if dyspnea on exertion increases.

18. Question

Which of the following physical assessment findings would the nurse expect to find in a client with advanced COPD?

A. Increased anteroposterior chest diameter.

B. Underdeveloped neck muscles.

C. Collapsed neck veins.

D. Increased chest excursions with respiration.

Incorrect

Correct Answer: A. Increased anteroposterior chest diameter.

19. Question

Which of the following is the primary reason to teach pursed-lip breathing to clients with emphysema?

A. To promote oxygen intake.

B. To strengthen the diaphragm.

C. To strengthen the intercostal muscles.

D. To promote carbon dioxide elimination.

Correct

Correct Answer: D. To promote carbon dioxide elimination.

20. Question

Which of the following is a priority goal for the client with COPD?

A. Maintaining functional ability.

B. Minimizing chest pain.

C. Increasing carbon dioxide levels in the blood.

D. Treating infectious agents.

Incorrect

Correct Answer: A. Maintaining functional ability

21. Question

A client’s arterial blood gas levels are as follows: pH 7.31; PaO2 80 mm Hg, PaCO2 65 mm Hg; HCO3- 36 mEq/L. Which of the following signs or symptoms would the nurse expect?

A. Cyanosis

B. Flushed skin

C. Irritability

D. Anxiety

Incorrect

Correct Answer: B. Flushed skin

22. Question

When teaching a client with COPD to conserve energy, the nurse should teach the client to lift objects:

A. While inhaling through an open mouth.

B. While exhaling through pursed lips.

C. After exhaling but before inhaling.

D. While taking a deep breath and holding it.

Incorrect

Correct Answer: B. While exhaling through pursed lips.

23. Question

The nurse teaches a client with COPD to assess for s/s of right-sided heart failure. Which of the following s/s would be included in the teaching plan?

A. Clubbing of nail beds

B. Hypertension

C. Peripheral edema

D. Increased appetite

Incorrect

Correct Answer: C. Peripheral edema

24. Question

The nurse assesses the respiratory status of a client who is experiencing an exacerbation of COPD secondary to an upper respiratory tract infection. Which of the following findings would be expected?

Normal breath sounds

A. Normal breath sounds

B. Prolonged inspiration

C. Normal chest movement

D. Coarse crackles and rhonchi

Incorrect

Correct Answer: D. Coarse crackles and rhonchi

25. Question

Which of the following ABG abnormalities should the nurse anticipate in a client with advanced COPD?

A. Increased PaCO2

B. Increased PaO2

C. Increased pH

D. Increased oxygen saturation

Incorrect

Correct Answer: A. Increased PaCO2

26. Question

Which of the following diets would be most appropriate for a client with COPD?

A. Low fat, low cholesterol

B. Bland, soft diet

C. Low-Sodium diet

D. High calorie, high-protein diet

Correct

Correct Answer: D. High-calorie, high-protein diet

27. Question

The nurse is planning to teach a client with COPD how to cough effectively. Which of the following instructions should be included?

A. Take a deep abdominal breath, bend forward, and cough 3 to 4 times on exhalation.

B. Lie flat on back, splint the thorax, take two deep breaths and cough.

C. Take several rapid, shallow breaths and then cough forcefully.

D. Assume a side-lying position, extend the arm over the head, and alternate deep breathing with coughing.

Incorrect

Correct Answer: A. Take a deep abdominal breath, bend forward, and cough 3 to 4 times on exhalation.

28. Question

A 34-year-old woman with a history of asthma is admitted to the emergency department. The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/minute, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. Based on these findings, what action should the nurse take to initiate care of the client?

A. Initiate oxygen therapy and reassess the client in 10 minutes.

B. Draw blood for an ABG analysis and send the client for a chest x-ray.

C. Encourage the client to relax and breathe slowly through the mouth.

D. Administer bronchodilators.

Incorrect

Correct Answer: D. Administer bronchodilators.

29. Question

The nurse would anticipate which of the following ABG results in a client experiencing a prolonged, severe asthma attack?

A. Decreased PaCO2, increased PaO2, and decreased pH.

B. Increased PaCO2, decreased PaO2, and decreased pH.

C. Increased PaCO2, increased PaO2, and increased pH.

D. Decreased PaCO2, decreased PaO2, and increased pH.

Incorrect

Correct Answer: B. Increased PaCO2, decreased PaO2, and decreased pH.

30. Question

A client with acute asthma is prescribed short-term corticosteroid therapy. What is the rationale for the use of steroids in clients with asthma?

A. Corticosteroids promote bronchodilation.

B. Corticosteroids act as an expectorant.

C. Corticosteroids have an anti-inflammatory effect.

D. Corticosteroids prevent development of respiratory infections.

Incorrect

Correct Answer: C. Corticosteroids have an anti-inflammatory effect.

31. Question

The nurse is teaching the client how to use a metered-dose inhaler (MDI) to administer a Corticosteroid drug. Which of the following client actions indicates that he is using the MDI correctly? Select all that apply.

A. The inhaler is held upright.

B. Head is tilted down while inhaling the medication.

C. Client waits 5 minutes between puffs.

D. Mouth is rinsed with water following administration.

E. Client lies supine for 15 minutes following administration.

Incorrect

Correct Answers: A & D.

32. Question

A client is prescribed metaproterenol (Alupent) via a metered-dose inhaler (MDI), two puffs every 4 hours. The nurse instructs the client to report side effects. Which of the following are potential side effects of metaproterenol?

A. Irregular heartbeat

B. Constipation

C. Pedal edema

D. Decreased heart rate.

Correct Answer: A. Irregular heartbeat

33. Question

A client has been taking flunisolide (Aerobid), two inhalations a day, for treatment of asthma. He tells the nurse that he has painful, white patches in his mouth. Which response by the nurse would be the most appropriate?

A. “This is an anticipated side-effect of your medication. It should go away in a couple of weeks.”

B. “You are using your inhaler too much and it has irritated your mouth.”

C. “You have developed a fungal infection from your medication. It will need to be treated with an antifungal.”

D. “Be sure to brush your teeth and floss daily. Good oral hygiene will treat this problem.”

Incorrect

Correct Answer: C. “You have developed a fungal infection from your medication. It will need to be treated with an antifungal.”

34. Question

Which of the following health promotion activities should the nurse include in the discharge teaching plan for a client with asthma?

A. Incorporate physical exercise as tolerated into the treatment plan.

B. Monitor peak flow numbers after meals and at bedtime.

C. Eliminate stressors in the work and home environment.

D. Use sedatives to ensure uninterrupted sleep at night.

Incorrect

Correct Answer: A. Incorporate physical exercise as tolerated into the treatment plan.

35. Question

The client with asthma should be taught which of the following is one of the most common precipitating factors of an acute asthma attack?

A. Occupational exposure to toxins.

B. Viral respiratory infections.

C. Exposure to cigarette smoke.

D. Exercising in cold temperatures.

Incorrect

Correct Answer: B. Viral respiratory infections.

36. Question

A female client comes into the emergency room complaining of SOB and pain in the lung area. She states that she started taking birth control pills 3 weeks ago and that she smokes. Her VS are: 140/80, P 110, R 40. The physician orders ABG’s, results are as follows: pH: 7.50; PaCO2 29 mm Hg; PaO2 60 mm Hg; HCO3- 24 mEq/L; SaO2 86%. Considering these results, the first intervention is to:

A. Begin mechanical ventilation.

B. Place the client on oxygen.

C. Give the client sodium bicarbonate.

D. Monitor for pulmonary embolism.

Incorrect

Correct Answer: B. Place the client on oxygen

37. Question

Basilar crackles are present in a client’s lungs on auscultation. The nurse knows that these are discrete, non continuous sounds that are:

A. Caused by the sudden opening of alveoli.

B. Usually more prominent during expiration.

C. Produced by airflow across passages narrowed by secretions.

D. Found primarily in the pleura.

Incorrect

Correct Answer: A. Caused by the sudden opening of alveoli

38. Question

A cyanotic client with an unknown diagnosis is admitted to the E.R. In relation to oxygen, the first nursing action would be to:

A. Wait until the client’s lab work is done.

B. Not administer oxygen unless ordered by the physician.

C. Administer oxygen at 2 L flow per minute.

D. Administer oxygen at 10 L flow per minute and check the client’s nail beds.

Incorrect

Correct Answer: C. Administer oxygen at 2 L flow per minute.

39. Question

Immediately following a thoracentesis, which clinical manifestations indicate that a complication has occurred and the physician should be notified?

A. Serosanguineous drainage from the puncture site.

B. Increased temperature and blood pressure.

C. Increased pulse and pallor.

D. Hypotension and hypothermia.

Incorrect

Correct Answer: C. Increased pulse and pallor

40. Question

If a client continues to hypoventilate, the nurse will continually assess for a complication of:

A. Respiratory acidosis

B. Respiratory alkalosis

C. Metabolic acidosis

D. Metabolic alkalosis

Correct Answer: A. Respiratory acidosis

41. Question

A client is admitted to the hospital with acute bronchitis. While taking the client’s VS, the nurse notices he has an irregular pulse. The nurse understands that cardiac arrhythmias in chronic respiratory distress are usually the result of:

A. Respiratory acidosis

B. A build-up of carbon dioxide

C. A build-up of oxygen without adequate expelling of carbon dioxide.

D. An acute respiratory infection.

Incorrect

Correct Answer: B. A build-up of carbon dioxide.

42. Question

Auscultation of a client’s lungs reveals crackles in the left posterior base. The nursing intervention is to:

A. Repeat auscultation after asking the client to deep breathe and cough.

B. Instruct the client to limit fluid intake to less than 2000 ml/day.

C. Inspect the client’s ankles and sacrum for the presence of edema.

D. Place the client on bedrest in a semi-Fowler’s position.

Incorrect

Correct Answer: A. Repeat auscultation after asking the client to deep breathe and cough.

43. Question

The most reliable index to determine the respiratory status of a client is to:

A. Observe the chest rising and falling.

B. Observe the skin and mucous membrane color.

C. Listen and feel the air movement.

D. Determine the presence of a femoral pulse.

Incorrect

Correct Answer: C. Listen and feel the air movement.

44. Question

A client with COPD has developed secondary polycythemia. Which nursing diagnosis would be included in the plan of care because of the polycythemia?

A. Fluid volume deficit related to blood loss.

B. Impaired tissue perfusion related to thrombosis.

C. Activity intolerance related to dyspnea.

D. Risk for infection related to suppressed immune response.

Correct Answer: B. Impaired tissue perfusion related to thrombosis.

45. Question

The physician has scheduled a client for a left pneumonectomy. The position that will most likely be ordered postoperatively for his is the:

A. Nonoperative side or back

B. Operative side or back

C. Back only

D. Back or either side.

Correct Answer: B. Operative side or back

46. Question

Assessing a client who has developed atelectasis postoperatively, the nurse will most likely find:

A. A flushed face.

B. Dyspnea and pain.

C. Decreased temperature.

D. Severe cough and no pain.

Incorrect

Correct Answer: B. Dyspnea and pain

47. Question

A fifty-year-old client has a tracheostomy and requires tracheal suctioning. The first intervention in completing this procedure would be to:

A. Change the tracheostomy dressing.

B. Provide humidity with a trach mask.

C. Apply oral or nasal suction.

D. Deflate the tracheal cuff.

Correct Answer: C. Apply oral or nasal suction.

48. Question

A client states that the physician said the tidal volume is slightly diminished and asks the nurse what this means. The nurse explains that the tidal volume is the amount of air:

A. Exhaled forcibly after a normal expiration.

B. Exhaled after there is a normal inspiration.

C. Trapped in the alveoli that cannot be exhaled.

D. Forcibly inspired over and above a normal respiration.

Incorrect

Correct Answer: B. Exhaled after there is a normal inspiration.

49. Question

An acceleration in oxygen dissociation from hemoglobin, and thus oxygen delivery to the tissues, is caused by:

A. A decreasing oxygen pressure in the blood.

B. An increasing carbon dioxide pressure in the blood.

C. A decreasing oxygen pressure and/or an increasing carbon dioxide pressure in the blood.

D. An increasing oxygen pressure and/or a decreasing carbon dioxide pressure in the blood.

Incorrect

Correct Answer: C. A decreasing oxygen pressure and/or an increasing carbon dioxide pressure in the blood.

50. Question

The best method of oxygen administration for client with COPD uses:

A. Cannula

B. Simple Face mask

C. Non-rebreather mask

D. Venturi mask

Correct Answer: D. Venturi mask

SECTION 2

1. Question

Dr. Jones prescribes albuterol sulfate (Proventil) for a patient with newly diagnosed asthma. When teaching the patient about this drug, the nurse should explain that it may cause:

A. Nasal congestion

B. Nervousness

C. Lethargy

D. Hyperkalemia

Incorrect

Correct Answer: B. Nervousness

2. Question

Miriam, a college student with acute rhinitis sees the campus nurse because of excessive nasal drainage. The nurse asks the patient about the color of the drainage. In acute rhinitis, nasal drainage normally is:

A. Yellow

B. Green

C. Clear

D. Gray

Incorrect

Correct Answer: C. Clear

3. Question

A male adult patient hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis?

A. Nausea or vomiting

B. Abdominal pain or diarrhea

C. Hallucinations or tinnitus

D. Lightheadedness or parenthesis 

Correct Answer: D. Lightheadedness or paresthesia

4. Question

Before administering ephedrine, Nurse Tony assesses the patient’s history. Because of ephedrine’s central nervous system (CNS) effects, it is not recommended for:

A. Patients with an acute asthma attack.

B. Patients with narcolepsy.

C. Patients under age

D. Elderly patients.

Correct Answer: D. Elderly patients

5. Question

A female patient suffers acute respiratory distress syndrome as a consequence of shock. The patient’s condition deteriorates rapidly, and endotracheal intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator, alarm sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm?

A. Kinking of the ventilator tubing.

B. A disconnected ventilator tube.

C. An endotracheal cuff leak.

D. A change in the oxygen concentration without resetting the oxygen level alarm.

Correct Answer: A. Kinking of the ventilator tubing.

6. Question

A male adult patient on mechanical ventilation is receiving pancuronium bromide (Pavulon), 0.01 mg/kg I.V. as needed. Which assessment finding indicates that the patient needs another pancuronium dose?

Leg movement

A. Leg movement

B. Finger movement

C. Lip movement

D. Fighting the ventilator

Correct Answer: D. Fighting the ventilator

7. Question

On auscultation, which finding suggests a right pneumothorax?

A. Bilateral inspiratory and expiratory crackles.

B. Absence of breaths sound in the right thorax.

C. Inspiratory wheezes in the right thorax.

D. Bilateral pleural friction rub.

Incorrect

Correct Answer: B. Absence of breaths sound in the right thorax

8. Question

Rhea, confused and short breath, is brought to the emergency department by a family member. The medical history reveals chronic bronchitis and hypertension. To learn more about the current respiratory problem, the doctor orders a chest x-ray and arterial blood gas (ABG) analysis. When reviewing the ABG report, the nurses see many abbreviations. What does a lowercase “a” in ABG value present?

A. Acid-base balance

B. Arterial Blood

C. Arterial oxygen saturation

D. Alveoli

Correct Answer: B. Arterial Blood

9. Question

A male patient is admitted to the healthcare facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this patient?

A. Activity intolerance related to fatigue.

B. Anxiety related to actual threat to health status.

C. Risk for infection related to retained secretions.

D. Impaired gas exchange related to airflow obstruction.

Correct Answer: D. Impaired gas exchange related to airflow obstruction.

10. Question

Nurse Ruth assessing a patient for tracheal displacement should know that the trachea will deviate toward the:

A. Contralateral side in a simple pneumothorax.

B. Affected side in a hemothorax.

C. Affected side in a tension pneumothorax.

D. Contralateral side in hemothorax.

Correct Answer: D. Contralateral side in hemothorax.

11. Question

After undergoing a left pneumonectomy, a female patient has a chest tube in place for drainage. When caring for this patient, the nurse must:

A. Monitor fluctuations in the water-seal chamber.

B. Clamp the chest tube once every shift.

C. Encourage coughing and deep breathing.

D. Milk the chest tube every 2 hours.

Incorrect

Correct Answer: C. Encourage coughing and deep breathing

12. Question

When caring for a male patient who has just had a total laryngectomy, the nurse should plan to:

A. Encourage oral feeding as soon as possible.

B. Develop an alternative communication method.

C. Keep the tracheostomy cuff fully inflated.

D. Keep the patient flat in bed.

Correct Answer: B. Develop an alternative communication method.

13. Question

A male patient has a sucking stab wound to the chest. Which action should the nurse take first?

A. Drawing blood for a hematocrit and hemoglobin level.

B. Applying a dressing over the wound and taping it on three sides.

C. Preparing a chest tube insertion tray.

D. Preparing to start an I.V. line.

Correct Answer: B. Applying a dressing over the wound and taping it on three sides.

14. Question

For a patient with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?

A. Encouraging the patient to drink three glasses of fluid daily.

B. Keeping the patient in semi-Fowler’s position.

C. Using a high-flow venturi mask to deliver oxygen as prescribed.

D. Administering a sedative, as prescribed.

Correct Answer: C. Using a high-flow venturi mask to deliver oxygen as prescribe

15. Question

A male patient’s X-ray result reveals bilateral white-outs, indicating acute respiratory distress syndrome (ARDS). This syndrome results from:

A. Cardiogenic pulmonary edema

B. Respiratory alkalosis

C. Increased pulmonary capillary permeability

D. Renal failure

Correct Answer: C. Increased pulmonary capillary permeability

16. Question

For a female patient with chronic obstructive pulmonary disease, which nursing intervention would help maintain a patent airway?

A. Restricting fluid intake to 1,000 ml per day.

B. Enforcing absolute bed rest.

C. Teaching the patient how to perform controlled coughing.

D. Administering prescribed sedatives regularly and in large amounts.

Correct Answer: C. Teaching the patient how to perform controlled coughing.

17. Question

Nurse Lei, caring for a client with a pneumothorax and who has had a chest tube inserted, continues gentle bubbling in the suction control chamber. What action is appropriate?

A. Do nothing, because this is an expected finding.

B. Immediately clamp the chest tube and notify the physician.

C. Check for an air leak because the bubbling should be intermittent.

D. Increase the suction pressure so that the bubbling becomes vigorous.

Correct Answer: A. Do nothing, because this is an expected finding.

18. Question

Nurse Maureen has assisted a physician with the insertion of a chest tube. The nurse monitors the client and notes fluctuation of the fluid level in the water seal chamber after the tube is inserted. Based on this assessment, which action would be appropriate?

A. Inform the physician.

B. Continue to monitor the client.

C. Reinforce the occlusive dressing.

D. Encourage the client to deep breathe.

Correct Answer: B. Continue to monitor the client.

19. Question

Nurse Reynolds caring for a client with a chest tube turns the client to the side, and the chest tube accidentally disconnects. The initial nursing action is to:

A. Call the physician.

B. Place the tube in a bottle of sterile water.

C. Immediately replace the chest tube system.

D. Place a sterile dressing over the disconnection site.

Correct Answer: B. Place the tube in a bottle of sterile water.

20. Question

A nurse is assisting a physician with the removal of a chest tube. The nurse should instruct the client to:

A. Exhale slowly

B. Stay very still

C. Inhale and exhale quickly

D. Perform the Valsalva maneuver

Correct Answer: D. Perform the Valsalva maneuver.

21. Question

While changing the tapes on a tracheostomy tube, the male client coughs and the tube is dislodged. The initial nursing action is to:

A. Call the physician to reinsert the tube.

B. Grasp the retention sutures to spread the opening.

C. Call the respiratory therapy department to reinsert the tracheotomy.

D. Cover the tracheostomy site with a sterile dressing to prevent infection.

Correct Answer: B. Grasp the retention sutures to spread the opening.

22. Question

Nurse Oliver is caring for a client immediately after removal of the endotracheal tube. The nurse reports which of the following signs immediately if experienced by the client?

A. Stridor

B. Occasional pink-tinged sputum

C. A few basilar lung crackles on the right

D. Respiratory rate 24 breaths/min

Correct Answer: A. Stridor

23. Question

An emergency room nurse is assessing a male client who has sustained a blunt injury to the chest wall. Which of these signs would indicate the presence of a pneumothorax in this client?

A. A low respiratory rate.

B. Diminished breath sounds.

C. The presence of a barrel chest.

D. A sucking sound at the site of injury.

Correct Answer: B. Diminished breath sounds.

24. Question

Nurse Reese is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which of the following would the nurse expect to note on assessment of this client?

A. Hypocapnia

B. A hyperinflated chest noted on the chest x-ray.

C. Increased oxygen saturation with exercise.

D. A widened diaphragm noted on the chest x-ray.

Correct Answer: B. A hyperinflated chest noted on the chest x-ray.

25. Question

An oxygen delivery system is prescribed for a male client with chronic obstructive pulmonary disease to deliver a precise oxygen concentration. Which of the following types of oxygen delivery systems would the nurse anticipate to be prescribed?

A. Face tent

B. Venturi mask

C. Aerosol mask

D. Tracheostomy collar

Correct Answer: B. Venturi mask

26. Question

Blessy, a community health nurse is conducting an educational session with community members regarding tuberculosis. The nurse tells the group that one of the first symptoms associated with tuberculosis is:

A. Dyspnea

B. Chest pain

C. A bloody, productive cough.

D. A cough with the expectoration of mucoid sputum.

Correct Answer: D. A cough with the expectoration of mucoid sputum

27. Question

A nurse performs an admission assessment on a female client with a diagnosis of tuberculosis. The nurse reviews the result of which diagnosis test that will confirm this diagnosis?

A. Bronchoscopy

B. Sputum culture

C. Chest x-ray

D. Tuberculin skin test

I

Correct Answer: B. Sputum culture

28. Question

A nurse is caring for a male client with emphysema who is receiving oxygen. The nurse assesses the oxygen flow rate to ensure that it does not exceed:

A. 1 L/min

B. 2 L/min

C. 6 L/min

D. 10 L/min

Correct Answer: B. 2 L/min

29. Question

A nurse instructs a female client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to:

A. Promote oxygen intake.

B. Strengthen the diaphragm.

C. Strengthen the intercostal muscles.

D. Promote carbon dioxide elimination.

Correct Answer: D. Promote carbon dioxide elimination.

30. Question

A nurse is caring for a male client with acute respiratory distress syndrome. Which of the following would the nurse expect to note in the client?

A. Pallor

B. Low arterial PaO2

C. Elevated arterial PaO2

D. Decreased respiratory rate

Correct Answer: B. Low arterial PaO2

31. Question

A nurse is preparing to obtain a sputum specimen from a male client. Which of the following nursing actions will facilitate obtaining the specimen?

A. Limiting fluid.

B. Having the client take deep breaths.

C. Asking the client to spit into the collection container.

D. Asking the client to obtain the specimen after eating.

Correct Answer: B. Having the client take deep breaths.

32. Question

Nurse Joy is caring for a client after a bronchoscopy and biopsy. Which of the following signs, if noticed in the client, should be reported immediately to the physician?

A. Dry cough

B. Hematuria

C. Bronchospasm

D. Blood-streaked sputum

Correct Answer: C. Bronchospasm

33. Question

A nurse is suctioning fluids from a male client via a tracheostomy tube. When suctioning, the nurse must limit the suctioning time to a maximum of:

A. 1 minute

B. 5 seconds

C. 10 seconds

D. 30 seconds

Correct Answer: C. 10 seconds

34. Question

A nurse is suctioning fluids from a female client through an endotracheal tube. During the suctioning procedure, the nurse notes on the monitor that the heart rate is decreasing. Which if the following is the appropriate nursing intervention?

A. Continue to suction.

B. Notify the physician immediately.

C. Stop the procedure and reoxygenate the client.

D. Ensure that the suction is limited to 15 seconds.

Correct Answer: C. Stop the procedure and reoxygenate the client.

35. Question

A male adult client is suspected of having a pulmonary embolism. A nurse assesses the client, knowing that which of the following is a common clinical manifestation of pulmonary embolism?

A. Dyspnea

B. Bradypnea

C. Bradycardia

D. Decreased respirations

Correct Answer: A. Dyspnea

36. Question

A slightly obese female client with a history of allergy-induced asthma, hypertension, and mitral valve prolapse is admitted to an acute care facility for elective surgery. The nurse obtains a complete history and performs a thorough physical examination, paying special attention to the cardiovascular and respiratory systems. When percussing the client’s chest wall, the nurse expects to elicit:

A. Resonant sounds.

B. Hyperresonant sounds.

C. Dull sounds.

D. Flat sounds.

Correct Answer: A. Resonant sounds.

37. Question

A male client who weighs 175 lb (79.4 kg) is receiving aminophylline (Aminophylline) (400 mg in 500 ml) at 50 ml/hour. The theophylline level is reported as 6 mcg/ml. The nurse calls the physician who instructs the nurse to change the dosage to 0.45 mg/kg/hour. The nurse should:

A. Question the order because it’s too low.

B. Question the order because it’s too high.

C. Set the pump at 45 ml/hour.

D. Stop the infusion and have the laboratory repeat the theophylline measurement.

Correct Answer: A. Question the order because it’s too low.

38. Question

The nurse is teaching a male client with chronic bronchitis about breathing exercises. Which of the following should the nurse include in the teaching?

A. Make inhalation longer than exhalation.

B. Exhale through an open mouth.

C. Use diaphragmatic breathing.

D. Use chest breathing.

Correct Answer: C. Use diaphragmatic breathing.

39. Question

Which phrase is used to describe the volume of air inspired and expired with a normal breath?

A. Total lung capacity

B. Forced vital capacity

C. Tidal volume

D. Residual volume

Correct Answer: C. Tidal volume

40. Question

A male client abruptly sits up in bed, reports having difficulty breathing and has an arterial oxygen saturation of 88%. Which mode of oxygen delivery would most likely reverse the manifestations?

A. Simple mask

B. Non-rebreather mask

C. Face tent

D. Nasal cannula

Correct Answer: B. Non-rebreather mask

41. Question

A female client must take streptomycin for tuberculosis. Before therapy begins, the nurse should instruct the client to notify the physician if a health concern occurs?

A. Impaired color discrimination

B. Increased urinary frequency

C. Decreased hearing acuity

D. Increased appetite

Correct Answer: C. Decreased hearing acuity

42. Question

A male client is asking the nurse a question regarding the Mantoux test for tuberculosis. The nurse should base her response on the fact that the:

A. Area of redness is measured in 3 days and determines whether tuberculosis is present.

B. Skin test doesn’t differentiate between active and dormant tuberculosis infection.

C. Presence of a wheal at the injection site in 2 days indicates active tuberculosis.

D. Test stimulates a reddened response in some clients and requires a second test in 3 months.

Correct Answer: B. Skin test doesn’t differentiate between active and dormant tuberculosis infection.

43. Question

A female adult client has a tracheostomy but doesn’t require continuous mechanical ventilation. When weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the tube for:

A. 15 to 60 seconds.

B. 5 to 20 minutes.

C. 30 to 40 minutes.

D. 45 to 60 minutes.

Correct Answer: B. B. 5 to 20 minutes.

44. Question

Nurse Oliver observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude?

A. The system is functioning normally.

B. The client has a pneumothorax.

C. The system has an air leak.

D. The chest tube is obstructed.

Correct Answer: C. The system has an air leak.

45. Question

A black client with asthma seeks emergency care for acute respiratory distress. Because of this client’s dark skin, the nurse should assess for cyanosis by inspecting the:

A. Lips

B. Mucous membranes

C. Nail beds

D. Earlobes

Correct Answer: B. Mucous membranes

46. Question

For a male client with an endotracheal (ET) tube, which nursing action is most essential?

A. Auscultating the lungs for bilateral breath sounds.

B. Turning the client from side to side every 2 hours.

C. Monitoring serial blood gas values every 4 hours.

D. Providing frequent oral hygiene.

Correct Answer: A. Auscultating the lungs for bilateral breath sounds.

47. Question

The nurse assesses a male client’s respiratory status. Which observation indicates that the client is experiencing difficulty breathing?

A. Diaphragmatic breathing

B. Use of accessory muscles

C. Pursed-lip breathing

D. Controlled breathing

Correct Answer: B. Use of accessory muscles

48. Question

A female client is undergoing a complete physical examination as a requirement for college. When checking the client’s respiratory status, the nurse observes respiratory excursion to help assess:

A. Lung vibrations

B. Vocal sounds

C. Breath sounds

D. Chest movements.

Correct Answer: D. Chest movements

49. Question

A male client comes to the emergency department complaining of sudden onset of diarrhea, anorexia, malaise, cough, headache, and recurrent chills. Based on the client’s history and physical findings, the physician suspects Legionnaires’ disease. While awaiting diagnostic test results, the client is admitted to the facility and started on antibiotic therapy. What is the drug of choice for treating Legionnaires’ disease?

A. erythromycin (Erythrocin)

B. rifampin (Rifadin)

C. amantadine (Symmetrel)

D. amphotericin B (Fungizone)

Correct Answer: A. Erythromycin (Erythrocin)

50. Question

A male client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can’t produce an effective cough, the nurse should monitor closely for:

A. Pleural effusion

B. Pulmonary edema

C. Atelectasis

D. Oxygen toxicity

Correct Answer: C. Atelectasis

SECTION 3

1. Question

An elderly client with pneumonia may appear with which of the following symptoms first?

A. Altered mental status and dehydration

B. Fever and chills

C. Hemoptysis and dyspnea

D. Pleuritic chest pain and cough

Correct Answer: A. Altered mental status and dehydration

2. Question

Which of the following pathophysiological mechanisms that occur in the lung parenchyma allows pneumonia to develop?

A. Atelectasis

B. Bronchiectasis

C. Effusion

D. Inflammation

Correct Answer: D. Inflammation

3. Question

A 7-year-old client is brought to the E.R. He’s tachypneic and afebrile and has a respiratory rate of 36 breaths/minute and a nonproductive cough. He recently had a cold. From his history, the client may have which of the following?

A. Acute asthma

B. Bronchial pneumonia

C. Chronic obstructive pulmonary disease (COPD)

D. Emphysema

Correct Answer: A. Acute asthma

4. Question

Which of the following assessment findings would help confirm a diagnosis of asthma in a client suspected of having the disorder?

A. Circumoral cyanosis

B. Increased forced expiratory volume

C. Inspiratory and expiratory wheezing

D. Normal breath sounds

Incorrect

Correct Answer: C. Inspiratory and expiratory wheezing

5. Question

Which of the following types of asthma involves an acute asthma attack brought on by an upper respiratory infection?

A. Emotional

B. Extrinsic

C. Intrinsic

D. Mediated

Incorrect

Correct Answer: C. Intrinsic

6. Question

A client with acute asthma showing inspiratory and expiratory wheezes and a decreased expiratory volume should be treated with which of the following classes of medication right away?

A. Beta-adrenergic blockers

B. Bronchodilators

C. Inhaled steroids

D. Oral steroids

Correct Answer: B. Bronchodilators

7. Question

A 19-year-old comes into the emergency department with acute asthma. His respiratory rate is 44 breaths/minute, and he appears to be in acute respiratory distress. Which of the following actions should be taken first?

A. Take a full medication history.

B. Give a bronchodilator by nebulizer.

C. Apply a cardiac monitor to the client.

D. Provide emotional support to the client.

Correct Answer: B. Give a bronchodilator by nebulizer.

8. Question

A 58-year-old client with a 40-year history of smoking one to two packs of cigarettes a day has a chronic cough producing thick sputum, peripheral edema, and cyanotic nail beds. Based on this information, he most likely has which of the following conditions?

A. Adult respiratory distress syndrome (ARDS)

B. Asthma

C. Chronic obstructive bronchitis

D. Emphysema

Correct Answer: C. Chronic obstructive bronchitis

9. Question

The term “blue bloater” refers to which of the following conditions?

A. Adult respiratory distress syndrome (ARDS)

B. Asthma

C. Chronic obstructive bronchitis

D. Emphysema

Correct Answer: C. Chronic obstructive bronchitis

10. Question

The term “pink puffer” refers to the client with which of the following conditions?

A. ARDS

B. Asthma

C. Chronic obstructive bronchitis

D. Emphysema

Correct

Correct Answer: D. Emphysema

11. Question

A 66-year-old client has marked dyspnea at rest, is thin, and uses accessory muscles to breathe. He’s tachypneic, with a prolonged expiratory phase. He has no cough. He leans forward with his arms braced on his knees to support his chest and shoulders for breathing. This client has symptoms of which of the following respiratory disorders?

A. ARDS

B. Asthma

C. Chronic obstructive bronchitis

D. Emphysema

Correct Answer: D. Emphysema

12. Question

It’s highly recommended that clients with asthma, chronic bronchitis, and emphysema have Pneumovax and flu vaccinations for which of the following reasons?

A. All clients are recommended to have these vaccines.

B. These vaccines produce bronchodilation and improve oxygenation.

C. These vaccines help reduce the tachypnea these clients experience.

D. Respiratory infections can cause severe hypoxia and possibly death in these clients.

Correct Answer: D. Respiratory infections can cause severe hypoxia and possibly death in these clients.

13. Question

Exercise has which of the following effects on clients with asthma, chronic bronchitis, and emphysema?

A. It enhances cardiovascular fitness.

B. It improves respiratory muscle strength.

C. It reduces the number of acute attacks.

D. It worsens respiratory function and is discouraged.

Correct Answer: A. It enhances cardiovascular fitness.

14. Question

Clients with chronic obstructive bronchitis are given diuretic therapy. Which of the following reasons best explains why?

A. Reducing fluid volume reduces oxygen demand.

B. Reducing fluid volume improves clients’ mobility.

C. Restricting fluid volume reduces sputum production.

D. Reducing fluid volume improves respiratory function.

Incorrect

Correct Answer: A. Reducing fluid volume reduces oxygen demand.

15. Question

A 69-year-old client appears thin and cachectic. He’s short of breath at rest and his dyspnea increases with the slightest exertion. His breath sounds are diminished even with deep inspiration. These signs and symptoms fit which of the following conditions?

A. ARDS

B. Asthma

C. Chronic obstructive bronchitis

D. Emphysema

Correct Answer: D. Emphysema

16. Question

A client with emphysema should receive only 1 to 3 L/minute of oxygen if needed, or he may lose his hypoxic drive. Which of the following statements is correct about hypoxic drive?

A. The client doesn’t notice he needs to breathe.

B. The client breathes only when his oxygen levels climb above a certain point.

C. The client breathes only when his oxygen levels dip below a certain point.

D. The client breathes only when his carbon dioxide level dips below a certain point.

Incorrect

Correct Answer: C. The client breathes only when his oxygen levels dip below a certain point.

17. Question

Teaching for a client with chronic obstructive pulmonary disease (COPD) should include which of the following topics?

A. How to have his wife learn to listen to his lungs with a stethoscope from Wal-Mart.

B. How to increase his oxygen therapy.

C. How to treat respiratory infections without going to the physician.

D. How to recognize the signs of an impending respiratory infection.

Correct Answer: D. How to recognize the signs of an impending respiratory infection.

18. Question

Which of the following respiratory disorders is most common in the first 24 to 48 hours after surgery?

A. Atelectasis

B. Bronchitis

C. Pneumonia

D. Pneumothorax

Correct Answer: A. Atelectasis

19. Question

Which of the following measures can reduce or prevent the incidence of atelectasis in a postoperative client?

A. Chest physiotherapy

B. Mechanical ventilation

C. Reducing oxygen requirements

D. Use of an incentive spirometer.

Correct Answer: D. Use of an incentive spirometer.

20. Question

Emergency treatment of a client in status asthmaticus includes which of the following medications?

A. Inhaled beta-adrenergic agents

B. Inhaled corticosteroids

C. I.V. beta-adrenergic agents

D. Oral corticosteroids

Correct Answer: A. Inhaled beta-adrenergic agents

21. Question

Which of the following treatment goals is best for the client with status asthmaticus?

A. Avoiding intubation.

B. Determining the cause of the attack.

C. Improving exercise tolerance.

D. Reducing secretions.

Correct Answer: A. Avoiding intubation

22. Question

Dani was given Dilaudid for pain. She’s sleeping and her respiratory rate is 4 breaths/minute. If action isn’t taken quickly, she might have which of the following reactions?

A. Asthma attack

B. Respiratory arrest

C. Improve cardiac output

D. Constipation

Correct Answer: B. Respiratory arrest

23. Question

Which of the following additional assessment data should immediately be gathered to determine the status of a client with a respiratory rate of 4 breaths/minute?

A. Arterial blood gas (ABG) and breath sounds.

B. Level of consciousness and a pulse oximetry value.

C. Breath sounds and reflexes.

D. Pulse oximetry value and heart sounds.

Correct Answer: B. Level of consciousness and a pulse oximetry value.

24. Question

A client is in danger of respiratory arrest following the administration of a narcotic analgesic. An arterial blood gas value is obtained. The nurse would expect PaCO2 to be which of the following values?

A. 15 mm Hg

B. 30 mm Hg

C. 40 mm Hg

D. 80 mm Hg

Correct Answer: D. 80 mm Hg

25. Question

A client has started a new drug for hypertension. Thirty minutes after he takes the drug, he develops chest tightness and becomes short of breath and tachypnea. He has a decreased level of consciousness. These signs indicate which of the following conditions?

A. Asthma attack

B. Pulmonary embolism

C. Respiratory failure

D. Rheumatoid arthritis

Correct Answer: C. Respiratory Failure

26. Question

Emergency treatment for a client with impending anaphylaxis secondary to hypersensitivity to a drug should include which of the following actions first?

A. Administering oxygen.

B. Inserting an I.V. catheter.

C. Obtaining a complete blood count (CBC).

D. Taking vital signs.

Correct Answer: A. Administering oxygen.

27. Question

Following the initial care of a client with asthma and impending anaphylaxis from hypersensitivity to a drug, the nurse should take which of the following steps next?

A. Administer beta-adrenergic blockers.

B. Administer bronchodilators.

C. Obtain serum electrolyte levels.

D. Have the client lie flat in the bed.

Correct Answer: B. Administer bronchodilators.

28. Question

A client’s ABG results are as follows: pH: 7.16; PaCO2 80 mm Hg; PaO2 46 mm Hg; HCO3- 24 mEq/L; SaO2 81%. This ABG result represents which of the following conditions?

A. Metabolic acidosis

B. Metabolic alkalosis

C. Respiratory acidosis

D. Respiratory alkalosis

Correct Answer: C. Respiratory acidosis

29. Question

A nurse plans care for a client with chronic obstructive pulmonary disease, knowing that the client is most likely to experience what type of acid-base imbalance?

A. Respiratory acidosis

B. Respiratory alkalosis

C. Metabolic acidosis

D. Metabolic alkalosis

Correct Answer: A. Respiratory acidosis

30. Question

A nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a PCO2 of 30 mm Hg. The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in this condition?

A. Sodium level of 145 mEq/L

B. Potassium level of 3.0 mEq/L

C. Magnesium level of 2.0 mg/L

D. Phosphorus level of 4.0 mg/dl

Correct Answer: B. Potassium level of 3.0 mEq/L

SECTION 4 

1. The nurse is caring for a male client with a chest tube. If the chest drainage system is accidentally disconnected, what should the nurse plan to do?  

A. 

Place the end of the chest tube in a container of sterile saline.

B. 

Apply an occlusive dressing and notify the physician.

C. 

Clamp the chest tube immediately.

D. 

Secure the chest tube with tape.

Correct Answer

A. Place the end of the chest tube in a container of sterile saline.

2. A male elderly client is admitted to an acute care facility with influenza. The nurse monitors the client closely for complications. What is the most common complication of influenza?

A. Septicemia

B. Pneumonia

C. Meningitis

D. Pulmonary edema

Correct Answer

B. Pneumonia

3. A female client has a tracheostomy but doesn’t require continuous mechanical ventilation. When weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the tube for:

A. 5 to 60 seconds.

B. 5 to 20 minutes.

C. 30 to 40 minutes.

D. 45 to 60 minutes.

Correct Answer

B. 5 to 20 minutes.

4. Gina, a home health nurse, is visiting a home care client with advanced lung cancer. Upon assessing the client, the nurse discovers wheezing, bradycardia, and a respiratory rate of 10 breaths/minute. These signs are associated with which condition?

A. Hypoxia

B. Delirium

C. Hyperventilation

D. Semiconsciousness

Correct Answer

A. Hypoxia

5. A male client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?

A. PH 5.0; PaCO2 30 mm Hg

B. PH 7.40; PaCO2 35 mm Hg

C. PH 7.35; PaCO2 40 mm Hg

D. PH 7.25; PaCO2 50 mm Hg

Correct Answer

D. PH 7.25; PaCO2 50 mm Hg

6. A female client with interstitial lung disease is prescribed prednisone (Deltasone) to control inflammation. During client teaching, the nurse stresses the importance of taking prednisone exactly as prescribed and cautions against discontinuing the drug abruptly. A client who discontinues prednisone abruptly may experience:

A. Hyperglycemia and glycosuria.

B. Acute adrenocortical insufficiency.

C. GI bleeding.

D. Restlessness and seizures.

Correct Answer

B. Acute adrenocortical insufficiency.

7. A male client is admitted to the health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this client?

A. Activity intolerance related to fatigue.

B. Anxiety related to actual threat to health status.

C. Risk for infection related to retained secretions.

D. Impaired gas exchange related to airflow obstruction.

Correct Answer

D. Impaired gas exchange related to airflow obstruction.

8. A male client abruptly sits up in bed, reports having difficulty breathing and have an arterial oxygen saturation of 88%. Which mode of oxygen delivery would most likely reverse the manifestations?

A. Simple mask

B. Non-rebreather mask

C. Face tent

D. Nasal cannula

Correct Answer

B. Non-rebreather mask

9. A male adult client with cystic fibrosis is admitted to an acute care facility with an acute respiratory infection. Prescribed respiratory treatment includes chest physiotherapy. When should the nurse perform this procedure?

A. Immediately before a meal

B. At least 2 hours after a meal

C. When bronchospasms occur

D. When secretions have mobilized

Correct Answer

B. At least 2 hours after a meal

10. On arrival at the intensive care unit, a critically ill female client suffers respiratory arrest and is placed on mechanical ventilation. The physician orders pulse oximetry to monitor the client’s arterial oxygen saturation (SaO2) noninvasively. Which vital sign abnormality may alter pulse oximetry values?

A. Fever

B. Tachypnea

C. Tachycardia

D. Hypotension

Correct Answer

D. Hypotension

11. The nurse is caring for a male client who recently underwent a tracheostomy. The first priority when caring for a client with a tracheostomy is:

A. Helping him communicate

B. Keeping his airway patent

C. Encouraging him to perform activities of daily living

D. Preventing him from developing an infection

Correct Answer

B. Keeping his airway patent

12. For a male client with chronic obstructive pulmonary disease, which nursing intervention would help maintain a patent airway?

A. Restricting fluid intake to 1,000 ml/day

B. Enforcing absolute bed rest

C. Teaching the client how to perform controlled coughing

D. Administering prescribed sedatives regularly and in large amounts

Correct Answer

C. Teaching the client how to perform controlled coughing

13. The amount of air inspired and expired with each breath is called:

A. Tidal volume.

B. Residual volume.

C. Vital capacity.

D. Dead-space volume.

Correct Answer

A. Tidal volume.

14. A male client with pneumonia develops respiratory failure and has a partial pressure of arterial oxygen of 55 mm Hg. He’s placed on mechanical ventilation with a fraction of inspired oxygen (FIO2) of 0.9. The nursing goal should be to reduce the FIO2 to no greater than:

A. 0.21

B. 0.35

C. 0.5

D. 0.7

Correct Answer

C. 0.5

15. Nurse Mickey is administering a purified protein derivative (PPD) test to a homeless client. Which of the following statements concerning PPD testing is true?

A. A positive reaction indicates that the client has active tuberculosis (TB).

B. A positive reaction indicates that the client has been exposed to the disease.

C. A negative reaction always excludes the diagnosis of TB.

D. The PPD can be read within 12 hours after the injection.

Correct Answer

B. A positive reaction indicates that the client has been exposed to the disease.

16. Nurse Murphy administers albuterol (Proventil), as prescribed to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect?

A. Respiratory rate of 22 breaths/minute.

B. Dilated and reactive pupils.

C. Urine output of 40 ml/hour.

D. Heart rate of 100 beats/minute.

Correct Answer

A. Respiratory rate of 22 breaths/minute.

17. What is the normal pH range for arterial blood?

A. 7 to 7.49

B. 7.35 to 7.45

C. 7.50 to 7.60

D. 7.55 to 7.65

Correct Answer

B. 7.35 to 7.45

18. Before weaning a male client from a ventilator, which assessment parameter is most important for the nurse to review?

A. Fluid intake for the last 24 hours.

B. Baseline arterial blood gas (ABG) levels.

C. Prior outcomes of weaning.

D. Electrocardiogram (ECG) results.

Correct Answer

B. Baseline arterial blood gas (ABG) levels.

19. Which of the following would be most appropriate for a male client with an arterial blood gas (ABG) of pH 7.5, PaCO2 26 mm Hg, O2 saturation 96%, HCO3 24 mEq/L, and PaO2 94 mm Hg?

A. Administer a prescribed decongestant.

B. Instruct the client to breathe into a paper bag.

C. Offer the client fluids frequently.

D. Administer prescribed supplemental oxygen.

Correct Answer

B. Instruct the client to breathe into a paper bag.

20. A female client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important?

A. PH

B. Bicarbonate (HCO3–)

C. Partial pressure of arterial oxygen (PaO2)

D. Partial pressure of arterial carbon dioxide (PaCO2)

Correct Answer

C. Partial pressure of arterial oxygen (PaO2)

21. Nurse Julia is caring for a client who has a tracheostomy and temperature of 103° F (39.4° C). Which of the following interventions will most likely lower the client’s arterial blood oxygen saturation?

A. Endotracheal suctioning.

B. Encouragement of coughing.

C. Use of a cooling blanket.

D. Incentive spirometry.

Correct Answer

A. Endotracheal suctioning.

22. For a male client who has a chest tube connected to a closed water-seal drainage system, the nurse should include which action in the plan of care?

A. Measuring and documenting the drainage in the collection chamber.

B. Maintaining continuous bubbling in the water-seal chamber.

C. Keeping the collection chamber at chest level.

D. Stripping the chest tube every hour.

Correct Answer

A. Measuring and documenting the drainage in the collection chamber.

23. Nurse Eve formulates a nursing diagnosis of Activity intolerance related to inadequate oxygenation and dyspnea for a client with chronic bronchitis. To minimize this problem, the nurse instructs the client to avoid conditions that increase oxygen demands. Such conditions include:

A. Drinking more than 1,500 ml of fluid daily.

B. Being overweight.

C. Eating a high-protein snack at bedtime.

D. Eating more than three large meals a day.

Correct Answer

B. Being overweight.

24. A black male client with asthma seeks emergency care for acute respiratory distress. Because of this client’s dark skin, the nurse should assess for cyanosis by inspecting the:

A. Lips

B. Mucous membranes

C. Nail beds

D. Earlobes

Correct Answer

B. Mucous membranes

25. A female client with asthma is receiving a theophylline preparation to promote bronchodilation. Because of the risk of drug toxicity, the nurse must monitor the client’s serum theophylline level closely. The nurse knows that the therapeutic theophylline concentration falls within which range?

A. 1 to 2 mcg/ml

B. 2 to 5 mcg/ml

C. 5 to 10 mcg/ml

D. 10 to 20 mcg/ml

Correct Answer

D. 10 to 20 mcg/ml

26. A male client is to receive I.V. vancomycin (Vancocin). When preparing to administer this drug, the nurse should keep in mind that:

A. Vancomycin should be infused over 60 to 90 minutes in a large volume of fluid.

B. Vancomycin may cause irreversible neutropenia.

C. Vancomycin should be administered rapidly in a large volume of fluid.

D. Vancomycin should be administered over 1 to 2 minutes as an I.V. bolus.

Correct Answer

A. Vancomycin should be infused over 60 to 90 minutes in a large volume of fluid.

27. Before seeing a newly assigned female client with respiratory alkalosis, the nurse quickly reviews the client’s medical history. Which condition is a predisposing factor for respiratory alkalosis?

A. Myasthenia gravis.

B. Type 1 diabetes mellitus.

C. Extreme anxiety.

D. Narcotic overdose.

Correct Answer

C. Extreme anxiety.

28. At 11 p.m., a male client is admitted to the emergency department. He has a respiratory rate of 44 breaths/minute. He’s anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone (Depo-Medrol) I.V. At 11:30 p.m., the client’s arterial blood oxygen saturation is 86% and he’s still wheezing. The nurse should plan to administer:

A. Alprazolam (Xanax)

B. Propranolol (Inderal)

C. Morphine

D. Albuterol (Proventil)

Correct Answer

D. Albuterol (Proventil)

29. Pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?

A. Encouraging the client to drink three glasses of fluid daily.

B. Keeping the client in semi-Fowler’s position.

C. Using a high-flow Venturi mask to deliver oxygen as prescribed.

D. Administering a sedative as prescribed.

Correct Answer

C. Using a high-flow Venturi mask to deliver oxygen as prescribed.

30. Nurse Joana is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide?

A. It increases inspiratory muscle strength.

B. It decreases use of accessory breathing muscles.

C. It prolongs the inspiratory phase of respiration.

D. It helps prevent early airway collapse.

Correct Answer

D. It helps prevent early airway collapse.

SECTION 5

1.A male patient has a sucking stab wound to the chest. Which action should the nurse take first?

ADrawing blood for a hematocrit and hemoglobin level

BApplying a dressing over the wound and taping it on three sides

CPreparing a chest tube insertion tray

DPreparing to start an I.V. line

B

2.A male patient is admitted to the health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this patient?

AActivity intolerance related to fatigue

BAnxiety related to actual threat to health status

CRisk for infection related to retained secretions

DImpaired gas exchange related to airflow obstruction

D

3.A male adult patient hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis?

A Nausea or vomiting

BAbdominal pain or diarrhea

CHallucinations or tinnitus

DLightheadedness or parenthesis 

D

4.Before administering ephedrine, Nurse Tony assesses the patient’s history. Because of ephedrine’s central nervous system (CNS) effects, it is not recommended for:

A Patients with an acute asthma attack

B Patients with narcolepsy

C Patients under age 6

D Elderly patients

D

5.A female patient suffers adult respiratory distress syndrome as a consequence of shock. The patient’s condition deteriorates rapidly, and endotracheal intubation and mechanical ventilation are initiated. When the high pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high pressure alarm?

A Kinking of the ventilator tubing

B A disconnected ventilator tube

C An endotracheal cuff leak

D A change in the oxygen concentration without resetting the oxygen level alarm

A

6. A male adult patient on mechanical ventilation is receiving pancuronium bromide (Pavulon), 0.01 mg/kg I.V. as needed. Which assessment finding indicates that the patient needs another pancuronium dose?

A Leg movement

B Finger movement

C Lip movement

D Fighting the ventilator

D

7.On auscultation, which finding suggests a right pneumothorax?

A Bilateral inspiratory and expiratory crackles

B Absence of breaths sound in the right thorax

C Inspiratory wheezes in the right thorax

D Bilateral pleural friction rub

B

8.Rhea, confused and short breath, is brought to the emergency department by a family member. The medical history reveals chronic bronchitis and hypertension. To learn more about the current respiratory problem, the doctor orders a chest x-ray and arterial blood gas (ABG) analysis. When reviewing the ABG report, the nurses sees many abbreviations. What does a lowercase “a” in ABG value present?

A Acid-base balance

B Arterial Blood

C Arterial oxygen saturation

D Alveol

B.

9. Nurse Ruth assessing a patient for tracheal displacement should know that the trachea will deviate toward the:

A Contralateral side in a simple pneumothorax

B Affected side in a hemothorax

C Affected side in a tension pneumothorax

D Contralateral side in hemothorax

D. 

10. After undergoing a left pneumonectomy, a female patient has a chest tube in place for drainage. When caring for this patient, the nurse must:

A Monitor fluctuations in the water-seal chamber

B Clamp the chest tube once every shift

C Encourage coughing and deep breathing

D Milk the chest tube every 2 hours

C

11. For a patient with advance chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?

A Encouraging the patient to drink three glasses of fluid daily

B Keeping the patient in semi-fowler’s position

C Using a high-flow venturi mask to deliver oxygen as prescribe

D Administering a sedative, as prescribe

C

12. A male patient’s X-ray result reveals bilateral white-outs, indicating adult respiratory distress syndrome (ARDS). This syndrome results from:

A Cardiogenic pulmonary edema

B Respiratory alkalosis

C Increased pulmonary capillary permeability

D Renal failure

C

13. Nurse Lei caring for a client with a pneumothorax and who has had a chest tube inserted notes continues gentle bubbling in the suction control chamber. What action is appropriate?

A Do nothing, because this is an expected finding

B Immediately clamp the chest tube and notify the physician

C Check for an air leak because the bubbling should be intermittent

D Increase the suction pressure so that the bubbling becomes vigorous

A

14 .Nurse Maureen has assisted a physician with the insertion of a chest tube. The nurse monitors the client and notes fluctuation of the fluid level in the water seal chamber after the tube is inserted. Based on this assessment, which action would be appropriate?

A Inform the physician

B Continue to monitor the client

C Reinforce the occlusive dressing

D Encourage the client to deep-breathe

B

15. Nurse Reynolds caring for a client with a chest tube turns the client to the side, and the chest tube accidentally disconnects. The initial nursing action is to:

A Call the physician

B Place the tube in bottle of sterile water

C Immediately replace the chest tube system

D Place a sterile dressing over the disconnection site

B

16.A nurse is assisting a physician with the removal of a chest tube. The nurse should instruct the client to:

A Exhale slowly

B Stay very still

C Inhale and exhale quickly

D Perform the Valsalva maneuver

D

17. While changing the tapes on a tracheostomy tube, the male client coughs and tube is dislodged. The initial nursing action is to:

A Call the physician to reinsert the tube

B Grasp the retention sutures to spread the opening

C Call the respiratory therapy department to reinsert the tracheotomy

D Cover the tracheostomy site with a sterile dressing to prevent infection

B

18. Nurse Oliver is caring for a client immediately after removal of the endotracheal tube. The nurse reports which of the following signs immediately if experienced by the client?

A Stridor

B Occasional pink-tinged sputum

C A few basilar lung crackles on the right

D Respiratory rate 24 breaths/min

A

19. An emergency room nurse is assessing a male client who has sustained a blunt injury to the chest wall. Which of these signs would indicate the presence of a pneumothorax in this client?

A A low respiratory rate

B Diminished breath sounds

C The presence of a barrel chest

D A sucking sound at the site of injury

B

20.Nurse Reese is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which of the following would the nurse expect to note on assessment of this client?

A Hypocapnia

B A hyperinflated chest noted on the chest x-ray

C Increased oxygen saturation with exercise

D A widened diaphragm noted on the chest x-ray

B

21.An oxygen delivery system is prescribed for a male client with chronic obstructive pulmonary disease to deliver a precise oxygen concentration. Which of the following types of oxygen delivery systems would the nurse anticipate to be prescribed?

A Face tent

B Venturi mask

C Aerosol mask

D Tracheostomy collar

B

22.Blessy, a community health nurse is conducting an educational session with community members regarding tuberculosis. The nurse tells the group that one of the first symptoms associated with tuberculosis is:

A Dyspnea

B Chest pain

C A bloody, productive cough

D A cough with the expectoration of mucoid sputum

D

23. A nurse performs an admission assessment on a female client with a diagnosis of tuberculosis. The nurse reviews the result of which diagnosis test that will confirm this diagnosis?

A Bronchoscopy

B Sputum culture

C Chest x-ray

D Tuberculin skin test

B

23.A nurse is caring for a male client with emphysema who is receiving oxygen. The nurse assesses the oxygen flow rate to ensure that it does not exceed:

A 1 L/min

B 2 L/min

C 6 L/min

D 10 L/min

B

24. A nurse instructs a female client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to:

A Promote oxygen intake

B Strengthen the diaphragm

C Strengthen the intercostal muscles

D Promote carbon dioxide elimination

D

25. A nurse is caring for a male client with acute respiratory distress syndrome. Which of the following would the nurse expect to note in the client?

A Pallor

B Low arterial PaO2

C Elevated arterial PaO2

D Decreased respiratory rate

B

26. A nurse is preparing to obtain a sputum specimen from a male client. Which of the following nursing actions will facilitate obtaining the specimen?

ALimiting fluid

BHaving the client take deep breaths

CAsking the client to spit into the collection container

DAsking the client to obtain the specimen after eating

B

27. Nurse Joy is caring for a client after a bronchoscopy and biopsy. Which of the following signs, if noticed in the client, should be reported immediately to the physician?

A Dry cough

B Hematuria

CBronchospasm

DBlood-streaked sputum

C

28. A nurse is suctioning fluids from a male client via a tracheostomy tube. When suctioning, the nurse must limit the suctioning time to a maximum of:

A1 minute

B5 seconds

C10 seconds

D30 seconds

C

29. A nurse is suctioning fluids from a female client through an endotracheal tube. During the suctioning procedure, the nurse notes on the monitor that the heart rate is decreasing. Which if the following is the appropriate nursing intervention?

AContinue to suction

BNotify the physician immediately

C Stop the procedure and reoxygenate the client

DEnsure that the suction is limited to 15 seconds

C

30. A male adult client is suspected of having a pulmonary embolus. A nurse assesses the client, knowing that which of the following is a common clinical manifestation of pulmonary embolism?

A Dyspnea

B Bradypnea

C Bradycardia

D Decreased respirations

A

31. A slightly obese female client with a history of allergy-induced asthma, hypertension, and mitral valve prolapse is admitted to an acute care facility for elective surgery. The nurse obtains a complete history and performs a thorough physical examination, paying special attention to the cardiovascular and respiratory systems. When percussing the client’s chest wall, the nurse expects to elicit:

A Resonant sounds

B Hyperresonant sounds

C Dull sounds

D Flat sounds

A 

32. Which phrase is used to describe the volume of air inspired and expired with a normal breath?

Tidal volume

33. A male client abruptly sits up in bed, reports having difficulty breathing and has an arterial oxygen saturation of 88%. Which mode of oxygen delivery would most likely reverse the manifestations?

A Simple mask

B Non-rebreather mask

C Face tent

D Nasal cannula

B

34. A female client must take streptomycin for tuberculosis. Before therapy begins, the nurse should instruct the client to notify the physician if which health concern occurs?

A Impaired color discrimination

B Increased urinary frequency

C Decreased hearing acuity

D Increased appetite

C

35. A male client is asking the nurse a question regarding the Mantoux test for tuberculosis. The nurse should base her response on the fact that the:

A Area of redness is measured in 3 days and determines whether tuberculosis is present.

B Skin test doesn’t differentiate between active and dormant tuberculosis infection.

C Presence of a wheal at the injection site in 2 days indicates active tuberculosis.

D Test stimulates a reddened response in some clients and requires a second test in 3 months.

B

36. A female adult client has a tracheostomy but doesn’t require continuous mechanical ventilation. When weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the tube for:

A15 to 60 seconds

B 5 to 20 minutes

C30 to 40 minutes

D 45 to 60 minutes

B

37. Nurse Oliver observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude?

AThe system is functioning normally

B The client has a pneumothorax

C The system has an air leak

D The chest tube is obstructed

C

38. A black client with asthma seeks emergency care for acute respiratory distress. Because of this client’s dark skin, the nurse should assess for cyanosis by inspecting the:

A Lips

B Mucous membranes

C Nail beds

D Earlobes

B

39. For a male client with an endotracheal (ET) tube, which nursing action is most essential?

A Auscultating the lungs for bilateral breath sounds

B Turning the client from side to side every 2 hours

C Monitoring serial blood gas values every 4 hours

D Providing frequent oral hygiene

A

40. A male client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can’t produce an effective cough, the nurse should monitor closely for:

A Pleural effusion

B Pulmonary edema

C Atelectasis

D Oxygen toxicity

C

41. The nurse in charge is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide?

A It helps prevent early airway collapse

B It increases inspiratory muscle strength

C It decreases use of accessory breathing muscles

D It prolongs the inspiratory phase of respiration

A

42. A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?

A pH, 5.0; PaCO2 30 mm Hg

B pH, 7.40; PaCO2 35 mm Hg

C pH, 7.35; PaCO2 40 mm Hg

D pH, 7.25; PaCO2 50 mm Hg

D

SECTION 1

1. Question

Aminophylline (theophylline) is prescribed for a client with acute bronchitis. A nurse administers the medication, knowing that the primary action of this medication is to:

A. Promote expectoration.

B. Suppress the cough.

C. Relax smooth muscles of the bronchial airway.

D. Prevent infection.

Incorrect

Correct Answer: C. Relax smooth muscles of the bronchial airway.

2. Question

A client is receiving isoetharine hydrochloride (Bronkosol) via a nebulizer. The nurse monitors the client for which side effect of this medication?

A. Constipation

B. Diarrhea

C. Bradycardia

D. Tachycardia

Correct

Correct Answer: D. Tachycardia

3. Question

A nurse teaches a client about the use of a respiratory inhaler. Which action by the client indicated a need for further teaching?

A. Removes the cap and shakes the inhaler well before use.

B. Press the canister down with your finger as he breathes in.

C. Inhales the mist and quickly exhales.

D. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed.

Incorrect

Correct Answer: C. Inhales the mist and quickly exhales.

4. Question

A female client is scheduled to have a chest radiograph. Which of the following questions is of most importance to the nurse assessing this client?

A. “Is there any possibility that you could be pregnant?”

B. “Are you wearing any metal chains or jewelry?”

C. “Can you hold your breath easily?”

D. “Are you able to hold your arms above your head?”

Incorrect

Correct Answer: A. “Is there any possibility that you could be pregnant?”

5. Question

A client has just returned to a nursing unit following bronchoscopy. A nurse would implement which of the following nursing interventions for this client?

A. Encouraging additional fluids for the next 24 hours

B. Ensuring the return of the gag reflex before offering foods or fluids

C. Administering atropine intravenously

D. Administering small doses of midazolam (Versed).

Incorrect

Correct Answer: B. Ensuring the return of the gag reflex before offering foods or fluids

6. Question

A client has an order to have radial ABG drawn. Before drawing the sample, a nurse occludes the:

A. Brachial and radial arteries, and then releases them and observes the circulation of the hand.

B. Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the process with the other artery.

C. Radial artery and observes for color changes in the affected hand.

D. Ulnar artery and observes for color changes in the affected hand.

Incorrect

Correct Answer: B. Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the process with the other artery.

7. Question

A nurse is assessing a client with chronic airflow limitation and notes that the client has a “barrel chest.” The nurse interprets that this client has which of the following forms of chronic airflow limitation?

A. Chronic obstructive bronchitis

B. Emphysema

C. Bronchial asthma

D. Bronchial asthma and bronchitis

Incorrect

Correct Answer: B. Emphysema

8. Question

A client has been taking benzonatate (Tessalon Perles) as prescribed. A nurse concludes that the medication is having the intended effect if the client experiences:

A. Decreased anxiety level.

B. Increased comfort level.

C. Reduction of N/V.

D. Decreased frequency and intensity of cough.

Correct

Correct Answer: D. Decreased frequency and intensity of cough.

9. Question

Which of the following would be an expected outcome for a client recovering from an upper respiratory tract infection? The client will:

A. Maintain a fluid intake of 800 ml every 24 hours.

B. Experience chills only once a day.

C. Cough productively without chest discomfort.

D. Experience less nasal obstruction and discharge.

Correct

Correct Answer: D. Experience less nasal obstruction and discharge.

10. Question

Which of the following individuals would the nurse consider to have the highest priority for receiving an influenza vaccination?

A. A 60-year-old man with a hiatal hernia.

B. A 36-year-old woman with 3 children.

C. A 50-year-old woman caring for a spouse with cancer.

D. A 60-year-old woman with osteoarthritis.

Incorrect

Correct Answer: C. A 50-year-old woman caring for a spouse with cancer.

11. Question

A client with allergic rhinitis asks the nurse what he should do to decrease his symptoms. Which of the following instructions would be appropriate for the nurse to give the client?

A. “Use your nasal decongestant spray regularly to help clear your nasal passages.”

B. “Ask the doctor for antibiotics. Antibiotics will help decrease the secretion.”

C. “It is important to increase your activity. A daily brisk walk will help promote drainage.”

D. “Keep a diary when your symptoms occur. This can help you identify what precipitates your attacks.”

Incorrect

Correct Answer: D. “Keep a diary when your symptoms occur. This can help you identify what precipitates your attacks.”

12. Question

An elderly client has been ill with the flu, experiencing headache, fever, and chills. After 3 days, she developed a cough productive of yellow sputum. The nurse auscultates her lungs and hears diffuse crackles. How would the nurse best interpret these assessment findings?

A. It is likely that the client is developing a secondary bacterial pneumonia.

B. The assessment findings are consistent with influenza and are to be expected.

C. The client is getting dehydrated and needs to increase her fluid intake to decrease secretions

D. The client has not been taking her decongestants and bronchodilators as prescribed.

Incorrect

Correct Answer: A. It is likely that the client is developing a secondary bacterial pneumonia.

13. Question

Guaifenesin 300 mg four times daily has been ordered as an expectorant. The dosage strength of the liquid is 200mg/5ml. How many mL should the nurse administer each dose? Fill in the blank and record your final answer using one decimal place.

Answer:  mL

Correct

Correct Answer: 7.5 ml

14. Question

Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant. Which of the following is a possible side effect of this drug?

A. Constipation

B. Bradycardia

C. Diplopia

D. Restlessness

Correct

Correct Answer: D. Restlessness

15. Question

A client with COPD reports steady weight loss and being “too tired from just breathing to eat.” Which of the following nursing diagnoses would be most appropriate when planning nutritional interventions for this client?

A. Altered nutrition: Less than body requirements related to fatigue.

B. Activity intolerance related to dyspnea.

C. Weight loss related to COPD.

D. Ineffective breathing pattern related to alveolar hypoventilation.

Incorrect

Correct Answer: A. Altered nutrition: Less than body requirements related to fatigue.

16. Question

When developing a discharge plan to manage the care of a client with COPD, the nurse should anticipate that the client will do which of the following?

A. Develop infections easily.

B. Maintain current status.

C. Require less supplemental oxygen.

D. Show permanent improvement.

Incorrect

Correct Answer: A. Develop infections easily.

17. Question

Which of the following outcomes would be appropriate for a client with COPD who has been discharged to home? The client:

A. Promises to do pursed lip breathing at home.

B. States actions to reduce pain.

C. States that he will use oxygen via a nasal cannula at 5 L/minute.

D. Agrees to call the physician if dyspnea on exertion increases.

Correct

Correct Answer: D. Agrees to call the physician if dyspnea on exertion increases.

18. Question

Which of the following physical assessment findings would the nurse expect to find in a client with advanced COPD?

A. Increased anteroposterior chest diameter.

B. Underdeveloped neck muscles.

C. Collapsed neck veins.

D. Increased chest excursions with respiration.

Incorrect

Correct Answer: A. Increased anteroposterior chest diameter.

19. Question

Which of the following is the primary reason to teach pursed-lip breathing to clients with emphysema?

A. To promote oxygen intake.

B. To strengthen the diaphragm.

C. To strengthen the intercostal muscles.

D. To promote carbon dioxide elimination.

Correct

Correct Answer: D. To promote carbon dioxide elimination.

20. Question

Which of the following is a priority goal for the client with COPD?

A. Maintaining functional ability.

B. Minimizing chest pain.

C. Increasing carbon dioxide levels in the blood.

D. Treating infectious agents.

Incorrect

Correct Answer: A. Maintaining functional ability

21. Question

A client’s arterial blood gas levels are as follows: pH 7.31; PaO2 80 mm Hg, PaCO2 65 mm Hg; HCO3- 36 mEq/L. Which of the following signs or symptoms would the nurse expect?

A. Cyanosis

B. Flushed skin

C. Irritability

D. Anxiety

Incorrect

Correct Answer: B. Flushed skin

22. Question

When teaching a client with COPD to conserve energy, the nurse should teach the client to lift objects:

A. While inhaling through an open mouth.

B. While exhaling through pursed lips.

C. After exhaling but before inhaling.

D. While taking a deep breath and holding it.

Incorrect

Correct Answer: B. While exhaling through pursed lips.

23. Question

The nurse teaches a client with COPD to assess for s/s of right-sided heart failure. Which of the following s/s would be included in the teaching plan?

A. Clubbing of nail beds

B. Hypertension

C. Peripheral edema

D. Increased appetite

Incorrect

Correct Answer: C. Peripheral edema

24. Question

The nurse assesses the respiratory status of a client who is experiencing an exacerbation of COPD secondary to an upper respiratory tract infection. Which of the following findings would be expected?

Normal breath sounds

A. Normal breath sounds

B. Prolonged inspiration

C. Normal chest movement

D. Coarse crackles and rhonchi

Incorrect

Correct Answer: D. Coarse crackles and rhonchi

25. Question

Which of the following ABG abnormalities should the nurse anticipate in a client with advanced COPD?

A. Increased PaCO2

B. Increased PaO2

C. Increased pH

D. Increased oxygen saturation

Incorrect

Correct Answer: A. Increased PaCO2

26. Question

Which of the following diets would be most appropriate for a client with COPD?

A. Low fat, low cholesterol

B. Bland, soft diet

C. Low-Sodium diet

D. High calorie, high-protein diet

Correct

Correct Answer: D. High-calorie, high-protein diet

27. Question

The nurse is planning to teach a client with COPD how to cough effectively. Which of the following instructions should be included?

A. Take a deep abdominal breath, bend forward, and cough 3 to 4 times on exhalation.

B. Lie flat on back, splint the thorax, take two deep breaths and cough.

C. Take several rapid, shallow breaths and then cough forcefully.

D. Assume a side-lying position, extend the arm over the head, and alternate deep breathing with coughing.

Incorrect

Correct Answer: A. Take a deep abdominal breath, bend forward, and cough 3 to 4 times on exhalation.

28. Question

A 34-year-old woman with a history of asthma is admitted to the emergency department. The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/minute, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. Based on these findings, what action should the nurse take to initiate care of the client?

A. Initiate oxygen therapy and reassess the client in 10 minutes.

B. Draw blood for an ABG analysis and send the client for a chest x-ray.

C. Encourage the client to relax and breathe slowly through the mouth.

D. Administer bronchodilators.

Incorrect

Correct Answer: D. Administer bronchodilators.

29. Question

The nurse would anticipate which of the following ABG results in a client experiencing a prolonged, severe asthma attack?

A. Decreased PaCO2, increased PaO2, and decreased pH.

B. Increased PaCO2, decreased PaO2, and decreased pH.

C. Increased PaCO2, increased PaO2, and increased pH.

D. Decreased PaCO2, decreased PaO2, and increased pH.

Incorrect

Correct Answer: B. Increased PaCO2, decreased PaO2, and decreased pH.

30. Question

A client with acute asthma is prescribed short-term corticosteroid therapy. What is the rationale for the use of steroids in clients with asthma?

A. Corticosteroids promote bronchodilation.

B. Corticosteroids act as an expectorant.

C. Corticosteroids have an anti-inflammatory effect.

D. Corticosteroids prevent development of respiratory infections.

Incorrect

Correct Answer: C. Corticosteroids have an anti-inflammatory effect.

31. Question

The nurse is teaching the client how to use a metered-dose inhaler (MDI) to administer a Corticosteroid drug. Which of the following client actions indicates that he is using the MDI correctly? Select all that apply.

A. The inhaler is held upright.

B. Head is tilted down while inhaling the medication.

C. Client waits 5 minutes between puffs.

D. Mouth is rinsed with water following administration.

E. Client lies supine for 15 minutes following administration.

Incorrect

Correct Answers: A & D.

32. Question

A client is prescribed metaproterenol (Alupent) via a metered-dose inhaler (MDI), two puffs every 4 hours. The nurse instructs the client to report side effects. Which of the following are potential side effects of metaproterenol?

A. Irregular heartbeat

B. Constipation

C. Pedal edema

D. Decreased heart rate.

Correct Answer: A. Irregular heartbeat

33. Question

A client has been taking flunisolide (Aerobid), two inhalations a day, for treatment of asthma. He tells the nurse that he has painful, white patches in his mouth. Which response by the nurse would be the most appropriate?

A. “This is an anticipated side-effect of your medication. It should go away in a couple of weeks.”

B. “You are using your inhaler too much and it has irritated your mouth.”

C. “You have developed a fungal infection from your medication. It will need to be treated with an antifungal.”

D. “Be sure to brush your teeth and floss daily. Good oral hygiene will treat this problem.”

Incorrect

Correct Answer: C. “You have developed a fungal infection from your medication. It will need to be treated with an antifungal.”

34. Question

Which of the following health promotion activities should the nurse include in the discharge teaching plan for a client with asthma?

A. Incorporate physical exercise as tolerated into the treatment plan.

B. Monitor peak flow numbers after meals and at bedtime.

C. Eliminate stressors in the work and home environment.

D. Use sedatives to ensure uninterrupted sleep at night.

Incorrect

Correct Answer: A. Incorporate physical exercise as tolerated into the treatment plan.

35. Question

The client with asthma should be taught which of the following is one of the most common precipitating factors of an acute asthma attack?

A. Occupational exposure to toxins.

B. Viral respiratory infections.

C. Exposure to cigarette smoke.

D. Exercising in cold temperatures.

Incorrect

Correct Answer: B. Viral respiratory infections.

36. Question

A female client comes into the emergency room complaining of SOB and pain in the lung area. She states that she started taking birth control pills 3 weeks ago and that she smokes. Her VS are: 140/80, P 110, R 40. The physician orders ABG’s, results are as follows: pH: 7.50; PaCO2 29 mm Hg; PaO2 60 mm Hg; HCO3- 24 mEq/L; SaO2 86%. Considering these results, the first intervention is to:

A. Begin mechanical ventilation.

B. Place the client on oxygen.

C. Give the client sodium bicarbonate.

D. Monitor for pulmonary embolism.

Incorrect

Correct Answer: B. Place the client on oxygen

37. Question

Basilar crackles are present in a client’s lungs on auscultation. The nurse knows that these are discrete, non continuous sounds that are:

A. Caused by the sudden opening of alveoli.

B. Usually more prominent during expiration.

C. Produced by airflow across passages narrowed by secretions.

D. Found primarily in the pleura.

Incorrect

Correct Answer: A. Caused by the sudden opening of alveoli

38. Question

A cyanotic client with an unknown diagnosis is admitted to the E.R. In relation to oxygen, the first nursing action would be to:

A. Wait until the client’s lab work is done.

B. Not administer oxygen unless ordered by the physician.

C. Administer oxygen at 2 L flow per minute.

D. Administer oxygen at 10 L flow per minute and check the client’s nail beds.

Incorrect

Correct Answer: C. Administer oxygen at 2 L flow per minute.

39. Question

Immediately following a thoracentesis, which clinical manifestations indicate that a complication has occurred and the physician should be notified?

A. Serosanguineous drainage from the puncture site.

B. Increased temperature and blood pressure.

C. Increased pulse and pallor.

D. Hypotension and hypothermia.

Incorrect

Correct Answer: C. Increased pulse and pallor

40. Question

If a client continues to hypoventilate, the nurse will continually assess for a complication of:

A. Respiratory acidosis

B. Respiratory alkalosis

C. Metabolic acidosis

D. Metabolic alkalosis

Correct Answer: A. Respiratory acidosis

41. Question

A client is admitted to the hospital with acute bronchitis. While taking the client’s VS, the nurse notices he has an irregular pulse. The nurse understands that cardiac arrhythmias in chronic respiratory distress are usually the result of:

A. Respiratory acidosis

B. A build-up of carbon dioxide

C. A build-up of oxygen without adequate expelling of carbon dioxide.

D. An acute respiratory infection.

Incorrect

Correct Answer: B. A build-up of carbon dioxide.

42. Question

Auscultation of a client’s lungs reveals crackles in the left posterior base. The nursing intervention is to:

A. Repeat auscultation after asking the client to deep breathe and cough.

B. Instruct the client to limit fluid intake to less than 2000 ml/day.

C. Inspect the client’s ankles and sacrum for the presence of edema.

D. Place the client on bedrest in a semi-Fowler’s position.

Incorrect

Correct Answer: A. Repeat auscultation after asking the client to deep breathe and cough.

43. Question

The most reliable index to determine the respiratory status of a client is to:

A. Observe the chest rising and falling.

B. Observe the skin and mucous membrane color.

C. Listen and feel the air movement.

D. Determine the presence of a femoral pulse.

Incorrect

Correct Answer: C. Listen and feel the air movement.

44. Question

A client with COPD has developed secondary polycythemia. Which nursing diagnosis would be included in the plan of care because of the polycythemia?

A. Fluid volume deficit related to blood loss.

B. Impaired tissue perfusion related to thrombosis.

C. Activity intolerance related to dyspnea.

D. Risk for infection related to suppressed immune response.

Correct Answer: B. Impaired tissue perfusion related to thrombosis.

45. Question

The physician has scheduled a client for a left pneumonectomy. The position that will most likely be ordered postoperatively for his is the:

A. Nonoperative side or back

B. Operative side or back

C. Back only

D. Back or either side.

Correct Answer: B. Operative side or back

46. Question

Assessing a client who has developed atelectasis postoperatively, the nurse will most likely find:

A. A flushed face.

B. Dyspnea and pain.

C. Decreased temperature.

D. Severe cough and no pain.

Incorrect

Correct Answer: B. Dyspnea and pain

47. Question

A fifty-year-old client has a tracheostomy and requires tracheal suctioning. The first intervention in completing this procedure would be to:

A. Change the tracheostomy dressing.

B. Provide humidity with a trach mask.

C. Apply oral or nasal suction.

D. Deflate the tracheal cuff.

Correct Answer: C. Apply oral or nasal suction.

48. Question

A client states that the physician said the tidal volume is slightly diminished and asks the nurse what this means. The nurse explains that the tidal volume is the amount of air:

A. Exhaled forcibly after a normal expiration.

B. Exhaled after there is a normal inspiration.

C. Trapped in the alveoli that cannot be exhaled.

D. Forcibly inspired over and above a normal respiration.

Incorrect

Correct Answer: B. Exhaled after there is a normal inspiration.

49. Question

An acceleration in oxygen dissociation from hemoglobin, and thus oxygen delivery to the tissues, is caused by:

A. A decreasing oxygen pressure in the blood.

B. An increasing carbon dioxide pressure in the blood.

C. A decreasing oxygen pressure and/or an increasing carbon dioxide pressure in the blood.

D. An increasing oxygen pressure and/or a decreasing carbon dioxide pressure in the blood.

Incorrect

Correct Answer: C. A decreasing oxygen pressure and/or an increasing carbon dioxide pressure in the blood.

50. Question

The best method of oxygen administration for client with COPD uses:

A. Cannula

B. Simple Face mask

C. Non-rebreather mask

D. Venturi mask

Correct Answer: D. Venturi mask

SECTION 2

1. Question

Dr. Jones prescribes albuterol sulfate (Proventil) for a patient with newly diagnosed asthma. When teaching the patient about this drug, the nurse should explain that it may cause:

A. Nasal congestion

B. Nervousness

C. Lethargy

D. Hyperkalemia

Incorrect

Correct Answer: B. Nervousness

2. Question

Miriam, a college student with acute rhinitis sees the campus nurse because of excessive nasal drainage. The nurse asks the patient about the color of the drainage. In acute rhinitis, nasal drainage normally is:

A. Yellow

B. Green

C. Clear

D. Gray

Incorrect

Correct Answer: C. Clear

3. Question

A male adult patient hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis?

A. Nausea or vomiting

B. Abdominal pain or diarrhea

C. Hallucinations or tinnitus

D. Lightheadedness or parenthesis 

Correct Answer: D. Lightheadedness or paresthesia

4. Question

Before administering ephedrine, Nurse Tony assesses the patient’s history. Because of ephedrine’s central nervous system (CNS) effects, it is not recommended for:

A. Patients with an acute asthma attack.

B. Patients with narcolepsy.

C. Patients under age

D. Elderly patients.

Correct Answer: D. Elderly patients

5. Question

A female patient suffers acute respiratory distress syndrome as a consequence of shock. The patient’s condition deteriorates rapidly, and endotracheal intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator, alarm sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm?

A. Kinking of the ventilator tubing.

B. A disconnected ventilator tube.

C. An endotracheal cuff leak.

D. A change in the oxygen concentration without resetting the oxygen level alarm.

Correct Answer: A. Kinking of the ventilator tubing.

6. Question

A male adult patient on mechanical ventilation is receiving pancuronium bromide (Pavulon), 0.01 mg/kg I.V. as needed. Which assessment finding indicates that the patient needs another pancuronium dose?

Leg movement

A. Leg movement

B. Finger movement

C. Lip movement

D. Fighting the ventilator

Correct Answer: D. Fighting the ventilator

7. Question

On auscultation, which finding suggests a right pneumothorax?

A. Bilateral inspiratory and expiratory crackles.

B. Absence of breaths sound in the right thorax.

C. Inspiratory wheezes in the right thorax.

D. Bilateral pleural friction rub.

Incorrect

Correct Answer: B. Absence of breaths sound in the right thorax

8. Question

Rhea, confused and short breath, is brought to the emergency department by a family member. The medical history reveals chronic bronchitis and hypertension. To learn more about the current respiratory problem, the doctor orders a chest x-ray and arterial blood gas (ABG) analysis. When reviewing the ABG report, the nurses see many abbreviations. What does a lowercase “a” in ABG value present?

A. Acid-base balance

B. Arterial Blood

C. Arterial oxygen saturation

D. Alveoli

Correct Answer: B. Arterial Blood

9. Question

A male patient is admitted to the healthcare facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this patient?

A. Activity intolerance related to fatigue.

B. Anxiety related to actual threat to health status.

C. Risk for infection related to retained secretions.

D. Impaired gas exchange related to airflow obstruction.

Correct Answer: D. Impaired gas exchange related to airflow obstruction.

10. Question

Nurse Ruth assessing a patient for tracheal displacement should know that the trachea will deviate toward the:

A. Contralateral side in a simple pneumothorax.

B. Affected side in a hemothorax.

C. Affected side in a tension pneumothorax.

D. Contralateral side in hemothorax.

Correct Answer: D. Contralateral side in hemothorax.

11. Question

After undergoing a left pneumonectomy, a female patient has a chest tube in place for drainage. When caring for this patient, the nurse must:

A. Monitor fluctuations in the water-seal chamber.

B. Clamp the chest tube once every shift.

C. Encourage coughing and deep breathing.

D. Milk the chest tube every 2 hours.

Incorrect

Correct Answer: C. Encourage coughing and deep breathing

12. Question

When caring for a male patient who has just had a total laryngectomy, the nurse should plan to:

A. Encourage oral feeding as soon as possible.

B. Develop an alternative communication method.

C. Keep the tracheostomy cuff fully inflated.

D. Keep the patient flat in bed.

Correct Answer: B. Develop an alternative communication method.

13. Question

A male patient has a sucking stab wound to the chest. Which action should the nurse take first?

A. Drawing blood for a hematocrit and hemoglobin level.

B. Applying a dressing over the wound and taping it on three sides.

C. Preparing a chest tube insertion tray.

D. Preparing to start an I.V. line.

Correct Answer: B. Applying a dressing over the wound and taping it on three sides.

14. Question

For a patient with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?

A. Encouraging the patient to drink three glasses of fluid daily.

B. Keeping the patient in semi-Fowler’s position.

C. Using a high-flow venturi mask to deliver oxygen as prescribed.

D. Administering a sedative, as prescribed.

Correct Answer: C. Using a high-flow venturi mask to deliver oxygen as prescribe

15. Question

A male patient’s X-ray result reveals bilateral white-outs, indicating acute respiratory distress syndrome (ARDS). This syndrome results from:

A. Cardiogenic pulmonary edema

B. Respiratory alkalosis

C. Increased pulmonary capillary permeability

D. Renal failure

Correct Answer: C. Increased pulmonary capillary permeability

16. Question

For a female patient with chronic obstructive pulmonary disease, which nursing intervention would help maintain a patent airway?

A. Restricting fluid intake to 1,000 ml per day.

B. Enforcing absolute bed rest.

C. Teaching the patient how to perform controlled coughing.

D. Administering prescribed sedatives regularly and in large amounts.

Correct Answer: C. Teaching the patient how to perform controlled coughing.

17. Question

Nurse Lei, caring for a client with a pneumothorax and who has had a chest tube inserted, continues gentle bubbling in the suction control chamber. What action is appropriate?

A. Do nothing, because this is an expected finding.

B. Immediately clamp the chest tube and notify the physician.

C. Check for an air leak because the bubbling should be intermittent.

D. Increase the suction pressure so that the bubbling becomes vigorous.

Correct Answer: A. Do nothing, because this is an expected finding.

18. Question

Nurse Maureen has assisted a physician with the insertion of a chest tube. The nurse monitors the client and notes fluctuation of the fluid level in the water seal chamber after the tube is inserted. Based on this assessment, which action would be appropriate?

A. Inform the physician.

B. Continue to monitor the client.

C. Reinforce the occlusive dressing.

D. Encourage the client to deep breathe.

Correct Answer: B. Continue to monitor the client.

19. Question

Nurse Reynolds caring for a client with a chest tube turns the client to the side, and the chest tube accidentally disconnects. The initial nursing action is to:

A. Call the physician.

B. Place the tube in a bottle of sterile water.

C. Immediately replace the chest tube system.

D. Place a sterile dressing over the disconnection site.

Correct Answer: B. Place the tube in a bottle of sterile water.

20. Question

A nurse is assisting a physician with the removal of a chest tube. The nurse should instruct the client to:

A. Exhale slowly

B. Stay very still

C. Inhale and exhale quickly

D. Perform the Valsalva maneuver

Correct Answer: D. Perform the Valsalva maneuver.

21. Question

While changing the tapes on a tracheostomy tube, the male client coughs and the tube is dislodged. The initial nursing action is to:

A. Call the physician to reinsert the tube.

B. Grasp the retention sutures to spread the opening.

C. Call the respiratory therapy department to reinsert the tracheotomy.

D. Cover the tracheostomy site with a sterile dressing to prevent infection.

Correct Answer: B. Grasp the retention sutures to spread the opening.

22. Question

Nurse Oliver is caring for a client immediately after removal of the endotracheal tube. The nurse reports which of the following signs immediately if experienced by the client?

A. Stridor

B. Occasional pink-tinged sputum

C. A few basilar lung crackles on the right

D. Respiratory rate 24 breaths/min

Correct Answer: A. Stridor

23. Question

An emergency room nurse is assessing a male client who has sustained a blunt injury to the chest wall. Which of these signs would indicate the presence of a pneumothorax in this client?

A. A low respiratory rate.

B. Diminished breath sounds.

C. The presence of a barrel chest.

D. A sucking sound at the site of injury.

Correct Answer: B. Diminished breath sounds.

24. Question

Nurse Reese is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which of the following would the nurse expect to note on assessment of this client?

A. Hypocapnia

B. A hyperinflated chest noted on the chest x-ray.

C. Increased oxygen saturation with exercise.

D. A widened diaphragm noted on the chest x-ray.

Correct Answer: B. A hyperinflated chest noted on the chest x-ray.

25. Question

An oxygen delivery system is prescribed for a male client with chronic obstructive pulmonary disease to deliver a precise oxygen concentration. Which of the following types of oxygen delivery systems would the nurse anticipate to be prescribed?

A. Face tent

B. Venturi mask

C. Aerosol mask

D. Tracheostomy collar

Correct Answer: B. Venturi mask

26. Question

Blessy, a community health nurse is conducting an educational session with community members regarding tuberculosis. The nurse tells the group that one of the first symptoms associated with tuberculosis is:

A. Dyspnea

B. Chest pain

C. A bloody, productive cough.

D. A cough with the expectoration of mucoid sputum.

Correct Answer: D. A cough with the expectoration of mucoid sputum

27. Question

A nurse performs an admission assessment on a female client with a diagnosis of tuberculosis. The nurse reviews the result of which diagnosis test that will confirm this diagnosis?

A. Bronchoscopy

B. Sputum culture

C. Chest x-ray

D. Tuberculin skin test

I

Correct Answer: B. Sputum culture

28. Question

A nurse is caring for a male client with emphysema who is receiving oxygen. The nurse assesses the oxygen flow rate to ensure that it does not exceed:

A. 1 L/min

B. 2 L/min

C. 6 L/min

D. 10 L/min

Correct Answer: B. 2 L/min

29. Question

A nurse instructs a female client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to:

A. Promote oxygen intake.

B. Strengthen the diaphragm.

C. Strengthen the intercostal muscles.

D. Promote carbon dioxide elimination.

Correct Answer: D. Promote carbon dioxide elimination.

30. Question

A nurse is caring for a male client with acute respiratory distress syndrome. Which of the following would the nurse expect to note in the client?

A. Pallor

B. Low arterial PaO2

C. Elevated arterial PaO2

D. Decreased respiratory rate

Correct Answer: B. Low arterial PaO2

31. Question

A nurse is preparing to obtain a sputum specimen from a male client. Which of the following nursing actions will facilitate obtaining the specimen?

A. Limiting fluid.

B. Having the client take deep breaths.

C. Asking the client to spit into the collection container.

D. Asking the client to obtain the specimen after eating.

Correct Answer: B. Having the client take deep breaths.

32. Question

Nurse Joy is caring for a client after a bronchoscopy and biopsy. Which of the following signs, if noticed in the client, should be reported immediately to the physician?

A. Dry cough

B. Hematuria

C. Bronchospasm

D. Blood-streaked sputum

Correct Answer: C. Bronchospasm

33. Question

A nurse is suctioning fluids from a male client via a tracheostomy tube. When suctioning, the nurse must limit the suctioning time to a maximum of:

A. 1 minute

B. 5 seconds

C. 10 seconds

D. 30 seconds

Correct Answer: C. 10 seconds

34. Question

A nurse is suctioning fluids from a female client through an endotracheal tube. During the suctioning procedure, the nurse notes on the monitor that the heart rate is decreasing. Which if the following is the appropriate nursing intervention?

A. Continue to suction.

B. Notify the physician immediately.

C. Stop the procedure and reoxygenate the client.

D. Ensure that the suction is limited to 15 seconds.

Correct Answer: C. Stop the procedure and reoxygenate the client.

35. Question

A male adult client is suspected of having a pulmonary embolism. A nurse assesses the client, knowing that which of the following is a common clinical manifestation of pulmonary embolism?

A. Dyspnea

B. Bradypnea

C. Bradycardia

D. Decreased respirations

Correct Answer: A. Dyspnea

36. Question

A slightly obese female client with a history of allergy-induced asthma, hypertension, and mitral valve prolapse is admitted to an acute care facility for elective surgery. The nurse obtains a complete history and performs a thorough physical examination, paying special attention to the cardiovascular and respiratory systems. When percussing the client’s chest wall, the nurse expects to elicit:

A. Resonant sounds.

B. Hyperresonant sounds.

C. Dull sounds.

D. Flat sounds.

Correct Answer: A. Resonant sounds.

37. Question

A male client who weighs 175 lb (79.4 kg) is receiving aminophylline (Aminophylline) (400 mg in 500 ml) at 50 ml/hour. The theophylline level is reported as 6 mcg/ml. The nurse calls the physician who instructs the nurse to change the dosage to 0.45 mg/kg/hour. The nurse should:

A. Question the order because it’s too low.

B. Question the order because it’s too high.

C. Set the pump at 45 ml/hour.

D. Stop the infusion and have the laboratory repeat the theophylline measurement.

Correct Answer: A. Question the order because it’s too low.

38. Question

The nurse is teaching a male client with chronic bronchitis about breathing exercises. Which of the following should the nurse include in the teaching?

A. Make inhalation longer than exhalation.

B. Exhale through an open mouth.

C. Use diaphragmatic breathing.

D. Use chest breathing.

Correct Answer: C. Use diaphragmatic breathing.

39. Question

Which phrase is used to describe the volume of air inspired and expired with a normal breath?

A. Total lung capacity

B. Forced vital capacity

C. Tidal volume

D. Residual volume

Correct Answer: C. Tidal volume

40. Question

A male client abruptly sits up in bed, reports having difficulty breathing and has an arterial oxygen saturation of 88%. Which mode of oxygen delivery would most likely reverse the manifestations?

A. Simple mask

B. Non-rebreather mask

C. Face tent

D. Nasal cannula

Correct Answer: B. Non-rebreather mask

41. Question

A female client must take streptomycin for tuberculosis. Before therapy begins, the nurse should instruct the client to notify the physician if a health concern occurs?

A. Impaired color discrimination

B. Increased urinary frequency

C. Decreased hearing acuity

D. Increased appetite

Correct Answer: C. Decreased hearing acuity

42. Question

A male client is asking the nurse a question regarding the Mantoux test for tuberculosis. The nurse should base her response on the fact that the:

A. Area of redness is measured in 3 days and determines whether tuberculosis is present.

B. Skin test doesn’t differentiate between active and dormant tuberculosis infection.

C. Presence of a wheal at the injection site in 2 days indicates active tuberculosis.

D. Test stimulates a reddened response in some clients and requires a second test in 3 months.

Correct Answer: B. Skin test doesn’t differentiate between active and dormant tuberculosis infection.

43. Question

A female adult client has a tracheostomy but doesn’t require continuous mechanical ventilation. When weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the tube for:

A. 15 to 60 seconds.

B. 5 to 20 minutes.

C. 30 to 40 minutes.

D. 45 to 60 minutes.

Correct Answer: B. B. 5 to 20 minutes.

44. Question

Nurse Oliver observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude?

A. The system is functioning normally.

B. The client has a pneumothorax.

C. The system has an air leak.

D. The chest tube is obstructed.

Correct Answer: C. The system has an air leak.

45. Question

A black client with asthma seeks emergency care for acute respiratory distress. Because of this client’s dark skin, the nurse should assess for cyanosis by inspecting the:

A. Lips

B. Mucous membranes

C. Nail beds

D. Earlobes

Correct Answer: B. Mucous membranes

46. Question

For a male client with an endotracheal (ET) tube, which nursing action is most essential?

A. Auscultating the lungs for bilateral breath sounds.

B. Turning the client from side to side every 2 hours.

C. Monitoring serial blood gas values every 4 hours.

D. Providing frequent oral hygiene.

Correct Answer: A. Auscultating the lungs for bilateral breath sounds.

47. Question

The nurse assesses a male client’s respiratory status. Which observation indicates that the client is experiencing difficulty breathing?

A. Diaphragmatic breathing

B. Use of accessory muscles

C. Pursed-lip breathing

D. Controlled breathing

Correct Answer: B. Use of accessory muscles

48. Question

A female client is undergoing a complete physical examination as a requirement for college. When checking the client’s respiratory status, the nurse observes respiratory excursion to help assess:

A. Lung vibrations

B. Vocal sounds

C. Breath sounds

D. Chest movements.

Correct Answer: D. Chest movements

49. Question

A male client comes to the emergency department complaining of sudden onset of diarrhea, anorexia, malaise, cough, headache, and recurrent chills. Based on the client’s history and physical findings, the physician suspects Legionnaires’ disease. While awaiting diagnostic test results, the client is admitted to the facility and started on antibiotic therapy. What is the drug of choice for treating Legionnaires’ disease?

A. erythromycin (Erythrocin)

B. rifampin (Rifadin)

C. amantadine (Symmetrel)

D. amphotericin B (Fungizone)

Correct Answer: A. Erythromycin (Erythrocin)

50. Question

A male client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can’t produce an effective cough, the nurse should monitor closely for:

A. Pleural effusion

B. Pulmonary edema

C. Atelectasis

D. Oxygen toxicity

Correct Answer: C. Atelectasis

SECTION 3

1. Question

An elderly client with pneumonia may appear with which of the following symptoms first?

A. Altered mental status and dehydration

B. Fever and chills

C. Hemoptysis and dyspnea

D. Pleuritic chest pain and cough

Correct Answer: A. Altered mental status and dehydration

2. Question

Which of the following pathophysiological mechanisms that occur in the lung parenchyma allows pneumonia to develop?

A. Atelectasis

B. Bronchiectasis

C. Effusion

D. Inflammation

Correct Answer: D. Inflammation

3. Question

A 7-year-old client is brought to the E.R. He’s tachypneic and afebrile and has a respiratory rate of 36 breaths/minute and a nonproductive cough. He recently had a cold. From his history, the client may have which of the following?

A. Acute asthma

B. Bronchial pneumonia

C. Chronic obstructive pulmonary disease (COPD)

D. Emphysema

Correct Answer: A. Acute asthma

4. Question

Which of the following assessment findings would help confirm a diagnosis of asthma in a client suspected of having the disorder?

A. Circumoral cyanosis

B. Increased forced expiratory volume

C. Inspiratory and expiratory wheezing

D. Normal breath sounds

Incorrect

Correct Answer: C. Inspiratory and expiratory wheezing

5. Question

Which of the following types of asthma involves an acute asthma attack brought on by an upper respiratory infection?

A. Emotional

B. Extrinsic

C. Intrinsic

D. Mediated

Incorrect

Correct Answer: C. Intrinsic

6. Question

A client with acute asthma showing inspiratory and expiratory wheezes and a decreased expiratory volume should be treated with which of the following classes of medication right away?

A. Beta-adrenergic blockers

B. Bronchodilators

C. Inhaled steroids

D. Oral steroids

Correct Answer: B. Bronchodilators

7. Question

A 19-year-old comes into the emergency department with acute asthma. His respiratory rate is 44 breaths/minute, and he appears to be in acute respiratory distress. Which of the following actions should be taken first?

A. Take a full medication history.

B. Give a bronchodilator by nebulizer.

C. Apply a cardiac monitor to the client.

D. Provide emotional support to the client.

Correct Answer: B. Give a bronchodilator by nebulizer.

8. Question

A 58-year-old client with a 40-year history of smoking one to two packs of cigarettes a day has a chronic cough producing thick sputum, peripheral edema, and cyanotic nail beds. Based on this information, he most likely has which of the following conditions?

A. Adult respiratory distress syndrome (ARDS)

B. Asthma

C. Chronic obstructive bronchitis

D. Emphysema

Correct Answer: C. Chronic obstructive bronchitis

9. Question

The term “blue bloater” refers to which of the following conditions?

A. Adult respiratory distress syndrome (ARDS)

B. Asthma

C. Chronic obstructive bronchitis

D. Emphysema

Correct Answer: C. Chronic obstructive bronchitis

10. Question

The term “pink puffer” refers to the client with which of the following conditions?

A. ARDS

B. Asthma

C. Chronic obstructive bronchitis

D. Emphysema

Correct

Correct Answer: D. Emphysema

11. Question

A 66-year-old client has marked dyspnea at rest, is thin, and uses accessory muscles to breathe. He’s tachypneic, with a prolonged expiratory phase. He has no cough. He leans forward with his arms braced on his knees to support his chest and shoulders for breathing. This client has symptoms of which of the following respiratory disorders?

A. ARDS

B. Asthma

C. Chronic obstructive bronchitis

D. Emphysema

Correct Answer: D. Emphysema

12. Question

It’s highly recommended that clients with asthma, chronic bronchitis, and emphysema have Pneumovax and flu vaccinations for which of the following reasons?

A. All clients are recommended to have these vaccines.

B. These vaccines produce bronchodilation and improve oxygenation.

C. These vaccines help reduce the tachypnea these clients experience.

D. Respiratory infections can cause severe hypoxia and possibly death in these clients.

Correct Answer: D. Respiratory infections can cause severe hypoxia and possibly death in these clients.

13. Question

Exercise has which of the following effects on clients with asthma, chronic bronchitis, and emphysema?

A. It enhances cardiovascular fitness.

B. It improves respiratory muscle strength.

C. It reduces the number of acute attacks.

D. It worsens respiratory function and is discouraged.

Correct Answer: A. It enhances cardiovascular fitness.

14. Question

Clients with chronic obstructive bronchitis are given diuretic therapy. Which of the following reasons best explains why?

A. Reducing fluid volume reduces oxygen demand.

B. Reducing fluid volume improves clients’ mobility.

C. Restricting fluid volume reduces sputum production.

D. Reducing fluid volume improves respiratory function.

Incorrect

Correct Answer: A. Reducing fluid volume reduces oxygen demand.

15. Question

A 69-year-old client appears thin and cachectic. He’s short of breath at rest and his dyspnea increases with the slightest exertion. His breath sounds are diminished even with deep inspiration. These signs and symptoms fit which of the following conditions?

A. ARDS

B. Asthma

C. Chronic obstructive bronchitis

D. Emphysema

Correct Answer: D. Emphysema

16. Question

A client with emphysema should receive only 1 to 3 L/minute of oxygen if needed, or he may lose his hypoxic drive. Which of the following statements is correct about hypoxic drive?

A. The client doesn’t notice he needs to breathe.

B. The client breathes only when his oxygen levels climb above a certain point.

C. The client breathes only when his oxygen levels dip below a certain point.

D. The client breathes only when his carbon dioxide level dips below a certain point.

Incorrect

Correct Answer: C. The client breathes only when his oxygen levels dip below a certain point.

17. Question

Teaching for a client with chronic obstructive pulmonary disease (COPD) should include which of the following topics?

A. How to have his wife learn to listen to his lungs with a stethoscope from Wal-Mart.

B. How to increase his oxygen therapy.

C. How to treat respiratory infections without going to the physician.

D. How to recognize the signs of an impending respiratory infection.

Correct Answer: D. How to recognize the signs of an impending respiratory infection.

18. Question

Which of the following respiratory disorders is most common in the first 24 to 48 hours after surgery?

A. Atelectasis

B. Bronchitis

C. Pneumonia

D. Pneumothorax

Correct Answer: A. Atelectasis

19. Question

Which of the following measures can reduce or prevent the incidence of atelectasis in a postoperative client?

A. Chest physiotherapy

B. Mechanical ventilation

C. Reducing oxygen requirements

D. Use of an incentive spirometer.

Correct Answer: D. Use of an incentive spirometer.

20. Question

Emergency treatment of a client in status asthmaticus includes which of the following medications?

A. Inhaled beta-adrenergic agents

B. Inhaled corticosteroids

C. I.V. beta-adrenergic agents

D. Oral corticosteroids

Correct Answer: A. Inhaled beta-adrenergic agents

21. Question

Which of the following treatment goals is best for the client with status asthmaticus?

A. Avoiding intubation.

B. Determining the cause of the attack.

C. Improving exercise tolerance.

D. Reducing secretions.

Correct Answer: A. Avoiding intubation

22. Question

Dani was given Dilaudid for pain. She’s sleeping and her respiratory rate is 4 breaths/minute. If action isn’t taken quickly, she might have which of the following reactions?

A. Asthma attack

B. Respiratory arrest

C. Improve cardiac output

D. Constipation

Correct Answer: B. Respiratory arrest

23. Question

Which of the following additional assessment data should immediately be gathered to determine the status of a client with a respiratory rate of 4 breaths/minute?

A. Arterial blood gas (ABG) and breath sounds.

B. Level of consciousness and a pulse oximetry value.

C. Breath sounds and reflexes.

D. Pulse oximetry value and heart sounds.

Correct Answer: B. Level of consciousness and a pulse oximetry value.

24. Question

A client is in danger of respiratory arrest following the administration of a narcotic analgesic. An arterial blood gas value is obtained. The nurse would expect PaCO2 to be which of the following values?

A. 15 mm Hg

B. 30 mm Hg

C. 40 mm Hg

D. 80 mm Hg

Correct Answer: D. 80 mm Hg

25. Question

A client has started a new drug for hypertension. Thirty minutes after he takes the drug, he develops chest tightness and becomes short of breath and tachypnea. He has a decreased level of consciousness. These signs indicate which of the following conditions?

A. Asthma attack

B. Pulmonary embolism

C. Respiratory failure

D. Rheumatoid arthritis

Correct Answer: C. Respiratory Failure

26. Question

Emergency treatment for a client with impending anaphylaxis secondary to hypersensitivity to a drug should include which of the following actions first?

A. Administering oxygen.

B. Inserting an I.V. catheter.

C. Obtaining a complete blood count (CBC).

D. Taking vital signs.

Correct Answer: A. Administering oxygen.

27. Question

Following the initial care of a client with asthma and impending anaphylaxis from hypersensitivity to a drug, the nurse should take which of the following steps next?

A. Administer beta-adrenergic blockers.

B. Administer bronchodilators.

C. Obtain serum electrolyte levels.

D. Have the client lie flat in the bed.

Correct Answer: B. Administer bronchodilators.

28. Question

A client’s ABG results are as follows: pH: 7.16; PaCO2 80 mm Hg; PaO2 46 mm Hg; HCO3- 24 mEq/L; SaO2 81%. This ABG result represents which of the following conditions?

A. Metabolic acidosis

B. Metabolic alkalosis

C. Respiratory acidosis

D. Respiratory alkalosis

Correct Answer: C. Respiratory acidosis

29. Question

A nurse plans care for a client with chronic obstructive pulmonary disease, knowing that the client is most likely to experience what type of acid-base imbalance?

A. Respiratory acidosis

B. Respiratory alkalosis

C. Metabolic acidosis

D. Metabolic alkalosis

Correct Answer: A. Respiratory acidosis

30. Question

A nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a PCO2 of 30 mm Hg. The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in this condition?

A. Sodium level of 145 mEq/L

B. Potassium level of 3.0 mEq/L

C. Magnesium level of 2.0 mg/L

D. Phosphorus level of 4.0 mg/dl

Correct Answer: B. Potassium level of 3.0 mEq/L

SECTION 4 

1. The nurse is caring for a male client with a chest tube. If the chest drainage system is accidentally disconnected, what should the nurse plan to do?  

A. 

Place the end of the chest tube in a container of sterile saline.

B. 

Apply an occlusive dressing and notify the physician.

C. 

Clamp the chest tube immediately.

D. 

Secure the chest tube with tape.

Correct Answer

A. Place the end of the chest tube in a container of sterile saline.

2. A male elderly client is admitted to an acute care facility with influenza. The nurse monitors the client closely for complications. What is the most common complication of influenza?

A. Septicemia

B. Pneumonia

C. Meningitis

D. Pulmonary edema

Correct Answer

B. Pneumonia

3. A female client has a tracheostomy but doesn’t require continuous mechanical ventilation. When weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the tube for:

A. 5 to 60 seconds.

B. 5 to 20 minutes.

C. 30 to 40 minutes.

D. 45 to 60 minutes.

Correct Answer

B. 5 to 20 minutes.

4. Gina, a home health nurse, is visiting a home care client with advanced lung cancer. Upon assessing the client, the nurse discovers wheezing, bradycardia, and a respiratory rate of 10 breaths/minute. These signs are associated with which condition?

A. Hypoxia

B. Delirium

C. Hyperventilation

D. Semiconsciousness

Correct Answer

A. Hypoxia

5. A male client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?

A. PH 5.0; PaCO2 30 mm Hg

B. PH 7.40; PaCO2 35 mm Hg

C. PH 7.35; PaCO2 40 mm Hg

D. PH 7.25; PaCO2 50 mm Hg

Correct Answer

D. PH 7.25; PaCO2 50 mm Hg

6. A female client with interstitial lung disease is prescribed prednisone (Deltasone) to control inflammation. During client teaching, the nurse stresses the importance of taking prednisone exactly as prescribed and cautions against discontinuing the drug abruptly. A client who discontinues prednisone abruptly may experience:

A. Hyperglycemia and glycosuria.

B. Acute adrenocortical insufficiency.

C. GI bleeding.

D. Restlessness and seizures.

Correct Answer

B. Acute adrenocortical insufficiency.

7. A male client is admitted to the health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this client?

A. Activity intolerance related to fatigue.

B. Anxiety related to actual threat to health status.

C. Risk for infection related to retained secretions.

D. Impaired gas exchange related to airflow obstruction.

Correct Answer

D. Impaired gas exchange related to airflow obstruction.

8. A male client abruptly sits up in bed, reports having difficulty breathing and have an arterial oxygen saturation of 88%. Which mode of oxygen delivery would most likely reverse the manifestations?

A. Simple mask

B. Non-rebreather mask

C. Face tent

D. Nasal cannula

Correct Answer

B. Non-rebreather mask

9. A male adult client with cystic fibrosis is admitted to an acute care facility with an acute respiratory infection. Prescribed respiratory treatment includes chest physiotherapy. When should the nurse perform this procedure?

A. Immediately before a meal

B. At least 2 hours after a meal

C. When bronchospasms occur

D. When secretions have mobilized

Correct Answer

B. At least 2 hours after a meal

10. On arrival at the intensive care unit, a critically ill female client suffers respiratory arrest and is placed on mechanical ventilation. The physician orders pulse oximetry to monitor the client’s arterial oxygen saturation (SaO2) noninvasively. Which vital sign abnormality may alter pulse oximetry values?

A. Fever

B. Tachypnea

C. Tachycardia

D. Hypotension

Correct Answer

D. Hypotension

11. The nurse is caring for a male client who recently underwent a tracheostomy. The first priority when caring for a client with a tracheostomy is:

A. Helping him communicate

B. Keeping his airway patent

C. Encouraging him to perform activities of daily living

D. Preventing him from developing an infection

Correct Answer

B. Keeping his airway patent

12. For a male client with chronic obstructive pulmonary disease, which nursing intervention would help maintain a patent airway?

A. Restricting fluid intake to 1,000 ml/day

B. Enforcing absolute bed rest

C. Teaching the client how to perform controlled coughing

D. Administering prescribed sedatives regularly and in large amounts

Correct Answer

C. Teaching the client how to perform controlled coughing

13. The amount of air inspired and expired with each breath is called:

A. Tidal volume.

B. Residual volume.

C. Vital capacity.

D. Dead-space volume.

Correct Answer

A. Tidal volume.

14. A male client with pneumonia develops respiratory failure and has a partial pressure of arterial oxygen of 55 mm Hg. He’s placed on mechanical ventilation with a fraction of inspired oxygen (FIO2) of 0.9. The nursing goal should be to reduce the FIO2 to no greater than:

A. 0.21

B. 0.35

C. 0.5

D. 0.7

Correct Answer

C. 0.5

15. Nurse Mickey is administering a purified protein derivative (PPD) test to a homeless client. Which of the following statements concerning PPD testing is true?

A. A positive reaction indicates that the client has active tuberculosis (TB).

B. A positive reaction indicates that the client has been exposed to the disease.

C. A negative reaction always excludes the diagnosis of TB.

D. The PPD can be read within 12 hours after the injection.

Correct Answer

B. A positive reaction indicates that the client has been exposed to the disease.

16. Nurse Murphy administers albuterol (Proventil), as prescribed to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect?

A. Respiratory rate of 22 breaths/minute.

B. Dilated and reactive pupils.

C. Urine output of 40 ml/hour.

D. Heart rate of 100 beats/minute.

Correct Answer

A. Respiratory rate of 22 breaths/minute.

17. What is the normal pH range for arterial blood?

A. 7 to 7.49

B. 7.35 to 7.45

C. 7.50 to 7.60

D. 7.55 to 7.65

Correct Answer

B. 7.35 to 7.45

18. Before weaning a male client from a ventilator, which assessment parameter is most important for the nurse to review?

A. Fluid intake for the last 24 hours.

B. Baseline arterial blood gas (ABG) levels.

C. Prior outcomes of weaning.

D. Electrocardiogram (ECG) results.

Correct Answer

B. Baseline arterial blood gas (ABG) levels.

19. Which of the following would be most appropriate for a male client with an arterial blood gas (ABG) of pH 7.5, PaCO2 26 mm Hg, O2 saturation 96%, HCO3 24 mEq/L, and PaO2 94 mm Hg?

A. Administer a prescribed decongestant.

B. Instruct the client to breathe into a paper bag.

C. Offer the client fluids frequently.

D. Administer prescribed supplemental oxygen.

Correct Answer

B. Instruct the client to breathe into a paper bag.

20. A female client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important?

A. PH

B. Bicarbonate (HCO3–)

C. Partial pressure of arterial oxygen (PaO2)

D. Partial pressure of arterial carbon dioxide (PaCO2)

Correct Answer

C. Partial pressure of arterial oxygen (PaO2)

21. Nurse Julia is caring for a client who has a tracheostomy and temperature of 103° F (39.4° C). Which of the following interventions will most likely lower the client’s arterial blood oxygen saturation?

A. Endotracheal suctioning.

B. Encouragement of coughing.

C. Use of a cooling blanket.

D. Incentive spirometry.

Correct Answer

A. Endotracheal suctioning.

22. For a male client who has a chest tube connected to a closed water-seal drainage system, the nurse should include which action in the plan of care?

A. Measuring and documenting the drainage in the collection chamber.

B. Maintaining continuous bubbling in the water-seal chamber.

C. Keeping the collection chamber at chest level.

D. Stripping the chest tube every hour.

Correct Answer

A. Measuring and documenting the drainage in the collection chamber.

23. Nurse Eve formulates a nursing diagnosis of Activity intolerance related to inadequate oxygenation and dyspnea for a client with chronic bronchitis. To minimize this problem, the nurse instructs the client to avoid conditions that increase oxygen demands. Such conditions include:

A. Drinking more than 1,500 ml of fluid daily.

B. Being overweight.

C. Eating a high-protein snack at bedtime.

D. Eating more than three large meals a day.

Correct Answer

B. Being overweight.

24. A black male client with asthma seeks emergency care for acute respiratory distress. Because of this client’s dark skin, the nurse should assess for cyanosis by inspecting the:

A. Lips

B. Mucous membranes

C. Nail beds

D. Earlobes

Correct Answer

B. Mucous membranes

25. A female client with asthma is receiving a theophylline preparation to promote bronchodilation. Because of the risk of drug toxicity, the nurse must monitor the client’s serum theophylline level closely. The nurse knows that the therapeutic theophylline concentration falls within which range?

A. 1 to 2 mcg/ml

B. 2 to 5 mcg/ml

C. 5 to 10 mcg/ml

D. 10 to 20 mcg/ml

Correct Answer

D. 10 to 20 mcg/ml

26. A male client is to receive I.V. vancomycin (Vancocin). When preparing to administer this drug, the nurse should keep in mind that:

A. Vancomycin should be infused over 60 to 90 minutes in a large volume of fluid.

B. Vancomycin may cause irreversible neutropenia.

C. Vancomycin should be administered rapidly in a large volume of fluid.

D. Vancomycin should be administered over 1 to 2 minutes as an I.V. bolus.

Correct Answer

A. Vancomycin should be infused over 60 to 90 minutes in a large volume of fluid.

27. Before seeing a newly assigned female client with respiratory alkalosis, the nurse quickly reviews the client’s medical history. Which condition is a predisposing factor for respiratory alkalosis?

A. Myasthenia gravis.

B. Type 1 diabetes mellitus.

C. Extreme anxiety.

D. Narcotic overdose.

Correct Answer

C. Extreme anxiety.

28. At 11 p.m., a male client is admitted to the emergency department. He has a respiratory rate of 44 breaths/minute. He’s anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone (Depo-Medrol) I.V. At 11:30 p.m., the client’s arterial blood oxygen saturation is 86% and he’s still wheezing. The nurse should plan to administer:

A. Alprazolam (Xanax)

B. Propranolol (Inderal)

C. Morphine

D. Albuterol (Proventil)

Correct Answer

D. Albuterol (Proventil)

29. Pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?

A. Encouraging the client to drink three glasses of fluid daily.

B. Keeping the client in semi-Fowler’s position.

C. Using a high-flow Venturi mask to deliver oxygen as prescribed.

D. Administering a sedative as prescribed.

Correct Answer

C. Using a high-flow Venturi mask to deliver oxygen as prescribed.

30. Nurse Joana is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide?

A. It increases inspiratory muscle strength.

B. It decreases use of accessory breathing muscles.

C. It prolongs the inspiratory phase of respiration.

D. It helps prevent early airway collapse.

Correct Answer

D. It helps prevent early airway collapse.

SECTION 5

1.A male patient has a sucking stab wound to the chest. Which action should the nurse take first?

ADrawing blood for a hematocrit and hemoglobin level

BApplying a dressing over the wound and taping it on three sides

CPreparing a chest tube insertion tray

DPreparing to start an I.V. line

B

2.A male patient is admitted to the health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this patient?

AActivity intolerance related to fatigue

BAnxiety related to actual threat to health status

CRisk for infection related to retained secretions

DImpaired gas exchange related to airflow obstruction

D

3.A male adult patient hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis?

A Nausea or vomiting

BAbdominal pain or diarrhea

CHallucinations or tinnitus

DLightheadedness or parenthesis 

D

4.Before administering ephedrine, Nurse Tony assesses the patient’s history. Because of ephedrine’s central nervous system (CNS) effects, it is not recommended for:

A Patients with an acute asthma attack

B Patients with narcolepsy

C Patients under age 6

D Elderly patients

D

5.A female patient suffers adult respiratory distress syndrome as a consequence of shock. The patient’s condition deteriorates rapidly, and endotracheal intubation and mechanical ventilation are initiated. When the high pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high pressure alarm?

A Kinking of the ventilator tubing

B A disconnected ventilator tube

C An endotracheal cuff leak

D A change in the oxygen concentration without resetting the oxygen level alarm

A

6. A male adult patient on mechanical ventilation is receiving pancuronium bromide (Pavulon), 0.01 mg/kg I.V. as needed. Which assessment finding indicates that the patient needs another pancuronium dose?

A Leg movement

B Finger movement

C Lip movement

D Fighting the ventilator

D

7.On auscultation, which finding suggests a right pneumothorax?

A Bilateral inspiratory and expiratory crackles

B Absence of breaths sound in the right thorax

C Inspiratory wheezes in the right thorax

D Bilateral pleural friction rub

B

8.Rhea, confused and short breath, is brought to the emergency department by a family member. The medical history reveals chronic bronchitis and hypertension. To learn more about the current respiratory problem, the doctor orders a chest x-ray and arterial blood gas (ABG) analysis. When reviewing the ABG report, the nurses sees many abbreviations. What does a lowercase “a” in ABG value present?

A Acid-base balance

B Arterial Blood

C Arterial oxygen saturation

D Alveol

B.

9. Nurse Ruth assessing a patient for tracheal displacement should know that the trachea will deviate toward the:

A Contralateral side in a simple pneumothorax

B Affected side in a hemothorax

C Affected side in a tension pneumothorax

D Contralateral side in hemothorax

D. 

10. After undergoing a left pneumonectomy, a female patient has a chest tube in place for drainage. When caring for this patient, the nurse must:

A Monitor fluctuations in the water-seal chamber

B Clamp the chest tube once every shift

C Encourage coughing and deep breathing

D Milk the chest tube every 2 hours

C

11. For a patient with advance chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?

A Encouraging the patient to drink three glasses of fluid daily

B Keeping the patient in semi-fowler’s position

C Using a high-flow venturi mask to deliver oxygen as prescribe

D Administering a sedative, as prescribe

C

12. A male patient’s X-ray result reveals bilateral white-outs, indicating adult respiratory distress syndrome (ARDS). This syndrome results from:

A Cardiogenic pulmonary edema

B Respiratory alkalosis

C Increased pulmonary capillary permeability

D Renal failure

C

13. Nurse Lei caring for a client with a pneumothorax and who has had a chest tube inserted notes continues gentle bubbling in the suction control chamber. What action is appropriate?

A Do nothing, because this is an expected finding

B Immediately clamp the chest tube and notify the physician

C Check for an air leak because the bubbling should be intermittent

D Increase the suction pressure so that the bubbling becomes vigorous

A

14 .Nurse Maureen has assisted a physician with the insertion of a chest tube. The nurse monitors the client and notes fluctuation of the fluid level in the water seal chamber after the tube is inserted. Based on this assessment, which action would be appropriate?

A Inform the physician

B Continue to monitor the client

C Reinforce the occlusive dressing

D Encourage the client to deep-breathe

B

15. Nurse Reynolds caring for a client with a chest tube turns the client to the side, and the chest tube accidentally disconnects. The initial nursing action is to:

A Call the physician

B Place the tube in bottle of sterile water

C Immediately replace the chest tube system

D Place a sterile dressing over the disconnection site

B

16.A nurse is assisting a physician with the removal of a chest tube. The nurse should instruct the client to:

A Exhale slowly

B Stay very still

C Inhale and exhale quickly

D Perform the Valsalva maneuver

D

17. While changing the tapes on a tracheostomy tube, the male client coughs and tube is dislodged. The initial nursing action is to:

A Call the physician to reinsert the tube

B Grasp the retention sutures to spread the opening

C Call the respiratory therapy department to reinsert the tracheotomy

D Cover the tracheostomy site with a sterile dressing to prevent infection

B

18. Nurse Oliver is caring for a client immediately after removal of the endotracheal tube. The nurse reports which of the following signs immediately if experienced by the client?

A Stridor

B Occasional pink-tinged sputum

C A few basilar lung crackles on the right

D Respiratory rate 24 breaths/min

A

19. An emergency room nurse is assessing a male client who has sustained a blunt injury to the chest wall. Which of these signs would indicate the presence of a pneumothorax in this client?

A A low respiratory rate

B Diminished breath sounds

C The presence of a barrel chest

D A sucking sound at the site of injury

B

20.Nurse Reese is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which of the following would the nurse expect to note on assessment of this client?

A Hypocapnia

B A hyperinflated chest noted on the chest x-ray

C Increased oxygen saturation with exercise

D A widened diaphragm noted on the chest x-ray

B

21.An oxygen delivery system is prescribed for a male client with chronic obstructive pulmonary disease to deliver a precise oxygen concentration. Which of the following types of oxygen delivery systems would the nurse anticipate to be prescribed?

A Face tent

B Venturi mask

C Aerosol mask

D Tracheostomy collar

B

22.Blessy, a community health nurse is conducting an educational session with community members regarding tuberculosis. The nurse tells the group that one of the first symptoms associated with tuberculosis is:

A Dyspnea

B Chest pain

C A bloody, productive cough

D A cough with the expectoration of mucoid sputum

D

23. A nurse performs an admission assessment on a female client with a diagnosis of tuberculosis. The nurse reviews the result of which diagnosis test that will confirm this diagnosis?

A Bronchoscopy

B Sputum culture

C Chest x-ray

D Tuberculin skin test

B

23.A nurse is caring for a male client with emphysema who is receiving oxygen. The nurse assesses the oxygen flow rate to ensure that it does not exceed:

A 1 L/min

B 2 L/min

C 6 L/min

D 10 L/min

B

24. A nurse instructs a female client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to:

A Promote oxygen intake

B Strengthen the diaphragm

C Strengthen the intercostal muscles

D Promote carbon dioxide elimination

D

25. A nurse is caring for a male client with acute respiratory distress syndrome. Which of the following would the nurse expect to note in the client?

A Pallor

B Low arterial PaO2

C Elevated arterial PaO2

D Decreased respiratory rate

B

26. A nurse is preparing to obtain a sputum specimen from a male client. Which of the following nursing actions will facilitate obtaining the specimen?

ALimiting fluid

BHaving the client take deep breaths

CAsking the client to spit into the collection container

DAsking the client to obtain the specimen after eating

B

27. Nurse Joy is caring for a client after a bronchoscopy and biopsy. Which of the following signs, if noticed in the client, should be reported immediately to the physician?

A Dry cough

B Hematuria

CBronchospasm

DBlood-streaked sputum

C

28. A nurse is suctioning fluids from a male client via a tracheostomy tube. When suctioning, the nurse must limit the suctioning time to a maximum of:

A1 minute

B5 seconds

C10 seconds

D30 seconds

C

29. A nurse is suctioning fluids from a female client through an endotracheal tube. During the suctioning procedure, the nurse notes on the monitor that the heart rate is decreasing. Which if the following is the appropriate nursing intervention?

AContinue to suction

BNotify the physician immediately

C Stop the procedure and reoxygenate the client

DEnsure that the suction is limited to 15 seconds

C

30. A male adult client is suspected of having a pulmonary embolus. A nurse assesses the client, knowing that which of the following is a common clinical manifestation of pulmonary embolism?

A Dyspnea

B Bradypnea

C Bradycardia

D Decreased respirations

A

31. A slightly obese female client with a history of allergy-induced asthma, hypertension, and mitral valve prolapse is admitted to an acute care facility for elective surgery. The nurse obtains a complete history and performs a thorough physical examination, paying special attention to the cardiovascular and respiratory systems. When percussing the client’s chest wall, the nurse expects to elicit:

A Resonant sounds

B Hyperresonant sounds

C Dull sounds

D Flat sounds

A 

32. Which phrase is used to describe the volume of air inspired and expired with a normal breath?

Tidal volume

33. A male client abruptly sits up in bed, reports having difficulty breathing and has an arterial oxygen saturation of 88%. Which mode of oxygen delivery would most likely reverse the manifestations?

A Simple mask

B Non-rebreather mask

C Face tent

D Nasal cannula

B

34. A female client must take streptomycin for tuberculosis. Before therapy begins, the nurse should instruct the client to notify the physician if which health concern occurs?

A Impaired color discrimination

B Increased urinary frequency

C Decreased hearing acuity

D Increased appetite

C

35. A male client is asking the nurse a question regarding the Mantoux test for tuberculosis. The nurse should base her response on the fact that the:

A Area of redness is measured in 3 days and determines whether tuberculosis is present.

B Skin test doesn’t differentiate between active and dormant tuberculosis infection.

C Presence of a wheal at the injection site in 2 days indicates active tuberculosis.

D Test stimulates a reddened response in some clients and requires a second test in 3 months.

B

36. A female adult client has a tracheostomy but doesn’t require continuous mechanical ventilation. When weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the tube for:

A15 to 60 seconds

B 5 to 20 minutes

C30 to 40 minutes

D 45 to 60 minutes

B

37. Nurse Oliver observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude?

AThe system is functioning normally

B The client has a pneumothorax

C The system has an air leak

D The chest tube is obstructed

C

38. A black client with asthma seeks emergency care for acute respiratory distress. Because of this client’s dark skin, the nurse should assess for cyanosis by inspecting the:

A Lips

B Mucous membranes

C Nail beds

D Earlobes

B

39. For a male client with an endotracheal (ET) tube, which nursing action is most essential?

A Auscultating the lungs for bilateral breath sounds

B Turning the client from side to side every 2 hours

C Monitoring serial blood gas values every 4 hours

D Providing frequent oral hygiene

A

40. A male client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can’t produce an effective cough, the nurse should monitor closely for:

A Pleural effusion

B Pulmonary edema

C Atelectasis

D Oxygen toxicity

C

41. The nurse in charge is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide?

A It helps prevent early airway collapse

B It increases inspiratory muscle strength

C It decreases use of accessory breathing muscles

D It prolongs the inspiratory phase of respiration

A

42. A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?

A pH, 5.0; PaCO2 30 mm Hg

B pH, 7.40; PaCO2 35 mm Hg

C pH, 7.35; PaCO2 40 mm Hg

D pH, 7.25; PaCO2 50 mm Hg

D 

ANATOMY AND PHYSIOLOGY OF THE CNS

SECTION 1

1. Question

A 68-year-old male patient who had a left-sided stroke is admitted to the hospital. The patient has right-sided weakness and is unable to perform activities of daily living without assistance. The nurse is providing oral hygiene to the patient and is preparing to use a padded tongue blade to open the patient’s mouth. Which nursing measure is inappropriate when providing oral hygiene to the patient who had a stroke?

A. Placing the client on the back with a small pillow under the head.

B. Keeping portable suctioning equipment at the bedside.

C. Opening the client’s mouth with a padded tongue blade.

D. Cleaning the client’s mouth and teeth with a toothbrush.

Correct Answer: A. 

2. Question

A 64-year-old client with a history of hypertension is admitted to the emergency department with sudden onset right-sided weakness, facial droop, and difficulty speaking. Which nursing intervention is the highest priority in the initial management of this client?

A. Prepare to administer recombinant tissue plasminogen activator (rt-PA).

B. Discuss the precipitating factors that caused the symptoms.

C. Schedule for A STAT computer tomography (CT) scan of the head.

D. Notify the speech pathologist for an emergency consultation.

Correct Answer: C. 

3. Question

A client arrives in the emergency department with an ischemic stroke and receives tissue plasminogen activator (t-PA) administration. Which is the priority nursing assessment?

A. Time of onset of current stroke

B. Complete physical and history

C. Current medications

D. Upcoming surgical procedures

Correct Answer: A. Time of onset of current stroke

4. Question

During the first 24 hours after thrombolytic therapy for ischemic stroke, the primary goal is to control the client’s:

A. Pulse

B. Respirations

C. Blood pressure

D. Temperature

Correct Answer: C. Blood pressure

5. Question

What is a priority nursing assessment in the first 24 hours after admission of the client with a thrombotic stroke?

A. Cholesterol level

B. Pupil size and pupillary response

C. Bowel sounds

D. Echocardiogram

Correct Answer: B. Pupil size and pupillary response

6. Question

What is the expected outcome of thrombolytic drug therapy?

A. Increased vascular permeability

B. Vasoconstriction

C. Dissolved emboli

D. Prevention of hemorrhage

Correct Answer: C. Dissolved emboli.

7. Question

The client diagnosed with atrial fibrillation has experienced a transient ischemic attack (TIA). Which medication would the nurse anticipate being ordered for the client on discharge?

A. A thrombolytic medication

B. A beta-blocker medication

C. An anti-hyperuricemic medication

D. An oral anticoagulant medication

Correct Answer: D. An oral anticoagulant medication.

8. Question

Which client would the nurse identify as being most at risk for experiencing a CVA?

A. A 39-year-old pregnant female.

B. A 67-year-old Caucasian male.

C. An 84-year-old Japanese female.

D. A 55-year-old African American male

Correct Answer: D. A 55-year-old African American male.

9. Which assessment data would indicate to the nurse that the client would be at risk for a hemorrhagic stroke?

A. A blood glucose level of 480 mg/dl.

B. A right-sided carotid bruit.

C. A blood pressure of 220/120 mmHg.

D. The presence of bronchogenic carcinoma.

Correct Answer: C. A blood pressure of 220/120 mmHg.

10. Question

The nurse and unlicensed assistive personnel (UAP) are caring for a client with right-sided paralysis. Which action by the UAP requires the nurse to intervene?

A. The assistant places a gait belt around the client’s waist prior to ambulating.

B. The assistant places the client on the back with the client’s head to the side.

C. The assistant places her hand under the client’s right axilla to help him/her move up in bed.

D. The assistant praises the client for attempting to perform ADL’s independently.

Correct Answer: C. The assistant places her hand under the client’s right axilla to help him/her move up in bed.

11. Question

A client admitted to the hospital with a subarachnoid hemorrhage has complaints of severe headache, nuchal rigidity, and projectile vomiting. The nurse knows lumbar puncture (LP) would be contraindicated in this client in which of the following circumstances?

A. Vomiting continues.

B. Intracranial pressure (ICP) is increased.

C. The client needs mechanical ventilation.

D. Blood is anticipated in the cerebrospinal fluid (CSF).

Correct Answer: B. Intracranial pressure (ICP) is increased.

12. Question

A client with a subdural hematoma becomes restless and confused, with dilation of the ipsilateral pupil. The physician orders mannitol for which of the following reasons?

A. To reduce intraocular pressure.

B. To prevent acute tubular necrosis.

C. To promote osmotic diuresis to decrease ICP.

D. To draw water into the vascular system to increase blood pressure.

Correct Answer: C. To promote osmotic diuresis to decrease ICP.

13 A client with subdural hematoma was given mannitol to decrease intracranial pressure (ICP). Which of the following results would best show the mannitol was effective?

A. Urine output increases.

B. Pupils are 8 mm and nonreactive.

C. Systolic blood pressure remains at 150 mm Hg.

D. BUN and creatinine levels return to normal

Correct Answer: A. Urine output increases.

14. Question

Which of the following values is considered normal for ICP?

A. 0 to 15 mm Hg

B. 25 mm Hg

C. 35 to 45 mm Hg

D. 120/80 mm Hg

Correct Answer: A. 0 to 15 mm Hg

15. Question

Which of the following symptoms may occur with a phenytoin level of 32 mg/dl?

A. Ataxia and confusion

B. Sodium depletion

C. Tonic-clonic seizure

D. Urinary incontinence

Correct Answer: A. Ataxia and confusion

16. Question

Which of the following signs and symptoms of increased ICP after head trauma would appear first?

A. Bradycardia

B. Large amounts of very dilute urine

C. Restlessness and confusion

D. Widened pulse pressure

Correct Answer: C. Restlessness and confusion

17. Question

Problems with memory and learning would relate to which of the following lobes?

A. Frontal

B. Occipital

C. Parietal

D. Temporal

Correct Answer: D. Temporal

18. Question

While cooking, your client couldn’t feel the temperature of a hot oven. Which lobe could be dysfunctional?

A. Frontal

B. Occipital

C. Parietal

D. Temporal

Correct Answer: C. Parietal

19. Question

The nurse is assessing the motor function of an unconscious client. The nurse would plan to use which of the following to test the client’s peripheral response to pain?

A. Sternal rub

B. Pressure on the orbital rim

C. Squeezing the sternocleidomastoid muscle

D. Nail bed pressure

Correct Answer: D. Nail bed pressure

20. Question

The client is having a lumbar puncture performed. The nurse would plan to place the client in which position for the procedure?

A. Side-lying, with legs pulled up and head bent down onto the chest.

B. Side-lying, with a pillow under the hip.

C. Prone, in a slight Trendelenburg’s position.

D. Prone, with a pillow under the abdomen.

Correct Answer: A. Side-lying, with legs pulled up and head bent down onto the chest

21. Question

A nurse is assisting with caloric testing of the oculovestibular reflex of an unconscious client. Cold water is injected into the left auditory canal. The client exhibits eye conjugate movements toward the left followed by a rapid nystagmus toward the right. The nurse understands that this indicates the client has:

A. A cerebral lesion

B. A temporal lesion

C. An intact brainstem

D. Brain death

Correct Answer: C. An intact brainstem

22. Question

The nurse is caring for the client with increased intracranial pressure. The nurse would note which of the following trends in vital signs if the ICP is rising?

A. Increasing temperature, increasing pulse, increasing respirations, decreasing blood pressure.

B. Increasing temperature, decreasing pulse, decreasing respirations, increasing blood pressure.

C. Decreasing temperature, decreasing pulse, increasing respirations, decreasing blood pressure.

D. Decreasing temperature, increasing pulse, decreasing respirations, increasing blood pressure.

Correct Answer: B. Increasing temperature, decreasing pulse, decreasing respirations, increasing blood pressure.

23. Question

The nurse is evaluating the status of a client who had a craniotomy 3 days ago. The nurse would suspect the client is developing meningitis as a complication of surgery if the client exhibits:

A. A negative Kernig’s sign.

B. A positive Brudzinski’s sign.

C. Absence of nuchal rigidity.

D. A Glascow Coma Scale score of 15.

Correct Answer: B. A positive Brudzinski’s sign

24. Question

A client is arousing from a coma and keeps saying, “Just stop the pain.” The nurse responds based on the knowledge that the human body typically and automatically responds to pain first with attempts to:

A. Tolerate the pain.

B. Decrease the perception of pain.

C. Escape the source of pain.

D. Divert attention from the source of pain.

Correct Answer: C. Escape the source of pain.

25. Question

During the acute stage of meningitis, a 3-year-old child is restless and irritable. Which of the following would be most appropriate to institute?

A. Limiting conversation with the child.

B. Allowing the child to play in the bathtub.

C. Keeping extraneous noise to a minimum.

D. Performing treatments quickly.

Correct Answer: C. Keeping extraneous noise to a minimum

26. Question

Which of the following would lead the nurse to suspect that a child with meningitis has developed disseminated intravascular coagulation?

A. Hemorrhagic skin rash

B. Edema

C. Cyanosis

D. Dyspnea on exertion

Correct Answer: A. Hemorrhagic skin rash

27. Question

When interviewing the parents of a 2-year-old child, a history of which of the following illnesses would lead the nurse to suspect pneumococcal meningitis?

A. Bladder infection

B. Middle ear infection

C. Fractured clavicle

D. Septic arthritis

Correct Answer: B. Middle ear infection

28. Question

The nurse is assessing a child diagnosed with a brain tumor. Which of the following signs and symptoms would the nurse expect the child to demonstrate? Select all that apply.

A. Increased appetite

B. Vomiting

C. Polydipsia

D. Lethargy

E. Head tilt

F. Increased pulse

Correct Answer: B, D & E

29. Question

A lumbar puncture is performed on a child suspected of having bacterial meningitis. CSF is obtained for analysis. A nurse reviews the results of the CSF analysis and determines which of the following results would verify the diagnosis?

A. Cloudy CSF, decreased protein, and decreased glucose.

B. Cloudy CSF, elevated protein, and decreased glucose.

C. Clear CSF, elevated protein, and decreased glucose.

D. Clear CSF, decreased pressure, and elevated protein.

Correct Answer: B. Cloudy CSF, elevated protein, and decreased glucose.

30. Question

A nurse is planning care for a child with acute bacterial meningitis. Based on the mode of transmission of this infection, which of the following would be included in the plan of care?

A. No precautions are required as long as antibiotics have been started.

B. Maintain enteric precautions.

C. Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics.

D. Maintain neutropenic precautions.

Correct Answer: C. Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics

31. Question

A nurse is reviewing the record of a child with increased ICP and notes that the child has exhibited signs of decerebrate posturing. On assessment of the child, the nurse would expect to note which of the following if this type of posturing was present?

A. Abnormal flexion of the upper extremities and extension of the lower extremities.

B. Rigid extension and pronation of the arms and legs.

C. Rigid pronation of all extremities.

D. Flaccid paralysis of all extremities.

Correct Answer: B. Rigid extension and pronation of the arms and legs.

32. Question

Which of the following assessment data indicated nuchal rigidity?

A. Positive Kernig’s sign

B. Negative Brudzinski’s sign

C. Positive homan’s sign

D. Negative Kernig’s sign

Correct Answer: A. Positive Kernig’s sign

33. Question

Meningitis occurs as an extension of a variety of bacterial infections due to which of the following conditions?

A. Congenital anatomic abnormality of the meninges.

B. Lack of acquired resistance to the various etiologic organisms.

C. Occlusion or narrowing of the CSF pathway.

D. Natural affinity of the CNS to certain pathogens.

Correct Answer: B. Lack of acquired resistance to the various etiologic organisms.

34. Question

Which of the following pathologic processes is often associated with aseptic meningitis?

A. Ischemic infarction of cerebral tissue.

B. Childhood diseases of viral causation such as mumps.

C. Brain abscesses caused by a variety of pyogenic organisms.

D. Cerebral ventricular irritation from a traumatic brain injury.

Correct Answer: B. Childhood diseases of viral causation such as mumps.

35. Question

You are preparing to admit a patient with a seizure disorder. Which of the following actions can you delegate to LPN/LVN?

A. Complete admission assessment.

B. Place a padded tongue blade at the bedside.

C. Set up oxygen and suction equipment.

D. Pad the side rails before the patient arrives.

Correct Answer: C. Set up oxygen and suction equipment.

36. Question

If a male client experienced a cerebrovascular accident (CVA) that damaged the hypothalamus, the nurse would anticipate that the client has problems with:

A. Body temperature control

B. Balance and equilibrium

C. Visual acuity

D. Thinking and reasoning

Correct Answer: A. Body temperature control

37. Question

A female client admitted to an acute care facility after a car accident develops signs and symptoms of increased intracranial pressure (ICP). The client is intubated and placed on mechanical ventilation to help reduce ICP. To prevent a further rise in ICP caused by suctioning, the nurse anticipates administering which drug endotracheally before suctioning?

A. phenytoin (Dilantin)

B. mannitol (Osmitrol)

C. lidocaine (Xylocaine)

D. furosemide (Lasix)

Correct Answer: C. lidocaine (Xylocaine)

38. Question

After striking his head on a tree while falling from a ladder, a young man age 18 is admitted to the emergency department. He’s unconscious and his pupils are nonreactive. Which intervention would be the most dangerous for the client?

A. Give him a barbiturate.

B. Place him on mechanical ventilation.

C. Perform a lumbar puncture.

D. Elevate the head of his bed.

Correct Answer: C. Perform a lumbar puncture.

39. Question

When obtaining the health history from a male client with retinal detachment, the nurse expects the client to report:

A. Light flashes and floaters in front of the eye.

B. A recent driving accident while changing lanes.

C. Headaches, nausea, and redness of the eyes.

D. Frequent episodes of double vision.

Correct Answer: A. Light flashes and floaters in front of the eye.

40. Question

Which nursing diagnosis takes highest priority for a client with Parkinson’s crisis?

A. Imbalanced nutrition: Less than body requirements

B. Ineffective airway clearance

C. Impaired urinary elimination

D. Risk for injury

Correct Answer: B. Ineffective airway clearance

41. Question

The nurse has given the male client with Bell’s palsy instructions on preserving muscle tone in the face and preventing denervation. The nurse determines that the client needs additional information if the client states that he or she will:

A. Wrinkle the forehead, blow out the cheeks, and whistle.

B. Massage the face with a gentle upward motion.

C. Perform facial exercises.

D. Exposure to cold and drafts.

Correct Answer: D. Exposure to cold and drafts.

42. Question

A female client is admitted to the hospital with a diagnosis of Guillain-Barre syndrome. The nurse inquires during the nursing admission interview if the client has a history of:

A. Seizures or trauma to the brain.

B. Meningitis during the last five (5 years).

C. Back injury or trauma to the spinal cord.

D. Respiratory or gastrointestinal infection during the previous month.

Answer: D. Respiratory or gastrointestinal infection during the previous month.

43. Question

A female client with Guillain-Barre syndrome has ascending paralysis and is intubated and receiving mechanical ventilation. Which of the following strategies would the nurse incorporate in the plan of care to help the client cope with this illness?

A. Giving the client full control over care decisions and restricting visitors.

B. Providing positive feedback and encouraging active range of motion.

C. Providing information, giving positive feedback and encouraging relaxation.

D. Providing intravenously administered sedatives, reducing distractions and limiting visitors.

Correct Answer: C. Providing information, giving positive feedback, and encouraging relaxation.

44. Question

A male client has an impairment of cranial nerve II. Specific to this impairment, the nurse would plan to do which of the following to ensure the client to ensure client safety?

A. Speak loudly to the client.

B. Test the temperature of the shower water.

C. Check the temperature of the food on the delivery tray.

D. Provide a clear path for ambulation without obstacles.

Correct Answer: D. Provide a clear path for ambulation without obstacles.

45. Question

A female client has a neurological deficit involving the limbic system. Specific to this type of deficit, the nurse would document which of the following information related to the client’s behavior.

A. Is disoriented to person, place, and time.

B. Affect is flat, with periods of emotional lability.

C. Cannot recall what was eaten for breakfast today.

D. Demonstrate inability to add and subtract; does not know who is the president.

Correct Answer: B. Affect is flat, with periods of emotional lability.

46. Question

A client is admitted with a diagnosis of Sturge-Weber syndrome. Which of the following information would you expect to find in this client?

A. It is a dysfunction of the trigeminal nerve causing a severe sharp pain in the nose, lips, gums, or across the cheeks.

B. It is a non-progressive neurological disorder of the seventh cranial nerve causing paralysis of one of the sides of the face.

C. It is a rare degenerative brain disorder characterized by sudden development of progressive neurological and neuromuscular symptoms.

D. It is a neurocutaneous disorder with angiomas causing abnormalities in the skin, brain, and eyes from birth.

Correct Answer: D. It is a neurocutaneous disorder with angiomas causing abnormalities in the skin, brain, and eyes from birth.

47. Question

A client is admitted to the emergency room with a spinal cord injury. The client is complaining of lightheadedness, flushed skin above the level of the injury, and headache. The client’s blood pressure is 160/90 mm Hg. Which of the following is a priority action for the nurse to take?

A. Loosen tight clothing or accessories

B. Assess for any bladder distention

C. Raise the head of the bed

D. Administer anti hypertensive  

Correct Answer: C. Raise the head of the bed

48. Question

A client who had a stroke is seen bumping into things on the side and is having difficulty picking up the beginning of the next line of what he is reading. The client is experiencing which of the following conditions?

A. Visual neglect

B. Astigmatism

C. Blepharitis

D. Homonymous Hemianopsia

Correct Answer: D. Homonymous Hemianopsia

49. Question

Which of the following medical treatments should the nurse anticipate administering to a client with increased intracranial pressure due to brain hemorrhage, except?

A. acetaminophen (Tylenol)

B. dexamethasone (Decadron)

C. mannitol (Osmitrol)

D. phenytoin (Dilantin)

E. nitroglycerin (Nitrostat)

Correct Answer: E. nitroglycerin (Nitrostat)

50. Question

Which of the following symptoms would you expect to a client with a phenytoin level of 35 mg/dL?

A. Ataxia

B. Potassium deficit

C. Neglect syndrome

D. Tetraplegia

Correct Answer: A. Ataxia

SECTION 2

1. Question

To encourage adequate nutritional intake for a female client with Alzheimer’s disease, the nurse should:

A. Stay with the client and encourage him to eat.

B. Help the client fill out his menu.

C. Give the client privacy during meals.

D. Fill out the menu for the client.

Correct Answer: A. Stay with the client and encourage him to eat.

2. Question

The nurse is performing a mental status examination on a male client diagnosed with a subdural hematoma. This test assesses which of the following?

A. Cerebellar function

B. Intellectual function

C. Cerebral function

D. Sensory function

Correct Answer: C. Cerebral function

3. Question

Shortly after admission to an acute care facility, a male client with a seizure disorder develops status epilepticus. The physician orders diazepam (Valium) 10 mg I.V. stat. How soon can the nurse administer the second dose of diazepam, if needed and prescribed?

A. In 30 to 45 seconds

B. In 10 to 15 minutes

C. In 30 to 45 minutes

D. In 1 to 2 hours

Correct Answer: B. In 10 to 15 minutes

4. Question

A female client complains of periorbital aching, tearing, blurred vision, and photophobia in her right eye. Ophthalmologic examination reveals a small, irregular, nonreactive pupil — a condition resulting from acute iris inflammation (iritis). As part of the client’s therapeutic regimen, the physician prescribes atropine sulfate (Atropisol), two drops of 0.5% solution in the right eye twice daily. Atropine sulfate belongs to which drug classification?

A. Parasympathomimetic agent

B. Sympatholytic agent

C. Adrenergic blocker

D. Cholinergic blocker

Correct Answer: D. Cholinergic blocker

5. Question

Emergency medical technicians transport a 27-year-old ironworker to the emergency department. They tell the nurse, “He fell from a two-story building. He has a large contusion on his left chest and a hematoma in the left parietal area. He has a compound fracture of his left femur and he’s comatose. We intubated him and he’s maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manual resuscitation bag.” Which intervention by the nurse has the highest priority?

A. Assessing the left leg.

B. Assessing the pupils.

C. Placing the client in Trendelenburg’s position.

D. Assessing level of consciousness.

Correct Answer: A. Assessing the left leg.

6. Question

An auto mechanic accidentally has battery acid splashed in his eyes. His coworkers irrigate his eyes with water for 20 minutes, and then take him to the emergency department of a nearby hospital, where he receives emergency care for the corneal injury. The physician prescribes dexamethasone (Maxidex Ophthalmic Suspension), two drops of 0.1% solution to be instilled initially into the conjunctival sacs of both eyes every hour; and polymyxin B sulfate (Neosporin Ophthalmic), 0.5% ointment to be placed in the conjunctival sacs of both eyes every 3 hours. Dexamethasone exerts its therapeutic effect by:

A. Increasing the exudative reaction of ocular tissue.

B. Decreasing leukocyte infiltration at the site of ocular inflammation.

C. Inhibiting the action of carbonic anhydrase.

D. Producing a miotic reaction by stimulating and contracting the sphincter muscles of the iris.

Correct Answer: B. Decreasing leukocyte infiltration at the site of ocular inflammation.

7. Question

Nurse Amber is caring for a client who underwent a lumbar laminectomy two (2) days ago. Which of the following findings should the nurse consider abnormal?

A. More back pain than the first postoperative day.

B. Paresthesia in the dermatomes near the wounds.

C. Urine retention or incontinence.

D. Temperature of 99.2° F (37.3° C).

Correct Answer: C. Urine retention or incontinence.

8. Question

After an eye examination, a male client is diagnosed with open-angle glaucoma. The physician prescribes Pilocarpine ophthalmic solution (Pilocar), 0.25% gtt i, OU q.i.D. Based on this prescription, the nurse should teach the client or a family member to administer the drug by:

A. Instilling one drop of pilocarpine 0.25% into both eyes daily.

B. Instilling one drop of pilocarpine 0.25% into both eyes four times daily.

C. Instilling one drop of pilocarpine 0.25% into the right eye daily.

D. Instilling one drop of pilocarpine 0.25% into the left eye four times daily.

Correct Answer: B. Instilling one drop of pilocarpine 0.25% into both eyes four times daily.

9. Question

A female client who’s paralyzed on the left side has been receiving physical therapy and attending teaching sessions about safety. Which behavior indicates that the client accurately understands safety measures related to paralysis?

A. The client leaves the side rails down.

B. The client uses a mirror to inspect the skin.

C. The client repositions only after being reminded to do so.

D. The client hangs the left arm over the side of the wheelchair.

Correct Answer: B. The client uses a mirror to inspect the skin.

10. Question

A male client in the emergency department has a suspected neurologic disorder. To assess gait, the nurse asks the client to take a few steps; with each step, the client’s feet make a half-circle. To document the client’s gait, the nurse should use which term?

A. Ataxic

B. Dystrophic

C. Helicopod

D. Steppage

Correct Answer: C. Helicopod

11. Question

A client, age 22, is admitted with bacterial meningitis. Which hospital room would be the best choice for this client?

A. A private room down the hall from the nurses’ station.

B. An isolation room three doors from the nurses’ station.

C. A semi-private room with a 32-year-old client who has viral meningitis.

D. A two-bedroom with a client who previously had bacterial meningitis.

Correct Answer: B. An isolation room three doors from the nurses’ station

12. Question

A physician diagnoses a client with myasthenia gravis, prescribing pyridostigmine (Mestinon), 60 mg P.O. every 3 hours. Before administering this anticholinesterase agent, the nurse reviews the client’s history. Which preexisting condition would contraindicate the use of pyridostigmine?

A. Ulcerative colitis

B. Blood dyscrasia

C. Intestinal obstruction

D. Spinal cord injury

Correct Answer: C. Intestinal obstruction

13. Question

A female client is admitted to the facility for investigation of balance and coordination problems, including possible Ménière’s disease. When assessing this client, the nurse expects to note:

A. Vertigo, tinnitus, and hearing loss.

B. Vertigo, vomiting, and nystagmus.

C. Vertigo, pain, and hearing impairment.

D. Vertigo, blurred vision, and fever.

Correct Answer: A. Vertigo, tinnitus, and hearing loss.

14. Question

A male client with a conductive hearing disorder caused by ankylosis of the stapes in the oval window undergoes a stapedectomy to remove the stapes and replace the impaired bone with a prosthesis. After the stapedectomy, the nurse should provide which client instruction?

A. “Lie in bed with your head elevated, and refrain from blowing your nose for 24 hours.”

B. “Try to ambulate independently after about 24 hours.”

C. “Shampoo your hair every day for ten (10) days to help prevent ear infection.”

D. “Don’t fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself to loud sounds for 30 days.”

Correct Answer: D. “Don’t fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself to loud sounds for 30 days.”

15. Question

Nurse Marty is monitoring a client for adverse reactions to dantrolene (Dantrium). Which adverse reaction is most common?

A. Excessive tearing

B. Urine retention

C. Muscle weakness

D. Slurred speech

Correct Answer: C. Muscle weakness

16. Question

The nurse is monitoring a male client for adverse reactions to atropine sulfate (Atropine Care) eyedrops. Systemic absorption of atropine sulfate through the conjunctiva can cause which adverse reaction?

A. Tachycardia

B. Increased salivation

C. Hypotension

D. Apnea

Correct Answer: A. Tachycardia

17. Question

A male client is admitted with a cervical spine injury sustained during a diving accident. When planning this client’s care, the nurse should assign the highest priority to which nursing diagnosis?

A. Impaired physical mobility

B. Ineffective breathing pattern

C. Disturbed sensory perception (tactile)

D. Self-care deficit: Dressing/grooming

Correct Answer: B. Ineffective breathing pattern

18. Question

A male client has a history of painful, continuous muscle spasms. He has taken several skeletal muscle relaxants without experiencing relief. His physician prescribes diazepam (Valium), two (2) mg P.O. twice daily. In addition to being used to relieve painful muscle spasms, Diazepam also is recommended for:

A. Long-term treatment of epilepsy.

B. Postoperative pain management of laminectomy clients.

C. Postoperative pain management of diskectomy clients.

D. Treatment of spasticity associated with spinal cord lesions.

Correct Answer: D. Treatment of spasticity associated with spinal cord lesions.

19. Question

A female client who was found unconscious at home is brought to the hospital by a rescue squad. In the intensive care unit, the nurse checks the client’s oculocephalic (doll’s eye) response by:

A. Introducing ice water into the external auditory canal.

B. Touching the cornea with a wisp of cotton.

C. Turning the client’s head suddenly while holding the eyelids open.

D. Shining a bright light into the pupil.

Correct Answer: C. Turning the client’s head suddenly while holding the eyelids open.

20. Question

While reviewing a client’s chart, the nurse notices that the female client has myasthenia gravis. Which of the following statements about neuromuscular blocking agents is true for a client with this condition?

A. The client may be less sensitive to the effects of a neuromuscular blocking agent.

B. Succinylcholine shouldn’t be used; pancuronium may be used in a lower dosage.

C. Pancuronium shouldn’t be used; succinylcholine may be used in a lower dosage.

D. Pancuronium and succinylcholine both require cautious administration.

Correct Answer: D. Pancuronium and succinylcholine both require cautious administration.

21. Question

A male client is color blind. The nurse understands that this client has a problem with:

A. Rods.

B. Cones.

C. Lens.

D. Aqueous humor.

Correct Answer: B. Cones.

22. Question

A female client who was trapped inside a car for hours after a head-on collision is rushed to the emergency department with multiple injuries. During the neurologic examination, the client responds to painful stimuli with decerebrate posturing. This finding indicates damage to which part of the brain?

A. Diencephalon

B. Medulla

C. Midbrain

D. Cortex

Correct Answer: C. Midbrain

23. Question

The nurse is assessing a 37-year-old client diagnosed with multiple sclerosis. Which of the following symptoms would the nurse expect to find?

A. Vision changes

B. Absent deep tendon reflexes

C. Tremors at rest

D. Flaccid muscles

Correct Answer: A. Vision changes

24. Question

The nurse is caring for a male client diagnosed with a cerebral aneurysm who reports a severe headache. Which action should the nurse perform?

A. Sit with the client for a few minutes.

B. Administer an analgesic.

C. Inform the nurse manager.

D. Call the physician immediately.

Correct Answer: D. Call the physician immediately.

25. Question

During recovery from a cerebrovascular accident (CVA), a female client is given nothing by mouth, to help prevent aspiration. To determine when the client is ready for a liquid diet, the nurse assesses the client’s swallowing ability once each shift. This assessment evaluates:

A. Cranial nerves I and II.

B. Cranial nerves III and V.

C. Cranial nerves VI and VIII.

D. Cranial nerves IX and X.

Correct Answer: D. Cranial nerves IX and X.

26. Question

A white female client is admitted to an acute care facility with a diagnosis of cerebrovascular accident (CVA). Her history reveals bronchial asthma, exogenous obesity, and iron deficiency anemia. Which history finding is a risk factor for CVA?

A. Caucasian race

B. Female sex

C. Obesity

D. Bronchial asthma

Correct Answer: C. Obesity

27. Question

The nurse is teaching a female client with multiple sclerosis. When teaching the client how to reduce fatigue, the nurse should tell the client to:

A. Take a hot bath.

B. Rest in an air-conditioned room.

C. Increase the dose of muscle relaxants.

D. Avoid naps during the day.

Correct Answer: B. Rest in an air-conditioned room.

28. Question

A male client is having tonic-clonic seizures. What should the nurse do first?

A. Elevate the head of the bed.

B. Restrain the client’s arms and legs.

C. Place a tongue blade in the client’s mouth.

D. Take measures to prevent injury.

Correct Answer: D. Take measures to prevent injury.

29. Question

A female client with Guillain-Barré syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation. When the client asks the nurse about the paralysis, how should the nurse respond?

A. “You may have difficulty believing this, but the paralysis caused by this disease is temporary.”

B. “You’ll have to accept the fact that you’re permanently paralyzed. However, you won’t have any sensory loss.”

C. “It must be hard to accept the permanency of your paralysis.”

D. “You’ll first regain use of your legs and then your arms.”

Correct Answer: A. “You may have difficulty believing this, but the paralysis caused by this disease is temporary.”

30. Question

The nurse is working on a surgical floor. The nurse must log roll a male client following a:

A. Laminectomy.

B. Thoracotomy.

C. Hemorrhoidectomy.

D. Cystectomy.

Correct Answer: A. Laminectomy.

31. Question

A female client with a suspected brain tumor is scheduled for computed tomography (CT). What should the nurse do when preparing the client for this test?

A. Immobilize the neck before the client is moved onto a stretcher.

B. Determine whether the client is allergic to iodine, contrast dyes, or shellfish.

C. Place a cap on the client’s head.

D. Administer a sedative as ordered.

Correct Answer: B. Determine whether the client is allergic to iodine, contrast dyes, or shellfish.

32. Question

During a routine physical examination to assess a male client’s deep tendon reflexes, the nurse should make sure to:

A. Use the pointed end of the reflex hammer when striking the Achilles’ tendon.

B. Support the joint where the tendon is being tested.

C. Tap the tendon slowly and softly.

D. Hold the reflex hammer tightly.

Correct Answer: B. Support the joint where the tendon is being tested.

33. Question

A female client is admitted in a disoriented and restless state after sustaining a concussion during a car accident. Which nursing diagnosis takes highest priority for this client’s plan of care?

A. Disturbed sensory perception (visual)

B. Self-care deficit: Dressing/grooming

C. Impaired verbal communication

D. Risk for injury

Correct Answer: D. Risk for injury

34. Question

A female client with amyotrophic lateral sclerosis (ALS) tells the nurse, “Sometimes I feel so frustrated. I can’t do anything without help!” This comment best supports which nursing diagnosis?

A. Anxiety

B. Powerlessness

C. Ineffective denial

D. Risk for disuse syndrome

Correct Answer: B. Powerlessness

35. Question

For a male client with suspected increased intracranial pressure (ICP), a most appropriate respiratory goal is to:

A. Prevent respiratory alkalosis.

B. Lower arterial pH.

C. Promote carbon dioxide elimination.

D. Maintain partial pressure of arterial oxygen (PaO2) above 80 mm Hg.

Correct Answer: C. Promote carbon dioxide elimination.

36. Question

Nurse Mary witnesses a neighbor’s husband sustain a fall from the roof of his house. The nurse rushes to the victim and determines the need to open the airway in this victim by using which method?

A. Flexed position

B. Head tilt-chin lift

C. Jaw-thrust maneuver

D. Modified head tilt-chin lift

Correct Answer: C. Jaw-thrust maneuver

37. Question

The nurse is assessing the motor function of an unconscious male client. The nurse would plan to use which of the following to test the client’s peripheral response to pain?

A. Sternal rub

B. Nail bed pressure

C. Pressure on the orbital rim

D. Squeezing of the sternocleidomastoid muscle

Correct Answer: B. Nail bed pressure

38. Question

A female client admitted to the hospital with a neurological problem asks the nurse whether magnetic resonance imaging may be done. The nurse interprets that the client may be ineligible for this diagnostic procedure based on the client’s history of:

A. Hypertension

B. Heart failure

C. Prosthetic valve replacement

D. Chronic obstructive pulmonary disorder

Correct Answer: C. Prosthetic valve replacement

39. Question

A male client is having a lumbar puncture performed. The nurse would plan to place the client in which position?

A. Side-lying, with a pillow under the hip.

B. Prone, with a pillow under the abdomen.

C. Prone, in slight-Trendelenburg’s position.

D. Side-lying, with the legs, pulled up and head bent down onto the chest.

Correct Answer: D. Side-lying, with the legs, pulled up and head bent down onto the chest.

40. Question

The nurse is positioning the female client with increased intracranial pressure. Which of the following positions would the nurse avoid?

A. Head midline

B. Head turned to the side

C. Neck in neutral position

D. Head of bed elevated 30 to 45 degrees

Correct Answer: B. Head turned to the side

41. Question

A female client has clear fluid leaking from the nose following a basilar skull fracture. The nurse assesses that this is cerebrospinal fluid if the fluid:

A. Is clear and tests negative for glucose.

B. Is grossly bloody in appearance and has a pH of 6.

C. Clumps together on the dressing and has a pH of 7.

D. Separates into concentric rings and tests positive for glucose.

Correct Answer: D. Separates into concentric rings and tests positive for glucose.

42. Question

A male client with a spinal cord injury is prone to experiencing autonomic dysreflexia. The nurse would avoid which of the following measures to minimize the risk of recurrence?

A. Strict adherence to a bowel retraining program.

B. Keeping the linen wrinkle-free under the client.

C. Preventing unnecessary pressure on the lower limbs.

D. Limiting bladder catheterization to once every 12 hours.

Correct Answer: D. Limiting bladder catheterization to once every 12 hours

43. Question

The nurse is caring for the male client who begins to experience seizure activity while in bed. Which of the following actions by the nurse would be contraindicated?

A. Loosening restrictive clothing.

B. Restraining the client’s limbs.

C. Removing the pillow and raising padded side rails.

D. Positioning the client to the side, if possible, with the head flexed forward.

Correct Answer: B. Restraining the client’s limbs.

44. Question

The nurse is assigned to care for a female client with complete right-sided hemiparesis. The nurse plans care knowing that this condition:

A. The client has complete bilateral paralysis of the arms and legs.

B. The client has weakness on the right side of the body, including the face and tongue.

C. The client has lost the ability to move the right arm but can walk independently.

D. The client has lost the ability to move the right arm but can walk independently.

Correct Answer: B. The client has weakness on the right side of the body, including the face and tongue.

45. Question

The client with a brain attack (stroke) has residual dysphagia. When a diet order is initiated, the nurse avoids doing which of the following?

A. Giving the client thin liquids.

B. Thickening liquids to the consistency of oatmeal.

C. Placing food on the unaffected side of the mouth.

D. Allowing plenty of time for chewing and swallowing.

Correct Answer: A. Giving the client thin liquids.

46. Question

The nurse is assessing the adaptation of the female client to changes in functional status after a brain attack (stroke). The nurse assesses that the client is adapting most successfully if the client:

A. Gets angry with family if they interrupt a task.

B. Experiences bouts of depression and irritability.

C. Has difficulty with using modified feeding utensils.

D. Consistently uses adaptive equipment in dressing self.

Correct Answer: D. Consistently uses adaptive equipment in dressing self

47. Question

Nurse Kristine is trying to communicate with a client with brain attack (stroke) and aphasia. Which of the following actions by the nurse would be least helpful to the client?

A. Speaking to the client at a slower rate.

B. Allowing plenty of time for the client to respond.

C. Completing the sentences that the client cannot finish.

D. Looking directly at the client during attempts at speech.

Correct Answer: C. Completing the sentences that the client cannot finish.

48. Question

A female client has experienced an episode of myasthenic crisis. The nurse would assess whether the client has precipitating factors such as:

A. Getting too little exercise.

B. Taking excess medication.

C. Omitting doses of medication.

D. Increasing intake of fatty foods.

Correct Answer: C. Omitting doses of medication.

49. Question

The nurse is teaching the female client with myasthenia gravis about the prevention of myasthenic and cholinergic crisis. The nurse tells the client that this is most effectively done by:

A. Eating large, well-balanced meals.

B. Doing muscle-strengthening exercises.

C. Doing all chores early in the day while less fatigued.

D. Taking medications on time to maintain therapeutic blood levels.

Correct Answer: D. Taking medications on time to maintain therapeutic blood levels

50. Question

A male client with Bell’s Palsy asks the nurse what has caused this problem. The nurse’s response is based on an understanding that the cause is:

A. Unknown, but possibly includes ischemia, viral infection, or an autoimmune problem.

B. Unknown, but possibly includes long-term tissue malnutrition and cellular hypoxia.

C. Primary genetic in origin, triggered by exposure to meningitis.

D. Primarily genetic in origin, triggered by exposure to neurotoxins.

Correct Answer: A. Unknown, but possibly includes ischemia, viral infection, or an autoimmune problem

PAPER III
Instructions: Enter your examination number and login Time allowed: 3 hours
Answer ALL questions

1. A break in the continuity of the skin or mucous membrane is ……….?
   (a) Infection
   (b) Haemorrhage
   (c) Wound
   (d) Fracture
2. Type of shock where there is loss of blood or fluid is ……….?
   (a) Oligemic shock
   (b) Bacteriaemic shock
   (c) Anaphylactic shock
   (d) Neurogenic shock
3. The best form of tourniquet is …………?
   (a) Broad rubber band
   (b) Piece of rag
   (c) A twing
   (d) Elastic band
4. If a tourniquet is not tight enough it will only limit………………. Flow of blood
   (a) Venous
   (b) Capillary
   (c) Arterial
   (d) Aortic
5. Haemorrhage occurring 24 hours after an injury or surgery is …………………?
   (a) Primary haemorrhage
   (b) Secondary haemorrhage
   (c) Capillary haemorrhage
   (d) Reactionary haemorrhage
6. Blood in urine may result from…………….?
   (a) Anaemia
   (b) Infection of the bladder
   (c) Reproductive tract infection

(d) Shock

7. Secondary haemorrhage may be due to …………………..?
   (a) Reaction of the body
   (b) Lowered blood pressure
   (c) Lack of clot formation
   (d) Infection
8. Blood or fluid loss may result in…………….?
   (a) Hypovolaemic shock
   (b) Bacteriamic shock
   (c) Cardiogenic shock
   (d) Neurogenic shock
9. Methods of artificial respiration include the following EXCEPT (a) Month-to-month
   (b) Hagel method
   (c) Eve’s rocking method
   (d) Silvester’s method
10. ……………. Is used to check for urine specific gravity (a) Litmus paper
    (b) Urinometer
    (c) Bath thermometer
    (d) Pulse oximeter
11. The normal volume of urine per hour should be at least…………… (a) 400mls
    (b) 200mls
    (c) 30mls
    (d) 100mls
12. Normal colour of urine is………………… (a) Coffee straw
    (b) Crayfish
    (c) Yellow
    (d) Amber
13. The normal reaction of urine is……….?
    (a) Slightly acidic
    (b) Strongly acidic (c) Slightly alkaline

(d) Strongly alkaline

14. Acidic urine will turn blue litmus paper…………? (a) Brown
    (b) Green
    (c) Red
    (d) Reddish brown
15. Normal finding in urine include all EXCEPT (a) Water
    (b) Urea
    (c) Phosphate
    (d) Sugar
16. The standard scale for measuring temperature is…………….? (a) Thermometer
    (b) Gram
    (c) Kilogram
    (d) Centigrade
17. A state of heat or coldness of a substance measured against a standard scale is called……………?
    (a) Blood pressure (b) Respiration
    (c) Temperature (d) Pulse
18. The pressure exerted by the blood on the vessels is……………….? (a) Respiration
    (b) Blood pressure
    (c) Temperature
    (d) Pulse
19. Green stick fracture occurs mostly in ……………………..? (a) Elderly
    (b) Adolescents
    (c) Children
    (d) Congenital disorders
20. The most accurate site for obtaining body temperature is………..? (a) Axilla
    (b) Groin
    (c) Mouth (d) Rectum

21. Normal body temperature is……………? (a) 38 – 39oC
    (b) 36.6 – 37.2oC
    (c) 35 – 36oC
    (d) 38 – 39oC
22. The wave of distension felt on the wall of an artery is called ……………….? (a) Respiration
    (b) Blood pressure
    (c) Pulse
    (d) Temperature
23. General principles of first aid treatment include all EXCEPT…………….? (a) Remove source of danger
    (b) Undo tight clothing around the neck, chest and waist
    (c) Bath victim with either warm or cold water
    (d) Clear airway of any obstruction
24. A life saving technique used in emergencies is known as ……………? (a) Restoration
    (b) Resurrection
    (c) Revigoration
    (d) Resuscitation
25. Adverse reactionto a drug can cause………? (a) Anaemia
    (b) Malaria
    (c) Septic shock
    (d) Anaphylactic shock
26. The combination of carbon monoxide and haemoglogin is termed……….? (a) Haemoglobinopathies
    (b) Carboxyhaemoglobin
    (c) Carboxyglobulin
    (d) Carbohydroxylhaemoglobin
27. Epitaxis refers to ………….?
    (a) Bleeding from the nose
    (b) Bleeding from the ear (c) Blood in urine

(d) Coughing out blood

28. A condition which arise when an individual is unable to inhale or exhale air is …………? (a) Shock
    (b) Fainting
    (c) Asphyxia
    (d) Asthma
29. Which of the following is a general antidote?
    (a) Charcoal
    (b) Naxolone
    (c) Normal saline (d) 50% dextrose
30. When an artery is injured, the blood is…….? (a) Dark red
    (b) Bright red
    (c) Pale brown
    (d) Oozes
31. Blood spurting from a wound, indicates ……….. bleeding?
    (a) Arterial
    (b) Capillary (c) Venous (d) Primary
32. These instances are related to carbon monoxide poisoning EXCEPT…..? (a) If a tap on gas appliance is not turn-off properly
    (b) Drowning or choking
    (c) Poorly ventilated space where carbon fuel is burnt
    (d) Working in an enclosed space with car engine running
33. Nature’s method of arresting haemorrhage include the following EXCEPT……..? (a) Formation of clot
    (b) Elastic coat of the blood vessel recoil and turn in
    (c) Depression of the vital centers
    (d) Blood pressure is lowered
34. Normal respiratory rate in an adult is…………..? (a) 30 – 50 c/m
    (b) 16 – 18 c/m
    (c) 20 – 30 c/m

(d) 10 – 12 c/m

35. The group of people mostly at risk of swallowing foreign objects are………….?
    (a) Infants / toddlers
    (b) Adult
    (c) Adolescents (d) Adult
36. One of these group of wound is of greater depth and danger to internal organs (a) Incised
    (b) Lacerated
    (c) Punctured
    (d) Contused
37. Vomiting blood is called……..? (a) Haemoptysis
    (b) Haematemesis
    (c) Haematuria
    (d) Melena
38. Bone cells include the following EXCEPT…..
    (a) Normoblasts
    (b) Fibroblasts (c) Osteoblasts (d) Osteoclasts
39. Burns affecting the anterior trunk of children account for………….
    (a) 18%
    (b) 9% (c) 14% (d) 20%
40. Insulating materials include the following EXCEPT……………. (a) Rubber matting
    (b) Rubber gloves
    (c) Dry clothes
    (d) Fresh wood
41. A condition where there is depression of the vital centers in the brain is……………? (a) Heart failure
    (b) Shock
    (c) Renal failure

(d) Haemorrhage

42. Which of these will happen due to insufficient blood supply to the brain? (a) Stupor
    (b) Stridor
    (c) Fainting
    (d) Coma
43. The following can cause unconsciousness EXCEPT? (a) Asphyxia
    (b) Cerebral anaemia
    (c) Schizophrenia
    (d) Cerebro – vascular accident
44. The phase that precedes loss of unconsciousness in epilepsy is …………..? (a) Clonic phase
    (b) Tonic phase
    (c) Aura phase
    (d) Coma phase
45. The body of spermatozoa is packed with …………..?
    (a) Mitochondria
    (b) Ribosome
    (c) Ribonucleic acid
    (d) Deoxyriboneuleic acid
46. At term, platelets are high in amount at the ……………………? (a) Uterus
    (b) Cervical site
    (c) Placental site
    (d) Fundus
47. Near term, the uterus is divided into …………………. Segments (a) 4
    (b) 2
    (c) 3
    (d) 6
48. The following are signs of shock EXCEPT (a) Bradycardia
    (b) Tachycardia
    (c) Hypotension

(d) Cold and clamming skin

49. Which of the following is an important source for identification of research problem in Midwifery.
    (a) Research textbooks
    (b) Midwifery practice
    (c) Nursing ethics (d) Codes of conduct
50. The life span of erythrocyte is ……………………? (a) Less than 120 days
    (b) 120 days
    (c) 20 days
    (d) 90days
51. The vagina in normal labour is …………………? (a) Hot and dry
    (b) Warm and moist
    (c) Cool and wet
    (d) Hot and soft
52. The detrusor muscle is found at the ……………….? (a) Uterus
    (b) Ovaries
    (c) Kidneys
    (d) Bladder
53. Which of the following are component of Central Processing Unit (CPU) …………………..?
    (a) Arithmetic logic unit, mouse
    (b) Arithmetic logic unit, integrated circuit
    (c) Control unit, monitor
    (d) Arithmetic logic unit, control unit
54. A portion of memory that serves as a temporarily repository for data as it await for a given action is known as ……………………?
    (a) Memory pool
    (b) Memory processor
    (c) Antenna

(d) Cache

55. The difference between the structure of deoxyribonucleic acid and ribonucleicacid is the absence of ………………
    (a) Nitrogen (b) Carbon (c) Oxygen (d) Hydrogen
56. The major modes of HIV transmission is …………………….?
    (a) Sexual intercourse and sharing of sharps
    (b) Blood transfusion (c) Mother – to – child (d) Kissing and saliva
57. The window period in HIV is ………………..?
    (a) The period between HIV infection and detection of virus in the blood
    (b) The earliest stage of infection
    (c) The time the body respond to the infection (d) The time condom burst during intercourse
58. The group of drugs used in management of HIV infection is called ……………………..? (a) Antifungal
    (b) Antivirals
    (c) Antiretrovirals
    (d) Antibacterial
59. Babies born to HIV positive mothers are called …? (a) Infected infant
    (b) Affect infant
    (c) Exposed infant
    (d) Exceptional infant
60. The following are criteria for the Apgar Score EXCEPT?
    (a) Temperature
    (b) Heart rate
    (c) Respiratory rate
    (d) Muscle tone
61. The following reflexes are present at birth EXCEPT? (a) Rooting reflex
    (b) Grasping reflex
    (c) Moro reflex
    (d) Stepping reflex
62. Normal infant double in weight by ………….? (a) 1 year
    (b) 3 months
    (c) 6months
    (d) 18 months
63. Collapse of the lungs is referred to as ……………? (a) Lobectomy
    (b) Bronchiectasis
    (c) Homeostasis
    (d) Atelectasis
64. The state of physiologic equilibrium between the external and internal environment is called ……………….?
    (a) Hemoptysis
    (b) Homeostasis
    (c) hemostasis (d) Atelectasis
65. The school health nurse provides the following care EXCEPT? (a) Preventive
    (b) Promotive
    (c) Rehabilitative
    (d) Diagnostic and curative
66. The following are the aims and objectives of integrated management of neonatal and childhood illnesses except?
    (a) To focus on child as a whole
    (b) To promote growth & development
    (c) To reduce illness and disabilities
    (d) Help in planning of the family
67. The best index for assessing a child’s growth and development is …………………….?
    (a) Weight
    (b) Height
    (c) Width
    (d) Circumference
68. The type of consent obtained from client is known as ……………………? (a) Informed consent
    (b) Implied consent
    (c) Agreed consent
    (d) Coerced consent
69. The type of nursing audit that monitors the setting in which client care occurs is …….?
    (a) Outcome audit
    (b) Process audit (c) Structural audit (d) Tool audit
70. Which of the following propounded the Health Promotion Model?
    (a) Nola Pender
    (b) Dorothea Orem (c) Jean Watson (d) Imogene King
71. One of these theorists is associated with the environmental model
    (a) FlorenceNightingale
    (b) Betty Nauman (c) Levine
    (d) Henderson
72. The sequential order of lochia is ……………… (a) Alba, serosa, rubra
    (b) Rubra, serosa, alba
    (c) Serosa, alba, rubra
    (d) Rubra, alba, serosa
73. The upright position in labour has the advantage of …………….? (a) Restricting mobility
    (b) Shorter duration of labour
    (c) Preventing complication
    (d) Shorter third stage of labor
74. The following hormonal contraception can be used during lactation EXCEPT? (a) Mini pills
    (b) Combined oral contraceptive pills
    (c) Implanon
    (d) Depot medroxyl progesterone acetate (DMPA)
75. The following are neurotransmitters except? (a) Serotonin
    (b) Dopamine
    (c) Oestrogen
    (d) Substance P
76. The combination of 3 or more antiretroviral agents in HIV management is known as ….?
    (a) Highly active antiretroviral therapy
    (b) Highly active antiviral therapy (c) Highly active viral therapy
    (d) Highly active bactericidal
77. The following are methods of collecting data in research EXCEPT? (a) Questionnaire
    (b) Observation
    (c) Demonstration
    (d) Experiment
78. A citation to the source of information used by a researcher at the completion of his/her work is called
    (a) Table of content
    (b) autography
    (c) References (d) Referendum
79. A statement of the expected relationship between two or more variables is known as……?
    (a) Statement of the problem
    (b) Concept definition
    (c) Research questions
    (d) Hypothesis
80. When a pressure area becomes inflamed, break down and ulcerates, it is called ……. (a) Cold sore
    (b) Inflammation
    (c) Ulcer
    (d) Pressure sore
81. The following are rules for bed – making EXCEPT
    (a) All requirements should be gathered before procedure (b) Two nurses are required and should work in harmony (c) The patient’s face and body should be slightly exposed (d) Extra assistant may be required to lift the patient
82. Rules for filling hot water bottle include all EXCEPT
    (a) Fill the bottle directly from the kettle
    (b) Fill the bottle three quarters full
    (c) Invert and inspect the bottle for leaks
    (d) Blanket should be tucked – in between the patient and the bottle
83. The first step in processing instruments and other items for re–use is ………………
    (a) Decontamination
    (b) Cleaning
    (c) High level disinfection (d) Sterilization
84. One of these processes eliminates all microorganisms including bacterial endospores (a) Boiling
    (b) Steaming
    (c) Autoclaving
    (d) Cleaning
85. Obstetric forceps were invented by ……………….. (a) Ambiose pare
    (b) Soranus of Ephesus
    (c) Peter Chamberlin
    (d) Aristotle
86. In Maslow’s hierarchy of needs, self-actualization connotes …………………….? (a) Reaching societal recognition
    (b) Achieving one’s ambition in life
    (c) An endeavour to reach the peak
    (d) Self esteem
87. Expected outcome of the client’s health status in the nursing care plan is represented by …………………?
    (a) Nursing diagnosis
    (b) Nursing objectives
    (c) Nursing orders
    (d) Scientific rationale
88. A professional in midwifery is known as ………………….. (a) Expert
    (b) Midwife
    (c) Polyvalent nurse
    (d) Midwifery
89. A client problem that is present at the time of nursing assessment is called ………? (a) Possible diagnosis
    (b) Illness diagnosis
    (c) Risk nursing diagnosis
    (d) Actual nursing diagnosis
90. Which of the following is associated with psychosexual theory of development. (a) Abraham Maslow
    (b) Albert Bandura
    (c) Erick Erikson
    (d) Sigmund Freud
91. The functional unit of the kidney is……..? (a) Bowman’s capsule
    (b) Nephron
    (c) Glomerulus
    (d) Hilum
92. The smallest cell in the human body is………………? (a) Ovum
    (b) Sperm cell
    (c) Nerve cell
    (d) Bone cell
93. The largest cell in the human body is …….? (a) Bone cell
    (b) Ovum
    (c) Sperm cell
    (d) Nerve cell
94. The basic building blocks of life are….? (a) Tissues
    (b) Cells
    (c) Oxygen
    (d) Hydrogen
95. Which of the following is NOT a type of epithelial tissue (a) Simple squamous epithelium
    (b) Simple cuboidal epithelium
    (c) Simple columnar, pseudo stratified epithelium
    (d) Connective tissue
96. Overlapping of the fetal skull bone at the sutures is called………..? (a) Caput
    (b) Chignon
    (c) Cephalhematoma
    (d) Moulding
97. The following are examples of connective tissues EXCEPT (a) Bone
    (b) Blood
    (c) Lymph
    (d) Skin
98. The following vaccines are contra-indicated in pregnancy EXCEPT (a) Varicella
    (b) Measles, mumps and rubella
    (c) Live Influenza
    (d) Hepatitis B
99. The following are brands of Covid-19 vaccine EXCEPT (a) Moderna
    (b) Pfizer/ Bio Ntech
    (c) Oxford/ Astrazeneca
    (d) mRNA vaccines
100. Unsafe injection practices include the following EXCEPT (a)Re-use of injection device without sterilization
     (b) Re-use of opened vials and ampoules of drugs
     (c)Rinsing syringes and needles in antiseptic lotion
     (d) Collection and disposal of dirty injection equipments
101. Which of the following is NOT the duty of Nursing and Midwifery Council of Nigeria
     (a) Prosecute legal training institutions
     (b) Registration and licensing for all categories of nurses
     (c) Ensure professional standards of practice
     (d) Accreditation of training schools
102. A shared pattern of behaviour that is found in the majority of people
     is _ a. Community b. Society
     c. Culture d. Tradition
103. An individual that fails to conform to the norms of the society is a a. Conformist b. Reformist c. Deviant d. Congruence
104. The back bone of the society is _ a. Police b. Constitution c. Armforce d. Family
105. A Pattern of behaviour that is found worldwide is known as _ a. Culturalpattern b. Cultural universal c. Culturalbeliefs d. Cultural diversity
106. Which of this is the father of moral development theory? a. Laurette Kohlberg b. Lawrence Kohlberg c. SigmundFreud d. Simeon Ford
107. The stages of moral development are a. 4 b. 3 c. 5 d. 6
108. The first socialization agent to a child is _ a. Community b. Siblings c. Mother d. Father
109. What an individual holds to be true is a. Tradition b. Culture c. Beliefs d. Norms
110. The process of learning culture is known as _ a. Acculturation b. Enculturation c. Socialization d. Integration
111. Culture is dynamic means that _a. Cultures interact and change b. Culture is holism c. Culture is based on symbols d. Culture is biological
112. The Germ Theory of disease causation is associated with a. CharlesDarwin b. Louise Pasteur c. LazzaroSpallanzani d. John T. Needham
113. The father of evolution theory is _ a. LouisPasteur b. Charles Darwin c. George Louise Lecierce d. Lazzo Spallanzani
114. Disease causing microorganisms are also known as a. Pathogens b. Teratogens c. Carcinogen d. Bacteria
115. The international body that regulates the practice of midwifery is _ a. International Council for Nurses b. International Council for Midwives c. International Associations of Nurse and Midwives d. Nursing and Midwifery Council International
116. Sharps are discarded into __ a. Injection safety box b. The kidney dish c. The dump site of the hospital d. The waste bin outside the ward
117. The male type of pelvis that does not favours delivery is _ a. Android pelvis b. Justo-minor pelvis c. Gyneacoidpelvis d. Anthropoid pelvis
118. Group of drugs that can be carried and administered independently by the midwife include all EXCEPT a. Analgesic b. Oxytocic agents c. Cytotoxic drugs d. Antibiotics
119. Methods of rehabilitation of the mentally ill include all Except _ a. Half-way house or home b. Perambulation of the district c. Dayandnighthospital d. Occasional leave/trial leave 120
120. PMCT means ___ a. Prevention of Mother to Child Transmission b. Postpartum Maternal Communication Transmission c. Prevention of Malaria to Child Transmission d. Postpartum Maternal Cervical Treatment
121. NIC means _ a. Neonatal Intervention Care b. Nursing Intervention Classification c. Nursing Identification Communications d. Nursing Intervention Care
122. NIC means— a. Nursing Observation of Care b. Nursing Obstetric Care c. Nursing Outcome Classification d. Nose Occiput Circumference

123 The imaginary flat surface at the brim, cavity and outlet of the pelvis are referred to as
a. Axis of the pelvis
b. Planes of the pelvis
c. Diameter of the pelvis
d. Angles of the pelvis

124 The following are methods of assessment of nutritional status of under 5 years old EXCEPT
a. anthropometric measurement
b. mid-armcircumference
c. weight measurement
d. assessment of height

125Domiciliary midwifery is known as
a. home delivery undertaken by a community midwife
b. home delivery undertaken by a student midwife
c. home delivery carried out by an obstetrician
d. home delivery carried out by all the health care team

126 Health visitor can perform the following duties EXCEPT
a. Safe motherhood duties
b. Health education
c. Environmentalsanitation
d. Socio-medical Care

127 Which of the following is the most critical period of foetal development? a. Firstweekofpregnancy
b. 2nd – 12th week of pregnancy
c. 13th – 24th week of pregnancy
d. 25th – 36th week of pregnancy

128 In the community, monitoring of growth of children 0 – 8 years is best
done through
a. Mid upper arm circumference
b. Adequate feeding
c. Weighing
d. Medical hygiene inspection

129 One of the following diseases is endemic in the tropics of Africa.
a. Malaria
b. Measles c. Cholera d. Tetanus

130 Unimke has just been stung by bees on the face and runs to you a third year student midwife. You will administer one of the following group of drugs
a. Antibiotics
b. Anti-inflammatory c. Analgesics
d. Antihistamines

131 Ugbe fell off a motor cycle and fractured the leg. The edges of the bone pierced the tissues and can be seen externally. This type of fracture is _ a. Compound fracture b. Greenstick fracture c. Simple fracture d. Comminuted fracture

132 Chain of spread of infection process include all except
a. causative agent
b. reservoirs/carries
c. kemptenvironment
d. portal of exit

133 The progressive increase in size of a child is called a. Development b. Maturation c. Growth d. Growth and development

134 The principles of infectious diseases control include the following EXCEPT _
a. Proper hand washing with liquid soap
b. Proper handling and disposal of sharp
c. Improper aseptic technique
d. Disinfection/waste disposal

135 Libel and slander are examples of a. unintentionaltort
b. intentional tort
c. criminallaw
d. cultural law

136__________ is a serious nature as murder or armed robbery
a. Felony
b. Misdemeanour c. Negligence
d. Libel

137 Decontamination of instruments with 0.5% chlorine/jik solution for _ minutes before cleaning destroys most microorganisms including Hepatitis B, Hepatitis C and HIV viruses. a. 10 b. 15 c. 20 d. 30

138 Baby Umun 3kg was born on 10th December, 2021 to a healthy mother. You will advise the mother to start complementary foods after
a. June10,2022
b. March 10, 2022 c. April 10, 2022 d. May 10, 2022

139 The consistency of complementary foods should be the following EXCEPT
a. solid
b. semi solid
c. finelymashed d. pureed

140 Prolong milk feeding without timely introduction of weaning or complementary foods is the commonest cause of in young children.
a. sickle cell anaemia
b. iron deficiency
c. folic acid deficiency
d. haemolytic anaemia

141 Patient consent can be obtained from significant others in exceptional cases
EXCEPT
a. mentallyillpatientwhoisawake
b. conscious adult who can read and write
c. a child under a guardian
d. unconscious patient

142 A midwife is expected to renew her licence every
a. twoyears
b. three years
c. four years
d. six years

143 The nursing care plan for each patient should be reviewed ____
a. assoonasthepatient’sconditionchanges
b. every 24 hours
c. when the nursing officer in charge orders a change d. When the patient is ready for discharge

144 One of the following is not a member of the emergency team.
a. Nurse/midwife
b. Doctor
c. Wardorderly
d. Laboratoryscientist

145 Tetanus Toxoid vaccine is given to protect women against tetanus and also prevent the disease in their new born infants. The 5th course of TT vaccine provides duration of protection for the mother a. 10years b. 5 years c. 3years d. Life time

146 A six month old baby, who has not been immunized since birth, is brought to your clinic. Which of the following vaccines will you not give to the baby? a. BCGVaccine b. Pentavalent vaccine c. Oralpoliovaccine d. Measles vaccines

147 The tier of government responsible for Primary Health Care is
a. The community
b. Local government
c. State government
d. Federal government

148 A doctor prescribes 1000ml of normal saline to be infused for a period of
10 hours. The drop factor is 15 drops per ml. How many drops per minute
will the midwife set as the rate of flow?
a. 21 drops per minute
b. 23 drops per minute
c. 25drops per minute
d. 27 drops per minute

149 Legal safe-guards in nursing/midwifery practice include all but one.
a. Recordandincidentreport b. Providing competent report c. Non-professionalliability d. Health insurance

150 Mrs. Adie a 27 years old G2, P1 with 40weeks gestation is brought into the labour ward in 2nd stage of labour. You will advise her to lie in ___ position for delivery.

a. Trendelenburgposition b. Supine position
c. Lithotomyposition
d. Left lateral position

151 The following are the nursing responsibilities in the emergency unit for a patient presenting with symptoms of hyperglycaemia EXCEPT
(a) Loosen tight clothing.
(b) Give sweet drinks.
(c) Call for help if condition seems to worsen. (d) Give insulin.

152 The following are emergency treatment for snake bite EXCEPT (a) Calm the casualty and keep him as still as possible
(b) Refer the casualty quickly
(c) Tie a tourniquet above the area
(d) Cut the area and allow it to bleed freely

153 A rule of conduct established and enforced by the government for a society
(a) Tort
(b) Law
(c) Ethics
(d) Midwife’s right

154 Benefit of Nursing Processing including the following except:
(a) It provides unity of language for the nursing profession
(b) It facilitate documentation of care
(c) It delivers holistic patient focused care
(d) It provides disorderly method of planning and providing care

155 Components of assessment include the following except
(a) Nursing history
(b) Physical examination
(c) Diagnosing the condition
(d) Review of relevant document and report

156 Physical examination is accomplished via all the following except:
(a) Inspection
(b) Palpation
(c) Vagina examination
(d) Percussion and auscultation

157 A syndrome diagnosis is associated with a
(a) Cluster of actual or high risk signs and symptoms
(b) Single actual or high risk sig and symptoms
(c) Cluster of potential or low risk signs and symptoms
(d) Single potential or low risk sign and symptoms

158 Subjective data refers to all the following except (a) Feelings
(b) Discoloration
(c) Sensations
(d) Attitudes

159 Objective data are also referred to as:
(a) Signs or overt data
(b) Symptoms verbalized
(c) Values of the patient
(d) Beliefs of all patients

160 If a midwife interferes with a person’s freedom to move about at will without legal authority to do so, the midwife can be charged with (a) Crime (b) Assault (c) Malpractice (d) Slander

161 Midwife Paula admitted a G21P woman, 12 weeks gestation with a blood pressure of 160/100Hg into the antenatal ward without information doctor. This is case of:
(a) Battery
(b) Assault
(c) False imprisonment
(d) Defamation

162 The principle that defines action as being right or wrong is
(a) Philosophy
(b) Ethics
(c) Standard (d) Legislation

163 The systemic, problem-solving approach that provides nursing care to individual, families and communities is
(a) Nursing theory
(b) Qualities
(c) Nursing process
(d) Nursing audit

164 The theorist who first used the term “Nursing Process is:
(a) Lydia Hall
(b) Dorathea Orem
(c) Callista Roy
(d) Hildegard Peplau

165 The proponent of the theory of cognitive development is
(a) Abraham Maslow
(b) Jean Piaget
(c) Eric Erickson
(d) Von Berthlanffy

166 The functional health approaches used in the collection of assessment data
were developed in 1982 by
(a) Dorathea Orem
(b) Virginia Henderson
(c) Majorie Gordon
(d) Imogene King

167 A clinical judgement about an individual, family or community responses to actual or potential health problems is:
(a) Assessment
(b) Planning
(c) Diagnosis
(d) Evaluation

168 The theorist who categorized human needs according to the order of importance is:
(a) Imogene King
(b) Abraham Maslow
(c) Evelyn Duvall
(d) Callista Roy

169 There are _ main types of nursing care plans
(a) Two
(b) Three
(c) Four
(d) Six

170 The nursing care plan for each patient should be reviewed:
(a) As soon as the patient condition change
(b) Every 24 hours
(c) When the nursing officer in charge orders a change
(d) When the patient is about to be discharged

171 Social effects of substance abuse include all except:
(a) Poor school performance
(b) Brilliant school performance
(c) Lying or giving excuses
(d) Unprotected or risky sex/unwanted pregnancies

172 One of the following is to a characteristics of a well stated outcome criteria
(a) Specific
(b) Unattainable
(c) Measurable
(d) Time bound

173 A nurse/midwife is expected renew her license every
(a) Six years
(b) Four years
(c) Three years
(d) Two years

174 In order to achieve its healthcare reform agenda, the N&MCN work closely with the following sister organization under Federal Ministry of Health except
(a) Medical and Dental Council of Nigeria
(b) Pharmacist Council of Nigeria
(c) Local Government Commission
(d) Primary Health Care Development Agency

175 The student nursing care plan for each patient has……….. Major columns
(a) Two
(b) Three
(c) Four
(d) Five

176 The third subsystem in the sequence of Nursing Process is:
(a) Nursing diagnosis
(b) Assessment Phase
(c) Planning phase
(d) Outcome identification

177 The process of prioritizing nursing diagnosis, identifying the objectives and
selecting appropriate intervention is the __ phase of the nursing process
(a) Assessment
(b) Diagnosing
(c) Planning
(d) Implementation

178 One of the following is not a purpose for regulating midwife practice
(a) Protect the public from unsafe practices
(b) Confer accountability status upon the midwife
(c) Ensure quality of care
(d) Ensure competency of the midwife

179 Primary Healthcare aims at:
(a) Providing enough social amenities to people at the grass root level.
(b) Creating political awareness
(c) Eradicate basic health services at the grass level
(d) Bringing basic health services to meet people’s needs at the grass root
level

180 Non-maleficence is associated with
(a) Promotion of standards of the profession
(b) Doing no intentional harm
(c) Self governance
(d) Risks and cost

181 The nursing process terminates or begin again after
(a) Objectives
(b) Intervention
(c) Assessment
(d) Evaluation

182 The chairman of the board of Nursing and Midwife Council of Nigeria is appointed by the

(a) Head of Nursing Services, Federal Ministry of Health
(b) Minister of State for Health
(c) Honourable Minister of Health
(d) The Secretary of board

183 The governing board of Nursing and Midwife Council of Nigeria is made up of:
(a) 9 members
(b) 19 members
(c) 91 members
(d) 99 members

184 The officer who is responsible for the day to day administration of Nursing and
Midwife Council of Nigeria is:
(a) Secretary General/Registrar
(b) The chairman, education committee
(c) The Director, Examination Committee
(d) The Directors standard and Accreditation Committee

185 Function of the Nursing and Midwife Council of Nigeria include
(a) Registration of qualified nurses/midwives
(b) Admission of student into the various schools (c) Conduction of semester examinations
(d) Mentoring of student nurses/midwives in the clinical areas.

186 Mrs. Eze who was discharge six weeks ago following a safe vaginal delivery of a baby boy has just arrived the hospital for postnatal checkup. What type of assessment are you going to carry out on her?
(a) Ongoing assessment
(b) Initial assessment
(c) Time lapse assessment
(d) Emergency assessment

187 In order to bring her services to all states of the country for easy access, the
Nursing and Midwifery Council of Nigeria created __ additional zonal offices across the geopolitical zones.
(a) 16
(b) 12
(c) 10
(d) 1

188 Sometimes one drug will increase the effect of another drug if taken at the same time , this is referred to as :
(a) Potentiation
(b) Simple summation (c) Efficacy (d) Tolerance

189 One of these vitamins enhances the absorption of iron.
(a) vitamin C
(b) vitamin A (c) vitamin K (d) vitamin D

190 Which is the most widely used anthropometric measurement of Nutrition value
(a) Weight
(b) Height (c) Age (d) Gender

191 What is the body mass index (BMT) of a youth with weight of 50kg and height of 1.79m2
(a) 15kg/m2
(b) 15.6kg/m2
(c) 20.2kg/m2 (d) 10.5kg/m2

192 Other Parameters used to measure growth in children include all EXCEPT: (a) Height
(b) Head circumference (c) Chest circumference (d) Age

193 Deficiency of fiber in the diet can cause all of the following EXCEPT:

(a) Loss of appetite
(b) Diarrhea
(c) Constipation
(d) Rectal prolapsed

194 One of these is only a good source of fat (a) Woos milk
(b) Whole pulses (c) Whole cereals (d) Eggs

195 One of these is a unit used to measure energy content of food as well energy expenditure by the body
(a) Joule
(b) Pulsumeter
(c) Thermometer
(d) Calorie

196 The narcotics are habit forming drugs: This means they are drugs of
(a) Addiction
(b) Routine use (c) Relaxation (d) Wellbeing

197 As Nebules the route of administration of salbutamol or ventolin is through (a) Injection
(b) Rectum
(c) Inhalation
(d) Topically

198 One of the following is not an indication for the use of Neurogenic ointment (a) Muscle aches
(b) Open wounds
(c) swelling and stiffness
(d) sprains

199 Mrs. Oko is given two tablets of paracetamol tds for three days in addition to other drugs, this means she is taking __ per dose.
(a) 500mg
(b) 1000mg
(c) 960mg (d) 600mg

200 Mrs. Ogah is rushed to your health facility with excessive vomiting and weakness of the body , the fastest route that will help to reduce vomiting and prevent further electrolyte loss is:
(a) Oral route
(b) Intramuscular route (c) Intravenous route
(d) Subcutaneous route

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Mcq On Medical Surgical Nursing

Physiological Changes in the First Stage of Labour

This is the stage of dilatation of the cervix.

On average, it lasts eight to twelve hours in a primigravida and six to eight hours in a multipara.

It should not go beyond 14 hours in either.

This stage is characterized by the uterus doing an immense amount of muscular work in the form of contracting and relaxing.

Contractions are involuntary in that they do not come on through voluntary effort of the woman nor can they be voluntarily stopped. 

They are peristaltic and regular.

Contractions at the start of labour come every 10 to 15 minutes and last between 30 to 45 seconds. 

They increase in frequency and strength as labour progresses until they are separated by a minute or two.

Towards the end of the first stage they last for one minute. The relaxation phase during which the muscles remain retracted also shortens.

Each contraction begins with a gradual build-up towards a peak of intensity. 

This is followed by a relaxation phase.

During the relaxation phase, the muscle recovers and gets ready for the next contraction.

This relaxation phase is important to both the foetus and the mother during the first and second stages of labour.

During a contraction the circulation through the uterine wall is reduced and the foetal heart rate is slowed but regains its normal rate as soon as the contraction has passed.

If there is increasing foetal tachycardia between contractions or if the bradycardia is prolonged after each contraction, then foetaldistress sets in. If the uterus contracts continuously the foetus dies from lack of oxygen (anoxia).

The mother is also able to relax during the relaxation phase.

However, if the uterus contracts continuously, the mother also gets very exhausted because the uterus uses up a lot of energy during contractions.

If this goes on for too long, as is the case during prolonged labour, her energy stores become depleted and maternal distress sets in.

As the mother will not be able to eat or absorb much by mouth, she should be given supplementary carbohydrates intravenously. 

In a normal first stage, oral fluids to which additional sugar has been added are sufficient.

As the uterus contracts and retracts more and more, the upper muscular part becomes progressively thicker.

The less muscular lower segment is pulled upwards over the presenting part and becomes thinner.

The cervix becomes effaced. 

The effacement is followed or accompanied by progressive dilation of the cervix until full dilatation when the uterus becomes a continuous cavity with the vagina.

A fully dilated cervix is 10 cm dilated. During the first stage the uterine cavity gets progressively smaller but the foetus moves down very little.

The cervix becomes effaced. The effacement is followed or accompanied by progressive dilation of the cervix until full dilatation when the uterus becomes a continuous cavity with the vagina.

A fully dilated cervix is 10 cm dilated. During the first stage the uterine cavity gets progressively smaller but the foetus moves down very little.

A fully dilated cervix is 10 cm dilated. During the first stage the uterine cavity gets progressively smaller but the foetus moves down very little.

The presenting part helps in dilating the cervix.

During this stage the woman should not use her voluntary efforts to bear down as this will exhaust her unnecessarily and may cause oedema of the cervix and/or foetal distress.

Management of Normal Labour in the
Admission Room

The proper management of labour is essential, if you are to avoid problems or to detect them early when they occur.

The patient will come to you believing she is in labor. You should be able to assess and decide whether she is in labour or not.

The patient may be in early labor, but often she might arrive in the late second or even third stage.

If you are sure she is not in labour send her home to wait. If she is in labour, keep her in the ward and continue monitoring her progress.

Danger, especially to the fetus, can arise suddenly and unexpectedly.

No labor should be assumed normal until the fourth stage has successfully concluded.

Admission

You would take the patient’s personal history, conduct a physical examination and carry out tests/investigations.

On admission, you should check the woman’s antenatal card for any identified risk factors.

It will also help you to see if there were any abnormalities during her pregnancy.

The records will also have information on her medical and obstetric history. If she has not been attending an antenatal.

Once this information has been established, find out more about the present labor.

Take her history, do an examination, and carry out the necessary investigations to establish the stage of labor and the state of the mother and the fetus.

History Taking

A detailed personal history should have been taken during pre-natal care.

However, if this has not been done, this is a good time to get it recorded.

Make sure the names are correctly spelled because this can eventually result in problems when registering the baby.

Review the last day of menstruation to calculate the expected date of delivery.

Check her age, parity, and contraceptive

Assuming that a detailed personal history had been taken during pre-natal care, you should now take information about the following:

➢ Any presence of show

➢Presence or absence of contractions

➢ Onset of contractions and their characteristics

➢ Activity of the foetus

➢ Rupture of the membranes

➢ Any treatment given

Head-to-Toe Physical Examination

Conduct an abdominal examination checking for:

➢Height of fundus

➢ Over-distension of the abdomen, scars or other abnormality

➢Over-distension of bladder

➢ Possible presence of twins or multiple pregnancy

➢ Contractions – frequency, length, type etc

You should also check on the presentation.

Which part of the foetus is at the pelvic brim?

Is it a head (cephalic) or the buttocks (breech)? Check the attitude; whether the head is well flexed or extended.

A well-flexed head presents the smallest diameter and delivers easily.

A deflexed head presents a larger diameter and causes delayed or obstructed labour.

Finally check the position of the relation of the foetal parts to the mother.

This is confirmed through a vaginal examination by checking the position of the foetal occiput relative to the mother.

The position of the foetal spine is the same as that of the occiput.

Vaginal Examination in Labour

This is an important examination as it can give you a lot of information, which you might not get from an abdominal examination.

On the other hand, if you do it often it is uncomfortable for the woman and you might introduce an infection into the uterine cavity, especially if the membranes have ruptured.

To avoid infections, you should scrub and put on gloves as you would for any other sterile procedure.

Then thoroughly swab the perineum of the woman with an antiseptic solution such as Savlon or Hibitane, or boiled water if these are not available.

A vaginal examination is necessary to:

Check if the patient is in labour and what stage of labour (this is done on admission of the patient)

Assess the progress of labour (this is done every four hours during the first stage of labour)

The degree of effacement and dilatation of the cervix and the station of the head relative to the ischial spines will give you the necessary information.

Remember: Do not do a vaginal examination if the mother has an antepartum hemorrhage, because if there is placenta praevia, severe hemorrhage will occur.

A vaginal examination is contraindicated if the mother has ante-partum haemorrhage unless it is performed in an operating theatre. In the case of pre-eclampsia, the procedure should be performed only after giving a sedative.

Vaginal Examination

Arrange your vaginal examination pack with cheatle forceps and pour solution.

Scrub your hands for at least five minutes.

Glove yourself methodically to prevent contamination.

Explain the semi-lithotomy position that should be maintained during the examination to the mother.

Swab the vulva and drop the swab methodically (used swabs should be decontaminated in jik before disposal).

Ask the mother to breathe in and out while you perform digital examination.

With the right hand, gently insert the fingers obliquely inside the vagina with the thumb, facing the symphysis pubis. Your left hand.

The fingers are directed along the anterior wall of the vagina. The wall should feel soft and dilatable while the vagina should be warm and moist.

The fingers are then directed upwards to the position of the cervical Os.

At times the Os is not felt readily, the fingers should then be directed backwards and upwards.

While performing a vaginal examination, you should observe the mother’s non-verbal communication.

The Vagina

The Cervix

➢ Is it bruised or oedematous?

➢Is it firm or soft?

➢ Is it taking up, that is effaced?

➢ How much is the Os dilated?

Do not insert more than two fingers in the cervical Os.

The Membranes

After deciding the state of the cervical Os, check for presence of membranes. Note the following:

Are they ruptured or intact?

If intact are they bulging?

The Cord

Is it presenting or prolapsed?

If prolapsed is it pulsating?

The Presenting Part

Next, determine the level of the presenting part. You should ask the following questions:

Is it fitting the pelvis and cervix well?

If it is the head, can you feel a suture or fontanel? Which one?

Is it well flexed?

If the head is at the brim it, will not be felt vaginally unless you push it down with your left hand which is on the mother’s abdomen

If the head has just engaged, it can be touched or just be tipped

If the head is deeply engaged, the head is felt at the level of the ischial spines.

While performing a vaginal examination, you should observe the mother’s non-verbal communication.

The Presenting Part

The station or level of the presenting part is the level to which the presenting part has descended in the pelvis.

The level of the presenting part is expressed in relation to the easily palpable ischial spines.

You can also state if it is above the brim, at the brim, in the cavity or at the outlet.

Remember that if the presenting part is at the brim then it is at station -5.

As the head descends down in to the cavity of the pelvis it decreases from -5, -4, -3, -2, -1. By the time it is at the ischial spines, it is said to be at ‘zero station’. It reappears from the pelvic outlet into the perineum, which is classified as +1, +2, +3, and +4.

By the time it is seen at the perineum it is at

To get the position right, you have to palpate the sutures and fontanel to determine their position relative to the pelvis. 

This can be confirmed by abdominal examination.

In a breech or a face presentation, the reference points on the foetus are the sacrum and the chin or mentum respectively. A soft mass is felt.

Foetal genital parts or the anus may be felt with the examining finger. 

The position is determined by the position of the sacrum in relation to the side of the mother’s pelvis. The left side is expressed as left sacro-anterior (LSA) or the right side, which is known as right sacro-anterior (RSA).

In a vertex presentation, when the occiput is persistently posterior, this causes prolonged labour.

In a cephalic presentation, you will feel the hard head sutures and fontanel.

Determine whether it is the anterior or posterior fontanel by its shape.

If it is the posterior fontanel, then the position is occipito-anterior.

If it is the anterior fontanel then the position is occipital-posterior.

Face presentation is important as the chin is the facial landmark. 

Note how the position of the chin is related to the mother’s right thigh (RT) or left thigh (LT), side of the pelvis and the anterior and posterior position expressed as RMP (right mentoposterior). You should also note the brow or sinciputpresentation on vaginal examination (VE).

You should be able to feel the brow, frontal sutures and possibly the posterior fontanel. The extension is usually a temporary presentation, which converts to face or occiputpresentation during labour.

However, at times it persists and in such instances, a caesarean section is usually called for.

Note whether the long axis of the body of the foetus is perpendicular to that of the body of the mother.

A left acromiodorso posterior (LADP) indicates that the baby’s lower shoulder is to the mother’s left and its back is towards her back.

A compound presentation is when the hand or occasionally a foot lies alongside the head.

The Pelvis

Next, check for moulding or caput succedaneum.

What is moulding?

Moulding is when the diameters of the foetalskull are reduced in size. During labour the bones of the foetal skull tend to overlap at the sutures so that the head can easily pass through the birth canal.

During a vaginal examination this is how you should check for moulding:

In cephalic presentation, run the finger on the head feeling for the sutures

Judge the degree of moulding by feeling the amount of overlapping of skull bones

Check for caput.

The pelvis is assessed to check if it is adequate

The following factors should be checked:

• Is it roomy?
• Are the sidewalls well spaced?
• Can you touch the promontory of the sacrum easily?
• Is the pubic arch wide enough?
• After checking for moulding, direct the fingers behind the head and make an effort to reach the sacro-promontory. The palm of the hand.

With the palm facing downwards run the two fingers down along the hollow of the sacrum and determine the shape. The hollow of the sacrum should be curved.

The two fingers are then moved to where the ischial spines are located on either side of the pelvis. Run the finger along this area to determine whether or not the ischial spines are unduly prominent. Or else you can stretch your fingers to see if the spines are prominent. The ischial spines should not be prominent.

As you move the fingers with the palm facing upward, on reaching the pubic arch check if it can accommodate two fingers. The apex usually should accommodate two fingers.

Make a fist facing downwards then place the fist between the ischial tuberosities.

The Intertuberosity should accommodate four knuckles.

The Discharge

Withdraw the fingers and check if there is:

➢Any vaginal discharge

➢Any smell

➢Any liquor or meconium staining

➢Any bleeding

The following steps should be taken as part of your investigation:

• Take a urine sample for albumin and sugar
• Check for acetone, especially if the patient is in prolonged labour
• Take blood for haemoglobin and cross matching if the patient is anaemic or might need an operation

By this time you will have gathered enough information as to the stage of labour and whether the patient belongs to the ‘at risk’ category and needs referral or not.

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