NURS EXAM QUESTIONS AND ANSWERS ASSURED A+ END OF WINTER SEASON
• Apatients experiencing end-stage kidney disease has an arteriovenous (AV) fistula
placed surgically for hemodialysis. Most accurate for the nurse to document in the
plan for care of the AV fistula?
• Palpate the bruit of the AV fistula weekly to assess for thrombosis.
• Use the AV fistula site for blood draws to prevent increased pain of multiple blood
draws.
• Take the blood pressure readings in the extremity with the AV fistula to get a more
accurate reading.
• Teach thepatientsto avoid carrying heavy objects that would compress
the AV fistula and cause thrombosis.
• In performing a physical assessment of apatients with chronic kidney disease (CKD), which
finding should the nurse KNOW?
• Glucosuria
• Polyphagia
• Crackles auscultated in the lungs
•The nurse has completed teaching with the hemodialysis patients about self-monitoring
between hemodialysis treatments. The nurse should determine that education was
impotance to the patients in record which parameters daily?
• Pulse and respiratory rate
• Amount of activity and sleep
• Intake and output (I&O) and weight
• Blood urea nitrogen (BUN) and creatinine levels
• The nurse is preparing to care for apatients receiving peritoneal dialysis. Which nursing plan of
care to prevent the major complication associated with peritoneal dialysis?
• Maintain strict aseptic technique.
• Add heparin to the dialysate solution.
• Change the catheter site dressing daily
• Monitor the client's level of consciousness.
• Apatients has chronic kidney disease (CKD) that does yet not require dialysis. Which
indicates the patient need for further teaching?
CKD is a condition in which the kidneys have progressive problems in their ability to
clear nitrogenous waste products and control fluid and electrolyte balance;To slows
progression of the disease and includes reducing the protein, sodium, potassium, and
phosphorus in the diet and controlling the blood pressure
• A patient with stage 4 chronic kidney disease asks what type of diet they should follow?.
• Low protein, low sodium, low potassium, low phosphate diet
• High protein, low sodium, low potassium, high phosphate diet
• Low protein, high sodium, high potassium, high phosphate diet
• Low protein, low sodium, low potassium, high phosphate diet
. type of diet because protein breaks down into urea , low sodium to prevent fluid
retention, low potassium to prevent hyperkalemia and low phosphate to prevent
hyperphosphatemia.
• Apatients who had an esophagectomy less than 24 hrs ago has a pulse rate of 90 bpm,
, respiration rate of 16/min, BP of 130/80 mmHg, O2 sat 91%, and a temp of 100.4°F. What
should you do first?
• Obtain a culture of the incision
• Notify the surgeon to obtain an antibiotic order
• Offer pain medication
• Assist thepatientsto a sitting position to take deep breaths
• A patient has undergone a colon resection. While turning the patient, wound
dehiscence with evisceration occurs. The nurse’s first response is to:
• Call the physician
• Cover the wound with saline-moistened sterile dressing
• Take a BP and pulse
• Pull the dehiscence closed and fasten with steri-strips
The nurse should placed a saline-moistened sterile dressings on the open wound to
prevent tissue drying and possible infection.
• A patient with a recent history of rectal bleeding is being prepared for a colonoscopy.
The best position of the patient should the nurse place for test initially?
• Lying on right side with legs straight
• Lying on lef t side with knees bent
• Prone with the torso elevated
• Bent over with hands touching the floor
• A patient is recovering from an ileostomy that was performed to treat IBS. During discharge
the nurse should stress what?
• Increasing fluid intake to prevent dehydration
• Wearing an appliance pouch only at bedtime
• Consuming a low-protein, high-fiber diet
• Taking only enteric-coated medications
• The nurse should instruct the patients with an ileostomy to report which s/s immediately?
• Passage of liquid stool from the stoma
• Occasional presence of undigested food in the stool
• Absence of drainage from the ileostomy for 6 or more hours
• Temp of 99.8° F
• Apatients who is receiving enteral feedings via a NG tube suddenly becomes dyspneic and
cyanotic. What first RN action?
• Notify the physician and prepare the patient for an x-ray
• Check the placement of the tube by testing gastric pH
• Stop the feedings and further elevate the head of the bed
• Assess the patient’s bowel sounds
• A patient with a diagnosis of peptic ulcer disease reports vomiting coffee grounds
material. What should the nurse do ?
• Notify the physician
• Test the next
stool for occult
blood Take vital
signs
Insert an NG tube
,• The nurse teaches a patient with GERD which of the following measures to manage his disease?
• Elevate foot of bed on 6-8 inch blocks
• Avoid eating or drinking 2 hours before bedtime
• Eat a low carbohydrate diet
• Increase intake of foods containing peppermint and spearmint
• The nurse is evaluating a patient’s ulcer symptoms to differentiate the ulcer as duodenal or
gastric. Which of the following symptoms would the nurse attribute to a duodenal ulcer?
• Hemorrhage
• Weight loss
• Vomiting
• Awakening in pain
• A patient with acute diarrhea of 24 hours’ duration calls the clinic to ask for directions for
care. the nurse should:
• Ask the patient to describe the character of the stools and any associated symptoms.
• Advise the patient to use over-the-counter loperamide (Immodium) to slow GI motility.
• Inform the patient that laboratory testing of blood and stool specimens will be
necessary.
• patient has been diagnosed with achalasia based on his history and diagnostic
imaging results. The nurse should identify what risk ?
• Risk for Aspiration Related to Inhalation of Gastric Contents
• Risk for Imbalanced Nutrition: Less than Body Requirements Related to Impaired
Absorption
• nurse is providing health promotion education to a patient diagnosed with an
esophageal reflux disorder. What practice should the nurse encourage the
patient to implement?
• Keep the head of the bed lowered.
• Drink a cup of hot
tea before bedtime
Avoid carbonated
drinks.
. Eat a low-protein diet.
• patient seeking care because of recurrent heartburn and regurgitation is subsequently
diagnosed with a hiatal hernia. Which should the nurse include in health education?
• Drinking beverages after your meal, rather than with your meal, may bring some relief.
• Its best to avoid dry foods, such as rice and chicken, because theyre harder to swallow.
• Many patients obtain relief by taking over-the-counter antacids 30
minutes before eating Instead of
eating three meals a day, try eating smaller amounts more often.
• nurse is caring for a patient who just has been diagnosed with a peptic ulcer. When
educating the patient about his new diagnosis, how should the nurse best describe
a peptic ulcer?
• Inflammation of the lining of the stomach
• Erosion of the lining of the stomach or intestine
• Bleeding from the mucosa in the stomach
• Viral invasion of the stomach wall
• patient comes to the clinic complaining of pain in the epigastric region. What
assessment during the health interview would most help the nurse determine if the
patient has a peptic ulcer?
, • Does your pain resolve when you have something to eat?
• Do over-the-counter pain medications help your pain?
• Does your pain get worse if you get up and do some exercise?
• Do you find that your pain is worse when you need to have a bowel movement?
• patient with a diagnosis of peptic ulcer disease has just been prescribed omeprazole
.How should the nurse best describe this medications therapeutic action?
• This medication will reduce the amount of acid secreted in your stomach.
• This medication will make the lining of your stomach more resistant to damage.
• This medication will specifically address the pain that accompanies peptic ulcer disease.
• This medication will help your stomach lining to repair itself.
• nurse caring for a patient who has had bariatric surgery is developing a educating plan in
anticipation of the patients discharge. Which should the nurse to include?
• Drink a minimum of 12 ounces of fluid
with each meal
. Eat several small meals daily spaced at
equal intervals.
• Choose foods that are high in simple carbohydrates.
• Sit upright when eating and for 30 minutes afterward.
• nurse is completing a health history on a patient whose diagnosis is chronic gastritis. Which of
the data should the nurse consider most related to the etiology of the patients health
problem?
• Consumes one or more protein drinks daily.
• Takes over-the-counter antacids frequently
throughout the day Smokes one
pack of cigarettes daily.
. Reports a history of social drinking on a weekly basis.
• community health nurse is preparing for an initial home visit to a patient discharged
following a total gastrectomy for treatment of gastric cancer. What would the nurse
anticipate that the plan of care is most likely to include?
• Enteral feeding via gastrostomy tube (G tube)
• Gastrointestinal decompression by nasogastric tube
• Periodic assessment for esophageal distension
• Monthly administration of injections of vitamin B12
Since vitamin B12 is absorbed in the stomach, the patient requires vitamin B12
replacement to prevent pernicious anemia. A gastrectomy precludes the use of a G
tube. Since the stomach is absent, a nasogastric tube would not be indicated. As well,
this is not possible in the home setting. Since there is no stomach to act as a reservoir
and fluids and nutrients are passing directly into the jejunum, distension is unlikely.
• nurse is assessing a patient who has peptic ulcer disease. The patient requests more
information about the typical causes of Helicobacter pylori infection. What would it be
accurate for the nurse to instruct the patient?
• Most affected patients acquired the infection during
international travel
Infection typically occurs due to ingestion of contaminated
food and water.
• Many people possess genetic factors causing a predisposition to H. pylori infection.
• The H. pylori microorganism is endemic in warm, moist climates.
Ans: B. Most peptic ulcers result from infection with the gram-negative bacteria H. pylori,
which may be acquired through ingestion of food and water. The organism is endemic to
all areas of the United States. Genetic factors have not been identified.
• Apatients experiencing end-stage kidney disease has an arteriovenous (AV) fistula
placed surgically for hemodialysis. Most accurate for the nurse to document in the
plan for care of the AV fistula?
• Palpate the bruit of the AV fistula weekly to assess for thrombosis.
• Use the AV fistula site for blood draws to prevent increased pain of multiple blood
draws.
• Take the blood pressure readings in the extremity with the AV fistula to get a more
accurate reading.
• Teach thepatientsto avoid carrying heavy objects that would compress
the AV fistula and cause thrombosis.
• In performing a physical assessment of apatients with chronic kidney disease (CKD), which
finding should the nurse KNOW?
• Glucosuria
• Polyphagia
• Crackles auscultated in the lungs
•The nurse has completed teaching with the hemodialysis patients about self-monitoring
between hemodialysis treatments. The nurse should determine that education was
impotance to the patients in record which parameters daily?
• Pulse and respiratory rate
• Amount of activity and sleep
• Intake and output (I&O) and weight
• Blood urea nitrogen (BUN) and creatinine levels
• The nurse is preparing to care for apatients receiving peritoneal dialysis. Which nursing plan of
care to prevent the major complication associated with peritoneal dialysis?
• Maintain strict aseptic technique.
• Add heparin to the dialysate solution.
• Change the catheter site dressing daily
• Monitor the client's level of consciousness.
• Apatients has chronic kidney disease (CKD) that does yet not require dialysis. Which
indicates the patient need for further teaching?
CKD is a condition in which the kidneys have progressive problems in their ability to
clear nitrogenous waste products and control fluid and electrolyte balance;To slows
progression of the disease and includes reducing the protein, sodium, potassium, and
phosphorus in the diet and controlling the blood pressure
• A patient with stage 4 chronic kidney disease asks what type of diet they should follow?.
• Low protein, low sodium, low potassium, low phosphate diet
• High protein, low sodium, low potassium, high phosphate diet
• Low protein, high sodium, high potassium, high phosphate diet
• Low protein, low sodium, low potassium, high phosphate diet
. type of diet because protein breaks down into urea , low sodium to prevent fluid
retention, low potassium to prevent hyperkalemia and low phosphate to prevent
hyperphosphatemia.
• Apatients who had an esophagectomy less than 24 hrs ago has a pulse rate of 90 bpm,
, respiration rate of 16/min, BP of 130/80 mmHg, O2 sat 91%, and a temp of 100.4°F. What
should you do first?
• Obtain a culture of the incision
• Notify the surgeon to obtain an antibiotic order
• Offer pain medication
• Assist thepatientsto a sitting position to take deep breaths
• A patient has undergone a colon resection. While turning the patient, wound
dehiscence with evisceration occurs. The nurse’s first response is to:
• Call the physician
• Cover the wound with saline-moistened sterile dressing
• Take a BP and pulse
• Pull the dehiscence closed and fasten with steri-strips
The nurse should placed a saline-moistened sterile dressings on the open wound to
prevent tissue drying and possible infection.
• A patient with a recent history of rectal bleeding is being prepared for a colonoscopy.
The best position of the patient should the nurse place for test initially?
• Lying on right side with legs straight
• Lying on lef t side with knees bent
• Prone with the torso elevated
• Bent over with hands touching the floor
• A patient is recovering from an ileostomy that was performed to treat IBS. During discharge
the nurse should stress what?
• Increasing fluid intake to prevent dehydration
• Wearing an appliance pouch only at bedtime
• Consuming a low-protein, high-fiber diet
• Taking only enteric-coated medications
• The nurse should instruct the patients with an ileostomy to report which s/s immediately?
• Passage of liquid stool from the stoma
• Occasional presence of undigested food in the stool
• Absence of drainage from the ileostomy for 6 or more hours
• Temp of 99.8° F
• Apatients who is receiving enteral feedings via a NG tube suddenly becomes dyspneic and
cyanotic. What first RN action?
• Notify the physician and prepare the patient for an x-ray
• Check the placement of the tube by testing gastric pH
• Stop the feedings and further elevate the head of the bed
• Assess the patient’s bowel sounds
• A patient with a diagnosis of peptic ulcer disease reports vomiting coffee grounds
material. What should the nurse do ?
• Notify the physician
• Test the next
stool for occult
blood Take vital
signs
Insert an NG tube
,• The nurse teaches a patient with GERD which of the following measures to manage his disease?
• Elevate foot of bed on 6-8 inch blocks
• Avoid eating or drinking 2 hours before bedtime
• Eat a low carbohydrate diet
• Increase intake of foods containing peppermint and spearmint
• The nurse is evaluating a patient’s ulcer symptoms to differentiate the ulcer as duodenal or
gastric. Which of the following symptoms would the nurse attribute to a duodenal ulcer?
• Hemorrhage
• Weight loss
• Vomiting
• Awakening in pain
• A patient with acute diarrhea of 24 hours’ duration calls the clinic to ask for directions for
care. the nurse should:
• Ask the patient to describe the character of the stools and any associated symptoms.
• Advise the patient to use over-the-counter loperamide (Immodium) to slow GI motility.
• Inform the patient that laboratory testing of blood and stool specimens will be
necessary.
• patient has been diagnosed with achalasia based on his history and diagnostic
imaging results. The nurse should identify what risk ?
• Risk for Aspiration Related to Inhalation of Gastric Contents
• Risk for Imbalanced Nutrition: Less than Body Requirements Related to Impaired
Absorption
• nurse is providing health promotion education to a patient diagnosed with an
esophageal reflux disorder. What practice should the nurse encourage the
patient to implement?
• Keep the head of the bed lowered.
• Drink a cup of hot
tea before bedtime
Avoid carbonated
drinks.
. Eat a low-protein diet.
• patient seeking care because of recurrent heartburn and regurgitation is subsequently
diagnosed with a hiatal hernia. Which should the nurse include in health education?
• Drinking beverages after your meal, rather than with your meal, may bring some relief.
• Its best to avoid dry foods, such as rice and chicken, because theyre harder to swallow.
• Many patients obtain relief by taking over-the-counter antacids 30
minutes before eating Instead of
eating three meals a day, try eating smaller amounts more often.
• nurse is caring for a patient who just has been diagnosed with a peptic ulcer. When
educating the patient about his new diagnosis, how should the nurse best describe
a peptic ulcer?
• Inflammation of the lining of the stomach
• Erosion of the lining of the stomach or intestine
• Bleeding from the mucosa in the stomach
• Viral invasion of the stomach wall
• patient comes to the clinic complaining of pain in the epigastric region. What
assessment during the health interview would most help the nurse determine if the
patient has a peptic ulcer?
, • Does your pain resolve when you have something to eat?
• Do over-the-counter pain medications help your pain?
• Does your pain get worse if you get up and do some exercise?
• Do you find that your pain is worse when you need to have a bowel movement?
• patient with a diagnosis of peptic ulcer disease has just been prescribed omeprazole
.How should the nurse best describe this medications therapeutic action?
• This medication will reduce the amount of acid secreted in your stomach.
• This medication will make the lining of your stomach more resistant to damage.
• This medication will specifically address the pain that accompanies peptic ulcer disease.
• This medication will help your stomach lining to repair itself.
• nurse caring for a patient who has had bariatric surgery is developing a educating plan in
anticipation of the patients discharge. Which should the nurse to include?
• Drink a minimum of 12 ounces of fluid
with each meal
. Eat several small meals daily spaced at
equal intervals.
• Choose foods that are high in simple carbohydrates.
• Sit upright when eating and for 30 minutes afterward.
• nurse is completing a health history on a patient whose diagnosis is chronic gastritis. Which of
the data should the nurse consider most related to the etiology of the patients health
problem?
• Consumes one or more protein drinks daily.
• Takes over-the-counter antacids frequently
throughout the day Smokes one
pack of cigarettes daily.
. Reports a history of social drinking on a weekly basis.
• community health nurse is preparing for an initial home visit to a patient discharged
following a total gastrectomy for treatment of gastric cancer. What would the nurse
anticipate that the plan of care is most likely to include?
• Enteral feeding via gastrostomy tube (G tube)
• Gastrointestinal decompression by nasogastric tube
• Periodic assessment for esophageal distension
• Monthly administration of injections of vitamin B12
Since vitamin B12 is absorbed in the stomach, the patient requires vitamin B12
replacement to prevent pernicious anemia. A gastrectomy precludes the use of a G
tube. Since the stomach is absent, a nasogastric tube would not be indicated. As well,
this is not possible in the home setting. Since there is no stomach to act as a reservoir
and fluids and nutrients are passing directly into the jejunum, distension is unlikely.
• nurse is assessing a patient who has peptic ulcer disease. The patient requests more
information about the typical causes of Helicobacter pylori infection. What would it be
accurate for the nurse to instruct the patient?
• Most affected patients acquired the infection during
international travel
Infection typically occurs due to ingestion of contaminated
food and water.
• Many people possess genetic factors causing a predisposition to H. pylori infection.
• The H. pylori microorganism is endemic in warm, moist climates.
Ans: B. Most peptic ulcers result from infection with the gram-negative bacteria H. pylori,
which may be acquired through ingestion of food and water. The organism is endemic to
all areas of the United States. Genetic factors have not been identified.
