NCSBN Practice Questions
Which individual is at greatest risk for the development of hypertension?
A. 40 year-old Caucasian nurse
B. 60 year-old Asian-American shop owner
C. 45 year-old African-American attorney
D. 55 year-old Hispanic teacher - ANSW C
The incidence of hypertension is greater among African-Americans than other groups in
the United States. The incidence among the Hispanic population is rising.
A woman, who delivered five days ago and who had been diagnosed with pregnancy
induced hypertension (PIH), calls a hospital triage nurse hotline to ask for advice. She
states, "I have had the worst headache for the past two days. It pounds and by the
middle of the afternoon everything I look at looks wavy. Nothing I have taken helps."
What should the nurse do next?
A. Advise the client to have someone bring her to the emergency room as soon as
possible
B. Ask the client to explain what she has taken and how often, and then evaluate other
specific complaints
C. Advise the client that the swings in her hormones may be the problem; suggest that
she call her health care provider
D. Ask the client to stay on the line, get the address, and send an ambulance to the
home - ANSW D
The woman is at risk for seizure activity. The ambulance needs to bring the woman to
the hospital for evaluation and treatment. For at-risk clients, PIH may progress to
preeclampsia and eclampsia prior to, during, or after delivery; this may occur up to 10
days after delivery.
There's a new medication order that reads: "administer 1 gtt ciprofloxacin solution OD Q
4 h" What action should the nurse take?
A. Squeeze one drop of the medication in the left eye every 4 hours
B. Apply one drop in the right ear every 4 hours
C. Call the prescriber to clarify and rewrite the order
D. Ask other nurses for their interpretation of the order - ANSW C
Abbreviations, symbols and dose designations can be misinterpreted and lead to
medication errors. "OD" can mean "right eye" (oculus dexter) or "once daily"; it should
never be used when communicating medical information. The abbreviation "Q" should
be written out as "every." Although "gtt" is not on the official "Do Not Use List", it's best
,to use "drop" instead. Asking other nurses to interpret an order is a potentially
dangerous "workaround." The nurse should call the health care provider who prescribed
the medication and clarify the order.
A client expresses anger when a call light is not answered within five minutes. The client
demanded a blanket. How should the nurse respond?
A. "I see this is frustrating for you. I have a few minutes so let's talk."
B. "I am surprised that you are upset. The request could have waited a few more
minutes."
C. "Let's talk. Why are you upset about this?"
D. "I apologize for the delay. I was involved in an emergency." - ANSW A
This is the best response because it gives credence to the client's feelings and then
concerns. To say "let's talk" and ask a why question is not a therapeutic approach
because it does not acknowledge or validate the client's feelings. To apologize and not
notice the client's feelings is inappropriate. To say it could have waited a few minutes is
rude and non-accepting of the client's verbalized needs.
The clinic nurse is assisting with medical billing. The nurse uses the DRG (Diagnosis
Related Group) manual for which purpose?
A. Determine reimbursement for a medical diagnosis
B. Identify findings related to a medical diagnosis
C. Classify nursing diagnoses from the client's health history
D. Implement nursing care based on case management protocol - ANSW DRGs are
the basis of prospective payment plans for reimbursement for Medicare clients. Other
insurance companies often use it as a standard for determining payment.
A nurse is planning care for a 2 year-old hospitalized child. Which issue will produce the
most stress at this age?
A. Fear of pain
B. Separation anxiety
C. Loss of control
D. Bodily injury - ANSW B
While a toddler will experience all of the stresses, separation from parents is the major
stressor. Separation anxiety peaks in the toddler years.
The nurse receives a client from the post anesthesia care unit following a left femoral-
popliteal bypass graft procedure. Which of the following assessments requires
immediate notification of the health care provider?
A. Left foot is cool to the touch
B. Absent left pedal pulse using Doppler analysis
C. Inability to palpate the left pedal pulse
D. Acute pain in the left lower leg - ANSW B
,Although the inability to palpate the left pedal pulse, a cool extremity, and increased
pain in the left lower leg are important findings, they all require additional nursing
assessment prior to contacting the health care provider. In clients without palpable
pedal pulses, the next step in the assessment is to perform a Doppler analysis. The
inability to locate the left pedal pulse using the Doppler analysis requires immediately
notifying the health care provider.
The nurse is reviewing the laboratory results for several clients. Which of the laboratory
result indicates a client with partly compensated metabolic acidosis?
A. PaCO2 30 mm Hg
B. Hemoglobin 15 g/dL (150 g//L)
C. Sodium 130 mEq/L (130 mmol/L)
D. Chloride 100 mEq/L (100 mmol/L) - ANSW A
Metabolic acidosis can be caused by many conditions, including renal failure, shock,
severe diarrhea, dehydration, diabetic acidosis, and salicylate poisoning. With metabolic
acidosis, you should expect a low pH (less than 7.35) and a low HCO3 (less than 22
mEq/L.) Compensation means the body is trying to get the pH back in balance;
therefore, a pure metabolic acidosis should elicit a compensatory decrease in PaCO3
(normal is 35-45 mm Hg.) The hemoglobin is within normal limits (WNL) for both males
and females. The chloride and sodium results are also WNL.
A nurse is teaching a group of adults about modifiable cardiac risk factors. Which of the
following should the nurse focus on first?
A. Weight reduction
B. Stress management
C. Smoking cessation
D. Physical exercise - ANSW C
Smoking cessation is the priority for clients at risk for cardiac disease. Smoking's effects
result in reduction of cell oxygenation and constriction of the blood vessels. All of the
other factors should be addressed at some point in time.
The client is admitted to an ambulatory surgery center and undergoes a right inguinal
orchiectomy. Which option is the priority before the client can be discharged to home?
A. Able to tolerate a regular diet
B. Post-operative pain is managed
C. Psychological counseling is scheduled
D. Able to ambulate in the hallway with assistance - ANSW B
An orchiectomy is the surgical removal of one or both testicles. It is usually performed to
treat cancer (testicular, prostate or cancer of the male breast), but it may also be
performed to prevent cancer (with an undescended testicle.) Due to the location of the
incision, pain management is the priority. Most men will be able to eat regularly when
they get home; they should at least tolerate liquids before discharge. It's important that
the client is able to get up and walk with assistance, but this is not the priority.
, Psychological counseling may be needed as part of long-term aftercare, but this is not
an immediate priority.
A client is transported to the emergency department after a motor vehicle accident.
When assessing the client 30 minutes after admission, the nurse notes several physical
changes. Which finding would require the nurse's immediate attention?
A. Increased restlessness
B. Tachypnea
C. Tachycardia
D. Tracheal deviation - ANSW D
Tracheal deviation is a sign that a mediastinal shift has occurred, most likely due to a
tension pneumothorax. Air escaping from the injured lung into the pleural cavity causes
pressure to build, collapsing the lung and shifting the mediastinum to the opposite side.
This obstructs venous return to the heart, leading to circulatory instability and may result
in cardiac arrest. This is a medical emergency, requiring emergency placement of a
chest tube to remove air from the pleural cavity relieving the pressure.
A client has a chest tube inserted immediately after surgery for a left lower lobectomy.
During the repositioning of the client during the first postop check, the nurse notices 75
mL of a dark, red fluid flowing into the collection chamber of the chest drain system.
What is the appropriate nursing action?
A. Continue to monitor the rate of drainage
B. Call the surgeon immediately
C. Check to see if the client has a type and cross match
D. Turn the client back to the original position - ANSW A
It is not unusual for blood to collect in the chest and be released into the chest drain
when the client changes position this soon after surgery. The dark color of the blood
indicates it is not active bleeding inside of the chest. Sanguinous drainage should be
expected within the initial 24 hours postop, progressing to serosanguinous and then to a
serous type. If the drainage exceeds 100 mL/hr, the nurse should call the surgeon.
The client with a T-2 spinal cord injury reports having a "pounding" headache. Further
assessment by the nurse reveals excessive sweating, rash, pilomotor erection, facial
flushing, congested nasal passages and a heart rate of 50. What action should the
nurse take next?
A. Assist client with relaxation techniques
B. Measure the client's respirations, blood pressure, temperature and pupillary
responses
C. Check the client for bladder distention and the urinary catheter for kinks
D. Place the client into the bed and administer the ordered PRN analgesic - ANSW C
These are findings of autonomic dysreflexia, also called hyperreflexia. This response
occurs in clients with a spinal cord injury above the T-6 level. It is typically initiated by
any noxious stimulus below the level of injury such as a full bladder, an enema or bowel
Which individual is at greatest risk for the development of hypertension?
A. 40 year-old Caucasian nurse
B. 60 year-old Asian-American shop owner
C. 45 year-old African-American attorney
D. 55 year-old Hispanic teacher - ANSW C
The incidence of hypertension is greater among African-Americans than other groups in
the United States. The incidence among the Hispanic population is rising.
A woman, who delivered five days ago and who had been diagnosed with pregnancy
induced hypertension (PIH), calls a hospital triage nurse hotline to ask for advice. She
states, "I have had the worst headache for the past two days. It pounds and by the
middle of the afternoon everything I look at looks wavy. Nothing I have taken helps."
What should the nurse do next?
A. Advise the client to have someone bring her to the emergency room as soon as
possible
B. Ask the client to explain what she has taken and how often, and then evaluate other
specific complaints
C. Advise the client that the swings in her hormones may be the problem; suggest that
she call her health care provider
D. Ask the client to stay on the line, get the address, and send an ambulance to the
home - ANSW D
The woman is at risk for seizure activity. The ambulance needs to bring the woman to
the hospital for evaluation and treatment. For at-risk clients, PIH may progress to
preeclampsia and eclampsia prior to, during, or after delivery; this may occur up to 10
days after delivery.
There's a new medication order that reads: "administer 1 gtt ciprofloxacin solution OD Q
4 h" What action should the nurse take?
A. Squeeze one drop of the medication in the left eye every 4 hours
B. Apply one drop in the right ear every 4 hours
C. Call the prescriber to clarify and rewrite the order
D. Ask other nurses for their interpretation of the order - ANSW C
Abbreviations, symbols and dose designations can be misinterpreted and lead to
medication errors. "OD" can mean "right eye" (oculus dexter) or "once daily"; it should
never be used when communicating medical information. The abbreviation "Q" should
be written out as "every." Although "gtt" is not on the official "Do Not Use List", it's best
,to use "drop" instead. Asking other nurses to interpret an order is a potentially
dangerous "workaround." The nurse should call the health care provider who prescribed
the medication and clarify the order.
A client expresses anger when a call light is not answered within five minutes. The client
demanded a blanket. How should the nurse respond?
A. "I see this is frustrating for you. I have a few minutes so let's talk."
B. "I am surprised that you are upset. The request could have waited a few more
minutes."
C. "Let's talk. Why are you upset about this?"
D. "I apologize for the delay. I was involved in an emergency." - ANSW A
This is the best response because it gives credence to the client's feelings and then
concerns. To say "let's talk" and ask a why question is not a therapeutic approach
because it does not acknowledge or validate the client's feelings. To apologize and not
notice the client's feelings is inappropriate. To say it could have waited a few minutes is
rude and non-accepting of the client's verbalized needs.
The clinic nurse is assisting with medical billing. The nurse uses the DRG (Diagnosis
Related Group) manual for which purpose?
A. Determine reimbursement for a medical diagnosis
B. Identify findings related to a medical diagnosis
C. Classify nursing diagnoses from the client's health history
D. Implement nursing care based on case management protocol - ANSW DRGs are
the basis of prospective payment plans for reimbursement for Medicare clients. Other
insurance companies often use it as a standard for determining payment.
A nurse is planning care for a 2 year-old hospitalized child. Which issue will produce the
most stress at this age?
A. Fear of pain
B. Separation anxiety
C. Loss of control
D. Bodily injury - ANSW B
While a toddler will experience all of the stresses, separation from parents is the major
stressor. Separation anxiety peaks in the toddler years.
The nurse receives a client from the post anesthesia care unit following a left femoral-
popliteal bypass graft procedure. Which of the following assessments requires
immediate notification of the health care provider?
A. Left foot is cool to the touch
B. Absent left pedal pulse using Doppler analysis
C. Inability to palpate the left pedal pulse
D. Acute pain in the left lower leg - ANSW B
,Although the inability to palpate the left pedal pulse, a cool extremity, and increased
pain in the left lower leg are important findings, they all require additional nursing
assessment prior to contacting the health care provider. In clients without palpable
pedal pulses, the next step in the assessment is to perform a Doppler analysis. The
inability to locate the left pedal pulse using the Doppler analysis requires immediately
notifying the health care provider.
The nurse is reviewing the laboratory results for several clients. Which of the laboratory
result indicates a client with partly compensated metabolic acidosis?
A. PaCO2 30 mm Hg
B. Hemoglobin 15 g/dL (150 g//L)
C. Sodium 130 mEq/L (130 mmol/L)
D. Chloride 100 mEq/L (100 mmol/L) - ANSW A
Metabolic acidosis can be caused by many conditions, including renal failure, shock,
severe diarrhea, dehydration, diabetic acidosis, and salicylate poisoning. With metabolic
acidosis, you should expect a low pH (less than 7.35) and a low HCO3 (less than 22
mEq/L.) Compensation means the body is trying to get the pH back in balance;
therefore, a pure metabolic acidosis should elicit a compensatory decrease in PaCO3
(normal is 35-45 mm Hg.) The hemoglobin is within normal limits (WNL) for both males
and females. The chloride and sodium results are also WNL.
A nurse is teaching a group of adults about modifiable cardiac risk factors. Which of the
following should the nurse focus on first?
A. Weight reduction
B. Stress management
C. Smoking cessation
D. Physical exercise - ANSW C
Smoking cessation is the priority for clients at risk for cardiac disease. Smoking's effects
result in reduction of cell oxygenation and constriction of the blood vessels. All of the
other factors should be addressed at some point in time.
The client is admitted to an ambulatory surgery center and undergoes a right inguinal
orchiectomy. Which option is the priority before the client can be discharged to home?
A. Able to tolerate a regular diet
B. Post-operative pain is managed
C. Psychological counseling is scheduled
D. Able to ambulate in the hallway with assistance - ANSW B
An orchiectomy is the surgical removal of one or both testicles. It is usually performed to
treat cancer (testicular, prostate or cancer of the male breast), but it may also be
performed to prevent cancer (with an undescended testicle.) Due to the location of the
incision, pain management is the priority. Most men will be able to eat regularly when
they get home; they should at least tolerate liquids before discharge. It's important that
the client is able to get up and walk with assistance, but this is not the priority.
, Psychological counseling may be needed as part of long-term aftercare, but this is not
an immediate priority.
A client is transported to the emergency department after a motor vehicle accident.
When assessing the client 30 minutes after admission, the nurse notes several physical
changes. Which finding would require the nurse's immediate attention?
A. Increased restlessness
B. Tachypnea
C. Tachycardia
D. Tracheal deviation - ANSW D
Tracheal deviation is a sign that a mediastinal shift has occurred, most likely due to a
tension pneumothorax. Air escaping from the injured lung into the pleural cavity causes
pressure to build, collapsing the lung and shifting the mediastinum to the opposite side.
This obstructs venous return to the heart, leading to circulatory instability and may result
in cardiac arrest. This is a medical emergency, requiring emergency placement of a
chest tube to remove air from the pleural cavity relieving the pressure.
A client has a chest tube inserted immediately after surgery for a left lower lobectomy.
During the repositioning of the client during the first postop check, the nurse notices 75
mL of a dark, red fluid flowing into the collection chamber of the chest drain system.
What is the appropriate nursing action?
A. Continue to monitor the rate of drainage
B. Call the surgeon immediately
C. Check to see if the client has a type and cross match
D. Turn the client back to the original position - ANSW A
It is not unusual for blood to collect in the chest and be released into the chest drain
when the client changes position this soon after surgery. The dark color of the blood
indicates it is not active bleeding inside of the chest. Sanguinous drainage should be
expected within the initial 24 hours postop, progressing to serosanguinous and then to a
serous type. If the drainage exceeds 100 mL/hr, the nurse should call the surgeon.
The client with a T-2 spinal cord injury reports having a "pounding" headache. Further
assessment by the nurse reveals excessive sweating, rash, pilomotor erection, facial
flushing, congested nasal passages and a heart rate of 50. What action should the
nurse take next?
A. Assist client with relaxation techniques
B. Measure the client's respirations, blood pressure, temperature and pupillary
responses
C. Check the client for bladder distention and the urinary catheter for kinks
D. Place the client into the bed and administer the ordered PRN analgesic - ANSW C
These are findings of autonomic dysreflexia, also called hyperreflexia. This response
occurs in clients with a spinal cord injury above the T-6 level. It is typically initiated by
any noxious stimulus below the level of injury such as a full bladder, an enema or bowel
