CPNRE MIDTERM EXAM WITH
QUESTIONS AND ANSWERS 2025
UPDATE.
The client was provided with preop teaching on deep breathing and coughing. How should the
PN best determine the outcome of this teaching? - ANS Ask the client to demonstrate deep
breathing and coughing.
What manifestation of liver failure should the nurse report first?
A) Yellowing of the sclera
B) Decreased appetite
C) Increased respirations
D) Decreased consciousness - ANS D) Decreased consciousness - hepatic encephalopathy is a
nervous system complication that can often lead to coma and death.
Hepatic Encephalopathy - ANS Central nervous system dysfunction resulting from liver disease;
frequently associated with elevated ammonia levels that produce changes in mental status,
altered level of consciousness, and coma.
Ms. Smith recalls the first day of her last menstrual period as December 14th, 2019. What should
be PN write down as her expected date of delivery using Naegele's rule? - ANS December 14th,
+ 7 days = December 21 - 3 months = September 21, + one year = December 21, 2020
Naegele's Rule - ANS Add 7 days to first day of LMP, subtract 3 months, and add 1 year.
Mrs. T delivered a healthy baby girl two hours ago; what is the nurse's primary assessment?
A) Location and tone of the uterus
B) Parent and infant attachment behaviours
C) Vital signs, especially blood pressure
D) Perineal edema and lochia - ANS A) Hemorrhage is frequently associated with uterine atony
and is considered a major complication during the recovery period and therefore this is the most
important.
How does the mother know that breastfeeding is going well? - ANS The newborn should have at
least six wet diapers per day; *frequency of feeding does NOT ensure ADEQUATE feeding.
In preparing the new mom for DC, the nurse notices the baby appears jaundiced - what strategy
should the nurse teach Mrs. T to address this concern?
A) Supplement with sterile water
B) Feed the NB a minimum of every 4 hours
C) Feed the NB whenever she demands
,D) Supplement with glucose between feedings - ANS The correct answer is B); adequate
nutritional intake is vital for the formation of hepatic binding proteins. Even if the NB is
lethargic - wake for feedings.
A) Supplement with sterile water *This will cause even more jaundice and rising levels of
bilirubin.
B) Feed the NB a minimum of every 4 hours
C) Feed the NB whenever she demands *Baby may be lethargic and have no interest in eating.
D) Supplement with glucose between feedings *This is an appropriate intervention, but not the
best.
Autonomic Dysreflexia (Common in SCI) - ANS Patients with spinal cord injuries are at risk for
developing autonomic dyreflexia (T-7 or above). *Reassess to identify triggering stimulus and
remove as quickly as possible so that it is not fatal.
The physician's order reads: intermediate duration insulin NPH (Novolin NPH) 36 units with
regular insulin 12 units subcutaneously. Which process should the PN use to draw it up?
A) Inject 36 units of air into the NPH followed by 12 units into regular, invert vial and withdraw
regular insulin
B) Inject 12 units of air into regular insulin followed by inserting 36 units air into NPH
C) Withdraw 12 units regular insulin followed by 36 units of NPH - ANS A) Inject 36 units of
air into NPH followed by 12 units into regular, invert vial and withdraw regular insulin.
*Remember to always inject air first; remember that rapid/short-acting insulin must always be
withdrawn first to prevent contamination with intermediate/long-acting insulin.
NPH Insulin - ANS intermediate acting insulin
Regular Insulin - ANS Humulin R
Cardiac Glycosides (Digoxin) - ANS Increase force and velocity of myocardial contractions
>>improve stroke volume and CO
Slows the conduction rate >>allowing for increased ventricular filling
Therapeutic Uses:
-Heart Failure
-Atrial Fibrillation
Precautions/Interactions:
-Thiazide or loop diuretics increase risk of hypokalemia and precipitate digoxin toxicity
-ACEs and ARBs increase risk of hyperkalemia
-verapamil (CCB) increases toxicity risk
- Omeprazole may increase Digoxin levels
Side Effects:
, -Digoxin Toxicity: anorexia, N/V, abdominal pain, fatigue, weakness, diplopia, blurred vision,
yellow/green/white halos around objects
Interventions/Education:
-assess apical pulse for 1 min prior to administration
-notify Dr if HR is less than 60 (adult), less than 70 (child), or less than 90 (infant)
-monitor for s/s of digoxin toxicity, hypokalemia, and hypomagnesemia
-notify Dr of any sudden increase in pulse rate that previously been normal or low
-maintain therapeutic digoxin level (0.8-2.0); toxic levels >2.4
Management of digoxin toxicity:
-D/C digoxin and potassium wasting meds
-treat dysrhythmias with phenytoin or lidocaine
-treat bradycardia with atropine
-for excess overdose, administer digibind to prevent absorption
Hypokalemia:
-IV potassium
Hyperkalemia:
-kayalex
In someone with bi polar disorder, how will someone present that is in a manic phase? - ANS
Signs of mania include increased distractibility, elated presentation, and delusions of grandeur.
A patient offers the nurse $20.00 for being so kind and helpful; what is an appropriate thing for
the nurse to do? - ANS Refuse the money and explain that staff cannot accept money.
How can someone with recurrent UTI's prevent infections? - ANS Drink a lot of water, maintain
good hygiene, and void frequently.
What are two common indicators of a systemic infection? - ANS Elevated WBC's and increased
heart rate.
Ms. H is to receive 100 mL of NS with 1 g of prescribed antibiotic over a 20 min period via IV
pump. At what rate should the nurse program the pump to deliver the medication as ordered? -
ANS Amount to be infused/Time to be infused
100 mL/20 min
20 min/60 = 0.33333...
100 mL/0.3333 =
300. 0300....
therefore, 300 mL/hr
Ms. J is 72 and has right-sided heart failure; she presents with swollen feet. What other common
manifestations would be expected? - ANS Nausea, ascites, distended jugular vein.
Right-Sided Heart Failure - ANS 1. Jungular Vein Distention
QUESTIONS AND ANSWERS 2025
UPDATE.
The client was provided with preop teaching on deep breathing and coughing. How should the
PN best determine the outcome of this teaching? - ANS Ask the client to demonstrate deep
breathing and coughing.
What manifestation of liver failure should the nurse report first?
A) Yellowing of the sclera
B) Decreased appetite
C) Increased respirations
D) Decreased consciousness - ANS D) Decreased consciousness - hepatic encephalopathy is a
nervous system complication that can often lead to coma and death.
Hepatic Encephalopathy - ANS Central nervous system dysfunction resulting from liver disease;
frequently associated with elevated ammonia levels that produce changes in mental status,
altered level of consciousness, and coma.
Ms. Smith recalls the first day of her last menstrual period as December 14th, 2019. What should
be PN write down as her expected date of delivery using Naegele's rule? - ANS December 14th,
+ 7 days = December 21 - 3 months = September 21, + one year = December 21, 2020
Naegele's Rule - ANS Add 7 days to first day of LMP, subtract 3 months, and add 1 year.
Mrs. T delivered a healthy baby girl two hours ago; what is the nurse's primary assessment?
A) Location and tone of the uterus
B) Parent and infant attachment behaviours
C) Vital signs, especially blood pressure
D) Perineal edema and lochia - ANS A) Hemorrhage is frequently associated with uterine atony
and is considered a major complication during the recovery period and therefore this is the most
important.
How does the mother know that breastfeeding is going well? - ANS The newborn should have at
least six wet diapers per day; *frequency of feeding does NOT ensure ADEQUATE feeding.
In preparing the new mom for DC, the nurse notices the baby appears jaundiced - what strategy
should the nurse teach Mrs. T to address this concern?
A) Supplement with sterile water
B) Feed the NB a minimum of every 4 hours
C) Feed the NB whenever she demands
,D) Supplement with glucose between feedings - ANS The correct answer is B); adequate
nutritional intake is vital for the formation of hepatic binding proteins. Even if the NB is
lethargic - wake for feedings.
A) Supplement with sterile water *This will cause even more jaundice and rising levels of
bilirubin.
B) Feed the NB a minimum of every 4 hours
C) Feed the NB whenever she demands *Baby may be lethargic and have no interest in eating.
D) Supplement with glucose between feedings *This is an appropriate intervention, but not the
best.
Autonomic Dysreflexia (Common in SCI) - ANS Patients with spinal cord injuries are at risk for
developing autonomic dyreflexia (T-7 or above). *Reassess to identify triggering stimulus and
remove as quickly as possible so that it is not fatal.
The physician's order reads: intermediate duration insulin NPH (Novolin NPH) 36 units with
regular insulin 12 units subcutaneously. Which process should the PN use to draw it up?
A) Inject 36 units of air into the NPH followed by 12 units into regular, invert vial and withdraw
regular insulin
B) Inject 12 units of air into regular insulin followed by inserting 36 units air into NPH
C) Withdraw 12 units regular insulin followed by 36 units of NPH - ANS A) Inject 36 units of
air into NPH followed by 12 units into regular, invert vial and withdraw regular insulin.
*Remember to always inject air first; remember that rapid/short-acting insulin must always be
withdrawn first to prevent contamination with intermediate/long-acting insulin.
NPH Insulin - ANS intermediate acting insulin
Regular Insulin - ANS Humulin R
Cardiac Glycosides (Digoxin) - ANS Increase force and velocity of myocardial contractions
>>improve stroke volume and CO
Slows the conduction rate >>allowing for increased ventricular filling
Therapeutic Uses:
-Heart Failure
-Atrial Fibrillation
Precautions/Interactions:
-Thiazide or loop diuretics increase risk of hypokalemia and precipitate digoxin toxicity
-ACEs and ARBs increase risk of hyperkalemia
-verapamil (CCB) increases toxicity risk
- Omeprazole may increase Digoxin levels
Side Effects:
, -Digoxin Toxicity: anorexia, N/V, abdominal pain, fatigue, weakness, diplopia, blurred vision,
yellow/green/white halos around objects
Interventions/Education:
-assess apical pulse for 1 min prior to administration
-notify Dr if HR is less than 60 (adult), less than 70 (child), or less than 90 (infant)
-monitor for s/s of digoxin toxicity, hypokalemia, and hypomagnesemia
-notify Dr of any sudden increase in pulse rate that previously been normal or low
-maintain therapeutic digoxin level (0.8-2.0); toxic levels >2.4
Management of digoxin toxicity:
-D/C digoxin and potassium wasting meds
-treat dysrhythmias with phenytoin or lidocaine
-treat bradycardia with atropine
-for excess overdose, administer digibind to prevent absorption
Hypokalemia:
-IV potassium
Hyperkalemia:
-kayalex
In someone with bi polar disorder, how will someone present that is in a manic phase? - ANS
Signs of mania include increased distractibility, elated presentation, and delusions of grandeur.
A patient offers the nurse $20.00 for being so kind and helpful; what is an appropriate thing for
the nurse to do? - ANS Refuse the money and explain that staff cannot accept money.
How can someone with recurrent UTI's prevent infections? - ANS Drink a lot of water, maintain
good hygiene, and void frequently.
What are two common indicators of a systemic infection? - ANS Elevated WBC's and increased
heart rate.
Ms. H is to receive 100 mL of NS with 1 g of prescribed antibiotic over a 20 min period via IV
pump. At what rate should the nurse program the pump to deliver the medication as ordered? -
ANS Amount to be infused/Time to be infused
100 mL/20 min
20 min/60 = 0.33333...
100 mL/0.3333 =
300. 0300....
therefore, 300 mL/hr
Ms. J is 72 and has right-sided heart failure; she presents with swollen feet. What other common
manifestations would be expected? - ANS Nausea, ascites, distended jugular vein.
Right-Sided Heart Failure - ANS 1. Jungular Vein Distention
