PNmAdultmMedicalmSurgical
1. Amnurse mismreviewingmthe mlaboratorymresultsmofmamclientmwhomismscheduledmformamCTmscanmwith
m anm IV m
contrastmagent.mWhichmofmthe mfollowingmlaboratorymfindingsmshouldmthe mnurse mreportm
tomthe mprovidermpriormtomthe mprocedure?
Creatine m1.9mmg/dl
2. Amnurse mismmonitoringmamclientmwhomismtake macarbose.mWhichmofmthemfollowingmfindingsmshoul
dmthe mnurse midentifymasmanmadverse meffectmof mthe mmedication?
AbdominalmCramps
3. Amnurse mismassistingmwithmthe mcare mofmamclientmwhomhadmamcardiacmcatheterizationmviamthe mrig
htmfemoralmartery.mWhichmof mthe mfollowingmactionsmshouldmthe mnurse mtake mtompreventmpost-
procedure mcomplications?
Monitormthe minsertionmsitemformbleeding,mMaintainmthempressure mdressing,mCheckmthemclient’smperi
pheralmpulses
4. Amnurse mismcontributingmtomthe mplanmofmcaremformamclientmwomhasmchronicmobstructivempulmonar
ymdisease m(COPD)mandmismdyspneic.mWhichmofmthemfollowingminterventionsmshouldmthe mnursemincl
ude minmthe mplan?
Encourage mabdominalmbreathing
5. Amnurse mismpreparingmtomadministermphytonadionem7mmgmsubcutaneouslymtomamclientmwhomhasma
nmINRmofm4.mAvailable mismphytonadionem10mmg/mL.mHowmmanymmLmshouldmthe mnurse madminister
?m(Roundmthe manswermtomthemnearestmtenth.mUsemamleadingmzeromifmitmapplies.mDomnotmuse mamtrai
lingmzero.)
0.7
6. Amnurse mismexaminingmamclient’smIVmandmnotesmamredmlinemupmhismarm.mThe mclientmreportsmamthro
bbing,mburningmpainmatmthemIV msite.mThemnursemshouldmidentifymthatmthe mclient’smmanifestations
m indicate m whichm of m the m followingm complications m of m IV m therapy?
Thrombophlebitis
7. Amnurse mismreinforcingmteachingmaboutmmanagementmof mconstipationmwithmamclientmwho
m hasmhypothyroidism. mWhichmodmthe mfollowingmshouldmthemnurseminclude minm the m teachi
ng?
Increase mintake mof mfiber-richmfoods.
,8. Amnurse mismcaringmformamclientmwhomhasmamcompoundmfracture mofmthe mfemurmandmwasmplac
edminmbalancedmsuspensionmskeletalmtractionm4mdaysmago.mWhichmofmthemfollowingmactionsm
shouldmthe mnurse mtake?
Performmpinmsite mcare mdaily
9. Amnurse mobservesmamclientmwhomismlyingminmbedmexperiencingmamtonic-
clonicmseizure.mWhichmof mthe mfollowingmactionsmshouldmthe mnurse mtake?
Loosenmclothingmaroundmthe mclient’smneck.
10. Amnurse mismcontributingmtomthemplanmof mcaremformamclientmwhomhasmmultiple msclerosismandmism
takingmdantrolene mtommanagemmuscle mspasms.mWhichmofmthemfollowingminterventionsmshoul
dmthe mnurse minclude?
Encourage mthe mclientmtomcomplete mADLs
11. Amnurse mismreinforcingmdischarge mteachingmtompreventmdumpingmsyndromemformamclientmfollowi
ngmampartialmgastrectomymformulcers.mWhichmof mthemfollowingminformationmshouldmthemnursemi
nclude minmthe mteaching?
Avoidmliquidsmatmmealtimes.
12. Amnurse mismcollectingmdatamfrommamclientmwhomhasmheartmfailure mandmismtakingmdigoxin.mWhichm
of mthe mfollowingmoutcomesmfrommthe mmedicationmshouldmthe mnurse mexpect?
Decreasedmshortnessmof mbreath
13. Amnurse mismreinforcingmdischargemteachingmwithmamclientmwhomhasmhearingmloss.mWhichmo
f mthe mfollowingmactionsmshouldmthemnurse mtake mwhenmcommunicatingmwithmthe mclient?
Rephrase mclientminstructionsmwhenmnotmunderstood.
14. Amnurse mismpreparingmtomremove mamclient'smNGmtube.mWhichmofmthe mfollowingminterventionsms
houldmthe mnurse mtake mtomdecrease mthe mriskmof maspiration?
Pinchmthe mNG mtube.
15. Amnurse mismcontributingmtomthemplanmofmcare mformanmoldermadultmclientmwhomismatmriskmformosteop
orosis.mWhichmofmthe mfollowingminterventionsmshouldmthemnursemincludemtompreventmbone mloss?
Encourage mweight-bearingmexercises.
,16. Amhome mhealthmnursemismreinforcingmteachingmwithmamclientmaboutmpreventingmcomplicatio
nsmof mperipheralmvascularmdisease.mWhichmofmthemfollowingmstatementsmindicatesmthatmthem
clientmismadheringmtomthe mnurse'sminstructions?
"Imdon'tmcrossmmymlegsmanymore."
17. Amnurse mismreinforcingmteachingmaboutmglycosylatedmhemoglobinm(HbA1c) mtestingmwithmamclientm
whomhasmdiabetesmmellitus.mWhichmof mthe mfollowingmstatementsmindicatesmthatmthe mclientmund
erstandsmthe mteaching?
"Imwillmhave mmymHbA1cmcheckedmtwice mpermyear."
18. Amnurse mismassistingmthe mcharge mnurse mwithmdevelopingmanmin-
service maboutmcaringmformclientsmwhomhaveminternalmsealedmradiationmimplants.mWhichmofmthem
followingminformationmshouldmthe mnurse minclude?
Dispose mof mradiationmimplantsminmamleadmcontainer.
19. Amnurse mismcaringmformamclientmwhomhadmanmacutemischemicmstrokem1mdaymago.mWhichmofmthemfoll
owingmactionsmshouldmthe mnurse mtake mtomreduce mthe mriskmformaspiration?
Allowmform30mminmof mrestmbefore mmeals.
20. Amnurse mismcaringmformamclientmwhomism1mdaympostoperativemfollowingmamhipmarthroplasty.mThe mcli
entmismexhibitingmhypotension,mtachycardia,mandmtachypnea.mThe mnurse mshouldmrecognize mthatm
these mfindingsmindicate mwhichmof mthe mfollowingmcomplications?
Pulmonarymembolism
21. Amnurse mismreinforcingmteachingmwithmamclientmwhomhasmgonorrhea.mWhichmofmthemfollo
wingminformationmshouldmthe mnurse minclude?
"Youmare matmriskmforminfertilitymwithmthisminfection,mregardlessmof mtreatment."
22. Amnurse mismcontributingmtomthe mplanmofmcaremformamclientmwhomwasmadmittedmtomthe mneurologic
almunitmfollowingmamstrokem3mhrmago.mWhichmofmthe mfollowingminterventionsmshouldmthemnurse mid
entifymasmthe mpriority?
Keepmthe mclientminmamside-lyingmposition.
23. Amnurse mismassistingminmthemcare mofmamclientmwhomhasmmanifestationsmofmsepsis.mWhichm
of mthe mfollowingmprovidermprescriptionsmshouldmthe mnurse mimplementmfirst?
Initiate moxygenmatm4mL/minmviamnasalmcannula.
, 24. Amnurse mismreinforcingmteachingmwithmamclientmwhomismtakingminsulinmglargine.mWhichmofmthe mfoll
owingminformationmshouldmthe mnurse minclude minmthe mteaching?
"Thismtype mofminsulinmshouldmbe mgivenmatmthe msame mtime meverymday."
25. Amnurse mismcollectingmdatamfrommamclientmwhomhasmhypothyroidism.mWhichmofmthemfollo
wingmmanifestationsmshouldmthe mnurse manticipate?
Bradycardia
26. Amnurse mismcollectingmdatamfrommamclientmwhomhasmchronicmkidneymdisease mwithmhyperkalemia.m
Whichmofmthe mfollowingmfindingsmshouldmthe mnurse mexpectmrelatedmtomhyperkalemia?
Bradycardia
27. Amnurse mentersmthemroommof mamclientmwhosemtransfusionmofmpackedmRBCsmwasminitiatedm15mmi
nmagombymthemRN.mThemclientmreportsmdyspneamandmurticaria.mWhichmofmthemfollowingmactionsm
shouldmthe mnurse mperformmfirst?
Stopmthe minfusion.
28. Amnurse mismcollectingmdatamfrommam55-year-
oldmfemale mclientmwhomreportsmvaginalmdrynessmandmhotmflashes.mThemclientmisminterestedminmtr
yingmhormone mreplacementmtherapym(HRT).mWhichmofmthemfollowingmshouldmthemnurse mrecog
nize masmamcontraindicationmtomHRT?
Historymof mtreatmentmformbloodmclots
29. Amnurse mismreinforcingmteachingmwithmthemfamilymofmamclientmwhomhasmamcervicalminjurymandmhasm
amhalomvestminmplace.mWhichmofmthemfollowingmsafetymprecautionsmshouldmthemnurseminclude minmt
he mteaching?
Change mthe msheepskinmlinermweekly.
30. Amnurse mismcollectingmdatamfrommamclientmwhomhasmhypokalemia.mWhichmofmthemfollowingmfin
dingsmshouldmthe mnurse midentifymasmthe mpriority?
Dysrhythmia
31. Amnurse minmamlong-
termmcare mfacilitymismcollectingmdatamfrommamclientmwhomreportsmfullnessminmthemrectummandm
abdominalmcramping.mWhichmofmthemfollowingmfindingsmshouldmindicate mtomthemnurse mthatmth
e mclientmmightmhave mamfecalmimpaction?
Smallmliquidmstools
1. Amnurse mismreviewingmthe mlaboratorymresultsmofmamclientmwhomismscheduledmformamCTmscanmwith
m anm IV m
contrastmagent.mWhichmofmthe mfollowingmlaboratorymfindingsmshouldmthe mnurse mreportm
tomthe mprovidermpriormtomthe mprocedure?
Creatine m1.9mmg/dl
2. Amnurse mismmonitoringmamclientmwhomismtake macarbose.mWhichmofmthemfollowingmfindingsmshoul
dmthe mnurse midentifymasmanmadverse meffectmof mthe mmedication?
AbdominalmCramps
3. Amnurse mismassistingmwithmthe mcare mofmamclientmwhomhadmamcardiacmcatheterizationmviamthe mrig
htmfemoralmartery.mWhichmof mthe mfollowingmactionsmshouldmthe mnurse mtake mtompreventmpost-
procedure mcomplications?
Monitormthe minsertionmsitemformbleeding,mMaintainmthempressure mdressing,mCheckmthemclient’smperi
pheralmpulses
4. Amnurse mismcontributingmtomthe mplanmofmcaremformamclientmwomhasmchronicmobstructivempulmonar
ymdisease m(COPD)mandmismdyspneic.mWhichmofmthemfollowingminterventionsmshouldmthe mnursemincl
ude minmthe mplan?
Encourage mabdominalmbreathing
5. Amnurse mismpreparingmtomadministermphytonadionem7mmgmsubcutaneouslymtomamclientmwhomhasma
nmINRmofm4.mAvailable mismphytonadionem10mmg/mL.mHowmmanymmLmshouldmthe mnurse madminister
?m(Roundmthe manswermtomthemnearestmtenth.mUsemamleadingmzeromifmitmapplies.mDomnotmuse mamtrai
lingmzero.)
0.7
6. Amnurse mismexaminingmamclient’smIVmandmnotesmamredmlinemupmhismarm.mThe mclientmreportsmamthro
bbing,mburningmpainmatmthemIV msite.mThemnursemshouldmidentifymthatmthe mclient’smmanifestations
m indicate m whichm of m the m followingm complications m of m IV m therapy?
Thrombophlebitis
7. Amnurse mismreinforcingmteachingmaboutmmanagementmof mconstipationmwithmamclientmwho
m hasmhypothyroidism. mWhichmodmthe mfollowingmshouldmthemnurseminclude minm the m teachi
ng?
Increase mintake mof mfiber-richmfoods.
,8. Amnurse mismcaringmformamclientmwhomhasmamcompoundmfracture mofmthe mfemurmandmwasmplac
edminmbalancedmsuspensionmskeletalmtractionm4mdaysmago.mWhichmofmthemfollowingmactionsm
shouldmthe mnurse mtake?
Performmpinmsite mcare mdaily
9. Amnurse mobservesmamclientmwhomismlyingminmbedmexperiencingmamtonic-
clonicmseizure.mWhichmof mthe mfollowingmactionsmshouldmthe mnurse mtake?
Loosenmclothingmaroundmthe mclient’smneck.
10. Amnurse mismcontributingmtomthemplanmof mcaremformamclientmwhomhasmmultiple msclerosismandmism
takingmdantrolene mtommanagemmuscle mspasms.mWhichmofmthemfollowingminterventionsmshoul
dmthe mnurse minclude?
Encourage mthe mclientmtomcomplete mADLs
11. Amnurse mismreinforcingmdischarge mteachingmtompreventmdumpingmsyndromemformamclientmfollowi
ngmampartialmgastrectomymformulcers.mWhichmof mthemfollowingminformationmshouldmthemnursemi
nclude minmthe mteaching?
Avoidmliquidsmatmmealtimes.
12. Amnurse mismcollectingmdatamfrommamclientmwhomhasmheartmfailure mandmismtakingmdigoxin.mWhichm
of mthe mfollowingmoutcomesmfrommthe mmedicationmshouldmthe mnurse mexpect?
Decreasedmshortnessmof mbreath
13. Amnurse mismreinforcingmdischargemteachingmwithmamclientmwhomhasmhearingmloss.mWhichmo
f mthe mfollowingmactionsmshouldmthemnurse mtake mwhenmcommunicatingmwithmthe mclient?
Rephrase mclientminstructionsmwhenmnotmunderstood.
14. Amnurse mismpreparingmtomremove mamclient'smNGmtube.mWhichmofmthe mfollowingminterventionsms
houldmthe mnurse mtake mtomdecrease mthe mriskmof maspiration?
Pinchmthe mNG mtube.
15. Amnurse mismcontributingmtomthemplanmofmcare mformanmoldermadultmclientmwhomismatmriskmformosteop
orosis.mWhichmofmthe mfollowingminterventionsmshouldmthemnursemincludemtompreventmbone mloss?
Encourage mweight-bearingmexercises.
,16. Amhome mhealthmnursemismreinforcingmteachingmwithmamclientmaboutmpreventingmcomplicatio
nsmof mperipheralmvascularmdisease.mWhichmofmthemfollowingmstatementsmindicatesmthatmthem
clientmismadheringmtomthe mnurse'sminstructions?
"Imdon'tmcrossmmymlegsmanymore."
17. Amnurse mismreinforcingmteachingmaboutmglycosylatedmhemoglobinm(HbA1c) mtestingmwithmamclientm
whomhasmdiabetesmmellitus.mWhichmof mthe mfollowingmstatementsmindicatesmthatmthe mclientmund
erstandsmthe mteaching?
"Imwillmhave mmymHbA1cmcheckedmtwice mpermyear."
18. Amnurse mismassistingmthe mcharge mnurse mwithmdevelopingmanmin-
service maboutmcaringmformclientsmwhomhaveminternalmsealedmradiationmimplants.mWhichmofmthem
followingminformationmshouldmthe mnurse minclude?
Dispose mof mradiationmimplantsminmamleadmcontainer.
19. Amnurse mismcaringmformamclientmwhomhadmanmacutemischemicmstrokem1mdaymago.mWhichmofmthemfoll
owingmactionsmshouldmthe mnurse mtake mtomreduce mthe mriskmformaspiration?
Allowmform30mminmof mrestmbefore mmeals.
20. Amnurse mismcaringmformamclientmwhomism1mdaympostoperativemfollowingmamhipmarthroplasty.mThe mcli
entmismexhibitingmhypotension,mtachycardia,mandmtachypnea.mThe mnurse mshouldmrecognize mthatm
these mfindingsmindicate mwhichmof mthe mfollowingmcomplications?
Pulmonarymembolism
21. Amnurse mismreinforcingmteachingmwithmamclientmwhomhasmgonorrhea.mWhichmofmthemfollo
wingminformationmshouldmthe mnurse minclude?
"Youmare matmriskmforminfertilitymwithmthisminfection,mregardlessmof mtreatment."
22. Amnurse mismcontributingmtomthe mplanmofmcaremformamclientmwhomwasmadmittedmtomthe mneurologic
almunitmfollowingmamstrokem3mhrmago.mWhichmofmthe mfollowingminterventionsmshouldmthemnurse mid
entifymasmthe mpriority?
Keepmthe mclientminmamside-lyingmposition.
23. Amnurse mismassistingminmthemcare mofmamclientmwhomhasmmanifestationsmofmsepsis.mWhichm
of mthe mfollowingmprovidermprescriptionsmshouldmthe mnurse mimplementmfirst?
Initiate moxygenmatm4mL/minmviamnasalmcannula.
, 24. Amnurse mismreinforcingmteachingmwithmamclientmwhomismtakingminsulinmglargine.mWhichmofmthe mfoll
owingminformationmshouldmthe mnurse minclude minmthe mteaching?
"Thismtype mofminsulinmshouldmbe mgivenmatmthe msame mtime meverymday."
25. Amnurse mismcollectingmdatamfrommamclientmwhomhasmhypothyroidism.mWhichmofmthemfollo
wingmmanifestationsmshouldmthe mnurse manticipate?
Bradycardia
26. Amnurse mismcollectingmdatamfrommamclientmwhomhasmchronicmkidneymdisease mwithmhyperkalemia.m
Whichmofmthe mfollowingmfindingsmshouldmthe mnurse mexpectmrelatedmtomhyperkalemia?
Bradycardia
27. Amnurse mentersmthemroommof mamclientmwhosemtransfusionmofmpackedmRBCsmwasminitiatedm15mmi
nmagombymthemRN.mThemclientmreportsmdyspneamandmurticaria.mWhichmofmthemfollowingmactionsm
shouldmthe mnurse mperformmfirst?
Stopmthe minfusion.
28. Amnurse mismcollectingmdatamfrommam55-year-
oldmfemale mclientmwhomreportsmvaginalmdrynessmandmhotmflashes.mThemclientmisminterestedminmtr
yingmhormone mreplacementmtherapym(HRT).mWhichmofmthemfollowingmshouldmthemnurse mrecog
nize masmamcontraindicationmtomHRT?
Historymof mtreatmentmformbloodmclots
29. Amnurse mismreinforcingmteachingmwithmthemfamilymofmamclientmwhomhasmamcervicalminjurymandmhasm
amhalomvestminmplace.mWhichmofmthemfollowingmsafetymprecautionsmshouldmthemnurseminclude minmt
he mteaching?
Change mthe msheepskinmlinermweekly.
30. Amnurse mismcollectingmdatamfrommamclientmwhomhasmhypokalemia.mWhichmofmthemfollowingmfin
dingsmshouldmthe mnurse midentifymasmthe mpriority?
Dysrhythmia
31. Amnurse minmamlong-
termmcare mfacilitymismcollectingmdatamfrommamclientmwhomreportsmfullnessminmthemrectummandm
abdominalmcramping.mWhichmofmthemfollowingmfindingsmshouldmindicate mtomthemnurse mthatmth
e mclientmmightmhave mamfecalmimpaction?
Smallmliquidmstools
