LVN Test Questions. NURSING.

  BLANK PAGE.   "The nurse is caring for a patient with a deep venous thrombosis (DVT). Which medication would likely be used for initial inpatient treatment? A - Dabigatran (Pradaxa) B - Heparin C - Warfarin (Coumadin) D - Edoxaban (Lixiana) Med Surg Ch. 18 - CORRECT ANSWER B - Heparin" "The nurse is caring for a patient with suspected right-sided heart failure. Which manifestation best supports this potential diagnosis? A - Wheezing B - Orthopnea C - Edema D - Pallor Med Surg Ch. 19 - CORRECT ANSWER C - Edema" "The nurse is caring for a patient with a history of left-sided congestive heart failure (CHF). Which finding leads the nurse to suspect that the patient could be experiencing an acute exacerbation of this condition? A - The abdomen is tight and shiny B - Wheezes are present during lung auscultation C - The pupils react sluggishly to light D - The heart rate is irregularly irregular Med Surg Ch. 19 - CORRECT ANSWER B - Wheezes are present during lung auscultation" "The nurse is caring for a patient with severe congestive heart failure (CHF) who denies pain and is fearful of taking prescribed morphine. Which explanation best works to alleviate the patient's anxiety about risk of addiction? A - "Many people with CHF use morphine for pain control" B - "We can treat your pain with aspirin or ibuprofen" C - "Morphine has properties that help relieve air hunger in CHF patients" D - "You can refuse to take it" Med Surg Ch. 19 - CORRECT ANSWER C - "Morphine has properties that help relieve air hunger in CHF patients"" "The nurse is caring for a patient with congestive heart failure (CHF). Which intervention should the nurse include in the plan of care? A - Encourage intake of canned soups B - Place the patient in a side lying position to prevent venous pooling C - Encourage large meals for increased nutritional impact D - Alternate rest with activity Med Surg Ch. 19 - CORRECT ANSWER D - Alternate rest with activity" "The home health nurse is caring for a patient with congestive heart failure (CHF). Which assessment finding should the nurse report immediately to the physician? A - Moderate shortness of breath after walking down the hall B - A 3 pound weight gain over the course of a week C - Heart rate of 104 beats/min after ambulating to the bathroom D - Increase in urinary output to 50mL in the last hour Med Surg Ch. 19 - CORRECT ANSWER B - A 3 pound weight gain over the course of a week" "The nurse is performing an initial assessment on a new patient with suspected right-sided heart failure. Which finding(s) is/are consistent with the patient's potential diagnosis? (Select all that apply) A - Clammy skin B - Splenomegaly C - Abdominal distention D - Wheezing E - Dyspnea Med Surg Ch. 19 - CORRECT ANSWER Answer: B, C, and E" "The nurse is caring for a patient who returns to the floor at lunch time after undergoing an upper GI (UGI series). Which action is most important for the nurse to perform first? A - Administer a laxative B - Educate the patient about the possibility of white stools C - Offer the patient a small snack D - Provide oral care Med Surg Ch. 27 - CORRECT ANSWER A - Administer a laxative" "An 80 year old man falls and suffers a compound fracture of the femur. Which immediate action is most appropriate? A - Position him flat on his back B - Apply a tourniquet on the leg C - Carefully splint the leg D - Carefully straighten the leg Med Surg Ch. 32 - CORRECT ANSWER C - Carefully splint the leg" "The nurse performing a neurovascular check on a limb in traction would report and document which finding(s) as indicative of altered circulation? (Select all that apply) A - Pulse is equal to uncasted limb B - Patient is aware of touch and warm and cold application C - Limb is cool to the touch D - Capillary refill is 5 seconds E - Distal limb can flex and extend Peds Ch. 24 - CORRECT ANSWER Answer: C & D The limb should be warm, and capillary refill should be less than 3 seconds" "Why is the relaxing phase between contractions important? A -The laboring woman needs to rest B - The uterine muscles fatigue without relaxation C - The contractions can interfere with fetal oxygenation D - The infant progresses toward delivery at these times Mother/Baby Ch. 6 - CORRECT ANSWER C - The contractions can interfere with fetal oxygenation" "The nurse is caring for a woman in the first stage of labor. What will the nurse remind the patient about contractions during this stage of labor? A - They get the infant positioned for delivery B - They push the infant into the vagina C - They dilate and efface the cervix D - They get the mother prepared for labor Mother/Baby Ch. 6 - CORRECT ANSWER C - They dilate and efface the cervix" "A woman is 7cm dilated, and her contractions are 3 minutes apart. When she begins cursing at her birthing coach, and the nurse, what does the nurse assess as the most likely explanation for the woman's change in behavior? A - Labor has progressed to the transition stage B - She lacked adequate preparation for the labor experience C - The woman would benefit from a different form of analgesia D - The contractions have increased from mild to moderate intensity Mother/Baby Ch. 6 - CORRECT ANSWER A - Labor has progressed to the transition stage" "What is the function of contractions during the second stage of labor? A - Align the infant into the proper position for delivery B - Dilate and efface the cervix C - Push the infant out of the mothers body D - Separate the placenta from the uterine wall Mother/Baby Ch. 6 - CORRECT ANSWER C - Push the infant out of the mothers body" "What marks the end of the third stage of labor? A - Full cervical dilation B - Expulsion of the placenta and membrane C - Birth of the infant D - Engagement of the head Mother/Baby Ch. 6 - CORRECT ANSWER B - Expulsion of the placenta and membrane" "Why should the nurse encourage the mother to void during the fourth stage of labor? A - A full bladder could interfere with cervical dilation B - A full bladder could obstruct progress of the infant through the birth canal C - A full bladder could obstruct the passage of the placenta D - A full bladder could predispose the mother to uterine damage Mother/Baby Ch. 6 - CORRECT ANSWER D - A full bladder could predispose the mother to uterine damage" "What is the most important nursing intervention during the fourth stage of labor? A - Monitor the frequency and intensity of contractions B - Provide comfort measures C - Assess for hemorrhage D - Promote bonding Mother/Baby Ch. 6 - CORRECT ANSWER C - Assess for hemorrhage" "The nurse formulates a nursing diagnosis for a woman in the fourth stage of labor. What is the most appropriate nursing diagnosis? A - Pain related to increasing frequency and intensity of contractions B - Fear related to the probable need for cesarean delivery C - Dysuria related to prolonged labor and decreased intake D - Risk for injury related to hemorrhage Mother/Baby Ch. 6 - CORRECT ANSWER D - Risk for injury related to hemorrhage" "A pregnant woman, gravida 2, para 1, tells the nurse she desires a VBAC (vaginal birth after cesarean section) with this pregnancy. What is the primary concern regarding complications for this patient during labor and birth? A - Eclampsia B - Placental abruption C - Congestive heart failure D - Uterine rupture Mother/Baby Ch. 6 - CORRECT ANSWER D - Uterine rupture" "The mother of a 4 day old calls the pediatricians office because she is concerned about her infants skin. Which finding needs to be reported promptly to the child's pediatrician? A - The hands and feet feel cooler than the rest of the body B - Skin is peeling on several parts of the infants body C - There is a small pink patch on the left eyelid and one on the neck D - Today, the infants skin has a yellowish tinge Mother/Baby Ch. 6 - CORRECT ANSWER D - Today, the infants skin has a yellowish tinge" "What does the nurse note when measuring the frequency of a laboring woman's contractions? A - How long the patient states the contractions last B - The time between the end of one contraction and the beginning of the next C - The time between the beginning and end of one contraction D - The time between the beginning of one contraction to the beginning of the next Mother/Baby Ch. 6 - CORRECT ANSWER D - The time between the beginning of one contraction to the beginning of the next" "At a prenatal visit, a primigravida asks the nurse how she will know her labor has started. The nurse knows that what indicates the beginning of true labor? A - Contractions that are relieved by walking B - Discomfort in the abdomen and groin C - A decrease in vaginal discharge D - Regular contractions becoming more frequent and more intense Mother/Baby Ch. 6 - CORRECT ANSWER D - Regular contractions becoming more frequent and more intense" "A nurse positions a patient for the insertion of a nasogastric (NG) tube by: A - turning the patient to a right side lying position B - sitting the patient upright and hyperextending the patients head C - lowering the head of the bed to a flat position D - raising the head of the bed to 30 degrees Advanced Ch. 27 - CORRECT ANSWER B - sitting the patient upright and hyperextending the patients head" "The nurse who is preparing to give a feeding per a nasogastric (NG) tube tests the placement of the tube most safely by: A - checking the lungs for rhonchi B - instilling 10mL of sterile water and checking for cough C - aspirating stomach contents D - injecting 20mL of air and listen at the tip of the xiphoid Advanced Ch. 27 - CORRECT ANSWER C - aspirating stomach contents" "A patient is scheduled to receive an intermittent tube feeding. This feeding should be allowed to flow in over how many minutes? A - 1 minute B - 2 minutes C - 5 minutes D - 10 minutes Advanced Ch. 27 - CORRECT ANSWER D - 10 minutes" "Stopping the infusion and checking for residual volume, the nurse aspirates 250mL of gastric contents. The nurse should next: A - replace the aspirate and continue with the feeding B - throw the aspirate away and flush the tubing C - replace the aspirate and delay feeding for 1 to 2 hours D - throw the aspirate away and delay feeding for 2 hours Advanced Ch. 27 - CORRECT ANSWER C - replace the aspirate and delay feeding for 1 to 2 hours" "When the patient has just finished receiving a tube feeding, the nurse leaves the head of the patient's bed elevated for 30 to 60 minutes after feeding in order to: A - facilitate stomach emptying and prevent aspiration B - maintain skin integrity to the buttocks C - facilitate lung drainage and promote ventilation D - prevent feeding tube from clogging Advanced Ch. 27 - CORRECT ANSWER A - facilitate stomach emptying and prevent aspiration" "The nurse caring for the patient receiving total parental nutrition (TPN) should monitor the flow rate every: A - 2 hours B - 3 hours C - 4 hours D - 6 hours Advanced Ch. 27 - CORRECT ANSWER C - 4 hours" "A patient recently started on external tube feedings starts complaining of nausea and having diarrhea. The best nursing action is to: A - check the external tube for placement B - slow down the feedings and monitor C - perform a finger stick blood glucose test D - stop the feedings and inform the physician Advanced Ch. 27 - CORRECT ANSWER D - stop the feedings and inform the physician" "A patient has a new order to have an NG tube removed. The nurse should initially: A - wash her hands and apply clean gloves B - encourage mouth care as needed C - explain the procedure to the patient D - pinch the tube while removing it Advanced Ch. 27 - CORRECT ANSWER C - explain the procedure to the patient" "A patient has a new order to have an NG tube removed. The nurse should initially: A - wash her hands and apply clean gloves. B - encourage mouth care as needed. C - explain the procedure to the patient. D - pinch the tube while removing it. Advanced Ch. 27 - CORRECT ANSWER C - explain the procedure to the patient" "A nurse is instructing a family member who will be caring for a patient receiving enteral feedings after discharge to home. The nurse would emphasize: A - taping the gastrostomy tube so that it does not hang lower than the stomach. B - discarding unused opened refrigerated formula after 3 to 4 days. C - administering tube feedings while they are still cold from the refrigerator. D - mixing all medications together for administration at the same time. Advanced Ch.27 - CORRECT ANSWER A - taping the gastrostomy tube so that it does not hang lower than the stomach." "The nurse inserting an NG tube through the nostril into the back of the throat of a patient would instruct the patient to: A - hyperextend the head. B - cough forcefully. C - drop head forward and begin to swallow. D - open mouth and extend tongue. Advanced Ch. 27 - CORRECT ANSWER C - drop head forward and begin to swallow." "The nurse caring for a patient receiving enteral feedings would assess for tolerance of the feeding by monitoring: A - for gastric tube patency. B - for duodenal tube patency. C - for abdominal distention. D - the rate of the feeding. Advanced Ch.27 - CORRECT ANSWER C - for abdominal distention." "While the nurse is explaining the procedure for inserting a tube for external feedings, the patient interrupts and asks why there is a need for this tube. The nurse's best response is: A - "Your physician has ordered this to help your condition." B - "Tell me what your primary care provider told you about this procedure." C - "Are you telling me you don't want this tube inserted?" D - "This tube placement will only be temporary." Advanced Ch. 27 - CORRECT ANSWER B - "Tell me what your primary care provider told you about this procedure."" "When the patient complains about the insertion of the total parenteral nutrition (TPN) tube interfering with his movement, the nurse explains that the insertion in the subclavian vein allows: (Select all that apply.) A - adequate dilution of TN solution. B - closer proximity to the heart. C - more effective monitoring from the IV pump. D - for adequate blood flow. E - for more ease in dressing insertion site. Advanced Ch. 27 - CORRECT ANSWER Answer: A, & D" "A nurse giving a bolus feeding through a nasogastric tube with a syringe would: (Select all that apply.) A - pull up 50 mL of formula in the syringe. B - lower the head of the bed to flat position. C - allow feeding to flow in by gravity. D - flush the tube with 50 mL of water. E - check the position of the tube. Advanced Ch. 27 - CORRECT ANSWER Answer: C, & E" "The nurse elarifies that the condition in which there is a decreased amount of oxygen in the blood is: A - hypoxia. B - hypercapnia. C - dyspnea. D - hypoxemia. Advanced Ch. 28 - CORRECT ANSWER D - hypoxemia" "The multiple causes of hypoxia include: (select all that apply) A - extreme fright B - aspirated vomit C - pulmonary fibrosis D - hiccoughs E - high altitude Advanced Ch. 28 - CORRECT ANSWER Answer: B, C, & E" "A patient has an order for a nitroglycerin transdermal patch. The best way to ensure proper administration of this medication is to: A - apply it behind the ear B - rotate sites to avoid skin irritation C - place it over a hairy skin area D - put the initials on patch when applied Advanced Ch. 34 - CORRECT ANSWER B - rotate sites to avoid skin irritation" "The nurse administering nitroglycerin ointment to a patient will: A - apply with gloves or tongue blade B - apply in same area as the old patch C - place the paste on the chest and massage it in the skin D - inform the patient that the medicinal effect will take about 45 minutes Advanced Ch. 34 - CORRECT ANSWER A - apply with gloves or tongue blade" "When the 8-year-old child complains that he does not want to have a "shot," the nurse explains that the use of a parenteral route: A - is the best way to give medicine. B - will hasten the action of the medication. C - will take less medicine to make him well. D - will be painless because the needles are so sharp. Advanced Ch. 35 - CORRECT ANSWER B - will hasten the action of the medication." "To ensure the proper administration of a tuberculin test, the nurse will: A - use a 3 mL syringe. B - choose a 21 gauge, 1 inch needle. C - insert the needle at a 30-degree angle. D - inject slowly to form a bleb. Advanced Ch. 35 - CORRECT ANSWER D - inject slowly to form a bleb." "The best angle to insert the needle when administering a subcutaneous injection is at an angle of: A - 45 to 90 degrees. B - 30 to 45 degrees. C - 15 to 30 degrees. D - 5 to 15 degrees. Advanced Ch. 35 - CORRECT ANSWER A - 45 to 90 degrees." "The nurse has an order to administer an injection of purified protein derivative (PPD) by the intradermal route. The maximum amount of medication that can be given using this route is: A - 0.1 mL B - 0.75 mL C - 0.5 mL D - 0.2 mL Advanced Ch. 35 - CORRECT ANSWER A - 0.1 mL" "While discussing labor and delivery during a prenatal visit, a primigravida asks the nurse when she should go to the hospital. What is the nurses most informative response? A - When you feel increased fetal movement B - When contractions are 10 minutes apart C - When membranes have ruptured D - When abdominal or groin discomfort occurs Mother/Baby Ch. 6 - CORRECT ANSWER C - When membranes have ruptured" "What is the most appropriate statement from the nurse when coaching the laboring woman with a fully dilated cervix to push? A - At the beginning of a contraction, hold your breath and push for 10 seconds B - Take a deep breath and push between contractions C - Begin pushing when a contraction starts and continue for the duration of the contraction D - At the beginning of a contraction, take two deep breaths and push with the second exhalation Mother/Baby Ch. 6 - CORRECT ANSWER D - At the beginning of a contraction, take two deep breaths and push with the second exhalation" "The nurse is caring for a patient who is not certain if she is in true labor. How might the nurse attempt to stimulate cervical effacement and intensity contractions in the patient? A - By offering the patient warm fluids to drink B - By helping the patient to ambulate in the room C - By seating the patient upright in a straight back chair D - By positioning the patient on her right side Mother/Baby Ch. 6 - CORRECT ANSWER B - By helping the patient to ambulate in the room" "What is the nurse primarily concerned about maintaining in the initial care of the newborn? A - Fluid intake B - Feeding schedule C - Thermoregulation D - Parental bonding Mother/Baby Ch. 6 - CORRECT ANSWER C - Thermoregulation" "At 1 and 5 minutes of life, a newborns Apgar score is 9. What does the nurse understand that a score of 9 indicates? A - The newborn will require resuscitation B - The newborn may have physical disabilities C - The newborn will have above average intelligence D - The newborn is in stable condition Mother/Baby Ch. 6 - CORRECT ANSWER D - The newborn is in stable condition" "A 4 week postpartum patient with mastitis asks the nurse if she can continue to breastfeed. What is the nurses response? A - Stop breastfeeding until the infection clears B - Pump the breasts to continue milk production, but do not give breast milk to the infant C - Begin all feedings with the affected breast until the mastitis is resolved D - Breastfeeding can continue unless there is abscess formation Mother/Baby Ch. 10 - CORRECT ANSWER D - Breastfeeding can continue unless there is abscess formation" "What statement by the patient leads the nurse to determine a woman with mastitis understands treatment instructions? A - I will apply cold compresses to the painful areas B - I will take a warm shower before nursing the baby C - I will nurse first on the affected side D - I will empty the affected breast every 8 hours Mother/Baby Ch. 10 - CORRECT ANSWER B - I will take a warm shower before nursing the baby" "What will the nurse teach a nursing mother to do to reduce the risk of mastitis? (Select all that apply) A - Limit fluid intake to 1 liter per day B - Empty both breasts with each feeding C - Take warm showers D - Wear a supportive bra E - Pump breasts to ensure emptying Mother/Baby Ch. 10 - CORRECT ANSWER Answers: B, C, D, E" "The embryo is termed a fetus at which stage of prenatal development? A - 2 weeks B - 4 weeks C - 9 weeks D - 16 weeks Mother/Baby Ch. 3 - CORRECT ANSWER C - 9 weeks" The nurse discussed treatment of hypoglycemia with an adolescent. Which statement by the adolescent leads the nurse to determine the patient understood the instructions? A - When my blood glucose is low or if I begin to feel hungry & weak, I will eat 6 lifesavers B - When my blood glucose is low or if I begin to feel hungry & weak, I will give myself Lispro insulin C - When my blood glucose is low or if I begin to feel hungry & weak, I will have a slice of cheese D - When my blood glucose is low or if I begin to feel hungry & weak, I will drink a diet soda Peds Ch. 31 - CORRECT ANSWER A - When my blood glucose is low or if I begin to feel hungry & weak, I will eat 6 lifesavers The immediate treatment of hypoglycemia" "A child with diabetes mellitus is observed to have cold symptoms. What signs & symptoms will alert parents of the possibility of ketoacidosis? (Select all that apply) A - Chest Congestion B - Ear Pain C - Fruity Breath D - Hyperactivity E - Nausea Peds Ch. 31 - CORRECT ANSWER Answer: C & E Symptoms of ketoacidosis are compared with those of hypoglycemia" "What assessment made by the school nurse would lead to the suspicion of strabismus? A - Reddened sclera in one eye B - Child covers one eye to read the chalkboard C - Child complains of a headache D - Copious tears while watching TV Peds Ch. 23 - CORRECT ANSWER B - Child covers one eye to read the chalkboard" "A child is diagnosed with nonparalytic strabismus. How will this disorder most likely be corrected? A - Patching the unaffected eye B - Corrective lenses C - Laser treatment D - Surgery Peds Ch. 23 - CORRECT ANSWER B - Corrective lenses" "What finding would the nurse assessing the neurovascular status of a child in Russell traction report immediately? A - Skin that's warm to the touch B - Capillary refill less than 3 seconds C - Ability to wiggle toes D - Bluish coloration of skin Peds Ch. 24 - CORRECT ANSWER D - Bluish coloration of skin" "What nursing action will significantly decrease the risk of serious complications for a child in Bryants traction? A- Neurovascular checks are done frequently B - Bandages are wrapped tightly C - The child is restrained from rolling over D - The child buttocks are resting on the bed Peds Ch. 24 - CORRECT ANSWER A- Neurovascular checks are done frequently" "What would the nurse consider an abnormal finding on a musculoskeletal assessment of a 4 year old child? A - Has inward turned knees B - Walks on the toes C - Appears to have flat feet D - Swings his arms when walking Peds Ch. 24 - CORRECT ANSWER B - Walks on the toes" "Which assessment performed by a nursing student performing a neurovascular check alerts the instructor that further education is necessary? A - Pulses B - Capillary refill C - Movement D - Pupils Peds Ch. 24 - CORRECT ANSWER D - Pupils Pupils are assessed with a neurological check, the rest are assessed with a neurovascular check" "The nurse is reviewing fetal circulation with a pregnant patient and explains that blood circulates through the placenta to the fetus. What vessel(s) carry blood to the fetus? A - One umbilical vein B - Two umbilical veins C - One umbilical artery D- Two umbilical arteries Mother/Baby Ch. 3 - CORRECT ANSWER A - One umbilical vein" "A patient asks the nurse when her infants heart will begin to pump blood. What will the nurse reply? A - By the end of week 3 B - Beginning in week 8 C - At the end of week 16 D - Beginning in week 24 Mother/Baby Ch. 3 - CORRECT ANSWER A - By the end of week 3" "A woman who is 25 weeks pregnant asks the nurse what her fetus looks like. What does the nurse explain is one physical characteristic present in a 25 week old fetus? A - Lanugo covering the body B - Constant motion C - Skin that is pink and moist D - Eyes that are closed Mother/Baby Ch. 3 - CORRECT ANSWER A - Lanugo covering the body By 25 weeks the eyes are open, skin is wrinkled, and fetus has definite periods of movement" "At what point in prenatal development do the lungs begin to produce surfactant? A - 17 weeks B - 20 weeks C - 25 weeks D - 30 weeks Mother/Baby Ch. 3 - CORRECT ANSWER C - 25 weeks" "The nurse is educating a class of expectant parents about fetal development. What is considered fetal age of viability? A - 14 weeks B - 20 weeks C - 25 weeks D - 30 weeks Mother/Baby Ch. 3 - CORRECT ANSWER B - 20 weeks" "A couple just learned they are expecting their first child and are curious if they are having a boy or a girl. At what point of development can the couple first expect to see the sex of their child on ultrasound? A - 4 weeks gestational age B - 6 weeks gestational age C - 10 weeks gestational age D - 16 weeks gestational age Mother/Baby Ch. 3 - CORRECT ANSWER C - 10 weeks gestational age" "A nurse is teaching a lesson on fetal development to a class of high school students and explains the primary germ layers. What are the germ layers? (Select all that apply) A - Ectoderm B - Endoderm C - Mesoderm D - Plastoderm E - Blastoderm Mother/Baby Ch. 3 - CORRECT ANSWER Answer: A, B, & C" "A woman is 9 weeks pregnant and experiencing heavy bleeding and cramping. She reports passing some tissue. Cervical dilation is noted on examination. What is the most likely cause of these symptoms? A - Inevitable abortion B - Incomplete abortion C - Complete abortion D - Missed abortion Mother/Baby Ch. 5 - CORRECT ANSWER B - Incomplete abortion" "A 25 year old man comes to the college clinic with fever of 101 F, nausea, and flank pain that radiates into the thigh and genitals. The nurse anticipates that the patient will undergo workup for which condition? A - Urethritis B - Pyelonephritis C - Glomerulonephritis D - Cystitis Med Surg Ch. 34 - CORRECT ANSWER B - Pyelonephritis" "The nurse is caring for a young man who has been prescribed ciprofloxacin (Cipro) for pyelonephritis. Which information should the nurse include in order to prevent recurrence? A - Take this medication with a full glass of water B - Take antacids 2hrs after this medication C - Take the entire prescription D - Take this medication on an empty stomach Med Surg Ch. 34 - CORRECT ANSWER A - Take this medication with a full glass of water" "The nurse is reviewing a history and physical examination of a 22 year old man hospitalized for acute glomerulonephritis. Which finding best alerts the nurse to a potential causative agent? A - A recent trip to Mexico B - Unprotected sexual activity C - A recent strep throat infection D - A recent protocol of Ciprofloxacin (Cipro) Med Surg Ch. 34 - CORRECT ANSWER C - A recent strep throat infection" "Which statement best indicates that the patient understands teaching about dietary restrictions in glomerulonephritis? A - "I should avoid canned soup and hot dogs" B - "I should drink more water" C - "I should eat more meat and cheeses" D - " I should not eat fresh produce" Med Surg Ch. 34 - CORRECT ANSWER A - " I should avoid canned soup and hot dogs"" "A patient with glomerulonephritis has an order to undergo plasmapheresis. Which statement indicates that the patient accurately understands teaching about the procedure? A - "This procedure removes my affected plasma and gives me a clean replacement" B - "This procedure will use the IV in my hand" C - "I will need to lie very still while the pictures are taken" D - "I should drink this contrast with a straw to keep it from staining my teeth" Med Surg Ch. 34 - CORRECT ANSWER A - "This procedure removes my affected plasma and gives me a clean replacement"" "The nurse is caring for a patient diagnosed with glomerulonephritis. The patient reports feeling "bored and caged", and asks when he can resume normal activities. Which finding indicates that bed rest may be discontinued? A - The patient has been complaint with medication for 2 weeks B - The serum sodium level is 140mEq/L C - The patients weight returns to preillness baseline D - The patients blood pressure is 110/74 Med Surg Ch. 34 - CORRECT ANSWER D - The patients blood pressure is 110/74" "As chronic glomerulonephritis progresses, how is the kidney usually affected? A - The kidney swells B - The kidney atrophies C - The kidney develops "skip lesions" D - The kidney develops multiple cysts Med Surg Ch.. 34 - CORRECT ANSWER B - The kidney atrophies" "The nurse is caring for a patient with glomerulonephritis. Which finding best leads the nurse to suspect that the patient is developing nephrotic syndrome? A - Ascites B - Anorexia C - Pruritus D - Lethargy Med Surg Ch. 34 - CORRECT ANSWER A - Ascites" "The nurse is assessing a patient who is being treated for acute pyelonephritis. Which finding best indicates to the nurse that the patient is in the early stages of pyelonephritis? A - Smoky colored urine B - Temperature of 99.4 F C - Weakness D - Flank pain Med Surg - Ch. 34 - CORRECT ANSWER D - Flank pain" "The nurse is caring for a child suspected of having acute glomerulonephritis. When reviewing the health history, which finding is most concerning to the nurse? A - Recent upper respiratory infection B - Recent outpatient surgery C - History of asthma D - Recent history of gastroenteritis Med Surg Ch. 34 - CORRECT ANSWER A - Recent upper respiratory infection" "A patient has been admitted to the acute care facility to rule out glomerulonephritis. Which assessment finding(s) is/are supportive of the potential diagnosis? A - Flank pain B - Hematuria C - Periorbital edema D - Decrease in blood urea nitrogen (BUN) and creatinine E - Hypertension Med Surg Ch. 34 - CORRECT ANSWER Answer: A, B, C, and E" "The nurse is caring for a patient immediately postoperative after a left pneumonectomy. How should the nurse position the patient? A - In high Fowler position B - In semi Fowler position C - In a right side lying position D - In a left side lying position Med Surg Ch. 14 - CORRECT ANSWER D - In a left side lying position" "The nurse is caring for a first day postoperative thoracotomy patient. The nurse assesses that the level of drainage has not increased over the last 3 hours. After assessing the patient's respiratory status, what should the nurse do next? A - Raise the system above the patients arm B - Check the tubing for kinks C - Reposition the patient D - Notify the physician Med Surg Ch. 14 - CORRECT ANSWER B - Check the tubing for kinks" "The nurse is caring for a patient with a deep venous thrombosis (DVT). Which finding requires the nurse's immediate attention? A - Hematuria B - Decreased sensation in the affected leg C - Urine output of 35 mL in 1 hour D - Hemoptysis Med Surg Ch. 18 - CORRECT ANSWER D - Hemoptysis" "The nurse is performing morning care for a patient who sustained a fractured pelvis and bilateral femur fractures yesterday in a motorcycle collision. The patient complains of shortness of breath. Assessment reveals audible wheezes and oxygen saturation of 76%. What action should the nurse take first? A - Establish a peripheral intravenous (IV) line B - Inform the charge nurse C - Explain the patient's change in status to his family D - Raise patient to high Fowler position Med Surg Ch. 32 - CORRECT ANSWER D - Raise patient to high Fowler position Fat embolism is a rare but serious complication of a fracture of a bone that has an abundance of marrow fat." "Which vitamin is essential in treating osteoporosis? A - Vitamin A B - Vitamin D C - Vitamin B12 D - Vitamin C Med Surg Ch. 32 - CORRECT ANSWER B - Vitamin D" "A patient in Russell traction with a Pearson attachment for a fracture of the tibia complains of intense pain at the fracture site. The nurse assesses a temperature of 102 F and increased swelling at the fracture site. Which complication do these finding suggest? A - Osteomyelitis B - Fat embolism C - Traction misalignment D - Nonunion of the fracture Med Surg Ch. 32 - CORRECT ANSWER A - Osteomyelitis" "The nurse is instructing a patient with rheumatoid arthritis about a prescribed exercise program. Which information should the nurse include? A - Perform exercises every day, 3 to 10 times for every joint B - Perform exercises even if inflammation is present C - Perform exercises past the point of pain D - Perform twice the number of exercises the next day if one day is missed Med Surg Ch. 32 - CORRECT ANSWER A - Perform exercises every day, 3 to 10 times for every joint" "Because of the patients dysphagia, the nurse recommends to the physician that the patient be placed on a Level 2 texture level diet, which means the food is: A - thickened to prevent aspiration B - pureed to a pudding consistency C - mechanically altered, moist, minced helpings D - minced into bite size pieces Advanced Ch. 27 - CORRECT ANSWER C - mechanically altered, moist, minced helpings" "A nurse has administered a Tuberculin skin test to a patient in the outpatient clinic at 9:00 AM on Monday. The patient should be scheduled to return to the clinic to have the result read: A - late Monday afternoon. B - late Tuesday afternoon. C - any time on Wednesday. D - any time on Friday. Advanced Ch. 35 - CORRECT ANSWER C - any time on Wednesday. results should be read within 48 to 72 hours after injection" "A hospitalized patient has an order for subcutaneous heparin. The best location to administer this medication is the: A - upper arm B - anterior thigh C - buttock D - abdomen Advanced Ch. 35 - CORRECT ANSWER D - abdomen" "When administering an intramuscular injection to an adult patient using the ventrogluteal site, the nurse should use which landmark to locate the area for injection? A - The lower end of the trochanter and the knee B - The upper end of the trochanter and the knee C - The head of the trochanter and the posterior iliac spine D - The head of the trochanter and the anterior iliac spine Advanced Ch. 35 - CORRECT ANSWER D - The head of the trochanter and the anterior iliac spine" "When administering an intramuscular injection for a 4-year-old child, the best site to use is the: A - gluteus medius. B - vasts lateralis. C - ventrogluteal. D - dorsogluteal. Advanced Ch. 35 - CORRECT ANSWER B - vasts lateralis" "A nurse giving a subcutaneous injection will select a: A - 3 mL syringe and 22 gauge, 1 1/2 inch needle. B - 3 mL syringe and 18 gauge, 1 1/2 inch needle. C - 3 mL syringe and 25 gauge, 5/8 inch needle. D - 3 mL syringe and 20 gauge, 1 inch needle. Advanced Ch. 35 - CORRECT ANSWER C - 3 mL syringe and 25 gauge, 5/8 inch needle." "The nurse is educating a patient who weighs 325 pounds on how to administer a subcutaneous would suggest that the patient would: A - require a longer needle because of his weight. B - experience a faster response to the medication. C - use a 15 degree angle to inject the medication. D - need extra pressure at the injection site to prevent bleeding. Advanced Ch. 35 - CORRECT ANSWER A - require a longer needle because of his weight" "A patient has an order to receive two intramuscular injections in the same syringe. The nurse should initially: A - determine if the two medications are compatible in the same syringe B - obtain a larger syringe that will accommodate both medications C - select two syringes to give the medications separately D - ask the patient whether he would prefer one or two injections Advanced Ch. 35 - CORRECT ANSWER A - determine if the two medications are compatible in the same syringe" "The nurse directs the immobilized patient in frequent deep breathing exercises during the day in order to combat: A - low oxygen saturation B - atelectasis C - hypostatic pneumonia D - respiratory alkalosis Advanced Ch. 39 - CORRECT ANSWER C - hypostatic pneumonia" "The nurse designs care for the immobilized patient to help combat the major dangers of immobilization, which include: (select all that apply) A - pressure injuries B - loss of bone mass C - urinary infection D - pneumonia E - permanent loss of function Advanced Ch. 39 - CORRECT ANSWER Answer: A, B, D, & E" "Which of the following antidepressant drugs is a preferred drug for clients at a high risk of suicide? A - Tranylcypromine (Parnate) B - Sertraline (Zoloft) C - Imipramine (Tofranil) D - Phenelzine (Nardil.) Mental Health Ch. 2 - CORRECT ANSWER B - Sertraline (Zoloft)" "The nurse knows that the client understands the rationale for dietary restrictions when taking MAOI when the client makes which of the following statements? A - "I am now allergic to foods that are high in the amino acid tyramine such as aged cheese, organ meats, wine, and chocolate" B - "Certain foods will cause me to have sexual dysfunction when I take this medication" C - "Food that are high in tyramine will reduce the medication's effectiveness" D - "I should avoid foods that are high in the amino acid tyramine such as aged cheese, meats, and chocolate because this drug causes the level of tyramine to go up to dangerous levels" Mental Health Ch. 2 - CORRECT ANSWER D - "I should avoid foods that are high in the amino acid tyramine such as aged cheese, meats, and chocolate because this drug causes the level of tyramine to go up to dangerous levels"" "In planning a client's discharge, the nurse must know that the most serious risk for the client taking a tricyclic antidepressant is which of the following? A - Hypotension B - Narrow angle glaucoma C - Seizures D - Suicide by overdose Mental Health Ch. 2 - CORRECT ANSWER D - Suicide by overdose" "A client with severe and persistent mental illness has been taking antipsychotic mulestion for 20 wears. 'The nurce onserves that the clients ochavior includes repetitive movements of the mouth and tongue, facial grimacing, and rocking back and forth. The nurse recognizes these behaviors as indicative of: A - extrapyramidal side eflects B - loss of voluntary muscle control C - posturing D - tardive dyskinesia Mental Health Ch. 2 - CORRECT ANSWER D - tardive dyskinesia" "Which of the tollowing is the primary consideration with clients taking antidepressants? A - Decreased motility B - Emotional changes C - Suicide D - Increased sleep Mental Health Ch. 2 - CORRECT ANSWER C - Suicide" "The nurse has completed health teaching aboul dietary restrictions for a client taking 3 monoamine oxidase inhibitor. The nurse will know that teaching has been etfective by which of the following client statements? A - "I'm glad I can eat pizza since its my favorite food" B - "I must follow this diet or I will have severe vomiting" C - "It will be difficult for me to avoid pepperoni" D - "None of the foods that are restricted are part of a regular daily diet" Mental Health Ch. 2 - CORRECT ANSWER C - "It will be difficult for me to avoid pepperoni"" "The nurse has established a therapeutic relationship with a patient. The patient is beginning to share feelings openly with the nurse. The relationship has entered which phase according to Peplau's theory? A - Orientation B - Identification C - Exploitation D - Resolution Mental Health Ch. 3 - CORRECT ANSWER B - Identification" "During the initial interview with a client in crisis. the initial prionty is to A - assess the adequacy of the support system B - assess for substance abuse C - determine the precrisis level of functioning D - evaluate the potential for self-harm Mental Health Ch. 3 - CORRECT ANSWER D - evaluate the potential for self-harm" "Which of the following statements about the use of defense mechanisms in persons with anxiety disorders are accurate? Select all that apply A - Defense mechanisms are a human's attempt to reduce anxiety. B - Persons are usually aware when they are using defense mechanisms C - Defense mechanisms can be harmful when overused D - Defense mechanisms are cognitive distortions. E - The use of defense mechanisms should be avoided. F - Defense mechanisms can control the awareness of anxiety. Mental Health Ch. 14 - CORRECT ANSWER Answers: A, C, D, & F" "Which one of the following can be a positive outcome of using defense mechanisms? A - Defense mechanisms can inhibit emotional growth. B - Defense mechanisms can lead to poor problem-solving skills C - Defense mechanisms can create difficulty with relationships D - Defense mechanisms can help a person to reduce anxiety Mental Health Ch. 14 - CORRECT ANSWER D - Defense mechanisms can help a person to reduce anxiety" "A mother expresses concern to the nurse that the child's regularly scheduled vaccines may not be safe. The mother states that she has heard reports that they cause autism. The most appropriate response by the nurse is, A - "It is recommended that you wait until the child is older to vaccinate" B - "There are safer alternative immunizations available now" C - "There has been no research to establish a relationship between vaccines and autism" D - "The risks do not outweigh the benefits of immunization against childhood diseases" Mental Health Ch. 22 - CORRECT ANSWER C - "There has been no research to establish a relationship between vaccines and autism"" "A chIld with ADHD complains lo his parents that he does not like the side effects of his medicine, Adderall. The parents ask the nurse for suggestions to reduce the medication's negative side effects. The nurse can best help the parents by offering which advice? A - Give the child his medicine at night B - Have the child eat a good breakfast and snacks late in the day and at bedtime C - Limit the number of calories the child eats each day D - Let the child take daytime naps Mental Health Ch. 22 - CORRECT ANSWER B - Have the child eat a good breakfast and snacks late in the day and at bedtime" "A child with attention deficit hyperactivity disorder is taking methylphenidate (Ritalin) in divided doses. If the child takes the first dose at 8 AM, which behavior might the school nurse expect to see at noon? A - Increased impulsivity or hyperactive behavior B - Lack of appetite for lunch C - Sleepiness or drowsiness D - Social isolation from peers Mental Health Ch. 22 - CORRECT ANSWER A - Increased impulsivity or hyperactive behavior" "Which statement would indicate that medication teaching for the parents of a 6-year-old child with attention deficit hyperactivity disorder (ADHD) has been effective? A - "We'll teach him the proper way to take the medication, so he can manage it independently" B - "We'll be sure he takes Ritalin at the same time every day, just before bedtime" C - "We're so glad thal Ritalin will eliminate the problems of ADHD" D - "We'll be sure to record his weight on a weekly basis" Mental Health Ch. 22 - CORRECT ANSWER D - "We'll be sure to record his weight on a weekly basis"" "Which of the following terms is used to describe the process by which a person experiences the grief? A - Anticipatory grieving B - Disenfranchised grief C - Bereavement D - Mourning Mental Health Ch. 10 - CORRECT ANSWER C - Bereavement" "A married couple has just received the news that the husband has terminal cancer. The wife tells the nurse, "Maybe if we get another opinion and start treatment right away there is a chance of survival." The nurse documents that the wife is expressing signs of which of Kubler-Ross's stages of grief? A - Denial B - Anger C - Bargaining D - Depression Mental Health Ch. 10 - CORRECT ANSWER C - Bargaining" "After being laid off from work, a client becomes increasingly withdrawn and fatigued, spends entire days in bed, is unkempt, and is eating and sleeping poorly. The nurse would recognize that the client is in which stage of grieving, according to Kubler-Ross? A - Anger B - Bargaining C - Denial D - Depression Mental Health Ch. 10 - CORRECT ANSWER D - Depression" "The client says to the nurse, "I really want to see my first grandchild born before I die. Is that too much to ask?" The nurse would recognize that the client is in which stage of grieving, according to Kubler-Ross? A - Acceptance B - Anger C - Bargaining D - Depression Mental Health Ch. 10 - CORRECT ANSWER C - Bargaining" "Friends of a teenage male recently killed in a car accident are discussing their sense of loss. Which of the following comments best indicates that the friends are trying to make sense of the loss of cognitively? A - "Why did he have to die so young?" B - "He shouldn't have been driving so recklessly." C - "If we had only stayed longer, he would not have been on that road." D - "It took the ambulance to long to get there." Mental Health Ch. 10 - CORRECT ANSWER A - "Why did he have to die so young?"" "The nurse is working with a woman who lost her partner nearly 3 weeks prior. The woman has recently become less emotional and expressed that few things in her life have meaning right now. Which response by the nurse is most appropriate at this time? A - "I am concerned. You are starting to show signs of ineffective grieving." B - "You must feel some anger. It is alright to let that out." C - "Let's look at the things in your life that you still enjoy." D - "You are just starting to accept that this loss is real." Mental Health Ch. 10 - CORRECT ANSWER D - "You are just starting to accept that this loss is real."" "The nurse is working with a client who lost her youngest child 2 months ago. When the nurse approaches the client, the client yells, "I don't want to talk to you. You have no idea what it's like to lose a child!" The nurse bases her response to the client on the understanding of which of the following? A - Hostility is a common behavioral response to grief B - It is too soon after the loss to empathize with the client C - Personality traits such as aggressiveness are exaggerated during the grief process D - The nurse may have nonverbally indicated a judgmental attitude towards the client Mental Health Ch. 10 - CORRECT ANSWER A - Hostility is a common behavioral response to grief" "A client who has been grieving the loss of his wife 2 weeks ago says to the nurse, "The best part of my day is when I am back at work. Is that wrong?" The nurse educates that work and other daily activities serve which purpose? A - "You cannot work effectively this soon. You should finish grieving first." B - "Working reminds you of your loss. It may be too early to go back." C - "Working is your way of avoiding grief, which will make it harder for you to move on." D - "Working is letting you take an emotional break from grieving. There's nothing wrong with that." Mental Heath Ch. 10 - CORRECT ANSWER D - "Working is letting you take an emotional break from grieving. There's nothing wrong with that."" "A client is scheduled for a mastectomy for breast cancer. She is quiet, shows little emotion, and states that she has no questions. The nurse's assessment would need to focus on A - the client's plans for reconstructive surgery B - the meaning of the mastectomy to the client C - whether the client truly understands the surgery D - why the client seems depressed Mental Health Ch. 10 - CORRECT ANSWER B - the meaning of the mastectomy to the client" "The LPN demonstrates an evidence-based practice by: A - using a drug manual to check compatibility of drugs B - using scientific information to guide decision making C - using medical history of a patient to direct nursing interventions D - basing nursing care on advice from an experienced nurse Concepts Ch. 1 - CORRECT ANSWER B - using scientific information to guide decision making" "The nurse assesses a terminal illness in: A - A 76 year old admitted to a nursing home with Alzheimer's disease who is pacing and asking to go home B - A 43-year-old with Lou Gehrig's disease who is refusing food and fluid C - A 2 year old child who burned her esophagus by drinking drain cleaner and who is being fed by a tube D - A 52 year old diagnosed with lung cancer who had part of one lung removed and has a closed chest drainage device in place Concepts Ch. 2 - CORRECT ANSWER B - A 43-year-old with Lou Gehrig's disease who is refusing food and fluid" "The nurse clarifies to a patient who now has an abscess following a ruptured appendix that the abscess is considered to be: A - A secondary illness B - A life threatening complication C - An expected event following any surgery D - A disorder easily treated with antibiotics Concepts Ch. 2 - CORRECT ANSWER A - A secondary illness" "The nurse assesses that a person is in the acceptance stage of illness when the patient: A - looks to home remedies to become well B - reassumes usual responsibilities and roles C - assumes the "sick" role D - rejects medical treatment Concepts Ch. 2 - CORRECT ANSWER C - assumes the "sick" role" "Nurse instructs a patient that according to Selye's GAS theory, when stress is strong enough and occurs over long period, the patient will enter the stage of: A - convalescence B - alarm C - transition D - exhaustion Concepts Ch. 2 - CORRECT ANSWER D - exhaustion" "The nurse takes into consideration that in the state of resistance in Selye's GAS, the patient: A - regresses to a dependent state B - continues to battle for equilibrium C - becomes maladaptive D - begins to develop stress related disorders Concepts Ch. 2 - CORRECT ANSWER B - continues to battle for equilibrium" "The nurse describes behaviors of the transition stage of illness, which are: (select all that apply) A - awareness of the vague symptoms B - denial of feeling ill C - resorts to self medication D - withdrawal from roles and responsibilities E - recovery from illness begins Concepts Ch. 2 - CORRECT ANSWER Answer: A, B, & C" "A student can begin to develop critical thinking skills by means of: A - Working with a more experience nurse B - Questioning every statement made by instructors to be sure of its correctness C - Memorizing class notes for tests and studying all night for big tests D - Listening attentively and focusing on the speaker's words and meaning Concepts Ch. 4 - CORRECT ANSWER D - Listening attentively and focusing on the speaker's words and meaning" "When a nurse prioritizes the patient care, consideration is given to: A - completing assessments before mid shift B - considering situations that may result in an alteration of health C - assuming all health care activities for a group of patients D - identifying who can assist with the aspect of care Concepts Ch. 4 - CORRECT ANSWER B - considering situations that may result in an alteration of health" "An emergency room nurse will give first priority to the patient with the most critical need, which is the patient who: A - is bleed from a chin laceration B - complains of a productive cough C - has a fever of 102 F D - complains of severe chest pain Concepts Ch. 4 - CORRECT ANSWER D - complains of severe chest pain" "Prior to the nurse implementing a nursing procedure for a patient, the nurse should initially: A - question the rationale for the procedure B - perform a physical assessment of the patient C - check the agency manual for the procedure D - mentally review the procedure Concepts Ch. 6 - CORRECT ANSWER D - mentally review the procedure" "The purpose of the evaluation stuff of the nursing process is to: A - determine if outcomes have been reached and the goals are met B - compare actual outcomes with expected outcomes C - identify inefficient care given by assigned staff D - confirm that nursing interventions are effective E - ensure that the facility has not put itself at risk for litigation Concepts Ch. 6 - CORRECT ANSWER Answer: A, B, & D" "When assessing the lungs of a patient, the nurse assesses a wheezing sound on inspiration. This finding is documented as: A - apnea B - dyspnea C - stridor D - retractions - CORRECT ANSWER C - stridor" "