RN Pedia: PNLE NP1 Test 1 Questions
And Answers
/ 1. The nurse In-charge in labor and delivery unit administered a dose of terbutaline to
a client without checking the client's pulse. The standard that would be used to
determine if the nurse was negligent is:
A. The physician's orders.
B. The action of a clinical nurse specialist who is recognized expert in the field.
C. The statement in the drug literature about administration of terbutaline.
D. The actions of a reasonably prudent nurse with similar education and experience. -
Answer-✅Answer: (D) The actions of a reasonably prudent nurse with similar education
and experience.
The standard of care is determined by the average degree of skill, care, and diligence
by nurses in similar circumstances.
/.2. Nurse Trish is caring for a female client with a history of GI bleeding, sickle cell
disease, and a platelet count of 22,000/μl. The female client is dehydrated and receiving
dextrose 5% in half-normal saline solution at 150 ml/hr. The client complains of severe
bone pain and is scheduled to receive a dose of morphine sulfate. In administering the
medication, Nurse Trish should avoid which route?
A. I.V
B. I.M
C. Oral
D. S.C - Answer-✅Answer: (B) I.M.
With a platelet count of 22,000/μl, the clients tends to bleed easily. Therefore, the nurse
should avoid using the I.M. route because the area is a highly vascular and can bleed
readily when penetrated by a needle. The bleeding can be difficult to stop.
/.3. Dr. Garcia writes the following order for the client who has been recently admitted
"Digoxin .125 mg P.O. once daily." To prevent a dosage error, how should the nurse
document this order onto the medication administration record?
A. "Digoxin .1250 mg P.O. once daily"
B. "Digoxin 0.1250 mg P.O. once daily"
C. "Digoxin 0.125 mg P.O. once daily"
D. "Digoxin .125 mg P.O. once daily" - Answer-✅Answer: (C) "Digoxin 0.125 mg P.O.
once daily"
The nurse should always place a zero before a decimal point so that no one misreads
the figure, which could result in a dosage error. The nurse should never insert a zero at
,the end of a dosage that includes a decimal point because this could be misread,
possibly leading to a tenfold increase in the dosage.
/.4. A newly admitted female client was diagnosed with deep vein thrombosis. Which
nursing diagnosis should receive the highest priority?
A. Ineffective peripheral tissue perfusion related to venous congestion.
B. Risk for injury related to edema.
C. Excess fluid volume related to peripheral vascular disease.
D. Impaired gas exchange related to increased blood flow. - Answer-✅Answer: (A)
Ineffective peripheral tissue perfusion related to venous congestion.
Ineffective peripheral tissue perfusion related to venous congestion takes the highest
priority because venous inflammation and clot formation impede blood flow in a client
with deep vein thrombosis.
/.5. Nurse Betty is assigned to the following clients. The client that the nurse would see
first after endorsement?
A. A 34-year-old post operative appendectomy client of five hours who is complaining of
pain.
B. A 44-year-old myocardial infarction (MI) client who is complaining of nausea.
C. A 26-year-old client admitted for dehydration whose intravenous (IV) has infiltrated.
D. A 63-year-old post operative's abdominal hysterectomy client of three days whose
incisional dressing is saturated with serosanguinous fluid. - Answer-✅Answer: (B) A 44
year-old myocardial infarction (MI) client who is complaining of nausea.
Nausea is a symptom of impending myocardial infarction (MI) and should be assessed
immediately so that treatment can be instituted and further damage to the heart is
avoided.
/.6. Nurse Gail places a client in a four-point restraint following orders from the
physician. The client care plan should include:
A. Assess temperature frequently.
B. Provide diversional activities.
C. Check circulation every 15-30 minutes.
D. Socialize with other patients once a shift. - Answer-✅Answer: (C) Check circulation
every 15-30 minutes.
Restraints encircle the limbs, which place the client at risk for circulation being restricted
to the distal areas of the extremities. Checking the client's circulation every 15-30
minutes will allow the nurse to adjust the restraints before injury from decreased blood
flow occurs.
/.7. A male client who has severe burns is receiving H2 receptor antagonist therapy.
The nurse In-charge knows the purpose of this therapy is to:
A. Prevent stress ulcer
, B. Block prostaglandin synthesis
C. Facilitate protein synthesis.
D. Enhance gas exchange - Answer-✅Answer: (A) Prevent stress ulcer.
Curling's ulcer occurs as a generalized stress response in burn patients. This results in
a decreased production of mucus and increased secretion of gastric acid. The best
treatment for this prophylactic use of antacids and H2 receptor blockers.
/.8. The doctor orders hourly urine output measurement for a postoperative male client.
The nurse Trish records the following amounts of output for 2 consecutive hours: 8 a.m.:
50 ml; 9 a.m.: 60 ml. Based on these amounts, which action should the nurse take?
A. Increase the I.V. fluid infusion rate
B. Irrigate the indwelling urinary catheter
C. Notify the physician
D. Continue to monitor and record hourly urine output - Answer-✅Answer: (D) Continue
to monitor and record hourly urine output.
Normal urine output for an adult is approximately 1 ml/minute (60 ml/hour). Therefore,
this client's output is normal. Beyond continued evaluation, no nursing action is
warranted.
/.9. Tony, a basketball player twist his right ankle while playing on the court and seeks
care for ankle pain and swelling. After the nurse applies ice to the ankle for 30 minutes,
which statement by Tony suggests that ice application has been effective?
A. "My ankle looks less swollen now".
B. "My ankle feels warm".
C. "My ankle appears redder now".
D. "I need something stronger for pain relief" - Answer-✅Answer: (A) "My ankle looks
less swollen now"
Ice application decreases pain and swelling. Continued or increased pain, redness, and
increased warmth are signs of inflammation that shouldn't occur after ice application
/.10. The physician prescribes a loop diuretic for a client. When administering this drug,
the nurse anticipates that the client may develop which electrolyte imbalance?
A. Hypernatremia
B. Hyperkalemia
C. Hypokalemia
D. Hypervolemia - Answer-✅Answer: (B) Hyperkalemia.
A loop diuretic removes water and, along with it, sodium and potassium. This may result
in hypokalemia, hypovolemia, and hyponatremia.
/.11. She finds out that some managers have benevolent-authoritative style of
management. Which of the following behaviors will she exhibit most likely?
A. Have condescending trust and confidence in their subordinates.
And Answers
/ 1. The nurse In-charge in labor and delivery unit administered a dose of terbutaline to
a client without checking the client's pulse. The standard that would be used to
determine if the nurse was negligent is:
A. The physician's orders.
B. The action of a clinical nurse specialist who is recognized expert in the field.
C. The statement in the drug literature about administration of terbutaline.
D. The actions of a reasonably prudent nurse with similar education and experience. -
Answer-✅Answer: (D) The actions of a reasonably prudent nurse with similar education
and experience.
The standard of care is determined by the average degree of skill, care, and diligence
by nurses in similar circumstances.
/.2. Nurse Trish is caring for a female client with a history of GI bleeding, sickle cell
disease, and a platelet count of 22,000/μl. The female client is dehydrated and receiving
dextrose 5% in half-normal saline solution at 150 ml/hr. The client complains of severe
bone pain and is scheduled to receive a dose of morphine sulfate. In administering the
medication, Nurse Trish should avoid which route?
A. I.V
B. I.M
C. Oral
D. S.C - Answer-✅Answer: (B) I.M.
With a platelet count of 22,000/μl, the clients tends to bleed easily. Therefore, the nurse
should avoid using the I.M. route because the area is a highly vascular and can bleed
readily when penetrated by a needle. The bleeding can be difficult to stop.
/.3. Dr. Garcia writes the following order for the client who has been recently admitted
"Digoxin .125 mg P.O. once daily." To prevent a dosage error, how should the nurse
document this order onto the medication administration record?
A. "Digoxin .1250 mg P.O. once daily"
B. "Digoxin 0.1250 mg P.O. once daily"
C. "Digoxin 0.125 mg P.O. once daily"
D. "Digoxin .125 mg P.O. once daily" - Answer-✅Answer: (C) "Digoxin 0.125 mg P.O.
once daily"
The nurse should always place a zero before a decimal point so that no one misreads
the figure, which could result in a dosage error. The nurse should never insert a zero at
,the end of a dosage that includes a decimal point because this could be misread,
possibly leading to a tenfold increase in the dosage.
/.4. A newly admitted female client was diagnosed with deep vein thrombosis. Which
nursing diagnosis should receive the highest priority?
A. Ineffective peripheral tissue perfusion related to venous congestion.
B. Risk for injury related to edema.
C. Excess fluid volume related to peripheral vascular disease.
D. Impaired gas exchange related to increased blood flow. - Answer-✅Answer: (A)
Ineffective peripheral tissue perfusion related to venous congestion.
Ineffective peripheral tissue perfusion related to venous congestion takes the highest
priority because venous inflammation and clot formation impede blood flow in a client
with deep vein thrombosis.
/.5. Nurse Betty is assigned to the following clients. The client that the nurse would see
first after endorsement?
A. A 34-year-old post operative appendectomy client of five hours who is complaining of
pain.
B. A 44-year-old myocardial infarction (MI) client who is complaining of nausea.
C. A 26-year-old client admitted for dehydration whose intravenous (IV) has infiltrated.
D. A 63-year-old post operative's abdominal hysterectomy client of three days whose
incisional dressing is saturated with serosanguinous fluid. - Answer-✅Answer: (B) A 44
year-old myocardial infarction (MI) client who is complaining of nausea.
Nausea is a symptom of impending myocardial infarction (MI) and should be assessed
immediately so that treatment can be instituted and further damage to the heart is
avoided.
/.6. Nurse Gail places a client in a four-point restraint following orders from the
physician. The client care plan should include:
A. Assess temperature frequently.
B. Provide diversional activities.
C. Check circulation every 15-30 minutes.
D. Socialize with other patients once a shift. - Answer-✅Answer: (C) Check circulation
every 15-30 minutes.
Restraints encircle the limbs, which place the client at risk for circulation being restricted
to the distal areas of the extremities. Checking the client's circulation every 15-30
minutes will allow the nurse to adjust the restraints before injury from decreased blood
flow occurs.
/.7. A male client who has severe burns is receiving H2 receptor antagonist therapy.
The nurse In-charge knows the purpose of this therapy is to:
A. Prevent stress ulcer
, B. Block prostaglandin synthesis
C. Facilitate protein synthesis.
D. Enhance gas exchange - Answer-✅Answer: (A) Prevent stress ulcer.
Curling's ulcer occurs as a generalized stress response in burn patients. This results in
a decreased production of mucus and increased secretion of gastric acid. The best
treatment for this prophylactic use of antacids and H2 receptor blockers.
/.8. The doctor orders hourly urine output measurement for a postoperative male client.
The nurse Trish records the following amounts of output for 2 consecutive hours: 8 a.m.:
50 ml; 9 a.m.: 60 ml. Based on these amounts, which action should the nurse take?
A. Increase the I.V. fluid infusion rate
B. Irrigate the indwelling urinary catheter
C. Notify the physician
D. Continue to monitor and record hourly urine output - Answer-✅Answer: (D) Continue
to monitor and record hourly urine output.
Normal urine output for an adult is approximately 1 ml/minute (60 ml/hour). Therefore,
this client's output is normal. Beyond continued evaluation, no nursing action is
warranted.
/.9. Tony, a basketball player twist his right ankle while playing on the court and seeks
care for ankle pain and swelling. After the nurse applies ice to the ankle for 30 minutes,
which statement by Tony suggests that ice application has been effective?
A. "My ankle looks less swollen now".
B. "My ankle feels warm".
C. "My ankle appears redder now".
D. "I need something stronger for pain relief" - Answer-✅Answer: (A) "My ankle looks
less swollen now"
Ice application decreases pain and swelling. Continued or increased pain, redness, and
increased warmth are signs of inflammation that shouldn't occur after ice application
/.10. The physician prescribes a loop diuretic for a client. When administering this drug,
the nurse anticipates that the client may develop which electrolyte imbalance?
A. Hypernatremia
B. Hyperkalemia
C. Hypokalemia
D. Hypervolemia - Answer-✅Answer: (B) Hyperkalemia.
A loop diuretic removes water and, along with it, sodium and potassium. This may result
in hypokalemia, hypovolemia, and hyponatremia.
/.11. She finds out that some managers have benevolent-authoritative style of
management. Which of the following behaviors will she exhibit most likely?
A. Have condescending trust and confidence in their subordinates.
