RPN Integrated Practice Test Sept 2010

1. Of the four clients listed below, which responsibility should the nurse direct the technician to carry out first?
a. 89 year old with COPD resting quietly on 2 liters of O 2 needs morning vitals with 02 sat
b. 77 year old with gastrointestinal bleeding needs bedside commode emptied
c. 55 year old diabetic with fasting blood sugar of 75, at 80% of breakfast and needs morning snack
d. 49 year old with rheumatoid arthritis needs splints reapplied to both hands.

2. The RPN is assigned to care for a client who had a total right hip two days ago. Which observation should the RPN
report immediately to the nurse?
a. incisional paid rated on 6 on a scale of 0-10
b. reddened incision line with a temperature of 99.6 F
c. pain and redness in the left lower leg
d. the client is not tolerating 20lbs of weight bearing on the right leg

3. The registered nurse is planning the client assignments. Which assignment is an appropriate assignment for the
nursing assistant?
a. assist a 12 year old boy with Down’s syndrome, who is profoundly, developmentally disabled, to eat lunch
b. obtain a temperature of a 29 year old woman receiving the final 30 minutes of a whole blood transfusion
c. complete initial vital signs on a 51 year old man who has just returned from surgery and PACU for a bowel
transfusion
d. complete a sterile dressing change on a 70 year old woman admitted for skin graft

4. Which task would be the least appropriate to delegate to a nursing assistant?

a. feed 10 month old a bottle who has crackles bilaterally, harsh, productive cough and in room air
b. help 10 year old with cystic fibrosis, diminished breath sounds in the RLL up to the bathroom
c. obtain vital signs of a 9 year old who was admitted yesterday for an acute asthma exacerbation
d. obtain the respiratory rate of a 6 week old infant who was admitted two hours ago with a respiratory rate of 64

5. In a busy medical unit, how would the RPN appropriately delegate the task among the 4 PSW?
a. Assign the same patients to keep continuity of care
b. Divide patients equally among the 4 PSWs
c. Ask the PSWs which patients they want to be assigned today
d. Ask the charge nurse to do the assignment

6. You are working in a busy surgical unit. When you look at your assignment, you have 6 post-op patients in your
assignment. What will you do?
a. This is too much for you. Notify the nurse in charge
b. Know how to prioritize your work and attend to the patients who has the most needs
c. File an incident report
d. Complaints to the nursing supervisor

7. You are assigned to a patient who is on PCA for his post op pain. You’d noticed that the patient received 10 mgs
more than the ordered dosage due to malfunctioning PCA pump. What will you do?
a. Assess and observe the patient’s respiratory status
b. Notify the physician
c. Record your observation in the progress notes
d. Inform your colleague

8. Marilyn is a young 24-year-old female patient who came in with a diagnosis of hypothyroidism. She was placed on
medication. When evaluating the patient’s response to medication, which one is an indication that the medication is
effective?
a. The patient’s weight remains the same
 b. The patient has gained weight
c. The patient has very dry skin
d. The patient complains of feeling cold

9. You discontinued your patient’s IV and you noticed that the site is bleeding. What will do?
a. Apply cold compress
b. Apply warm compress
c. Inform the physician
d. Asses the patient’s vital signs

10. You are working in a long term facility. One of the patients wander around and unable to find her room. One time
you noticed that she was sitting beside her bed. What will do first?
a. Put her in her bed
b. Ask her where she is
c. Ask her to state her name
d. Ignore her

11. Two days following delivery of a normal infant, the mother noted a small, red spot on her newborn and asked the
nurse, “What is this?” What would be an appropriate response?
a. This could be normal among newborn
b. This is caput succedaneum
c. Your baby is bleeding. Let me inform the physician
d. This is cephalohematoma

12. The mother delivers a 6.8 lb baby vaginally. While cuddling the infant, the mother asks the nurse, “What do you
mean by macro or micro when describing the size of babies?” What would be an appropriate response?
a. Macro means small; micro means big
b. Macro mean big; micro means small
c. Those words have nothing to do with size of babies
d. These are medical terminologies that cannot be applied in children

13. In a certain facility, the medical unit has adopted therapeutic touch as adjunct to nursing care. When performing this
treatment regimen, the RPN is aware that therapeutic touch consists of 4 sequences. Which one is correct?
a. Sweeping of hands starts from center of the body to the periphery
b. Sweeping of hands starts from head down
c. Sweeping of hands starts from leg up
d. Sweeping of hands in no particular order

14. The patient was admitted with anorexia nervosa. When evaluating the patient’s progress on nutritional status, the
RPN will appropriately perform which of the following?
a. Weigh the patient
b. Ask the patient how much food she is eating
c. Check the patient’s skin turgor
d. Monitor the patient’s I/O’s

15. Post gastrectomy, the RPN was giving health teaching on diet. Which of the following health teaching given by the
RPN prevents or minimizes dumping syndrome post gastrectomy?
a. High CHO diet with additional fluids while eating
b. High protein diet with fluids in between meals
c. Lie down right after meals
d. High fiber diet with fluids between meals
16. A patient in the pediatric unit was admitted with Cystic Fibrosis. When giving information on diet to the patient’s
mother, the RPN has correctly stated that:
a. The appropriate diet for the patient with cystic fibrosis is large of amount fluids with Vit ADEK
b. The appropriate diet should for the patient with cystic fibrosis should be high in protein with large amount of
fluids
c. The appropriate diet for the patient with cystic fibrosis is high in fat and with Vit ADEK
d. The appropriate diet for the patient with cystic fibrosis is high in fat soluble vitamins

17. When administering iron injection on the patient who came in with anemia requires Z-tract technique to prevent
irritation of tissue. Which technique uses by the RPN is correct?
a. Use large muscle; displace the skin and subcutaneous tissue 1-1.5 inches (2.5-3.75 cm), laterally; release the
tissue immediately after the injection
b. Use large muscles, displace the tissue laterally and release as soon as the needle is inserted
c. Administer the medication using a 90° when injecting the medication
d. Rub the site vigorously after removing the needle

18. You are working in a long term facility. One of your patients has dementia and has frequent falls at night. How would
you promote safety on this patient?
a. Leave the night light on; lower the bed so the patient can get out of bed easily
b. Leave the night light on; attach the call bell on the patient’s gown so she can readily call for help
c. Leave the night light on; raise the side rails so the patient cannot get out of bed
d. Leave the night light on; apply hand restraints and tied them on the side rails

19. Marie is a 16 year-old young female patient who was admitted with abdominal pain. Blood test and abdominal
ultrasound were ordered to confirm the diagnosis. When doing physical assessment, the RPN has correctly assessed
the abdomen by which of the following?
a. Auscultate the abdomen and monitor the vital signs
b. Percuss then auscultate the abdomen
c. Auscultate then palpate the tender area
d. Press the tender area and ask the patient if the pain intensifies while pressure is applied

20. When performing neurological assessment on the patient, you observe that the normal pupil reaction to light would
be:
a. One eye constrict with light and one eye dilates when light is out
b. Both eyes constrict then dilate when light is applied
c. Both eyes constrict with light
d. One eye dilates with light and constrict when light is off

21. Pepe is a 6 year old boy who was admitted with sickle cell crisis. He was started on IV fluids running at 85 ml/hour;
warm compresses applied on painful extremities and Morphine Sulphate at 5 mg IM every 4 to 6 hours were
ordered. In light of the Morphine order, what would be an appropriate nursing action?
a. Administer as ordered
b. Clarify the order with the physician
c. Inform the nurse – in-charge, the dosage is too much for the child
d. Do not give the medication

22. A 4-year-old girl was admitted in your unit. She came in with Lukemia. The physician ordered Tylenol 500 mg for pain
and fever. The child has a fever of 102.2° C. Prior to administering the Tylenol, what would be an appropriate
nursing action?
a. Verify the physician’s order, the dose is too large for the child
b. Administer the dose, the child has fever
c. Ask your colleague to check the Tylenol prior to administering it to the child
d. Perform tepid sponge bath prior to administering the Tylenol
23. How would the RPN transfer the patient with back injury from bed to the stretcher?
a. Ask the patient to use the overhead trapeze
b. Use the trochanter roll
c. Use the bottom sheet when transferring the patient
d. Raise the head of the bed and put the patient in sitting position then transfer

24. In the unit participates on pilot study on turning the patient with the use of draw sheet. You’ve noticed that one of
your colleagues does not follow the guideline stated in the study. What will you do?
a. Report the colleague to the nurse spearheading the pilot study
b. Suggest that your colleague use an alternative method
c. Speak to your colleague and find out the reason of not following the guideline
d. Report your colleague to the nursing supervisor

25. Mr. SS is in your unit. He has a diagnosis of ALL. His WBC dropped to 0.5 mm 3. Due to severely decreased WBC
count, Mr. SS was placed on reverse isolation. As you transport Mr. SS to the Radiology Department for CXR, which
one will you do?
a. You wear mask when transporting Mr. SS for CXR
b. You put mask on Mr. SS when transporting for CXR
c. You put on extra gown to Mr. SS when transporting for CXR
d. You put on a clean gown when transporting Mr. SS for CXR

26. Mr. SS, with diagnosis of ALL, has bone marrow depression from chemotherapy. When shaving, which one is
appropriate?
a. Provide a razor blade
b. Provide an electric shaver
c. Instruct him to shave opposite hair growth
d. Put shaving cream prior to shaving

27. Mr. D is in your unit. He had a diagnosis of diabetes type I. When doing foot care which one is appropriate?
a. Soak his feet in warm water for 20 minutes
b. Soak his feet in warm water for 30 minutes
c. Wash his feet with soap and water then dry them using soft towel
d. Refuse to provide foot care as you are not familiar with this procedure

28. Anna Marie is a lovely 5-month-old infant who is going for brain operation. She was assigned to you, however, you
are not familiar with her pre-op care. What will you do?
a. Inform the physician about your competency level
b. Perform some pre-op care that you are familiar with
c. Call her parents for some additional input that helps you with pre-op preparation
d. Inform the charge nurse about your competency level

29. Anthony is on Morphine ATC for his chronic pain. When you assess his vital signs, you noticed that his RR was only 8
bpm. Which action taken is appropriate?
a. Report your finding to the physician
b. Monitor his RR
c. Monitor his HR
d. Document your finding

30. Which of the following assessment findings on the patient with DM needs to be reported?
a. Nails are hard to touch
b. Nails with extra growth
c. Some nails are hanging out of toes
 d. Redness on skin around the nails

31. Mr. CC is a 56-year-old patient admitted in your unit with a diagnosis of acute heart failure. He is receiving IV fluids
and Lasix. The nurse from the night shift has reported that the patient’s urine output during the last 24 hours was
only 250 cc. What will be an appropriate nursing action?
a. Palpate his bladder first to find out if he had distention
b. Palpate his stomach for abdominal distention
c. Notify the physician
d. Confirm if the output was correctly measured

32. Mr. Lovely was admitted with pneumonia. He is apprehensive, diaphoretic and with open wounds with small
bleeding on his open wounds in his arms, thighs and legs. When providing care for Mr. Lovely, what precautionary
measures will you implement?
a. Ask the charge nurse to put him in a private room and implement contact isolation
b. Ask the charge nurse to put him in a private room and implement the use of HEPA MASK
c. Ask the charge nurse to put him in a private room and implement reverse isolation
d. Ask the charge nurse to put him in a private room and implement respiratory isolation

33. Post op, when the patient was trying to ambulate to the wash room, her abdominal incision gaped open. What will
be an appropriate nursing intervention?
a. Insert a wet sterile dressing inside the open operative site
b. Cover the surgical site with wet sterile gauze
c. Tell the patient not to worry and ask him to finish his toileting then usher him to bed
d. Get a wet towel and cover the open site

34. A client had a Caesarean delivery and is postpartum day 1. She asks for pain medication when the nurse enters the
room to do her shift assessment. The client states that her pain level is an 8 on a scale of 1 to 10. What should be the
nurse's priority of care?
a. Give the pain medication and return in an hour for further assessment to allow time for the medication to work.
b. Complete the postpartum assessment and then give the client pain medication.
c. Give the pain medication first, do a quick assessment while administering the medication to ensure the pain is
not caused by a complication, and return for the full assessment after the client's pain has subsided.
d. Instruct the patient to do relaxation exercises to relieve her discomfort.

35. The nurse is caring for a client diagnosed with end-stage liver disease. The client has completed an advance directive
and a do-not-resuscitate (DNR) document and wishes to receive palliative care. Which of the following would
correspond to the client's wish for comfort care?
a. Positioning frequently to prevent skin breakdown and providing pain management and other comfort measures.
b. Carrying out vigorous resuscitation efforts if the client were to stop breathing, but no resuscitation if the heart
stops beating.
c. Providing intravenous fluids when the client becomes dehydrated.
d. Providing total parenteral nutrition (TPN) if the client is not able to eat.

36. The nurse is preparing to administer an I.M. injection in a client with a spinal cord injury that has resulted in
paraplegia. Which of the following muscles is best site for the injection in this case?
a. Deltoid.
b. Dorsal gluteal.
c. Vastus lateralis.
d. Ventral gluteal.

37. The nurse is caring for a client with heart failure. Which of the following statements by the client suggests that the
client has left-sided heart failure?
a. "I sleep on three pillows each night."
 b. "My feet are bigger than normal."
c. "My pants don't fit around my waist."
d. "I have to get up three times during the night to urinate."

38. The nurse is teaching a client newly diagnosed with type 1 diabetes how to self-administer subcutaneous insulin
injections. How does the nurse best evaluate the effectiveness of her teaching?
a. Have the client repeat the steps back to the nurse.
b. Give the client a written test on self-administration of insulin.
c. Ask the client to write out the steps for self-administration of insulin injections.
d. Ask the client to give a return demonstration of self-administration of insulin.

39. A nurse is caring for a client returning from an x-ray. The nursing assistant is helping transfer the client back to bed.
Which transfer technique by the nurse uses appropriate ergonomic principles?
a. Lowering the bed for transfer and then raising the bed before leaving the room, making sure to place the call
light is within reach.
b. Maintaining a narrow base of support during transfer and encouraging the client to hold onto her if afraid during
transfer.
c. Raising the bed for transfer, maintaining a wide base of support during transfer, and lowering the bed before
leaving the room.
d. Explaining the procedure to the client and grabbing the client underneath the arms to pull her over to the bed.

40. The nurse is caring for a client with cirrhosis of the liver. The client has developed ascites and requires a
paracentesis. Which of the following symptoms is associated with ascites and should be relieved by the
paracentesis?
a. Pruritus.
b. Dyspnea.
c. Jaundice.
d. Peripheral neuropathy.

41. A client underwent a colostomy for a ruptured diverticulum. He did well throughout the surgery and returned to the
medical-surgical floor in stable condition. The nurse assesses the client's colostomy stoma 2 days after surgery.
Which assessment finding should the nurse report immediately to the physician?
a. Blanched stoma.
b. Edematous stoma.
c. Reddish-pink stoma.
d. Brownish-black stoma.

42. A 37-year-old forklift operator presents with shakiness, sweating, anxiety, and palpitations and tells the nurse he
has type 1 diabetes mellitus. Which of the follow actions should the nurse do first?
a. Inject 1 mg of glucagon subcutaneously.
b. Administer 50 mL of 50% glucose I.V.
c. Give 4 to 6 oz (118 to 177 mL) of orange juice.
d. Give the client four to six glucose tablets.

43. A client with cirrhosis of the liver develops ascites. Which of the following orders would the nurse expect?
a. Restrict fluid to 1000 mL per day.
b. Ambulate 100 ft. three times per day.
c. High-sodium diet.
d. Maalox 30 ml P.O. BID.

44. A client who underwent abdominal surgery now has a gaping open incision due to delayed wound healing. The
nurse must irrigate the wound with a piston syringe and sterile normal saline and provide wound care. Which of the
following procedures is correct?
 a. Rapidly instill a stream of irrigating solution into the wound to flush out debris.
b. Apply a wet-to-dry dressing to the wound after the irrigation.
c. Moisten the area around the wound with normal saline solution after the irrigation.
d. Irrigate slowly and continuously until the solution becomes clear or all of the solution is used.

45. The nurse is doing teaching with the family of a client with liver failure. Which of the following foods should the
nurse advise them to limit in the client's diet?
a. Meats and beans.
b. Butter and gravies.
c. Potatoes and pasta.
d. Cakes and pastries.

46. The nurse is preparing to administer medications to two clients with the same last name. The nurse checks the
medication three times before entering the room to administer medications to the first client. While leaving the
room following administration, the nurse realizes she did not check the identification of the client prior to
administering medication. Which of the following actions should the nurse complete first?
a. Return to the room to check the client identification and complete a variance report if an error was made.
b. Administer the remaining medication to the other client and check the client identification.
c. Alert the charge nurse that a medication error has been committed.
d. Document completion of the variance report and the medication error in the client's chart and notify the
physician

47. After an abdominal resection for colon cancer, the client returns to her room with a Jackson-Pratt drain in place. The
client's spouse asks the nurse what the purpose of the drain is. Which of the following is the nurse's best response?
a. "To irrigate the incision with a saline solution."
b. "To prevent bacterial infection of the incision."
c. "To measure the amount of fluid lost after surgery."
d. "To prevent accumulation of drainage in the wound."

48. 13. An elderly client is recently diagnosed with hypothyroidism. He lives in his own apartment in a community
development designed for the elderly. He asks the nurse for advice about his condition. What is the best advice for
the nurse to give the client?
a. "Stop attending group activities."
b. "Increase fiber and fluids in your diet."
c. "Stop taking your self-prescribed daily aspirin."
d. "Keep the temperature in your apartment cooler than usual."

49. The nurse is providing care needed to support the respiratory function of a client with thick secretions. Which
measure is most effective in helping a client with thick secretions mobilize and expectorate them?
a. Drinking salty fluids such as broth and bouillon.
b. Drinking 3 to 4 L of water per day.
c. Inhaling cool mist from a vaporizer daily.
d. Sitting in a tub of warm water three times a day.

50. The nurse is caring for a client newly diagnosed with chronic obstructive pulmonary disease (COPD). Which of the
following exercises is most appropriate for this client?
a. Intercostal muscle expansion exercises.
b. Isometric leg exercises.
c. Diaphragmatic and pursed-lip breathing exercises.
d. Lumbar sacral strengthening exercises.
51. The nurse is giving instructions to a parent of a 13-month-old who weighs 18 lbs. The child is being discharged from
the pediatric unit after hospitalization for gastroenteritis. When talking to the parent about car seat safety, the
nurse knows the parent understands the teaching when the mother states:
a. "My child can be in a front-facing car seat because he is 1 year old."
b. "My child can be in a front facing car seat as soon as he weighs 21 pounds."
c. "As long as I drive a sports utility vehicle, I can have my child rear or front facing."
d. "My child will need to be in a rear facing care seat until her is three years old."

52. A client is admitted to the Emergency Department after a three-car accident. He's exhibiting early signs of increased
intracranial pressure. Which of the following groups of symptoms is the nurse most likely to observe?
a. Decreasing pulse, increasing respiratory rate, and decreasing blood pressure.
b. Decreasing pulse, decreasing respiratory rate, and increasing systolic pressure.
c. Increasing pulse, decreasing respiratory rate, and increasing pulse pressure.
d. Decreasing pulse, increasing respiratory rate, and increasing pulse pressure.

53. The nurse is caring for a child who was in a house fire that killed 7 people, including his parents. He is the only
survivor. The local newspapers and television stations are at the hospital and are trying to receive information
regarding his condition. Which of the following is the correct action for the nurse?
a. The nurse does not give out any information regarding the child's condition.
b. The nurse does not give the name, only the condition of the patient.
c. The nurse gives a statement about how sad she is for the family and friends of the little boy.
d. The nurse contacts an attorney because of the legal issues regarding caring for the child.

54. The nurse is caring for a client diagnosed with a stroke. Because of the stroke, the client has dysphagia (difficulty
swallowing). Which intervention by the nurse is best for preventing aspiration?
a. Placing the client in high Fowler's position to eat.
b. Offering liquids and solids together.
c. Keeping liquids thinned.
d. Placing food on the affected side of the mouth.

55. The nurse is caring for a client who suddenly develops a tonic-clonic seizure. Which nursing action is most
appropriate during a seizure?
a. Forcing a padded tongue blade into the client's mouth.
b. Restraining the client's limbs.
c. Placing the client in a supine position.
d. Loosening constrictive clothing.

56. A client with AIDS complains of a weight loss of 20 pounds in the past month. Which diet is suggested for the client
with AIDS?
a. High calorie, high protein, high fat
b. High calorie, high carbohydrate, low protein
c. High calorie, low carbohydrate, high fat
d. High calorie, high protein, low fat

57. A client with diverticulitis is admitted with nausea, vomiting, and dehydration. Which finding suggests a complication
of diverticulitis?
a. Pain in the left lower quadrant
b. Boardlike abdomen
c. Low-grade fever
d. Abdominal distention

58. The physician has discussed the need for medication with the parents of an infant with congenital hypothyroidism.
The nurse can reinforce the physician's teaching by telling the parents that:
 a. The medication will be needed only during times of rapid growth.
b. The medication will be needed throughout the child's lifetime.
c. The medication schedule can be arranged to allow for drug holidays.
d. The medication is given one time daily every other day.

59. 132 The nurse has taken the blood pressure of a client hospitalized with methicillin-resistant staphylococcus aureus.
Which action by the nurse indicates an understanding regarding the care of clients with MRSA?
a. The nurse leaves the stethoscope in the client's room for future use.
b. The nurse cleans the stethoscope with alcohol and returns it to the exam room.
c. The nurse uses the stethoscope to assess the blood pressure of other assigned
clients.
d. The nurse cleans the stethoscope with water, dries it, and returns it to the nurse's
station.

60. A client with breast cancer is returned to the room following a right total mastectomy. The nurse should:
a. Elevate the client's right arm on pillows
b. Place the client's right arm in a dependent sling
c. Keep the client's right arm on the bed beside her
d. Place the client's right arm across her body

61. The nurse is caring for a client with an above-the-knee amputation (AKA). To prevent contractures, the nurse should:
a. Place the client in a prone position 15–30 minutes twice a day
b. Keep the foot of the bed elevated on shock blocks
c. Place trochanter rolls on either side of the affected leg
d. Keep the client's leg elevated on two pillows

62. Which statement describes the contagious stage of varicella?

a. The contagious stage is 1 day before the onset of the rash until the appearance of
vesicles.
b. The contagious stage lasts during the vesicular and crusting stages of the lesions.
c. The contagious stage is from the onset of the rash until the rash disappears.
d. The contagious stage is 1 day before the onset of the rash until all the lesions are
crusted.

63. A client with congestive heart failure has been receiving Digoxin (lanoxin). Which finding indicates that the
medication is having a desired effect?
a. Increased urinary output
b. Stabilized weight
c. Improved appetite
d. Increased pedal edema

64. Which of the following symptoms is associated with exacerbation of multiple sclerosis?
a. Anorexia
b. Seizures
c. Diplopia
d. Insomnia

65. A client with a bowel resection and anastamosis returns to his room with an NG tube attached to intermittent
suction. Which of the following observations indicates that the nasogastric suction is working properly?
a. The client's abdomen is soft.
b. The client is able to swallow.
c. The client has active bowel sounds
d. The client's abdominal dressing is dry and intact.
66. The nurse is reviewing with a client how to collect a urine specimen for culture and sensitivity. What is the
appropriate sequence to teach the client?
a. Clean the meatus, begin voiding, then catch urine stream
b. Void a little, clean the meatus, then collect specimen
c. Clean the meatus, then urinate into container
d. Void continuously and catch some of the urine

67. When caring for a client receiving warfarin sodium (Coumadin), which lab test would the nurse monitor to
determine therapeutic response to the drug?
a. Bleeding time
b. Coagulation time
c. INR
d. Partial thromboplastin time

68. A client had 20 mg of Lasix (furosemide) PO at 10 AM. Which would be essential for the nurse to include at the
change of shift report?
a. The client lost 2 pounds in 24 hours
b. The client’s potassium level is 4 mEq/liter.
c. The client’s urine output was 1500 cc in 5 hours
d. The client is to receive another dose of Lasix at 10 PM

69. The nurse has performed the initial assessments of 4 clients admitted with an acute episode of asthma. Which
assessment finding would cause the nurse to call the provider immediately?
a. prolonged inspiration with each breath
b. expiratory wheezes that are suddenly absent in 1 lobe
c. expectoration of large amounts of purulent mucous
d. appearance of the use of abdominal muscles for breathing

70. The nurse has performed the initial assessments of 4 clients admitted with an acute episode of asthma. Following a
bronchodilator treatment, which assessment finding is expected?
a. prolonged inspiration with each breath
b. expiratory wheezes disappear
c. expectoration of large amounts of purulent mucous
d. appearance of the use of abdominal muscles for breathing

71. During the initial home visit, a nurse is discussing the care of a client newly diagnosed with Alzheimer's disease with
family members. Which of these interventions would be most helpful at this time?
a. leave a book about relaxation techniques
b. write out a daily exercise routine for them to assist the client to do
c. list actions to improve the client's daily nutritional intake
d. suggest communication strategies

72. An 80 year-old client admitted with a diagnosis of possible cerebral vascular accident has had a blood pressure from
160/100 to 180/110 over the past 2 hours. The nurse has also noted increased lethargy. Which assessment finding
should the nurse report immediately to the provider?
a. Slurred speech
b. Incontinence
c. Muscle weakness
d. Rapid pulse
73. A client is admitted to the emergency room following an acute asthma attack. Which of the following assessments
would be expected by the nurse?
a. Diffuse expiratory wheezing
b. Loose, productive cough
c. No relief from inhalant
d. Fever and chills

74. A client has been admitted with a fractured femur and has been placed in skeletal traction. Which of the following
nursing interventions should receive priority?
a. Maintaining proper body alignment
b. Frequent neurovascular assessments of the affected leg
c. Inspection of pin sites for evidence of drainage or inflammation
d. Applying an over-bed trapeze to assist the client with movement in bed

75. The nurse is assigned to care for a client who had a myocardial infarction (MI) 2 days
ago. The client has many questions about this condition. What area is a priority for the nurse to discuss at this time?
a. Daily needs and concerns
b. The overview cardiac rehabilitation
c. Medication and diet guideline
d. Activity and rest guidelines

76. The nurse is assigned to care for a client who had a myocardial infarction (MI) 5 days ago and now for discharge to
home. The client has many questions about this condition. What area is a priority for the nurse to discuss at this
time?
a. Daily needs and concerns
b. The overview cardiac rehabilitation
c. Medication and diet guideline
d. Activity and rest guidelines

77. The nurse is developing a meal plan that would provide the maximum possible amount of iron for a child with
anemia. Which dinner menu would be best?
a. Fish sticks, french fries, banana, cookies, milk
b. Ground beef patty, lima beans, wheat roll, raisins, milk
c. Chicken nuggets, macaroni, peas, cantaloupe, milk
d. Peanut butter and jelly sandwich, apple slices, milk

78. The provider orders Lanoxin (digoxin) 0.125 mg PO and furosemide 40 mg every day. Which of these foods would
the nurse reinforce for the client to eat at least daily?
a. Spaghetti
b. Watermelon
c. Chicken
d. Tomatoes

79. The nurse is giving instructions to the parents of a child with cystic fibrosis. The nurse would emphasize that
pancreatic enzymes should be taken
a. once each day
b. 3 times daily after meals
c. with each meal or snack
d. each time carbohydrates are eaten

80. The nurse notes that a 2 year-old child recovering from a tonsillectomy has an temperature of 98.2 degrees
Fahrenheit at 8:00 AM. At 10:00 AM the child's parent reports that the child "feels very warm" to touch. The first
action by the nurse should be to
 a. reassure the parent that this is normal
b. offer the child cold oral fluids
c. reassess the child's temperature
d. administer the prescribed acetaminophen

81. The nurse is caring for a client who was successfully resuscitated from a pulseless dysrhythmia. Which of the
following assessments is critical for the nurse to include in the plan of care?
a. hourly urine output
b. white blood count
c. blood glucose every 4 hours
d. temperature every 2 hours

82. The nurse instructs the client taking dexamethasone (Decadron) to take it with food or milk. The physiological basis
for this instruction is that the medication
a. retards pepsin production
b. stimulates hydrochloric acid production
c. slows stomach emptying time
d. decreases production of hydrochloric acid

83. An old client on digitalis (Lanoxin) reports nausea, vomiting, abdominal cramps and halo vision. Which of the
following laboratory results should the nurse analyze first?
a. Potassium levels
b. Blood pH
c. Magnesium levels
d. Blood urea nitrogen

84. The nurse caring for a 9 year-old child with a fractured femur is told that a medication error occurred. The child
received twice the ordered dose of morphine an hour ago. Which nursing diagnosis is a priority at this time?
a. Risk for fluid volume deficit related to morphine overdose
b. Decreased gastrointestinal mobility related to mucosal irritation
c. Ineffective breathing patterns related to central nervous system depression
d. Altered nutrition related to inability to control nausea and vomiting

85. The nurse is teaching a class on HIV prevention. Which of the following should be emphasized as increasing risk?
a. Donating blood
b. Using public bathrooms
c. Unprotected sex
d. Touching a person with AIDS

86. Therapeutic nurse-client interaction occurs when the nurse

a. assists the client to clarify the meaning of what the client has said
b. interprets the client’s covert communication
c. praises the client for appropriate feelings and behavior
d. advises the client on ways to resolve problems

87. Mr. SD, 66 y/o has AIDS and is hospitalized with pneumonia. He has just arrived on the respiratory unit. Should Mr.
SD’s nurse take special precautionary measures?
a. No, standard (universal) precautions are sufficient.
b. Yes, gown, mask and gloves should be worn at all times.
c. Yes, it is important to wear a mask because of pneumonia.
d. No, since the risk and transmission of this disease is limited.
88. Doreen, 75 y/o lost sight in her L eye as a result of poorly controlled glaucoma. What must the PN include in
Doreen’s plan of
care?
a. Place the bedside table and personal effects close to Doreen
b. Approach Doreen from the R side as much as possible
c. Maintain subdued lighting on the R side of the room
d. Position Doreen on her L side

89. Ms. Branson, 65 years old, is post-operative client who suddenly develops hematemesis. She is pale, diaphoretic and
says she
feels faint. The PN asks the student nurse to take Ms. Branson vitals sign when she calls the physician. On
returning to the client rooms, the student nurse reports that the vital signs have not changed since earlier in the
shift. What should the PN do?
a. Places the client in trendelenburg position.
b. Instructs the student nurse to recheck the vital signs in 10 minutes.
c. Rechecks the vital signs.
d. Administers a bolus of 200 ml of normal saline.

90. You’ll be teaching a patient’s wife how to suction his tracheostomy. When developing the teaching plan, you must,
a. assess the wife’s knowledge and skills.
b. set up a schedule to demonstrate the technique.
c. provide the wife with written materials about the procedure.
d. establish goals and learning objectives.

91. Which of the following nursing assessments indicate that the health teaching on colostomy care was effective?
a. The patient states, ‘I was able to empty my colostomy bag once today.’
b. The patient states, ‘I will ask you to show me how I should put my colostomy bag.’
c. The patient states, ‘My mom can empty the colostomy bag for me.’
d. The patient states, ‘I am afraid that my boyfriend may leave me…’

92. A patient who sustained paraplegia stated, ‘I cannot feel when my bladder is full.’ The PN would anticipate that the
patient
will
a. be taught how to do self-catheterization.
b. have condom catheter.
c. be taught how to perform keagal exercise.
d. have his bladder massage.

93. Ms. Mills receives Demerol and Atropine Sulfate pre-operatively. Which of the following should the nurse recognize
as the
expected outcome of these medications?
a. The effectiveness of the anesthesia was increased.
b. There was no postoperative dehydration.
c. The tone of smooth muscle was improved, thus preventing hemorrhage.
d. The respiratory secretions were reduced during surgery.

94. A colleague’s license expired a week ago. She says she forgot to renew it. She is working with you on the evening
shift. What
are you required to do?
a. Notify the registration organization.
b. Notify the nursing supervisor.
c. Notify the doctor.
d. Remind the nurse that she must get it done.
95. A native Aboriginal teenager asked you where he could avail a place to stay after being devastated of knowing his
positive HIV
result. He further told you, “You don’t understand the situation I am in right now.” What would be your best nursing
response?
a. Make an arrangement to the nearest Friendship community center.
b. Refer him to a psychologist and a social worker.
c. Contact the community health center for an immediate follow up.
d. Inform the medical doctor for another consultation.

96. An elderly male individual with COPD is living with his wife and his younger son in an apartment. Everyone of them is
smoking. As a community health nurse, how will you plan your health teaching to this family in preventing
respiratory illnesses and infection?
a. Ask the family what they do in preventing infection.
b. Encourage and offer them an annual flu vaccination.
c. Encourage the family to take multivitamins daily and to increase their daily fluid intake.

97. What is your best health teaching to a group of IV drug users in fighting against AIDS?
a. Avoid exchanging and sharing needles.
b. Abstain from drugs.
c. Emphasize rehabilitation programs.
d. Provide reading materials on drug cessation.

98. A conscious male individual is found on the scene of a car accident with a large laceration on his leg. You are the first
person to
witness. What should you do?
a. call for help
b. open airway
c. immobilize leg
d. apply pressure

99. Provision of fluid hydration is one of your nursing goals for an Alzheimer’s patient in the nursing home. What is the
best nursing
action to implement to improve his fluid intake?
a. Encourage him to take1,500 mls. of fluid in 24 hours
b. Assist and encourage him to increase his fluid intake
c. Let him take a large amount of fluids during the early part of the day.
d. Start giving intravenous fluid.

100. A patient who has been on Elavil for 3 days complains of not feeling better. How should the PN respond?
a. Suggest to the patient to report it to the doctor.
b. Suggest to the patient to stop taking the medication.
c. Encourage the patient to continue taking the medication.
d. Record the patient’s response to the medication.

101. How will you promote sensory stimulation to an unconscious female child?
a. Give the child her favorite toy.
b. Ask her mother to help you with the care.
c. Give medications as ordered.
d. Talk to her while giving care.

102. A patient is complaining to the PN that he didn’t have enough sleep last night because his roommate was too
noisy. What
 would the best nursing action to this?
a. Draw the curtain that divides the two patients.
b. Transfer the patient to a quiet room once available.
c. Inform the doctor about the patient’s concerns.
d. Inform the doctor for some medication to help relieve the patient’s insomnia.

103. Roy tells his nurse that he has multiple sexual partners and usually does not use condom. He tells his PN that he will
die soon.
What is the PN’s best response?
a. “Would you like to talk to someone who works the same with your case?”
b. “Where there is a problem, there is a solution.”
c. “You have a long way to go, Roy.”
d. “Not everyone who has HIV-positive develops AIDS and die.”

104. Rogers who had a stroke is going to be discharged soon and is going to have some rehabilitation after discharge.
The wife of
the patient has been complaining that she couldn’t handle taking care of her husband anymore. Which among the
following
statements made by the wife signifies that Rogers is ready for rehabilitation?
a. “I have been working in a rehabilitation institution for 20 years now.”
b. “My son is a carpenter and he said he is going to help me with his father.”
c. “My sister will come every Thursday to help me out and I can go out to buy groceries.”

105. In conducting a seminar for a group of people with ages10-14, which of the following will you include in your
health teachings
about safety?
a. proper wearing of helmet when riding bicycles
b. proper wearing of seatbelt
c. Keeping all poisonous substance away from the house
d. proper wearing of hiking gears

106. While the other nurse is on her break, you were asked by one of her patients to change the IV bag as it was almost
finished.
What should you do?
a. Change the bag according to doctor’s orders.
b. Remind the patient to use a call bell next time.
c. Wait for the other nurse to come back from her break and then let the other nurse change the bag.

107. Mrs. Kent has recently finished her chemotherapy for breast cancer. She is anxious to return to work as an
accountant in the
bank. She expressed that she is depressed and that her therapist thinks it is premature for her to return to work.
Which of the
following is the most appropriate action for the PN to take?
a. Encourage Mrs. Kent to attend the upcoming support group.
b. Facilitate ways to get her involved in community activities.
c. Call the therapist to come and observe her perform some of her duties.
d. Ask Mrs. Kent to consult another therapist.

108. You are admitting a 58-year-old female client to your unit with a history of COPD. She was brought in by family
members. How
will you establish a therapeutic nurse-client relationship?
a. “Hi, my name is Carol, a registered nurse. I will be your nurse for the shift.”
b. “Hello, I am the registered nurse in the unit. Let me know if you have any problems.”
 c. “Hi, just ring the bell whenever you feel like to.”
d. “Hi, my name is Carol. I will be your nurse for the shift.”

109. Mrs. Brown is about to receive her Humulin NPH and Humulin R in the morning. What is your responsibility before
giving the
drug?
a. shake both vials
b. check last night’s glucometer result
c. check the expiration date on each vial
d. tell the patient about her glucometer result

110. A patient with AIDS is discharge on palliative care. However, he doesn’t have any family member to care for him at
home. What
is the most appropriate care setting for this patient?
a. respite care
b. rehabilitation center
c. hospice
d. nursing home

111. Debbie died of cancer of the sigmoid colon. When you entered the patient’s room you saw the husband lying
beside the patient
who died just 15 minutes ago. As a nurse, what is your best nursing action?
a. Leave them alone.
b. Tell the husband that he is not allowed to lie beside her.
c. Tell the husband to go out of the room.
d. Stay in the room and offer comfort to the husband.

112. The patient has been receiving 2500 ml of IV fluid and 300 to 400 ml of oral intake daily for 2 days.
The patient’s urine output has been decreasing and now has been less than 40 ml per hour for the past 3 hours. The
PN should immediately:
a. Catheterize the patient to empty the bladder.
b. Assess breath sounds and obtain the patient’s vital signs.
c. Check for dependent edema and continue to monitor I/O.
d. Decrease the IV flow rate and increase oral fluids to compensate.

113. Hyponatremia is defined as decreased sodium level. Which of the following reflects possible hyponatremia?
a. Vomiting
b. Hypertension
c. Sodium level of 146 mEq/L
d. Loss of weight

114. The nurse is caring for a client with uncontrolled hypertension. Which findings require immediate
nursing action?
a. lower extremity pitting edema
b. rales
c. jugular vein distension
d. weakness in left arm

115. An elderly lady has a maintenance of Inderal (beta blockers), the nurse must be aware that the medication has to
be given too
which of the following critical assessment?
a. Client has no headache.
b. No verbalization of dizziness.
 c. Client has a blurring vision.
d. BP 128/80.

116. A client undergoes procedure that requires the use of general anesthesia. During the postoperative period, the
client is most at
risk for:
a. Atelectasis
b. Anemia
c. Dehydration
d. Peripheral edema

117. While suctioning a client’s tracheostomy tube, the patient HR was noted to go down from 100 to 58. What should
the nurse do?
a. Continue suctioning to remove the mucus
b. Stop suctioning and provide oxygen
c. Turn the client to the left side
d. Administer a precordial thump

118. A pregnant mother, on her first trimester, develops urinary tract infection (UTI). What would be the appropriate
health teaching
to prevent UTI in the future?
a. Increase fluid intake
b. Drink cranberry juice
c. Limit fluid intake
d. Frequent perineal washing

119. Which of the following statement indicates that the patient requires further teaching?
a. “I will ask my friend to put sugar in my cheek when I get hypoglycemic”
b. “I will put peanut butter and sugar in my sandwich when I get hypoglycemic”
c. “I will drink a lot of orange juice when I started feeling dizzy”
d. “I will bring hard candies with me all the time”

120. A 5-year-old was admitted with asthma attack. Her grandmother is at the bedside. Oxygen 4 to 6 L/min was
ordered along with
nebulizers. Following treatments, the nurse noted that the wheezing sound has already disappeared and the child is
now fast asleep. What would you tell the grandmother who called your attention?
a. Tell the grandmother that the child is a lot better now
b. Tell the grandmother that you are anticipating transfer to ICU
c. Tell the grandmother that you will stop the oxygen therapy
d. Tell the grandmother that you need to re-assess and monitor the child more frequently

121. A 46-year old patient was diagnosed with multiple sclerosis 20 years ago. Which of the
following symptoms would you expect your patient to manifest:
a. Muscle weakness, numbness and tingling sensation
b. Stationary tremors, bradykinesia, and muscle weakness
c. Muscle weakness, rigidy, and difficulty in breathing
d. Dysphagia, diplopia, and tremors

122. Referring to question #121, which of the following are predisposing factors of Multiple
Sclerosis:
a. High fat and high purine diet
b. Young adults and lives away from the equator
c. African-American race
d. Stress and old age

123. Four call bells went off at the same time. Which of the following patients should you see first?
a. Patient with compartment syndrome
b. Patient complaining of pain
c. Patient complaining of chest pain
d. Patient with anaphylactic shock

124. The PN is about to give blood transfusion. However, the PN noticed that the IV fluid that is
currently being administered is D5LR. What would be the most appropriate nursing action of the PN?
a. Change the IV fluid to NS then administer the blood
b. Change the IV tubing and change the IV fluid to NS then administer the blood
c. Flush the IV tubing with NS through the Y-port of the tubing then administer the blood
d. Flush the IV with NS through the Y-port then piggyback the blood

125. The PN is giving IM injection to a 12-year old child. Which size of the needle should the PN
use?
a. ½ Inch
b. 1 Inch
c. 1 ½ Inch
d. 2 Inches

126. A patient was having seizure. The PN did the appropriate nursing interventions. Aside from the
duration and characteristics of a seizure, the PN should also document which of the following?
a. Aura of seizure
b. Hallucination
c. Confusion
d. Respiratory Rate

127. When performing abdominal assessment on a 12-year old child, which of the following sequence
is most appropriate?
a. Auscultation, percussion, inspection, palpation
b. Auscultation, inspection, palpation, percussion
c. Inspection, auscultation, palpation, percussion
d. Inspection, auscultation, percussion, palpation

128. The PN is teaching the patient how to use an incentive spirometer. The PN will instruct the
patient to:
a. Inhale when using the spirometer
b. Hold breath after puffing
c. Make sure there is a one-minute interval between puffs
d. Hold the canister upright
 129. A patient was diagnosed with ovarian cancer. The patient’s daughter often visits her in hospital.
During one of your shifts, the daughter asks you about her mother’s condition. What should the PN
consider when answering the daughter’s inquiry?
a. Confidentiality
b. Informed consent
c. Hospital policy
d. Nursing standard

130. The PN is doing a stoma dressing of a patient’s colostomy. The PN noticed that the stoma is
bluish and is swollen. What would be the PN’s appropriate action?
a. Request that the physician be notified
b. Continue the dressing
c. Check vital signs
d. Do pain assessment

Case Study 1 (Questions 11-16)

Mrs. Clarke, a 73 year old widow, is brought to hospital after a fall. She is slightly confused, complains of pain
in her right hip, and is unable to move her right leg. X-rays indicate that she has a fracture of her right femur.
131. An observation of Mrs. Clarke that would likely indicate a fracture of the right hip would be that
the right leg is:
a. rotated internally
b. held in a flexed position
c. moved away from the body midline
d. shorter than the leg on the unaffected side

132. Mrs. Clarke is slightly confused and anxious. The best nursing approach would to be to
a. explain to Mrs. Clarke what is going to happen to her
b. call Mrs. Clarke by her first name
c. visit Mrs. Clarke frequently
d. listen to what Mrs. Clarke has to say

133. During the night Mrs. Clarke wakes up and does not remember her daughter had visited her early
in the evening. She asks, “Why has my daughter not been to see me. Didn’t you call her?” The best
reply would be
a. “Are you afraid she won’t come to visit you?”
b. “I’m sure you will hear from her soon.”
c. “You’re confused, she was here earlier tonight.”
d. “Your daughter was here just after supper this evening.”

134. Mrs. Clarke has an open reduction of the hip and a pin is inserted. After surgery when
positioning Mrs. Clarke, the RPN should
a. elevate the affected limb on a pillow
b. log roll her when positioning her on her side
c. place pillows between her legs at all times
d. place sand bags along the entire lateral aspect of the limbs

135. On the second day post-op Mrs. Clarke is to get out of bed into a chair. The best way to
accomplish this is to have her
a. lifted from her bed to the chair
b. stand on her unaffected leg and pivot to the chair
 c. put weight equally on both legs and step to the chair
d. slide from the bed to the chair without weight-bearing

136. Which of the following would provide Mrs. Clarke with a balanced, nutritious lunch?
a. milk, cheese, omelets, whole wheat toast
b. tuna sandwich, milk, sliced tomato, banana
c. fried chicken, beef bouillon, peas, herbal tea
d. macaroni and cheese, tomato and lettuce salad, apple, coffee

Case Study 2 (Questions 17-26)

David Stewart is a 20 year old who has a compound fracture of the femur of the right leg and a simple fracture
of the right ulna as a result of a motorcycle accident.
137. At the accident site a splint is applied. It is important that the splint
a. be applied to the right leg in the position of good alignment
b. be applied to the right leg in the position in which it is found
c. extend from the fracture site downward
d. extend from the fracture site upward

138. When Mr. Stewart is being transported in the ambulance to the hospital, he should be positioned
with affected limbs
a. elevated
b. in a low flat position
c. lower than his heart
d. slightly abducted

Mr. Stewart is taken to the operating room. The wound caused by the fractured femur is cleansed and debrided.
The fracture is then reduced and a Steinmann pin for skeletal traction is inserted. A closed reduction of the ulna
is performed and a cast applied.
139. The most important nursing measure in the immediate postoperative period will be
a. encouragement of isometric exercises
b. cleansing of the area around the Steinmann pin
c. observation of vital signs
d. massage of pressure areas

140. After Mr. Stewart returns to his room, he complains of pain in his right arm. The initial action of
the RPN should be to
a. administer analgesics as ordered
b. check his fingers
c. notify the doctor immediately
d. pad the edges of the cast

141. In dealing with the weights that are applied to the traction, the RPN should
a. allow them to hang freely in place
b. hold them up if the client is shifting position in bed
c. remove them if the client is being moved up in bed
d. lighten them for short periods if the client complains of pain

142. Mr. Stewart has a Thomas splint in place. In addition to the usual nursing procedures for a client
in traction, it will be important that the RPN observe
a. the groin area for pressure
b. for constipation
c. his skin for signs of breakdown
d. for signs of hypostatic pneumonia

143. In caring for a wet cast, the RPN should

a. use a hair dryer to help dry the cast
b. cover the cast to prevent the client from feeling chilled
c. use a fan in the room to help dry the cast
d. move the cast using only the finger tips to lift it

144. If. Mr. Stewart should show a increase in blood pressure, signs of confusion, and increased
restlessness the RPN should suspect
a. a concussion
b. impending shock
c. fat emboli
d. anxiety

145. Because of the nature of Mr. Stewart’s wound and the insertion of a Steinmann pin, it is
especially important that the RPN observe for
a. a foul odor
b. foot drop
c. pulmonary congestion
d. fecal impaction

146. On discharge the patient was given three different types of eye drops, to be taken QID daily. The
patient asked the RPN, “In what order do I have to put the drops in.” The RPN should reply
a. it really does not matter, you can put the drops in at any time
b. the order you follow does not matter, but wait at least two minutes between drops
c. you can use your judgment, as long as you put them in one time
d. put the three drops in then close your eyes for two minutes

147. The doctor ordered Culture and Sensitivity Urine Test. How would the PN collect the specimen?
a. Obtain first stream of urine
b. Obtain midstream urine
c. Obtain any stream of urine
d. Obtain specimen by swabbing the urinary orifice

148. The patient with Type I Diabetes Mellitus was seen by the UCP unconscious. Which task should
the RPN delegate to the UCP?
a. Obtain a glass of Orange Juice
b. Obtain the glucometer
c. Check the vital signs
d. Stay with the patient while the RPN obtain the glucometer

149. On the 3rd day post hip replacement, your patient complained of swollen and painful legs. What
would be your first action?
a. Remove the abduction pillow
b. Notify RN
c. Put patient back to bed
d. Abduct the patient’s affected leg
150. Your patient has renal failure. The doctor ordered the administration of insulin. The patient’s
family asks, “Why is my father being given insulin?” What would be your most appropriate response?
a. Your father developed Diabetes Type I
b. Your father developed Diabetes Type II
c. Your father has increased ammonia level in the blood
d. Your father has increased potassium level in the blood

151. The PN observed the IV site and find signs of phlebitis. The patient complains of pain on the IV
site and that the pain is graded 4 out of 10 using the pain scale. After discontinuing the IV, what will the
PN do next?
a. Give PRN analgesics
b. Apply warm moist compress on the IV site
c. Apply cold compress on the IV site
d. Report to RN

152. The patient is on respiratory isolation because he developed cough and it has been going on for 3
days. The doctor ordered chest xray. What would be the most appropriate action of the PN before
wheeling the client to the xray room?
a. The client will wear mask
b. The PN will wear mask
c. Inform the xray staff that the patient is on his way
d. Inform nurse

153. The patient has oliguria secondary to acute renal failure. Which of the following signs and
symptoms would the PN expect to find?
a. Decrease K+ and decreased Na+
b. Generalized edema and chest pains
c. Edematous ankles and crackles
d. Wheezing and Pitting edema

154. The doctor ordered NPO for a female patient that is experiencing dysphagia. When the nurse
comes into the patient’s room for morning rounds, the PN notices that the patient’s husband is feeding
the patient with a homecooked meal. The PN informed the husband about the patient’s NPO status.
However, the husband conveyed to the patient, “How can my wife survive if she does not eat?” What
would be the PN’s most appropriate response?
a. Do you know what would be the complication if your wife does not follow proper doctor’s orders?
b. You sound very concerned of your wife not eating
c. Do not worry, your wife is getting nutrition from the IV.
d. Next time, do not feed anything to your wife unless you let me know first.

155. A patient with sundowning syndrome is assigned to the PN. The PN knows that the patient
would be at risk for injury during the night time. To ensure patient’s safety, which of the following
would be the most appropriate action of the PN?
a. Provide night light
b. Remove obstructions from the floor
c. Provide nonslip carpet
d. Put signs on each room

156. An 85-year old patient whose husband died three years ago woke up at 3 AM. When asked by
the PN to go back to bed, she told the PN that she needs to cook for her husband because her husband
would be going to work at 5 AM. What would be the most appropriate response by the PN?
a. Go back to bed, no cooking til morning.
b. Your husband died 3 years ago. It is sometimes easy to forget, isn’t it?
c. You really must have missed your husband so much.
d. If you sleep now, I’ll let you cook tomorrow.

157. How often should an IV tubing be changed?

a. Every 12 hours
b. Every 24 hours
c. Every 48 hours
d. Every 72 hours

158. What is the most accurate way of checking NGT placement?

a. Flushing tubing with NS
b. Instilling air through the tubing
c. Aspirating gastric contents through the tubing
d. Chest X-Ray

159. A patient on bed became agitated. The PN who assessed the patient diagnosed risk for injury.
How can the PN ensure safety?
a. Side rails up
b. Implement safety precautions
c. Lower the bed
d. Raise the bed

160. A patient was rushed to the Emergency Department due to a Vehicular Accident. The patient is
losing a lot of blood. The doctor ordered blood transfusion. However, the patient refused blood
transfusion as treatment due to religious belief. What would the PN do next?
a. Respect the patient’s decision and inform RN
b. Present an alternative solution to the doctor
c. Present an alternative solution to the patient
d. Explain the importance of blood transfusion to the patient

161. The patient’s IV site is red , swollen, and has purulent discharge. The PN used her initiative by
discontinuing the IV as the PN knows that these are signs and symptoms of infection. The patient is
complaining of pain on the IV site. What would be the best nursing action?
a. Give analgesics as ordered
b. Apply warm moist compress
c. Apply cold compress to numb the painful site
d. Report to RN

162. What is the fastest route of administration for Nitroglycerin?

a. Sublingual
b. IV
c. Spray
d. Patch

163. When a patient with history of angina is having an attack, which would be the best route of
administration?
a. Sublingual
b. IV
c. Spray
d. Patch

164. A PN knows that nitroglycerin in this type of form is useless to give to a patient that is having an
ongoing angina attack:
a. Sublingual
b. IV
c. Spray
d. Patch

165. A patient is receiving blood transfusion at 8:00 AM. The patient complained that the PN might
have transfused the one unit of blood too quickly as the blood product was done transfusing at 10:30
AM. As the nurse-in-charge, how would you respond?
a. I’m sorry that this happened, what the nurse did was inappropriate.
b. The nurse was concerned of bacterial growth in the blood that is why she regulated the blood to finish in
2 ½ hours.
c. What the nurse did was appropriate.
d. One unit of blood can also be given in a minimum of 2 hours as long as there are no complications.

166. You are about to get one unit of blood for your patient when another PN who is a colleague of
yours asked you to get one unit of blood for her patient as well. How should you proceed?
a. Get the blood product for your patient then return for the blood product of your colleague’s patient.
b. Inform your colleague that she has to get her own patient’s blood product herself.
c. Take both blood products as longs both are in separate containers and are properly identified and
marked.
d. Get the blood product of your patient only.

167. An outbreak of Norwalk virus is happening in the long-term facility that you are working in. The
PN knows that Norwalk virus is spread through:
a. Airborne
b. Contact
c. Food borne
d. Droplet

168. Because of the Norwalk virus outbreak, the longterm facility sent out a memo stating the
standard procedure to prevent more spread of the virus. The PN would expect the memo to state:
a. Proper handwashing
b. Respiratory isolation
c. Restricting visitors
d. Wearing of gloves, masks, and gowns

169. The PN is taking care of a patient with spica cast. Which of the following signs or symptoms
would opt the PN to notify the physician immediately?
a. Delayed capillary refill
b. Extremity is slightly cool to touch
c. Patient complains of pain
d. Affected extremity is painful upon movement

170. A community daycare center has an outbreak of Pertussis or “whooping cough’’ As a community
health nurse, what would be your most prompt response?
a. Report to the public health authorities
b. Provide test to all the children affected
c. Advise to close the operations of the day care center
d. Conduct screening tests for immunization

171. A female client is admitted to the emergency room for abdominal bleeding and anxiety. While
you were collecting information about the history, the client was quiet and silent. It was the husband
who was answering the questions in behalf of the client. What would be your nursing action to
determine if she was abused?
a. Ask the husband to leave during the reassessment interview
b. Use a tool or a set of guidelines in assessing abused clients
c. Inform the physician for the data collected
d. Ask assistance from your colleague to witness the interview.

172. A nurse has realized that she didn’t know how to initiate an IV line on a client whom she
performed CPR previously. What should she do in order to gain knowledge on this specific procedure?
a. Buy and read an IV therapy book
b. Ask the nursing supervisor if she could attend an IV therapy session offerd in the hospital
c. Seek the help to the most senior nurse in the unit
d. Call the IV team to teach her how to start and IV line

173. A media reporter came to your institution and asked you regarding an outbreak in the hospital of
a certain disease. How will you respond?
a. Tell the reporter that hospital problems are confidential to the institution
b. Redirect the reporter to the public relations officer of the hospital
c. Answer the reporter’s questions as appropriately as possible as you have a duty to share to the
community’s right to information
d. Tell the reporter that you are not on the authority to divulge the back ground of this problem and request
your supervisor to release the appropriate information instead.

174. A nurse received a call from a lady who is 75 years old and stated that her husband took a full
bottle of Tylenol tables which was brought by her few hours ago, and inquired if her husband is
admitted to the hospital. It sounds to the nurse that the lady herself is a drug overdosed. What action the
nurse is supposed to take?
a. Inform police
b. Inform nurse supervisor
 c. Prepare for admission, send a security person to ER to rind out whether her husband collapsed in ER
d. Call the family Doctor

175. Tim 32 years old fall from a motorcycle ride and was admitted to the hospital with a close
reduction on his left leg and was on skin traction. Nurse B was assigned to the client and nurse a saw
nurse B lifting the weight as she’s going to turn the patient. What will be the best nursing action
a. Tell a colleague about the incident
b. Inform the Doctor
c. I will inform the nurse supervisor
d. Order for an x-ray of left leg

176. A colleague’s license has expired a week ago She says she forgot to renew it. She is working
with you on the evening shift. What are your required to do?
a. Notify the registration organization
b. Notify the nursing supervisor
c. Notify the Doctor
d. Remind the nurse that she must get it done

177. A newly hired RN confronted two aids because they didn’t turn the patient every 2 hours- as they
were sleeping while on duty and even told the nurse, ‘’ Wow know what we are doing, just take care of
your own pills. ‘’ How would the nurse respond to this ?
a. Explain to them the possible consequences of their actions
b. Report the incident to the supervisor
c. Confront both nurses
d. Inform the administrator

178. You are giving a shift report to nurse Anita, the incoming nurse for the new shift. She told you in
the past that she has another job and has lots of problems at home. You notice her to be tired and feel
she can’t give a good and safe nursing care to the patients. What is your best nursing action?
a. Inform the manager
b. Encourage her to quit her other job
c. Offer to take care of her patient assignment
d. Encourage her to discuss these difficulties with the charge nurse and go home to rest.

179. A client is admitted with substance abuse, and frequently asking the nurse for narcotic pain
medication every 3-4 hours. You notice his nurse pocketed the medication. What should you do?
a. Make an incident report to the nurse in charge
b. Confront the nurse
c. Inform the client that medication was taken by his nurse
d. Report the nurse to CNO

180. When you were doing your rounds you overheard that, one nurse is saying we are very busy and
cannot finish our documentation. Another nurse has to be called for documentation. What should be the
right response?
a. It is in appropriate to proceed with this type of documentation
b. Report to the nurse manager about the accountability
c. Leave the documentation to the incoming shift
d. Documentation has to be written by the nurse who performed the procedure