LIBERIAN BOARD FOR NURSING AND MIDWIFERY

MINISTRY OF HEALTH AND SOCIAL WELFARE

REPUBLIC OF LIBERIA

REGISTERED MIDWIFE EXAMS

SUBJECT: MEDICAL-SURGICAL

TIME: 2 HOURS

DO NOT OPEN THIS BOOKLET UNTIL YOU ARE INSTRUCTED TO DO SO!

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Directions: Read each question carefully and consider all possible answers, then shade the
letter of your choice on the corresponding answer sheet. There is only one best answer for
each question (1 point each). Do not shade or write in this booklet!

1. The primary purpose of the midwife documenting all steps of the nursing process is:
a. To communicate the patient’s information with the doctor
b. For reimbursement of nursing services
c. To provide a record of nursing plan, implementation and client’s
response
d. To maintain quality of care to all populations
2. A nurse started a whole blood transfusion for Mr. X. What is the next responsibility of
the nurse to ensure the patient’s safety?
a. Regulate the transfusion and go for a 15 minutes break
b. Reassure Mr. Harris that there will be no problem
c. Stay with Mr. Harris for the first 15 minutes and monitor the transfusion
d. Stay with Mr. Harris for the first 10 minutes and monitor the transfusion
3. The doctor ordered one unit of whole blood, B+, to be transfused for a male client.
What is the responsibility of the nurse to prevent transfusion reaction or shock?
a. Transfuse the blood immediately from the blood bank
b. Assure the client that everything will be all right during transfusion
c. Make sure the blood is typed and cross matched
d. Ask the client to take small exercise before transfusion begins
4. A 72-year-old male client is in a state of confusion and has a temperature of 104°F
(40°C), B/P 70/40 Heart Rate 110b/min and Respiration of 42b/m. He’s a diabetic
with purulent discharge from his left leg. This client’s symptoms indicate that he is
suffering:
a. Anaphylactic shock
b. Cardiogenic shock
c. Hypovolemic shock
d. Septic shock
5. The most accurate assessment parameters used by the nurse to determine adequate
tissue perfusion in a shock patient include:
a. B/P, Pulse, Respiration
b. Level of consciousness, urine output, skin color
c. Pulse pressure, level of consciousness, papillary response
d. Breath sound, B/P, body temperature
6. The prolong use of which of the below listed drugs causes bone marrow suppression
leading to aplastic anemia?
a. Folic acid
b. Ampicillin

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 c. Chloramphenical
d. Chloroquine
7. The nurse on the Medical surgical unit just received report on her client care assessment.
Which client should she assess first:
a. The client with anorexia, weight loss, and night sweats
b. The client with crackles and fever who is complaining of pleuritic pain
c. The client who had difficulty sleeping, day time, fatigue, and morning headache
d. The client with petechiae over the chest who’s complaining of anxiety
8. A 45-year-old male is rushed to the hospital convulsing and sweating profusely.
Which of the following diagnostic tests should be immediately ordered?
a. Blood glucose
b. Hemoglobin
c. Hematocrit
d. Urinalysis
9. Hypoglycemia is defined as a blood glucose _______.
a. < 50 mg/dl
b. < 40 mg/dl
c. > 50 mg/dl
d. > 40 mg/dl
10. The maintenance fluid volume for an adult who weighs 80 Kg is:
a. 2500 mL/day
b. 3000 mL/day
c. 4000 mL/day
d. 4800 mL/day
11. Mary was brought in the emergency room with severe skin rash. What is the most
important assessment technique related to the skin that the nurse would do?
a. Inspection
b. Palpation
c. Percussion
d. Auscultation
12. Which of the following statements regarding opportunistic diseases in HIV is true?
a. Opportunistic diseases usually occur one at a time
b. Opportunist diseases are curable with appropriate drugs
c. Opportunistic diseases occur in the presence of immunosuppressant
d. Opportunistic diseases are generally slow to develop and progress
13. An elderly man was brought from ZOE Town village with partial thickness burn.
Which of the following characteristics is the nurse going to use to describe partial
thickness burn?
a. Red, shiny, wet appearance
b. Generalized erythema with no vesicle
c. Exposed fascia
d. Dry, waxy appearance

14. A patient was brought to the Outpatient Department for lymph node examination.
What is normal finding of lymph node examination?
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 a. Superficial Nodes of 1cm
b. Firm, tender nodes
c. Hard, fixed nodes
d. Mobile, hard nodes
15. Mr. Rod was admitted with anemia of chronic disease. The nursing intervention of the
patient with chronic disease includes:
a. Teach self-injection of erythropoietin
b. Monitoring RBC size
c. Dietary teaching
d. Monitoring urine output
16. The nurse was asked to give emotional support to a patient with STD. Which of these
is the best way through which the emotional support can be given?
a. Offering of many alternatives
b. Concerned listening
c. Isolation from others
d. Emphasis on duration of disease
17. Mr. Paye Gono was rushed to the ER this afternoon vomiting and in painful distress.
On physical examination, he was diagnosed of bilateral incarcerated hernia. Dr.
Gbayeah ordered atropine pre-operatively. What is the rational?
a. To reduce sedation
b. To reduce anxiety
c. To reduce respiratory secretions
d. To reduce discomfort

Case study

Ms. M, age 24, is admitted to the hospital in a sickle cell crisis. She has had the disease since
age 2. Her complaints are severe pain in the knees and abdomen. Questions 18-21 relate to
this case.

18. Which of the following statements best explains the etiology of sickle cell anemia?
a. Fatal disease occurring after blood transfusion
b. A disease characterized by acute bleeding episodes
c. A chronic hereditary disorder characterized by an abnormal hemoglobin
d. An acute hereditary disease that is treatable

19. The nurse conducts her assessment, which of the following findings is a characteristic
of the disease?
a. Confusion
b. Anaphylaxis
c. Irritability
d. Leg ulcer
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20. Which of the following events in Ms. M’s history may have precipitated the current
crisis?
a. Recent divorce
b. Recent intestinal virus
c. Promotion at work
d. Change in medication
21. The reason for the pain in Ms. M’s knees is:
a. Occlusion of the circulatory system
b. Bleeding into the joints
c. Traumatic fall
d. Lack of intrinsic factors
22. In the immediate post-operative period, the nurse would promptly report a rapid,
thready pulse and drop in blood pressure, since the changes may indicate;
a. Hypertensive crisis
b. Cardiogenic shock
c. Hypovolemic shock
d. Respiratory distress
23. If during the post-operative period a patient shows signs of fever, tachypnea,
tachycardia, decreased breath sounds, and crackles, the nurse would suspect:
a. Atelectasis
b. Aspiration
c. Shock
d. Pulmonary embolism
24. Following a surgery, the nurse would monitor for signs of wound infection which
include:
a. Edema and serosaquineous drainage
b. Redness and edema
c. Partial separation of the wound edges
d. Persistent pain, purulent discharge, delayed healing

25. Ms. P. had an ambulatory surgery in which a benign breast lesion was removed. It
was done under local anesthesia and she returned to the recovery room alert and pain
free. Which of the following measures would the nurse implement?
a. Monitor vital signs every 30 minutes
b. Monitor vital signs every 2 hours
c. Keep Ms. P. Flat in bed for 8 hours
d. Order regular diet
26. After appendectomy, the patient is placed in Semi-Fowler’s position for the following
major reasons EXCEPT:
a. To reduce tension on the incision and abdominal organs

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 b. To facilitate oral fluid administration
c. To help reduce pain
d. To promote comfort
27. Nursing intervention to reduce anxiety in preoperative patient includes all EXCEPT:
a. Providing time for patient to ask questions and express feelings
b. Careful listening and sensitivity to nonverbal indicators of anxiety
c. Administration of sedative to induce sleep
d. If available provide pictures and illustrations to help explain the surgical
procedure
28. A nurse is instructing a client to perform a testicular self-examination (TSE). Which
instruction would the nurse provide to the client?
a. The best time for the examination is after a shower
b. Examine the testicles while lying down
c. Testicular examinations should be done at least every 6 months
d. Gently feel the testicle with one finger to feel for a growth
29. A mother complained that her child sustained the presenting chemical eye injury
when battery acid splashed in his face. The nurse would immediately intervene by:
a. Asking, “What was the location of the child”?
b. Irrigating the eye with sterile saline solution
c. Referring the child to the physician on call
d. Apply neomycin eye ointment
30. When administering ear drop to an adult, the nurse would:
a. Pull the pinna up and then back
b. Pull the pinna back and then up
c. Pull the cochlea up and then back
d. Pull the cochlea back and then up

31. The client asks the nurse, “Why was the Weber tuning folk test performed on my
father”? The best response would be:
a. Because we were assessing him for hearing loss
b. Because we were assessing him for motor reflexes
c. Because we were assessing him for level of consciousness
d. Because we were assessing him for renal function
32. Albertline, a 74 year old retired secretary, is admitted to the medical-surgical area for
management of chest pain caused by angina pectoris. The nurse knows that the basic
cause of angina pectoris is believed to be:
a. Dysrhythmias triggered by stress
b. Insufficient coronary blood flow
c. Minute emboli discharged through the narrow lumen of the coronary vessels

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 d. Spasms of the vessels walls owing to excessive secretion of epinephrine
(Adrenaline)
33. The most sensitive test for diabetes mellitus is:
a. Fasting plasma glucose test
b. Oral glucose tolerance test
c. Intravenous glucose test
d. Urine glucose test
34. The method of oxygen administration primarily used for patients with chronic
obstructive pulmonary disease is:
a. Nasal cannula
b. Oropharyngeal catheter
c. Non-rebreathing mask
d. Venture mask
35. Nora, a 17-year old student, was sexually assaulted on October 9, 2007 at Redlight,
Monrovia. When assisting with physical examination, the nurse should do all of the
following EXCEPT:
a. Have the patient shower or wash the perineal area before the examination
b. Assess and document any bruises and lacerations
c. Record a history of the event, using the patient’s own words
d. Label all torn or bloody clothes and place each item in a separate brown bag
so that any evidence can be given to the police
36. Open-ended questions permit persons to express themselves. Choose the sentence that
is NOT an open-ended question.
a. “Describe the pain
b. “Tell me more about your feeling”
c. “How did the accident happen”
d. “Is the pain sharp and piercing?”
37. The nurse inspects the thorax of a client with advanced emphysema. The nurse
expects chest configuration change consistent with a deformity known as:
a. Barrel chest
b. Funnel chest
c. Kyphoscoliosis
d. Pigeon chest
38. Flomo Kollie, a 40 year-old father of three, has just returned to the medical-surgical
ward from the recovery room. Flomo Kollie has had a subtotal thyroidectormy. Post
operatively to the bed, the most comfortable position for him to assume would be:
a. High fowler’s position with his neck supported by soft collars
b. Recumbent with his neck hyperextended and supported by a neck pillow
c. Recumbent with sandbags preventing his neck from rotating
d. Semi-fowler’s with his head supported by pillows
39. David Sendolo, a 27 year-old Type 1 diabetic, is unconscious when admitted to the
hospital. His daily dose of insulin has been 32 units of NPH each morning. Based on

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 knowledge of hypoglycemia, the nurse would expect that David’s serum glucose level
on admission is approximately:
a. 50mg/dl
b. 70mg/dl
c. 90mg/dl
d. 110mg/dl
40. The hip and shoulder are examples of particular joints that are classified as:
a. Ball and socket types
b. Hinge joints
c. Pivot joints
d. Saddle joints
41. The physician has ordered a cleansing enema for 7-year-old Michael. The nurse
realizes the maximum volume to be given would be:
a. 100 to 150 ml
b. 150 to 250 ml
c. 300 to 500 ml
d. 600 to 700 ml
42. Mrs. Young, a 45-year-old diabetic client, is having a hysterectomy in the morning.
Because of her history, the nurse would expect:
a. An increased risk of hemorrhaging
b. Fluid and electrolyte imbalances
c. Altered elimination of anesthetic agents
d. Impaired wound healing

43. A patient is brought into the emergency room in an acute respiratory distress. When
managing this patient, the first thing the nurse does is:
a. Start oxygen therapy
b. Start giving sodium bicarbonate intravenously
c. Provide an open airway
d. Give mouth-to-mouth resuscitation
44. The nurse uses 30 ml of solution to irrigate a patient’s gastric tube and notes that 20
ml returns promptly into the drainage container. When the nurse records the results of
the irrigation, how much solution should be recorded as intake?
a. 10 ml
b. 20 ml
c. 30 ml
d. 40 ml
45. If the physician orders a tubeless gastric analysis for patient Bendu, she would have
ingested a dye after which the nurse should expect to collect a specimen of:
a. Stool
b. Urine
c. Blood
d. Gastric content

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46. The nurse is caring for a patient whose chest tube accidently slips out while he was
turning onto his side. The action the nurse should take will be:
a. Disconnect the suction machine
b. Apply a sterile gauze dressing to the chest wall
c. Place the heel of her/his hand over the chest opening
d. Clamp the chest tube at its connection to the suction machine
47. In contrast to younger patients, elderly patients have higher incidence of postoperative
infections primarily because older persons:
a. Have atrophy of lymph node
b. Tend to react unfavorably to stress
c. Have reduce cardiovascular circulation
d. Tend to observe careless habits of health
48. During a neurologic check, you observe your neurological patient’s arm, wrist and
fingers to be flexed and arm adducted. The legs are fully extended and internally
rotated with plantar flexion of the feet. You note this in your nurse’s note as:
a. Decorticate posturing
b. Decelerate posturing
c. Abnormal extension
d. Normal flexion

49. After a hemorrhoidectomy, a patient may need a Seitz’s bath. Which of the following
IS NOT a rationale for the nurse giving the patient such bath?
a. To relieve discomfort
b. To relieve spasm
c. To promote healing
d. To promote bowel movement
50. The first thing to note when the patient comes from post-anesthesia care unit (PACU)
is the:
a. General discomfort
b. Cardiovascular status
c. Respiratory status
d. Wound drainage
1. An example of an independent nursing intervention is:
a. Administering medication per doctor’s order
b. Administering blood transfusion
c. Applying lotion to dry skin
d. Starting an IV fluid
2. The nurse is interviewing a newly admitted client. The client’s medical history and
nursing assessments form the foundation for the client’s:
a. Health history
b. Kardex
c. Medical diagnosis
d. Teaching plans
3. The primary purpose of the nurse documenting all steps of the nursing process is:
a. For communication with the doctor
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 b. For re-imbursement of nursing services
c. To maintain quality care
d. To provide record for nursing plan, and implementation
4. The nurse consciously influences a client to better understand care provided by
use of :
a. Client observation techniques
b. Demonstration techniques
c. Role play techniques
d. Therapeutic communication techniques
5. All of the following are nonverbal communication skills EXCEPT:
a. Confrontation
b. Facial Expression
c. Gestures
d. Physical appearance
6. Which of the following communication styles requires self-awareness?
a. Bilateral communication style
b. Intrapersonal communication style
c. Interpersonal communication style
d. Personal communication style
7. Communication techniques include all of the following EXCEPT:
a. Interruption
b. Listening
c. Restating
d. Silence

8. A large, thick-walled vessel that carries blood away from the heart is:
a. Artery
b. Capillary
c. Vein
d. Venule
9. The most common reason people seek healthcare is:
a. Belief
b. Cure
c. Pain
d. Prevention
10. A nurse is working in the emergency room following a tornado disaster that caused a
tremendous amount of damage and injury to the population. Using the utilitarian
ethical theory, the nurse should attempt to:
a. care for only the clients that are likely to need surgery
b. perform nursing procedures that are morally neutral
c. provide the greatest good for the greatest number of individuals
d. use higher-level moral principles if there is a conflict
11. The first thing that a nurse should do in preparing for physical examination is:
a. Don gloves and mask
b. Position the client
c. Set up equipment
d. Wash his/her hands
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12. A heart murmur was detected during a physical examination; the technique used to
obtain this information was:
a. Auscultation
b. Inspection
c. Palpation
d. Percussion
13. A basic method of physical examination that uses the hands to touch and feel is
called:
a. Auscultation
b. Inspection
c. Palpation
d. Percussion
14. The sequence of abdominal examination is:
a. Inspection, auscultation, percussion, palpation
b. Inspection, palpation, percussion, auscultation
c. Inspection, percussion, palpation, auscultation
d. Inspection, percussion, auscultation, palpation
15. When a nurse collects a urine specimen and notes the color of the urine, this
assessment data is referred to as:
a. Comprehensive
b. Objective
c. Secondary
d. Subjective

16. A focused assessment of a client complaining of abdominal pain would include

assessing the client’s:
a. Blood pressure
b. Bowel movement
c. Legs and hands
d. Vision and hearing
17. A client has a history of alcohol abuse and has developed cirrhosis of the liver. His
conjunctivae are yellow and he is complaining of abdominal tenderness in the upper
right quadrant. The nurse might expect to observe what change in his skin color?
a. Cyanosis
b. Erythema
c. Jaundice
d. Mottling
18. A client developed a bowel obstruction after abdominal surgery 3 days ago. To
monitor peristalsis, the nurse would:
a. Auscultate the abdomen
b. Inspect the abdomen
c. Palpate the abdomen
d. Percuss the abdomen
19. A nurse assesses a client who has isotonic IV solution in progress. The nurse is aware
that this solution has an equal osmotic pressure inside and outside of the cells. The
equilibrium in the osmotic pressure is of human benefit because:
a. Isotonic are categorized by their tonicity and osmolality
b. It prevents any fluid shifting in and out of the cells
c. The isotonic contains potassium
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 d. They are used for fluid replacement in diabetic ketoacidosis
20. It is preferable to collect assessment data from secondary sources instead of directly
from the client when:
a. The client is an infant, or is unconscious or confused
b. The client is irritable or agitated
c. The client’s family prefers to speak for him or her
d. The medical records are unavailable
21. The MOST IMPORTANT member of the rehabilitation team is the:
a. Medical doctor
b. Nurse educator
c. Patient’s family
d. Physical therapist
22. The first normal emotional reaction to disability:
a. Anger and hostility
b. Confusion and denial
c. Depression and regress
d. Withdrawal and crying

23. The study of old age is:

a. Ageism
b. Geriatrics
c. Gerontonics
d. Pediatrics
24. Extra cellular fluid has high concentration of:
a. Calcium
b. Magnesium
c. Potassium
d. Sodium
25. The average daily urine output in adults is:
a. O.5 liters
b. 1.5 liters
c. 2.5 liters
d. 3.0 liters
26. An isotonic solution that contains electrolytes similar to the concentration of
electrolytes found in plasma is:
a. 0.45% NaCl
b. 5% dextrose
c. 50% dextrose
d. Ranger lactate
27. If a nurse was asked to administer a hypotonic intravenous solution, which of the
following is to be administered?
a. 5% Dextrose in water
b. 0.90 sodium chloride
c. 50% dextrose
d. 0.45 sodium chloride
28. A nurse on the medical surgical ward observed a client and discovered that the client
showed signs of stage one (compensatory stage) shock. What will be the first action
of the nurse?
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 a. The nurse will call for the doctor
b. The nurse will ensure that the client’s environment is safe
c. The nurse will observe for changes in consciousness
d. The nurse will teach the client about shock
29. A common kind of cancer in women of all ages is:
a. Breast cancer
b. Cervical cancer
c. Ovarian cancer
d. Uterine cancer
30. Surgery done to remove lesions that are likely to develop into cancer is known as:
a. Diagnostic surgery
b. Palliative surgery
c. Prophylactic surgery
d. Reconstructive surgery

31. A client has developed contracture of the right hand, due to third degree burn. Which
of the following Surgical Interventions would be the best?
a. Constructive
b. Emergent
c. Palliative
d. Prophylactic
32. The nurse providing pre-operative education to a patient would teach all of the
following EXCEPT:
a. Deep breathing
b. Mobility
c. Pain management
d. Nasal gastric suction
33. One of the most common complications of surgery is:
a. Hypertension
b. Hypervolemia
c. Hypotension
d. Hyperthermia
34. The primary goal for withholding food and water before a surgical procedure is to
prevent:
a. Aspiration
b. Distention
c. Infection
d. Obstruction
35. One of the best nursing measures to prevent postoperative embolism is for the nurse
to:
a. Administer IV antibiotics
b. Elevate the patient’s legs
c. Encourage early ambulation
d. Place client in Trendelenburg’s position
36. Guidelines for immediate postoperative care include all of the following EXCEPT:
a. Assess breathing
b. Assess surgical site
c. Monitor vital signs
d. Start intravenous fluid
37. The lungs are enclosed in a serous membrane called:
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 a. Diaphragm
b. Mediasternum
c. Pleura
d. Xiphoid process
38. Inflammation of the lung is considered as:
a. Asthma
b. Pneumonia
c. Tuberculosis
d. Bronchitis

39. A client noticed three months ago that she has started coughing, sweating a lot at
night and has lost much weight. It is most likely that she has developed which of
these conductions?
a. Asthma
b. Brachialis
c. Bronchitis
d. Tuberculosis
40. The client made the following statements to the nurse, “My doctor just told me that he
cannot save my leg and that I need to have an above-the-knee amputation.” Which of
the following responses by the nurse is most appropriate for her client?
a. “Are you in pain?”
b. “Dr. Brown is an excellent Surgeon.”
c. “If I were you, I’d get a second opinion.”
d. “Tell me more...”
41. The nurse is communicating with a doctor about medical interventions prescribed for
a client. Which of the following statements is most representative of a collaborative
nurse-doctor relationship?
a. “Can we talk about Mrs. Dolo?”
b. “Excuse me doctor. I think we need to talk about Mrs. Dolo’s blood pressure.”
c. “I am worried about Mrs. Dolo’s blood pressure. It is not decreasing even
with the new antihypertensive drug.”
d. “That new medication you prescribed for Mrs. Dolo is ineffective.”

42. A client is admitted to the surgical unit at 6.00 am after a tragic road traffic accident.
One of the nursing diagnoses is hypovolemic shock related to blood loss. At 10.00
am, the nurse finds that the client’s Foley catheter has about 50 mL of dark, tea-
colored urine. Which of the following nursing actions would be most appropriate at
this time?
a. Ask if the client feel light-headed
b. Assess the client’s pain level
c. Check the client’s Complete Blood Count results
d. Check the client’s Foley catheter tubing for kinks or knots
43. A nurse is caring for a client with septic shock who is receiving intravenous fluids and
antibiotic regimen. Which of the following findings indicate that the intravenous
fluids are having therapeutic effects for the client?
a. Blood pressure is increased
b. Dry and warm skin
c. Irregular heart beat
d. Respirations are rapid and shallow

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44. A client with diabetes mellitus experiences hypoglycemia at night followed by
episodes of hyperglycemia when the blood glucose is assessed in the morning. The
nurse recognizes these symptoms as:
a. Dawn phenomenon
b. Diabetic ketoacidosis
c. Hyperglycemic state
d. Somogyi effect

45. A client is admitted to the medical surgical unit with a diagnosis of diabetic
ketoacidosis. Which of the following clinical manifestations should the nurse expect
to find?
a. Acetone breath odor
b. Cold, clammy skin
c. Radial pulse 70 bounding
d. Slurred speech
46. A client sustains burn to the anterior and posterior trunks of his body and right arm
anterior and posterior. Using the “rule of nines”, the nurse would determine total body
surface area (TBSA) burned as:
a. 27%
b. 30%
c. 42%
d. 45%
47. A client is admitted to the intensive care unit with severe burns to the back and lower
legs. The injured skin is dry and lethargy, without pain sensations present. The nurse
best classifies this burn as:
a. A deep partial thickness burn
b. A full thickness burn
c. A superficial partial thickness burn
d. A superficial burn
48. An activity that is contraindicated for maintaining the line of pull when caring for a
patient in traction is:
a. Applying pain relieving measures as ordered
b. Informing the orthopedic surgeon about any sign of complication
c. Monitoring neurovascular status of affected limb
d. Range of motion exercise of the affected limb
49. A patient with hepatitis A virus is advised to avoid alcohol drinking because alcohol:
a. Causes blood loss
b. Causes weight loss
c. Decreases appetite
d. Worsens the disease
50. Rectal bleeding is the most significant sign of:
a. Colorectal cancer
b. Diverticulitis
c. Regional enteritis
d. Ulcerative colitis

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51. When a client’s condition is diagnosed as appendicitis, appendectomy is quickly done
in order to:
a. Avoid the risk of perforation
b. Eliminate infection
c. Prevent fluid volume deficit
d. Prevent postoperative hemorrhage
52. Setting up sterile tables, preparing sutures, ligatures and special equipment are
responsibilities of the:
a. Circulating nurse
b. Nurse anesthetist
c. PACU nurse
d. Scrub nurse
53. Checking a client’s feet for heat and color of skin is meant to:
a. Alleviate fear and anxiety
b. Determine circulatory impairment
c. Promote wound healing
d. Provide comfort
54. A combination of factors responsible for the occurrence of hernia is:
a. Increased abdominal pressure and immobility
b. Increased abdominal pressure and muscle weakness
c. Lack of exercise and obesity
d. Obesity and increased abdominal pressure
55. The most common sign of internal hemorrhoid is:
a. Anal itch
b. Bright red blood on stool
c. Mucous discharge
d. Rectal pain
56. The physician requests that you position a client for prostate examination. Your
position of choice will be:
a. Lateral position
b. Lithotomy position
c. Sim’s position
d. Supine position
57. Kollie, a 40 year old, has just returned to the medical-surgical ward from the recovery
room. He has had a subtotal thyroidectomy. The most comfortable postoperative
position for him in bed would be:
a. High fowler’s position with his neck supported by soft collars
b. Recumbent with his neck hyperextended and supported by a neck pillow
c. Recumbent with sandbag preventing his neck from rotating
d. Semi-fowler’s position with his head supported by pillows
58. A nurse is caring for a client who has peptic ulcer disease. Which of the following
clinical manifestations will indicate major complication?
a. Gastric bleeding
b. Heartburn
c. Pain
d. Vomiting
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59. A nurse assesses a client who has appendicitis. The nurse realizes that the physician’s
note after surgery revealed areas of tissue necrosis and microscopic perforations are
present in the appendix. This type of disorder is called:
a. Gangrenous appendicitis
b. Peritonitis
c. Simple appendicitis
d. Zollinger’s Ellison Syndrome
60. A nurse assesses a client who has appendicitis. The nurse noticed that the client has
developed perforation. The nurse anticipates that appendiceal perforation leads to:
a. Gastritis
b. Peptic ulcer
c. Peritonitis
d. Hemorrhoids
61. A nurse is caring for a client who has peptic ulcer disease (PUD) notes client
expressing lack of information about prevention and management of the condition.
Which of the below will be an expected outcome after client education?
a. Chooses relaxed atmosphere for meal
b. Experiences less pain
c. Expresses interest in learning how to manage the disease
d. Needs to drink eight to nine glasses of water
62. The nurse assesses a 21 year old patient and noticed a potential risk of impaired skin
integrity. Which of the below interventions should be provided to prevent this risk?
a. Administering narcotics
b. Arranging for physical and occupational therapists
c. Loosing circumferential
d. Massaging bony prominences to increase circulation
63. A patient comes to the emergency department with history of fall this morning. The
patient has short and swollen left leg oozing blood and protruding bone fragments.
The type of fracture the nurse suspects is:
a. Comminuted fracture
b. Greenstick facture
c. Oblique fracture
d. Simple fracture
64. Mary experienced delayed surgical wound healing as a result of decreased amino acid
supply for tissue repair. Which of the following nutrient deficit could be associated:
a. Carbohydrates
b. Protein
c. Vitamin C
d. Zinc
65. What nursing intervention would be appropriate to reduce pain, swelling and stop
bleeding observed at a patients’ wound site after a traumatic injury?
a. Cold application
b. Elevation

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 c. Oxygenation
d. Warm application
66. Mrs. Kay was rushed in the Emergency Room with contaminated wound where a
considerable amount of nonviable tissues are present. The nurse anticipates this
procedure:
a. Application of antimicrobial agent
b. Mechanical debridement
c. Surgical debridement
d. Wet-to-dry dressing
67. Secondary hypertension is differentiated from primary hypertension in that secondary
hypertension:
a. Does not cause the target organ damage that occur with the primary
hypertension
b. Has a specific cause that often can be corrected by medicine or surgery
c. Is caused by aged-related changes in blood pressure regulatory mechanism in
those individual over 68 years of age
d. Is characterized by sustained elevation of systolic blood pressure over 160
with diastolic pressure less than 90mmhg
68. As part of the nursing management for the patient with heart failure, the nurse intends
to weigh the patient daily. The nurse judges correctly that such patient should usually
be weighed:
a. In the morning
b. In the morning after urination
c. Morning and evening after meal
d. Morning and evening after urination
69. The nurse’s greatest concern during ileostomy care is to:
a. Ensure that the patient passes flatus
b. Give skin and stoma care
c. Give supplemental vitamins
d. Measure input and output
70. A patient is brought into the emergency room in acute respiratory distress. When
managing this patient, the first thing the nurse does is:
a. Give mouth-to- mouth resuscitation
b. Provide an open airway
c. Start IV sodium bicarbonate
d. Start oxygen therapy
71. A post-operative client who has had cataract extraction complains of nausea and
severe pain over the surgical site. The initial nursing action would be?
a. Assure the client that the pain will subside
b. Keep the client on NPO
c. Reduce the layers of the gauze dressing
d. Report the client’s complaints
72. A mother complains that her child sustained eye injury when battery acid splashed in
his face. The nurse would immediately intervene by:
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 a. Apply neomycin eye ointment
b. Asking, “What was the location of the child”?
c. Irrigating the eye with sterile saline solution
d. Referring the child to the physician on call
73. When administering ear drop to an adult client, the nurse would:
a. Pull the cochlea back and then up
b. Pull the cochlea up and then back
c. Pull the pinna back and then up
d. Pull the pinna up and then back
74. The client asks the nurse, “Why was the Weber turning folk test performed on my
father?” Her best response would be:
a. Because we were assessing him for hearing loss
b. Because we were assessing him for level of consciousness
c. Because we were assessing him for motor reflexes
d. Because we were assessing him for renal function
75. A nurse can expect that acute pain may have which of the following effects on the
client’s vital signs?
a. The temperature may be elevated
b. The pulse rate may be rapid
c. the respiratory rate may be slow
d. the blood pressure may be slow
76. The doctor order 100ml D5W every 6hr for 24hrs. What are the basic materials
needed for measuring input and output?
a. Foley catheter and IV tubing
b. IV fluid, urine bag, foley catheter and IV tubing
c. IV tubing, urine bag and suction machine
d. Suction machine and fluid
77. A 74 year old patient on admission is confused and has temperature reading of 40oC,
B/P 70/40, pulse110b/min and respiration is 42b/m. He’s a diabetic with purulent
discharge from his left leg. This client’s symptoms are most likely indicative of
which type of shock?
a. Analphylactic
b. Hypovolemic
c. Cardiogenic
d. Septic

78. The most accurate assessment parameters used by a nurse to determine adequate
tissue perfusion in a client suffering shock are:
a. B/P, pulse, respiration
b. Breath sound, BP and papillary response
c. Level of consciousness, urine output and skin color
d. Pulse pressure, level of consciousness
79. A client has been admitted to the med-surg unit this afternoon for treatment of
dehydration. The discharge planning for this client should begin:
a. After the physician writes discharge order
b. During the initial contact between the client and nurse
c. The morning prior to discharge
d. When the client is ready to discuss discharge

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80. The evaluation process of your nursing plan of care would include which of the
following?
a. Ambulating your client 20 feet down the hallway
b. Assessing your client’s progress toward the desired outcome
c. Assigning a nursing diagnosis to an identified need
d. Questioning your client about his family medical history
81. A nurse is planning a home visit to a postoperative client who needs a dressing
change and wound assessment. When the nurse provides care in the home:
a. Cleanliness standards similar to the hospital must be maintained
b. Supplies are similar to what is used in the hospital
c. The client maintains control or his or her care
d. The nurse retains full decision-making authority
82. A nurse is preparing to teach a client how to ambulate using crutches. The nurse is
aware that one of the major variables that influences a client’s readiness to learn is:
a. Age
b. Culture
c. Gender
d. Medications
83. A nurse started a whole blood transfusion for Mr. John Harris. What is the next
responsibility of the nurse to ensure Mr. Harris safety:
a. Reassure Mr. Harris that there will be no problem
b. Regulate the transfusion and go for 15 minutes break
c. Stay with Mr. Harris for the first 10 minutes and continue monitoring the
transfusion
d. Stay with Mr. Harris for the first 15 minutes and continue monitoring the
transfusion
84. The midwife knows that blood cells can deteriorate after a certain period of time.
Which one of the information is important for the nurse to check on regarding the age
of blood before transfusion begins?
a. Blood group and type
b. Blood identification number
c. Expiration date
d. Presence of clots
85. The doctor ordered one unit of whole blood, B+, to be transfused for a client. What is
the responsibility of the nurse to ensure safe transfusion?
e. Ask the client to take small exercise before transfusion begins
f. Assure the client that everything will be all right during transfusion
g. Make sure the blood is typed and cross matched before transfusion
h. Transfuse the blood immediately from the blood bank
86. A midwife receives an order to transfuse a unit of PRBCs. Which initial question will
she ask the client before transfusing the blood?
a. “Do you know any complications of transfusion”?
b. “Do you know what shock is”?
c. “Have you ever had a transfusion before”?
d. “Why do you think you need this blood”?
87. A nurse is preparing to teach a 65 year-old client how to change his ostomy bag. One
of the best methods to teach the client this skill is by:
a. Demonstration
b. Discussion
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 c. Group teaching
d. Lecture
88. Mrs. Davis has low self-concept. She continually puts herself down and feels inferior
to others. Which approach by the nursing staff would best help her maintain a feeling
of worth and dignity?
a. Assigning specific tasks for her
b. Calling her by the name she prefers
c. Refraining from being critical on her
d. Refraining probing into her background
89. In contrast to younger patients, elderly patients have higher incidence of postoperative
infections primarily because older persons:
a. Have atrophy of lymph node
b. Have reduced cardiovascular circulation
c. Tend to not practice good health
d. Tend to react unfavorably to stress
90. When an anticoagulant is given to manage CVA due to cerebral infarction, the nurse
specifically:
a. Avoids sudden postural changes
b. Maintains adequate perfusion
c. Monitors level of consciousness
d. Watches for bleeding
91. As part of the nursing management for the patient with heart failure, the nurse plans to
weigh the patient daily. The nurse judges correctly that such patient should usually be
weighed:
a. In the morning after meal
b. In the morning after urination
c. Morning & evening after meal
d. Morning & evening after urination
92. A nurse assesses a patient’s blood pressure for three consecutive days and then
suggests an uncomplicated hypertension. The recommended initial medications for
this patient include:
a. Diuretics and/or beta blockers
b. Diuretics and/or vasodilators
c. Vasodilators and/or beta blockers
d. Vasodilators and/or calcium blockers
93. The nurse is aware that following a GI series, measures are usually taken to guard
against:
a. Acute diarrhea
b. Acute heartburn
c. Fecal impaction
d. Nausea & vomiting
94. In the immediate postoperative period, a nurse should immediately report:
a. Diastolic blood pressure of 70mmHg
b. Respiratory rate between 20—25 per minute
c. Systolic blood pressure lower than 90mmHg
d. Temperature reading between 36.1—36.7 oC
95. To elicit the knee jerk, the nurse taps the:
a. Achilles tendon
b. Biceps brachii tendon
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 c. Quadriceps femoris tendon
d. Ttriceps brachii tendon
96. The physician orders 1L of ranger lactate to be infused in 8hours. The nurse calculates
and concludes the flow rate to be:
a. 42 gtt/min
b. 43gtt/min
c. 44 gtt/min
d. 45gtt/min
97. A patient is brought into the ER with facial burn. The attending nurse will mainly
focus on:
a. Airway patency
b. Breathing pattern
c. Percent of burn
d. Severity of the burn
98. When administering hydrochlorothiazide (HCTZ), the nurse should encourage the
patient to eat foods high in potassium. An example of such food is:
a. Banana
b. Beans
c. Cassava
d. Salad

99. At the time of discharge, the nurse undertakes to give home instruction to a patient
admitted for angina pectoris. Of the following statements, which is correct?
a. Do moderate exercise during attack
b. Encourage large frequent meal
c. Repeat nitroglycerine as necessary
d. Take Paracetamol as necessary
100. Which of the following is a nurse who is a member of the surgical team, but
works outside of the sterile field? She serves as the patient’s advocate while the client
is least able to care for him/herself.
a. Circulating nurse
b. Scrub nurse
c. Station nurse
d. Travelling nurse

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