1. A client with allergic rhinitis is instructed on the correct technique for using an intranasal inhaler. Which of the following statements would demonstrate to the nurse that the client understands the instructions?
a.) I should limit the use of the inhaler to early morning and bedtime use.
b.) It is important to not shake the canister because that can damage the spray device
c. ) I should hold one nostril closed while I insert the spray into the other nostril
d.) The inhaler tip is inserted into the nostril and pointed toward the inside nostril wall
2. Which of the following would be an expected outcome for a client recovering from an upper respiratory tract infection?
a.) the client maintains a fluid intake of 800 ml every 24 hours
b.) the client experiences chill only once a day
c.) the client coughs productively without chest discomfort
d.) the client experiences less nasal obstruction and discharge
3. The nurses teaches the client how to instill nasal drops. Which of the following techniques is correct?
a.) the client uses sterile technique when handling the dropper
b.) the client blows the nose gently before instilling the drops
c.) the client uses a new dropper for each instillation
d.) the client sits in a semi-fowler's position with the head tilted forward after administration of the drops
4. A client with acute sinusitis is examined in an ambulatory clinic. The nurse can anticipate the use of which of the following medications in the client's treatment plan?
d.) oral corticosteroids
5. The nurse should include which of the following instructions in the teaching plan for a client with chronic sinusitis?
a.) avoid the use of caffeinated beverages
b.) perform postural drainage everyday
c.) take hot showers twice daily
d.) report a temperature of 102F (38.9C) or higher
6. Which of the following individuals would the nurse consider to have the highest priority for receiving an influenza vaccination?
a.) a 60-year old man with a hiatal hernia
b.) a 36-year old with three children
c.) a 50-year old woman caring for a spouse with cancer
d.) a 60-year old woman with osteoporosis
7. Which of the following individuals would the nurse consider to have the highest priority for receiving an influenza vaccination?
a.) deficient fluid volume related to difficulty swallowing
b.) impaired verbal communication related to inability to speak
c.) feeding self-care deficit related to inability to swallow
d.) powerlessness related to diagnosis of cancer
8. A client who has had a total laryngectomy appears withdrawn and depressed. He keeps the curtain drawn, refuses visitors, and indicates a desire to be left alone. Which nursing intervention would most likely be therapeutic for the client?
a.) discussing his behavior with his wife to determine the cause
b.) exploring his future plans
c.) respecting his need for privacy
d.) encouraging him to express his feelings non-verbally and in writing
9. The nurse is suctioning a client who had laryngectomy. What is the maximum amount of time the nurse should suction the client?
a.) 10 seconds
b.) 15 seconds
c.) 25 seconds
d.) 30 seconds
10. The nurse is preparing a community presentation on the prevention ofcancer. Which of the following should be included as a primary risk factor for developing laryngeal cancer?
a.) chronic allergy
b.) chewing tobacco
c.) exposure to airborne environmental toxins
11. Which of the following signs and symptoms would the nurse include in a teaching plan as an early warning sign of laryngeal cancer?
c.) airway obstruction
12. A client has just turned from post-anesthesia care unit (PICU) after undergoing a laryngectomy. Which of the following interventions should the nurse include in the plan of care?
a.) maintain the head of the bed at 30 to 40 degrees
b.) teach the client how to use esophageal speech
c.) initiate small feedings of soft foods
d.) irrigate drainage tunes as needed
13. A 79-year old female client is admitted to the hospital with a diagnosis of bacterial pneumonia. While obtaining the client's health history, the nurse learns that the client has osteoarthritis, follows a vegetarian diet, and is very concerned with cleanliness. which of the following would most likely be a predisposing factor for the diagnosis of pneumonia?
c.) vegetarian diet
d.) daily bathing
14. A client with bacterial pneumonia is to be started on intravenous antibiotics. Which of the following must be completed before antibiotic therapy begins?
b.) sputum culture
c.) chest radiograph
d.) red blood cell count
15. A client with pneumonia has a temperature of 102 F, is diaphoretic, and has a productive cough. The nurse should include which of the following measures in the plan of care?
a.) position changes every 4 hours
b.) nasotracheal suctioning to clear secretions
c.) frequent linen changes
d.) frequent offering of bedpan
16. Bed rest is prescribed for a client with pneumonia during the acute phase of the illness. Bed rest serves which of the following purposes?
a.) it reduces the cellular demand for oxygen
b.) it decreases the episodes of coughing
c.) it promotes safety
d.) it promotes clearance of secretions
17. The cyanosis that accompanies bacterial pneumonia is primarily caused by which of the following?
a.) decreases cardiac output
b.) pleural effusion
c.) inadequate peripheral circulation
d.) decreased oxygenation of the blood
18. Aspirin is administeredto clients with pneumonia because its antipyretic and:
a.) analgesic effects
b.) anticoagulant effects
c.) adrenergic effects
d.) antihistamine effects
19. Which of the following mental status changes may occur when a client with pneumonia is first experiencing hypoxia?
20. The nurse obtains a sputum specimen from a client with suspected tuberculosisfor laboratory study. Which of the following laboratory techniques is most commonly used to identify tubercle bacilli in sputum?
a.) acid-fast bacilli
b.) sensitivity testing
c.) agglutination testing
d.) dark-field illumination
21. Which of the following can cause damage to the eight cranial nerve?
b. isoniazid (INH)
c. para-aminosalicylic acids (PAS)
d. ethambutol hydrochloride (myambutol)
22. The client who experiences eight cranial nerve damage will most likely report which of the following symptoms?
b. facial paralysis
c. impaired vision
d. difficulty swallowing
23. What is the rationale that supports Multi-drug treatment in TB?
a) multiple drug potentiate the drug's actions
b) multiple drugs reduce undesirable drug side effects
c) multiple drugs allow reduced drug dosages to be given
d) multiple drugs reduce development of resistant strains of bacteria
24. The client with is to be discharged home with follow-up. Of the following interventions, which would have highest priority?
a) offering the client emotional support
b) teaching the client about the disease and its treatment
c) coordinating various agency services
d) assessing the client's environment for sanitation
25. Which of the following techniques for administering the Mantoux testis correct?
a) hold the needle and syringe almost parallel to the client's skin
b) pinch the skin when inserting the needle
c) aspirate before injecting the medication
d) massage the site after injecting the medication
26. The nurse should caution sexually active female clients taking INH that the drug has which of the following effects?
a) increases the risk of vaginal infection
b) has mutagenic effects on ova
c) decreases the effectiveness of oral contraceptives
d) inhibits ovulation
27. Clients who have had active TB are at risk for recurrence. Which of the following conditions increases that risk?
a) cool and damp weather
b) active exercise and exertion
c) physical and emotional stress
d) rest and inactivity
28. When instructing clients on how to decrease the risk of COPD, the nurse should emphasize which of the following behaviors?
a) participate regularly in aerobic exercises
b) maintain a high protein diet
c) avoid exposure to people with known respiratory infections
d) abstain from cigarette smoking
29. When performing postural drainage, which of the following factors promotes the movement of secretions from the lower to the upper respiratory tract?
a) friction between the cilia
b) force of gravity
c) sweeping motion of cilia
d) involuntary muscle contractions
30. The nurse teaches a client with COPD to assess for signs and symptoms of right-sided heart failure. Which of the following signs and symptoms should be included in the teaching plan?
a) clubbing nail beds
c) peripheral edema
d) increased appetite
31) A 434 y/o woman with history of asthma is admitted to the emergency department. The nurse notes that the client is dyspneic, with a respiratory rate of 35brm, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. Based on these findings, what action should should the nurse take to initiate care of the client?
a) initiate oxygen therapy and reassess the client after 10 minutes
b) draw blood for an arterial blood gas analysis and send the client for a chest x-ray
c) encourage the client to relax and breathe slowly through mouth
d) administer bronchodialtors
32. A client with acute asthma is prescribed short-term corticosteroid therapy. What is the rationale for the use of steroids in clients with asthma?
a) corticosteroid promote bronchodilaton
b) corticosteroids acts as an expectorant
c) corticosteroids have an anti-inflammatory effect
d) corticosteroids prevent development of respiratory infections
33. Which of the following areas is a priority to evaluate when completing discharge planning for a client who has had a lobectomy for treatment of lung cancer
a. the support available to assist the client at home
b) the distance of the client lives from the hospital
c) the client's ability to do home blood pressure monitoring
d) the client's knowledge of the causes of lung cancer
34. Which of the following interventions would be most likely to prevent the development of acute respiratory distress syndrome (ARDS)?
a) teaching cigarette smoking cessation
b) maintain adequate serum potassium levels
c) monitoring clients for signs of hypercapnia
d) replacing fluids adequately during hypovolemic stress
35. The nurse interprets which of the following as an early sign of ARDS in a client at risk?
a) elevated carbon dioxide level
b) hypoxia not responsive to oxygen therapy
c) metabolic acidosis
d) severe, unexplained electrolyte imbalance
36. A nurse is preparing to obtain serum specimen from a client. Which of the following nursing actions will facilitate obtaining the specimen?
a) limiting fluids
b) having the client take three deep breaths
c) asking the client to spit into the collection container
d) asking the client to obtain the specimen after eating
37. A nurse is caring for a client after a bronchoscopy and biopsy. Which of the following signs if noted in the client should be reported immediately to the physician?
a) blood-streaked sputum
b) dry cough
38. A nurse is suctioning a client through an endotracheal tube. During the suctioning procedure the nurse notes cardiac irregularities on the monitor. Which of the following is the most appropriate nursing intervention?
a) continue to suction
b) ensure that the suction is limited to 15 seconds
c) stop the procedure and re-oxygenate the client
d) notify the physician immediately
39. An emergency room nurse is assessing a client who sustained a blunt injury to the chest wall. Which of these signs would indicate the presence of pneumothorax
a) a sucking sound at the site of injury
b) diminished breath sound
c) a low respiratory rate
d) the presence of barrel chest
40. A nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary diseases (COPD). Which of the following would the nurse expect to note in evaluating this client?
a) increased oxygen saturation with exercise
c) a hyperinflated chest on x-ray
d) a widened diaphragm noted on chest x-ray
41. A nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will enhance the effectiveness of breathing during dyspneic periods. Which of the following positions will the nurse instruct the client to assume?
a. side-lying in bed
b. sitting in recliner chair
c. sitting up in bed
d. sitting on the side of the bed and leaning on an overbed table
42. A community nurse is conducting an educational session with community members regarding TB. The nurse tells the group that the first symptoms of TB is:
a) bloody, productive cough
b) a morning cough with the expectoration of mucoid sputum
c) chest pain
43. A nursing instructor asks a nursing student to describe the route of transmission of TB The nursing instructor concludes that the student understands the route of transmission if the student states that TB is transmitted by:
a) the airborne route
b) bloody and bloody fluids
c) the fecal-oral route
d) hand to mouth
44. A nurse is caring for a client with emphysema. The client is receiving oxygen. The nurse assesses the oxygen flow rate to ensure that it does not exceed:
a) 1 liter per minute
b) 2 liter per minute
c) 6 liter per minute
d) 10 liter per minute
45. Which of the following arterial blood gas results indicates metabolic alkalosis?
a) pH of 7.34, pCO2 of 50, HCO3 of 32, pO2 of 70
b) pH of 7.46, pCO2 of 30, HCO3 of 26, pO2 of 80
c) pH of 7.38, pCO2 of 45, HCO3 of 22, pO2 of 50
d) pH of 7.47, pCO2 of 40, HCO3 of 36, pO2 of 78
46. A nurse reviews the arterial blood gas values of a client. The results indicate respiratory acidosis. Which of the following values would indicate that this acid base imbalance exists?
a) pH of 7.48
b) pCO2 of 32
c) pH of 7.30
d) HCO3 of 20
47. A nurse instructs a client to use the purse-lip method of breathing. The client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to:
a) promote oxygen intake
b) strengthen the diaphragm
c) strengthen the intercostal muscle
d) promote carbon dioxide elimination
48. INH & Refadin have been prescribed for a client withTB A nurse reviews the medical record of the client. Which of the following, if noted in the client's history, would require physician notification?
a) heart disease
b) allergy to penicillin
c) hepatitis B
d) rheumatic fever
49. A client is suspected of having a pulmonary embolus (PE). A nurse assesses the client, knowing that which of the following is not a common clinical manifestation of PE?
a) decreased respiration
d) chest pain
50. A client has just returned to a nursing unit following bronchoscopy. A nurse would implement which of the following nursing interventions for this client?
a) forcing fluid for the next 24 hours
b) ensuring the return of gag reflex before offering food or fluids
c) administering atropine IV
d) administering small doses of midazolam (Versed)
51. A client has an order to have radial arterial blood gases drawn. Prior to drawing the sample, a nurse occludes the:
a) brachial and radial arteries, and then releases them and observes the circulation to the hand
b) radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the process with the other artery
c) radial artery and observes for color changes in the affected hand
d. ulnar artery and observes for color changes in the affected hand
52. a nurse is teaching a client with chronic respiratory failure how to use metered-dose inhaler correctly. The nurse instructs the client to:
a) inhale through the nose
b) inhale quickly
c) take two inhalations during one breath
d) hold the breath after inhalation
53. A nurse assessing a client with chronic airflow limitation (CAL) and notes that the client has a "barrel chest." The nurse interprets that this client has which of the following forms of CAL?
a) chronic obstructive bronchitis
c) bronchial asthma
d) both bronchial asthma and bronchitis
54. A client has experienced pulmonary embolism. A nurse assesses for which symptom, which is most commonly reported?
a) dyspnea when deep breaths are taken
b) hot, flushed feeling
c) chest pain that occurs suddenly
d) sudden chills and fever
55. A nurse is caring for a client with TB Which assessment. if made by the nurse, would not be consistent with the usual clinical presentation of TB
a) non-productive or productive cough
b) anorexia with weight loss
c) chills and night sweats
d) high-grade fever
56. A nurse is teaching a client diagnosed with TB about dietary elements that should be increased in the diet. The nurse suggests that the client increase intake of:
a) meats and citrus fruits
b) grains and broccoli
c) eggs and spinach
d) potatoes and fish
57. A nurse is preparing to give a bed bath to an immobilized client with TB.The nurse should plan to wear which of the following items when performing this care?
a) particulate respirator, gown, and gloves
b) particulate respirator, and protective eyewear
c) surgical mask anf gloves
d) surgical mask, gown, and protective eyewear
58. A nurse initially will use an Ambu-bag in the intensive care unit when:
a) a respiratory arrest occurs
b) the client is in ventricular fibrillation
c) the respiratory output must be monitored
d) a surgical incision with copious drainage is present
59. A client begins to expectorate blood. The nurse describes this episode as:
60. A client is admitted and the physician suspects atelectasis. When assessing this individual, the nurse would expect:
a) slow, deep respiration
b) a dry, unproductive cough
c) a normal oral temperature
d) diminished breath sounds
61. An Asthmatic client's pulmonary function studies are abnormal. The nurse should realize that one of the most common complications of chronic asthma is:
d) pulmonary fibrosis
62. The factor that would have little influence in predisposing an individual to cancer of the larynx would be:
a) air pollution
b) poor dental hygiene
c) heavy alcohol consumption
d) chronic respiratory disease
63. Immediate post-operative management for a client with total laryngectomy would include:
a) instructing the client to whisper
b) placing the client in the orthopneic position
c) removing the outer tracheostomy tube prn
d) suctioning the tracheostomy tube whenever necessary
64. When suctioning a client with tracheostomy the nurse must remember to:
a) use new sterile catheter with each insertion
b) initiate suctioning as the catheter is being withdrawn
c) insert the catheter until the cough reflex is stimulated
d) remove the inner cannula before inserting the suction catheter
65. A thoracentesis is performed. Following the procedure it is most important for the nurse to observe the client for:
a) periods of confusion
b) expectoration of blood
c) increased breath sounds
d) decreased respiratory rate
66. The nurse's responsibility in preventing atelectasis in a client with chest trauma, such as fractured ribs or flail chest, would be to:
a) ensure a high fluid intake over 24 hours
b) encourage coughing and deep breathing
c) defer pain medication the first day after injury
d) position the client face down on a soft mattress
67. The arterial blood gases of a client with COPD deteriorate, and respiratory failure is impending. The nurse should first assess the client for:
c) mental confusion
d) distended neck pain
68. The synovial fluid of the joints minimizes:
b) work output
c) friction in the joints
d) velocity of movements
69. The risk of osteoporosis is increased when a client:
a) receives long-term asteroid therapy
b) has a history of hypoparathyroidism
c) engages in strenuous physical activity
d) consumes excessive amounts of estrogen
70. A client with osteoporosis is vulnerable to:
a) fatigue fractures
b) pathologic fractures
c) greenstick fractures
d) compound fractures
71. Following an above the knee amputation of the leg, a client complains of pain in the foot that is no longer there. The nurse understands that phantom limb pain is caused by:
a) tactile illusions associated with severed blood vessels
b) an unconscious phenomenon to aid with the grieving over the lost of body parts
c) hallucinations secondary to emotional symptoms associated with the distress of amputation
d) sensations in the amputated limb secondary to thalamic localization of stimuli from nerve endings
72. The crutch gait the nurse should teach the client wearing prosthesis after single leg amputation is the:
a) four-point gait
b) three-point gait
c) tripod crutch gait
d) swing-through crutch gait
73. The principle that the nurse use when teaching a client the four-point gait is:
a) elbows should be maintained in rigid extension
b) most of weight should be supported by the axillae
c) the client must be able to bear weight on both legs
d) the affected extremity should be kept about 15 cm (6 inches) off the ground
74. A client's leg is set in a long leg cast. Because of the long leg cast, the nurse should observe for signs that indicate compromised circulation such as:
a) foul odor
b) swelling of the toes
c) drainage on the cast
d) increased temperature
75. To prepare a client with a long leg cast for crutch walking, the nurse should encourage the client to:
a) use the trapeze to strengthen the biceps muscle
b) keep the affected limb in extension and abduction
c) sit up straight in a chair to develop the back muscle
d) do exercises in bed to strengthen upper extremities
76. After total hip replacement surgery the nurse should avoid placing the client in the:
a) supine position
b) lateral position
c) orthopneic position
d) semi-fowler's position
77. When ready to walk with crutches after knee surgery, the client will probably be taught:
a) swing-through gait
b) two-point crutch gait
c) four-gait crutch gait
d) three-point crutch walking
78. The primary consideration when caring for a client with rheumatoid arthritis is:
79. The nurse understands the joints most likely involved in a client with osteoporosis are the:
a) hips and knees
b) ankles and metatarsals
c) fingers and metacarpals
d) cervical spine and shoulders
80. A client with rheumatoid arthritis asks the nurse why the physician is going to inject hydrocortisone into the knee joint. The nurse explains that the most important reason for doing this is to:
a) relieve pain
b) reduce inflammation
c) provide physiotherapy
d) prevent ankylosis of the joint
81. The nurse should know that a client with rheumatoid arthritis will most often have pain and limited movement of the joints:
a) when the room is cool
b) after assistive exercise
c) in the morning on awakening
d) when the latex fixation test is positive
82. A client who has intermittently been having painful, swollen knee and wrist joints during the past 3 months is admitted to the hospital for treatment of rheumatoid arthritis.The diet the nurse would expect the physician to order for this client would be:
a) salt free and low in fiber
b) high calorie with low cholesterol
c) high protein with minimal calcium
d) regular diet with vitamins and minerals
83. On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. Which of the following would the nurse most likely assess?
a) limited motion of joints
b) deformed joints of the hands
c) early morning stiffness
d) rheumatoid nodules
84. When developing the plan of care for a client during the acute phase of rheumatoid arthritis. Which of the following would the nurse identify as the lowest priority?
a) relieve pain
b) preserving joint function
c) maintaining usual ways of accomplishing tasks
d) preventing joint deformity
85. After the nurse teaches a client about heat and cold treatment to manage arthritis pain, which of the following client statements indicates that the client still has a knowledge deficit?
a) I can use heat and cold as often as I want
b) with heat, I should apply it for no longer than 20 minutes at a time
c) heat producing liniments can be used with other heat devices
d) 10 to 15 minutes per application is the maximum time for cold applications
86. When developing the teaching plan for the client with rheumatoid arthritis to promote rest, which of the following would the nurse expect to instruct the client to avoid during rest periods?
a) proper body alignment
b) elevating the part
c) prone lying positions
d) positions of flexion
87. After teaching the client with rheumatoid arthritis about measures to conserve energy in his activities of daily living specially involving the small joints, which of the following, if stated by the client, would indicate the need for additional teaching?
a) pushing with palms when rising from a chair
b) holding packages close to the body
c) sliding objects
d) carrying a laundry basket with clenched fingers and fists
88. When completing the history and physical examination of the client diagnosed with ostoearthritis, which of the following would the nurse assess?
c) weight loss
d) local joint pain
89. After the client undergoes a total knee replacement for severeosteoarthritis, which of the following assessment findings would lead the nurse to suspect possible nerve damage?
90. A client with a hip fracture has undergone surgery for insertion of femoral head prosthesis. Which of the following activities would the nurse instruct the client to avoid?
a) crossing the legs while sitting down
b) sitting on a raised commode seat
c) using an abductor splint while lying on the side
d) rising straight from a chair to a standing position
91. The nurse encourages the client who has a femoral head prosthesis placement to use which of the following types of chairs to sit in during the first 6 to 8 weeks after surgery?
a) a desk type swivel chair
b) a padded upholstered chair
c) a high backed chair with armrests
d) a recliner with an attached footrest
92. When admitting a client with a fractured extremity, the nurse would focus the assessment on which of the following first?
a) the area proximal to the fracture
b) the actual fracture site
c) the area distal to the fracture
d the opposite extremity for baseline comparison
93. Regardless of the type of cast material used, the nurse identifies a knowledge deficit when the client makes which of the following statements about the care of cast?
a) I'll elevate the cast above my heart initially
b) I'll exercise my joints above and below the cast
c) I can pull out cast padding to scratch inside the cast
d) I'll apply ice for 10 minutes to control edema for the first 24 hours
94. A client who crashed her motorcycle suffered a tibial fracture that required casting. Approximately 5 hours later, the client begins to complain of increasing pain distal to the left tibial fracture despite the morphine injection administered 30 minutes previously. The nurse's next action should be to assess for which of the following?
a) presence of a distal pulse
b) pain with a pain rating scale
c) vital signs changes
d) potential for drug tolerance
95. A client with a fracture develops compartment syndrome. When caring for the client, the nurse would be alert for which of the following signs of possible organ failure?
c) generalized edema
d) dark, scanty urine
96. The client asks the nurse what his activity limitations are while he is in Buck's traction. Which of the following responses by the nurse would be most appropriate?
a) you can sit up whenever you want
b) you must lie flat on your back most of the time
c) you can turn your body
you must lie on your stomach
97. A client treated in a physician's office after a fall that sprained an ankle. X-ray examination has ruled out a fracture. Before sending the client home, the nurse plans to teach the client to avoid which of the following in the next 24 hours?
a) application of a heating pad
b) application of an ace wrap
c) resting the foot
d) elevating the ankle on a pillow while sitting or lying down
98. A nurse has given dietary instructions to a client to minimize the risk of osteoporosis. The nurse would evaluate that the client understands the recommended dietary changes if the client stated he or she should increase intake of which food?
99. A nurse is conducting health screening for osteoporosis. The nurse would interpret that which of the following clients is at greatest risk of developing this disorder?
a) a 36 year old male who has asthma
b) a 25 year old female who jogs
c) a sedentary 65 year old female who smokes cigarettes
d) a 70 year old male who consumes excess alcohol
100. A home health nurse is planning to teach a client with osteoporosis about home modifications to reduce the risk of falls. Which of the following recommendations would be unnecessary to include in the teaching plan?
a) use of staircase railings
b) use of night-lights
c) removing wall-to-wall carpeting
d) placing handrails in the bathroom
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