Medical Surgical practice test 8

MS-8 -Questions

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?

a.) antibiotics
b.) antihistamine
c.) bronchodilators
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
d.) smoking

11. Which of the following signs and symptoms would the nurse include in a teaching plan as an early warning sign of laryngeal cancer?

a.) dysphagia
b.) hoarseness
c.) airway obstruction
d.) stomatitis


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?

a.) age
b.) osteoarthritis
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?

a.) urinalysis
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?

a.) coma
b.) apathy
c.) irritability
d.) depression

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?

a. streptomycin
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?

a. vertigo
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
b) hypertension
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
c) hematuria
d) stridor

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
b) hypocapnia
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
d) dyspnea

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
b) tachypnea
c) dyspnea
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
b) emphysema
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:

a) hematuria
) hematoma
c) hemoptysis
d) hematemesis

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:

a) atelectasis
b) emphysema
c) pneumothorax
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:

a) cyanosis
b) bradycardia
c) mental confusion
d) distended neck pain

68. The synovial fluid of the joints minimizes:

a) efficiency
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:

a) surgery
b) comfort
c) education
d) motivation

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?

a) anemia
b) osteoporosis
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?

a) numbness
b) bleeding
c) dislocation
d) pinkness

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?

a) rales
b. jaundice
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?

a) rice
b) yogurt
c) sardines
d) chicken

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



ANSWERS

Medical Surgical practice test 7

MS-7- Questions

1. The nursing care plan for a toddler diagnosed with Kawasaki Disease
(mucocutaneous lymph node syndrome) should be based on the high risk for
development of which problem?


A)Chronic vessel plaque formation
B)Pulmonary embolism

C)Occlusions at the vessel bifurcations
D)Coronary artery aneurysm

2. A nurse has just received a medication order which is not legible. Which
statement best reflects assertive communication?

A)"I cannot give this medication as it is written. I have no idea of what you mean."
B)"Would you please clarify what you have written so I am sure I am reading it correctly?"
C)"I am having difficulty reading your handwriting. It would save me time if you would be more careful."
D)"Please print in the future so I do not have to spend extra time attempting to read your writing."

3. The nurse is discussing negativism with the parents of a 30 month-old child. How should the nurse tell the parents to best respond to this behavior?

A)Reprimand the child and give a 15 minute "time out"
B)Maintain a permissive attitude for this behavior
C)Use patience and a sense of humor to deal with this behavior
D)Assert authority over the child through limit setting

4. An ambulatory client reports edema during the day in his feet and an ankle that disappears while sleeping at night. What is the most appropriate follow-up question for the nurse to ask?

A)"Have you had a recent heart attack?"
B)"Do you become short of breath during your normal daily activities?"
C)"How many pillows do you use at night to sleep comfortably?"
D)"Do you smoke?"

5. The nurse is planning care for a client during the acute phase of a sickle cell vaso-occlusive crisis. Which of the following actions would be most appropriate?

A)Fluid restriction 1000cc per day
B)Ambulate in hallway 4 times a day
C)Administer analgesic therapy as ordered
D)Encourage increased caloric intake

6. While working with an obese adolescent, it is important for the nurse to recognize that obesity in adolescents is most often associated with what other behavior?


A)Sexual promiscuity
B)Poor body image

C)Dropping out of school
D)Drug experimentation


7. A nurse and client are talking about the client’s progress toward understanding his behavior under stress. This is typical of which phase in the therapeutic relationship?


A)Pre-interaction
B)Orientation

C)Working
D)Termination

8. A nurse is eating in the hospital cafeteria when a toddler at a nearby table chokes on a piece of food and appears slightly blue. The appropriate initial action should be to

A)Begin mouth to mouth resuscitation
B)Give the child water to help in swallowing
C)Perform 5 abdominal thrusts
D)Call for the emergency response team

9. The emergency room nurse admits a child who experienced a seizure at school. The father comments that this is the first occurrence, and denies any family history of epilepsy. What is the best response by the nurse?

A)"Do not worry. Epilepsy can be treated with medications."
B)"The seizure may or may not mean your child has epilepsy."
C)"Since this was the first convulsion, it may not happen again."
D)"Long term treatment will prevent future seizures."

10. A nurse admits a 3 week-old infant to the special care nursery with a diagnosis of bronchopulmonary dysplasia. As the nurse reviews the birth history, which data would be most consistent with this diagnosis?

A)Gestational age assessment suggested growth retardation
B)Meconium was cleared from the airway at delivery
C)Phototherapy was used to treat Rh incompatibility
D)The infant received mechanical ventilation for 2 weeks

11. Parents of a 6 month-old breast fed baby ask the nurse about increasing the baby's diet. Which of the following should be added first?


A)Cereal
B)Eggs

C)Meat
D)Juice


12. A victim of domestic violence states, "If I were better, I would not have been beat." Which feeling best describes what the victim may be experiencing?


A)Fear
B)Helplessness

C)Self-blame
D)Rejection


13. The nurse is assessing the mental status of a client admitted with possible organic brain disorder. Which of these questions will best assess the function of the client's recent memory?

A)"Name the year." "What season is this?" (pause for answer after each question)
B)"Subtract 7 from 100 and then subtract 7 from that." (pause for answer) "Now continue to subtract 7 from the new number."
C)"I am going to say the names of three things and I want you to repeat them after me: blue, ball, pen."
D)"What is this on my wrist?" (point to your watch) Then ask, "What is the purpose of it?"

14. Which oxygen delivery system would the nurse apply that would provide the highest concentrations of oxygen to the client?


A) Venturi mask
B) Partial rebreather mask

C) Non-rebreather mask
D) Simple face mask

15. A nurse is caring for a client who had a closed reduction of a fractured right wrist followed by the application of a fiberglass cast 12 hours ago. Which finding requires the nurse’s immediate attention?

A) Capillary refill of fingers on right hand is 3 seconds
B) Skin warm to touch and normally colored
C) Client reports prickling sensation in the right hand
D) Slight swelling of fingers of right hand

16. Included in teaching the client with tuberculosis taking INH about follow-up home care, the nurse should emphasize that a laboratory appointment for which of the following lab tests is critical?


A) Liver function
B) Kidney function

C) Blood sugar
D) Cardiac enzymes


17. Which client is at highest risk for developing a pressure ulcer?

A) 23 year-old in traction for fractured femur
B) 72 year-old with peripheral vascular disease, who is unable to walk without assistance
C) 75 year-old with left sided paresthesia and is incontinent of urine and stool
D) 30 year-old who is comatose following a ruptured aneurysm

18. Which contraindication should the nurse assess for prior to giving a child immunization?


A) Mild cold symptoms
B) Chronic asthma

C) Depressed immune system
D) Allergy to eggs


19. The nurse is caring for a 2 year-old who is being treated with chelation therapy, calcium disodium edetate, for lead poisoning. The nurse should be alert for which of the following side effects?


A) Neurotoxicity
B) Hepatomegaly

C) Nephrotoxicity
D) Ototoxicity


20. A newborn is having difficulty maintaining a temperature above 98 degrees Fahrenheit and has been placed in a warming isolette. Which action is a nursing priority?

A) Protect the eyes of the neonate from the heat lamp
B) Monitor the neonate’s temperature
C) Warm all medications and liquids before giving
D) Avoid touching the neonate with cold hands

21. At a senior citizens meeting a nurse talks with a client who has diabetes mellitus Type 1. Which statement by the client during the conversation is most predictive of a potential for impaired skin integrity?

A) "I give my insulin to myself in my thighs."
B) "Sometimes when I put my shoes on I don't know where my toes are."
C) "Here are my up and down glucose readings that I wrote on my calendar."
D) "If I bathe more than once a week my skin feels too dry."




22. A 4 year-old hospitalized child begins to have a seizure while playing with hard plastic toys in the hallway. Of the following nursing actions, which one should the nurse do first?

A) Place the child in the nearest bed
B) Administer IV medication to slow down the seizure
C) Place a padded tongue blade in the child's mouth
D) Remove the child's toys from the immediate area

23. The nurse is at the community center speaking with retired people. To which comment by one of the retirees during a discussion about glaucoma would the nurse give a supportive comment to reinforce correct information?

A) "I usually avoid driving at night since lights sometimes seem to make things blur."
B) "I take half of the usual dose for my sinuses to maintain my blood pressure."
C) "I have to sit at the side of the pool with the grandchildren since I can't swim with this eye problem."
D) "I take extra fiber and drink lots of water to avoid getting constipated.”

24. The nurse is teaching a parent about side effects of routine immunizations. Which of the following must be reported immediately?


A) Irritability
B) Slight edema at site

C) Local tenderness
D) Temperature of 102.5 F


25. A client is admitted with the diagnosis of pulmonary embolism. While taking a history, the client tells the nurse he was admitted for the same thing twice before, the last time just 3 months ago. The nurse would anticipate the health care provider ordering

A) Pulmonary embolectomy
B) Vena caval interruption
C) Increasing the coumadin therapy to an INR of 3-4
D) Thrombolytic therapy

26. A woman in her third trimester complains of severe heartburn. What is appropriate teaching by the nurse to help the woman alleviate these symptoms?

A) Drink small amounts of liquids frequently
B) Eat the evening meal just before retiring
C) Take sodium bicarbonate after each meal
D) Sleep with head propped on several pillows

27. The nurse is teaching the mother of a 5 month-old about nutrition for her baby. Which statement by the mother indicates the need for further teaching?

A) "I'm going to try feeding my baby some rice cereal."
B) "When he wakes at night for a bottle, I feed him."
C) "I dip his pacifier in honey so he'll take it."
D) "I keep formula in the refrigerator for 24 hours."

28. For a 6 year-old child hospitalized with moderate edema and mild hypertension associated with acute glomerulonephritis (AGN), which one of the following nursing interventions would be appropriate?


A) Institute seizure precautions
B) Weigh the child twice per shift

C) Encourage the child to eat protein-rich foods
D) Relieve boredom through physical activity


29. Which statement by the client with chronic obstructive lung disease indicates an understanding of the major reason for the use of occasional pursed-lip breathing?

A) "This action of my lips helps to keep my airway open."
B) "I can expel more when I pucker up my lips to breathe out."
C) "My mouth doesn't get as dry when I breathe with pursed lips."
D) "By prolonging breathing out with pursed lips the little areas in my lungs don't collapse."

30. A 57 year-old male client has hemoglobin of 10 mg/dl and a hematocrit of 32%. What would be the most appropriate follow-up by the home care nurse?

A) Ask the client if he has noticed any bleeding or dark stools
B) Tell the client to call 911 and go to the emergency department immediately
C) Schedule a repeat Hemoglobin and Hematocrit in 1 month
D) Tell the client to schedule an appointment with a hematologist

31. Which response by the nurse would best assist the chemically impaired client to deal with issues of guilt?

A) "Addiction usually causes people to feel guilty. Don’t worry, it is a typical response due to your drinking behavior."
B) "What have you done that you feel most guilty about and what steps can you begin to take to help you lessen this guilt?"
C) "Don’t focus on your guilty feelings. These feelings will only lead you to drinking and taking drugs."
D) "You’ve caused a great deal of pain to your family and close friends, so it will take time to undo all the things you’ve done."

32. An adolescent client comes to the clinic 3 weeks after the birth of her first baby. She tells the nurse she is concerned because she has not returned to her pre-pregnant weight. Which action should the nurse perform first?

A) Review the client's weight pattern over the year
B) Ask the mother to record her diet for the last 24 hours
C) Encourage her to talk about her view of herself
D) Give her several pamphlets on postpartum nutrition

33. Which of the following measures would be appropriate for the nurse to teach the parent of a nine month-old infant about diaper dermatitis?

A) Use only cloth diapers that are rinsed in bleach
B) Do not use occlusive ointments on the rash
C) Use commercial baby wipes with each diaper change
D) Discontinue a new food that was added to the infant's diet just prior to the rash

34. A 16 year-old client is admitted to a psychiatric unit with a diagnosis of attempted suicide. The nurse is aware that the most frequent cause for suicide in adolescents is


A) Progressive failure to adapt
B) Feelings of anger or hostility

C) Reunion wish or fantasy
D) Feelings of alienation or isolation



35. A mother brings her 26 month-old to the well-child clinic. She expresses frustration and anger due to her child's constantly saying "no" and his refusal to follow her directions. The nurse explains this is normal for his age, as negativism is attempting to meet which developmental need?


A) Trust
B) Initiative

C) Independence
D) Self-esteem


36. Following mitral valve replacement surgery a client develops PVC’s. The health care provider orders a bolus of Lidocaine followed by a continuous Lidocaine infusion at a rate of 2 mgm/minute. The IV solution contains 2 grams of Lidocaine in 500 cc’s of D5W. The infusion pump delivers 60 microdrops/cc. What rate would deliver 4 mgm of Lidocaine/minute?


A) 60 microdrops/minute
B) 20 microdrops/minute

C) 30 microdrops/minute
D) 40 microdrops/minute


37. A couple asks the nurse about risks of several birth control methods. What is the most appropriate response by the nurse?

A) Norplant is safe and may be removed easily
B) Oral contraceptives should not be used by smokers
C) Depo-Provera is convenient with few side effects
D) The IUD gives protection from pregnancy and infection

38. The nurse is caring for a client in the late stages of Amyotrophic Lateral Sclerosis (A.L.S.). Which finding would the nurse expect?


A) Confusion
B) Loss of half of visual field

C) Shallow respirations
D) Tonic-clonic seizures


39. A client experiences post partum hemorrhage eight hours after the birth of twins. Following administration of IV fluids and 500 ml of whole blood, her hemoglobin and hematocrit are within normal limits. She asks the nurse whether she should continue to breast feed the infants. Which of the following is based on sound rationale?

A) "Nursing will help contract the uterus and reduce your risk of bleeding."
B) "Breastfeeding twins will take too much energy after the hemorrhage."
C) "The blood transfusion may increase the risks to you and the babies."
D) "Lactation should be delayed until the "real milk" is secreted."

40. A client complained of nausea, a metallic taste in her mouth, and fine hand tremors 2 hours after her first dose of lithium carbonate (Lithane). What is the nurse’s best explanation of these findings?

A) These side effects are common and should subside in a few days
B) The client is probably having an allergic reaction and should discontinue the drug
C) Taking the lithium on an empty stomach should decrease these symptoms
D) Decreasing dietary intake of sodium and fluids should minimize the side effects

41. The nurse is caring for a post-surgical client at risk for developing deep
vein thrombosis. Which intervention is an effective preventive measure?

A) Place pillows under the knees
B) Use elastic stockings continuously
C) Encourage range of motion and ambulation
D) Massage the legs twice daily

42. The parents of a newborn male with hypospadias want their child circumcised.
The best response by the nurse is to inform them that

A) Circumcision is delayed so the foreskin can be used for the surgical repair
B) This procedure is contraindicated because of the permanent defect
C) There is no medical indication for performing a circumcision on any child
D) The procedure should be performed as soon as the infant is stable

43. The nurse is teaching parents about the treatment plan for a 2 weeks-old infant with Tetralogy of Fallot. While awaiting future surgery, the nurse instructs the parents to immediately report


A) Loss of consciousness
B) Feeding problems

C) Poor weight gain
D) Fatigue with crying


44. An infant weighed 7 pounds 8 ounces at birth. If growth occurs at a normal rate, what would be the expected weight at 6 months of age?

A) Double the birth weight
B) Triple the birth weight
C) Gain 6 ounces each week
D) Add 2 pounds each month


45. The nurse is caring for a 13 year-old following spinal fusion for scoliosis. Which of the following interventions is appropriate in the immediate post-operative period?

A) Raise the head of the bed at least 30 degrees
B) Encourage ambulation within 24 hours
C) Maintain in a flat position, logrolling as needed
D) Encourage leg contraction and relaxation after 48 hours

46. A client asks the nurse about including her 2 and 12 year-old sons in the care of their newborn sister. Which of the following is an appropriate initial statement by the nurse?

A) "Focus on your sons' needs during the first days at home."
B) "Tell each child what he can do to help with the baby."
C) "Suggest that your husband spend more time with the boys."
D) "Ask the children what they would like to do for the newborn."

47. A nurse is caring for a 2 year-old child after corrective surgery for Tetralogy of Fallot. The mother reports that the child has suddenly begun seizing. The nurse recognizes this problem is probably due to


A) A cerebral vascular accident
B) Postoperative meningitis

C) Medication reaction
D) Metabolic alkalosis


48. A client with schizophrenia is receiving Haloperidol (Haldol) 5 mg t.i.d.. The client’s family is alarmed and calls the clinic when "his eyes rolled upward." The nurse recognizes this as what type of side effect?


A) Oculogyric crisis
B) Tardive dyskinesia

C) Nystagmus
D) Dysphagia




49. A home health nurse is at the home of a client with diabetes and arthritis. The client has difficulty drawing up insulin. It would be most appropriate for the nurse to refer the client to

A) A social worker from the local hospital
B) An occupational therapist from the community center
C) A physical therapist from the rehabilitation agency
D) Another client with diabetes mellitus and takes insulin

50. A client was admitted to the psychiatric unit after complaining to her friends and family that neighbors have bugged her home in order to hear all of her business. She remains aloof from other clients, paces the floor and believes that the hospital is a house of torture. Nursing interventions for the client should appropriately focus on efforts to

A) Convince the client that the hospital staff is trying to help
B) Help the client to enter into group recreational activities
C) Provide interactions to help the client learn to trust staff
D) Arrange the environment to limit the client’s contact with other clients

51. A client is scheduled for a percutaneous transluminal coronary angioplasty (PTCA). The nurse knows that a PTCA is the

A) Surgical repair of a diseased coronary artery
B) Placement of an automatic internal cardiac defibrillator
C) Procedure that compresses plaque against the wall of the diseased coronary artery to improve blood flow
D) Non-invasive radiographic examination of the heart

52. A newborn has been diagnosed with hypothyroidism. In discussing the condition and treatment with the family, the nurse should emphasize

A) They can expect the child will be mentally retarded
B) Administration of thyroid hormone will prevent problems
C) This rare problem is always hereditary
D) Physical growth/development will be delayed

53. A priority goal of involuntary hospitalization of the severely mentally ill client is


A) Re-orientation to reality
B) Elimination of symptoms

C) Protection from harm to self or others
D) Return to independent functioning

54. A 19 year-old client is paralyzed in a car accident. Which statement used by the client would indicate to the nurse that the client was using the mechanism of "suppression"?

A) "I don't remember anything about what happened to me."
B) "I'd rather not talk about it right now."
C) "It's the other entire guy's fault! He was going too fast."
D) "My mother is heartbroken about this."

55. The nurse is caring for a woman 2 hours after a vaginal delivery. Documentation indicates that the membranes were ruptured for 36 hours prior to delivery. What are the priority nursing diagnoses at this time?


A) Altered tissue perfusion
B) Risk for fluid volume deficit

C) High risk for hemorrhage
D) Risk for infection

56. A 3 year-old had a hip spica cast applied 2 hours ago. In order to facilitate drying, the nurse should

A) Expose the cast to air and turn the child frequently
B) Use a heat lamp to reduce the drying time
C) Handle the cast with the abductor bar
D) Turn the child as little as possible

57. A client is scheduled for an Intravenous Pyelogram (IVP). In order to prepare the client for this test, the nurse would:

A) Instruct the client to maintain a regular diet the day prior to the examination
B) Restrict the client's fluid intake 4 hours prior to the examination
C) Administer a laxative to the client the evening before the examination
D) Inform the client that only 1 x-ray of his abdomen is necessary

58. Following a diagnosis of acute glomerulonephritis (AGN) in their 6 year-old child, the parent’s remark: “We just don’t know how he caught the disease!” The nurse's response is based on an understanding that

A) AGN is a streptococcal infection that involves the kidney tubules
B) The disease is easily transmissible in schools and camps
C) The illness is usually associated with chronic respiratory infections
D) It is not "caught" but is a response to a previous B-hemolytic strep infection

59. The nurse is caring for a 20 lbs (9 kg) 6 month-old with a 3 day history of diarrhea, occasional vomiting and fever. Peripheral intravenous therapy has been initiated, with 5% dextrose in 0.33% normal saline with 20 mEq of potassium per liter infusing at 35 ml/hr. Which finding should be reported to the health care provider immediately?


A) 3 episodes of vomiting in 1 hour
B) Periodic crying and irritability

C) Vigorous sucking on a pacifier
D) No measurable voiding in 4 hours


60. While caring for the client during the first hour after delivery, the nurse determines that the uterus is boggy and there is vaginal bleeding. What should be the nurse's first action?


A) Check vital signs
B) Massage the fundus

C) Offer a bedpan
D) Check for perineal lacerations


61. The nurse is assessing an infant with developmental dysplasia of the hip. Which finding would the nurse anticipate?


A) Unequal leg length
B) Limited adduction

C) Diminished femoral pulses
D) Symmetrical gluteal folds


62. To prevent a valsalva maneuver in a client recovering from an acute myocardial infarction, the nurse would

A) Assist the client to use the bedside commode
B) Administer stool softeners every day as ordered
C) Administer antidysrhythmics prn as ordered
D) Maintain the client on strict bed rest


63. On admission to the psychiatric unit, the client is trembling and appears fearful. The nurse’s initial response should be to

A) Give the client orientation materials and review the unit rules and regulations
B) Introduce him/her and accompany the client to the client’s room
C) Take the client to the day room and introduce her to the other clients
D) Ask the nursing assistant to get the client’s vital signs and complete the admission search

64. During the admission assessment on a client with chronic bilateral glaucoma, which statement by the client would the nurse anticipate since it is associated with this problem?

A) "I have constant blurred vision."
B) "I can't see on my left side."
C) "I have to turn my head to see my room."
D) "I have specks floating in my eyes."

65. A client with asthma has low pitched wheezes present on the final half of exhalation. One hour later the client has high pitched wheezes extending throughout exhalation. This change in assessment indicates to the nurse that the client


A) Has increased airway obstruction
B) Has improved airway obstruction

C) Needs to be suctioned
D) Exhibits hyperventilation

66. Which behavioral characteristic describes the domestic abuser?


A) Alcoholic
B) Over confident

C) High tolerance for frustrations
D) Low self-esteem


67. The nurse is caring for a client with a long leg cast. During discharge teaching about appropriate exercises for the affected extremity, the nurse should recommend


A) Isometric
B) Range of motion

C) Aerobic
D) Isotonic

68. A client is in her third month of her first pregnancy. During the interview, she tells the nurse that she has several sex partners and is unsure of the identity of the baby's father. Which of the following nursing interventions is a priority?

A) Counsel the woman to consent to HIV screening
B) Perform tests for sexually transmitted diseases
C) Discuss her high risk for cervical cancer
D) Refer the client to a family planning clinic

69. A 16 month-old child has just been admitted to the hospital. As the nurse assigned to this child enters the hospital room for the first time, the toddler runs to the mother, clings to her and begins to cry. What would be the initial action by the nurse?

A) Arrange to change client care assignments
B) Explain that this behavior is expected
C) Discuss the appropriate use of "time-out"
D) Explain that the child needs extra attention



70. While planning care for a 2 year-old hospitalized child, which situation would the nurse expect to most likely affect the behavior?


A) Strange bed and surroundings
B) Separation from parents

C) Presence of other toddlers
D) Unfamiliar toys and games


71. While explaining an illness to a 10 year-old, what should the nurse keep in mind about the cognitive development at this age?

A) They are able to make simple association of ideas
B) They are able to think logically in organizing facts
C) Interpretation of events originate from their own perspective
D) Conclusions are based on previous experiences

72. The nurse is has just admitted a client with severe depression. From which focus should the nurse identify a priority nursing diagnosis?


A) Nutrition
B) Elimination

C) Activity
D) Safety


73. Which playroom activities should the nurse organize for a small group of 7 year-old hospitalized children?


A) Sports and games with rules
B) Finger paints and water play

C) "Dress-up" clothes and props
D) Chess and television programs


74. A client is discharged following hospitalization for congestive heart failure. The nurse teaching the family suggests they encourage the client to rest frequently in which of the following positions?


A) High Fowler's
B) Supine

C) Left lateral
D) Low Fowler's


75. The nurse is caring for a 10 year-old on admission to the burn unit. One assessment parameter that will indicate that the child has adequate fluid replacement is


A) Urinary output of 30 ml per hour
B) No complaints of thirst
C) Increased hematocrit
D) Good skin turgor around burn

ANSWERS

Medical Surgical practice test 6

1.) A client is receiving NPH insulin 20 units subq at 7:00 AM daily, at 3 PM how would the nurse finds if the client were having a hypoglycemic reaction?
A.) Feel the client and bed for dampness
B.) Observe client kussmaul respirations
C.) Smell client’s breathe for acetone odor
D.) Check client’s pupils for dilation

2.) Postoperative thyroidectomy nursing care includes which measures?
A.) Have the client speak every 5-10 mins if hoarseness is present
B.) Provide a low calcium diet to prevent hypercalcemia
C.) Check the dressing all the back of the neck for bleeding
D.) Apply a soft cervical collar to restrict neck movement

3.) What would the nurse note as typical findings on the assessment of a client with acute pancreatitis?
A.) Steatorrhea, abd. Pain, fever
B.) Fever, hypoglycemia, DHN
C.) Melena, persistent vomiting, hyperactive bowel sounds
D.) Hypoactive bowel sounds, decreased amylase and lipase levels

4.) A client is found to be comatose and hypoglycemic with a blood suger level 50 mg/dl. What nursing action is implemented first?
A.) Infuse 1000 ml of D5W over a 12-hour period
B.) Administer 50% glucose IV
C.) Check the client’s urine for the presence of sugar and acetone
D.) Encourage the client to drink orange juice with added sugar

5.) Which medication will the nurse have
available for the emergency treatment of tetany in the client who has had a thyroidectomy?
A.) Calcium chloride
B.) Potassium chloride
C.) Magnesium sulfate
D.) Sodium bicarbonate

6.) What is the primary action of insulin in the body?
A.) Enhances the transport of glucose across cell walls
B.) Aids in the process of gluconeogenesis
C.) Stimulates the pancreatic beta cells
D.) Decreases the intestinal absorption of glucose

7.) What will the nurse teach the diabetic client regarding exercise in his /her treatment program?
A.) During exercise the body will use carbohydrates for energy production, which in turn will decrease the need for insulin
B.) With an increase in activity the body will utilize more carbohydrates; therefore more insulin will be required.
C.) The increase in activity results in an increase in the utilization of insulin; therefore the client should decrease his/her carbohydrate intake
D.) Exercise will improve pancreatic circulation and stimulate the islet of Langerhans to increase the production of intrinsic insulin

8.) The nurse is caring for a client who has exophthalmos associated with her thyroid disease. What is the cause of exophthalmos?
A.) Fluid edema in the retro-orbital tissues which force the eyes to protrude
B.) Impaired vision, which causes the client to squint in order to see
C.) Increased eye lubrication, which makes the client blink less
D.) Decrease in extraocular eye movements, which results in the “thyroid stare.”

9.) What is characteristic symptom of hypoglycemia that should alert nurse to an early insulin reaction?
A.) Diaphoresis
B.) Drowsiness
C.) Severe thirst
D.) Coma

10.) A client is scheduled for routine glycosylated hemoglobin (HbA1c) test. What is important for the nurse to tell the client before this test?
A.) Drink only water after midnight and come to the clinic early in the morning
B.) Eat a normal breakfast and be at the clinic 2 hours because of the multiple blood draws
C.) Expect to be at the clinic for several hours because of the multiple blood draws
D.) Come to the clinic at the earliest convenience to have blood drawn

11.) A client has been inhalation vasopressin therapy. What will the nurse evaluate to determine the therapeutic response to this medication?
A.) Urine specific gravity
B.) Blood glucose
C.) Vital signs
D.) Oxygen saturation levels

12.) A client with diagnosis of type 2 diabetes has been ordered a course of prednisone for her severe arthritic pain. An expected change that requires close monitoring by the nurse is;
A.) Increased blood glucose level
B.) Increased platelet aggregation
C.) Increased ceatinine clearance
D.) Increased ketone level in urine

13.) The nurse performing an assessment on a client who has been receiving long-term steroid therapy would expect to find:
A.) Jaundice
B.) Flank pain
C.) Bulging eyes
D.) Central obesity

14.) A diabetic client receives a combination of regular and NPH insulin at 0700 hours. The nurse teaches the client to be alert for signs of hypoglycemia at
A.) 1200 and 1300 hours
B.) 1100 and 1700 hours
C.) 1000 and 2200 hours
D.) 0800 and 1100 hours

15.) It is important for the nurse to teach the client that metformin (Glcucophage):
A.) May cause nocturia
B.) Should be taken at night
C.) Should be taken with meals
D.) May increase the effects of aspirin

16.) A nurse assessing a client with SIADH would expect to find laboratory values of:
A.) Serum Na= 150 mEq/L and low urine osmolality
B.) Serum K= 5 mEq/L and low serum osmolality
C.) Serum Na=120 mEq/L and low serum osmolality
D.) Serum K= 3 mEq/L and high serum osmolality

17.) A priority nursing diagnostic for a client admitted to the hospital with a diagnosis of diabetes insipidus is:
A.) Sleep pattern deprivation related nocturia
B.) Activity intolerance r/t muscle weakness
C.) Fluid volume excess r/t intake greater that output
D.) Risk for impaired skin integrity r/t generalized edema

18.) A client admitted with a pheochrocytoma returns from the operating room after adrenalectomy. The nurse should carefully assess this client for:
A.) Hypokalemia
B.) Hyperglycemia
C.) Marked Na and water intake
D.) Marked fluctuations in BP

19.) When caring for client in thyroid crisis, the nurse would question an order for:
A.) IV fluid
B.) Propanolol (Inderal)
C.) Prophylthiouracil
D.) A hyperthermia blanket

20.) A client is prescribed levothyroxine (Synthroid) daily. The most important instruction to give the client for administration of this drug is:
A.) Taper dose and discontinue if mental and emotional statuses stabilize
B.) Take it at bedtime to avoid the side effects of nausea and flatus
C.) Call the M.D. immediately at the onset of palpitations or nervousness
D.) Decrease intake of juices and fruits with high potassium and calcium contents

21.) The nurse would question which medication order for a client with acute-angled glaucoma?
A.) Atropine (Atrposil) 1-2 drops in each eye now
B.) Hydrochloride (Diuril) 25 mg PO daily
C.) Propanolol (Inderal) 20 mg PO 2 times a day
D.) Carbanyl choline (Isopto carbachol) eye drops; 1 drop 2 times a day

22.) A client tells you she has heard that glaucoma may be a hereditary problem and she is concerned about her adult children. What is the best response?
A.) “There is no need for concern; glaucoma is not hereditary order.”
B.) “Screening for glaucoma should be included in an annual eye exam for everyones over 50.”
C.) “There may be a genetic factor with glaucoma and your children over 30 y/o should be screened yearly.”
D.) “Are your grandchildren complaining of any eye problems? Glaucoma generally skips a generation.”

23.) What will be important to include in the nursing care for the client with angle-closure glaucoma?
A.) Evaluation of medications to determine if any of them cause an increase in IOP is a side effect.
B.) Observation for an increase in loss of vision; it can be reversed if promptly identified.
C.) Control BP to decrease the client’s potential loss of peripheral vision.
D.) Assessment for a level of discomfort; the client may experience considerable pain until the optic nerve atrophies

24.) A child is scheduled for a myringotomy. What goal of this procedure will the nurse discuss with the parents?
A.) Promote drainage from the ear
B.) Irrigate the Eustachian tube
C.) Correct a malformation in the inner ear
D.) Equalize pressure on the tympanic membrane

25.) After a client’s eye has been anesthetized, what instructions will be important for the nurse to give the client?
A.) Do not watch TV for at least one day
B.) Do not rub the eye for 15-20 minutes
C.) Irrigate the eye every hour to prevent dryness
D.) Wear sunglasses when in direct sunlight for the next 6 hours

26.) A child diagnosed with conjunctivitis. Which statement reflects that the child understood the nurse’s teaching?
A.) “It’s okay for me to let my friends use my sunglasses while we are playing together.”
B.) “It’s okay for me to softly rub my eye, as long as I use the back of my hand.”
C.) “I can pick the crustly stuff out of my eyelashes with my fingers when I wake up in the morning.”
D.) “I will use my own washrag and towel while my eyes are sick.”

27.) What medication would the nurse anticipate giving a client with Meniere’s dse?
A.) Nifedipine
B.) Amoxicillin
C.) Propanolol
D.) Hydrochloride (Hydro DIURIL)

28.) When teaching a family and a client about the use of a hearing aid, the nurse will base the teaching on what information regarding the hearing aid?
A.) Provides mechanical transmission for damaged part of the ear
B.) Stimulates the neural network of the inner ear to amplify sound
C.) Amplifies sound but does not improve the ability to hear
D.) Tunes out extraneous noise in the lower-frequency sound spectrum

29.) What statement by the client recovering from cataract surgery would indicate to the nurse need for additional teaching?
A.) “I’ll call if I have a significant amount of pain.”
B.) “I’ll continue to take my Metamucil for another week.”
C.) “I’ll just do some laundry this afternoon instead of going to work.”
D.) “I’ll take my acetazolamide (Diamox) drops with my other morning medications

30.) A client is walking down the hall and begins to experience vertigo. What is the most important nursing action when this occurs?
A.) Have the client sit in a chair and lower his head
B.) Administer meclizine (Antivert) PO
C.) Assist the client to sit or lie down
D.) Assess if the occurrence is vertigo or dizziness

31.) Which client is at highest risk for retinal detachment?
A.) 4-year old with amblyopia
B.) 17 y/o who plays physical contact
C.) 33 y/o with severe ptosis and diplopia
D.) 72 y/o with nystagmus and Bell’s palsy

32.) To promote and maintain safety for a client after a stapedectomy. What would be included in the nursing care plan?
A.) Implement fall precautions
B.) Prevent aspirations
C.) Begin oxygen 2-4L/min via nasal cannula
D.) Change inner ear dressing when saturated

33.) The nurse would question the administration of which eye drop in a patient with increased ICP?
A.) Artificial tears
B.) Betaxolol (Betoptic)
C.) Acetazolamide (Diamox)
D.) Epinephrine HCL (Epirate)

34.) A client is being admitted for problems with Meniere’s disease. What is most important to the nurse to assess?
A.) Diet history
B.) Screening hearing test
C.) Effect on client’s activities of daily living (ADLs)
D.) Frequency and severity

35.) A client calls the nurse regarding an accident that just occurred during which an unknown chemical was splashed in his eyes. What is the most important for the nurse to tell the client to do immediately?
A.) Rinse the eye with large amount of water or saline solution
B.) Put a pad soaked in the sterile saline solution over the eye
C.) Go to the closest emergency room
D.) Have a co-worker visually checks the eye for a foreign body

36.) A 25- year old woman comes to the clinic complaining of dizziness, weakness and palpitations. What will be important for the nurse to initially evaluate when obtaining the health history?
A.) Activity and exercise patterns
B.) Nutritional patterns
C.) Family health status
D.) Coping and stress tolerance


37.) A child with leukemia is being discharged after beginning chemotherapy. What instructions will the nurse include in the teaching plan for the parents of this child?
A.) Provide a diet low in protein and high in carbohydrates
B.) Avoid fresh vegetables that are not cooked or peeled
C.) Notify the M.D. if the child’s temperature exceeds 101F (39C)
D.) Increase the use of humidifiers throughout the house

38.) Which client is most likely to have iron deficiency anemia?
A.) A client with cancer receiving radiation therapy twice a week
B.) A toddler whose primary nutritional intake is milk
C.) A client with peptic ulcer who had surgery 6 weeks ago
D.) A 15-year old client in sickle cell crisis

39.) A client has an order for one unit of whole blood. What is a correct nursing action?
A.) Initiate an IV with 5% dextrose in water (D5W) to maintain a patent access site
B.) Initiate the transfusion within 30 minutes of receiving the blood
C.) Monitor the client’s vital signs for the first 5 minutes
D.) Monitor V/S every 2 hours during the transfusion

40.) The nurse is caring for a client who is receiving a blood transfusion. The transfusion was started 30 mins ago at a rate of 100 ml/hr. The client begins to complain of low back pain and headache and is increasing restless, what is the first nursing action?
A.) Slow the infusion and evaluate the V/S and client’s history of transfusion reaction
B.) Stop the transfusion, disconnect the blood tubing and begin a primary infusion of normal saline solution
C.) Stop the infusion of blood and begin infusion of NSS from the Y connector
D.) Recheck the unit of blood for correct identification numbers and cross-match information

41.) The nurse is preparing to start an IV infusion before the administration of a unit of packed red blood cells, what fluid will the nurse select to maintain the infusion before hanging the unit of blood?
A.) D5W
B.) D5W/.45NaCl
C.) LR solution
D.) .9% Na Cl

42.) A client in sickle cell crisis is admitted to the emergency department what are the priorities of care?
A.) Nutrition, hydration, electrolyte balance
B.) Hydration, pain management, electrolyte balance
C.) Hydration, oxygenation, apin management
D.) Hydration, oxygenation, electrolyte balance

43.) A client in the ICU has been diagnosed with DIC. The nurse will anticipate administering which of the following fluids?
A.) Packed RBC
B.) Fresh Frozen plasma (FFP)
C.) Volume expanders, such as D10W
D.) Whole blood

44.) The nurse is assessing a client who has been given a diagnosis of polycythemia vera. What characteristics will the nurse anticipate finding when assessing this client?
A.) Increased fatigue and bleeding tendencies
B.) Hemoglobin below 13 mg/dl
C.) Headaches, dyspnea, claudication
D.) Back pain, ecchymosis, and joint tenderness

45.) A client has been diagnosed with pernicious anemia what will the nurse teach this client regarding medication he will need to take after he goes home?
A.) Monthly Vit. B12 injections will be necessary
B.) Ferrous sulfate PO daily will be prescribed
C.) Coagulation studies are important to evaluate medications
D.) Decrease intake of leafy green vegetables because of increased Vit. K

46.) First postop day after a right lower lobe (RLL) lobectomy, the client breathes and coughs but has difficulty raising mucus. What indicates that the client is not adequately clearing secretions?
A.) Chest x-ray film shows right sided pleural fluid
B.) A few scattered crackles on RLL on auscultation
C.) PCO2 increases from 35-45 mm Hg
D.) Decrease in forced vital capacity

47.) What nursing observations indicate that the cuff on an endotracheal tube is leaking?
A.) An increase in peak pressure on the ventilator
B.) Client is able to speak
C.) Increased swallowing efforts by client
D.) Increased crackles (rales) over left lung field

48.) The client with COPD is to be discharged home while receiving continuous oxygen at a rate of 2 L/min via cannula. What information does the nurse provide to the client and his wife regarding the use of oxygen at home?
A.) Because of his need for oxygen, the client will have to limit activity at home
B.) The use of oxygen will eliminate the client’s shortness of breath
C.) Precautions are necessary because oxygen can spontaneously ignite and explode
D.) Use oxygen during activity to relieve the strain on the client’s heart


49.) The wife of a client with COPD is worried about caring for her husband at home. Which statement by the nurse provides the most valid information?
A.) “You should avoid emotional situations that increase his shortness of breathe.”
B.) “Help your husband arrange activities so that he does as little walking as possible.”
C.) “Arrange a schedule so your husband does all necessary activities before noon; then he can rest during the afternoon and evening.”
D.) “Your husband will be no more short of breath when he walks but that will not hurt him.”

50.) Which statement correctly describes suctioning through an endotracheal tube
A.) The catheter is inserted into the endotracheal tube; intermittent suction is applied until no further secretions are retrieved; the catheter is then withdrawn.
B.) The catheter is inserted through the nose, and the upper airway is suctioned; the catheter is then removed from the upper airway and inserted into the endotracheal tube to suction the lower airway
C.) With suction applied, the catheter is inserted into the endotracheal tube; when resistance is met, the catheter is slowly withdrawn
D.) The catheter is inserted into the endotracheal tube to a point of resistance, and intermittent suction is applied during withdrawal.

51.) The primary problem in cataract is:
A.) Blurring of vision
B.) Loss of peripheral vision
C.) Presence of floaters
D.) Halos around light

52.) The primary reason for performing iridectomy after cataract extraction is:
A.) To prevent secondary glaucoma
B.) To improve the vision of the client
C.) To prevent postop hemorrhage
D.) To reduce eye discomfort

53.) Pterygium is caused primarily by:
A.) Exposure to sunlight
B.) Exposure to dust
C.) Exposure to wind
D.) Exposure to chemicals

54.) The surgical procedure which involves removal of the eyeball is:
A.) Enucleation
B.) Evisceration
C.) Exanteration
D.) Extraction

55.) A sterile chronic granulomatous inflammation of the meibomian gland is:
A.) Chalazion
B.) Hordeulum
C.) Uveitis
D.) Keratoconjunctivitis

56.) The following are nursing interventions for a blind person EXCEPT:
A.) When approaching the client, talk before touching
B.) Orient the client to the environment
C.) When assisting the client during ambulation, the nurse stays beside the client
D.) Promote the independence in activities of daily living

57.) Otosclerosis is characterized by:
A.) Increased endolymphatic pressure
B.) Replacement of normal bones by spongy and highly-vascularized bones and the stapes become fixed with the oval window
C.) Rupture of the tympanic membrane
D.) Damage of the labyrinth or acoustic nerve

58.) Hyperopia is corrected with that type of lens?
A.) Concave lens
B.) Convex lens
C.) Aphakic lens
D.) Bifocal lens

59.) The following are appropriate nursing interventions after cataract extraction EXCEPT:
A.) Place the client in supine position or turn towards unoperated side
B.) Advise the client to avoid bending, stooping or lifting heavy objects for several weeks postop
C.) Instruct the client to limit fluid intake
D.) Advise the client to protect his eyes with eye pad and eye shield for a week

60.) The client with retinal detachment would least likely manifest which of the following signs & symptoms:
A.) Floating spots before the eyes
B.) Flashes of light
C.) Progressive constriction of vision in one area
D.) Pain in the eye

61.) In acute glaucoma, the obstruction to the flow of aqueous humor is caused by:
A.) Thickening of the trabecular meshwork
B.) Displacement of the iris
C.) Narrowing of the canal schlemm
D.) Constriction of the pupil
62.) Which of the following is true about glaucoma?
A.) It is characterized by irreversible blindness
B.) It is treated with mydriatics
C.) The IOP is 14-21mmHg
D.) Central vision is lost initially, followed by the peripheral vision

63.) The following drugs maybe administered to the client with glaucoma EXCEPT:
A.) Diamox (Acetazolamide)
B.) Pilocarpine
C.) Atropine SO4
D.) Timolol maleate

64.) The client with retinal detachment had undergone scleral buckling. The following are appropriate nursing interventions EXCEPT:
A.) Position the client with the area of detachment dependent
B.) Cover the eyes with pressure dressing
C.) Advise the client to avoid reading for few weeks
D.) Encourage the client to increase fluid intake

65.) Which of the following is the most characteristic manifestation of Meniere’s Dse?
A.) Tinnitus
B.) Headache
C.) Vertigo
D.) Nausea and Vomiting

66.) The diet of the client with Meniere’s disease should be:
A.) Low-Protein
B.) Low-fats
C.) Low-potassium
D.) Low-Sodium

67.) Which of the following is inappropriate nursing intervention for the client with hearing impairment:
A.) Talk in clearly enunciated words using normal tone of voice
B.) Talk directly in front of the client
C.) Use speech with gestures
D.) Use high-pitch voice

68.) Which of the following dx tests compare air conduction with bone conduction
A.) Rinne’s test
B.) Weber’s test
C.) Barany’s Rotation Test
D.) Caloric Ice Test

69.) A client who had cataract should be told to call his MD if he has which of the following situations?
A.) Blurred Vision
B.) Eye Pain
C.) Glare
D.) Itching

70.) The following are appropriate nursing interventions after ear surgery EXCEPT:
A.) Position the client on the operated side
B.) Instruct the client not to blow the nose for at least 2 weeks
C.) Observe for signs and symptoms of 7th cranial nerve damage
D.) Advise the client against wathing TV or fast-moving objects for few weeks postop

71.) Which of the ff test assesses visual acuity
A.) Snellen’s Test
B.) Ishihara Plate
C.) Retinoscopy
D.) Tonometry

72.) Which of the following nursing interventions has priority when a client has a foreign body protruding from the eye?
A.) Irrigate the eye with sterile saline
B.) Assess visual acuity with snellen’s chart
C.) Remove the foreign body with sterile gauze
D.) Patch both eyes until seen by Opthalmologist

73.) A client is diagnosed with Meniere’s disease. Which of the following nursing diagnosis should take priority for the client?
A.) Altered body image
B.) Risk for injury
C.) Impaired social interaction
D.) Ineffective coping

74.) The following are characteristics of conductive hearing loss EXCEPT:
A.) The client hears better in a noisy environment
B.) The client talks in a loud voice
C.) The client hears and understands telephone conversation well
D.) The external or the middle ear is damaged

75.) It is an eye disorder characterized by lessening of the effective powers of accommodation:
A.) Myopia
B.) Presbyopia
C.) Hypertropia
D.) Presbycusis

76.) The following drugs dilate the pupils EXCEPT:
A.) Atropine SO4
B.) Neosynephrine
C.) Scopolamine
D.) Pilocarpine


ANSWERS

Medical Surgical practice test 5

MS-5- Questions

1. Following surgery, Gerald Anderson complains of mild incisional pain while performing deep- breathing and coughing exercises. The nurse’s best response would be:

A. “Pain will become less each day.”
B. “This is a normal reaction after surgery.”
C. “With a pillow, apply pressure against the incision.”
D. “I will give you the pain medication the physician ordered.”

2. The nurse needs to carefully assess the complaint of pain of the elderly because older people

A. are expected to experience chronic pain
B. have a decreased pain threshold
C. experience reduced sensory perception
D. have altered mental function

3. Marimar received AtropineSO4 as a pre-medication 30 minutes ago and is now complaining of dry mouth and her PR is higher, than before the medication was administered. The nurse’s best

A. The patient is having an allergic reaction to the drug.
B. The patient needs a higher dose of this drug
C. This is normal side-effect of AtSO4
D. The patient is anxious about upcoming surgery

4. Ana’s postoperative vital signs are a blood pressure of 80/50 mm Hg, a pulse of 140, and respirations of 32. Suspecting shock, which of the following orders would the nurse question?

A. Put the client in modified Trendelenberg's position.
B. Administer oxygen at 100%.
C. Monitor urine output every hour.
D. Administer Demerol 50mg IM q4h

5. Mr. Pablo, diagnosed with Bladder Cancer, is scheduled for a cystectomy with the creation of an ileal conduit in the morning. He is wringing his hands and pacing the floor when the nurse enters his room. What is the best approach?

A. "Good evening, Mr. Pablo. Wasn't it a pleasant day, today?"
B. "Mr, Pablo, you must be so worried, I'll leave you alone with your thoughts.
C. “Mr. Pablo, you'll wear out the hospital floors and yourself at this rate."
D. "Mr. Pablo, you appear anxious to me. How are you feeling about tomorrow's surgery?"

6. After surgery, Gina returns from the Post-anesthesia Care Unit (Recovery Room) with a nasogastric tube in place following a gall bladder surgery. She continues to complain of nausea. Which action would the nurse take?

A. Call the physician immediately.
B. Administer the prescribed antiemetic.
C. Check the patency of the nasogastric tube for any obstruction.
D. Change the patient’s position.

7. Mr. Perez is in continuous pain from cancer that has metastasized to the bone. Pain medication provides little relief and he refuses to move. The nurse should plan to:

A. Reassure him that the nurses will not hurt him
B. Let him perform his own activities of daily living
C. Handle him gently when assisting with required care
D. Complete A.M. care quickly as possible when necessary

8. A client returns from the recovery room at 9AM alert and oriented, with an IV infusing. His pulse is 82, blood pressure is 120/80, respirations are 20, and all are within normal range. At 10 am and at 11 am, his vital signs are stable. At noon, however, his pulse rate is 94, blood pressure is 116/74, and respirations are 24. What nursing action is most appropriate?

A. Notify his physician.
B. Take his vital signs again in 15 minutes.
C. Take his vital signs again in an hour.
D. Place the patient in shock position.

9. A 56 year old construction worker is brought to the hospital unconscious after falling from a 2-story building. When assessing the client, the nurse would be most concerned if the assessment revealed:

A. Reactive pupils
B. A depressed fontanel
C. Bleeding from ears
D. An elevated temperature

10. Which of the ff. statements by the client to the nurse indicates a risk factor for CAD?

A. “I exercise every other day.”
B. “My father died of Myasthenia Gravis.”
C. “My cholesterol is 180.”
D. “I smoke 1 1/2 packs of cigarettes per day.”

11. Mr. Braga was ordered Digoxin 0.25 mg. OD. Which is poor knowledge regarding this drug?

A. It has positive inotropic and negative chronotropic effects
B. The positive inotropic effect will decrease urine output
C. Toxixity can occur more easily in the presence of hypokalemia, liver and renal problems
D. Do not give the drug if the apical rate is less than 60 beats per minute.



12. Valsalva maneuver can result in bradycardia. Which of the following activities will not stimulate Valsalva's maneuver?

A. Use of stool softeners.
B. Enema administration
C. Gagging while toothbrushing.
D. Lifting heavy objects

13. The nurse is teaching the patient regarding his permanent artificial pacemaker. Which information
given by the nurse shows her knowledge deficit about the artificial cardiac pacemaker?

A. take the pulse rate once a day, in the morning upon awakening
B. may be allowed to use electrical appliances
C. have regular follow up care
D. may engage in contact sports

14. A patient with angina pectoris is being discharged home with nitroglycerine tablets. Which of the
following instructions does the nurse include in the teaching?

A. “When your chest pain begins, lie down, and place one tablet under your tongue. If the pain continues, take another tablet in 5 minutes.”
B. “Place one tablet under your tongue. If the pain is not relieved in 15 minutes, go to the hospital.”
C. “Continue your activity, and if the pain does not go away in 10 minutes, begin taking the nitro tablets one every 5 minutes for 15 minutes, then go lie down.”
D. “Place one Nitroglycerine tablet under the tongue every five minutes for three doses. Go to the hospital if the pain is unrelieved.

15. A client with chronic heart failure has been placed on a diet restricted to 2000mg. of sodium per day. The client demonstrates adequate knowledge if behaviors are evident such as not salting food and avoidance of which food?

A. Whole milk
B. Canned sardines
C. Plain nuts
D. Eggs

16. A student nurse is assigned to a client who has a diagnosis of thrombophlebitis. Which action by this team member is most appropriate?

A. Apply a heating pad to the involved site.
B. Elevate the client's legs 90 degrees.
C. Instruct the client about the need for bed rest.
D. Provide active range-of-motion exercises to both legs at least twice every shift.


17. A client receiving heparin sodium asks the nurse how the drug works. Which of the following points would the nurse include in the explanation to the client?

A. It dissolves existing thrombi.
B. It prevents conversion of factors that are needed in the formation of clots.
C. It inactivates thrombin that forms and dissolves existing thrombi.
D. It interferes with vitamin K absorption.

18. The nurse is conducting an education session for a group of smokers in a “stop smoking” class. Which finding would the nurse state as a common symptom of lung cancer? :

A. Dyspnea on exertion
B. Foamy, blood-tinged sputum
C. Wheezing sound on inspiration
D. Cough or change in a chronic cough

19. Which is the most relevant knowledge about oxygen administration to a client with COPD?

A. Oxygen at 1-2L/min is given to maintain the hypoxic stimulus for breathing.
B. Hypoxia stimulates the central chemoreceptors in the medulla that makes the client breath.
C. Oxygen is administered best using a non-rebreathing mask
D. Blood gases are monitored using a pulse oximeter.

20. When suctioning mucus from a client's lungs, which nursing action would be least appropriate?

A. Lubricate the catheter tip with sterile saline before insertion.
B. Use sterile technique with a two-gloved approach
C. Suction until the client indicates to stop or no longer than 20 second
D. Hyperoxygenate the client before and after suctioning

21. Dr. Santos prescribes oral rifampin (Rimactane) and isoniazid (INH) for a client with a positive Tuberculin skin test. When informing the client of this decision, the nurse knows that the purpose of this choice of treatment is to

A. Cause less irritation to the gastrointestinal tract
B. Destroy resistant organisms and promote proper blood levels of the drugs
C. Gain a more rapid systemic effect
D. Delay resistance and increase the tuberculostatic effect

22. Mario undergoes a left thoracotomy and a partial pneumonectomy. Chest tubes are inserted, and one-bottle water-seal drainage is instituted in the operating room. In the
postanesthesia care unit Mario is placed in Fowler's position on either his right
side or on his back to

A. Reduce incisional pain.
B. Facilitate ventilation of the left lung.
C. Equalize pressure in the pleural space.
D. Increase venous return

23. A client with COPD is being prepared for discharge. The following are relevant instructions to the client regarding the use of an oral inhaler EXCEPT

A. Breath in and out as fully as possible before placing the mouthpiece inside the mouth.
B. Inhale slowly through the mouth as the canister is pressed down
C. Hold his breath for about 10 seconds before exhaling
D. Slowly breath out through the mouth with pursed lips after inhaling the drug.

24. A client is scheduled for a bronchoscopy. When teaching the client what to expect afterward, the nurse's highest priority of information would be
A. Food and fluids will be withheld for at least 2 hours.
B. Warm saline gargles will be done q 2h.
C. Coughing and deep-breathing exercises will be done q2h.
D. Only ice chips and cold liquids will be allowed initially.

25. The nurse enters the room of a client with chronic obstructive pulmonary disease. The client's nasal cannula oxygen is running at a rate of 6 L per minute, the skin color is pink, and the respirations are 9 per minute and shallow. What is the nurse’s best initial action?

A. Take heart rate and blood pressure.
B. Call the physician.
C. Lower the oxygen rate.
D. Position the client in a Fowler's position.

26. The nurse is preparing her plan of care for her patient diagnosed with pneumonia. Which is the most appropriate nursing diagnosis for this patient?

A. Fluid volume deficit
B. Decreased tissue perfusion.
C. Impaired gas exchange.
D. Risk for infection

27. A nurse at the weight loss clinic assesses a client who has a large abdomen and a rounded face. Which additional assessment finding would lead the nurse to suspect that the client has Cushing’s syndrome rather than obesity?

A. large thighs and upper arms
B. pendulous abdomen and large hips
C. abdominal striae and ankle enlargement
D. posterior neck fat pad and thin extremities

28. Which statement by the client indicates understanding of the possible side effects of Prednisone therapy?

A. “I should limit my potassium intake because hyperkalemia is a side-effect of this drug.”
B. “I must take this medicine exactly as my doctor ordered it. I shouldn’t skip doses.”
C. “This medicine will protect me from getting any colds or infection.”
D. “My incision will heal much faster because of this drug.”

29. A client, who is suspected of having Pheochromocytoma, complains of sweating, palpitation and headache. Which assessment is essential for the nurse to make first?

A. Pupil reaction
B. Hand grips
C. Blood pressure
D. Blood glucose

30. The nurse is attending a bridal shower for a friend when another guest, who happens to be a diabetic, starts to tremble and complains of dizziness. The next best action for the nurse to take is to:
A. Encourage the guest to eat some baked macaroni
B. Call the guest’s personal physician
C. Offer the guest a cup of coffee
D. Give the guest a glass of orange juice

31. An adult, who is newly diagnosed with Graves disease, asks the nurse, “Why do I need to take
Propanolol (Inderal)?” Based on the nurse’s understanding of the medication and Grave’s
disease, the best response would be:

A. “The medication will limit thyroid hormone secretion.”
B. “The medication limit synthesis of the thyroid hormones.”
C. “The medication will block the cardiovascular symptoms of Grave’s disease.”
D. “The medication will increase the synthesis of thyroid hormones.”

32. During the first 24 hours after thyroid surgery, the nurse should include in her care:

A. Checking the back and sides of the operative dressing
B. Supporting the head during mild range of motion exercise
C. Encouraging the client to ventilate her feelings about the surgery
D. Advising the client that she can resume her normal activities immediately

33. On discharge, the nurse teaches the patient to observe for signs of surgically induced hypothyroidism. The nurse would know that the patient understands the teaching when she states she should notify the MD if she develops:

A. Intolerance to heat
B. Dry skin and fatigue
C. Progressive weight gain
D. Insomnia and excitability


34. What is the best reason for the nurse in instructing the client to rotate injection sites for insulin?

A. Lipodystrophy can result and is extremely painful
B. Poor rotation technique can cause superficial hemorrhaging
C. Lipodystrophic areas can result, causing erratic insulin absorption rates from these
D. Injection sites can never be reused

35. Which of the following would be inappropriate to include in a diabetic teaching plan?

A. Change position hourly to increase circulation
B. Inspect feet and legs daily for any changes
C. Keep legs elevated on 2 pillows while sleeping
D. Keep the insulin not in use in the refrigerator

36. Included in the plan of care for the immediate post-gastroscopy period will be:

A. Maintain NGT to intermittent suction
B. Assess gag reflex prior to administration of fluids
C. Assess for pain and medicate as ordered
D. Measure abdominal girth every 4 hours

36. Included in the plan of care for the immediate post-gastroscopy period will be:

A. Maintain NGT to intermittent suction
B. Assess gag reflex prior to administration of fluids
C. Assess for pain and medicate as ordered
D. Measure abdominal girth every 4 hours

37. Which description of pain would be most characteristic of a duodenal ulcer?

A. Gnawing, dull, aching, hungerlike pain in the epigastric area that is relieved by food intake
B. RUQ pain that increases after meal
C. Sharp pain in the epigastric area that radiates to the right shoulder
D. A sensation of painful pressure in the midsternal area

38. The client underwent Billroth surgery for gastric ulcer. Post-operatively, the drainage from his NGT is thick and the volume of secretions has dramatically reduced in the last 2 hours and the client feels like vomiting. The most appropriate nursing action is to:

A. Reposition the NGT by advancing it gently NSS
B. Notify the MD of your findings
C. Irrigate the NGT with 50 cc of sterile
D. Discontinue the low-intermittent suction

39. After Billroth II Surgery, the client developed dumping syndrome. Which of the following should
the nurse exclude in the plan of care?

A. Sit upright for at least 30 minutes after meals
B. Take only sips of H2O between bites of solid food
C. Eat small meals every 2-3 hours
D. Reduce the amount of simple carbohydrate in the diet

40. The laboratory of a male patient with Peptic ulcer revealed an elevated titer of Helicobacter pylori.
Which of the following statements indicate an understanding of this data?

A. Treatment will include Ranitidine and Antibiotics
B. No treatment is necessary at this time
C. This result indicates gastric cancer caused by the organism
D. Surgical treatment is necessary

41. What instructions should the client be given before undergoing a paracentesis?

A. NPO 12 hours before procedure
B. Empty bladder before procedure
C. Strict bed rest following procedure
D. Empty bowel before procedure

42. The husband of a client asks the nurse about the protein-restricted diet ordered because of advanced liver disease. What statement by the nurse would best explain the purpose of the diet?

A. “The liver cannot rid the body of ammonia that is made by the breakdown of protein in the digestive system.”
B. “The liver heals better with a high carbohydrates diet rather than protein.”
C. “Most people have too much protein in their diets. The amount of this diet is better for liver healing.”
D. “Because of portal hyperemesis, the blood flows around the liver and ammonia made from protein collects in the brain causing hallucinations.”

43. Which of the drug of choice for pain controls the patient with acute pancreatitis?

A. Morphine
B. NSAIDS
C. Meperidine
D. Codeine

44. Immediately after cholecystectomy, the nursing action that should assume the highest priority is:

A. encouraging the client to take adequate deep breaths by mouth
B. encouraging the client to cough and deep breathe
C. changing the dressing at least BID
D. irrigate the T-tube frequently

45. A Sengstaken-Blakemore tube is inserted in the effort to stop the bleeding esophageal varices in a patient with complicated liver cirrhosis. Upon insertion of the tube, the client complains of difficulty of breathing. The first action of the nurse is to:

A. Deflate the esophageal balloon
B. Monitor VS
C. Encourage him to take deep breaths
D. Notify the MD

46. The client presents with severe rectal bleeding, 16 diarrheal stools a day, severe abdominal pain, tenesmus and dehydration. Because of these symptoms the nurse should be alert for other problems associated with what disease?

A. Chrons disease
B. Ulcerative colitis
C. Diverticulitis
D. Peritonitis

47. A client is being evaluated for cancer of the colon. In preparing the client for barium enema, the nurse should:

A. Give laxative the night before and a cleansing enema in the morning before the test
B. Render an oil retention enema and give laxative the night before
C. Instruct the client to swallow 6 radiopaque tablets the evening before the study
D. Place the client on CBR a day before the study

48. The client has a good understanding of the means to reduce the chances of colon cancer when
he states:

A. “I will exercise daily.”
B. “I will include more red meat in my diet.”
C. “I will have an annual chest x-ray.”
D. “I will include more fresh fruits and vegetables in my diet.”

49. Days after abdominal surgery, the client’s wound dehisces. The safest nursing intervention when
this occurs is to

A. Cover the wound with sterile, moist saline dressing
B. Approximate the wound edges with tapes
C. Irrigate the wound with sterile saline
D. Hold the abdominal contents in place with a sterile gloved hand



50. An intravenous pyelogram reveals that Paulo, age 35, has a renal calculus. He is believed to have a small stone that will pass spontaneously. To increase the chance of the stone passing, the nurse would instruct the client to force fluids and to

A. Strain all urine.
B. Ambulate.
C. Remain on bed rest.
D. Ask for medications to relax him.

51. A female client is admitted with a diagnosis of acute renal failure. She is awake, alert, oriented, and complaining of severe back pain, nausea and vomiting and abdominal cramps. Her vital signs are blood pressure 100/70 mm Hg, pulse 110, respirations 30, and oral temperature 100.4°F (38°C). Her electrolytes are sodium 120 mEq/L, potassium 5.2 mEq/L; her urinary output for the first 8 hours is 50 ml. The client is displaying signs of which electrolyte imbalance?

A. Hyponatremia
B. Hyperkalemia
C. Hyperphosphatemia
D. Hypercalcemia

52. Assessing the laboratory findings, which result would the nurse most likely expect to find in a
client with chronic renal failure?


A. BUN 10 to 30 mg/dl, potassium 4.0 mEq/L, creatinine 0.5 to 1.5 mg/dl
B. Decreased serum calcium, blood pH 7.2, potassium 6.5 mEq/L
C. BUN 15 mg/dl, increased serum calcium, creatinine l.0 mg/dl
D. BUN 35 to 40 mg/dl, potassium 3.5 mEq/L, pH 7.35, decreased serum calcium

53. Treatment with hemodialysis is ordered for a client and an external shunt is created. Which nursing action would be of highest priority with regard to the external shunt?

A. Heparinize it daily.
B. Avoid taking blood pressure measurements or blood samples from the affected arm.
C. Change the Silastic tube daily.
D. Instruct the client not to use the affected arm.

54. Romeo Diaz, age 78, is admitted to the hospital with the diagnosis of benign prostatic hyperplasia (BPH). He is scheduled for a transurethral resection of the prostate (TURP). It would be inappropriate to include which of the following points in the preoperative teaching?

A. TURP is the most common operation for BPH.
B. Explain the purpose and function of a two-way irrigation system.
C. Expect bloody urine, which will clear as healing takes place.
D. He will be pain free.

55. Roxy is admitted to the hospital with a possible diagnosis of appendicitis. On physical examination, the nurse should be looking for tenderness on palpation at McBurney’s point, which is located in the

A. left lower quadrant
B. left upper quadrant
C. right lower quadrant
D. right upper quadrant

56. Mr. Valdez has undergone surgical repair of his inguinal hernia. Discharge teaching should include
A. telling him to avoid heavy lifting for 4 to 6 weeks
B. instructing him to have a soft bland diet for two weeks
C. telling him to resume his previous daily activities without limitations
D. recommending him to drink eight glasses of water daily

57. A 30-year-old homemaker fell asleep while smoking a cigarette. She sustained severe burns of the face,neck, anterior chest, and both arms and hands. Using the rule of nines, which is the best estimate of total body-surface area burned?

A. 18%
B. 22%
C. 31%
D. 40%

58. Nursing care planning is based on the knowledge that the first 24-48 hours post-burn are characterized by:

A. An increase in the total volume of intracranial plasma
B. Excessive renal perfusion with diuresis
C. Fluid shift from interstitial space
D. Fluid shift from intravascular space to the interstitial space

59. If a client has severe bums on the upper torso, which item would be a primary concern?

A. Debriding and covering the wounds
B. Administering antibiotics
C. Frequently observing for hoarseness, stridor, and dyspnea
D. Establishing a patent IV line for fluid replacement

60. Contractures are among the most serious long-term complications of severe burns. If a burn is located on the upper torso, which nursing measure would be least effective to help prevent contractures?

A. Changing the location of the bed or the TV set, or both, daily
B. Encouraging the client to chew gum and blow up balloons
C. Avoiding the use of a pillow for sleep, or placing the head in a position of hyperextension
D. Helping the client to rest in the position of maximal comfort

61. An adult is receiving Total Parenteral Nutrition (TPN). Which of the following assessment is essential?

A. evaluation of the peripheral IV site
B. confirmation that the tube is in the stomach
C. assess the bowel sound
D. fluid and electrolyte monitoring

62. Which drug would be least effective in lowering a client's serum potassium level?
A. Glucose and insulin
B. Polystyrene sulfonate (Kayexalate)
C. Calcium glucomite
D. Aluminum hydroxide

63. A nurse is directed to administer a hypotonic intravenous solution. Looking at the following labeled solutions, she should choose
A. 0.45% NaCl
B. 0.9% NaCl
C. D5W
D. D5NSS

64. A patient is hemorrhaging from multiple trauma sites. The nurse expects that compensatory mechanisms associated with hypovolemia would cause all of the following symptoms EXCEPT
A. hypertension
B. oliguria
C. tachycardia
D. tachypnea

65. Maria Sison, 40 years old, single, was admitted to the hospital with a diagnosis of Breast Cancer. She was scheduled for radical mastectomy. Nursing care during the preoperative period should consist of

A. assuring Maria that she will be cured of cancer
B. assessing Maria's expectations and doubts
C. maintaining a cheerful and optimistic environment
D. keeping Maria's visitors to a minimum so she can have time for herself

66. Maria refuses to acknowledge that her breast was removed. She believes that her breast is intact under the dressing. The nurse should

A. call the MD to change the dressing so Kathy can see the incision
B. recognize that Kathy is experiencing denial, a normal stage of the grieving process
C. reinforce Kathy’s belief for several days until her body can adjust to stress of surgery.
D. remind Kathy that she needs to accept her diagnosis so that she can begin rehabilitation exercises.

67. A chemotherapeutic agent 5FU is ordered as an adjunct measure to surgery. Which of the ff. statements about chemotherapy is true?
A. it is a local treatment affecting only tumor cells
B. it affects both normal and tumor cells
C. it has been proven as a complete cure for cancer
D. it is often used as a palliative measure.

68. Which is an incorrect statement pertaining to the following procedures for cancer diagnostics?

A. Biopsy is the removal of suspicious tissue and the only definitive method to diagnose cancer
B. Ultrasonography detects tissue density changes difficult to observe by X-ray via sound waves.
C. CT scanning uses magnetic fields and radio frequencies to provide cross-sectional view of tumor
D. Endoscopy provides direct view of a body cavity to detect abnormality.

69. A post-operative complication of mastectomy is lymphedema. This can be prevented by

A. ensuring patency of wound drainage tube
B. placing the arm on the affected side in a dependent position
C. restricting movement of the affected arm
D. frequently elevating the arm of the affected side above the level of the heart.

70. Which statement by the client indicates to the nurse that the patient understands precautions necessary during internal radiation therapy for cancer of the cervix?

A. “I should get out of bed and walk around in my room.”
B. “My 7 year old twins should not come to visit me while I’m receiving treatment.”
C. “I will try not to cough, because the force might make me expel the application.”
D. “I know that my primary nurse has to wear one of those badges like the people in the x-ray department, but they are not necessary for anyone else who comes in here.”

71. High uric acid levels may develop in clients who are receiving chemotherapy. This is caused by:

A. The inability of the kidneys to excrete the drug metabolites
B. Rapid cell catabolism
C. Toxic effect of the antibiotic that are given concurrently
D. The altered blood ph from the acid medium of the drugs

72. Which of the following interventions would be included in the care of plan in a client with cervical
implant?

A. Frequent ambulation
B. Unlimited visitors
C. Low residue diet
D. Vaginal irrigation every shift

73. Which nursing measure would avoid constriction on the affected arm immediately after mastectomy?

A. Avoid BP measurement and constricting clothing on the affected arm
B. Active range of motion exercises of the arms once a day.
C. Discourage feeding, washing or combing with the affected arm
D. Place the affected arm in a dependent position, below the level of the heart

74. A client suffering from acute renal failure has an unexpected increase in urinary output to 150ml/hr. The nurse assesses that the client has entered the second phase of acute renal failure. Nursing actions throughout this phase include observation for signs and symptoms of

A. Hypervolemia, hypokalemia, and hypernatremia.
B. Hypervolemia, hyperkalemia, and hypernatremia.
C. Hypovolemia, wide fluctuations in serum sodium and potassium levels.
D. Hypovolemia, no fluctuation in serum sodium and potassium levels.

75. An adult has just been brought in by ambulance after a motor vehicle accident. When assessing the client, the nurse would expect which of the following manifestations could have resulted from sympathetic nervous system stimulation?

A. A rapid pulse and increased RR
B. Decreased physiologic functioning
C. Rigid posture and altered perceptual focus
D. Increased awareness and attention

76. Ms. Sy undergoes surgery and the abdominal aortic aneurysm is resected and replaced with a graft. When she arrives in the RR she is still in shock. The nurse's priority should be

A. placing her in a trendeleburg position
B. putting several warm blankets on her
C. monitoring her hourly urine output
D. assessing her VS especially her RR

77. A major goal for the client during the first 48 hours after a severe bum is to prevent hypovolemic shock. The best indicator of adequate fluid balance during this period is

A. Elevated hematocrit levels.
B. Urine output of 30 to 50 ml/hr.
C. Change in level of consciousness.
D. Estimate of fluid loss through the burn eschar.

78. A thoracentesis is performed on a chest-injured client, and no fluid or air is found. Blood and fluids is administered intravenously (IV), but the client's vital signs do not improve. A central venous pressure line is inserted, and the initial reading is 20 cm H^O. The most likely cause of these findings is which of the following?

A. Spontaneous pneumothorax
B. Ruptured diaphragm
C. Hemothorax
D. Pericardial tamponade

79. Intervention for a pt. who has swallowed a Muriatic Acid includes all of the following except

A. administering an irritant that will stimulate vomiting
B. aspirating secretions from the pharynx if respirations are affected
C. neutralizing the chemical
D. washing the esophagus with large volumes of water via gastric lavage

80. Which initial nursing assessment finding would best indicate that a client has been successfully resuscitated after a cardio-respiratory arrest?
A. Skin warm and dry
B. Pupils equal and react to light
C. Palpable carotid pulse
D. Positive Babinski's reflex

81. Chemical burn of the eye are treated with
A. local anesthetics and antibacterial drops for 24 – 36 hrs.
B. hot compresses applied at 15-minute intervals
C. Flushing of the lids, conjunctiva and cornea with tap or preferably sterile water
D. cleansing the conjunctiva with a small cotton-tipped applicator

82. The Heimlich maneuver (abdominal thrust), for acute airway obstruction, attempts to:

A. Force air out of the lungs
B. Increase systemic circulation
C. Induce emptying of the stomach
D. Put pressure on the apex of the heart


83. John, 16 years old, is brought to the ER after a vehicular accident. He is pronounced dead on arrival. When his parents arrive at the hospital, the nurse should:

A. ask them to stay in the waiting area until she can spend time alone with them
B. speak to both parents together and encourage them to support each other and express their emotions freely
C. Speak to one parent at a time so that each can ventilate feelings of loss without upsetting the other
D. ask the MD to medicate the parents so they can stay calm to deal with their son’s death.

84. An emergency treatment for an acute asthmatic attack is Adrenaline 1:1000 given hypodermically. This is given to:

A. increase BP
B. decrease mucosal swelling
C. relax the bronchial smooth muscle
D. decrease bronchial secretions

85. A nurse is performing CPR on an adult patient. When performing chest compressions, the nurse understands the correct hand placement is located over the

A. upper half of the sternum
B. upper third of the sternum
C. lower half of the sternum
D. lower third of the sternum

86. The nurse is performing an eye examination on an elderly client. The client states ‘My vision is blurred, and I don’t easily see clearly when I get into a dark room.” The nurse best response is:

A. “You should be grateful you are not blind.”
B. “As one ages, visual changes are noted as part of degenerative changes. This is normal.”
C. “You should rest your eyes frequently.”
D. “You maybe able to improve you vision if you move slowly.”

87. Which of the following activities is not encouraged in a patient after an eye surgery?

A. sneezing, coughing and blowing the nose
B. straining to have a bowel movement
C. wearing tight shirt collars
D. sexual intercourse

88. Which of the following indicates poor practice in communicating with a hearing-impaired client?

A. Use appropriate hand motions
B. Keep hands and other objects away from your mouth when talking to the client
C. Speak clearly in a loud voice or shout to be heard
D. Converse in a quiet room with minimal distractions

89. A client is to undergo lumbar puncture. Which is least important information about LP?

A. Specimens obtained should be labeled in their proper sequence.
B. It may be used to inject air, dye or drugs into the spinal canal.
C. Assess movements and sensation in the lower extremities after the
D. Force fluids before and after the procedure.

90. A client diagnosed with cerebral thrombosis is scheduled for cerebral angiography. Nursing care of the client includes the following EXCEPT

A. Inform the client that a warm, flushed feeling and a salty taste may be
B. Maintain pressure dressing over the site of puncture and check for
C. Check pulse, color and temperature of the extremity distal to the site of
D. Kept the extremity used as puncture site flexed to prevent bleeding.

91. Which is considered as the earliest sign of increased ICP that the nurse should closely observed for?

A. abnormal respiratory pattern
B. rising systolic and widening pulse pressure
C. contralateral hemiparesis and ipsilateral dilation of the pupils
D. progression from restlessness to confusion and disorientation to lethargy

92. Which is irrelevant in the pharmacologic management of a client with CVA?

A. Osmotic diuretics and corticosteroids are given to decrease cerebral edema
B. Anticonvulsants are given to prevent seizures
C. Thrombolytics are most useful within three hours of an occlusive CVA
D. Aspirin is used in the acute management of a completed stroke.

93. What would be the MOST therapeutic nursing action when a client’s expressive aphasia is severe?

A. Anticipate the client wishes so she will not need to talk
B. Communicate by means of questions that can be answered by the client shaking the head
C. Keep us a steady flow rank to minimize silence
D. Encourage the client to speak at every possible opportunity.

94. A client with head injury is confused, drowsy and has unequal pupils. Which of the following nursing diagnosis is most important at this time?

A. altered level of cognitive function
B. high risk for injury
C. altered cerebral tissue perfusion
D. sensory perceptual alteration

95. Which nursing diagnosis is of the highest priority when caring for a client with myasthenia gravis?
A. Pain
B. High risk for injury related to muscle weakness
C. Ineffective coping related to illness
D. Ineffective airway clearance related to muscle weakness

96. The client has clear drainage from the nose and ears after a head injury. How can the nurse determine if the drainage is CSF?

A. Measure the ph of the fluid
B. Measure the specific gravity of the fluid
C. Test for glucose
D. Test for chlorides

97. The nurse includes the important measures for stump care in the teaching plan for a client with an amputation. Which measure would be excluded from the teaching plan?

A. Wash, dry, and inspect the stump daily.
B. Treat superficial abrasions and blisters promptly.
C. Apply a "shrinker" bandage with tighter arms around the proximal end of the affected limb.
D. Toughen the stump by pushing it against a progressively harder substance (e.g., pillow on a foot-stool).

98. A 70-year-old female comes to the clinic for a routine checkup. She is 5 feet 4 inches tall and weighs 180 pounds. Her major complaint is pain in her joints. She is retired and has had to give up her volunteer work because of her discomfort. She was told her diagnosis was osteoarthritis about 5 years ago. Which would be excluded from the clinical pathway for this client?

A. Decrease the calorie count of her daily diet.
B. Take warm baths when arising.
C. Slide items across the floor rather than lift them.
D. Place items so that it is necessary to bend or stretch to reach them.

99. A client is admitted from the emergency department with severe-pain and edema in the right foot. His diagnosis is gouty arthritis. When developing a plan of care, which action would have the highest priority?

A. Apply hot compresses to the affected joints.
B. Stress the importance of maintaining good posture to prevent deformities.
C. Administer salicylates to minimize the inflammatory reaction.
D. Ensure an intake of at least 3000 ml of fluid per day.

100. A client had a laminectomy and spinal fusion yesterday. Which statement is to be excluded from your plan of care?

A. Before log rolling, place a pillow under the client's head and a pillow between the client's legs.
B. Before log rolling, remove the pillow from under the client's head and use no pillows between the client's legs.
C. Keep the knees slightly flexed while the client is lying in a semi-Fowler's position in bed.
D. Keep a pillow under the client's head as needed for comfort.

101. The nurse is assisting in planning care for a client with a diagnosis of immune deficiency. The nurse would incorporate which of the ff. as a priority in the plan of care?

A. providing emotional support to decrease fear
B. protecting the client from infection
C. encouraging discussion about lifestyle changes
D. identifying factors that decreased the immune function


102. Joy, an obese 32 year old, is admitted to the hospital after an automobile accident. She has a fractured hip and is brought to the OR for surgery.

After surgery Joy is to receive a piggy-back of Clindamycin phosphate (Cleocin) 300 mg in 50 ml of D5W. The piggyback is to infuse in 20 minutes. The drop factor of the IV set is 10 gtt/ml. The nurse should set the piggyback to flow at:

A. 25 gtt/min
B. 30 gtt/min
C. 35 gtt/min
D. 45 gtt/min

103. The day after her surgery Joy asks the nurse how she might lose weight. Before answering her question, the nurse should bear in mind that long-term weight loss best occurs when:

A. Fats are controlled in the diet
B. Eating habits are altered
C. Carbohydrates are regulated
D. Exercise is part of the program

104. The nurse teaches Joy, an obese client, the value of aerobic exercises in her weight reduction program. The nurse would know that this teaching was effective when Joy says that exercise will:

A. Increase her lean body mass
B. Lower her metabolic rate
C. Decrease her appetite
D. Raise her heart rate

105. The physician orders non-weight bearing with crutches for Joy, who had surgery for a fractured hip. The most important activity to facilitate walking with crutches before ambulation begun is:

A. Exercising the triceps, finger flexors, and elbow extensors
B. Sitting up at the edge of the bed to help strengthen back muscles
C. Doing isometric exercises on the unaffected leg
D. Using the trapeze frequently for pull-ups to strengthen the biceps muscles


106. The nurse recognizes that a client understood the demonstration of crutch walking when she places her weight on:

A. The palms and axillary regions
B. Both feet placed wide apart
C. The palms of her hands
D. Her axillary regions


107. Joey is a 46 year-old radio technician who is admitted because of mild chest pain. He is 5 feet, 8 inches tall and weighs 190 pounds. He is diagnosed with a myocardial infarct. Morphine sulfate, Diazepam (Valium) and Lidocaine are prescribed.

The physician orders 8 mg of Morphine Sulfate to be given IV. The vial on hand is labeled 1 ml/ 10 mg. The nurse should administer:

A. 8 minims
B. 10 minims
C. 12 minims
D. 15 minims

108. Joey asks the nurse why he is receiving the injection of Morphine after he was hospitalized for severe anginal pain. The nurse replies that it:

A. Will help prevent erratic heart beats
B. Relieves pain and decreases level of anxiety
C. Decreases anxiety
D. Dilates coronary blood vessels

109. Oxygen 3L/min by nasal cannula is prescribed for Joey who is admitted to the hospital for chest pain. The nurse institutes safety precautions in the room because oxygen:

A. Converts to an alternate form of matter
B. Has unstable properties
C. Supports combustion
D. Is flammable

110. Myra is ordered laboratory tests after she is admitted to the hospital for angina. The isoenzyme test that is the most reliable early indicator of myocardial insult is:

A. SGPT
B. LDH
C. CK-MB
D. AST

111. An early finding in the EKG of a client with an infarcted mycardium would be:

A. Disappearance of Q waves
B. Elevated ST segments
C. Absence of P wave
D. Flattened T waves

112. Jose, who had a myocardial infarction 2 days earlier, has been complaining to the nurse about issues related to his hospital stay. The best initial nursing response would be to:

A. Allow him to release his feelings and then leave him alone to allow him to regain his composure
B. Refocus the conversation on his fears, frustrations and anger about his condition
C. Explain how his being upset dangerously disturbs his need for rest
D. Attempt to explain the purpose of different hospital routines

113. Twenty four hours after admission for an Acute MI, Jose’s temperature is noted at 39.3 C. The nurse monitors him for other adaptations related to the pyrexia, including:

A. Shortness of breath
B. Chest pain
C. Elevated blood pressure
D. Increased pulse rate

114. Jose, who is admitted to the hospital for chest pain, asks the nurse, “Is it still possible for me to have another heart attack if I watch my diet religiously and avoid stress?” The most appropriate initial response would be for the nurse to:

A. Suggest he discuss his feelings of vulnerability with his physician.
B. Tell him that he certainly needs to be especially careful about his diet and lifestyle.
C. Avoid giving him direct information and help him explore his feelings
D. Recognize that he is frightened and suggest he talk with the psychiatrist or counselor.

115. Ana, 55 years old, is admitted to the hospital to rule out pernicious anemia. A Schilling test is ordered for Ana. The nurse recognizes that the primary purpose of the Schilling test is to determine the client’s ability to:

A. Store vitamin B12
B. Digest vitamin B12
C. Absorb vitamin B12
D. Produce vitamin B12

116. Ana is diagnosed to have Pernicious anemia. The physician orders 0.2 mg of Cyanocobalamin (Vitamin B12) IM. Available is a vial of the drug labeled 1 ml= 100 mcg. The nurse should administer:

A. 0.5 ml
B. 1.0 ml
C. 1.5 ml
D. 2.0 ml

117. Health teachings to be given to a client with Pernicious Anemia regarding her therapeutic regimen concerning Vit. B12 will include:

A. Oral tablets of Vitamin B12 will control her symptoms
B. IM injections are required for daily control
C. IM injections once a month will maintain control
D. Weekly Z-track injections provide needed control


118. The nurse knows that a client with Pernicious Anemia understands the teaching regarding the vitamin B12 injections when she states that she must take it:

A. When she feels fatigued
B. During exacerbations of anemia
C. Until her symptoms subside
D. For the rest of her life

119. Arthur Cruz, a 45 year old artist, has recently had an abdominoperineal resection and colostomy. Mr. Cruz accuses the nurse of being uncomfortable during a dressing change, because his “wound looks terrible.” The nurse recognizes that the client is using the defense mechanism known as:

A. Reaction Formation
B. Sublimation
C. Intellectualization
D. Projection

120. When preparing to teach a client with colostomy how to irrigate his colostomy, the nurse should plan to perform the procedure:

A. When the client would have normally had a bowel movement
B. After the client accepts he had a bowel movement
C. Before breakfast and morning care
D. At least 2 hours before visitors arrive

121. When observing an ostomate do a return demonstration of the colostomy irrigation, the nurse notes that he needs more teaching if he:

A. Stops the flow of fluid when he feels uncomfortable
B. Lubricates the tip of the catheter before inserting it into the stoma
C. Hangs the bag on a clothes hook on the bathroom door during fluid insertion
D. Discontinues the insertion of fluid after only 500 ml of fluid has been instilled

122. When doing colostomy irrigation at home, a client with colostomy should be instructed to report to his physician :

A. Abdominal cramps during fluid inflow
B. Difficulty in inserting the irrigating tube
C. Passage of flatus during expulsion of feces
D. Inability to complete the procedure in half an hour

123. A client with colostomy refuses to allow his wife to see the incision or stoma and ignores most of his dietary instructions. The nurse on assessing this data, can assume that the client is experiencing:

A. A reaction formation to his recent altered body image.
B. A difficult time accepting reality and is in a state of denial.
C. Impotency due to the surgery and needs sexual counseling
D. Suicide thoughts and should be seen by psychiatrist

124. The nurse would know that dietary teaching had been effective for a client with colostomy when he states that he will eat:

A. Food low in fiber so that there is less stool
B. Everything he ate before the operation but will avoid those foods that cause gas
C. Bland foods so that his intestines do not become irritated
D. Soft foods that are more easily digested and absorbed by the large intestines

125. Eddie, 40 years old, is brought to the emergency room after the crash of his private plane. He has suffered multiple crushing wounds of the chest, abdomen and legs. It is feared his leg may have to be amputated.

When Eddie arrives in the emergency room, the assessment that assume the greatest priority are:

A. Level of consciousness and pupil size
B. Abdominal contusions and other wounds
C. Pain, Respiratory rate and blood pressure
D. Quality of respirations and presence of pulsesQuality of respirations and presence of pulses

126. Eddie, a plane crash victim, undergoes endotracheal intubation and positive pressure ventilation. The most immediate nursing intervention for him at this time would be to:

A. Facilitate his verbal communication
B. Maintain sterility of the ventilation system
C. Assess his response to the equipment
D. Prepare him for emergency surgery

127. A chest tube with water seal drainage is inserted to a client following a multiple chest injury. A few hours later, the client’s chest tube seems to be obstructed. The most appropriate nursing action would be to

A. Prepare for chest tube removal
B. Milk the tube toward the collection container as ordered
C. Arrange for a stat Chest x-ray film.
D. Clam the tube immediately

128. The observation that indicates a desired response to thoracostomy drainage of a client with chest injury is:

A. Increased breath sounds
B. Constant bubbling in the drainage chamber
C. Crepitus detected on palpation of chest
D. Increased respiratory rate

129. In the evaluation of a client’s response to fluid replacement therapy, the observation that indicates adequate tissue perfusion to vital organs is:

A. Urinary output is 30 ml in an hour
B. Central venous pressure reading of 2 cm H2O
C. Pulse rates of 120 and 110 in a 15 minute period
D. Blood pressure readings of 50/30 and 70/40 within 30 minutes

130. A client with multiple injury following a vehicular accident is transferred to the critical care unit. He begins to complain of increased abdominal pain in the left upper quadrant. A ruptured spleen is diagnosed and he is scheduled for emergency splenectomy. In preparing the client for surgery, the nurse should emphasize in his teaching plan the:

A. Complete safety of the procedure
B. Expectation of postoperative bleeding
C. Risk of the procedure with his other injuries
D. Presence of abdominal drains for several days after surgery

131. To promote continued improvement in the respiratory status of a client following chest tube removal after a chest surgery for multiple rib fracture, the nurse should:

A. Encourage bed rest with active and passive range of motion exercises
B. Encourage frequent coughing and deep breathing
C. Turn him from side to side at least every 2 hours
D. Continue observing for dyspnea and crepitus

132. A client undergoes below the knee amputation following a vehicular accident. Three days postoperatively, the client is refusing to eat, talk or perform any rehabilitative activities. The best initial nursing approach would be to:

A. Give him explanations of why there is a need to quickly increase his activity
B. Emphasize repeatedly that with as prosthesis, he will be able to return to his normal lifestyle
C. Appear cheerful and non-critical regardless of his response to attempts at intervention
D. Accept and acknowledge that his withdrawal is an initially normal and necessary part of grieving

133. The key factor in accurately assessing how body image changes will be dealt with by the client is the:

A. Extent of body change present
B. Suddenness of the change
C. Obviousness of the change
D. Client’s perception of the change

134. Larry is diagnosed as having myelocytic leukemia and is admitted to the hospital for chemotherapy. Larry discusses his recent diagnosis of leukemia by referring to statistical facts and figures. The nurse recognizes that Larry is using the defense mechanism known as:

A. Reaction formation
B. Sublimation
C. Intellectualization
D. Projection

135. The laboratory results of the client with leukemia indicate bone marrow depression. The nurse should encourage the client to:

A. Increase his activity level and ambulate frequently
B. Sleep with the head of his bed slightly elevated
C. Drink citrus juices frequently for nourishment
D. Use a soft toothbrush and electric razor

136. Dennis receives a blood transfusion and develops flank pain, chills, fever and hematuria. The nurse recognizes that Dennis is probably experiencing:

A. An anaphylactic transfusion reaction
B. An allergic transfusion reaction
C. A hemolytic transfusion reaction
D. A pyrogenic transfusion reaction

137. A client jokes about his leukemia even though he is becoming sicker and weaker. The nurse’s most therapeutic response would be:

A. “Your laugher is a cover for your fear.”
B. “He who laughs on the outside, cries on the inside.”
C. “Why are you always laughing?”
D. “Does it help you to joke about your illness?”

138. In dealing with a dying client who is in the denial stage of grief, the best nursing approach is to:

A. Agree with and encourage the client’s denial
B. Reassure the client that everything will be okay
C. Allow the denial but be available to discuss death
D. Leave the client alone to discuss the loss

139. During and 8 hour shift, Mario drinks two 6 oz. cups of tea and vomits 125 ml of fluid. During this 8 hour period, his fluid balance would be:

A. +55 ml
B. +137 ml
C. +235 ml
D. +485 ml



140. Mr. Ong is admitted to the hospital with a diagnosis of Left-sided CHF. In the assessment, the nurse should expect to find:

A. Crushing chest pain
B. Dyspnea on exertion
C. Extensive peripheral edema
D. Jugular vein distention

141. The physician orders on a client with CHF a cardiac glycoside, a vasodilator, and furosemide (Lasix). The nurse understands Lasix exerts is effects in the:

A. Distal tubule
B. Collecting duct
C. Glomerulus of the nephron
D. Ascending limb of the loop of Henle

142. Mr. Ong weighs 210 lbs on admission to the hospital. After 2 days of diuretic therapy he weighs 205.5 lbs. The nurse could estimate that the amount of fluid he has lost is:

A. 0.5 L
B. 1.0 L
C. 2.0 L
D. 3.5 L

143. Mr. Ong, a client with CHF, has been receiving a cardiac glycoside, a diuretic, and a vasodilator drug. His apical pulse rate is 44 and he is on bed rest. The nurse concludes that his pulse rate is most likely the result of the:

A. Diuretic
B. Vasodilator
C. Bed-rest regimen
D. Cardiac glycoside

144. The diet ordered for a client with CHF permits him to have a 190 g of carbohydrates, 90 g of fat and 100 g of protein. The nurse understands that this diet contains approximately:

A. 2200 calories
B. 2000 calories
C. 2800 calories
D. 1600 calories

145. After the acute phase of congestive heart failure, the nurse should expect the dietary management of the client to include the restriction of:

A. Magnesium
B. Sodium
C. Potassium
D. Calcium

146. Jude develops GI bleeding and is admitted to the hospital. An important etiologic clue for the nurse to explore while taking his history would be:

A. The medications he has been taking
B. Any recent foreign travel
C. His usual dietary pattern
D. His working patterns

147. The meal pattern that would probably be most appropriate for a client recovering from GI bleeding is:

A. Three large meals large enough to supply adequate energy.
B. Regular meals and snacks to limit gastric discomfort
C. Limited food and fluid intake when he has pain
D. A flexible plan according to his appetite

148. A client with a history of recurrent GI bleeding is admitted to the hospital for a gastrectomy. Following surgery, the client has a nasogastric tube to low continuous suction. He begins to hyperventilate. The nurse should be aware that this pattern will alter his arterial blood gases by:

A. Increasing HCO3
B. Decreasing PCO2
C. Decreasing pH
D. Decreasing PO2

149. Routine postoperative IV fluids are designed to supply hydration and electrolyte and only limited energy. Because 1 L of a 5% dextrose solution contains 50 g of sugar, 3 L per day would apply approximately:

A. 400 Kilocalories
B. 600 Kilocalories
C. 800 Kilocalories
D. 1000 Kilocalories

150. Thrombus formation is a danger for all postoperative clients. The nurse should act independently to prevent this complication by:

A. Encouraging adequate fluids
B. Applying elastic stockings
C. Massaging gently the legs with lotion
D. Performing active-assistive leg exercises

151. An unconscious client is admitted to the ICU, IV fluids are started and a Foley catheter is inserted. With an indwelling catheter, urinary infection is a potential danger. The nurse can best plan to avoid this problem by:

A. Emptying the drainage bag frequently
B. Collecting a weekly urine specimen
C. Maintaining the ordered hydration
D. Assessing urine specific gravity

152. The nurse performs full range of motion on a bedridden client’s extremities. When putting his ankle through range of motion, the nurse must perform:

A. Flexion, extension and left and right rotation
B. Abduction, flexion, adduction and extension
C. Pronation, supination, rotation, and extension
D. Dorsiflexion, plantar flexion, eversion and inversion

153. A client has been in a coma for 2 months. The nurse understands that to prevent the effects of shearing force on the skin, the head of the bed should be at an angle of:

A. 30 degrees
B. 45 degrees
C. 60 degrees
D. 90 degrees

154. Rene, age 62, is scheduled for a TURP after being diagnosed with a Benign Prostatic Hyperplasia (BPH). As part of the preoperative teaching, the nurse should tell the client that after surgery:

A. Urinary control may be permanently lost to some degree
B. Urinary drainage will be dependent on a urethral catheter for 24 hours
C. Frequency and burning on urination will last while the cystotomy tube is in place
D. His ability to perform sexually will be permanently impaired

155. The transurethral resection of the prostate is performed on a client with BPH. Following surgery, nursing care should include:

A. Changing the abdominal dressing
B. Maintaining patency of the cystotomy tube
C. Maintaining patency of a three-way Foley catheter for cystoclysis
D. Observing for hemorrhage and wound infection

156. In the early postoperative period following a transurethral surgery, the most common complication the nurse should observe for is:

A. Sepsis
B. Hemorrhage
C. Leakage around the catheter
D. Urinary retention with overflow


157. Following prostate surgery, the retention catheter is secured to the client’s leg causing slight traction of the inflatable balloon against the prostatic fossa. This is done to:

A. Limit discomfort
B. Provide hemostasis
C. Reduce bladder spasms
D. Promote urinary drainage

158. Twenty-four hours after TURP surgery, the client tells the nurse he has lower abdominal discomfort. The nurse notes that the catheter drainage has stopped. The nurse’s initial action should be to:

A. Irrigate the catheter with saline
B. Milk the catheter tubing
C. Remove the catheter
D. Notify the physician

159. The nurse would know that a post-TURP client understood his discharge teaching when he says “I should:”

A. Get out of bed into a chair for several hours daily
B. Call the physician if my urinary stream decreases
C. Attempt to void every 3 hours when I’m awake
D. Avoid vigorous exercise for 6 months after surgery

160. Lucy is admitted to the surgical unit for a subtotal thyroidectomy. She is diagnosed with Grave’s Disease. When assessing Lucy, the nurse would expect to find:

A. Lethargy, weight gain, and forgetfulness
B. Weight loss, protruding eyeballs, and lethargy
C. Weight loss, exopthalmos and restlessness
D. Constipation, dry skin, and weight gain

161. Lucy undergoes Subtotal Thyroidectomy for Grave’s Disease. In planning for the client’s return from the OR, the nurse would consider that in a subtotal thyroidectomy:
A. The entire thyroid gland is removed
B. A small part of the gland is left intact
C. One parathyroid gland is also removed
D. A portion of the thyroid and four parathyroids are removed

162. Before a post- thyroidectomy client returns to her room from the OR, the nurse plans to set up emergency equipment, which should include:

A. A crash cart with bed board
B. A tracheostomy set and oxygen
C. An airway and rebreathing mask
D. Two ampules of sodium bicarbonate

163. When a post-thyroidectomy client returns from surgery the nurse assesses her for unilateral injury of the laryngeal nerve every 30 to 60 minutes by:

A. Observing for signs of tetany
B. Checking her throat for swelling
C. Asking her to state her name out loud
D. Palpating the side of her neck for blood seepage

164. On a post-thyroidectomy client’s discharge, the nurse teaches her to observe for signs of surgically induced hypothyroidism. The nurse would know that the client understands the teaching when she states she should notify the physician if she develops:

A. Intolerance to heat
B. Dry skin and fatigue
C. Progressive weight loss
D. Insomnia and excitability

165. A client’s exopthalmos continues inspite of thyroidectomy for Grave’s Disease. The nurse teaches her how to reduce discomfort and prevent corneal ulceration. The nurse recognizes that the client understands the teaching when she says: “I should:

A. Elevate the head of my bed at night
B. Avoid moving my extra-ocular muscles
C. Avoid using a sleeping mask at night
D. Avoid excessive blinking


166. Clara is a 37-year old cook. She is admitted for treatment of partial and full-thickness burns of her entire right lower extremity and the anterior portion of her right upper extremity. Her respiratory status is compromised, and she is in pain and anxious.

Performing an immediate appraisal, using the rule of nines, the nurse estimates the percent of Clara’s body surface that is burned is:

A. 4.5%
B. 9%
C. 18 %
D. 22.5%

167. The nurse applies mafenide acetate (Sulfamylon cream) to Clara, who has second and third degree burns on the right upper and lower extremities, as ordered by the physician. This medication will:

A. Inhibit bacterial growth
B. Relieve pain from the burn
C. Prevent scar tissue formation
D. Provide chemical debridement

168. Forty-eight hours after a burn injury, the physician orders for the client 2 liters of IV fluid to be administered q12 h. The drop factor of the tubing is 10 gtt/ml. The nurse should set the flow to provide:

A. 18 gtt/min
B. 28 gtt/min
C. 32 gtt/min
D. 36 gtt/min

169. Clara, a burn client, receives a temporary heterograft (pig skin) on some of her burns. These grafts will:
A. Debride necrotic epithelium
B. Be sutured in place for better adherence
C. Relieve pain and promote rapid epithelialization
D. Frequently be used concurrently with topical antimicrobials.

170. A client with burns on the chest has periodic episodes of dyspnea. The position that would provide for the greatest respiratory capacity would be the:

A. Semi-fowler’s position
B. Sims’ position
C. Orthopneic position
D. Supine position

171. Jane, a 20- year old college student is admiited to the hospital with a tentative diagnosis of myasthenia gravis. She is scheduled to have a series of diagnostic studies for myasthenia gravis, including a Tensilon test. In preparing her for this procedure, the nurse explains that her response to the medication will confirm the diagnosis if Tensilon produces:


A. Brief exaggeration of symptoms
B. Prolonged symptomatic improvement
C. Rapid but brief symptomatic improvement
D. Symptomatic improvement of just the ptosis

172. The initial nursing goal for a client with myasthenia gravis during the diagnostic phase of her hospitalization would be to:

A. Develop a teaching plan
B. Facilitate psychologic adjustment
C. Maintain the present muscle strength
D. Prepare for the appearance of myasthenic crisis

173. The most significant initial nursing observations that need to be made about a client with myasthenia include:
A. Ability to chew and speak distinctly
B. Degree of anxiety about her diagnosis
C. Ability to smile an to close her eyelids
D. Respiratory exchange and ability to swallow
174. Helen is diagnosed with myasthenia gravis and pyridostigmine bromide (Mestinon) therapy is started. The Mestinon dosage is frequently changed during the first week. While the dosage is being adjusted, the nurse’s priority intervention is to:

A. Administer the medication exactly on time
B. Administer the medication with food or mild
C. Evaluate the client’s muscle strength hourly after medication
D. Evaluate the client’s emotional side effects between doses

175. Helen, a client with myasthenia gravis, begins to experience increased difficulty in swallowing. To prevent aspiration of food, the nursing action that would be most effective would be to:

A. Change her diet order from soft foods to clear liquids
B. Place an emergency tracheostomy set in her room
C. Assess her respiratory status before and after meals
D. Coordinate her meal schedule with the peak effect of her medication, Mestinon



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