1. After Billroth II Surgery, the client developed dumping syndrome.

Which of the
following should the nurse exclude in the plan of care? (MSN)
a. Eat small meals every 2-3 hours
b. Sit upright for at least 30 minutes after meals
c. Take only sips of H2O between bites of solid food
d. Reduce the amount of simple carbohydrate in the diet

2. A student nurse is assigned to a client who has a diagnosis of thrombophlebitis.

Which action by this team member is most appropriate? (MSN)
a. Instruct the client about the need for bed rest
b. Apply a heating pad to the involved site
c. Elevate the client’s legs 90 degrees
d. Provide active range-of-motion exercises to both legs at least twice every shift

3. 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? (MSN)
a. Chrons disease
b. Diverticulitis
c. Peritonitis
d. Ulcerative colitis

4. The laboratory test 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? (MSN)
a. No treatment is necessary at this time
b. Surgical treatment is necessary
c. Treatment will include Ranitidine and Antibiotics
d. This result indicates gastric cancer caused by the organism

5. 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? (MSN)
a. Place the patient in shock position.
b. Take his vital signs again in an hour.
c. Take his vital signs again in 15 minutes.
d. Notify his physician.

6. 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 (MSN)
a. Slowly breath out through the mouth with pursed lips after inhaling the drug.
b. Breath in and out as fully as possible before placing the mouthpiece inside the mouth.
c. Inhale slowly through the mouth as the canister is pressed down
d. Hold his breath for about 10 seconds before exhaling

7. The client has a good understanding of the means to reduce the chances of colon
cancer when he states: (MSN)
a. “I will include more fresh fruits and vegetables in my diet.”
b. “I will exercise daily.”
c. “I will include more red meat in my diet.”
d. “I will have an annual chest x-ray.”

8. Harry 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: (MSN)
a. The patient is having an allergic reaction to the drug.
b. The patient is anxious about upcoming surgery
c. This is normal side-effect of AtSO4
d. The patient needs a higher dose of this drug

9. Which is the most relevant knowledge about oxygen administration to a client

with COPD? (MSN)
a. Blood gases are monitored using a pulse oximeter.
b. Oxygen at 1-2L/min is given to maintain the hypoxic stimulus for breathing.
c. Hypoxia stimulates the central chemoreceptors in the medulla that makes the client
breath.
d. Oxygen is administered best using a non-rebreathing mask
10. 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: (MSN)
a. Give the guest a glass of orange juice
b. Encourage the guest to eat some baked macaroni
c. Call the guest’s personal physician
d. Offer the guest a cup of coffee

11. Which statement by the client indicates understanding of the possible side
effects of Prednisone therapy? (MSN)
a. “I should limit my potassium intake because hyperkalemia is a side-effect of this
drug.”
b. “My incision will heal much faster because of this drug.”
c. “This medicine will protect me from getting any colds or infection.”
d. “I must take this medicine exactly as my doctor ordered it. I shouldn’t skip
doses.”

12. What is the best reason for the nurse in instructing the client to rotate injection
sites for insulin? (MSN)
a. Injection sites can never be reused
b. Lipodystrophy can result and is extremely painful
c. Lipodystrophic areas can result, causing erratic insulin absorption rates from
these
d. Poor rotation technique can cause superficial hemorrhaging

13. You are taking the history of a 14-year-old girl who has a (BMI) of 18. The girl
reports inability to eat, induced vomiting and severe constipation. Which of the
following would you most likely suspect?

A. Multiple sclerosis
B. Anorexia nervosa
C. Bulimia
D. Systemic sclerosis

14. 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: (MSN)
a. “The medication will limit thyroid hormone secretion.”
b. “The medication will increase the synthesis of thyroid hormones.”
c. “The medication will block the cardiovascular symptoms of Grave’s disease.”
d. “The medication limit synthesis of the thyroid hormones.”

15. When suctioning mucus from a client’s lungs, which nursing action would be
least appropriate? (MSN)
a. Lubricate the catheter tip with sterile saline before insertion.
b. Suction until the client indicates to stop or no longer than 20 second
c. Hyperoxygenate the client before and after suctioning
d. Use sterile technique with a two-gloved approach
16. Which description of pain would be most characteristic of a duodenal ulcer?
(MSN)
a. A sensation of painful pressure in the midsternal area
b. Sharp pain in the epigastric area that radiates to the right shoulder
c. RUQ pain that increases after meal
d. Gnawing, dull, aching, hunger like pain in the epigastric area that is relieved by
food intake

17. Mr Raman 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 Raman is placed in Fowler’s
position on either his right side or on his back to (MSN)
a. Reduce incisional pain
b. Equalize pressure in the pleural space
c. Facilitate ventilation of the left lung
d. Increase venous return
18. Following surgery, Mario complains of mild incisional pain while performing
deep- breathing and coughing exercises. The nurse’s best response would be:
(MSN)
a. “I will give you the pain medication the physician ordered.”
b. “This is a normal reaction after surgery.”
c. “With a pillow, apply pressure against the incision.”
d. “Pain will become less each day.”

19. What instructions should the client be given before undergoing a paracentesis?
(MSN)
a. Empty bladder before procedure
b. NPO 12 hours before procedure
c. Empty bowel before procedure
d. Strict bed rest following procedure

20. 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?
(MSN)
a. It prevents conversion of factors that are needed in the formation of clots.
b. It interferes with vitamin K absorption.
c. It dissolves existing thrombi.
d. It inactivates thrombin that forms and dissolves existing thrombi.

21. 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? (MSN)
a. Lower the oxygen rate
b. Position the client in a Fowler’s position.
c. Call the physician
d. Take heart rate and blood pressure

22. Rohan’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? (MSN)
a. Put the client in modified Trendelenberg’s position.
b. Administer oxygen at 100%.
c. Administer Demerol 50mg IM q4h
d. Monitor urine output every hour.

23. A client is scheduled for a bronchoscopy. When teaching the client what to
expect afterward, the nurse’s highest priority of information would be: (MSN)
a. Coughing and deep-breathing exercises will be done q2h.
b. Warm saline gargles will be done q 2h.
c. Only ice chips and cold liquids will be allowed initially.
d. Food and fluids will be withheld for at least 2 hours
24. A client, who is suspected of having Pheochromocytoma, complains of sweating,
palpitation and headache. Which assessment is essential for the nurse to make
first? (MSN)
a. Pupil reaction
b. Blood pressure
c. Hand grips
d. Blood glucose

25. 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: (MSN)
a. Ambulate
b. Remain on bed rest.
c. Strain all urine.
d. Ask for medications to relax him.

26. 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: (MSN)
a. Reactive pupils
b. Bleeding from ears
c. A depressed fontanel
d. An elevated temperature

27. 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?
(MSN)
a. Eggs
b. Plain nuts
c. Whole milk
d. Canned sardines
28. The nurse is preparing her plan of care for her patient diagnosed with
pneumonia. Which is the most appropriate nursing diagnosis for this patient?
(MSN)
a. Risk for infection
b. Fluid volume deficit
c. Impaired gas exchange.
d. Decreased tissue perfusion.

29. A patient with angina pectoris is being discharged home with nitroglycerine
tablets. Which of the following instructions does the nurse include in the
teaching? (MSN)
a. Place one tablet under your tongue. If the pain is not relieved in 15 minutes, go to the
hospital
b. 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
c. Place one Nitroglycerine tablet under the tongue every five minutes for three
doses. Go to the hospital if the pain is unrelieved.
d. When your chest pain begins, lie down, and place one tablet under your tongue. If the
pain continues, take another tablet in 5 minutes.

30. 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: (MSN)
a. Encourage him to take deep breaths
b. Deflate the esophageal balloon
c. Monitor VS
d. Notify the MD

31. 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? (MSN)
a. “Most people have too much protein in their diets. The amount of this diet is better for
liver healing.”
b. “Because of portal hyperemesis, the blood flows around the liver and ammonia made
from protein collects in the brain causing hallucinations.”
c. “The liver heals better with a high carbohydrates diet rather than protein.”
d. “The liver cannot rid the body of ammonia that is made by the breakdown of
protein in the digestive system.”
32. During the first 24 hours after thyroid surgery, the nurse should include in her
care: (MSN)
a. Encouraging the client to ventilate her feelings about the surgery
b. Checking the back and sides of the operative dressing
c. Advising the client that she can resume her normal activities immediately
d. Supporting the head during mild range of motion exercise

33. Immediately after cholecystectomy, the nursing action that should assume the
highest priority is: (MSN)
a. Encouraging the client to take adequate deep breaths by mouth
b. Encouraging the client to cough and deep breathe
c. Irrigate the T-tube frequently
d. Changing the dressing at least BID

34. Days after abdominal surgery, the client’s wound dehisces. The safest nursing
intervention when this occurs is to (MSN)
a. Cover the wound with sterile, moist saline dressing
b. Irrigate the wound with sterile saline
c. Hold the abdominal contents in place with a sterile gloved hand
d. Approximate the wound edges with tapes

35. 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? (MSN)
a. Posterior neck fat pad and thin extremities
b. Abdominal striae and ankle enlargement
c. Large thighs and upper arms
d. Pendulous abdomen and large hips

36. Dr. Santosh 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
(MSN)
a. Gain a more rapid systemic effect
b. Cause less irritation to the gastrointestinal tract
c. Destroy resistant organisms and promote proper blood levels of the drugs
d. Delay resistance and increase the tuberculostatic effect

37. 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? (MSN)
a. Foamy, blood-tinged sputum
b. Dyspnea on exertion
c. Wheezing sound on inspiration
d. Cough or change in a chronic cough

38. 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: (MSN)
a. Insomnia and excitability
b. Intolerance to heat
c. Dry skin and fatigue
d. Progressive weight gain

39. 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? (MSN)
a. may be allowed to use electrical appliances
b. take the pulse rate once a day, in the morning upon awakening
c. have regular follow up care
d. may engage in contact sports

40. After surgery, Ginni 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? (MSN)
a. Change the patient’s position.
b. Check the patency of the nasogastric tube for any obstruction.
c. Call the physician immediately.
d. Administer the prescribed antiemetic.

41. Valsalva maneuver can result in bradycardia. Which of the following activities
will not stimulate Valsalva’s maneuver? (MSN)
a. Enema administration
b. Gagging while toothbrushing.
c. Lifting heavy objects
d. Use of stool softeners.

42. Mr. Pradeep 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: (MSN)
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

43. 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: (MSN)
a. Discontinue the low-intermittent suction
b. Reposition the NGT by advancing it gently NSS
c. Irrigate the NGT with 50 cc of sterile
d. Notify the MD of your findings

44. A patient has taken an overdose of aspirin. Which of the following should a nurse
most closely monitor for during acute management of this patient?

A. Onset of pulmonary edema

B. Metabolic alkalosis
C. Respiratory alkalosis
D. Parkinson’s disease type symptoms

45. A fifty-year-old blind and deaf patient has been admitted to your floor. As the charge
nurse your primary responsibility for this patient is?

A. Let others know about the patient’s deficits

B. Communicate with your supervisor your concerns about the patient’s deficits.
C. Continuously update the patient on the social environment.
D. Provide a secure environment for the patient.