Care of Clients with Physiologic and Psychosocial Alterations (part1)

1. A client has driven himself to the ER. He is 50 years old, has a history of hypertension, and informs the
nurse that his father died of a heart attack at 60 years of age. The client is presently complaining of
indigestion. The nurse connects him to an ECG monitor and begins administering oxygen at 2 L/minute
per NC. The nurse’s next action would be to:
A. Call for the doctor
B. Start an intravenous line
C. Obtain a portable chest radiograph
D. Draw blood for laboratory studies

2. The nurse receives emergency laboratory results for a client with chest pain and immediately informs
the physician. An increased myoglobin level suggests which of the following?
A. Cancer
B. Hypertension
C. Liver disease
D. Myocardial infarction

3. When teaching a client about propranolol hydrochloride, the nurse should base the information on
the knowledge that propranolol hydrochloride:
A. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility,
and conduction.
B. Increases norepinephrine secretion and thus decreases blood pressure and heart rate.
C. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers
blood pressure.
D. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the
conversion of angiotensin I to angiotensin II.

4. The most important long-term goal for a client with hypertension would be to:
a. Learn how to avoid stress
b. Explore a job change or early retirement
c. Make a commitment to long-term therapy
d. Control high blood pressure

5. Hypertension is known as the silent killer. This phrase is associated with the fact that hypertension
often goes undetected until symptoms of other system failures occur. This may occur in the form of:
A. Cerebrovascular accident
B. Liver disease
C. Myocardial infarction
D. Pulmonary disease

6. During the previous few months, a 56-year-old woman felt brief twinges of chest pain while working
in her garden and has had frequent episodes of indigestion. She comes to the hospital after experiencing
severe anterior chest pain while raking leaves. Her evaluation confirms a diagnosis of stable angina
pectoris. After stabilization and treatment, the client is discharged from the hospital. At her follow-up
appointment, she is discouraged because she is experiencing pain with increasing frequency. She states
that she is visiting an invalid friend twice a week and now cannot walk up the second flight of steps to
the friend’s apartment without pain. Which of the following measures that the nurse could suggest
would most likely help the client deal with this problem?
A. Visit her friend earlier in the day.
B. Rest for at least an hour before climbing the stairs.
C. Take a nitroglycerin tablet before climbing the stairs.
D. Lie down once she reaches the friend’s apartment.
7. Which of the following symptoms should the nurse teach the client with unstable angina to report
immediately to her physician?
A. A change in the pattern of her pain
B. Pain during sex
C. Pain during an argument with her husband
D. Pain during or after an activity such as lawn mowing

8. The physician refers the client with unstable angina for a cardiac catheterization. The nurse explains
to the client that this procedure is being used in this specific case to:
A. Open and dilate the blocked coronary arteries
B. Assess the extent of arterial blockage
C. Bypass obstructed vessels
D. Assess the functional adequacy of the valves and heart muscle.

9. As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3mg
given sublingually. This drug’s principal effects are produced by:
A. Antispasmodic effect on the pericardium
B. Causing an increased myocardial oxygen demand
C. Vasodilation of peripheral vasculature
D. Improved conductivity in the myocardium

10. The nurse teaches the client with angina about the common expected side effects of nitroglycerin,
including:
A. Headache
B. High blood pressure
C. Shortness of breath
D. Stomach cramps

11. Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the nurse instruct
the client to use the drug when chest pain occurs?
A. Take one (1) tablet every two (2) to five (5) minutes until the pain stops.
B. Take one (1) tablet and rest for ten (10) minutes. Call the physician if pain persists after ten (10)
minutes.
C. Take one (1) tablet, then an additional tablet every 5 minutes for a total of three (3) tablets. Call the
physician if pain persists after three (3) tablets.
D. Take one (1) tablet. If pain persists after five (5) minutes, take two (2) tablets. If pain persists five (5)
minutes later, call the physician

12. Which of the following actions is the first priority of care for a client exhibiting signs and symptoms
of coronary artery disease?
A. Decrease anxiety
B. Enhance myocardial oxygenation
C. Administer sublingual nitroglycerin
D. Educate the client about his symptoms

13. Medical treatment of coronary artery disease includes which of the following procedures?
A. Cardiac catheterization
B. Coronary artery bypass surgery
C. Oral medication therapy
D. Percutaneous transluminal coronary angioplasty

14. Which of the following is the most common symptom of myocardial infarction (MI)?
A. Chest pain
B. Dyspnea
C. Edema
D. Palpitations
15. Which of the following symptoms is the most likely origin of pain the client described as knifelike
chest pain that increases in intensity with inspiration?
A. Cardiac
B. Gastrointestinal
C. Musculoskeletal
D. Pulmonary

16. A client admitted with angina complains of severe chest pain and suddenly becomes unresponsive.
After establishing unresponsiveness, which of the following actions should the nurse take first?
A. Activate the resuscitation team
B. Open the client’s airway
C. Check for breathing
D. Check for signs of circulation

17. A 55-year-old client is admitted with an acute inferior-wall myocardial infarction. During the
admission interview, he says he stopped taking his metoprolol (Lopressor) 5 days ago because he was
feeling better. Which of the following nursing diagnoses takes priority for this client?
A. Anxiety
B. Ineffective tissue perfusion; cardiopulmonary
C. Acute pain
D. Ineffective therapeutic regimen management

18. A client comes into the E.R. with acute shortness of breath and a cough that produces pink, frothy
sputum. Admission assessment reveals crackles and wheezes, a BP of 85/46, a HR of 122 BPM, and a
respiratory rate of 38 breaths/minute. The client’s medical history included DM, HTN, and heart failure.
Which of the following disorders should the nurse suspect?
A. Pulmonary edema
B. Pneumothorax
C. Cardiac tamponade
D. Pulmonary embolus

19. The nurse coming on duty receives the report from the nurse going off duty. Which of the following
clients should the on-duty nurse assess first?
A. The 58-year-old client who was admitted 2 days ago with heart failure, BP of 126/76, and a
respiratory rate of 21 breaths a minute.
B. The 88-year-old client with end-stage right-sided heart failure, BP of 78/50, and a DNR order.
C. The 62-year-old client who was admitted one day ago with thrombophlebitis and receiving IV
heparin.
D. A 76-year-old client who was admitted 1 hour ago with new-onset atrial fibrillation and is receiving
IV diltiazem (Cardizem).

20. When developing a teaching plan for a client with endocarditis, which of the following points is most
essential for the nurse to include?
A. “Report fever, anorexia, and night sweats to the physician.”
B. “Take prophylactic antibiotics after dental work and invasive procedures.”
C. “Include potassium rich foods in your diet.”
D. “Monitor your pulse regularly.”

21. The nurse is preparing to teach a client with microcytic hypochromic anemia about the diet to follow
after discharge. Which of the following foods should be included in the diet?
A. Eggs
B. Lettuce
C. Citrus fruits
D. Cheese

22. The nurse would instruct the client to eat which of the following foods to obtain the best supply of
vitamin B12?
A. Whole grains
B. Green leafy vegetables
C. Meats and dairy products
D. Broccoli and Brussels sprouts

23. The nurse has just admitted a 35-year-old female client who has a serum B12 concentration of 800
pg/ml. Which of the following laboratory findings would cue the nurse to focus the client history on
specific drug or alcohol abuse?
A. Total bilirubin, 0.3 mg/dL
B. Serum creatinine, 0.5 mg/dL
C. Hemoglobin, 16 g/dL
D. Folate, 1.5 ng/mL

24. Which of the following blood components is decreased in anemia?

A. Erythrocytes
B. Granulocytes
C. Leukocytes
D. Platelets

25. A client with anemia may be tired due to a tissue deficiency of which of the following substances?
A. Carbon dioxide
B. Factor VIII
C. Oxygen
D. T-cell antibodies

26. A client with iron deficiency anemia is scheduled for discharge. Which instruction about prescribed
ferrous gluconate therapy should the nurse include in the teaching plan?
A. “Take the medication with an antacid.”
B. “Take the medication with a glass of milk.”
C. “Take the medication with cereal.”
D. “Take the medication on an empty stomach.”

27. A child suspected of having sickle cell disease is seen in a clinic, and laboratory studies are
performed. A nurse checks the lab results, knowing that which of the following would be increased in
this disease?
A. Platelet count
B. Hematocrit level
C. Reticulocyte count
D. Hemoglobin level

28. A clinic nurse instructs the mother of a child with sickle cell disease about the precipitating factors
related to pain crisis. Which of the following, if identified by the mother as a precipitating factor,
indicates the need for further instructions?
A. Infection
B. Trauma
C. Fluid overload
D. Stress

29. Laboratory studies are performed for a child suspected of having iron deficiency anemia. The nurse
reviews the laboratory results, knowing that which of the following results would indicate this type of
anemia?
A. An elevated hemoglobin level
B. A decreased reticulocyte count
C. An elevated RBC count
D. Red blood cells that are microcytic and hypochromic

30. A pediatric nurse health educator provides a teaching session to the nursing staff regarding
hemophilia. Which of the following information regarding this disorder would the nurse plan to include
in the discussion?
A. Hemophilia is a Y linked hereditary disorder
B. Males inherit hemophilia from their fathers
C. Females inherit hemophilia from their mothers
D. Hemophilia A results from a deficiency of factor VIII

31. An elderly client with pneumonia may appear with which of the following symptoms first?
A. Altered mental status and dehydration
B. fever and chills
C. Hemoptysis and dyspnea
D. Pleuritic chest pain and cough

32. Which of the following pathophysiological mechanisms that occur in the lung parenchyma allows
pneumonia to develop?
A. Atelectasis
B. Bronchiectasis
C. Effusion
D. Inflammation

33. A 7-year-old client is brought to the E.R. He’s tachypneic and afebrile and has a respiratory rate of 36
breaths/minute and a nonproductive cough. He recently had a cold. From his history, the client may
have which of the following?
A. Acute asthma
B. Bronchial pneumonia
C. Chronic obstructive pulmonary disease (COPD)
D. Emphysema

34. Which of the following assessment findings would help confirm a diagnosis of asthma in a client
suspected of having the disorder?
A. Circumoral cyanosis
B. Increased forced expiratory volume
C. Inspiratory and expiratory wheezing
D. Normal breath sounds

35. Which of the following types of asthma involves an acute asthma attack brought on by an upper
respiratory infection?
A. Emotional
B. Extrinsic
C. Intrinsic
D. Mediated

36. A client with acute asthma showing inspiratory and expiratory wheezes and a decreased expiratory
volume should be treated with which of the following classes of medication right away?
A. Beta-adrenergic blockers
B. Bronchodilators
C. Inhaled steroids
D. Oral steroids

37. A 19-year-old comes into the emergency department with acute asthma. His respiratory rate is 44
breaths/minute, and he appears to be in acute respiratory distress. Which of the following actions
should be taken first?
A. Take a full medication history
B. Give a bronchodilator by nebulizer
C. Apply a cardiac monitor to the client
D. Provide emotional support to the client.

38. A 58-year-old client with a 40-year history of smoking one to two packs of cigarettes a day has a
chronic cough producing thick sputum, peripheral edema, and cyanotic nail beds. Based on this
information, he most likely has which of the following conditions?
A. Adult respiratory distress syndrome (ARDS)
B. Asthma
C. Chronic obstructive bronchitis
D. Emphysema

39. The term “blue bloater” refers to which of the following conditions?
A. Adult respiratory distress syndrome (ARDS)
B. Asthma
C. Chronic obstructive bronchitis
D. Emphysema

40. The term “pink puffer” refers to the client with which of the following conditions?
A. ARDS
B. Asthma
C. Chronic obstructive bronchitis
D. Emphysema

41. 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. Bronchospasm

42. A nurse is suctioning fluids from a client via a tracheostomy tube. When suctioning, the nurse must
limit the suctioning to a maximum of:
A. 5 seconds
B. 10 seconds
C. 30 seconds
D. 1 minute

43. A nurse is suctioning fluids from a client through an endotracheal tube. During the suctioning
procedure, the nurse notes on the monitor that the heart rate decreases. 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 reoxygenated the client
D. Notify the physician immediately.

44. An unconscious client is admitted to an emergency room. Arterial blood gas measurements reveal a
pH of 7.30, a low bicarbonate level, a normal carbon dioxide level, and a normal oxygen level. An
elevated potassium level is also present. These results indicate the presence of:
A. Metabolic acidosis
B. Respiratory acidosis
C. Combined respiratory and metabolic acidosis
D. over compensated respiratory acidosis

45. A nurse is caring for a client hospitalized with acute exacerbation of COPD. Which of the following
would the nurse expect to note on assessment of this client?
A. Increased oxygen saturation with exercise
B. Hypocapnia
C. A hyperinflated chest on x-ray film
D. A widened diaphragm noted on chest x-ray film

46. An oxygenated delivery system is prescribed for a client with COPD to deliver a precise oxygen
concentration. Which of the following types of oxygen delivery systems would the nurse anticipate to be
prescribed?
A. Venturi mask
B. Aerosol mask
C. Face tent
D. Tracheostomy collar

47. Theophylline (Theo-Dur) tablets are prescribed for a client with chronic airflow limitation, and the
nurse instructs the client about the medication. Which statement by the client indicates a need for
further teaching?
A. “I will take the medication on an empty stomach.”
B. “I will take the medication with food.”
C. “I will continue to take the medication even if I am feeling better.”
D. “Periodic blood levels will need to be obtained.”

48. 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 L/min
B. 2 L/min
C. 6 L/min
D. 10 L/min

49. The nurse reviews the ABG 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 mm Hg
C. pH of 7.30
D. HCO3- of 20 mEq/L

50. A nurse instructs a client to use the pursed 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:
A. Promote oxygen intake
B. Strengthen the diaphragm
C. Strengthen the intercostal muscles
D. Promote carbon dioxide elimination

“The difference between a successful person and others is not a lack of strength, not a lack of knowledge, but rather a lack in will.”
~Vince Lombardi

PREPARED BY:
ARNIE JUDE CARIDO, RN, MD, MPH
 Care of Clients with Physiologic and Psychosocial Alterations (part1)

51. A 79-year-old client is admitted with pneumonia. Which nursing diagnosis should take priority?
1. Acute pain related to lung expansion secondary to lung infection
2. Risk for imbalanced fluid volume related to increased insensible fluid losses secondary to fever.
3. Anxiety related to dyspnea and chest pain.
4. Ineffective airway clearance related to retained secretions.

52. A community health nurse is conducting an educational session with community members regarding
TB. The nurse tells the group that one of the first symptoms associated with TB is:
1. A bloody, productive cough
2. A cough with the expectoration of mucoid sputum
3. Chest pain
4. Dyspnea

53. Clients with chronic illnesses are more likely to get pneumonia when which of the following
situations is present?
1. Dehydration
2. Group living
3. Malnutrition
4. Severe periodontal disease

54. Which of the following pathophysiological mechanisms that occurs in the lung parenchyma allows
pneumonia to develop?
1. Atelectasis
2. Bronchiectasis
3. Effusion
4. Inflammation

55. Which of the following organisms most commonly causes community-acquired pneumonia in adults?
1. Haemiphilus influenzae
2. Klebsiella pneumoniae
3. Streptococcus pneumoniae
4. Staphylococcus aureus

56. A client who is HIV+ has had a PPD skin test. The nurse notes a 7-mm area of induration at the site
of the skin test. The nurse interprets the results as:
1. Positive
2. Negative
3. Inconclusive
4. The need for repeat testing.

57. A nurse is caring for a client diagnosed with TB. Which assessment, if made by the nurse, would not
be consistent with the usual clinical presentation of TB and may indicate the development of a
concurrent problem?
1. Nonproductive or productive cough
2. Anorexia and weight loss
3. Chills and night sweats
4. High-grade fever

58. A nurse is teaching a client with TB about dietary elements that should be increased in the diet. The
nurse suggests that the client increase intake of:
1. Meats and citrus fruits
2. Grains and broccoli
3. Eggs and spinach
4. Potatoes and fish

59. Which of the following would be priority assessment data to gather from a client who has been
diagnosed with pneumonia? Select all that apply.
1. Auscultation of breath sounds
2. Auscultation of bowel sounds
3. Presence of chest pain.
4. Presence of peripheral edema
5. Color of nail beds

60. A client with pneumonia has a temperature of 102.6*F (39.2*C), is diaphoretic, and has a productive
cough. The nurse should include which of the following measures in the plan of care?
1. Position changes q4h
2. Nasotracheal suctioning to clear secretions
3. Frequent linen changes
4. Frequent offering of a bedpan.

61. The cyanosis that accompanies bacterial pneumonia is primarily caused by which of the following?
1. Decreased cardiac output
2. Pleural effusion
3. Inadequate peripheral circulation
4. Decreased oxygenation of the blood.

62. Which of the following mental status changes may occur when a client with pneumonia is first
experiencing hypoxia?
1. Coma
2. Apathy
3. Irritability
4. Depression

63. A client with pneumonia has a temperature ranging between 101* and 102*F and periods of
diaphoresis. Based on this information, which of the following nursing interventions would be a priority?
1. Maintain complete bedrest
2. Administer oxygen therapy
3. Provide frequent linen changes.
4. Provide fluid intake of 3 L/day

64. Which of the following would be an appropriate expected outcome for an elderly client recovering
from bacterial pneumonia?
1. A respiratory rate of 25 to 30 breaths per minute
2. The ability to perform ADL’s without dyspnea
3. A maximum loss of 5 to 10 pounds of body weight
4. Chest pain that is minimized by splinting the ribcage.

65. Which of the following symptoms is common in clients with TB?

1. Weight loss
2. Increased appetite
3. Dyspnea on exertion
4. Mental status changes

66. A 24-year-old client comes into the clinic complaining of right-sided chest pain and shortness of
breath. He reports that it started suddenly. The assessment should include which of the following
interventions?
1. Auscultation of breath sounds
2. Chest x-ray
3. Echocardiogram
4. Electrocardiogram (ECG)
67. A client with shortness of breath has decreased to absent breath sounds on the right side, from the
apex to the base. Which of the following conditions would best explain this?
1. Acute asthma
2. Chronic bronchitis
3. Pneumonia
4. Spontaneous pneumothorax

68. Which of the following treatments would the nurse expect for a client with a spontaneous
pneumothorax?
1. Antibiotics
2. Bronchodilators
3. Chest tube placement
4. Hyperbaric chamber

69. Which of the following methods is the best way to confirm the diagnosis of a pneumothorax?
1. Auscultate breath sounds
2. Have the client use an incentive spirometer
3. Take a chest x-ray
4. stick a needle in the area of decreased breath sounds

70. A pulse oximetry gives what type of information about the client?
1. Amount of carbon dioxide in the blood
2. Amount of oxygen in the blood
3. Percentage of hemoglobin carrying oxygen
4. Respiratory rate

71. Regular oral hygiene is an essential intervention for the client who has had a stroke. Which of the
following nursing measures is inappropriate when providing oral hygiene?
1. Placing the client on the back with a small pillow under the head.
2. Keeping portable suctioning equipment at the bedside.
3. Opening the client’s mouth with a padded tongue blade.
4. Cleaning the client’s mouth and teeth with a toothbrush.

72. A 78-year-old client is admitted to the emergency department with numbness and weakness of the
left arm and slurred speech. Which nursing intervention is a priority?
1. Prepare to administer recombinant tissue plasminogen activator (rt-PA).
2. Discuss the precipitating factors that caused the symptoms.
3. Schedule for A STAT computer tomography (CT) scan of the head.
4. Notify the speech pathologist for an emergency consult.

73. A client arrives in the emergency department with an ischemic stroke and receives tissue
plasminogen activator (t-PA) administration. Which is the priority nursing assessment?
1. Current medications.
2. Complete physical and history.
3. Time of onset of current stroke.
4. Upcoming surgical procedures.

74. During the first 24 hours after thrombolytic therapy for ischemic stroke, the primary goal is to
control the client’s:
1. Pulse
2. Respirations
3. Blood pressure
4. Temperature

75. What is a priority nursing assessment in the first 24 hours after admission of the client with a
thrombotic stroke?
1. Cholesterol level
2. Pupil size and pupillary response
3. Bowel sounds
4. Echocardiogram

76. Which nursing diagnosis takes highest priority for a client with Parkinson’s crisis?
A. Imbalanced nutrition: Less than body requirements
B. Ineffective airway clearance
C. Impaired urinary elimination
D. Risk for injury

77. To encourage adequate nutritional intake for a female client with Alzheimer’s disease, the nurse
should:
A. Stay with the client and encourage him to eat.
B. Help the client fill out his menu.
C. Give the client privacy during meals.
D. Fill out the menu for the client.

78. The nurse is performing a mental status examination on a male client diagnosed with a subdural
hematoma. This test assesses which of the following?
A. Cerebellar function
B. Intellectual function
C. Cerebral function
D. Sensory function

79. A female client with a suspected brain tumor is scheduled for computed tomography (CT). What
should the nurse do when preparing the client for this test?
A. Immobilize the neck before the client is moved onto a stretcher.
B. Determine whether the client is allergic to iodine, contrast dyes, or shellfish.
C. Place a cap on the client’s head.
D. Administer a sedative as ordered.

80. During a routine physical examination to assess a male client’s deep tendon reflexes, the nurse
should make sure to:
A. Use the pointed end of the reflex hammer when striking the Achilles’ tendon.
B. Support the joint where the tendon is being tested.
C. Tap the tendon slowly and softly
D. Hold the reflex hammer tightly.

81. Dr. Smith has determined that the client with hepatitis has contracted the infection from
contaminated food. The nurse understands that this client is most likely experiencing what type of
hepatitis?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D

82. A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this
diagnosis?
A. Elevated hemoglobin level
B. Elevated serum bilirubin level
C. Elevated blood urea nitrogen level
D. Decreased erythrocyte sedimentation rate

83. The nurse is reviewing the physician’s orders written for a male client admitted to the hospital with
acute pancreatitis. Which physician order should the nurse question if noted on the client’s chart?
A. NPO status
B. Nasogastric tube inserted
C. Morphine sulfate for pain
D. An anticholinergic medication

84. A female client being seen in a physician’s office has just been scheduled for a barium swallow the
next day. The nurse writes down which instruction for the client to follow before the test?
A. Fast for 8 hours before the test
B. Eat a regular supper and breakfast
C. Continue to take all oral medications as scheduled
D. Monitor own bowel movement pattern for constipation

85. The nurse is performing an abdominal assessment and inspects the skin of the abdomen. The nurse
performs which assessment technique next?
A. Palpates the abdomen for size
B. Palpates the liver at the right rib margin
C. Listens to bowel sounds in all for quadrants
D. Percusses the right lower abdominal quadrant

86. The nurse is caring for a hospitalized female client with a diagnosis of ulcerative colitis. Which
finding, if noted on assessment of the client, would the nurse report to the physician?
A. Hypotension
B. Bloody diarrhea
C. Rebound tenderness
D. A hemoglobin level of 12 mg/dL

87. The nurse is caring for a male client postoperatively following creation of a colostomy. Which nursing
diagnosis should the nurse include in the plan of care?
A. Sexual dysfunction
B. Body image, disturbed
C. Fear related to poor prognosis
D. Nutrition: more than body requirements, imbalanced

88. The nurse is reviewing the record of a female client with Crohn’s disease. Which stool characteristics
should the nurse expect to note documented in the client’s record?
A. Diarrhea
B. Chronic constipation
C. Constipation alternating with diarrhea
D. Stools constantly oozing from the rectum

89. The nurse is performing a colostomy irrigation on a male client. During the irrigation, the client
begins to complain of abdominal cramps. What is the appropriate nursing action?
A. Notify the physician
B. Stop the irrigation temporarily
C. Increase the height of the irrigation
D. Medicate for pain and resume the irrigation

90. The nurse is teaching a female client how to perform a colostomy irrigation. To enhance the
effectiveness of the irrigation and fecal returns, what measure should the nurse instruct the client to
do?
A. Increase fluid intake
B. Place heat on the abdomen
C. Perform the irrigation in the evening
D. Reduce the amount of irrigation solution

91. The correct sequence for abdominal assessment is:

A. inspection, percussion, palpation, auscultation.
B. inspection, auscultation, palpation, percussion.
C. inspection, palpation, auscultation, percussion.
D. inspection, percussion, auscultation, palpation.
92. Peritonitis can occur as a complication of:
A. septicemia
B. multiple organ failure
C. hypovolemic shock
D. peptic ulcer disease

93. A patient has become very depressed postoperatively after receiving colostomy for GI cancer. He
does not participate in his colostomy care or look at the stoma. An appropriate nursing diagnosis for this
situation is:
A. Ineffective Individual Coping
B. Knowledge Deficit
C. Impaired Adjustment
D. Anxiety

94. Patients with esophageal varices would reveal the following assessment:
A. increased blood pressure.
B. increased heart rate.
C. decreased respiratory rate.
D. increased urinary output.

95. A clinical manifestation of acute pancreatitis is epigastric pain. Your nursing intervention to facilitate
relief of pain would place the patient in a:
A. knee-chest position
B. semi-Fowler’s position
C. recumbent position
D. low-Fowler’s position

96. What assessment finding of a patient with acute pancreatitis would indicate a bluish discoloration
around the umbilicus?
A. Grey-Turner’s sign
B. Homan’s sign
C. Rovsing’s sign
D. Cullen’s sign

97. You’re assessing the stoma of a patient with a healthy, well-healed colostomy. You expect the stoma
to appear:
1. Pale, pink and moist
2. Red and moist
3. Dark or purple colored
4. Dry and black

98. You’re caring for a patient with a sigmoid colostomy. The stool from this colostomy is:
1. Formed
2. Semisolid
3. Semiliquid
4. Watery

99. You’re advising a 21 y.o. with a colostomy who reports problems with flatus. What food should you
recommend?
1. Peas
2. Cabbage
3. Broccoli
4. Yogurt

100. Anna is 45 y.o. and has a bleeding ulcer. Despite multiple blood transfusions, her HGB is 7.5g/dl and
HCT is 27%. Her doctor determines that surgical intervention is necessary and she undergoes partial
gastrectomy. Postoperative nursing care includes:
1. Giving pain medication Q6H.
2. Flushing the NG tube with sterile water.
3. Positioning her in high Fowler’s position.
4. Keeping her NPO until the return of peristalsis.

“The difference between a successful person and others is not a lack of strength, not a lack of knowledge, but rather a lack in will.”
~Vince Lombardi

PREPARED BY:
ARNIE JUDE CARIDO, RN, MD, MPH