SUCCEED REVIEW CENTER

PREBOARD 2013
NURSING PRACTICE III - CARE OF THE CLIENTS WITH PHYSIOLOGIC AND PSYCHOSOCIAL
ALTERATIONS (PART A)

1. A clinic nurse is providing instructions to a client with hypertension who will be taking captopril (Capoten). Which
statement by the client indicates a need for further instruction?
A. “I need to drink increased amounts of water.”
B. “I need to change positions slowly.”
C. “I need to avoid taking hot baths or showers.”
D. “I need to sit down and rest if dizziness or lightheadedness occurs.”
2. A nurse is providing instructions to a client with a diagnosis of hypertension regarding high-sodium items to be
avoided.The nurse instructs the client to avoid consuming:
A. Cantaloupe B. Broccoli C. Antacids D. Bananas
3. A nurse is preparing discharge instructions for a client with Raynaud’s disease. The nurse plans to tell the client
to:
A. Stop smoking because it causes cutaneous vasospasm.
B. Always wear warm clothing even in warm climates to prevent vasoconstriction.
C. Use nail polish to protect the nail beds from injury.
D. Wear gloves for all activities involving use of both hands.
4. A nurse in the medical unit is reviewing the laboratory test results for a client who has been transferred from the
intensive care unit. The nurse notes that a cardiac troponin T level assay was performed while the client was in the
intensive care unit. The nurse determines that this test was performed to assist in diagnosing which of the following
conditions?
A. Myocardial infarction B. Congestive heart failure C. Ventricular tachycardia D. Atrial fibrillation
5. A nurse is caring for a client with cardiac disease who has been placed on a cardiac monitor. The nurse notes
that the client has developed atrial fibrillation and has a ventricular rate of 150 beats/mm. The nurse should next
assess the client for which of the following?
A. Flat neck veins B. Complaints of nausea C. Complaints of headache D. Hypotension
6. A nurse is performing an assessment on a client with a diagnosis of left-sided heart failure. Which assessment
component would elicit specific information regarding the clients left-sided heart function?
A. Listening to lung sounds C. Assessing for jugular vein distention
B. Assessing for peripheral and sacral edema D. Monitoring for organomegaly
7. The clinic nurse is reviewing the assessment findings for a client who has been taking spironolactone (Aldactone)
for treatment of hypertension. Which of the following, if noted in the clients record, would indicate that the client is
experiencing a side effect related to the medication?
A. A potassium level of 3.2 mEq/L C. Client complaint of constipation
B. A potassium level of 5.8 mEq/L D. Client complaint of dry skin
8. A nurse is reviewing the electrocardiogram (ECG) rhythm strip obtained on a client with a diagnosis of
myocardial infarction. The nurse notes that the PR interval is 0.20 second. The nurse determines that this is:
A. A normal finding C. Indicative of impending reinfarction
B. Indicative of atrial flutter D. Indicative of atrial fibrillation
9. A nurse is developing a plan of care for a client who will be admitted to the hospital with a diagnosis of deep vein
thrombosis (DVT) of the right leg. The nurse develops the plan, expecting that the physician will most likely
prescribe which of the following?
A. Maintain the affected leg in a dependent position.
B. Apply cool packs to the affected leg for 20 minutes every 4 hours.
C. Maintain bedrest.
D. Administer an opioid analgesic every 4 hours around the clock.
10. A client with a diagnosis of varicose veins is scheduled for treatment by sclerotherapy and asks the nurse to
describe
the procedure. The appropriate nursing response is which of the following?
A. “It involves tying off the veins to prevent sluggishness of blood from occurring.”
B. “It involves tying off the veins so that circulation is redirected in another area.”
C. “It involves surgically removing the varicosity, so anesthesia will be required.”
D. “It involves injecting an agent into the vein to damage the vein wall and close it off.”
11. A female client calls the nurse at the clinic and reports that ever since the vein ligation and stripping procedure
was performed, she has been experiencing a sensation as though the affected leg is falling asleep. Which response
to the client is appropriate?
A. “Keep the leg elevated as much as possible.
B. “Apply warm packs to the leg.”
C. “This normally occurs after surgery and will subside when the edema goes down.”
D. “Contact your physician right away to report this problem.’
12. A nurse is caring for a client who has been hospitalized with a diagnosis of angina pectoris. The client is
receiving oxygen via nasal cannula at 2 L/min. The client asks why the oxygen is necessary. The nurse accurately
explains that:
A. Oxygen has a calming effect.
B. Oxygen will prevent the development of any thrombus.
C. Oxygen dilates the blood vessels so they can supply more nutrients to the heart muscle.
D. The pain of angina pectoris occurs because of a decreased oxygen supply to heart cells.
13. A client with a diagnosis of angina pectoris is hospitalized for an angioplasty. The client returns to the nursing
unit after the procedure, and the nurse provides instructions to the client regarding home care measures. Which of
the following statements, if made by the client, indicates an understanding of the instructions?
A. “I am so relieved that I can eat anything that I want to now.”
B. “I need to cut down on cigarette smoking.”
C. “I am so relieved that my heart is repaired.”
D. “I need to adhere to my dietary restrictions.’
14. A nurse is caring for a client with a diagnosis of myocardial infarction (Ml) and is assisting the client in
completing the diet menu. Which of the following beverages would the nurse instruct the client to select from the
menu?
A. Coffee B. Tea C. Lemonade D. Cola
15. A nurse is performing an admission assessment on a client with a diagnosis of angina pectoris who takes
nitroglycerin for chest pain at home. During the assessment the client complains of chest pain. The nurse
immediately asks the client which of the following questions?
A. “Are you having any nausea?” C. “Are you allergic to any medications?”
B. “Where is the pain located?” D. “Do you have your nitroglycerin with you?”
16. A nurse has provided dietary instructions to a client with coronary artery disease. Which statement by the client
indicates an understanding of the dietary instructions?

A. “I need to substitute eggs and whole milk for meat.”

B. “I should eliminate all cholesterol and fat from my diet.”
C. “I should use polyunsaturated oils in my diet.”
D. “I’ll need to become a strict vegetarian.”
17. A client is admitted to the visiting nurse service for assessment and follow-up after being discharged from the
hospital with new-onset congestive heart failure (CHF). The nurse teaches the client about the dietary restrictions
required with CHF. Which statement by the client indicates that further teaching is needed?
A. “I’m going to have a ham and cheese sandwich and potato chips for lunch.”
B. “I’m going to weigh myself daily to be sure I don’t gain too much fluid.”
C. “I can have most fresh fruits and fresh vegetables.”
D. “I’m not supposed to eat cold cuts.”
18. A client has a nursing diagnosis of Activity intolerance related to underlying cardiovascular disease, as
evidenced by exertional fatigue and increased blood pressure. Which observation by the nurse best indicates client
progress in meeting goals for this nursing diagnosis?
A. Chooses a healthy diet that meets caloric needs
B. Sleeps without awakening throughout the night
C. Verbalizes the benefits of increasing activity
D. Ambulates 10 feet farther each day
19. A client with coronary artery disease is scheduled to have a diagnostic exercise stress test. The nurse plans to
include which of the following instructions in client teaching about this procedure?
A. Avoid cigarettes for 30 minutes before the procedure.
B. Wear loose clothing with a shirt that buttons in front
C. Eat breakfast just before the procedure. .
D. Wear firm, rigid shoes, such as workboots.
20. A client is scheduled for a cardiac catheterization to diagnose the extent of coronary artery disease. The nurse
places highest priority on telling the client to report which of the following sensations during the procedure?
A. Pressure at the insertion site B. Urge to cough C. Warm, flushed feeling D. Chest pain
21. A client with a history of angina pectoris tells the nurse that chest pain usually occurs after going up two flights of
stairs or after walking four blocks. The nurse determines that the client is experiencing which of the following types
of angina?
A. Stable B. Unstable C. Variant D. Intractable
22. A client with a first-degree heart block has an electrocardiogram (ECG) taken during an episode of chest pain.
The nurse knows that which ECG finding indicates first-degree heart block?
A. Prolonged PR interval B. Widened QRS complex C. Tall, peaked T waves D. Presence of Q waves
23. An ambulatory care nurse is working with a client who has been diagnosed with Prinzmetal’s (variant) angina.
The nurse plans to reinforce to the client that this type of angina:
A. Is most effectively managed by B-blocking agents
B. Generally is treated with calcium-channel—blocking agents
C. Has the same risk factors as stable and unstable angina
D. Can be controlled with a low-sodium, high-potassium diet
24. A nurse working in a long-term care facility is assessing a client who is experiencing chest pain. The nurse
would interpret that the pain is most likely due to myocardial infarction (Ml) on the basis of which of the following
assessment findings?
A. The client is not experiencing nausea or vomiting.
B. The client says the pain began while she was trying to open a stuck dresser drawer.
C. The pain has not been relieved by rest and three nitroglycerin tablets.
D. The client is not experiencing dyspnea.
25. A client has experienced an episode of pulmonary edema. The nurse determines that the client’s respiratory
status is improving after this episode if which of the following breath sounds are noted?
A. Crackles throughout the lung fields C. Wheezes
B. Crackles in the bases D. Rhonchi
26. A client is returned to the nursing unit after thoracic surgery with chest tubes in place. During the first few hours
postoperatively, a nurse assesses for drainage and expects to note that it is:
 A. Serous C. Bloody
B. Serosanguineous D. Bloody, with frequent small clots
27. A nurse is preparing to care for a client who will be weaned from a cuffed tracheostomy tube. The nurse is
planning to use a tracheostomy plug and plans to insert it into the opening in the outer cannula. Which of the
following nursing interventions are required before plugging the tube?
A. Place the inner cannula into the tube. C. Ensure that the client is able to swallow.
B. Deflate the cuff on the tube. D. Ensure that the client is able to speak.
28. A nurse is caring for a client who is on strict bedrest. The nurse develops a plan of care with goals related to the
prevention of deep vein thrombosis and pulmonary emboli. Which of the following nursing actions would be most
helpful to prevent these disorders from developing?
A. Applying a heating pad to the lower extremities C. Placing a pillow under the knees
B. Encouraging active range-of-motion exercises D. Restricting fluids
29. A nurse is monitoring the chest tube drainage system in a client with a chest tube. The nurse notes intermittent
bubbling in the water seal chamber. Which of the following is the appropriate action?
A. Change the chest tube drainage system. C. Check for an air leak.
B. Document the findings. D. Notify the physician.
30. A nurse has assisted the physician and the anesthesiologist with placement of an endotracheal (ET) tube for a
client in respiratory distress. Which of the following is the initial nursing action to evaluate proper ET tube
placement?
A. Ask the radiology department to obtain a stat portable radiograph at the client’s bedside.
B. Use an Ambu (resuscitation) bag to ventilate the client and assess for bilateral breath sounds.
C. Tape the ET tube in place, and note the centimetre marking at the lip line.
D. Attach the ET tube to the ventilator and determine whether the client is able to tolerate the tidal volume
prescribed.
31. A nurse is preparing to perform suctioning for a client with a tracheostomy tube and gathers the supplies needed
for the procedure. Which of the following is the initial nursing action?
A. Set the suction pressure range at 150mm Hg.
B. Hyperoxygenate the client.
C. Place the catheter into the tracheostomy tube.
D. Apply suction on the catheter and insert it into the tracheostomy tube.
32. A nursing instructor is observing a nursing student suctioning a client through a tracheostomy tube. Which of the
following observations by the nursing instructor indicates an inappropriate action by the student?
A. Hyperventilating the client with 100% oxygen before suctioning
B. Applying suction intermittently during withdrawal of the catheter
C. Suctioning the client every hour
D. Applying suction only during withdrawal of the catheter
33. A client is intubated with an endotracheal (ET) tube by the anesthesiologist. Which of the following is the
responsibility of the nurse with regard to checking for ET tube placement immediately after tube insertion?
A. It is not the responsibility of the nurse to check for tube placement.
B. Arrange for a chest radiograph.
C. Auscultate the lungs for the presence of bilateral breath sounds.
D. Instill air into the ET tube and listen for its being forced into the lungs.
34. A nurse is performing nasotracheal suctioning of a client. The nurse determines that the client is adequately
tolerating the procedure if which of the following observations is made?

A. Secretions are becoming bloody.

B. Heart rate decreases from 78 to 54 beats per minute.
C. Coughing occurs with suctioning.
D. Skin color becomes cyanotic.
35. The nurse is assessing breath sounds in a bronchovesicular client. She should expect that:
A. Inspiration is longer than expiration C. Breath sounds are slightly muffled
B. Breath sounds are high pitched D. Inspiration and expiration are equal
36. A client with a tracheostomy tube who is on a ventilator is at risk for impaired gas exchange. The nurse should
assess for which of the following as the best indicator of adequate ongoing respiratory status?
A. Moderate amounts of tracheobronchial secretions
B. Small to moderate amounts of frank blood suctioned from the tube
C. Respiratory rate of 16 breaths per minute
D. Oxygen saturation of 90%
37. A nurse is monitoring the respiratory status of a client after creation of a tracheostomy. The nurse understands
that oxygen saturation measurements obtained by pulse oximetry may be inaccurate if the client has which of the
following coexisting problems?
A. Hypotension B. Fever C. Respiratory failure D. Epilepsy
38. A nurse is monitoring the function of a client’s chest tube that is attached to a Pleur-Evac drainage system. The
nurse notes that the fluid in the water-seal chamber rises with inspiration and falls with expiration. The nurse
determines that:
A. The client has residual pneumothorax. C. Suction should be added to the system.
B. The system is patent. D. There is a leak in the system.
39. A nurse is caring for a postoperative pneumonectomy client. Which of the following findings on nursing
assessment of the client is an adverse sign or symptom indicating pulmonary edema?
A. Respiratory rate of 20 breaths per minute C. Lung crackles
B. Pain with deep breathing D. Increased chest tube drainage
40. A clinic nurse is providing instructions to a client with a diagnosis of pharyngitis. The nurse instructs the client to:

A. Drink hot tea throughout the day. C. Avoid foods that are highly seasoned.
B. Drink hot cocoa in place of coffee. D. Restrict fluid intake to 1000 mL daily.
41. A client has had an arterial blood gas sample drawn from the radial artery, and the nurse is asked to hold
pressure on the site. The nurse should apply pressure for at least:
A. 1 minute B. 2 minutes C. 5 minutes D. 10 minutes
42. When a client suffers a complete pneumothorax. there is danger of a mediastinal shift. If such a shift occurs,
what potential effect should cause the nurse to be concerned?
A. Rupture of the pericardium C. Decreased tilling of the right heart
B. Infection of the subpleural lining D. Increased volume of the unaffected lung
43. What would be the priority goal established for a client with asthma who is being discharged from the hospital?
The client:
A. Is able to obtain pulse oximeter readings C. Knows the primary care providers office hours
B. Demonstrates use of a metered-dose inhaler D. Can identify the foods that may cause wheezing
44. A client is admitted for an exacerbation of emphysema. The client has a fever. chills, and difficulty breathing on
exertion. Based on the client’s history and present status, what is a priority nursing action?
A. Checking for capillary refill C. Suctioning secretions from the airway
B. Encouraging increased fluid intake D. Administering high concentration of 02
45. A client states that the physician said the tidal volume is slightly diminished and asks the nurse what this means.
What explanation should the nurse give the client? Tidal volume is the amount of air:
A. Exhaled forcibly after a normal expiration C. Inspired forcibly above a normal inspiration
B. Exhaled after there is a normal inspiration D. Trapped in the alveoli that cannot be exhaled
46. What is the underlying reason the nurse must assess a client with emphysema for clinical indicators of hypoxia?
A. Pleural effusion B. Infectious obstructions C. Loss of aerating surface D. Respiratory muscle paralysis
47. A client has an endotracheal tube and is receiving mechanical ventilation. The nurse identifies that periodic
suctioning may be necessary. The nurse follows a specific protocol when performing this procedure. After obtaining
the clients vital signs the nurse’s next intervention should be to:
A. Auscultate the lung sounds C. Suction for approximately 10 seconds
B. Hyperoxygenate for 30 seconds D. Rotate the catheter during its withdrawal
48. A client is scheduled for a pulmonary function test. The nurse explains that during the test one of the instructions
the respiratory therapist will give the client is to breathe normally. What is being measuring when the client follows
these directions?
A. Tidal volume B. Vital capacity C. Expiratory reserve D. lnspiratory reserve
49. A client with emphysema experiences a sudden episode of shortness of breath and is diagnosed with a
spontaneous pneumothorax. What likely cause of the spontaneous pneumothorax should the nurse’s response take
into consideration?
A. Pleural friction rub C. Rupture of a subpleural bleb
B. Tracheoesophageal fistula D. Puncture wound of the chest wall
50. A client with asthma is being taught how to use a peak flow meter to monitor how well the asthma is being
controlled. What should the nurse instruct the client to do?
A. Perform the procedure once in the morning and once at night.
B. Move the trunk from an upright to a bending position while exhaling.
C. Inhale completely and then blow out as hard and as fast as possible through the mouthpiece.
D. Place the mouthpiece between the lips and in front of the teeth before starting the procedure.
51. When caring for a client with an ileostomy, the nurse should:
A. Teach the client to eat foods high in residue
B. Explain that drainage can be controlled with daily irrigations
C. Expect the stoma to start draining on the third postoperative day
D.Anticipate that any emotional stress can increase intestinal penstalsis
52. For which clinical indicator should the nurse monitor when caring for a client with cholelithiasis and obstructive
jaundice?
A. Yellow sclera B. Pain on urination C. Dark brown stool D. Coffee-ground vomitus
53. A client asks, “Why do I have to have barium salts for the GI series and barium enema?” Which is the best
response by the nurse? “Barium salts:
A. Give off visible light and illuminate the alimentary tract.”
B. Provide fluorescence and thus illuminate the alimentary tract.”
C. Dye the alimentary tract and thus provide for color contrast.”
D. Absorb x-rays and thus give contrast to the soft tissues of the alimentary tract.”
54. The nurse understands that the main reason why the risk for developing respiratory tract infections increases
after pancreatic surgery is the:

A. Length of time required for surgery

B. Proximity of the incision to the diaphragm
C. Lowered resistance caused by bile in the blood
D. Transfer of bacteria from the pancreas to the blood
55. The nurse is caring for a client with a diagnosis of acute pancreatitis and alcoholism. The nurse understands
that an acute attack of pancreatitis can be precipitated by heavy drinking because
A. Alcohol promotes the formation of calculi in the cystic duct
B. The pancreas is stimulated to secrete more insulin than it can immediately produce
C. The alcohol alters the composition of enzymes so they are capable of damaging the pancreas
D. Alcohol increases enzyme secretion and pancreatic duct pressure and causes backflow of enzymes
 into the pancreas
56. How many inches should the nurse insert a catheter into the stoma when performing a colostomy irrigation?
A. 5 cm (2 inches) B. 8 cm (3 inches) C. 15 cm (6 inches) D. 20 cm (8 inches)
57. A client is receiving a percutaneous endoscopic gastrostomy (PEG) tube feeding. When the nurse assesses the
client, which response indicates that the client is unable to tolerate a continuation of the feeding?
A. A passage of flatus C. A rise of formula in the tube
B. Epigastnc tenderness D. The rapid flow of the feeding
58. A client is scheduled for ligation of hemorrhoids. Which diet should the nurse expect the physician to encourage
the client to ingest in preparation for this surgery?
A. Bland diet B. Clear liquid diet C. High-protein diet D. Low-residue diet
59. Which explanation is most accurate when the nurse teaches a client about intussusception of the bowel?
A. Kinking of the bowel onto itself
B. A band of connective tissue compressing the bowel
C. Telescoping of a proximal loop of bowel into a distal loop
D. A protrusion of an organ or part of an organ through the wall that contains it
60. A client is scheduled for a colonoscopy and the physician orders a tap water enema. In which position should
the nurse place the client?
A. Sims’ position B. Back-lying position C. Knee-chest position D. Mid-Fowler’s position
61. A 93-year-old client with a history of diverticulitis is admitted with severe abdominal pain, anorexia. nausea,
vomiting for 24 hours, a markedly elevated temperature and increased white blood cells. The nurse understands the
most likely reason for surgical intervention is that:
A. Surgery is usually indicated for a diagnosis of diverticulitis
B. The symptoms exhibited by the client on admission are life threatening
C. In some instances diverticulitis is difficult to differentiate from carcinoma except surgically
D. The clients age indicates immediate correction of the potentially fatal condition is needed
62. An 18-year-old is admitted with an acute onset of right lower quadrant pain. Appendicitis is suspected. For which
clinical indicator should the nurse assess the client to determine if the pain is secondary to appendicitis?
A. Urinary retention C. Rebound tenderness
B. Gastric hyperacidity D. Increased lower bowel motility
63. A nurse is caring for a client who is receiving total parenteral nutrition (TPN) after extensive colon surgery. The
nurse concludes that the client understands teaching about the purpose of TPN when the client states, “TPN:
A. Provides short-term nutrition after surgery.”
B. Assists in providing supplemental nutrition.”
C. Provides total nutrition when GI function is questionable.”
D. Assists people who are unable to eat but have active GI function.”
64. A nurse is caring for a client with acute panacreatitis is monitoring the client for paralytic ileus. Which
assessment data would alert the nurse to this occurrence?
A. Firm, nontender mass palpable at the lower right costal margin C. Inability to pass flatus
B. Severe, constant pain with rapid onset D. Loss of anal sphincter control
65. After performing an initial abdominal assessment on a client with a diagnosis of cholelithiasis, a nurse
documents that the bowel sounds are normal. Which of the following descriptions best describes “normal bowel
sounds”?
A. Waves of loud gurgles auscultated in all four quadrants
B. Very high-pitched loud rushes auscultated especially in one or two quadrants
C. Relatively high-pitched clicks or gurgles auscultated in all four quadrants
D. Low-pitched swishing auscultated in one or two quadrants
66. A client is admitted to the hospital with a diagnosis of regional enteritis (Crohn’s disease). Which is the most
likely reason for the physician to order administration of parenteral vitamins to this client?
A. More rapid action results. C. They decrease colon irritability.
B. They are ineffective orally. D. Intestinal absorption may be inadequate.
67. When an intestinal obstruction is suspected, a client has a nasogastric tube inserted and attached to suction.
The nurse should critically assess this client for:
A. Edema B. Belching C. Dehydration D. Excessive salivation
68. A client has severe diarrhea and the physician orders intravenous therapy. sodium bicarbonate. and an
antidiarrheal medication. The nurse expects that the physician will probably order which most frequently ordered
antidiarrheal drug?
A. Bisacodyl (Dulcolax) C. Docusate sodium (Colace)
B. Psyllium (Metamucil) D. Loperamide HCI (Imodium)
69. After undergoing Billroth I gastric surgery, the client experiences fatigue and complains of numbness and tingling
in the feet and difficulties with balance. On the basis of these symptoms, the nurse suspects which postoperative
complication?
A. Pernicious anemia B. Bacterial meningitis C. Stroke D. Peripheral arterial disease
70. The nurse is caring for a client with a peptic ulcer who has just had an esophagogastroduodenoscopy (EGD).
Which nursing diagnosis would be the priority?
A. Risk for aspiration related to poor gag reflex secondary to local anesthesia
B. Deficient knowledge of post-procedure care related to not having had an EGD before
C. Risk for Deficient fluid volume related to hemorrhage or perforation of the gastrointestinal tract
D. Impaired comfort (sore throat) related to passage of the endoscope through the pharyngeal region
during EGD
71. A nurse obtains an admission history for a client with suspected peptic ulcer disease (PUD). Which of the
following client factors documented by the nurse would increase the risk for PUD?
A. Recently retired from a job
 B. Significant other has a gastric ulcer
C. Takes ibuprofen (Motrin) for osteoarthritis
D. Occasionally drinks one cup of coffee in the morning
72. In performing a physical assessment of a client with a diagnosis of ulcerative colitis, the nurse would expect
which of the following findings?
A. Hypercalcemia B. Fibrous stricture C. Frothy, fatty stools D. Decreased hemoglobin
73. A nurse is performing an assessment on a client with acute pancreatitis who was admitted to the hospital. Which
of the following assessment questions would most specifically elicit information regarding the pain that is associated
with acute pancreatitis?
A. “Does the pain in your lower abdomen radiate to your groin?”
B. “Does the pain in your stomach radiate to the back?”
C. “Does the pain in your stomach radiate to your lower middle abdomen?”
D. “Does the pain in your lower abdomen radiate to the hip?”
74. The nurse is teaching a client with a permanent colostomy about self-care in preparation for discharge from the
hospital. Which should the nurse discuss with the client? The:
A. Need for special clothing C. Importance of limiting activity
B. Periodic dilation of the stoma D. Bland. low-residue diet regimen
75. A nurse is caring for a client after abdominal surgery and creation of a colostomy. The nurse is assessing the
client for a prolapsed stoma and would expect to note which of the following if this is present?
A. A sunken and hidden stoma
B. A stoma that is dusky or bluish
C. A narrow and flattened stoma
D. A protrusion of the bowel with an elongated, swollen appearance of the stoma
76. The nurse is caring for a client with an indwelling urinary catheter. What is the most important action for the
nurse to take when planning to irrigate the bladder?
A. Use sterile equipment. C. Warm the solution to body temperature.
B. Instill the fluid under high pressure. D. Aspirate immediately to ensure return flow.
77. A client diagnosed with chronic renal failure (CRF) is scheduled to begin hemodialysis. The nurse determines
that which of the following neurological and psychosocial manifestations, if exhibited by this client, is unrelated to the
CRF?
A. Labile emotions B. Withdrawal C. Euphoria D. Depression
79. For what should the nurse monitor when caring for a client who has hematuria?
A. Intractable diarrhea B. Acetone in the urine C. Symptoms of peritonitis D. Gross blood in the urine
80. A nurse is giving general instructions to a client receiving hemodialysis. Which of the following statements would
be appropriate for the nurse to include?
A. “Several types of medications should be withheld on the day of dialysis until after the procedure.”
B. “Medications should be double-dosed on the morning of hemodialysis to prevent loss.”
C. “It is acceptable to exceed the fluid restriction on the day before hemodialysis.”
D. “It is acceptable to eat whatever you want on the day before hemodialysis.”
81. A client with chronic renal failure has been on dialysis for 3 years. The client is receiving the usual combination
of medications for the disease, including aluminum hydroxide as a phosphate-binding agent. The client now
presents with mental cloudiness, dementia, and complaints of bone pain. The nurse determines that these
assessment data are compatible with:
A. Phosphate overdose B. Aluminum intoxication C. Advancing uremia D. Folic acid deficiency
82. A client undergoing hemodialysis is at risk for bleeding from the heparin used during the hemodialysis treatment.
The nurse assesses for this occurrence by periodically checking the results of which of the following laboratory
tests?
A. Partial thromboplastin time (PU) C. Thrombin time
B. Prothrombin time (PT) D. Bleeding time
83. A nurse is monitoring the fluid balance of an assigned client. The nurse determines that the client has proper
fluid balance if which of the following 24-hour intake and output totals is noted?
A. Intake 1500 mL, output 800 mL C. Intake 2400 mL, output 2900 mL
B. Intake 3000 mL, output 2400 mL D. Intake 1800 mL, output 1750 mL
84. A nurse is caring for a client with acute renal failure (ARF). When performing an assessment, the nurse would
expect to note which of the following breathing patterns?
A. Decreased respirations B. Apnea C. Cheyne-Stokes respirations D. Kussmaul’s respirations
85. A nursing student is assigned to care for a client with a diagnosis of acute renal failure (ARF), diuretic phase.
The nursing instructor asks the student about the primary goal of the treatment plan for this client. Which of the
following goals, if stated by the nursing student, would indicate an adequate understanding of the treatment plan or
this client?
A. Prevent loss of electrolytes. C. Promote the excretion of wastes.
B. Reduce the urine specific gravity. D. Prevent fluid overload.
86. A client with chronic renal failure is about to begin hemodialysis therapy. The client asks the nurse about the
frequency and scheduling of hemodialysis treatments. The nurse’s response is based on an understanding that the
typical schedule is:
A. 5 hours of treatment 2 days per week C. 2 to 3 hours of treatment 5 days per week
B. 3 to 4 hours of treatment 3 days per week D. 2 hours of treatment 6 days per week
87. A client is about to begin hemodialysis. Which of the following measures should the nurse avoid in the care of
the client?
A. Giving the client a mask to wear during connection to the machine
B. Wearing full protective clothing such as goggles, mask, gloves, and apron
 C. Covering the connection site with a bath blanket to enhance extremity warmth
D. Using sterile technique for needle insertion
88. A nurse is assessing the renal function of a client at risk for renal failure. After noting the amount of urine output
and urine characteristics, the nurse proceeds to assess which of the following as the best indirect indicator of renal
status?
A. Jugular vein distention B. Level of consciousness C. Apical heart rate D. Blood pressure
89. The home care nurse is preparing to visit a client who has undergone renal transplantation. The nurse develops
a plan of care that includes monitoring the client for signs of acute graft rejection. The nurse documents in the plan
to assess the client for which signs of acute graft rejection?
A. Hypotension, graft tenderness, and hypothermia C. Fever, hypotension, and polyuria
B. Hypertension, polyuria, and thirst D. Fever, hypertension, and graft tenderness
90. A nurse is planning a teaching session with a client who has chronic renal failure (CRF) about managing the
condition between dialysis treatments. The nurse plans to include the instruction that weight gain between dialysis
treatments should be ideally no more than:
A. 0.5 to 1.0 kg B. 1 to 1.5 kg C. 2 to 4 kg D. 5 to 6 kg
91. When caring for a client with a diagnosis of benign prostatic hyperplasia. it is important for the nurse to
understand that it:
A. Is a congenital abnormality C. Predisposes to hydronephrosis
B. usually becomes malignant D. Causes an elevated acid phosphatase level
92. The nurse is caring for a client with chronic kidney failure. Which adaptation should the nurse expect?
A. Polyuria B. Hypotension C. Muscle twitching D. Respiratory acidosis
93. The pathology report states that a client’s urinary calculus is composed of uric acid. Which should the nurse
instruct the client to avoid?
A. Eggs B. Fruit C. Meat extracts D. Raw vegetables
94. A client with acute kidney failure becomes confused and irritable. The nurse understands that the most likely
cause of this behavior is:
A. Hyperkalemia B. Hypernatremia C. An elevated BUN D. A limited fluid intake
95. The nurse is caring for clients with renal calculi. Which is the most important nursing action?
A. Limit fluid intake at night. C. Record the client’s blood pressure.
B. Strain the urine at each voiding. D. Administer analgesics every 3 hours.
96. The nurse understands which pnnciple is associated with the reabsorption of water from glomerular filtrate in the
kidney tubules?
A. Osmosis B. Diffusion C. Active dialysis D. Active transport
97. The nurse is caring for a client with a diagnosis of cancer of the prostate Which serum level should be monitored
to follow the course of the disease?
A. Creatinine B. Blood urea nitrogen C. Nonprotein nitrogen D. Prostate-specific antigen
98. The nurse understands that metabolic acidosis develops in kidney failure as a result of:
A. Inability of the renal tubules to secrete hydrogen ions and conserve bicarbonate
B. Depressed respiratory rate by metabolic wastes, causing carbon dioxide retention
C. Inability of the renal tubules to reabsorb water to dilute the acid contents of blood
D. Impaired glomerular filtration, causing retention of sodium and metabolic waste products
99. The nurse is caring for a client with an external shunt used for hemodialysis. The nurse understands that the
most serious complication associated with hemodialysis is:
A. Septicemia B. Clot formation C. Exsanguination D. Sclerosis of vessels
100. A client with acute kidney failure is to receive a very low-protein diet. The nurse understands that this diet is
based on the principle that:
A. A high-protein intake ensures an adequate daily supply of amino acids to compensate for losses
B. Essential and nonessential amino acids are necessary in the diet to supply materials for tissue protein
synthesis
C. This supplies only essential amino acids, reducing the amount of metabolic waste products. thus decreasing
stress on the kidneys
D. Urea nitrogen cannot be used to synthesize amino acids in the body. so the nitrogen for amino acid synthesis
must come from the dietary protein