MEDSURG- 1
SAS #1
1. As a nurse, what is the importance of a
thorough preoperative assessment?
a. To identify and correct problems before
surgery and establish a baseline for
postoperative comparison
b. To save time doing an assessment after the
patient returns from surgery
c. To provide the doctor with information that
may have been missed during the preadmission
assessment
d. To ensure that postoperative complications
don’t occur
2. Before administering preoperative
medication to a client, nurse Jonalyn should
plan to:
a. Verify the consent
b. Check the vital signs
c. Have the client void
d. Remove the client’s dentures
3. A client with Cataract is about to undergo
surgery. Nurse Princess is preparing plan of
care. Which of the following nursing diagnosis is
most appropriate to address the long term need
of this type of patient?
a. Anxiety related to the operation and its
outcome
b. Sensory perceptual alteration related to lens
extraction and replacement
c. Knowledge deficit related to the pre-
operative and post-operative self-care
d. Body Image disturbance related to the eye
packing after surgery
4. On the morning of Mrs. Sy’s planned
cholecystectomy, she awakens with a pain in
her right scapular area and thinks she slept in
poor position. While doing the pre-op check list
you note that on her routine CB report her WBC
is 15,000. Your responsibility at this point is:
a. To notify the surgeon at once; this is an
elevated WBC indicating an inflammatory
reaction
b. To record this finding in a prominent place on
the pre-op checklist and in your pre-op notes
c. To call the laboratory for a STAT repeat WBC
d. None. This is not an unusual finding
5. Mrs. Sy is scheduled for surgery 2 days later
and is to be given atropine 0.3 mg IM and
Demerol 50 mg IM one hour preoperatively.
Which nursing actions follow the giving of the
pre-op medication?
a. Have her void soon after receiving the
medication
b. Allow her family to be with her before the
medication takes effect
c. Bring her valuables to the nursing station
d. Reinforce pre-op teaching
6. A patient is admitted to the same day surgery
unit for liver biopsy. Which of the following
laboratory tests assesses coagulation? SATA.
a. Partial thromboplastin time.
b. Prothrombin time.
c. Platelet count.
d. Hemoglobin
7. A client with a perforated gastric ulcer is
scheduled for emergency surgery. The client
cannot sign the operative consent form because
he has been sedated with opioid analgesics. The
nurse should take which of the following
actions in the care of this client?
a. Obtain a telephone consent from the family
member witnessed by two persons.
b. Obtain a court order for the surgery.
c. Send the client to surgery without the
consent form being signed.
d. Have the hospital chaplain sign the informed
consent immediately
10. A nurse is reviewing the physician’s order
sheet for the preoperative client, which states
that the client must be on nothing per mouth
(NPO) status after midnight. The nurse would
clarify whether which of the following
medications should be given to the client and
not withheld?
a. Conjugated estrogen (Premarin)
b. Atenolol (Tenormin)
c. Cyclobenzaprine (Flexeril)
d. Ferrous sulfate

8. A preoperative client expresses anxiety to the

nurse about the upcoming surgery. Which of
SAS #2
the following responses by
1. Nurse Jay is preparing to change a client’s
the nurse is most likely to stimulate further
dressing. The statement that best explains the
discussion between the client and the nurse?
basis of surgical asepsis that nurse will perform
a. “I will be happy to explain the entire surgical in this procedure is:
procedure to you.”
a. Keep the area free from microorganisms
b. “Let me tell you about the care you’ll receive
b. Protect self from microorganisms in the
after surgery and the amount of pain you can
wound
anticipate.”
c. Confine the microorganisms to the surgical
c. “If it’s any help, everyone is nervous before
site
surgery.”
d. Keep the number of opportunistic
d. “Can you share with me what you’ve been
microorganisms to a minimum
told about your surgery?”
2. Function of a circulating nurse is:
9. A nurse is preparing the client for transfer to
the operating room (OR). The nurse should take a. Assists the scrub nurse and surgeon
which of the following
b. Draping the client with sterile drapes
actions in the care of this client at this time?
c. Wear sterile gloves, gowns, caps
a. Administer all the daily medications.
d. Handling sterile instruments and supplies
b. Ensure that the client has voided.
3. Which among the following are not
c. Verify that the client has not eaten for the members of the sterile team in the operating
last 24 hours. room? Select that all apply:
d. Practice postoperative breathing exercises. 1. Surgeon

2. Anesthesiologist
3. Radiation technician
4. Scrub nurse
5. Circulating nurse
a. 1, 2, 3
b. 2, 3
c. 2, 3, 5
d. 3, 4, 5
4. What is the responsibility of the nurse
regarding informed consent?
a. To explain the surgical options
b. To describe the operative procedure to be
done
b. To explain the operative risks
d. To witness a patient’s signature
5. Which of the following is the primary
responsibility of the nurse before surgical
operation?
a. Taking the vital signs
b. Explaining the procedure
c. Obtaining the permit
d. Checking the lab works
6. Mr. Alejandro is scheduled for a
prostatectomy and the anesthesiologist plans
to use a spinal (subarachnoid) block during
surgery. In the operating room, the nurse
positions the client according to the
anesthesiologist's instructions. Why
does the client require special positioning for
this type of anesthesia?
a. To prevent confusion
b. To prevent seizures
c. To prevent cerebrospinal fluid (CSF) leakage
d. To prevent cardiac arrhythmias
7. What is the most important postoperative
instruction nurse Nikki must give to Mrs.
Serrano who has just returned from the
operating room after receiving a subarachnoid
block?
a. "Avoid drinking liquids until the gag reflex
returns."
b. "Avoid eating milk products for 24 hours."
c. "Notify a nurse if you experience blood in
your urine."
d. "Remain supine for the time specified by the
physician."
8. The common anesthesia used for
appendectomy is?
a. Spinal
b. General
c. Caudal
d. Hypnosis
9. The client returns from surgery with a blood
pressure of 90/50, pulse 132, and respirations
30. Which action by Nurse Jo should receive
priority?
a. Continue to monitor the vital signs
b. Contact the physician
c. Ask the client how he feels
d. Ask the nursing assistant to continue the
post-op care
10. An additive given to potentiate and
prolong the effects of regional anesthesia is:
a. Lidocaine
b. Epinephrine
c. Digoxin
d. Lanoxin d. When the patient can be aroused and
recognizes where he or she is

5. What is included in the routine assessment

SAS #3
of the patient’s cardiovascular function on
1. What does progression of patients through admission to the PACU?
various phases of care in a post anesthesia
a. Monitoring arterial blood gases
care unit (PACU) primarily depend on?
b. Electrocardiographic (ECG) monitoring
a. Condition of patient
c. Determining fluid and electrolyte status
b. Type of anesthesia used
d. Direct arterial blood pressure monitoring
c. Preference of surgeon
6. With what are the postoperative respiratory
d. Type of surgical procedure
complications of atelectasis and aspiration of
2. Priority Decision: Upon admission of a gastric contents associated?
patient to the PACU, the nurse’s priority
a. Hypoxemia
assessment is
b. Hypercapnia
a. vital signs.
c. Hypoventilation
b. surgical site.
d. Airway obstruction
c. respiratory adequacy.
7. To prevent airway obstruction in the
d. level of consciousness
postoperative patient who is unconscious or
3. How is the initial information given to the semiconscious, what will the nurse do?
PACU nurses about the surgical patient?
a. Encourage deep breathing
a. A copy of the written operative report
b. Elevate the head of the bed
b. A verbal report from the circulating nurse
c. Administer oxygen per mask
c. A verbal report from the anesthesia care
d. Position the patient in a side-lying position
provider (ACP)

d. An explanation of the surgical procedure

from the surgeon

4. To prevent agitation during the patient’s 8. Priority Decision: To promote effective

recovery from anesthesia, when should the
nurse begin orientation explanations?
a. When the patient is awake
b. When the patient first arrives in the PACU
c. When the patient becomes agitated or
frightened
coughing, deep breathing, and ambulation in
the postoperative patient, what is most
important for the nurse to do?
a. Teach the patient-controlled breathing
b. Explain the rationale for these activities
c. Provide adequate and regular pain
medication
d. Use an incentive spirometer to motivate the
patient
9. While assessing a patient in the PACU, the
nurse finds that the patient’s blood pressure is
below the preoperative baseline. The nurse
determines that the patient has residual
vasodilating effects of anesthesia when what is
assessed?
a. A urinary output >30 mL/hr.
b. An oxygen saturation of 88%
c. A normal pulse with warm, dry, pink skin
d. A narrowing pulse pressure with normal
pulse
10. Priority Decision: A patient in the PACU has
emergence delirium manifested by agitation
and thrashing. What should the nurse assess
for first in the patient?
a. Hypoxemia
b. Neurologic injury
c. Distended bladder
d. Cardiac dysrhythmias
SAS #4
1. The nurse is providing patient teaching to a
young mother who has brought her 3-month-
old infant to the clinic for a well-baby checkup.
What action should the nurse recommend to
the woman to prevent the transmission of
organisms to
her infant during the cold season?
a. Take preventative antibiotics, as ordered.
b. Gargle with warm salt water regularly.
c. Dress herself and her infant warmly.
d. Wash her hands frequently.
2. The nurse is explaining the safe and
effective administration of nasal spray to a
patient with seasonal allergies. What
information is most important to include in
this teaching?
a. Finish the bottle of nasal spray to clear the
infection effectively.
b. Nasal spray can only be shared between
immediate family members.
c. Nasal spray should be administered in a
prone position.
d. Overuse of nasal spray may cause rebound
congestion
3. A patient visiting the clinic is diagnosed with
acute sinusitis. To promote sinus drainage, the
nurse should instruct the patient to perform
which of the following?
a. Apply a cold pack to the affected area.
b. Apply a mustard poultice to the forehead.
c. Perform postural drainage.
d. Increase fluid intake.
4. The nurse is creating a plan of car for a
patient diagnosed with acute laryngitis. What
intervention should be included in the
patient’s plan of care?
a. Place warm clothes on the patient’s throat,
as needed.
b. Have the patient inhale warm steam three
times daily.
c. Encourage the patient to limit speech
whenever possible.
d. Limit the patient’s fluid intake to 1.5 L/day.
5. A patient comes to the ED and is admitted
with epistaxis. Pressure has been applied to
the patient’s midline septum for 10 minutes,
but the bleeding continues. The nurse should
anticipate using what treatment to control the
bleeding?
a. Irrigation with a hypertonic solution
b. Nasopharyngeal suction
c. Normal saline application
d Silver nitrate application
6. The nurse is planning the care of a patient
who is scheduled for a laryngectomy. The
nurse should assign the highest priority to
which postoperative nursing diagnosis?
a. Anxiety related to diagnosis of cancer
b. Altered nutrition related to swallowing
difficulties
c. Ineffective airway clearance related to
airway alterations
d. Impaired verbal communication related to
removal of the larynx
7. The home care nurse is assessing the home
environment of a patient who will be
discharged from the hospital shortly
after his laryngectomy. The nurse should
inform the patient that he may need to
arrange for the installation of which system in
his home?
a. A humidification system
b. An air conditioning system
c. A water purification system
d. A radiant heating system
8. The nurse is caring for a patient whose
recent unexplained weight loss and history of
smoking have prompted diagnostic testing for
cancer. What symptom is most closely
associated with the early stages of laryngeal
cancer?
a. Hoarseness
b. Dyspnea
c. Dysphagia
d. Frequent nosebleeds
9. The campus nurse at a university is assessing
a 21-year-old student who presents with a
severe nosebleed. The site of bleeding appears
to be the anterior portion of the nasal septum.
The nurse instructs the student to tilt her head
forward and the nurse applies pressure to the
nose, but the student’s nose continues to
bleed. Which intervention should the
nurse next implement?
a. Apply ice to the bridge of her nose
b. Lay the patient down on a cot
c. Arrange for transfer to the local ED
d. Insert a tampon in the affected nares
10. The nurse is conducting a presurgical
interview for a patient with laryngeal cancer.
The patient states that he drinks
approximately six to eight shots of vodka per
day. It is imperative that the nurse inform the
surgical team so the patient can be assessed
for what?
a. Increased risk for infection
b. Delirium tremens
c. Depression
d. Nonadherence to postoperative care D. Albuterol nebulizer

4. When teaching the patient about going from

SAS #5
1. While assisting a patient with intermittent
asthma to identify specific triggers of asthma,
what should the nurse explain?
a metered-dose inhaler (MDI) to a dry powder
inhaler (DPI), which statement by the patient
shows the nurse that the patient needs more
teaching?
A. “I do not need to use the spacer like I used
to.”

A. Food and drug allergies do not manifest in B. “I will hold my breath for 10 seconds or
respiratory symptoms. longer if I can.”

B. Exercise-induced asthma is seen only in C. “I will not shake this inhaler like I did with
individuals with sensitivity to cold air. my old inhaler.”

C. Asthma attacks are psychogenic in origin D. “I will store it in the bathroom so I will be
and can be controlled with relaxation able to clean it when I need to.”
techniques.

D. Viral upper respiratory infections are a

common precipitating factor in acute asthma
attacks.

2. A patient is admitted to the emergency

department with an acute asthma attack.
Which patient assessment is of greatest
concern to the nurse?

A. The presence of a pulsus paradoxus

B. Markedly diminished breath sounds with no

wheezing
C. Use of accessory muscles of respiration and
a feeling of suffocation
D. A respiratory rate of 34 and increased pulse
and blood pressure
3. Priority Decision: Which medication should
the nurse anticipate being used first in the
emergency department for relief of severe
respiratory distress related to asthma?
A. Prednisone orally
B. Ipratropium inhaler
5. Which statements by a patient with
moderate asthma inform the nurse that the
patient needs more teaching about
medications (Select All That Apply)?
A. “If I can’t afford all of my medicines, I will
only use the salmeterol (Serevent).”
B. “I will stay inside if there is a high pollen
count to prevent having an asthma attack.”
C. “I will rinse my mouth after using
fluticasone (Flovent HFA) to prevent oral
candidiasis.”

C. Fluticasone inhaler
D. “I must have omalizumab (Xolair) injected
every 2 to 4 weeks because inhalers don’t help
my asthma.”
E. “If I can’t afford all of my medicines, I will
only use the salmeterol (Serevent).”
6. To decrease the patient’s sense of panic
during an acute asthma attack, what is the
best action for the nurse to do?
A. Leave the patient alone to rest in a quiet,
calm environment.
B. Stay with the patient and encourage slow,
pursed lip breathing.
C. Reassure the patient that the attack can be
controlled with treatment.
D. Let the patient know that frequent
monitoring is being done using measurement
of vital signs and SpO2.
equipment, what should the nurse teach the
patient?
A. The portable unit will last about 6 to 8
hours.
B. The unit is strictly for portable and
emergency use.
C. The unit concentrates O2 from the air,
providing a continuous O2 supply.
D. Weekly delivery of one large cylinder of O2
will be necessary for a 7- to 10-day supply of
O2
9. During an acute exacerbation of mild COPD,
the patient is severely short of breath and the
nurse identifies a nursing diagnosis of
ineffective breathing pattern related to
obstruction of airflow and anxiety. What is the
best action by the
nurse?

7. When teaching the patient with mild asthma A. Prepare and administer routine
about the use of the peak flow meter, what bronchodilator medications.
should the nurse instruct the patient to do?
B. Perform chest physiotherapy to promote
A. Carry the flow meter with the patient at all removal of secretions.
times in case an asthma attack occurs
C. Administer oxygen at 5 L/min until the
B. Use the flow meter to check the status of shortness of breath is relieved.
the patient’s asthma every time the patient
D. Position the patient upright with the elbows
takes quick-relief medication
resting on the over-the-bed table
C. Follow the written asthma action plan (e.g.,
10. In planning care for the patient with
take quick-relief medication) if the expiratory
bronchiectasis, which nursing intervention
flow rate is in the yellow zone
should the nurse include?
D. Use the flow meter by emptying the lungs,
A. Relieve or reduce pain
closing the mouth around the mouthpiece, and
inhaling through the meter as quickly as B. Prevent paroxysmal coughing
possible
C. Prevent spread of the disease to others
8. A patient is being discharged with plans for
home O2 therapy provided by an O2 D. Promote drainage and removal of mucus
concentrator with an O2-conserving portable
unit. In preparing the patient to use the
SAS #6
1. To evaluate the effectiveness of prescribed
therapies for a patient with ventilatory failure,
which diagnostic test will be most useful to the
nurse?
a. Chest x-rays
b. Pulse oximetry
c. Arterial blood gas (ABG) analysis
d. Pulmonary artery pressure monitoring
2. While caring for a patient who has been
admitted with a pulmonary embolism, the
nurse notes a change in the patient's oxygen
saturation (SpO2) from 94% to 88%. The nurse
will
a. increases the oxygen flow rate.
b. suction the patient's oropharynx.
c. assists the patient to cough and deep
breathe.
d. helps the patient to sit in a more upright
position.
3. A patient with respiratory failure has a
respiratory rate of 8 and an SpO2 of 89%. The
patient is increasingly lethargic. The nurse will
anticipate assisting with
a. administration of 100% oxygen by non-
rebreather mask.
b. endotracheal intubation and positive
pressure ventilation.
c. insertion of a mini-tracheostomy with
frequent suctioning.
d. initiation of bilevel positive pressure
ventilation (BiPAP).
4. When admitting a patient in possible
respiratory failure with a high PaCO2, which
assessment information will be of most
concern to the nurse?
a. The patient is somnolent.
b. The patient's SpO2 is 90%.
c. The patient complains of weakness.
d. The patient's blood pressure is 162/94.
5. A nurse answers a call light and finds a client
anxious, short of breath, reporting chest pain,
and having a blood pressure of 88/52 mm Hg
on the cardiac monitor. What action by the
nurse takes priority?
a. Assess the client’s lung sounds.
b. Notify the Rapid Response Team.
c. Provide reassurance to the client.
d. Take a full set of vital signs.
6. A client is admitted with a pulmonary
embolism (PE). The client is young, healthy,
and active and has no known risk factors for
PE. What action by the nurse is most
appropriate?
a. Encourage the client to walk 5 minutes each
hour.
b. Refer the client to smoking cessation
classes.
c. Teach the client about factor V Leiden
testing.
d. Tell the client that sometimes no cause for
disease is found.
7. A client has a pulmonary embolism and is
started on oxygen. The student nurse asks why
the clients oxygen saturation has not
significantly improved. What response by the
nurse is best?
a. Breathing so rapidly interferes with
oxygenation.
b. Maybe the client has respiratory distress
syndrome.
c. The blood clot interferes with perfusion in
the lungs.
d. The client needs immediate intubation and
mechanical ventilation.
8. A client appears dyspneic, but the oxygen
saturation is 97%. What action by the nurse is
best?
a. Assess for other manifestations of hypoxia.
b. Change the sensor on the pulse oximeter.
C. cardiomegaly and pulmonary fibrosis.
D. ventricular dysrhythmias and wheezing.
2. You are caring for a patient with a diagnosis
of iron-deficiency anemia. Which clinical
manifestations are you most likely to observe
when assessing this patient?
A. Convex nails, bright red gums, and alopecia
B. Brittle nails; smooth, shiny tongue; and
cheilosis

c. Obtain a new oximeter from central supply. C. Tenting of the skin, sunken eyes, and
complaints of diarrhea
d. Tell the client to take slow, deep breaths.
D. Pale pink tongue; dull, brittle hair; and blue
9. A nurse is assisting the health care provider
mucous membranes
who is intubating a client. The provider has
been attempting to intubate for 40 seconds. 3.When providing teaching for the patient with
What action by the nurse takes priority? iron-deficiency anemia who has been
prescribed iron supplements, you should
a. Ensure the client has adequate sedation.
include taking the iron with which beverage?
b. Find another provider to intubate.
A. Milk
c. Interrupt the procedure to give oxygen.
B. Ginger ale
d. Monitor the client’s oxygen saturation.
C. Orange juice
10. An intubated clients oxygen saturation has
D. Water
dropped to 88%. What action by the nurse
takes priority?

a. Determine if the tube is kinked.

b. Ensure all connections are patent. 4.The primary pathophysiology underlying

thalassemia is
c. Listen to the client’s lung sounds.
A. erythropoietin deficiency.
d. Suction the endotracheal tube.
B. abnormal hemoglobin synthesis.

SAS #7
1. In a severely anemic patient, you expect to
find
A. dyspnea and tachycardia.
B. cyanosis and pulmonary edema.
C. autoimmunity.
D. S-shaped hemoglobin.
5. Which individual is at high risk for a
cobalamin (vitamin B12) deficiency anemia?
A. A 47-year-old man who had a gastrectomy
(removal of the stomach)
B. A 54-year-old man with a history of irritable
bowel disease and ulcerative colitis
C. A 26-year-old woman who complains of
heavy menstrual periods
D. A 15-year-old girl who is a vegetarian
6. You encourage the patient with cobalamin
deficiency to seek treatment because
untreated pernicious anemia may result in
A. death.
B. liver failure.
C. heart failure.
D. gastrectomy.
7. The Schilling test for pernicious anemia
involves
A. administration of radioactive cobalamin and
measuring its excretion in the urine.
B. blood cultures for organism identification.
C. the measurement of serum iron.
D. the administration of iron and blood
assessment of total iron binding in 24 hours.
8. Which finding allows you to identify the
patient's anemia as folic acid deficiency rather
than cobalamin deficiency?
A. Loss of appetite
B. Lack of neuromuscular symptoms
C. Red tongue
D. Change in nail shape
9. Which foods should you encourage patients
with folic acid deficiency to include in their
daily food intake (select all that apply)?
A. Ready-to-eat cereal
B. Wheat tortillas
C. Lentils
D. Strawberries
E. Potatoes
10. You are evaluating the laboratory data of
the patient with suspected aplastic anemia.
Which findings support this diagnosis?
A. Reduced RBCs, reduced white blood cells
(WBCs), and reduced platelets
B. Reduced RBCs, normal WBCs, and normal
platelets
C. Normal RBCs, reduced WBCs, and reduced
platelets
D. Elevated RBCs, increased WBCs, and
increased platelets
SAS #8
1. What are non-modifiable risk factors for
primary hypertension (select all that apply)?
a. Age
b. Obesity
c. Gender
d. Ethnicity
e. Genetic link
2. How is secondary hypertension
differentiated from primary hypertension?
a. Has a more gradual onset than primary
hypertension
b. Does not cause the target organ damage
that occurs with primary hypertension
c. Has a specific cause, such as renal disease,
that often can be treated by medicine or
surgery
d. Is caused by age-related changes in BP
regulatory mechanisms in people over 65 years
of age
3. What is the patient with primary
hypertension likely to report?
a. No symptoms
b. Cardiac palpitations
c. Dyspnea on exertion
d. Dizziness and vertigo
4. A patient with stage 2 hypertension who is
taking hydrochlorothiazide (Hydrodiuril) and
lisinopril (Prinivil) has prazosin (Minipress)
added to the medication regimen. What is
most important for the nurse to teach the
patient to do?
a. Weigh every morning to monitor for fluid
retention
b. Change position slowly and avoid prolonged
standing
c. Use sugarless gum or candy to help relieve
dry mouth
d. Take the pulse daily to note any slowing of
the heart rate
5. A 38-year-old man is treated for
hypertension with triamterene and
hydrochlorothiazide (Maxzide) and metoprolol
(Lopressor). Four months after his last clinic
visit, his BP returns to pretreatment levels and
he admits he has not been taking his
medication regularly. What is the nurse’s best
response to this patient?
a. “Try always to take your medication when
you carry out another daily routine so you do
not forget to take it.”
b. “You probably would not need to take
medications for hypertension if you would
exercise more and stop smoking.”
c. “The drugs you are taking cause sexual
dysfunction in many patients. Are you
experiencing any problems? in this area?
d. “You need to remember that hypertension
can be only controlled with medication, not
cured, and you must always take your
medication.”
6. A 78-year-old patient is admitted with a BP
of 180/98 mm Hg. Which age-related physical
changes may contribute to this patient’s
hypertension? (Select All That Apply)
a. Decreased renal function
b. Increased baroreceptor reflexes
c. Increased peripheral vascular resistance
d. Increased adrenergic receptor sensitivity
e. Increased collagen and stiffness of the
myocardium
f. Loss of elasticity in large arteries from
arteriosclerosis
7. What should the nurse emphasize when
teaching a patient who is newly prescribed
clonidine (Catapres)?
a. The drug should never be stopped abruptly.
b. The drug should be taken early in the day to
prevent nocturia.
c. The first dose should be taken when the
patient is in bed for the night.
d. Because aspirin will decrease the drug’s
effectiveness, Tylenol should be used instead.
8. What is included in the correct technique for
BP measurements?
a. Always take the BP in both arms.
b. Position the patient supine for all readings.
c. Place the cuff loosely around the upper arm.
d. Take readings at least two times at least 1
minute apart
9. Which manifestation is an indication that a
patient is having a hypertensive emergency?
a. Symptoms of a stroke with an elevated BP
b. A systolic BP >200 mm Hg and a diastolic BP
>120 mm Hg
c. A sudden rise in BP accompanied by
neurologic impairment
d. A severe elevation of BP that occurs over
several days or weeks
10. During treatment of a patient with a BP of
222/148 mm Hg and confusion, nausea, and
vomiting, the nurse initially titrates the
medications to achieve which goal?
a. Decrease the mean arterial pressure (MAP)
to 129 mm Hg
b. Lower the BP to the patient’s normal within
the second to third hour
c. Decrease the SBP to 160 mm Hg and the DBP
to between 100- and 110-mm Hg as quickly as
possible
d. Reduce the systolic BP (SBP) to 158 mm Hg
and the diastolic BP (DBP) to 111 mm Hg
within the first 2 hours
SAS #9
1. Which patient is most likely to be in the
fibrous stage of development of coronary
artery disease (CAD)?
a. Age 40, thrombus adhered to the coronary
artery wall
b. Age 50, rapid onset of disease with
hypercholesterolemia
c. Age 32, thickened coronary arterial walls
with narrowed vessel lumen
d. Age 19, elevated low-density lipoprotein
(LDL) cholesterol, lipid-filled smooth muscle
cells
2. What accurately describes the
pathophysiology of CAD?
a. Partial or total occlusion of the coronary
artery occurs during the stage of raised fibrous
plaque
b. Endothelial alteration may be caused by
chemical irritants such as hyperlipidemia or by
tobacco use
c. Collateral circulation in the coronary
circulation is more likely to be present in the
young patient with CAD
d. The leading theory of atherogenesis
proposes that infection and fatty dietary
intake are the basic underlying causes of
atherosclerosis
3. While obtaining patient histories, which
patient does the nurse identify as having the
highest risk for CAD?
a. A white man, age 54, who is a smoker and
has a stressful lifestyle
b. A white woman, age 68, with a BP of
172/100 mm Hg and who is physically inactive
c. An Asian woman, age 45, with a cholesterol
level of 240 mg/dL and a BP of 130/74 mm Hg
d. An obese African American man, age 65,
with a cholesterol level of 195 mg/dL and a BP
of 128/76 mm Hg
4. Priority Decision: While teaching women
about the risks and incidence of CAD, what
does the nurse emphasize?
a. Smoking is not as significant a risk factor for
CAD in women as it is in men.
b. Women seek treatment sooner than men
when they have symptoms of CAD.
c. Estrogen replacement therapy in
postmenopausal women decreases the risk for
CAD.
d. CAD is the leading cause of death in women,
with a higher mortality rate after MI than in
men.
5. Which characteristics are associated with
LDLs (select all that apply)?
a. Increases with exercise
b. Contains the most cholesterol
c. Has an affinity for arterial walls
d. Carries lipids away from arteries to liver
d. Angina in the patient with atherosclerotic
coronary arteries
e. Left ventricular hypertrophy caused by
chronic hypertension
f. Sympathetic nervous system stimulation by
drugs, emotions, or exertion
8. What causes the pain that occurs with
myocardial ischemia?
a. Death of myocardial tissue
b. Dysrhythmias caused by cellular irritability
c. Lactic acid accumulation during anaerobic
metabolism

e. High levels correlate most closely with CAD d. Elevated pressure in the ventricles and
pulmonary vessels
6. Which serum lipid elevation, along with
elevated LDL, is strongly associated with CAD? 9. What types of angina can occur in the
absence of CAD (select all that apply)?
a. Apolipoproteins
a. Silent ischemia
b. Fasting triglycerides
b. Nocturnal angina
c. Total serum cholesterol
c. Prinzmetal’s angina
d. High-density lipoprotein (HDL)
d. Microvascular angina

e. Chronic stable angina

7. Myocardial ischemia occurs as a result of

increased oxygen demand and decreased 10. Which characteristics describe unstable
oxygen supply. What factors and disorders angina (select all that apply)?
result in increased oxygen demand (select all
a. Usually precipitated by exertion
that apply)?
b. Unpredictable and unrelieved by rest
a. Hypovolemia or anemia
c. Characterized by progressive severity
b. Increased cardiac workload with aortic
stenosis d. Occurs only when the person is recumbent
c. Narrowed coronary arteries from
atherosclerosis
SAS #10
1. Which of the following is the most common
symptom of myocardial infarction (MI)?
a. Chest pain
b. Dyspnea
c. Edema
d. Palpitations
2. An intravenous analgesic frequently
administered to relieve chest pain associated
with MI is:
a. Meperidine hydrochloride
b. Hydromorphone hydrochloride
c. Morphine sulfate
d. Codeine sulfate
3. The classic ECG changes that occur with an
MI include all of the following except:
a. An absent P wave
b. An abnormal Q wave
c. T-wave inversion
d. ST segment elevation
4. Which of the following statements about
myocardial infarction pain is incorrect?
a. It is relieved by rest and inactivity.
b. It is substernal in location.
c. It is sudden in onset and prolonged in
duration.
d. It is viselike and radiates to the shoulders
and arms.
5. Myocardial cell damage can be reflected by
high levels of cardiac enzymes. The cardiac-
specific isoenzyme is:
a. Alkaline phosphatase
b. Creatine kinase (CK-MB)
c. Myoglobin
d. Troponin
6. A patient admitted to the hospital for
evaluation of chest pain has no abnormal
serum cardiac markers 4 hours after the onset
of pain. What noninvasive diagnostic test can
be used to differentiate angina from other
types of chest pain?
a. 12-lead ECG
b. Exercise stress test
c. Coronary angiogram
d. Transesophageal echocardiogram
7. A 52-year-old man is admitted to the
emergency department with severe chest pain.
On what basis would the nurse suspect an MI?
a. He has pale, cool, clammy skin.
b. He reports nausea and vomited once at
home.
c. He says he is anxious and has a feeling of
impending doom.
d. He reports he has had no relief of the pain
with rest or position change.
8. At what point in the healing process of the
myocardium following an infarct does early
scar tissue result in an unstable heart wall?
a. 2 to 3 days after MI
b. 4 to 10 days after MI
c. 10 to 14 days after MI
d. 6 weeks after MI
9. To detect and treat the most common
complication of MI, what should the nurse do?
a. Measure hourly urine output.
b. Auscultate the chest for crackles.
c. Use continuous cardiac monitoring.
d. Take vital signs every 2 hours for the first 8
hours.
10. Which treatment is used first for the
patient with a confirmed MI to open the
blocked artery within 90 minutes of arrival to
the facility?
a. Stent placement
b. Coronary artery bypass graft (CABG)
c. Percutaneous coronary intervention (PCI)
d. Trans myocardial laser revascularization
(TMR)
SAS #11
1. Which statements accurately describe heart
failure (select all that apply)?
a. A common cause of diastolic failure is left
ventricular hypertrophy.
b. A primary risk factor for heart failure is
coronary artery disease (CAD).
c. Systolic heart failure results in a normal left
ventricular ejection fraction.
d. Systolic failure is characterized by abnormal
resistance to ventricular filling.
e. Hypervolemia precipitates heart failure by
decreasing cardiac output and increasing
oxygen consumption.
2. What describes the action of the natriuretic
peptides and nitric oxide in their counter
regulatory processes in response to heart
failure (HF)?
a. Excretion of potassium
b. Increased release of ADH
c. Vasodilation and decreased blood pressure
d. Decreased glomerular filtration rate and
edema
3. The acronym FACES is used to help educate
patients to identify symptoms of heart failure.
What does this acronym mean?
a. Frequent activity leads to cough in the
elderly and swelling
b. Factors of risk: activity, cough, emotional
upsets, salt intake
c. Follow activity plan, continue exercise, and
know signs of problems
d. Fatigue, limitation of activities, chest
congestion/cough, edema, shortness of breath
4. What is the pathophysiologic mechanism
that results in the pulmonary edema of left-
sided heart failure?
a. Increased right ventricular preload
b. Increased pulmonary hydrostatic pressure
c. Impaired alveolar oxygen and carbon
dioxide exchange
d. Increased lymphatic flow of pulmonary
extravascular fluid
5. Which initial physical assessment finding
would the nurse expect to be present in a
patient with acute left-sided heart failure?
a. Bubbling crackles and tachycardia
b. Hepatosplenomegaly and tachypnea
c. Peripheral edema and cool, diaphoretic skin
d. Frothy blood-tinged sputum and distended
jugular veins
6. A patient with chronic heart failure has
atrial fibrillation and a left ventricular ejection
fraction (LVEF) of 18%. To decrease the risk of
complications from these conditions, what received from the pharmacy, which medication
drug does the nurse anticipate giving? should not be included

a. Diuretics for this patient?

b. Anticoagulants a. Losartan (Cozaar)

c. β-Adrenergic blockers b. Carvedilol (Coreg)

d. Potassium supplements c. Dopamine (Intropin)

7. Which diagnostic test is most useful in d. Hydrochlorothiazide (HCTZ)

differentiating dyspnea related to pulmonary
effects of heart failure from dyspnea related to
pulmonary disease?

a. Exercise stress testing

b. Cardiac catheterization

c. B-type natriuretic peptide (BNP) levels

d. Determination of blood urea nitrogen (BUN)

8. Which medication is currently approved only

for use with African American patients for
hypertension and angina?

a. Captopril (Capoten)

b. Nitroglycerin (Nitro-Bid)

c. Spironolactone (Aldactone)

d. Isosorbide dinitrate and hydralazine (BiDil)

9. A patient is admitted to the emergency

department with acute decompensated heart
failure (ADHF). Which IV medication would the
nurse expect to administer first?

a. Digoxin (Lanoxin)

b. Morphine sulfate

c. Nesiritide (Natrecor)

d. Bumetanide (Bumex)

10. The patient with chronic heart failure is

being discharged with a diuretic, a renin-
angiotensin-aldosterone system (RAAS)
inhibitor and a β-adrenergic blocker. When
MEDSURG -1 P2 (SAS 12-22)
SAS #12
1. When obtaining a health history from a 72-
year-old man with peripheral arterial disease
(PAD) of the lower extremities, the nurse asks
about a history of related conditions, including
a. venous thrombosis.
b. venous stasis ulcers.
c. pulmonary embolism.
d. coronary artery disease (CAD).
2. Following teaching about medications for
PAD, the nurse determines that additional
instruction is necessary when the patient
makes which statement?
a. “I should take one aspirin a day to prevent
clotting in my legs.”
b. “The lisinopril I use for my blood pressure
may help me walk further without pain.”
c. “I will need to have frequent blood tests to
evaluate the effect of the Coumadin I will be
taking.”
d. “Pletal should help me increase my walking
distance and help prevent clots from forming in
my legs.”
3. A patient with PAD has a nursing diagnosis of
ineffective peripheral tissue perfusion. What
should be included in the teaching plan for this
patient (select all that apply)?
a. Keep legs and feet warm.
b. Apply cold compresses when the legs
become swollen.
c. Walk at least 30 minutes per day to the point
of discomfort.
d. Use nicotine replacement therapy as a
substitute for smoking.
e. Inspect lower extremities for pulses,
temperature, and any injury.
4. When teaching the patient with PAD about
modifying risk factors associated with the
condition, what should the nurse emphasize?
a. Amputation is the ultimate outcome if the
patient does not alter lifestyle behaviors.
b. Modifications will reduce the risk of other
atherosclerotic conditions such as stroke.
c. Risk-reducing behaviors initiated after
angioplasty can stop the progression of the
disease.
d. Maintenance of normal body weight is the
most important factor in controlling arterial
disease.
5. During care of the patient following femoral
bypass graft surgery, the nurse immediately
notifies the health care provider if the patient
experiences
a. fever and redness at the incision site.
b. 2+ edema of the extremity and pain at the
incision site.
c. a loss of palpable pulses and numbness and
tingling of the feet.
d. increasing ankle-brachial indices and serous
drainage from the incision.
6. What are characteristic of arteriospastic
disease (Raynaud’s phenomenon) (select all
that apply)?
a. Predominant in young females
b. May be associated with autoimmune
disorders
c. Precipitated by exposure to cold, caffeine, and
tobacco
d. Involves small cutaneous arteries of the
fingers and toes
e. Inflammation of small and medium-sized
arteries and veins
f. Episodes involve white, blue, and red color
changes of fingertips
7. Which aneurysm is uniform in shape and a
circumferential dilation of the artery?
a. False aneurysm
b. Pseudoaneurysm
c. Saccular aneurysm
d. Fusiform aneurysm
8. A surgical repair is planned for a patient who
has a 5.5-cm abdominal aortic aneurysm (AAA).
On physical assessment of the patient, what
should the nurse expect to find?
a. Hoarseness and dysphagia
b. Severe back pain with flank ecchymosis
c. Presence of a bruit in the periumbilical area
d. Weakness in the lower extremities
progressing to paraplegia
9. A thoracic aortic aneurysm is found when a
patient has a routine chest x-ray. The nurse
anticipates that additional diagnostic testing to
determine the size and structure of the
aneurysm will include which test?
a. Angiography
b. Ultrasonography
c. Echocardiography
d. Computed tomography (CT) scan
10. A patient with a small AAA is not a good
surgical candidate. What should the nurse teach
the patient is one of the best ways to prevent
expansion of the lesion?
a. Avoid strenuous physical exertion.
b. Control hypertension with prescribed
therapy.
c. Comply with prescribed anticoagulant
therapy.
d. Maintain a low-calcium diet to prevent
calcification of the vessel.
SAS #13
1. A 20-year-old patient has acute infective
endocarditis. While obtaining a nursing history,
what should the nurse ask the patient about
(select all that apply)?
a. Renal dialysis
b. IV drug abuse
c. Recent dental work
d. Cardiac catheterization
e. Recent urinary tract infection
2. A patient has an admitting diagnosis of acute
left-sided infective endocarditis. What is the best
test to confirm this diagnosis?
a. Blood cultures
b. Complete blood count
c. Cardiac catheterization
d. Transesophageal echocardiogram
3. Which manifestation of infective endocarditis
is a result of fragmentation and
microembolization of vegetative lesions?
a. Petechiae
b. Roth’s spots
c. Osler’s nodes
d. Splinter hemorrhages
4. What describes Janeway’s lesions that are
manifestations of infective endocarditis?
a. Hemorrhagic retinal lesions
b. Black longitudinal streaks in nail beds
c. Painful red or purple lesions on fingers or
toes
d. Flat, red, painless spots on the palms of
hands and soles of feet
5. The patient with acute pericarditis is having a
pericardiocentesis. Postoperatively what
complication should the nurse monitor the
patient for?
a. Pneumonia
b. Pneumothorax
c. Myocardial infarction (MI)
d. Cerebrovascular accident (CVA)
6. Priority Decision: A patient with acute
pericarditis has a nursing diagnosis of pain
related to pericardial inflammation. What is the
best nursing intervention for the patient?
a. Administer opioids as prescribed on an
around-the-clock schedule.
b. Promote progressive relaxation exercises with
the use of deep, slow breathing.
c. Position the patient on the right side with the
head of the bed elevated 15 degrees.
d. Position the patient in Fowler’s position with a
padded over-the-bed table for the patient to lean
on.
7. When obtaining a nursing history for a patient
with myocarditis, what should the nurse
specifically question the patient about?
a. Prior use of digoxin for treatment of cardiac
problems
b. Recent symptoms of a viral illness, such as
fever and malaise
c. A history of coronary artery disease (CAD)
with or without an MI
d. A recent streptococcal infection requiring
treatment with penicillin
8. Priority Decision: What is the most important
role of the nurse in preventing rheumatic
fever? a. Teach patients with infective
endocarditis to adhere to antibiotic prophylaxis.
b. Identify patients with valvular heart disease
who are at risk for rheumatic fever.
c. Encourage the use of antibiotics for treatment
of all infections involving a sore throat.
d. Promote the early diagnosis and immediate
treatment of group A streptococcal pharyngitis.
9. What manifestations most strongly support a
diagnosis of acute rheumatic fever?
a. Carditis, polyarthritis, and erythema
marginatum
b. Polyarthritis, chorea, and decreased anti-
streptolysin O titer
c. Organic heart murmurs, fever, and elevated
erythrocyte sedimentation rate (ESR)
d. Positive C-reactive protein, elevated white
blood cells (WBCs), and subcutaneous nodules
10. A patient with rheumatic heart disease with
carditis asks the nurse how long his activity will
be restricted. What is the best answer by the
nurse?
a. “Full activity will be allowed as soon as acute
symptoms have subsided.”
b. “Bed rest will be continued until symptoms of
heart failure are controlled.”
c. “Nonstrenuous activities can be performed as
soon as antibiotics are started.”
d. “Bed rest must be maintained until anti-
inflammatory therapy has been discontinued.”
11. The patient is admitted post–radiation
therapy with symptoms of cardiomyopathy
(CMP). Which type of CMP should the nurse
suspect that the patient is experiencing?
a. Dilated
b. Restrictive
c. Takotsubo
d. Hypertrophic
12. What accurately describes dilated CMP
(select all that apply)?
a. Characterized by ventricular stiffness
b. The least common type of cardiomyopathy
c. The hyperdynamic systolic function creates a
diastolic failure
d. Echocardiogram reveals cardiomegaly with
thin ventricular walls
e. Often follows an infective myocarditis or
exposure to toxins or drugs
f. Differs from chronic heart failure in that there
is no ventricular hypertrophy
13. When planning care for the patient with
hypertrophic CMP, what should the nurse
include? a. Ventricular pacing
b. Administration of vasodilators
c. Teach the patient to avoid strenuous activity
and dehydration
d. Surgery for cardiac transplantation will need
to be done soon
14. When performing discharge teaching for a
patient with any type of CMP, what should the
nurse instruct the patient to do (select all that
apply)?
a. Eat a low-sodium diet.
b. Go to the gym every day.
c. Engage in stress reduction activities.
d. Abstain from alcohol and caffeine intake.
e. Avoid strenuous activity and allow for periods
of rest.
f. Suggest that caregivers learn cardiopulmonary
resuscitation (CPR).
15.A patient admitted with acute dyspnea is
newly diagnosed with dilated cardiomyopathy.
Which information will the nurse plan to teach
the patient about managing this disorder?
a. A heart transplant should be scheduled as
soon as possible.
b. Elevating the legs above the heart will help
relieve dyspnea.
c. Careful compliance with diet and medications
will prevent heart failure.
d. Notify the doctor about any symptoms of heart
failure such as shortness of breath.
SAS #14
1. When a burn damages cells, you would
expect the cells to release the major
electrolyte:
A. potassium.
B. chloride.
C. calcium.
D. sodium.
2. Diuretics affect the kidneys by altering the
reabsorption and excretion of:
A. water only.
B. electrolytes only.
C. water and electrolytes.
D. other drugs.
3. The main extracellular cation is:
A. calcium.
B. potassium.
C. bicarbonate.
D. sodium.
4. Patient X is diagnosed with constipation. As a
knowledgeable nurse, which nursing intervention
is appropriate for maintaining normal bowel
function?
A. Assessing dietary intake
B. Decreasing fluid intake
C. Providing limited physical activity
D. Turning, coughing, and deep breathing
5. A 12-year-old boy was admitted in the
hospital two days ago due to hyperthermia. His
attending nurse, Dennis, is quite unsure about
his plan of care. Which of the following nursing
intervention should be included in the care of
plan for the client?
A. Room temperature reduction
B. Fluid restriction of 2,000 ml/day
C. Axillary temperature measurements every 4
hours
D. Antiemetic agent administration
6. A 36-year-old male client is about to be
discharged from the hospital after 5 days due to
surgery. Which intervention should be included
in the home health care nurse’s instructions
about measures to prevent constipation? A.
Discouraging the client from eating large
amounts of roughage-containing foods in the
diet. B. Encouraging the client to use laxatives
routinely to ensure adequate bowel elimination.
C. Instructing the client to establish a bowel
evacuation schedule that changes every day.
D. Instructing the client to fill a 2-L bottle with
water every night and drink it the next day.
7. Mrs. Dela Riva is in her first trimester of
pregnancy. She has been lying all day because
her OB-GYN requested her to have a complete
bed rest. Which nursing intervention is
appropriate when addressing the client’s need to
maintain skin integrity?
A. Monitoring intake and output accurately
B. Instructing the client to cough and deep-
breathe every 2 hours
C. Keeping the linens dry and wrinkle free
D. Using a foot board to maintain correct
anatomic position
8. A patient with tented skin turgor, dry mucous
membranes, and decreased urinary output is
under nurse Mark’s care. Which nursing
intervention should be included the care plan of
Mark for his patient?
A. Administering I.V. and oral fluids
B. Clustering necessary activities throughout the
day
C. Assessing color, odor, and amount of
sputum
D. Monitoring serum albumin and total protein
levels
9. A client with very dry mouth, skin and mucous
membranes is diagnosed of having dehydration.
Which intervention should the nurse perform
when caring for a client diagnosed with fluid
volume deficit?
A. Assessing urinary intake and output
B. Obtaining the client’s weight weekly at
different times of the day
C. Monitoring arterial blood gas (ABG) results
D. Maintaining I.V. therapy at the keep-vein-
open rate
10. Which electrolyte would the nurse identify as
the major electrolyte responsible for determining
the concentration of the extracellular fluid?
A. Potassium
B. Phosphate
C. Chloride
D. Sodium
SAS #15
1. Orly Khan is suffering from fluid
volume deficit (FVD), which of the
following symptoms would the nurse
expect to assess in the patient?
A. rales
B. bounding pulse
C. tachycardia
D. bulging neck veins
2. John Reid is admitted in the hospital
and is currently receiving hypertonic fluids.
Nursing management for the
client includes monitoring for all of the
following potential complications except:
A. water intoxication
B. fluid volume excess (FVE)
C. cellular dehydration
D. cell shrinkage
3. Mr. Wenceslao is scheduled to receive an
isotonic solution; which one of the following
is an example of such solution?
A. D10% W
B. 0.45% saline
C. 0.9% saline
D. 3% normal saline
4. Which of the following statements
provides the rationale for using a
hypotonic solution for a patient with
FVD?
A. A hypotonic solution provides
free water to help the kidneys
eliminate the solute.
B. A hypotonic solution supplies an excess of
sodium and chloride ions.
C. Excessive volumes are recommended in the
early postoperative period.
D. A hypotonic solution is used to treat
hyponatremia.
5. The process of endocrine regulation of
electrolytes involves:
A. sodium reabsorption and chloride excretion
B. chloride reabsorption and sodium excretion
C. potassium reabsorption and sodium
excretion
D. sodium reabsorption and potassium
excretion
6. Maria, an 85-year-old patient with a
feeding tube, has been experiencing severe
watery stool. The patient is lethargic and
has poor skin turgor, a pulse of 120, and
hyperactive reflexes. Nursing interventions
would include:
A. measuring and recording intake and
output and daily weights
B. administering salt tablets and monitoring
hypertonic parenteral solutions
C. administering sedatives
D. applying wrist restraints to avoid
displacement of the feeding tube
7. Disease of which of the following structures
is most likely to affect electrolyte reabsorption?
A. glomerulus
B. renal tubules
C. bladder
D. renal pelvis
8. Daniel who is a marathon runner is at
high risk for fluid volume deficit. Which one
of the following is a related factor? A.
decreased diuresis
B. disease-related process
C. decreased breathing and perspiration
D. increased breathing and perspiration
9. Jomarick is diagnosed with
FVD; which of the following
nursing diagnoses might apply
to his condition? A. altered
urinary elimination
B. decreased cardiac output
C. increased cardiac output
D. vomiting
10. Body fluids perform which of the following
functions?
A. transport nutrients
B. transport electrical charges
C. cushion the organs
D. facilitate fat metabolism
SAS #16
1. A client's kidneys are retaining increased
amounts of sodium. The nurse plans care,
anticipating that the kidneys also are
retaining greater amounts of which
substances?
A. Calcium and Chloride
B. Chloride and bicarbonate
C. Potassium and Phosphates
D. Aluminum and magnesium
2. The nurse is preparing to care for a client
with a potassium deficit. The nurse reviews the
client's record and determines that the client
was at risk for developing the potassium deficit
because of which situation?
A. Sustained tissue damage
B. Requires Nasogastric suction
C. Has a history of Addison's disease
D. Is taking a potassium-retaining diuretic
3. A nurse is planning care for a client
with hypokalemia. Which interventions
should be included in the plan of
care? Select all that apply.
A. Ensure adequate fluid intake.
B. Implement safety measures to prevent falls
C. Encourage low fiber foods to prevent
diarrhea.
D. Instruct the client about foods that contain
potassium.
E. Encourage the client to obtain assistance to
ambulate.
4. The nurse is caring for a client with heart
failure who is receiving high doses of a
diuretic. On assessment, the nurse notes
that the client has flat neck veins, generalized
muscle weakness, and diminished deep
tendon reflexes. The nurse suspects
hyponatremia. What additional signs would
the nurse expect to note in a client with
hyponatremia? A. Muscle twitches
B. Decreased Urinary output
C. Hyperactive bowel sounds
D. Increased specific gravity of the urine
5. A patient prescribed spironolactone is
demonstrating ECG changes &
complaining of muscle weakness. The
nurse realizes this patient is exhibiting
signs of which of the following.
A. hyperkalemia
B. hypokalemia
C. hypercalcemia
D. hypocalcemia
6. The nurse is planning care for a patient
with fluid volume overload & hyponatremia.
Which of the following should be included
in this patient's plan of care?
A. Restrict fluids.
B. Administer intravenous fluids.
C. Provide Kayexalate.
D. Administer intravenous normal saline with
furosemide
7. A patient is prescribed 20 mEq of
potassium chloride. The nurse realizes that
the reason the patient is receiving
this replacement is
A. to sustain respiratory function.
B. to help regulate acid-base balance.
C. to keep a vein open.
D. to encourage urine output.
8. A patient with fluid retention related to
renal problems is admitted to the hospital.
The nurse realizes that this patient could
possibly have which of the following
electrolyte imbalances?
A. hypokalemia
B. hypernatremia
C. carbon dioxide
D. magnesium
9. An elderly patient comes into the clinic with
the complaint of watery diarrhea for several
days with abdominal & muscle cramping. The
nurse realizes that this pt is demonstrating
which of the following?
A. hypernatremia
B. hyponatremia
C. fluid volume excess
D. hyperkalemia
10. A patient is admitted with
hypernatremia caused by being
stranded on a boat in the Atlantic Ocean
for five days without a fresh water
source. Which of the following is this
patient at risk for developing?
A. pulmonary edema
B. atrial dysrhythmias
C. cerebral bleeding
D. stress fractures
SAS #17
1. If your patient has hyperphosphatemia, he or
she may also have the secondary electrolyte
disturbance: A. hypermagnesemia.
B. hypocalcemia.
C. hypernatremia.
D. hyperkalemia.
2. For a patient with hyperphosphatemia and
renal failure, avoid giving the phosphate binding
antacid:
A. aluminum hydroxide.
B. calcium carbonate.
C. calcium acetate.
D. magnesium oxide.
3. Many of the signs and symptoms of
hypophosphatemia are related to:
A. low energy stores.
B. hypercalcemia.
C. extensive diuresis.
D. hypocalcemia.
4. If your patient is hypercalcemic, you would
expect to:
A. administer I.V. sodium bicarbonate.
B. administer vitamin D.
C. hydrate the patient.
D. administer digoxin.
5. Hypercalcemia would be most likely to
develop in:
A. a 60-year-old man who has squamous cell
carcinoma of the lung.
B. an 80-year-old woman who has heart failure
and is taking furosemide (Lasix).
C. a 25-year-old trauma patient who has
received massive blood transfusions.
D. a 40-year-old man with hypoalbuminemia.
6. You’re told during shift report that your patient
has a positive Chvostek’s sign. You would
expect his laboratory test results to reveal:
A. a total serum calcium level below 8.9 mg/dl.
B. a total serum calcium level above 10.1
mg/dl.
C. an ionized calcium level above 5.3 mg/dl.
D. an ionized calcium level between 4.4 and 5.3
mg/dl.
7. Your patient with Crohn’s disease develops
tremors while receiving TPN. Suspecting she
might have hypomagnesemia; you assess her
neuromuscular system. You should expect to
see:
A. Homans’ sign.
B. elevated serum potassium.
C. hyperactive DTRs.
D. slowed heart rate
8. When teaching your patient with
hypomagnesemia about a proper diet, you
should recommend that he consume plenty of:
A. seafood.
B. fruits.
C. corn products.
D. dairy products.
9. The doctor prescribes I.V. magnesium sulfate
for your patient with hypomagnesemia. Before
giving the magnesium preparation, you review
the practitioner’s order to make sure it specifies
the:
A. number of grams or milliliters to give.
B. number of ampules to give.
C. number of vials to give.
D. number of uses per vial.
10. Your patient is diagnosed with
hypermagnesemia. To treat this imbalance, the
practitioner is likely to order: A. magnesium
citrate.
B. magnesium sulfate diluted in fluids.
C. potassium-sparing diuretics.
D. oral and I.V. fluids.
SAS #18
1. A nurse assesses a client who is prescribed
furosemide (Lasix) for hypertension. For which
acid-base imbalance should the nurse assess
to prevent complications of this therapy?
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis
2. A patient who was involved in a motor vehicle
crash has had a tracheostomy placed to allow
for continued mechanical ventilation. How
should the nurse interpret the following arterial
blood gas results: pH 7.48, PaO2 85 mm Hg,
PaCO2 32 mm Hg, and HCO3 25 mEq/L?
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis
3. A patient who is lethargic and exhibits deep,
rapid respirations has the following arterial blood
gas (ABG) results: pH 7.32, PaO2 88 mm Hg,
PaCO2 37 mm Hg, and HCO3 16 mEq/L. How
should the nurse interpret these results? a.
Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis
4.The nurse explains to a concerned family
member of a client who has developed
respiratory acidosis that the kidneys a. achieve
optimal compensation immediately.
b. are unable to compensate.
c. can achieve optimal compensation in about 3
days.
d. will compensate within 24 hours.
5.A client is admitted to the hospital with severe
vomiting and is diagnosed with metabolic
alkalosis. The nurse anticipates that the
laboratory value that would support this
diagnosis
a. arterial carbon dioxide tension (PaCO2) of 30
mm Hg
b. arterial pH of 7.30.
c. serum calcium level of 9.0 mEq/L.
d. serum potassium level of 3.0 mEq/L
6. A cigarette vendor was brought to the
emergency department of a hospital after she
fell into the ground and hurt her left leg. She is
noted to be tachycardic and tachypneic.
Painkillers were carried out to lessen her pain.
Suddenly, she started complaining that she is
still in pain and now experiencing muscle
cramps, tingling, and
paraesthesia. Measurement of arterial blood
gas reveals pH 7.6, PaO2 120 mm Hg, PaCO2
31 mm Hg, and HCO3 25 mmol/L. What does
this mean?
a. Respiratory Alkalosis, Uncompensated
b. Respiratory Acidosis, Partially Compensated
c. Metabolic Alkalosis, Uncompensated
d. Metabolic Alkalosis, Partially Compensated
7. The nurse assesses that the client admitted in
respiratory acidosis has compensated when the
arterial blood gas (ABG) readings are
a. carbon dioxide level of 50 mm Hg and
bicarbonate level of 30 mEq/L.
b. carbon dioxide level of 50 mm Hg and
bicarbonate level of 20 mEq/L.
c. carbon dioxide level of 30 mm Hg and
bicarbonate level of 30 mEq/L.
d. carbon dioxide level of 30 mm Hg and
bicarbonate level of 24 mEq/L.
8. For a 34-year-old client in renal failure who
develops acidosis, the nurse would assess for
a. drowsiness.
b. hypoventilation.
c. muscle hyperactivity.
d. paresthesia.
9. Age-related physiologic changes the nurse
would consider when planning care for an
elderly client admitted with an acid-base
abnormality include (Select all that apply)
a. decreased pulmonary and renal function limit
the ability to compensate.
b. hypermetabolism predisposes the elderly to
metabolic acidosis.
c. hypoventilation can easily cause respiratory
acidosis in the elderly.
d. renal perfusion is diminished because of
decreased cardiac output.
e. there is decreased alveolar surface area for
gas exchange.
10. When evaluating the laboratory results of a
patient with diabetic ketoacidosis, which lab
value indicates the body has fully compensated
from this acid-base imbalance?
a. Normal serum glucose
b. Normal pH on arterial blood gases
c. Normal serum potassium
d. Normal bicarbonate on arterial blood gases
SAS #19
1. How do you determine that a patient's oliguria
is associated with acute renal failure (ARF)?
A. Specific gravity of urine at 3 different times is
1.010.
B. The serum creatinine level is normal.
C. The blood urea nitrogen (BUN) level is
normal or below.
D. Hypokalemia is identified.
2. When caring for a patient during the oliguric
phase of acute kidney injury, what would be an
appropriate nursing intervention?
A. Weigh patient three times weekly
B. Increase dietary sodium and potassium
C. Provide a low-protein, high-carbohydrate
diet
D. Restrict fluids according to the previous day's
fluid loss
3. Which assessment finding is commonly found
in the oliguric phase of acute kidney injury
(AKI)? A. Hypovolemia
B. Hyperkalemia
C. Hypernatremia
D. Thrombocytopenia
4. Which patient has the greatest risk for
prerenal AKI?
A. The patient is hypovolemic because of
hemorrhage.
B. The patient relates a history of chronic urinary
tract obstruction.
C. The patient has vascular changes related to
coagulopathies.
D. The patient is receiving antibiotics such as
gentamicin.
5. The patient admitted to the intensive care unit
after a motor vehicle accident has been
diagnosed with AKI. Which finding indicates the
onset of oliguria resulting from AKI?
A. Urine output less than 1000 mL for the past
24 hours
B. Urine output less than 800 mL for the past 24
hours
C. Urine output less than 600 mL for the past 24
hours
D. Urine output less than 400 mL for the past 24
hours
6. You are preparing to administer a dose of
PhosLo to a patient with chronic kidney disease
(CKD). This medication should have a
beneficial effect on which laboratory value?
A. Sodium
B. Potassium
C. Magnesium
D. Phosphorus
7. A patient is admitted to the hospital with CKD. c. Malnutrition
You understand that this condition is
characterized by
d. Severe periodontal disease
A. Progressive irreversible destruction of the
kidneys 2. Which of the following
B. A rapid decrease in urinary output with an pathophysiological mechanisms that occurs
elevated BUN level in the lung parenchyma allows pneumonia
C. Increasing creatinine clearance with a
decrease in urinary output
to develop?
D. Prostration, somnolence, and confusion with
coma and imminent death a. Atelectasis
8. Nurses need to educate patients at risk for b. Bronchiectasis
CKD. Which individuals are considered to be at
increased risk (select all that apply)?
A. Older African Americans c. Effusion
B. Individuals older than 60 years
C. Those with a history of pancreatitis d. Inflammation
D. Those with a history of hypertension
E. Those with a history of type 2 diabetes
3. Which of the following organisms most
9. Patients with CKD have an increased commonly causes community-acquired
incidence of cardiovascular disease related to pneumonia in adults?
(select all that apply)
a. Hemophilus influenzae
A. hypertension.
B. vascular calcifications.
C. a genetic predisposition. b. Klebsiella pneumoniae
D. hyperinsulinemia causing dyslipidemia.
E. increased high-density lipoproteins levels. c. Streptococcus pneumoniae
10. Your plan for care of a patient with AKI
includes which goal of dietary management? d. Staphylococcus aureus
A. Provide sufficient calories while preventing
nitrogen excess. 4. An elderly client with pneumonia may
B. Deliver adequate calories while restricting fat appear with which of the following
and protein intake. symptoms first?
C. Replace protein intake with enough fat intake
to sustain metabolism.
D. Restrict fluids, increase potassium intake, a. Altered mental status and dehydration
and regulate sodium intake
b. Fever and chills
SAS #20
c. Hemoptysis and dyspnea

1. Clients with chronic illnesses are more d. Pleuritic chest pain and cough
likely to get pneumonia when which of the
following situations is present?

a. Dehydration

b. Group living
5. Following assessment of a patient with
pneumonia, the nurse identifies a nursing
diagnosis of ineffective airwayclearance.
Which information best supports this
diagnosis?
a. Weak, nonproductive cough effort
b. Large amounts of greenish sputum
c. Respiratory rate of 28 breaths/minute
d. Resting pulse oximetry (SpO2) of 85%
6. During assessment of the chest in a
patient with pneumococcal pneumonia, the
nurse would expect to find
a. vesicular breath sounds.
b. increased tactile fremitus.
c. dry, nonproductive cough.
d. hyperresonance to percussion.
7. A patient with bacterial pneumonia has
rhonchi and thick sputum. Which action
will the nurse use to promote airway
clearance?
a. Assist the patient to splint the chest when
coughing.
b. Educate the patient about the need for
fluid restrictions.
c. Encourage the patient to wear the nasal
oxygen cannula.
d. Instruct the patient on the pursed lip
breathing technique.
8. Which statement by a patient who has
been hospitalized for pneumonia indicates a
good understanding of the
discharge instructions given by the nurse?
a. "I will call the doctor if I still feel tired
after a week."
b. "I will need to use home oxygen therapy
for 3 months."
c. "I will continue to do the deep breathing
and coughing exercises at home."
d. "I will schedule two appointments for the
pneumonia and influenza vaccines."
9. Which nursing action will be most
effective in preventing aspiration
pneumonia in patients who are at risk?
a. Turn and reposition immobile patients at
least every 2 hours.
b. Place patients with altered consciousness
in side-lying positions.
c. Monitor for respiratory symptoms in
patients who are immunosuppressed.
d. Provide for continuous subglottic
aspiration in patients receiving enteral
feedings.
10. After a patient with right lower-lobe
pneumonia has been treated with
intravenous (IV) antibiotics for 2 days,
whichassessment data obtained by the
nurse indicates that the treatment has been
effective?
a. Bronchial breath sounds are heard at the
right base.
b. The patient coughs up small amounts of
green mucus.
c. The patient's white blood cell (WBC)
count is 9000/μl.
 d. Increased tactile fremitus is palpable about possible toxic effects of the antitubercular
over the right chest. medications, the nurse will give instructions to
notify the health care provider if the patient
develops
SAS #21
a. yellow-tinged skin.
b. changes in hearing.
c. orange-colored sputum.
d. thickening of the fingernails.
1. The health care provider writes an order for
bacteriologic testing for a patient who has a
6. An alcoholic and homeless patient is
positive tuberculosis skin test. Which action will
diagnosed with active tuberculosis (TB). Which
the nurse take?
intervention by the nurse will be most effective
a. Repeat the tuberculin skin testing.
in ensuring adherence with the treatment
b. Teach about the reason for the blood tests.
regimen?
c. Obtain consecutive sputum specimens from
a. Educating the patient about the long-term
the patient for 3 days.
impact of TB on health
d. Instruct the patient to expectorate three
b. Giving the patient written instructions about
specimens as soon as possible.
how to take the medications
c. Teaching the patient about the high risk for
2. Which information about a patient who has a
infecting others unless treatment is followed
recent history of tuberculosis (TB) indicates that
d. Arranging for a daily noontime meal at a
the nurse can discontinue airborne isolation
community center and giving the medication
precautions?
then
a. Chest x-ray shows no upper lobe infiltrates.
b. TB medications have been taken for 6
7. After 2 months of tuberculosis (TB) treatment
months.
with a standard four-drug regimen, a patient
c. Mantoux testing shows an induration of 10
continues to have positive sputum smears for
mm.
acid-fast bacilli (AFB). Which action should the
d. Three sputum smears for acid-fast bacilli are
nurse take next?
negative.
a. Ask the patient whether medications have
been taken as directed.
3. The nurse recognizes that the goals of
b. Discuss the need to use some different
teaching regarding the transmission of
medications to treat the TB.
pulmonary tuberculosis (TB) have been met
c. Schedule the patient for directly observed
when the patient with TB
therapy three times weekly.
a. demonstrates correct use of a nebulizer.
d. Educate about using a 2-drug regimen for the
b. washes dishes and personal items after use.
last 4 months of treatment.
c. covers the mouth and nose when coughing.
d. reports daily to the public health department.
8. A staff nurse has a tuberculosis (TB) skin test
of 16-mm induration. A chest radiograph is
4. Which information will the nurse include in the
negative, and the nurse has no symptoms of
patient teaching plan for a patient who is
TB. The occupational health nurse will plan on
receiving rifampin (Rifadin) for treatment of
teaching the staff nurse about the
tuberculosis?
a. "Your urine, sweat, and tears will be orange
a. use and side effects of isoniazid (INH).
colored."
b. standard four-drug therapy for TB.
b. "Read a newspaper daily to check for
c. need for annual repeat TB skin testing.
changes in vision."
d. bacilli Calmette-Guérin (BCG) vaccine.
c. "Take vitamin B6 daily to prevent peripheral
nerve damage."
9. When caring for a patient who is hospitalized
d. "Call the health care provider if you notice any
with active tuberculosis (TB), the nurse observes
hearing loss."
a family member who is visiting the patient. The
nurse will need to intervene if the family
5. When teaching the patient who is receiving
member
standard multidrug therapy for tuberculosis (TB)
 a. washes the hands before entering the
patient's room.
b. hands the patient a tissue from the box at the
bedside.
c. puts on a surgical face mask before visiting
the patient.
d. brings food from a "fast-food" restaurant to
the patient.
10. Characteristics of the Mycobacterium
tuberculosis include all of the following except:
a. It can be transmitted only by droplet nuclei.
b. It is acid-fast.
c. It is able to lie dormant within the body for
years.
d. It survives in anaerobic conditions.
SAS #22
1. Lassa and Ebola are emergent viruses in W.
Africa. What is their origin?
a. Humans
b. Primates
c. Fruit bats
d. Pigs
2. How can the morphology of filoviruses be
described?
a. Very large ball like structure
b. Long filamentous threads
c. Icosahedral virion
d. Floppy membranes without defined
morphology
3. How can the spread of filoviruses be
restricted?
a. New antivirals
b. New humanized monoclonal antibodies
c. Hygiene and social distancing
d. New vaccine
4. What is the biggest risk factor for infection
with Ebola?
a. Working in a category IV laboratory
b. Attending a funeral of a victim outside
c. Nursing a patient at home
d. Attending football matches or large
gatherings
5. In which order will the nurse perform the
following actions as she prepares to leave the
room of a client with airborne precautions after
performing oral suctioning?
1. Take off goggles
2. Take off gown
3. Remove gloves
4. Remove N95 respirator
5. Perform hand hygiene
a. 1, 2, 3, 4, 5
b. 2, 1, 4, 3, 5
c. 3, 4, 1, 2, 5
d. 4, 3, 2, 1, 5
6. The nurse assessed the client and noted
shortness of breath and recent trip to China. The
client is strongly suspected of having Middle
East Respiratory Syndrome (MERS-CoV).
Which of these prescribed actions will the nurse
take first?
a. Place the client on airborne and contact
precautions
b. Introduce normal saline at 75 mL/hr
c. Give methylprednisolone (SOLU-Medrol) 1 g
intravenously (IV)
d. Take blood, urine, sputum cultures
7. The school nurse is asked which action will
take to have the most impact on the incidence of
infectious diseases in school. The correct
response is:
a. Grant written information about infection
control to all parents
b. Ensure that students are immunized
according to national guidelines
c. Make soap and water easily accessible in the
classrooms
d. Educate students on how to cover their
mouths when coughing
8. A 10-year-old client contracted SARS when
traveling abroad with her parents. The nurse
knows she must put on personal protective
equipment to protect herself while providing
care. Based on the mode of SARS transmission,
which personal protective should the nurse
wear?
a. Gloves
b. Gown and gloves
c. Gown, gloves, and mask
d. Gown, gloves, mask, and eye goggles or eye
shield
9. A client who has recently traveled to Hong
Kong comes to the emergency department (ED)
with increasing shortness of breath and is
strongly suspected of having a SARS. Which of
these prescribed actions will you take first?
a. Place the client on contact and airborne
precautions
b. Obtain blood, urine, and sputum for cultures
c. Administer methylprednisolone (Solu-Medrol)
1 gram/IV
d. Infuse normal saline at 100ml/hr

10. The school nurse is asked which action will

take to have the most impact on the incidence of
infectious diseases in school. The correct
response is:
a. Grant written information about infection
control to all parents
b. Ensure that students are immunized
according to national guidelines
c. Make soap and water easily accessible in the
classrooms
d. Educate students on how to cover their
mouths when coughing
MEDSURG -1 SAS 23-33 MULTIPLE CHOICE
SAS 23
1. The nurse questions a client with hepatitis B.
how long ago could the client have been
exposed to hepatitis B?
A. 3-7 days
B. 7-14 days
C. 40-50 days
D. 60-160 days
2. Which laboratory value increases would the
nurse expect to find in a client as a result of
hepatitis? Select that all apply.
A. SGPT(ALT) and SGOT(AST)
B. Alkaline Phosphatase
C. bilirubin, ESR
D. Leukocytes, Lymphocytes, Neutrophils
3. An adult client complains for frequent
episodes of constipation. What is an effective
strategy for preventing
constipation?
A. Reducing fluid intake to encourage bulk
formation in the intestinal lumen
B. Use laxative daily to establish a regular
elimination pattern.
C. A regimen of exercise directed at toning the
abdominal muscles.
D. Setting a routine for bowel elimination just
before bedtime
4. A patient with hepatitis B is being discharged
in 2 days. In the discharge teching plan the
nurse should include instructions to:
A. Avoid alcohol for the first 3 weeks
B. Use a condom during sexual intercourse
C. Have family members get an injection of
immunoglobin
D. Follow a low-protein, moderate-
carbohydrate, moderate-fat diet
5. Which priority teaching information should
the nurse discuss with the client to help prevent
contracting hep. B?
A. Explain the importance of good hand
washing.
B. Tell the client to take the hepatitis B vaccine
in three (3) doses.
C. Tell the client not to ingest unsanitary food or
water.
D. Discuss how to implement standard
precautions.
6. 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
7. A client with acute hepatitis is prescribed
lactulose. The nurse knows this medication will:
A. Prevent the absorption of ammonia from the
bowel.
B. Prevent hypoglycemia.
C. Remove bilirubin from the blood.
D. Mobilize iron stores from the liver
8. To prevent the spread of hepatitis A virus
(HAV) infection the nurse is especially careful
when:
A. Disposing of food trays
B. Emptying bed pans
C. Taking an oral temperature
D. Changing IV
9. Which type of hepatitis is transmitted by the
fecal-oral route via contaminated food, water,
or direct contact with an infected person?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
10. The nurse is performing an assessment on a
client being evaluated for viral hepatitis. Which
symptom will the nurse most likely assess on
this client?
A. Arthralgia
B. Excitability
C. Headache
D. Polyphagia
SAS 24
1. A nurse is teaching a client with genital
herpes. Education for this client should include
an explanation of:
a. why the disease is transmittable only when
visible lesions are present.
b. the need for the use of petroleum products.
c. the option of disregarding safer-sex practices
now that he's already infected.
d. the importance of informing his partners of
the disease.
2. Katrina Sterrett, a 26-year-old preschool
teacher, is being seen by a physician who is part
of the internist group where you practice
nursing. She is undergoing her annual physical
and is having many lab tests done as a condition
of her employment and upcoming wedding. She
is returning for her results and is devastated to
learn that she has the sexuallytransmitted
infection, gonorrhea. What would contribute to
her ignorance of her condition?
a. Being asymptomatic
b. All options are correct
c. Being sexually inactive
d. Knowing the signs and symptoms of STIs
3. Within the free clinic where you practice
nursing, you hold weekly sexual education
classes open to the public. Within
the classroom, you communicate the CDC's
numbers for the incidence of STIs and their
impact upon public health. Which
is the fastest-spreading bacterial STI in the
United States?
a. Gonorrhea
b. Chlamydia
c. Herpes simplex 1
d. HPV
4. A nurse is caring for a client diagnosed with a
chlamydia infection. The nurse teaches the
client about disease transmission and advises
the client to inform his sexual partners of the
infection. The client refuses, stating, "This is my
business and I'm not telling anyone. Besides,
chlamydia doesn't cause any harm like the
other STDs." How should the nurse proceed?
a. Do nothing because the client's sexual habits
place him at risk for contracting other STDs.
b. Educate the client about why it's important
to inform sexual contacts so they can receive
treatment.
c. Inform the health department that this client
contracted an STD.
d. Inform the client's sexual contacts of their
possible exposure to chlamydia.
5. A 16-year-old patient comes to the free clinic
and is diagnosed with primary syphilis. The
patient states that she contracted this disease
by holding hands with someone who has
syphilis. What is the most appropriate nursing
diagnosis for this patient?
a. Alteration in comfort related to impaired skin
integrity
b. Fear related to complications
c. Noncompliance with treatment regimen
related to age
d. Knowledge deficit related to modes of
transmission
6. Which opportunistic disease associated with
AIDS is characterized by hyperpigmented
lesions of skin, lungs, and gastrointestinal (GI)
tract?
a. Kaposi sarcoma
b. Herpes simplex type 1 infection
c. Candida albicans
d. Varicella-zoster virus infection
7. A patient comes to the clinic and requests
testing for HIV infection. Before administering
testing, what is most important for the nurse to
do?
a. Ask the patient to identify all sexual partners
b. Determine when the patient thinks exposure
to HIV occurred
c. Explain that all test results must be repeated
at least twice to be valid
c. Being sexually inactive
d. Knowing the signs and symptoms of STIs
d. Discuss prevention practices to prevent
transmission of the HIV to others
8. The “rapid” HIV antibody testing is performed
on a patient at high risk for HIV infection. What
should the nurse explain about this test?
a. The test measures the activity of the HIV and
reports viral loads as real numbers.
b. This test is highly reliable, and in 5 minutes
the patient will know if HIV infection is present.
c. If the results are positive, another blood test
and a return appointment for results will be
necessary.
d. This test detects drug-resistant viral
mutations that are present in viral genes to
evaluate resistance to antiretroviral drugs.
9. Treatment with two nucleoside reverse
transcriptase inhibitors (NRTIs) and a protease
inhibitor (PI) is prescribed for a patient with HIV
infection who has a CD4+ T-cell count of
<400/μL. The patient asks why so many drugs
are necessary for treatment. What should the
nurse explain as the primary rationale for
combination therapy?
a. Cross-resistance between specific
antiretroviral drugs is reduced when drugs are
given in combination.
b. Combinations of antiretroviral drugs
decrease the potential for development of
antiretroviral-resistant HIVvariants.
c. Side effects of the drugs are reduced when
smaller doses of three different drugs are used
rather than large doses of one drug.
d. When CD4+ T-cell counts are <500/μL, a
combination of drugs that have different
actions is more effective in slowing HIV growth.
10. What is one of the most significant factors
in determining when to start antiretroviral
therapy in a patient with HIV infection?
a. Whether the patient has high levels of HIV
antibodies
b. Confirmation that the patient has contracted
HIV infection
c. The patient’s readiness to commit to a
complex, lifelong, uncomfortable drug regimen
d. Whether the patient has a support system to
help manage the costs and side effects of the
drugs
SAS 25
1. The nurse would increase the comfort of the
patient with appendicitis by:
a. Having the patient lie prone
b. Flexing the patient's right knee
c. Sitting the patient upright in a chair
d. Turning the patient onto his or her left side
2. The nurse is caring for a patient in the
emergency department with complaints of
acute abdominal pain, nausea, and vomiting.
When the nurse palpates the patient's left
lower abdominal quadrant, the patient
complains of pain in the right
lower quadrant. The nurse will document this as
which of the following diagnostic signs of
appendicitis?
a. Rovsing sign
b. referred pain
c. Chvostek's sign
d. rebound tenderness
3. Which of the following position should the
client with appendicitis assume to relieve pain?
a. Prone
b. Sitting
c. Supine
d. Lying with legs drawn up
4. When evaluating a male client for
complications of acute pancreatitis, the nurse
would observe for:
a. increased intracranial pressure.
b. decreased urine output.
c. bradycardia.
d. hypertension.
5. When preparing a male client, age 51, for
surgery to treat appendicitis, the nurse
formulates a nursing diagnosis of Risk for
infection related to inflammation, perforation,
and surgery. What is the rationale for choosing
this nursing diagnosis?
a. Obstruction of the appendix may increase
venous drainage and cause the appendix to
rupture.
b. Obstruction of the appendix reduces arterial
flow, leading to ischemia, inflammation, and
rupture of the appendix.
c. The appendix may develop gangrene and
rupture, especially in a middle-aged client.
d. Infection of the appendix diminishes necrotic
arterial blood flow and increases venous
drainage.
6. A client with diverticulitis has developed
peritonitis following diverticular rupture. The
nurse should assess the client to determine
which of the following? Select all that apply.
a. Percuss the abdomen to note resonance and
tympany.
b. Percuss the liver to note lack of dullness.
c. Monitor the vital signs for fever, tachypnea,
and bradycardia.
d. Assess presence of polyphagia and
polydipsia.
e. Auscultate bowel sounds to note frequency.
7. A client with acute appendicitis develops a
fever, tachycardia, and hypotension. Based on
these assessment findings, the nurse should
further assess the client for which of the
following complications?
a. Deficient fluid volume.
b. Intestinal obstruction.
c. Bowel ischemia.
d. Peritonitis.
8. A client has just had surgery for colon cancer.
Which of the following disorders might the
client develop?
a. Peritonitis
b. Diverticulosis
c. Partial bowel obstruction
d. Complete bowel obstruction
9. Which of the following conditions is most
likely to directly cause peritonitis?
a. Cholelithiasis
b. Gastritis
c. Perforated ulcer
d. Incarcerated hernia
10. Which of the following symptoms would a
client in the early stages of peritonitis exhibit?
a. Abdominal distention
b. Abdominal pain and rigidity
c. Hyperactive bowel sounds
d. Right upper quadrant pain
SAS 26
1. A nurse is completing the admission
assessment of a client who has acute
pancreatitis. Which finding is the first priority?
A. History of cholelithiasis
B. Elevated serum amylase levels
C. Decrease in bowel sounds upon auscultation
D. Hand spasms present when blood pressure is
checked
2. A nurse is completing an admission
assessment of a client who has pancreatitis.
Which of the following findings should the
nurse expect?
A. Pain in the UQ rating to the shoulder
B. Report of pain being worse when sitting
upright
C. Pain relieved with defecation
D. Epigastric pain radiating to the left shoulder
3. A nurse is assessing a client who has
pancreatitis. Which of the following actions
should the nurse take to assess the presence of
Cullen's sign?
A. Tap lightly at the costovertebral margin on
the client's back
B. Palpate the RLQ
C. Inspect the skin around the umbilicus
D. Auscultate the area below the scapula
4. A nurse is completing nutritional teaching for
a client who has pancreatitis. Which of the
following statements by the client indicates an
understanding of the teaching? (SATA)
A. I plan to eat small, frequent meals.
B. I will eat easy-to-digest foods with limited
spice
C. I will use skim milk when cooking
D. I plan to drink regular cola
E. I will limit alcohol intake to two drinkers per
day
5. The nurse is caring for a 55-yr-old man
patient with acute pancreatitis resulting from
gallstones. Which clinical manifestation would
the nurse expect?
A. Hematochezia
B. Left upper abdominal pain
C. Ascites and peripheral edema
D. Temperature over 102 F
6. Nursing management of the patient with
acute pancreatitis includes: (SATA)
A. Check for signs of hypocalcemia
B. Provide a diet low in carbohydrates
C. Giving insulin based on sliding scale
D. Observing stools for signs of steatorrhea
E. Monitoring for infection, particularly
respiratory tract infection
7. A patient with sudden pain in the left upper
quadrant radiating to the back and vomiting
was diagnosed with acute pancreatitis. Which
intervention should the nurse include in the
patient's plan of care?
A. Immediately start enteral feeding to prevent
malnutrition.
B. Insert an NG and maintain NPO status to
allow pancreas to rest.
C. Initiate early prophylactic antibiotic therapy
to prevent infection.
D. Administer acetaminophen (Tylenol) every 4
hours for pain relief.
8. The client is admitted to the medical
department with a diagnosis of R/O acute
pancreatitis. What laboratory values should the
nurse monitor to confirm this diagnosis?
A. Creatinine and BUN
B. Troponin and CK-MB
C. Serum amylase and lipase
D. Serum bilirubin and calcium
9. What client problem has a priority for the
client diagnosed with acute pancreatitis?
A. Risk for fluid volume deficient
B. Alteration in comfort
C. Imbalanced nutrition: less than the boy C. Hereditary
requires
D. Lack of exercise
D. Knowledge deficient

10. The client is diagnosed with acute

4. Which of the following factors is believed to
pancreatitis. What health-care provider's
cause ulcerative colitis?
admitting order should the nurse question?
A. Acidic diet
A. Bedrest with bathroom privileges
B. Altered immunity
B. Initiate IV therapy of D5W at 125 mL/hr.
C. Chronic constipation
C. Weight client daily
D. Emotional stress
D. Low fat, low carb diet
5. Fistulas are most common with which of the
following bowel disorders?
SAS 27
A. Crohn's disease
1. Crohn's disease can be described as a chronic
B. Diverticulitis
relapsing disease. Which of the following areas
in the GI system may be involved with this C. Diverticulosis
disease?
D. Ulcerative colitis
A. The entire length of the large colon
6. Which of the following areas is the most
B. Only the sigmoid area common site of fistulas in clients with Crohn's
disease?
C. The entire large colon through the layers of
mucosa and submucosa A. Anorectal
D. The small intestine and colon; affecting the B. Ileum
entire thickness of the bowel
C. Rectovaginal
2. Which area of the alimentary canal is the
most common location for Crohn's disease? D. Transverse colon

A. Ascending colon the intestinal wall in this area.

B. Descending colon 7. Which of the following associated disorders

may a client with ulcerative colitis exhibit?
C. Sigmoid colon
A. Gallstones
D. Terminal ileum
B. Hydronephrosis
3. Which of the following factors is believed to
be linked to Crohn's disease? C. Nephrolithiasis

A. Constipation D. Toxic megacolon

B. Diet
8. Which of the following associated disorders 2. A client scheduled for a cholecystectomy asks
may the client with Crohn's disease exhibit? what caused the gallstones to develop. Which
risk factor should the nurse list when
A. Ankylosing spondylitis
responding to this client? (Select all that apply.)
B. Colon cancer
A. American Indian ethnicity
C. Malabsorption
B. Male sex
D. Lactase deficiency
C. Family history of gallstones
9. Which of the following symptoms is
D. Obesity
associated with ulcerative colitis?
E. Hyperlipidemia
A. Dumping syndrome
3. A client asks what causes gallstones to form.
B. Rectal bleeding
Which factor should the nurse explain as being
C. Soft stools present when these stones are formed? (Select
all that apply.)
D. Fistulas
A. Rapid weight gain
10. If a client had irritable bowel syndrome,
which of the following diagnostic tests would B. Abnormal bile composition
determine if the diagnosis is Crohn's disease or
C. Excess cholesterol
ulcerative colitis?
D. Inflammation of the gallbladder
A. Abdominal computed tomography (CT) scan
E. Biliary stasis
B. Abdominal x-ray
4. A client with acute cholecystitis is
C. Barium swallow
experiencing jaundice. Which should the nurse
D. Colonoscopy with biopsy consider as the reason for the jaundice?

A. Viral infection of the gallbladder

B. Obstruction of the cystic duct by a gallstone

SAS 28 C. Accumulation of bile in the hepatic duct

1. Which is a risk factor for gallbladder disease? D. Accumulation of fat in the wall of the
gallbladder
A. Male gender
5. A 40-year-old client is admitted to the
B. Hypocalcemia hospital with cholecystitis. The nurse should
C. Rapid weight loss contact the physician to question which of the
following prescriptions?
D. Hypolipidemia
A. IV fluid therapy of normal saline solution to
be infused at 100 mL/h until further
prescriptions
B. Administer morphine sulfate 10 mg IM every
4 hours as needed for severe abdominal pain
C. Nothing by mouth (NPO) until further
prescriptions
D. Insert a nasogastric tube and connect to low
intermittent suction
6. The nurse is preparing health promotion
teaching for a client with gallbladder disease.
Which topic should the nurse include in the
teaching session? (Select all that apply.)
A. Role of a high-cholesterol diet on gallstone
formation
B. Role of hypolipidemia on gallstone formation
C. Importance of a low-cholesterol diet
D. Dangers of rapid weight loss
E. Importance of a high-fiber diet
7. The nurse prepares discharge teaching for a
client recovering from a cholecystectomy.
Which topic should the nurse include in this
teaching? (Select all that apply.)
A. Surgical incision care
B. Manifestations of postoperative
complications
C. Pain control measures
D. Activity level
E. High-fat diet
8. A client with acute cholecystitis is
experiencing nausea and vomiting. Which
nursing action should the nurse use to address
this client's nutritional status? (Select all that
apply.)
A. Counseling regarding low-fat menu choices
B. Administering antiemetics as prescribed
C. Assessing height and weight
D. Advising to consume a low-protein diet
E. Reviewing serum electrolytes
9. A client is recovering from a laparoscopic
cholecystectomy. Which nursing action should
the nurse use to reduce this client's risk of
infection? (Select all that apply.)
A. Monitor vital signs, including temperature,
every 4 hours.
B. Administer antibiotics as prescribed.
C. Coach to take deep breaths every 1dash2
hours while awake.
D. Assess the abdomen every 4 hours.
E. Place in Fowler position.
10. The nurse evaluates a client's understanding
of discharge teaching following a laparoscopic
cholecystectomy. Which client statement
indicates teaching has been effective? (Select all
that apply.)
A. "I will take my pain medicine on an empty
stomach to get the maximum benefit."
B. "I will be sure to get up and walk every hour."
C. "I can have some hot chocolate with my
breakfast."
D. "I will increase the protein in my diet by
drinking whole milk."
SAS 29
1. When caring for the patient with interstitial
cystitis, what can the nurse teach the patient to
do?
A. Avoid foods that make the urine more
alkaline.
B. Use high-potency vitamin therapy to
decrease the autoimmune effects of the
disorder.
C. Always keep a voiding diary to document
pain, voiding frequency, and patterns of
nocturia.
D. Use the dietary supplement calcium
glycerophosphate (Prelief) to decrease bladder
irritation.
2. A female patient reports that she is
experiencing burning on urination, frequency,
and urgency. The nurse notes that a clean-
voided urine specimen is markedly cloudy. The
probable cause of these symptoms and findings
is:
A. Cystitis.
B. Hematuria.
C. Pyelonephritis.
D. Dysuria.
3. In cystitis to minimize experiencing nocturia,
the nurse would teach the patient to:
A. Perform perineal hygiene after urinating.
B. Set up a toileting schedule.
C. Double void.
D. Limit fluids before bedtime.
4. An older male patient states that he is having
problems starting and stopping his stream of
urine and he feels the urgency to void. The best
way to assist this patient is to
A. Help him stand to void.
B. Place a condom catheter.
C. Have him practice Credé's method.
D. Initiate Kegel exercises.
5. A 24-year-old female client comes to an
ambulatory care clinic in moderate distress with
a probable diagnosis of acute cystitis. When
obtaining the client's history, the nurse should
ask the client if she has had:
A. Fever and chills.
B. Frequency and burning on urination.
C. Flank pain and nausea.
D. Hematuria.
6. A client who has been diagnosed with renal
calculi reports that the pain is intermittent and
less colicky. Which of the following nursing
actions is most important at this time?
A. Report hematuria to the physician.
B. Strain the urine carefully.
C. Administer meperidine (Demerol) every 3
hours.
D. Apply warm compresses to the flank area.
7. The client is scheduled for an intravenous
pyelogram (IVP) to determine the location of
the renal calculi. Which of the following
measures would be most important for the
nurse to include in pretest preparation?
A. Ensuring adequate fluid intake on the day of
the test.
B. Preparing the client for the possibility of
bladder spasms during the test.
C. Checking the client's history for allergy to
iodine.
D. Determining when the client last had a bowel
movement.
8. After an intravenous pyelogram (IVP), the
nurse should anticipate incorporating which of
the following measures into
the client's plan of care?
A. Maintaining bed rest.
B. Encouraging adequate fluid intake.
C. Assessing for hematuria.
D. Administering a laxative.
9. Because a client's renal stone was found to
be composed of uric acid, a low-purine,
alkaline-ash diet was ordered. Incorporation of
which of the following food items into the
home diet would indicate that the client
understands the necessary diet modifications?
A. Milk, apples, tomatoes, and corn.
B. Eggs, spinach, dried peas, and gravy.
C. Salmon, chicken, caviar, and asparagus.
D. Grapes, corn, cereals, and liver.
10. Allopurinol (Zyloprim), 200 mg/ day, is
prescribed for the client with renal calculi to
take at home. The nurse should teach the client
about which of the following adverse effects of
this medication?
A. Retinopathy.
B. Maculopapular rash.
C. Nasal congestion.
D. Dizziness.
SAS 30
1. A 16-year-old sexually active female patient
with a history of pelvic inflammatory disease
(PID) presents to the emergency room with
complaints of sudden right-sided lower
abdominal pain and gastrointestinal distress.
She cannot recall the date of her last menstrual
period, but states she knows that she’s “late.”
Her exam demonstrates a unilateral, right
adnexal mass. The nurse knows that this patient
likely has which of these prenatal
complications?
A. gestational trophoblastic disease (GTD)
B. spontaneous abortion
C. ectopic pregnancy
D. premature rupture of membranes (PROM)
2. Which statement by the nurse demonstrates
effective communication techniques when
initiating a discussion about sex with a 25-year-
old female client?
A. "Do you know how to properly apply a male
condom?"
B. "What questions do you have related to your
sexual health?"
C. "Have you had sex with more than one
partner?"
D. "Why didn't you start receiving annual Pap
tests at an earlier age?"
3. While caring for a client who is being treated
for severe pelvic inflammatory disease (PID),
the nurse insists on keeping her in a semi sitting
position. What would be the best possible
reason for the nurse's advice?
A. To prevent nosocomial infections to other
clients
B. To facilitate easy distraction of the client
C. To prevent movement as it increases pain
D. To facilitate pelvic drainage and to minimize
the upward extension of infection
4. While caring for a patient who is being
treated for severe pelvic inflammatory disease
(PID), which of the following nursing actions
minimizes transmission of infection?
A. Keeping the patient in a sitting position
B. Performing hand hygiene when entering the
room
C. Strictly adhering to the no visitation policy
D. Implementing reverse isolation precautions
5. The nurse is obtaining the history from a
client who is suspected of having pelvic
inflammatory disease (PID). Which client
statement would help support the suspicion of
PID?
A. "I haven't had sex with anyone else except
my current partner."
B. "My partner and I use condoms during sexual
intercourse."
C. "I was 15 years old when I first had sex."
D. "I've never had any sexually transmitted
infection."
6. The nurse is assessing a client who is
suspected of experiencing an enlarging prostate
gland (BPH). The nurse expects the enlarging
prostate in BPH to be manifested by which of
the following symptoms?
A. Bowel elimination
B. Skin integrity
C. Peripheral vascular function
D. Urinary elimination
7. A man whose BPH has been successfully
managed through medical treatment visits the
provider's office and reports he has suddenly
had a return of symptoms including frequency,
urgency, and a sensation of incomplete
emptying after voiding. The nurse collects a
thorough history and suspects the possible
cause of the sudden exacerbation of the client's
symptoms may be:
A. increased sexual activity since his wife has
retired.
B. antihypertensive medications he was
recently prescribed.
C. increased levels of exercise as he trains for a
marathon.
D. over-the-counter medications he's been
taking to treat cold symptoms.
8. The nurse recognizes that urinary elimination
changes may occur even in healthy elders
because:
A. the bladder distends, and its capacity
increases.
B. elders ignore the need to void.
C. the amount of urine retained after voiding
increases.
D. urine becomes more concentrated.
9. The nurse is taking the history of a client who
has had benign prostatic hyperplasia in the
past. To determine whether the client currently
is experiencing difficulty, the nurse asks the
client about the presence of which of the
following early symptoms?
A. Urge incontinence
B. Nocturia
C. Decreased force in the stream of urine
D. Urinary retention
10. The client asks, "What does an elevated PSA
test mean?" On which scientific rationale
should the nurse base the response?
A. An elevated PSA can result from several
different causes.
B. An elevated PSA can be only from prostate
cancer.
C. An elevated PSA can be diagnostic for
testicular cancer.
D. An elevated PSA is the only test used to
diagnose BPH.
SAS 31
1) The client enters the outpatient clinic and
states to the triage nurse, "I think I have the flu.
I'm so tired, I have no appetite, and everything
hurts." The triage nurse assesses the client and
finds a butterfly rash over the bridge of nose
and on the cheeks. Which diagnosis does the
nurse expect?
A) Systemic lupus erythematosus
B) Fibromyalgia
C) Lyme disease
D) Gout
2) A female client asks the nurse if there are any
conditions that can exacerbate systemic lupus
erythematosus (SLE). Which is the best nurse
response?
A) "Conditions that cause hypotension can
often exacerbate SLE."
B) "GI upset is often associated with SLE
exacerbation."
C) "Pregnancy is often associated with an SLE
exacerbation."
D) "Fever is a known trigger for an SLE
exacerbation."
3) The nurse is providing health education to a
diverse group at a neighborhood community
center. Why does the nurse plan to include
signs and symptoms of systemic lupus
erythematosus (SLE)?
A) The neighborhood is composed of many
young female children.
B) The audience has asked the nurse to include
the information.
C) The audience is mainly composed of
Caucasian women.
D) The audience is mainly females of Asian-
American descent.
4) The nurse is caring for a client who is
hospitalized due to an exacerbation of systemic
lupus erythematosus (SLE). The nurse is
reviewing the client's lab work and finds the
white blood cell count (WBC) is shifted to the
left. Based on this information, which is a
priority nursing diagnosis for this client?
A) Ineffective Protection
B) Ineffective Health Maintenance
C) Ineffective Individual Coping
D) Risk for Impaired Skin Integrity
5) A client with SLE is being treated with
immunosuppressant drugs and corticosteroids.
Which precautions should the nurse provide
this client? Select all that apply.
A) Avoid large crowds.
B) Don't get a flu shot.
C) Use contraception to prevent pregnancy
D) Refrain from taking aspirin or ibuprofen.
E) Report signs of infection to the physician.
6) A nurse is caring for a client with systemic
lupus erythematosus (SLE). The client begins to
cry and tells the nurse that she is afraid that her
skin will be disfigured with lesions. Which
intervention does the nurse plan to teach this
client to minimize skin infections associated
with SLE? Select all that apply.
A) Use sunscreen with an SPF of 15 or greater.
B) Remain indoors on sunny days.
C) Avoid swimming in a pool or the ocean.
D) Avoid sun exposure between 10:00 a.m. and
3:00 p.m.
E) Decrease sun exposure between 3:00 p.m.
and 5:00 p.m.
7) The nurse is caring for a client who has been
diagnosed with discoid lupus erythematosus.
The nurse is collaborating with the client to set
goals for the nursing plan of care. What is an
appropriate goal for this client?
A) Work through the stages of death and dying.
B) Comply 100% of the time with a sun
protection plan.
C) Gain weight to within 10 pounds of normal
for height.
D) Report pain no higher than four on a scale of
1-10.
8) The nurse is planning care for an adolescent
client who has systemic lupus erythematosus
(SLE). The nurse knows that the treatment plan
implemented by the healthcare team is
appropriate for the situation when the client:
A) Refuses to attend school.
B) Does not want to attend any social functions.
C) Discusses skin changes with the healthcare
personnel.
D) Discusses skin changes with a good friend.
9) The nurse is providing care for a newly
married woman with systemic lupus
erythematosus (SLE). Which client statement
indicates plan of care understanding?
A) "I will take birth control pills while I am
taking cytotoxic medications."
B) "I do not need to contact the doctor if I
develop a fever or rash."
C) "I plan to go to the movies this weekend so
that I get out of the house."
D) "I can take ibuprofen as indicated for pain."
10) A nurse is caring for a client with systemic
lupus erythematous (SLE) who is taking
hydroxychloroquine (Plaquenil). The nurse
understands that the primary concern with this
drug is:
A) Pulmonary fibrosis.
B) Cushingoid effects.
C) Retinal toxicity.
D) Renal toxicity
SAS 32
1. When administering a blood transfusion to a
client with multiple traumatic injuries, the nurse
monitors closely for evidence of a transfusion
reaction. Shortly after the transfusion begins,
the client complains of chest pain, nausea, and
itching and there is a rise in the client's
temperature. The nurse stops the transfusion
and notifies the physician. The nurse suspects
which type of hypersensitivity reaction with a
blood transfusion?
a) Type II (cytolytic, cytotoxic) hypersensitivity
reaction
b) Type IV (cell-mediated, delayed)
hypersensitivity reaction
c) Type I (immediate, anaphylactic)
hypersensitivity reaction
d) Type III (immune complex) hypersensitivity
reaction
2. A nurse practicing in a nurse-managed clinic
suspects that an 8-year-old child's chronic
sinusitis and upper respiratory tract infections
may result from allergies. Which laboratory test
would the nurse most likely order? Select all
that apply.
a) Metabolic panel
b) Rheumatoid factor
c) Immunoglobulin assay (IgE)
d) Liver function studies
e) Complete blood count
3. During a school party a child with a known
food allergy has an itchy throat, is wheezing,
and reports not feeling "quite right." The nurse
should do the following in what order from first
to last? All options must be used.
a) Assess vital signs.
b) Position to facilitate breathing.
c) Send someone to activate the Emergency
Management Systems (EMS).
d) Administer the child's epinephrine.
e) Notify the parents.
4. A nurse encourages a client with an
immunologic disorder to eat a nutritionally
balanced diet to promote optimal immunologic
function. Which snacks have the greatest
probability of stimulating autoimmunity?
a) Applesauce and dried apricots
b) Potato chips and chocolate milk shakes
c) Raisins and carrot sticks
d) Fruit salad and mineral water
5. A client develops a facial rash and urticaria
after receiving penicillin. Which laboratory
value does the nurse expect to be elevated?
a) IgE
b) IgG
c) IgA
d) IgB
6. A nurse practicing in a nurse-managed clinic
suspects that an 8-year-old child's chronic
sinusitis and upper respiratory tract infections
may result from allergies. She orders an
immunoglobulin assay. Which immunoglobulin
would the nurse expect to find elevated?
a) Immunoglobulin M
b) Immunoglobulin E
c) Immunoglobulin D
d) Immunoglobulin G
7. A nurse is caring for a client with the
following laboratory values: white blood cell
count (WBC) 4,500/mm3, neutrophils 15%, and
bands 1%. Based on the client's absolute
neutrophil count (ANC), the nurse knows that
the client’s risk for infection is:
a) No increased risk
b) Significant risk
c) low risk
d) intermediate risk
8. A client is experiencing an allergic response.
The nurse should perform the actions in which
order from first to last? All options must be
used.
a) Activate the rapid response team.
b) Assess the airway and breathing pattern.
c) Notify the health care provider (HCP).
d) Assess for urticaria.
9. A 19-year-old male being tested for multiple
allergies develops localized redness and
swelling in reaction to a patch skin test. Which
intervention by the nurse would have the
highest priority?
a) Notify the primary care provider
b) Apply a topical anti-inflammatory cream
c) Remove the patch and extract from the skin
d) Administer oral diphenhydramine (Benadryl)
10. A patient's low hemoglobin and hematocrit
have necessitated a transfusion of packed red
blood cells (RBCs). Shortly after the first unit of
RBCs starts to infuse, the patient develops signs
and symptoms of a transfusion reaction. Which
type of hypersensitivity reaction has the patient
experienced?
a) Type I
b) Type II
c) Type III
d) Type IV
SAS 33
1. On a visit to the clinic, a client reports the
onset of early symptoms of rheumatoid
arthritis. The nurse should conduct a
focused assessment for:
A. Limited motion of joints.
B. Deformed joints of the hands.
C. Early morning stiffness.
D. Rheumatoid nodules.
2. A client with rheumatoid arthritis states, "I
can't do my household chores without
becoming tired. My knees hurt whenever I
walk." Which nursing diagnosis would be most
appropriate?
A. Activity intolerance related to fatigue and
pain.
B. Self-care deficit related to increasing joint
pain.
C. Ineffective coping related to chronic pain.
D. Disturbed body image related to fatigue and
joint pain.
3. Of the clients listed below, who is at risk for
developing rheumatoid arthritis (RA)? Select all
that apply.
A. Adults between the ages of 20 and 50 years.
B. Adults who have had an infectious disease
with the Epstein-Barr virus.
C. Adults that are of the male gender.
D. Adults who possess the genetic link,
specifically HLA-DR4.
E. Adults who also have osteoarthritis.
4. A client is in the acute phase of rheumatoid
arthritis. Which of the following should the
nurse identify as lowest priority in the plan of
care?
A. Relieving pain.
B. Preserving joint function.
C. Maintaining usual ways of accomplishing
tasks.
D. Preventing joint deformity.
5. Which of the following statements should the
nurse include in the teaching session when
preparing a client for arthrocentesis? Select all
that apply.
A. "A local anesthetic agent may be injected
into the joint site for your comfort."
B. "A syringe and needle will be used to
withdraw fluid from your joint."
C. "The procedure, although not painful, will
provide immediate relief."
D. "We'll want you to keep your joint active
after the procedure to increase blood flow."
E. "You will need to wear a compression
bandage for several days after the procedure."
6. A client with osteoarthritis will undergo an
arthrocentesis on his painful edematous knee.
What should be included in the nursing plan of
care? Select all that apply.
A. Explain the procedure.
B. Administer preoperative medication 1 hour
before surgery.
C. Instruct the client to immobilize the knee for
2 days after the surgery.
D. Assess the site for bleeding.
E. Offer pain medication
7. A physician orders a lengthy X-ray
examination for a client with osteoarthritis.
Which of the following actions by the nurse
would demonstrate client advocacy?
A. Contact the X-ray department and ask the
technician if the lengthy session can be divided
into shorter sessions.
B. Contact the physician to determine if an
alternative examination could be scheduled.
C. Provide a dose of acetaminophen (Tylenol).
D. Cancel the examination because of the hard
X-ray table.
8. Which of the following should the nurse
assess when completing the history and
physical examination of a client diagnosed with
osteoarthritis?
A. Anemia.
B. Osteoporosis.
C. Weight loss.
D. Local joint pain.
9 During a home health visit you are helping a
patient with gout identify foods in their pantry
they should avoid eating. Select all the foods
below the patient should avoid:
A. Sardines
B. Whole wheat bread
C. Sweetbreads
D. Crackers
E. Craft beer
F. Bananas
10. Identify which patient below is at MOST risk
for developing gout:
A. A 56-year-old male who reports consuming
foods low in purines.
B. A 45-year-old male with a BMI of 40 who
reports taking hydrochlorothiazide and aspirin.
C. A 39-year-old female hospitalized with
bulimia that has a BMI of 24.
D. A 27-year-old female with ulcerative colitis.
MEDSURG – 1 P2 Part 2 (SAS #34-44) c. "I should include more fiber in my diet than a
person who does not have diabetes."

d. "If I use an insulin pump, I will not need to

SAS #34
limit the amount of saturated fat in my diet."
1. The nurse is reviewing laboratory results for
4. Which patient with type 1 diabetes mellitus
the clinic patients to be seen today. Which
would be at the highest risk for developing
patient meets the diagnostic criteria for
hypoglycemic unawareness?
diabetes mellitus?
a. A 58-year-old patient with diabetic
a. A 48-year-old woman with a hemoglobin A1C
retinopathy
of 8.4%
b. A 73-year-old patient who takes propranolol
b. A 58-year-old man with a fasting blood
(Inderal)
glucose of 111 mg/dL
c. A 19-year-old patient who is on the school
c. A 68-year-old woman with a random plasma
track team
glucose of 190 mg/dL
d. A 24-year-old patient with a hemoglobin A1C
d. A 78-year-old man with a 2-hour glucose
of 8.9%
tolerance plasma glucose of 184 mg/dL
5. The nurse is teaching a 60-year-old woman
2. The nurse teaches a 38-year-old man who
with type 2 diabetes mellitus how to prevent
was recently diagnosed with type 1 diabetes
diabetic nephropathy. Which statement made
mellitus about insulin administration. Which
by the patient indicates that teaching has been
statement by the patient requires an
successful?
intervention by the nurse?
a. "Smokeless tobacco products decrease the
a. "I will discard any insulin bottle that is cloudy
risk of kidney damage."
in appearance."
b. "I can help control my blood pressure by
b. "The best injection site for insulin
avoiding foods high in salt."
administration is in my abdomen."
c. "I should have yearly dilated eye
c. "I can wash the site with soap and water
examinations by an ophthalmologist."
before insulin administration."
d. "I will avoid hypoglycemia by keeping my
d. "I may keep my insulin at room temperature
blood sugar above 180 mg/dL."
(75o F) for up to a month."
6. A 54-year-old patient admitted with type 2
3. The nurse instructs a 22-year-old female
diabetes asks the nurse what "type 2" means.
patient with diabetes mellitus about a healthy
What is the most appropriate response by the
eating plan. Which statement made by the
nurse?
patient indicates that teaching was successful?
a. "With type 2 diabetes, the body of the
a. "I plan to lose 25 pounds this year by
pancreas becomes inflamed."
following a high-protein diet."
b. "With type 2 diabetes, insulin secretion is
b. "I may have a hypoglycemic reaction if I drink
decreased, and insulin resistance is increased."
alcohol on an empty stomach."
c. "With type 2 diabetes, the patient is totally
dependent on an outside source of insulin."
d. "With type 2 diabetes, the body produces
autoantibodies that destroy β-cells in the
pancreas."
7. The nurse caring for a patient hospitalized
with diabetes mellitus would look for which
laboratory test result to obtain information on
the patient's past glucose control?
a. Prealbumin level
b. Urine ketone level
c. Fasting glucose level
d. Glycosylated hemoglobin level
8. The nurse has been teaching a patient with
diabetes mellitus how to perform self-
monitoring of blood glucose (SMBG). During
evaluation of the patient's technique, the nurse
identifies a need for additional teaching when
the patient does what?
a. Chooses a puncture site in the center of the
finger pad.
b. Washes hands with soap and water to
cleanse the site to be used.
c. Warms the finger before puncturing the
finger to obtain a drop of blood.
d. Tells the nurse that the result of 110 mg/dL
indicates good control of diabetes.
9. The nurse is assigned to the care of a 64-year-
old patient diagnosed with type 2 diabetes. In
formulating a teaching plan that encourages the
patient to actively participate in management
of the diabetes, what should be the nurse's
initial intervention?
a. Assess patient's perception of what it means
to have diabetes.
b. Ask the patient to write down current
knowledge about diabetes.
c. Set goals for the patient to actively
participate in managing his diabetes.
d. Assume responsibility for all of the patient's
care to decrease stress level.
10. The nurse has taught a patient admitted
with diabetes, cellulitis, and osteomyelitis about
the principles of foot care. The nurse evaluates
that the patient understands the principles of
foot care if the patient makes what statement?
a. "I should only walk barefoot in nice dry
weather."
b. "I should look at the condition of my feet
every day."
c. "I am lucky my shoes fit so nice and tight
because they give me firm support."
d. "When I am allowed up out of bed, I should
check the shower water with my toes."
SAS #35
1. A client diagnosed with pyelonephritis asks
the nurse "What is the disease?" The nurse's
best response "Pyelonephritis is an:
A. inflammation of the kidney and renal pelvis."
B. inflammation of the prostate gland."
C. inflammation of the urethra."
D. inflammation of the bladder."
2. The nurse is planning to teach the client
about the signs and symptoms of a urinary tract
infection. The nurse should include: (Mark all
that apply)
A. dysuria.
B. foul smelling cloudy urine.
C. urgency.
D. back pain.
3. A male client is complaining of urinary C. A 50 y.o. postmenopausal woman
frequency, dysuria, pain, fever and chills for the
D. A 28 y.o. with angina
third time in 9 months. The nurse should expect
which diagnostic test to be ordered since this is 7. Which of the following causes the majority of
the third infection in 9 months? UTI’s in hospitalized patients?
A. Urinalysis A. Lack of fluid intake
B. X-ray of kidneys, ureter and bladder B. Inadequate perineal care
C. Intravenous pyelography C. Invasive procedures
D. Computed tomography of the abdomen D. Immunosuppression
4. Which of the following symptoms do you 8. the most common early sign of kidney
expect to see in a patient diagnosed with acute disease is:
pyelonephritis?
A. Sodium retention
A. Jaundice and flank pain
B. Elevated BUN level
B. Costovertebral angle tenderness and chills
C. Development of metabolic acidosis
C. Burning sensation on urination
D. Inability to dilute or concentrate urine
D. Polyuria and nocturia
9. The nurse is aware that the following
5. A client with pyelonephritis is being laboratory values supports a diagnosis of
discharged from the hospital, and the nurse pyelonephritis?
provides instructions to the client to prevent
recurrence. The nurse determines that the A. Myoglobinuria
client understands the information that was B. Ketonuria
given if the client states an intention to:
C. Pyuria
A. increase fluids for 2 days if signs and
symptoms of a urinary tract infection develop D. Low white blood cell (WBC) count

B. take the prescribed antibiotics until all 10. When examining a female client’s
symptoms subside genitourinary system, Nurse Sandy assesses for
tenderness at the costovertebral angle by
C. return to the physician's office for scheduled placing the left hand over this area and striking
follow-up urine cultures it with the right fist. Normally, this percussion
D. decrease fluid intake if frequent urination technique produces
occurs which sound?
6. Which patient is at greatest risk for A. A flat sound
developing a urinary tract infection (UTI)?
B. A dull sound
A. A 35 y.o. woman with a fractured wrist
C. Hyperresonance
B. A 20 y.o. woman with asthma
D. Tympany
SAS #36
1. The nursing instructor explains the difference
between normal cells and benign tumor cells.
What information does the instructor provide
about these cells?
a. Benign tumors grow through invasion of
other tissue.
b. Benign tumors have lost their cellular
regulation from contact inhibition.
c. Growing in the wrong place or time is typical
of benign tumors.
d. The loss of characteristics of the parent cells
is called anaplasia.
2. A nurse has taught a client about dietary
changes that can reduce the chances of
developing cancer. What statement by the
client indicates the nurse needs to provide
additional teaching?
a. "Food high in vitamin A and vitamin C are
important."
b. "I'll have to cut down on the amount of
bacon I eat."
c. "I'm so glad I don't have to give up my juicy
steaks."
d. "Vegetables, fruit, and high-fiber grains are
important."
3. A nurse is participating in primary prevention
efforts directed against cancer. In which activities is
this nurse most likely to engage? (Select all that
apply.)
a. Demonstrating breast self-examination methods
to women
b. Instructing people on the use of chemoprevention
c. Providing vaccinations against certain cancers
d. Screening teenage girls for cervical cancer
e. Teaching teens the dangers of tanning booths
4. A client receiving intravenous chemotherapy
asks the nurse the reason for wearing a mask,
gloves, and gown while
administering drugs to the client. What is the
nurse's best response?
a. "These coverings protect you from getting an
infection from me."
b. "I am preventing the spread of infection from
you to me or any other client here."
c. "The policy is for any nurse giving these drugs
to wear a gown, gloves, and mask."
d. "The clothing protects me from accidentally
absorbing these drugs."
5. The nurse is administering a combination of
three different antineoplastic drugs to a patient
who has metastatic breast cancer. Which
statement best describes the rationale for
combination therapy?
a. There will be less nausea and vomiting.
b. Increased cancer-cell killing will occur.
c. The drugs will prevent metastasis.
d. Combination therapy reduces the need for
radiation therapy.
6. One patient has cancer of the bone; another
has cancer in the connective tissues of the thigh
muscles; a third patient has cancer in the
vascular tissues. These patients have a type of
tumor referred to as a
a. sarcoma.
b. leukemia
c. carcinoma.
d. lymphoma.
7. A patient who has cancer is about to begin
chemotherapy. The patient asks the nurse why
two chemotherapeutic agents are being used
instead of just one. Which response by the
nurse is correct?
a. "The drugs may be given in less toxic doses if
two drugs are used."
b. "Two agents used together can have
synergistic effects."
c. "Use of two drugs will increase tumoricidal
activity in the G0 phase of the cell."
d. "Using two agents will shorten the length of
time chemotherapy is needed."
8. The nurse is teaching a patient who will begin
receiving targeted therapy for cancer. The
patient asks how targeted therapy differs from
other types of chemotherapies. The nurse will
explain that targeted therapy
a. damages cancer cell DNA to prevent cell
replication.
b. directly kills or damages cancerous cells.
c. interferes with specific molecules in cancer
cells.
d. prevents metastasis of cancer cells.
9. The registered nurse is teaching a nursing
student about the importance of observing for
bone marrow suppression during
chemotherapy. Select the person who displays
bone marrow suppression.
a. Client with hemoglobin of 7.4 and hematocrit
of 21.8
b. Client with diarrhea and potassium level of
2.9 mEq/L
c. Client with 250,000 platelets
d. Client with 5000 white blood cells/mm3
10. Which manifestation of an oncologic
emergency requires the nurse to contact the
health care provider immediately?
a. New onset of fatigue
b. Edema of arms and hands
c. Dry cough
d. Weight gain
SAS #37
1. The nurse is taking the social history of a
client diagnosed with Small Cell Lung Cancer.
Which information is significant for this
disease?
a. Worked with asbestos for a short time many
years ago.
b. Has no family History of this type of lung
cancer.
c. Has numerous tattoos on upper and lower
arms.
d. Has smoked 2 packs of cigarettes/day for 20
years.
2. The nurse writes a problem of 'impaired gas
exchange' for a client diagnosed with cancer of
the lung. Which interventions should be
included for the plan of care? Select all that
apply.
a. Apply O2 via nasal cannula.
b. Have the dietician plan for 6 small meals per
day.
c. Place the client in respiratory isolation.
d. Assess vital signs for fever.
e. Listen to lung sounds every shift.
3. The nurse is discussing cancer statistics with a
group from the community. Which information
about death rates from lung cancer is accurate?
a. Lung Cancer is the number 2 cause of cancer
deaths in both men and women.
b. Lung Cancer is the number 1 cause of cancer
deaths in both men and women.
c. Lung Cancer deaths are not significant in
relation to other cancers.
d. Lung Cancer deaths have continued to
increase in the male population
4. The client diagnosed with lung cancer has
been told that the cancer has metastasized to
the brain. Which intervention should the nurse
implement?
a. Discuss implementing an advance directive.
b. Explain the use of chemotherapy for brain
involvement.
c. Teach the client to discontinue driving.
d. Have the significant other make decisions for
the client.
5. The client diagnosed with lung cancer is in an
investigational program and receiving a vaccine
to treat the cancer. Which information
regarding investigational regimens should the
nurse teach?
a. Investigational regimens provide a better
chance of survival for the client.
b. Investigational treatments have not been
proved helpful to clients.
c. Clients will be paid to participate in a
investigational program.
d. Only clients that are dying qualify for
investigational treatments.
6. The client diagnosed with Lung Cancer is
being discharged. Which statement made by
the client indicates that more teaching is
needed?
a. It doesn't matter if I smoke now. I already
have cancer.
b. I should see the oncologist at my scheduled
appointment
c. If I begin to run a fever, I should notify my
Health Care Provider.
d. I should plan for periods of rest throughout
the day.
7. The client is admitted to the outpatient
surgery center for a bronchoscopy to rule out
lung cancer. Which info should the nurse teach?
a. The test will confirm the MRI results.
b. The client can eat and drink immediately
after the test.
c. The Health Care Provider can do a biopsy of
the tumor through the scope.
d. There is no discomfort associated with this
procedure.
8. Which clinical manifestation would the nurse
expect to find in newly diagnosed intrinsic Lung
Cancer?
a. Dysphagia
b. Foul smelling breath
c. Hoarseness
d. Weight loss
9. A patient who smokes tells the nurse, "I want
to have a yearly chest x-ray so that if I get
cancer, it will be detected early." Which
response by the nurse is most appropriate?
a. "Chest x-rays do not detect cancer until
tumors are already at least a half-inch in size."
b. "Annual x-rays will increase your risk for
cancer because of exposure to radiation."
c. "Insurance companies do not authorize yearly
x-rays just to detect early lung cancer."
d. "Frequent x-rays damage the lungs and make
them more susceptible to cancer."
10. The nurse has identified the nursing
diagnosis of imbalanced nutrition: less than
body requirements related to altered taste
sensation in a patient with lung cancer who has
had a 10% loss in weight. An appropriate
nursing intervention that addresses the etiology
of this problem is to
a. provides foods that are highly spiced to
stimulate the taste buds.
b. avoids presenting foods for which the patient
has a strong dislike.
c. adds strained baby meats to foods such as
soups and casseroles.
d. teaches the patient to eat whatever is
nutritious since food is tasteless.
SAS #38
1. A patient with liver cancer has a nursing
diagnosis of imbalanced nutrition: less than
body requirements r/t anorexia and inadequate
food intake. An appropriate midday snack for
the patient would be
A. peanut butter and salt free crackers
B. a fresh tomato sandwich with salt free butter
C. popcorn with salt free butter and herbal
seasoning
D. canned chicken noodle soup with low protein
bread
2. The nurse is preparing Cyclophosphamide
(Cytoxan). Safe handling of the drug should be
implemented to protect thebnurse from injury.
Which of the following action by the nurse
should be corrected?
A. The nurse should wear mask and gloves.
B. Air bubbles should be expelled on wet
cotton.
C. Label the hanging IV bottle with
“ANTINEOPLASTIC CHEMOTHERAPY” sign.
D. Vent vials after mixing.
3. Neoplasm can be classified as either benign
or malignant. The following are characteristics
of malignant tumor apart
from:
A. Metastasis
B. Infiltrates surrounding tissues
C. Encapsulated
D. Poorly differentiated cells
4. On a clinic visit a client who has a relative
with cancer, is asking about the warning signs
that may relate to cancer. The nurse correctly
identifies the warning signs of cancer by
responding:
A. “If a sore healing took a month or more to
heal, cancer should be suspected.”
B. “Presence of dry cough is one of the warning
signs of cancer.”
C. “A lump located only in the breast area may
suggest the presence of cancer.”
D. “Sudden weight loss of unexplained etiology
can be a warning sign of cancer.”
5. Skin reactions are common in radiation
therapy. Nursing responsibilities on promoting
skin integrity should be promoted apart from:
A. Avoiding the use of ointments, powders and
lotion to the area
B. Using soft cotton fabrics for clothing
C. Washing the area with a mild soap and water
and patting it dry not rubbing it.
D. Avoiding direct sunshine or cold. B. 3 minutes

6. Nausea and vomiting is an expected side C. 5 minutes

effect of chemotherapeutic drug use. Which of
the following drug should be administered to a
client on chemotherapy to prevent nausea and
vomiting?
A. Metochlopramide (Metozol)
B. Succimer (Chemet)
D. 10 minutes
10. A client is taking Cyclophosphamide
(Cytoxan) for the treatment of lymphoma. The
nurse is very cautious in administering the
medication because this drug poses the fatal
side effect of:

C. Anastrazole (Arimidex) A. Alopecia

D. Busulfan (Myleran) B. Myeloma

7. Radiation protection is very important to C. CNS toxicity

implement when performing nursing
procedures. When the nurse is not performing
any nursing procedures what distance should
be maintained from the client?
A. 1 feet
B. 2 feet
C. 2.5 feet
D. Hemorrhagic cystitis
SAS #39
1. A patient diagnosed with thyroid cancer has
undergone a thyroidectomy after
thyroidectomy, which of the following is the
priority assessment to observe laryngeal nerve
damage?

D. 3 feet A hoarseness of voice

8. The following are teaching guidelines B difficulty in swallowing

regarding radiation therapy except:
A. The therapy is painless
B. To promote safety, the client is assisted by
therapy personnel while the machine is in
operation.
C. The client may communicate all his concerns
or needs or discomforts while the machine is
operating.
D. Safety precautions are necessary only during
the time of actual irradiation.
9. Contact of client on radiation therapy should
be limited only to how many minutes to
promote safety of the therapy personnel?
A. 1 minute
C tetany
D fever
2. For the first 72 hours after thyroidectomy
surgery, nurse Jamie would assess the female
client for Chvostek's sign and Trousseau's sign
because they indicate which of the following?
A. Hypocalcemia
B. Hypercalcemia
C. Hypokalemia
D. Hyperkalemia
3. Early this morning, a female client had a
subtotal thyroidectomy. During evening rounds,
nurse Tina assesses the client, who now has
nausea, a temperature of 105° F (40.5° C),
tachycardia, and extreme restlessness. What is C. Tumors form when carcinogens invade the
the most likely cause of these signs? gene structure of the cell in the latency phase.

A. Diabetic ketoacidosis D. Nutrition of cancer cells is provided by tumor

angiogenesis factor (TAF) in the promotion
B. Thyroid crisis
stage.
C. Hypoglycemia
7 Which potential side effects should be
D. Tetany included in the teaching plan for a client
undergoing radiation therapy for thyroid
4. In the administration of a drug such as cancer? select all that apply.
levothyroxine (Synthroid), the nurse should
teach the client: A. Fatigue

A. That therapy typically lasts about 6 months. B. Changes in color of hair

B. That weekly laboratory tests for T4 levels will C. Change in taste

be required.
D. Changes in skin of the neck
C. To report weight loss, anxiety, insomnia, and
E. Difficulty swallowing
palpitations.
8. The nurse has received in report that the
D. That the drug may be taken every other day
client receiving chemotherapy for thyroid
if diarrhea occurs.
cancer has severe neutropenia. Which of the
5. Which precaution is most important for the following does the nurse plan to implement?
nurse to teach a client receiving radiation Select all that apply.
therapy for head and neck cancer?
A. Assess for fever.
A. Avoid eating red meat during treatment.
B. Observe for bleeding.
B. Pace your leisure activities to prevent fatigue.
C. Administer pegfilgrastim (Neulasta).
C. See your dentist twice yearly for the rest of
D. Do not permit fresh flowers or plants in the
your life.
room.
D. Avoid using headphones or headsets until
E. Do not allow his 16-year-old son to visit.
your hair grows back.
F. Teach the client to omit raw fruits and
6. The registered nurse is teaching a group of
vegetables from his diet.
nursing students about malignant
transformation. Which statement about the 9. Which medication does the nurse plan to
process of malignant transformation is true? administer to a client before chemotherapy for
thyroid cancer to decrease the incidence of
A. Mutation of genes is an irreversible event
nausea?
that always leads to cancer development in the
initiation phase. A. Morphine

B. Insulin and estrogen enhance the division of B. Ondansetron (Zofran)

an initiated cell during the promotion phase.
C. Naloxone (Narcan)
D. Diazepam (Valium)
10. The nurse is caring for a patient with thyroid
cancer suffering from anorexia secondary to
chemotherapy. Which of the following
strategies would be most appropriate for the
nurse to use to increase the patient's nutritional
intake?
A. Increase intake of liquids at mealtime to
stimulate the appetite.
B. Serve three large meals per day plus snacks
between each meal.
C. Avoid the use of liquid protein supplements
to encourage eating at mealtime.
D. Add items such as skim milk powder, cheese,
honey, or peanut butter to selected foods.
SAS #40
1. A gastrectomy is performed on a client with
gastric cancer. In the immediate postoperative
period, the
nurse notes bloody drainage from the
nasogastric tube. Which of the following is the
appropriate nursing intervention?
a. notify the physician
b. measure abdominal girth
c. irrigate the nasogastric tube
d. continue to monitor the drainage
2. While being prepared for a biopsy; the
patient asks the nurse what the difference is
between a benign tumor and a malignant
tumor. The nurse explains that a benign tumor
differs from a malignant tumor in those benign
tumors:
a. do not cause damage to adjacent tissue.
b. do not spread to other tissues and organs.
c. are simply an overgrowth of normal cells.
d. frequently recur in the same site
3. The community nurse is conducting a health
promotion program and the topic of the
discussion relates to the risk factors for gastric
cancer. Which risk factor, if identified by a
client, indicates a need for further discussion?
a. smoking
b. a high-fat diet
c. foods containing nitrates
d. a diet of smoked, highly salted, and spiced
food
4. A gastrectomy is performed on a client with
gastric cancer. In the immediate postoperative
period, the nurse notes bloody drainage from
the nasogastric tube. Which of the following is
the appropriate nursing intervention?
a. notify the physician
b. measure abdominal girth
c. irrigate the nasogastric tube
d. continue to monitor the drainage
5. A female client with cancer is scheduled for
radiation therapy. The nurse knows that
radiation at any treatment site may cause a
certain adverse effect. Therefore, the nurse
should prepare the client to expect:
a. hair loss.
b. stomatitis.
c. fatigue.
d. vomiting.
6. A gastrectomy is performed on a client with
gastric cancer. In the immediate postoperative
period, the nurse notes
bloody drainage from the nasogastric tube.
Which of the following is the appropriate
nursing intervention.
a. Notify the physician
b. Measure the abdominal girth
c. Irrigate the nasogastric tube
d. Continue to monitor the drainage
7. An optimal teaching plan for an outpatient
with stomach cancer receiving radiation therapy
should include information about
a. cancer support groups.
b. avitaminosis, ostomy care, and community
resources.
c. prosthetic devices, skin conductance, and
grief counseling.
d. wound and skin care, nutrition, drugs, and
community resources
8. Chemotherapy is one of the therapeutic
modalities for cancer. This treatment is
contraindicated to which of the following
conditions?
a. Recent surgery
b. Pregnancy
c. Bone marrow depression
d. All of the above
9. Which one of the following expected
outcomes about nutrition would be appropriate
for a client who has had a total gastrectomy for
gastric cancer? The client will:
a.) Regain any weight lost within 4 weeks of the
surgical procedure.
b.) Eat three full meals a day without
experiencing gastric complications.
c.) Learn to self-administer enteral feedings
every 4 hours.
d.) Maintain adequate nutrition through oral or
parenteral feedings
10. Teaching a client who has had recent bowel
surgery how to facilitate the expulsion of feces
may include the process of increasing intra-
abdominal pressure. Which of the following
best matches this process?
a. Crede's maneuver.
b. Valsalva's maneuver.
c. Heimlich's maneuver.
d. Epley's maneuver
SAS #41
1. A nurse assesses clients at a community
health center. Which client is at highest risk for
the development of colorectal cancer?
a. A 37-year-old who drinks eight cups of coffee
daily
b. A 44-year-old with irritable bowel syndrome
(IBS)
c. A 60-year-old lawyer who works 65 hours per
week
d. A 72-year-old who eats fast food frequently
2. A nurse assessing a client with colorectal
cancer auscultates high-pitched bowel sounds
and notes the presence of visible peristaltic
waves. Which action should the nurse take?
a. Ask if the client is experiencing pain in the
right shoulder.
b. Perform a rectal examination and assess for
polyps.
c. Contact the provider and recommend
computed tomography.
d. Administer a laxative to increase bowel
movement activity.
3. A nurse prepares a client for a colonoscopy
scheduled for tomorrow. The client states, "My
doctor told me that the fecal occult blood test
was negative for colon cancer. I don't think I
need the colonoscopy and would like to cancel
it." How should the nurse respond?
a. Your doctor should not have given you that
information prior to the colonoscopy.
b. The colonoscopy is required due to the high
percentage of false negatives with the blood
test.
c. A negative fecal occult blood test does not
rule out the possibility of colon cancer.
d. I will contact your doctor so that you can
discuss your concerns about the procedure.
4. A nurse cares for a client newly diagnosed
with colon cancer who has become withdrawn
from family members. Which action should the
nurse take?
a. Contact the provider and recommend a
psychiatric consult for the client.
b. Encourage the client to verbalize feelings
about the diagnosis.
c. Provide education about new treatment
options with successful outcomes.
d. Ask family and friends to visit the client and
provide emotional support.
5. A nurse cares for a client with colon cancer
who has a new colostomy. The client states, "I
think it would be helpful to talk with someone
who has had a similar experience." How should
the nurse respond?
a. I have a good friend with a colostomy who
would be willing to talk with you.
b. The enterostomal therapist will be able to
answer all of your questions.
c. I will make a referral to the United Ostomy
Associations of America.
d. You'll find that most people with colostomies
don't want to talk about them.
6. A nurse teaches a client who is recovering
from a colon resection. Which statement should
the nurse include in these
clients plan of care?
a. You may experience nausea and vomiting for
the first few weeks.
b. Carbonated beverages can help decrease acid
reflux from anastomosis sites.
c. Take a stool softener to promote softer stools
for ease of defecation.
d. You may return to your normal workout
schedule, including weight lifting.
7. A nurse teaches a client who is at risk for
colon cancer. Which dietary recommendation
should the nurse teach this client?
a. Eat low-fiber and low-residual foods.
b. White rice and bread are easier to digest.
c. Add vegetables such as broccoli and
cauliflower to your new diet.
d. Food high in animal fat help to protect the
intestinal mucosa.
8. A nurse cares for a client who has a family
history of colon cancer. The client states, "My
father & brother had colon cancer. What is the
chance that I will get cancer?" How should the
nurse respond?
a. If you eat a low-fat and low-fiber diet, your
chances decrease significantly.
b. You are safe. This is an autosomal dominant SAS #42
disorder that skips generations.
1. The client frequently finds lumps in her
c. Preemptive surgery and chemotherapy will breasts, especially around the time of her
remove cancer cells and prevent cancer. period. Which information should the nurse
teach the client regarding breast self-care?
d. You should have a colonoscopy more
frequently to identify abnormal polyps early. A. This is a benign process that does not need
follow up.
9. After teaching a client who is recovering from
a colon resection, the nurse assesses the client's B. Eliminate chocolate and caffeine from diet.
understanding. Which statements by the client
C. Practice breast self-exam monthly.
indicate a correct understanding of the
teaching? (SATA) D. This is how breast cancer starts and she
needs surgery.
a. I must change the ostomy appliance daily and
as needed. 2. The client diagnosed with breast cancer is
considering whether to have a lumpectomy or a
b. I will use warm water and a soft washcloth to
more invasive procedure, a modified radical
clean around the stoma.
mastectomy. Which of the following should the
c. I might start bicycling and swimming again nurse discuss?
once my incision has healed.
A. Ask if she is afraid of general anesthesia.
d. Cutting the flange will help it fit snugly
B. Ask how she feels about radiation and
around the stoma to avoid skin breakdown.
chemotherapy.
e. I will check the stoma regularly to make sure
C. Tell her that she will need reconstruction
that it stays a deep red color.
with either procedure.
f. I must avoid dairy products to reduce gas and
D. Find out if she has Breast Cancer in her
odor in the pouch.
family.
10. A client has late-stage colon cancer with
3. The client has undergone a wedge resection
metastasis to the spine and bones. Which
for cancer on the left breast. Which discharge
nursing intervention does the nurse add to the
instruction should the nurse teach?
care plan to address a priority problem?
A. Don't life more than 5 lbs. with left hand until
a. Provide six small meals and snacks daily.
released by Health care provider
b. Offer the client prune juice twice a day.
B. The cancer has been totally removed and no
c. Ensure that the client gets adequate rest. follow up therapy is required.

d. Give the client pain medications around the C. Client should empty Hemovac every 12
clock. hours.

D. Client should arrange for an appointment

with a plastic surgeon for reconstruction.
4. The nurse is teaching a class on breast health include? Select all that apply:
to a group of ladies at the senior center. Which
A. Notify health care provider of temperature of
is the most important risk factor to emphasize
100 F
to this group?
B. Carry large purses and bundles with the right
A. Find out about family History of Breast
hand.
Cancer
C. Do not go to church or anywhere with
B. Men at this age can get breast cancer and
crowds.
should also be screened.
D. Try to keep the arm as still as possible until
C. Monthly self-exam is the key to early
seen by health care provider.
detection.
E. Have a mammogram of the right and left
D. The older a woman gets, the greater the
breast yearly
chance of developing Breast Cancer.
8. The client who has had a mastectomy tells
5. The client who is scheduled for breast biopsy
the nurse, "My husband will leave me now that
with sentinel node dissection sates, "I don't
I am not a whole woman anymore." Which
understand. What does a sentinel node biopsy
response is therapeutic?
do?"
A. Are you afraid that your husband will not find
A. A dye is injected into the tumor and traced to
you sexually appealing?
determine spread of cells.
B. Your husband should be grateful that you will
B. The surgeon removes the nodes that drain
be able to live and be with him.
the diseased portion of the breast.
C. Maybe your husband would like to attend a
C. The nodes that can be felt manually will be
support group for spouses.
removed and sent to pathology.
D. You don't know that's true. Give him a
D. A visual inspection of the lymph nodes will e
chance.
made while the client is sleeping.
9. The client has been diagnosed with BC. What
6. The client is 4 months pregnant and finds a
is the most appropriate referral for the nurse to
lump in her breast and the biopsy is positive for
make?
stage II Breast Cancer. Which Treatment should
the nurse anticipate? A. Hospital social worker
A. A lumpectomy to be performed after the B. CanSurmount
baby is born.
C. Reach to Recovery
B. A modified radical mastectomy.
D. ICanCope
C. Radiation therapy to chest wall only.
10 The client has undergone a wedge resection
D. Chemo only until baby is born. for cancer on the left breast. Which discharge
instruction should the nurse teach?
7. The client is being discharged after a left
modified radical mastectomy. Which discharge A. Don't life more than 5 lbs. with left hand until
instructions should the nurse released by health care provider
B. The cancer has been totally removed and no
follow-up therapy is required.
C. Client should empty Hemovac every 12
hours.
D. Client should arrange for an appt. with a
plastic surgeon for reconstruction.
SAS #43
1. The nurse is caring for a client with end-stage
ovarian cancer who needs clarification on the
purpose of palliative surgery. Which outcome
should the nurse teach the client is the goal of
palliative surgery?
A Cure of the cancer
B Relief of symptoms or improved quality of life
C Allowing other therapies to be more effective
D Prolonging the client's survival time
2. Which statement made by a client allows the
nurse to recognize whether the client receiving
brachytherapy for ovarian cancer understands
the treatment plan?
A "I may lose my hair during this treatment."
B "I must be positioned in the same way during
each treatment."
C "I will have a radioactive device in my body
for a short time."
D "I will be placed in a semiprivate room for
company."
3.When caring for a client receiving
chemotherapy, the nurse plans care during the
nadir of bone marrow activity to prevent which
complication?
A Drug toxicity
B Polycythemia
C Infection
D Dose-limiting side effects
4. The nurse corrects the nursing student when
caring for a client with neutropenia secondary
to chemotherapy in which circumstance?
A The student scrubs the hub of IV tubing
before administering an antibiotic.
B The nurse overhears the student explaining to
the client the importance of handwashing.
C The student teaches the client that symptoms
of neutropenia include fatigue and weakness.
D The nurse observes the student providing oral
hygiene and perineal care.
5. Which client problem does the nurse set as
the priority for the client experiencing
chemotherapy-induced peripheral neuropathy?
A Potential for lack of understanding related to
side effects of chemotherapy
B Potential for injury related to sensory and
motor deficits
C Potential for ineffective coping strategies
related to loss of motor control
D Altered sexual function related to erectile
dysfunction
6. Which finding alarms the nurse when caring
for a client receiving chemotherapy who has a
platelet count of 17,000/mm3?
A Increasing shortness of breath
B Diminished bilateral breath sounds
C Change in mental status
D Weight gain of 4 pounds in 1 day
7. Which medication does the nurse plan to
administer to a client before chemotherapy to
decrease the incidence of nausea and vomiting?
A Morphine
B Ondansetron (Zofran) D Breast tenderness

C Naloxone (Narcan) E Weight loss

D Diazepam (Valium) F Deep vein thrombosis

8. When caring for the client receiving cancer

chemotherapy, which signs or symptoms
SAS #44
related to thrombocytopenia should the nurse
report to the health care provider? (Select all 1. A 33-yr-old patient has recently been
that apply.) diagnosed with stage II cervical cancer. Which
statement by the nurse best explains the
A Bruises
diagnosis?
B Fever
a. "The cancer is found at the point of origin
C Petechiae only."

D Epistaxis b. "Tumor cells have been identified in the

E Pallor
9. The nurse has received in report that a client
receiving chemotherapy has severe
neutropenia. Which interventions does the
nurse plan to implement? (Select all that apply.)
cervical region."
c. "The cancer has been identified in the cervix
and the liver."
d. "Your cancer was identified in the cervix and
has limited local spread."

A Assess for fever. 2. The patient is told that her adenoma tumor is
not encapsulated but has normally
B Observe for bleeding.
differentiated cells and surgery will be needed.
C Administer pegfilgrastim (Neulasta). The patient asks the nurse what this means.
What should the nurse tell the patient?
D Do not permit fresh flowers or plants in the
room. a. It will recur.

E Do not allow the client's 16-year-old son to b. It has metastasized.

visit.
c. It is probably benign.
F Teach the client to omit raw fruits and
d. It is probably malignant.
vegetables from the diet.
3. Which statement by the nurse most
10. The nurse is teaching a client who is
facilitates patient cancer prevention during the
receiving an antiestrogen drug about the side
promotion stage of cancer development?
effects she may encounter. Which side effects
does the nurse include in the discussion? (Select a. "Exercise every day for 30 minutes."
all that apply.)
b. "Follow smoking cessation
A Heavy menses recommendations."

B Smooth facial skin c. "Following a vitamin regime is highly

recommended."
C Hyperkalemia
d. "I recommend excision of the cancer as soon
as possible."
4. The laboratory reports that the cells from the
patient's tumor biopsy are grade II. What
should the nurse know about this histologic
grading?
a. Cells are abnormal and moderately
differentiated.
b. Cells are very abnormal and poorly
differentiated.
c. Cells are immature, primitive, and
undifferentiated.
d. Cells differ slightly from normal cells and are
well-differentiated.
5. Patients may reduce the risk of developing
cancer using health promotion strategies.
Identify strategies which can reduce the risk of
developing cancer (select all that apply.).
a. Control weight
b. Genetic testing
c. Immunizations
d. Use sunscreen
e. Stop smoking
f. Limit alcohol intake
6. The patient and his family are upset that the
patient is going through procedures to diagnose
cancer. What nursing actions should the nurse
use first to facilitate their coping with this
situation (select all that apply.)?
a. Maintain hope
b. Exhibit a caring attitude
c. Plan realistic long-term goals
d. Give them anti-anxiety medications
e. Be available to listen to fears and concerns
f. Teach them about the different types of
cancer that could be diagnosed
7. The patient is receiving an IV vesicant
chemotherapy drug. The nurse notices swelling
and redness at the site. What should the nurse
do first?
a. Ask the patient if the site hurts.
b. Turn off the chemotherapy infusion.
c. Call the ordering health care provider.
d. Administer sterile saline to the reddened
area.
8. When caring for the patient with cancer,
what does the nurse understand as the
response of the immune system to antigens of
the malignant cells?
a. Metastasis
b. Tumor angiogenesis
c. Immunologic escape
d. Immunologic surveillance
9. The patient is being treated with
brachytherapy for cervical cancer. What factors
must the nurse be aware of to protect herself
when caring for this patient?
a. The medications the patient is taking
b. The nutritional supplements that will help the
patient
c. How much time is needed to provide the
patient's care
d. The time the nurse spends at what distance
from the patient
10. A client, age 41, visits the gynecologist. After
examining her, the physician suspects cervical
cancer. The nurse
reviews the client’s history for risk factors for
this disease. Which history finding is a risk
factor for cervical cancer?

a. Onset of sporadic sexual activity at age 17

b. Spontaneous abortion at age 19

c. Pregnancy complicated with eclampsia at age

27

d. Human papillomavirus infection at age 32