1.

The nurse has provided discharge instructions to a client who is newly diagnosed with nephrotic
syndrome. Which of the following client statements indicates a correct understanding of the teaching

A. I should take all prescribed antibiotics until their gone

B. I should avoid using any type of salt substitute on my food
C. I must decrease my intake of foods high in potassium
D. I must protect myself from developing an infection Pg 1362

2. The nurse is reviewing the laboratory results of an assigned client; it is a priority for the nurse to
follow up with the PCP if the client

A. is receiving prescribed digoxin and has a BUN level that has increased from 15 to 19mg/dl
over the past 3 days

B. had a mitral mechanical valve replacement and taking prescribed warfarin that has an INR
that is 3.2

C. is receiving prescribed enoxaparin post op cardiac surgery and the platelets have decreased
from 200,000 to 175,000 over the past 2 days

D. had a AAA repair 2 days ago and has a creatinine that has increased from 0.9 to 2.5mg/dl

3. The nurse is caring for a client who has been hospitalized for 8 days with AKI caused by dehydration
which of the following should the nurse report immediately to the PCP

A. a BUN level of 67mg/dl

B. a rhythm strip reading that has tall, peaked T waves

C. a decreased GFR

D. a creatinine level of 3mg/dl

4. The nurse is caring for a client who is receiving gentamicin IV for infection and has developed oliguria
and increased blood pressure. Which of the following actions should the nurse take first

A. collect a urine sample to check specific gravity

B. obtain a prescription for gentamicin peak and trough levels

C. insert a prescribed urinary catheter

D. raise the head of the bed to a 45-degree angle

5. The nurse is caring for a client with CKD, the client is reporting muscle weakness diarrhea, and tingling
in the hands. Which action should the nurse take first

A. notify the PCP

B. check the client’s most recent serum electrolyte levels

C. evaluate the client’s urine output for the past 4 hrs

D. determine if the client is scheduled to receive hemodialysis

 E. obtain a blood specimen for ABG’s

6. The nurse is talking with a client who has CKD and has been receiving hemodialysis 3x week. Which of
the following client statements is a priority follow-up by the nurse

A. I try and limit my intake of dietary sodium to 5g a day

B. I have noticed that my skin looks like it has a layer of frost on it

C. I have noticed that my breath has developed a very unpleasant odor

D. I will make sure that I consume at least 50g of protein every day

7. The nurse is teaching a client who is in the late stage of CKD. Which of the following client statements
indicates a correct understanding of the teaching

A. I should obtain much of my protein from dairy products and eggs

B. I can expect to have an increase in my energy level after dialysis treatment

C. hemodialysis will be performed 2x week in an outpt ceneter

D. if I develop and fatigue or weakness I should report it to my doctor

8. The nurse is caring for a client who has returned from receiving hemodialysis treatment. It requires
immediate follow up by the nurse if the client has

A. developed a bp of 90/58mmhg

B. develop a temperature of 99.4F

C. K+ level that decrease from 6.1 to 5.1

D. reports of feeling tired and no desire to eat

9. The nurses came for assigned client. Which of the following actions should the nurse take

A. place mask on the client when changing the client peritoneal dialysis catheter dressing

B. walk a client to the bathroom during the peritoneal dialysis infusion cycle

C. apply a pressure dressing on a clients AV fistula between hemodialysis treatments

D. obtain a blood specimen from a client’s AV fistula

10. The nurse preceptor is observing a newly hired nurse care for a client who is receiving peritoneal
dialysis. It indicates correct technique if the newly hired nurse is observed

A. obtaining a prescription to give the client an enema prior to beginning dialysis

B. placing the PD dialysate bag in the microwave to warm the solution

C. starting dialysis prior to cleaning the catheter site

D. repositioning the client to High Fowler’s during dialysis to improve dialysate drainage
11. The nurse is assessing a newly admitted client who has acute pancreatitis. Which of the following
should the nurse expect to assess

A. spider angiomas

B. left shoulder pain

C. Htn

D. bradycardia

E. back pain

12. The nurse is reviewing lab results of a client who had acute pancreatitis. Which results from the box
below should the nurse expect to find in the client

1. an increased calcium level of 12 4. an increased mag level of 3

2. an increased amylase level of 215 5. a platelet count of 300,000mm

3. a WBC of 15mm 6. a blood glucose level of 65mg/dl

A. 1,2,3,4 C. 2,3

B. 3,6 D. 2,5,6

13. The nurse working on the med surg unit is caring for assigned clients. The nurse should first plan to
assess a client who has

A. cirrhosis of the liver and has a musty odor to the breath

B. CKD and is drinking fluids immediately before hemodialysis

C. acute pancreatitis and has developed restlessness

D. AKI and has a creatinine level of 2.5

E. acute pancreatitis and has a pulse of 126 with a bp of 98/54mmhg

14. The nurse has provided discharge teaching to a client who has chronic pancreatitis. Which of the
following client statements indicates a correct understanding of the teaching

A. I should expect that my stools will become progressively frothy

B. I will use spices to season my food instead of using salt

C. I will eat 3 meals a day and avoid snacking

D. I should take my prescribed pancreatic enzymes with meals

E. I will avoid eating foods that are high in fat

15. The nurse is developing a POC for a client who has cirrhosis and is scheduled to have a paracentesis
performed. Which of the following should the nurse include in the POC
 A. insert an IV line to administer sedatives

B. measure the client’s abdominal girth before, during, and after the procedure

C. position the client with the HOB elevated

D. instruct the client to maintain a full bladder for the procedure

16. The nurse is providing discharge instructions for a client with cirrhosis. Which of the following
statements best indicates that the client has understood the teaching

A. I will wash my skin with warm water and soap if I develop pruritus

B. I should avoid constipation to decrease my risk of bleeding

C. It is safer for me to take acetaminophen for pain rather than aspirin

D. I should eat a low protein low carb diet to provide energy

17. The nurse has received handoff report for the following assigned clients. Which client should the
nurse see first

A. 58yr old who has cirrhosis of the liver and reports anorexia

B. 43yr old who has hepatic encephalopathy and is confused

C. 40yr old who had chronic pancreatitis and reports gnawing abdominal pain

D. 55yr old who has cirrhosis of the liver and has tachypneic

18. The nurse is caring for a client who has cirrhosis and has been prescribed lactulose. It would indicate
that the client is having an expected outcome from his medication if the client experiences a decrease in

A. the ammonia level

B. the level of confusion

C. abdominal distention

D. nausea and vomiting

19. The nurse is caring for assigned clients. The nurse should first plan to assess the client who has

A. returned from hemodialysis and is reporting pain radiating down the left arm

B. pancreatitis and has had a temperature of 101.1F for the past hr

C. hepatic encephalopathy and has been having flapping tremor off the hand

D. Afib and is requesting acetaminophen for a headache

20. The nurse working in a cardiac unit is admitting a client who has unstable angina. Which of the
following actions should the nurse take

A. administer O2 via NC
 B. check BNP levels

C. obtain a stat chest radiography

D. prepare to send the client for cardiac catheterization

21. The nurse is caring for a client who was admitted 45 min ago with a diagnosis of MI. Which of the
following findings should the nurse anticipate may occur within the first few hrs after an MI

A. sinus tachycardia with PVC’s

B. the development of 3+ to 4+ pitting edema of the LE

C. an ABG that indicates metabolic acidosis

D. jugular vein distention

22. The nurse is caring for a client who experienced an acute MI 24 hrs ago. It would be necessary for the
nurse to immediately notify the PCP if the client has

A. an elevated troponin level

B. crackles auscultated to the midline of the lung fields

C. a WBC of 13000mm

D. 2 unifocal PVC’s per minute

23. The nurse caring for a group of client’s on the cardiac floor, the nurse should immediately follow up
on the client who is

A. receiving diltiazem for AFIB and has a decrease in systolic bp from 148 to 123mmhg

B. being treated for AFIB with an amiodarone drip analysis to have dysarthria

C. being treated for PVC’s with an infusion of potassium chloride and by mouth

D. 2 days post op from a CABG and has a capillary blood glucose of 312mg/dl

24. The nurse has received a handoff report for a client who was admitted with chest pain and is
receiving Nitro 50mg/250ml D5W at a rate of 10mcg/min, the client weighs 187lbs. The nurse observes
that the clients IV pump is set at a rate of 3ml/hr. Which of the following should the nurse take

A. continue to infuse the Nitro at a rate of 3ml/hr

B. request the pharmacy to send Nitro 100mg/500ml DD5W

C. increase the infusion rate to 6ml/hr

D. complete an incident report

25. The nurse in the ER is caring for a client who just had an MI and is receiving a continuous infusion of
TPA. It would be most important for the nurse to notify the PCP if the client develops

A. oozing blood at the IV site

 B. skin that is diaphoretic

C. a feeling of apprehension

D. an increase in HR from 90 to 106 bpm

26. The nurse is caring for a client who has had chest pain for the past 45 min and has been prescribed
the intravenous thrombolytic Tenecteplase. Which of the following questions is the most important for
the nurse to ask the client before administering the medication

A. do you currently take blood thinners

B. are you allergic to aspirin

C. do you have a history of cigarette smoking

D. do you take prescribed beta blockers

27. The nurse working in a rehab is assisting a client who had an MI to increase activity tolerance. Which
of the following client symptoms indicates a need to stop the clients current activity

A. O2 saturation level has decreased from 98% to 95%

B. pulse rate has increased from 86-98

C. systolic bp has decreased from 126/96 to 106/68mmhg

D. respirations have increased from 22 to 28

28. The nurse has received a prescription to increase a clients dopamine drip from 3mcg/kg/min to
5mcg/kg/min. The concentration of dopamine is 400mg/250ml D5W and the client weighs 235lbs. What
would the nurse increase the clients infusion pump

A. 20ml/hr

B. 5ml/hr

C. 15ml/hr

D. 10ml/hr

29. The nurse working in the tele step down unit is caring for a client who is scheduled for a cardiac
catheterization and an angioplasty. Which of the following lab findings is most important for the nurse to
report to the PCP

A. WBC of 4.9mm

B. hematocrit level of 44%

C. BUN of 26mg/dl

D. creatinine level of 0.9mg/dl

30. The nurse has instructed a client who is scheduled to have a cardiac catheterization. Which of the
following client statements would indicate a correct understanding of the teaching
 A. I will need to fast for 8hrs before this test

B. I will need to drink radiopaque dye 1hr before this test

C. this test is performed to help detect problems with my heart valves and chambers

D. this test will help determine how much plaque has developed in my coronary arteries

31. The nurse has been made aware of the following client situation. The nurse should initially plan to
assess the client

A. has infective endocarditis with clinical manifestations of splinter hemorrhages and petechia

B. had CABG surgery 24 hrs ago and has developed distant muffled heart sounds

C. is diagnosed with AKI and is scheduled to receive an NSAID

D. has CKD and is reporting a metallic taste in their mouth

32. The nurse is assessing a client who has a suspected aortic dissection. Which of the following findings
should the nurse anticipate the client to have

A. hemorrhagic splinters in the nail beds

B. sharp pain in the anterior chest

C. respirations of 8

D. pounding peripheral pulses

E. a right sternal border heart murmur

33. The nurse is caring for assigned clients. It would be priority for the nurse to follow up with the PCP of
a client who

A. has a prosthetic valve and has an INR level of 3.0

B. had an MI 4 days ago and is anxious about the planned discharge

C. has pericarditis and is reporting a sharp, stabbing chest pain

D. has a suspected thoracic aortic aneurysm and is reporting the development of back pain

34. The nurse is assessing a client who has developed cardiac tamponade. Which of the following
findings should the nurse expect to observe

A. bibasilar crackles

B. sinus tachycardia

C. a bp of 190/90mmhg

D. jugular venous distention with clear lung sounds

35. The nurse has been made aware of the following client situations. The nurse should initially assess
the client who

A. has HF and is receiving a continuous infusion of NS and the IV pump is infusing at rate of
250ml/hr

B. has AF and has been receiving prescribed digoxin for 2 days and has a subtherapeutic digitalis
level

C. has cirrhosis of the liver with jaundice and reports not having had a BM in 3 days

D. has CKD and is eating food brought in by a family member that is high in potassium

36. The nurse is caring for a client who was recently diagnosed with pericarditis. It would require follow
up by the nurse if

A. UAP reported the client is sitting upright in the bed leaning forward to help relieve the chest
pain

B. nurse assessment of the client reveals muffled heart sound sand reported fatigue by the client

C. PCP prescribes an NSAID to relieve the clients chest pain

D. nurse assessment of the client revealed a pericardial friction rub heard on auscultation

37. The nurse working in the med surg unit is caring for a client who reports a racing heart and feeling
anxious. The client is placed on a heart monitor and displays a heart rhythm indicated below. Which of
the following findings should the nurse correlate to this assignment

A. the client just had a bowel movement

B. the client has a low magnesium level

C. the client has a history of Lyme disease

D. the client takes a daily dose of levothyroxine

38. The nurse is caring for a client who reports dizziness and has a bp of 80/49mmhg and has a cardiac
rhythm indicated below. Which of the following actions should the nurse take

A. administer prescribed adenosine

B. prepare the client for synchronized cardioversion

C. place the client with the HOB lower than the foot of the bed

D. administer prescribed nitroprusside sodium at a rate of 0.3mcg/kg/min

39. The nurse came for a client who develops the following dysrhythmia. The nurse should assess which
of the following manifestations in the client

A. htn

B. irregular apical pulse

 C. bounding peripheral pulses

D. headache

40. The nurse is caring for a client who develops the cardiac rhythm indicated below. Which of the
following actions should the nurse take

A. ask the client if their experiencing palpitations

B. replace the clients EKG leads

C. prepare the client for cardiovert

D. prepare to administer prescribed amiodarone

41. The nurse is caring for a client who has received a prescription to administer a continuous infusion of
lidocaine 2g/5ml D5W at a rate of 3mg/min the client weighs 175lbs. At what rate should the nurse set
the clients infusion rate

A. 80ml/hr

B. 3ml/hr

C. 45ml/hr

D. 30ml/hr

42. The nurse has provided discharge teaching to a client following the insertion of a permanent
pacemaker to the left chest area. Which of the following client statements would indicate a correct
understanding of the teaching

A. I will avoid cooking with a microwave oven or around any that are being used

B. I will not lift my left arm very high until after I follow up with my doctor

C. It will only be one month before I can take a bath or return to my usual activities

D. I will notify the airline when I make flight reservations that I have a pacemaker

43. The nurse has provided discharge teaching to a client who had a mitral valve replacement with a
mechanical prosthetic valve. Which of the following statements by the client would indicate a correct
understanding of the teaching

A. I will stop taking my warfarin 2 full weeks before I have my invasive surgery

B. I should avoid having invasive dental work performed for 6 months

C. I will need to have an MRI of my heart in 6 months

D. I should increase my intake of foods high in Vit K

E. I will be able to return to my weight lifting routine after 6 wks

44. The nurse is providing discharge instructions to a client who had a mitral valve replaced with a
biologic porcine valve. Which of the following client statements indicates a need for further teaching
 A. I will need to have the valve replaced every 7 to 10yrs

B. I will keep my arm in a sling for 2 wks while the incision heals

C. I should avoid heavy physical activity involving my upper extremity for the next 3-6 months

D. It will not be necessary for me to take blood thinners for the rest of my life

45. The nurse has developed a teaching plan for a client who has dilated cardiomyopathy. Which of the
following client statements indicates a need for further teaching

A. I will need to take a lipid lowering agent to help control my symptoms

B. I should report any feelings of dizziness to my doctor

C. I will need to take diuretic therapy for the rest of my life

D. I may need to have a heart transplant if my condition becomes severe

46. The nurse is caring for the following clients. It would be necessary to schedule an interdisciplinary
conference for the client who is

A. 42yrs old, is single with 2 teenage children, works as a cashier, and has dilated
cardiomyopathy

B. 57yrs old, is married, works as accountant, and is being discharged home to an apartment
following CABG surgery

C. 65yrs old, lives with a partner, is retired, and was recently diagnosed with an AAA that is being
medically managed

D. 73yrs old, lives with an adult child and grandchildren, and is scheduled to have a mitral

47.The nurse is caring for a client who has right sided HF and is receiving hemodynamic monitoring
which reveals an elevated CVP reading. Which of the following assessments is consistent with this finding

A. pink, frothy, sputum

B. jugular venous distention

C. weak peripheral pulses

D. bibasilar crackles in the lungs

48. The nurse is assessing the following assigned clients. The nurse should immediately notify the PCP
about the client who

A. has hepatic encephalopathy with slow, slurred speech

B. has chronic pancreatitis with steatorrhea and dark colored urine

C. has infective endocarditis and auscultation of a heart murmur that has increased in intensity

D. had an MI 4 hrs ago and has an increase in their current troponin level
49. The nurse is reviewing prescriptions for assigned clients. It requires follow up with PCP if a client

A. has a AAA and is prescribed metoprolol 25mg po daily

B. is newly admitted with an MI and is prescribed a loading dose of clopidogrel

C. has CAD and has been prescribed isosorbide mononitrate 60mg po

D. is newly diagnosed with infective endocarditis and has been prescribed an anticoagulant

50. The nurse is caring for a client who has infective endocarditis. Which of the following findings
indicates the client is having a complication associated with this disease

A. an EKG with a ST elevation

B. a persistent elevated temperature

C. the development of HF

D. gnawing pain radiating to the back

51. The nurse working in the ED is caring for a client who was admitted 30 min ago with substernal chest
discomfort, nausea, and diaphoresis. Which of the following findings would be consistent with a
diagnosis of an MI

A. an ECG revealing ST elevation

B. a bp of 180/110mmhg

C. an elevated LDL level

D. muffled heart sounds

52. The nurse is caring for a client who was admitted from the ED with chest pain. In the ED the client
received sublingual nitro with relief of the chest pain, a 12 lead ECG, and ABG. Which of the following
should the nurse anticipate the PCP will prescribe

A. cardiac catheterization

B. echocardiogram

C. transesophageal echocardiogram

D. CT of the chest

53. The nurse is caring for a client who has cirrhosis and is having a paracentesis performed. Which of
the following should the nurse take following the procedure

A. instruct the client to empty their bladder

B. position the client prone for one hr

C. place an adhesive bandage to the paracentesis site

D. initiate NS IV fluids
54. The nurse is caring for a client who has nephrotic syndrome with severe proteinuria. Which of the
following actions is appropriate for the nurse to take

A. administering lisinopril

B. withholding diuretic medications

C. [providing an NS bolus

D. obtaining a narcotic prescription for flank pain