NURSING DEPARTMENT

INSTRUCTOR: KERWIN RICO L. REYES

NCM 112 (CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS,
INFLAMMATORY AND IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS, ACUTE AND CHRONIC)

INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC DISEASES

PREFINAL EXAMINATION
GENERAL INSTRUCTIONS:
Shade your answers on the answer sheet.
Use Black/Blue-inked colored pen.
Write in BOLD LETTERS your last name first followed by your given name in the space provided.
Strictly no erasures, alterations and superimpositions.(DEDUCTION OF 20 PTS ON YOUR RAW SCORE)
Writing on the questionnaire is allowed.
Answer sheets should be clean, tidy, and wrinkled-free as much as possible.
Read and comprehend each test questions.
If you are caught cheating, the proctor will confiscate your paper and disciplinary action will take place.

INSTRUCTIONS:
SELECT THE BEST ANSWER
1. During the hospital stay, the massive, hefty, and older patient with the stroke develops an infected
decubitus on the sacrum. About two weeks after going home, the patient returns to the hospital with
pneumonia. Which of the following distinguishes these two infections from one another?
A. The decubitus infection was transmitted from other patients on the unit, but the pneumonia was
transmitted from a neighbor visiting when the patient was at home.
B. The decubitus and pneumonia are caused by the same host.
C. The decubitus is termed nosocomial and the pneumonia is termed community-acquired.
D. The decubitus is considered to be caused by protozoa, whereas the pneumonia is termed
unpreventable because of the size of the patient.

2. The laboratory test results for four patients are reviewed by the home health nurse. Which laboratory
results should the nurse emphasize to the healthcare provider?
A. Client clostridium difficile infection receiving metronidazole has a white blood cell count of 15,000/mm 3
B. Client with liver cirrhosis has an international ratio of 1.5
C. Client with mild asthma exacerbation receiving prednisone has a blood glucose of 250 mg/dL
D. Client with rheumatoid arthritis taking adalimumab has a white blood cell count of 14.000/mm 3

3. An overweight 85-year-old patient is admitted to the hospital with pneumonia after suffering from an
upper respiratory infection for a week. The patient is an avid gardener and exclusively consumes
homegrown fruits, legumes, and vegetables. Which element increases the client's risk of having
pneumonia?
A. Advanced age
B. Environmental exposure
C. Nutritional deficit
D. Obesity

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4. A homeless patient receiving nursing care is moderately underweight and has pneumonia. For the
delivery of fluids, the client requires a peripheral IV line. Which IV location should the nurse choose to
lower the chance of infection?
A. Antecubital fossa
B. Dorsal surface of hand
C. Dorsum of foot
D. Lateral of wrist

5. A tracheostomy patient is conscious, oriented, and able to tolerate oral intake. Which course of action
is best for lowering the client's risk of aspiration pneumonia?
A. Fully inflate the cuff before feeding
B. Have the client sit in an upright position with the neck hyperextended
C. Partially or fully deflated the cuff
D. Provide a modified diet of pureed foods

6. Michael is an older client with dysphagia learns some measures from the home health nurse to reduce
the number of times they must be admitted to the hospital for aspiration pneumonia. Which of the
following is a sign that the client needs more instruction?
A. I have to remember to rise my chin slightly upward when I swallow
B. I have to remember to swallow 2 times before taking another bite of food
C. I should avoid taking over the counter cold medications when I’m sick
D. I should sit upright for at least 30-40 minutes after I eat

7. Nurse Carie is giving the incoming nurse a hand-off-of-care report for a client who was admitted with
pneumonia that morning. Which details about the client should the nurse emphasize during the handoff
report?
A. Chest x-ray showed lung infiltrates; WBC count is 14,000/mm 3
B. Client’s spouse was acting rudely toward the nurse earlier
C. Current respirations are 24/min; pulse oximetry is 92% on 2 L/min
D. Intravenous line is infusing with no signs of infiltration

8. An 80-year-old client has been hospitalized with pneumonia and malnutrition. Physical assessment
findings include weakness and decreased muscle mass. Which finding best indicates that the client is
responding to treatment?
A. Client consuming 90% of each meal
B. Serum albumin of 3.6 g/dL
C. Weight gain of 2 lb in 2 weeks
D. White blood cell count of 15,000/ mm3

9. The nurse reviews the most current laboratory results for assigned clients. Which finding is the highest
priority for the nurse to report to the health care provider?
A. CD4 cell count of 500/mm3 in a client with oral candidiasis and HIV who is receiving fluconazole orally
B. Hemoglobin A1C of 7.3 % in a client with community acquired pneumonia and type 2 diabetes who is
receiving IV levofloxacin
C. Platelet count of 148,000/mm3 in a client with a venous thrombosis who is receiving a continuous
heparin infusion
D. Serum glucose of 68 mg/dl in a client with radiation enteritis who is receiving total parenteral nutrition

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10. The nurse is caring for a client who has been receiving mechanical ventilator for 4 days. During
multidisciplinary morning rounds, the health care provider questions the development of a ventilator
associated pneumonia. Which of the following manifestations does the nurse assess as the best
indicator of VAP?
A. Blood tinged sputum
B. Positive blood cultures
C. Positive purulent sputum culture
D. Rhonchi and crackles

11. An 86-year-old client with diabetes and gastroparesis has had repeated hospitalizations for aspiration
pneumonia following a stroke and is now hospitalized with altered level of consciousness. Which nursing
action is most appropriate to decrease the client’s risk for developing aspiration pneumonia?
A. Assessing client’s breath sounds every 2 hours
B. Placing client in the side lying position in bed
C. Titrating client’s oxygen to maintain saturation >93%
D. Turning and repositioning the client every 2 hours

12. The nurse assesses these symptoms in a client with bacterial pneumonia; chills, elevated temperature,
tachypnea, productive cough of yellow sputum, shortness of breath, and fatigue. Based on the
assessment data, what is the most appropriate nursing diagnosis for this client?
A. Impaired gas exchange
B. Impaired spontaneous ventilation
C. Ineffective breathing pattern
D. Risk for infection

13. A client type 2 diabetes, coronary artery disease and peripheral arterial disease developed hospital-
acquired pneumonia and has been receiving intravenous antibiotics for 4 days. Which parameter
monitored by the nurse best indicates the effectiveness of treatment?
A. Color of sputum
B. Lung sounds
C. Saturation level
D. White blood cell count

14. A client diagnosed with septic shock has an upward trending glucose level (180-225 mg/dL) requiring
control with insulin. The client’s spouse asks why insulin is needed as the client is not a diabetic. What is
the most appropriate response by the nurse?
A. It is common for critically ill clients to develop type II diabetes. We give insulin to keep the glucose level
under control <140 mg/dL
B. The client was diabetic before, but you just didn’t know it. We give insulin to keep the glucose level in
the normal range 70-110 mg/dL
C. The increase in glucose is a normal response to stress by the body. We give insulin to keep the level at
140-180 mg/dL
D. This increase is common in critically ill clients and affect their ability to fight off injection. We give insulin
to keep the glucose level in the normal range (70-110 mg/dL)

15. The charge nurse is evaluating the skills of a new registered nurse assigned to care for a client with
shock. Which action taken by the new RN indicates a need for further education?
A. Administer furosemide to a client with pulmonary artery wedge pressure of 24 mmHg with cardiogenic
shock
B. Increases norepinephrine infusion rate to maintain mean arterial pressure > 65 mmHg in a client with
anaphylactic shock
C. Moves pulse oximeter sensor from the finger to the forehead of a client with septic shock

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D. Places the head of the bed for a client with hypovolemic shock in high Fowler’s position

16. A patient who is receiving daily steroids for control of a condition calls the nurse to ask advice about
whether a small child who has been exposed to influenza should come and visit because she has not
had any symptoms. Which of the following responses is appropriate statement by the office nurse?
A. “Yes, let the child visit. There is no reason not to visit, because this child is not sick.”
B. “No, the child should not visit. Infectious diseases are often most communicable in the short period
before the child actually becomes ill.”
C. “It would be up to the patient. Plan not to get overtired with a small child running and bouncing
around.”
D. “Take the child who is not sick to her own doctor and ask this question first.”

17. Several 12-month-old infants are brought to the clinic for routine immunizations. Which situation would
be most important for the nurse to clarify with the provider administering the vaccination?
A. Haemophilus influenza type b vaccine for client allergic to penicillin
B. Hepatitia A vaccine for a client with a cold and temperature of 99.0 F
C. Pneumococcal vaccine for client with local swelling after last immunization
D. Varicella-zoster vaccine for client recently diagnosed with leukemia

18. The spouse of the immunocompromised client is diagnosed with influenza virus infection. The spouse
asks the office nurse how long contact with the client should be avoided to prevent the infection from
spreading. What is the nurse’s most important appropriate response?
A. “Avoid close contact for about a week.”
B. “It’s impossible to avoid contact with the client. Just wash your hands often.”
C. “You are sick already, and so you are not contagious anymore.”
D. “You don’t have to worry as long as the client has received the influenza vaccination.”

19. Which of the following statements of the nurse points out that the spleen’s primary function in the
immune process?
A. filter microorganisms from the blood.
B. store lymphocytes used to fight infections.
C. produce additional red blood cells.
D. stimulate white blood cell production.

20. Which of the following statement would the nurse best differentiates the antibody of passive acquired
immunity?
A. acquired from outside the host and instilled in the host.
B. manufactured in response to a disease in the host.
C. innately acquired because of being born a human being.
D. cell-mediated inside the host.

21. Which of the following statement would the nurse best differentiates the antibody of active naturally
acquired immunity?
A. acquired from outside the host and instilled in the host.
B. manufactured in response to a disease in the host.
C. innately acquired because of being born a human being.
D. cell-mediated inside the host.

22. The patient is hospitalized with cryptococcal pneumonia and AIDS. The nurse knows that the Standard
Precautions for this patient will include the most important precaution. Which of the following is correct?
A. Hands are washed before and after gloving.
B. Once gloves are put on, they do not need to be changed until care is finished.

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C. Needles and sharps should be placed in puncture-resistant containers on the medicine cart out of the
room.
D. Mouth-to-mouth resuscitation must be performed immediately unless the patient is a “No Code.”

23. The nurse caring for an immunosuppressed patient is diligent about protecting the patient from
infection. When visitors come in, in addition to having them put on isolation garb, which of the following
things would the nurse prohibit?
A. a battery-operated DVD player
B. books
C. fresh fruits
D. boxed candy

24. The home health nurse is teaching the family that the most effective method to control the spread of
communicable disease is which of the following?
A. Isolate the infected person from all contact with non-infected persons
B. Vigorously petition the community health department to increase spraying
C. Administer prophylactic antibiotics to the rest of the family
D. Demonstrate and monitor a return demonstration of good hand washing technique by the family.

25. When a mosquito or a fly carries an organism that infects another living organism, this mode of
transmission is infection via:
A. a common vehicle
B. direct excretion
C. ingestion
D. a vector

26. The nurse explains that with the exposure to an antigen, the initiator of the inflammatory response is the
presence of histamine, which is released by the:
A. neutrophils
B. eosinophils
C. basophils
D. monocytes

27. The nurse explains that medication being given to a client with a severe inflammatory response mimics
a hormone secreted by the adrenal cortex. This hormone is:
A. aldosterone
B. testosterone
C. histamine
D. cortisol

28. The nurse is discussing the body’s first and second lines of defense against infection with a community
group. The first line of defense includes which of the following?
A. Teeth
B. Sweat
C. White blood cells
D. T lymphocytes

29. The patient in early labor says to the nurse: “I will pass on protection from diseases and the baby will not
ever need any shots.” Which of the following response by the nurse is the best?
A. “Babies are born with innate (natural) immunity at birth.”

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B. “Babies are born with IgE, an antibody that crosses the placenta, but it only protects the baby briefly.”
C. “Yes, immediate antibody immunity from the mother is the first line of defense against disease for
babies.”
D. “Yes, the mother passes on cell-mediated immunity.”

30. The graduate nurse receives report on a postpartum client with an Rh-negative blood type. Which
statement by the GN regarding the Rh immune globulin injection requires the preceptor to provide
further teaching?
A. Additional dose of Rh immune globulin may be required if excessive fetomaternal hemorrhage is
suspected.
B. I should administer Rh immune globulin to the client within 72 hours after birth
C. If the maternal antibody screen is negative, I will hold immune globulin and contact the health care
provider
D. Rh immune globulin is not required of the newborn’s blood type is negative

31. The nurse on the medical unit finishes receiving the change of shift hand-off report at 7:30 AM. Which
assigned client should the nurse see first?
A. Client with a gastrointestinal bleed, who is receiving a unit of packed red blood cells
B. Client with an ulcerative colitis flare up has temperature of 101 F (38.3 C) and abdominal cramping
C. Client with atrial fibrillation, on telemetry, prescribed warfarin, with International Normalized Ratio of 3.2
D. Client with chronic kidney disease scheduled for bedside hemodialysis at 8:00 AM, with a serum
creatinine of 8.4 mg/dL

32. The nurse cares for a client with type I diabetes. Which action, by the nurse. Best assesses the chronic
complication of autonomic neuropathy?
A. Assess how far the client can walk
B. Check sensation in finger and toes
C. Inspect extremities for diabetic ulcers
D. Take the blood pressure sitting and standing

33. A client is seen in the clinic for the third time for a nonhealing, infected diabetic foot ulcer. The client is
able to verbalize the correct procedure for wound care but reports not adhering to the ordered routine
at home. What intervention does the nurse prioritize to promote proper self-care?
A. Assess the client’s feeling about placement at a skilled nursing facility for care
B. Educate the client on the risks of tissue death if not properly cared for at home
C. Explore the client’s abilities and motivating to perform care at home
D. Provide the client with the supplies needed to change dressings as recommended

34. A nurse on the telemetry unit receives a client admitted from the emergency department with acute
alcohol intoxication, confusion and a diabetic toe ulcer. Which intervention would be the priority?
A. Assess for signs of alcohol withdrawal
B. Assess the need for alcohol rehabilitation referral
C. Let the client sleep of the alcohol intoxication
D. Monitor blood glucose levels during the night

35. A client is seen in the clinic for the third time for a nonhealing, infected diabetic foot ulcer. The client is
able to verbalize the correct procedure for wound care but reports not adhering to the ordered routine
at home. What intervention does the nurse prioritize to promote proper self-care?
A. Assess the client’s feeling about placement at a skilled nursing facility for care
B. Educate the client on the risks of tissue death if not properly cared for at home
C. Explore the client’s abilities and motivating to perform care at home

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D. Provide the client with the supplies needed to change dressings as recommended

36. When no changes are made to the diet or prescribed insulin, which client with type 1 diabetes mellitus
does the nurse anticipate having the highest risk of developing hypoglycemia?
A. 29-year-old with new onset of influenza
B. 40-year-old experienced cyclist who rides an extra 10 miles
C. 65-year-old with cellulitis of the right leg
D. 72-year-old with emphysema who is taking prednisone

37. The emergency department nurse receives report on clients. Which client will the nurse prioritize for
placement in an isolation room?
A. 4-yer-old diagnosed with scabies who has red burrows and bumps along the neckline and inner elbows
B. 7-year-old diagnosed with measles who has a fever, conjunctivitis, cough and maculopapular rash
C. 12-year-old with a positive rapid influenza test who has a fever, cough and runny nose
D. 14-year-old with 4-inch wound on the inner aspect of thigh with a positive culture for methicillin-resistant
staphylococcus

38. The nurse is preparing a patient for a liver-spleen scan. Which of the following interventions is most
important before the procedure?
A. Prepare the biopsy site with a clean field.
B. Check for any allergies to contrast media.
C. Explain the procedure to the patient’s family.
D. Have the patient eat a complete regular diet.

39. The nurse receives the following information in the hand-off report. Which client should the nurse assess
first?
A. Client with a paralytic ileus following a colon resection who has abdominal distension, no audible bowel
sounds and nausea
B. Client with alcoholic cirrhosis who has coffee ground nasogastric drainage, blood pressure of 90/60
mmHg, and pulse of 110/min
C. Client with bacterial peritonitis following surgery for a ruptured appendix who is receiving IV tobramycin
and has a temperature of 101 F (38.3 C)
D. Client with dysphagia and a sore throat who has a nasogastric tube to administer contrast media for an
abdominal CT scan

40. The nurse is reviewing new prescription from the health care provider. Which prescription would require
further clarification?
A. Atorvastatin for hyperlipidemia in a client with angina pectoris
B. Bupropion for smoking cessation in a client with emphysema
C. Cyclobenzaprine for muscle spasms in client with hepatitis
D. Metronidazole for trichomoniasis in a client with Crohn disease

41. A student is preparing to administer the hepatitis B vaccine to a newborn. Which statement by the
student nurse requires the perception to provide further teaching?
A. A 1/2 inch 25-gauge needle is appropriate for intramuscular injection in newborns
B. I will clean the injection site with an antiseptic swab before administration
C. I will draw the medication into 1-mL syringe
D. The medication should be administered into the deltoid muscle

42. The nurse is caring for a client with end stage liver failure from hepatitis C who is being seen in the clinic
for worsening ascites. The client is treated in the infusion center with intravenous albumin, IV furosemide,
and oral spironolactone. The following day the nurse checks the client’s labs. Which of the following lab
findings is most important for the nurse to communicate to the health care provider?

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A. Albumin 2.5 g/dL
B. INR 1.4
C. Potassium 3.0 mEq/L
D. Sodium 131 mEq/L

43. The nurse is caring for a client diagnosed with Guillain-Barre syndrome after a recent gastrointestinal
illness. Monitoring for which of the following is a nursing care priority for this client?
A. Diaphoresis with facial flushing
B. Hypoactive or absent bowel sounds
C. Inability to cough of lift the head
D. Warm tender and swollen leg

44. When developing a plan of care for the patient with human immunodeficiency virus (HIV), which of the
following would the nurse includes?
A. careful aseptic technique to prevent infection
B. limiting fluids to prevent congestive heart failure
C. oral alcohol rinses to control mouth infections
D. selections of high-fat foods in the daily diet

45. Which client is at the greatest risk for development of hospital-acquired pressure injuries?
A. 25-year-old client with quadriplegia, urosepsis, temperature of 101 F (38.3 C) and white blood cell count
of 18,000/mm3
B. 50-year-old client with AIDS who is receiving norepinephrine infusion and has a weight loss of 20 lb in a
month, prealbumin level <10 mg/dL and mean arterial pressure of 50 mmHg
C. 80-year-old client 2 days post hip replacement with dementia, 2 Jackson-Pratt drains, and hemoglobin
level of 14 g/dL
D. 87-year-old client 2 days post open cholecystectomy

46. A client with AIDS treated for intractable seizures is transferred from the intensive care unit to the
medical unit. There are 4 semiprivate room beds available. Which room assignment does he charge
nurse as the best option for this client?
A. Room 1- client with clostridium difficile
B. Room 2- client with fever of unknown origin
C. Room 3- client with bacterial pneumonia
D. Room 4- client with upper gastrointestinal bleed

47. A 14-year-old is seen in the sexually transmitted disease outpatient department and diagnosed with
gonorrhea. The client tells the nurse of having sexual relations with only a 19-yer-old partner. What is the
best response by the nurse?
A. Has your partner been evaluated and treated by a health care provider?
B. I have to report your situation to local law enforcement
C. One of your parents will need to consent to your treatment
D. You should use condom when you have sex

48. The nurse reinforces teaching to a client with HIV during a follow up clinic visit after being on
antiretroviral drugs for the past 2 months. Which statement by the client indicates a need for further
instruction?
A. I can stop taking these HIV drugs once my viral levels are undetectable
B. I need to get tested regularly for sexually transmitted infection because I’m sexually active
C. I should use latex condoms and barrier when having anal, vaginal, or oral sex
D. I won’t stop injecting drugs, but I will use a needle exchange program

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49. The nurse is documenting assessment of pregnant clients in the antepartum unit. Which client’s
assessment findings are most important to report to the health care provider?
A. Client at 28 weeks gestation with an asymptomatic systolic murmur
B. Client at 34 weeks gestation with 1+ edema of bilateral lower extremities
C. Client at 35 weeks gestation with painful genital lesions
D. Client at 39 weeks gestation with brownish, mucoid vaginal discharge

50. The nurse is teaching self-care management to a client experiencing an outbreak of genital herpes.
Which statement by the client indicates a need for further teaching?
A. I will be sure we use condoms during intercourse as long as I have lesions
B. I will not touch the lesions to prevent spreading the virus to other parts of my body
C. I will use a hair dryer on a cool setting to dry the lesions after taking a shower
D. I will use warm running and mild soap without perfumes to wash the area

51. The health care provider has prescribed amitriptyline 25 mg orally every morning for an elderly client
with recent herpes zoster infection (shingles) and severe post-herpetic neuralgia. What is the priority
nursing action?
A. Encourage increased fluid intake
B. Provide frequent rest periods
C. Teach the client to get up slowly from the bed or a sitting position
D. Tell the client to wear sunglasses when outdoors

52. The nurse plans discharge teaching for a client with active herpes lesions who has a new prescription for
oral acyclovir and topical lidocaine. What information will the nurse include in the teaching plan?
A. Adhesive bandaging should remain on the lesions to prevent virus shedding
B. Blood tests will be drawn to ensure the virus is eradicated
C. Condoms should be used during intercourse until the lesions are healed
D. Gloves should be used to apply the medication to the lesions

53. The nurse is verifying the medical history of a client who is scheduled for a labor induction. Which client
statement should prompt the nurse to request further evaluation for a primary cesarean birth from the
health care provider?
A. “A vacuum was used to help deliver my last baby because the baby’s heart rate was dropping.”
B. “I have an atrial septal defect that has never given me any problems and I plan to receive and
epidural during labor.”
C. “I lost my acyclovir prescription and I’ve noticed lesions on my labia that are stinging and burning.”
D. “I took enoxaparin during this pregnancy due to a history of blood clots and my last dose was
yesterday.”

54. The graduate nurse is caring for a client at 20 weeks’ gestation with secondary syphilis. The client reports
an allergic reaction to penicillin as a child but does not know what kind of reaction occurred. When
discussing the client’s potential treatment plan with the precepting nurse, which statement by the GN
indicates an appropriate understanding?
A. Doxycycline is an acceptable alternative to penicillin for treatment of syphilis during pregnancy
B. The client will require penicillin desensitization to receive appropriate treatment
C. The newborn can be treated after birth if antepartum treatment is contraindicated
D. Treatment is only effective if provided during the primary stage of syphilis

55. The nurse is providing education to a 32-year-old female client diagnosed with human papillomavirus.
Which client statement indicates a need for further instruction?
A. I can transmit the virus when I don’t have symptoms
B. I know the virus can be spread through oral sex
C. I need to have a Papanicolaou test on an annual basis
D. My partner won’t get HPV as long as we use a condom

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56. The nurse reinforces teaching to a client with HIV during a follow up clinic visit after being on
antiretroviral drugs for the past 2 months. Which statement by the client indicates a need for further
instruction?
A. I can stop taking these HIV drugs once my viral levels are undetectable
B. I need to get tested regularly for sexually transmitted infection because I’m sexually active
C. I should use latex condoms and barrier when having anal, vaginal, or oral sex
D. I won’t stop injecting drugs, but I will use a needle exchange program

57. The nurse accidentally sticks him/herself in the finger with a client’s contaminated needle. The client has
HIV infection. Place order the steps the nurse should take. All options must be used.
1. Notify the nurse’s supervisor
2. Go to employee health clinic
3. Take post-exposure prophylaxis
4. Wash area with soap and water
5. Remove gloves

A. 54123
B. 12345
C. 25341
D. 54321

58. A client at 32 weeks gestation has been diagnosed with syphilis. The client expresses to the nurse her
belief that antibiotic therapy is harmful and refuses treatment. What is the nurse’s appropriate response
at this time?
A. Educate the client about potential fetal harm or death if antibiotics are refused
B. Explain that the fetus’s right to receive appropriate treatment is prioritized during pregnancy
C. Express respect for the client’s belief and discuss natural treatment alternatives
D. Inform the client about the symptoms of a Jarisch-herxheimer reaction, which may potentially occur
after treatment

59. The nurse receives report on 4-trimester pregnant clients. Which client should the nurse assess first?
A. Client with hydatidiform mole reporting dark brown vaginal discharge
B. Client with hyperemesis gravidarum reporting excessive vomiting and weight loss
C. Client with suspected ectopic pregnancy reporting abdominal and shoulder pain
D. Client with threatened miscarriage who says, I am a Jehovah’s Witness

60. The nurse explains that the inflammatory response is initiated by immunoglobulin (IgE) and the:
A. macrophages and eosinophils
B. macrophage and histamine
C. monocytes and basophils
D. neutrophils and IgE

61. The school nurse starts a clean-up campaign at a local elementary school in an effort to combat some
of the allergens. Which of the following is one of the most common allergic response disorders?
A. anaphylaxis.
B. asthma
C. contact dermatitis
D. urticaria

62. A client with asthma was recently prescribed fluticasone/salmeterol. After the client has received
instructions about this medication, which statement would require further teaching by the nurse?
A. After taking this medication, I will rinse my mouth with water

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B. At the first sign of an asthma attack, I will take this medication
C. I have been smoking for 12 years, but I just quit a month ago
D. I received the pneumococcal vaccine about a month ago

63. The nurse receives news of a local mass shooting. State clients need to be discharged to make room for
newly admitted clients. Which client would the nurse identify as safe to recommend for discharge?
A. Client on chemotherapy who started antibiotics today for cellulitis of the leg
B. Client with asthma exacerbation who has not required oxygen or a nebulizer in 12 hours
C. Client with diabetes who has nausea, abdominal pain and vomiting
D. Client with ulcerative colitis and diarrhea who has developed fever and vomiting

64. The nurse is assessing 4 clients in the emergency department. Which client should the nurse prioritize for
care?
A. Client with liver cirrhosis and ascites who has increasing abdominal distension and needs therapeutic
parenthesis
B. Client with new-onset ascites from a suspected ovarian mass who needs paracentesis for diagnostic
studies
C. Client with ulcerative colitis who has fever, bloody diarrhea, and abdominal distension and needs an
abdominal x-ray
D. Nursing home client with dementia who has stool impaction and abdominal distension and needs stool
disimpaction

65. The registered nurse is developing a nursing care plan for a client who has just undergone surgery for
treatment of ulcerative colitis with the creation of permanent ileostomy. What is the priority outcome for
this client?
A. The client will contact the united Ostomy association of America
B. The client will look at and touch the stoma
C. The client will read the materials provided on ostomy care
D. The client will verbalize methods to control gas and odor

66. The nurse is caring for a client who had surgery yesterday. When administering omeprazole, the client
asks What is that for? I don’t take it at home. Which reply by the nurse is most appropriate?
A. Omeprazole helps prevent by making your stomach empty faster
B. Omeprazole helps prevent from developing an ulcer due to the stress of surgery
C. Omeprazole protects you from getting an infection while on antibiotics
D. This medication will treat your gastroesophageal reflux disease (GERD)

67. The nurse reinforce teaching to a female client about taking misoprostol to prevent stomach ulcers.
Which statement by the client would prompt further instruction?
A. “I can take this medication with food if it hurts my stomach.”
B. “I should use a reliable form of birth control while taking this medication.”
C. “I should continue to take my ibuprofen as prescribed.”
D. “I will take this medicine with an antacid to decrease stomach upset.”

68. The nurse is preparing medications for the following 4 clients. Which prescription should the nurse clarify
with the health care provider before administration?
A. Acetaminophen for a client with a temperature of 102.2 F with productive cough
B. Azathioprine for a client with Crohn disease with leukopenia who is reporting malaise
C. Baclofen for a client with multiple sclerosis who reports dizziness when changing positions
D. Colchicine for a client with an acute gout attack who reports intense, burning left toe pain

69. The nurse assesses a client with suspected appendicitis and anticipates the client reporting pain in
which anatomical area?

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A. Left flank radiating to the left groin area
B. Left upper quadrant radiating to the back
C. Periumbilical area shifting to the right lower quadrant
D. Right upper quadrant radiating to the right shoulder

70. The nurse receives new prescription for a client with right lower quadrant pain and suspected acute
appendicitis. Which prescription would the nurse implement first?
A. Administer 0.25 mg hydromorphone IV push for pain
B. Draw blood for complete blood count and electrolyte levels
C. Initiate IV access and infuse normal saline 100 mL/hr
D. Obtain urine specimen for urinalysis

71. A graduate nurse is caring for a client with acute appendicitis who is awaiting surgery. Which action by
the GN would require the precepting nurse to intervene?
A. Administers morphine IV PRN for pain
B. Initiates continuous normal saline IV
C. Provides a heating pad for abdominal discomfort
D. Teaches client about prescribed strict NPO status

72. The nurse assessing a client’s pain would expect the client to make which statement when describing
the abdominal pain associated with appendicitis?
A. My pain is a burning sensation in my upper abdomen
B. My pain is an 8 out of 10 on my left side below my belly button
C. My pain is excruciating in my lower abdomen above my right hip
D. My pain is intermittent in my abdomen and right shoulder

73. The nurse assesses a client with suspected acute pancreatitis and anticipates the client reporting pain in
which anatomical area?
A. Left flank radiating to the left groin area
B. Left upper quadrant radiating to the back
C. Periumbilical area shifting to the right lower quadrant
D. Right upper quadrant radiating to the right shoulder

74. Based on the lung assessment information included in the hand-off report, which client should the nurse
assess first?
A. Client 1-day postoperative abdominal surgery who has fine inspiratory crackles at the lung bases
B. Client with chronic bronchitis who has rhonchi in the anterior and posterior chest
C. Client with right-sided pleural effusion who has decreased breath sounds at the right lung base
D. Client with severe acute pancreatitis who has inspiratory crackles at the lung bases

75. A client is admitted with severe acute pancreatitis. While obtaining the client’s blood pressure, the nurse
notices a carpal spasm. What laboratory result would the nurse assess in response to this symptom?
A. Decreased albumin
B. Elevated troponin
C. Hyperkalemia
D. Hypocalcemia

76. The nurse assesses a client with suspected cholecystitis and anticipates the client reporting pain in
which anatomical area?
A. Left flank radiating to the left groin area
B. Left upper quadrant radiating to the back
C. Periumbilical area shifting to the right lower quadrant

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D. Right upper quadrant radiating to the right shoulder

77. The nurse assesses a client with benign prostatic hyperplasia. Which client statement requires further
assessment?
A. I have burning sensation when I urinate
B. I have been having dribbling after I finish urinating
C. I missed 3 days of finasteride while on a trip last week
D. I was awakened 3 times last night by the need to urinate

78. A client undergoes transurethral resection of the prostate for benign prostatic hyperplasia. The client has
a 3-Foley catheter with continuous bladder irrigation. Which assessment is the best indication that the
bladder irrigation flow rate is productive?
A. Blood pressure 120/80 mmHg, pulse 80/min
B. Client has no bladder spasms
C. Irrigation input 3,000 mL Foley catheter output 3,000 mL
D. Output urine is light pink in color

79. A nurse is preparing an educational presentation on herbal supplements for the local community
center. Saw palmetto is one herbal medicine being discussed. Which advance participation would find
this information beneficial?
A. Client diagnosed with heart failure
B. Clients experiencing major depressive disorder
C. Elderly clients with benign prostatic hyperplasia
D. Peri-menopausal clients experiencing hot flashes
80. A 24-year-old woman is admitted to the hospital for a complete medical examination. Her current
complaints are indicative of systemic lupus erythematosus (SLE). Which of the following symptoms would
indicate this diagnosis?
A. Recent weight gain of 10 pounds
B. Difficulty breathing in the morning
C. Frequent episodes of diarrhea
D. Musculoskeletal pain in the hands

81. In preparing discharge plans for a patient with systemic lupus erythematosus (SLE), it is most important
for the nurse to include:
A. the need to consume 2 L of fluid daily.
B. close monitoring of daily blood glucose.
C. use of daily sunscreens with SPF higher than 15.
D. careful concern for certain food allergies.

82. The nurse reviews the serum laboratory results of a client who was seen in the clinic 2 days ago for
worsening joint pain from a flare of systemic lupus erythematosus. Which result is of greatest concern
and prompts the nurse to notify the health care provider?
A. Creatinine of 1.8 mg/dL
B. Elevated erythrocyte sedimentation rate
C. Positive antinuclear antibody titer
D. White blood cell count of 3600/mm3

83. The clinic nurse performs an admission assessment on a client diagnosed with systemic lupus
erythematosus. Which characteristic cutaneous manifestation of SLE would the nurse most likely assess?
A. Butterfly shape rash

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B. Petechiae
C. Pruritus
D. Urticarial

84. A client is prescribed long term pharmacologic therapy with hydroxychloroquine to treat systemic lupus
erythematosus. Which intervention related to the drug’s adverse effects should the nurse include in the
technique plan?
A. Have an ophthalmologic examination every 6 months
B. Take the medication on an empty stomach
C. Take vitamin D and calcium supplements
D. Wear a Medic Alert bracelet

85. When the skin test shows a redness and swelling a few days after injection, the nurse assesses this as a
hypersensitivity reaction of type:
A. I
B. II
C. III
D. IV

86. The parent asks the nurse to explain which type of drugs will not be used in the medical treatment of
their child’s allergic reaction to bee stings.
A. Antihistamines and salicylates
B. Bronchodilators and corticosteroids
C. Cardiotonics and anticholinergics
D. Diuretics and sedatives

87. A patient has had several increasingly severe allergic reactions during last year’s pollen season. This
year, the patient comes regularly to the office to receive some antigen injections. Which of the
following reasons is the best for the nurse to teach to the patient? The nurse teaches that these will:
A. combat infection brought on by the allergic response.
B. act as a steroid to lessen the allergic response.
C. increase tolerance to the antigen.
D. decrease the production of the antibodies.

88. The patient receiving a large IM dose of antibiotic was asked to please wait 20 to 30 minutes before
checking out. Which of the following statements is the reason for this request?
A. the office staff needs to make sure that it was the right medicine before the patient leaves.
B. the nurse always forgets to ask patients about allergies before administering the antibiotic.
C. antibiotics are a common source of severe allergic reactions within the first few minutes after injection.
D. the staff wants to make sure that the patient has time to pay for the services delivered that day.

89. After receiving an injection of penicillin, the patient undergoes an anaphylactic reaction. The nurse
should immediately:
A. administer oxygen
B. prepare fluids to combat shock
C. notify the charge nurse
D. cover with several blankets

90. A hospitalized patient has been prescribed dexamethasone (Decadron) for an allergic reaction. The
instructions that the patient should be given with the discharge teaching relative to this drug is:

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A. report blurry vision
B. take the medication on an empty stomach
C. do not operate heavy machinery
D. take this medication with meals

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