FINAL COACHING: MEDICAL SURGICAL 2

1. Knowing that gluconeogenesis helps to maintain blood glucose levels, a nurse should:
*
1 point
A. Document weight changes because of fatty acid mobilization.
B. Evaluate the patient’s sensitivity to low room temperatures because of decreased adipose tissue
insulation.
C. Protect the patient from sources of infection because of decreased cellular protein deposits.
D. Do all of the above.
2. An agitated, confused female client arrives in the emergency department. Her history includes
type 1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals pallor,
diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and
the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the
client to treat hypoglycemia by ingesting:
*
1 point
A. 2 to 5 g of a simple carbohydrate.
B. 10 to 15 g of a simple carbohydrate.
C. 18 to 20 g of a simple carbohydrate.
D. 25 to 30 g of a simple carbohydrate.

**
RULE OF 15 FOR HYPOGLYCEMIA:
• 15 GRAMS OF SIMPLE CHO THEN RECHECK AFTER 15 MINUTES

DM TYPE 1 DM TYPE 2

INSULIN DEFICIENCY INSULIN RESISTANCE

→ GENETIC BY NATURE → LIFESTYLE
→ AUTOIMMUNE → ADULT
→ JUVENILE

INSULIN DEPENDENT NON-INSULIN DEPENDENT

→ INSULIN IS REQUIRED! → OHA (METFORMIN)

3P’S: 3P’S:
→ POLYPHAGIA → POLYPHAGIA
→ POLYDIPSIA → POLYDIPSIA
→ POLYURIA → POLYURIA
 PATIENT IS THIN; RAPID ONSET OBESE, EYE PROBLEMS, COMMON
OVER TYPE 1
COMPLICATION: DKA COMPLICATION: HHNKS

DIABETIC KETOACIDOSIS
→ KUSSMAULS (INC DEPTH & RATE OF
RR)
→ INC CO2 REMOVAL (RESPI ALKA)
→ COMMON IN TYPE 1 BUT CAN HAPPEN
IN TYPE 2
→ DEVELOPS FOR 1-2 DAYS
→ GLUCOSE: >250 MG/DL (MGT: INSULIN
WITH POTASSIUM)
HYPERGLYCEMIC HYPEROSMOLAR
NON KETOTIC SUNDROME
→ COMMON IN TYPE 2 BUT CAN HAPPEN
IN TYPE 1
→ HIGHER MORTALITY (DEHYDRATION)
→ DEVELOPS FOR DAYS TO WEEKS'
→ GLUCOSE: >600 MG/DL (MGT: INSULIN
WITH POTASSIUM, FLUIDS FOR
DEHYDRATION)
→ TARGET GLUCOSE: 250 – 300 MG/DL

WITH ACIDOSIS
→ PH: < 7.25
→ HCO3: < 18 NON ACIDOSIS
→ MGT: SODIUM BICARB DRIP – IV → PH: > 7.30
→ HCO3: 15
*METABOLIC ACIDOSIS – CARDIAC
ARREST

TYPES OF INSULIN PEAK EFFECT NOTES

1. RAPID ACTING (LISPRO) 30 MINS – 1 HOUR SEE FOOD INSULIN
2. SHORT ACTING REGULAR
→ REGULAR 2 – 4 HOURS → CLEAR, CAN BE GIVEN
→ HUMULIN R VIA IV
3. INTERMEDIATE ACTING 4 – 12 HOURS
NPH
→ HUMULIN N 6 – 12 HOURS
→ CLOUDY
→ NPH (AVERAGE IS 6 – 8 HRS)
4. LONG ACTING SAFEST
→ GLARGIN NO PEAK EFFECT INSULIN/PANCREATIC
→ LANTUS INSULIN
ROTATE SITES: TO PREVENT LIPODYSTROPHY
(SAGGING SKIN, NUMBNESS, IRRITATION, THICKENING)

COCKTAIL INSULIN

A. INJECT AIR (NR) – NPH (CLOUDY) > REGULAR

B. ASPIRATE INSULIN (RN) – REGULAR (CLEAR) > CLOUDY
 DAWNS PHENOMENON SOMOGYI EFFECT

HYPERGLYCEMIA IN THE MORNING

HYPERGLYCEMIA IN THE MORNING → CAUSE: REBOUNDING
→ CAUSE: PHYSIOLOGIC HYPERGLYCEMIA – HYPOGLYCEMIA AT
→ RELATED TO: DECREASED INSULIN NIGHT
→ RELATED TO: SOBRA ANG INSULIN
MGT: INCREASE INSULIN MGT: DECREASE INSULIN
3 AM CHECK – GLUCOSE IS NORMAL 3 AM CHECK – HYPOGLYCEMIA

3. A female adult client with a history of chronic hyperparathyroidism admits to being non-
compliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk
for injury. To complete the nursing diagnosis statement for this client, which “related-to” phrase
should the nurse add?*
1 point
A. Related to bone demineralization resulting in pathologic fractures.
B. Related to exhaustion secondary to an accelerated metabolic rate.
C. Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces.
D. Related to tetany secondary to a decreased serum calcium level.

**
PARATHYROID – FOR CALCIUM BALANCE
PARATHORMONE – BONE DECALCIFICATION CA FROM THE BONE TO THE BLOOD

HYPERPARATHYROIDISM HYPOPARATHYROIDISM
→ TUMOR RELATED TO →
ACCIDENTAL
REMOVAL POST THYROIDECTOMY –
UNEXPECTED MALPRACTICE!
CONSEQUENCE: HYPERCALCEMIA – CONSEQUENCE: HYPOCALCEMIA –
RISK FOR RENAL STONES CALCOIUM FROM THE MUSCLE
→ INCREASE FLUID INTAKE → TETANY
→ AMBULATION → CHVOSTEK
→ STRAIN URINE → TROSSEAUS (CARPOPEDAL SPASMS)
WEAK BRITTLE BONES (RISK FOR MGT: CALCIUM GLUCONATE (IV), > CA
PATHOLOGIC FRACTURES) DIET WITH VITAMIN D
→ SAFETY
→ PROMOTE NON WEIGHT BEARING *CA GLUCONATE -VESICANR (IRRITATING
EXERCISE (PROMOTES CALCIUM UPTAKE TO THE VEIN – EXTRAVASATION (USE
OF THE BONE) BIGGEN VEINS – MORE BLOOD – BETTER
DILUTION)
MGT: SURGERY, CALCITONIN (CA PRIO: HEART!
FROM BLOOD TO BONE) → CARDIAC MONITOR @ BEDSIDE

WOF: BLEEDING GUMS

→ DO ORAL CARE
4. The nurse is admitting a patient diagnosed with type 2 diabetes mellitus. The nurse should
expect the following symptoms during an assessment, except:
*
1 point
A. Hypoglycemia
B. Frequent bruising
C. Ketonuria
D. Dry mouth

5. Humatrope (somatropin) is being given to a female patient with turner syndrome. Which of
the following findings is associated with this medication?
*
1 point
A. Decreases ALT and AST level
B. Mild hyperglycemia
C. Hypotension
D. Water intoxication = FLUID VOLUME EXCESS → RELATED TO ADH

6. A nurse provides instructions to a client regarding the administration of the prednisone and
instructs the client that the best time to take the medication is during?
*
1 point
A. Before breakfast
B. After breakfast
C. Evening
D. Before bedtime

**
STEROIDS – DECREASES IMMUNE SYSTEM, IS GASTRIC TOXIC, CAUSES INSOMNIA

7. Nurse Joey is assigned to care for a postoperative male client who has diabetes mellitus. During
the assessment interview, the client reports that he’s impotent and says he’s concerned about its
effect on his marriage. In planning this client’s care, the most appropriate intervention would be
to:
*
1 point
A. Encourage the client to ask questions about personal sexuality.
B. Provide time for privacy.
C. Provide support for the spouse or significant other.
D. Suggest referral to a sex counselor or other appropriate professional.

8. During a class on exercise for diabetic clients, a female client asks the nurse educator how
often to exercise. The nurse educator advises the clients to exercise how often to meet the goals
of planned exercise?
*
1 point
A. At least once a week
B. At least three times a week
C. At least five times a week
D. Every day

9. Nurse Oliver should expect a client with hypothyroidism to report which health concerns?
*
1 point
A. Increased appetite and weight loss - HYPERTHYROIDISM
B. Puffiness of the face and hands – HYPOTHYROIDISM → MYXEDEMA COMA
C. Nervousness and tremors - HYPERTHYROIDISM
D. Thyroid gland swelling - HYPERTHYROIDISM

HYPERTHYROIDISM HYPOTHYROIDISM
→ INCREASED METABOLISM → DECREASED METABOLISM

→ ALL INCREASED EXCEPT FOR → ALL INCREASED EXCEPT FOR

WEIGHT & MENS (WEIGHT LOSS AND WEIGHT & MENS (WEIGHT GAIN AND
AMENORRHEA) MENORRHAGIA)
→ INCREASED HR & RR → DECREASED HR & RR
→ HEAT INTOLERANCE → COLD INTOLERANCE
→ DIARRHEA → CONSTIPATION

CAUSE: TUMOR
MGT: THYROIDECTOMY

PRIO: AIRWAY – LARYNGOSPASM –

THYROID STORM
→ HYPERTHERMIA CAUSE: REMOVAL OF THYROID
→ CARDIAC ARREST GLANDS, RADIATION
→ HYPERTENSION
→ HYPOCALCEMIA
→ LARYNGEAL NERVE DAMAGE

WOF: HYPOTHYROIDISM
 MGT:
1. PTU – SE: AGRANULOCYTOSIS
→ BEST FOR PREGNANT PX
→ FOR THYROID STORM

2. METHIMAZOLE/TAPAZOLE - SE: MGT:

AGRANULOCYTOSIS 1. LEVOTHYROXIN
→ MAINTENANCE 2. LIOTHYRONIN

3. LUGOLS – GIVEN BEFORE WOF: HYPERTHYROIDISM SX

THYROIDECTOMY (LESSEN (SPECIALLY HEART!)
BLEEDING) – GIVE WITH ORANGE
JUICE

4. SSKI – GIVE WITH JUICE TO

INCREASE PALATABILITY
COMPLICATION: MYXEDEMA COMA
COMPLICATION: GRAVES DISEASE
→ COARSE FACIAL FEATURES

10. A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25

mcg P.O. daily. Which finding should nurse Hans recognize as an adverse drug effect?
*
1 point
A. Dysuria
B. Leg cramps
C. Tachycardia
D. Blurred vision

11. Glycosylated hemoglobin (HbA1C) test measures the average blood glucose control of an
individual over the previous three months. Which of the following values is considered a
diagnosis of pre-diabetes?
*
1 point
A. 6.5-7%
B. 5.7-6.4%
C. 5-5.6%
D. >5.6%

**
CONFIRMATORY FOR DM – FBS (> 126 MG/DL)

12. A client with diabetes insipidus is taking antidiuretic hormone. Which of the following
symptoms would alert the need to decrease the dosage?
*
1 point
A. Alopecia
B. Jaundice
C. Diarrhea
D. Drowsiness – WATER TOXICITY
**
ADH – DESMOPRESSIN/VASOPRESSIN
DIABETES INSIPIDUS
→ DECREASE ADH
→ INCREASE URINE OUTPUT
→ FLUID VOLUME DEFICIT
S/SX:
→ DIURESIS
→ DILUTED URINE
→ DRY INSIDE
(HYPOVOLEMIA, HYPERNATREMIA)
→ DRINKING A LOT (THIRSTY)
→ DEHYDRATED
→ DECREASED BP
→ DESMOPRESSON/VASOPRESSIN
PRIO: CHECK NASAL PATENCY –
(INTRANASAL ROUTE)
TOXICITY WOF: FLUID VOLUME
EXCESS/WATER TOXICITY – SX
SIADH
SIADH (SYNDROME OF INAPPRORIATE
ANTIDIURETIC HORMONE)
→ INCREASE ADH
→ DECREASE URINE OUTPUT
→ FLUID VOLUME EXCESS
S/SX:
→ DECREASED URINE OUTPUT
→ CONCENTRATED URINE
(STICKY URINE)
SPECIFIC GRAVITY: > 1.030
→ SOAKED INSIDE
(HYPERVOLEMIA, DILUTIONAL HYPONATREMIA)
→ SODIUM INCREASE (HEADACHE)
→ SEIZURES – HYPONATREMIA
→ SEVERE HIGH BP
→ STOP FLUIDS
SURGERY: REMOVE TUMOR
13. Which of the following medications decreases their action while taking thyroid hormone?
*
1 point
A. Metformin – OHA → DECREASES GLUCOSE - ANTAGONIST
B. Warfarin
C. Zoloft
D. Epinephrine

14. The nurse is aware that the following is the most common cause of hyperaldosteronism?
*
1 point
A. Excessive sodium intake
B. Pituitary adenoma
C. Deficient potassium intake
D. Adrenal adenoma

**
ALDOSTERONE – FOR SODIUM AND WATER RETENTION

15. Following a unilateral adrenalectomy, nurse Betty would assess for hyperkalemia shown by
which of the following?
*
1 point
A. Muscle weakness
B. Tremors
C. Diaphoresis
D. Constipation
16. Which of the following group of hormones are released by the medulla of the adrenal gland?
*
1 point
A. Epinephrine and norepinephrine
B. Glucocortecoids, meneralocorticoids, and androgens
C. T3, T4, calcitonin
D. Insulin, glucagon, and somatostatin
17. Adrenal insufficiency develops secondary to inadequate secretion of which of the following
pituitary hormones?
*
1 point
A. Cortical hormone
B. ADH
C. FSH
D. TSH

18. Hydrocortisone given IV is the proper treatment for which of the following diseases?
*
1 point
A. Addison’s disease
B. Hyperthyroidism
C. Cushing syndrome
D. Hypoparathyroidism

CUSHINGS ADDISONS
GLUCOCORTICOID → HYPERGLYCEMIA GLUCOCORTICOID → HYPOGLYCEMIA
MINERALOCORTICOID (ALDOSTERONE) MINERALOCORTICOID (ALDOSTERONE)
→ HYPERNATREMIA → HYPONATREMIA
→ HYPOKALEMIA → HYPERKALEMIA
→ HYPERVOLEMIA → HYPOVOLEMIA
ANDROGEN – HIRSUTISM ANDROGEN – HIRSUTISM
(ABNORMALITY IN SEX HORMONE) (ABNORMALITY IN SEX HORMONE)
INCREASED CORTISOL
DECREASED CORTISOL
→ STRESS RESPONSE
→ STRESS MANAGEMENT
DECREASED WBC
INCREASED WBC
→ RISK FOR INFECTION
CAUSE: TUMOR → SURGICAL REMOVAL
MGT: LIFETIME HORMONE
→ POST PROCEDURE: ADDISONIAN
REPLACEMENT
CRISIS – STEROIDS IV

19. After undergoing a thyroidectomy, a client develops hypocalcemia and tetany.Which of the
following medications should the nurse anticipate administering?
*
1 point
A. Calcium gluconate
B. Sodium bicarbonate
C. Potassium chloride
D. Sodium phosphorus
20. Which of the following refers to the benign tumor of the adrenal medulla?
*
1 point
A. Apical aneurysm
B. Pheochromocytoma
C. Endemic goiter
D. Ulcerogenic tumor

21. Which among the following is not included in the triad of symptoms of pheochromocytoma,
EXCEPT?
*
1 point
A. Hypertension
B. Hypoglycemia
C. Diaphoresis
D. Palpitations

22. Pheochromocytoma also has a characteristic of 5H’s. Which of the following are included in
this group of symptoms?

1. Hypertension
2. Headache
3. Hyperhidrosis
4. Hypermetabolism
5. Hyperuremia
6. Hyperthermia
*
1 point
A. 1, 2, 3, 4, 5, 6
B. 1, 2, 3, 4, 6
C. 1, 2, 3, 4
D. 1, 2, 4

23. Tricyclic antidepressant can induce hypertensive crisis in Pheochromocytoma. It is because

*
1 point
A. It causes the systemic circulation to become more sensitive to the action of norepinephrine
B. It inhibits reuptake of norepinephrine leading to further increase in its levels
C. It catalyzes the usage of norepinephrine by the body leading which worsens symptoms
D. It acts on the adrenal medulla to produce more catecholamines leading to worsening of symptoms

24. You have formulated a nursing diagnosis, "Risk for Corneal Injury R/T Exophthalmos" for
patient Janice. Which of the following interventions in the MOST appropriate to prevent this
problem to happen?
*
1 point
A. Use sunglasses
B. Have an intraocular exercise as tolerated
C. Put patient Janice in upright position
D. Include salt restriction in her diet

25. A patient is admitted to the hospital because of impending diabetic coma. Which of the
following is a typical sign of this condition?
*
1 point
A. Excessive sweating and perspiration
B. Presence of glucose in the urine
C. Increased glucose in the blood
D. Kussmaul respiration

26. When a patient is going for thyroidectomy which of the following should be available at the
bedside?
*
1 point
A. Cardiac monitor
B. Tracheostomy set
C. Naso gastric tube
D. suction apparatus

SITUATION: Cushing’s disease and Addison’s disease are just some of the
common disorders involving the adrenal glands. The following questions apply.

27. A nurse is caring for Aling Magda, a client with a diagnosis of Cushing’s syndrome. The nurse
plans which of these measures to prevent complications from this medical condition?
*
1 point
A. Monitoring glucose levels
B. Encouraging daily jogging
C. Monitoring epinephrine levels
D. Encouraging visits from friends

28. The nurse caring for Aling Magda anticipates that which of the following electrolyte
imbalances will be seen in the laboratory result?
*
1 point
A. Hyponatremia, Hyperkalemia, Hyperchloremia
B. Hypernatremia, Hypokalemia, Hypochloremia
C. Hypernatremia, Hyperkalemia, Hyperchloremia
D. Hyponatremia, Hypokalemia, Hypochloremia

29. The nurse evaluates no need for further instruction for self-care for patient with Cushing
syndrome who states:
*
1 point
A. “ I know I should have salt to everything I eat.”
B. “ I make a point to avoid excessive exposure to sun.”
C. “ I avoid to being exposed to anyone with an infection.”
D. “I am careful to wear well-fitted shoes.”
30. The nurse assessing a 1 day postoperative subtotal thyroidectomy patient notes that the color
is poor,the pulse and respiration are rapid, and patient feels warm to touch. The patient says that
she feels frightened. The nurse’s initial implementation should be:
*
1 point
A. Tell her there is nothing to be afraid of and stay to calm her.
B. Ask her if she would like pain medications.
C. Call the doctor, these are signs of thyroid storm.
D. Get a tracheosomy set at bedside.

31. A 40 year old female client with hyperthyroidism is taking propythiouracil( PTU) for 6 months
now. The nurse should monitor the client for the most serious and toxic side effect of PTU, which
is:
*
1 point
A. Autonomic dysfunction
B. Pruritus
C. Agranulocytosis
D. Constipation.

32. The nurse is caring for a client who has a thyroidectomy and is at risk for hypocalcemia.
What should the nurse do?
*
1 point
A. Monitor laboratory values daily for an elevated thyroid –stimulating hormone.
B. Observe for swelling of the neck, tracheal deviation, and severe pain.
C. Evaluate the quality of the client’s voice post-operatively, noting any dratic changes.
D. Observe for muscle twitching and numbness or tingling of the lips, fingers and toes.

33. Head trauma, brain tumor, or surgical removal of the pituitary gland can lead to which of
the following conditions?
*
1 point
A. Addison’s disease
B. Cushing syndrome
C. Diabetes insipidus
D. Hypothyroidism

34. .Which of the following conditions could be diagnosed in the client with serum ketones and
serum glucose level above 300mg/dl?
*
1 point
A. diabetic insipidus
B. diabetic ketoacidosis
C. hypoglycemia
D. HNKKS
35. Objectives for treating diabetic ketoacidosis (DKA) includes administration of which of the
following treatment?
*
1 point
A. Glucagon
B. Glucocorticoids
C. insulin and sodium
D. Insulin and IV fluids

36. If Aling Marites suffers Cushing’s disease, the nurse knows that Aling Marites will receive
the following medications but:
*
1 point
A. Lasix – POTASSIUM WASTING
B. Aldactone
C. Triamterene
D. Potassium Chloride

37. The nurse is caring for another client named Dabby, who is scheduled for bilateral
adrenalectomy for treatment of an adrenal tumor that is producing excessive aldosterone (primary
hyperaldosteronism). The nurse plans to administer which medication in the preoperative period
to prevent Addisonian crisis?
*
1 point
A. Prednisone orally
B. Fludrocortisone (Florinef) subcutaneously
C. Spironolactone (Aldactone) intramuscularly
D. Methylprednisolone sodiumsuccinate (Solu-Medrol) intravenously
38. The nurse caring for patient Dabby appropriately tells her which of the following?
*
1 point
A. “You will need to wear an abdominal binder after surgery.”
B. “You will most likely need to undergo chemotherapy after surgery.”
C. “You will not require any special long-term treatment after surgery.”
D. “You will need to take hormone replacements for the rest of your life.”

39. Which information should the nurse include when developing a teaching plan for a client
newly diagnosed with type 2 diabetes mellitus. Select all that apply.
*
1 point
A. A major risk factor for complications is obesity and central abdominal obesity.
B. Supplemental insulin is mandatory for controlling the disease.
C. Exercise increases insulin resistance.
D. The primary nutritional source requiring monitoring in the diet is carbohydrates.
E. Annual eye and foot examinations are recommended by the American Diabetes Association (ADA).
– PODIATRIST (nagaalaga ng paa)

40. A client with diabetes mellitus comes to the clinic for a regular 3-month follow-up
appointment. The nurse notes several small bandages covering cuts on the client’s hands. The
client says, “I’m so clumsy. I’m always cutting my finger cooking or burning myself on the iron.”
Which of the following responses by the nurse would be most appropriate?
*
1 point
A. “Wash all wounds in isopropyl alcohol.”
B. “Keep all cuts clean and covered.”
C. “Why don’t you have your children do the cooking and ironing?”
D. “You really should be fi ne as long as you take your daily medication.”

41. What is the safest insulin?

*
1 point
A. Glargine
B. NPH
C. Regular
D. Lispro

42. What is the priority nursing management for patient suffering HHNKS?
*
1 point
A. Hydration
B. Insulin administration to lower blood glucose below 200md/DL
C. Sodium bicarbonate drip
D. Potassium administration
43. What is also known as “see food” insulin?
*
1 point
A. Glargine
B. NPH
C. Regular
D. Lispro

44. Clear insulin is given to the patient via IV at 1000H. At what time would the insulin cause
hypoglycemia?
*
1 point
A. 1200 – 14000H
B. 1600 – 1800H
C. No hypoglycemia
D. 1030 – 1100H

45. What is the phenomenon wherein there is rebound hyperglycemia for patients that took
insulin before going to bed?
*
1 point
A. Somogyi effect
B. Rebound effect
C. Hawthorne effect
D. Nephropathy effect

46. What is the pattern of injecting air for cocktail insulin?

*
1 point
A. Regular then NPH
B. NPH then regular
C. NPH then regular then tequila
D. Any would do. Pattern does not matter. Nothing really matters, anyone can see. Nothing really matters..
nothing really matters.. TOOOO MEEEE~~~
47. For a male client with hyperglycemia, which assessment finding best supports a nursing
diagnosis of Deficient Fluid Volume?
*
1 point
A. Cool clammy skin
B. Distended neck veins
C. Increased urine osmolarity
D. flat neck veins
E. pain in my neck, my back, my pulley, and my crack

48. Rotation sites for insulin injection should be separated from one another by 2.5 cm (1 inch)
and should be used only every:
*
1 point
A. Third day
B. Every other day
C. 1-2 weeks
D. 2-4 weeks

49. A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is:
*
1 point
A. blurred vision
B. diaphoresis
C. nausea
D. weakness

50. Clinical nursing assessment for a patient with microangiopathy who has manifested impaired
peripheral arterial circulation includes all of the following, except:
*
1 point
A. Integumentary inspection for the presence of brown spots on the lower extremities
B. Observation for paleness of the lower extremities
C. Observation for blanching of the feet after the legs are elevated for 60 seconds
D. Palpation for increased pulse volume in the arteries of the lower extremities

51. The nurse expects that a type 1 diabetic may receive how much of his or her morning dose of
insulin preoperatively?
*
1 point
A. 10-20%
B. 25-40%
C. 50-60%
D. 85-90%
52. The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who
is scheduled for surgery in 2 hours. The client begins o complain of increased abdominal pain and
begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds
are diminished. Which is the appropriate nursing intervention?
*
1 point
A. Notify the physician.
B. Administer the prescribed pain medication.
C. Call and ask the operating room team to performthe surgery as soon as possible.
D. Reposition the client and apply a heating padon warm setting to the client’s abdomen.

53. The client has been admitted to the hospital with a diagnosis of acute pancreatitis and the nurse
is assessing the client’s pain. What type of pain inconsistent with this diagnosis?
*
1 point
A. Burning and aching, located in the left lowerquadrant and radiating to the hip
B. Severe and unrelenting, located in the epigastricarea and radiating to the back
C. Burning and aching, located in the epigastricarea and radiating to the umbilicus
D. Severe and unrelenting, located in the leftlower quadrant and radiating to the groin

**
PANCREATITIS
→ DUE TO ALCOHOLISM
→ LUQ SEVERE PAIN/COLIC PAIN

54. The nurse is assessing a client who is experiencing an acute episode of cholecystitis. Where
should the nurse anticipate the location of the pain?
*
1 point
A. Right lower quadrant, radiating to the back
B. Right lower quadrant, radiating to the umbilicus
C. Right upper quadrant, radiating to the left scapula and shoulder
D. Right upper quadrant, radiating to the right scapula and shoulder

55. Nurse Pinang is scheduling a client for diagnostic studies of the gastrointestinal system. The
patient asked what would be the order in which he would take the tests. Which of the following
studies should the nurse scheduled last?
*
1 point
A. Endoscopy
B. CT Scan
C. Ultrasound
D. Barium Enema

**
BARIUM ENEMA OVER BARIUM SWALLOW TO PREVENT DOUBLE CLOUDING →
MISDIAGNOSIS

56. Patient Nightingale has just undergone an upper gastrointestinal series. Upon the client’s
return to the unit, the nurse should check the physician’s order for which of the following as a
part of routine post-procedure care?
*
1 point
A. High fat diet
B. Limit Fluids
C. Mild laxative
D. NPO

57. A patient is being transferred to your unit with acute cholecystitis. In report the transferring
nurse tells you that the patient has a positive Murphy’s Sign. You know that this means:
*
1 point
A. The patient stops breathing in when the examiner palpates under the ribs on the right upper side
of the abdomen at the midclavicular line.
B. The patient stops breathing out when the examiner palpates under the ribs on the right upper side of the
abdomen at the midclavicular line.
C. The patient verbalizes pain when the lower right quadrant is palpated.
D. The patient reports pain when pressure is applied to the right lower quadrant but then reports an increase
in pain intensity when the pressure is released.

58. Your patient is post-op day 3 from a cholecystectomy due to cholecystitis and has a T-Tube.
Which finding during your assessment of the T-Tube requires immediate nursing intervention?
*
1 point
A. The drainage from the T-Tube is yellowish/green in color.
B. There is approximately 750 cc of drainage within the past 24 hours.
C. The drainage bag and tubing is at the patient’s waist.
D. The patient is in the Semi-Fowler’s position.
59. The physician orders a patient’s T-Tube to be clamped 1 hour before and 1 hour after meals.
You clamp the T-Tube as prescribed. While the tube is clamped which finding requires you to
notify the physician?
*
1 point
A. The T-Tube is not draining.
B. The T-Tube tubing is below the patient’s waist.
C. The patient reports nausea and abdominal pain.
D. The patient’s stool is brown and formed.

**
T-TUBE MAINTAINS THE PATENCY OF COMMON BILE DUCT TO PREVENT PANCREATITIS
AFTER SURGERY NGAKAKAROON NG PANCREATIC DUCT PROBLEM

60. You’re precepting a nursing student who is helping you provide T-Tube drain care. You
explain to the nursing student that the t-shaped part of the drain is located in what part of the biliary
tract?
*
1 point
A. Cystic duct
B. Common hepatic duct
C. Common bile duct
D. Pancreatic duct

61. Your patient is unable to have a cholecystectomy for the treatment of cholecystitis.
Therefore, a cholecystostomy tube is placed to help treat the condition. Which statement about a
cholecystostomy (C-Tube) is TRUE?
*
1 point
A. The C-Tube is placed in the cystic duct of the gallbladder and helps drain infected bile from the
gallbladder.
B. Gallstones regularly drain out of the C-Tube, therefore, the nurse should flush the tube regularly to
ensure patency.
C. The C-Tube is placed through the abdominal wall and directly into the gallbladder where it will
drain infected bile from the gallbladder.
D. The tubing and drainage bag of the C-Tube should always be level with the insertion site to ensure the
tube is draining properly.

62. A patient, who has recovered from cholecystitis, is being discharged home. What meal
options below are best for this patient?
*
1 point
A. Baked chicken with steamed carrots and rice
B. Broccoli and cheese casserole with gravy and mashed potatoes
C. Cheeseburger with fries
D. Fried chicken with a baked potato
63. Which condition is NOT a known cause of cirrhosis?
*
1 point
A. Obesity
B. Alcohol consumption
C. Blockage of the bile duct
D. Hepatitis C
E. All are known causes of Cirrhosis

64. The liver receives it blood supply from two sources. One of these sources is called the
_________________, which is a vessel network that delivers blood _____________ in nutrients
but ________ in oxygen.
*
1 point
A. hepatic artery, low, high
B. hepatic portal vein, high, low
C. hepatic lobule, high, low
D. hepatic vein, low, high

65. A patient is admitted with hepatic encephalopathy secondary to cirrhosis. Which meal option
selection below should be avoided with this patient?
*
1 point
A. Beef tips and broccoli rabe
B. Pasta noodles and bread
C. Cucumber sandwich with a side of grapes
D. Fresh salad with chopped water chestnuts

66. During your morning assessment of a patient with cirrhosis, you note the patient is disoriented
to person and place. In addition while assessing the upper extremities, the patient’s hands
demonstrate a flapping motion. What lab result would explain these abnormal assessment
findings?
*
1 point
A. Decreased magnesium level
B. Increased calcium level
C. Increased ammonia level
D. Increased creatinine leve

67. A 45 year old male has cirrhosis. The patient reports concern about the development of
enlarged breast tissue. You explain to the patient that this is happening because?
*
1 point
A. The liver cells are removing too much estrogen from the body which causes the testicles to produce
excessive amounts of estrogen, and this leads to gynecomastia.
B. The liver is producing too much estrogen due to the damage to the liver cells, which causes the level to
increase in the body, and this leads to gynecomastia.
C. The liver cells are failing to recycle estrogen into testosterone, which leads to gynecomastia.
D. The liver cells are failing to remove the hormone estrogen properly from the body, which causes
the level to increase in the body, and this leads to gynecomastia.
68. Which patient below is at MOST risk for CHRONIC pancreatitis?
*
1 point
A. A 25 year old female with a family history of gallstones.
B. A 35 year old male who reports social drinking of alcohol.
C. A 15 year old female with cystic fibrosis.
D. A 66 year old female with stomach cancer.

69. Your patient, who is presenting with signs and symptoms of GERD, is scheduled to have a test
that assesses the function of the esophagus' ability to squeeze food down into the stomach and the
closer of the lower esophageal sphincter. The patient asks you, "What is the name of the test I'm
having later today?" You tell the patient the name of the test is:
*
1 point
A. Lower Esophageal Gastrointestinal Series
B. Transesophageal echocardiogram
C. Esophageal manometry
D. Esophageal pH monitoring

70. After dinner time, during hourly rounding, a patient awakes to report they feel like "food is
coming up" in the back of their throat and that there is a bitter taste in their mouth. What nursing
intervention will you perform next?
*
1 point
A. Perform deep suctioning
B. Assist the patient into the Semi-Fowler's position
C. Keep the patient NPO
D. Instruct the patient to avoid milk products

71. After providing education to a patient with GERD. You ask the patient to list 4 things they
can do to prevent or alleviate signs and symptoms of GERD. Which statement is INCORRECT?
*
1 point
A. "It is best to try to consume small meals throughout the day than eat 3 large ones."
B. "I'm disappointed that I will have to limit my intake of peppermint and spearmint because I love eating
those types of hard candies."
C. "It is important I avoid eating right before bedtime."
D. "I will try to lie down after eating a meal to help decrease pressure on the lower esophageal
sphincter."
72. A patient is taking Bethanechol "Urecholine" for treatment of GERD. This is known as what
type of drug?
*
1 point
A. Proton-pump inhibitor
B. Histamine receptor blocker
C. Prokinetic
D. Mucosal Healing Agent

73. In the stomach lining, the parietal cells release _________ and the chief cells release
__________ which both play a role in peptic ulcer disease.
*
1 point
A. pepsin, hydrochloric acid
B. pepsinogen, pepsin
C. pepsinogen, gastric acid
D. hydrochloric acid, and pepsinogen

74. A patient has developed a duodenal ulcer. As the nurse, you know that which of the following
plays a role in peptic ulcer formation. Select ALL that apply:
*
1 point
A. Spicy foods
B. Helicobacter pylori
C. NSAIDs
D. Milk
E. Zollinger-Ellison Syndrome

75. You're educating a group of patients at an outpatient clinic about peptic ulcer formation.
Which statement is correct about how peptic ulcers form?
*
1 point
A. "An increase in gastric acid is the sole cause of peptic ulcer formation."
B. "Peptic ulcers can form when acid penetrates unprotected stomach mucosa. This causes histamine
to be released which signals to the parietal cells to release more hydrochloric acid which erodes the
stomach lining further."
C. "Peptic ulcers form when acid penetrates unprotected stomach mucosa. This causes pepsin to be released
which signals to the parietal cells to release more pepsinogen which erodes the stomach lining further."
D. "The release of prostaglandins cause the stomach lining to breakdown which allows ulcers to form."

76. Your patient is diagnosed with peptic ulcer disease due to h.pylori. This bacterium has a
unique shape which allows it to penetrate the stomach mucosa. You know this bacterium is:
*
1 point
A. Rod shaped
B. Spherical shaped
C. Spiral shaped
D. Filamentous shaped
77. Helicobacter pylori can live in the stomach's acidic conditions because it secretes
___________ which neutralizes the acid.
*
1 point
A. ammonia
B. urease
C. carbon dioxide
D. bicarbonate

78. The physician orders a patient with a duodenal ulcer to take a UREA breath test. Which lab
value will the test measure to determine if h. pylori is present?
*
1 point
A. Ammonia
B. Urea
C. Hydrochloric acid
D. Carbon dioxide

79. A patient arrives to the clinic for evaluation of epigastric pain. The patient describes the pain
to be relieved by food intake. In addition, the patient reports awaking in the middle of the night
with a gnawing pain in the stomach. Based on the patient's description this appears to be what
type of peptic ulcer?
*
1 point
A. Duodenal
B. Gastric
C. Esophageal
D. Refractory

80. A patient with chronic peptic ulcer disease underwent a gastric resection 1 month ago and is
reporting nausea, bloating, and diarrhea 30 minutes after eating. What condition is this patient
most likely experiencing?
*
1 point
A. Gastroparesis
B. Fascia dehiscence
C. Dumping Syndrome
D. Somogyi effect

81. Thinking back to the patient in question 8, select ALL the correct statements on how to
educate this patient about decreasing their symptoms:
*
1 point
A. "It is best to eat 3 large meals a day rather than small frequent meals."
B. "After eating a meal lie down for 30 minutes."
C. "Eat a diet high in protein, fiber, and low in carbs."
D. "Be sure to drink at least 16 oz. of milk with meals."
82. A patient is recovering from discomfort from a peptic ulcer. The doctor has ordered to
advance the patient’s diet to solid foods. The patient's lunch tray arrives. Which food should the
patient avoid eating?
*
1 point
A. Orange
B. Milk
C. White rice
D. Banana

83. Which statement is INCORRECT about Histamine-receptor blockers?

*
1 point
A. "H2 blockers block histamine which causes the chief cells to decrease the secretion of hydrochloric
acid."
B. "Ranitidine and Famotidine are two types of histamine-receptor blocker medications."
C. "Antacids and H2 blockers should not be given together."
D. All the statements are CORRECT.

84. You are providing discharge teaching to a patient taking Sucralfate (Carafate). Which
statement by the patient demonstrates they understand how to take this medication?
*
1 point
A. "I will take this medication at the same time I take Ranitidine."
B. "I will always take this medication on an empty stomach."
C. "It is best to take this medication with antacids."
D. "I will take this medication once a week."

85. A patient with a peptic ulcer is suddenly vomiting dark coffee ground emesis. On
assessment of the abdomen you find bloating and an epigastric mass in the abdomen. Which
complication may this patient be experiencing?
*
1 point
A. Obstruction of pylorus
B. Upper gastrointestinal bleeding
C. Perforation
D. Peritonitis

86. A patient with Crohn's Disease is MOST likely to have the disease is what part of the GI tract?
*
1 point
A. Rectum
B. Duodenum of the small intestine
C. Terminal Ileum
D. Descending colon
87. You're providing teaching to a patient who has been newly diagnosed with Crohn's Disease.
Which statement by the patient's spouse requires re-education?
*
1 point
A. "Crohn's Disease can be scattered throughout the GI tract in patches with some areas appearing healthy
while others are diseased."
B. "There is no cure for Crohn's Disease."
C. "Strictures are a common complication with Crohn's Disease."
D. "Crohn's Disease can cause the haustra of the large intestine to lose its form."
88. A patient experiencing a flare-up with Crohn's Disease is ordered complete bowel rest by the
physician. You are administering TPN (total parental nutrition) per physician order. When
developing the patient's nursing plan of care, which nursing diagnosis is MOST important to
include in the care plan?
*
1 point
A. Risk for allergy response
B. Risk for unstable blood glucose level
C. Risk for imbalance nutrition: more than body requirements
D. Risk for imbalanced nutrition: less than body requirements

89. A patient is receiving treatment for Crohn's Disease. Which food found on the patient's food
tray should the patient avoid?
*
1 point
A. Fresh Salad
B. White rice
C. Baked chicken
D. Cooked skinless apples

90. A physician has prescribed a patient with a severe case of Crohn's Disease to take a drug that
works by suppressing the immune system. This medication achieves this by blocking a protein that
plays a role the inflammatory process. Which drug does this describe?
*
1 point
A. Azathioprine
B. Sulfasalazine
C. Infliximab
D. Prednisone

91. A patient with Crohn's Disease is taking corticosteroids. The patient is complaining of extreme
thirst, polyuria, and blurred vision. What is your next nursing action?
*
1 point
A. Check the patient's blood glucose
B. Give the patient a food containing sugar (ex: orange juice)
C. Administer oxygen via nasal cannula
D. D. Assess bowel sounds
92. A patient diagnosed with pancolitis is experiencing extreme abdominal distension, pain 10 on
1-10 scale in the abdomen, temperature of 103.6 'F, HR 120, and profuse diarrhea. What
complication due you suspect the pain is experiencing?
*
1 point
A. Fistulae
B. Stricture
C. Bowel obstruction
D. Toxic megacolon

93. What is the cause of disequilibrium syndrome?

*
1 point
A. Rapid shifts of nitrogen wastes
B. Rapid exchange of blood
C. Decreased perfusion in the kidneys
D. Defective dialyzer

HEMODIALYSIS PERITONEAL DIALYSIS

MOA: DIALYSATE → RICH IN GLUCOSE →

HYPERGLYCEMIC HYPEROSMOLAR
ULTRAFILTRATION (GLUCOSE ATTRACTS
MOA: DIALYZER → ARTIFICIAL KIDNEY
INFECTION – CAN LEAD TO PERITONITIS)
→ MEDICAL EMERGENCY!

**IMPORTANT: STERILE TECHNIQUE

ACCESS POINT: AV FISTULA
PRIO: PATENCY! ACCESS POINT: PERITONEUM (MORE
→ (+) BRUIT UPON AUSCULTATION –
ACCESSIBLE)
WHOOSHING SOUND
→ (+) THRILL UPON PALPATION – MACHINE
*BETWEEN UMBILICUS & SUPRAPUBIC
LIKE VIBRATIONS
AREA – EMPTY BLADDER TO PREVENT
→ SAVE THE SIDE! – AVOID TAKING BP AND
BLADDER PUNCTURE
PHLEBOTOMY

MORE EFFICIENT LESS EFFICIENT

WHO PERFORMS: RN WHO PERFORMS: PATIENT
→ LOWER RISK FOR INFECTION → HIGHER RISK FOR INFECTION

COMPLICATION: DISEQUILIBRIUM
SYNDROME
→ CAUSE: RAPID EXCHANGES OF
NITROGEN WASTES (RAPID RATE OF HD)
MAIN COMPLICATION: PERITONITIS
→ PREVENTION: START SLOW

PRIO BEFORE: CHECK PX WEIGHT

PRIO DURING: CHECK LOC & VS Q 15
MINS
PRIO AFTER: CHECK PX WEIGHT
OTHER COMPLICATIONS:
 OTHER COMPLICATIONS: → BLADDER PUNCTURE
→ HEMORRHAGE → ABDOMINAL ADHESIONS
→ AIR EMBOLUS
→ HYPOTENSION
→ HEMODYNAMIC INSTABILITIES
→ MUSCLE CRAMPS – DUE TO RAPID
REMOVAL OF FLUID & SODIUM (MGT:
PNSS)
TIME:
→ INFUSION – 15 MINS
TIME: 4 HOURS
→ EXCHANGES – 20 TO 30 MINS
→ SOLUTION CAN STAY UP TO 4 – 6 HOURS

94. What is the priority nursing management for patients with peritoneal dialysis that suffers
from rigid board like abdomen?
*
1 point
A. Report to the doctor
B. Position semi fowlers position
C. Oxygen
D. Antibiotics

95. What statement of the patient with AV fistula should be corrected, except?
*
1 point
A. I should auscultate for thrill
B. I should palpate for bruit
C. I can use the arm with fistula for BP monitoring
D. I should keep the site clean and free of irritants

96. What causes the ultrafiltration of peritoneal dialysis?

*
1 point
A. High glucose content of dialysate
B. High sodium content of dialysate
C. High efficiency of dialyzer
D. Slow exchange of blood at first time

97. The nurse should assess the client with bladder cancer for which of the following?
*
1 point
A. Suprapubic pain.
B. Dysuria.
C. Painless hematuria.
D. Urine retention.
98. A client is to have a cystoscopy to rule out cancer of the bladder. Which of the following
indicate that the client has developed a complication after the cystoscopy?
*
1 point
A. Dizziness.
B. Chills.
C. Pink-tinged urine.
D. Bladder spasms.

99. If the client develops lower abdominal pain after a cystoscopy, the nurse should instruct the
client to do which of the following?
*
1 point
A. Apply an ice pack to the pubic area.
B. Massage the abdomen gently.
C. Ambulate as much as possible.
D. Sit in a tub of warm water.

100. After surgery for an ileal conduit, the nurse should closely assess the client for the occurrence
of which of the following complications related to pelvic surgery?
*
1 point
A. Peritonitis.
B. Thrombophlebitis.
C. Ascites.
D. Inguinal hernia.

**
ILEAL CONDUIT – NEOBLADDER → DONE POST CYSTECTOMY

101. A client has renal colic due to renal stones. What is the nurse’s first priority in managing
care for this client?
*
1 point
A. Do not allow the client to ingest fluids.
B. Encourage the client to drink at least 500 mL of water each hour.
C. Request the central supply department to send supplies for straining urine.
D. Administer an opioid analgesic as prescribed.
102. A client is admitted to the hospital with a diagnosis of renal calculi. The client is
experiencing severe flank pain and nausea; the temperature is100.6° F (38.1° C). Which of the
following would be a priority outcome for this client?
*
1 point
A. Prevention of urinary tract complications.
B. Alleviation of nausea.
C. Alleviation of pain.
D. Maintenance of fluid and electrolyte balance.

103. In addition to nausea and severe flank pain, a female client with renal calculi has pain in
the groin and bladder. The nurse should assess the client further for signs of:
*
1 point
A. Nephritis.
B. Referred pain.
C. Urine retention.
D. Additional stone formation.

104. A client with acute renal failure has an increase in the serum potassium level. The nurse
should monitor the client for:
*
1 point
A. Cardiac arrest.
B. Pulmonary edema.
C. Circulatory collapse.
D. Hemorrhage

105. A high-carbohydrate, low-protein diet is prescribed for the client with acute renal failure.
The intended outcome of this diet is to:
*
1 point
A. Act as a diuretic.
B. Reduce demands on the liver.
C. Help maintain urine acidity.
D. Prevent the development of ketosis.

106. During dialysis, the client has disequilibrium syndrome. The nurse should first?
*
1 point
A. Administer oxygen per nasal cannula.
B. Slow the rate of dialysis.
C. Reassure the client that the symptoms are normal.
D. Place the client in Trendelenburg’s position

107. A client with chronic renal failure has completed a hemodialysis treatment. The nurse would
use which of the following standard indicators to evaluate the client’s status after dialysis?
*
1 point
A. Vital signs and weight loss
B. Potassium level and weight
C. Vital signs and BUN
D. Blood urea nitrogen (BUN) and creatinine

108. Which is the best management for hyperkalemia in emergency cases?

*
1 point
A. Insulin with glucose
B. Kayexelate
C. Spironolactone
D. Furosemide

109. A client with chronic renal failure (CRF) returns to the nursing unit after following a
hemodialysis treatment. On assessment the nurse notes that the client’s temperature is 100.20C.
which of the following is the most appropriate nursing action?
*
1 point
A. Encourage fluids
B. Continue to monitor vital signs
C. Notify the physician
D. Monitor the site of the shunt for infection
110. A nurse is reviewing a list of components for peritoneal dialysis solution with a client. The
nurse asks the client of the purpose of the glucose contained in the solution. The nurse bases the
response on the knowledge that the glucose:
*
1 point
A. Increases osmotic pressure to produce ultrafiltration
B. Prevents disequilibrium syndrome
C. Prevents excessive glucose from being removed from the client
D. Decreases the risk of peritonitis

111. A nurse is caring for an 88-yaer-old woman suspected of having urinary tract infection (UTI).
Which of the following if noted on the client would alert the nurse for a possibility of a UTI?
*
1 point
A.Frequency
B.Urgency
C.Confusion
D.Fever

112. A nurse is caring for a client following a kidney transplant. The client develops oliguria.
Which of the following would the nurse anticipate to be prescribed in the treatment for oliguria?
*
1 point
A.Forcing fluids
B.Irrigation of Foley catheter
C.Restricting fluids
D.Administration of diuretics

113. A client with chronic renal failure who is schedule for hemodialysis this morning is due to
receive a daily dose of enalapril (Vasotec). The nurse would plan to administer the medication:
*
1 point
A.Upon return from dialysis
B.Just prior to dialysis
C.The day after the dialysis
D.During dialysis
114. A nurse is reviewing the medication record of a client diagnosed with CRF. The nurse
notes that the client is receiving Aluminum hydroxide. The nurse plans care, knowing that the
purpose of this medication is to:
*
1 point
A. Combine phosphorous and help eliminate phosphates from the body
B. Prevent ulcers
C. Promote the elimination of potassium from the body
D. Prevent constipation

115. The client has an order for Microzide 10mg orally every day. What should you be sure to
include in the teaching plan for this drug?
*
1 point
A. Take this medication in the morning
B. This medication should be taken in 2 divided doses when you get up and when you go to bed
C. Inform your prescriber if you notice weight gain or increased swelling
D. You should expect your urine output to increase

116. Which blood test result would you sure be to monitory for the client taking Microzide?
*
1 point
A. Sodium level
B. Potassium level
C. Chloride level
D. Calcium level

117. A nurse is reviewing the medication record of a client diagnosed with CRF. The nurse
notes that the client is receiving Aluminum hydroxide. The nurse plans care, knowing that the
purpose of this medication is to:
*
1 point
A.Combine phosphorous and help eliminate phosphates from the body
B.Prevent ulcers
C.Promote the elimination of potassium from the body
D. Prevent constipation

118. A female client with chronic renal failure (CRF) is receiving a hemodialysis treatment.
After hemodialysis, nurse Sarah knows that the client is most likely to experience:
*
1 point
A. hematuria.
B. Weight loss.
C.increased urine output.
D. increased blood pressure
119. Epoetinalfa (Epogen) is prescribed for a client with chronic renal failure. The client ask the
nurse about the purpose of the medication. The following appropriate response would be which
of the following?
*
1 point
A.“It is used to lower your blood pressure”
B.“It is used to treat anemia”
C.“It will help to increase the potassium level in your body”
D.:It is an anticonvulsant medication given to all clients after dialysis to prevent seizure activity”

120. Which of the following is not a purpose of the kidney?

*
1 point
A.Water balance
B.Electrolyte balance
C.Blood pressure control
D.C02 balance

121. What is the most common cause of glomerulonephritis?

*
1 point
A.GABHS - IMPETIGO
B.HIV
C.SLE
D.igA nephropathy
122. What is the clinical symptom of BPH?
*
1 point
A.Dribbling urine
B.Nocturia
C.Increased frequency
D.Increased urgency
123. On morning assessment of your patient in room 2502 who has severe burns. You notice
that fluid is starting to accumulate in his abdominal tissue. You note that his weight has not
changed and his intake and output is equal. What do you suspect?
*
1 point
A. Third spacing
B. This is normal and expected after a burn and it is benign
C. Document this finding as non-pitting abdominal edema.
D. Intravascular compartment syndrome

→ BRAIN
SODIUM
→ WATER BALANCE
CHLORIDE → FOR WATER BALANCE
POTASSIUM → FOR HEART
CALCIUM → FOR MUSCLES (CONTRACTILITY, BONES)
PHOSPHATE → INVERSELY RELATED TO CALCIUM
MAGNESIUM → DEPRESSANT

124. Which patient is at more risk for an electrolyte imbalance?

*
1 point
A. An 8 month old with a fever of 102.3 'F and diarrhea
B. A 55 year old diabetic with nausea and vomiting
C. A 5 year old with RSV
D. A healthy 87 year old with intermittent episodes of gout
125. patient is admitted to the ER with the following findings: heart rate of 110 (thready upon
palpation), 80/62 blood pressure, 25 ml/hr urinary output, and Sodium level of 160. What
interventions do you expect the medical doctor to order for this patient?
*
1 point
A. Restrict fluid intake and monitor daily weights
B. Administer hypertonic solution of 5% Dextrose 0.45% Sodium Chloride and monitor urinary
output
C. Administer hypotonic IV fluid and administer sodium tablets.
D. No interventions are expected
126. After obtaining an EKG on a patient you notice that ST depression is present along with an
inverted T wave and prominent U wave. What lab value would be the cause of this finding?
*
1 point
A. Magnesium level of 2.2
B. Potassium level of 5.6
C. Potassium level of 2.2
D. Phosphorus level of 2.0

127. Which patient below would have a potassium level of 5.5?

*
1 point
A. A 76 year old who reports taking Lasix four times a day
B. A patient with Addison's disease
C. A 55 year old woman who have been vomiting for 3 days consistently
D. A patient with liver failure

128. You are taking a patient's blood pressure manually. As you pump up the cuff above the
systolic pressure for a few minutes you notice that the patient develop a carpal spasm. Which of
the following is true?
*
1 point
A. The patient is having a normal nervous response to an inflating blood pressure cuff that is inflated above
the systolic pressure
B. This is known as Trousseau's Sign and is present in patients with hypercalcemia
C. This is known as Chvostek's Sign
D. This is known as Trousseau's Sign and is present in patients with hypocalcemia

129. Which patient is at most risk for hypomagnesemia?

*
1 point
A. A 55 year old chronic alcoholic
B. A 57 year old with hyperthyroidism
C. A patient reporting overuse of antacids and laxatives
D. A 25 year old suffering from hypoglycemia
**
WOF IN HYPOMAGNESEMIA:
• BP
• URINE OUTPUT
• RR
• PATELLAR REFLEXES

130. In report from a transferring facility you receive information that your patient's Magnesium
level is 1.2. When the patient arrives you are ordered by the doctor to administer Magnesium
Sulfate via IV. Which of the following interventions takes priority?
*
1 point
A. Set-up bedside suction
B. Set-up IV Atropine at bedside due to the bradycardia effects of Magnesium Sulfate
C. Monitor the patient's for reduced deep tendon reflexes and initiate seizure precautions
D. None of the above are correct

131. Which patient is at most risk for fluid volume deficient?

*
1 point
A. A patient who has been vomiting and having diarrhea for 2 days.
B. A patient with continuous nasogastric suction.
C. A patient with an abdominal wound vac at intermittent suction.
D. All of the above are correct.
132. A patient is admitted with exacerbation of congestive heart failure. What would you expect
to find during your admission assessment?
*
1 point
A. Flat neck and hand veins
B. Furrowed dry tongue
C. Increased blood pressure and crackles throughout the lungs
D. Bradycardia and pitting edema in lower extremities

133. An adult experiences severe vomiting from cancer chemotherapy drugs. Which acid-base
imbalance should the nurse anticipate?
*
1 point
A. Ketoacidosis.
B. Metabolic acidosis.
C. Metabolic alkalosis. – VOMITING ONLY
D. Respiratory alkalosis.

134. A woman loses most of her hair as a result of cancer chemotherapy. The nurse understands
that which of the following is true about chemotherapy-induced alopecia?
*
1 point
A. New hair will be gray.
B. Avoid the use of wigs.
C. The hair loss is temporary.
D. Pre-chemo hair texture will return

135. An adult is diagnosed with Hodgkin’s disease Stage 1A. He is being treated with radiation
therapy. To minimize skin damage from radiation therapy, the nursing care plan should include
which of the following?
*
1 point
A. Avoid washing with water.
B. Apply a heating pad to the site.
C. Cover the area with an airtight dressing.
D. Avoid applying creams and powders to the area.

136. An adult develops a second-degree or second level skin reaction from radiation therapy.
When evaluating his symptoms, which of the following would not be present?
*
1 point
A. Scaly skin. - PSORIASIS
B. An itchy feeling.
C. Dry desquamation.
D. Reddening of the skin.
137. The nurse is teaching the client about signs of radiation-induced thrombocytopenia.
Which symptom would be included in the teaching?
*
1 point
A. Fatigue.
B. Shortness of breath.
C. Elevated temperature.
D. A tendency to bruise easily.

138. The nurse is caring for a client who is receiving radiation therapy. Which activity by the
client indicates further instruction on the side effects of radiation therapy?
*
1 point
A. Using an electric razor.
B. Eating a high-protein diet.
C. Taking his children to see Santa at the mall.
D. Calling the doctor for a temperature of 101°F (38.3°C).

139. The nurse at a senior citizen center is teaching a class on the early warning signals of
cancer. Which of the following will be a part of the teaching plan for this class?
*
1 point
A. Reduction in the amount of dietary fat.
B. Stop cigarette smoking.
C. Avoid overexposure to the sun.
D. Practice monthly breast self-exam (BSE).

140. Which statement tells the nurse that a man needs further information about testicular self-
examination (TSE)?
*
1 point
A. “The best time to perform TSE is immediately before sexual intercourse.”
B. “It’s normal to find one testis lower than the other.”
C. “I should have my doctor examine any lumps I find, even though they might be benign.”
D. “That cord-like thing that I feel on the top and back of the testicle is not something to be worried about.”

141. A woman is receiving internal radiation therapy for cancer of the cervix. Which statement
indicates to the nurse that the client understands precautions necessary during her treatment?
*
1 point
A. “I should get out of bed and walk around in my room at least every other hour.”
B. “My seven-year-old twins should not come to visit me while I’m receiving treatment.”
C. “I will try not to cough, because the force might make me expel the applicator.”
D. “I know that my primary nurse has to wear one of those badges like the people in the X-ray department
wear, but they aren’t necessary for anyone else who comes in here.”
142. The patient undergoing external radiation therapy is assigned under your care. What
instruction will you not give him as preparation for self-management?
*
1 point
A. Do not remove dye markings where the radiation is focused.
B. When using prescribed soap, rinse it thoroughly from the skin.
C. Never use your hand in washing the affected area. – USE HANDS NOT WASH CLOTH
D. None of the above.

143. The nurse admits a patient diagnosed with liposarcoma. The nurse will base her
interventions on the correct knowledge that liposarcoma is
*
1 point
A.A benign tumor of the epithelial glands
B.A malignant tumor of the adipose tissues
C.A benign tumor of the glial cells in the brain
D.A malignant tumor of the skeletal muscle

144. The nurse is preparing to administer chemotherapeutic agents to a client being treated for
ovarian cancer. What is the most important action for the nurse to do?
*
1 point
A. Instruct the client to remain in bed.
B. Take the client’s vital signs before administration.
C. Hang the medication in a light-protective container.
D. Use personal protective equipment.

145. A client newly diagnosed with cancer says he does not understand how cancer cells are
identified. A nurse in the clinic is conducting physical assessment to clients attending health
promotive sessions. What information should the nurse give regarding cancer cells?
*
1 point
A. "Cancer cells are immature and vary in size and shape by mutation."
B. "Cancer cells multiply at a much slower rate than normal cells."
C. "Cancer cells are very well organized and are like the tissue of origin."
D. "Cancer cells are oval in shape and are missing the nucleus."

146. A client being treated for prostate cancer returns for an office visit to discuss his treatment
plan after receiving the results of his prostate-specific antigen (PSA) test, which was 1.7. What
should the nurse expect?
*
1 point
A. The current treatment is effective and the cancer is gone.
B. The current treatment is ineffective and cancer remains.
C. The cancer has reoccurred.
D. The cancer is growing.
147. A client diagnosed with early stage breast cancer and tumor removal tells the nurse she is
considering foregoing the adjunct chemotherapy. What is the best response by the nurse?
*
1 point
A. "Chemotherapy or hormonal therapy is not needed because the tumor has been removed."
B. "Even though no visible tumor remains, by completing adjunct chemotherapy your risk of
reoccurrence will be decreased."
C. "Chemotherapy will prevent any risk of tumor cells circulating in the bloodstream."
D. "Chemotherapy provides a neuroprotective effect and prevents

148. The nurse is caring for a client following a mastectomy. Which nursing intervention would
assist in preventing lymphedema of the affected arm?
*
1 point
A. Placing a cool compress on the affected arm
B. Elevating the affected arm on a pillow above heart level
C. Avoiding arm exercises in the immediate postoperative period
D. Maintaining an intravenous site below the antecubital area on the affected side

149. he nurse should plan to implement which intervention in the care of a client experiencing
neutropenia as a result of chemotherapy?
*
1 point
A. Restrict all visitors
B. Teach the client and his family about the importance of handwashing.
C. Restrict the patient from having fluid intake.
D. Insert an indwelling catheter to prevent skin excoriation.

150. A patient with thyroid carcinoma underwent brachytherapy with an unsealed radiation
source. How should the nurse care for this patient?
*
1 point
A. Request the supervisor to be the only nurse assigned to the patient for consistency of care.
B. Regularly change the linens while the patient is undergoing the therapy.
C. Do not allow pregnant women to visit.
D. Remind visitors to stay as close as 3 feet from the patient while he is under therapy.
151. You notice that the implant of a patient undergoing radiation therapy has been dislodged.
What is your FIRST action?
*
1 point
A.Apply double gloves.
B. Instruct the patient to ambulate immediately.
C.Obtain long forceps.
D. Call the nurse supervisor.

152. What will be the priority instruction for a patient with thrombocytopenia as a result of his
chemotherapy?
*
1 point
A.Avoid meddling with large crowds.
B. Use only electric shavers and soft-bristled toothbrushes.
C.Address pain by taking aspirin.
D.Engage in physical activities like trekking and mountain climbing.

153. What will be the nursing action to prevent nausea and vomiting in a client who is
prescribed to receive the first round of IV chemotherapy?
*
1 point
A.Keep the client on NPO during infusion of the chemotherapy.
B.Administer prescribed anti-emetic drugs before administering chemotherapy.
C.Regulate to make sure that the chemotherapy infuses for 6 hours.
D.Assess the client for signs of dehydration during the infusion period.

154. The home health care nurse is caring for a client with cancer who is complaining of acute
pain. The most appropriate determination of the client’s pain should include which assessment?
*
1 point
A.Nonverbal cues from the client
B.The nurse’s impression of the client’s pain
C.The client’s pain rating
D.Pain relief after appropriate nursing intervention

155. A client is diagnosed with multiple myeloma and the client asks the nurse about the diagnosis.
The nurse bases the response on which description of this disorder?
*
1 point
A. Altered red blood cell production
B. Altered production of lymph nodes
C. Malignant exacerbation in the number of leukocytes
D. Malignant proliferation of plasma cells within the bones
156. What is the marker cell in diagnosing Hodgkin’s lymphoma?
*
1 point
A.Redberger cell
B.Spielberg cell
C.Reed-Sternberg cell
D.Reed-spenberg cell

157. Leukemia is suspected in a patient complaining of petechiae and weakness. To confirm this,
the nurse prepares the patient for what procedure?
*
1 point
A. Chest x-ray
B. Bone marrow aspiration
C. Venipuncture
D. Arterial blood gas

158. A client diagnosed with testicular cancer expresses concerns about fertility. The couple
desires to eventually have a family and the nurse discusses the option of sperm banking. The nurse
should inform the couple that sperm banking would need to be performed:
*
1 point
A. Before treatment is started.
B. Once the client is tolerating the treatment.
C. Upon completion of treatment.
D. When tumor markers drop to normal levels.

159. Lifestyle influences that are considered risk factors for colorectal cancer include:
*
1 point
A. A diet low in vitamin C.
B. A high dietary intake of artificial sweeteners (Aspartame).
C. A high-fat, low-fiber diet.
D. Multiple sex partners.

160. When caring for a client with a central venous line, which of the following nursing actions
should be implemented in the plan of care for chemotherapy administration? Select all that apply.
*
1 point
A. Verify patency of the line by the presence of a blood return at regular intervals.
B. Inspect the insertion site for swelling, erythema, or drainage.
C. Administer a cytotoxic agent to keep the regimen on schedule even if blood return is not present.
D. If unable to aspirate blood, reposition the client and encourage the client to cough.
E. Contact the health care provider about verifying placement if the status is questionable.
161. The nurse is assessing a child diagnosed with a brain tumor. Which of the following signs
and symptoms would the nurse expect the child to demonstrate? Select all that apply.
*
1 point
1. Head tilt
2. Vomiting
3. Polydipsia
4. Lethargy
5. Increased appetite
6. Increased pulse

162. The nurse is evaluating the discharge teaching for a client who has an ileal conduit. Which
of the following statements indicates that the client has correctly understood the teaching? Select
all that apply.
*
1 point
1. “If I limit my fluid intake I will not have to empty my ostomy pouch as often.”
2. “I can place an aspirin tablet in my pouch to decrease odor.”
3. “I can usually keep my ostomy pouch on for 3 to 7 days before changing it.”
4. “I must use a skin barrier to protect my skin from urine.”
5. “I should empty my ostomy pouch of urine when it is full.”

163. A 25 year old patient is inquiring about the methods or ways to detect cancer earlier. The
nurse least likely identify this method by stating:
*
1 point
A. Annual chest x-ray.
B. Annual Pap smear for sexually active women only.
C. Annual digital rectal examination for persons over age 40.
D. Yearly physical and blood examination

164. The removal of entire breast, pectoralis major and minor muscles and neck lymph nodes
which is followed by skin grafting is a procedure called:
*
1 point
A. Simple mastectomy – REMOVE BREAST TISSUE ONLY
B. Modified radical mastectomy – REMOVE EVERYTHING EXCEPT CERVICAL LYMPH NODES
C. Radiation therapy
D. Radical mastectomy

165. Chemotherapy is one of the therapeutic modalities for cancer. This treatment is
contraindicated to which of the following conditions?
*
1 point
A. Recent surgery
B. Pregnancy
C. Bone marrow depression
D. All of the above
166. The nurse is preparing Cyclophosphamide (Cytoxan). Safe handling of the drug should be
implemented to protect the nurse from injury. Which of the following action by the nurse should
be corrected?
*
1 point
A. The nurse should wear mask and gloves. – COMPLETE PPE DAPAT
B. Air bubbles should be expelled on wet cotton.
C. Label the hanging IV bottle with “ANTINEOPLASTIC CHEMOTHERAPY” sign.
D. Vent vials after mixing.

167. Neoplasm can be classified as either benign or malignant. The following are characteristics
of malignant tumor apart from:
*
1 point
A. Metastasis
B. Infiltrates surrounding tissues
C. Encapsulated
D. Poorly differentiated cells

168. 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:
*
1 point
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.”

169. In staging and grading neoplasm TNM system is used. TNM stands for:
*
1 point
A. Time, neoplasm, mode of growth
B. Tumor, node, metastasis
C. Tumor, neoplasm, mode of growth
D. Time, node, metastasis
170. Breast self-examination (BSE) is one of the ways to detect breast cancer earlier. The nurse
is conducting a health teaching to female clients in a clinic. During evaluation the clients are
asked to state what they learned. Which of the following statement made by a client needs
further teaching about BSE?
*
1 point
A. “BSE is done after menstruation.”
B. “BSE palpation is done by starting at the center going to the periphery in a circular motion.”
C. “BSE can be done in either supine or standing position.”
D. “BSE should start from age 20.”

171. . A client had undergone radiation therapy (external). The expected side effects include the
following apart from:
*
1 point
A. Hair loss
B. Ulceration of oral mucous membranes
C. Constipation – DIARRHEA
D. Headache

172. . Nurse Janet is assigned in the oncology section of the hospital. Which of the following
orders should the nurse question if a client is on radiation therapy?
*
1 point
A. Analgesics before meals
B. Saline rinses every 2 hours
C. Aspirin every 4 hours
D. Bland diet

173. Skin reactions are common in radiation therapy. Nursing responsibilities on promoting skin
integrity should be promoted apart from:
*
1 point
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.