STATE EXAMS 21

 Which of the following represents a positive change of pregnancy

a) Morning sickness
b) Quickening
c) Positive pregnancy test
d) Foetal heart beat auscultated with Doppler

 Maria aged 24 years, is a 3 month primagravida, visiting ante natal clinic for the first time.
Maria is concerned that she has not put on any weight. The most appropriate advice would be
a) Due to the babies requirements you need to eat more
b) You need to exercise less or you stress the baby
c) There is no need to put on weight in the first trimester
d) Rest more and eat more carbohydrates

 In order to prevent infection of hepatitis B virus, the pregnant woman should

a) Receive gamma globulin during the first trimester
b) Carefully wash hands before eating or preparing food
c) Receive the hepatitis B vaccine
d) Take AZT during the second and third trimester

 Which of the following represents a recommended weight gain during pregnancy

a) 6 to 11 kgs
b) 11 to 16 kgs
c) 13 to 18 kgs
d) 18 to 20 kgs

 A pregnant woman at 30 weeks gestation exhibits a rise in her baseline systolic blood
pressure of 32 mm Hg, a weight gain of 4 kgs since last week and difficulty removing rings
she normally wears. This is suggestive of
a) Gestational hypertenision
b) Pre eclampsia
c) Eclampsia
d) Elevated liver enzymes

 The primary pathophysiologic basis for the clinical manifestations of pregnancy induced
hypertension (PIH) is
a) Fluid retention related to excessive salt intake
b) Ineffective excretion of fluid by the kidneys
c) Cardiac decompenstion
d) Ineffective dilatation of the vascular network to accommodate the expanding blood
volume of pregnancy

 Which measure would be least effective in relieving the signs and symptoms of mild pre
eclampsia
a) Low salt diet
b) Period of bed rest
c) Balanced diet with protein
d) Relaxation techniques

 A woman with severe pre eclampsia is being monitored for assessment findings indicative of
cerebral oedema and venospasm. Which of the following would you not expect to find
 a) Hypotonic deep tendon reflexes
b) Headache
c) Vision changes including blurring and spots before the eyes
d) Insomnia

 Newly expectant parents, ask the nurse how they can prepare their 3yr old preschool daughter
for the new baby. All of the following would be useful expect
a) tell the child about the pregnancy as soon as mother begins to look pregnant
b) Arrange for a few sleep overs with the person who will care for the child at the time of
the birth
c) Transfer their child to her new room and bed just before the expected birth of the baby
d) Introduce their child to preschool as soon as possible

 Inability to chew might result from damage to which cranial nerve

a) Facial
b) Trigeminal
c) Abducens
d) Vagus

 In most people, the left cerebral hemisphere is more important for which of the following
a) Spoken and written language
b) Space and pattern perception
c) Musical and artistic awareness
d) Imagination

 Which of the following is true concerning the limbic system

a) It is comprised of parts of the cerebrum and diencephalon
b) It assumes a primary function in emotions
c) Both a and b
d) Neither a nor b

 Cooridination of muscular activity is a function of the

a) Cerebral peduncles
b) Cerebellum
c) Thalamus
d) Medulla oblongata

 Which of the following statements is correct

a) Appetite control is a function of the thalamus
b) The midbrain is a conduction pathway and reflex center
c) The cerebellum has sensory centers for thirst and speech
d) Respiratory centers are located in the basal ganglia

 The structure that connects the cerebral hemispheres and facilitates the sharing of cerebral
information is the
a) Corpus callosum
b) Cingulated sulcus
c) Fourth ventricle
d) Aqueduct of sylvius
 The portion of bone laid down first in bone formation is the
a) Matrix
b) Calcium salts
c) Trabeculae
d) Marrow

 What is the most common cause of heart failure (HF)

a) Smoking
b) Diabetes
c) Coronary artery disease
d) Family history

 The action of ACE inhibitors (angiotensin converting enzyme) is

a) Increased urinary output, therefore decreased blood pressure
b) Relax blood vessels, therefore decreased vascular resistance
c) Strengthens cardiac contraction, therefore increase cardiac output
d) Relax cardiac muscle, therefore decrease heart rate

 Hyperkalemia is
a) Increased serum potassium levels
b) Increased serum calcium levels
c) Increased red blood cell count
d) Increased serum chloride levels

 Manifestations of heart failure are

a) Hepatomeglia, pitted dependent edema
b) Increased serum glucose levels
c) Increased appetite and weight gain
d) Decreased respiration and dyspnea

 Nursing interventions associated with your clients taking loop diuretics such as frusimide are
a) Blood sugar levels, dietary fibre
b) Monitoring of weight and K+ levels
c) Blood pressure and urinary output
d) Make sure your client eats ½ hour following administration

 Loop diuretics act by

a) Increasing the blood flow to the glomerular network
b) Decreasing the blood flow to the kidneys therefore decreased urinary output
c) Increased H20 reabsorption in the distal convoluted tubules of the nephron
d) Inhibition complex active pump mechanism therefore increase excretion of electrolytes

 The primary ossification center of long bone is located in which of the following structures
a) Ephipysis
b) Epiphyseal plate
c) Diaphysis
d) Endosterum

 The body tissues affected by rheumatoid arthritis is

a) Adipose
 b) Muscular
c) Connective
d) Epithelial

 The pattern of rheumatoid arthritis is best described by its

a) Chronicity
b) Remissions and exacerbations
c) Little relief from aches and pains
d) A progressive increase in disability

 Rheumatoid arthritis is characterized by

a) Bone pain
b) Sharp tingling sensations
c) Inflammation of the joints
d) Pain and swelling of joints

 Synovial joints are characterized by

a) Articular cartilage
b) Fibrous capsule
c) Joint cavity
d) All of these

 The major support that the muscular system gets from the cardiovascular system
a) A direct response by controlling the heart rate and the respiratory rate
b) Constriction of blood vessels and decrease in heart rate for thermoregulatory control
c) Nutrient and oxygen delivery and carbon dioxide removal
d) Decreased volume of blood and rate of flow for maximal muscle contraction

 Manifestations of right sided heart failure are

a) Fatigue, cyamosis, blood tinged sputum
b) Anorexia, complaints of gastrointestinal distress, fatigue and pitted edema
c) Dyspnea, orthopnea and cyanosis
d) Fatigue dependant edema and cough

 Nursing intervention necessary prior to the administration of digoxin is

a) Palpation of arterial pulse less than 60 beats/minute
b) Palpation of venous pulse less than 60 beats/minute
c) Palpation of arterial pulse greater than 60 beats/minute
d) Palpation of pedal pulse less than 60 beats/minute

 Left sided heart failure affects directly the

a) Liver and extremities
b) Lungs
c) Level of consciousness
d) Lungs and extremities

 Basic nursing objectives in the treatment of HF are

a) Start heparinization immediately
b) Nursing the client in trendlenberg position
c) Promote rest therefore decrease workload on heart and decrease H20 accumulation
d) Assess levels of consciousness and give 02 61/min via Hudson mask
 Define a cerebral vascular accident (CVA)
a) Sudden loss of consciousness due to a decreased contractility of the cardia
b) Loss of brain function due to disruption of blood supply to the brain
c) Intermittent spasms of blood vessels interrupting blood flow to the brain
d) Neurologic dysfunction due to diminished blood flow to the cranium

 Cerebral thrombosis is
a) Most common cause of a stroke
b) Originates from a large vessel and lodges in the brain
c) May be caused by an arterial spasm in the brain
d) Usually occurs during strenuous exercise

 Risk factors of CVA that cannot be altered are

a) Sex, race and raised blood cholesterol levels
b) High BP, previous TIA
c) Race, prior stroke and overweight
d) High BP, previous TIA and increased blood cholesterol levels

 A person who has experienced a right CVA may present with

a) Receptive or expressive aphasia
b) Right hemiplegia
c) Left hemiplegia
d) Deficit of new language information

 Where and what is the circle of willis

a) A capillary meshwork found in bowmans capsule of the nephron
b) A vascular network at the base of the brain
c) A roundabout at the top[ of bank st
d) The capsule membrane of a malignant growth

 List the 3 main causes of stroke

a) Cerebral haemorrhage, thrombosis, embolism
b) Cerebral thrombosis, infarction, aneurysm
c) Cerebral embolism, metastatic lesions, coagulopathy
d) Cerebral ischemia, vascular spasms, hypoxia

 Angina symptoms include

a) Radiating pain, decreased BP and increased pulse
b) Shortness of breath, loss of consciousness and these effects may last indefinitely
c) Ringing in the ears, anxiety and cramping in the extremities
d) Shortness of breath, sweating, nausea and tiredness

 Emphysema is
a) An alveolar disease
b) Due to hypertrophy and hyperplasia of bronchial glands
c) Persistent episodes of productive cough
d) An airway disease
 The term blue bloater refers to
a) Decreased erythropoietin production therefore decreased 02 carrying capability of the
RBC
b) Polycythemia and cyanosis from right ventricular failure
c) Cyanosis due to decreased RBC production
d) Increased BP due to high blood volume or fluid overload

 Bronchitis is
a) Results from a breakdown in the normal lung defence mechanisms
b) Destruction of alveolar
c) Due to enlarged terminal non respiratory bronchioles and alveolar walls
d) History of daily productive cough that last at lease 3 months, for 2 years

 Emphysema is characterised by
a) Fat people due to decreased activity tolerance
b) Unproductive cough and pursed lip breathing
c) Pursed lip breathing and productive cough
d) Blue bloater, normal skin colour and rapid respirations

 Nursing interventions for the CORD patient include everyone of these except
a) Improve ventilation
b) Remove secretions
c) Prevent complications
d) Promote cooperation and understanding
e) Encourage exercise to test tolerance levels

 Bronchodilators
a) Aid the movement of secretions
b) Liquefy the sputum therefore increase expectoration
c) Include aminophylline for the acute exacerbation
d) Are only used in emergency cases

 Corticosteroids are used

a) Prophylactically in most cases
b) To aid in vitamin D synthesis
c) To aid the liquefaction and expectoration of sputum
d) Used during the acute exacerbation of CORD

 The foetal presenting part is described as vertex when the

a) Face enters the pelvis first
b) Buttocks emerge with legs extended over the abdomen
c) Flexed head enters pelvis first
d) Foetal lie is longitudinal

 When examining the umbilical cord immediately after birth the nurse should expect to
observe
a) One artery
b) Two veins
c) Whitish grey colouration
d) Slight odour
 Vitamin K is given to the newborn to
a) Reduce bilirubin levels
b) Increase the production of red blood cells
c) Stimulate the formation of surfactant
d) Enhance the ability of the blood to clot

 The nurse is performing a 5 minute apgar on a newborn. Which of the following observations
is included in the apgar score
a) blood pressure
b) Temperature
c) Muscle tone
d) Weight

 At birth the major cause of heat loss is by

a) Evaporation
b) Radiation
c) Conduction
d) Convection

 Following the birth of graces baby, a healthy male, you are assisting grace to feed her baby
for the first time. The action of prolactin at this time
a) Immediately stimulates full milk production
b) Stimulates involution
c) Is inhibited until progesterone and oestrogen levels have decreased
d) Is not influenced by other hormones

 A newborns birth weight is 3400 grms. The maximum expected weight loss for this newborn
would be
a) 170 gms
b) 340 gms
c) 510 gms
d) 680 gms

 The birth weight of a breast feed newborn was 3600 grms. On the third day the newborns
weight was 3350 grms. The nurse should
a) Encourage the mother to continue breast feeding as her babys nutrient and fluid needs are
brin met
b) Suggest that the mother switch to bottle feeding as breast feeding is ineffective in meeting
her babys needs
c) Notify the doctor as the baby has lost too much weight
d) Refer the mother to a lactation consultant to improve her breastfeeding technique

 Which of the following would be an unexpected sign of dehydration in the newborn

a) Weight loss
b) Reduced turgor
c) Concentrated urine
d) Decreased frequency and amount of urine
 A breast fed baby will have bowel motions
a) That are yellow and runny at least twice a day
b) May go 2-3 days without a bowel motion
c) Will pas meconium for a shorter period
d) Establishes a very regular pattern of bowel motions

 Supplementary fluids for babies

a) Are advisable to prevent jaundice
b) Are needed for the baby under phototherapy
c) May be required if the mother has had a caesarean section
d) Are unlikely to be needed if the mother is breast feeding

 Lucy is charted 5 mls of augmentin ‘125’ T.D.S. you notice the doctor hasn’t signed the order
form. A senior colleague tells you to give it. You respond by
a) Giving the medication as ordered
b) Contacting the doctor to sign the order
c) Asking lucy if the doctor told her she would have this
d) Signing the form for the doctor

 The augmentin is given to lucy. she is found to be allergic when she exhibits
a) Tinnitus and vertigo
b) Wheezing and urticaria
c) Abdominal cramps and diarrhoea
d) Blurred vision and ataxia

 Jack is 15 years old. He is admitted to the hospital after briefly loosing consciousness when
tackled during a rugby game. Which of the following is an indication of increasing
intracranial pressure
a) Change in his level of consciousness
b) Anorexia and thirst
c) Increased pulse and respiration rates
d) Blurred vision and halos around lights

 Jack has had two seizures while hospitalised. These have been controlled by anticonvulsant
medications. Jack and his family must understand
a) The medication must be taken for at least one year
b) The doctor should be seen when the prescription has finished
c) The medication will be discontinued on discharge
d) The medication will be necessary for the rest of his life

 Jack is prescribed rivotril 8 mgs daily. He weighs 68 kgs. The initial doses for 2-3 days
should no exceed 0.01 mgs/kg/day. Your nursing responsibility is to
a) Observe for any side effects after giving the drug
b) Contact the doctor to reassess the dose prescribed
c) Consider his weight loss and administer the dose prescribed
d) Check with the charge nurse prior to administration

 Oral suspension of rivotril, 2.5 mgs per ml is available to administer 1.8 mgs you will give
a) 0.53
b) 0.72
 c) 5.3 mls
d) 7.2 mls

 Jack is concerned about returning to school. He should be encouraged to

a) Take leave of absence for a semester
b) Initially, attend school only part time
c) Plan an alternative lifestyle
d) Resume all previous activities

 James aged six weeks, is admitted with a history of frequent vomiting after feeding. The most
important nursing assessment specific to this would be to observe for
a) Pain in his abdomen
b) The amount and frequency of his vomits
c) The type of milk mixture he is having
d) The level of his hydration

 His vomiting is described as projectile, this means

a) It has an unusual colour
b) It is a forceful vomit
c) It is curd like in appearance
d) He has frequent spills

 James is diagnosed to have pyloric stenosis. This requires surgery to

a) Increase the opening to the pyloric sphincter
b) Stretch james stomach to cope with fluids
c) Decrease the opening in the cardiac sphincter
d) Put in a gastroscopy tube to bypass the stomach

 James is prepared for surgery by

a) Having a sedative four hours pre operatively
b) Being hydrated with IV fluids
c) Amusing him to keep him alert
d) Feeding him on demand to keep him contented

 James weighs 3.4 kgs. His fluid requirement is 150 ml/kg/day. To maintain his hydration
james requires
a) 20 mls per hour
b) 27 mls per hour
c) 23 mls per hour
d) 22 mls per hour

 James mother is living in. She is breast feeding james. Nursing consideration for her should
include
a) Plenty of rest and distraction
b) Education about breast feeding
c) Providing privacy and means to express milk
d) Checking her breasts for cracked nipples

 James returns from theatre with an apnoea monitor. This is used to monitor
a) The rate of james breathing
 b) The length of his sleeping
c) The length of time between breaths
d) Delays between breaths exceeding 20 seconds

 You are a staff nurse working in a rehabilitation unit. Carl is 12 years old. He was involved in
a road traffic accident and sustained a head injury. He has been unconscious for four weeks.
You are his primary nurse. While providing his nursing care you will
a) Encourage his mother to always help you
b) Talk to him clearly in a normal voice
c) Provide him with intensive stimulation
d) Offer him drinks to check his swallow reflex

 It is important to assess his level of consciousness. The first definite sign of consciousness is
when
a) His eyes begin to open
b) His facial expression changes
c) He has involuntary body movement
d) He has plantar flexion of his feet

 Carl has a dense r) hemiplegia and some spasticity to his L) limbs. To improve his ability to
ambulate in the future it is important he
a) Always has his limbs extended when resting
b) Is turned to alternate sides two hourly
c) Has his joints flexed and rotated regularly
d) Maintains a healthy well balanced diet

 Carl is beginning to make progress and is relearning skills. When encouraging carls
relearning of feeding you
a) Let him have a spoon and do his best
b) Occasionally try to tell him the right way to feed himself
c) Teach him in small steps and progress at his rate
d) Take over when he makes a mess

 Carl is learning to communicate with signals. He is using his eyes to indicate yes and no. To
encourage him to use these signals you
a) Give carl a range of choices to facilitate a decision
b) Discontinue his care until he has communicated
c) Reprimand carl and explain to him he must communicate
d) Give two choices to facilitate decision making

 Carl is becoming irritable and communicating with loud noises which are disruptive. He
reacts to visitors and the phone ringing. To help lessen this reaction you should
a) Get some sedation charted for him
b) Use a mild punishment when he is disruptive
c) Try and find out what is really bothering him
d) Provide him with something interesting to quieten him

 Carl is to go home for two weeks with his family. They have bee3n visiting him 2-3 times a
week and feel they can cope with him at home. In planning his discharge you would
a) Provide community contacts the family can assess
b) Encourage the parents to cope without help
c) Provide a daily schedule which is to be adhered to
d) Encourage the parents to phone if necessary
 Hypertension, oedema and proteinuria (GPH) syndrome commonly occurs in women who
a) Have essential hypertension
b) Have diabetes mellitus
c) Are primigravidas
d) All of the above

 Martin is a 6 months old, admitted in acute respiratory distress. His mother has accompanied
him to hospital and is very anxious. Which isgn of repiratory distress is evident in children
and not adults
a) Rasping respirations
b) Slow respiratory rate
c) Blue peripheries
d) Intercostals indrawing

 Martin has a hoarse cough and is wheezing. Further assessment is important. Select the most
appropriate question to initially ask his mother.
a) When did martin first start coughing and wheezing
b) How long since martin last had a drink
c) Was martin playing with toys with small pieces
d) Has martin had any medication recently

 His diagnosis is bronchiolitis. He requires oxygen therapy for at least 24 hours. Which is the
most appropriate method of administration of oxygen for your client
a) Oxygen tent
b) Mask
c) Nasal prongs
d) Head box or cone

 Which is the most important nursing observation to consider for a child having oxygen
therapy
a) Monitoring his oxygen saturations regularly
b) Visual observation of childs respiratory status
c) Doing pulse and respiration recordings
d) Analysis of level of oxygen in the tent

 Martins mother states, im not getting enough rest here and im tired and cant cope anymore.
Which is the best response to this statement
a) You need to go home and rest to have a break
b) Why hasnt your family helped you with martins care
c) Shall i get a hospital grandparent for you
d) If youd like to have a break, i’ll look after martin for you

 Which of the following factors does research show most assists caregivers to cope with their
childs hospitalization
a) Control of decision making
b) Individualised care
c) Knowledge of what to expect
d) Time away from the child
 Jenny aged 4 was brought to the emergency clinic while having an acute asthma attack.
Jennys breathing would be characterized by
a) Grunting inspirations
b) Wheezing on expiration
c) Frequent periods of apnoea
d) Laboured abdominal breathing

 Nursing measures for a child suffering from an acute asthma attack would be
1. Management of IV fluids and oral fluids
2. Administering medications as ordered
3. Keep the child on flat bedrest until the acute attack is over
4. Assisting with positive pressure breathing as ordered
a) All of these
b) 1 and 2
c) 1, 2 and 4
d) 1, 3 and 4

 Jenny is 3 years old, she has been admitted with acute asthma. Jenny requires IV
aminophylline. It is charted at 56 mg. Each vial contains 250 mg in 10 mls. You calculate the
correct dose, which is
a) 3.16 mls
b) 0.4 mls
c) 1.25 mls
d) 2.24 mls

 Jenny appears to have a secondary infection and is prescribed 375,000 units of penicillin. The
vial contains 600,000 units in 2 mls. Calculate the amount jenny requires for one dose
a) 1.25 mls
b) 0.625 mls
c) 0.125 mls
d) 0.32 mls

 The nurse encourages jennys mother to stay with her as much as possible. The rationale for
this is which of the following
a) Mothers of hospitalized children often experience guilt
b) The mothers presence will reduce anxiety and ease the childs respiratory efforts
c) Separation from mother is a major developmental threat at this age
d) The mother can provide constant observations of the childs respiratory efforts

 Jenny is to have ventolin nebulisers every two hours until respirations improve. She becomes
distressed as soon as you try to put the mask on her face. You would best manage this
situation initially by
a) Getting her mother to assist with administration
b) Not giving it to her as being distressed may make her worse
c) Realising the importance of the ventolin so forcing it on her
d) Letting her have a mask to play with

 As jennys condition improves she is to commence oral medication. Which approach is most
likely to gain compliance
a) Its time for your medication now, would you like to drink it with a straw or from a glass
b) Wouldn’t you like to take your medicine now
c) You must take your medication, because the doctor says it will make you better
d) See how nicely Johnny took his medicine, now take yours
 An asthmatic child is charted IV aminophylline. Your responsibility prior to the giving of this
drug would include checking
1. The drug with a registered nurse
2. The childs dose in relation to her weight
3. The childs identity by calling by name
4. The correct route of the drug
a) All of these
b) 1, 2 and 4
c) 1 and 4
d) 2 and 3

 A preschooler is febrile and requires 4 hourly temperature recordings. The most appropriate
method would be
a) Orally
b) Rectally
c) Orally or axillary
d) Axillary

 Christina age 10 is admitted to your unit with a diagnosis of rheumatic fever. You are her
primary nurse. The causative organism for rheumatic fever is
a) Haemophilus influenza
b) Staphylococcus bacteria
c) Syncytial virus
d) Group a streptococcal bacteria

 The most serious complication of rheumatic fever is

a) Endocarditis
b) Pneumonia
c) Arthritis
d) Meningitis

 Christina is admitted to your unit. You are her primary nurse. Your responsibilities will be to
a) Do an assessment and history appraisal
b) Orientate her to the area
c) Establish a trusting relationship
d) Do all of the above

 Which of the following would support a diagnosis of chickenpox

a) Chills, headache, malaise
b) Nausea, vomiting, diarrhoea
c) Kopliks spots, photo phobia, fever
d) Sore throat, chills, fever

 You are a practice nurse and kevins mother asks for advice on how to care for Kevin at home.
Aims of care for Kevin are
a) Ensure rest and relieve itching
b) Maintain hydration and isolate Kevin
c) Maintain hydration and relieve itching
d) Ensure rest and isolate Kevin

 Kevins mother asks you when she can send him back to kindergarten. You advise
a) When all spots have gone
b) In one weeks time if temperature is normal
c) He is not contagious now spots have appeared
 d) When all spots are dry and crusted

 Kevins mother asks you why the chicken pox immunisation is not offered as part of the
immunisation programme
a) There is no vaccine for chickenpox
b) There are no major sequelae of chicken pox
c) The public would not accept another immunisation
d) The vaccine for chicken pox is too expensive

 You are a practice nurse. Dannys mother phones you. Danny is 18 months old. She is
concerned over his difficulty with respirations and ‘barking’ cough. You suspect he may have
laryngotracheobronchitis (croup). The characteristic crowing sound of respirations in croup is
a) Stridor
b) Rhonchi
c) Wheeze
d) Rales

 Which of the following comments by dannys mother most strongly supports a diagnosis of
croup
a) Hes been very lethargic and drowsy these last few days
b) His older sister has bad asthma since she was 7 years old
c) He seems to cough much more when hes lying down
d) He had the flu a week ago

 Dannys mother should be instructed to watch for signs of worsening respiratory status,
including which of the following
a) Low grade fever
b) Productive cough
c) Increased restlessness
d) Hoarse voice

 Danny shows signs of acute respiratory distress, and his mother brings him to the accident
and emergency clinic. Which of the following changes in vital signs would the nurse expect
to note
a) Bradycardia, tachypnea
b) Bradycardia, bradypnea
c) Tachycardia, tachypnea
d) Tachycardia, bradypnea

 Ongoing assessment of danny includesregular oximetry readings. The reading changes to

75%. Your immediate reaction is to
a) Increase the level of oxygen being administered
b) Check the accuracy of the oximeter
c) Visually check the childs respiratory status
d) Go and get someone to check your recordings

 Dannys health improves, he is able to go home. His mother says i have used all my money to
get the taxi here. I cannot get home. Your response is
a) Thats okay, i’ll pay for thetaxi for you
b) You cant stay here, this is an emergency clinic
c) Can i ring someone else at home for you
 d) You can use a credit card with the taxi

 Dannys mother bursts into tears. I don’t want to go home because my husbands drunk and
he’ll beat me. Your response is
a) Would you like to talk about this in a quieter place
b) Shall we ring him to see if hes sober yet
c) I’ll contact a social worker for you
d) How often does he get drunk and beat you

 At the time of leonards admission to hospital, it would be impossible to accurately predict the
neurological deficit that would ultimately be left because
a) With correct alignment of the severed sections of cord, some healing of fibres will occur
b) Some of his symptoms may be the result of spinal shock rather than severance of the cord
c) If the cord has been severed cleanly, it may be possible to suture the tracts together
d) It is impossible for the spinal tracts to heal until the disrupted blood vessels supplying
the cord regenerate

 Reflex control over the bowel and bladder functions following spinal injury is expected to be
regained. This control over evacuation may develop because
a) Initial bowel and bladder problems result more from psychological than from physical
injury
b) Some of the severed motor fibres will reconnect, permitting impulse transmission
c) With mobilisation and improved circulation, muscle control will improve
d) Return of parasympathetic activity will permit automatic emptying of bladder and bowel

 Which of the following actions should you take if a patient you know to have cancer asks if
the lump that was removed is malignant
a) Say yes and sit down and discuss this with her
b) Gloss over the question and talk about something else
c) Tell her it was benign, in case she is not supposed to know yet
d) Acknowledge your lack of seniority and ask the charge nurse to talk to her

STATE EXAMS 22

 The three meningeal layers of the spinal cord include

a) Spinal meninges, cranial meninges, conus medullaris
b) Cauda equine, conus medullaris, filum terminale
c) White matter, gray matter, central canal
d) Dura mater, pia mater, arachnoid

 The caudia equine is a complex of the spinal cord that includes

a) The enlargements of the cervical and thoracic regions of the cord
b) The posterior and anterior median sulci
c) The coccygeal and dentricualte ligaments
d) The filum terminale and the ventral and dorsal roots caudal to the conus medullaris

 The epidural space is an area that contains

a) Blood vessels and sensory and motor fibers
b) Loose connective tissue, blood vessels, adipose tissue
c) A delicate network of collagen and elastic fibers
d) The spinal fluid
 In the spinal cord the cerebrospinal fluid is found within the
a) Central canal and subarachnoid space
b) Subarachnoid and epidural spaces
c) Central canal and epidural space
d) Subdural and epidural spaces

 Pain receptors are literally the

a) Dendrites of sensory neurons
b) Axons of motor neurons
c) Specialized cells that respond to a limited range of stimuli
d) Activators of motor neurons

 Cranial nerves, III, IV, VI and XI which provide motor control are
a) Trigeminal, facial, glossopharyngeal, vagus
b) Oculomotor, trochlear, abducens, spinal accessory
c) Olfactory, optic, vestibulocochlear, hypoglossal
d) Oculomotor, hypoglossal, optic, olfactory

 The cranial nerves that carry sensory information and involuntary motor commands are
a) I, II, III, IV
b) II, IV, VI, VIII
c) V, VI, VIII, XII
d) V, VII, IX, X

 The corneal reflex produces

a) Closure of the eye due to neural stimulation
b) Rapid blinking of the affected eye following contact to the cornea
c) Eye movement in the opposite direction of the stimulus
d) Constriction of the pupil of the eye

 Which of the following effects would be the result of sympathetic activity

a) Dilation of pupils of the eye
b) Constriction of blood vessels of the viscera
c) Increased heart rate
d) All of these

 The sympathetic division is primarily concerned with which activity

a) Conserving the bodys energy
b) Restoring the bodys energy levels
c) Expending energy and preparing to combat stress
d) Lessening the bodys level of arousal

 A sudden sound behind and to the right, which causes a rotation of the eyes, head, and neck to
that side, is a response to the
a) Vestibule ocular reflex
b) Consensual light reflex
c) Auditory reflex
d) Tympanic reflex

 Jack is 19 years old. He is admitted to the hospital after briefly losing consciousness when he
was tackled during an anzac day football game. During the neurologic assessment the nurse is
careful to note and report the following response by jack
a) He did not know the name of the hospital
 b) He could not remember the name of the nurse
c) He said the month was june
d) He could not remember the incident of the football field

 is generally relieved by sitting up in a forward leaning position

a) Hyperpnoea
b) Orthopneoea
c) Apnoea
d) Dyspnoea on exertion

 In a client with emphysema, hypoventilation could initially cause

a) Respiratory alkalosis
b) Respiratory acidosis
c) Metabolic acidosis
d) Metabolic alkalosis

 A client is anxious and is hyperventilating. In order to prevent respiratory alkalosis the nurse
will
a) Administer oxygen
b) Instruct the client to pant
c) Have the client breathe deeply and slowly
d) Have the client breathe into a paper bag

 A district nurse is sent to assess a new client with cor pulmonale. This term refers to
a) Enlargement of the pulmonary artery
b) Enlargement of the right ventricle
c) Atrophy of the right ventricle
d) Giant bullae growth on the lung

 Tony buffer, 54 years old, has a long history of smoking. He decides to have lung and blood
studies done because he is very tired, is short of breath, and just does not feel good. His blood
gases reveal the following findings: pH 7.3; HCO3, 27; CO2 58. Tonys condition may be
a) Respiratory alkalosis
b) Metabolic acidosis
c) Respiratory acidosis
d) Metabolic alkalosis

 When giving advice to a vegetarian, you would suggest a good source of protein would be
contained in
a) Cereal and grains
b) Vegetables and fruits
c) Eggs and cheese
d) Beans and lentils

 Iron is important for healthy red blood cells. what other nutrients are also important
a) Vitamin E and vitamin c
b) Vitamin B12 and vitamin E
c) Folic acid and vitamin B12
d) Ascorbic acid and folic acid

 The bodys need for ascorbic acid and iron are inter related because
a) Iron assists in the use of ascorbic acid
b) Iron assists in the transport of ascorbic acid
c) Ascorbic acid assists the transport of iron
 d) Ascorbic acid assists the absorption of iron

 The term phenylketonuria refers to a disorder involving

a) Increased sugar in the urine
b) Inability to metabolise some fats
c) Excessive breakdown of red blood cells
d) Inability

 A 79 year old client has pale, cold feet bilaterally, no hair tufts on toes, and a circumscribed 3
cm lesion on the plantar surface at the first metatarsal joint. Which of the following is the
most likely source of the clients problem
a) Insufficient venous circulation
b) Venous thrombosis
c) Expected age related physiological changes
d) Insufficient arterial circulation

 On assessing an older client the nurse notes that the left leg is swollen and warm, with
papable pedal pulses; an open, wet ulcer above the medial malleolus, and thick, course, brown
pigmented skin surrounding the ulcer. The probable cause of the ulcer would be
a) Acute deep vein thrombosis
b) Chronic venous insufficiency
c) Chronic arterial insufficiency
d) Chronic lymphoedema

 A client is admitted to ED following a car accident. He complains of abdominal discomfort.

The nurse encourages the client to lie down. The reason for this action is
a) To decrease abdominal pain
b) To decrease the risk of dislodging an intra abdominal clot
c) To facilitate peristalsis
d) To decrease the risk of peritoneal infection

 A client sustained moderate concussion. He has a Glasgow coma scale score of 7. Which of
the following interventions would you include in your care plan
a) Decrease stimuli, monitor vital signs and neurological status nurse him flat on his back
b) Gradually increase stimuli, monitor vital signs and neurological status, elevate the head of
the bed 60 degrees
c) Encourage family involvement, reduce monitoring at night to allow client to rest, elevate
the head of the bed 60 degrees
d) Decrease stimuli, monitor vital signs and neurological status elevate the head of the bed
30 degrees, positioning the client on his side

 James has sustained a fracture of his left lower leg in a car accident. Classical signs of a
fracture may include
a) Intermittent pain, flushing of surrounding tissues and vascular spasm
b) Local bone tenderness, soft tissue swelling and inability to use extremity
c) Neural compromise, sharp stabbing pain and obvious ischaemia of the extremity
 d) Blanching, hyperextension and parasthesia

 Monitoring for compartment syndrome is done by checking for

a) Active movement of the limb
b) Colour, warmth, sensation and movement of the extremity
c) Pulse and blood pressure changes
d) The tightness of the plaster cast

 On assessment, the nurse suspects that james is developing compartment syndrome because
he complains of
a) Severe pain, motor compromise and a ‘pins and needles’ sensation
b) A radiating pain and loss of two point discrimination
c) Swelling, muscle atrophy and intermittent parasthesia
d) Dull aching, spasms and lack of fine co ordination

 A comminuted fracture is characterised by

a) A partial break in bone continuity
b) Injury in which two bones are crushed together
c) An injury in which the bone is broke into two or more pieces
d) An injury in which the bone fragments have broken through the skin

 A client with multiple fractures is at risk for a fat embolism. What early sign should you
monitor for
a) Haematuria
b) Mental confusion or restlessness
c) Sudden temperature elevation
d) Pallor and discolouration at the fracture site

 Following an application of a full arm cast a client complains of deep throbbing elbow pain.
You note diminished capillary refill in the fingers. You should
a) Notify the doctor immediately and prepare to bivalve the cast
b) Cut a window in the cast over the elbow area and check for infection
c) Elevate the arm, aply ice packs and assess hourly
d) Administer prescribed analgesics and notify the doctor

 When assessing a patient at risk for increased intracranial pressure, the first thing you would
check is
a) Reaction to pain stimuli
b) Papillary function
c) Level of consciousness
d) Motor function

 Pupillary dilation occurs when herniating brain tissue

a) Compress the occulomotor nerve
b) Chokes the optic disks
c) Stretches the optic nerve
d) Paralyses th occulare muscles

 Changes in vital signs with increasing intracranial pressure would include

a) Hypotension and tachycardia
b) Narrowing pulse pressure and tachypnea
c) Hypotension and a pulse deficit
d) Widening pulse pressure and bradycardia
 Bleeding within the skull results in increased intracranial pressure because
a) Arteries bleed rapidly and profusely
b) Bleeding from veins goes undetected
c) Spinal fluid is produced more rapidly
d) The cranium is a closed ,rigid vault

 Which patient is at highest risk for pulmonary embolus

a) A 25 year old man with a history of alcohol abuse recuperating from a gastric ulcer
b) A 36 year old woman on a liquid diet beginning an exercise programme
c) A 40 year old, obese, pregnant woman placed on bed rest
d) A 90 year old man with no identified health problems

 James has sustained a fracture of his left lower leg in a car accident. Classical signs of a
fracture may include
a) Intermittent pain, flushing of surrounding tissues and vascular spasm
b) Local bone tenderness, soft tissue swelling and inability to use extremity
c) Neural compromise, sharp stabbing pain and obvious ischaemia of the extremity
d) Blanching, hyperextension and parasthesia

 Monitoring for compartment syndrome is done by checking for

a) Active movement of the limb
b) Colour, warmth, sensation and movement of the extremity
c) Pulse and blood pressure changes
d) The rightness of the plaster case

 On assessment, the nurse suspects that james is developing compartment syndrome because
he complains of
a) Severe pain, motor compromise and a ‘pins and needles’ sensation
b) A radiating pain and loss of two point discrimination
c) Swelling, muscle atrophy and intermittent parasthesia
d) Dull aching, spasms and lack of fine co ordination

 Uraemia is a clinical syndrome associated with

a) Retention of urea and other nitrogenous wastes
b) The presence of urine in the blood
c) The presence of blood in the urine
d) High ammonia excretion

 Spinal anaesthesia is inserted in to the

a) Intravenous space
b) Sacral canal
c) Dural membrane
d) Subarachnoid space

 To monitor abdominal distension you should

a) Assess bowel sounds every shift
b) Measure abdominal girth at the umbilicus every 24 hours
c) Measure abdominal girth every shift, using two fixed points
d) Weigh the patient every shift

 The fluid outside the vascular system, which surrounds tissue cells, and which includes lymph
is called
a) Interstitial fluid
b) Extracellular fluid
 c) Intravascular fluid
d) Intracellular fluid

 When there is a decrease in blood volume (as in dehydration or blood loss), the body reacts
by retaining sodium and thus water. This occurs mainly as a result of adrenal gland secretion
of
a) Aldosterone
b) Antidiuretic hormone (ADH)
c) Cortisol
d) Parathyroid hormone

 Which of the following is a defining characteristic for a nursing diagnosis of ‘fluid volume
deficit’
a) Distended neck veins
b) Weak, rapid pulse
c) Moist rales in lungs
d) Bounding, full pulse

 The nurse should assess carefully for hypervolaemia, (fluid volume excess) when working
with the client with
a) Nausea and vomiting
b) Kidney failure
c) Decreased fluid intake
d) Blood loss

 Which is probably the most accurate indication of a clients fluid balance status
a) Intake and output record
b) Skin turgor
c) Daily weight
d) Complete blood count

 When receiving your patients serum potassium results over the phone, you discover the
results was 2.3mEq/L. Your first action is to
a) Give potassium supplements
b) Take the patients pulse
c) Call the doctor
d) Advise the patient of the result

 Two signs of respiratory depression are

a) Decrease in muscle reflexes and mobility
b) Lowered respiratory rate and shallow breathing
c) Decreased level of consciousness and hypotension
d) Bradycardia and petechiae

 You must not give a pre operative patient food and fluids 2 hours before the surgery due to
a) The digestion of food and fluid interferes with the action of some anaesthetic drugs
b) The potential for fluid volume overload
c) The risk for hypernatraemia due to the salt content in the food
d) Stomach contents increase the risk of aspiration

 An adverse side effect of spinal anaesthesia is

a) Restlessness
b) Hypotension
c) Loss of sensation
 d) Drowsiness

 Three days post op, a patient develops a bowel obstruction. The nurse should prepare the
patient for
a) Administration of medications to stimulate peristalsis
b) Insertion of a nasogastric or intestinal tube
c) Transfer to the intensive care unit
d) Emergency surgery

 When assessing a patient at risk for increased intracranial pressure, the first thing you would
check is
a) Reaction to pain stimuli
b) Pupilalry function
c) Level of consciousness
d) Motor function

 Which symptoms should make the nurse suspect pulmonary embolus (PE)
a) Changes in pulse rate and a slowly rising blood pressure
b) Frothy sputum and slow, deep respirations
c) Shortness of breath, chest pain and anxiety
d) Crackles in the lung bases and pursed lip breathing

 When you check the time tape on your clients IV bag, you note that the proper amount has not
been infused. The prescribed rate is 200 ml/hour but in the past hour only 100 mls have
infused. Your first action should be to
a) Call the physician for a new order
b) Adjust the roller clamp and increase the rate to 300 ml/hour to catch up
c) Restart the IV at a different site
d) Count the drops per minute to be sure it is running at a rate of 200 ml/hour

 In evaluating for complications of IV therapy, which of the following are evidence that the IV
has infiltrated
a) In the past hour, only 50ml of fluid have infused
b) The insertion site is red, hot and swollen
c) The clients temperature has gone up to 38oC
d) The site is pale, cool, swollen and painful

 Swelling and paleness of the skin at the venipuncture site could be indicative of
a) Infiltration
b) Phlebitis
c) Infection
d) Air embolism

 Mr smith is to have one litre of normal saline Iv over 6 hours. The giving set has a drop factor
of 10. The correct flow rate would be
a) 14 dpm
b) 28 dpm
c) 140 dpm
d) 280 dpm

 John has been prescribed dextrose/saline 125 mls per hour IV. The giving set has a drop
factor of 60. The correct flow rate would be
a) 125 dpm
b) 120 dpm
 c) 60 dpm
d) 65 dpm

 Hone has been prescribed plasmolyte 500 mls over 2 hours IV. The giving set has a drop
factor of 10. The correct flow rate would be
a) 24 dpm
b) 42 dpm
c) 84 dpm
d) 48 dpm

 The optimal position for the comatose patient is

a) Prone
b) Supine
c) Semi fowlers
d) Side lying
e) High semi fowlers

 Which of the following would a nurse be testing if she asked a 65 year old patient questions
like, ‘what day is it’, ‘what time is it’ ‘what month is it’
a) Intelligence
b) Perception
c) Orientation
d) Personality

 When a person experiences loss or decreased sensation of pain, temperature and touch, the
major nursing concern will be meeting their need for
a) Communication
b) Nutrition
c) Safety
d) Belonging

 When caring for a patient with aphasia, you should

a) Talk loudly so she can hear you
b) Refrain from giving explanations about procedures
c) Provide as much environmental stimuli as possible to prevent feelings of isolation
d) Consider the type that the person has and adapt communications methods accordingly

 Narcotics are given as preanaesthetic medication to

a) Decrease oral secretions
b) Reduce the risk of intra operation DUT
c) Decrease postoperative pain
d) Reduce postoperative nausea and vomiting

 Clinical manifestations of hypovolaemic shock include all except

a) A fall in blood pressure
b) A decreased urinary output
c) A weak, rapid, thread pulse
d) Warm moist skin
 Your clients physician writes an order for antibiotics stat that you feel is too high a dosage for
that client. What should your reaction to this order be
a) Administer the drug as prescribed since the physician is legally responsible for any
mistakes in the order
b) Check with the prescribing physician before administering the drug
c) Administer the drug first since it is a stat drug, and then check with the physician
d) Check with the client about dosages administered to him in the past and compare this
response to the ordered dosage

 The area of the greatest degree of flexibility along with the vertebral column is found from
a) C3 – C7
b) T1 – T6
c) T7 – T12
d) L1 – L5

 The only ankle bone that articulates with the tibia and the fibula is the
a) Calcaneus
b) Talus
c) Navicular
d) Cuboid

 Severe fractures of the femoral neck have the highest complication rate of any fracture
because
a) Primary limits are imposed by the surrounding muscles
b) Of the restrictions imposed by ligaments and capsular fibers
c) Of the thickness and length of the bone
d) The blood supply to the region is relatively delicate

 The purpose of myoglobin in skeletal muscle cells is

a) Assist anaerobic reactions
b) Store oxygen for use during vigorous exercise
c) Catabolise pyruvic acid
d) All of these

 With a milk product free diet, which of the following supplements would you need
a) Vitamin C and iron
b) Iron and phosphorous
c) Calcium and manganese
d) Vitamin C and riboflavin

 Protein should be eaten as it

a) Reduces the risk of anaemia
b) Ensures an adequate supply of energy
c) Assists the body to produce new tissues
d) Maintains the bodys protein stores

 Miss blake has suddenly had a cardiac arrest. What is the critical time period that the nurse
must keep in mind before irreversible brain damage occurs
a) 1-3 minutes
b) 8-10 minutes
c) 2-4 minutes
d) 4-6 minutes
 David white is in the hospital with a medical diagnosis of viral pneumonia. He is getting
oxygen via a simple face mask. Why must it fit snugly over the clients face
a) Prevents mask movement and consequent skin breakdown
b) Helps the client feel secure
c) Maintains carbon dioxide retention
d) Aids in maintaining expected oxygen delivery

 The Heimlich manoeuvre is described in which of the following statements

a) Arms encircling persons waist from behind with firm abdominal thrusts
b) Quick, forceful blow with fist on clients sternum
c) Sweeping out foreign objects form clients mouth with fingers
d) Sharp blow on centre of clients back

 In teaching a patient about foods that affect his fluid balance, the nurse will keep in mind that
the electrolyte which primarily controls water distribution throughout the body is
a) Sodium
b) Potassium
c) Calcium
d) Magnesium

 Mrs zikes is receiving frequent medication. Which of the following would be the correct
identification procedure
a) Check the identification bracelet and call mrs zikes by name
b) Check the name on the foot of the bed, and check the identification bracelet
c) Call mrs zikes by name, this is all that is needed
d) Ask mrs zikes her name, and check her identification bracelet

 When you answer the clients call light, you note that he has suffered a wound evisceration.
Your response will be to
a) Call the physician immediately for offers. Do not touch the wound
b) Cover the wound with sterile dressing, call the lab to do a culture and then call the
physician
c) Cover the wound with sterile, saline soaked towels and immediately notify the physician
d) Take the clients vital signs, cover the wound with a sterile towel and call the physician

 Which surgical consent would not be considered legal

a) Consent signed by a 36 yer old lady one hour after receiving her preoperative medication
of morphine
b) Conscent signed by 21 year old man who has a fractured leg due to an auto accident
c) Telephone consent from the father to perform an emergency surgery on a 17 year old girl
d) Consent signed by a 60 year old man the evening prior to surgery and prior to his evening
sedative

 Which statement by the nurse would be most therapeutic when the client says, ‘my friend has
a terrible scar from her surgery’
a) Don’t worry, your surgeon is very good
b) You need the surgery, and a little scarring is okay
c) Are you concerned about how your surgical scar will look
d) I wouldn’t worry about that right now, all people are different

 Several screening tests are performed on clients preoperatively. Which test demonstrates
the presence of bleeding or anaemia
a) An elevated white blood cell count
 b) Decreased haemoglobin and hematocrit
c) Elevated blood urea nitrogen
d) Hypokalemia

 Leg exercises are taught to clients in order to increase venous return and prevent
thrombophylebitis. Which step of this procedure is incorrect
a) Alternately dorsiflex and plantar flex toes
b) Flex and extend the knee
c) Raise and lower each leg
d) Repeat exercise every one to two hours

 Two days post surgery ms D continues to complain of pain. There are a number of
interventions available for pain relief. Which comfort measure has the potential of increasing
ms daniels risk of cardiovascular complications
a) Turn ms D every two hours
b) Place pillows under ms Ds knees
c) Splint ms Ds abdomen when she coughs
d) Encourage ambulation as tolerated

 Your client develops a fever and complains of calf pain over an area that is red and swollen.
Nursing interventions for thrombophlebitis will include all except
a) Elevate the affected leg to heart level
b) Maintain bedrest as ordered
c) Measure bilateral calf circumference every shift
d) Massage the affected calf

 Which of the following is an autonomic nervous system response to acute pain

a) Decreased heart rate
b) Decreased depth of respiration
c) Pupil constriction
d) Increased blood pressure

 Which of the following is a natural opiate of the brain involved in the analgesic system
a) Endorphins
b) Histamine
c) Collagenase
d) Neurotensi

 Judgement and caution must be used when nonpharmacologic interventions are applied in the
treatment of acute pain because
a) No proof exists that they work
b) They are very expensive to implement
c) They are outside the scope of nursing practice
d) They do not guarantee pain relief

 If morphine is given intravenously, regularly as post operative analgesic for 10 days to a

multiple trauma patient, what is the possibility that this patient would become addicted to the
narcotic
a) Almost never
b) Sometimes
c) Often
d) Almost always
 A malignant neoplasm
a) Grows very slowly
b) Is usually surrounded by a well defined capsule
c) Consists of cells that only form tissues in a very disorganised manner
d) Is composed of goblet cells

 Which of the following characteristics generally differentiate malignant tumours from benign
tumours
1. Lack of a capsule
2. More rapid growth
3. Infiltrates normal tissues
4. Respects other cells boundaries
a) 1, 2 and 3
b) 1, 2 and 4
c) 1, 3 and 4
d) 2, 3 and 4

 Malignant tumours and leukaemias may be treated with chemotherapy. The primary aims of
this therapy is to
1. Attack newly developing cancer cells
2. Reduce the size of a tumour
3. Build up a persons defence system
4. Reduce the oxygen bearing capacity of the blood
5. Destroy cancer cells and leave normal cells
a) 1,2 and 3
b) 1, 2 and 5
c) 2, 3 and 4
d) 2, 3 and 5

 During chemotherapy, soreness of the mouth and anus may develop because
a) The effects of the chemotherapeutic agents concentrate in these body areas
b) These tissues normally divide rapidly and are damaged by chemotherapeutic agents
c) The entire GI tract is involved because of the direct irritating effects of chemotherapy
d) The tissues have become damaged fro mprolonged vomiting and diarrhoea

 Which of the following should be considered in order to avoid skin reactions following
radiotherapy
1. Not to apply ointments of lotions
2. Not to vigorously dry the skin
3. To apply powder p.r.n
4. To deep the skin area dry and open to air
5. To avoid exposure to sunlight
a) 1, 2 and 3
b) 2, 3 and 5
c) 3, 4 and 5
d) 1,2, 4 and 5
e) 2, 3, 4 and 5

 A common problem after open cholecystectomy is shallow breathing. This is mainly due to
a) The site of the incision making breathing painful
b) Damage to the phrenic nerves during surgery
c) The obese state of most patients pre operatively
d) Inadequate pre operative instruction
 Your patient is charted 1 L normal saline 12 hourly via an IV line (drop factor 10). Calculate
the correct drops per minute (d.p.m)
a) 8
b) 12
c) 14
d) 20
e) 24

 If the drop factor is 15, how fast should an infusion of 1000 ml normal saline run over 10
hours
a) 15 dpm
b) 20 dpm
c) 25 dpm
d) 40 dpm

 Mrs graham is an active, retired 62 year old. She has been admitted for investigation of
possible renal calculi. Which of the following investigations would be most useful in
confirming mrs Gs provisional diagnosis of renal calculi
a) Cystoscopy
b) Intravenous pyelogram
c) Renal biopsy
d) Urinary electrolytes

 Mrs s, aged 56 has undergone elective abdominal surgery. In the evening of the day of
surgery she feels that she wants to pass urine but is unable to do so. The nurse could best
assist her to micturate by
1. Applying manual pressure to the suprapubic region
2. Assisting her to sit at the edge of the bed and use a pan
3. Encouraging her to increase her fluid intake
4. Changing her position, ensuring comfort and giving pain relief
5. Emptying her bladder to give relief by use of a urinary catheter
a) 1 and 3
b) 1 and 4
c) 2 and 3
d) 2 and 4

 Side effects of radiotherapy include

a) Burns, lethargy
b) Alopecia
c) Increased rate of cell division
d) Increased WBC production

 Cytotoxic therapy
a) Is used only as a last resort – a palliative care
b) May be used in conjunction with radiotherapy
c) Not to be given if radiotherapy is anticipated
d) Is used if surgery is impossible

 Chemotherapy acts by
a) Attacking existing malignant cells and kill tumours
b) Decreases the blood supply to the tumour
c) Interferes with the cell division
d) Increases the clients feelings of wellness therefore giving a boost to cancer patients
 Cancer clients pain is assessed by
a) The doctor
b) The health care team
c) The client
d) The family

 If paracetamol is no longer effective in the treatment of malignant pain

a) Strong opiods are prescribed
b) The end is near
c) Weak opioids and / or NSAIDS may be prescribed
d) The client needs hospitalisation for pain control

 Important components of pain assessment include

a) Site of pain
b) Onset and patterns
c) Current therapy and effects
d) All of the above

 Chest problems may best be prevented after cholecystectomy by

1. Giving the patient oxygen
2. Regular deep breathing and coughing
3. Keeping the patients pain minimised
4. Prophylactic antibiotic therapy
5. Keeping the patient rested and warm
a) 1 and 3
b) 1 and 4
c) 2 and 3
d) 2 and 4

 Your client suffers from nausea and vomiting in the early post operative period. Vomiting at
this time is most likely due to
a) Volvulus
b) Phrenic irritation
c) Effect of anaesthetic
d) Paralytic ileus

 Mrs S is scheduled for a choelscystectomy and asks you how she will manage without a
gallbladder. Your best reply is
a) Dilute bile will still pass into your digestive tract but will be less efficient at digesting fat
b) Your liver will not longer produce bile now so your must stay strictly off fatty foods
c) Your gallbladder was not a very important organ and you will not miss it
d) You can take a bile supplement in your diet to compensate

 An intravenous infusion of 500 ml dextrose/saline through a metriset infusion set (60 drops
per ml) is ordered to run over 6 hours. Calculate the drops per minute
a) 137
b) 36
c) 60
d) 83

 An injection of morphine 7.5 mg is required – on hand are ampoules containing 10 mg per ml.
Calculate the volume to be drawn up
a) 0.5 ml
 b) 0.6 ml
c) 0.65 ml
d) 0.7 ml
e) 0.75 ml

 As the nurse assesses jack for increased intracranial pressure, she would be concerned if she
observed
a) Change in level of consciousness
b) Anorexia and thirst
c) Increased pulse and respiration rates
d) Blurred vision and halos around lights

 A person has just been involved in an accident that affected the medulla oblongata. The body
process most directly affected by this would be
a) Sight
b) Hearing
c) Muscular coordination
d) Respiration

 If your are dealing with a person whose phrenic nerve has been damaged, what would you
expect to observe
a) Reduced diaphragm function
b) Less mucus secretion by the goblet cells
c) Decreased elasticity of the lung tissue
d) Increased coughing

 The spinal cord extends through the vertebral canal fro mthe foramen magnum to the
a) 7th cervical vertebra
b) 12th thoracic vertebra
c) 2nd lumbar vertebra
d) 1st sacral vertebra

 Synaptic conduction of a nerve impulse can be affected by

a) Certain diseases
b) Drugs
c) Changes in Ph
d) All of these

 Lack of muscle coordination is called

a) Monoplegia
b) Ataxia
c) Tia
d) None of these

 Pursed lip and diaphragmatic breathing

a) Calms the anxious client
b) Speed up slow respirations and used to promote effective coughing
c) Prevents bronehiolar collapse and air trapping
d) Encourages longer inhalation and faster exhalation
 Percussion, vibration, and postural drainage
a) Is effective management of nursing frustrations
b) Promotes loosening secretions and movement out of airway
c) Increases blood supply to area therefore increased expectoration
d) Should be done prior to all meals

 A normal blood sugar level (BSL) is

a) 7.35 – 7.45
b) 120 – 160 mm dL
c) 4 – 7 mmol/l
d) +/- 2 mmEq

 Blood sugar levels (BSL) are

a) Best done ½ hour prior to meals
b) Best done ½ hour after meals
c) Need only be done for the IDDM client
d) Need an arterial blood sample

 Diabetes is
a) An exocrine disorder
b) Decreased production of insulin by the liver
c) An endocrine disorder
d) Decreased secretion of insulin by the alpha cells in the pancreas

 Type I diabetes are characterised by

a) Non insulin dependence
b) Majority of the diabetic population
c) Require hypoglycaemic agents to maintain glucose levels
d) Need insulin to maintain normal BSL

 Type 2 diabetics
a) Need insulin to maintain homeostasis
b) May develop ketoacidosis easily
c) May go undetected for years
d) Are usually very slim and malnourished

 Hyperglycemia
a) Is alright only once in a while
b) Due to an over medication of insulin
c) If left uncontrolled, this can lead to DKA in type 1 or HNK in type 2
d) Also called insulin shock reaction

 Macrovascular complication of diabetes

a) Occur shortly after the onset of the disease
b) Affects coronary, peripheral and cerebral circulation
c) Affects the eyes and the kidneys
d) Affects sensorimotor and autonomic nerves

 For the relief of angina, the client may

a) Call 111
b) Take a dose of glyceryl trinitrate up to 3 times, 5 minutes apart until the pain subsides
c) Slowly exercise to the individuals tolerance level
d) Take only one dose of glyceryl trinitrate, if this has no effect, call 111
 Ways to minimise precipitating effects of angina are
a) Avoid over exertion
b) Reduce stress
c) Avoid overeating
d) All above

 Angina
a) May be referred to as angina majoralis
b) Not relieved by rest
c) Include chest pain which may radiate down the arms, neck, jaw and back
d) Needs immediate medical attention

 Angina is
a) Caused by a sudden blockage of one of the coronary arteries
b) Caused by anaerobic metabolism exciting pain receptors
c) Causes cardiac tissue necrosis and scaring
d) Interferes with cardiac contractility

 Myocardial infarction (MI)

a) Causes irreversible tissue damage
b) The final extent of the damage depends on the ability of the surrounding tissue to recruit
collateral circulation
c) 15% of all MIs are silent
d) All of the above

 MIs may be caused by

a) A formation of a thrombus in a coronary artery
b) Sudden progression of atherosclerotic changes
c) Prolong constriction of the arteries
d) All of the above

 Manifestations of an MI are
a) Bradycardia
b) Necrosis of a potion of the myocardium
c) Treated only by bypass surgery
d) Not seen on an ECG for 24 hours

 Medications which are of the utmost importance for a patient following an MI are
a) 02
b) Stool softeners
c) Morphine
d) All of the above

 ACE inhibitors include

a) Catopril, enalapril
b) Propranolol, atenolol
c) Niphedipine, dittiazen
d) Fruisemide

 Antidiuretic hormone is
a) Secreted by the posterior pituitary
 b) Increases glomerular filtration rate
c) Increases urinary output
d) Secreted by the hypothalamus

 Aldosterone is
a) Secreted from the adrenal medulla
b) Increases the distal tubules reabosrption, therefore increases H20 absorption
c) Decreases the blood pressure
d) Decreases the blood supply to the bowmans capsule

 The renal system maintains homeostasis by

a) Maintaining electrolyte balances
b) Maintenance of blood volume
c) Conversion of vitamin d for calcium reabsorption
d) All of the above

 Prerenal failure may be cuased by

a) Burns
b) nephrotoxic drugs
c) Multiple transfusions
d) Renal calculi

 Acute renal failure (ARF) is

a) Incurable
b) Only curable by kidney transplantation
c) Occurs suddenly and may be reversible
d) Characterised by polyuria

 Chronic renal failure (CRF)

a) Occurs suddenly and is reversible
b) Occurs over a long period of time an is reversible
c) Occurs over a long period of time and is irreversible
d) Is a nuisance but not fatal

 Chronic renal failure may be characterised by

a) Lethargy, mental confusion
b) Headaches, GI symptoms
c) General weakness and bleeding tendencies
d) All of the above

 Problems associated with CRF are

a) Polycythemia
b) Metabolic alkalosis
c) Accentuated sex drive
d) Reduced healing, susceptibility to infections

 Nursing interventions with a client with renal failure includes

a) Increase dietary protein
b) Increase fluid intake
c) Increase potassium intake
 d) Maintain adequate nutritional status and decrease the metabolic demands

 Malignant tumours have

a) Irregular shapes with poorly defined borders
b) Cells similar to their parent cells
c) Expansive growth
d) Fibrous capsule

 Which of the following are not malignant

a) Sarcoma
b) Metastasis
c) Neoplasm
d) Benign

 The world health organisations (WHO) analgesia ladder is

a) A systematic tool used for the identification of medications to prescribe for patients with
cancer pain
b) Initial treatment includes simple analgesics, to progression of mild opioids to strong
opioids
c) Opioids may be used in conjunction with anticonvulsant and antidepressant drugs to
promote effectiveness
d) All of the above

 If your client is experiencing break through pain

a) They are not administering their medications correctly
b) Morphine should only be taken when pain is experienced
c) They may require a quick release morphine titrated to alleviate their pain
d) Start an IV and double the dose of morphine

 Potential side effects of morphine administration for the alleviation of malignant pain are
a) Addiction
b) Constipation, nausea and vomiting
c) Antisocial behaviour
d) Once the maximum dose of morphine is reached, the pain may no longer be controlled

 When an arterial blood gas (ABG) sample is taken ,the initial nursing intervention should be
a) Assessing the movement of the extremity
b) Apply pressure to prevent an arterial bleed
c) Calming and educating the client to alleviate anxiety
d) All of the above

 Normal oxygen saturation (SaO) values are

a) 80-100% saturation
b) 70-90%saturation
c) 90-100% saturation
d) 100% saturation

 Approximately 1000ml (1L0 of oxygen is transported to cells each minute. Most of the
oxygen is transported
a) Dissolve in his plasma
 b) Loosely bound to his haemoglobin
c) In the form of CO2
d) As a free floating molecule

 Mary a 46 year old woman, is admitted to your ward with a chest infection due to an
exacerbation of chronic obstructive pulmonary disease (COPD). A person with emphysema is
susceptible to respiratory infections primarily because
a) Failure of his bone marrow to produce phagocytic white blood cells
b) Retention of tracheobronchial secretions
c) Decreased detoxification of body fluids by compressed liver cells
d) Persistent mouth breathing associated with dyspnoea

 Emphysema differs from chronic bronchitis in that

a) Emphysema obstruction results from mucous production and inflammation
b) Emphysema obstruction results from changes in lung tissues
c) Chronic bronchitis obstruction results from changes in lung tissue
d) There are no visual difference between the two conditions

 The tissue change most characteristic of emphysema is

a) Accumulation of pus in the pleural space
b) Constriction of capillaries by fibrous tissue
c) Filling of air passages by inflammatory coagulum
d) Over distension, inelasticity, and rupture of alveoli

 Which of the following results of emphysema is primarily responsible for cardiomegaly

a) Hypertrophy of muscles encircling the bronchi
b) Increased pressure in the pulmonary circulation
c) Decreased number of circulating red blood cells
d) Secretion of excessive amounts of pericardial fluids

 Circulatory shock can best be described as a condition in which there is

a) A state of hypotension
b) Loss of blood
c) Loss of consciousness due to blood loss
d) Inadequate blood flow to meet the metabolic needs of the body tissues

 Causes of hypovolemic shock include

a) Vomiting and loss of body fluids
b) Allergic reactions to drugs
c) Cardiac failure
d) Hypoglycaemia

 Early signs of hypovolemic shock include

a) Restlessness, thirst and increased heart rate
b) Decreased blood pressure and apathy
c) Increase in heart rate and increased pulse pressure
d) Decreased blood pressure and unconsciousness

 In shock, one of the best indicators of blood flow to vital organs is

a) Rate of blood and fluid administration
b) Blood pressure
c) The colour and temperature
 d) Urine output

 Oliguria an early sign of shock, occurs for what reason

a) Cessation of glomerular filtration
b) Acute tubular necrosis
c) Metabolic acidosis
d) Sympathetic stimulation

 A person admitted to the emergency room with trauma and an estimated blood loss of 1200 to
1400 mls has a blood pressure of 110/170mmHg and a heart rate of 120 beats per minute. The
best explanation for these observations would be that
a) The persons actual blood loss was less than the originally estimated loss
b) The person was normally hypertensive and hence did not have as great a drop in blood
pressure as a normotensive person
c) The cause of the bleeding is now under control and the increased heart rate is due to
anxiety
d) An increase in heart rate is compensating for the loss of blood volume

 The pale, cool, and clammy skin that is often observed in an individual with shock, can be
explained in terms of
a) Loss of red blood cells
b) Bodys attempt to shunt blood to vital organs by constricting skin vessels
c) Decreased metabolic needs that accompany shock
d) Bodys attempt to conserve heat loss

 A 48 year old complains of chest pain. Signs and symptoms that would support a diagnosis of
myocardial infarction would include
a) Jugular vein distension and hepatomegaly
b) Fever and petechiae over the chest area
c) Nausea and vomiting and cool, clammy, pale skin
d) Pericardial friction rub and absent apical pulse

 Teaching for the client taking GT or glycerol with nitrate for angina would include
a) Instructing the client to take the nitroglycerin regularly
b) Explain to the client that a subsequent headache indicates ineffective medication
c) Instructing the client to put the tablet on the tongue and swallow after the tablet dissolves
d) Teaching the client to take a tablet every 5 minutes (x3) when chest pain occurs

 A female client is diagnosed with unstable angina. The nurse finds her crying because she
fears she will become a burden to her husband. Which of the following nursing diagnosis
would be most appropriate
a) Impaired verbal communication
b) Ineffective family coping
c) Relationship difficulties
d) Fear due to knowledge deficit

 Which of the following steps should a client with periodic angina pain take first when pain
occurs at home
a) Take sublingual nitroglycerin and lie down
b) Do mild breathing exercises
 c) Take an extra long lasting nitrate tablet
d) Sit down and relax

 The nurse detects premature ventricular contractions and (PVCs) on the ECG of a client who
had a mitral valve replacement 2 days ago. PVCs may be dangerous because they
a) Significantly increase cardiac workload
b) May lead to ventricular tachycardia or fibrillation
c) Are the most common cause of myocardial infarction
d) Decreased heart rate and blood pressure

 Blood pressure control is carried out by regulation of smooth muscle via

a) Parasympathetic stimulation
b) Parasympathetic and sympathetic stimulation
c) Sympathetic stimulation
d) None of these

 The areas of the body that sense blood pressure are know as
a) Barareceptors
b) Chemoreceptors
c) Viscoreceptors
d) None of these

 When taking a blood pressure, the first sound picked up by the stethoscope as blood pulses
through the artery is the
a) Mean arterial pressure
b) Pulse pressure
c) Diastolic pressure
d) Peak systolic pressure

 At any given moment, the systemic circulation contains about of the total
blood volume
a) 10%
b) 51%
c) 71%
d) 91%

 The nurse gets the arterial blood gases report and it shows that a person has hypercapnia. This
means that
a) There is an increased blood carbon dioxide
b) The blood oxygen level is reduced
c) Carbon dioxide has been lost
d) There is respiratory alkalosis

 Gregory aged 70 was admitted with congestive heart failure. Which of these changes in
physiology is present in congestive heart failure
a) Heart muscle degeneration due to old age
b) A decrease of blood flow through the heart
c) An abnormality in the structure of the heart
d) A blood clot forms in one of the heart chambers
 The doctor asks the whanau for the corneas of iris for transplantation. The whanau cannot
make a decision right now. What is the most appropriate action nyou should take in support of
the whanau
a) Tell the doctor that this is not culturally appropriate
b) Listen to them and support them in their decision
c) Explain nto the whanau why corneas are transplanted
d) Suggest the whanau talk to the hospital chaplain

 Tipene a 44 year old male, who identifies as maori, is admitted to your ward. He is an insulin
dependent diabetic. His whanau (family) are with him. What is your first nursing action
a) Introduce yourself to tipene and his whanau
b) Take his baseline observations
c) Ask the whanau if there is anything they wish to know
d) Orientate tipene and his whanau to the ward

 Oral hypoglycaemic agents are effective and short acting. Their specific action is
a) As an oral form of insulin
b) To increase the output of insulin
c) To control the islets of langerhans
d) To decrease the output of insulin

 Individuals whose diabetes is not well controlled are vulnerable to several complications,
which of the following are they least likely to develop
a) Artherosclerosis
b) Cateracts
c) Lympyhadenopathy
d) Nephropathy

 The most important feature of foot care for a diabetic would be to

a) Cut nails straight across
b) Maintain adequate blood flow to the lower limbs
c) Wear sandals at all times
d) Avoid wearing garters

 You are a community nurse in charge of an adolescent wellness centre at a local high school.
You are planning a programme to promote self esteem in adolescence. Your final plan is
governed by
a) Your perception of their needs
b) The focus of the health curriculum
c) Consultation with the adolescents
d) Ideas from the teaching staff

 Autoimmune disease occurs when

a) Antibodies fail to recognise own tissue as an antigen
b) Antigens fail to stimulate antibody response
c) Antibodies identify own tissue as an antigen
d) Antibody production ceases

 You present a seminar to your colleagues on immunisation. After the presentation you are
asked to clarify the following. Immunity that results from the natural exposure to an antigen
in the environment is called
 a) Active immunity
b) Natural passive immunity
c) Autoimmunity
d) Passive immunization

 Immunity that results from antibodies that pass the placenta from mother to foetus is called
a) Active immunity
b) Natural passive immunity
c) Autoimmunity
d) Natural active immunity

 In active immunisation
a) The immune system attacks normal body cells
b) The body receives antibodies produced by another person
c) Genes for antibodies are introduced into the body
d) The body is deliberately exposed to an antigen

 Suppressor t cells act to

a) Suppress antigens
b) Limit the degree of memory in memory cells
c) Limit antigen proliferation
d) Depress the responses of other t and b cells

 You are preparing vaccines for an immunization programme. In the preparation of vaccines,
the cold chain refers to a system of
a) Maintaining vaccines at temperatures under 10 degrees C
b) Preventing heat damage to vaccine
c) Storing vaccines at stable temperatures in a separate refrigerator
d) Transport storage and administration of vaccine in a potent state

 Which of the following is a contraindication to immunization

a) Contact with an infectious disease
b) Prematurity
c) Temperature over 38 C
d) Asthma

 When carrying out immunizations a nurse must have with her/him

a) Oxygen
b) A medical officer
c) Intravenous fluids
d) Adrenaline

 Increased incidence of meningitis led to the introduction of a new vaccine into the new
Zealand immunization schedule in 1994. The causative organism of this disease is
a) Beta a streptococcus
b) Respiratory syncytial virus
c) Haemophilus influenza
d) Neisseria meningitis

 The immunization usually given at 3 months of age provides protection against

a) Diphtheria, tetanus, whopping chough, polio haemophilus influenza
b) Diphtheria, tetanus, whooping cough, polio, hepatitis B, haemophilus influenza
c) Diphtheria, tetanus, whooping cough, haemophilus influenza
d) Diphtheria, tetanus, polio, hepatitis B, haemophilus influenza
  As a community nurse at the school you are asked to see suzie who has unexplained bruising
on her arms and legs. Your initial assessment indicates she has been abused. Your first
professional responsibility is to
a) Contact the child protection coordinator
b) Contact the childs parents
c) Contact the police
d) Carry out a full physical examination

 It has been decided that physical abuse has occurred. Which intervention will be implemented
under the children, young persons and their families act
a) The chid will be removed from the home to a place of safety
b) The child protection coordinator calls a family case conference
c) The abuser will be removed from the home
d) The community nurse calls a family conference

 You return to your office and receive a call from a man stating he is suzies father. He says i
believe you think i have been hitting my daughter. Your response is
a) Suzie told me you had been hitting her
b) I wont discuss this with you at the moment
c) It would be better if you rang the school
d) I cant discuss this on the phone

STATE EXAMS 23

 A man comes to the clinic complaining of headache irritability. He lost his job a week ago
and has to relocate. He is experiencing
a) Anxiety reaction
b) Situational crises
c) Maturational crises
d) Adventitious crises

 Which of the following phrases best describes the major goal of crises intervention
a) Decrease anxiety
b) Facilitate personality change
c) Identify the precipitating event
d) Re-establish psychological equilibrium

 Anne is admitted to the psychiatric unit with distorted perceptions and disordered thoughts
and cannot complete her morning care even when given directions. At this time your nursing
assessment indicated that she is experiencing which level of anxiety
a) Mild
b) Panic
c) Severe
d) Moderate

 All the following nursing actions are appropriate for a patient experiencing anxiety, but which
one should be your initial priority when a patient is at panic level
a) Provide for the patients safety
b) Decrease environmental stimuli
 c) Respect the patients use of personal space
d) Encourage the patient to discuss his feelings

 Anne tends to use the defence mechanism of displacement. Her husband, to whom she is very
devoted, bawls her out for being disorganised and flightly. She is most likely to react by
a) Burning his dinner
b) Scolding the delivery boy for being late
c) Telling her husband she is furious with him
d) Being an especially gracious hostess the next time they entertain

 Mr w is a 45 year old man who is admitted to an alcohol detoxification unit. He has had
nothing to drink in 3 days. On admission his behaviours include tremor, anxiety, visual
hallucinations, insomnia, paranoia, and disorientation accompanied by vomiting, temperature
elevation, tachycardia, and diaphoresis. These are behaviours characteristic of the syndrome
known as
a) Alcoholic hallucinosis
b) Alcohol induced psychosis
c) Alcoholic seizure disorder
d) Alcohol withdrawal delirium

 The highest priority nursing action relative to alcohol withdrawal delirium would be
a) Orientation to reality
b) Application of r
c) restraints
d) Identification and social supports
e) Replacement of fluids and electrolytes

 A patient with schizophrenia says to the nurse, ‘I’m like a fallen star. But I won’t go into a bar
… it would be a mar on my family, on the tar.’ This is an example of
a) A delusion
b) Word salad
c) Clang association
d) A loose association

 A person who has schizophrenia refuses to remove her clothing. The planned nursing
intervention which indicates the best understanding of her communication is
a) Providing her with a selection of outfits in order to offer alternatives
b) Forcible removal of her clothing in order to meet her basic hygiene needs
c) Stating that she would look more attractive in clean clothes in order to increase her self
esteem
d) Telling her that she may wait and change when she is ready to in order to help her
maintain her identity

 John smith aged 50 receives 30% burns to his face, neck, arms and upper thorax when he
pours petrol onto his barbeque. The most appropriate immediate first aid treatment for mr
smith is to
a) Roll him in a damp rug to extinguish the flames
b) Remove his burning clothes as fast as possible
c) Quickly throw him into the swimming pool
 d) Quickly roll him in a wet sheet and apply ice to his burns

 Smoke inhalation can complicate burn injuries. While waiting for the ambulance the most
appropriate position for conscious victims of smoke inhalation is
a) Sitting in the semi fowlers position
b) Laying down with neck hyperextended
c) Lying supine with the legs elevated
d) Lying in the recovery position

 Which of the following is correct with regard to burn injuries

a) Partial thickness burns are not painful as the nerve endings are destroyed
b) Full thickness burns are often very painful as the nerve endings are irritated
c) Full thickness burns are often not painful as the nerve endings are destroyed
d) Blistering are redness often occur very quickly following a full thickness burn

 Factors determining the severity of the burn injury include

a) Depth of burn and percentage of body surface area burnt
b) Location of the burn and age of victim
c) Size of the burn and previous medical history of the victim
d) All of the above

 Recent research indicates that arthritis may be an autoimmune disease. Which of the
following statements most accurately describes the process of autoimmunity
a) A rare complication of vaccination when the body reacts to the vaccine by producing
symptoms of the disease
b) An inherent factor in the blood which render the person susceptible to certain disease
c) Lack of antitoxins in the blood which render the person susceptible to the certain disease
d) Formation of antibodies in the blood which destroy certain healthy cells in the individual

 Patients with rheumatoid arthritis commonly have a raised ESR (erythrocyte sedimentation
rate) this is because
a) arthritic patients usually have a degree of anemia
b) rheumatoid factor decreases the viscosity of the cells
c) protein changes result in the erthrocytes becoming heavier
d) there is an increase in leucocyte numbers

 chuck jones, 12 years old, has been hospitalized on the pediatric unit with an acute asthmatic
attack. He is receiving 2,000mls of 5% dextrose in water with 20 millieqivalents of KCL per
day. The drop factor is 60 drops per millilitre. How many drops per minute should he receive
a) 60
b) 68
c) 76
d) 83
 Chick drinks small amounts of fluids, which total 400 mls per day. His daily total, including
the intravenous fluid intake is 2,400 mils. His total output is 1,500 mls per day. The specific
gravity of his urine is 1.015. based upon the evaluation of this data, the nurse should
a) Call the physician and request a change in the amount of intravenous fluid
b) Continue to encourage chuck to drink fluids, and offer choices
c) Suggest to chuck that he eat more solid foods
d) Tell chuck that he need not force himself to drink fluids

 A 24 hr urine collection is ordered to determine mrs cousins oestriol levels. The nurse should
advise mrs cousins to
a) Save all urine samples from the first one in the morning until the first one next morning
b) Discard the first morning urine sample and save all urine samples including the first one
the next day
c) Begin the collecting at any time during the day and save all urine samples for the next 24
hours
d) Include the next urine sample after the completion of the 24 hour period, if a urine sample
has been discarded accidently

 Mrs cousins has gestational diabetes. Assessment of mrs cousins diabetic status during the
first 24 hours after delivery should include monitoring her blood glucose levels for a possible
complication of
a) Hypoglycaemic
b) Hyperkalemia
c) Keoacidosis
d) Galactosemia

 Mr and mrs cousins are concerned that their children will develop diabetes. The nurse should
respond that
a) Because diabetes is inherited their children should be assessed periodically
b) A genetic counsellor can determine the probability of their children developing diabetes
c) There is little chance that their children will develop diabetes because mr cousins is not
diabetic
d) Statistical predictions of whether children of diabetics will develop diabetes are not too
reliable
 Shirley, aged 4, has been brought to the health clinic because according to her mother, she
does not talk. She is diagnosed as having autistic behaviour. In planning long term care for
Shirley, the health team especially needs to consider
a) The role of the father in the family
b) Separating Shirley from her family
c) A nurse who will be a surrogate mother
d) Supporting the mothers role

 Shirley has to be hospitalised. Which nurinsg approach will best help shirleys maladaptive
behaviour
a) Isolation whenever Shirley is acting out
b) Allowing Shirley to have her own way
c) Rewards given when Shirley co operates
d) A one to one relationship with Shirley

 The nurse plans to have Shirley involved in daily sessions of therapeutic play. The main
reason for this activity is that
a) The nurse can motivate Shirley through play
b) Shirley can best express herself through play
c) Shirley will be happier when she is playing
d) The nurse will be more objective watching Shirley play

 Mr wolfe, a 46 year old executive, is admitted to the C.C.U. with chest pain and shortness of
breath. A diagnosis of myocardial infarction is made. One of the more common complications
of myocardial infarction is
a) Cardiac arrhythmias
b) Anaphylactic shock
c) Cardiac enlargement
d) Hypokalemia

 The nurse observes mr wolfes monitor and identifies asystole. This arrhythmia requires urgent
attention because the heart is …
a) Beating very rapidly
b) Beating very slowly
c) Not beating
d) Beating very irregularly

 A cardiac arrest code is called for mr wolfe. The nursing priority is to

a) Ensure the airway is clear
b) Give 4 full lung inflations
c) Compress the lower sternum 15 times
d) Check for a radial pulse

 The commonist cause of mitral valve stenosis is

a) Atherosclerosis
b) Sub acute bacterial endocarditis
c) Rheumatic fever
d) Left ventricular failure
 People with cardiac valve disease are especially prone to develop bacterial endocarditis when
undergoing the following type of surgery
a) Dental
b) Thoracic
c) Abdominal
d) Orthopaedic

 Which of the following molecules cannot pass through capillary endothelium

a) Oxygen and carbon dioxide
b) Plasma proteins
c) Glucose, oxygen and carbon dioxide
d) Amino acids and water

 Ammonia is excreted by the kidney to help maintain

a) Low bacterial levels in the urine
b) Osmotic pressure of the blood
c) Hydrostatic pressure in the glomerulus
d) Acid base balance of the body

 Chronic renal failure results in anaemia primarily because

a) Low levels of urea destroy red blood cells
b) The bone marrow is depressed
c) The kidney produces erythropoietin
d) High levels of vitamin k in the blood

 Carbon dioxide acts as a

a) Respiratory stimulant
b) Vaso dilator
c) Respiratory depressant
d) Bronchodilator

 The antidote to heparin is

a) Vitamin d
b) Vitamin k
c) Prothrombin
d) protaine sulphate

 mr thomas has tb. Tb is spread by

a) inhalation of droplets
b) ingestion of contaminated food
c) injection with unsterile equipment
d) entry through skin lesion on the hand
 which of the following complications may occur if mr thomas fails to take his medications
regularly
a) allergic reactions to his medications
b) loss of tissue sensitivity to tuberculin
c) bacterial resistance to the drugs
d) calcification of the lymph nodes

 a possible toxic effect of streptomycin is

a) anaemia
b) anuria
c) deafness
d) hypotension

 susan, aged 16 years was admitted for investigation of grand mal epilepsy following a seizure
and complaining of blurred vision. The most important test to diagnose epilepsy would be
a) an electroencephalogram
b) an electrocardiogram
c) lumbar puncture
d) coombe test

 the site of vision in the brain is located in the

a) temporal lobe
b) occipital lobe
c) parietal lobe
d) thalamus

 which of the following medication may be given to prevent a grand mal seizure
a) Dilantin
b) Bromide
c) Neocytamen
d) Levo dopa

 Following a grand mal seizure susan is likely to be

a) Hostile
b) Hyperactive
c) Enphoric
d) Confused

 Susans mother asks you ‘will this trouble make susan slow in school. Which response would
be most appropriate
a) Absolutely not. Susans disease has nothing to do with her intelligence
b) So long as she small seizure they will have no effect on her brain
c) There is no reason to expect the disease to decrease susans ability to learn
d) As epilepsy causes mental deteriorations, susans learning ability may be affected

 Millie crowe, a nursing student, develops muscular weakness in her right arm and intermittent
urinary incontinence. The diagnosis of multiple sclerosis is made. The pathology underlying
the manifestations of multiple sclerosis has been identified as the
 a) Deficiency of neurotransmitters
b) Destruction of the nerve myelin sheath
c) Interference with neuronal transmission
d) Premature destruction of transmitter substance

 When discussing the future with millie it is important to explain that multiple sclerosis
a) Is a disorder that becomes progressively worse
b) Is caused by an underlying viral infection
c) Can be cured with appropriate treatment
d) Has remission of months or years

 The main goal in treating millie is to minimize the risk of

a) Prolonged discomfort
b) Symptom exacerbation
c) Delayed recovery
d) Dehydration

 The persons who are most likely to have the greatest effect in assisting millie to maintain a
positive self concept are
a) The occupational therapists during job retraining
b) Other people with multiple sclerosis who manage independent lives
c) Physiotherapists who help her to achieve maximum mobility
d) People unaffected by multiple sclerosis such as the Ms society field worker

 A public health nurse has been invited to talk about child health with a group of mothers.
Which is the single most important factor in the early social development of children
a) Living in an extended family setting
b) The way their needs are met and stability
c) Their physiological status and stability
d) Their inherited biological characteristics

 An important factor which makes two year old children feel physically secure is
a) Acknowledging they are individuals
b) Allow them to have what they want
c) Ensure they know what they can and cannot do
d) Be very strict when disciplining them at home

 Which of eriksons psychosocial cirises is present at age four years

a) Trust versus mistrust
b) Initiative versus guilt
c) Industry versus inferiority
d) Autonomy versus shame and doubt

 Parents are likely to have less conflict with their adolescent children if they
a) Use rules and punishment to control adolescents
b) Make a conscious effort to remember their own adolescence
c) Keep communication open and allow reasonable independence
d) Plan a set of rules which will be followed at all times

 Which of the following statements would best help a mother who says that she does not
believe in immunisation because it is unnatural
 a) Your children are in danger of infection if they were not given breast milk to gain natural
immunity
b) Immunisation assists the body to produce its own immunity and give protection against
dangerous infections
c) If your children are not immunised they will have to be kept away from other children
because they could make other children ill
d) If you do not have your children immunised they can be admitted to hospital with
infectious diseases and cost the country a lot of money

 The nurse should explain to a youth who has not been immunised against tetanus that he will
be given a
a) Single dose of tetanus serum
b) Single dose of tetanus toxoid
c) Small dose of tetanus anti toxin
d) Course of tetanus toxoid injections

 Vaccinations are often given at specified intervals with weeks or months in between each
injection because
a) This is convenient to the doctors and nurses
b) A stronger secondary response is induced
c) This is a long standing medical procedure
d) The body could not cope with a large dose at one time

 Vaccines induce immunity that is

a) Active artificially acquired
b) Passive artificially acquired
c) Active naturally acquired
d) Passive naturally acquired

 Which of the following signs/symptoms would induce mumps

a) Swelling of the lymph nodes
b) Tenderness of the parotid gland
c) Enlargement of the prostate gland
d) Ulceration of vesicular stomatitis

 Which option is important for the nurse to know with regard to prevention of the spread of
mumps
a) Safe disposal of all bodily excretions
b) No specific isolation measures are needed
c) Control of all food stuffs prepared for sale
d) Isolation for ten days after the last notified case

 Which of the following is the best description of a vaccine

a) Dead modified bacilli
b) Live attenuated virus
c) Dead virus given orally
d) Antibodies suspended in serum

 Mr adams suffers from dementia and requires a dressing to a shin wound. The nurse suspects
the wound is the result of a non accidental injury. What is the main cause of non accidental
injury in an elderly person suffering from dementia
a) A dependent person being more prone to injury
b) A long standing pattern of domestic violence
 c) The home not being a suitable place for dependent person
d) The increased stress in caring for a dependent person at home

 When dressing the shin wound the nurses most appropriate remark is
a) How did you scrape your shin mrs adams
b) How did you scrape your wifes shin mr adams
c) This shin must hurt. Was it really an accident
d) A shin is easy to hurt. How did this injury happen

 The most appropriate way to help mr and mrs adams at the first visit is to
a) Express professional concern at the cause of the injury
b) Conceal feelings about the possible cause of the injury
c) Reassure mrs adams that this injury will not occur again
d) Acknowledge the stress on mr adams in caring for his wife

 Which is the major pathophysiological abnormality occurring in asthma

a) Cardiac arrhythmias
b) Bronchiole dysplasia
c) Spasm of the smooth muscles of the bronchi
d) Inflammation of the alveoli

 Aminophylline 350 mg is prescribed. Each ampoule contains 250mg in 10ml. how much
should be added to the intravenous solution
a) 12 ml
b) 14ml
c) 16ml
d) 35ml

 Jillians intravenous infusion of 300ml normal saline is due to run over 4 hours. The drop
factor is 60. How many drops per minute must be given for the IV to be completed on time
a) 55
b) 65
c) 75
d) 85

 Salbutamol (ventolin) is administered through a nebuliser four hourly. The primary action of
this drug is as a
a) Bronchodilator
b) Cardiac stimulant
c) Respiratory stimulant
d) Respiratory depressant

 A client is charted nitrazepam (mogadon) tablets to sleep. She refuse to take them at 9pm. She
tells you that the other nurses always leave the tablets on the locker and she takes them when
she is ready. What should you do
a) Put them back in the container
b) Give her the tablets and let her take them later
c) Tell the patient to ring when she is ready for them
d) Tell her if she doesn’t take them now she may not get them later
 Jo is a third year comprehensive student nurse who has just completed her elective clinical
experience. Whilst on clinical jo was able to observe the management role. Jo noticed that the
charge nurse managed to control all the activities in the ward really well. Controlling refers to
actions taken to
a) Increase job satisfaction and motivation among employees
b) Increase productivity, innovation and quality outcomes
c) Ensure that actual outcomes are consistent with those planned and anticipated
d) Determine success or failure with tasks

 Quality control refers to activities which

a) Set standards and determine criteria
b) Determine whether standards have been met
c) Educate staff about corrective actions required
d) Evaluate, monitor or regulate services rendered to customers

 One of the reasons the charge nurse controls well is that she has set standards for
performance. A standard is
a) An agreed upon base line condition or level of excellence
b) An evaluation instrumental tool used by all
c) A set of behaviours that are common and understood by all
d) A set of behaviours that are defined by others for a profession

 While jo was on the ward a nursing audit was done. The nursing audit is a tool designed to
evaluate
a) The nurses clinical practice
b) The nursing care clients receive
c) The charge nurses managerial skill
d) The cost of nursing care of clients

 Mrs gs menstrual cycle began on 27 october 1995 and finished on 31 october 1995. She is
confirmed pregnant. What is her estimated due date
a) 30 june 1996
b) 27 july 1996
c) 31 july 1996
d) 3 august 1996

 A positive result when using a pregnancy test kit is due to

a) Chorionic gonadatropin in the urine
b) Oestrogen in the urine
c) Increased amounts of estrogen in the urine
d) More oestrogen and progesterone in the urine

 Mrs g asks you about the reliability of pregnancy test kits. Which is the best response
a) Used according to directions, they are 95% reliable
b) You need to be trained to use and read those kits
c) The test can give inaccurate results
d) Discuss this with your chemist
 If mrs g were to have a threatened abortion, she is most likely to present with
a) Diminished resistance of the cervix to increasing pressure exerted by the conception
b) Expulsion of the embryo with slight bleeding
c) Slight haemorrhage with no cervical dilation
d) Some products of conception being retained in the uterus

 The muscular wall of the uterus is known as the

a) Endometrium
b) Endothelium
c) Mymetrium
d) Deciduas

 Mrs g tells you she seems adjusted to the pregnancy one day and unsure of her feelings the
next. What do you tell her
a) Role change is a complex task
b) Ambivalence is quite normal in early pregnancy
c) Acceptance of the pregnancy occurs in the fifth month
d) Make an appointment with your doctor

 Mrs gs pregnancy progresses and she is admitted in labour. Which of the following is true of
normal labour
a) The foetus is born at term
b) The foetus presents by vertex
c) The onset is spontaneous
d) All of the above

 A normal bowel motion for baby g on its 4th day, would be

a) Small and dark green
b) Pale yellow and smell slightly offensive
c) Soft, bright yellow with a tinge of green
d) Black, tarry and soft

 Cultural safety to practice in nursing is best describe by all of the following except
a) Actions which recognise, respect and nurture the unique cultural identify of tangata
whenua
b) Actions which safety meet expectations, rights and needs of the tangata whenua
c) Actions which empower tangata whenua by working with, rather than on behalf
d) Actions which diminish, demean, or disempower the cultural identity and well being of
and individual

 Professor mason durie describes maori health as the

a) Spiritual, intellectual, social and family kinship components
b) Spiritual, mental physical, and family kinship components
c) Mental, physical and family kinship components
d) Physical, psychological, social and spiritual components
 One way in which nurses can deliver more personalized, culturally safe/appropriate care for
maori clients is
a) To be sensitive and non judgemental and expect the client to conform to prescribed care
b) In a sensitive manner actively discourage any treatment or care strategy not congruent
with the clients own beliefs
c) Give sensitive and non judgemental explanations when refusing client requests for own
cultural/care remedies
d) Adapt nursing care plans to accommodate any treatment or care strategy congruent with
clients own beliefs

 Communication patterns are also a cultural factor that may influence health care practices.
The best way to overcome miscommunication when nursing a maori client would be to
a) Use jargon free language
b) Check client understanding
c) Check for any non verbal cues
d) All of the above are correct

 When assessing families or an individual within a cultural context the nurse in either a
community or hospital setting needs to be aware of
a) Beliefs about the relationship between culture and medical intervention
b) Beliefs concerning body organs and or systems and how they function
c) Beliefs concerning social and economic responsibilities of their clients
d) Beliefs concerning medical practice and nursing care

 Nurses have a responsibility to improve accessibility to health care for their clients, and to
provide culturally relevant and safe health care. This can be achieved by
a) Recognizing that the human experience of illness is identical to the biomedical
interpretation of disease
b) Recognizing that many maori clients have their own concepts and interpretations about
illness and health
c) Being aware that all maori clients have the same belief system regarding health, illness
and its treatment
d) Acknowledging the impact for humans experiencing the current political and social forces
on their health

 Maori people since ancient times have always been closely attuned to nature and used plants
and herbs for remedies to cure many ailments and illnesses. The following is correct
a) This is no longer true, in fact such customary practices are declining
b) This is continuing, with widespread use of a variety of plants for medicinal purposes by
maori people
c) This is only permitted with permission from a tohunga
d) This is no longer true, due to persistent negativity of makutu

 The development of primary health care in maori communities requires all primary health
care providers to
a) Be involved in their own health care
 b) Take greater responsibility for maori health care
c) Identify maori health concerns and devise solutions to meet these
d) See a more equitable allocation of health resources into preventative and health
promotion programmes

 As a staff nurse you overhear an elderly maori patient (due for surgery later in the day) asking
another nurse if his kuia could come in and say a prayer for him, to which the nurse replies,
‘what good are prayers’, ignoring his request to carry on with other work. What actions would
you take in this situation
a) Arrange to call kuia yourself without informing the nurse or patient
b) Inform the charge nurse, explaining what you overheard and leave it for her to deal with
c) Explain (in private) to the nurse concerned the importance of her patients needs. Inform
charge nurse if nurse concerned remains unco operative
d) Ignore the incident completely and continue on with your own work, acknowledging that
non interference is the best strategy as he is not your patient anyway

 You have chosen to work in an obstetric unit for your elective experience. A level 1 student
nurse tells you ‘mrs t wants to take her babys’ placenta and umbilical cord. What a strange
request. Your response would be to
a) Agree with the student and say, ‘forget about it’
b) See this opportunity to promote cultural safety in a clinical setting
c) Tell the student to go and talk to the nurse manager about it
d) Ask a minister to come and talk to mrs t

 As a community nurse you are planning a health check programme at a kohanga reo that is on
a marae. Your plan of action would include
a) Contacting the kohanga reo and establishing correct protocol for your visit
b) Research and review knowledge of cultural variables
c) A culturally appropriate health programme
d) All of the above

 Which statement about spirometry is correct

a) FEV1 measures airflow in the small airways
b) FEV1 is the forced vital capacity in 1 minute
c) In an acute asthma episode, FEV is less than 90%
d) Normal values are based on age, weight, and sex

 Maintenance asthma medications include

a) Salmeterol
b) Terbutaline
c) Ipratropium
d) Albuterol/pratropium

 Adverse effects of beta2 agonists include

a) Bradycardia
b) Hypotension
c) Sedation
d) Headache

 Which statement about corticosteroids is correct

a) They decrease inflammation by increasing migration of T lymphocytes and eosinophils
 b) They decrease inflammation by preventing migration of T lymphocytes and eosinophils
c) The incidence of oral yeast infections increases if the patient uses a spacer and rinses her
mouth after taking an inhaled corticosteroid
d) They re indicated for exercise induced asthma

 The normal peak flow is

a) 50% to 60% of the predicted value
b) 60% to 70% of the predicted value
c) 70% to 80% of the predicted value
d) 80% to 100% of the predicted value

 The national heart, lung, and blood institutes national asthma education and prevention
program recommends
a) Using an objective measurement of lung function
b) Avoiding pharmacologic therapy for asthma
c) Limiting patient and family education
d) Using a subjective measurement of lung function

 Symptoms of an acute asthma exacerbation include

a) Shortness of breath, bradycardia, and chest tightness
b) Shortness of breath, tachycardia, and chest tightness
c) Coughing, hypotension, and bradycardia
d) Diaphoresis, hypotension and wheezing

 Which statement about asthma is correct

a) It’s the second leading cause of hospital admissions
b) Morbidity and mortality has decreased dramatically in the past several years
c) Adults rarely are diagnosed with asthma later in life
d) Asthma is characterized by reversible airflow obstruction and airway
hyperresponsiveness to normal stimuli

STATE EXAMS 24

 Larry and mary smith had planned their first pregnancy for sometime, but when it is
confirmed, mary feels conflicting emotions. She comes to the clinic for her first prenatal
(antenatal) visit at ten weeks gestation. Mary shares her mixed feelings about the pregnancy
with the midwife. The midwifes best response would be to
a) Encourage her to consider abortion counselling
b) Encourage her to seek support from larry
c) Reassure her that when she feels the baby move, her mixed feelings will disappear
completely
d) Reassure her that most women experience some mixed feelings in early pregnancy, even
when their pregnancies are planned

 Marys last menstrual period was 11 april. Her EDD (expected date of delivery) would be
a) 4 january
b) 18 january
c) 25 january
d) 4 february

 During a subseq1uent visit, mary states she has begun to feel foetal movement. Foetal
movement is usually felt by the pregnant woman when the fetus is approximately
 a) 12 weeks gestation
b) 16 weeks gestation
c) 22 weeks gestation
d) 26 weeks gestation

 Tui K is 22 years old and has missed two of her regular menstrual periods. Her doctor
confirms she is pregnant. This is her first pregnancy. Tui can expect to experience all the
following signs in the early stages of her pregnancy, except
a) Chadwicks sign
b) Goodells sign
c) Homans sign
d) Frequency of micturition

 During tuis sixth weeks of pregnancy she experienced a small episode of vagina bleeding.
You would suspect
a) Placenta previa
b) Urinary tract infection
c) Threatened abortion
d) Abruption placenta

 Tui asks for advice on diet. Which of the following is the best approach
a) Give her a list of the five basic food groups and tell her to include them in her daily intake
b) Tell her to increase her caloric intake so she gains about 12 kg during the pregnancy
c) Take a diet history that includes socio economic states, previous nutritional status and
food preferences
d) Take a diet history, analyse it and say what foods she must now omit

 Tui and her partner hawea, attend antenatal classes together. One of the topics discussed are
danger signs of pregnancy. Which of the following is normal and not a danger sign
a) Regular contraction occurring before the due date
b) Vaginal changes, including leucorrhoea
c) A sudden change in fetal activity patterns
d) Any bleeding from the vagina

 At 34 weeks, gestation, mary is hospitalised with severe HOP (hypertension, oedema,

proteinuria) syndrome. Which of the following represents an unusual finding for this
condition
a) Blood pressure 150/100
b) Large amount of protein in the urine
c) Convulsions
d) Generalised oedema

 Candice meeker is expecting her first baby. Candice is interested in having an independent
midwife deliver her baby. The certified midwife is licensed to
a) Manage the care of women throughout the childbearing cycle
b) Manage the care of women only during the intrapartal period
 c) Manage the care of women throughout the childbearing cycle under direct supervison of a
gp
d) Contract with a gp to do their prenatal care

 John is timing the frequency of candices contractions. This means he is timing

a) From the end of one contraction to the beginning of the next
b) From the beginning of one contraction to the beginning of the next
c) From the beginning of one contraction until it begins to go away
d) From the beginning of one contraction until it is completely over

 Neil grant, six months old, is admitted to the childrens ward with severe dehydration due to
vomiting and diarrhoea. Iv fluids are commenced. One of the dangers of iv therapy is
overhydration. This could lead to
a) Infiltration
b) Kidney failure
c) Rupture of the bladder
d) Pulmonary oedema

 Neils blood pressure is very low. You realise that a low blood pressure is expected because
a) Neil has been vomiting
b) Her has beeen receiving IV therapy
c) He has an elevated temperature
d) His circulating blood volume is low

 Patty ray, 6 years old, is admitted to the childrens ward with a diagnosis of cystic fibrosis.
Postural drainage is ordered for patty. Postural drainage consists of
a) Chest percussion, and vibration
b) Retaining techniques, allowing patty to be more active
c) Chest percussion and positioning to drain and remove secretions from pattys lungs
d) Providing patty with exercises that will assist her to control breathing and prevent
dyspnoea

 The most important nursing intervention in giving daily care to patty is

a) Forcing her to eat because she is malnourished
b) Seeing she receives the appropriate dietary regime
c) Frequent skin care to remove excessive salt deposits from increased perspiration
d) Having her repress her feelings of anger

 Patty spends a lot of time in the play room. What does make believe play in hospital provide
for a child
a) Ability to accept a parent substitute
b) opportunity to learn to know other children more quickly
c) opportunity to reject the reality of the hospital
d) opportunity to express fears

 you are teaching pattys parents how to care for her at home. Which of the following do you
include
a) regular medication dosage according to urine testing
b) use cough suppressant only at bedtime
c) do postural drainage three times a day
d) restrict her activities
 while working in the childrens ward, the staff nurse asks you the following questions relating
to legal issues. How would you reply
a) if they require treatment
b) if they need a blood transfusion
c) in the emergency care situation
d) in the absence of a parent or guardian

 under what circumstances must permission from the court be sought to treat a minor
a) when the parent or guardian refuses treatment
b) In the case of parental absence, abandonment or incompetence
c) When the minor is seriously injured
d) In the case of parental separation

 You are working with the public health nurse in a rural area. A mother attends the childrens
clinic asking for information regarding an outbreak of chicken pox in the area. You advise
a) That the effects of chicken pox on the child are minimal and the childs schooling will not
be affected
b) That an immunisation is available for chicken pox for all children at 18 months of age
c) That chicken pox is a notificable disease and the child must be seen by the general
practitioner if you suspect this condition
d) That chicken pox is a contagious viral disease which can be transmitted by direct contact
with skin lesions

 Later that morning, joan smith phones to tell you that her 18 month old son, jared, has been
diagnosed with whooping cough. Joan asks you what she can do for jared. You suggest
a) Regular fluids and increased food intake
b) Continue as normal and encourage activity
c) Humidified air, regular fluids and rest
d) Isolate from other adults and rest

 Matthew, is nursed at rest with the head of the bed elevated to 30 degrees as directed. The
purpose of this is to
a) Prevent Mathew developing skin abrasions from shifting and turning in the bed
b) Prevent Mathew from developing complication such as a DVT and chest infection
c) Assisting Mathew to see and have conversations with the other patients in his cubicle
d) Assisting in reducing any cerebral oedema Mathew may have and improving venous
drainage from his head

 Your assessment of Mathew shows a widening pulse pressure. The term pulse pressure refers
to
a) The difference between a bounding and or thready pulse
b) The difference between a bounding and thready pulse rate
c) The difference between diastolic and systolic blood pressure
d) The difference between diastolic blood pressure and pulse rate
 Jacksons fracture is immobilised by open reduction and internal fixation. A nurse, new to the
orthopaedic area ask you to explain what is meant by open reduction and internal flixation.
Your reply
a) Bringing both bone ends into alignment by surgical intervention and holding them in
position with a metal plate and screws
b) Brings bone ends into alignment by external manipulation and holding them in position
with a stienman pin and traction
c) Bringing bone ends into alignment by external manipulation and holding them in position
by an external fixation device
d) Bringing bone ends into alignment by surgical intervention and holding them in position
by a tight back slab and firm bandage

 You are on duty in the surgical ward of a small rural hospital when james dickey aged 30 is
admitted with a crush injury to his right arm. On arrival james arm is wrapped in a blood
soaked towel, but he hasnit received any other first aid. As you do your initial assessment you
note james has extensive soft tissue damage which includes a 15cm laceration, a large
haemotoma and severe bruising. James becomes very agitated at the sight of the haemotoma
and asks you to explain it. You reply
a) It was caused by splintering of underlying bone at the time of injury
b) It was caused by muscle spasm occurring at the time of injury
c) It was caused by blood vessels bleeding into the soft tissue at the time of injury
d) It was caused by the tearing of subcutaneous tissue at the time of injury

 While treating james wound the doctor becomes aware that it will require extensive
debridment before good healing will occur. The term debridment means to
a) Irrigate the wound to remove blood clots
b) Cauterize all bleeding points and wash out blood clots
c) Tie off blood vessels and nerves deep in the wound
d) Cut away all damaged and necrotic tissue and remove and foreign material

 Due to the nature of james wound prophylactic IV antibiotics and intravenous therapy is to be
commenced. The doctor prescribes a litre of dextrose/saline over 8 hours. The giving set you
use has a drop factor of 60 drops/ml. which of the following flow rates will ensure james
receives the IV fluid within the correct time frame
a) 115
b) 125
c) 135
d) 145

 As transfered james waits to be to theatre you note his bleeding is increasing and you monitor
him more closely. What changes to his vital signs would you expect to see if his blood loss
becomes excessive
a) Slowing of pulse rate, increasing blood pressure, elevated temperature
b) Increasing pulse rate, stable blood pressure, elevated temperature
c) Stable pulse rate, dropping blood pressure, normal temperature
d) Increasing pulse rate, dropping blood pressure, normal temperature

 James is becoming shocked in this instance. What type of shock will this be
 a) Neurogenic shock
b) Hypovolemic shock
c) Septic shock
d) Cardiogenic shock

 Physiological compensation by the body in this type of shock will include all of the following
except
a) Vasoconstriction of the capillary beds
b) Increased pumping efficiency of the heart
c) Fluid shift extra cellular to intravascular
d) Increased sodium excretion of sodium by the kidneys

 Henare is a 25 year old man admitted for emergency surgery, he has a left inquinal hernia
which is nonreducible. This means that he has
a) A weakness in the abdominal wall opening through which the spermatic cord emerges
b) A hernia sac which does not return to the abdominal cavity as a result of swelling
c) Abdominal content, usually omentum or intestine descending into the groin or scrotum
creating a mass
d) A direct inguinal hernia resulting from bowel and bladder content passing through the
posterior inguinal wall

 Pat is a 20 year old woman with a diagnosis of PID (pelvic inflammatory disease). Her
nursing assessment includes temperature 38.4c, moderate lower abdominal pain, and an
offensive vaginal discharge. Nursing interventions for pats care would include
a) Bed and chair rest with legs elevated
b) Monitor temperature and pulse twice daily
c) Nurse at rest in a semi fowlers position
d) Monitor blood pressure three times a day

 Pat asks you ‘is it true that some STDs can cause cervical cancer’ your answer would be
a) Recent research strongly, suggest that both genital warts and genital herpes may cause
cervical cancer
b) Yes all the STDs are capable of causing cervical cancer
c) Any woman who has multiple partners has a high risk of developing cervical cancer
d) Yes, but only those who have the genital herpes virus

 Nina is 33 years old, she has had rheumatoid arthritis for the last five years, and is currently
suffering from an exacerbation of her disease. You are visiting nina with the district nurse.
Although nina is troubled with pain, she is most worried about caring for her 8 month old son
and her home. Nina and the nurse establish a plan to manage ninas pain which is related to
joint inflammation. Which of the following strategies will provide relief for her
a) Applying warm, moist compresses 30 minutes before doing house hold activites requiring
hand and finger movements
b) Taking salicylates after activity to decrease the inflammation caused by activity
c) Loosing 5kg to limit stress placed on joints
d) Applying cold compresses after activities to numb the pain if it does occur

 Which is the correct statement about rheumatoid arthritis. This disease

a) Affects both men and women equally
b) Mainly affects the larger weight bearing joints
c) Is a systemic disease with multiple joint involvement
d) Never occurs in children
 Mrs mary brown aged 34 years has had abdominal surgery. 24 hours later she complains of
pain in her left calf. Your first action should be to
a) Palpate the calf to note tenderness of pain
b) Check mrs browns pedal pulses
c) Ask mrs brown to extend her leg and dorsi flex her foot and note if this causes pain
d) Measure the circumference of the right and left calves and note the difference

 Compartment syndrome is a possible complication of fractures. Which assessment data

should the nurse report immediately
a) Increasing pain out of proportion to the sustained injury
b) Capillary refill which takes two seconds
c) Parathesia which decreases with movement of the affected part
d) Mild oedema of the affected limb

 Mrs skinner has a blood transfusion in progress following hip replacement. Her blood group
is A. this means that in an emergency she could receive blood from
a) Any other group
b) Any group except B
c) Group a only
d) Group A and O only

 Twelve hours after the operation mrs skinner started shivering and complaining of pain in her
back. Her pulse was very rapid. In these circumstances which one of the following should the
nurse do first
a) Take her temperature
b) Give her an extra blanket
c) Send for medical aid
d) Stop the blood transfusion

 The most probable explanation for mrs skinners symptoms is

a) Infection of the urinary tract
b) Reaction to the anaesthetic
c) An allergic reaction to the blood transfusion
d) An allergic reaction to the metal prosthesis

 John an 18 yr old student, has been assigned to your care. He is jaundiced and his clinical
appearance suggests that he has hepatitis A. hepatitis A is an inflammatory condition of the
liver caused by
a) Auto immune processes following a viral infection
b) A virus which infects the person via the GI system
c) A virus which is only transmitted via contaminated blood products
d) A virus which is mainly transmitted by sharing needles

 Following a bout of hepatitis A most people can expect

a) To become a carrier
b) Frequent relapses
c) Lifelong immunity to hepatitis A
d) Increased risk of liver cancer

 The jaundice in hepatitis a is best described as

 a) Haemolytic
b) Bilio static
c) Obstructive
d) Hepato cellular

 The incubation period is

a) Less than 10 days
b) 5-15 days
c) 15-50 days
d) 40-60 days

 A reason why smokers with chronic respiratory problems should not be given medications
that inhibit the cough reflex as
a) These medications dry up mucous and make secretions difficult to expel
b) The hypoxic drive is inhibited causing a slowing in breathing rate
c) Coughing is their only means of preventing mucous accumulating in the lungs
d) In people with chronic problems these medications have no effect anyway

 Asthma is a disorder primarily characterised by

a) Hyperinflation and over expansion of lung tissue
b) Spastic constriction of the respiratory airway
c) A breadown in the walls of alveolar tissue
d) Chronic dilation and expansion of he airways

 During acute asthmatic attacks theophylline medications are given because they
a) Stimulate the inspiratory centre
b) Raise the blood PO2 levels
c) Hyperinflate the lung
d) Dilate the bronchioles

 Aminophylline comes in ampoules of 250mgs in 10 mls. How much in mils, would you draw
up to obtain 300mgs
a) 8.3
b) 12.0
c) 83.0
d) 120.0

 In the early stages of obstruction to urine flow, symtoms which a client with an enlarged
prostate gland might experience include
a) Difficulty in emptying his bladder and hematuria
b) Foul smelling urine with a high bacteria count
c) Complete retention of urine and dribbling
d) Frequency, urgency a poor stream and nocturia

 A client is prescribed 1 litre of dextrose/saline to be given over 3 hours. If the IV giving set
has a drop factor of 15 drops per ml, which of the following, in drops per minute, gives the
correct rate
a) 17
b) 33
c) 67
d) 83
 Your client states that she is most unhappy with the care she is receiving from her doctor and
wishes to change doctors. You respond
a) Would you like to talk to me about why you are unhappy with your care I may be able to
help
b) Okay should be no problem, its your choice after all
c) I don’t think that’s a good idea it can lead to the doctor becoming annoyed
d) Hospital policy does not allow for you to make a choice of doctor but would you like to
talk to me about your concerns

 In an acute presentation, such as jenny, the need to administer medication so as to address the
situation is important. (frightened and psychotic). The most likely choice of drug would be
a) Trifluoperazine
b) Thioridiasine
c) Haloperidol decanoate
d) Benzotropine mesylate

 When administering this medication what is the dosage and upper limit or ceiling in a twenty
four hour period
a) 2mgs, up to 6mgs//24 hrs
b) 6mgs, up to 12mgs/24 hrs
c) 20 mgs, up to 60mgs/24hrs
d) 4mgs, up to 12mgs/24hrs

 Following this episode, jenny is commended on a regular anticholinergic antiparkinsonia

drug. The most likely drug of choice would be
a) Procyclidine
b) Lorazepam
c) Pipothiazine
d) Diazepam

 Jenny is charted this medication. Which of the following drug orders reflects the
amount/dosage to be received accurately
a) 5mgs TDS
b) 20mgs nocte
c) 10mgs QQH
d) 15mgs mane and 15mgs nocte

 Jenny responds well to her care and is discharged 14 days later. She is charted an
antipsychotic injectable medication which the mental health nurse gives her at home. The
medication is flupenthixol decanoate. The dosage and frequency is likely to be
a) 400mgs every 3 weeks
b) 150mgs every week
c) 60mgs every 3 weeks
d) 200mgs every 2 weeks

 Tom has a diagnosis of bipolar affective disorder and his family ask you to talk with them
about it. They ask you what an affective disorder is. A therapeutic response is
a) An abornality in the mood or feeling state of a person
b) A dysfunctional emotive illness exacerbated intermittently
c) A chronic and progressive deterioration in the emotion of a person
 d) A strange feeling which is abnormal in origin

 Tom is admitted to the unit where you work. You are concerned in your assessment to ensure
he is physically well. You care plan would include therefore, a focus on
a) Rest and sleep, fluid and nutritional needs, elimination and personal safety
b) Relationship needs, diet and exercise, and group therapy
c) Counselling needs, altered thought processes and orientation
d) Food and fluids, lowered mood and poor communication

 Foms family asks you why he must take the big white tablets. They say they tast like chalk
and that he only needs them when he is sick. A therapeutic response would be
a) I can understand how it seems that way but the tablets work best when they are taken all
the time
b) That’s why he is sick because he should have been taking them
c) You ought to be encouraging him to take them all the time
d) Yes, perhaps encourage him to take them just when he needs to

 Tom is due for a test today and the lab technicians arrive to do the blood test. Tom asks you
what the level needed in his blood is. The correct response is
a) 1.5-2meg
b) 0.1-0.3meg
c) 0.5-1.3meg
d) 1.0-1.9meg

 Toms level comes back from the lab who ring you to tell you that his level is very high. The
immediate nursing actions would involve
a) A check to see if a.m. dose was given, discontinue meds and notify doctor
b) Commencement on fluid balance chart and vital recordings
c) Encourage fluid intake and continue meds and document observations
d) Inform tom he is toxic, place on bedrest and notify next of kin

 Tom is assessed and has lithium toxicity. The symptoms we would expect to see as nurses are
a) Palpitations, skin rash and headache
b) Photophobia, bradycardia and dyspnoea
c) Coarse tremor, diarrhoea, vomiting and sluggishness
d) Thirst, nausea, skin rash and pain on dorsal flexion

 You are a domicillary nurse and have been visiting liz in the community. Liz is receiving an
antipsychotic in injectable form. Which medication is not an injectable antipsychotic
a) Pipothiazine
b) Thioridiazine
c) Haldol decanoate
d) Flupenthixol

 Before liz was commenced on her medication you asked that she be charted a test dose. This
lower dose is
a) Given then reviewed after 5 days before regular charting begins
b) Given fortnightly for a period of six months
c) Administered and then followed immediately by a regular dose if no reaction is noted
d) Administered once and then repeated weekly for four weeks
 Liz continues to request that her injection site be in her buttock and refuses to have it in the
thigh. You have permission to do this. You assure the accurate site by
a) Locating the upper, outer quadrant of the buttock
b) Locating the lower, outer quadrant of the buttock
c) Locating the iliac crest and administering the injection
d) Locating the midline and injecting 3cms to the side of it

 In regularly dispensing injectable medication you are aware as a nurse that the medication is
locally irritating. You therefore
a) Administer it in one area only
b) Rub the area gently following administration
c) Rotate sites and do not rub/massage the area
d) Apply heat and massage the area

 Jan is a first line manager responsible for the care of a group of patients. She is concerned
because for the last three weeks the physiotherapist has been late to see the patients and
sometimes has not come at all. She has called the physiotherapist but the situation has not
improved. Jans next action should be to
a) Write a memo to the physiotherapy department
b) Contact a nursing clinical advisor
c) Notify the physician of the situation
d) Consult her nurse manager

 In organisations the primary management function is to

a) Assess and establish goals
b) Establish a framework in which to function
c) Plan for results
d) Control all operations

 Cohesiveness is important to all teams. This means

a) The process a group goes through in deciding what do do
b) A mutual attraction which holds a group together
c) A decision made by a knowledgeable leader for the group
d) A strong organisational support system of the group

 Part of jans postion requires her to manage the budget. This is

a) A statement of future expenditures
b) A list of current expenditure
c) A plan for meeting expenses
d) A recording of past expenditure

 Jan is aware that nursing tasks and quality of nursing practice are compared with which
pivotal question
a) Does the performance match standards and objectives
b) Does the performance reflect interest and enthusiasm for the job
c) Does performance indicate knowledge and expertise
d) Does performance leave the patients comfortable

 Elanor brown aged 20 is a passenger who is thrown clear when the car she is travelling in this
a lamp post. Elanor exhibits internal bleeding later diagnosed a ruptured spleen. First aid care
for elanor includes elevating her limbs. This is done to
a) Decrease her venous return
 b) Lower her blood pressure
c) Increase her venous return
d) Assist her to breathe

 Elanor is admitted to the accident and emergency department in advanced stage 2 shock.
When taking her base line observations you would expect to find
a) Elevated BP, elevated pulse rate and elevated respiratory rate
b) Decreased bP, decreased pulse rate and decreased respiratory rate
c) Decreased BP, increased pulse rate and increased respiratory rate
d) Decreased BP, decreased pulse rate and increased respiratory rate

 Elanor is catherterised and her urine output is monitored hourly. This is done to
a) Provide an indication of her renal perfusion
b) Ensure she does not go into fluid overload
c) Ensure she is receiving adequate hydration
d) Monitor the concentration of serum electrolytes

 Elanor also requires additional nursing observations. Which of the following is the most
appropriate
a) Mental status exam and urinary electrolytes
b) Level of consciousness and abdominal girth
c) Papillary reaction to light and limb movement
d) Swallowing reflex and orientation to time and place

 A sample of elanors blood is sent to the laboratory for cross matching. When elanor blood
group has been identified the best treatment for her is to transfuse her with
a) Packed cells
b) Whole blood
c) Lactated ringers
d) Plasma

 John smith, aged 50 receives 30% burns to his face, neck arms and upper thorax when he
pours petrol onto his barbecue. The most appropriate immediate first aid treatment for mr
smith is to
a) Roll him in a damp rug to extinguish the flames
b) Remove his burning clothes as fast as possible
c) Quickly throw him into the swimming pool
d) Quickly roll him in a wet sheet and apply ice to his burns

 Smoke inhalation can complicate burn injuries. While waiting the ambulance the most
appropriate position for conscious victims of smoke inhalation is
a) Sitting in the semi fowlers position
b) Laying down with neck hyperextended
c) Lying supine with the legs elevated
d) Lying in the recovery position

 Which of the following is correct with regard to burn injuries

a) Partial thickness burns are often very painful as the nerve are destroyed
b) Full thickness burns are often very painful as the nerve endings are irritated
c) Full thickness burns are often not painful as the nerve endings are destroyed
d) Blistering and redness often occur very quickly following a full thickness burn
  Factors determining the severity of the burn injury include
a) Depth of burn and percentage of body surface area burnt
b) Location of the burn on the body and age of the victim
c) Size of the burn and previous medical history of the victim
d) All of the above

STATE EXAMS 25

 Ampicillin 100mg IM has been charted for an infant. Ampicillin 250mg in 2ml is available.
Which dose should be given
a) 0.4 ml
b) 0.5 ml
c) 0.8 ml
d) 1.0 ml
e) 1.5 ml

 What is the earliest age of the infant when the mother can sign an interin order for adoption
a) At birth
b) 5 days
c) 7 days
d) 10 days
e) 14 days

 What is the most likely cause of breast engorgement at three days post partum
a) Stasis of milk in ducts
b) Poor suckling by the infant
c) Strong suckling for long periods
d) Poor venous and lymphatic drainage
e) Frequent feeding at irregular intervals

 What is the essential point to teach a woman in regard to self perineal toilet
a) Avoid using toilet paper
b) Empty her bladder completely
c) Wash her bands before and after
d) Empty her bowel immediately prior
e) Observe the blood loss on the pad

 Mrs brodie was transferred to the post natal ward with her newly delivered baby. Mrs brodie
is human immunodeficiency virus antibody positive. Which of these precaustions should the
nurse take
1. Gloves worn for cord care
2. Disposable napkins for the baby
3. Single room with adjoining toilet facility
4. Plastic gloves and apron for the nurse disposing of body fluids
5. Discourage mrs brodies visitors
a) 1 and 2
b) 1, 3 and 5
c) 2, 4 and 5
d) 2, 3 and 4
e) 1, 2, 3 and 4
 Mrs todd is in the post natal exercise room. Baby todd, a healthy two day old is suctioned
because he is mucosy. What is the responsibility of the nurse to mrs todd
a) Go to the exercise room and bring her back to the ward
b) Inform her when she returns from the exercise class
c) Inform her only if she asks if all was well while she was away
d) Say nothing about the suctioning if she asks what happened during her absence

 Mrs todds nurse has a paronychia (infected finger). What action should the nurse take
a) Take sick leave
b) Go to work as usual
c) Work with the paronychia covered
d) Go to work and only care for mrs todd
e) Inform the nurse in charge and ask for ‘dry duties’

 Mrs todd is found to have a haemoglobin of 68g% and is ordered a blood transfusion. She
says to the nurse who is checking the blood, ‘I don’t really want this, but the doctor says I
have to’. What should the nurse do
a) Discuss the matter with the doctor and give the blood if she confirms the need
b) Not give the blood until the doctor has discussed it with the patient
c) Start the blood as charted and inform the doctor of the patients concern
d) Encourage the patient to have the blood and give it when she consents
e) Not give the blood if the patient remains unsure and notify the doctor of this decision

 Mrs todd is placed in a room with three other people, she asks ‘what is the matter with that
person opposite me’ what should the nurse say
a) She do not know
b) Everything they know about the patient
c) That it is the other persons business
d) They will ask someone else to talk to her
e) They are in no position to give that information

 What is the most likely cause of abdominal pain and offensive lochia in the puerperium
a) A pelvic abscess
b) Venereal disease
c) Retained products
d) A cervical infection

 A rehabilitation programme should promote

a) Client autonomy and independence
b) The best possible level of mobility and ambulation
c) Psychological and social adjustment
d) All of the above

 While mr march is hospitalised, the nurse is concerned with preventing the complications of
prolonged bed rest. Mr march already has a reddened area over the sacrum and coccyx. The
nurse knows that the most important action to prevent a decubitus ulcer is to
a) Keep the skin area clean, dry and free from urine, faeces and perspiration
b) Place an alternating air pressure or water mattress on the bed
c) Massage the reddened area with lotion or oil to stimulate circulation
d) Turn and reposition the client at least q2hrly; avoid positioning him on the affected side if
possible
 Which of the following is the most correct statement about positioning the stroke client
a) Flexor muscles are generally stronger than extensors
b) Extensor muscles are generally stronger than flexor
c) The fingers should be flexed tightly
d) The footboard should be flush with the mattress

 Mrs sweetman, aged sixty two years, has non insulin dependent diabetes mellitus. She
recently returned home from hospital where she received treatment for an infection of her left
big toe. Mrs sweetmans toe infection resulted from an injury of which she was unaware. The
most likely reason for this would be that
a) Her vision is impaired
b) She did not regularly wash her feet
c) She finds it difficult to flex her knees and hips
d) She has diminished sensation in her feet

 Mrs sweetmans foot problems result from neuropathic, vascular and infectious changes. The
most important feature of foot care should be to
a) Inspect the feet daily and wash with mild soap and water
b) Maintain adequate blood flow to the lower limbs
c) Rub the feet with alcohol once a week
d) Avoid wearing garters of constricting shoes

 Peter has a temper tantrum during which he lies on the floor at the entrance to the hallway.
This is making it difficult for other residents. He has been asked to get up but continues his
tantrum. Using the principles of extinction how would you deal with peter
a) Continuing to ask him in a firm voice to get up
b) Ignore him and instruct the other residents to step over him
c) Explain to him that he is blocking the entrance and it is unsafe for him to remain where he
is
d) Let him know that if he doesn’t get up immediately, he will be punished

 What would be the most likely effect initially on pters behaviour when commensing to apply
the principles of extinctions
a) Behaviour shows minimal change
b) Inappropriate behaviour would increase
c) Inappropriate behaviour would rapidly decrease
d) Inappropriate behaviour would slowly decrease

 Peter has a habit of hugging new staff members and visitors to the residence. In order for
extinction of this inappropriate social behaviour it would be necessary for him
a) Not to be punished for inappropriate behaviour
b) To be rewarded for inappropriate behaviour
c) To be punished for inappriate behaviour
d) Not to receive reinforcement for this inappropriate behaviour

 If the staff were to apply the principles of response cost in dealing with peters inappropriate
social behaviour they could do so by
a) Taking away something that peter found reinforcing such as restricting his TV viewing
 b) Taking away from peter something that he found unpleasant such as having to eat his
vegetables
c) Applying an aversive stimuli such as making him stay in his room
d) Ignoring the inappropriate behaviour but reinforcing an appropriate behaviour such as his
willingness to help with the dishes

 The safest and most effective way to clear secretions from the respiratory tract is
a) Postural drainage
b) An effective cough
c) Pharyngeal suctioning
d) Endotracheal suctioning

 Carl comes to the mental health clinic where you work because of nerviousness. He tells you
‘I have butterflies in my stomach most of the time. I havnt missed work but it is getting harder
to concentrate on things for a long time. What level of anxiety is carl most likely experiencing
a) Mild
b) Moderate
c) Severe
d) Panic

 Which of the following questions would be the best way to begin taking carls history
a) Could you tell me about your family
b) What are you feeling now
c) Have you ever felt this way before
d) Does anyone else in your family experience these feelings

 Which of the following explains the major differences between normal anxiety and the
syndrome associated with anxiety reactions
a) Normal anxiety is constant; an anxiety reaction is intermittent and rather short lived
b) Normal anxiety is free floating; in an anxiety reaction there is an impending sense of
doom
c) An anxiety reaction is seldom controllable and usually must run its course
d) Normal anxiety is a fact of life and rarely becomes an anxiety reaction

 Signs and symptoms associated with anxiety are

a) Complaints of apprehension, narrowed perception, stomach pains and restlessness
b) Inability to get to sleep, early morning awakening, excessive weight loss and lack of
energy
c) Ideas of reference, grandiose delusion, hallucinations and delusions
d) Spending or giving away large amounts of money

 Michael has been brought by the police into the psychiatric unit. He was found curled up
under a bridge. When asked his name all he would say was ‘nice boy’. His father informs you
that he has not had a psychotic episode for 2 years, and that medication has controlled his
condition. This episode occurred when Michael refused his medication. Which of the
following area should the nurse gather data first
a) Michaels perception of reality
b) Michaels physical condition
c) The observations of Michaels, made by the police
 d) Michaels speech patterns

 Michael becomes regressed and withdrawn. He appears to be listening to something, the nurse
hears nothing. What is the most appropriate response
a) Give him an additional dose of his antipsychotic medication
b) Ignore his behaviour
c) Contact his doctor and request a seclusion order
d) Talk to him about what hes experiencing

 Michaels doctor prescribes haloperidol, 6 mgs IM for three doses. After the third dose of the
medication, Michael is still severly regressed and also agitated. He also appears to be
hallucinating. What would the nurse do
a) Call the doctor for further orders
b) Administer another dose of the medication
c) Record the results of the medication
d) Observe the client for an hour

 Michael yells for the nurse. As the nurse enters his room he says ‘do you see there the virgin
mary is appearing. Which of the following is the best nursing response
a) No I don’t see her but I understand she is real to you
b) She is not there. You must be imagining things Michael
c) Show me where in the room she is appearing
d) The virgin mary is appearing

 Michael is very withdrawl, he moves slowly and is uncommunicative. The best initial goal is
which of the following
a) Michael will increase his social skills
b) Michael will be orientated to reality
c) Michael will increase his level of communication
d) Michael will form a trusting relationship with the nurse

 Four year old sean white was admitted to hospital with burns received while playing with
matches. His legs and lower abdomen are burned. On assessment of seans hydrated status,
which of the following indicates
a) Decreasing hematocrit and increasing urine volume
b) Falling hematocrit and decreasing urine volume
c) Rising hematocrit and decreasing urine volume
d) Stable hematocrit and increasing urine volume

 Which signs/symptoms indicate overhydration

a) Dieresis
b) Drowsiness and lethargy
c) Dyspnea, moist rales
d) Warmth and redness around intravenous site

 Seans output via his foley catheter is 10ml hour. What should be the first nursing action
a) Check the catheter to see if it is plugged (blocked)
b) Call the doctor immediately
c) Record the information on the chart
d) Increase the intravenous fluids
 The doctor has prescribed 500ml of IV fluid to be given over 10 hours. Using a soluset which
delivers 60 drops per ml, calculate the rate in drops per min
a) 48
b) 50
c) 52
d) 54

 When sean starts oral feeding it is particularly important that his client has a high amount of
a) Fats and carbohydrates
b) Minerals and vitamins
c) Fluids and vitamins
d) Proteins and carbohydrates

 Allan martin, is admitted to hospital with acute chest pain. Provisional diagnosis is
myocardial infarction. When asking about the quality of a clients chest pain you are primarily
looking for
a) An indication of its severity
b) The patients own description
c) A response found on a list of possible descriptions
d) Its cause

 When a client is anxious and upset about chest pain, it is best to

a) Explain in detail the pathologic changes that may be occurring
b) Provide short, clear explanations of your assessment, and treatment interventions
c) Don’t say anything until you are sure of his diagnosis
d) Explain that his doctor can answer his questions better

 The nurse asks you to check some pain relief for mr martins severe chest pain. This
prescription is for morphine 6 mgs every 2 hours. The stock available is morphine 10 mg in 1
ml. calculate the correct amount
a) 0.5 ml
b) 0.6 ml
c) 1 ml
d) 1.3ml

 The doctor prescribes frusemide (lasix) intravenously for mr martin. What is the action of
frusemide
a) Diuretic
b) Antiemetic
c) Analgesic
d) Bronchodilator

 What side effects of frusemide (lasix) should the nurse be aware of

a) Hypervolaemia
b) Hypovolaemia
c) Hypotension
d) Hypoventilation

 Mrs maring was brought to an acute psychiatric unit by the police. She was found wandering
around the streets, incoherent, and her behaviour appeared to be inappropriate. She was
 tentatively diagnosed as having schizophrenia. The nurse knows that a diagnosis of
schizophrenia implies that a patient would manifest which of the following behaviours
a) Inability to concentrate
b) Loss of contact with reality
c) Guilt feelings
d) Feelings of worthlessness

 Mrs maring says that the voices are telling her to do things and she cont stop listening. The
best response from the nurse would be
a) Never mind the voices; lets just concentrate on the game
b) The voices will go away soon
c) I don’t hear any voices. I think the voices are part of your illness. Try to listen to what im
saying
d) Everyone hears voices at times

 Mrs maring, after a two week stay, appears much better. She is in contact with reality and is
able to interact with others in an appropriate way. The doctor is sending her home with
medication. The most common medications given for schizophrenia are
a) ECT
b) Phenothiazines
c) MAO inhibitors
d) Antidepressants

 A young maori man dies, as a result of a motor bike accident. The doctor requests his kidneys
for a transplant. His whanau refuse. What is the most appropriate action of the nurse in this
situation
a) You accept the wishes of the whanau
b) You pressure the whanau to re consider
c) You seek permission form other whanau members
d) You support the doctor to over ride what the whanau wish to do

 Mr H, a 72 year old kaumatua (elder) is admitted to the medical ward with cellulitis of his left
leg. He is palced on strict bed rest. Because he is whakama (embarrassed) he refuses to use a
bedpan and demands to walk to the toilet. How should you deal with this situation
a) Give him a bedpan anyway
b) Talk over the situation with him
c) Tell him the doctor has ordered bed rest
d) Ask the other patients to leave the room

 True labour can be differentiated from prodromal or false labour in that in true labour there is
a
a) Strengthening of uterine contractions with walking
b) Failure of presenting part to descend
c) Lack of cervical effacement or dilation
d) Cessation of uterine contractions with walking

 First fetal movements felt by the mother are known as

a) Ballottement
b) Engagement
c) Lightening
d) Quickening
 Growth is most rapid during the phase of prenatal development known as
a) Implantation
b) First trimester
c) Second trimester
d) Third trimester

 The chief function of progresterone is the

a) Establishment of secondary male sex characteristics
b) Rupturing of follicles for ovulation to occur
c) Development of female reproductive organs
d) Preparation of the uterus to receive a fertilised ovum

 Mrs greene, a 22 year old primigravida is attending prenatal clinic

a) Give her a list of foods so she can better plan her meals
b) Assess what she eats by taking a diet history
c) Emphasise the importance of limiting salt and highly seasoned foods
d) Instruct her to continue eating a normal diet

 Mr quang duc pho 65 years old, is admitted to hospital after arriving with a group of ‘boat
people’ from Vietnam. On the basis of the results of a mantoux test, chest x ray examination,
and sputum cultures a diagnosis of active pulmonary tuberculosis is made. The most
appropriate area in which to nurse mr quang on admission is
a) A single room, isolated from all other patients
b) The general male ward
c) Among other patients with infectious disease
d) With other male Vietnamese refugees

 The nurse evaluates mr quangs mantoux test as positive by the presence of

a) A small red swelling less than 7mm in diameter
b) An erythematious area greater than 7mm
c) Swelling and erythema together measuring between 7mm and 9mm
d) A lump greater than 7mm in diameter

 On mr quangs chest x ray film a lesion is observed in an upper lobe. Why is this area of the
lung most commonly affected in tuberculosis
a) There is a slightly higher oxygen concentration in the upper lobes
b) Sputum collects more readily in upper lobes than in lower lobes
c) Upper lobes are less easily ventilated than are lower lobes
d) Tubercule bacilli are less dense than air and therefore remain in the upper lobes

 Which of the following precautions must the nurse take when attending routinely to mr quang
a) Put on a gown, mask and gloves
b) Wash hands thoroughly after handling contaminated articles
c) Wear a mask when in close proximity to him
d) Insist that he wear a mask when care is given

 Mr quangs tuberculosis is considered to be under control when

a) He becomes mantoux negative
b) His chest x ray film is free of any lesion
c) He has three consecutive negative sputum cultures
d) His symptoms of tuberculosis have subsided
  For how long will mr quang need treatment
a) Until he leaves the hospital
b) For 18 months
c) Until all tests are negative
d) For two years

 One of mr quangs cousins in mantoux negative. Evaluate this finding

a) No evidence of tuberculosis
b) A subclinical case of tuberculosis
c) Inactive tuberculosis
d) Possible military tuberculosis

 Given his negative mantoux reaction, what is the appropriate action for mr quangs cousin
a) Discharge from hospital
b) No treatment is necessary
c) Commence triple therapy
d) Chest examination by x ray

 Mrs fitzpatick, a client in a ward opposite chris, asks the nurse ‘what is wrong with that
person opposite me. What should the nurse say
a) I do not know
b) Oh nothing. She just wanted to talk about some problems she is having
c) Ill get the doctor to talk to you
d) Im sorry I cannot disclose that information

 Chris says she wants to discharge herself and go home. Which of the following is the best
nursing response
a) I will ask the doctor to talk with you
b) It would be very unsafe for you to leave hospital without proper medical treatment
c) Can we talk about what is worrying you
d) If that’s what you have decided I will get a self discharge form

STATE EXAMS 26

 Cholesterol is frequently discussed in relation to atherosclerosis. Cholesterol is a substance

that
a) All persons would be better off without because it causes the disease process
b) Circulates in the blood, the level of which responds usually to dietary substitutions of
unsaturated fats for saturated fats
c) Is found in many foods, both plant and animal sources
d) Maybe controlled entirely by eliminating food sources

 Angina pectoris is caused by

a) Sudden and complete occlusion of one or more coronary arteries
b) Mild ischaemia due to temporary or partial occlusion of the coronary artery
c) Obstruction of blood flow between the right and the left atria
d) Mild ischaemia due to partial blockage of the aorta
 The symptoms of angina pectoris are the result of
a) A reduction in the amount of blood circulating through the heart
b) More oxygen being required by the heart muscle than is available
c) The lack of oxygen carrying capacity in the blood supply
d) An interruption to the blood supply which results in decreased tissue perfusion

 Evaluation of the effectiveness of cardiac nitrates is based on

a) Relief of anginal pain
b) A decrease in blood pressure
c) Improved cardiac output
d) Dilation of superficial blood vessels

 Death following a myocardial infarction is most likely caused by

a) Dysrhythmia
b) cardiogenic shock
c) congestive heart failure
d) ventricular rupture

 which of the following factors increases insulin resistance

a) obesity
b) hypoglycemia
c) decrease in amyloid deposits
d) increase in muscle mass

 in metabolism of carbohydrate, the most important function of insulin is

a) precipitating the breakdown of glycogen in the liver
b) to facilitate the passage of glucose into the cell
c) acting as a antagonist to glucagon in the muscle sheath
d) increasing the circulating blood sugar level

 which of the following is the most preventable risk factor for preventing chronic obstructive
pulmonary disease (COPD)
a) adequate nutrition
b) regular exercise
c) exposure to dust and pollen
d) cigarette smoking

 when teaching the diabetic who is taking insulin, the nurse emphasizes the importance of
exercise, which
a) prevents mental deterioration
b) often decreases insulin requirements
c) prevents muscle dystrophy
d) often improves visual acuity

 blood is ejected into the circulation as the chambers of the heart becomes smaller. This action
of the heart is referred to as
a) systole
b) diastole
 c) hypertension
d) ejection fraction

 the patient is experiencing orthopnea. What is the best position for this patient for relief of
symptoms
a) sitting upright leaning forward slightly
b) low fowlers
c) prone
d) Trendelenburg

 Which of the following would be most appropriate for a patient who is receiving diuretic
therapy for cardiac failure
a) Check laboratory results for creatinine levels
b) Monitor for hypotension
c) Encourage the patient to spend time outdoors to aid in vitamin D absorption
d) Discourage use of potassium

 Which of the following complications of diabetes is termed macrovascular

a) Retinopathy
b) Stroke (cerebro vascular accident
c) Nephropathy
d) Renal failure

 Large quantities of frothy blood tinged sputum would indicate which of the following
a) Suctioning required
b) Severe pulmonary oedema
c) Respiratory infection
d) Pneumothorax

 An adult patient has damage to the electrical conduction of the ventricles of the heart. The
nurse would expect to see changes in the
a) Decreases myocardial oxygen consumption
b) Causes venous constriction
c) Decreases collateral circulation in the heart
d) Causes arterial constriction

 Which of the following may develop in the patient when ketone bodies accumulate in
excessive amounts
a) Hypovolemia
b) Polyuria
c) Diabetic ketoacidosis
d) Blurred vision

 A patient has been admitted to the hospital with the diagnosis of type 1 diabetes mellitus.
From this information you recognise that this patient
a) Has an autosomal dominant disease
b) Is a maori or Polynesian origin and over the age of 50
c) Is insulin deficient and exogenous insulin dependent
 d) Is insulin resistant and relies on oral hypoglycaemic agents for glucose control

 Which of the following patients with diabetes may require exogenous insulin but not likely to
experience ketoacidosis
a) The person with type 2 diabetes mellitus
b) The person with type 1 diabetes mellitus
c) The person with type 1 gestational diabetes
d) The person with reactive hypoglycaemia

 Which of the following statements is true regarding type 1 diabetes mellitus

a) There is no genetic or hereditary pattern
b) There is no strong familial link
c) There is a strong autoimmune basis
d) There is no environmental link

 If your patients insulin is labelled U-100, this means

a) 100 units per dose
b) 100 units in the bottle
c) 100 mg per unit
d) 100 units per millilitre

 Which of the following are oral hypoglycaemic agents

a) Oral insulin
b) Insulin substitutes
c) Artificial insulin
d) Sulfonylureas

 Your patient is experiencing hypoglycaemia related to excessive insulin. Your first line
treatment for this type of hypoglycaemia in the conscious patient with diabetes is
a) An injection of glucagon
b) An intravenous injection of 50% glucose
c) Simple carbohydrates, such as juice
d) Complex carbohydrates, such as rice or potatoes

 In metabolism of carbohydrates, the most important function of insulin is

a) Precipitating the breakdown of glycogen in the liver
b) To facilitate the passage of glucose in the cell
c) Acting as an antagonist to glucagon in the muscle sheath
d) Increasing the circulating blood sugar level

 Which of the following factors increases insulin resistance

a) Obesity
b) Hypoglycaemia
c) Decrease in amyloid deposits
d) Increase in muscle mass
 Which of the following findings would indicate that a person with diabetes might be suffering
from neuropathy
a) Blurred vision
b) Loss of memory
c) Numbness of arms
d) Sensory loss in legs

 When water is lost from the body but there is no electrolyte loss, the condition which occurs
is
a) Osmotic diuresis
b) Shock
c) Dehydration
d) Water intoxication

 The nurse teaches a client with COAD how to perform pursed lip breathing, explaining that
this technique will assist respiration in what manner
a) Slows the expiratory rate and gives the client control of respiratory patterns
b) Promotes maximal inhalation for better oxygenation of the lungs
c) Prevents collapse of bronchioles and air trapping in the lungs during expiration
d) Loosens secretions so that they may be coughed up more easily

 Mr langley aged 50 has severe emphysema, during assessment the nurse notes that he has
jugular vein distention and oedematous feet. The nurse recognises that these finds are
indicative of which complication of COAD
a) Acute respiratory failure
b) Fluid volume excess secondary to cor pulmonale
c) Pulmonary oedema caused by left sided heart failure
d) Secondary respiratory infection

 The most dangerous complication of oxygen therapy for persons with chronic obstructive
lung disease is
a) Pulmonary embolism
b) Damage to alveolar and lung parenchyma
c) Dry lung secretions and promote atelectasis
d) Depression of the respiratory drive

 A compensatory mechanisms for respiratory acidosis is

a) Retention of hydrogen ions by the kidneys
b) Decreased rate and depth of respiration
c) Increased bicarbonate production by the kidneys
 d) Decrease bicarbonate production by the kidneys

 Mrs green has an acute episode of right sided heart failure and is receiving frusemide (lasix).
The symptoms mrs green most likely displayed on admission are
a) Dyspnoea, oedema and fatigue
b) Weakness, palpitations, nausea
c) Fatigue, vertigo and headache
d) A feeling of distress when breathing

 Evaluation of the effectiveness of cardiac nitrates is based on

a) Relief of anginal pain
b) A decrease in blood pressure
c) Improved cardiac output
d) Dilation of superficial blood vessels

 Heart failure may be defined as

a) The inability of the heart of pump sufficient blood to the tissues
b) The inability of the heart to pump sufficient blood to the myocardium
c) The inability of the atrio ventricular valves to control blood flow within the heart
d) Inflammation of the endocardium

 Mrs green has an acute episode of right sided heart failure and is receiving frusemide (lasix).
The symptoms mrs green most likely displayed on admission are
a) Dyspnoea, oedema, fatigue
b) Weakness, palpitations, nausea
c) Fatigue, vertigo and headache
d) A feeling of distress when breathing

 The nurse notes that mrs greens abdomen is distended. The nurse should realise that the client
with congestive heart failure develops ascites because of
a) Increased pressure within the circulatory system
b) Rapid diffusion of solutes and solvents into plasma
c) Rapid osmosis from tissue spaces to cells
d) Loss of cellular consituents in blood

 In the systemic circulation, blood returning to the heart from the legs would have to pass
through the
a) Right coronary artery
b) Inferior vena cava
c) Abdominal aorta
d) Thoracic aorta

 Which of the following factors increases insulin resistance

a) Obesity
b) Hypoglycemia
c) Decrease in amyloid deposits
d) Increase in muscle mass
 Which of the following findings would indicate that a person with diabetes might be suffering
from neuropathy
a) Blurred vision
b) Loss of memory
c) Numbness of arms
d) Sensory loss in legs

 In metabolism of carbohydrate, the most important function of insulin is

a) Precipitating the breakdown of glycogen in the liver
b) To facilitate the passage of glucose in to the cell
c) Acting as an antagonist to glucagon in the muscle sheath
d) Increasing the circulating blood sugar level

 Lasix 15 mg is ordered for a client. Available stocks contain 10mg in a 2ml ampoule. The
correct dose would be
a) 5ml
b) 3ml
c) 1.5 ml
d) 2.5ml

 If you suspect the dose of a prescribed medication is too high, your best action would be to
a) Delay giving it until an adequate explanation is given to you about the dosage
b) Give it once, but don’t repeat the medication until the dosage is confirmed
c) Give it if the medication is given orally, but delay it if it is given by injection
d) Give the dose you know is appropriate

 Death following a myocardial infarction is most likely caused by

a) Dysrhythmia
b) Cardiogenic shock
c) Congestive heart failure
d) Ventricular rupture

 When collecting a client from post anaesthetic recovery room, the nurse places the highest
priority on assessing
a) The patients level of consciousness
b) The condition of the surgical site
c) The status of fluid and electrolyte balance
d) The adequacy of respiratory function

 DKA occurs when there is

a) A profound lack of insulin in the body
b) A severe decrease in blood glucose
c) Insufficient insulin production
d) Excessively rigid glycemic control

 Which symptom of DKA causes patients to seek care

a) Dehydration
b) Abdominal discomfort
 c) Acetone breath
d) Blurred vision

 Which of the following is a late sign of DKA

a) Diarrhoea
b) Hypertension
c) Lethargy
d) Deep rapid breathing

 What makes HONK so dangerous

a) It has an insidious onset
b) It presents with a myriad of symptoms
c) It has a rapid downhill course
d) It mimics other diabetic problems

 Plasma glucose levels in HONK are usually

a) <11 mmol/L
b) 11-27 mmol/L
c) 13.8-44 mmol/L
d) >33mmol/L

 The goals for emergency treatment of DKA and HONK include all the following except
a) Correcting the underlying cause
b) Normalising glucose
c) Restoring fluid and electrolytes
d) Stabilising respiratory status

 The nurse should instruct the diabetic patient to follow all of the following sick day guidelines
except
a) Drink plenty of caffeine free fluids
b) Always take your normal dose of insulin even if you cant eat
c) Monitor blood glucose every six to eight hours
d) Always take your oral diabetic medications even if you cant eat

 Large quantities of frothy blood tinged sputum would indicate which of the following
a) Suctioning required
b) Severe pulmonary oedema
c) Respiratory infection
d) Pneumothorax

 An adult patient has damage to the electrical conduction of the ventricles of the heart. The
nurse would expect to see changes in
a) P wave
b) T wave
c) Qrs complex
d) U wave
 To relieve angina pectoris symptoms, the nurse administers nitroglycerin sublingual to the
patient. Which of the following is an action of nitroglycerin
a) Decreases myocardial oxygen comsumption
b) Causes venous constriction
c) Decreases collateral circulation in the heart
d) Causes arterial constriction

 Which of the following may develop in the patient when ketone bodies accumulate in
excessive amounts
a) Hypovolemia
b) Polyuria
c) Diabetic ketoacidosis
d) Blurred vision

 To gain a postoperative patients co operation in ambulating, coughing, deep breathing, and

turning, which intervention is most important for the nurse to perform
a) Administer analgesics freely to achieve the patients relative freedom from pain
b) Ensure that the patient understands the rationale for these activities
c) Warn the patient about complications that can occur if the activities are not performed
d) Praise the patient when the activities are completed

 The nurse is teaching a group cardiac patients to evaluate the nutritional content of food. The
nurse explains that if a serving of 100 gram peanut butter has 36 grams of fat and 190 calories
the percentage of fat per serving is
a) 52%
b) 66%
c) 36%
d) 18%

 Mr doncald graham, aged 81, has a large obstruction that occurred as a result of a faecal
impaction. During assessment of mr graham, the nurse recognises which finding as consistent
with a large bowel obstruction
a) Rapid onset of copious vomiting
b) Metabolic alkalosis
c) Referred pain to the back
d) Constant, generalised abdominal pain

 The physician orders 2 units of blood to be infused for a client who is bleeding. Before blood
administration the nurses highest priority should be
a) Obtaining the clients vital signs
b) Allowing the blood to reach room temperature
c) Monitoring the haemoglobin and hematrocrit levels
d) Determining proper typing and cross matching of blood

 A feature of type 1 diabetes is

 a) Autoimmune destruction of pancreatic beta cells in pancreas
b) Late onset usually older than 40 years
c) Resistance to insulin in target tissues
d) Obesity

 The percentage of the people with diabetes type 2 out of all diabetic clients is
a) Over 40%
b) Over 50%
c) Over 60%
d) Over 80%

 Type 2 diabetes usually requires

a) Oral hypoglycaemic medications, diet and exercise
b) Sub cutaneous insulin
c) Regular daily monitoring of blood sugar levels
d) Four times daily monitoring of blood sugar levels

STATE EXAMS 27

Critical thinking skills that assist the nurse in appropriately setting priorities are which type of
nursing skill
Intellectual
Interpersonal
Technical
Mechanical

Factors that influence goal achievement include the

Clients age and developmental goals
Nurses ability to focus on the client
Strong commitment by the instituation to client care
Nurses commitment to the utilisation of the nursing process

The nurse notes that a hospitalised adult client has orthopnea. The nurse plans to assess the clients
respiration while the client
Lies in a side lying position in bed
Sits upright in a chair
Has the head of the bed elevated 20o
Lies supine in bed

Which position best facilitates assessment of a clients lung expansion

Sitting
Supine
Dorsal recumbent
Prone

A client with chronic constipation tells the nurse that he would like to improve his diet. Besides
encouraging high fibre foods, the nurse should instruct the client to
Drink 2000 to 3000 ml of fluid daily
Refrain from eating spicy foods
Eat more processed cheese daily
Avoid milk products
When a dressing is removed from a wound the nurse notices that the drainage is bright red blood.
This exudates would be described as
Serosanguineous
Purulent
Serous
Sanguineous

Important data to include in a spirituality assessment would be

General spirituality beliefs
Judgement about a clients belief
Appropriate client interventions
Rationale for specific belief

An adult client is to have a complete bed bath. Before beginning the bath, the nurse should
Offer the client the bedpan
Lower the clients bed to the lowest position
Assist the client to brush her teeth
Remove the clients hospital gown

The nurse knows that to promote sleep in the hospital for a client, the client must
Feel comfortable and safe
Have physiotherapy completed early
Take medications by 10.00pm
Have adequate exercise

Terminology
Anaphylaxis

Enuresis

Exudates

Gingivitis

Insomnia

Necrosis

Oliguria

Sputum

Ventilation

Stat

P.r.
Mrs winters (78) is admitted for investigation due to her increasing immobility. You have just
completed a nursing assessment with mrs winters. In analysing the data you have gathered the
following problems are identified
Mrs winters is unsteady on her feet when walking and is afraid she might fall
Mrs winters is experiencing urinary incontinence as she is unable to walk to the toilet
State one nursing goal and list three interventions for each of the problems identified
Nursing goal

Interventions

Nursing goal

Interventions

Mrs winters is at risk of developing certain complications due to her increasing immobility
Explain how immobility affects the following body systems
Musculoskeletal

Cardiovascular

Mrs winters had developed a decubitus ulcer prior to admission. Discuss four factors that
influence wound healing
When performing a change of dressing on mrs winters wound, what actions will maintain surgical
asepsis. Identify three actions and provide rationale
Action

Rationale

Action

Rationale

Action

Rationale

The department of health advises that all infants six weeks of age should be immunised against
the diseases of
Diphtheria, tetanus, measles, hepatitis B
Diphtheria, tetanus, whooping cough, measles
Diphtheria, whooping cough, tetanus, hepatitis B
Diphtheria, whooping cough, rubella, hepatitis B

The department of health advised that all children should first be immunised against rubella in
action at age
3 months
5 months
15 months
5 years

Which statement would best help a mother who says that she does not believe in immunisation
because it is unnatural
Your children are in danger of infection if they were not given breast milk to gain natural
immunity
Immunisation assists the body to produce its own immunity and give protection against
dangerous infections
If your children are not immunised they will have to be kept away from other children
because they could make other children ill
 If you do not have your children immunised they can be admitted to hospital with infectious
diseases and cost the country a lot of money

What is the most appropriate response by the nurse to the question ‘is morbilli a serious disease’
It is a normal childhood complaint
It can cause deformities in the foetus
Septic skin lesions usually follow this condition
Complications such as otitis media or pneumonia can occur

A mother thinks her daughter has measles and is worried because her next door neighbour is three
months pregnant. The nurse should advise the mother
The foetus would not be affected at this stage
She should bring her daughter promptly to the doctor
The daughter should be kept away from the neighbour
She should be immediately vaccinated against rubella

Which of the following responses should the nurse give to the question, ‘why is immunisation
against rubella recommended when rubella is usually a mild illness
Rubella is serious in childhood but not in adults
Rubella is the cause of severe complications in the newborn baby
Rubella can cause deformity in the developing foetus if the mother contracts it
Rubella has been identified as the cause of blindness and heart defects developing in pre
schoolers

A five year old has been discharged from hospital after having swallowed his mothers
contraceptive pills. Which is the most important advice for the nurse to give when making
follow up home visit
Keep all medicines in a locked cupboard
Take out of the bottle only the dose required each time
Use child resistant containers for all medicines
Dispose of unwanted medicines or chemicals safety

Which information source provides most knowledge about the health problems of a community
The local health groups
The prevalence of unemployment
The standard of available housing
Mortality and morbidity statistics

What action should the nurse take when on three home visits the mother of nine months old baby
prevents him from being seen as ‘he is sleeping’
Notify the social welfare of the situation
Notify the family doctor in writing of this occurrence
Insist on seeing the child and refuse to leave the home
Respect the patients right to accept or refuse treatment

Violence and rejection of children in a society have been considered as associated health
problems. Which is the most appropriate first step in planning to reduce violence
Introduce legislation aimed at curbing violence
Reduce violence on television at peak viewing times
Examine the social, cultural and economic conditions and assumptions of society
Teach all health workers to recognise the factors which predispose to violence

When planning nursing care for a client with a different cultural background, the nurse should
Identify how cultural variables impact on the health problem
 Try to explain how the client must fit into hospital routines
Speak slowly and clearly to ensure effective communication
Allow family to provide care during the hospital stay

What action has been proposed to improve maori health in the short term
Provide jobs and better access to health care
Raise the social, economic and cultural status of maori
Provide funding for nga tohunga and nga kamatura
Start education programmes on the marae

When making a home visit to a maroi family which of the following actions should the nurse be
aware of
Taking her shoes off at the door
Avoiding placing her nursing bag on the kitchen table
Obtaining good eye contact with each person she speaks with
Greeting male members of the family first
1 and 2
1 and 4
2 and 3
3 and 4

Mr Sherwood aged 78 years is admitted following a suspected cerebral vascular accident. He has
a left hemiplegia, and is comatosed. All of the following can be used to assess a patients level
of consciousness except
Degree of orientation to surroundings
Quality of verbal responses
Reaction to painful stimulation
Muscular power and tone

Even though mr Sherwood is unconscious the nurse should continue to talk to him while
providing care
In order to show that mr Sherwood is not bein neglected
Because his family might see this as a positive prognosis
Because talking encourages a response when consciousness improves
Because he may be able to hear, yet not respond

When mr Sherwood regains consciousness he is unable to move his right arm or leg. Which type
of paralysis is mr Sherwood most likely to have at this stage
Bilateral
Flaccid
Periodic
Incomplete

Mr sherwoods mouth is drawn over to the left. This suggests non conduction by the
Left facial nerve
Right facial nerve
Left abducent nerve
Right trigeminal nerve

Mr Sherwood seems to understand what is said to him but speaks in garbled words or
inappropriate phrases. This is referred to as
Dysphagia
Global aphasia
Expressive amnesia
Expressive aphasia
Mr Sherwood describes a throbbing bi frontal and suboccipital headache after a lumbar puncture.
This is likely to be
Relieved by lying supine
Anxiety related
A sign of spinal cord compression
Related to increased intracranial pressure

Mrs Sherwood asks if her husband will ever regain the use of his arm and leg. The nurse should
know that mr Sherwood can be expected to regain some degree of function because
Neurons will be regenerated to replace dead ones
Some of the paralysis will subside as does cerebral oedema
Strokes are characterized by functional rather than organic changes
Periods of remission and exacerbation of the paralysis always occur

Mr Sherwood inability to speak is most likely due to

Paralysis of muscles of the larynx
Pressure on the brain stem
Damage to the nerves of the face and tongue
Injury to the cortical speech centre

Jillian, aged 11 years, was admitted to hospital with an acute attack of asthma. How does asthma
affect respiration
Lessens the expulsive action of cilia
Destroys the structure of alveolar walls
Prevents full use of respiratory muscles
Obstructs the flow of air through the airways

Which is the major pathophysiological abnormality occurring in asthma

Cardiac arrhythmias
Bronchiole dysplasia
Spasm of the smooth muscles of the bronchi
Inflammation of the alveoli

Breathing in asthma is commonly described as

Gasping
Grunting
Wheezing
Stertorous

R difficulties can most effectively be relieved by agents which cause

Bronchodilation
Increased oxygen tension
Decreased production of mucus
An action against causative allergens

In jillians immediate care the nurse should stay with her and
Assist her in controlled expiration
Use oxygen as a ventilator stimulus
Explain that the doctor has increased her drugs
Provide reassurance that treatment is being effective
Aminophylline 350mg is prescribed. Each ampoule contains 250mg in 10ml. how much should be
added to the intravenous solution
12ml
14 ml
16 ml
35 ml

While jillian is having intravenous aminophylline, the most important nursing action is to
Assess the intravenous site once each duty
Sit her well up in bed to aid ventilation
Monitor her respiratory and heart rates regularly
Record all medications as charted when they have been given

Jillians intravenous infusion of 300ml normal saline is due to run over 4 hours. The drop factor is
60. How many drops per minute must be given for the IV to be completed on time
55
65
75
85

Even after intravenous medication jillian is still anxious, dyspnoic and restless; respiratory rate is
36; she is still wheezing and using her accessory muscles. What action must the nurse take
Jillian needs physiotherapy to help her breathing
Lack of response to treatment requires medical review
She needs to use her inhaler as well as her medication
A higher concentration of oxygen will help her breathe more easily

As part of the treatment regime the doctor prescribes ampicillin (ampicyn) 400mg. the ampoule
contains 500mg in 10ml. what volume should be given
4ml
6ml
8ml
12ml

After her severe attack of asthma jillian says ‘im never going to get better, im going to die’ what
is the most appropriate response by the nurse
Joke with her and get her to laugh
Reassure her that she will be alright
Arrange to spend some time sitting with her
Listen to her talk all about her problems

Salbutamol (ventolin) is administered through a nebuliser four hourly. The primary action of this
drug is as a
Broncho’dilator
Cardiac stimulant
Respiratory stimulant
Respiratory depressant

Which is the most important reason for administering ventolin through a nebuliser
A low dose can be given for local effect
The method is more acceptable to children
The drug is completely absorbed and acts quickly
 It is the most convenient method when an oxygen mask is in use

All of the following must be done when jillian is using her inhaler except
Shake the inhaler before using it
Expire fully before inhaling the spray
Hold the inhaler within ones open mouth
Use the inhaler repeatedly until some relief is felt

Which is the first step in helping jillian to live a normal life in spite of her asthma
Monitor her long term drug therapy
Help her understand the nature of the condition
Teach her parents postural drainage with percussion and vibration
Listen to her difficulties and help her find ways of coping with them

What should the nurse do when jillian refuses to get involved in an activity because of fear of an
asthma attack
Take away other privileges until she participates
Allow her to remain in bed when she is short of breath
Listen to her and encourage participation in the activity
Let her decide what type of activities she would like to do

The most important factor about jillians prognosis that her parents should know is that she
Has an unpredictable prognosis
Will never be completely cured
May experience other disabling symptoms
Can recover but attacks can recur if she is under stress

Mrs hill a 30 year old housewife, with a husband and three children, has just been told by her
doctor that she has multiple sclerosis. Multiple sclerosis is characterised by
Increasing deterioration which ultimately ends in death
Gradual deterioration with progressive loss of movement
Recurrences and remissions extending over a period of many years
Loss of movement and sensory functions, mainly in the lower body

The diagnosis of multiple sclerosis is usually made after

Confirmation of positive blood tests
Recurring bouts of acute depression
Identification of the micro organism causing the disease
Signs of damage to the nervous system that occur from time to time

Mrs hills family should be included in discussions on

Her dietary requirements
The fact that the illness wont improve
The need for daily physiotherapy for her limbs
How to encourage mrs hill to remain self reliant

What is the best amount of exercise for mrs hill

Resting quietly as much as possible
Exercising daily but not getting too tired
Just exercising smaller muscles, not her large muscles
Doing as much as she can to prevent contractures occurring
Why should a person who has multiple sclerosis always be very careful to avoid infections such
as the common cold
It takes longer to get over an infection
Poor immunity is associated with the disease
Infection may trigger off an acute episode of the disease
An infection masks other symptoms and prevents early intervention

Mrs hill expresses hopelessness about her loss of independence. Which of the following
statements by the nurse would be most helpful
What is it that worries you most
Could your family help you a bit more
You may be setting goals which are too high
Your depression is just part of your disease

The persons who are most likely to have the greatest effect in assisting millie to maintain a
positive self concept are
The occupational therapists during job retraining
Other people with multiple sclerosis who manage independent lives
Physiotherapists who help her to achieve maximum mobility
People unaffected by multiple sclerosis such as the MS society field worker

Mr green, 56 years old has been in hospital for two weeks with a diagnosis of cerebral
thrombosis. His symptoms include expressive aphasia, right sided paralysis and loss of the
gag reflex. As part of the long term planning the nurse should
Help the family accept the fact that mr green cannot be verbally communicated with
Wait for mr green to verbalize his needs regardless of how long it takes
Begin associating words with physical objects
Help mr green accept this disability as permanent

Mrs green seems unable to accept the idea that her husband must be encouraged to do things for
himself. The nurse may be able to work around these feelings by
Telling mrs green to let her husband do things for himself
Letting mrs green know that the nursing staff has full responsibility for the patients activities
Letting mrs green assume the responsibility as she sees fit
Asking mrs green for her assistance in planning the activities most helpful to the patient

A public health nurse has been invited to talk about child health with a group of mothers. Which
is the single most important factor in the early social development of children
Living in an extended family setting
The way their needs are met by others
Their physiological status and stability
Their inherited biological characteristics

An important factor which makes two year old children feel physically secure is
Acknowledge they are individuals
Allow them to have what they want
Ensure they know what they can and cannot do
Be very strict when disciplining them at home

Which of eriksons psychosocial crises is present at age four years

Trust versus mistrust
 Initiative versus guilt
Industry versus inferiority
Autonomy versus shame and doubt

Parents are likely to have less conflict with their adolescent children if they
Use rules and punishment to control adolescents
Make a conscious effect to remember their own adolescence
Keep communication open and allow reasonable independence
Plan a set of rules which will be followed at all times

A man has a bleeding socket after getting his tooth removed. The correct action to take is to
Give him an ice cube to suck
Give him a warm saline mouthwash
Pack the socket with ribbon gauze
Tell him to bite on a gauze pad for twenty minutes

Mr smith suffered severe burns to both legs from flames at a barbecue on the beach. His friends
carried him to the waters edge and let the sea flow over his legs. Which statement is correct
about the suitability of this first aid treatment
Advisable to reduce the heat of the flames
Strongly recommended as sea water is healing
Risky because of the contaminants in sea water
Not acceptable because of the risk of chilling and shock

A 42 year old farmer is pinned under his tractor. His breathing is laboured, he is slightly
cyanosed, shocked and has severe chest pain. While waiting for the doctor the nurse should
especially note any
Alteration in pain
Decrease in temperature
Change in his respirations
Increase in the amount of restlessness

The farmer is removed from behind the wheel. He is in severe respiratory distress and is
becoming more cyanosed. The farmer is found to have an open pneumothorax. The most
appropriate first aid is to
Seal the wound in the chest wall
Start mouth to mouth resuscitation
Place the farmer to in recovery position
Lie the farmer flat, extending his neck

The ambulance driver gives the farmer oxygen therapy. This improves his respirations and
decreases his degree or acidosis by decreasing the
Carbon dixide and carbonic acid in the blood and the ratio of carbonic acid to bicarbonate
Hydrogen ion concentration in the blood and increasing the ratio of carbonic acid to
bicarbonate
Carbonic acid, so chloride moves into the red cells leaving more sodium available to form
bicarbonate
Build up of potassium in the blood stream and increasing oxygenation of the haemoglobin in
the blood cells

Which statement would best help a mother who says that she does not believe in immunisation
because it is unnatural
Your children are in danger of infection if they were not given breast milk to gain natural
immunity
 Immunisation assists the body to produce its own immunity and give protection against
dangerous infections
If your children are not immunised they will have to be kept away from other children
because they could make other children ill
If you do not have your children immunised they can be admitted to hospital with infectious
diseases and cost the country a lot of money

The nurse should explain to a youth who has not been immunised against tetanus that he will be
given a
Single dose of tetanus serum
Single dose of tetanus toxoid
Small dose of tetanus anti toxin
Course of tetanus toxoid injections

Vaccinations are often given at specified intervals with weeks or months in between each
injection because
This is convenient to the doctors and nurses
A stronger secondary response is induced
This is a long standing medical procedure
The body could not cope with a large dose at one time

Vaccines induced immunity that is

Active artificially acquired
Passive artificially acquired
Active naturally acquired
Passive naturally acquired

Which of the following signs symptoms would indicate mumps

Swelling of the lymph nodes
Tenderness of the parotid gland
Enlargement of the prostate gland
Ulceration of vesicular stomatitis

Which option is important for the nurse to know with regard to prevention of the spread of
mumps
Safe disposal of all bodily excretions
No specific isolation measures are needed
Control of all food stuffs prepared for sale
Isolation for ten days after the last notified case

Which of the following is the best description of a vaccine

Dead modified bacilli
Live attenuated virus
Dead virus given orally
Antibodies suspended in serum

Mrs shaw brings her 8 year old daughter jane to the clinic. Jane has eczema. Janes eczema is most
likely the result of
Inadequate skin care and hygiene
Excretion of acids through sweat pores
An inherited predisposition to skin infections
 Sensitivity to a substance in her external environment

Excema is the term used to describe a (n)

Acute, contagious inflammation of the skin
Non contagious inflammatory response of the skin
Fungal infection more commonly seen in childhood
Condition marked by the appearance of erthematous wheals

Which statement best describes ‘vesicles’

Reddened, pinprick like rash
Small round area of discolouration
Small area of swelling on the skin
Small blister filled with serous fluid

You are employed as a practice nurse. A friend telephones and asks if her boyfriend has been to
see the doctor this week. Your most appropriate response is
I don’t know
Ill have to ask the doctor
I am not able to tell you that
Just a moment, ill check the files

STATE EXAMS 28

Mrs adams suffers from dementia and requires a dressing to a shin wound. The nurse suspects the
wound is the result of a non accidental injury. What is the main cause of non accidental injury
in an elderly person suffering from dementia
A dependent person being more prone to injury
A long standing pattern of domestic violence
The home not being a suitable place for a dependent person
The increased stress in caring for a dependent person at home

When dressing the shin wound the nurse most appropriate remark is
How did you scrape your shin mrs adams
How did you scrape your wifes shin mr adams
This shin must hurt. Was it really an accident
A shin is easy to hurt. How did this injury happen

The most appropriate way to help mr and mrs adams at the first visit is to
Express professional concern at the cause of the injury
Conceal feelings about the possible cause of the injury
Reassure mrs adams that this injury will not occur again
Acknowledge the stress on mr adams in caring for his wife

An increased incidence of vaginal infections occurs when contraceptive pills are taken because
there is
A shift in the vaginal pH
Drying of the vaginal mucosa
An increase in vaginal fluids
A reduction in white cell numbers

What action should the nurse take when on three home visits the mother of the nine months old
baby prevents him from being seen as he is sleeping
Notify the social welfare of the situation
 Notify the family doctor in writing of this occurrence
Insist on seeing the child and refuse to leave the home
Respect the patients right to accept or refuse treatment

Which is the major pathophysiological abnormality occurring in asthma

Cardiac arrhythmias
Bronchiole dysplasia
Spasm of the smooth muscles of the bronchi
Inflammation of the alveoli

The first and probably the most important awareness that a person with an intellectual disability
should be assisted to develop is a feeling of
Trust
Belonging
Acceptance
Physical satisfaction

Which is not a characteristic of a therapeutic environment

Free communication
Everyone doing as they like
Provision of learning experiences
Modifying authoritarian structures

A person in a training session using reinforcement will learn most effectively when he
Is reinforced intermittently
Is reinforced contingently
Is reinforced non contingently
Initiates others who are contingently reinforced

Norman aged 10 has a severe intellectual disability, but is a physically active child. He has been
admitted to hospital for assessment. The best indication that a child reacts poorly to
frustration is when he
acts silly to gain attention
is jealous of attention given to others
sulks because he thinks playmates are begin unfair
throws temper tantrums when he does not get his own way

the most helpful assessment for planning the nursing care of a person with a severe intellectual
disability is
details of his abilities
a description of his characteristic syndrome
a study of photographic records of his progress
data relevant to past and present environmental factors

aminophylline 350mg is prescribed. Each ampoule contains 250mg in 10ml. how much should be
added to the intravenous solution
12ml
14ml
16ml
35ml

Jillians intravenous infusion of 300ml normal saline is due to run over 4 hours. The drop factor is
60. How many drops per minute must be given for the IV to be completed on time
 55
65
75
85

Salbutamol (ventolin) is administered through a nebuliser four hourly. The primary action of this
drug is as a
Broncho dilator
Cardiac stimulant
Respiratory stimulant
Respiratory depressant

A client is charted nitrazepam (mogadon) tablets to sleep. She refuses to take them at 9pm. She
tells you that the other nurses always leave the tables on the locker and she takes them when
she is ready. What should you do
Put them back in the container
Give her the tablets and let her take them later
Tell the patient to ring when she is ready for them
Tell her if she doesn’t take them now she may not get them later

Hyperventilation may initially cause

Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis

The nurse should explain to Normans mother that an electro encephalogram is

Like a mild electric shock, but is not painful
Helpful in finding the cause of his epilepsy
A test to record the electrical activity of the brain
A test to find the cause of the childs behaviour disturbance

Normans father asks if he can expect his sons condition to improve. Which is the most
appropriate reply for the nurse to give
Yes but it will take a long time
No but he can be helped with therapy
No but further degeneration will not take place
No but his condition can be controlled with drugs

The concept of normalisation as a direction of care for the mentally disabled would ensure that
norman is treated as an individual
With human rights and needs
According to actual mental age
With adaptive deficits
According to actual chronological age

Which of the following is the most important information to give to the parents when they take
norman home for the weekend
Advice about his general abilities
A report on his progress at school
The details of his training programme
The changes noticed in his general condition
Peter aged 19 is disabled due to intellectual impairment and epilepsy. He is ambulant and lives at
home. The nurse is asked to visit as peter has developed mumps. Which of the following
micro organisms cause mumps
Viruses
Bacteria
Gram negative organism
Gram positive organism

Which of the following signs symptoms would indicate mumps

Swelling of the lymph nodes
Tenderness of the parotid gland
Enlargement of the prostate gland
Inflammation of naso pharyngeal lymph tissue

Which option is important for the nurse to know with regard to prevention of the spread of
mumps
Safe disposal of all bodily excretions
No specific isolation measures are needed
Control of all food stuffs prepared for sale
Isolation for ten days after the last notified case

The best way to help peter develop his creative potential is by

Motivation to become independent by earning some money
Accepting as valuable something he has made
Concentrating on the lessening of his liabilities
Group activities that encourage him to interact with others

Which of the following is essential in assisting the family to help peter to develop independence
Observe what he can and cannot do
Recognise his need to be treated as a normal adolescent
Stress that going away from home is a creative adventure
Gain an insight into the limitations imposed by his family circumstances

Simon aged 14 years is paraplegic and has an athetoid type of cerebral palsy. He has been
admitted to a psychopaedic assessment unit. Which of the following best describes athetoisis
Hypertonicity of head, neck and shoulder muscles
Voluntary writing or throwing movements of the whole body
Hypotonia and impairment of postural fixation of the trunk
Involuntary movements affecting almost all muscles of the body

What characterises the muscle movement of athetosis

Abnormal reflex activity
Exacerbated by attempts at intentional movement
Exaggerated spasticity in movement
Slow, writhing, continous involuntary movements

All of the following may be the cause of chronic constipation except

Very refined food
Too much fibre in the diet
Too little fluid in the diet
Poor muscle tone in the bowel

Which of the following is the best combination of foods to help relieve constipation
 Raw fruit and vegetables
Cooked meat and raw vegetables
Cooked fruit and refined cereals
Refined cereals and well cooked vegetables

How are passive exercises undertaken

Without the persons active assistance
Without any help from the physiotherapist
Only with assistance from the physiotherapist
By the use of weights to strengthen the muscles

Why is joint movement promoted in simons physiotherapy programme

Prevents contractures of his muscles
Stimulates voluntary muscular movements
Maintains circumduction of the hip joint
Maintains the strength of his leg muscles

Which action is most likely to prevent the formation of a bed sore

Changing the position every two hours
Placing a sheepskin under the buttocks
Placing a rubber ring under the buttocks
Vigorously massage the area with silicone cream

The most helpful measure to assist a 14 year old boy with paraplegia and cerebral palsy to cope
with urinary incontinence is to
Offer a urinal at regular intervals
Keep a disposable urinal in place at all times
Teach him to use a penile appliance and self emptying bag
Insert a retention catheter to prevent overdistension of the bladder

Which urinary tract problem is most likely to occur as a complication of immobility

Haematuria and infection
Stress, incontinence and infection
Renal calculi and infection
Bladder distension and haematuria

Bruce, aged 15 years has had a moderate intellectual disability from infancy. He has recently
moved into a hostel and attends a special school where his behaviour is reported to be both
antisocial and disruptive. What is the most likely reason or bruces recently reported behaviour
problem
He has no single set of ideals on which he can depend
He is concerned about what may happen next to him
His thoughts about being independent have caused an identity crises
He needs to regain a feeling of security and confidence he felt when he lived at home

The most effective behaviour therapy in bruces situation would be to

Punish him so that disruptive tendencies are eliminated
Develop a reliable behaviour pattern for effective social functioning
Arrange contingencies between his behaviour and its long term consequences
Manipulate the environmental factors to make acceptable behaviour highly probable
What is the most important reason for keeping records during bruces behaviour therapy
programme
Provide a primary source of baseline information
Provide evidence of programmes that achieve their desired effect
Limit personal biases when his behavioural programme is discussed
Provide some objective method for evaluating the outcome of the techniques used

Which of the following should be undertaken first when planning a behaviour therapy programme
for bruce
Consulting his relatives
Assessing his present level of functioning
Deciding on the overall goals for his programme
Arranging with the psychologist for psychological testing

When introducing bruce to a reward schedule it is best to

Make sure bruce feels he never gets enough of the reward
Use a strong reward for target behaviour every time it happens
Use the chosen schedule until his behaviour is completely controlled
Use an intermittent schedule until bruce understands what is expected of him

Which of the following applies when changing bruce from a continuous to an intermittent
behaviour schedule
Explain to him what is happening
Reduce the number of rewards slowly
Use only natural rewards for target behaviour
Continue to reward target behaviour each time it occurs

The primary principle in preparing a new teaching programme for bruce is to

Prevent him repeating mistakes
Use and extend his current learning achievements
Assist him to achieve a satisfactory quality of life
Offer encouragement for socially appropriate behaviour

Prescribed is heparin 125000 units. The vial you have contains heparin 1 mega unit in 2mls. What
is the correct dose
0.025 mls
0.25 mls
0.5 mls
1.0 ml

The doctor orders 1000 mls of barts to be infused over 8 hours. The drip factor is 15. What is the
number of drops per minute
3
30
31
310

Penicillin 250 mgs is prescribed. The drug available in powdered form is reconstituted to contain
600 mg in 2 ml. what amount should be given
0.75 ml
0.8 ml
0.83 ml
 0.9 ml

Under the misuse of drugs act 1975, a registered nurse may be convicted in a criminal court of
law for
Giving prescribed sedation to a patient in hospital
Possessing a controlled drug, not prescribed for the nurse by a medical practitioner
Signing the controlled drug register, having given a prescribed medication
Refusing to give a prescribed controlled drug to a patient suffering from chronic pain

The preliminary precaution that must be observed first before the nurse gives the ampule of
medication handed to her by the charge nurse is to
Wash her hands
Sight the doctors prescription
Check the charge nurse gives the orders in writing
Check the prescription is writing in duplicate on the patients chart

Mrs jan carr is a 45 year old, non maori woman who is married and has two adult children living
away from home. Recently mrs carr has experienced a weight loss of 10 kg, has disturbed
sleep patterns and has very little energy. She is admitted to hospital with a diagnosis of
depression. What other feature is she likely to demonstrate on admission
Flight of ideas
Halluscinations
Feelings of persecution
Feelings of worthlessness

The most important priority in your assessment would be to gain information concerning which of
the following
Unresolved conflicts
Ideas of self harm
Current stresses
Previous history

Mrs carr tells you she would like to go to sleep and never wake up. Which response is the most
appropriate
Lets go for a walk to cheer you up
Youll feel better in a day or so
Are you saying you want to die
Your medication will make you feel differently

Mrs carr is assessed as being actively suicidal and has refused all food and fluids since admission
this morning. Choose the most appropriate group of nursing interventions
Nutrition, psychotherapy and medication
Constant observation, supportive care and nutrition
Supervised activity, nutrition and family visits
Constant observation nutrition and medication

Mrs carr is given tricyclic anti depressant medication. After four days she tells you that the pills
are not working. Choose the most appropriate action
Report her statement to the house surgeon
Tell mrs carr that the medication will take at least 10 days to start working
Discuss mrs carrs anxieties about medication with her
Record her statement in the nursing records

Mrs carr asks you how long she will have to take medication. Your most appropriate response
would be
 The medication takes a maximum of four weeks to be fully effective
Usually people continue on this type of medicine all their lives
Once your condition improves your medication may be gradually reduced
The maximum time on this type of medication is six to twelve months

Mrs carr complains of a dry mouth. The most likely reason for this is
Insufficient fluids
Anxiety
Side effects of medication
Nervous system response

Four weeks later mrs carr is granted weekend leave. She tells you she has a bottle of anti
depressants at home, which she will take if things do not go well. Your response would be to
Tell her that the responsibility is hers
Listen and report to the team so that her leave can be reconsidered
Make a contract with her that she will not harm herself
Reassure her that she is much improved and will cope with leave

The physician orders a different type of medication when mrs carr does not respond positively to
a tricyclic anti depressant. While the patient is taking the newly prescribed drug,
tranylcyclopromine sulphate (parnate), which one of the following reactions is likely to occur
if the patients diet includes foods containing tyramine
Heart block
Grand mal seizure
Hypertensive crises
Renal failure

Mrs carr again obtains permission for leave. Which one of the following preparations by her
husband indicates the best understanding of the her needs
Planning to involve her in their usual at home pursuits
Bringing her bed downstairs so she can rest during the day
Scheduling a day of interesting activites outside of the home
Arranging for a friend of the family to watch her at all times

Mrs carr has learnt that practicing relaxation gives her a feeling of control over her depressing
thoughts. The particular part of the nervous system activated through relaxation training is the
Sympathetic nervous system
Parasympathetic nervous system
Central nervous system
Peripheral vasoconstriction

Eric smythe, a 45 year old non maori man is admitted as an informal patient the psychiatric unit
after a week in intensive care following an over dose of imipramine. He had been on this
medication for depression for the preceding twelve months. During the interview, you as the
admitting nurse, observe that no longer appears depressed, is somewhat detached and is
joking about his foolishness (referring to his suicide attempt). Eric requests discharge, stating
that he is afraid to lose any more time off work and that his family will not cope if he doesn’t
go home now. From the interview data you assume that
Eric has gained insight into his self destructive behaviour
Eric desire to return to work and his family indicates good judgement
Erics affect indicates that his bout of depression is now over
Erics comments may indicate he is suicidal and is trying to bide it

Establishing a therapeutic relationship with eric will contribute to which of the following
The feeling that he is worthless
 The feeling that others pressure him
The feeling that he is overprotected
The feeling that others want him to live

One day when erics wife visits she finds him quietly weeping and saying he cant go on. She asks
you to calm him down. Your best response would be
All right, ill talk to him and see if I can find out whats wrong
If you just sit quietly with him, im sure hell calm down
Its hard to see him so upset, but he needs to let the feelings out
We can both stay with him until he has regained control if you like

One of the things that the nurse must be aware of when caring for eric as he recovers from
depression is
He is considered less of a suicide risk than when severly depressed
He is no longer considered a suicide risk as he recovers
He is considered more of a suicide risk when he is recovering
He is considered more of a suicide risk when in the depths of depression

While on leave eric again takes an overdose of his antidepressants. He rings the ward to let you
know he will not be back and tells you why. What approach will you take in this situation
Keep him on the phone and send the police to bring him to hospital
Persuade him to put his wife on the phone and ask her to bring him to hospital
Convince him to drive himself back to the hospital to get treatment
Look up his address go out and bring him to hospital yourself

The team decide that erics condition is serious. They decide he should undergo a course of E.C.T.
before his first treatment at 8am, you should be sure eric has
Has recently urinated
Has not drunk for 12 hours
Signed a consent form
Has not eaten for 12 hours
All of the above

Mrs smythe asks you what to expect when she visits eric after his treatment, which of the
following is the most accurate information
It is possible that he may not recognise you for a few days
There will probably be a temporary and expected loss of memory
He will be so confused that it will be best not to visit today
He will be very sleepy and unable to tolerate a long visit

Eric makes good progress with E.C.T and antidepressant therapy and is ready for discharge. He
asks you what signs to look out for in the future that might indicate a recurrence of
depression. Your best response is
Grandiosity, insomnia, self devaluation, psychomotor retardation
Persecution, insomnia, self devaluation, psychomotor retardation
Paranoia, insomnia, self devaluation, psychomotor retardation
Withdrawal, insomnia, self devaluation, psychomotor retardation

You are working the evening shift in the intensive care unit. You observe that there are times
when patients appear not to respond to injections of diazepam (valium). On further
investigation you discover that the lack of response occurs ofter the medication has been
administered by mrs H, a day shift nurse. One evening mrs H is assigned to work with you on
the evening shift because one of the regular staff is absent. After dinner you observe that one
of the patients received diazepam but is still anxious. You also observe that mrs H appears
slightly euphoric, uncoordinated, and her speech is slurred. The first action for you to take is
 Arrange to observe mrs h when she prepared medications
Ask other nurses if they have observed anything unusual
Call the nursing supervisor and ask her to confront mrs h with you
Tell mrs h that you know she has been stealing drugs

What distinguishes substance dependence from substance abuse

Tolerance for the substance and psychological dependency
Tolerance for the substance and polydrug abuse
Tolerance for the substance and withdrawal reactions
Psychological dependency and withdrawal reactions

It is determined that mrs h has a drug abuse problem. A positive initial intervention would be
Dismissal from her job
Referral to a self help group
Counselling by the head nurse
Referral to a drug treatment programme

When withdrawing the client from benzodiazepines the most important thing to remember is
To get the client off the substance as quickly as possible
To perform an accurate assessment and establish a baseline before proceeding
To get the client off the substance slowly
To educate them re other problem solving techniques

Which of the following groups of responses is characteristic of addiction to antianxiety agents

Psychological addiction, tolerance no physical addiction
Physical addiction, tolerance, no psychological addiction
Psychological addiction, no physical addiction, no tolerance
Physical addiction, psychological addiction, tolerance

Mr D B brown a 45 year old non maori man is admitted to the ward in which you are working
following a domestic dispute, during which time he smashed the family home up and punched
his fist through a window, causing severe lacerations of his hand, for which he has received
treatment. It is suspected that a drinking problem has played a major part in his presentation.
This may be confirmed by his developing early signs of withdrawal which would include
Anxious, restless, and perspiring profusely
Presenting as undernourished and unsteady on his feet
Confused and disorientated
Denying vehemently that he has a drinking problem

Generally, the long term course of alcoholism

Follows a common progression in different people
Differs between men and women but is the same within the sexes
Shows that blockouts after modest drinking are a valid early indicator of alcoholism
Is highly variable for each individual

How can it be that alcohol consumption is initiated to reduce distress, if most of its effects are
negative
Denial of the negative effects keeps drinkers as seeing them as a punishment
The negative effects are transient and weak, while the positive effects are powerful and long
lasting
People who start to drink have a diminished capacity to learn from experience
Negative effects of alcohol consumption are relatively remote, while positive effects are
immediate
One night when mr browns wife does visit, after two weeks, she asks to speak you privately and
tells you that her husband has asked her to come home again. She wonders whether this is just
another ploy, or should she give the marriage another go. Would you
Advise her that alcoholics lie and deceive, and can never change
Tell her that marriage is for better or worse and that the most appropriate thing to do is for
them to get back together again
Advise her to get professional help for herself, in order to work out her immediate priorities,
preferably from an alcohol related agency
Tell her that shes best out of it; suggest terminating as its only like to happen again

Co dependent people would be best served from a therapeutic point of view in

Helping their partner get help
Getting out of the situation before they get physically hurt
Looking at the damage the dependency has caused them
Finding out why they always end up with a loser

Kate elliot, a 38 year old non maori woman, is admitted to hospital. She shares a flat with her long
time friend edith. Edith tells you that kate has recently become over active and upset and
claims that her butcher and local supermarket are both trying to poison her. The newspaper is
printing lies about her past and she has started a few fires in their garden recently in an
attempt to burn the newspaper. She is unable to sleep at night and is always finding things to
do. Last night she was vacuum cleaning the flat at 3 am. Kate is unable to add any
information as she switches topics so rapidly she does not make sense. Which of the
following is the best description of the reason for kates admission
She is creating a disturbance
She is frightened of being poisoned
She is a danger to herself and others
She has no one to look after her

Which of the following is a priority for kates care on admission

Distract her from unrealistic thoughts
Orient her to reality
Alleviate her anxiety
Introduce her to others

To assist kate to regain self control she is given an intramuscular injection of ahlorpromazine
100mg. following the injection her blood pressure is likely to be
Much higher than before
Moderately higher than before
About he same as before
Marginally lower than before

Kates mood settles and she says she feels her old self except for dizziness when she stands up.
Which of the following responses would you choose
It is nothing to worry about, just try to straighten up more slowly in future
Its quite normal at your age, especially if you bend with straight knees
You medicine has many side effects and dizziness is one of them
Sit down in your chair and ill check your blood pressure

Kate continues to complain of dizziness and says she feels nauseous most of the time. Which of
the following signs would lead you to suspect lithium toxicity
Weight gain, staggering, thirst
 Weight gain, hypertension thirst
Vomiting, thirst, hypertension
Vomiting, coarse tremor, staggering

In the client with an elevated mood there is often difficulty with diet because they
Feel unworthy of food
Are preoccupited with trivialities
Do not slow down long enough to eat
Think the food is poisoned

John, aged 18 years, has been a patient in a psychiatric unit for three days. He was brought in for
5 day compulsory assessment in response to his self destructive behaviour and his threats to
harm others. On admission he is mistrustful and is experiencing hallucinations. He has had
one previous admission when he was diagnosed as having schizophrenia. While
communicating with john, the nurse should
Remain silent with him and not encourage him to verbalise
Talk with john as she would a normal person
Allow john to do all the talking
Use simple concrete language when talking to john

Schizophrenia is often characterised by a lack of insight. This refers to

Poor social skills
Superficiality
Failure to recognize that they are suffering from anemotional disorder
Difficulty in reading other peoples motives

John is taking chlorpromazine 100mg q.i.d. after 4 days he is unable to sit for any length of time,
fidgets a lot, and tends to wander around the unit. Which side effect is he exhibiting
Dystonia
Akathisia
Parasthemia
Dyskinesia

John refuses his antipsychotic tablets because he thinks he is getting too drowsy. Which of the
following is the most appropriate initial nursing action
Offer it in an alternative form
Discuss with him the consequences of refusing
Accept his refusal and record this
Crush the tablets and add them to his food

The four ‘A”s of schizophrenia are

Association, ambivalence, alienation and autism
Ambivalence, autism, affect and association
Affect, ambivalence, assimilation, and autism
Affect, accommodation, autism and ambivalence

STATE EXAMS 29

Which of the following is not a typical sign of early epatitis

 Ascites
Slightly yellowing of the sclera
Clay stools
Anorexia

During the infectious stage, a person with hepatitis A is excreting the virus mainly in
Faeces
Urine
Saliva
All body fluids

When a person is in the infectious stage of hepatitis A, special precautions are taken when you
Take a food tray to the person
Administer medications
Gave an antiemetic injection
Remove a used bedpan

Client has been back from surgery for several hours and has not asked for pain medication. The
client and nurse are from different cultural groups. Being aware of cultural influences on
health behaviours, the nurse will
Realise the client probably does not feel as much pain as some people
Wait for the client to ask before bringing pain medication
Look for non verbal signs of pain, such as holding the incision or lying still
Tell the client to be sure to call her if he/she is in pain

Although the home health nurse has taught the client the importance of taking his antibiotic
exactly every six hours, he still cannot seem to take it on schedule. In evaluating the facts of
her teaching, the holistic nurse should consider that the client (who is from a different culture)
possibly
Is relating to time differently than she
Has not understood what she taught
Does not believe the medicine will help
All of above

Smoking is bad for people with chronic respiratory disorders because cigarette smoke
Destroys the cilia which cleanse debris from the airways
Inhibits the inspiratory centres in the central nervous system
Inhibit nerves involved in the reflex pathways involved in coughing
Prevents the vocal cords closing tightly together when swallowing

One reason why smokers with chronic respiratory problems should not be given medications that
inhibit the cough reflex is
These medications dry up mucus and make secretions difficult to expel
The hypoxic drive is inhibited causing a slowing in breathing rate
Coughing is their only means of preventing mucous accumulating in the lungs
In people with chronic problems these medications have no effect anyway

Asthma is a disorder primarily characterised by

Hyperinflation and over expansion of lung tissue
Spastic constriction of the respiratory airways
A breakdown in the walls of alveolar tissue
Chronic dilation and expansion of the airways

During acute asthmatic attacks theophylline medications are given because they
Stimulate the inspiratory centre
 Raise the blood PO2 levels
Hyperinflate the lung
Dilate the bronchioles

Aminophylline comes in ampoules of 250 mgs in 10 mls. How much in mls, would you draw up
to obtain 300 mgs
8.3
12.0
83.0
120.0

In the early stages of obstruction to urine flow, symtoms which a client with an enlarged prostate
gland might experience include
Difficulty in emptying his bladder and hematuria
Foul smelling urine with a high bacteria count
Complete retention of urine and dribbling
Frequency, urgency, a poor stream and nocturia

A client is prescribed 1 litre of dextrose/saline to be given over 3 hours. If the I>V giving set has a
drop factor of 15 drops per ml, which of the following, in drops per minute, gives the correct
rate
17
33
67
83

Your client states that she is most unhappy with the care she is receiving from her doctor and
wishes to change doctors. You respond
Would you like to talk to me about why you are unhappy with your care – I may be able to
help
Okay – should be no problem, its your choice after all
I don’t think that’s a good idea – it can lead to the doctor becoming annoyed
Hospital policy does not allow for you to make a choice of doctor but would you like to talk
to me about your concerns

Johnny is 22 years old and has been admitted under section 8 of the mental health act (1992).
Period of assessment of Johnny is for
14 days
6 months
7 days
5 days

In an acute presentation, such as Johnny, the need to administer medication so as to address the
situation is important. The most likely choice of drug would be
Trifluoperazine
Thioridiazine
Haloperidol decanoate
Benzotropine mesylate

When administering this medication what is the dosage and upper limit or ceiling in a twenty four
hour period
2mgs, up to 6mgs/24hrs
6mgs, up to 12mgs/24hrs
20mgs, up to 60mgs/24hrs
4mgs, up to 12mgs/24hrs
Following this episode, Johnny is commenced on a regular anticholinergic antiparkinsonian drug.
The most likely drug of choice would be
Procyclidine
Lorazepam
Pipothiazine
Diazepam

Johnny is charted this medication. Which of the following drug orders reflects the amount/dosage
to be received accurately
5mgs TDS
20mgs nocte
10mgs QQII
15mgs mane and 15mgs nocte

Johnny responds well to her care and is discharged 14 days later. He is charted an antipsychotic
injectable medication which the mental health nurse gives her at home. The medication is
flupenthixol deconoate. The dosage and frequency is likely to be
400mgs every 3 weeks
150mgs every week
60mgs every 3 weeks
200 mgs every 2 weeks

Tom has a diagnosis of bipolar affective disorder and his family ask you to talk with them about
it. They ask you what an affective disorder is. The therapeutic response would be
An abnormality in the mood or feeling state of a person
A dysfunctional emotive illness exacerbated intermittently
A chronic and progressive deterioration in the emotion of a person
A strange feeling which is abnormal in origin

Tom is admitted to the unit where you work. You are concerned in your assessment to ensure he
is physically well. Your care plan would include therefore, a focus on
Rest and sleep, fluid and nutritional needs, elimination and personal safety
Relationship needs, diet and exercise, and group therapy
Counselling needs, altered thought processes and orientation
Food and fluids, lowered mood and poor communication

Toms family asks you why he must take the big white tablets. They say they taste like chalk and
that he only needs them when he is sick. A therapeutic response would be
I can understand how it seems that way but he tablets work best when they are taken all the
time
That’s why he is sick because he should have been taking them
You ought to be encouraging him to take them all the time
Yes, perhaps encourage him to take them just when he needs to

Tom is due for a test today and the lab technicians arrive to do the blood test. Tom asks you what
the level needed in his blood is. A correct response is
1.5 – 2meg
0.1 – 0.3 meg
0.5 – 1.3 meg
1.0 – 1.9 meg

Toms level comes back from the lab who ring you to tell you that his level is very high. The
immediate nursing actions would involve
A check to see if a.m dose was given, discontinue meds and notify doctor
 Commencement on fluid balance chart and vital recordings
Encourage fluid intake and continue meds and document observations
Inform tom he is toxic, place on bedrest and notify next of kin

Tom is assessed and has lithium toxicity. The symptoms we would expect to see as nurses are
Palpitations, skin rash and headache
Potophobia, bradycardia and dyspnoea
Coarse tremor, diarrhoea, vomiting and sluggishness
Thirst, nausea, skin rash and pain on dorsal flexion

You are a domicillary nurse and have been visiting liz in the community. Liz is receiving an
antipsychotic in infectable form. Which medication is not an injectable antipsychotic
Pipothiazine
Thioridiazine
Haldol decanoate
Flupenthixol

Before liz was commenced on her medication you asked that she be charted a test dose. This
lower dose is
Given then received after 5 days before regular charting begins
Given fortnightly for a period of six months
Administered and then followed immediately by a regular dose if no reaction is noted
Administered once and then repeated weekly for four weeks

Liz continues to request that her injection site be in her buttock and refuses to have it in the thigh.
You have permission to do this. You assure the accurate site by
Locating the upper, outer quadrant of the buttock
Locating the lower, outer quadrant of the buttock
Locating the iliac crest and administering the injection
Locating the midline and injecting 3cms to the side of it

In regularly dispensing injectable medication you are aware as a nurse that the medication is
locally irritating. You therefore
Administer it in one area only
Rub the area gently following administration
Rotate sites and do not rub/massage the area
Apply heat and massage the area

Jan is a first line manager responsible for the care of a group of patients. She is concerned
because for the last three weeks the physiotherapist has been late to see the patients and
sometimes has not come at all. She has called the physiotherapist but the situation has not
improved. Jans next action should be to
Write a memo to the physiotherapy department
Contact a nursing clinical advisor
Notify the physician of the situation
Consult her nurse manager

In organisations the primary management function is to

Assess and establish goals
Establish a framework in which to function
Plan for results
Control all operations

Cohesiveness is important to all teams. This means

The process a group goes through in deciding what to do
 A mutual attraction which holds a group together
A decision made by a knowledgeable leader for the group
A strong organisational support system of the group

Part of jans position requires her to manage the budget. This is

A statement of future expenditures
A list of current expenditure
A plan for meeting expenses
A recording of past expenditure

Jan is aware that nursing tasks and quality of nursing practice are compared with which pivotal
question
Does the performance match standards and objectives
Does the performance reflect interest and enthusiasm for the job
Does performance indicate knowledge and expertise
Does performance leave the patients comfortable

Elanor brown aged 20 is a passenger who is thrown clear when the car she is travelling in hits a
lamp post. Eleanor exhibits internal bleeding later diagnosed a ruptured spleen. First aid care
for Eleanor includes elevating her limbs. This is done to
Decrease her venous return
Lower her blood pressure
Increase her venous return
Assist her to breathe

Eleanor is admitted to the accident and emergency department in advanced stage 2 shock. When
taking her base line observations you would expect to find
Elevated BP, elevated pulse rate and elevated respiratory rate
Decreased BP, decreased pulse rate and decreased respiratory rate
Decreased BP, increased pulse rate and increased respiratory rate
Decreased BP, decreased pulse rate and increased respiratory rate

You are a community nurse working with families who have lost a child to sudden infant death
syndrome. A parent says ‘sally was so healthy I just cant understand what would have caused
this. Where did we go wrong’. What is the most appropriate response
I don’t know why you feel responsible for what happened to sally
Try not to blame yourself for sallys death
You didn’t no one knows the cause of S.I.D.S
Did sally seem sick before bedtime

The primary etiology of S.I.D.S is

Cardiac arrhythmias
Unknown
Depression of respirations
Exhaustion

Sudden infant death syndrome often occurs

Between 2-6 months following birth
Within 3 weeks of birth
More than 6 months after birth
Between 9-12 months of age

Babies who die from sudden infant death syndrome/S.I.D.S are more frequently
Low birthweight babies
 Born to a mother over 40
From middle class families
From families with a history of s.I.D.S

Research has indicated that the best way to try to reduce the incidence of sudden infant death
syndrome is
Feeding baby four hourly
Having baby sleeping on their back
Wrapping baby up firmly
Sleeping prone

A family have already had one child die from SIDS. They are offered an apnoea monitor for their
new baby. To assist this family you should begin by
Teaching cardiopulmonary resuscitation
Teaching use of monitoring equipment including safety precautions
Creating an opportunity for parents to discuss their feeling and concerns
Referring to an appropriate support group in the community

Items relate to congenital defects in children. A positive diagnostic test for cystic fibrosis is
Sweat analysis
Sputum analysis
Liver function test
Bone marrow biopsy

The earliest recongnizable clinical manifestations of cystic fibrosis is

Foul smelling, frothy, greasy stools
Recurrent pneumonia and lung infections
Meconium ileus
History of poor intestinal absorption

In providing nourishment for a child with cystic fibrosis, which of the following factors should
the nurse keep in mind
Most fruits and vegetables are not well tolerated
Diet should be high in carbohydrates and protein
Diet should be high in easily digested carbohydrates and fats
Fats and proteins must be greatly curtailed

Which statement expresses accurately the genetic implications of cystic fibrosis

If it is present in a child both parents are carriers of this defective gene
It is inherited as an autosomal dominant trait
It is a genetic defect found primarily in non white population groups
There is a 50% chance that siblings of an affected child will also be affected

Which of the following statements best describes hirschsprung disease

It is a disease characterized by the absence of parasympathetic ganglion cells in a segment of
the colon
It is a disease that results in excessive peristaltic movements within the gastrointestinal tract
It is a disease that results in frequent evaculation of solids, liquids, and gas
It is often diagnosed in newborns when they fail to pass the transitional stool within 24 hours
after birth
Congential defects of the genitourinary tract such as hypospadias are usually repaired as early as
possible to
Prevent mental illness
Prevent separation anxiety
Promote acceptance of hospitalization
Promote development of normal body image

Hypospadias refers to which of the following

Urethral opening along dorsal surface of penis
Urethral opening along ventral surface of penis
Absence of an urethral opening
Penis shorter than usual for age

Foetal alcohol syndrome results when the

Mother is an alcoholic
Mother drinks excessively during the first trimester
Alcohol consumed by the mother is in excess of the brains ability to detoxify
Alcohol consumed by the mother is in excess of the livers ability to detoxify

The doctor observed a child with phloric stenosis closely during feeding periods. Which of the
following observations made of the exposed abdomen is most indicative of pyloric stenosis
Abdominal rigidity
Substernal retraction
Visible peristalsis
Marked distention

Physical characteristics associated with downs syndrome include

Slanting eyes with prominent epicanthic folds
Single palmar creases on the hands
Small mouth with protruding tongue
The presence of the Mongolian blue spot
1 and 2
1 and 3
1, 2 and 4
1, 2 and 3

You are asked about the incidence of downs syndrome. The incidence/1000 live births is greatest
when the maternal age is
Under 16 years
16-20 years
21-40 years
Over 40 years

The genetic defect which causes downs syndrome is mostly due to

Trisomy
Meiosis
Mutation
Mitosis

Sophie one day old was born with a hernia protrusion of a sac li?? Cyst of meninges, spinal fluid
and a portion of the spinal cord with its nerves through a defect in the vertebral column. This
defect in the vertebral column is called
 Hydrocephalus
Encephalocele
Meningocele
Meningomyelocele

Sophies paralysis is most likely to occur

In the motor sphere below the level of the deformity
In the motor and sensory spheres below the level of the deformity
In the motor sphere above the deformity
In the motor and sensory spheres above the deformity

You are sophies primary nurse in the special care baby unit. When her father visits for the first
time, he is most likely to exhibit which reaction
Anger
Depression
Disbelief
Bargaining

Sophies father is standing hesitantly beside the incubator. What is your best initial action
Show him how to touch and talk to his daughter
Give him a detailed explanation of his daughters defect
Ask him if he wants to hold his daughter
Ask him how his wife is doing

The most important nursing intervention when caring for sophie would be
Placing sophie on her side to decrease pressure on the spinal cord
Applying a heat lamp to facilitate drying and toughening of the sac
Measure head circumference daily to identify developing hydrocephalus
Assist the parents to bond with sophie

This type of congenital deformity is commonly known as spina bifida. Spina bifida is
A deformity of the spine due to injury at birth
A congenital malformation of the spine
A developmental defect of the spine where one or more vertebrae fail to fuse
A gap in the spine where only the spinal cord proteudes
A gap in the spinal column where meninges, cerebral spinal fluid and/or spinal cord
are contained in a sac
1 and 5
2 and 4
1,2 and 5
2, 3 and 5

A spinal cord defect such as sophies positioned at lumbar 1, would result in

Total paralysis of arms and legs
Lack of sensation of arms and legs
Total paralysis of legs with bladder involvement
Total paralysis and lack of sensation of legs with bowel and bladder involvement

Some children with spina bifida show spinal deformities at birth or develop them during growth
after birth eg kyphosis which is
The spine bends sideways and also rotates on a vertical axis – often a rib hump is present
The lumbar spine bows inwards
A lateral curve of the spine
The spine bows backwards and resembles the letter c when viewed from the side in a sitting
position
Sophies head measurements are of concern. The doctor diagnoses hydrocephalus. This is most
accurately defined as
Greatly increased head diameter due to spreading of the sutures by massive cerebral oedema
Progressive enlargement of the head due to excessive accumulation of cerebrospinal fluid
Elevation of the dome of the skull by a haematoma secondary to skull fracture
Distention of the frontal, maxillary and ethnoid sinuses with inflammatory exudates

Cane suddently complains of severe chest pains, is dyspnoeic and shocked. Which of the
following steps would you take
Lie the client prone in bed
Assess cardio vascular function
Check respiratory rate
Administer I.M omnopon 10mg as charted
Administer oxygen via a mask at 6 litres per minute
2, 3 and 4
2, 3 and 5
1, 2, 3, and 4
2, 3, 4, and 5

The causative factors of shock following a myocardial infarction are

Undetected and untreated arrhythmias
Rupture of chordate tendinae
Administration of IV morphine 5 mg
Diminished cardiac output
Six glycerol trinitrate tablets prior to admission
3, 4 and 5
2, 3 and 4
1, 4 and 5
1, 2 and 4

The main therapeutic action of IV morphine given to a client following a myocardial infarction is
to
Relax the client and allow him/her to sleep
Relieve pain and to help prevent severe shock
Relieve acute level of anxiety
Relieve pain and stimulate respiratory function

The occupation health nurse observes a sucking chest wound in the right wall of Harvey, a man
who has been involved in an industrial accident. The initial action by the nurse should be to
Immediately cover the wound with anything available
Assess the chest for asymmetry
Obtain a sterile petroleum gauze dressing
Place Harvey in an upright position

To facilitate lung expansion, the nurse should encourage Harvey to breath in which manner
Shallowly, through the nose
Inhale deeply, then exhale with the mouth and nose closed
 Inhale normally, breathe out through pursed lips
Breathe as normally as possible

Which of the following type of crises is Harvey experiencing

Developmental crises
Adventitious crises
Situational crises
Maturational crises

Later, the occupational health nurse is asked to give a session on chest injuries. The most
important pre crises emphasis would be
Accident prevention
Chest assessment
Pathophysiology of chest injuries
Rapid treatment techniques

In spite of treatment in the hospital emergency department, Harvey dies. His death becomes a
coroners case because
The doctor refused to sign a death certificate
He dies in suspicious circumstances
He hadn’t seen his general practitioner for a long time
His family refused permission for an autopsy

Percy a 55 year old is suffering from parkinsons disease. You are administering anti parkinsons
drugs. Which of the following would increase their absorption
Marmite sandwich
Glass of milk
Glass of water
Plain biscuit

Which of the following are symptoms of parkinsons disease

Speech disturbance, confusion
Muscle rigidity, tremors
Weak arms, difficulty in swallowing
Depression, hemianopia

Percy often has difficulty maintaining balance while ambulating. The most helpful intervention to
prevent him falling would be
Instruct him to wear elastic stockings
Instruct him to use wide based stance
Teach him how to perform range of motion exercises
Instruct him to change position slowly

The nursing care plan for percy should include

Restricted ambulation
Scheduled rest periods
A diet high in protein
Cold packs for finger joints

Parkinsonian crisis occurs when

The client overdoses on their anti Parkinson drugs
 The clients basal ganglia starts to make its own dopamine again
The client forgets to take their anti Parkinson drugs for a day or more
The client is allergic to the anti Parkinson drugs

Parkinsonian crisis may lead to

Hypoglycaemia
Death
Rash and severe tremors
Anaphylactic reaction

Percy deteriorates rapidly. Which of the following would be the most appropriate long term
nursing goal
Improving percys symptoms with medication
Increasing percys independence
Improving percys self esteem
Helping percy accept increasing parkinsonian symptoms

Which of the following observations indicate toxicity to levodopa

Decreased muscle rigidity
Anorexia, vomiting
Psychotic episodes
Excessive salivation

Patricia wakes up one morning with a severe headache. While attempting to get up to take some
aspirin she collapses. Her husband sends for the doctor, who, suspecting a cerebrovascular
accident arranges hospitalisation. On admission patricia is comatosed. All the following can
be used when assessing a patients level of consciousness except
Degree of orientation to surroundings
Reaction of the pupils to light
Reaction to painful stimuli
Ability to obey commands

In assessing consciousness, you begin by using

Verbal stimulation
Tactile stimulation
Light pain
Deep pain

Your neurologic assessment includes monitoring urinary output. That’s becaused

Injury to the hypothalamus causes oliguria
Polyuria with specific gravity of <1.005 is desired
Volume depletion will increase ICP (intracranial pressure)
Hyponatremia can lead to cerebral edema

The unconscious patient

Cannot perceive stimuli through the five senses
Is unable to perceive auditory stimuli
Is able to perceive auditory stimuli
Can only respond to painful stimuli

Safety precautions in caring for the unconscious patient should include all the following except
Maintain in recovery position
Support head and limbs when moving
Provide only clear liquids orally
Speak calmly and frequently to the patient
Your client is unresponsive and shows unilateral reflexes. You would
Observe his vital signs and wait
Suspect a spinal injury
Suspect a drug overdose
Call a doctor and anticipate surgery

bleeding within the skull results in increased intracranial pressure because

Arteries bleed rapidly and profusely
Bleeding from veins goes undetected
Spinal fluid is produced more rapidly
The cranium is a closed, rigid vault

When assessment a client at risk for increased intracranial pressure. The first thing you would
check is
Reaction to pain stimuli
Papillary function
Level of consciousness
Motor function

Papillary dilation occurs when herniating brain tissue

Compresses the occulomotor nerve
Chokes the optic disks
Stretches the optic nerve
Paralyses the ocular muscles

Contralateral muscle weakness develops because of

Cerebellar dysfunction
Compression of the pariental lobe
Pressure on the vasomotor centre
Pressure on the sensory motor pathway

If intracranial pressure is increasing, the patient is apt to complain of a headache

On coughing or straining
When the head of the bed is elevated
Late in the day
When you shine a light in his eyes

The most crucial consequence of a cerebral vascular accident is

Inability to communicate
Acute hypotension
Cerebral anoxia
Hemiplegia

After a stroke the strong adductor muscles favour the formation contractures. There is a tendency
for the
Foot to drop (plantar flexion)
Arm to be drawn to the chest
Elbow to hyperextend
Wrist to drop

An action most likely to contribute to recovery of speech would

Anticipate their wishes so as to eliminate the need to talk
Communicate by means of questions which can be answered shaking the head
 Speak slowly so that they are able to lip read
Listen patiently as they attempt to talk

Discharge planning for patricia should begin

When her condition has stabilized and she understands instructions
When she begins to ask questions about home care
At the time she is admitted to the ward
When her family begin to ask for information

Phyllis a 65 year old retired secondary school teacher with a history of hypertension, currently on
medication, falls to the ground unconscious while attending an opera. State the level of
priority in which you would take the following measures for an unconscious client
Check for other injuries
Notify his relatives
Take and record of his temperature, pulse and respirations
Observe and record his pupil responses to light
Assess his level of consciousness
1,3,4,5,2
1,4,5,3,2
3,4,5,1,2
5,4,3,1,2

Ann a student nurse, is playing tennis after duty when she is stung by a bee. Her friends recognise
signs of systemic anaphylaxis and immediately take her to the emergency department. The
signs and symptoms of systemic anaphylaxis include dyspnoea and which of the following
Facial oedema, hypotension
Facial oedema, hypertension
Polyuria, hypotension
Polyuria, hypertension

Your priority in the immediate care of a person in anaphylactic shock is to

Raise the legs to increase blood volume to vital organs
Maintain an airway to ensure ventilation
Ensure fluids to maintain urinary output
Pack ice around patient to reduce inflammation

The most effective drug in the immediate treatment of anaphylactic shock is

Penicillin
Solu-medrol
Benadryl
Adrenalin

Mrs green 29 years old, is admitted with acute abdominal pain, vomiting and suspected
peritonitis. After admission mrs green is on nil per mouth in anticipation of early
Diagnosis
X-ray
Ultrasound scan
Surgery

Mrs green is going to theatre for a laparotomy. She should sign the operation consent form
After the house surgeon has spoken to mrs greens partner
Before administration of anaesthesia
Before pre medication is administered
 After explanation by the nurse

Mrs green returns from theatre following an appendectomy. Your immediate nursing response
would be to assess
Wound site
Intravenous line
Heart rate
Airway

Mrs green is ordered intravenous normal saline 1000ml over 8 hours. You have a metriset in situ
(drop factor =60). How many drops per minute will you be monitoring this at
21
42
84
125

Mrs green develops a paralytic ileus. Which of the following is almost always an indication of
paralytic ileus
Alteration in vital signs
Increasing abdominal distension
Persistent vomiting
Absence of bowel motions

Mrs green has a naso gastric tube inserted to

Reduce gastric motility
Decompress the bowel
Evacuate blood clots
Assess volume of gastric content

Mrs greens temperature is 39.4o Celsius. Which of the following would most effectively
reduce her temperature
Fanning and panadol, tepid sponge
Fanning and stemetil, tepid sponge
Fanning and stemetil, remove bed clothes
Fanning and panadol, ice packs

Mrs green is ordered amoxicillin 1.2gm. on hand are 500 mgm vials, each to be dissolved in 2ml
of sterile water. How much will you give
2.4ml
3.6ml
4.8ml
5.2ml

On the third day of hospitalisation a patient informs the nurse that she would rather bathe at night.
To best promote continuity of care the nurse should
Explain the am care is given in the morning
Verbally inform the other health team members
Indicate this preference on the nursing care plan
Encourage her to modify her routine while hospitalised
The charge nurse directs the nurse to do something that is outside the legal role of the nurse. The
nurse should
Complete the task and grieve later
Notify the supervisor immediately
Decline to do the assigned task
Inform the union representative

After a month in the hospital a jewish patient says she misses lightening her candles on Friday
night (shabbas licht). The most therapeutic response would be
It must be difficult to change old habits
Religious traditions have a peaceful effect
I am sorry but that’s against the fire code
I will try to arrange it so you can light your candles

Mrs hill is charted nitrazepam (mogadon) tablets to sleep. She refuses to take them at 9pm. She
tells you that the other nurses always leave the tablets on the locker and she takes them when
she is ready. What should you do
Put them back in the container
Give her the tablets and let her take them later
Tell the patient to ring when she is ready for them
Tell her if she doesn’t take them now she may not get them later

The nurse is working in a surgical ward. Ivan, aged 18 years is admitted to hospital with a
fractured leg following a car accident. He is in a shocked condition due to loss of blood and is
hyperventilating. Which of the following recordings indicate shock
Blood pressure 110/70, respiration 34, pulse 120
Blood pressure 128/90, respiration 32, perspiring
Blood pressure 120/80, pulse 70, skin cold and clammy
Blood pressure 78/56, pulse 152, weak, thread; perspiring

Hyperventilation may initially cause

Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis

Without describing to them what is involved, the surgeon asks for consent for surgery from ivans
parents. What is your responsibility in this situation
Ensure the parents have been given appropriate information
Question the validity of this consent
Ensure the consent form is completed
Check whether the parents have any questions about the surgery

Ivan is prescribed pethidine 75mg intramuscularly as a premedication. The drug is available in

ampoules containing 100mg in 2ml. what dosage should be administered
0.75ml
1.25ml
1.5ml
1.75ml

The nurse believes the drug dose prescribed for ivan is incorrect. The best action to take is
Refuse to give the medication
Give the medication as prescribed by the doctor
Withhold the medication and check the dosage with the doctor
Give the medication and consult a current drug handbook
Why does a person who has a fracture of a bone feel pain
Bones contain many nerve endings
The nerve endings are irritated by the jagged bone ends
There is always severe haemorrhage with any type of fracture
There is damage to surrounding tissue and the muscles go into spasm

Which group of observations would the nurse make when checking the limb for vascular
occlusion after the application of a plaster cast to limb
Heat, burning, loss of feeling, immobility
Loss of function, redness, swelling, pain
Coldness, stiffness, odour, loss of feeling
Coldness, impairment of function, swelling, discolouration

Which option explains the numbness or a tingling sensation felt by the patient under the plaster
cast
This is due to nerve damage or pressure on the nerve
This will subside as soon as he gets used to the cast
As soon as the cast dries, these symptoms may disappear
The wet cast is cold and this impulse is passed onto the nerves

Which is the most important nursing measure for a person in a plaster cast
Inspect the cast once a day
Always investigate any complaint
Observe the skin at edges of the cast
Observe the cast for limpness or cracks

Which is the first action the nurse should take when a patient in leg traction complains of pain
Remove the weights
Increase the weights
Tell the doctor when he does his rounds
Check the patients position, weights and cords

A reporter from a local paper phones the ward and asks for information on ivans condition. What
is the appropriate response in this circumstance
Ivan has a broken leg but is comfortable
Ill go and get the senior nurse on duty who will assist you with your queries
I cannot give you any information
Please contact the senior medical adviser for such information

The nurse is working in a psychiatric hospital. Susan aged 22 years is a lab technician who has a
long history of compulsive food avoidance and a desire to be thin. Susan looks wasted and
has pitted ankle edema. Height 162cm, weight 32kg. she is prescribed rest and a diet high in
protein and calories. What is the most likely psychiatric diagnosis for susan
Anorexia nervosa
Myasthenia gravis
Neurotic depression
Acute psychotic disorder

Denial is an important part of susans behaviour. Which of the following intervensions is most
therapeutic at the start of her care
Confronting her with her problem of weight loss
 Discussing the issue of her work related problems
Discussing the concept of slimness in relation to obesity
Attempting to establish rapport by discussing her interests

Susan is dehydrated. The doctor orders 500ml normal saline Iv over 2 hours. The administration
set delivers 15 drops per ml. what is the correct number of drops to be administered per
minute
a) 44
62
70
100

Which of the following signs/symptoms are most likely to be present in maries condition
Nausea
Dysmenorrhoea
Distorted body image
Weight loss
Down like hair growth
1,2
1,4
2,5
3,4,5

Susan dislikes foods high in caloric value. Which action is most likely to change maries eating
pattern
Allow her to choose her own diet
Encourage her to eat what she can
Allow her to eat only what she wants
Encourage her to eat small, frequent meals

What is susan likely to do in order to prevent gaining weight

Dispose of her food
Leave some food on her plate
Undertake very little exercise
Ask for aperients for constipation
Induce vomiting immediately after meals
1,2
3,4
1,3,5
1,2,4,5

Which treatment will best help susan establish personal relationships

Sociodrama
Psychodrama
Group therapy
Occupational therapy

On taking charge of the ward one afternoon duty, the nurse discovers that a patient is missing.
Which is the correct action to take
Call the police, search the ward, check the patients status
Check the patients status, call the senior nurse ,check the ward
Check the patients status, check the ward, call the senior nurse
Check the patients status, call the senior medical advisor, call the senior nurse
The nurse checks the drugs with a colleague who says, im not sleeping well, how about checking
out a couple of mogadon for me to take home. Which is the appropriate response by the nurse
Refuse, but offer panadeine
Discuss the reason why she cannot oblige
Encourage her to talk about her sleeplessness
Report the matter to the manager for advice

A voluntary psychiatric patient left the hospital the day following her admission without telling
anyone. What action is the hospital required by law to take with regard to this patient
Provide domicillary nursing care for the patient in the home
Legal action to have the patient re admitted to the hospital
Ask the police to make the patient return to the hospital to sign a statement
No legal action, as the patient has the right to leave a health care facility

What should be the action of the nurse who is in charge of the ward when the police arrive to
interview a committed (compulsory) patient who is responding to treatment
Refuse them entry to the ward
Allow them their legal right to enter
Discuss the situation with patient
Refer them to the senior medical advisor

A nurse who is concerned that a patient is being treated harshly by one of the visiting psychiatrists
should first
Tell the charge nurse
Inform the senior medical officer
Inform the patients relatives of the problem
Discuss the problem with the psychiatrist concerned

A psychiatric patient asks the nurse to post a letter he has written. The nurse should
Post it as requested
Say she cannot post it
Open it to check the contents
Hand it unopened to the nurse manager

The most distinctive feature of community mental health centers is an emphasis on

Psychotherapy as opposed to somatic therapy
Prevention of psychological problems
Improved training for psychiatric workers
Revolving door policies

When caring for a client in a drugged state, the nurse is often faced with verbal abuse. The nurse
should handle this abuse by
Insulting the client since it is deserved
Making a neutral response to the client
Refusing to provide care for the client
Ignoring the client and leaving the room
With regard to informed consent and the law, which of the following persons require decisions to
be made for them
Prisoners
Mentally handicapped
Residents of nursing homes
Adolescents under 16
Comatose clients
1,2,3
2,3,4
2,4,5
3,4,5

When administering medications, a nurse responsibilities include all of the following except
Deciding the correct dose
Knowing the side effects
Knowing the average dose
Securing the patients co-operation

The treaty of Waitangi was in essence a partnership between the

Maori chiefs and governor gray
Maori chiefs and European settlers
Maori inhabitants of new Zealand and the british government
Maori chiefs and the English

Social policy makers have argued that maori health has suffered greatly because of inappropriate
health service delivery. This can be attributed to
Provision of a totally monocultural western type health care system
Lack of government health functioning
Low number of maori health providers
Maori urban migration

Which is the most appropriate response by the nurse making her first home visit to a newborn
baby and mother when she learns from a neighbour that the mother and baby are at tangi on
the local marae
Leave a note to say she called
Leave a message with the neighbour
Visit the marae in search of mother and baby
Wait for the mother and baby to return from the tangi
Leave a note with your phone number and date of next visit

The nurse visits the local marae based health clinic. Grace jones, aged 6 months has a chronic
respiratory condition. Mrs jones states my grandmother says that grace is sick because the
whenua (placenta) was not disposed of properly. What is the nurses most appropriate
response
Grace is sick because of bacterial infection
What do you think about your grandmothers statement
The placenta should have been buried under a tree
What does your grandmother suggest to help grace and can I help

In hauora the 1988 report which considered maori health standards, the leading cause of maori
infant deaths was identified as
Gastroenteritis
Middle and inner ear infections
Meningitis
 Sudden infant death syndrome

The report also found the maori have relatively high rates of physical and mental ill health.
According to the report, the main reason for this is that they
Prefer to consult a tohunga regarding any health problem
Generally have poorer nutrition and stress management skills
Put family interests before the needs of the individual
Are more likely to be unemployed or have low earning capacity
Are disadvantaged socially, economically and culturally

STATE EXAMS 30

Mrs latu, a tongan, is being admitted in the late first state of labour. She tells the nurse her
husband is, ‘in the waiting room’. Which is the most appropriate response
Would you like me to bring your husband in now
Would you like to have your husband present at delivery
It would be good for your husband to be with you when baby is born
Do you know it helps a father bond with his baby if he sees the birth
If he is not comfortable with you now, he is probably better not coming in for delivery

Effective timing of contractions is undertaken by placing the fingers lightly on the fundus of the
uterus. This is because the fundus is the
Most accessible area to feel
Area that never fully relaxes
Most contractile part of the uterus
Portion where there is least discomfort
Area where the upper and lower segments meet

Which physiological factors are responsible for the pain experienced during labour
Contraction of uterine muscle when it is in an ischaemic state
Pressure on nerve ganglia in the cervix and lower uterine segment
Stretching of ligaments adjacent to the uterus and in the pelvic joints
Stretching and displacement of the tissues of the vulva and perineum
1 and 2
1 and 4
1, 2 and 3
2, 3 and 4
1, 2, 3 and 4

The doctor has just assessed the cervical dilatation as six centimetres. The woman begins to cry
out saying ‘the baby is coming, the baby is coming’ which action should the nurse take
Tell her to relax
Give her analgesic
Examine the perineum
Ask her partner to calm her
Wheel her into the delivery suite

Mrs finau, a samoan, is admitted to hospital in labour. Her husband and mother in law are in the
waiting room. The best way to provide support for mrs finau is to
Ask her husband to be with her
Check often but allow her to labour alone
Ask her mother in law to be with her
 Spend time with her throughout her labour, providing companionship

Which action should the nurse take when mrs finaus membranes rupture while she is being
examined
Observe the liquor
Inform the midwife
Apply a sterile pad
Record the blood pressure
Record the fetal heart rate
1 and 5
2 and 5
3, 4 and 5
1, 2, 3 and 5
1, 2, 3, 4 and 5

Which of the following should not be done under any circumstances during the third stage of
labour
Express clots after the placenta is out
Let the mother ‘push’ the placenta out unaided
Use cord traction and simultaneously push the fundus down
Pull gently on the cord after the cord has lengthened
Wait longer than 5 minutes before delivering the placenta

This relates to mother and infant. What preliminary safety precaution must the nurse observe
before giving an ampoule of anti D serum to a woman who recently gave birth
Wash her hands
Sight the doctors prescription
Collect the equipment for giving the anti D
Check it with the nurse in charge
Ensure the prescription is written in triplicate on the patients chart

What must happen to the newborn baby before it is taken from the delivery room
Identified by name
Put to the mothers breast
Shown to the patient
Checked for skin lesions
Wrapped up firmly on his side

To whom is the ‘notification of birth’ form forwarded after completion

Senior medical adviser
Medical officer of health
Hospital social worker
Medical officer of obstetrics
Registrar of births, deaths and marriages

A newborn baby is cyanosed and appears not to be breathing. Which of the following is the
appropriate first action to take
 Go to find assistance
Clear the airway by suctioning
Commence mouth to mouth resuscitation
Administer oxygen via a nasal catheter
Check to see whether he has an atresia

Which statement best describes the basis for maternal bonding in the neonatal period
Parental acceptance of the baby
Maternal recognition of the baby
Stimulation of the maternal reflex
Establishment of successful breast feeding
Maintenance of contact between mother and child

Which nursing action is essential before giving the baby an intragastric tube feed
Check the feed has been warmed
Place him in a semi prone position
Check the tubing is in the stomach
Run sterile water through the tubing
Place air into the stomach via the tubing

Signs of sepsis in the infant would include all the following except
Irritability
Constipation
Abnormal temperature
Poor sucking reflex and feeding
Irregular respirations or periods of apnoea

Relate of nursing in the community. Which is the most appropriate response by the nurse making
her first home visit to a newborn baby and mother when she learns from a neighbour that the
mother and baby are at a tangi on the local marae
Leave a note to say she called
Leave a message with the neighbour
Visit the marae in search of mother and baby
Wait for the mother and baby to return from the tangi
Leave a note with your phone number and date of next visit

A four year old has been discharged from hospital after having swallowed his fathers blood
pressure tablets. Which is the most important advice for the nurse to give when making a
follow up home visit
Keep all medicines in a locked cupboard
Take out of the bottle only the dose required each time
Use child resistant containers for all medicines
Dispose of unwanted medicines or chemicals safely
Return substances to the medicine cabinet immediately after use

When making a home visit to a maori family which of the following actions should the nurse be
aware of
Taking her shoes off at the door
Avoiding placing her nursing bag on the kitchen table
Obtaining good eye contact with each person she speaks with
Greeting male members of the family first
1 and 2
1 and 4
2 and 3
 3 and 4

Which information source provides most knowledge about the health problems of a community
Data on environmental pollution
The prevalence of unemployment
The standard of available housing
The local health groups
Mortality and morbidity statistics

If a child tips boiling water over herself what is the most appropriate first aid action to take
Remove her clothing
Apply a soothing lotion
Pour cold water over the burn
Cover the burnt area with clean sheets

What action should the nurse take when a three home visits the mother of nine months old baby
prevents him from being seen as ‘he is sleeping’
Question neighbours closely
Notify the social welfare of the situation
Notify the family doctor in writing of this occurrence
Insist on seeing the child and refuse to leave the home
Respect the patients right to accept or refuse treatment

The nurse is working in a children ward. Brian, aged 5 years, is admitted to hospital with burns to
his legs, arms and lower abdomen. What is the purpose of an intravenous infusion
commenced while brian is in the accident and emergency department
To correct hypovolaemia
To administer packed cells
To quickly obtain blood samples
To quickly administer pain relief
To administer large doses of hydrocortisone

200ml of barts solution is prescribed to infuse over 3 hours. The drip factor is 60 drops per ml.
How many drips per minute should be given
33
47
53
67
73

The rate of the intravenous infusion is less than that prescribed and also approximately 2 hours
behind the ordered schedule. The best action by the nurse is to
Consult the physician concerning a new schedule for the intravenous infusion
Calculate a new drip rate so that within a 24 hour period. The total amount of ordered solution
will be infused
Increase the drip rate so that the total amount of ordered solution will be infused within an 4
hour period
Restart the drip rate to the prescribed rate so the total ordered amount for the 4 hour period
will be infused
Allow the transfusion to proceed at a slower rate to prevent over hydration

Which body reaction will occur if the blood pressure of a very shocked person with severe burns
is allowed to remain low
Renal failure
 Dehydration
Spastic colon
Deep vein thrombosis
Protein loss from the burned areas

Which blood test is used to help estimate the amount of fluid replacement required
Hematocrit level
Complete blood count
Blood creatinine level
Blood oxygen tension (pO2)
Leukocyte differential count

The main aim in the treatment of a partial thickness burns will be to prevent
Infection
Haemorrhage
Inflammation
Blistering
Discolouration

Which electrolyte is lost from the body in the largest amount during the first 48 hours following a
severe burn
Sodium
Calcium
Potassium
Magnesium
Phosphorus

Which part of the skin contains the injured nerve endings and receptor cells which cause the pain
following a burn
Dermis
Underlying muscle
Subcutaneous layer
Horny layer of the epidermis
Basal cell layer of the epidermis

Necrotic tissue in a burnt area supports clostridium tetani. A characteristic of the clostridium
tetani organisms is their ability to
Acidify body fluids
Agglutinate red blood cells
Cause destruction of muscle tissues
Live without the presence of oxygen
Take up sodium ions from body tissues

Penicillin 125mgms is prescribed prophylactically. The drug available in powdered form is

reconstituted to contain 600mg in 2ml. What amount should be given
0.23ml
0.4ml
0.7ml
0.73ml
 0.8ml

Brian is found to have a chest infection. The micro organism is sensitive to gentamycin sulphate.
Brian is charted 8mg BD. The ampoule in the ward is labelled 80mg in 2 ml. What volume
should be given
0.2ml
0.4ml
0.8ml
1.0ml

Which is the main reason for a person recovering from burns needing a high protein diet
Prevents infection
Rebuilds damaged tissue
Assists with utilisation of vitamins and minerals
Prevents contractures developing
Improves the use of available iron to overcome anaemia

Respiratory difficulties can most effectively be relieved by agents which produce

Bronchodilation
Increased oxygen tension
Decreased production of mucous
Increased production of mucous
An action against causative allergens

Thirty minutes after the intravenous medication is commenced mr jones is anxious, restless and
dyspnoeic; respiratory rate is 36. He is still wheezing and using his accessory respiratory
muscles. What is the most appropriate decision for the nurse to make
He needs to use his inhaler as a supplementary aid
He needs a higher concentration of oxygen
Lack of treatment response requires medical review
He needs physiotherapy to aid effective breathing

When using a ventolin inhaler, it is important to do all of the following except

Shake the inhaler before using it
Expire fully before inhaling the spray
Hold the aerosol within ones open mouth
Use the inhaler repeatedly until some relief is felt

Which behaviour may the nurse observe in mr jones shortly before he has an asthma attack
Greater restfulness
Increased irritability
A sense of contentment
Decreased independence
A sense of superiority

The most important factor about his prognosis that mr jones should know is that he
Has an unpredictable prognosis
Will never be ‘completely’ cured
May experience other disabling symptoms
Will require ongoing stress therapy
Can recover but under stress attacks may recur

Aminophylline is used in the treatment of asthma mainly because it

 Improves the action of the heart
Dries up the bronchial secretions
Relaxes the smooth muscles of the airways
Stimulates the respiratory centre of the brain
Relieves the persons anxiety and restlessness

The role of parent surrogate is most therapeutic when the nurse

Respects the need for dependence and fosters this need
Avoids restricting the behaviour and makes decisions for him
Allows a completely permissive environment, to encourage the person to take responsibility
for himself
Allows the patient to be dependent as long as necessary, but encourages independence as soon
as possible
Conveys complete acceptance of the behaviour and willingness t o do for him what he cannot
do himself

What is the first action of the nurse who is about to give jeff an 8 year old, his pre medication
when she notices crumbs around his mouth
Check for any food in his locker
Ask him when he last had something to eat
Give the pre medication and then report your observation
Report your observation before giving the pre medication

The nurse is working in a medical area. Mr jones, aged 53 years, was admitted with an acute
attack of asthma. How does asthma affect respiration
Lessens the expulsion action of cilia
Destroys the structure of alveolar walls
Prevents full use of respiratory muscles
Obstructs the flow of air through the airways

Which is the major pathophysiological abnormality occurring in asthma

Cardiac arrhythmias
Bronchiole dysplasia
Inflammation of the alveoli
Constriction of the pleural lining
Spasm of the smooth muscles of the bronchi

Breathing in asthma is commonly described as

Wheezing
Stertorous
Grunting
Gasping
Gurgling

All of the following are side effects of aminophylline except

Nausea
Headache
Insomnia
 Hypertension
Increased heart rate

Mr jones requires digoxin for a heart condition. What effect does the drug digoxin have
Lower the blood pressure
Raises the blood pressure
Slows and strengthens the heart beat
Increases and strengthens the heart beat
Increases and regulates the heart beat

Mr jones asks why his pulse rate is noted before each dose of digoxin. Which is the most
appropriate explanation for him
There is really nothing to worry about
We want to see if you are having sufficient of the drug
If you have tachycardia it would be dangerous to give you the dose
If your pulse is rather slow, it may indicate that the drug is accumulating in your body
If your pulse is too slow the doctor may have charted the incorrect dosage of the drug

The doctor orders 1000 mls of barts to be infused over 8 hours. The drip factor is 15. What is the
number of drops per minute
3
30
31
300
310

Mr jones says he feels very depressed. What aspects of his thinking/behaviour should be explored
with mr jones
His interactions and feelings toward other members of the household
His thoughts and feelings about his illness
The reasons for allowing depressing thoughts and feelings to overcome him
Religious beliefs about life and death
Recent interactions with members of his own family

The nurse is asked to administer 15,000 international units of heparin to mr jones. The ampoule
contains 25,000 international units in one millilitre. Which amount should be given
0.2ml
0.6ml
0.8ml
1.2ml
1.6ml

Mr jones has a cardiac arrest. In performing external cardiac compression in adults, downward
vertical pressure is exerted on the heart by
Pushing the fleshy part of the clenched fist on the lower sternum and the heel of the other
hand on top of it
Placing the heels of each hand side by side. Extending the fingers over the chest
Putting the heel of one hand on the lower sternum and the heel of the other hand on top of it
Placing the heel of one hand on the xiphisternum and the heel of the other hand on top of it
 Spreading the fingers of one hand on the lower sternum and the fingers of the other hand on
top of them

Mr jones dies. The best answer to a telephone caller asking the condition of mr jones is to
Say the patient is deteriorating rapidly
Say that the patient has just died and express condolences
Ask them to hold the line while a senior nurse is called
Say you cannot provide any further information about the patient
Ask if the caller is a relation, then tell them the patient is dead

What action should be taken in circumstances where a person is wearing a registered nurses
medal to which she is not entitled
Tell the principal nurse at your hospital
Ignore the situation as you do not want to get involved
Ask the person what she is doing wearing a registered nurses medal
Go to her employer, and tell him that you know she is not a registered nurse
Write to the nursing council giving her name and the name of her place of employment

The nurse is working in a surgical ward. jeremy, aged 14 years is admitted to hospital with a
fractured leg following a car accident. Jeremy is in a shocked condition due to blood loss. He
is hyperventilating. Which of the following recordings indicate shock
Blood pressure 110/70, respiration 34, pulse 120
Blood pressure 128/90, respiration 32, perspiring
Blood pressure 120/80, pulse 70, skin cold and clammy
Blood pressure 78/56, pulse 152, weak, thread perspiring
Pulse 84, irregular, skin hot and dry, voided 50 mls clear urine

Hyperventilation may initially cause

Metabolic acidosis
Metabolic alkalosis
Respiratory failure
Respiratory acidosis
Respiratory alkalosis

Without describing to them what is involved, the surgeon asks for consent for surgery from
jeremys parents. What is your responsibility in this situation
Ensure the parents has been given appropriate information
Question the validity of this consent
Ensure the consent form is completed
Check whether the parents have any questions about the surgery

Jeremy is prescribed pethidine 75mgs intramuscularly as a premedication. The drug is available in

ampoules containing 100mgs in 2ml. What dosage should be administered
0.125ml
0.75ml
1.25ml
1.5ml
1.75ml
The nurse believes the drug dose prescribed for Jeremy is incorrect. The best action to take is
Refuse to give the medication
Give the medication as prescribed by the doctor
Withhold the medication and check the dosage with the doctor
Check the drug dosage against another patients chart
Give the medication and consult a current drug handbook

After the operation a traffic officer comes to the ward and asks to interview Jeremy in regard to
the car accident. What is the appropriate action
Direct him to jeremys room
Be present during the interview
Ensure jeremys parents are present during the interview
Assess whether Jeremy is well enough to be interviewed

A reporter from a local paper phones the ward and asks for information on jeremys condition.
What is the appropriate response in this circumstance
Jeremy has a broken leg but is comfortable
Ill go and get the senior nurse on duty who will assist you with your queries
I cannot give you any information
Please contact the senior medical adviser for such information

Mrs lever, aged 72 years was admitted for removal of a cataract from her right eye. Which
statement best defines the term cataract
Severely increased pressure within the eye
clouding or opacity of the crystalline lens
Incoordinated action of muscles of the eyeball
Ulceration of the cornea secondary to infection
Low grade bacterial infection of the iris and ciliary body
Which physiological change is mrs lever likely to have noted
Gradual blurring of vision
Severe unilateral headaches
Floating spots before the eyes
Halo effects around bright lights
Itching and increased watering of her eyes

Which post operative behaviour will mrs lever be protected from if shown the room and ward
layout on admission
Boredom
Hostility
Depression
regression
Disorientation

A cataract in an older person is probably due to

Low grade infection
Endocrine imbalance
Mechanical trauma of the lens
Degenerative changes of the lens
Increased intra ocular pressure

Atropine eye drops 1% are instilled into the eye pre operatively to produce the condition of
Decreased tearing
Papillary dilation
 Palpebral relaxation
Capillary constriction
Decreased intra ocular pressure

Which of the following is your responsibility when preparing mrs lever for surgery
Obtaining consent for the surgery
Giving an explanation of the surgery
Advising on alternative treatments
Ensuring the patient understands the surgery

Despite your explanation to mrs lever about her pre medication, she insists she does not want it.
Your response is to
Tell mrs lever she cannot have surgery without pre medication
Take mrs lever to the operating theatre and tell the nurse she has not had pre medication
Advise her doctor that she does not wish to have pre medication
Ask her husband to persuade her to have the pre medication

Pethidine has been ordered for severe headache. When should the nurse give the pethidine
Only when the headache becomes very severe
Every four hours whether mrs lever needs it or not
Not more often than six hourly to prevent her becoming addicted
When mrs lever says the headache is unbearable and asks for an analgesic
As often as necessary to keep mrs lever comfortable and control restlessness

The misuse of drugs regulations 1977 states that controlled drugs should be stored in a
Locked metal cupboard fixed to the building
Locked safe, within a locked cupboard designated for dugs
Specified locked cupboard in an area designated for drug administration
Locked metal cabinet on drug trolley

When counting the pethidine ampoules you discover that there is one short. Your responsibility in
this situation is to
Check with the pharmacist who did the restock
Record the correct stock in the drug register
Withhold giving the pethidine until the loss is accounted for
Tell the nurse in charge and document the loss

In what circumstance may a nurse be convicted in a court of law under the misuse of drugs act
1975
Giving prescribed sedation to a patient in hospital
Possessing a controlled drug, not prescribed for the nurse by a medical practitioner
Signing the controlled drug register, having given a prescribed medication
Administering a controlled drug under medical guidance in an emergency
Refusing to give a controlled drug to a patient suffering from chronic pain

You return to the office to find a stranger reading mrs levers notes. What should you do first
Remove the notes from the person
Ask the person to identify themselves
Request that the person leave the office
Check whether other notes have been disturbed
STATE EXAMS 31

Robert Obrien, 49 years old, has early cirrhosis of the liver due to 10 years of alcohol abuse.
After recent blank out spells he admits himself to the alcohol unit for treatment. The nurse
observes withdrawal symptoms that require immediate intervention. Which would be the best
approach when giving the prescribed medication
Gain his cooperation by explaining the procedure
Give him the injection when he is not aware
Restrain his arms and legs with restraints
Explain and have other staff members restrain him

Mr Obrien reacts angrily to being told he will need further treatment and must remain in the
hospital another week. He blames the staff for this setback. Which plan would be most
therapeutic
Telling him to calm down when he has these outbursts
Encouraging expression of his true feelings
Leaving him alone until he calms down
Explaining to him why these treatments are necessary

Mrs Obrien asks the nurse what to do if she smells alcohol on her husbands breath after he is
discharged. Which response would best help mr Obrien and his wife work through his periods
of relapse
Confront Robert whenever he has been drinking
Talk about neutral topics and show an interest in him
Tell him to go to his room and sleep
Call his boss and make excuses for his absences

Mr Obrien is admitted 1 year later with jaundice, ascites and peripheral oedema. While taking his
social history he states he is impotent the nurse should recognize that
Impotency is of psychogenic origin
Impotency is a symptom of cirrhosis of the liver
Antidepressants can cause impotency
Male impotency shows a sharp decline after the age of 40

The laboratory studies indicate an increase in mr obriens circulating oestrogens. A symptom

associated with this is
Gynecomastia
Hirsutism
Increased libido
Thrombophlebitis

The physician orders serum albumin 25% intravenously. The expected outcome from this
administration would be decreased
Urinary output
Jaundice
Abdominal girth
Serum ammonia
Joey one week old was born with a cleft lip and cleft palate. He has returned to the unit for
surgery to repair his cleft lip. The nurse should position him on his
Back
Left side
Stomach
Right side

Joeys mother asks the nurse if she will spoil him by holding him whenever he starts to cry. The
nurse should reply that it is most important to prevent crying at this time
Therefore, spoiling him should not be the major concern
However, once his lip has healed he should be allowed extra crying time
Furthermore he needs extra holding and cuddling because he cannot suckle
But she should try first to comfort him in the crib to avoid spoiling him

Robert 3 weeks old after a history of projectile vomiting, has a surgical repair of his pyloric
stenosis. He is returned to the unit, alert, his intake and output are balanced and his vital signs
are stable. He is ready for his first oral feeding, which sould consist of a small amount of
Glucose water
Sterile water
Skimmed milk and water
Dilute formula

Roberts parents ask if he will always have a sensitive stomach. The nurse should respond that the
prognosis is excellent
But he will need close medical supervision until solid foods are his main source of nutrition
Provided he learns to eat slowly and remains sitting for 1 hour after meals
Although a revision will probably be required during the rapid growth period of adolescence
With complete relief of symptoms and no future problems anticipated

A client confides in you that her 16 year old daughter lisa is 5 months pregnant but refuses to
return to the clinic for her scheduled visit. The nurse explains that lisa should be told that
each visit is important
Even though problems rarely occur during the second trimester
Because toxaemia usually occurs at this time and can be controlled if recognised early
Even though she had no problems at her last visit
Because at her age complications are more likely to occur that could affect he or the baby

Lisa tells the nurse that she has gained 2 kg in a month and plans to diet by skipping lunches.
Which of the following responses would be the most appropriate
Have you noticed that your hands and feet have become swollen
You should cut down on high calorie foods like cake and candy, but you shouldn’t skip lung
Your weight gain is just right for you for this period of your pregnancy, you are doing fine
Your supposed to gain 2 kgs of weight its good for the baby youll lose it after the baby is
born

50mg is equal to
0.5 gram
5 grams
5000 micrograms
50,000 micrograms

The drugs used to treat parkinsons disease act by

Increasing cholinergic activity and increasing dopamine
Reducing cholinergic activity and increasing dopamine
Increasing cholinergic activity and reducing dopamine
 Reducing cholinergic activity and reducing dopamine

Recent research indicates that arthritis may be an autoimmunedisease. Which of the following
statements most accurately describes the process of autoimmunity
A rare complication of vaccination when the body reacts to the vaccine by producing
symptoms of the disease
An inherent factor in the blood which renders the person susceptible to certain diseases
Lack of antitoxins in the blood which render the person susceptible to the certain disease
Formation of antibodies in the blood which destroy certain healthy cells in the individual

Patients with rheumatoid arthritis commonly have a raised ESR (erythrocyte sedimentation rate).
This is because
Arthritic patients usually have a degree of anaemia
Rheumatoid factor decreases the viscosity of the cells
Protein changes result in the erythrocytes becoming heavier
There is an increase in leucocyte numbers

Before administering a dose of digoxin the patients pulse (apex beat) should be taken. Which is
the correct action for the nurse to take if the pulse is found to be under 60 beats per minute
Give the drug and take the pulse again an hour later
Give the drug and notify the staff nurse that the pulse is slow
Do not give the drug and report the slow pulse to the doctor
Omit the drug and make a note on the nursing care plan

Which of the following can be causes of anaemia in the elderly

Apathy and depression
Ill fitting dentures
A physiological inability to utilize food properly
3 only
1 and 2
1 and 3
1, 2 and 3

Old people are inevitably a burden on the community (assertion) because old people cannot work
because they are slow and cannot be relied on (reason). With reference to the above statement
which of the following is true
Both assertion and reason are true statements but the reason is not a correct explanation of
assertion
The assertion is true but the reason is a false statement
The assertion is false but the reason is a true statement
Both the assertion and reason are false statements

A common problem with the elderly is their reluctance to drink adequate amounts of fluid. The
most probable reason for this is that they are
Frightened of being incontinent
More likely to sweat then younger people
Unable to afford adequate fluids
Afraid of developing diarrhoea

Haemorrhage into the anterior chamber of the eye following a cataract extraction is called
Hyaemia
 Hyphaema
Hyfever
Hyena

Mr d has an enlarged prostate gland. The development of increased frequency is likely to be a

result of
Inability to empty the bladder completely
Delay in initiating micturition
Slowness of the urinary stream
Burning on micturition

Chuck jones 12 years old has been hospitalized on the pediatric unit with an acute asthmatic
attack. He is receiving 2,000 mls of 5% dextrose in water with 20 millieqivalents of KCL per
day. The drop factor is 60 drops per millilitre. How many drops per minute should he receive
60
68
76
83

Chuck drinks small amounts of fluids, which total 400 mls per day. His daily total including the
intravenous fluid intake is 2,4000 mls. His total output is 1 ,500 mls per day. The specific
gravity of his urine is 1.015. based upon the evaluation of this data the nurse should
Call the physician and request a change in the amount of intravenous fluid
Continue to encourage chuck to drink fluids, and offer choices
Suggest to chuck that he eat more solid foods
Tell chuck that he need not force himself to drink fluids

A 24 hour urine collection is ordered to determine mrs cousins oestriol levels. The nurse should
advise mrs cousins to
Save all urine samples from the first one in the morning until the first one next morning
Discard the first morning urine sample and then save all urine samples including the first one
the next day
Begin the collection at any time during the day and save all urine samples for the next 24
hours
Include the next urine sample after the completion of the 24 hour period, if a urine sample has
been discarded accidentally

Mrs cousins has gestational diabetes. Assessment of mrs cousins diabetic status during the first 24
hours after delivery should include monitoring her blood glucose levels for a possible
complication of
Hypoglycaemia
Hyperkalemia
Ketoacidosis
Galactosemia

Mr and mrs cousins are concerned that their children will develop diabetes. The nurse should
respond that
Because diabetes is inherited their children should be assessed periodically
A genetic counsellor can determine the probability of their children developing diabetes
 There is little chance that their children will develop diabetes because mr cousins is not
diabetic
Statistical predictions of whether children of diabetics will develop diabetes are not too
reliable

A client is given a prescription for chlorothiazide, (chlotride) 500mg once a day. Patient teaching
concerning the drug should include the necessity for
Restricting fluid intake to 1.000 ml/day
Taking the drug before retiring
Avoiding the use of alcohol
Checking his blood pressure daily

Mr smith has a transient cerebral ischemic attack with the following symptoms: aphasia, dizziness
and numbness in the left arm. His nursing care plan should include provision for
Physical safety measures
Suctioning
Seizure precautions
Positioning every 2 hours

A CT scan is ordered for mr smith. Preparation for the procedure should include
Not allowing him anything by mouth after midnight
Administering sedation as ordered
Instructing him concerning the importance of lying still
Explaining that a lumbar puncture will be necessary

Shirley aged 4 has been brought to the health clinic because according to her mother she does not
talk. She is diagnosed as having autistic behaviour. In planning long term care for Shirley, the
health team especially needs to consider
The role of the father in the family
Separating Shirley from her family
A nurse who will be a surrogate mother
Supporting the mothers role

Shirley has to be hospitalized. Which nursing approach will best help shirleys maladaptive
behaviour
a ) isolation whenever Shirley is acting out
Allowing Shirley to have her own way
Rewards given when Shirley cooperates
A one to one relationship with Shirley

The nurse plans to have Shirley involved in daily sessions of therapeutic play. The main reason
for this activity is that
The nurse can motivate Shirley through play
Shirley can best express herself through play
Shirley will be happier when she is playing
The nurse will be more objective watching Shirley play

Mr wolfe a 46 year old executive is admitted to the CCU with chest pain and shortness of breath.
A diagnosis of myocardial infarction is made. One of the more common complications of
myocardial infarction is
Cardiac arrhythmias
Anaphylactic shock
Cardiac enlargement
 Hypokalemia

The nurse observes mr wolfes monitor and identifies asystole. This arrhythmia requires urgent
attention because the heart is
Beating very rapidly
Beating very slowly
Not beating
Beating very irregularly

A cardiac arrest code is called for mr wolfe. The nursing priority is to

Ensure the airway is clear
Give 4 full lung inflations
Compress the lower sternum 15 times
Check for a radial pulse

The commonest cause of mitral valve stenosis is

Atherosclerosis
Sub acute bacterial endocarditis
Rheumatic fever
Left ventricular failure

People with cardiac valve disease are especially prone to develop bacterial endocarditis when
undergoing the following type of surgery
Dental
Thoracic
Abdominal
Orthopaedic

Mr kent is a 78 year old with pneumonia which of the following signs and symptoms would
indicate a fluid deficit
Skin that remains wrinkled and peaked when pinched
Weakness and lethargy
Elevated pulse and respiratory rates
Dyspnoea and cyanosis
1, 2 and 3
1, 3 and 4
1, 2 and 4
1, 2, 3 and 4

Which of the following molecules cannot pass through capillary endothelium

Oxygen and carbon dioxide
Plasma proteins
Glucose, oxygen and carbon dioxide
Amino acids and water

Ammonia is excreted by the kidney to help maintain

Low bacterial levels in the urine
Osmotic pressure of the blood
Hydrostatic pressure in the glomerulus
Acid base balance of the body
Chronic renal failure results in amaemia primarily because
Low levels of urea destroy red blood cells
The bone marrow is depressed
The kidney produces erythropoietin
High levels of vitamin K in the blood

Carbon dioxide acts as a

Respiratory stimulant
Vaso dilator
Respiratory depressant
Bronchodilator

The antidote to heparin is

Vitamin D
Vitamin K
Prothrombin
Protamine sulphate

Mr Thomas was admitted with pulmonary TB. When taking mr Thomas medical history the nurse
should be alert for any mention of the following symptoms of tuberculosis
Loss of weight
Easily fatigued
Afternoon fever
Night sweats
Blood tinged sputum
1, 2 and 3
1 and 2
All of the symptoms
1, 3 and 5

TB is spread by
Inhalation of droplets
Ingestion of contaminated food
Injection with unsterile equipment
Entry through skin lesion on his hand

Which of the following complications may occur if mr Thomas fails to take his medications
regularly
Allergic reactions to his medications
Loss of tissue sensitivity to tuberculin
Bacterial resistance to the drugs
Calcification of the lymph nodes

A possible toxic effect of streptomycin is

Anaemia
Anuria
Deafness
Hypotension

Susan aged 16 years was admitted for investigation of grand mal epilepsy following a seizure and
complaining of blurred vision. The most important test to diagnose epilepsy would be
 An electroencephalogram
An electrocardiogram
Lumbar puncture
Coombes test

The site of vision in the brain is located in the

Temporal lobe
Occipital lobe
Parietal lobe
Thalamus

Which of the following medication may be given to prevent a grand mal seizure
Dilantin
Bromide
Neocytamen
Levo dopa

Following a grand mal seizure susan is likely to be

Hostile
Hyperactive
Euphoric
Confused

Susans mother asks you will this trouble make susan slow in school which response would be
most appropriate
Absolutely not. Susans disease has nothing to do with her intelligence
So long as she has small seizures they will have no effect on her brain
There is no reason to expect the disease to decrease susans ability to learn
As epilepsy causes mental deteriorations, susans learning ability may be affected

Millie crowe a nursing student develops muscular weakness in her right arm and intermittent
urinary incontinence. The diagnosis of multiple sclerosis is made. The pathology underlying
the manifestations of multiple sclerosis has been identified as the
Deficiency of neurotransmitters
Destruction of the nerve myelin sheath
Interference with neuronal transmission
Premature destruction of transmitter substance

When discussing the future with millie it is important to explain that multiple sclerosis
Is a disorder that becomes progressively worse
Is caused by an underlying viral infection
Can be cured with appropriate treatment
Has remissions of months or years

The main goal in treating millie is to minimize the risk of

Prolonged discomfort
Symptom exacerbation
Delayed recovery
Dehydration

The persons who are most likely to have the greatest effect in assisting millie to maintain a
positive self concept are
The occupational therapists during job retraining
 Other people with multiple sclerosis who manage independent lives
Physiotherapists who help her to achieve maximum mobility
People unaffected by multiple sclerosis such as the MS society field worker

Mr green 56 years old has been in hospital for two weeks with a diagnosis of cerebral thrombosis.
His symptoms include expressive aphasia, right sided paralysis and loss of the gag reflex. As
part of the long term planning the nurse should
Help the family accept the fact that mr green cannot be verbally communicated with
Wait for mr green to verbalize his needs regardless of how long it takes
Begin associating words with physical objects
Help mr green accept this disability as permanent

Mrs green seems unable to accept the idea that her husband must be encouraged to do things for
himself. The nurse may be able to work around these feelings by
Telling mrs green to let her husband do things for himself
Letting mrs green know that the nursing staff has full responsibility for the patients activities
Letting mrs green assume the responsibility as she sees fit
Asking mrs green for her assistance in planning the activities most helpful to the patient

A public health nurse has been invited to talk about child health with a group of mothers. Which
is the single most important factor in the early social development of children
Living in an extended family setting
The way their needs are met by others
Their physiological status and stability
Their inherited biological characteristics

An important factor which makes two year old children feel physically secure is
Acknowledge they are individuals
Allow them to have what they want
Ensure they know what they can and cannot do
Be very strict when disciplining them at home

Which of eriksons psychosocial crises is present at age four years

Trust versus mistrust
Initiative versus guilt
Industry versus inferiority
Autonomy versus shame and doubt

Parents are likely to have less conflict with their adolescent children if they
Use rules and punishment to control adolescents
Make a conscious effort to remember their own adolescence
Keep communication open and allow reasonable independence
Plan a set of rules which will be followed at all times

A man has a bleeding socket after getting his tooth removed. the correct action to take is to
Give him an ice cube to suck
Give him a warm saline mouthwash
Pack the socket with ribbon gauze
Tell him to bite on a gauze pad for twenty minutes
Mr smith suffered severe burns to both legs from flames at a barbecue on the beach. His friends
carried him to the waters edge and let the sea flow over his legs. Which statement is correct
about the suitability of this first aid treatment
Advisable to reduce the heat of the flames
Strongly recommended as sea water is healing
Risky because of the contaminants in sea water
Not acceptable because of the risk of chilling and shock

A 42 year old farmer is pinned under his tractor. His breathing is laboured, he is slightly
cyanosed, shocked and has severe chest pain. While waiting for the doctor the nurse should
especially note any
Alteration in pain
Decrease in temperature
Change in his respirations
Increase in the amount of restlessness

The farmer is removed from behind the wheel. He is in severe respiratory distress and is
becoming more cyanosed. The farmer is found to have an open pneumothorax. The most
appropriate first aid is to
Seal the wound in the chest wall
Start mouth to mouth resuscitation
Place the farmer in recovery position
Lie the farmer flat, extending his neck

The ambulance driver gives the farmer oxygen therapy. This improves his respirations and
decreases his degree of acidosis by decreasing the
Carbon dioxide and carbonic acid in the blood and the ratio of carbonic acid to bicarbonate
Hydrogen ion concentration in the blood and increasing the ratio of carbonic acid to
bicarbonate
Carbonic acid, so chloride moves into the red cells leaving more sodium available to form
bicarbonate
Build up of potassium in the blood stream and increasing oxygenation of the haemoglobin in
the blood cells

Which statement would best help a mother who says that she does not believe in immunisation
because it is unnatural
Your children are in danger of infection if they were not given breast milk to gain natural
immunity
Immunisation assists the body to produce its own immunity and give protection against
dangerous infections
If your children are not immunised they will have to be kept away from other children
because they could make other children ill
If you do not have your children immunised they can be admitted to hospital with infectious
diseases and cost the country a lot of money

The nurse should explain to a youth who has not been immunised against tetanus that he will be
given a
Single dose of tetanus serum
Single dose of tetanus toxoid
Small dose of tetanus anti toxin
Course of tetanus toxoid injections

Vaccinations are often given at specified intervals with weeks or months in between each
injection because
 This is convenient to the doctors and nurses
A stronger secondary response is induced
This is a long standing medical procedure
The body could not cope with a large dose at one time

Vaccines induce immunity that is

Active artificially acquired
Passive artificially acquired
Active naturally acquired
Passive naturally acquired

Which of the following signs/symptoms would indicate mumps

Swelling of the lymph nodes
Tenderness of the parotid gland
Enlargement of the prostate gland
Ulceration of vesicular stomatitiis

Which option is important for the nurse to know with regard to prevention of the spread of
mumps
Safe disposal of all bodily excretions
No specific isolation measures are needed
Control of all food stuffs prepared for sale
Isolation for ten days after the last notified case

Which of the following is the best description of a vaccine

Dead modified bacilli
Live attenuated virus
Dead virus given orally
Antibodies suspended in serum

Mrs shaw brings her 8 year old daughter jane to the clinic. Jane has eczema. Janes eczema is most
likely the result of
Inadequate skin care and hygiene
Excretion of acids through sweat pores
An inherited predisposition to skin infections
Sensitivity to a substance in her external environment

Eczema is the term used to describe a (n)

Acute, contagious inflammation of the skin
Excretion of acids through sweat pores
An inherited predisposition to skin infections
Sensitivity to a substance in her external environment

Eczema is the term used to describe a (n)

Acute, contagious inflammation of the skin
Non contagious inflammatory response of the skin
Fungal infection more commonly seen in childhood
Condition marked by the appearance of erythematous wheals

Which statement best describes ‘vesicle’

Reddened, pinprick like rash
Small round area of discolouration
Small area of swelling on the skin
 Small blister filled with serous fluid

You are employed as a practice nurse. A friend telephones and asks if her boyfriend has been to
see the doctor this week. Your most appropriate response is
I don’t know
Ill have to ask the doctor
I am not able to tell you that
Just a moment ill check the files

Mrs adams suffers from dementia and requires a dressing to a shin wound. The nurse suspects the
wound is the result of a non accidental injury. What is the main cause of non accidental injury
in an elderly person suffering from dementia
A dependent person being more prone to injury
A long standing pattern of comestic violence
The home not being a suitable place for a dependent person
The increased stress in caring for a dependent person at home

When dressing the shin wound the nurse most appropriate remark is
How did you scrape your shin mrs adams
How did you scrape your wifes shin mr adams
This shin must hurt. Was it really an accident
A shin is easy to hurt. How did this injury happen

The most appropriate way to help mr and mrs adams at the first visit is to
Express professional concern at the cause of the injury
Conceal feelings about the possible cause of the injury
Reassure mrs adams that this injury will not occur again
Acknowledge the stress on mr adams in caring for his wife

An increased incidence of vaginal infections occurs when contraceptive pills are taken because
there is
A shift in the vaginal pH
Drying of the vaginal mucosa
An increase in vaginal fluids
A reduction in white cell numbers

What action should the nurse take when on three home visits the mother of a nine months old
baby prevents him from being seen as ‘he is sleeping’
Notify the social welfare of the situation
Notify the family doctor in writing of this occurrence
Insist on seeing the child and refuse to leave the home
Respect the patients right to accept or refuse treatment

Which is the major pathophysiological abnormality occurring in asthma

Cardiac arrhythmias
Bronchiole dysplasia
Spasm of the smooth muscles of the bronchi
Inflammation of the alveoli
 Aminophlline is prescribed. Each ampoule contains 250 mg in 10ml. How should be added to the
intravenous solution
12ml
14ml
16ml
35ml

Jillians intravenous infusion of 300ml normal saline is due to run over 4 hours. The drop factor is
60. How many drops per minute must be given for the IV to be completed on time
55
65
75
85

Salbutamol (ventolin) is administered through a nebuliser four hourly. The primary action of this
drug is as a
Broncho dilator
Cardiac stimulant
Respiratory stimulant
Respiratory depressant

A client is charted nitrazepam (mogadon) tablets to sleep. She refuses to take them at 9pm. She
tells you that the other nurses always leave the tablets on the locker and she takes them when
she is ready. What should you do
Put them back in the container
Give her the tablets and let her take them later
Tell the patient to ring when she is ready for them
Tell her if she doesn’t take them now she may not get them later

Hyperventilation may initially cause

Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis

STATE EXAMS 32

Angela Roberts aged 9 years fell off a ladder whilst trying to put a fairy on the Christmas tree.
Although angela hit her head when she fell she was fully conscious when her mother found
her. Her left arm was very painful, she could not move it, but otherwise, apart from being
very pale and frightened, she seemed unhurt. Mrs Roberts took angela to the accident and
emergency department of the local hospital. There it was found that she had sustained a
greenstick fracture of the midshaft of the left radius and ulna. Bearing in mind what we know
of angela which one of the following observations would it be most important for the nurse to
maintain accurately after angela has been admitted to the childrens ward
Temperature
Blood pressure
Power and movement of her lower limbs
Size and reaction of her pupils

A greenstick fracture is defined as one in which the

Bone is bent but there is not break in the continuity of the compact tissue of periosteum
Bone is broken at one side and bent at the other
Periosteum is completely severed while the underlying compact tissue is unbroken
 Periosteum and compact tissue are not broken but the underlying bone marrow is damaged

Which one of the following is associated with the greatest risk of damage to the brachial artery
Dislocated of shoulder
Dislocation of elbow
Mid shaft fracture of radius
Supracondylar fracture of humerus

A comminuted fracture is defined as one which always

Communicates with an open wound
Has the bone broken into more than two pieces
Causes injury to the surrounding organs
Has the fractured ends of the bone driven into each other

After he had seen the xrays thehouse surgeon explained to mr and mrs Roberts that he would need
their permission to get angelas arm in a good position, and apply plaster of paris. He also
explained that in view of the fact that angela had fallen from a height he would prefer to keep
her in hospital overnight for observation, but providing there were no complications she could
go home the following day. Prior to having the plaster applied, angelas arm was manipulated.
In this situation, manipulation is a term which implies
An open surgical operation to ensure the bone fragments are in a good position and not
trapping any nerves or blood vessels
Movement of the fragments of the bone, at the fracture site until they are in a good position
for healing
The insertion of guide wires to ensure that the bone is in perfect alignment
Violent forceful movements of the injured arm to free the bone fragments from surrounding
ligaments and so prevent adhesions

Which of the following is the most important feature in the drying of angelas cast
Avoid covering the plaster with plastic sheeting
Ease the plaster with bending shears at the first sign of swelling of the fingers
When touching the plaster, use only the palm of the hands
Avoid using any forms of hot convection air currents

If angela complains of tingling and itching inside her plaster at a point level with the head of the
ulna, which of the following explanations should the nurse suspect first. The symptoms are
probably caused by
A perfectly natural return of sensation following the original injury
The early stages of a pressure sore forming
Damage to the peripheral sensory nerve supply
The radial artery being trapped by the bone fragments

With reference to the healing of a fracture, which of the following statements is true
Callus formation is the first stage of repair
The first stage of repair is haematoma formation, which is gradually replace by granulation
tissue
A broken bone will eventually unite and be restored to full function, but the torn periosteum
will never repair
Callus is not formed until after full ossification has taken place

Mrs skinner 43 years, is diagnosed as having rheumatoid arthritis. Which of the following
statements is true regarding rheumatoid arthritis
Equally common in both sexes
More common in women than men
 Rare in young adults
Never occurs in children

Rheumatoid arthritis and osteo arthritis (osteo arthrosis) differ in that rheumatoid arthritis
Is usually associated with systemic disturbance
Usually results from injury to a joint
Affects mainly larger weight bearing joints
Is a progressive non inflammatory condition

With reference to rheumatoid arthritis, which of the following statements is true

There is no known cure for this condition
A common complication of this condition is damage to the valves of the heart
Primary symptoms occur within 10 days of the patient having a haemolytic streptococcal
infection
Involvement of the joints or the cervical vertebrae is rate

The stiffness associated with rheumatoid arthritis is typically described as

Better after resting
Bad in the morning and gets worse as the day progresses
At its worst in the morning and improves as the day progresses
Present all the time and keeps me awake at night

Which of the following analgesics is most commonly prescribed for patients with rheumatoid
arthritis
Aspirin
Pethidine
Meralen (flufenamic acid)
Ponstan (mefanamic acid)

Mrs skinner was later in hospital for six weeks. During this time her general condition improved
considerably. She was discharged, arrangements were made for her to attend physiotherapy.
Which of the following is of prime importance in the care of the patient during an acute
(active) phase of rheumatoid arthritis
Rest the body and the affected limbs
Rest the body but give vigorous active exercises to the affected limbs
Apply splints to the affected limbs
Encourage the patient to walk about the ward and increase the range of activity each day

During the (acute) phase of rheumatoid arthritis the patient should be nursed in which of the
following positions
Upright
Recumbent
Lateral
A variety of different positions

When mrs skinner attended the physiotherapy department as an outpatient, she was given local
applications of heat. The main purpose of this form of treatment is to
Produce sufficient temporary pain relief to enable the patient to perform her exercises
Increase the range of movement to the affected joints without the need of active exercises
Increase the supply of white cells to the affected joints and so reduce inflammation
Reduce swelling of the joint
Six years have passed and twice in recent years mrs skinner has been admitted to hospital. The
first time for an arthrodesis of the left knee and the second time for an arthroplasty of the
right knee. The purpose of an arthrodesis is to provide a joint which
Have a full range of movement
Has a limited range of movement
Is stable but not moveable
Is moveable but not stable

Which of the following activities is mrs skinner most likely to need help as a result of having had
an arthrodesis of the knee
Putting on her shoes
Using the toilet
Washing her legs
Cutting her toe nails

Following arthrodesis of the knee, the most difficult action for a patient to perform is
Standing
Walking
Rising from a chair to the standing position
Turning over in bed

Which of the following is the most important duty of the nurse caring for mrs skinner in the
immediate post operative period
Maintain a clear airway
Record her pulse and blood pressure ½ hourly
Prevent her from moving her legs
Ensure that any instruction from the surgeon concerning application of traction are carried out
at once

Mrs skinner has a blood transfusion in progress following hip replacement. Her blood group is A.
This means that in an emergency she could receive blood from
Any other group
Any group except B
Group A only
Group A and O only

Twelve hours after the operation mrs skinner started shivering and complaining of pain in her
back. Her pulse was very rapid. In these circumstances which one of the following should the
nurse do first
Take her temperature
Give her an extra blanket
Send for medical aid
Stop the blood transfusion

John an 18 year old student, has been assigned to your care. He is jaundiced and his clinical
appearance suggests that he has hepatitis A. Hepatitis A is an inflammatory condition of the
liver caused by
Auto immune processes following a viral infection
A virus which infects the person via the GI system
 A virus which is only transmitted via contaminated blood products
A virus which is mainly transmitted by sharing needles

Following a bout of hepatitis A most people can expect

To become a carrier
Frequent relapses
Lifelong immunity to hepatitis A
Increased risk of liver cancer

The jaundice in hepatitis A is best described as

Haemolytic
Bilio-static
Obstructive
Hepato-cellular

The incubation period is

Less than 10 days
5-15 days
15-50 days
40-60 days

During the infectious stage, a person with hepatitis A is excreting the virus mainly in
Faeces
Urine
Saliva
All body fluids

When a person is in the infectious stage of hepatitis A, special precautions are taken when you
Take a food tray to the person
Administer medications
Gave an antiemetic injection
Remove a used bedpan

The most common cause of chronic liver failure in new Zealand is

Post hepatitis fibrosis
Alcoholic cirrhosis
Hepatic damage following overdose of paracetamol
Drug induced hepatic fibrosis

Mrs G asks you about sexually transmitted diseases. Among other facts you tell her
STDs are not cured without treatment
You cannot get STDs more than once
You can only get one STD at a time
STDs are only transferred from heterosexual contact

Staff working in STD clinics use a non judgemental approach. A judgemental approach is likely
to have which of these effects
Generate hostility in the client
Relieve clients reeling of guilt
Cause an inability of understanding in client
Give rise to a sense of abandonment in client
Which of the following attitudes displayed by STD clinic staff are the most therapeutic
Accepting, sympathetic, friendly
Supportive, motherly, friendly
Sincere, understanding, consistent
Strict, clinical, punishing

Joe is 15 years old and attends a local high school. He lives with his mother, brother and sister in
a rented flat. Three months ago joes school performance began falling and his teacher
contacted joes mother. Where joe once had been a moderately bright student with a small
circle of friends, his teacher reported that joe had become less communicative. He also
noticed joe was less inclined to mix or join in group activities such as games, and in class,
often seemed distracted and preoccupied. Which of the following is psychologically
significant and requires further assessment
Joes concern about acne
Joes concern about the world
Joes concern about what is real
Joes concern about pocket money

Joes mother shares that his behaviour has changed at home too. Which is not typical behaviour of
normal adolescence
Spending long periods of time alone in his room
Awake all night some nights during the weeks
Less inclined to talk, more sulky and moody
less co operative, more inclined to get angry

a favourable outcome to the life crisis of adolescence would include

an ability to feel intimate
concern for family, society, and future generations
an integrated image of oneself as a unique person
confidence in productive skills, learning how to work

joe looks worried and tells you that he can cause terrible things to happen just by thinking about
them. To prove this, he relates when he is thinking about aeroplanes and one crashed on the
same day. Your most therapeutic response would be
no. Its just a coincidence that the plane crashed
what sort of plane was it and where did it happen
it must be a scary feeling to believe you have that responsibility
that must make you a very powerful person, eh

you consider joe to be quite disturbed and communicate this to joes doctor. Eventually joe is
hospitalised for assessment and treatment. Joe continues to have delusions. Reality for joe
will be reinforced by
listening to him carefully
calling him by name
calling him at mealtimes
reminding him to change his clothes
 1, 2 and 3
2 only
1, 2 and 4
All of the above

Therapeutically, doing what you say you will is important in establishing

Patterns of reliability
Trust in a relationship
Self respect
Patterns of predictability

At the next team meeting it is decided to commence joe on medication in an attempt to impose a
control on his disordered thoughts. Of the following which will contribute most to the teams
choice of the mode of administration of the drug
Joes attitude to medication generally
The amount of the insight about his situation
Joes trust in the medical staff
Joes trust in his primary nurse

In any situation where restraint is necessary, which of the following is not true
Questions asked by the patient are answered by one staff member
One staff member per limb is the minimum safe requirement
Medication will always be given to effect control
The patient is most safely restrained lying down

Mr white is a depressed patient who has said ‘im fed up don’t intend to go on like this’. The nurse
should
Ask him directly if he is considering suicide
Ignore the statement and continue the conversation
Change the subject but report incident to charge nurse
Comment that others are worse off than he is

The most common event to trigger addictive behaviour in the elderly is

A change in work status
Death of a spouse
Divorce
A move

Disulfiram (antabuse) is given to people suffering from alcoholism

To ease their anxiety
To discourage them from drinking
To help them with depression
during detoxification

individuals experiencing violent mood swings suffer from

unipolar mood disorders
bipolar mood disorders
endogenous depression
manic mood disorders

smoking is bad for people with chronic respiratory disorders because cigarette smoke
destroys the cilia which cleanse debris from the airways
inhibits the inspiratory centres in the central nervous system
 inhibit nerves involved in the reflex pathways involved in coughing
prevents the vocal cords closing tightly together when swallowing

one reason why smokers with chronic respiratory problems should not be given medications that
inhibit the cough reflex is
these medications dry up mucus and make secretions difficult to expel
the hypoxic drive is inhibited causing a slowing in breathing rate
coughing is their only means of preventing mucus accumulating in the lungs
in people with chronic problems these medications have no effect anyway

asthma is a disorder primarily characterised by

hyperinflation and over expansion of lung tissue
spastic constriction of the respiratory airways
a breakdown in the walls of alveolar tissue
chronic dilation and expansion of the airways

during acute asthmatic attacks theophylline medications are given because they
stimulate the inspiratory centre
raise the blood PO2 levels
hyperinflate the lung
dilate the bronchioles

aminophylline comes in ampoules of 250mgs in 10mls. How much in mls, would you draw up to
obtain 300mgs
8.3
12.0
83.0
120.0

A client is prescribed 1 litre of dextrose/saline to be given over 3 hours. If the IV giving set has a
drop factor of 15 drops per ml, which of the following in drops per minute, gives the correct
rate
17
33
67
83

STATE EXAMS 33

 Cholesterol is frequently discussed in relation to atherosclerosis. Cholesterol is a substance

that
e) All persons would be better off without because it causes the disease process
f) Circulates in the blood, the level of which responds usually to dietary substitutions of
unsaturated fats for saturated fats
g) Is found in many foods, both plant and animal sources
h) Maybe controlled entirely by eliminating food sources

 Angina pectoris is caused by

e) Sudden and complete occlusion of one or more coronary arteries
f) Mild ischaemia due to temporary or partial occlusion of the coronary artery
g) Obstruction of blood flow between the right and the left atria
 h) Mild ischaemia due to partial blockage of the aorta

 The symptoms of angina pectoris are the result of

e) A reduction in the amount of blood circulating through the heart
f) More oxygen being required by the heart muscle than is available
g) The lack of oxygen carrying capacity in the blood supply
h) An interruption to the blood supply which results in decreased tissue perfusion

 Evaluation of the effectiveness of cardiac nitrates is based on

e) Relief of anginal pain
f) A decrease in blood pressure
g) Improved cardiac output
h) Dilation of superficial blood vessels

 Death following a myocardial infarction is most likely caused by

e) Dysrhythmia
f) cardiogenic shock
g) congestive heart failure
h) ventricular rupture

 which of the following factors increases insulin resistance

e) obesity
f) hypoglycemia
g) decrease in amyloid deposits
h) increase in muscle mass

 in metabolism of carbohydrate, the most important function of insulin is

e) precipitating the breakdown of glycogen in the liver
f) to facilitate the passage of glucose into the cell
g) acting as a antagonist to glucagon in the muscle sheath
h) increasing the circulating blood sugar level

 which of the following is the most preventable risk factor for preventing chronic obstructive
pulmonary disease (COPD)
e) adequate nutrition
f) regular exercise
g) exposure to dust and pollen
h) cigarette smoking

 when teaching the diabetic who is taking insulin, the nurse emphasizes the importance of
exercise, which
e) prevents mental deterioration
f) often decreases insulin requirements
g) prevents muscle dystrophy
h) often improves visual acuity
 blood is ejected into the circulation as the chambers of the heart becomes smaller. This action
of the heart is referred to as
e) systole
f) diastole
g) hypertension
h) ejection fraction

 the patient is experiencing orthopnea. What is the best position for this patient for relief of
symptoms
e) sitting upright leaning forward slightly
f) low fowlers
g) prone
h) Trendelenburg

 Which of the following would be most appropriate for a patient who is receiving diuretic
therapy for cardiac failure
e) Check laboratory results for creatinine levels
f) Monitor for hypotension
g) Encourage the patient to spend time outdoors to aid in vitamin D absorption
h) Discourage use of potassium

 Which of the following complications of diabetes is termed macrovascular

e) Retinopathy
f) Stroke (cerebro vascular accident
g) Nephropathy
h) Renal failure

 Large quantities of frothy blood tinged sputum would indicate which of the following
e) Suctioning required
f) Severe pulmonary oedema
g) Respiratory infection
h) Pneumothorax

 An adult patient has damage to the electrical conduction of the ventricles of the heart. The
nurse would expect to see changes in the
e) Decreases myocardial oxygen consumption
f) Causes venous constriction
g) Decreases collateral circulation in the heart
h) Causes arterial constriction

 Which of the following may develop in the patient when ketone bodies accumulate in
excessive amounts
e) Hypovolemia
f) Polyuria
g) Diabetic ketoacidosis
h) Blurred vision
 A patient has been admitted to the hospital with the diagnosis of type 1 diabetes mellitus.
From this information you recognise that this patient
e) Has an autosomal dominant disease
f) Is a maori or Polynesian origin and over the age of 50
g) Is insulin deficient and exogenous insulin dependent
h) Is insulin resistant and relies on oral hypoglycaemic agents for glucose control

 Which of the following patients with diabetes may require exogenous insulin but not likely to
experience ketoacidosis
e) The person with type 2 diabetes mellitus
f) The person with type 1 diabetes mellitus
g) The person with type 1 gestational diabetes
h) The person with reactive hypoglycaemia

 Which of the following statements is true regarding type 1 diabetes mellitus

e) There is no genetic or hereditary pattern
f) There is no strong familial link
g) There is a strong autoimmune basis
h) There is no environmental link

 If your patients insulin is labelled U-100, this means

e) 100 units per dose
f) 100 units in the bottle
g) 100 mg per unit
h) 100 units per millilitre

 Which of the following are oral hypoglycaemic agents

e) Oral insulin
f) Insulin substitutes
g) Artificial insulin
h) Sulfonylureas

 Your patient is experiencing hypoglycaemia related to excessive insulin. Your first line
treatment for this type of hypoglycaemia in the conscious patient with diabetes is
e) An injection of glucagon
f) An intravenous injection of 50% glucose
g) Simple carbohydrates, such as juice
h) Complex carbohydrates, such as rice or potatoes

 In metabolism of carbohydrates, the most important function of insulin is

e) Precipitating the breakdown of glycogen in the liver
f) To facilitate the passage of glucose in the cell
g) Acting as an antagonist to glucagon in the muscle sheath
h) Increasing the circulating blood sugar level

 Which of the following factors increases insulin resistance

e) Obesity
f) Hypoglycaemia
 g) Decrease in amyloid deposits
h) Increase in muscle mass

 Which of the following findings would indicate that a person with diabetes might be suffering
from neuropathy
e) Blurred vision
f) Loss of memory
g) Numbness of arms
h) Sensory loss in legs

 When water is lost from the body but there is no electrolyte loss, the condition which occurs
is
e) Osmotic diuresis
f) Shock
g) Dehydration
h) Water intoxication

 The nurse teaches a client with COAD how to perform pursed lip breathing, explaining that
this technique will assist respiration in what manner
e) Slows the expiratory rate and gives the client control of respiratory patterns
f) Promotes maximal inhalation for better oxygenation of the lungs
g) Prevents collapse of bronchioles and air trapping in the lungs during expiration
h) Loosens secretions so that they may be coughed up more easily

 Mr langley aged 50 has severe emphysema, during assessment the nurse notes that he has
jugular vein distention and oedematous feet. The nurse recognises that these finds are
indicative of which complication of COAD
e) Acute respiratory failure
f) Fluid volume excess secondary to cor pulmonale
g) Pulmonary oedema caused by left sided heart failure
h) Secondary respiratory infection

 The most dangerous complication of oxygen therapy for persons with chronic obstructive
lung disease is
e) Pulmonary embolism
f) Damage to alveolar and lung parenchyma
g) Dry lung secretions and promote atelectasis
h) Depression of the respiratory drive
 A compensatory mechanisms for respiratory acidosis is
e) Retention of hydrogen ions by the kidneys
f) Decreased rate and depth of respiration
g) Increased bicarbonate production by the kidneys
h) Decrease bicarbonate production by the kidneys

 Mrs green has an acute episode of right sided heart failure and is receiving frusemide (lasix).
The symptoms mrs green most likely displayed on admission are
e) Dyspnoea, oedema and fatigue
f) Weakness, palpitations, nausea
g) Fatigue, vertigo and headache
h) A feeling of distress when breathing

 Evaluation of the effectiveness of cardiac nitrates is based on

e) Relief of anginal pain
f) A decrease in blood pressure
g) Improved cardiac output
h) Dilation of superficial blood vessels

 Heart failure may be defined as

e) The inability of the heart of pump sufficient blood to the tissues
f) The inability of the heart to pump sufficient blood to the myocardium
g) The inability of the atrio ventricular valves to control blood flow within the heart
h) Inflammation of the endocardium

 Mrs green has an acute episode of right sided heart failure and is receiving frusemide (lasix).
The symptoms mrs green most likely displayed on admission are
e) Dyspnoea, oedema, fatigue
f) Weakness, palpitations, nausea
g) Fatigue, vertigo and headache
h) A feeling of distress when breathing

 The nurse notes that mrs greens abdomen is distended. The nurse should realise that the client
with congestive heart failure develops ascites because of
e) Increased pressure within the circulatory system
f) Rapid diffusion of solutes and solvents into plasma
g) Rapid osmosis from tissue spaces to cells
h) Loss of cellular consituents in blood

 In the systemic circulation, blood returning to the heart from the legs would have to pass
through the
e) Right coronary artery
f) Inferior vena cava
g) Abdominal aorta
h) Thoracic aorta

 Which of the following factors increases insulin resistance

e) Obesity
 f) Hypoglycemia
g) Decrease in amyloid deposits
h) Increase in muscle mass

 Which of the following findings would indicate that a person with diabetes might be suffering
from neuropathy
e) Blurred vision
f) Loss of memory
g) Numbness of arms
h) Sensory loss in legs

 In metabolism of carbohydrate, the most important function of insulin is

e) Precipitating the breakdown of glycogen in the liver
f) To facilitate the passage of glucose in to the cell
g) Acting as an antagonist to glucagon in the muscle sheath
h) Increasing the circulating blood sugar level

 Lasix 15 mg is ordered for a client. Available stocks contain 10mg in a 2ml ampoule. The
correct dose would be
e) 5ml
f) 3ml
g) 1.5 ml
h) 2.5ml

 If you suspect the dose of a prescribed medication is too high, your best action would be to
e) Delay giving it until an adequate explanation is given to you about the dosage
f) Give it once, but don’t repeat the medication until the dosage is confirmed
g) Give it if the medication is given orally, but delay it if it is given by injection
h) Give the dose you know is appropriate

 Death following a myocardial infarction is most likely caused by

e) Dysrhythmia
f) Cardiogenic shock
g) Congestive heart failure
h) Ventricular rupture

 When collecting a client from post anaesthetic recovery room, the nurse places the highest
priority on assessing
e) The patients level of consciousness
f) The condition of the surgical site
g) The status of fluid and electrolyte balance
h) The adequacy of respiratory function

 DKA occurs when there is

e) A profound lack of insulin in the body
f) A severe decrease in blood glucose
g) Insufficient insulin production
h) Excessively rigid glycemic control
 Which symptom of DKA causes patients to seek care
e) Dehydration
f) Abdominal discomfort
g) Acetone breath
h) Blurred vision

 Which of the following is a late sign of DKA

e) Diarrhoea
f) Hypertension
g) Lethargy
h) Deep rapid breathing

 What makes HONK so dangerous

e) It has an insidious onset
f) It presents with a myriad of symptoms
g) It has a rapid downhill course
h) It mimics other diabetic problems

 Plasma glucose levels in HONK are usually

e) <11 mmol/L
f) 11-27 mmol/L
g) 13.8-44 mmol/L
h) >33mmol/L

 The goals for emergency treatment of DKA and HONK include all the following except
e) Correcting the underlying cause
f) Normalising glucose
g) Restoring fluid and electrolytes
h) Stabilising respiratory status

 The nurse should instruct the diabetic patient to follow all of the following sick day guidelines
except
e) Drink plenty of caffeine free fluids
f) Always take your normal dose of insulin even if you cant eat
g) Monitor blood glucose every six to eight hours
h) Always take your oral diabetic medications even if you cant eat

 Large quantities of frothy blood tinged sputum would indicate which of the following
e) Suctioning required
f) Severe pulmonary oedema
g) Respiratory infection
h) Pneumothorax

 An adult patient has damage to the electrical conduction of the ventricles of the heart. The
nurse would expect to see changes in
e) P wave
 f) T wave
g) Qrs complex
h) U wave

 To relieve angina pectoris symptoms, the nurse administers nitroglycerin sublingual to the
patient. Which of the following is an action of nitroglycerin
e) Decreases myocardial oxygen comsumption
f) Causes venous constriction
g) Decreases collateral circulation in the heart
h) Causes arterial constriction

 Which of the following may develop in the patient when ketone bodies accumulate in
excessive amounts
e) Hypovolemia
f) Polyuria
g) Diabetic ketoacidosis
h) Blurred vision

 To gain a postoperative patients co operation in ambulating, coughing, deep breathing, and

turning, which intervention is most important for the nurse to perform
e) Administer analgesics freely to achieve the patients relative freedom from pain
f) Ensure that the patient understands the rationale for these activities
g) Warn the patient about complications that can occur if the activities are not performed
h) Praise the patient when the activities are completed

 The nurse is teaching a group cardiac patients to evaluate the nutritional content of food. The
nurse explains that if a serving of 100 gram peanut butter has 36 grams of fat and 190 calories
the percentage of fat per serving is
e) 52%
f) 66%
g) 36%
h) 18%

 Mr doncald graham, aged 81, has a large obstruction that occurred as a result of a faecal
impaction. During assessment of mr graham, the nurse recognises which finding as consistent
with a large bowel obstruction
e) Rapid onset of copious vomiting
f) Metabolic alkalosis
g) Referred pain to the back
h) Constant, generalised abdominal pain

 The physician orders 2 units of blood to be infused for a client who is bleeding. Before blood
administration the nurses highest priority should be
e) Obtaining the clients vital signs
f) Allowing the blood to reach room temperature
 g) Monitoring the haemoglobin and hematrocrit levels
h) Determining proper typing and cross matching of blood

 A feature of type 1 diabetes is

e) Autoimmune destruction of pancreatic beta cells in pancreas
f) Late onset usually older than 40 years
g) Resistance to insulin in target tissues
h) Obesity

 The percentage of the people with diabetes type 2 out of all diabetic clients is
e) Over 40%
f) Over 50%
g) Over 60%
h) Over 80%

 Type 2 diabetes usually requires

e) Oral hypoglycaemic medications, diet and exercise
f) Sub cutaneous insulin
g) Regular daily monitoring of blood sugar levels
h) Four times daily monitoring of blood sugar levels

STATE EXAMS 34

Following surgery, mr J is ready to be transferred from the recovery unit to the surgical ward
when
The vital signs are established and the temperature is normal
The gag reflex and voluntary movements have returned
His blood transfusion is completed and reflexes are normal
He pushes the airway out and respiration are normal
He regains consciousness and vital signs are stabilised

On the way back from the operating theatre mr j stops breathing and becomes very cyanosed.
Your best action would be to
Commence cardiac massage
Ensure that his airways are clear
Give oxygen
Send the orderly for medical aid
Return mr j to theatre

Mr j is charted pethidine 100 mg for post operative pain. As a registered nurse you have to make
the decision about giving the first post operative dose of analgesic. It is generally regarded
that this should be given
Only if the patient asks for it
Before the pain becomes too severe
When pain is severe
 When the doctor tells you to give it
When the supervisor permits it to be given

Wound bleeding which occurs seven to ten days post operatively is most likely due to
Infection
Defective suturing
Not enough exercise
Premature removal of wound drain
Premature removal of sutures

Which of the following may be the cause for inability to void following lower abdominal surgery
Oedma of urethra
Spasm of bladder sphincter
Atony of bladder muscle
Fear
Pressure of the bladder against the pubes

The nurse notices that the clients surgical wound is swollen and red. The client complains of pain
and says it feels warm. This condition is known as
Maladaption
Inflammatory response
Hormonal activity
Exhaustion stage

A patient develops the following signs 48 hours following surgery 1 progressive (faecal) vomiting
2 marked abdominal distension 3 absence of bowel sounds. What is likely to be wrong with
this patient
Impaction of faeces
Paralytic ileus
Irritable bowel
Early peritonitis

The purpose of reversible surgery for ulcerative colitis is to

Reduce anaemia
Rest the bowel
Improve the appetite
Alleviate abdominal pain

An 82 year old woman is admitted with a fractured hip. She is thin, and her skin has poor turgor;
she is alert and cooperative. This client is at risk for developing pressure sores. Which factor
increases her risk the most
A haemoglobin level of 14 g/100ml
An adequate muscle mass
The absence of the shearing force
Moisture on the skin

Which intervention would the nurse use to prevent post operative deep vein thrombosis
Encourage the client to stay in bed
Maintain skin integrity
Order a sheepskin for the bed
Teach the client to do leg exercises

The nurse suspects that a client has a deep vein thrombosis. The nurses initial action is to
 Document findings in the clients chart
Massage the area
Measure the circumference of the calf
Notify the physician

Which of the following best states the rationale for assessing preoperative vital signs
Complies with standard policy for all clients admitted to the hospital
Helps to determine which anesthetic should be given to the client
Provides a baseline to assist in determining problems
Reassures the client that he is being cared for appropriately

Which of the following signs would indicate that mrs Collins is haemorrhaging post operatively
Decreased BP, pulse and respirations
Decreased BP, increased pulse and respirations
Increased BP, pulse and respirations
Increased BP, and respirations, decreased pulse

Mr Dixon, aged 42 years is admitted with alcohol dependency and cirrhosis of the liver. The main
aid in the treatment of an alcoholic is to help him to
Become independent of his dependency on alcohol
Become dependent on an alternative support
Give up alcohol and associating with drinkers
Feel completely independent and self sufficient
Realise the hurt his actions have caused his family

Mr Dixon brings with him his morphine tablets prescribed by his general practitioner. What
action should the nurse take
Put the bottle on the drug trolley
Take the patient to send them home
Hand them in immediately to be locked up
Tell the patient to keep them in his locker
Put them in her pocket to later give to the charge nurse

The alcoholics anonymous organisations step wise programme includes

Acceptance of ones powerlessness to manage the use of alcohol
Receiving the forgiveness and guidance of a higher power
Making restriction to those one has harmed as a result of drinking
Taking regular inventory of ones motives and actions through meditation
Providing support for others needing release from alcoholism
1 and 2
3 and 4
1, 4 and 5
2, 3 and 4
1, 2, 3 4 and 5

The next day mr Dixon refused to eat in the dining room with other patients, despite suggestions
from the nurse. This behaviour is best recorded as
He is depressed and not eating
He was uncooperative and refused to eat with others
He preferred to eat in his room, against nurses advice
 The patient seemed withdrawn and did not follow suggestion
He did not eat in the dining room

What is the cause of ascites in cirrhosis of the liver

Renal failure due to back pressure
Biliary obstruction by fibrous tissue
Reduced hepatic synthesis of albumin
Malnutrition due to the lack of protein
Renal failure due to portal hypertension

A week later you meet mr Dixons neighbour. She tells you that mr Dixon has gone into hospital
and asks you what wrong with him .your best response is to
Tell her that you cannot discuss any details about patients
Acknowledge her concern and suggest that she talks to mrs Dixon
Suggest that she rings the ward and enquiries about mr Dixon
Explain to her the symptoms of alcohol dependency

The first phase of the nurse patient relationship with mr Dixon mainly involves
Making contact with him
Determining his wants and needs
Assessing his needs for nursing care
Establishing a therapeutic goal for him
Establishing comfortable rapport with him

Which behaviour of the nurse will provide the best therapeutic care of mr Dixon
Liking every patient she cares for
Accept the patient as a human being
Sympathizing with mr Dixons problems
Keeping a distant professional attitude
Accept mr Dixons maladaptive behaviour

Mr Dixon finds verbal communication difficult. It would be most helpful and therapeutic to
Involve mr Dixon in a group activity so he has a choice of persons to talk to
Focus on mr doxon and his problems and mention similar problems of your own
Ask mr Dixon direct questions which require straight forward concrete answers
Ask several non productive questions that will not make mr dixon feel threatened
Engage in a concurrent activity with mr Dixon in which he can feel more comfortable

After a day of abstinence, mr Dixon has coarse tremors of the hands. He asks how long it will be
before his ‘shakes go away’. The nurse should base her reply on the fact that the tremors
Come and go regardless of treatment
Usually are relieved after two days of abstinence
Can only be relieved by anti parkinsonism medication
Are a permanent condition due to irreversible central nervous system damage
May persist for several days or longer after alcoholic intake has stopped

Delirium tremens (withdrawal delirium) is regarded as a serious complication. What are the signs
and symptoms of delirium tremens
Tremulousness
Talkativeness
Anxiety, uncontrollable fear
Visual, tactile and auditory hallucinations
 1 and 2
1, 2 and 3
1, 3 and 4
2, 3 and 4
1, 2, 3 and 4

Mr Dixon was committed to an institution under the alcoholism and drug addiction act 1966 and
is thought well enough to leave hospital prior to the expiry of the commitment to achieve this
aim he should
Apply to the court for early release
Be discharged by the admitting officer
Be placed on trial leave by the doctor
Plan to attend the hospital as an outpatient
Plan to attend the national society of alcoholism and drug addiction

Mr Dixon is diagnosed as having hepatitis B. With which of the following should special
precautions be taken
Toothbrush, sputum bottle and handkerchiefs
Handling the patients personal property
Electric shaver, crockery and cutlery
Blood products, syringes and needles
Urine soaked clothing and bedlinen
1 and 2
2 and 5
1, 4 and 5
3, 4 and 5
2, 3, 4 and 5

How does alcohol cause indigestion

Increased pancreatic enzyme action
Decreased bile production
Irritates the stomach lining
Stimulates the stomach juices
Causes pain from a damaged liver

Alcoholics anonymous is an organisation which caters for

Anyone seeking assistance to overcome an alcohol problem
Anyone who is interested in helping people with alcoholism in the community
Relatives and friends of people with alcoholism who understand how to help them
Religious people who are willing to hive free assistance and counsel to people suffering from
alcoholism
Professional people with special skills and understanding about alcoholism and how to
overcome it

What change does mr Dixon need to make before he can be helped with his drinking problem
Decide he wants to stop drinking
Recognise he can control his drinking habits
Be willing to change his way of life and make new friends
Admit that alcohol is causing problems in his life and that he needs help
Accept responsibility for his drinking and face up to his problem

Mr Dixon is prescribed antabuse. What is the action of antabuse

Inhibits albumin production in the liver
Inhibits the metabolism of alcohol by the liver
 Induces vomiting by acting on the stomach lining
Interferes with the action of alcohol in the brain
Interferes with the excretion of alcohol form the kidneys

Antabuse may be prescribed to help a person with a drinking problem to

Remove the need for alcoholic beverages
Ease misery so benefits other treatment
Provide a disincentive to take alcohol
Repair body tissues directly affected
Reduce the side effects of alcoholism

Mr Dixon says that some colleagues have asked him to go out for a drink at the hotel with them.
The best response by the nurse is
Would you like to spend some time with your colleagues
you definitely must not go, as you have no will power
Go but you are not allowed to drink as you are on antabuse
Would you like to discuss ways of dealing with this request
A few drinks will not hurt. Later we can discuss how you coped

Mr Dixon feels faint while in the bath. The first action of the nurse should be to
Call for help
Take his pulse
Hold his head out of the water
Pull the plug and let the water out
Get him out of the bath with assistance

For several years you have headed a ward where a registered nurse who works hard is well
intentioned and safe, but fails to practise at an acceptable level of competence. Several of the
staff complain about ‘carrying’ this nurse
Tell them to do their own work and not be concerned with others
Tell them to sort it out themselves
Tell them you will have a talk with her about her poor performance
Talk to the nurse and encourage her to try some other form of work
Tell the nurse to speak to the others who are complaining

One of the complaining staff says she is going to report this staff member to the principal nurse,
before you have had a chance to handle the situation. Do you
Encourage her to do this
Forbid her from doing this
Arrange for you and her to talk to the staff member together
Arrange for all the staff to have a meeting about it with the staff member
Ask the supervisor her advice

A patient tells you he has heard negative ‘whispers’ about the staff member from other staff. He
says her care of him has been exemplary. Do you
Chastise the gossiping staff
Thank the patient and say it will go no further
Use the information when trying to persuade the supervisor to intervene
Do nothing
Use the information positively when approaching the staff member about her standards of care

The staff member who has been complained about comes to you and says she wants a transfer to
another ward as the staff have become unbearable to work with. Do you
Call all the staff together and challenge them with this
 Call in the supervisor and ask her to intervene
Use this opportunity to discuss with the staff member how she feels about her standards of care
Say you will arrange a transfer
Arrange for her to have a holiday

A charge nurse friend of yours tells you this staff member has asked to go to her ward and asks
you your opinion of her work ability. Do you
Praise her work to get rid of her
Tell the charge nurse all the negative aspects
Suggest a trial period in another ward
Say she will have to ask nursing administration
Say you will let her have all the work appraisal records with the staff members permission

Mr Williams is a 48 year old taxi driver who drinks heavily. Recently the pain in his right leg
which has become progressively worse, so he sought advise of his general practitioner. The
doctor told him he has atherosclerosis and arranged for him to be seen by a specialist. He is
then admitted for rest and investigations. Atherosclerosis is best described as
An allergic response
A narrowing of the veins
A narrowing of the arteries
An inflammation of the arteries
A blocking of an artery

The reason to advise mr Williams to stop smoking is because smoking

Produces muscle spasm
Lowers cardiac output
Constricts the arterioles
Increases blood carbon dioxide levels
Causes venous stasis

The priority care for mr Williams ischaemic leg is to

Maintain complete bed rest
Stop mr Williams from smoking
Improve his peripheral circulation
Protect his leg from injury
Perform regular physiotherapy to the affected leg

The best advice to give mr Williams on discharge is for him to

Exercise regularly
Avoid exposure to cold and excessive heat
Take analgesics every four hours
Wear a supportive bandage
Remain on bed rest at home

Mr shaw a newspaper reporter aged 38, is married with three young children. They have their own
home and a large garden. Whilst cutting the lawn mr shaw suddenly had severe chest pain and
felt unwell. His wife called the doctor who diagnosed a myocardial infarction and sent for the
ambulance. Mr shaw was admitted to the coronary care unit. Myocardial infarction is best
described as
Death of heart muscle
A clot in the coronary artery
Lack of blood to the heart muscle
Thickening of the arteries of the heart
Spasm of the coronary arteries
The nurses first action when the oscilloscope connected to a patient suddenly shows a straight line
is to
Initiate CPR
Call an emergency
Connect him to another monitor
Give a predcordial thump
Check his pulse rate

The most important observations for the nurse to make when mr shaw returns to the ward to
convalesce concern
His urinary output
The amount of exercise he does
The amount of activity that induces heart pain
The amount of food he eats
His pulse rate and blood pressure

The action potential of each heart beat begins in the

Sinoatrial node
Purkinje fibres
Atrioventricular node
Intercalated discs
Fossa ovalus

Muscle contraction occurs when

Myosin is converted into actin
Glucose is converted into muscle glycogen
Actin and myosin slide between each other
Smooth muscle is transformed into skeletal muscle
Hormones are released into the cross bridges

Mrs E is 60 she has pernicious anaemia. She is admitted to hospital for investigation and
treatment. As she is transferred from the wheelchair to her bed the nurse notes her shortness
of breath. Her dyspnoea was probably the result of
Hypoxia
Anxiety
Heart failure
Pneumonia
Splenomegaly

The smooth beefy red appearance of mrs Es tongue is probably due to

Low grade infection
Chemical irritations
Mechanical trauma
Vitamin deficiency
Poor oral hygiene
A 21 year old male patient called david has been admitted to your ward having been involved in a
major house fire. He has suffered severe burns, involving the whole of his trunk, and has
sustained a compound fracture of his left femoral shaft. What % of his body area has been
burnt 9%
18%
36%
54%
72%

At the time of injury david would have most benefited by the following treatment to his burnt area
Removing his clothing
Application of cold water
Covering with a clean water
Covering with a clean sheet
Covering burnt area with antiseptic cream
Soak area in sodium bicarbonate

David is a normal healthy adult. What would his haemotocrit (packed cell volume) have been
before his accident
25%
45%
65%
85%
95%

shock, due to a haemorrhage from a compound fracture of the femur is called

neurogenic
oligaemic
vasomotor
toxaemic
anaphylactic

48 hours after his injury david is still receiving intra venous fluids and develops a ‘bubbly cough’
rising pulse rate and dyspneoa. Which of the following courses of action will you and the
doctor take
Obtain a sputum specimen for culture and sensitivity
Place david in trendelenbergs position
Prepare david for a chest aspiration
Administer oxygen to david
Slow down or stop IV fluids
1, 2 and 3
2, 3 and 4
3, 4 and 5
1, 3 and 4
1, 4 and 5

When davids condition has been stabilized he is to undergo surgery under a general anaesthetic.
His most important immediate pre operative care is to ensure that
His consent form has been signed
He has not drunk or eaten anything for 4-6 hours
His relatives have been notified
His pre medication has been given
 He has emptied his bowels

Immediately following surgery the most important role of the recovery nurse is to
Record davids pulse and blood pressure
Maintain a clear airway
Observe his dressing for haemorrhage
Assess davids level of consciousness
Give david pain relieving medication

David returns to the ward with closed suction drainage to his leg wound. The purpose of closed
suction drainage in a surgical wound is to
Prevent haematoma formation
Allow the nurse to measure blood loss accurately
Prevent david from moving the body part operated on
Draw the edges of the wound together
Prevent tissue hypoxia

The purpose of a dry dressing to a wound is to

Protect the wound from contamination
Pull the edges of the wound together
Provide a means for the application of medication
Protect the wound from friction
Allow wound debridement
1, 2 and 3
2, 3 and 4
1, 3 and 4
2, 3 and 5
2, 4 and 5

You have a close friend mrs Alexander age 85. While visiting with her she asks you if she can
change her dietary habits. You reply that elderly women need a diet that is
Low in protein, high in fibre
High in phosphorus, low in fibre
High in protein, high in calcium
High in thiamine, high in copper
Low in phosphorus, how in calcium

The majority of elderly clients live in

Nursing homes
Boarding homes for the elderly
Their own homes
Retirement villages
Flats for the elderly

Mrs Alexander complains of constipation and she asks you for suggestions of measures to be used
on an occasional basis. You recommend
Milk of magnesia
Soap suds enema
Dulcolax suppositories
Tap water enema
Senekot tablets

Over the last several months you have noticed that you must talk louder when speaking to mrs
Alexander. You are aware that mrs alexanders hearing difficulty is most likely due to
 Serious otitis media
Conductive deficit
Presbycusis
Otosclerosis
Otitis externa

You notice that mrs Alexander also appears lonely. To help alleviate her loneliness you suggest
that she
Make a life review scrapbook which focuses on important occasions in her life
Join an exercise class for elderly clients at the YMCA
Phone her son who lives in a distant town at least twice a week
Pursue her needlework interest by joining a needlework club
Contact her son and organise a holiday visit with him

Mrs Alexander states that she is having difficulty sleeping at night. You suggest that she
Ask her general practitioner to prescribe a hypnotic
Drink a warm cup of tea prior to bedtime
Engage in an active exercise programme once hour before bedtime
Drink a glass of warm milk at night and take naps as needed
Keep herself awake during the day with plenty of activity

The skin change which mrs Alexander is most likely to exhibit is

Increased elasticity
Decreased number of sweat glands
Increased subcutaneous fat
Decreased number of epidermal cells
Increased melanin production

Mrs Alexander mentions that her skin is dry, particularly in winter. You suggest to her that she
Use bath oils each time she bathes
Applies a moisturising cream after her bath
Uses a cooler water temperature when she bathes
Applies an astringent agent after her bath
Take a multivitamin tablet daily

Mr Matthews (65) is admitted to your ward with the complaint of gradual loss of vision. What
occupies most of the anterior chamber of the eye
Vitreous body
Aqueous fluid
Perilymph
Endolymph
Optic disc

The pathophysiology of chronic open angle glaucoma is

Pressure of the anteriorly displaced iris against the filtration network
Clogging of the aqueous outflow tract with inflammatory debris
Thickening of the meshwork covering the canal of schlemm
Overproduction of aqueous humor by hypertrophied ciliary body
Degeneration of sclera veins preventing absorption of aqueous humor
Mr Matthews should be advised to protect his eyes for an hour or two following intraocular
pressure readings because
The weight of the pressure measuring device may rupture sclera vessels
Mechanical irritation of the eye produces severe temporary photophobia
Corneal anaesthesia renders the eye insensitive to the presence of a foreign body
Mineral oil used as a lubricant retards normal lacrimal secretions
His eyes will need time to restore their normal surface tensions following tonometry

Pilocrpine is effective in treating glaucoma because it

Draws the iris away from the cornea allowing aqueous to drain from the anterior chamber
Depresses cells of the ciliary body responsible for aqueous humor production
Relaxes extraocular muscles permitting increase in the diameter of the globe
Closes the opening between the iris and the lens preventing forward movement of the vitreous
Fosters aqueous outflow by dilating the canal of schlemm

Mr Matthews 40 year old son asks you if he will get glaucoma when he is older. Which of the
following responses by the nurse would be most helpful
Tell me how you feel about the possibility of your getting glaucoma
You have made a useful observation. It would be a good idea to have your eyes examined
now Scientists haven’t yet worked out all the genetic patterns involved, but glaucoma is
inheritable In this day and age there are so many diseases which have been found to be
inherited
You are obviously worried about your eyesight, so i suggest you have your eyes examined

Cathy is 4 years old and is admitted suffering from glomerulonephritis. She has passed red urine
at home, has a puffy face and is lethargic and anorexic. Which of the following will be most
reduced by bedrest
Oedema
Malaise
Haematuria
Hypertension
Proteinuria

It would be most important to know the following about cathy; she has
Lost weight since yesterday
Not eaten her lunch
Started vomiting
worsening haematuria
experienced generalised itching

one of the following disorders is considered contributory to cathys condition – recent

measles
cold sores
red eye
mumps
tonsillitis

one of the following foods should be omitted when tempting cathy to eat
jelly beans
bananas
lollies
crisps
chocolate
marsha 9 years old is admitted suffering from rheumatic fever. She lives with her parents 3 brothers
and 2 sisters in a flat. On admission her temperature is elevated and she has painful joints. The
most important intervention is providing care during the acute phase of her illness is
maintaining contact with her parents
physical and psychological rest
a nutritious diet
maintaining her interest in school
preventing infection

the doctor orders salicylates for marsha. The nurse should be aware that some of the toxic
symptoms of this drug are
tinnitus and nausea
dermatitis and blurred vision
drowsiness and charge in breath odour
chills and pyrexia
leg cramps and oliguria

the cardiac valves most often affected as a result of rheumatic fever

aortic and tricuspid
tricuspid and mitral
tricuspid and pulmonary
mitral and pulmonary
mitral and aortic

what is the most likely cause of abdominal pain and offensive lochia in the pneuperium
a pelvic abscess
venereal disease
retained products
a cervical infection

what is the physiological reason for the administration of vitamin K to the newborn
prevents clotting
prevents jaundice
promotes clotting
increases the prothrombin time

treatment of renal failure is aimed at

increasing the flow of urine from the kidney
preventing the loss of electrolytes through the kidneys
decreasing the workload of the kidneys
preventing protein depletion by increasing the protein intake
increasing the removal of electrolytes through the excretion of urine

typical symptoms of hypothyroidism include

increased appetite and weight loss
muscle twitching and dysphagia
consistant weight gain and increasing fatigue
increased thirst and weight loss
a client who is paralyzed down one side is said to be
guadriplegic
hemiplegic
paraplegic
monoplegic
tetraplegic

a client who experiences aphasia has lost his

ability to speak
hair from his head
sense of taste
appetite for food
ability to swallow

angina pectoris occurs as a direct result of

reduction in the volume of blood passing through the chambers of the heart
an increase in the volume of blood passing through the chamber of the heart
a reduction in the blood supply to the muscles of the heart
a complete absences of the blood supply to a portion of the myocardium
an increase in the blood to the muscles of the heart

which is the most important health information kiwifruit farmers need to know
how to complete accident compensation claims
legislation relating to the health of farm workers
wear protective clothing when using toxic sprays
prevention of disease transmitted from animal to men

the problem of hydatids can be easily corrected because

eggs survive only in sheep and the cycle can be interrupted
the hydatid life cycle is dependent on the dog as the carrier
humans seldom become contaminated because of strict handwashing
the parasite can only survive inside the bodies of dogs and sheep

which of the following is an offence under the hydatids act 1959

feeding raw offal to any dogs in your care
failure to report stray, unregistered dogs
tenuicollis worms in lambs at the time of killing
tenuicollis cysts in any purged material from dogs

mr wood aged 42 has a mole on his back which he asks you to look at. Which of the following
changes are characteristic of a melanoma
a change in colour and decrease in size
bleeding from and decrease in size
increase in size and change in colour
bleeding from and increase in size

mr brown complains that he has blurred vision. What is the most appropriate nursing action to take
check his blood glucose level
advise him to get stronger glasses
explain that he should wear dark glasses
suggest he visits his doctor for a checkup
STATE EXAMS 35

in planning care of a client admitted to ICU with pneumothorax the nurse should recognise that
an opening in the chest wall, causes the lung on that side to
expand due to intake of atmospheric air
collapse due to disturbed negative pressure in the pleural space
expand due to altered lung pressures
collapse due to disturbed positive pressure in the pleural space

oedema may be caused by

increasing capillary permeability
increasing hydrostatic pressure
reducing plasma proteins
increasing interstitial proteins
any of the above

Kevin aged 19 is admitted with an acute attack of asthma. During an asthma attack the reaction to
excessive histamine release would be
Bronchospasm
Bronchodilation
Excessive production of mucous
Production of IGE antibodies
Tachycardia
1, 3 and 4
1, 3 and 5
1, 4 and 5
2, 3 and 4

Which of the following signs would a person be admitted to hospital with an acute attack of
asthma present with
Dyspnoea, tachycardia, anxiety
Dyspnoea, bradycardia, frothy sputum
Tachycardia, chest pain, pallor
Increased anxiety, sweating, chest pain

It has been suggested that asthma may be caused by environmental antigens

Extrinsic
Intrinsic
Nonatopic
B and c

A client diagnosed with acute exacerbation of asthma, is dyspneic orthopneic and irritable. Her
admission history was partially done by on the previous shift. Your best course of action
would now be
Wait or try to obtain the necessary information from the clients family
Obtain the information from the client
Obtain the information from the medical notes
Obtain part of the history now and the rest later

When a client diagnosed with liver failure secondary to cirrhosis of the liver the nurse would
assess which of the following signs indicating portal hypertension
Fluid wave on abdominal percussion
Dark frothy urine
Clay coloured stools
 Tremors of the hands

Portal hypertension results from which of the following pathophysiologic processes

Obstructed blood flow from the GI tract to the liver
Diversion of ascetic fluid from the peritoneal cavity back to the venous system
Rupture of oesophageal varices
Obstruction of bile flow through the common bile duct

When caring for client following a large 2/3 litre paracentesis the nurse should focus on
monitoring for which of the following complications to ensure safe care
Respiratory distress
Encephalopathy
Bleed from the site
Vascular collapse

A client is diagnosed with renal calculi. Nursing interventions to help prevent stone recurrence
would include
Encouraging fluid intake to 1000ml daily
Explaining the need for decreased physical activity
Encouraging dietary modification based on the stones composition
Teaching the client to care for ileal conduit

is generally relieved by sitting up in a forward leaning position

Hyperpnoea
Orthopnoea
Apnoea
Dyspnoea on exertion

In a client with emphysema, hypoventilation could initially cause

Respiratory alkalosis
Respiratory acidosis
Metabolic acidosis
Metabolic alkalosis

A client is anxious and is hyperventilating. In order to prevent respiratory alkalosis the nurse will
Administer oxygen
Instruct the client to pant
Have the client breathe deeply and slowly
Have the client breathe into a paper bag

A district nurse is sent to assess a new client with cor pulmonale. This term refers to
Enlargement of the pulmonary artery
Enlargement of the right ventricle
atrophy of the right ventricle
Giant bullae growth on the lung

Tony buffer 54 years old has a long history of smoking. He decides to have lung and blood
studies done because he is very tired is short of breath and just does not feel good. His blood
gases reveal the following findings pH 7.3 HCO3 27 CO 58 tonys condition may be
Respiratory alkalosis
Metabolic acidosis
Respiratory acidosis
Metabolic alkalosis
A 79 year old client has pale cold feet bilaterally, no hair tufts on toes, and a circumscribed 3cm
lesion on the plantar surface of the first metatarsal joint. Which of the following is the most
likely source of the clients problem
Insufficient venous circulation
Venous thrombosis
Expected age related physiological changes
Insufficient arterial circulation

On assessing and older client the nurse notes that the left leg is swollen and warm, with palpable
pedal pulses; an open, wet ulcer above the medial malleolus; and thick, course, brown
pigmented skin surrounding the ulcer. The probable cause of the ulcer would be
Acute deep vein thrombosis
Chronic venous insufficiency
Chronic arterial insufficiency
Chronic lymphoedema

Interventions to relieve discomfort associated with chronic arterial occlusive vascular disease are
directed at
Improving venous return from the involved extremity
Avoiding narcotic analgesic drugs
Preventing oedema in the extremities
Increasing circulation to the extremities

Normal physiological changes in the aging pulmonary system include

Decreased flow resistance
No change in gas exchange
Stiffening of the chest wall
Improved elastic recoil

A nurse educator explains to a group of new graduates that normally ventilation is regulated by
the central chemoreceptor response to levels of
O2
pH
CO2
pCO2

approximately 1000ml (1L) of oxygen is transported to mr jones cells each minute. Most of the
oxygen is transported
dissolved in his plasma
loosely bound to his haemoglobin
in the form of CO2
as a free floating molecule

mary a 46 year old woman is admitted to your ward with a chest infection due to acute
exacerbation of chronic obstructive pulmonary disease (COPD). A person with emphysema is
susceptible to respiratory infections primarily because
failure of her bone marrow to produce phagocytic white blood cell
retention of tracheobronchial secretions
decreased detoxification of body fluids by compressed liver cells
persistent mouth breathing associated with dyspnoea

emphysema differs from chronic bronchitis is that

 emphysema obstruction results from mucous production and inflammation
emphysema obstruction results from changes in lung tissues
chronic bronchitis obstruction results from changes in lung tissue
there are no visual difference between the two conditions

the tissue change most characteristic of emphysema is

accumulation of pus in the pleural space
constriction of capillaries by fibrous tissue
filling of air passages by inflammatory coagulum
over distension inelasticity and rupture of alveoli

which of the following results of emphysema is primarily responsible for cardiomegaly

hypertrophy of muscles encircling the bronchi
increased pressure in the pulmonary circulation
decreased number of circulating red blood cells
secretion of excessive amounts of pericardial fluids

which of the following statements indicates that a 70 year old stroke client with right lower
paralysis understands ways to prevent pressure sores
ill shift my weight while sitting, and examine my right foot daily
ill spend my day in a reclining chair and massage my right leg every day
ill wear my support stockings and get my daughter to give me a good back rub every night
ill sit on an inflatable ring in my chair and wear comfortable non skid shoes

a client diagnosed with congestive heart failure is placed digoxin 0.125mg daily. A nursing
intervention for this medication is
do no administer if radial pulse is less than 60
hold medication if digoxin level is low
administer if apical pulse is 84
administer if potassium level is 3.1mEq/L

the nurse would assess which of the following signs and symptoms in the client whose serum
potassium level is 3.1mEq/L
anorexia, fatigue, and muscle cramping
tetany, elevated temperature and seizures
hot, flushed skin, dieresis and hypotension
headache, drowsiness and tachypnoea

which of the following data would lead the nurse to establish falling precautions for an elderly
ambulatory hospital client being treated for congestive heart failure and depression
use of cathartics
chronic depression
excessive dieresis
slow ambulation

a client is admitted with complaints of lethargy, confusion during the last few days and lose of
appetite with nausea and vomiting over the last two weeks. The clients ECG shows a
shortened QT interval. Based on this data the nurse would suspect that the client is
experiencing
hyponatremia
hypermagnesemia
hypercalcemia
hyperkalemia
a 48 year old complains of chest pain. Signs and symptoms that would support a diagnosis of
myocardial infarction would include
jugular vein distension and hepatomegaly
fever and petechiae over the chest area
nausea and vomiting and cool, clammy, pale skin
pericardial friction rub and absent apical pulse

teaching for the client taking GT or glycerol with nitrate for angina would include
instructing the client to take the nitroglycerin regularly
explain to the client that a subsequent headache indicates ineffective medication
instructing the client to put the tablet on the tongue and swallow after the tablet dissolves
teaching the client to take a tablet every 5 minutes (x3) when chest pain occurs

a female client is diagnosed with unstable angina. The nurse finds her crying because she fears
she will become a burden to her husband. Which of the following nursing diagnoses would be
appropriate
impaired verbal communication
ineffective family coping
relationship difficulties
fear due to knowledge deficit

which of the following steps should a client with periodic angina pain take first when pain occurs
at home
take sublingual nitroglycerin and lie down
do mild breathing exercises
take an extra long lasting nitrate tablet
sit down and relax

the nurse detects premature ventricular contractions and (PVCs) on the ECG of a client who had
a mitral valve replacement 2 days ago. PVCs may be dangerous because they
significantly increase cardiac workload
may lead to ventricular tachycardia or fibrillation
are the most common cause of myocardial infarction
decrease heart rate and blood pressure

which of the following signs and symptoms would the nurse assess for the client diagnosed with
chronic open angle glaucoma
gradual loss of peripheral vision
cloudy appearing lens
no pain or eye redness
complaints of floating spots

which of the following post operative assessment findings would indicate intraocular
haemorrhage
temperature elevation
diplopia
visual floaters
eye pain
when teaching a client how to do a testicular self examination the nurse should advise him that
tenderness is an early sign of testicular cancer
the testes should feel smooth and oval with no masses
masses are difficult to find and prognosis for cancer cure is poor
a firm pea size lump may be normal

the nurse and client would identify which the following outcomes for a client diagnosed with a
sexually transmitted disease
the client demonstrates increased lymphadenopathy
the client reports decreased sexual activity
the client reports decreased pain and discharge
the client chooses sexual partners who do not need treatment

Phyllis a 65 year old retired secondary school teacher with a history of hypertension, currently on
medication, falls to the ground unconscious while attending an opera. Bleeding within the
skull results in increased intracranial pressure because
Arteries bleed rapidly and profusely
Bleeding from veins goes undetected
Spinal fluid is produced more rapidly
The cranium is a closed, rigid vault

When assessing a patient at risk for increased intracranial pressure, the first thing you would
check is
Reaction to pain stimuli
Papillary function
Level of consciousness
Motor function

Papillary dilation occurs when herniating brain tissue

Compresses the occulomotor nerve
Chokes the optic disks
Stretches the optic nerve
Paralyses the occular muscles

Changes in vital signs with increasing intracranial pressure would include

Hypotension and tachycardia
Narrowing pulse pressure and tachypnea
Hypotension and a pulse deficit
Widening pulse pressure and bradycardia

A client has hypertension and is started on medication. You ask about the clients usual stressors
and ways of dealing with them because
The major cause of primary hypertension is excessive stress
Measures to reduce stress are important when treating hypertension
To foster a better nurse client relationship
Stress must be reduced before learning can occur

A client is admitted for a transient ischemic attack. The clients family asks what is a TIA. The
best response would be
I think you should ask the doctor would you like me to call her for you
The blood supply to the brain has decreased and permanent damage has occurred
A TIA is a temporary interruption of blood flow to the brain but the symptoms are temporary
 TIA means transient ischemic attack

An expected outcome during the acute phase for the client with a stroke includes
Airway patent
Contractures treated
Minimal cerebral perfusion
Lowered fluid and electrolyte levels

Changes in vital signs with increasing intracranial pressure would include

Hypotension and tachycardia
Narrowing pulse pressure and tachypnea
Hypotension and a pulse deficit
Widening pulse pressure and bradycardia

A client is admitted to ED following a car accident. He complains of abdominal discomfort. The

nurse encourages the client to lie down. The reason for this action is
To decrease abdominal pain
To decrease the risk of dislodging an intra abdominal clot
To facilitate peristalsis
To decrease the risk of peritoneal infection

A client sustained moderate concussion. He has a Glasgow coma scale score of 7. Which of the
following interventions would you include in your care plan
Decrease stimuli, monitor vital signs and neurological status nurse him flat on his back
Gradually increase stimuli, monitor vital signs and neurological status, elevate the head of the
bed 60 degrees
Encourage family involvement, reduce monitoring at night to allow client to rest, elevate the
head of the bed 60 degrees
Decrease stimuli, monitor vital signs and neurological status elevate the head of the bed 30
degrees, positioning the client on his side

James has sustained a fracture of his left lower leg in a car accident. Classical signs of a fracture
may include
Intermittent pain, flushing of surrounding tissues and vascular spasm
Local bone tenderness, soft tissue swelling and inability to use extremity
Neural compromise, sharp stabbing pain and obvious ischaemia of the extremity
Blanching, hypertension and parathesia

Monitoring for compartment syndrome is done by checking for

Active movement of the limb
Colour, warmth, sensation and movement of the extremity
Pulse and blood pressure changes
The tightness of the plaster cast

On assessment, the nurse suspects that james is developing compartment syndrome because he
complains of
Severe pain, motor compromise and a pins and needles sensation
A radiating pain and loss of two point discrimination
Swelling, muscle atrophy and intermittent parasthesia
 Dull aching, spasms and lack of fine co ordination

A comminuted fracture is characterised by

A partial break in bone continuity
Injury in which two bones are crushed together
An injury in which the bone is broken into two or more pieces
An injury in which the bone fragments through the skin

A client with multiple fractures is at risk for a fat embolism. What early sign should you monitor
for
Haematuria
Mental confusion or restlessness
Sudden temperature elevation
Pallor and discolouration at the fracture site

Following an application of a full arm cast a client complains of deep throbbing elbow pain. You
note diminished capillary refill in the fingers. You should
Notify the doctor immediately and prepare to divalve the cast
Cut a window in the cast over the elbow area and check for infection
Elevate the arm, apply ice packs and asses hourly
Administer prescribed analgesics and notify the doctor

The priority nursing diagnosis for a client with an ear drum perforation would be
Knowledge deficit regarding general ear care
Sensory/perceptual alteration relating to hearing loss
Risk for injury related to infection
Pain related to vertigo, nausea and vomiting

Hearing loss resulting from a large amount of dry, hard wax in the ear canal would be classified
as
Conductive
Perceptive
Sensorineural
Impacted

Neil a 17 year old is hit on the head by a cricket ball while playing with a friend at home. He fell
against the glasshouse, severely lacerating his right wrist. He was unconscious for about 5
minutes. On arrival at the emergency department he was drowsy. Neil should be
Sent home with an adult to observe him
Admitted to a neurosurgical ward
Observed in hospital
Sent home with head injury instructions

Circulatory shock can best be described as a condition in which there is

A state of hypotension
Loss of blood
Loss of consciousness due to blood loss
Inadequate blood flow to meet the metabolic needs of the body tissues

Causes of hypovolemic shock include

Vomiting and loss of body fluids
Allergic reactions to drugs
 Cardiac failure
Hypoglycemica

Early signs of hypovolemic shock include

Restlessness, thirst and increased heart rate
Decreased blood pressure and apathy
Increase in heart rate and increased pulse pressure
Decreased blood pressure and unconsciousness

In shock one of the bet indicators of blood flow to vital organs is

Rate of blood and fluid administration
Blood pressure
The colour and temperature
Urine output

Oliguria an early sign of shock occurs for what reason

Cessation of glomerular filtration
Acute tubular necrosis
Metabolic acidosis
Sympathetic stimulation

A person admitted to the emergency room with trauma and an estimated blood loss of 1200 to
1400 mls has a blood pressure of 110/70 mmHg and a heart rate of 120 beats per minute. The
best explanation for these observations would be that
The persons actual blood loss was less than the original estimated loss
The person was normally hypertensive and hence did not have as great a drop in blood
pressure as a normotensive person
The cause of the bleeding is now under control and the increased hear rate is due to anxiety
An increase in heart rate is compensating for the loss of blood volume

The pale cool and clammy skin that is often observed in an individual with shock, can be
explained in terms of
Loss of red blood cells
Bodys attempt to shunt blood to vital organs by constricting skin vessels
Decreased metabolic needs that accompany shock
Bodys attempt to conserve heat loss

Which of the following represents the most appropriate criterion for evaluating a clients
management of elevated phosphate levels in chronic renal failure
The client eliminates dairy products from the diet
The client increases dietary calcium intake
The client takes iron supplements with meals
The client takes phosphate binding medications with meals

The spouse of a client with chronic renal failure confides to the nurse that the client has been
confused, irritable, and paranoid and that as a result is causing marital problems. Which of
the following diagnoses would you make
Noncompliance with prescribed medication regimen
Self esteem disturbance related to lose of kidney function
Anxiety related to the dialysis procedure
Altered family processes related to the effects of chronic renal failure
When teaching a client about home peritoneal dialysis the nurse should explain that the primary
concept in prevention of peritonitis is to
Consume a high sodium diet
Increase the amount of dextrose in the dialysis solution
Maintain aseptic technique throughout the procedure
Add heparin to the dialysis solution

Which of the following statements regarding allergic dermatitis is correct

Reaction to the allergen is immediate
Contact dermatitis always results from a chemical irritant
The effects of allergic dermatitis rarely progress beyond skin rash
The range and intensity of reaction varies depending on the allergen

When preparing a client for magnetic resonance imaging the nurse should
Obtain informed consent and administer prescribed medication
Cleanse the injection site using aseptic technique
Remove any jewellery and inquire about metal implants
Assess for allergies to seafood and iodine

A benign neoplasia
Grows very slowly
Is usually surrounded by well defined capsule
Consists of cells that only form tissues in a very disorganised manner
Is composed of goblet cells
1,2 and 3
1, 2 and 4
1, 3 and 4
2, 3 and 4

Which of the following characteristics generally indicate a malignant tumor

Lack of capsule
More rapid growth
Infiltrates normal tissues
Respects other cells boundaries
1, 2 and 3
1, 2 and 4
1, 3 and 4
2, 3 and 4

Malignant tumors often spread to parts of the body away from the primary site of the cancer. This
invasive process is called
Anaplasia
Metastasis
Neoplasm
Transformation

A client who has been receiving radiation therapy for breast cancer complains of dysphagia and
skin texture changes at the radiation site. To help reduce the risk of complications and to
enhance healing the nurse would advise the client
Apply heat to the radiation site to increase metabolic activity
Eat a diet high in protein and calories to optimise tissue repair
Apply cool packs to the radiation site to reduce swelling
Drink warm fluid frequently throughout the day to relieve discomfort on swallowing
STATE EXAMS 36

Typically the pain of angina pectoris occurs on exertion and improves after resting. This is
because
Increased effort causes constriction of the coronary arteries
The heartbeat is weak
The sinoatrial node is not receiving sufficient stimulation
The blood supply to the myocardium is inadequate for increased activity

A 48 year old complains of chest pain. Signs and symptoms that would support a diagnosis of
myocardial infarction would include
Jugular vein distension and hepatomegaly
Fever and petechiae over the chest area
Nausea, vomiting and cool clammy pale skin
Pericardial friction rub and absent apical pulse

What symptoms are commonly associated with an acute MI

Crushing substernal pain, diaphoresis nausea and dyspnoea
Syncope increased urine output and decreased respiratory rate
Chest pain relieved by rest syncope tachycardia and dyspnoea
Nausea tinnitus diaphoresis and chest pain relieved by nitroglycerin

The chief pharmacological action of glyceryl trinitrate is to

Constrict cardiac chambers
Stimulate myocardial fibres
Accelerate cardiac contraction
Dilate coronary arteries

Angina is caused by
Friction between the visceral and parietal pericardium
A decrease in the alveolar surface for gas exchange
Increased blood pressure in the pulmonary circulation
An inadequate supply of oxygen to the myocardium

Before administration of digoxin you record a clients radial pulse. You would withhold this
medication if the pulse was
90 beats per minute or above
80 beats per minute or below
70 beats per minute or below
60 beats per minute or below

Congestive heart failure can best be described as

Excessive hypertrophy of the heart
Inability of the heart to pump sufficient blood to meet the needs of the body
A condition that develops because of coronary heart disease
The impaired pumping ability due to cardiac dysrhythmias
Signs and symptoms of left sided heart failure include
Cyanosis cough with frothy sputum dyspnoea
Oedema of the dependent extremities and orthopnea
Enlargement of the liver and anorexia
Cyanosis and peripheral edema

It is thought that ankle oedema develops in congestive heart failure as a consequence of

Elevated hydrostatic pressure in capillaries distal to distended veins
The congested liver which produces an excess quantity of albumin
Retention of sodium and water in the inadequately perfused kidney
Decreased osmotic pressure of the blood secondary to anaemia

The usual cause of myocardial infarction is

Critical reduction in blood supply in the coronary arteries
Marked increase in muscle metabolism
Sudden irregularity of cardiac contraction
Gradual reversal of impulse conduction

All of the following are causes of acute renal failure except

Glomeruloneophritis
Acute urinary tract obstruction
Nephrotoxic
Diabetic nephropathy

When a client with chronic renal failure is evaluated one of the hallmarks of renal disease is
Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory isolation

If a client is experiencing alkalosis the clients kidneys will compensate by

Retaining hydrogen ions
Retaining bicarbonate ions
Excreting sodium ions
Excreting potassium ions

The nurse plans to weigh a client to determine the clients fluid balance status. The nurse plans to
weigh the client
Before breakfast
After breakfast
After supper
Before bedtime

The type of pressure whereby force is exerted by a fluid against the container wall is termed
Filtration
Oncotic
Metabolic
Hydrostatic

The nurse is caring for a client with congestive failure when the client asks the nurse ‘why are my
hands so swollen’ the nurse should explain to the client that the oedema is due to the retention
of
Sodium
 Potassium
Magnesium
Phosphorus

Water movement between the intracellular fluid compartment and the extracellular compartment
is primarily a function of
Osmotic forces
Plasma oncotic pressure
Antidiuretic hormone
Filtration

Oedema may be caused by

Increasing capillary permeability
Increasing hydrostatic pressure
Reducing plasma proteins
Any of the above

The tissue change most characteristic of emphysema is

Accumulation of pus in the pleural space
Constriction of capillaries by fibrous tissue
Filling air passages by inflammatory coagulum
Over distention, inelasticity and rupture of alveoli

When planning care for a client with chronic lung disease who is receiving oxygen by was of
nasal cannula the nurse expects that
The oxygen should always be humidified
The rate will be 2 litres per minute or less
Arterial blood gases will be drawn every 4 hours
The rate will be 6 litres per minute or more

The pathophysiology of asthma includes

Spasm of bronchial muscles
Dilation of terminal bronchioles
Oedema of bronchial mucosa
Excessive mucous production
Filling of alveoli with exudates
1
4
1, 3 and 4
2, 3 and 5

Mr parks has chronic obstructive pulmonary disease. The nurse has taught him pursed lip
breathing that helps him by
Increasing carbon dioxide, which stimulates breathing
Teaching him to prolong inspiration and shorten expiration
Helping liquefy his secretions
Decreasing the amount of air trapping and resistance

Which of the following signs would a person admitted to hospital with an acute attack of asthma
present with
Dyspnoea, tachycardia anxiety
Dyspnoea bradycardia frothy sputum
Tachycardia chest pain pallor
Increased anxiety sweating chest pain
A nurse educator explains to a group of student nurses that normally ventilation is regulated by
the central chemoreceptor response to levels of
O2
pH
Co2
pCO2

salbutamol (ventolin) is given to the patient in order to produce which of the following effects
relaxation of bronchial spasm
acceleration of pulmonary circulation
reduction of the amount of respiratory secretion
liquefaction of the respiration secretions

a home health nurse is sent to assess a new client with cor pulmonale. This term refers to
enlargement of the pulmonary artery
enlargement of the right ventricle
atrophy of the right ventricle
giant bullae growth on the lung

which of the following positions is most comfortable for a person with emphysema
lying flat in bed
reclining on his/her left side
sitting on the edge of the bed
lying flat on their back (supine)

a client is anxious and is hyperventilating. In order to prevent respiratory alkalosis the nurse will
administer oxygen
instruct the client to pant
have the client breathe deeply and slowly
have the client breathe into a paper bag

a district nurse instructing client with chronic obstructive pulmonary disease about the disease
explains that gas exchange from the pulmonary system to the blood occurs through
osmosis
diffusion
active transport
oncotic pressure

which of the following blood gas values are considered within the normal range
pH 7.25; pCO2 25 to 35mmHg pO2 50 to 100mmHg
pH 7.35 to 7.45 pCO2 45 to 50 mmHg pO2 90 to 100mmHg
pH 7.35 to 7.45 pCO2 35 to 45 mmHg pO2 80 to 100mmHg
pH 7.30 to 7.40 pCO2 30 to 45 mmHg pO2 70 to 100mmHg

excessive thirst for people with diabetes mellitus is a result of

need for increased amounts of water to hydrolyse food during digestion
loss of excessive body water due to increased daily urine volume
reflex adaptation to a sustained elevation of body temperature
compensatory adjustment to decreased production of posterior pituitary hormone
characteristically respirations of the client in diabetic acidosis are
shallow and irregular
uneven in rate and depth
deep rapid with acetone breath (kussmaul)
rapid and shallow

what is the result of fasting in a diabetic person receiving insulin

hypoglycaemia
hyperglycaemia
underproduction of insulin
none of the above

insulin is necessary for normal body function because it

stimulates the liver to release glucose
causes the breakdown of fats for energy
cause excess glucose to be excreted by the kidneys
stimulates body cells to take in glucose

why do some diabetic patients often experience delayed wound healing in lower limbs
glucose aids in healing
most diabetics are obese
impaired circulation
impaired metabolism of vitamin C

insulin dependent diabetes mellitus (IDDM) is common in persons under age 30yrs who produce
no insulin
ketoacids
minimal insulin
increased insulin

suitable emergency treatment at onset of a hypoglycaemic attack would be to

record blood pressure and pulse and report to the doctor
obtain a blood glucose level and record vital signs
give the patient a glucose drink
smell the patients breath for acetone

a normal C.B.G (capillary blood glucose) reading is within the range of

1-5 mmol/L
4-7 mmol/L
4-12 mmol/L
3-10 mmol/L

Helen has been admitted to the ward in which you are working for stabilisation of diabetes
mellitus. She is charted a short acting and long acting insulin. Insulin cannot be given orally
because it is
Irregularly absorbed from the intestine
Absorbed too slowly to be effective
Rendered inactive by gastro intestinal enzymes
Excreted before a sufficient amount has been absorbed

Helens initial presenting signs and symptoms prior to diagnosis would probably have included
 Polydipsia weight loss polyuria
Weight loss itchy skin cough
Polyuria visual disturbances cough
Itchy skin polyuria weight gain

A flight attendant has acquired hepatitis A after a trip abroad. The best way to prevent the spread
of this disease is
Testing blood supplies
Good personal hygiene
Antibiotic therapy
Respiratory isolation

A client who has cirrhosis of the liver, will present with jaundice and
Paresthesias
Redness of the palms
White facial blotches
Swollen moist skin

Common signs and symptoms associated with liver dysfunction include

Diarrhoea and increased blood clotting
Coma, disseminated intravascular coagulation and oedema
Jaundice, ascites and excess bleeding
Gastrointestinal bleeding and fever

Which o fthe following does the liver store

Excess carbohydrates
Cholesterol
Plasma proteins
Aldosterone

Parkinsonism has several characteristic symptoms. When assessing a client with this disease the
nurse may observe
Normal speech
Facial tremor
Shuffling gait
Fast body movement

In understanding the pathophysiology of parkinsons disease the nurse is aware that his
degenerative process is caused by a loss of
Dopamine
Zona incerta
Acetycholine
Gamma amino butyric acid

Which of the following characteristics generally indicate a malignant tumor

Lack of capsule
More rapid growth
Infiltrates normal tissues
All of the above
Malignant tumors often spread to parts of the body away from the primary site of the cancer. This
invasive process is called
Anaplasia
Metastasis
Neoplasm
Transformation

Jack aged 30 years has been admitted to your ward with a respiratory infection. He is diagnosed
as being HIV positive (human immunodeficiency virus). Which of the following has a similar
mode of transmission to the HIV virus
Influenza
Hepatitis B
Herpes simplex
Chicken pox

HIV is transmitted by which of the following

Mosquitos
Toilet seats
Exchange of infected blood/serum
Food handling

Mr Robert jones aged 74 years is admitted with a diagnosis of myocardial infarction. The chest
pain mr jones has experienced is probably
Heavy crushing central
Intense sharp pain on inspiration
Rhythmic waves of pain that run across the chest
Intense burning behind the sternum

Mr jones has a decreased ability to tolerate activity. This is due to

A fear of suffering another heart attack if he is active
Difficulty in being able to breathe because of pain
Raised cardiac enzymes interfering with muscle function
Overall loss of energy as a consequence of a myocardial infarction

Which of the following would suggest to you that mr harper had developed a paralytic ileus
Decreasing pulse rate
Abdominal colic
Lack of bowel sounds
Increasing blood pressure

The emotional process mr harper is most likely to go through following the formation of his
colostomy is
Denial of the existence of the colostomy
Anger at the surgeon for altering his body image
Guilt regarding previous lifestyle
Grief for loss of normal body function

Coronary artery disease is a generic term used broadly to encompass

Pathological conditions involving the coronary arteries
 All conditions that result in congestive heart failure
Coronary arteriosclerotic heart disease
Changes as a consequence of atherogenesis

Angina pectoris is caused by

Sudden and complete occlusion of one or more coronary arteries
Mild ischaemia due to temporary or partial occlusion of the coronary artery
Obstruction to blood flow between the right and left atria
Mild ischaemia due to partial blockage of the aorta

The symptoms of angina pectoris are the result of

A reduction in the amount of blood circulating through the heart
More oxygen being required by the heart muscle than is available
The lack of oxygen carrying capacity in the blood supply
A reduction in circulating blood volume with consequential ischaemia

It is thought that regular mild exercise may be beneficial to the client with ischaemic heart
disease, because exercise
Increases the thickness of the cardiac muscle
Causes dilatation of the lower cardiac chambers
Accelerates development of myocardial collateral circulation
Decreases glycogen stores in the myocardium

Mr john powers a 55 year old businessman consulted his doctor concerning episode of pressing
chest pain. The diagnosis after tests is arteriosclerotic heart disease with angina pain.
Characteristically the onset of angina pectoris causes a person to
Breathe deeply
Bend forward
Become immobile
Lose balance

When a woman lies on her back during active labour she may experience
Hypertension
Supine hypotension syndrome
Abnormal blood loss
A prolapsed cord

The term position of the foetus refers to

The relationship of the long axis of the foetus to the long axis of the mother
The posture which the foetus assumes in the uterus
The degree of descent of the foetus in the pelvis
The relationship of the presenting part of the foetus to the four quadrants of the pelvis

Lactation following birth is initiated by the

Rise in level of luteinising hormone
Release of oxygocin in response to suckling
Rise in the level of prolactin
Drop in levels of oestrogen and progesterone
A major function of the colon is
Absorption of bile pigments
Secretion of electrolytes
Secretion of vitamin K
Absorption of water

Which of the following diets is most likely to cause bowel cancer

High calorie, high fibre
High fibre, low calorie
Low fibre, high fat
High protein, high fibre

Mr Thomas harper aged 51 years is admitted to the hospital with a diagnosis of cancer of the
descending colon. He is scheduled for a bowel resection and formation of colostomy.
Common symptoms of colonic and rectal cancer include
Nausea vomiting and anaemia
Abdominal pain altered bowel function and rectal bleeding
Rectal bleeding weight loss and diarrhoea
A boardlike abdomen rebound tenderness and rectal bleeding

The most important reason for mr harper to have an intravenous infusion following his surgery is
to
Meet fluid and electrolyte requirement
Prevent nausea and vomiting
Facilitate drug administration
Maintain blood pressure

Mr Lecramp is anxious about his condition and tends to hyperventilate. This will lead to
his carbon dioxide levels which will lead to
Increase, respiratory acidosis
Decrease, respiratory alkalosis
Decrease, metabolic acidosis
Increase, respiratory alkalosis

You notice that mr lecramp has dry skin, concentrated urine, and seems to be losing weight. You
suspect that he is suffering from
Kidney infarction
Hypoglycaemia
Dehydration
Myxedema

The factors that normally affect water balance are hydrostatic (fluid) pressure and osmotic
pressure due to the concentration of proteins and ions that attract water. In the elderly a
possible cause of oedema would be due to decreased pressure in the
blood due to inadequate intake
Hydrostatic, protein
Osmotic, protein
Hydrostatic, diuretic
 Osmotic, diuretic

Louise smith suspects she is pregnant. Pregnancy may be positively confirmed by

Feelings of nausea throughout the day
Presence of vaginal discharge
Hearing the foetal heart
Tingling sensation in the breast

The expelling of mature ovum by the ovary is known as

Conception
Ovulation
Fertilisation
Oogenesis

Louise suspects the onset of labour by

A feeling of tightness in her abdomen
Increased vaginal discharge
A sudden burst of energy
Blood stained vaginal discharge

In the primigravida during the first stage of labour

Effacement precedes dilatation of the cervix
Dilatation precedes effacement of the cervix
Effacement and dilatation occur simultaneously
Effacement is dependent upon dilation

Senile dementia alzheimers type (SDAT) is

Primarily a disease of the brain itself
Primarily a disease of the blood vessels supplying the brain
Has focal neurological symptoms like hemiparesis and dysphagia
Has a rapid progression and death within weeks of onset

Legal and financial matters can be a problem when a person has alzheimers disease. A nominated
person may be given power of attorney. This means that the person can
Alter the clients will
Delegate a clients legal affairs to someone else
Act on the clients behalf
Be liable for the clients debts

If one looked at the brain of a person who had diet of alzheimers one would see
Swelling of the brain and shrunken ventricles
Diffuse cerebral atrophy with enlargement of the ventricles and sulci
Extra ventricles
Enlargement of the pituitary gland putting pressure on the optic nerve

A client who had a thrombus occluding the posterior cerebral artery which supplies the occipital
lobe would be most likely to have which of the following deficits
Visual disturbance including loss of one half the visual field on the side of the stroke and
colour blindness
Ataxia vertigo and dysphagia
 Contralateral hemiparesis and receptive aphasia
Urinary incontinence and problems making decisions

The reason a stroke on the left side of the brain is more likely to affect language function is
because
In approximately 90% of people, the left hemisphere is the dominant hemisphere
We only listen with our right ear which is supplied by the left hemisphere
This leads to paralysis of the vocal cords
An embolus in the vertebral artery has occurred

Mr lecramp is a 68 year old client who is on a medical care ward following surgery to clear
artheriosclerosis plaquing in his right popliteal artery. You learn that he had a mild
myocardial infarction three years ago. He is also suffering from short term memory loss and
slight left sided hemiparesis. Based on the rest of his history, you would expect the cause of
his memory loss and hemiparesis to be
MID (multi infarct dementia)
SDAT (senile dementia alzheimers type)
A brain tumour
Depression of the elderly

Based on his vascular symptoms which of the following would you expect mr lecramp has done
for much of his life
Been a smoker
Played golf
Exercised regularly
Consumed lots of fruit and vegetables

Being seropositive to HIV means that the

Serum is positive for virus particles
Individual has antibodies against the virus
Serum contains antigens against the virus
Individual cannot be reinfected with HIV

In a person with AIDS the number of

Helper T lymphocytes decrease
B lymphocytes decrease
Lymphocytes remains the same
Macrophages increase

Cells that clean up cellular debris bacteria and foreign matter are
Macrophages
Erythrocytes
Platelets
Fibroblasts

Dysplasia is tissue that is

Abnormal
Cancerous
Invasive
Inflamed

Abnormal changes in the cells of the cervix usually occur in the

Columnar epithelium
 Squamous epithelium
Squamocolumnar junction
Endocervical canal

Carcinoma in situ describes

Mild dysplasia
Invasive cancer that has breeched the basement membrane
Premalignant cells that have not invaded the basement membrane
An increase in the number of basal cells

The ovaries
Are attached to the uterus by the uterine tubes
Have a cortex and a medulla
Lie outside the peritoneal cavity
Are continuous with the fallopian tubes

Wernickes area is a part of the brain found at the junction of the temporal parietal and occipital
lobes, usually in the left hemisphere. If its blood supply is occluded the client will have
difficulty with
Speech comprehension
Listening
Fine motor control
Recognising faces

Amnesia a phenomenon that illustrates some aspects of the defense mechanism called
Displacement
Undoing
Reaction formation
Repression

Irvin yalom identified corrective re enactment of the primary family group as a curative factor in
group therapy. This is best described as
Assigning family roles to group members with role plays
Opportunity to confront traumatic events from past family experiences
Ability of members to alter learning experiences gained in their families
Inclusion of family members for confrontation purposes

While you are facilitating a group session one of the members brian slams his fist into the chair
arm and yells why cant we smoke here its stupid rule and makes us more tense. Your most
appropriate response would be
I cant change the rules now brian
Yes i agree its very tense here
We don’t allow that kind of behaviour here
How do other people feel right now

Later brian says to you things are a bit rough right now. You respond with tell me whats going on
for you brian. This is an example of
Immediacy
Non possessive warmth
Respect
Concreteness
The next day you find brian crying and clutching a photo of his recently deceased wife. When you
admire it he hands it to you saying you have it nurse , i wont be needing it ill be with her
soon. Your most appropriate response would be
I don’t want to take your photo
You seem to be having a rough day
Im a little worried about you, brian
Are you planning to kill yourself, brian

Brian commences a regime of tricyclic antidepressant medication. After one day he tells you that
he wants to stop taking the pills as he is too sleepy and cant concentrate. Your best action
would be to
Talk to him about the benefits of medication
Check his dosage and times of administration
Encourage him to continue with the current regime
Refer him to the doctor as soon as possible

HIV is a virus that

Consists of DNA surrounded by a protein coat
Attacks the B lymphocytes in the lymph nodes
Causes kaposis sarcoma in men
Binds to the CD4 protein on macrophages

You notice a 50c coin sized blood stain on the outside of Nathans cast. Your most appropriate
action is to
Explain to Nathan that this is normal
Measure his vital signs every 15 minutes
Notify the doctor
Outline the area with a pen and observe

Alcohol hallucinosis usually occurs

During a bout of heavy drinking
Within 48 hours after heavy drinking
After a long period of abstinence from drinking
At any time during drinking or abstinence

An essential feature of an opiate intoxication is

Disturbed sleep
Papillary constriction
Psychomotor agitation
Coarse tremor

A client taking chlorpromazine an antipsychotic drug, experiences inner restlessness and cannot
stay still. This is a side effect known as
Akathesia
Dystonia
Paradox
Opisthotonos

A client says everyone here hates me. Indicate the most appropriate response
Perhaps youre in a bad mood today
What do you mean by everyone
You can depend on me to be nice to you
I don’t like to hear you so upset
People suffer from retrograde amnesia typically cannot remember
Traumatic events of childhood
Events just prior to a head injury
Who and where they are
Significant events following brain trauma

A week post operatively you notice miss Johnston has a small area of broken skin on her sacrum.
Your most appropriate nursing action is to
Change her position from side to side 2 hourly to relieve pressure on her sacrum
Ensure she has a diet rich in first class protein and vitamin D
Complete an incident form and describe the area in the nurses report
Cover area with a dressing and teach client pelvic floor exercises

Nathan willams aged 17 is admitted to your ward unconscious with head injuries and compound
midshaft fractures of his (R) radium and ulna. Part of your assessment includes observing
Nathan for signs of increasing intracranial pressure. A combination of signs indicating that
this is taking place is
Slow bounding pulse, rising blood pressure, pyrexia, sluggish papillary reaction to light
Rapid weak pulse, falling blood pressure, restlessness, temperature below 36oC
Rapid weak pulse, normal blood pressure, lethargy, intermittent pyrexia
Rapid bounding pulse, apyrexia, pinpoint pupils and brisk pupilliary reaction to light,
restlessness

Since Nathan is unconscious, you would expect him to be

Unable to react to painful stimuli
Incontinent of urine and faeces
Incapable of involuntary motion
Incapable of hearing

Nathan temperature should be taken

Orally
Rectally
Per axilla
In the groin

Nathan regains consciousness and within 48 hours his behaviour is typical of level 5 on rancho los
aminos scale. He would be
Alert, able to respond to simple commands and perform overlearned tasks such as eating and
dressing, but his short term memory is poor
Drowsy most of the time, but pulls away from discomfort eg insertion of a nasogastric tube
Capable of brief periods of alertness, and will slowly open eyes or squeeze your hand on
command
Able to perform daily routines automatically but unable without remembering them, has
limited insight but enjoys recreational activities

An appropriate intervention to promote Nathans cognitive recovery at this stage is to

Take him shopping at the hospital shop
Arrange a leave weekend at home with his family
Play simple memory and card games with him
Nurse him in a low stimulus environment

Once stable, Graeme is transferred to a spinal injuries rehabilitation unit. A base concept of
rehabilitation is
Rehabilitation is a speciality area with unique methods for meeting client needs
 Rehabilitation is unnecessary for clients returning to their usual activities following
hospitalization
Rehabilitation needs, immediate or potential, are exhibited by all clients with health problem
Rehabilitation needs are best met by the clients family and community resources

Optimum independence within the range of his residual functional ability is a primary
rehabilitative goal for Graeme. You are most likely to help him achieve this by
Demonstrating ways he can be independent
Establishing long term goals with Graeme
Reinforcing success in tasks accomplished
Pointing out his errors and helping him correct them

Miss Johnson aged 18 is admitted with a sub capital fractured (L) neck of femur. She is awaiting
surgical fixation of her fracture. To relieve pain, miss Johnston is placed in
Balanced skeletal traction
Gravitational traction
Manual traction
Skin traction

Avascular necrosis of the head of the femur is a common complication of this injury. You are
aware this is caused by
Infection of the surgical wound
Immobilisation after reduction of the fracture
Disruption of the blood supply to the head of the femur
Weight bearing before the fracture is healed

Miss Johnston has just returned to the ward following a matchette-brows hemiarthroplasty of her
(L) femur. She has a pillow placed between her legs to keep them in a position of
Flexion
Extension
Adduction
Abduction

You check to make sure that miss johnstons ‘redivac ‘is draining properly. You know that the
main purpose of the ‘redivac’ is to
Prevent formation of a haematoma
Allow assessment of drainage characteristics
Accurately measure the drainage from the post operative site
Provide a sterile negative pressure drainage environment

On the third post operative day, miss Johnston complains of pain in her unaffected leg. You notice
that the area along the saphenous vein is swollen, reddened and warm. Your most appropriate
nursing action is to
Apply continuous hot compresses
Elevate the affected leg
Apply an elastic stocking to the affected leg
Notify the doctor

One morning while sam is in his crib, the nurse notes his jaws are clamping and he is having a
seizure. The most important nursing responsibility at this time is to
Insert a padded tongue depressant
Start oxygen at 10 litres per minute by mask
 Protect sam from harm from the environment
Restrain sam to prevent injury to soft tissue

Febrile convulsions are common in children and

Usually occur after the first year old life
The cause is usually readily identified
May occur in minor illnesses
Occur more frequently in females than males

Eight year old Jennifer is admitted to the hospital with deep, rapid respirations; flushed, dry
cheeks; nausea and increased thirst. Her history reveals she has had type 1 diabetes mellitus
for two years. In reviewing the pathophysiology of her illness with Jennifer the nurses plan
should take into consideration that
Jennifer will respond favourably to opportunities to participate in her care
Jennifer is in the abstract level of cognition
Peer influence will decrease in importance to her
Her current developmental task involves achieving a sense of dignity

Jennifer received a combination of short and long acting insulin at 0700 hours. The nurse
should be aware that jennifers response prior to lunch at noon will be controlled by
The long acting rather than the short acting insulin
Equal effects of both the short and long acting insulin
Decreasing effects of short acting and increasing effects of long acting insulin
Increasing effects of short acting and long acting insulin

Graeme is a new client admitted to the emergency department with a suspected spinal cord injury
at C5/6. He is cyanotic and his vital signs are temp 36.5C, pulse 96/min, respirations 40/min,
blood pressure 90/50. Your most appropriate nursing actin is to
Hyperextend his neck to open his airway
Monitor his vital signs at frequent intervals
Use the jaw thrust method to open his airway
Notify the doctor and have a tracheotomy tray available

David aged one year weighs 12.6 kg but is pale and lethargic. His haemoglobin level is 5g and he
has an enlarged heart. When taking a nursing history from his mother the nurse learns that he
refuses food so she gives him 3 litres of milk per day from a bottle. The nurse suggests that
his mother
Put a large hole in the teat and put baby food in with his milk
Take him to the metabolic clinic for a check up
Immediately begin the weaning process
Give him finger foods such as raisings and chopped meat

David should have been started on solid food by at least five or six months of age because
His foetal reserve of iron was depleted
It would have taught him how to chew
His bone marrow activity had decreased at this time
It would have helped control his weight

Anaemia a nutritional problem encountered in children and adults involves several different
nutrients. The nutrients include proteins iron vitamin B12 and
Carbohydrates
Thiamine
Calcium
Folic acid
 Freddy 12 months of age is brought to the paediatric clinic for a regular physical assessment. In
reviewing his immunisations for the past ten months the nurse would expect him to have been
immunised against
Measles, rubella, polio, tuberculosis and pertussis
Polio, pertussis, tetanus and diphtheria
Measles, mumps rubella and tuberculosis
Pertussis, tetanus, polio and measles

The measles immunisation is usually routinely given after 12 months of age because of the
Increased hazard of side effects in infants
Presence of maternal antibodies during the first year
Contradictory effects it has on pertussis, diphtheria and tetanus immunisations
Rare incidence of measles infection prior to 12 months of age

Three year old sam has bad a fever for several days, his neck is rigid and is now vomiting. While
being examined he has a convulsion and is admitted to the ward. While instituting nursing
measures to reduce sams fever, the nurse recognises that an important consideration is to
Monitor vital signs every ten minutes
Force oral fluids
Measure output every hour
Limit exposure to prevent shivering

STATE EXAMS 37

Mrs legend and her son frank are seen at the clinic. They both have severe upper respiratory tract
infections and the physician plans to prescribe tetracycline (minomycin). The nurse reminds
him that frank is six years old and that mrs legend is in her 18th week of pregnancy. This data
is important because the drug may cause
Persistent vomiting when given to small children and pregnant women
Tooth enamel defects in children under eight years of age and in the maturing foetus
Lower red blood cell production at times in their development when anaemia is a common
problem
Changes in the bone structure of young children and pregnant women

Four year old sandy has a seizure disorder and has been taking phenytoin (dilantin) for three
years. An important nursing measure for sandy would be to
Check the urinal frequency
Administer scrupulous oral hygiene
Check for papillary reaction
Observe for flushing of the face

A small toddler is admitted to the hospital because of sudden hoarseness and an insistence on
continuous and somewhat unintelligible speech. In talking with the mother, the nurse will be
particularly concerned about
Acute respiratory tract infection
Undetected laryngeal abnormality
Respiratory tract obstruction due to a foreign body
Retropharyngeal abscess

When picked up, eight month old lucy screams. On assessment you will ask lucys mother about
 Her food and specific vitamins given to her
Accidents and injuries and the importance of their prevention
Any other behaviours that may have been noticed
Limiting lucys play time and activities with other children in the family

Fifteen minutes ago ailson was given panadol 500mgs for her pain. She is crying and continues to
complain of pain. Your initial intervention is
Contacting the doctor and getting more panadol charted
Telling her she is disturbing the other children
Turning the television on, giving her something to watch
Involving her with an interactive activity

You are a community nurse at a health centre. Your role includes the assessment of children and
information sharing with parents and families. Why doesn’t the doctor prescribe an antibiotic
for me when i have a cold
It is better to reserve the use of antibiotics for more severe infections
If you were prescribed an antibiotic for every cold the causative organism would become
resistant
Since the common cold is caused by a virus, antibiotics are unnecessary and ineffective
The side effects of antibiotics rule our their use for such a simple condition as a cold

As a community nurse at the school you are asked to see suzie who has unexplained bruising on
her arms and legs. Your initial assessment indicates she has been abused. The most useful
strategy for this prevention of sexual abuse is
Teaching children not to talk to strangers
Developing childrens self esteem and personal power
Teaching self defence skills
Teaching children about sexual abuse

Robert and Tanya married and had three children. Robbie john and katya. With their children
Robert and Tanya form
A family of orientation
A family of procreation
An extended family
A communal family

Your child health unit has adopted the concept of family centred care. Family centered care
Considers the child within the context of her/his family
Considers the whole family as being the client
Encourages at least one parent to remain in hospital
Encourages parents to have a rest from caring for their children

Staff encourage family involvement in the team process by

Including families in team meetings as the time for discharge approaches
Encouraging families to indentify goals for their child
Informing parents about the recommendations developed for their child
Insisting that families attend team meetings

Of the following is a contraindication to immunization

Contact with an infectious disease
Prematurity
Temperature over 38oC
Asthma
Carrying out immunizations a nurse must have with her/him
Oxygen
A medical officer
Intravenous fluids
Adrenaline

Based incidence of meningitis led to the introduction of a new programme into the new Zealand
immunization schedule in 1994. Causative organism of this disease is
Beta A streptococcus
Respiratory syncytial virus
Haemophilus influenza
Neisseria meningitis

Immunization usually given at 3 months of age provides protection

Diphtheria, tetanus, whooping cough, polio, haemophilus influenza
Diphtheria, tetanus, whooping cough, polio, hepatitis B, haemophilus influenza
Diphtheria, tetanus, whooping cough, haemophilus influenza
Diphtheria, tetanus, polio, hepatitis B, haemophilus inflenzae

James weighs 3.4kgs. his fluid requirement is 150 ml/kg/day to maintain his hydration james
requires
20 mls per hour
27 mls per hour
23 mls per hour
22 mls per hour

James mother is living in. She is breast feeding james. Nursing consideration for her should
include
Plenty of rest and distraction
Education about breast feeding
Providing privacy and means to express milk
Checking her breasts for cracked nipples

James returns from theatre with an apnoea monitor. This is used to monitor
The rate of james breathing
The length of his sleeping
The length of time between breaths
Delays between breaths exceeding 20 seconds

Five year old bill has been involved in a road traffic crash and has fractured right femur. He is
accompanied by his parents. The most effective pain management for bill would include
Using a pain scale, PRN medication and diversion therapy
Using a pain scale, regular medication and diversion therapy
Questioning about pain, PRN medication and diversion therapy
Observing non verbal behaviour, regular medication and repositioning

Jenny is to have ventolin nebulisers every two hours until respirations improve. She becomes
distressed as soon as you try to put the mask on her face. You would best manage this
situation initially by
 Telling her mother to give the nebuliser
Not giving it to her as being distressed may make her worse
Realising the importance of the ventolin so forcing it on her
Letting her have a mask to play with, thus withholding the first dose

Jennys breathing would be characterised by

Grunting inspirations
Wheezing on expiration
Frequent periods of apnoea
Laboured abdominal breathing

Kevin aged 19 is admitted with an acute attack of asthma. The major use of aminophylline is an
acute attack of asthma is to
Decrease autonomic nervous system response
Prevent production of histamine
Reduce bronchial oedema
Relieve bronchospasm

The action of hydrocortisone is an asthma attack is to

Improve gaseous exchange
Relieve bronchospasm
Reduce histamine release
Reduce inflammation

Justice proceedings for young people under the age of 17 years are administered by
The children, young persons and their families act
The guardianship act
The young persons protection act
The family, whanau and young persons act

After an offence has been committed, this act supports the offenders by
The police, the social workers and the maori wardens meet with the offender
The offender having the same rights as an adult to access a lawyer
Members of the family the offender and a multi disciplinary group meeting
The extended family meeting and deciding on a plan for the offender

You present a seminar to your colleagues on immunisation. After the presentation you are asked
to clarify the following. The main reason why some maori do not take their children for
immunisation is because
The services do not meet the needs of maori
The mothers lose their infant record books
They are unaware of the importance of immunisation
It is too expensive to visit the doctor

Immunity that results from the natural exposure to an antigen in the environment is called
Active immunity
Natural passive immunity
Autoimmunity
Passive immunization
When preparing a client for magnetic resonance imaging (MRI) the nurse should
Obtain informed consent and administer prescription medication
Cleanse the injection site using asceptic technique
Remove any jewellery and inquire about metal inplants
Assess for allergies to seafood or iodine

A client who has been receiving radiation therapy for breast cancer complains of dysphagia and
skin texture changes at the radiation site. To help reduce the risk of complications and to
enhance healing. The nurse would advise the client
Apply heat to the radiation site to increase metabolic activity
Eat a diet high in protein and calories to optimise tissue repair
Apply cool packs to the radiation site to reduce swelling
Drink warm fluid frequently throughout the day to relieve discomfort on swallowing

A client who recently received high dose chemotherapy has a white cell count of 1000/mm3. How
can the nurse best help protect the client during hospitalisation
Monitor closely for signs of infection
Place the client in protective isolation
Wash hands carefully before caring for the client
Restrict all visitors

16 year old diabetic client exhibits the following, school truancy, admission for uncontrolled
diabetes, missed insulin injections and isolation from friends. Which of the following nursing
diagnosis would apply
Knowledge deficit
Altered thought processes
Altered nutrition
Ineffective coping

Diabetic ketoacidosis most commonly is precipitated by

Overeating
Infection
A missed insulin dose
Psychologic stress

The nurse should advise diabetic client with an open foot would to
Clean the foot, and observe for infection
Soak the foot daily and bandage it
Clean the foot and apply mercurochrome
Elevate the foot and apply heat

A client has a seizure at home with family. Which of the following questions would the nurse ask
the family concerning the seizure
What was the client doing before the seizure
How do you feel after witnessing the seizure
Can you tell me how long the seizure lasted
Did anyone say something to upset the client
 Which of the following would be the most appropriate goals of care for a hospitalised, terminally
ill, cachectoic 90 year old client
He will verbalise that he is pain free, not hungry, and happy to remain in bed
He will demonstrate effective coughing and deep breathing exercises, ability to eat
independently, and acceptance of his diagnosis
He will be free of skin breakdown, demonstrate adequate nutritional intake, and be able to
take part in desired activities
He will exhibit no signs and symptoms of deep vein thrombosis pneumonia, or urinary tract
infection

STATE EXAMS 38

Amanda aged 38 is admitted to hospital after a motor vehicle accident. Amanda has one litre of
fluid running intravenously every 12 hours. The drop factor of the metriset is 60 drops per
minute. How many drops per minute should be given
68 drops per minute
83 drops per minute
96 drops per minute
120 drops per minute

In terms of section 50 of the area health board act 1983 information about the injuries of a patient
admitted after an accident may be given by the
Hospital telephonist
Charge nurse on duty
Doctor authorised by the chief medical officer
Patients next of kin

In terms of section 50 of the area health board act 1983 information about a patient suffering from
the results of an accident may be given within
48 hours of the accident
24 hours of the accident
48 hours of admission
24 hours of admission

In terms of section 50 of the area health boards act 1983 information about a patient suffering
from the results of an accident may be given to
An accredited reporter
Any police constable
Telephoning next of kin
All of the above

What immediate action would you take if you suspect any type of blood transfusion reaction
Notify the patients doctor and blood bank
Take vital signs
Obtain an order for an antihistamine
Stop the transfusion

A client with multiple fractures is an risk for a fat embolism. What early sign should you monitor
for
Haematuria
Mental confusion or restlessness
Sudden temperature elevation
Pallor and discolouration at the fracture site
Timothy aged 40 years is admitted to the emergency department. The most characteristic sign of a
fat embolism is
Petechiae
Dyspnoea
Altered level of consciousness
Hypertension

After injury the signs and symptoms of fat embolism usually occur within
6 to 12 hours
24 to 72 hours
3 to 5 days
1 week

Two primary signs of fat embolism are

Dyspnoea and hypotension
Haemoptysis and chest pain
Dyspnoea and altered level of consciousness
Calf pain and petechiae

The drugs most often used to prevent and treat fat embolism are
Bronchodilators
Rapid acting diuretics
Antibiotics
Steroids

You visit sally who has a medical diagnosis of parkinsons disease. While sallys husband makes a
cup of tea you discuss with sally what their expectations are of your visit. Her answers are
slow and difficult to understand. What should you do in this situation
Ignore her slowness of speech and continue with the discussion
Continue the conversation and check your understanding with her
Stop and wait for her husband to return to interpret for her
Finish her sentences for her to reduce her frustration level

Sallys husband says my wife takes so long to do anything. What is the most appropriate response
to make to this statement
You know thats due to the illness
You find this frustrating don’t you
Do you think its time you had a break
Is this something new that has occurred

On your next visit to sallys residence you notice that sallys husband often answers for his wife.
You can see that her tremor is becoming more pronounced and she is no longer attempting to
participate in the conversation. What is the best action to take in this situation
Continue to speak directly to sally
Ask sallys husband not to respond for his wife
Suggest sally take medication to reduce the tremor
Address all your questions to sallys husband

Vera aged 79 who has been diagnosed as having alzheimers disease, has become more confused
and disoriented and requires continuous nursing care. Her husband seems dewildered and asks
what is going to happen to my wife. The most appropriate response is
We will do our best to look after your wife
We will assess vera and keep you informed
Don’t worry your wife will soon be well again
 She will be alright now and soon back to her old self

When making an assessment and care plan the nurse should consider that vera
Cannot be trusted to be responsible for any of her daily care needs
Is more likely to be able to remember current experiences than past ones
Has been confused and disoriented since before her admission to hospital
May have moderate to severe memory impairment and shorter periods of concentration

During the assessment period the nurse is told that vera has a bath once a week. Which factor
should be considered when planning for hygiene needs
Hygiene practices are learned in childhood and always stay the same
Attention to cleanliness is more important in hospital than at home
To be able to look after ones own hygiene is an independent adult behaviour
Hygiene practices are influenced by cultural identity personal idiosyncrasies and values

Vera feels faint while in the bath. The first action of the nurse should be to
Call for help and support vera
Hold her head out of the water
Pull the plug and let the water out
Get her out of the bath with assistance

All of the following are appropriate in versa care except

Hurrying her through the daily activities
Only helping her as often as is appropriate
Engaging her in reality oriented conversations
Being firm and gentle, assisting her where needed

Irene requires an intravenous infusion. You are assisting the doctor with this procedure. The
doctor has made three attempts to insert the cannula and Irene appears distressed. What
advocacy role should the nurse take in this
Refuse to continue to assist the doctor any further and leave the room
Recommend the doctor uses more local anaesthetic to ease the pain
Comfort Irene and reassure her it will soon be over
Take the doctor aside and suggest that he call another doctor to assist

A patient is ordered 500ml of intravenous fluid over a 3 hour period. The intravenous set delivers
60 drops per ml. You will monitor the rate to run at
83 drops per minute
125 drops per minute
150 drops per minute
166 drops per minute

Allen is stabbed in the right anterior chest. Allen is admitted to the emergency department with a
haemothorax. Blood is accumulating in his
Chest wall
Bronchial tree
Pleural space
Thoracic cavity

A chest drain is inserted. The nurse recognises that this treatment is effective primarily because it
Re establishes a negative pressure in the pleaural space
 Promotes haemotstasis and coagulation of retained blood
Collapses the unaffected lung and allows for greater expansion of functional lung tissue
Permits the accumulation of free air in the chest

Which of the following explains the presence of a crackling sensation under allens skin
Pleural effusion
Pulmonary contusion
Percutaneous hyperoxaemia
Subcutaneous emphysema

A policeman begins to remove the knife from allens chest. He is stopped by the ambulance officer
because
It will be painful
Allen should remove the knife himself
The hands should be gloved
Movement can cause more damage

Allens condition deteriorates and he developes a tension pneumothorax. This complication being
caused by
Air causing pressure on the mediastinal space
Decrease of air with each inspiration
An increase in the pulmonary artery pressure
Pulling or tension on the chest tubing

The nurse monitors allen for the signs of mediastinal shift. The nurse should watch particularly
for which of the following
Decreasing cyanosis
Dyspnoea and stridor
Tachycardia and hypertension
Tracheal deviation

Allen becomes hypotensive, apprehensive and has a feeling of tightness in his chest. The nurse
should anticipate which of the following treatments
Insertion of a large needle into the pleural space
Emergency thoracotomy
Diagnostic electrocardiograph
Intubation and controlled mechanical ventilation

Lignocaine is supplied in 20ml ampoules of a 2% solution. In pharmacological terms, a 2%

solution (W/V) means
2g in 100ml
2mg in 100ml
200mg in 100ml
200mg in 1ml

You are asked to give lignocaine 40mg from a 20ml ampoule of lignocaine 2%. How much will
you give
0.2ml
2ml
0.4ml
4ml
Rosemary is being prepared for a craniotomy due to an extradural haemorrhage. The doctor
prescribes the following drugs for rosemary preoperatively. Which medication should the
nurse question prior to administration
Atropine
Corticosteroids
Mannitol
Morphine

Rosemary is placed in the lateral position during surgery. Which specific postoperative
observation would you now make
Observe the knees for flexion contractures
Check the shoulders for decubiti
Monitor for postural hypotension
Evaluate chest expansion

Postoperatively the nurse observes rosemary for signs of increased intracranial pressure which are
Bradycardia and ear discomfort
Headaches and papillary changes
Confusion and hyperthermia
Anorexia and nausea

If increased intracranial pressure was suspected in the postoperative period, in which position
would rosemary be placed
Flat with feet elevated
Head of the bed elevated 30 degrees
Side lying
Prone

3 days post intracranial surgery rosemary develops a fever, nuchal rigidity and headache. Which
of the following would you suspect
Cerebral emboli
Increased intracranial pressure
Meningitis
Extradural haematoma

Penicillin 450,000 units is charted for your client. In stock is penicillin 1 mega unit in 5 mls.
Calculate the volume you will administer to your client
1.75 mls
2.00 mls
2.75 mls
2.25 mls

Cane a 68 year old is scheduled for abdominal surgery. Cane is nil by mouth after midnight prior
to surgery. Which explanation is most appropriate in response to his request to explain why
he cant eat
You will not have to go to the toilet after surgery
The stomach should be empty to prevent vomiting during surgery
The anaesthesia works faster on an empty stomach
There is not enough time before surgery to digest the food

Which of the following is an essential concern of the nurse pre operatively

Doctor has prescribed the most appropriate surgery
Consent form is correctly completed
Patient understands and agrees to the operation
 Clients family is informed of the surgery

Cane is receiving morphine 10mg IM prn for post operative pain. The most crucial time for
assessing his respiratory status is
Immediately after the morphine is given
10 minutes after the morphine is given
30 minutes after the morphine is given
All the time

If respiratory depression is noted in cane, the nurse should prepare to administer which of the
following drugs
Aminophylline
Lasix
Naloxone
Numorphan

You are monitoring canes vital signs every 15 min post surgery. Which of the following changes
should be reported immediately
A systolic blood pressure that drops 30mm Hg
Dry, cool, skin
A pulse rate that increases and decreases with respirations
A diastolic pressure at 70mm Hg

Which nursing action would best help to prevent post operative thrombophlebitis in cane
Encouraging pre operative ambulation
Assisting cane to sit up in bed after surgery
Keeping cane nil by mouth
Reminding cane to move his feet

Kate aged 40 is admitted to the hospital after several episodes of right upper quadrant abdominal
pain and intolerance to fatty and gas forming foods. A diagnosis of biliary colic is made. The
ingestion of fatty foods will precipitate the pain of biliary colic because
Increased fat in the stomach increases peristalsis
Fat in the duodenum initiates contraction of the gallbladders
Fat in the duodenum increases abdominal distention
Increased fat intake may result in a gallbladder obstruction

In preparing kate for surgery, which of the following laboratory values would concern you
enough to call the doctor
WBC 10 x (10 c9) /L
Hemoglobin, 90g.L
Urine pH 8.5
Hematocrit .42

Following insertion of a nasogastric tube before surgery you ascertain that the tube is properly
placed by
Placing the end of the tube in a glass of water to make sure bubbles appear in the water on
expiration
Injecting 10ml of air into the tube and palpating for abdominal distention
Listening for the sound in the stomach with a stethoscope as 5ml of air is injected into the
tube
Feeling the end of the tube for the passage of air from the stomach
As a pre operative medication you are to give 75mg of pethidine intramuscularly. Pethidine
injection contains 50mg/ml. How much of the solution should be administered
0.5 ml
0.75 ml
1 ml
1.5 ml

In administering kates IM analgesic you should insert the needle at a

15 degree angle
45 degree angle
60 degree angle
90 degree angle

Following her cholecystectomy kate returns from recovery room with intravenous fluids a penrose
drain, ET tube and a nasogastric tube. Once settled in her bed, she complains of nausea and
looks like she is gagging. Your initial response in this situation is to
Administer ordered antiemetic
Check the nasogastric tube for patency
Check the wound for bleeding or dehiscence
See whether the t tube has been dislodged

Kate is to receive 1000 ml of IV fluids every 8 hours. Her IV set delivers 20 drops per ml. The
drip rate should be set at
10 drops per minute
21 drops per minute
36 drops per minute
42 drops per minute

To prevent the most common complication following a cholecystectomy, it would be most

important for kate to
Have the abdominal dressing changed prn for heavy drainage
Increase fluid intake and decrease fat intake
Receive prn pain medication at intervals ordered
Cough and deep breathe every 2 hrs and fully expand her lungs

A post operative symptom that should be reported to the house surgeon immediately is
A temperature of38.3c
An incisional pain
A productive cough
Audible bowel sounds

Kates abdomen feels distended and she complains of nausea. The nasogastric tube appears to be
in place. You should
Notify the physician
Administer the prescribed antiemetic
Irrigate the tube with 10 ml of sterile normal saline
Inject 50 ml of air into the tube to check for patency

In changing kates dressing it is particularly important to place a sterile dressing around the
penrose drain because
Leakage of bile from the penrose can cause skin irritation
The evacuated bile is normally high in bacteria and should not contact the abdominal incision
 Absorption of bile by 4 x 4s aid in accurate measurement
The suture line must be protected from moisture

While kate is being turned her nasogastric tube becomes dislodged and falls on the bed. You
should
Notify the house surgeon and fill out an incident report
Leave the tube out since this indicates no further need for one
Obtain a new tube from central supply and prepare for insertion
Administer kates prescribed medication for nausea

James has sustained a fracture of his left lower leg in a car accident. Monitoring for compartment
syndrome is done by checking for
Active movement of the limb
Colour, warmth, sensation, movement of the extremity
Pulse and blood pressure changes
The tightness of the plaster cast

Which of the following criteria is the most important in assessing the affected extremity for
compartment syndrome
Excessive pain, unrelieved by analgesia
Numbness, pins and needles
Inability to extend fingers, toes
Decreased blood flow to extremity

With compartment syndrome, james toes would be

Red and inflamed
Swollen and pink
Cool and ashen
Unchanged in appearance

Vera aged 79 who has been diagnosed as having alzheimers disease, has become more confused
and disoriented and requires continuous nursing care. Her husband seems dewildered and asks
‘what is going to happen to my wife’ the most appropriate response is
We will do our best to look after your wife
We will assess vera you informed
Don’t worry, your wife will soon be well again
She will be alright now and soon back to her old self

Jack aged 30 years has been admitted to your ward with a respiratory infection. He is diagnosed
as being HIV positive. Which of the following has a similar mode of transmission to the HIV
virus
Influenza
Hepatitis B
Herpes simplex
Chicken pox

When caring for jack a client who has HIV which of the following infection control precautions
are necessary
Disposable food trays
Gowns, gloves and masks for all procedures
Gowns and masks for routine procedures
 None of the above

HIV is transmitted by which of the following

Mosquitos
Toilet seats
Exchange of infected blood/semen
Food handling

Teaching for the client taking sublingual nitroglycerin for angina would include
Instructing the client to take the nitroglycerin regularly
Explain to the client that a subsequent headache indicates ineffective medication
Instructing the client to put the tablet on the tongue and swallow after the tablet dissolves
Teaching the client to take a tablet every 5 minutes (x3) when chest pain occurs

Connor a 55 year old is admitted to the hospital with a diagnosis of essential hypertension and
angina. The usual dose of nitroglycerin is
60 mg
6.0 mg
0.6 mg
0.06 mg

The chief pharmacologic action of glycerine trinitrate is to

Constrict cardiac chambers
Stimulate myocardial fibres
Accelerate cardiac contraction
Dilate coronary arteries

A client is prescribed digoxin 0.125 mg, in the morning. You have digoxin tablets 0.25mg. which
of the following will you give
Two tablets (of dogoxin 0.25mg)
One tablet (of dignoxin 0.25mg)
Half a tablet (of digoxin 0.25 mg)
One and a half tablets (of digoxin 0.25 mg)

Before administration of digoxin you record a clients radial pulse. You would withhold this
medication if the pulse was
90 beats per minute or above
80 beats per minute or below
70 beats per minute or below
60 beats per minute or below

Which is the most appropriate action for the nurse to take when Arnold says he has pain in the
calf of his leg especially on movement
Discuss this information with his doctor
Record the comments on Arnolds nursing records
Gently massage the area to relieve the pain
Tell him to flex and move his leg to promote venous return

You discover the nurse on a previous duty has given your patient a wrong drug dosage. What
action would you take
Give the prescribed medication, then inform the doctor
Assess the doctors notes and give a lower dose
Assess the patients vital signs and inform the charge nurse
 Assess the patient give an adjusted dose, inform the doctor

You are setting up for a catheterization when the emergency call bell rings three times. What
would be your immediate action in this situation
Cover the trolley with a sterile guard and answer the bell
Continue to prepare the sterile trolley
Immediately answer the bell, leaving what you are doing
Ignore the bell as other staff are available

Which of the following diseases is notifiable under the health act

HIV human immunodeficiency virus
Hepatitis A
Rheumatic fever
Epiglottitis

A client asks to see her records in a public hospital. Which act covers this situation
Official information act 1982
Hospital act 1980
Privacy act 1993
Nurses act 1980

If a client is admitted and dies within 24 hours following surgery who must be notified by law
Significant others
Doctor
Medical superintendent
Coroner

All of the following are a coroners case except

An unexpected death of client 24hrs after admission
Death of a client with an infectious disease
An unexpected death 24hrs after surgery
No established cause of death

Neil a 17 year old is hit on the head by a cricket ball while playing with a friend at home. He fell
against the glasshouse, severely lacerating his right wrist. He was unconscious for about 5
minutes. On arrival at the emergency department he was drowsy. You are taking neils
recordings when he appears to have a seizure. What nursing intervention would best assist
neil
Describing and recording the seizure activity observed
Restraining neil in order to prevent self harm
Placing a tongue blade between his teeth
Suctioning neil to prevent aspiration

A client diagnosed with congestive heart failure is placed digoxin 0.125 mg daily. A nursing
intervention for this medication is
Do not administer if radial pulse is less than 60
Hold medication if digoxin level is low
Administer if apical pulse is 84
Administer if potassium level is 3.1 mEq/L
A patient has been charted 0.25 mg. You have on hand digoxin PG 62.5mcg. which of the
following would you give
Quarter of a tablet
Two and a half tablets
Three tablets
Four tablets

Signs and symptoms of digitalis toxicity include

Anorexia, nausea, and vomiting
Urinary retention, dysuria and diaphoresis
Headache, constipation and polyuria
Rapid pulse, nausea and cyanosis

When caring for a client with pancretitis why would the nurse expect to administer pethidine
rather than morphine sulphate for pain analgesia
Pethidine provides more prolonged analgesia than morphine
Unlike pethidine, morphine causes spasms of the sphincter of oddi
Pethidine is less addicting than morphine
Unlike pethidine morphine may cause liver dysfunction

What is the first responsibility of the nurse who finds, when checking the drugs between morning
and afternoon duty, that ten ampoules of pethidine are missing
Notify the nurse manager immediately
Report the matter to the doctor immediately
Search patient records for non recorded administration
Document for the senior nurse to investigate the situation

Pethidine, which has been prescribed 3.4 hourly prn has just been given to a patient with a brain
tumour who has a severe headache. When should the pethidine be given again
Only when the headache becomes very severe
Every four hours whether the patient needs it or not
Not more than six hourly to prevent addiction
As often as necessary for patient comfort

You are on duty in the emergency department. A client is admitted and scheduled for an
emergency laparotomy. Indicate the act which relates to consent for medical procedures
Nurses act 1977
Official information act 1982
Accident compensation act 1972
Hospital act 1980

Maui a 2 year old maori boy is admitted with 10% burns. His mother who identifies as maori is
very distressed. The doctor tells her to go to the waiting room while he examines maui. A
major electrolyte imbalance occurring in the first 24 hours in a client with 20% burns would
be
Hypocalcaemia
Hyponatremia
Hypokalaemia
Hypercalcaemia

The acid base imbalance that occurs in the first 24 hours following a 10% burn will be
Respiratory acidosis
Metabolic acidosis
Respiratory alkalosis
 Metabolic alkalosis

The surface and colour of third degree burns would be

Moist, blistered and reddened
Moist, whitish, mottled red
Dry, whitish or charred
Dry whitish slough

Cane a 68 year old is scheduled for abdominal surgery. During the metabolic response to trauma,
such as major surgery, potassium is released from the cells and excreted. A low serum
potassium would be suspected if the patient has
Weakness of large muscles
Muscle cramps
Abdominal distension and poor peristalsis
Abdominal cramps and diarrhoea
1 and 3
1 and 4
2 and 3
2 and 4

Bill aged three sustained a fractured left femur and second and third degree burns over 43% of his
body following an accident in which his parents were killed. The paramedic communicated to
the hospital that bill was burned on both anterior and posterior of his torso including his arms
and hands. On arrival at the emergency department bill is semi conscious his radial pulse is
160 per minute, respirations 32 per minute and blood pressure 60/30. The rule of nine used to
evaluate burns is done to estimate
Need for fluid replacement
Amount of skin surface burned
Loss of electrolyte
Depth of burn

Which of the following types of burn cause the most pain

Superficial
Partial thickness
Full thickness
Full thickness and underlying structures
1 only
1 and 2
2 and 3
3 and 4

The cause of death of a patient some days after being severly burned is most likely to be
Shock
Dehydration
Kidney failure
Sepsis
Dennis aged 70 is admitted to hospital with a myocardial infarction. Dennis is given 80mg
frusemide (lasix) intravenously. What is the action of frusemide
Diuretic
Antiemetic
Analgesic
Bronchodilator

What side effects of frusemide (lasix) should the nurse be aware of

Hypervolaemia
Hypovolaemia
Hypotension
Hypoventilation

Which of the following is a postrenal cause of acute renal failure

Ischaemia of kidney tissue
Prostatism
Nephrotoxic drugs
All of the above

When renal function is interrupted

Acid base abnormalities occur
Fluid and electrolytes are out of balance
Endocrine and metabolic malfunctions take place
All of the above

Phyllis a 65 year old retired secondary school teacher with a history of hypertension, currently on
medication, falls to the ground unconscious while attending an opera. Bleeding within the
skull results in increased intracranial pressure because
Arteries bleed rapidly and profusely
Bleeding from veins goes undetected
Spinal fluid is produced more rapidly
The cranium is a closed, rigid vault

Changes in vital signs with increasing intracranial pressure would include

Hypotension and tachycardia
Narrowing pulse pressure and tachypnea
Hypotension and a pulse deficit
Widening pulse pressure and bradycardia

When suctioning a patient with increased intracranial pressure, you would

Choose a large catheter to clear the airway quickly
Suction gently for no more than 15 seconds
Encourage the patient to cough to bring up secretions
Lower the head of the bed

The critical pathologic event that precipitates most neurologic emergencies is

Airway obstruction
Increase intracranial pressure (ICP)
Cerebrovascular accident
Traumatic head injury
Patricia wakes up one morning with a severe headache. While attempting to get up to take some
aspirin she collapses. Her husband sends for the doctor, who, suspecting a cerebro vascular
accident arranges hospitalisation. On admission patricia is comatosed. In assessing
consciousness you begin by using
Verbal stimulation
Tactile stimulation
Light pain
Deep pain

Your neurologic assessment includes monitoring urinary output. Thats because

Injury to the hypothalamus causes oliguria
Polyuria with specific gravity of <1.005 is desired
Volume depletion will increase ICP (intracranial pressure)
Hyponatremia can lead to cerebral edema

Rosemary is being prepared for a craniotomy, due to an extradural haemorrhage. Your neurologic
assessment indicates increased ICP (intracranial pressure) so you raise the head of the bed 15
to 30 degrees in order to
Improve arterial flow to the brain
Promote venous drainage from the brain
Improve respirations
Increase cardiac output

Fifteen minutes after commending a blood transfusion you observe your patient to be flushed,
dyspnoeic and complaining of itchiness. In order of priority your actions will be
Stop infusion, call for help, take vital signs, remain with patient
Stop infusion, commence normal saline infusion, take vital signs, notify doctor
Stop infusion, ring 3 bells, elevate foot of bed, call doctor
Stop infusion, call for help, take vital signs, elevate foot of bed

A person admitted to the emergency room with trauma and an estimated blood loss of 1200 to
1400 ml has a blood pressure of 110/70mmHg and a heart rate of 120 beats minute. The best
explanation for these observations would be that
The persons actual blood loss was less than the originally estimated loss
The person was normally hypertensive and hence did not have as great a drop in blood
pressure as a normotensive person
The cause of the bleeding is now under control and the increased heart rate is due to anxiety
An increase in heart rate is compensating for the loss of blood volume

Early signs of hypovolemic shock include

Restlessness, thirst and increased heart rate
Decreased blood pressure and apathy
Increase in heart rate and increased pulse pressure
Decreased blood pressure and unconsciousness

Which of the following represents the most appropriate criterion for evaluating a clients
management of elevated phosphate levels in chronic renal failure
The client eliminates diary produces from the diet
The client increases dietary calcium intake
The client takes iron supplements with meals
 The client takes phosphate binding medications with meals

Pharmacological solutions may be expressed in ratio form. Which of the following would give
1mg of drug in 1ml of solution
1:1
1:10
1:100
1:1000

You wish to give 375,000 units of penicillin. The vial contains 600,000 units in 2mls. Calculate
the amount required
0.32 mls
0.625 mls
0.125 mls
1.25 mls

What is the first action of the nurse when a patient refuses to take an ordered medication
Safely dispose of the unused drug
Refer the matter to the medical staff
Record the incident on the patients chart
Ask the patient the reason for refusing the drug

A medical mishap, accident rehabilitation and compensation insurance act 1992 means
Failure to observe a reasonable standard of skill by health professionals
Harm caused following proper care is rare and severe
Compensation is given to people if medical care does not meet an expected outcome
Rare and severe illness can be compensated for

Medical misadventure in the accident rehabilitation and compensation insurance act

Medical error and medical mishap causing personal injury
Negligence by health professionals causing patient death
Mistakes in medical practice causing patient death
Mistakes made by hospital staff causing injury or death

Section 160 of the crimes act 1961

Identifies nurses legal duty to use reasonable knowledge and skill
Allows for the charge of murder or manslaughter if a nurse is found negligent
Identifies the nurses legal duty to provide the necessaties of life
Outlines the possible punishment for nurses found guilty of medical manslaughter

STATE EXAM 39

The nurses act is administered by the

New Zealand nurses organisation
Nursing council of new Zealand
Division of nursing (department of health)
All of the above

The registrar of nurses is employed in the

Department of health
 Nursing council
Nurses organisation
Hospital boards association

The nursing council is

A bureau in the department of health
A subcommittee of the nurses organisation
An incorporated society
A statutory body

The nursing council does all of the following except

Administer the nurses act
Administer the hospitals act
Approve schools of nursing
Issue practising certificates

The act which provides for the nursing council to have disciplinary jurisdiction over the conduct
of registered and enrolled nurses is
The nurses act of 1977
The nurses regulation act of 1977
The hospital act of 1951
The area health board act of 1989

Nurses employed in any setting can have formal complaints made against them. By law to whom
should these complaints be addressed
The medical superintendant
The registrar of the nursing council
The medical officer of health
The executive director of the nurses organisation

The maintenance of standards, discipline, examinations and registration are administered by the
nursing council under which act of parliament
Crimes act 1961
Nurses act 1977
Accident rehabilitation and compensation insurance act 1992
Official information act 1982

As you prepare a client for surgery she states that although she has signed her consent form she
doesn’t really understand what the doctor told her. She asks what sort of operation is she to
have. You respond with
I’ll just give you your premedication and soon you’ll feel alright
You seem worried about your operation, would you like me to stay
I can see you are upset. I’ll get the doctor to explain the operation again to clarify if for you
You don’t have to worry, the doctors do this operation all the time

If a client is admitted and dies within 24 hours following surgery who must be notified by law
Significant others
Doctor
Medical superintendent
Coroner
All of the following are a coroners case except
An unexpected death of client 24 hours after admission
Death of a client with an infectious disease
An unexpected death 24 hours after surgery
No established cause of death

One of the relevant parts of the abortion act of 1977 is authorization for the performance of an
abortion. Which statement is true
No abortion can be done unless authorized by 2 certifying consultants
Abortions can be performed anywhere where there are consultants
A woman who decides to have an abortion can ask a general practitioner
Only consultants can perform an abortion

Which statement is true regarding consent for an abortion

A female of any age can consent to or refuse an abortion
A guardian or parent can consent to or refuse an abortion if a child is not of legal age
Only females under 16 years of age can give consent to an abortion
Only females over 16 years of age can give consent to an abortion

You note that a child you are caring for was given a double dose of Panadol. Your responsibility
would be to
Ensure adequate airway and breathing
Fill out an incident form and inform the doctor
Inform the nurse who gave the medication
Keep it to yourself as no damage was apparent

Richard a 25 year old mildly retarded person was admitted to accident and emergency due to
multiple fractures after a motor vehicle accident. Richard is to have an emergency laparotomy
due to internal bleeding. The crimes act states that consent in the above case is
Implied from the circumstances surrounding the case and the need to take immediate action
for the welfare of the individual
Written and must be freely given and fully understood if major surgery was to be performed
Mentally ill and demented clients must have a consent of a parent or a guardian or significant
others representing them
Valid only if the client is 16 years and over or if married

Whilst in theatre a friend who knew Richard very well, rings to inquire about the client’s
condition. You are the staff nurse on duty. The official secrets act of 1951 allows you to
Give the full information as he is a very close friend of the client
Give him the information as he is a member of the health profession
Give him information in general terms concerning the condition of the client
None of the above

After surgery Richard is taken to the intensive care unit but dies shortly thereafter. A legal
responsibility in cases of unexplained death up to 24 hours after surgery is to
 Lay the body out so that the family and friends can see the client
Send a coroners referral for investigation
Make sure the clients name and address and the circumstances surrounding the death are
written in the 24 hours census book
Ensure that personal belonging are inspected and signed for by the family

Debbie a 16 year old student is admitted in a semi conscious state with a history of a 58 pound
weight loss in 3 months. Preliminary diagnosis is acute anorexia nervosa. Which of the
following admission lab values should the nurse caring for Debbie consider to most critical
Glucose 80
Potassium 3.0
Sodium 144
Haemoglobin 10

Which vital sign would provide the most essential information in light of Debbie’s current lab
values
Temperature
Pulse
Respirations
Blood pressure

Nutritional assessments of Debbie during this acute stage should include all of the following
except
Urine output
Level of consciousness
Skin turgor
Urine dextrostix

The nursing diagnosis of highest priority for Debbie in her acute anorexic episode would be
Alteration in nutrition: less than body requirements
Alteration in health maintenance
Fluid volume deficit
Disturbance in self concept

All of the following are common characteristics of anorexia nervosa except

Preoccupation with food
Fear of developing sexuality
Independence from parental and peer pressures
Distorted body image

The nurse recognises that anorexic behaviour often stems from the clients desire
For self abuse or self mutilation
To punish herself for past behaviour through starvation
To gain control over an aspect of her life
To express hatred towards her parents

The nurse should recognise that Debbie has recovered from her psychological conflicts associated
with anorexia when she
Demonstrates an increase in weight
Demonstrates ser4um electrolytes within normal parameters
Reduces her exercise regimen to only once a day
Makes a date with a companion for dinner
Claire aged 30 and single, is brought to the mental health unit by her brother, who tells the nurse
that she has become increasingly overactive and out of control over the past 2 months. She
begins tasks but doesn’t complete them, takes little time to eat and sleep and spends large
amounts of money and is now in debt. Which approach would be most therapeutic in working
with Claire?
Teaching the patient about banking procedures, then extending this approach to everyday
issues
Confronting the patient about all her inappropriate behaviour
kindly but firmly guiding the patient into such activities as bathing and eating
showing the patient that she is in a controlled environment so that no difficulties arise later

Claire lost 15 lb (6.8kg) last week and now weighs 100 lb (45.4 kg). The nurse formulates a
nursing diagnosis based on the diagnostic category altered nutrition: less than body
requirements. Which goal is most appropriate initially
The patient will consume an adequate diet
The patient will maintain her current weight of 100lb
The patient will gain 1 lb (0.5 kg) per week
The patient will remain adequately hydrated

The best approach to meeting claires hydration and nutrition needs would be to
Leave finger foods and liquids in her room and let her eat and drink as she moves about
Bring her to the dining room and encourage her to sit and eat with calm, quiet companions
Explain mealtime routines and allow her to make her own decisions about eating
Provide essential nutrition through high calorie gavage (naso gastric) feedings

The physician decides to start Claire on lithium therapy. Which of the following best describes
her dietary requirements while she is receiving this medication
A high calorie diet with reduced sodium and adequate fluid intake
A regular diet with normal sodium and adequate intake
A low calorie diet with reduced sodium and increased fluid intake
A regular diet with reduced sodium and adequate fluid intake

A few days later, Claire tells the nurse, I’m so ashamed of myself. I don’t deserve to be here and
be taken care of. Which action best demonstrates the nurses understanding of the patients
needs
Expressing relief that Claire has recognised the foolishness of her behaviour
Calling a team meeting to increase protection against possible self destructive behaviour
Reporting to staff members that Claire appears to be developing insight into her behaviour
Telling Claire that she has done nothing that she should regret

Claire would benefit most from which activity during the manic phase of her illness
Playing a game of badminton
Attending the units weekly bingo game
Putting together an intricate puzzle
Drawing or painting in her room
Early signs of lithium toxicity include
Tremors nausea vomiting and diarrhoea
Ataxia, confusion and seizures
Elevated white blood cell count and orthostatic hypotension
Restlessness, shuffling gait and involuntary muscle movements

The over activity observed in mania is believed to be a defence against underlying feelings of
depression. Which of the following defence mechanisms best identifies this process
Displacement
Reaction formation
Projection
Denial

Michelle aged 25 is found sitting on the floor of the bathroom in the treatment clinic with
moderate lacerations to both wrists. Surrounded by broken glass, she sits staring blankly at
her bleeding wrists while staff members call for an ambulance. How should the nurse
approach Michelle initially
Enter the room quietly and move beside Michelle to assess her injuries
Call for staff backup before entering the room and restraining Michelle
Move as much glass away from Michelle as possible and quietly sit next to her
Approach Michelle slowly while speaking in a calm voice, calling her name and telling her
that the nurse is here to help her

Michelle is taken to the hospital and admitted on an emergency basis for 5 days compulsory
assessment and treatment. Michelle says to the admitting nurse, im not staying here. I was a
little upset and did a stupid thing. I want to leave. Which response is most appropriate
Unfortunately you have no right to leave at this time. You must be evaluated further
Cutting your wrists certainly was a stupid thing to do. What were you trying to accomplish
anyway
You have been admitted on an emergency basis and can be held. You have the right to consult
a lawyer about your admission
I can see you’re upset. Why don’t you try to relax? You can explain to the doctor what upset
you. If what you say is true, you’ll be released sooner.

Dete3rmining Michelle suicide potential during the mental status examination, involves assessing
several factors, the most significant of which is her
History of previous suicide attempts
Suicide plan
Emotional state
Self esteem

Michelle is placed on suicide precautions, which include constant observation. When the nurse
accompanies her to the bathroom, Michelle complains, I can’t believe this. I can’t even go to
the bathroom without being watched. How would you like to have me watching you go the
toilet? Which response by the nurse is best
I’m sure i wouldn’t like it very much, but then i didn’t try to hurt myself
I’m sorry but these are the rules. Someone must be with you at all times
 If it’s more comfortable for you, i can stand right outside as long as the door is open. Would
you agree to that
I would probably feel uncomfortable too, but ensuring your safety is my first priority. I must
stay in the room with you

After 5 days hospitalisation, Michelle is to be discharged and treated on an outpatient basis at the
day treatment clinic. During the discharge planning, the nurse should set as a priority short
term goal that Michelle will
Identify support systems to help manage stress
Verbalise feelings of shame regarding her suicide attempt
Demonstrate an uplifted mood and optimism about the future
Admit that her wrist slashing was an attention seeking behaviour and not a true suicide
attempt

Megan aged 26 enters the emergency room for treatment of an acute overdose of amitriptyline.
Megan is very lethargic but rousable on admission. Gastric lavage is performed, and vital
signs are stable when she is transferred to ICU for close observation. Of greatest concern
during the next 48 hours would be
WBC of 6000
ECG changes
K+ value of 3.6
Slightly elevated TPR

Megan tells the ICU nurse, I’m sorry i didn’t die. Life is useless. Why did you have to save me?
The best response of the nurse would be
You know you don’t mean that
It’s our job Megan. Nothing is ever that bad
I know you’re feeling hopeless. Tell me what’s happening
Let’s concentrate on getting well. In a few days you’ll feel differently

Further history indicates Megan has been seeing a psychiatrist for depressive symptoms and has
been diagnosed as having borderline personality disorder. The nurse would be most surprised
to learn that this patient
Believes she has been chosen by god to be his special messenger on earth
Has a history of episodic substance abuse
Has made other suicide attempts
Has a pattern of unstable, intense relationships with others

Upon transfer to the psychiatric unit, Megan is informed by the admitting nurse that it will be
necessary to check her belongings for any unsafe or banned items. She begins to scream
angrily, what’s the matter with you. I’m upset. Get away from me. The nurse would first
Administer emergency tranquillizers as ordered
Place Megan in seclusion and restraints
Eliminate the belongings search so as to avoid upsetting her
Set verbal limits on her behaviour

Megan requests a weekend pass two days after transfer to the psychiatric unit. Her primary nurse,
informs her following the treatment team meeting that the pass has not been approved. Megan
responds angrily, they all hate me, they’re so mean. I know you’d have let me go. You’re the
only decent nurse here. The nurses best response is
I would have approved it, but you’re right. I’m only one voice
I don’t think the others realise how hard you’ve been trying
Megan, you’ll never get a pass behaving this way
 This was the team’s decision. Let’s talk about why we feel it’s not appropriate now

Megan’s behaviour in this situation illustrates the use of which defence mechanism
Splitting
Reaction formation
Conversion
Repression

Megan’s doctor resumes her regular dosage of amitriptyline. Which affect of this medication
might the staff and patient expect to see first
Elevated mood
Improved reality testing
Improved sleep pattern
Fewer hallucinations and delusions

Mary is admitted under section 11 of the mental health assessment and treatment act (1992). The
definition of mental disorder under the act includes all of the following except
A seriously diminished ability to care for oneself
Mental handicap and substance abuse
An abnormal state of mind
A serious danger to self or others

Marys rights under the act include, the right

To information about her status, to respect of her cultural identity, to seek legal representation
To respect as a human being, to respect of her cultural values, to receive visitors and make
phone calls
To information about her status, to receive treatment and health care, to change her treatment
at her request
To receive visitors and make telephone calls, to refuse seclusion on cultural grounds, to seek a
judicial inquiry

When it is time for Mary to take medication, she says to you, you can’t make me take this; I’m
only on an assessment section. Choose the best reply
This must seem confusing to you Mary, but under the act we can require you to take treatment
Under the act we can make you take medication and if you don’t we will have to give you an
injection
I can see this must be confusing Mary, but you are right you are not required to take treatment
on section 11
Section 11 is an assessment section but you can be required to take medication

Mary asks for a review of her legal status. Your action would be
Explain that her status will be reviewed by the responsible clinician before the end of five
days
Reassure her that you understand how frustrating it must be to be in hospital against her will
Offer to phone the client advocate on Marys behalf
Explain section 16 to Mary and allow her to phone the district inspector
A nurse finds john crouched in the corner of his room with a curtain covering him. His roommate
is sitting on the bed laughing and saying ‘this guy is really a nut. He should be in a padded
cell. How should the nurse respond to the roommate
Say I’m sure john’s behaviour is frightening to you. I understand that you are trying to cover
up how you really feel by laughing
Say, ‘I’d appreciate it if you’d step outside for awhile. I’d like to talk with you after I help
john’
Say nothing and attend to john
Say, in a neutral tone, ‘i think your laughing is making john feel worse. How would you feel
if you were john’

What is the least threatening approach to john while he sits huddled under the curtain
Sit next to him on the floor without speaking, and wait for him to acknowledge the nurse
Gently remove the curtain and say, ‘john, this is the nurse. What happened
Approach john slowly and say, ‘john this is the nurse. You appear to be very frightened. Can
you tell me what you are experiencing
Call for assistance and do not approach john until at least two other staff members are present

Because john has previously responded well to treatment with haloperidol (serenace), the doctor
orders haloperidol 10mg orally twice a day. Which adverse effect is most common with this
medication
Extrapyramidal symptoms
Hypotension
Drowsiness
Tardive dyskinesia

During the next several days, john is observed laughing, yelling and talking to himself. His
behaviour is characteristic of
Delusions
Looseness of association
Illusion
Hallucination

John tells the nurse, ‘the earth is doomed, you know. The ozone layer is being destroyed by hair
spray. You should get away before you die.’ John appears frightened as he say this. The most
helpful response is to
Say, ‘john i think you are overreacting. I know there is some concern about the earth’s ozone
layer, but there is no immediate danger to anyone’
Say, ‘I’ve heard about the destruction of the ozone layer and its effect on the earth. Why don’t
you tell me more about it’
Ignore john’s statement and redirect his attention to some activity on the unit
Say, ‘john is you saying you feel as though something bad will happen to you. I don’t believe
we are in danger right now’
After a half hour, john continues to ramble about the ozone layer and being doomed to die. He
paces in an increasingly agitated manner, and he begins to speak more loudly. At this time,
the nurse should
Check to see whether the doctor ordered haloperidol PRN
Allow john to continue pacing but observe him closely
Try to involve john in a current events discussion group that is about to start
Tell john to go to his room for a while

After several months, john improves, and the doctor decides to change the medication to
haloperidol decanoate (Haldol Decanoate). Why is this change made
Haloperidol decanoate is more effective
Haloperidol decanoate has fewer side effects
A change in medication produces a better response
Haloperidol decanoate can be given monthly instead of daily

Henry is brought to the mental health unit by his wife who states that for the past week her
husband has refused all meals and accused her of poisoning him; he has become withdrawn,
forgetful and inattentive and has frequent mood swings. Henry appears suspicious. His
speech, which is only partly comprehensible, reveals that his thoughts are controlled by
delusions of possession by the devil. He claims that the devil told him that people around him
are trying to destroy him. The doctor diagnoses paranoid schizophrenia. Schizophrenia is best
described as a disorder characterized by
Disturbed relationships related to an inability to communicate and think clearly
Severe mood swings and periods of low to high activity
Multiple personalities, one of which is more destructive than the others
Auditory and visual hallucinations

The nursing assessment of Henry should include careful observation

Thinking, perceiving and decision making skills
Verbal and nonverbal communication processes
Affect and behaviour
Psychomotor activity

When communicating with Henry the nurse should initially

Remain silent and wait for Henry to speak first
Talk with Henry as one would talk with a healthy person
Allow Henry to do all the talking
Speak to Henry using simple, concrete language

The patients thought content can be evaluated on the basis of which assessment area
Presence or absence of delusions
Unbiased information from the patients psychiatric history
degree of orientation to person, place and time
Ability to think abstractly

Henry mentions that voices are telling him that he is in danger and that he will be safe only if he
stays in his room and avoids ‘zoids’ how should the nurse respond
I understand that these voices are real to you, but I want you to know that I do not here them
 Don’t worry. I won’t let anything happen to you here.
What else can you tell me about the voices
Many patients hear voices when they come here. The voices will go away when you get better

The innermost layer of the eye is

Sclera
Retina
Choroid
Conjunctiva

The nurse observes henry pacing in his room. He is alone but talking in an angry tone. When
asked what he was experiencing, he replies ‘the devil is yelling in my ear. He say people here
want to hurt me’. The nurses best response is
Can you tell me more about what the devil is saying to you
How do you feel when the devil says such things to you
I don’t hear any voice, henry. Are you feeling afraid right now
Henry the devil cannot talk to you

Henry has been hearing voices for many years. An approach that has proven effective is for the
hallucinating patient to
Practice saying ‘go away’ or ‘stop’ when he hears voices
Take an as-needed dose of his psychotropic medication when ever hears voices
Sing loudly to drown out the voices and to distract himself
Go to his room until the voices go away

Henry requests that his room be changed. He states that his roommate is homosexual and has been
making advances to him. He wants to be in a private room. How should the nurse reply
Remind henry that he is in a hospital and not a hotel and tell him that patients are assigned to
rooms on the basis of need
Tell henry that his request will be discussed that morning and if a room is available he will be
moved
Inform henry that his roommate is not homosexual and that he should get to know him better
Ask henry if he is physically attracted to his roommate

Physical activity is an important part of the schizophrenic patients treatment plan. Assuming
henry is capable of the following activities which one is most appropriate for him
Taking a daily brisk walk with a staff member
Playing a basketball game
Participating in touch rugby
Playing tennis with another patient and a staff member

Plans are being made for henrys discharge. His wife expresses concern over whether her husband
will continue to take his prescribed medication. The nurse should inform her that
Her concern is valid but henry is an adult and has the right to make his own decisions
She can easily mix the medication in henrys food if he stops taking it
Henry can be given a long acting medication that is administered every 1 to 4 weeks
Henry knows that he must take his medications as prescribed to avoid future hospitalizations

The generic name for stelazine is

Chlorpromazine
Diazepam
Trifluoperazine
 prochloperazine

STATE EXAMS 40

Up until 1840, settlers in new Zealand were

Subject to maori (tribal) law
Obliged to obey busbys instructions
Governed from new south wales
In effect not answerable to any laws

The Waitangi tribunal was established under the treaty of Waitangi act in
1840
1953
1975
1986

The steps to cultural safety are in this order

Safety, awareness and sensitivity
Awareness, sensitivity and safety
Sensitivity, awareness and safety
Sensitivity, safety and awareness

Which of the following acts of parliament outlawed traditional maori health practices
Suppression of rebellion act 1860
Tohunga suppression act 1907/1908
Native lands act 1865
Constitution act 1852

Colonisation is the process whereby

A military dictatorship is set up
Democracy is the means of government
An independent republic is established
A government extends its sovereignty and imposes political control over an alien people or
territory

Colonisation has historically had a negative impact on the health of indigenous people. In the
early stages of colonisation in new Zealand which diseases had the strongest impact
Measles, influenza, tuberculosis
Cancer, coronary heart disease
Diabetes type 2, hypertension, arthritis
Chronic obstructive pulmonary diseases

In new Zealand health services, bicultural partnerships are characterised by

Maori involvement in health delivery and decisions making
Separate waiting lists for maori clients
Maori agreeing to policy developed by the ministry of health
Non maori health professionals learning marae protocol
Durie, M (2001) states: large scale alienation of maori land in the nineteenth century had
implications for health and disease. Which of the following does this apply to
Loss of identity
Loss of core features of culture
Increased mortality and morbidity
All of the above

Sally tells you she is pregnant. The first day of her last normal menstrual period was the 18
february 2003. Her EDD or EDC is
18 november 2003
25 november 2003
25 december 2003
18 december 2003

Sally states, i have heard that a pregnant woman needs more iron. Is that true. The nurses best
response would be
Yes a pregnant woman, 23-40 years, needs 25% more iron
Yes but the increase is so small a pregnant woman can meet the need by eating a well
balanced diet
Yes pregnant women need at least twice as much iron than non pregnant women
Only pregnant adolescents have an increased need for iron

Sally asks why it is important to eat protein during pregnancy. The nurse should explain, protein
is necessary for the
Development of fetal bones and teeth
Growth of fetal and maternal tissues
Prevention of anemia
Coagulation of the blood

For women of normal weight, the average total weight gain during pregnancy is
15-16 kgs
12-14 kgs
8-10 kgs
1 kg per week

Sally tells you that she has heard that pregnant women need to take folic acid. It is recommended
that women take 0.8 mg folic acid orally daily
From when finding out about the pregnancy until 12 weeks gestation
Throughout the whole pregnancy
From 12 weeks before conception to 12 weeks after conception
From 4 weeks before conception to 12 weeks after conception

Sallys friend has rubella and she is worried that it might affect her fetus. Rubella has the greatest
potential for damage when it is contracted during which period of pregnancy
The first 12 weeks
12-16 weeks
After 16 weeks
All of the above periods

Sally asks the nurse how will she know when she is going into labour. One of the signs of
impending labour is
A bloody show
 Increasing fatigue
Shortness of breath
Sudden gain of 0.5-1.5 kg

Sally goes into labour. Her partner asks you how to measure the frequency of contractions. The
nurses best response is
From the beginning of the contraction to the end of the contraction
From the end of a contraction to the beginning of the next contraction
From the beginning of a contraction to he beginning of the next contraction
From the beginning of a contraction to the end of the next contraction

The nurse tells sally she in the first stage of labour. The first stage of labour ends when
The babys head moves through the cervix into the vaginal canal
Dilatation of the cervix begins
The baby has left the mothers body
Full effacement of the cervix has occurred

Sally delivers a healthy baby boy, sid. The first nursing action in caring for sid immediately after
birth is
Maintenance of warmth
Maintenance of respirations
Acting as a client advocate
Establishing rapport with the client

Afters sids birth the nursing intervention which promotes the nursing goal of parental attachment
is
Allowing sally to rest immediately after delivering
Transferring sid to the newborn nursery for its initial assessment
Positioning sid where sally can have eye contact with him
Placing the infant in the nurses station so sally can rest knowing that he is being watched
carefully

Sids temperature is 36.5oC. temperature instability in a newborn is primarily the result of

Excessive heat loss
Impaired thermogenesis
Immature central control (hypothalamus)
Lack of glycogen stores

After sids birth, sally asks about the fine downy hair on sids skin. This is called
Furry down
Infantile hair
Lanugo
Baby hair which changes by week 2

At 12 hours of age sid passes meconium. The normal colour of this stool is
Brown
Grey
Black
Yellow
When assessing a 4 day old infant, the nurse notes that his umbilical cord is shivelled and black.
The nurse should
Notify the infants physician
Clean the cord with alcohol more frequently
Recognize this as a normal finding
Cover the cord with a small gauze dressing and reassess later

Sally is 4hours following the delivery. One of the most important assessments of ongoing healing
of the uterus at the placental site is
The type, amount and consistency of lochia
Uterine size
The womans blood pressure
The womans temperature

Which of the following behaviours would the nurse interpret as a normal reflex response. When
the nurse
Stimulates the newborns palm with her finger, he draws his hand away
Strokes the newborns left cheek, he makes a slight facial grimace.
Strokes the sole of the newborns foot, he flexes his toes tightly
Holds the newborn upright with the feet touching the table, he makes ‘walking’ movements

Sally wants to breast feed sid. Effective breast feeding is most dependent on
Adequate diet of the mother
A stress free environment
Continued frequent sucking by the infant
The size of the womans breasts

Sallys friend delivers a baby girl, jemima at 7 months gestation. This baby would be called a
infant
Post term
Pre term
PKU baby
Pre functional baby

Jemima has swelling under the scalp formed during labour. This swelling is called
Caput hematoma
Caput succedaneum
Caphal hematoma
Cephal succedaneum