WESLEYAN UNIVERSITY- PHILIPPINES

Cabanatuan City
College of Nursing

COMPETENCY APPRAISAL II
MIDTERM EXAMINATIONS

NAME: ___________________________________________DATE: _______________________

Year/Block:______________________________ Permit # _________________Score__________

General Instruction:
1. Place all your answer on the answer sheet provided.
2. Shade the letter of the correct answer. Use black or blue ink only
3. STRICTLY NO ERASURES
4. ABSOLUTELY NO CHEATING, anybody caught, automatically FAILED in this exam.
5. If you have question just raise your hand and the proctor will attend to you.
6. GOD BLESS!

1. The nurse is caring for a client with a colostomy. The client tells the nurse that he makes small pin
holes in the drainage bag to help relieve gas. The nurse should teach him that this action:
a. destroys the odor-proof seal.
b. won't affect the colostomy system.
c. is appropriate for relieving the gas in a colostomy system.
d. destroys the moisture-barrier seal.

2. For a client with cirrhosis, deterioration of hepatic function is best indicated by:
a. fatigue and muscle weakness c. nausea and anorexia
b. difficulty in arousal d. weight gain

3. Nursing board exams questions about a client with severe abdominal pain is being evaluated for
appendicitis. What is the most common cause of appendicitis?
a. Rupture of the appendix c. A high-fat diet
b. Obstruction of the appendix d. A duodenal ulcer

4. A client is scheduled for bowel resection with anastomosis involving the large intestine. Because of the
surgical site, the nurse formulates the nursing diagnosis of Risk for infection. To complete the nursing
diagnosis statement, the nurse should add which "related-to" phrase?
a. Related to major surgery required by bowel resection
b. Related to the presence of bacteria at the surgical site
c. Related to malnutrition secondary to bowel resection with anastomosis
d. Related to the presence of a nasogastric (NG) tube postoperatively

5. A client with advanced cirrhosis has a prothrombin time (PT) of 15 seconds, compared with a control
time of 11 seconds. The nurse expects to administer:
a. spironolactone (Aldactone) c. furosemide (Lasix)
b. phytonadione (Mephyton) d. warfarin (Coumadin)

6. The nurse is teaching a client with pernicious anemia who requires vitamin B12 replacement therapy.
Which statement indicates that the client understands the treatment program:
a. "I'll swallow one vitamin B12 pill every morning for 2 weeks."
b. "I'll take a vitamin B12 pill once each month for life."
c. "I'll need an injection of vitamin B12 every month for life."
d. "I'll only need daily injections of vitamin B12 until my blood count improves."

7. A client who is receiving cyclosporine (Sandimmune) must practice good oral hygiene, including
regular brushing and flossing of the teeth, to minimize gingival hyperplasia. Good oral hygiene also is
essential to minimize gingival hyperplasia during long-term therapy with certain drugs. Which of the
following drugs falls into this category?
a. procainamide (Pronestyl) c. phenytoin (Dilantin)
b. azathioprine (Imuran) d. allopurinol (Zyloprim)

8. Hematology questions and answers about the nurse who is caring for a 32-year-old client admitted
with pernicious anemia. Which set of findings should the nurse expect when assessing the client?
a. Pallor, bradycardia, and reduced pulse pressure
b. Pallor, tachycardia, and a sore tongue
c. Sore tongue, dyspnea, and weight gain
d. Angina, double vision, and anorexia

9. Which nursing diagnosis should the nurse expect to see in a plan of care for a client in sickle cell
crisis?
a. Imbalanced nutrition: Less than body requirements related to poor intake
 b. Disturbed sleep pattern related to external stimuli
c. Impaired skin integrity related to pruritus
d. Pain related to sickle cell crisis

10. A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The physician
begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences
vitamin B12 absorption?
a. Intrinsic factor c. Histamne
b. Hydrochloric acid d. Liver enzyme

11. A client arrives at the emergency department complaining of extreme muscle weakness after minimal
effort. The physician suspects myasthenia gravis. Which drug will be used to test for this disease?
a. Ambenonium (Mytelase) c. Edrophonium (Tensilon)
b. Pyridostigmine (Mestinon) d. Carbachol (Carboptic)

12. A client with seizure disorder comes to the physician's office for a routine checkup. Knowing that the
client takes phenytoin (Dilantin) to control seizures, the nurse assesses for which common adverse
drug reaction?
a. Excessive gum tissue growth c. Hypertension
b. Drowsiness d. Tinnitus

13. Neurosurgical nursing question about teaching a client about levodopa-carbidopa (Sinemet) therapy
for Parkinson's disease, the nurse should include which instruction?
a. "Report any eye spasms."
b. "Take this medication at bedtime."
c. "Stop taking this drug when your symptoms disappear."
d. "Be aware that your urine may appear darker than usual."

14. A client is suspected of having amyotrophic lateral sclerosis (ALS). To help confirm this disorder, the
nurse prepares the client for various diagnostic tests. The nurse expects the physician to order:
a. electromyography (EMG) c. Doppler ultrasonography
b. Doppler scanning d. quantitative spectral phonoangiography

15. The nurse is teaching a client who has facial muscle weakness and has recently been diagnosed with
myasthenia gravis. The nurse should teach the client that myasthenia gravis is caused by:
a. genetic dysfunction.
b. upper and lower motor neuron lesions.
c. decreased conduction of impulses in an upper motor neuron lesion.
d. a lower motor neuron lesion

16. A male client has an abnormal result on a Papanicolau test. After admitting, he read his chart while
the nurse was out of the room, the client asks what dysplasia means. Which definition the nurse
should provide?
a. Presence of completely undifferentiated cells that don’t resemble cells of the tissues of their origin.
b. Increase the number of normal cells in a normal arrangement in a tissue or an organ
c. Replacement of one type of fully differentiated cell by another in tissues where the second type
normally isn’t found
d. Alteration in the size, shape and organization of differentiated cells

17. For a female client with newly diagnosed cancer, the nurse formulates a nursing diagnosis of Anxiety
related to the threat of death secondary to cancer diagnosis. Which expected outcome would be
appropriate for this client?
a. “Client verbalizes feelings of anxiety.”
b. “Client doesn’t guess a diagnosis.”
c. “Client uses any effective method to reduce tension.”
d. “Client stops seeking information.”

18. A male client with cerebellar brain tumor is admitted to an acute care facility. The nurse formulates a
nursing diagnosis of Risk for injury. Which “related-to” phrase should the nurse add to complete the
nursing diagnosis statement?
a. Related to visual field deficits c. Related to impaired balance
b. Related to difficulty of swallowing d. Related to psychomotor seizures

19. A female client with cancer is schedules for radiation therapy. The nurse knows that radiation at any
treatment site may cause a certain adverse effect. Therefore the nurse should prepare the client to
expect:
a. Hair loss c. Fatigue
b. Stomatitis d. Vomiting

20. Nurse April is teaching a client who suspects that she has a lump in her breast. The nurse instructs
the client that a diagnosis of breast cancer is confirmed by:
a. Breast-self examination c. Fine needle aspiration
 b. Mammography d. Chest x-ray

21. A male client undergoes a laryngectomy to treat laryngeal cancer. When teaching the client how to
care for the neck stoma, the nurse should include which instruction?
a. “Keep the stoma uncovered.”
b. “Keep the stoma dry.”
c. “Have a family member perform stoma care initially until you get used to the procedure.”
d. “Keep the stoma moist.”

22. A female client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates
a fluid and electrolyte imbalance induced by chemotherapy?
a. Urine output of 400 ml in 8 hours
b. Serum potassium level of 3.6 mEq/L
c. Blood pressure of 120/64 to 130/72 mmHg
d. Dry oral mucous membranes and cracked lips

23. Nurse April teaching a group of women to perform breast self-examination. The nurse should explain
that the purpose of performing the examination is to discover:
a. Cancerous lumps c. Changes from previous self-examinations
b. Areas of thickness or fullness d. Fibrocystic masses

24. A client, age 41, visits the gynecologist. After examining her, the physician suspects cervical cancer.
The nurse reviews the client’s history for risk factors for this disease. Which history finding is a risk
factor for cervical cancer?
a. Onset of sporadic sexual activity at age 17
b. Spontaneous abortion at age 19
c. Pregnancy complicated with eclampsia atage 27
d. Human papilloma virus infection at age 32

25. The nurse is interviewing a male client about his past medical history. Which preexisting condition
may lead the nurse to suspect that a client has colorectal cancer?
a. Duodenal ulcers c. Weight gain
b. Hemorrhoids d. Polyps

26. Mrs. Chua a 78 year old client is admitted with the diagnosis of mild chronic heart failure. The nurse
expects to hear when listening to client’s lungs indicative of chronic heart failure would be:
a. Stridor c. Wheezes
b. Crackles d. Friction rubs

27. Patrick who is hospitalized following a myocardial infarction asks the nurse why he is taking morphine.
The nurse explains that morphine:
a. Decrease anxiety and restlessness c. Dilates coronary blood vessels
b. Prevents shock and relieves pain d. Helps prevent fibrillation of the heart

28. Which of the following should the nurse teach the client about the signs of digitalis toxicity?
a. Increased appetite c. Skin rash over the chest and back
b. Elevated blood pressure d. Visual disturbances such as seeing yellow spots

29. Nurse Trisha teaches a client with heart failure to take oral Furosemide in the morning. The reason for
this is to help…
a. Retard rapid drug absorption
b. Excrete excessive fluids accumulated at night
c. Prevents sleep disturbances during night
d. Prevention of electrolyte imbalance

30. What would be the primary goal of therapy for a client with pulmonary edema and heart failure?
a. Enhance comfort
b. Increase cardiac output
c. Improve respiratory status
d. Peripheral edema decreased

31. Nurse Linda is caring for a client with head injury and monitoring the client with decerebrate posturing.
Which of the following is a characteristic of this type of posturing?
a. Upper extremity flexion with lower extremity flexion
b. Upper extremity flexion with lower extremity extension
c. Extension of the extremities after a stimulus
d. Flexion of the extremities after stimulus

32. A female client is taking Cascara Sagrada. Nurse Betty informs the client that the following maybe
experienced as side effects of this medication:
a. GI bleeding
b. Peptic ulcer disease
c. Abdominal cramps
 d. Partial bowel obstruction

33. Dr. Marquez orders a continuous intravenous nitroglycerin infusion for the client suffering from
myocardial infarction. Which of the following is the most essential nursing action?
a. Monitoring urine output frequently
b. Monitoring blood pressure every 4 hours
c. Obtaining serum potassium levels daily
d. Obtaining infusion pump for the medication

34. During the second day of hospitalization of the client after a Myocardial Infarction. Which of the
following is an expected outcome?
a. Able to perform self-care activities without pain
b. Severe chest pain
c. Can recognize the risk factors of Myocardial Infarction
d. Can Participate in cardiac rehabilitation walking program

35. A 68 year old client is diagnosed with a right-sided brain attack and is admitted to the hospital. In
caring for this client, the nurse should plan to:
a. Application of elastic stockings to prevent flaccid by muscle
b. Use hand roll and extend the left upper extremity on a pillow to prevent contractions
c. Use a bed cradle to prevent dorsiflexion of feet
d. Do passive range of motion exercise

36. Nurse Liza is assigned to care for a client who has returned to the nursing unit after left nephrectomy.
Nurse Liza’s highest priority would be…
a. Hourly urine output
b. Temperature
c. Able to turn side to side
d. Able to sips clear liquid

37. A 64 year old male client with a long history of cardiovascular problem including hypertension and
angina is to be scheduled for cardiac catheterization. During pre cardiac catheterization teaching,
Nurse Cherry should inform the client that the primary purpose of the procedure is…..
a. To determine the existence of CHD
b. To visualize the disease process in the coronary arteries
c. To obtain the heart chambers pressure
d. To measure oxygen content of different heart chambers

38. During the first several hours after a cardiac catheterization, it would be most essential for nurse
Cherry to…
a. Elevate clients bed at 45°
b. Instruct the client to cough and deep breathe every 2 hours
c. Frequently monitor client’s apical pulse and blood pressure
d. Monitor clients temperature every hour

39. Kate who has undergone mitral valve replacement suddenly experiences continuous bleeding from the
surgical incision during postoperative period. Which of the following pharmaceutical agents should
Nurse Aiza prepare to administer to Kate?
a. Protamine Sulfate
b. Quinidine Sulfate
c. Vitamin C
d. Coumadin

40. In reducing the risk of endocarditis, good dental care is an important measure. To promote
good dental care in client with mitral stenosis in teaching plan should include proper use of…
a. Dental floss
b. Electric toothbrush
c. Manual toothbrush
d. Irrigation device

41. Among the following signs and symptoms, which would most likely be present in a client with mitral
gurgitation?
a. Altered level of consciousness
b. Exceptional Dyspnea
c. Increase creatine phospholinase concentration
d. Chest pain

42. Kris with a history of chronic infection of the urinary system complains of urinary frequency and
burning sensation. To figure out whether the current problem is in renal origin, the nurse should
assess whether the client has discomfort or pain in the…
a. Urinary meatus
b. Pain in the Labium
c. Suprapubic area
 d. Right or left costovertebral angle

43. Nurse Terry is evaluating the renal function of a male client. After documenting urine volume and
characteristics, Nurse Perry assesses which signs as the best indicator of renal function.
a. Blood pressure
b. Consciousness
c. Distension of the bladder
d. Pulse rate

44. John suddenly experiences a seizure, and Nurse Gina notice that John exhibits uncontrollable jerking
movements. Nurse Gina documents that John experienced which type of seizure?
a. Tonic seizure
b. Absence seizure
c. Myoclonic seizure
d. Clonic seizure

45. Smoking cessation is critical strategy for the client with Burger’s disease, Nurse Jasmin anticipates
that the male client will go home with a prescription for which medication?
a. Paracetamol
b. Ibuprofen
c. Nitroglycerin
d. Nicotine (Nicotrol)

46. Nurse Lilly has been assigned to a client with Raynaud’s disease. Nurse Lilly realizes that the etiology
of the disease is unknown but it is characterized by:
a. Episodic vasospastic disorder of capillaries
b. Episodic vasospastic disorder of small veins
c. Episodic vasospastic disorder of the aorta
d. Episodic vasospastic disorder of the small arteries

47. Nurse Jamie should explain to male client with diabetes that self-monitoring of blood glucose is
preferred to urine glucose testing because…
a. More accurate
b. Can be done by the client
c. It is easy to perform
d. It is not influenced by drugs

48. Jessie weighed 210 pounds on admission to the hospital. After 2 days of diuretic therapy, Jessie
weighs 205.5 pounds. The nurse could estimate the amount of fluid Jessie has lost…
a. 0.3 L
b. 1.5 L
c. 2.0 L
d. 3.5 L

49. Nurse Donna is aware that the shift of body fluids associated with Intravenous administration of
albumin occurs in the process of:
a. Osmosis
b. Diffusion
c. Active transport
d. Filtration

50. Myrna a 52 year old client with a fractured left tibia has a long leg cast and she is using crutches to
ambulate. Nurse Joy assesses for which sign and symptom that indicates complication associated
with crutch walking?
a. Left leg discomfort
b. Weak biceps brachii
c. Triceps muscle spasm
d. Forearm weakness

Situation 1: You are the nurse taking care of a 65-year-old client diagnosed with left-sided heart failure.
51. When assessing a patient with left-sided heart failure, you would expect to detect:
a. Distended neck veins c. Dyspnea on exertion
b. Edema of the lower extremities d. Hepatomegaly

52. The patient receives daily doses of furosemide (Lasix) and digoxin (Lanoxin) for treatment of heart failure.
The patient is more likely to develop a toxic reaction to digoxin if he has concurrent:
a. Hyponatremia c.Hypernatremia
b. Hyperkalemia d. Hypokalemia

53. His serum potassium level is 3.1 mEq/L. Which associated electrocardiogram changes would you expect?
a. Peaked T wave c. Narrow QRS complex
b. Depressed ST segment d. Absent P waves
54. As part of the patient’s treatment for hypokalemia, the doctor prescribes IV potassium supplementation. At
which rate should it be administered?
a. 5 mEq/hour c. 15 mEq/hour
b. 10 mEq/hour d. 20 mEq/hour

55. The patient calls you to her room because he’s short of breath. You assess him and find that his heart
failure is worsening. Which type of fluid volume excess is the patient experiencing because of his heart
failure?
A. Intravascular c. Intracellular
B. Extracellular d. Interstitial

Situation 2: A client, who suffered major burn injures, is rushed to hospital. The patient is a 155-lb
male and is estimated at having 50% of his total body surface area burned.
56. During the fluid accumulation phase of a major burn injury, fluid shifts from the:
a. Intravascular space to the interstitial space
b. Interstitial space to intravascular space
c. Intracellular space to interstitial space
d. Intravascular space to intracellular space

57. You insert an IV line and begin fluid resuscitation. The doctor wants you to use the Parkland formula. What
amount of Lactated Ringer’s solution should you administer over the first 8 hours?
a. 700 mL c. 1,400 mL
b. 7,000 mL d. 6,000 mL

58. 48 hours after the burn injury, what physiologic changes can be expected?
a. Edema development c. Decreased hemoglobin level
b. Increased blood volume d. Profuse urination

59. During the fluid remobilization phase, the nurse would expect to see signs of which electrolyte imbalance?
a. Hypokalemia c. Hypernatremia
b. Hyperkalemia d. Hypovolemia

60. Burn wound sepsis develops and mafenide acetate 10% (Sulfamylon) is ordered BID. While applying
Sulfamylon to the wound, it is important for the nurse to prepare the client for expected responses to the
topical application which include
A. Severe burning pain for a few minutes following application
B. Possible severe metabolic alkalosis with continued use
C. Black discoloration of everything that comes in contact with this drug
D. Chilling due to evaporation of solution from the moistened dressings

Situation 3: A 66-year-old woman, who survived a cardiac arrest, was admitted to the intensive care
unit. She experienced a prolonged episode of hypotension and is now in acute renal failure.
61. Which type of renal failure did the patient experience?
a. Intrarenal c. Postrenal
b. Prerenal d. Renal

62. Laboratory results associated with acute renal failure include:

a. Increased BUN level and decreased serum creatinine level
b. Decreased BUN level and increased urine output
c. Increased BUN and serum creatinine levels
d. Increased BUN level and increased urine output

63. Which acid-base imbalance is this patient most likely to experience?

A. Respiratory acidosis c. Metabolic acidosis
B. Respiratory alkalosis d. Metabolic alkalosis

64. Which of the following is the optimal diet for a patient with renal failure?
a. High-calorie, low-protein, low-sodium, low-potassium
b. High-calorie, high-protein, high-sodium, high-potassium
c. Low-calorie, high-protein, low-sodium, low-potassium
d. High-calorie, low-protein, low-sodium, high-potassium

65. While caring for the client with acute renal failure, the nurse should expect that hypertonic glucose, insulin
infusions, and sodium bicarbonate will be used to treat which complication?
A. Hyperkalemia c. Hyperlipidemia
B. Hypocalcemia d. Hyponatremia

Situation 4: John is admitted to the hospital with chief complaint of seizures. Client reported reduced
urine output and weight gain. He is diagnosed with Syndrome of Inappropriate Diuretic Hormone
(SIADH).
66. Which of the following laboratory findings would the nurse expect to find?
a. BUN level of 45 mg/dL
b. Serum osmolality level of 250 mOsm/kg
 c. Serum sodium level of 145 mEq/L
d. Urine specific gravity of 1.001

67. Which nursing diagnosis is most appropriate for John who has hyponatremia?
a. Risk for injury related to seizure activity
b. Impaired skin integrity related to peripheral edema
c. Fluid volume excess related to increased thyrotropin secretion
d. Impaired gas exchange related to pulmonary edema

68. John is thirsty and frequently asks the nurse for water. The most appropriate response would be to:
A. Keep adequate water at his bedside
B. Give him extra fluids with his medications
C. Explain that his fluid intake must be restricted to 27 to 34 oz (800 to 1,000 ml) per day
D. Prepare an IV infusion of hypotonic saline

69. John’s treatment plan should include which of the following to combat fluid imbalances with SIADH
secretion?
a. Hypotonic saline solution c. Colloids
b. Fluid restriction d. 5% dextrose solution

70. Which sign suggests that a patient with SIADH has developed complications?
a. Tetanic complications c. Weight loss
b. Neck vein distention d. Polyuria

Situation 5: The nurse is discussing the prevention of osteoporosis with a group of clients.
71. Which among the following factors do NOT keep the bones strong?
a. An adequate calcium intake c. Sufficient estrogen levels
b. Maintenance of a low weight d. Weight-bearing exercises

72. The nurse suggests that the client’s diet include adequate amounts of:
a. Vitamin A c. Vitamin E
b. Vitamin D d. Vitamin K

73. A woman reports all of the following. Which should the nurse recommend she stop doing to help reduce
the risk of osteoporosis?
a. Smoking c. Biting her nails
b. Overeating d. Skipping breakfast

74. To prevent or treat osteoporosis, adequate calcium intake:

a. Is essential throughout the lifespan
b. Is only necessary after menopause
c. Can only be obtained by supplements
d. Is important only until bone density peaks

75. Which two hormones regulate calcium and phosphate levels in the blood and stimulate (or inhibit) bone
cell activity?
A. Parathyroid hormone and calcitonin c. Serotonin and acetylcholine
B. Vitamin D and erythropoietin d. Thyroid hormone and cortisol

Situation 6: A nurse working in the orthopedic ward is assigned to handle clients with various cases of
fracture.
76. Kevin, age 18, is admitted to the hospital with possible fractured tibia. The x-ray shows that the bone is in
alignment but a fracture line extends around the ankle. This type of fracture is called a:
a. Comminuted fracture c. Transverse fracture
b. Colles’ fracture d. Greenstick fracture

77. Bobby has a short-leg cast applied. 6 hours later, he complains that pain has increased, especially when
his leg is elevated, and that the pain is not relieved by prescription analgesics. The nurse should:
a. Instruct him to keep his leg elevated and apply ice continuously
b. Call the doctor immediately
c. Tell him this is normal and the pain should lessen in 24 to 48 hours
d. Give ibuprofen (Motrin) with his pain medication to enhance its effectiveness

78. To decrease tissue pressure and maintain arterial perfusion to the lower arm, the nurse would prepare to
assist the doctor in:
a. Giving vasodilators IV c. Taking the patient to the operating room
b. Splitting or removing the cast d. Elevating the arm on a pole

79. The client in balanced suspension traction needs to be repositioned toward the head of the bed. During
repositioning, the nurse should:
a. Place sight additional tension on the traction cords
b. Release the weights and replace immediately after positioning
c. Lift the traction and the client during repositioning
 d. Maintain the same degree of traction tension

80. Which complication would the nurse suspect when assessing a client with a fractured femur and pelvis
who becomes restless, exhibits dyspnea and has petechiae over the chest area and crackles on
auscultation?
a. Compartment syndrome c. Fat embolism
b. Deep vein thrombosis d. Osteomyelitis

Situation 7: Edgardo, found lying unconscious in an enclosed parking space, is rushed to the
emergency room. Carbon monoxide poisoning is suspected.
81. The nurse expects the physician to prescribe which of the following to confirm the diagnosis?
a. Carboxyhemoglobin c. Pulse oximetry
b. Complete blood cell count d. CT scan of the head

82. Edgardo suffering from carbon monoxide poisoning:

a. Appears intoxicated
b. Presents with severe hypertension
c. Appears hyperactive
d. Will always present with a cherry red skin coloring

83. A nurse is setting up oxygen for Edgardo. He is to receive oxygen at 10 L per non-rebreather mask. It is
important for the nurse to do the following EXCEPT:
a. Adjust the flow rate to keep the reservoir bag inflated greater than 2/3 full during inspiration
b. Monitor the patient carefully for risk of aspiration
c. Make sure the valves and rubber flaps are patent, functional, and not stuck
d. Remind the client and his wife of the smoking policy

84. A nurse is monitoring the results of serial arterial blood gases of Edgardo who is asking for the oxygen
mask to be removed. The nurse determines that the oxygen may be safely removed once the
carboxyhemoglobin level decreases to less than:
a. 5% c. 15%
b. 10% d. 25%

85. A nurse evaluates Edgardo following treatment for carbon monoxide poisoning. The nurse would
document that the treatment was effective when the:
a. Client is awake and talking
b. Carboxyhemoglobin levels are less than 5%
c. Heart monitor shows sinus tachycardia
d. Client is sleeping soundly

Situation 8: A-75-year-old man with a 10-year history of Parkinson’s disease is admitted to the hospital
because his condition is deteriorating.
86. The symptom of Parkinson’s disease that would be most obvious during the admission assessment is:
a. Confusion c. Pallor
b. Intention tremor d. Pill rolling

87. Amantadine hydrochloride (Symmetrel) is prescribed for a client with Parkinson’s disease. The client asks
how the drug works. In formulating a response, the nurse recalls that the drug:
a. Allows accumulation of dopamine c. Elevate the client’s mood
b. Corrects mineral deficiencies d. Replaces enzymes

88. In planning care for the client with severe Parkinson’s disease, which of the following is of the highest
priority?
a. Positioning c. Increasing activity
b. Encouraging independence d. Preventing aspiration

89. Which activity is most likely to be effective in alleviating fatigue?

a. Getting him to bed on time
b. Avoiding high carbohydrate food
c. Collaborating with him when scheduling activities
d. Providing for morning and afternoon naps while he is in the hospital

90. When does the nurse encourage a client with Parkinson’s disease to schedule the most demanding
physical activities to minimize the effects of hypokinesia?
A. Early in the morning, when the client’s energy level is high
B. To coincide with the peak action of drug therapy
C. Immediately after a rest period
D. When family members will be available

Situation 9: Bryan, 55 years old, is admitted to the oncology ward. He has a history of weight loss,
persistent cough that has increased, and blood- tinged sputum for 2 weeks. He has smoked up to two
packs of cigarettes a day for 20 years. He is being admitted for further evaluation and treatment.
91. An early sign or symptom or lung cancer seen in the client’s history is:
 A. Persistent cough c. Weight loss
B. Hemoptysis d. Dyspnea

92. An MRI evaluation is scheduled. You prepare Bryan for this study by telling him that:
A. He will have to take laxatives before the study
B. A dye will be injected into his veins just before the test
C. No physical preparation is needed before the test
D. A nuclear medication is administered by the radiology department 24 hours before the test

93. Bryan is scheduled for a bronchoscopy so that the lesion can be evaluated for biopsy. Preoperative
teaching will include an explanation that following the biopsy he will:
A. Be unable to talk for several days
B. Have nothing by mouth until his gag reflex returns
C. Be unable to swallow for 12 hours
D. Experience no soreness of the throat

94. Which of the following would not be a common method of obtaining a specimen to diagnose lung cancer?
A. Thorancentesis c. Mediastinoscopy
B. Needle biopsy d. Wedge resection

95. To assist Bryan and his family to cope with his diagnosis, the nurse should:
A. Explain procedures and their purposes before they are carried out
B. Tell him the physician will have to tell him about the tests
C. Limit the number of visitors for a few days
D. Provide extensive teaching regarding his illness

Situation 10: Pain is considered the fifth vital sign. Clients have the right to appropriate assessment
and management of pain.
96. The pain associated with migraine headaches is believed to be caused by:
A. Dilation of the cranial arteries
B. A temporary decrease in intracranial pressure
C. Irritation and inflammation of the openings of the sinuses
D. Sustained contraction of muscles around the scalp and face

97. When the nurse administers meperidine hydrochloride, its effectiveness as an analgesic is related to its
ability to:
A. Reduce the perception of pain
B. Decrease the sensitivity of pain receptors
C. Interfere with pain impulses traveling along sensory nerve fibers
D. Block the conduction of pain impulses along the central nervous systems

98. The client asks the nurse why she has migraine headaches. What is the nurse’s best response?
A. Migraine headaches are believed to be caused by dilation of the cranial arteries
B. Migraine headaches are believed to be caused by a temporary decrease in intracranial pressure
C. Migraine headaches are believed to be caused by irrigation and inflammation of the opening of the
sinuses
D. Migraine headaches are believed to be caused by sustained contraction of muscles around the scalp
and face

99. A client, who crashed her motorcycle, suffered a tibial fracture that required casting. Approximately 5
hours later, the client begins to complain of increasing pain distal to the left tibial fracture despite the
morphine injection administered 30 minutes previously. The nurse’s next action should be to assess for
which of the following?
A. Presence of a distal pulse c. Vital signs changes
B. Pain with a pain rating scale d. Potential for drug tolerance

100. The nurse teaches the client with chronic cancer pain about optimal pain control. Which of the
following recommendations is most effective for pain control?
A. Get used to some pain and use a little less medication than needed to keep from being addicted
B. Take prescribed analgesics on an around-the-clock schedule to prevent recurrent pain
C. Take analgesics only when pain returns
D. Take enough analgesics around the clock so that you can sleep 12 to 16 hours a day to block the pain