1. A patient is
admitted to the hospital with a diagnosis of primary hyperparathyroidism. A
nurse checking the patient’s lab results would expect which of the following
changes in laboratory findings?
A. Elevated serum calcium.
B. Low serum parathyroid hormone (PTH).
D. Low urine calcium.
2. A patient with
Addison’s disease asks a nurse for nutrition and diet advice. Which of the
following diet modifications is NOT recommended?
A. A diet high in grains.
B. A diet with adequate caloric intake.
C. A high protein diet.
D. A restricted sodium diet.
3. A patient with a
history of diabetes mellitus is in the second post-operative day following
cholecystectomy. She has complained of nausea and isn’t able to eat solid
foods. The nurse enters the room to find the patient confused and shaky. Which
of the following is the most likely explanation for the patient’s symptoms?
A. Anesthesia reaction.
B. Hyperglycemia.
D. Diabetic ketoacidosis.
4. A nurse assigned to
the emergency department evaluates a patient who underwent fiberoptic
colonoscopy 18 hours previously. The patient reports increasing abdominal pain,
fever, and chills. Which of the following conditions poses the most immediate
concern?
A. Bowel perforation.
B. Viral gastroenteritis.
C. Colon cancer.
D. Diverticulitis.
5. A patient is
admitted to the same day surgery unit for liver biopsy. Which of the following
laboratory tests assesses coagulation?
A. Partial thromboplastin time.
B. Prothrombin time.
C. Platelet count.
6. A nurse is
assessing a clinic patient with a diagnosis of hepatitis A. Which of the
following is the most likely route of transmission?
A. Sexual contact with an infected partner.
B. Contaminated food.
C. Blood transfusion.
D. Illegal drug use.
7. A leukemia patient
has a relative who wants to donate blood for transfusion. Which of the
following donor medical conditions would prevent this?
A. A history of hepatitis C five years
previously.
B. Cholecystitis requiring cholecystectomy one
year previously.
C. Asymptomatic diverticulosis.
D. Crohn’s disease in remission.
8. A physician has
diagnosed acute gastritis in a clinic patient. Which of the following
medications would be contraindicated for this patient?
A. Naproxen sodium (Naprosyn).
B. Calcium carbonate.
D. Furosemide (Lasix).
9. The nurse is
conducting nutrition counseling for a patient with cholecystitis. Which of the
following information is important to communicate?
A. The patient must maintain a low calorie diet.
B. The patient must maintain a high protein/low
carbohydrate diet.
C. The patient should limit sweets and sugary
drinks.
D. The patient should limit fatty foods.
10. A patient admitted
to the hospital with myocardial infarction develops severe pulmonary edema.
Which of the following symptoms should the nurse expect the patient to exhibit?
A. Slow, deep respirations.
B. Stridor.
D. Air hunger.
11. A nurse caring for
several patients on the cardiac unit is told that one is scheduled for
implantation of an automatic internal cardioverter-defibrillator. Which of the
following patients is most likely to have this procedure?
A. A patient admitted for myocardial infarction
without cardiac muscle damage.
B. A post-operative coronary bypass patient,
recovering on schedule.
C. A patient with a history of ventricular
tachycardia and syncopal episodes.
D. A patient with a history of atrial tachycardia
and fatigue.
12. A patient is
scheduled for a magnetic resonance imaging (MRI) scan for suspected lung
cancer. Which of the following is a contraindication to the study for this
patient?
A. The patient is allergic to shellfish.
B. The patient has a pacemaker.
C. The patient suffers from claustrophobia.
D. The patient takes anti-psychotic medication.
13. A nurse calls a
physician with the concern that a patient has developed a pulmonary embolism.
Which of the following symptoms has the nurse most likely observed?
A. The patient is somnolent with decreased
response to the family.
B. The patient suddenly complains of chest pain
and shortness of breath.
C.
The patient has
developed a wet cough and the nurse hears crackles on auscultation of the
lungs. Nursing Path
D. The patient has a fever, chills, and loss of
appetite.
14. A patient comes to
the emergency department with abdominal pain. Work-up reveals the presence of a
rapidly enlarging abdominal aortic aneurysm. Which of the following actions
should the nurse expect?
A. The patient will be admitted to the medicine unit
for observation and medication.
B. The patient will be admitted to the day
surgery unit for sclerotherapy.
C. The patient will be admitted to the surgical
unit and resection will be scheduled.
D. The patient will be discharged home to
follow-up with his cardiologist in 24 hours.
15. A patient with
leukemia is receiving chemotherapy that is known to depress bone marrow. A CBC
(complete blood count) reveals a platelet count of 25,000/microliter. Which of
the following actions related specifically to the platelet count should be
included on the nursing care plan?
A. Monitor for fever every 4 hours.
B. Require visitors to wear respiratory masks and
protective clothing.
C. Consider transfusion of packed red blood
cells.
D. Check for signs of bleeding, including
examination of urine and stool for blood.
16. A nurse in the
emergency department is observing a 4-year-old child for signs of increased
intracranial pressure after a fall from a bicycle, resulting in head trauma.
Which of the following signs or symptoms would be cause for concern?
A. Bulging anterior fontanel.
C. Signs of sleepiness at 10 PM.
D. Inability to read short words from a distance
of 18 inches.
17. A nonimmunized
child appears at the clinic with a visible rash. Which of the following
observations indicates the child may have rubeola (measles)?
A. Small blue-white spots are visible on the oral
mucosa.
B. The rash begins on the trunk and spreads
outward.
C. There is low-grade fever.
D. The lesions have a “tear drop on a rose petal”
appearance.
18. A child is seen in
the emergency department for scarlet fever. Which of the following descriptions
of scarlet fever is NOT correct?
A. Scarlet fever is caused by infection with
group A Streptococcus bacteria.
B. “Strawberry tongue” is a characteristic sign.
C. Petechiae occur on the soft palate.
D. The pharynx is red and swollen.
19. A child weighing
30 kg arrives at the clinic with diffuse itching as the result of an allergic
reaction to an insect bite. Diphenhydramine (Benadryl) 25 mg 3 times a day is
prescribed. The correct pediatric dose is 5 mg/kg/day. Which of the following best
describes the prescribed drug dose?
A. It is the correct dose.
B. The dose is too low.
C. The dose is too high.
D. The dose should be increased or
decreased, depending on the symptoms.
20. The mother of a
2-month-old infant brings the child to the clinic for a well baby check. She is
concerned because she feels only one testis in the scrotal sac. Which of the
following statements about the undescended testis is the most accurate?
A. Normally, the testes are descended by birth.
B. The infant will likely require surgical intervention.
C. The infant probably has with only one testis.
D. Normally, the testes descend by one year of
age.
21. A patient is
admitted to the same day surgery unit for liver biopsy. Which of the following
laboratory tests assesses coagulation? Select all that apply.
A. Partial thromboplastin time.
B. Prothrombin time.
D. Hemoglobin
E. Complete Blood Count
F. White Blood Cell Count
22. A patient is
admitted to the hospital with suspected polycythemia vera. Which of the
following symptoms is consistent with the diagnosis? Select all that
apply.
A. Weight loss.
B. Increased clotting time.
C. Hypertension.
D. Headaches.
23. The nurse is
teaching the client how to use a metered dose inhaler (MDI) to administer a
Corticosteroid drug. Which of the following client actions indicates that
he is using the MDI correctly? Select all that apply.
A. The inhaler is held upright.
B. Head is tilted down while inhaling the
medication
C. Client waits 5 minutes between puffs.
D. Mouth is rinsed with water following
administration
E. Client lies supine for 15 minutes following
administration.
24. The nurse is
teaching a client with polycythemia vera about potential complications from
this disease. Which manifestations would the nurse include in the client’s
teaching plan? Select all that apply.
A. Hearing loss
B. Visual disturbance
D. Orthopnea
E. Gout
F. Weight loss
25. Which of the
following would be priority assessment data to gather from a client who has
been diagnosed with pneumonia? Select all that apply.
A. Auscultation of breath sounds
B. Auscultation of bowel sounds
C. Presence of chest pain.
D. Presence of peripheral edema
E. Color of nail beds
26. The nurse is
teaching a client who has been diagnosed with TB how to avoid spreading the
disease to family members. Which statement(s) by the client indicate(s) that he
has understood the nurses instructions? Select all that apply.
A. “I will need to dispose of my old clothing
when I return home.”
B. “I should always cover my mouth and nose
when sneezing.”
C. “It is important that I isolate myself
from family when possible.”
D. “I should use paper tissues to cough in
and dispose of them properly.”
E. “I can use regular plate and utensils
whenever I eat.”
27. The nurse is
admitting a client with hypoglycemia. Identify the signs and symptoms the nurse
should expect. Select all that apply.
A. Thirst
B. Palpitations
D. Slurred speech
E. Hyperventilation
28. Which
adaptations should the nurse caring for a client with diabetic ketoacidosis
expect the client to exhibit? Select all that apply:
A. Sweating
B. Low PCO2
C. Retinopathy
D. Acetone breath
E. Elevated serum bicarbonate
29. When planning
care for a client with ulcerative colitis who is experiencing symptoms, which
client care activities can the nurse appropriately delegate to a unlicensed
assistant? Select all that apply.
A. Assessing the client’s bowel sounds
B. Providing skin care following bowel movements
C. Evaluating the client’s response to
antidiarrheal medications
D. Maintaining intake and output records
E. Obtaining the client’s weight.
30. Which of the
following nursing diagnoses would be appropriate for a client with heart
failure? Select all that apply.
A. Ineffective tissue perfusion related to decreased peripheral blood flow
secondary to decreased cardiac output.
B. Activity intolerance related to increased cardiac output.
C. Decreased cardiac output related to structural and functional changes.
D. Impaired gas exchange related to decreased sympathetic nervous system
activity.
Answers and Rationales
1. A. Elevated serum calcium. The parathyroid glands regulate the calcium
level in the blood. In hyperparathyroidism, the serum calcium level will be
elevated. Parathyroid hormone levels may be high or normal but not low. The
body will lower the level of vitamin D in an attempt to lower calcium. Urine
calcium may be elevated, with calcium spilling over from elevated serum levels.
This may cause renal stones.
2. D. A restricted sodium diet. A patient with Addison’s disease requires
normal dietary sodium to prevent excess fluid loss. Adequate caloric intake is
recommended with a diet high in protein and complex carbohydrates, including
grains.
3. C. Hypoglycemia. A post-operative diabetic patient who is
unable to eat is likely to be suffering from hypoglycemia. Confusion and
shakiness are common symptoms. An anesthesia reaction would not occur on the
second post-operative day. Hyperglycemia and ketoacidosis do not cause
confusion and shakiness.
4. A. Bowel perforation. Bowel perforation is the most serious
complication of fiberoptic colonoscopy. Important signs include progressive
abdominal pain, fever, chills, and tachycardia, which indicate advancing
peritonitis. Viral gastroenteritis and colon cancer do not cause these
symptoms. Diverticulitis may cause pain, fever, and chills, but is far less
serious than perforation and peritonitis.
5. A.Partial thromboplastin time, B. Prothrombin
time, and C. Platelet count. Prothrombin time, partial thromboplastin time, and platelet
count are all included in coagulation studies. The hemoglobin level, though
important information prior to an invasive procedure like liver biopsy, does
not assess coagulation.
6. B. Contaminated food. Hepatitis A is the only type that is
transmitted by the fecal-oral route through contaminated food. Hepatitis B, C,
and D are transmitted through infected bodily fluids.
7. A. A history of hepatitis C five years
previously. Hepatitis C is a viral
infection transmitted through bodily fluids, such as blood, causing
inflammation of the liver. Patients with hepatitis C may not donate blood for
transfusion due to the high risk of infection in the recipient. Cholecystitis
(gall bladder disease), diverticulosis, and history of Crohn’s disease do not
preclude blood donation.
8. A. Naproxen sodium (Naprosyn). Naproxen sodium is a nonsteroidal
anti-inflammatory drug that can cause inflammation of the upper GI tract. For
this reason, it is contraindicated in a patient with gastritis. Calcium carbonate
is used as an antacid for the relief of indigestion and is not contraindicated.
Clarithromycin is an antibacterial often used for the treatment of Helicobacter
pylori in gastritis. Furosemide is a loop diuretic and is contraindicated in a
patient with gastritis.
9. D. The patient should limit fatty
foods. Cholecystitis,
inflammation of the gallbladder, is most commonly caused by the presence of
gallstones, which may block bile (necessary for fat absorption) from entering
the intestines. Patients should decrease dietary fat by limiting foods like
fatty meats, fried foods, and creamy desserts to avoid irritation of the
gallbladder.
10. D. Air hunger. Patients with pulmonary edema experience air
hunger, anxiety, and agitation. Respiration is fast and shallow and heart rate
increases. Stridor is noisy breathing caused by laryngeal swelling or spasm and
is not associated with pulmonary edema.
11. C. A patient with a history of
ventricular tachycardia and syncopal episodes. An automatic internal
cardioverter-defibrillator delivers an electric shock to the heart to terminate
episodes of ventricular tachycardia and ventricular fibrillation. This is
necessary in a patient with significant ventricular symptoms, such as
tachycardia resulting in syncope. A patient with myocardial infarction that
resolved with no permanent cardiac damage would not be a candidate. A patient
recovering well from coronary bypass would not need the device. Atrial
tachycardia is less serious and is treated conservatively with medication and
cardioversion as a last resort.
12. B. The patient has a pacemaker. The implanted pacemaker will interfere with
the magnetic fields of the MRI scanner and may be deactivated by them.
Shellfish/iodine allergy is not a contraindication because the contrast used in
MRI scanning is not iodine-based. Open MRI scanners and anti-anxiety
medications are available for patients with claustrophobia. Psychiatric
medication is not a contraindication to MRI scanning.
13. B. The patient suddenly complains of
chest pain and shortness of breath. Typical symptoms of pulmonary embolism include chest pain,
shortness of breath, and severe anxiety. The physician should be notified
immediately. A patient with pulmonary embolism will not be sleepy or have a
cough with crackles on exam. A patient with fever, chills and loss of appetite
may be developing pneumonia.
14. C. The patient will be admitted to the
surgical unit and resection will be scheduled. A rapidly enlarging abdominal aortic aneurysm
is at significant risk of rupture and should be resected as soon as possible.
No other appropriate treatment options currently exist.
15. D. Check for signs of bleeding, including
examination of urine and stool for blood. A platelet count of 25,000/microliter is severely
thrombocytopenic and should prompt the initiation of bleeding precautions,
including monitoring urine and stool for evidence of bleeding. Monitoring for
fever and requiring protective clothing are indicated to prevent infection if
white blood cells are decreased. Transfusion of red cells is indicated for
severe anemia.
16. B. Repeated vomiting. Increased pressure caused by bleeding or
swelling within the skull can damage delicate brain tissue and may become life
threatening. Repeated vomiting can be an early sign of pressure as the vomit
center within the medulla is stimulated. The anterior fontanel is closed in a
4-year-old child. Evidence of sleepiness at 10 PM is normal for a four year
old. The average 4-year-old child cannot read yet, so this too is normal.
17. A. Small blue-white spots are visible on
the oral mucosa. Koplik’s spots are
small blue-white spots visible on the oral mucosa and are characteristic of
measles infection. The body rash typically begins on the face and travels
downward. High fever is often present. “Tear drop on a rose petal” refers to
the lesions found in varicella (chicken pox).
18. C. Petechiae occur on the soft
palate. Petechiae on the soft
palate are characteristic of rubella infection. Choices A, B, and D are
characteristic of scarlet fever, a result of group A Streptococcus infection.
19. B. The dose is too low. This child weighs 30 kg, and the pediatric
dose of diphenhydramine is 5 mg/kg/day (5 X 30 = 150/day). Therefore, the
correct dose is 150 mg/day. Divided into 3 doses per day, the child should
receive 50 mg 3 times a day rather than 25 mg 3 times a day. Dosage should not
be titrated based on symptoms without consulting a physician.
20. D. Normally, the testes descend by one
year of age. Normally, the testes
descend by one year of age. In young infants, it is common for the testes to
retract into the inguinal canal when the environment is cold or the cremasteric
reflex is stimulated. Exam should be done in a warm room with warm hands. It is
most likely that both testes are present and will descend by a year. If not, a
full assessment will determine the appropriate treatment.
21. A, B, and C. Prothrombin time, partial thromboplastin time,
and platelet count are all included in coagulation studies. The hemoglobin
level, though important information prior to an invasive procedure like liver
biopsy, does not assess coagulation.
22. B, C, and D. Polycythemia vera is a condition in which the
bone marrow produces too many red blood cells. This causes an increase in
hematocrit and viscosity of the blood. Patients can experience headaches,
dizziness, and visual disturbances. Cardiovascular effects include increased
blood pressure and delayed clotting time. Weight loss is not a manifestation of
polycythemia vera.
23. A and D.
24. B, C, D and E. Polycythemia vera, a
condition in which too many RBCs are produced in the blood serum, can lead to
an increase in the hematocrit and hypervolemia, hyperviscosity, and
hypertension. Subsequently, the client can experience dizziness, tinnitus,
visual disturbances, headaches, or a feeling of fullness in the head. The
client may also experience cardiovascular symptoms such as heart failure
(shortness of breath and orthopnea) and increased clotting time or symptoms of
an increased uric acid level such as painful swollen joints (usually the big
toe). Hearing loss and weight loss are not manifestations associated with
polycythemia vera.
25. A, C, E. A respiratory assessment, which
includes auscultation of breath sounds and assessing the color of the nail
beds, is a priority for clients with pneumonia. Assessing for the presence of
chest pain is also an important respiratory assessment as chest pain can
interfere with the client’s ability to breathe deeply. Auscultating bowel
sounds and assessing for peripheral edema may be appropriate assessments, but
these are not priority assessments for the patient with pneumonia.
26. B, D, E.
27. B, C, D. Palpitations, an adrenergic
symptom, occur as the glucose levels fall; the sympathetic nervous system is
activated and epinephrine and norepinephrine are secreted causing this
response. Diaphoresis is a sympathetic nervous system response that occurs as
epinephrine and norepinephrine are released. Slurred speech is a
neuroglycopenic symptom; as the brain receives insufficient glucose, the
activity of the CNS becomes depressed.
28. B, D. Metabolic acidosis initiates
respiratory compensation in the form of Kussmaul respirations to counteract the
effects of ketone buildup, resulting in a lowered PCO2. A fruity odor to the
breath (acetone breath) occurs when the ketone level is elevated in
ketoacidosis.
29. B, D, and E. The nurse can delegate the
following basic care activities to the unlicensed assistant: providing skin
care following bowel movements, maintaining intake and output records, and
obtaining the client’s weight. Assessing the client’s bowel sounds and
evaluating the client’s response to medication are registered nurse activities
that cannot be delegated.
30. A and C. HF is a result of structural and
functional abnormalities of the heart tissue muscle. The heart muscle becomes
weak and does not adequately pump the blood out of the chambers. As a result,
blood pools in the left ventricle and backs up into the left atrium, and
eventually into the lungs. Therefore, greater amounts of blood remain in the
ventricle after contraction thereby decreasing cardiac output. In addition,
this pooling leads to thrombus formation and ineffective tissue perfusion
because of the decrease in blood flow to the other organs and tissues of the
body. Typically, these clients have an ejection fraction of less than 50% and
poorly tolerate activity. Activity intolerance is related to a decrease, not
increase, in cardiac output. Gas exchange is impaired. However, the decrease in
cardiac output triggers compensatory mechanisms, such as an increase in
sympathetic nervous system activity.
Previous Nursing Exam Question Paper
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