While performing a medication reconciliation the nurse notes that the patient takes zolpidem at home and knows that this is used to treat which condition?
Seizures
Insomnia
✓
HIV
Atrial fibrillation
Correct Answer
Insomnia
Zolpidem is a medication indicated in the short-term treatment of insomnia.
Question 2
The nurse educates a patient to remain upright following administration of alendronate to avoid which possible complication?
Seizure
Esophagitis
✓
Autonomic dysreflexia
Vomiting
Correct Answer
Esophagitis
A patient taking alendronate must remain upright for thirty minutes following administration due to the risk of esophagitis.
Question 3
The nurse educates a patient taking raloxifene to monitor for signs and symptoms which of the following potential complications?
Osteoporosis
Asthma
Thromboembolic events
✓
Breast cancer
Correct Answer
Thromboembolic events
Raloxifene is used to treat osteoporosis and may decrease breast cancer risk. However, it can increase a patient's risk for thromboembolic events such as DVT and PE.
Question 4
Which medication is most likely to be used in the treatment of an acute gout episode?
Febuxostat
Colchicine
✓
Allopurinol
Probenecid
Correct Answer
Colchicine
Colchicine is indicated in the treatment of acute gout. Allopurinol, probenecid, and febuxostat may be given to patients to treat chronic gout.
Question 5
The nurse expects a patient taking allopurinol experiences which type of condition?
Muscular dystrophy
Multiple sclerosis
Chronic gout
✓
Acute gout
Correct Answer
Chronic gout
Allopurinol is indicated in the treatment of chronic gout.
Question 6
Patients who self-administer insulin should be taught to rotate injection sites to prevent which complication?
Infection
Stevens-Johnson syndrome
Lipohypertrophy
✓
Phlebitis
Correct Answer
Lipohypertrophy
Lipohypertrophy is a possible complication of insulin use, which can be avoided by rotating injection sites.
Question 7
The nurse educates a patient taking metformin to report nausea, fatigue, and muscle cramps to the provider due to risk for which complication associated with metformin?
Lactic acidosis
✓
Metabolic alkalosis
Tendonitis
Deep Vein Thrombosis
Correct Answer
Lactic acidosis
Lactic acidosis is a potential complication associated with metformin use. Signs and symptoms of lactic acidosis include nausea, vomiting, fatigue, muscle cramps, abdominal pain, tachypnea, and hypotension.
Question 8
The nurse is caring for a patient who is unconscious and has a blood glucose level of 24 mg/dL. Which medication should the nurse administer?
D5W
Glucagon
✓
Regular insulin
Oral glucose gel
Correct Answer
Glucagon
An unconscious patient experiencing hypoglycemia should receive glucagon. Oral glucose gel is indicated for an alert patient who can maintain their own airway. D5W may be indicated for management of hypoglycemia, but is not indicated for the acute treatment. Regular insulin would worsen hypoglycemia.
Question 9
The nurse educates a patient with Graves' disease that which medication regimen will be initiated?
Levothyroxine
Liothyronine
Propylthiouracil
✓
Thyrotropin alfa
Correct Answer
Propylthiouracil
A patient with hyperthyroidism/Graves' disease may be treated with propylthiouracil. The other listed medications may be administered for hypothyroidism.
Question 10
A nurse is providing teaching to a patient and their parents on somatropin. The parents ask how long this medication will be given to their child. What response should the nurse provide?
The medication will be stopped prior to epiphyseal closure.
✓
The medication will be needed for the rest of their life.
The medication is only administered once.
The medication will be given for one month then reassessed.
Correct Answer
The medication will be stopped prior to epiphyseal closure.
Somatropin is a growth hormone. Growth rate and bone age should be monitored often, and the medication should be discontinued prior to epiphyseal closure.
Question 11
A patient with diabetes insipidus may receive treatment with which of the following medications?
Insulin glargine
Nitroprusside
Regular insulin
Vasopressin
✓
Correct Answer
Vasopressin
Patients with diabetes insipidus will have large volumes of dilute urine and may require vasopressin therapy for hemodynamic support.
Question 12
Which of the following is most likely to result in a patient experiencing an Addisonian crisis?
Long term fludrocortisone regimen
Beginning a prednisone burst
Ending a prednisone taper
Abrupt discontinuation of fludrocortisone
✓
Correct Answer
Abrupt discontinuation of fludrocortisone
Abrupt discontinuation of a steroid such as fludrocortisone may lead to an Addisonian crisis.
Question 13
A patient is prescribed sucralfate. The patient asks the nurse when they should take this medication. What is the best response by the nurse?
Take 1 hour before meals
Take 1 hour after meals and upon waking up
Take at bedtime
Take 1 hour before meals and at bedtime
✓
Correct Answer
Take 1 hour before meals and at bedtime
Sucralfate should be taken one hour before meals and at bedtime, a total of 4 times per day.
Question 14
A nurse is caring for a patient who is prescribed a laxative in order to lower ammonia levels. Which laxative was this patient most likely prescribed?
Lactulose
✓
Magnesium hydroxide
Docusate sodium
Magnesium citrate
Correct Answer
Lactulose
Lactulose is a laxative that can also be used to help treat hepatic encephalopathy by reducing serum ammonia levels.
Question 15
The nurse is caring for a patient experiencing gastroparesis as a result of diabetes mellitus. Which medication should the nurse anticipate administering?
Misoprostol
Metformin
Metoclopramide
✓
Ondansetron
Correct Answer
Metoclopramide
Metoclopramide can be used to increase GI tract motility in patients experiencing gastroparesis.
Question 16
A nurse is caring for a patient with irritable bowel syndrome with diarrhea. Which medication is this patient likely to be given?
Alosetron
✓
Lubiprostone
Bisacodyl
Sennosides
Correct Answer
Alosetron
A patient with IBS diarrhea will be given alosetron. A patient with IBS constipation would be given lubiprostone.
Question 17
A nurse is caring for a patient with cystic fibrosis. This patient is prescribed a medication to help break down food. The nurse knows this medication is what?
Pancrelipase
✓
Bisacodyl
Lubiprostone
Alosetron
Correct Answer
Pancrelipase
Pancrelipase is a digestive agent given to patients to help break down food when the pancreas is unable to.
Question 18
The nurse should educate a patient taking spironolactone to decrease their dietary intake of which electrolyte?
Potassium
✓
Sodium
Magnesium
Phosphorus
Correct Answer
Potassium
Patients taking spironolactone, a potassium-sparing diuretic, should decrease their dietary intake of potassium.
Question 19
Which of the following is a key adverse effect of methotrexate?
Hyperglycemia
Thrombocytosis
Increased risk of infection
✓
Hypertension
Correct Answer
Increased risk of infection
Methotrexate is an antimetabolite that suppresses the immune system, placing the patient at increased risk for infection. Anemia, leukopenia, and thrombocytopenia (NOT thrombocytosis) are also side effects of methotrexate. Methotrexate does not typically cause hypertension or hyperglycemia.
Question 20
A nurse is caring for a patient undergoing treatment with doxorubicin. The patient rings the call bell to alert the nurse that their urine is red. What should the nurse do first?
Call the provider to report hematuria
Order a urinalysis with specific gravity
Take the patient's vital signs focusing on their temperature
Explain to the patient that this is a normal side effect
✓
Correct Answer
Explain to the patient that this is a normal side effect
Red discoloration of sweat, tears, and urine can occur when taking doxorubicin.
Question 21
Tamoxifen is a medication which can be used to both prevent and treat which condition?
Breast cancer
✓
Type 2 diabetes mellitus
Hypertension
Neutropenia
Correct Answer
Breast cancer
Tamoxifen is indicated in the prevention and treatment of breast cancer.
Question 22
Which of the following medications treats cancer by enhancing the body's immune response?
Cyclophosphamide
Interferon alpha-2b
✓
Methotrexate
Prednisone
Correct Answer
Interferon alpha-2b
Interferon alpha-2b is an immune modifier that enhances the body's immune response to tumors and viruses.
Question 23
The nurse educates a patient beginning levofloxacin treatment to monitor for which of the following potential adverse effects?
Seizures
Fluid volume overload
Blue-gray skin discoloration
Tendon rupture
✓
Correct Answer
Tendon rupture
Fluoroquinolones, such as levofloxacin, carry a black box warning for achilles tendon rupture.
Question 24
Which of the following medications is used to treat giardiasis?
Acyclovir
Metronidazole
✓
Amoxicillin
Fluconazole
Correct Answer
Metronidazole
Metronidazole is an antimicrobial agent that is commonly used to treat a giardiasis, a parasitic infection. Penicillins, such as amoxicillin, are not typically used in the treatment of giardiasis. Fluconazole is used to treat fungal infections. Acyclovir is used to treat viral infections.
Question 25
A child presents at a health care clinic with impetigo. Which of the following medications does the nurse anticipate will be prescribed for the child?
Hydrocortisone
Mupirocin
✓
Clotrimazole
Acyclovir
Correct Answer
Mupirocin
Mupirocin is an antibiotic ointment that is used to treat bacterial skin infections such as impetigo. The other medications are not used to treat bacterial infections. Clotrimazole is an antifungal medication. Hydrocortisone is a topical steroid medication. Acyclovir is an antiviral medication.
Question 26
Which of the following topical medications used in the treatment of a burn wound is associated with the development of metabolic acidosis?
Mafenide acetate
✓
Manuka honey
Bacitracin
Silver sulfadiazine
Correct Answer
Mafenide acetate
Mafenide acetate may cause metabolic acidosis. This is not an adverse effect that is associated with the other topical antibiotics.
Question 27
A nurse is caring for a patient using silver sulfadiazine for a burn wound. Which of the following lab values should be closely monitored during therapy?
Calcium and vitamin D levels
Amylase and lipase levels
CBC levels
✓
T3 and TSH levels
Correct Answer
CBC levels
Silver sulfadiazine may cause leukopenia. Therefore, CBC levels should be monitored during therapy. This medication is not known to cause issues with the thyroid gland or pancreas, or issues with calcium and vitamin D absorption. Therefore, monitoring of T3, TSH, amylase, lipase, calcium, and vitamin D is not necessary during therapy.
Question 28
Which medication is used to soften and remove scales for patients with psoriasis?
Isotretinoin
Salicylic acid
✓
Corticosteroids
Nystatin
Correct Answer
Salicylic acid
Salicylic acid softens and removes scales associated with psoriasis.
Question 29
A nurse is caring for a patient with severe acne. The provider orders a pregnancy test for this patient. Which mediction is the doctor likely going to prescribe this patient for their acne?
Corticosteroids
Oral isotretinoin
✓
Benzoyl peroxide
Clindamycin
Correct Answer
Oral isotretinoin
Oral isotretinoin requires two negative pregnancy tests prior to starting therapy as well as monthly pregnancy tests.
Question 30
Which of the following topical medications used in the treatment of acne may cause bleaching of clothing and bedding?
Benzoyl peroxide
✓
Salicylic acid
Isotretinoin
Tretinoin
Correct Answer
Benzoyl peroxide
Benzoyl peroxide may cause bleaching of hair, clothing, and linens. Tretinoin and salicylic acid do not carry this side effect. Isotretinoin is an oral medication, not a topical agent.
Question 31
Which of the following is a consideration for patients taking isotretinoin?
A two week washout period is required prior to starting treatment
Patients should be placed on bleeding precautions
Patients should take monthly pregnancy tests
✓
Patients may continue this medication while breastfeeding
Correct Answer
Patients should take monthly pregnancy tests
Isotretinoin is a highly teratogenic medication which requires a negative pregnancy test prior to starting therapy as well as monthly pregnancy tests.
Question 32
A nurse is administering cyclosporine to a patient. Which assessment finding should be reported to the provider immediately?
Headache
Constipation
Fever
✓
Insomnia
Correct Answer
Fever
Signs of infection should be reported to a provider right away for patients on immunusuppressant drugs such as cyclosporine.
Question 33
For a fetus in the ROA position, the nurse should anticipate placing the external FHR transducer in which quadrant of the maternal abdomen?
LLQ
LUQ
RLQ
✓
RUQ
Correct Answer
RLQ
For a fetus in the ROA position, the transducer should be placed over the fetal back, which would be in the maternal right lower quadrant.
Question 34
The nurse is assessing the fetal position of a patient in active labor. Which fetal position should the nurse identify as being optimal for vaginal delivery?
ROA
RSA
LOA
✓
LSA
Correct Answer
LOA
Left occiput anterior (LOA) is the optimal fetal position for delivery. Right occiput anterior is less preferable. Sacral presentation (e.g., LSA, RSA) is not optimal.
Question 35
A laboring patient is noted to have a fetus in the occiput posterior position. Which maternal position should the nurse encourage to facilitate rotation to an anterior fetal presentation?
Hands and knees
✓
Lithotomy position
Trendelenburg positioning
Knee-chest
Correct Answer
Hands and knees
Placing a patient on their hands and knees may help rotate a posterior fetus to anterior positioning.
Question 36
When assessing a patient who is 30 weeks pregnant, the nurse measures the fundal height to be 38 cm. Which abnormality might the patient be experiencing?
Passage of meconium
Intrauterine growth restriction
Oligohydramnios
Polyhydramnios
✓
Correct Answer
Polyhydramnios
Polyhydramnios (i.e., excessive amniotic fluid volume) may cause the patient to have a larger than expected fundal height.
Question 37
A postpartum patient who is breastfeeding calls the OBGYN clinic reporting symptoms. Based on the patient's description, the nurse suspects mastitis. Which reported symptoms are consistent with mastitis? Select all that apply.
Unilateral erythema of the breast
Bilateral breast fullness and discomfort
Chills and malaise
Cracked or sore nipples
✓
Correct Answer
Cracked or sore nipples
Mastitis typically presents with localized erythema, pain/tenderness, cracked nipples that serve as a portal of entry for bacteria, and systemic flu-like symptoms (i.e., fever, chills, malaise).
Question 38
The nurse is assessing a postpartum patient who reports pain in the left calf. Which additional findings would require the nurse to suspect a thromboembolic event? Select all that apply.
Bilateral lower extremity edema
Unilateral lower extremity edema
Erythema along the vein pathway
Localized warmth in the affected leg
✓
Correct Answer
Localized warmth in the affected leg
Classic signs of DVT include unilateral swelling, warmth, redness, calf tenderness, and a positive Homan's sign. Bilateral lower extremity swelling is more consistent with systemic or dependent edema, not DVT.
Question 39
A nurse is assessing a patient for pregnancy. Which of the following is considered a probable sign of pregnancy? Select all that apply.
Hegar's sign
Fetal heart sounds
Positive pregnancy test
✓
Amenorrhea
Correct Answer
Positive pregnancy test
Probable signs include Chadwick's sign, Goodell's sign, Hegar's sign, ballottement, and positive pregnancy test. These signs are probably related to pregnancy.
Question 40
A nurse is reviewing signs of pregnancy with a newly pregnant patient. Which of the following are considered positive signs of pregnancy? Select all that apply.
Visualization of the fetus by ultrasound
✓
Positive pregnancy test
Fetal movement felt by the pregnant patient
Auscultation of fetal heart tones by doppler
Correct Answer
Visualization of the fetus by ultrasound
Positive signs include fetal movement felt by a healthcare provider, auscultation of fetal heart sounds, and fetal visualization on ultrasound.
Question 41
During a newborn assessment, the nurse palpates the anterior fontanel. Which finding(s) should the nurse expect in a healthy infant? Select all that apply.
Triangular-shaped
Bulging and pulsating
Smaller than the posterior
Diamond-shaped
✓
Correct Answer
Diamond-shaped
The newborn's anterior fontanel should be larger than the posterior, diamond-shaped, soft, and flat. A sunken or bulging fontanel is not an expected finding in a healthy infant.
Question 42
The nurse is providing safe sleep teaching to new parents. Which statements by the parents indicate correct understanding of crib safety? Select all that apply.
"If it is cold, I should use only a thin blanket in the crib."
"If my baby spits up, I should have them sleep on an incline."
"The crib slats should be no more than 2.75 inches apart."
"I should move the crib away from heating and cooling vents."
✓
Correct Answer
"I should move the crib away from heating and cooling vents."
Safe sleep practices include positioning the crib away from vents, a firm mattress with no gaps, supine positioning, and crib slats ≤ 2.75 inches apart. Blankets, pillows, bumper pads, or stuffed animals increase the risk of suffocation and should be avoided.
Question 43
The nurse is educating new parents on expected changes in their newborn during the first few days of life. Which statements indicate appropriate understanding about weight changes? Select all that apply.
"It's normal for my baby to lose up to 20% of their birth weight."
"My baby will continue losing weight steadily until 1 month old."
"It's normal for my baby to lose about 5-10% of birth weight in the first few days."
✓
"If my baby loses 5% of their birth weight, I must supplement with formula."
Correct Answer
"It's normal for my baby to lose about 5-10% of birth weight in the first few days."
Newborns normally lose 5-10% of their birth weight in the first days of life due to fluid shifts, regaining it by about 10-14 days.
Question 44
A breastfeeding patient presents with unilateral breast pain, erythema, cracked nipples, and flu-like symptoms. The provider diagnoses mastitis. Which nursing instructions are most appropriate for this patient? Select all that apply.
"Continue breastfeeding or pumping frequently from both breasts."
✓
"Apply warm compresses to the affected breast before feeding."
"Use tight breast binding to reduce milk supply."
"Stop breastfeeding until the infection resolves."
Correct Answer
"Continue breastfeeding or pumping frequently from both breasts."
Treatment of mastitis includes frequent emptying of the breasts, warm compresses, supportive care, and antibiotics. Breastfeeding should continue; binding the breasts or stopping feedings can worsen infection and risk complications.
Question 45
The nurse is assessing a patient on postpartum day 3. Which findings would the nurse expect when assessing lochia? Select all that apply.
Lochia serosa
Lochia alba
Scant to absent
Small to moderate amount
✓
Correct Answer
Small to moderate amount
On day 3, lochia should still be rubra (dark red), with a small to moderate amount. By day 4-10, lochia transitions to serosa (pink/brown), and then to alba (yellow-white) after day 10. A foul odor at any stage indicates infection and is abnormal.
Question 46
The nurse is reviewing risk factors for postpartum endometritis with a group of new graduate nurses. Which patients are at highest risk for developing this infection? Select all that apply.
A patient who delivered twins via c-section
A patient who had a spontaneous vaginal delivery within 6 hours of rupture of membranes
A patient with prolonged labor requiring internal monitoring
✓
A patient who had multiple vaginal exams during labor
Correct Answer
A patient with prolonged labor requiring internal monitoring
Endometritis risk increases with c-section delivery, prolonged rupture of membranes, multiple vaginal exams, and use of internal monitoring. A vaginal birth without complications is the lowest risk.
Question 47
The nurse is reviewing the obstetric history of a patient documented as G7 P2042. Which statements accurately interpret this history? Select all that apply.
The patient has had no preterm deliveries
The patient has two living children
The patient has had four miscarriages or abortions
The patient has had two term deliveries
✓
Correct Answer
The patient has had two term deliveries
This patient is currently pregnant for the seventh time. They have had 2 term births, 0 preterm births, 4 miscarriages or abortions, and have two living children.
Question 48
The nurse is assessing a newborn whose parent had gestational diabetes mellitus (GDM). Which complications are the newborn at increased risk for? Select all that apply.
Macrosomia
Hypoglycemia
✓
Shoulder dystocia/birth trauma
Craniofacial microsomia
Correct Answer
Hypoglycemia
Infants born to a patient with gestational diabetes mellitus may experience macrosomia (thereby increasing the risk for birth injuries) and hypoglycemia following delivery.
Question 49
The nurse is preparing for labor management of a patient with HIV. Which type of interventions should be avoided to reduce the risk of HIV transmission to the newborn? Select all that apply.
Epidural anesthesia
Fetal scalp electrode
✓
Effleurage for pain
Intermittent auscultation via doppler
Correct Answer
Fetal scalp electrode
Due to the risk for infection and fetal/maternal cross-contamination, internal monitoring must be avoided for patients who are HIV+.
Question 50
A patient has been treated for a hydatidiform mole. Which follow-up care instructions should the nurse provide? Select all that apply.
Have serial quantitative hCG levels drawn for 6 months
Avoid hormonal contraception for one year
Have serum hemoglobin monitoring for 6 months
Avoid pregnancy for one year
✓
Correct Answer
Avoid pregnancy for one year
Patients who experience a hydatidiform mole (molar pregnancy) should have monitoring of their serum hCG levels for six months due to the risk of choriocarcinoma. Pregnancy must be avoided (use contraception) to avoid confusing rising hCG from a new pregnancy with disease recurrence.
Question 51
The nurse is teaching a prenatal class about expected integumentary changes during pregnancy. Which changes should the nurse include as normal? Select all that apply.
Palmar petechiae
Linea nigra
✓
Chloasma
Senile lentigines
Correct Answer
Linea nigra
Chloasma, striae gravidarum, and linea nigra are all integumentary changes which may happen during pregnancy. Senile lentigines and petechiae are not expected findings.
Question 52
The nurse is reviewing labs for a patient with suspected HELLP syndrome. Which changes in laboratory values are consistent with this condition? Select all that apply.
Leukopenia
Thrombocytosis
Leukocytosis
Elevated AST and ALT
✓
Correct Answer
Elevated AST and ALT
HELLP = Hemolysis, Elevated Liver enzymes, Low Platelets. It is a severe complication of preeclampsia. HELLP syndrome lab value changes include elevated liver enzymes and low platelets (i.e., thrombocytopenia). White blood cells would not be affected from this condition.
Question 53
A nurse is educating a breastfeeding patient about contraception. Which methods are considered safe and appropriate for use while breastfeeding? Select all that apply.
Progestin-only oral contraceptives
✓
Copper IUD
Combined oral contraceptives
Diaphragm
Correct Answer
Progestin-only oral contraceptives
Contraceptives including estrogen, as in combined oral contraceptives, are contraindicated for patients who are currently breastfeeding.
Question 54
A patient with preeclampsia is receiving magnesium sulfate. The nurse is monitoring for signs of magnesium toxicity. Which findings would require immediate intervention? Select all that apply.
Respiratory rate of 6 breaths per minute
Absent deep tendon reflexes
Decreased level of consciousness
✓
Heart rate of 98 bpm
Correct Answer
Decreased level of consciousness
Magnesium toxicity may be marked by decreased DTRs, decreased LOC, decreased respirations, and urine output < 30 mL/hr.
Question 55
The nurse is teaching new graduate nurses about risk factors for cephalohematoma in the newborn. Which situations increase the likelihood of this condition? Select all that apply.
Elective c-section
Preterm birth
Forceps assisted delivery
Prolonged labor
✓
Correct Answer
Prolonged labor
Cephalohematoma is bleeding between the periosteum and skull caused by trauma during birth. Risk factors include forceps or vacuum assisted vaginal delivery, fetal macrosomia, and prolonged labor. A scheduled cesarean and a preterm birth carry minimal risk.
Question 56
A patient at 37 weeks' gestation is scheduled for an external cephalic version (ECV). The nurse explains that which complications are associated with this procedure? Select all that apply.
Umbilical cord compression
Postpartum endometritis
Uterine tachysystole
Placental abruption
✓
Correct Answer
Placental abruption
External cephalic version may result in the onset of labor, umbilical cord compression, and/or placental abruption. Uterine tachysystole and postpartum endometritis are not associated with an ECV.
Question 57
The nurse is teaching students about risk factors for postpartum hemorrhage (PPH). Which conditions increase the risk of PPH? Select all that apply.
Multiparity
Precipitous delivery
Treatment with magnesium sulfate
✓
Preterm birth
Correct Answer
Treatment with magnesium sulfate
Risk factors for PPH include uterine atony (from multiparity, prolonged/precipitous labor, magnesium sulfate use), infection, retained placenta, and operative birth. Preterm birth is not a risk factor for postpartum hemorrhage.
Question 58
The nurse is reviewing medications used in the management of postpartum hemorrhage. Which agents are appropriate for treatment? Select all that apply.
Carboprost
✓
Terbutaline
Methotrexate
Magnesium sulfate
Correct Answer
Carboprost
Oxytocin, methylergonovine, and carboprost are all indicated in the treatment of postpartum hemorrhage. Terbutaline, methotrexate, and magnesium sulfate are not appropriate for the treatment of PPH.
Question 59
The nurse is caring for a client who has experienced a spinal injury. The nurse would be concerned about neurogenic shock if the injury is above what level?
C5
T6
✓
S1
L3
Correct Answer
T6
Neurogenic shock is marked by hypotension, bradycardia, and temperature instability and most commonly occurs with a spinal injury above T6.
Question 60
A male client reports urinary frequency, hesitancy, and post-void dribbling. When reviewing the client's lab results, the nurse notes which lab result is indicative of benign prostatic hyperplasia?
BUN = 6 mg/dL
Creatinine = 1.2 mg/dL
WBC = 4,000/mm3
PSA = 6 ng/mL
✓
Correct Answer
PSA = 6 ng/mL
A patient with benign prostatic hyperplasia may have an increased prostate specific antigen level (PSA >4), increased WBCs if a UTI is present, and increased BUN and/or creatinine if the kidneys are involved.
Question 61
The nurse is caring for a client experiencing massive proteinuria, frothy urine, edema, and weight gain. Which diagnosis should the nurse anticipate?
Nephrotic syndrome
✓
Renal tubular acidosis
Glomerulonephritis
Hemolytic uremic syndrome
Correct Answer
Nephrotic syndrome
Nephrotic syndrome is marked by massive proteinuria (resulting in frothy urine), edema due to protein loss, and weight gain as a result of fluid retention.
Question 62
The nurse is caring for a client with a chest tube. The chest tube has become disconnected from the drainage system. What is the nurse's priority action?
Call the provider
Assess the patient's respiratory status
Remove the chest tube from the patient
Place the end of the tube in sterile water
✓
Correct Answer
Place the end of the tube in sterile water
Although the nurse should alert the provider and assess the patient's respiratory status, the priority action is to place the end of the tube into sterile water to maintain the water seal and prevent additional complications.
Question 63
The nurse is assessing a client's chest tube collection system. In which area does the nurse expect to see continuous bubbling?
At the insertion site
Water seal chamber
Suction control chamber
✓
Within the chest tube
Correct Answer
Suction control chamber
Continuous bubbling within the suction control chamber demonstrates that the suction is working appropriately. Continuous bubbling is an unexpected finding anywhere else in the closed system.
Question 64
The nurse is reviewing chest tubes with a student nurse as they assess a client's chest tube drainage system. The student nurse notes tidaling in the water seal chamber. Which of the following statements would be accurate if used to describe the cause of the tidaling?
An air leak
Too little suction
Too much suction
The patient's breathing
✓
Correct Answer
The patient's breathing
Tidaling refers to the gentle movement of the water seal caused by pressure changes related to a patient's breathing. This is an expected finding.
Question 65
The nurse is caring for a client who is to undergo a thoracentesis procedure. What position should the nurse assist the client into while preparing for this procedure?
Left lateral recumbent
Sitting upright with arms on an overbed table
✓
Prone
Trendelenburg
Correct Answer
Sitting upright with arms on an overbed table
A patient receiving a thoracentesis to drain fluid from the lungs should be positioned sitting upright with the arms supported on pillows or an overbed table.
Question 66
The nurse is reviewing the use of defibrillation with a student nurse. Which of the following arrhythmias if stated by a the student as appropriate for defibrillation would require follow up?
Coarse ventricular fibrillation
Pulseless ventricular tachycardia
Pulseless electrical activity
✓
Fine ventricular fibrillation
Correct Answer
Pulseless electrical activity
Defibrillation is indicated for pulseless ventricular tachycardia and ventricular fibrillation (both coarse and fine). Patients in pulseless electrical activity should receive CPR, not defibrillation.
Question 67
The nurse is reviewing the use of synchronized cardioversion with a student nurse. Which of the following arrhythmias if stated by a the student as appropriate for synchronized cardioversion would require follow up?
Stable ventricular tachycardia
Pulseless ventricular tachycardia
✓
Atrial fibrillation with rapid ventricular response
Supraventricular tachycardia
Correct Answer
Pulseless ventricular tachycardia
Synchronized cardioversion is indicated for the treatment of SVT, stable ventricular tachycardia, and atrial fibrillation with rapid ventricular response. Patients with pulseless ventricular tachycardia should receive defibrillation.
Question 68
The nurse is reviewing causes of metabolic acidosis with a student nurse. Which of the following potential causes if stated by the student nurse would require follow up?
Diabetic ketoacidosis
Kidney failure
Diarrhea
Hyperglycemic hyperosmolar state
✓
Correct Answer
Hyperglycemic hyperosmolar state
Diarrhea, kidney failure, and DKA may all cause metabolic acidosis. Hyperglycemic hyperosmolar state does not result in an acid/base imbalance.
Question 69
A nurse is caring for a client with a venous thromboembolism (VTE). While discussing contributing factors to VTE development with a student nurse, which of the following symptoms if stated by the student nurse as one of Virchow's triad would require follow up?
Impaired blood flow
Hypocoagulability
✓
Hypercoagulability
Endothelial injury
Correct Answer
Hypocoagulability
The three parts of Virchow's triad are endothelial injury, impaired blood flow, and hypercoagulability.
Question 70
The nurse is preparing to assist with synchronized cardioversion. Which of the following arrhythmias does the nurse anticipate is this client's diagnosis?
Ventricular fibrillation
Pulseless ventricular tachycardia
Supraventricular tachycardia
✓
Asystole
Correct Answer
Supraventricular tachycardia
Synchronized cardioversion is indicated for a patient in SVT. Patients in pulseless ventricular tachycardia and ventricular fibrillation should receive defibrillation. Patients in asystole should receive CPR.
Question 71
The nurse is developing a plan of care for a patient at risk for the development of rheumatic fever. Which of the following diagnoses would increase that risk?
Cellulitis infection with methicillin-resistant Staphylococcus aureus
Respiratory infection with group A Streptococci
✓
Consumption of raw or undercooked meat
Family history of rheumatic fever
Correct Answer
Respiratory infection with group A Streptococci
Respiratory infection with group A beta-hemolytic Streptococci (GABHS) is a key factor in the development of rheumatic fever.
Question 72
The nurse is assessing a client who complains of cyanotic, cold, numb, and painful fingers when exposed to cold or stress. Which of the following diagnoses does the nurse anticipate?
Venous insufficiency
Raynaud's phenomenon
✓
Compartment syndrome
Sjogren's syndrome
Correct Answer
Raynaud's phenomenon
Raynaud's phenomenon results in peripheral vasospasm causing cold, cyanotic, numb, and/or painful fingers after exposure to cold or stress.
Question 73
The nurse is caring for a client experiencing hepatic encephalopathy. Which of the following medications does the nurse anticipate administering to remove excess ammonia?
Insulin
Calcium gluconate
Lactulose
✓
Psyllium husk
Correct Answer
Lactulose
Lactulose is a laxative which also works to remove excess ammonia.
Question 74
The nurse is providing client education on the terminology used in staging their tumor. How should the nurse define the use of "N"?
Neurogenic involvement
Level of nodular appearance
Number of regional lymph nodes involves
✓
Severity of neoplastic disease
Correct Answer
Number of regional lymph nodes involves
The "N" value when staging a tumor represents the number of regional lymph nodes involved.
Question 75
The nurse is caring for a client diagnosed with osteomalacia. Which of the following treatment orders does the nurse anticipate for this client?
Continuous passive motion
Buck's traction
Vitamin D supplementation
✓
Phototherapy
Correct Answer
Vitamin D supplementation
The primary treatment for osteomalacia is supplementation of vitamin D.
Question 76
The nurse is providing education to a client with osteoporosis. Which type of exercise should the nurse include as a recommendation?
Swimming
Walking
✓
Using resistance bands while seated
Riding a bicycle
Correct Answer
Walking
Patients with osteoporosis should engage in weight-bearing exercise, such as walking. Swimming, riding a bicycle, and the use of resistance bands while seated are all examples of non-weight-bearing exercise.
Question 77
A nurse is caring for a client diagnosed with acute kidney injury (AKI). The client had a urine output of 150 mL during the last 12 hours. Which stage of AKI does the nurse anticipate this client is experiencing?
Diuresis
Recovery
Onset
Oliguria
✓
Correct Answer
Oliguria
Urine output of <400mL/day is the oliguria stage of AKI.
Question 78
The nurse has received an order to strain a client's urine. Which renal disorder is this client likely experiencing?
Glomerulonephritis
Urolithiasis
✓
Nephrotic Syndrome
Acute Kidney Injury
Correct Answer
Urolithiasis
Urolithiasis is the presence of stones within the urinary tract. The nurse should strain all of the patient's urine to find the stones. The stones should be sent to the lab for analysis.
Question 79
The nurse is caring for a client experiencing chest pain that occurs with exercise or at rest and has increased in duration, frequency, or severity over time. Which diagnosis does the nurse anticipate?
Microvascular angina
Stable angina
Variant (Prinzmetal's) angina
Unstable angina
✓
Correct Answer
Unstable angina
Unstable angina occurs with exercise or at rest and increases in duration, frequency and/or severity over time.
Question 80
The nurse is caring for a client with sickle cell anemia experiencing a vaso-occlusive crisis. Which of the following analgesics does the nurse anticipate administering?
Acetaminophen
Ketorolac
Ibuprofen
Hydromorphone
✓
Correct Answer
Hydromorphone
Patients with sickle cell anemia experiencing vaso-occlusive crisis should be treated with opioid analgesics such as hydromorphone, morphine, or fentanyl. Non-opioid analgesics such as acetaminophen, ibuprofen, or ketorolac are not indicated for this type of pain.
Question 81
The nurse is reviewing signs of hypocalcemia with a student nurse. Which of the following symptoms if stated by the student nurse would require follow up?
Peaked T-waves on EKG
✓
Circumoral numbness/tingling
Trousseau's sign
Chvostek's sign
Correct Answer
Peaked T-waves on EKG
Hypocalcemia is marked by positive Chvostek's and Trousseau's signs, muscle spasms, numbness/tingling in the lips and fingers, and GI upset. Peaked T-waves on EKG is a possible finding associated with hyperkalemia.
Question 82
The nurse is reviewing hyperglycemia symptoms with a client recently diagnosed with diabetes mellitus. Which of the following symptoms if stated by the client would require follow up?
Polyuria
Polyphagia
Polyplegia
✓
Polydipsia
Correct Answer
Polyplegia
Hyperglycemia can cause polydipsia (i.e., excessive thirst), polyphagia (i.e., excessive hunger), and polyuria (i.e., excessive urination). Polyplegia (i.e., paralysis of many muscles) is not an expected finding.
Question 83
A nurse is reviewing care for a client with a traumatic brain injury and the presence of symptoms associated with Cushing's triad. When discussing with a student nurse, which of the following symptoms if stated as a Cushing's triad would require follow up?
Tachycardia
✓
Systolic hypertension
Irregular breathing
Bradycardia
Correct Answer
Tachycardia
Systolic hypertension (widened pulse pressure), bradycardia, and irregular breathing are part of Cushing's triad.
Question 84
The nurse is reviewing instructions with a client prior to their EEG scheduled for tomorrow. Which of the following if stated by the client would require follow up?
Arrive sleep deprived
Remain NPO
✓
Avoid stimulants
Wash hair
Correct Answer
Remain NPO
Prior to an EEG a patient should wash their hair, arrive sleep deprived, avoid stimulants, and avoid sedatives. There is no need to remain NPO.
Question 85
The nurse is reviewing migraine headaches with a student nurse. Which of the following statements made by the student would require follow up?
They may be accompanied by vomiting
Photophobia may be present
They may be preceded by an aura
They are made better by pacing
✓
Correct Answer
They are made better by pacing
Migraine headaches may be characterized by unilateral throbbing headache, nausea and vomiting, aura, photophobia, phonophobia, and are made better by lying still in a dark, quiet environment.
Question 86
The nurse is reviewing medication typically used to treat tuberculosis with a nursing student. Which of the following medications if stated by the nursing student would require follow up?
Rifampin
Pyrazinamide
Phenazopyridine
✓
Isoniazid
Correct Answer
Phenazopyridine
The four most common medications used to treat tuberculosis are rifampin, isoniazid, pyrazinamide, and ethambutol. Phenazopyridine is used to treat pain associated with urinary tract infections.
Question 87
The nurse is reviewing causes of ventilator low pressure alarms with a new nurse. Which cause if stated by the new nurse as resulting in a low pressure alarm would require follow up?
Cuff leak
Tube displacement
Patient coughing
✓
Equipment disconnection
Correct Answer
Patient coughing
Low pressure alarms are typically a result of a leak or a disconnect. A patient coughing would trigger a high pressure alarm.
Question 88
The nurse is reviewing potential vitamin deficiencies with a client diagnosed with cystic fibrosis. Which of the following vitamins if stated by the nurse would require follow up?
Vitamin C
✓
Vitamin K
Vitamin A
Vitamin D
Correct Answer
Vitamin C
Cystic fibrosis may cause a deficiency in fat soluble vitamins (i.e., Vitamins A, D, E, and K). It should not impact an individual's ability to absorb water-soluble vitamins.
Question 89
The nurse is providing education about diabetic ketoacidosis (DKA) to a client with diabetes. Which of the following statements should the nurse include? Select all that apply.
DKA is more common in patients with type 2 diabetes.
DKA typically has a rapid onset.
An infection or illness increases the risk of DKA.
✓
Patients with DKA often present with hyperkalemia.
Correct Answer
An infection or illness increases the risk of DKA.
DKA is more common in patients with type 1 diabetes mellitus (vs. type 2). The other statements are all true regarding DKA.
Question 90
The nurse is developing a plan of care regarding a risk of developing myxedema coma. For which of the following client diagnoses would this be appropriate? Select all that apply.
Urinary tract infection in a patient with hypothyroidism
Abrupt discontinuation of levothyroxine
Untreated hypothyroidism
✓
Thyroid nodule, resulting in excess production of T3 and T4
Correct Answer
Untreated hypothyroidism
Myxedema coma is life-threatening hypothyroidism. It is often caused by untreated hypothyroidism, infection, illness, or abrupt discontinuation of levothyroxine. Excess T3 and T4 results in hyperthyroidism (vs. hypothyroidism).
Question 91
The nurse is caring for a client diagnosed with hypothyroidism. Which of the following findings would the nurse anticipate assessing? Select all that apply.
Tachycardia
Constipation
Hypotension
✓
Tachypnea
Correct Answer
Hypotension
Common symptoms of hypothyroidism include hypotension, weight gain, and constipation. Hypothyroidism does not typically cause tachycardia or tachypnea.
Question 92
The nurse is caring for a client diagnosed with hyperthyroidism. Which of the following findings would the nurse anticipate assessing? Select all that apply.
Insomnia
✓
Hypertension
Heat intolerance
Tachycardia
Correct Answer
Insomnia
Common symptoms of hyperthyroidism include tachycardia, hypertension, heat intolerance, and insomnia. Hyperthyroidism is more likely to cause weight loss (vs. weight gain).
Question 93
The nurse is providing education to a patient with newly diagnosed type 1 diabetes on what to do if they get sick. Which of the following teaching points is appropriate to include? Select all that apply.
Reduce insulin dosage in order to prevent hypoglycemia.
Notify provider if temperature is higher than 38.6 °C.
Limit water intake to < 2 L/day.
Test your blood sugar more frequently than usual, approximately every 4 hours.
✓
Correct Answer
Test your blood sugar more frequently than usual, approximately every 4 hours.
An individual with type 1 diabetes should NOT skip insulin when sick, as this increases the risk of complications such as diabetic ketoacidosis. In addition, the patient should check their blood sugar more frequently, drink MORE water to prevent dehydration, and test their urine for ketones. They should also notify their provider if their temperature is over 38.6 °C, their blood glucose is over 250 mg/dL, or if their urine is positive for ketones.
Question 94
A nurse is educating a patient with diabetes on common causes of hypoglycemia. Which of the following should be included in the teaching? Select all that apply.
Missed insulin dose.
Skipping a meal.
Excess alcohol intake.
Intense exercise.
✓
Correct Answer
Intense exercise.
Common causes of hypoglycemia include excess insulin, decreased food intake, exercise, and excess alcohol intake. A missed insulin dose and increased carbohydrate intake are more likely to cause hyperglycemia, vs. hypoglycemia.
Question 95
A nurse is providing education to a client with diabetes regarding foot care. Which of the following statement(s) if made by the client would require follow up? Select all that apply.
Avoid the use of over-the-counter corn or callus removers.
Apply moisturizer to feet, but avoid applying the lotion in between the toes.
Soak feet daily in lukewarm water for ~ 30 minutes.
✓
Inspect feet daily using a mirror.
Correct Answer
Soak feet daily in lukewarm water for ~ 30 minutes.
People with diabetes are at increased risk of serious foot problems. Individuals should inspect their feet daily using a mirror and apply moisturizer to feet, but not between toes. OTC corn and callus removers should be avoided. Feet should not be soaked as this can dry out the skin, leading to cracks and infection. Toenails should be cut straight across (not rounded at the corners) in order to prevent ingrown nails.
Question 96
A nurse is assessing a patient for pregnancy. Which of the following is considered a probable sign of pregnancy? Select all that apply.
Ballottement
✓
Fetal visualization on ultrasound
Positive pregnancy test
Fetal heart sounds
Correct Answer
Ballottement
Probable signs include Chadwick's sign, Goodell's sign, Hegar's sign, ballottement, and positive pregnancy test. These signs are probably related to pregnancy.
Question 97
The nurse is assessing the fetal position of a patient in active labor. Which fetal position should the nurse identify as being optimal for vaginal delivery?
LSA
LOA
✓
ROA
RSA
Correct Answer
LOA
Left occiput anterior (LOA) is the optimal fetal position for delivery. Right occiput anterior is less preferable. Sacral presentation (e.g., LSA, RSA) is not optimal.
Question 98
During a newborn assessment, the nurse palpates the anterior fontanel. Which finding(s) should the nurse expect in a healthy infant? Select all that apply.
Soft and flat
✓
Bulging and pulsating
Triangular-shaped
Sunken
Correct Answer
Soft and flat
The newborn's anterior fontanel should be larger than the posterior, diamond-shaped, soft, and flat. A sunken or bulging fontanel is not an expected finding in a healthy infant.
Question 99
The nurse is assessing a postpartum patient who reports pain in the left calf. Which additional findings would require the nurse to suspect a thromboembolic event? Select all that apply.
Positive Homan's sign
Erythema along the vein pathway
Calf tenderness on palpation
Localized warmth in the affected leg
✓
Correct Answer
Localized warmth in the affected leg
Classic signs of DVT include unilateral swelling, warmth, redness, calf tenderness, and a positive Homan's sign. Bilateral lower extremity swelling is more consistent with systemic or dependent edema, not DVT.
Question 100
The nurse is reviewing risk factors for postpartum endometritis with a group of new graduate nurses. Which patients are at highest risk for developing this infection? Select all that apply.
A patient who had a spontaneous vaginal delivery within 6 hours of rupture of membranes
A patient who had a planned c-section
✓
A patient with prolonged labor requiring internal monitoring
A patient who delivered twins via c-section
Correct Answer
A patient who had a planned c-section
Endometritis risk increases with c-section delivery, prolonged rupture of membranes, multiple vaginal exams, and use of internal monitoring. A vaginal birth without complications is the lowest risk.
Question 101
A nurse is caring for a patient on postpartum day 3 who reports sudden onset of sharp chest pain and shortness of breath. The patient is tachycardic and tachypneic with an oxygen saturation of 86% on room air. Which action should the nurse take first?
Administer prescribed anticoagulant therapy
Apply oxygen via nonrebreather mask
✓
Obtain a stat spiral CT of the chest
Encourage the patient to ambulate in the hallway
Correct Answer
Apply oxygen via nonrebreather mask
The patient is exhibiting signs of a pulmonary embolism, a life-threatening emergency. The nurse's priority action is to immediately improve oxygenation with high-flow oxygen. After stabilizing oxygenation, the nurse should notify the provider and anticipate interventions such as a 12-lead EKG and anticoagulant therapy.
Question 102
A patient reports to the nurse that they believe their water has broken. What is the nurse's priority action?
Test the pH of the fluid with nitrazine paper
Help the patient back to bed
Call the provider
Assess fetal heart rate
✓
Correct Answer
Assess fetal heart rate
Due to the risk for cord compression or prolapse, the nurse's priority action for a patient who may be experiencing rupture of membranes is to assess the fetal heart rate.
Question 103
The nurse is reviewing localized signs of a surgical site infection in a postoperative client with a student nurse. Which of the following symptoms if stated by the student nurse would require follow up?
Induration
Purulent drainage
Erythema
Fever
✓
Correct Answer
Fever
Although a sign of infection, fever is a systemic finding, not a localized sign of infection.
Question 104
Which respiratory medication can also be used as the antidote for acetaminophen poisoning?
Acetylcysteine
✓
Atropine
Albuterol
Advair
Correct Answer
Acetylcysteine
Acetylcysteine is used both as a mucolytic and as the antidote to acetaminophen.
Question 105
Which of the following serum theophylline levels is within the therapeutic range?
13 mcg/mL
✓
30 mcg/mL
22 mcg/mL
5 mcg/mL
Correct Answer
13 mcg/mL
The therapeutic serum level of theophylline is between 10 - 20 mcg/mL. Levels below 10 mcg/mL are subtherapeutic, while levels above 20 mcg/mL indicate toxicity.
Question 106
For which of the following medications should the nurse educate a patient to rinse out their mouth with water following administration?
Salmeterol
Atropine
Albuterol
Fluticasone propionate
✓
Correct Answer
Fluticasone propionate
Patients taking inhaled corticosteroids (e.g., fluticasone propionate) should be educated to rinse out their mouths with water after administration to avoid oral candidiasis.
Question 107
The nurse is preparing to administer an antitussive to a patient. The patient asks how the medication works. How should the nurse reply?
This medication works to suppress your need to cough
✓
This medication kills the bacteria causing your cough
This medication draws water into your lungs to break up your secretions
This medication makes it easier for you to cough out secretions
Correct Answer
This medication works to suppress your need to cough
Antitussives are used to suppress a patient's need to cough.
Question 108
The nurse should educate a patient taking guaifenesin to take which additional step?
Drink a full glass of water
✓
Remain NPO for 2 hours
Take it 4 hours apart from other medications
Avoid driving
Correct Answer
Drink a full glass of water
Guaifenesin is an expectorant which should be taken with a full glass of water to help loosen mucus in the lungs.
Question 109
The nurse educates a patient to avoid long term use of phenylephrine nasal spray due to the risk for which complication?
Bradycardia
Seizures
Rebound congestion
✓
Hypotension
Correct Answer
Rebound congestion
Rebound congestion is a possible complication of long term use of nasal decongestant sprays.
Question 110
Which of the following antihistamines is known to be more sedating than others?
Loratadine
Diphenhydramine
✓
Fexofenadine
Cetirizine
Correct Answer
Diphenhydramine
Diphenhydramine is a first generation antihistamine, known to be more sedating than the other options, which are all second generation antihistamines.
Question 111
A patient with heart failure is prescribed eplerenone. Which electrolyte should the nurse monitor most closely to prevent life-threatening complications?
Phosphorous
Potassium
✓
Sodium
Magnesium
Correct Answer
Potassium
Eplerenone is a selective aldosterone receptor antagonist, which retains potassium while promoting sodium and water excretion. Hyperkalemia is a serious risk and can lead to cardiac arrhythmias, especially in patients with renal impairment or those taking ACE inhibitors or ARBs.
Question 112
The nurse is preparing medications for a patient with a history of asthma. Which of the following prescriptions should the nurse question?
Propranolol
✓
Atenolol
Metoprolol
Esmolol
Correct Answer
Propranolol
Cardioselective beta blockers (e.g., metoprolol, atenolol, esmolol) are safe for administration to patients with asthma. Nonselective betablockers such as propranolol are contraindicated, as they can cause bronchoconstriction.
Question 113
A patient with chronic stable angina is prescribed sublingual nitroglycerin (0.4 mg) PRN chest pain. Which statement shows correct understanding of the nurse's education?
"I will call 911 five minutes after the first dose if there is no relief."
✓
"I will call 911 immediately after taking the first dose."
"I will call 911 as soon as I feel chest pain."
"I will call 911 five minutes after taking the third dose
Correct Answer
"I will call 911 five minutes after the first dose if there is no relief."
Patients taking nitroglycerin should be educated that when they experience chest pain they should immediately sit down and rest and take the first dose of nitroglycerin. Five minutes later, if they have no relief of chest pain, they should call 911 and take a second dose. Five minutes after the second dose, they may take a third while they wait for the ambulance.
Question 114
A medical-surgical patient receiving digoxin has an apical heart rate of 65 bpm. The patient denies nausea or visual halos. Labs this morning: K⁺ 4.1 mEq/L, creatinine 0.9 mg/dL, digoxin level 0.9 ng/mL. The next dose is due now. What is the nurse's best action?
Administer the medication as prescribed
✓
Administer double the dose with a potassium supplement
Redraw potassium and digoxin levels before administering
Hold the dose and notify the provider
Correct Answer
Administer the medication as prescribed
For adults, hold digoxin if the apical HR <60 or if toxicity is suspected (i.e., nausea, vomiting, anorexia, visual changes, new dysrhythmias). Here the heart rate is 65 with normal potassium, normal renal function, and therapeutic level, and digoxin is appropriate to administer.
Question 115
The nurse is preparing to administer amiodarone IV during a code situation. For which rhythm is this medication most appropriate?
Ventricular tachycardia
✓
Asystole
Pulseless electrical activity
Acute respiratory distress syndrome
Correct Answer
Ventricular tachycardia
Amiodarone is indicated in the management of ventricular fibrillation and ventricular tachycardia unresponsive to defibrillation.
Question 116
A hemodynamically stable patient has a regular narrow-complex tachycardia at 190 bpm with no visible P waves; BP is 118/72, and vagal maneuvers were ineffective. Which medication does the nurse anticipate?
Adenosine rapid IV push
✓
Lidocaine slow IV push
Amiodarone rapid IV push
Atropine slow IV push
Correct Answer
Adenosine rapid IV push
The patient's EKG description is suggestive of supraventricular tachycardia. First-line pharmacologic therapy for stable SVT is adenosine (given as a rapid bolus with immediate flush). Amiodarone/lidocaine are for other tachyarrhythmias; atropine treats bradycardia.
Question 117
A provider orders adenosine IV push for a patient in sinus tachycardia at 130 bpm. What is the nurse's best action?
Administer the medication as ordered while monitoring with continuous telemetry.
Take the patient's apical heart rate and hold the medication for a HR < 100 bpm.
Clarify the order with the provider, as adenosine is not indicated for sinus tachycardia.
✓
Prepare to administer slowly over a 24-hour time period to prevent complications.
Correct Answer
Clarify the order with the provider, as adenosine is not indicated for sinus tachycardia.
Adenosine is indicated for supraventricular tachycardia SVT, not sinus tachycardia. Administering in sinus tach can be harmful, and as such the nurse should clarify the order.
Question 118
The nurse is reviewing laboratory results for a patient receiving IV heparin infusion for treatment of DVT. Which laboratory value should the nurse monitor to evaluate the effectiveness of the therapy?
aPTT
✓
Platelets
PT
INR
Correct Answer
aPTT
Heparin therapy is monitored using aPTT, which reflects the intrinsic clotting pathway. Platelets should also be monitored in patients receiving heparin, but therapeutic effectiveness is determined by aPTT values.
Question 119
A patient receiving IV heparin therapy has a platelet count of 50,000/mm³. What complication should the nurse most suspect?
Heparin-induced thrombocytopenia
✓
Hypersensitivity reaction
Acute hepatitis
Aplastic anemia
Correct Answer
Heparin-induced thrombocytopenia
A platelet count <100,000/mm³ in a patient on heparin may indicate heparin-induced thrombocytopenia (HIT). HIT can paradoxically lead to life-threatening thromboses despite low platelets.
Question 120
A patient receiving IV heparin for a DVT has bruising, oozing at the IV site, and an aPTT of 110 seconds. After notifying the provider, which action should the nurse take?
Administer vitamin K and reassess aPTT
Administer protamine sulfate and monitor aPTT closely
✓
Increase the heparin dose to reach therapeutic levels
Hold heparin and administer aminocaproic acid
Correct Answer
Administer protamine sulfate and monitor aPTT closely
An aPTT above the therapeutic range plus signs of bleeding indicates heparin toxicity. The antidote is protamine sulfate. Vitamin K does not reverse heparin, but is the antidote to warfarin. The heparin dose should not be increased as the patient is already above the therapeutic range. Aminocaproic acid is an antifibrinolytic for clot stabilization, not for heparin reversal.
Question 121
The nurse is reviewing laboratory results for a patient receiving warfarin due to atrial fibrillation. Which laboratory value indicates therapeutic anticoagulation for this indication?
aPTT 48 seconds
INR 3.5
aPTT 64 seconds
INR 2.3
✓
Correct Answer
INR 2.3
The therapeutic effect of warfarin is monitored using the INR, not aPTT. INR values of 2.0 - 3.0 are considered therapeutic.
Question 122
A patient with postoperative bleeding is prescribed aminocaproic acid. The nurse correctly explains the mechanism of action as which of the following?
"It stimulates bone marrow to increase production of red blood cells."
"It helps stabilize blood clots by inhibiting enzymes that break them down."
✓
"It causes bone marrow to increase production of neutrophils."
"It helps to break down blood clots once your body no longer needs them."
Correct Answer
"It helps stabilize blood clots by inhibiting enzymes that break them down."
Aminocaproic acid is an antifibrinolytic that inhibits plasminogen activation, preventing fibrin clot breakdown. It stabilizes clots and is used in surgical bleeding, trauma, or bleeding disorders.
Question 123
A patient with chronic kidney disease asks the nurse, "Why am I taking epoetin alfa?" Which response by the nurse is most accurate?
"This medication helps to lower your blood pressure by relaxing the walls of your arteries."
"This medication makes your blood thinner and less likely to clot."
"This medication stimulates your bone marrow to make more red blood cells and treat anemia."
✓
"This medication works to improve your kidney function and decrease your creatinine."
Correct Answer
"This medication stimulates your bone marrow to make more red blood cells and treat anemia."
Epoetin alfa is a synthetic form of erythropoietin that stimulates the bone marrow to produce red blood cells. It is commonly used in CKD, chemotherapy, or HIV therapy-related anemia.
Question 124
A critically ill patient is in septic shock with severe hypotension unresponsive to fluid resuscitation. Which medication is most appropriate to restore perfusion?
Dopamine
Norepinephrine
✓
Epinephrine
Dobutamine
Correct Answer
Norepinephrine
Norepinephrine is the first-line vasopressor for septic shock, acting on alpha-1 receptors to cause vasoconstriction and improve blood pressure. Dopamine and dobutamine have variable effects on perfusion. Epinephrine is often reserved for anaphylactic shock or cardiac arrest.
Question 125
A nurse is providing nutrition education to a patient newly prescribed selegiline. Which of the following food choices demonstrates that the patient understands the teaching?
Chocolate
Oranges
✓
Pepperoni
Avocado
Correct Answer
Oranges
Foods rich in tyramine, such as chocolate, pepperoni, and avocado, must be avoided by patients taking MAOIs such as selegiline. Oranges are okay for this patient to eat.
Question 126
The nurse is reviewing serum lithium levels for a patient newly prescribed the medication. Which value should the nurse identify as being within the therapeutic range?
2.0 mEq/L
1.1 mEq/L
✓
0.3 mEq/L
1.5 mEq/L
Correct Answer
1.1 mEq/L
Lithium levels are considered therapeutic when they fall between 0.6 mEq/L and 1.2 mEq/L. Levels are considered toxic when they are greater than or equal to 1.5 mEq/L. Levels are considered subtherapeutic when they fall below 0.6 mEq/L.
Question 127
Which lab value of a patient's CBC should the nurse monitor in a patient taking clozapine?
Hemoglobin
Neutrophils
✓
Red blood cells
Platelets
Correct Answer
Neutrophils
Patients taking clozapine should have routine CBC monitoring due to the potential for developing agranulocytosis, which would be noted by monitoring the patient's neutrophil level.
Question 128
A nurse in the ICU is administering a propofol infusion to a mechanically ventilated patient. After administering the initial dose, there is a partially used vial remaining. Which action should the nurse take to ensure safe medication administration?
Discard the vial immediately after the first dose is withdrawn.
Use the remaining medication for another patient to decrease medication waste.
Label the vial and refrigerate; it may be used for up to 24 hours.
Keep the vial at room temperature but discard any unused portion within 6 hours.
✓
Correct Answer
Keep the vial at room temperature but discard any unused portion within 6 hours.
Because propofol is formulated in a lipid emulsion, it promotes bacterial growth if not handled properly. Any unused portion of a vial must be discarded within 6 hours of opening. This practice minimizes the risk of bloodstream infection and sepsis.
Question 129
The nurse is providing education to a patient newly prescribed metformin. Which of the following findings should the nurse educate the patient to report to the prescribing provider?
Insomnia
Nausea
Muscle pain
✓
Heat intolerance
Correct Answer
Muscle pain
Lactic acidosis is a potential complication associated with metformin use. Signs and symptoms of lactic acidosis include nausea, vomiting, fatigue, muscle cramps, abdominal pain, tachypnea, and hypotension.
Question 130
Fluid retention and edema are key adverse effects of which antidiabetic medication?
Pioglitazone
✓
Acarbose
Glyburide
Repaglinide
Correct Answer
Pioglitazone
Fluid retention and edema are key adverse effects of pioglitazone, a thiazolidinedione used to treat type 2 diabetes.
Question 131
A patient newly diagnosed with hypothyroidism is prescribed levothyroxine. During discharge teaching, the patient asks how long they will need to take the medication. Which response by the nurse is most appropriate?
"You will take this medication until your thyroid levels return to normal."
"You will take this medication for the rest of your life."
✓
"You will take this medication only when you have symptoms."
"You can only take this medication for a maximum of one year."
Correct Answer
"You will take this medication for the rest of your life."
Levothyroxine is a lifelong treatment for hypothyroidism, as it replaces thyroid hormone. Stopping the medication will cause symptoms to return.
Question 132
A patient taking a strong iodine solution for hyperthyroidism reports a metallic taste, burning in the mouth, and painful sores. Which complication should the nurse suspect?
Iodism
✓
Immunosuppression
Hypersensitivity reaction
Nephrotoxicity
Correct Answer
Iodism
Iodism is a key adverse effect of strong iodine solutions, causing symptoms that include a metallic taste, stomatitis, and severe gastrointestinal issues.
Question 133
A newly pregnant patient with a history of peptic ulcer disease asks about her prescription for misoprostol. Which statement by the nurse is most appropriate?
"Be sure to take this medication with a glass of orange juice."
"This medication forms a protective coating on your stomach ulcers."
"This medication is known to be safe in all 3 trimesters of pregnancy."
"This medication can cause miscarriage and should not be taken during pregnancy."
✓
Correct Answer
"This medication can cause miscarriage and should not be taken during pregnancy."
Misoprostol is a category X medication and should be avoided in patients who are pregnant due to the risk for miscarriage.
Question 134
A patient with opioid-induced constipation reports no bowel movement for 4 days. The provider orders a laxative to promote rapid bowel evacuation. Which medication should the nurse anticipate administering?
Bisacodyl
✓
Docusate sodium
Psyllium
Polyethylene glycol
Correct Answer
Bisacodyl
Bisacodyl is a stimulant laxative. Psyllium, docusate sodium, and polyethylene glycol are classified as non-stimulant laxatives.
Question 135
A patient with cystic fibrosis is prescribed pancrelipase for pancreatic enzyme replacement. When should the nurse educate the patient to take this medication?
Upon feeling nauseated following a meal
Immediately before/with meals or snacks
✓
1 hour apart from meals
Three times daily, with or without food
Correct Answer
Immediately before/with meals or snacks
Pancrelipase should be administered immediately before or with meals and snacks to help break down food.
Question 136
A nurse is caring for a patient with an overactive bladder. This patient is prescribed oxybutynin. Which of the following side effects may this medication cause?
Diarrhea
Vomiting
Urinary frequency
Dry mouth
✓
Correct Answer
Dry mouth
Oxybutynin is an anticholinergic medicine. It can cause dry mouth, urinary retention, constipation, and blurred vision.
Question 137
The nurse anticipates an order for which medication for a patient experiencing cerebral edema?
Mannitol
✓
Spironolactone
Torsemide
Furosemide
Correct Answer
Mannitol
Mannitol is a diuretic which may be used to treat cerebral edema.
Question 138
A 58-year-old postmenopausal patient is being evaluated for conjugated estrogen therapy. Which history finding would require the nurse to question the order?
Exercise-induced asthma
History of DVT
✓
Gastroesophageal reflux disease
History of thyroid cancer
Correct Answer
History of DVT
Conjugated estrogen therapy is contraindicated for patients with hypertension, high risk for embolic events, current nicotine use, estrogen-dependent cancer.
Question 139
A nurse is providing patient teaching to a patient prescribed medroxyprogesterone. Which of the following should the nurse teach the patient?
Increase your intake of calcium and vitamin D
✓
This lowers your risk of breast cancer
Your next injection will be in 6 months
Do not drink milk while on this medication
Correct Answer
Increase your intake of calcium and vitamin D
Medroxyprogesterone is a progesterone medication, used for contraception or treatment of dysmenorrhea. Because it can cause bone loss it is important for the patient to increase their intake of calcium and vitamin D.
Question 140
A patient is being given oxytocin for labor inducement. The patient's contractions have become too strong and too frequently. The nurse prepares to give the patient which medication to relax the uterus?
Methylergonovine
Finasteride
Estradiol
Magnesium sulfate
✓
Correct Answer
Magnesium sulfate
Magnesium sulfate can be given to relax the uterus.
Question 141
Asthma is a contraindication for which medication used to treat postpartum hemorrhage?
Carboprost
✓
Magnesium
Misoprostol
Methylergonovine
Correct Answer
Carboprost
Carboprost is contraindicated for patients who have asthma.
Question 142
A patient arrives at the emergency room in preterm labor. Which medication does the nurse give to the patient to delay labor?
Oxytocin
Methylergonovine
Terbutaline
✓
Estradiol
Correct Answer
Terbutaline
Terbutaline may be administered prior to 37 weeks gestation to delay preterm labor.
Question 143
A nurse is caring for a patient with benign prostatic hyperplasia. The patient is prescribed finasteride. The nurse knows this medication comes with which warning?
It may increase fertility
It may cause baldness
Do not handle this medication if pregnant
✓
It may cause increased sexual desire
Correct Answer
Do not handle this medication if pregnant
Finasteride, a medication for BPH and baldness, should not be handled by pregnant patients.
Question 144
A patient taking hydroxychloroquine reports nausea and mild stomach upset. Which teaching should the nurse provide?
"Take this medication with food to help decrease GI upset."
✓
"Take this medication with a large amount of water to decrease GI upset."
"Take this medication with vitamin C to prevent GI upset."
"Take this medication on an empty stomach to help decrease GI upset."
Correct Answer
"Take this medication with food to help decrease GI upset."
Hydroxychloroquine can be taken with meals to decrease GI upset.
Question 145
The nurse is reviewing a prescription for doxycycline for a 6-year-old child. Which action should the nurse take?
Assess the patient for allergies, then give the medication.
Clarify the prescription with the ordering provider.
✓
Instruct the caregiver to administer this medication with a full glass of milk.
Administer the medication as ordered.
Correct Answer
Clarify the prescription with the ordering provider.
Doxycycline should not be given to anyone under the age of 8 as it can cause tooth discoloration and impaired bone growth in children.
Question 146
A nurse is reviewing the medication administration record of a patient who develops sudden flushing of the face, neck, and upper trunk during IV therapy. Which medication is the nurse most likely to identify as the cause of this reaction?
Lidocaine
Epinephrine
Heparin
Vancomycin
✓
Correct Answer
Vancomycin
Vancomycin flushing syndrome is a possible side effect of vancomycin, which causes red flushing of the face, neck, and trunk.
Question 147
During admission, a patient reports a severe allergy to penicillin. Which medication should the nurse question?
Sulfamethoxazole
Ciprofloxacin
Cefazolin
✓
Metronidazole
Correct Answer
Cefazolin
Patients with a penicillin allergy may also react to cephalosporins (e.g., cefazolin) due to structural similarities. The nurse should question cephalosporins in penicillin-allergic patients, particularly if the reaction was anaphylaxis.
Question 148
A patient on warfarin for atrial fibrillation presents with INR 7.2, epistaxis, and bruising on arms. The provider orders reversal therapy. Which nursing actions are appropriate?
Prepare to administer fresh frozen plasma if rapid reversal is needed
Encourage patient to increase dietary vitamin K immediately
Administer vitamin K as ordered
✓
Administer protamine sulfate as ordered
Correct Answer
Administer vitamin K as ordered
An INR above the therapeutic range plus signs of bleeding indicates warfarin toxicity. Reversal may be obtained with oral or IV vitamin K, and rapid reversal can be achieved with administration of fresh frozen plasma. Protamine sulfate is the antidote to heparin. Dietary changes alone are insufficient for reversal.
Question 149
The nurse is providing care for a patient with cystic fibrosis. They can expect to administer which medication with the patient's meals and snacks?
Pancrelipase
✓
Amoxicillin
Salmeterol
Dornase alfa
Correct Answer
Pancrelipase
Pancrelipase is pancreatic enzymes which are given with meals and snacks to cystic fibrosis patients in order to help them digest food.
Question 150
A nurse is caring for a newly admitted patient with suspected rheumatic fever. Which assessment should the nurse do first?
Deep tendon reflexes
Auscultation of heart sounds
✓
Abdominal palpation
Abdominal auscultation
Correct Answer
Auscultation of heart sounds
Cardiac assessment should be a priority because rheumatic fever can lead to rheumatic heart disease with carditis, regurgitation, or murmur.
Question 151
A nurse measures a patient's blood pressure on the right arm and notes a high reading. The nurse decides to reassess by reading on the patient's leg. This reading shows low blood pressure. What could this result indicate?
Ventricular septal defect
Tetralogy of Fallot
Atrial Septal defect
Coarctation of the aorta
✓
Correct Answer
Coarctation of the aorta
Coarctation of the aorta affects upper extremity blood pressure because the blood has to work extra hard to fit through a constricted aorta.
Question 152
The nurse is admitting a newborn with a low-grade fever, high-pitched whooping cough, and cyanosis. The nurse should arrange which type of precautions for this patient?
Contact precautions
Droplet precautions
✓
Airborne precautions
No precautions needed
Correct Answer
Droplet precautions
This patient likely has pertussis which requires droplet precautions.
Question 153
The nurse suspects a child in the emergency department is suffering from rubella. Which isolation precautions should be implemented?
Droplet
✓
Contact
Airborne
Contact plus
Correct Answer
Droplet
Rubella (i.e., German measles) requires the use of droplet precautions.
Question 154
The nurse is providing eduation to new parents about vaccine schedules.
How often should the nurse recommend the influenza vaccine be administered?
Biannually
Semiannually
Quarterly
Annually
✓
Correct Answer
Annually
The influenza vaccine should be administered annually during flu season.
Question 155
The nurse is hosting a parenting class for expecting parents. When reviewing parenting styles, which style is high control, low warmth, with inflexible rules and little communication?
Authoritative
Authoritarian
✓
Permissive
Neglectful
Correct Answer
Authoritarian
Authoritarian parenting style exhibits high control and low warmth with inflexible rules and little communication.
Question 156
A nurse who typically works with adult clients is floating on a pediatric unit. Which of the following vital signs does the nurse need to recall is likely to be lower in a child than in an adult?
Blood pressure
✓
Pulse
Respirations
Pulse oximetry
Correct Answer
Blood pressure
The average blood pressure of children is lower than in adults.
Question 157
A child states that they live at home with their mother, step-father, and half-sister, and step-brother. The nurse correctly identifies this as which type of family?
Nuclear
Extended
Binuclear
Blended
✓
Correct Answer
Blended
A blended family is made up of parents who have biological children from previous marriages.
Question 158
The nurse is preparing to admit a new client diagnosed with Fifth's disease. The nurse should initiate which type of precautions for this client?
Droplet
✓
Airborne
Contact plus
Contact
Correct Answer
Droplet
Droplet precautions are required for a child with Fifth's disease (i.e., parvovirus B19).
Question 159
A child presents to the emergency room and the nurse notes multiple injuries in various stages of healing. The nurse is aware that this finding may be consistent with which finding?
Legg-Calve-Perthes disease
Physical abuse
✓
Zollinger-Ellison syndrome
Neglect
Correct Answer
Physical abuse
A child who is being physically abused may have multiple injuries in various stages of healing.
Question 160
The nurse is providing parenting classes for local families. Which of the following terms describes a child's behavior of treating inanimate objects as though they are alive?
Magical thinking
Pretend play
Artificialism
Animism
✓
Correct Answer
Animism
Animism is the childhood belief that inanimate objects are capable of actions and lifelike qualities.
Question 161
A child presents to the emergency department with a rash that started on their face and neck and has since spread to the rest of their body. What condition should the nurse suspect?
Parvovirus B19
Paramyxovirus
Rubella
✓
Rubeola
Correct Answer
Rubella
Rubella (i.e., German measles) typically presents with a rash that begins on the face and neck and spreads to the rest of the body afterwards.
Question 162
A nurse is caring for a school aged child who was recently diagnosed with ADHD. The nurse is providing family teaching. What should the nurse say when the parent asks, "What time of day should I give him his medicine?"
In the evening
In the morning
✓
At bedtime
In the afternoon
Correct Answer
In the morning
ADHD medication should be given in the morning to prevent insomnia.
Question 163
The nurse is caring for a pediatric client with a history of right-sided heart failure. Which of the following findings does the nurse anticipate?
Tachypnea
Wheezing
Hepatomegaly
✓
Nasal flaring
Correct Answer
Hepatomegaly
Hepatomegaly is a finding suggestive of right-sided heart failure. Tachypnea, wheezing, and nasal flaring are findings of left-sided heart failure.
Question 164
The nurse is preparing to perform an assessment on a new patient who is an infant. When considering which reflexes to assess, at what age should the walking/stepping reflex disappear?
6 months
4 months
2 months
✓
12 months
Correct Answer
2 months
The walking/stepping reflex disappears around 2 months of age.
Question 165
The nurse is caring for a child undergoing hemoglobin electrophoresis. The nurse knows this test is diagnostic for which condition?
Deep vein thrombosis
HIV
Cystic fibrosis
Sickle cell anemia
✓
Correct Answer
Sickle cell anemia
Sickle cell anemia may be diagnosed with hemoglobin electrophoresis.
Question 166
The nurse auscultates a systolic murmur with wide, fixed splitting of S2 on a pediatric client. Which congenital heart defect does the nurse expect the child has?
Truncus arteriosus
Patent ductus arteriosus
Atrial septal defect
✓
Ventricular septal defect
Correct Answer
Atrial septal defect
Atrial septal defect is characterized by a systolic murmur with wide, fixed splitting of S2.
Question 167
When caring for neonates, which pain scale should the nurse utilize?
OUCHER
CRIES scale
✓
Numeric scale
Wong-Baker
Correct Answer
CRIES scale
The CRIES scale should be used to assess pain in a neonatal patient.
Question 168
A parent reports to the nurse that their child is experiencing severe anal itching which is worse at night. What condition does the nurse expect the child has?
Pediculosis capitis
Enterobiasis
✓
Mites
Scabies
Correct Answer
Enterobiasis
Enterobiasis (i.e., pinworms) can cause intense anal itching which becomes worse at night.
Question 169
The nurse is admitting a patient who is drooling, has a hoarse voice, dysphagia, and appears to be in respiratory distress. What is the priority action for this nurse?
Put the patient in a supine position
Administer an antibiotic
Take a throat culture
Prepare for intubation
✓
Correct Answer
Prepare for intubation
This patient likely has epiglottitis and the priority is to secure the airway with intubation. The nurse should not put anything in the patient's mouth and should not allow them to lay flat.
Question 170
The nurse is admitting a patient with a diagnosis of measles. What is the appropriate transmission precaution for the nurse to initiate?
Droplet
Contact
Airborne
✓
No precautions needed
Correct Answer
Airborne
Airborne precautions are necessary for measles and should be continued for four days after the onset of the rash.
Question 171
The nurse recommends a parent perform a tape test on their child. What disorder does the nurse expect the child has?
Intussusception
Enterobiasis
✓
Pyloric stenosis
Cystic fibrosis
Correct Answer
Enterobiasis
Testing for enterobiasis (i.e., pinworms) can be performed by place a piece of tape on the child's perianal skin first thing in the morning when the child awakens.
Question 172
The nurse is providing a parenting class for expecting parents. When preparing a session on car seat safety, how should the nurse describe the positioning of the chest clip?
At the level of the child's xiphoid process
At the level of the child's umbilicus
At the level of the child's collarbones
At the level of the child's nipples
✓
Correct Answer
At the level of the child's nipples
Proper chest clip positioning for a car seat should be at the level of the child's nipples or armpits.
Question 173
The nurse is caring for a child with testicular torsion. The nurse should educate his family that which of the following treatments will be a priority?
Treatment with IV antibiotics
Placement of an indwelling urinary catheter
Immediate surgical repair
✓
Use of a testicular sling
Correct Answer
Immediate surgical repair
Testicular torsion is a true medical emergency marked by abrupt onset of severe, unilateral testicular pain which requires immediate surgical repair.