Class Questions

Question 1

Stephen’s arterial blood gas (ABG) results are in: pH 7.28, PaCO2 60 mm Hg, PaO2 58 mm Hg, and HCO3 25 mm Hg. The student nurse interprets these results as
A. Respiratory acidosis 
B. Respiratory alkalosis 
C. Metabolic acidosis
D. Metabolic alkalosis

Answer 1

ANSWER: A

Respiratory acidosis

Question 2

Mary is prescribed two inhalers. When the following behaviour is observed the nurse knows that additional teaching is required:
A. Mary shakes the inhalers prior to use
B. Mary administers Ventolin (Salbutamol) first and then Flovent (Fluticasone) second. C. Mary rinses her mouth following the administration of Flovent (Fluticasone).
D. Mary administers Flovent (Fluticasone) first and then Ventolin (Salbutamol) second.

Answer 2

ANSWER: B

Mary administers Ventolin (Salbutamol) first and then Flovent (Fluticasone) second.

Question 3

The nurse is evaluating the effectiveness of therapy for a patient with an acute exacerbation of asthma. The following finding indicate that the patient’s respiratory function is beginning to improve:
A. Wheezing becomes louder.
B. The cough remains unproductive.
C. Vesicular breath sounds decrease.
D. Aerosol bronchodilators stimulate coughing.

Answer 3

ANSWER: A

wheezing becomes louder

Question 4

Stephen has three different inhalers he was prescribed, Ipratropium (Atrovent), Beclomethasone (QVAR) and Albuterol (Ventolin). What are the nurse’s best actions to take to teach the patient to use the medications properly and effectively?
A. Teach Stephen to take each inhaler at 30 minute intervals
B. Have Stephen administer Beclomethasone first, then wait 5 minutes administer Ipratropium, followed by the Albuterol.
C. Have Stephen administer the Albuterol first, wait 5 minutes, and administer Ipratropium bromide, followed by Beclomethasone several minutes later.
D. Administer all three medications in a metered-dose inhaler.

Answer 4

ANSWER: C
Have Stephen administer the Albuterol first, wait 5 minutes, and administer Ipratropium bromide, followed by Beclomethasone several minutes later.

Question 5

Which of the following is a key characteristic of Asthma?
A. It is episodic and reversible in nature
B. It is a progressive deterioration of respiratory function
C. It is a disease limited to children under 13
D. None of the above

Answer 5

ANSWER: A

It is episodic and reversible in nature

Question 6

Which of the following is the correct rationale for using a spacer?
A. The spacer focuses the medication to the back of the throat
B. The spacer will generate a greater force for medication delivery
C. Using a spacer ensures more medication is delivered to the lung
D. All of the above

Answer 6

ANSWER: C

Using a spacer ensures more medication is delivered to the lung

Question 7

When educating a patient with a history of asthma on the methods to prevent respiratory infections. Which of the following are most important to include? Select all that apply.
A. “Get a flu shot annually.”
B. “Use your inhaler before activity.”
C. “Avoid sick individuals during flu season.”
D. “Wash your hands frequently.”
E. “Avoid exercise.”

Answer 7

ANSWER: A,C,D
Get flu shot anually
Avoid sick people during flu season
Avoid exercise

Question 8

The client is extremely uncomfortable and has been unable to void for the past 24 hours. The best method for the nurse to use when assessing for bladder distention in a male client is to check for:

a) A rounded swelling above the pubis
b) Dullness in the lower left quadrant
c) Rebound tenderness below the symphysis
d) Urinal discharge from the urethral meatus

Answer 8

a) A rounded swelling above the pubis

Question 9

Your patient with renal failure reports pruritus. Which instruction should you include in this patient’s teaching plan?

a) Rub the skin vigorously with a towel
b) Take frequent baths
c) Apply alcohol-based emollients to the skin
d) Keep fingernails short and clean

Answer 9

d) Keep fingernails short and clean

Question 10

You expect the patient in the oliguric phase of renal failure to have a 24 hour urine output of less than:

a) 200 mL
b) 400 mL
c) 800 mL
d) 1000 mL

Answer 10

b) 400 mL

Question 11

The most common early sign of early kidney disease is:

a) Na retention
b) Elevated BUN level
c) Metabolic acidosis
d) Inability to dilute or concentrate urine

Answer 11

b) elevated BUN level

Question 12

What can cause pre-renal acute renal failure?

a) Septic shock
b) Benign prostatic hyperplasia (BPH)
c) Acute tubular necrosis
d) Bladder tumor

Answer 12

a) Septic shock

Question 13

Polystyrene sulfonate (Kayexalate) is used in renal failure to:

a) Correct acidosis
b) Reduce serum phosphate levels
c) Exchange potassium for sodium
d) Prevent constipation from sorbitol use

Answer 13

c) Exchange potassium for sodium

Question 14

A colleague confides in you that they do not feel comfortable with the anaphylaxis protocol. You should: (SELECT ALL THAT APPLY)

a) Refer them to the hospital policy/protocol
b) File a complaint with the charge nurse for that shift against the colleague
c) Ask them to report their concerns to the department lead at the next staff meeting
d) Collaboratively arrange an interdepartmental mock exercise for practice

Answer 14

a) Refer them to the hospital policy/protocol

d) Collaboratively arrange an interdepartmental mock exercise for practice

Question 15

A 10-year-old boy recently diagnosed with anaphylaxis to bees and prescribed an EpiPen® auto-injector is seeking advice on how to self-administer. He is nervous about his friends finding out about his allergies. Your best response is:

a) “Let me get a sample auto-injector and mannequin thigh so that we can practice together.”
b) “It must be really hard to have an allergy to bees when all your friends are outside having fun.”
c) “It is more important that we teach your family and friends about this topic, as you most likely will be too ill to self-administer.”
d) “You should Google the new public service announcement. It’s really catchy.”

Answer 15

a) “Let me get a sample auto-injector and mannequin thigh so that we can practice together.”

Question 16

A patient believes that he had an allergic reaction to peanuts last night while eating at a potluck with a group of nursing students. The patient should be advised to:

a) Notify his school/workplace to prevent any unnecessary exposure
b) Make a follow-up appointment with his family medical doctor
c) Avoid peanuts until sensitivity is determined
d) Try to reintroduce the peanuts after forty-eight hours to desensitize the mast cells

Answer 16

Avoid peanuts until sensitivity is determined

Question 17

A patient is having an anaphylactic reaction and refuses the administration of oxygen as it goes against his religious beliefs. Your best course of action is to:

a) Reassure the client that the oxygen is necessary
b) Respect the patient’s decision and withhold the oxygen
c) Wait until the patient is unconscious and apply the oxygen anyway
d) Ask the patient, “Why? There’s oxygen in the air you breathe every day.”

Answer 17

b) Respect the patient’s decision and withhold the oxygen

Question 18

Comfort interventions after removal of an insect stinger include:

a) Application of heat to the sting site
b) Ambulation and exercise
c) Massaging the affected area
d) Application of cold to the sting site

Answer 18

d) Application of cold to the sting site

Question 19

1. Initial management of the anaphylactic patient can include administration of: (SELECT ALL THAT APPLY)
   a) Cephalosporins
   b) Cimetidine
   c) Diphenhydrinate
   d) Dopamine
   e) Epinephrine
   f) NSAIDs
   g) Oxygen

Answer 19

b) Cimetidine
d) Dopamine
e) epinephrine
g) oxygen

Question 20

A patient who has had an anaphylactic reaction will have altered CBC and lab values, including:

a) Elevated lymphocyte count and reduced B cell level
b) Elevated eosinophil count and elevated serum IgE level
c) Presence of mast cell indicators and elevated serum IgE level
d) Elevated eosinophil count and reduced B cell level

Answer 20

b) Elevated eosinophil count and elevated serum IgE level

Question 21

The following physical symptoms of anaphylaxis are considered life-threatening, with the exception of:

a) Bronchial constriction
b) Airway obstruction
c) Urticaria
d) Vascular collapse

Answer 21

c) Urticaria

Question 22

A drug commonly known to induce respiratory hypersensitivity in asthmatic patients and associated with Reye’s syndrome in children is:

a) Tetracycline
b) Insulin
c) Sulfonamides
d) Aspirin

Answer 22

a) Aspirin

Question 23

Which of the following is not one nursing intervention for appendicitis?
(Select all that apply)

a) Apply heat to the affected area for pain
b) NPO
c) Insert a catheter
d) Obtain history

Answer 23

a) apply heat to the affected area for pain

Question 24

Which of the following complications should be monitored after an appendectomy?
(Select all that apply)

a) Sepsis
b) Dehydration
c) Falls
d) Narcotic abuse

Answer 24

a) sepsis

b) dehydration

Question 25

Which of the following are nursing priorities postoperatively? (Select all that apply) a) Hydration b) Early ambulation c) Discharge 2 days post op d) Pain control

Answer 25

a) hydration b) early ambulation c) discharge 2 days post-op d) pain control

Question 26

For a self employed farmer with appendicitis, what are viable financial aid options for a 3 week medical leave? (Select all that apply) a) Private health insurance b) Ontario Disability Support Program c) Employment Insurance Special Benefits d) Canadian Pension Plan Disability Benefit e) ADP Canada

Answer 26

a) Private health insurance | c) Employment Insurance Special Benefits

Question 27

The nurse’s discharge teaching after an appendectomy should include: (Select all that apply) a) Do not take baths, swim, or go in hot tubs for 10 days b) Keep wound clean and dry c) Take OTC medication to relieve pain and discomfort when prescribed medication isn’t working d) Seek medical attention if you experience increased pain, discharge from incision, or shortness of breath e) Resume heavy lifting whenever you see fit

Answer 27

a) Do not take baths, swim, or go in hot tubs for 10 days b) Keep wound clean and dry d) Seek medical attention if you experience increased pain, discharge from incision, or shortness of breath

Question 28

Of the following, which are signs of appendicitis in a physical examination? (Select all that apply) a) Left lower quadrant pain b) pain on percussion c) rigid abdomen d) guarding e) positive kernig’s sign

Answer 28

b) pain on percussion c) rigid abdomen d) guarding

Question 29

Which of these is NOT a precipitating cause for heart failure? a. Uncontrolled Diabetes b. Unmanaged Hypertension c. Pulmonary Edema d. None of the above

Answer 29

d) none of the above

Question 30

In order to maintain a patient with congestive heart failure’s safety while they are in hospital a nurse should: (Select all that apply) a) ask about any allergies b) confirm patients identity before performing care such as giving medication c) perform hand hygiene d) encourage consumption of at least 2 L of fluid daily to prevent dehydration

Answer 30

a) ask about any allergies b) confirm patients identity before performing care such as giving medication c) perform hand hygiene

Question 31

The nurse is caring for a patient with heart failure who has just been prescribed digoxin. The nurse reviews the patient’s lab values and decides to withhold the dose and contact the prescriber based on which of the following findings? a.      Low troponin levels b.      Elevated GFR c.      Elevated serum albumin d.      Low serum potassium

Answer 31

d) low serum potassium

Question 32

A nurse is monitoring the status of a patient diagnosed with congestive heart failure. The assessment finding that would be MOST important for her to discuss with the health care provider would be: a) shortness of breath b) a weight gain of 3kg in 24 hours c) tachycardia of 105 bpm d) the patient needing rest after getting up to use the bathroom

Answer 32

b) weight gain of 3kg in 24 hr

Question 33

The sign(s) and/or symptom(s) of heart disease include : a) Breathlessness b) Fatigue c) Fluid retention d) All of the above

Answer 33

d) all of the above

Question 34

You are beginning a respiratory assessment on your client with type 1 diabetes mellitus when you notice a new onset of rapid, deep breathing. You quickly recognize this breathing pattern as being associated with metabolic acidosis. What is it? a. Stridor b. Cheyne-Stokes respirations c. Kussmaul’s respirations d. Apnea

Answer 34

c. Kussmaul’s respirations

Question 35

When meeting with a patient in the community, with type 1 diabetes, after an exasperation of diabetic ketoacidosis, what is the most important assessment for the continuum of care for the patient? a. Dispensing and administering medications b. Assessing glucose and ketone blood levels c. Assessing the patient’s knowledge of disease and use of medication/equipment d. Discussing determinants of health that affect the patient’s ability to deal with the disease   

Answer 35

c) assessing the patient's knowledge of disease and use of medication/equipment Rationale: Without an understanding of how/when to use mediation can cause the patient to administer medication to soon or to late and potentially the wrong way. By assessing the patients understanding of diabetes and DKA as well as the medication/equipment, gaps in knowledge and equipment can be discussed. This will lead to better care for the patient plus fewer medical issues. (Lewis., et al, 2011, p. 1453).

Question 36

When thinking about nutritional support for a person with diabetes the glycemic index (GI) is often used to describe how carbohydrate-containing foods affect blood glucose. Why is it important to maintain GI in a person with diabetes? a. To allow the patient to plan to eat what they want so their blood sugar stays within normal range b. To eliminate the need for medication therapy c. To improve their nutritional intake to help manage symptoms of diabetes d. To help the patient manage their blood sugar levels with the help of other therapies

Answer 36

Answer: D Rationale: When a person has diabetes many therapies are needed to manage their symptoms as well as their blood sugar levels. One therapy does not eliminate the need for the other, such a person with diabetes compensating for high sugar intake with higher doses of insulin. The point of the glycemic index is to give people a reference for the increase in blood sugar they will see with consumption of the foods they are eating. This way they can plan around metabolic/activity/insulin effects on their blood sugar from their daily routine.

Question 37

1) In order to prevent exacerbations of diabetic ketoacidosis, proper maintenance of diabetes mellitus is important. All of the following are required in the teaching of diabetic maintenance EXCEPT: a. Educating the client on the importance of a well balanced diet. b. Explaining the importance of exercising if blood glucose levels are very elevated. c. Ensuring the client can recognize and respond to the signs and symptoms of hyperglycemia and hypoglycemia. d. Teaching the client the correct method to monitoring blood glucose levels.

Answer 37

Answer: B Rationale: Exercising when blood glucose levels are very high can actually lead the the worsening of blood glucose levels temporarily

Question 38

1) In diabetic ketoacidosis (DKA) which of the following electrolytes becomes the MOST depleted: a. Sodium b. Magnesium c. Potassium d. Phosphate

Answer 38

Answer: C Rationale: “This leads to severe depletion of sodium, potassium, chloride, magnesium & phosphate. Potassium is the most affected in DKA”

Question 39

Which of the following symptoms/signs are included in the clinical features of diabetic ketoacidosis? a. Polyuria and weight loss b. Tachypnea and tachycardia c. Abdominal pain and vomiting d. Cheyne-Stokes respiration e. A, B & C

Answer 39

Answer: E a. Polyuria and weight loss b. Tachypnea and tachycardia c. Abdominal pain and vomiting

Question 40

It is advisable to manage diabetic ketoacidosis in the first 24-48 hours in an intensive care unit to ensure patient safety. Which of the following should be the initial priority of the nurse: a. Administering insulin and ensuring the patient is sitting in high Fowler’s position b. Fluid replacement to restore circulatory volume, clear ketones, and correct electrolyte imbalances c. Treatment of concurrent infection if present d. Allow the patient to use mouthwash and administering oxygen after

Answer 40

B) Fluid replacement to restore circulatory volume, clear ketones, and correct electrolyte imbalances

Question 41

Common symptoms that may be experienced by some living with prostate cancer include… (Select all that apply) (a) Diarrhea (b) Urinary retention (c) Impotence (d) Hematuria

Answer 41

(b) Urinary retention (c) Impotence (d) Hematuria

Question 42

A 67 year old patient comes into the clinic to undergo a DRE. Findings that would be expected in a patient with prostate cancer include… (Select the most correct answer) (a) Feels soft with palpable central groove, symmetrical (b) Hard, smooth, symmetrical, easily moveable (c) Hard, nodular, asymmetrical, fixed position (d) Bogy, easily moved, asymmetrical

Answer 42

(c) Hard, nodular, asymmetrical, fixed position

Question 43

Common complications associated with a radical prostatectomy include… (Select all that apply) (a) Erectile Dysfunction (b) Pneumonia (c) Incontinence (d) Elevated BUN

Answer 43

(a) Erectile Dysfunction | (c) Incontinence

Question 44

Which of the following three tests would be the most definitive in the diagnosis of prostate cancer? (a) DRE, PSA, CT (b) DRE, PSA, Biopsy (c) Colonoscopy, PAP, Ultrasound (d) SPECT, PSA, MRI

Answer 44

(b) DRE, PSA, Biopsy

Question 45

While working in an outpatient clinic, a patient asks you what they can do to keep their risk of developing prostate cancer as low as possible. What are some protective factors that you could teach the patient? (a) Exercise, Increased intake of fish and tomatoes (b) Yearly examination by medical professional , Exercise (c) Low-fat diet , Reduce stress (d) A & C (e) B & C

Answer 45

(d) A & C - Exercise, Increased intake of fish and tomatoes - Low-fat diet , Reduce stress

Question 46

Mrs. Saunders was diagnosed with cholecystitis. Which of the clinical manifestations below would you expect from a patient diagnosed with acute cholecystitis? a) Fever b) Jaundice c) Nausea and vomiting d) Indigestion e) All of the above

Answer 46

e) All of the above

Question 47

Select all that apply. Who is most likely to develop gallstones? a) A woman who is 35 years old b) A woman who is pregnant c) A woman who is on hormone replacement therapy d) A man who is overweight e) An 18 year old man who eats a high fat diet

Answer 47

b) A woman who is pregnant | c) A woman who is on hormone replacement therapy

Question 48

True or False? Mrs. Saunders now drinks one cup of coffee a day, instead of 4 cups a day. This will help to prevent a gallbladder attack. a) True b) False

Answer 48

a) True

Question 49

Mrs. Jones, a 40-year-old woman with a BMI of 32 (obese), is at risk for developing a gallbladder attack. A nurse has been teaching Mrs. Jones methods to prevent a gallbladder attack. Which response by Mrs. Jones would indicate the client needs more health teaching? a) “I’ll make sure to eat a lower in fat diet” b) “I’ll start taking a 500mg caffeine pill in the morning” c) “I’ll try to lose 1-2 pounds a week” d) “I’ll start light jogging in the mornings”

Answer 49

b) “I’ll start taking a 500mg caffeine pill in the morning”

Question 50

A patient experiencing a gallbladder attack would likely experience pain in which quadrant of the abdomen? a) Left Upper Quadrant (LUQ) b) Right Upper Quadrant (RUQ) c) Left Lower Quadrant (LLQ) d) Right Lower Quadrant (RLQ)

Answer 50

b) Right Upper Quadrant (RUQ)

Question 51

Which diagnostic test/procedure is the most commonly used diagnostic indicator of acute cholecystitis? a) Ultrasonography b) Liver Function Tests c) Computed Tomography (CT) d) Magnetic Resonance Imaging (MRI)

Answer 51

a) Ultrasonography

Question 52

Mr. Smith has been diagnosed with cholecystitis. The RN is assessing the patient for any complications associated with the diagnosis. What abnormal laboratory value would indicate an acute pancreatitis? a) Elevated direct and indirect bilirubin b) Elevated serum amylase c) Decreased ALT, AST and Alkaline phosphatase d) Decreased direct and indirect bilirubin

Answer 52

b) Elevated serum amylase

Question 53

What assessment would you expect to be positive when someone is having a gallbladder attack? a) Cullen’s sign b) McBerney’s point c) Murphy’s sign d) Morrow reflex

Answer 53

c) Murphy’s sign

Question 54

One complication of alcohol withdrawal includes Wernicke’s encephalopathy, which is primarily caused by which of the following: a) Potassium deficiency b) Thiamine deficiency c) Pepsin deficiency d) Acetylcholine deficiency

Answer 54

b) Thiamine deficiency

Question 55

1) The nurse experiences a client going through alcohol withdrawal in the emergency department. The client states he regularly takes aspirin. The nurse knows that alcohol in conjunction with aspirin may lead to: a) Tremors b) Nausea c) GI bleeding d) Worsening headache

Answer 55

c) GI bleeding

Question 56

Which of the following clinical manifestation are associated with alcohol withdrawal? (select all that apply). a) Hunger b) Tremors c) Tachycardia d) Diaphoresis e) All of the above

Answer 56

b) Tremors c) Tachycardia d) Diaphoresis

Question 57

Pharmacological treatment of alcohol withdrawal includes which of the following drugs a) Diazepam b) Rampiril c) Lovenox d) Donepezil

Answer 57

a) Diazepam

Question 58

How long does it take for a person to experience alcohol withdrawal, from their last drink? a) 6-12 hours b) 24-28 hours c) 68-72 hours d) 30 minutes-2 hours

Answer 58

a) 6-12 hours