State exams Flashcards by Paul Shin

You are caring for bill, a 50 year old man who has been hospitalised with a possible
diagnosis of pancreatitis

Which of the following symptoms would you anticipate observing in bill
a) Elevated white blood cell count, ankle oedema and right groin pain
b) Left upper quadrant abdominal pain, nausea, and vomiting
c) Hypoglycaemia, hypertension, and hypochondrial pain
d) Epigastric pain, pyrexia, and elevated white blood cell count

b) Left upper quadrant abdominal pain, nausea, and vomiting

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You are caring for bill, a 50 year old man who has been hospitalised with a possible
diagnosis of pancreatitis

The initial diagnosis of pancreatitis would be confirmed if bills blood test showed a
significant elevation in serum
a) Amylase
b) Glucose
c) Potassium
d) Trypsin

a) Amylase

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You are caring for bill, a 50 year old man who has been hospitalised with a possible
diagnosis of pancreatitis

Pain control is an important nursing goal. Which of the following medications would
be the drug of choice
a) Pethidine
b) Cimetidine
c) Morphine
d) Codeine

c) Morphine

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You are caring for bill, a 50 year old man who has been hospitalised with a possible
diagnosis of pancreatitis

You monitor bills vital signs frequently, observing for the signs of shock. Shock is
extremely difficult to manage in pancreatitis primarily because of the
a) Frequency and severity of gastrointestinal haemorrhage
b) Vasodilating effects of kinin peptides
c) Tendency towards congestive heart failure
d) Frequent incidence of acute tubular necrosis

a) Frequency and severity of gastrointestinal haemorrhage

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You are caring for bill, a 50 year old man who has been hospitalised with a possible
diagnosis of pancreatitis

While helping bill change position in bed, you note bill has muscle twitching in his
bands and forearms. These symptoms are significant because clients who suffer from
pancreatitis are at risk of
a) Hypermagnisemia
b) Hypoglycaemia
c) Hypocalcaemia
d) Hyponatremia

c) Hypocalcaemia

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You are caring for bill, a 50 year old man who has been hospitalised with a possible
diagnosis of pancreatitis

Bill does not drink alcohol because of his religious beliefs. When the physician
persists in asking him about his alcohol intake, bill becomes annoyed. You explain the
reasoning behind the questioning by telling bill that
a) There is a strong link between alcohol use and pancreatitis
b) Alcohol intake can interfere with some of the tests used to diagnose pancreatitis
c) Alcoholism is a major health problem and all hospitalised clients are asked about
their alcohol intake
d) The physician must obtain the pertinent facts, and religious beliefs cannot be
considered

c) Alcoholism is a major health problem and all hospitalised clients are asked about
their alcohol intake

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A home care nurse begins caring for a 25 year old female called Lydia who has just
been diagnosed with human immunodeficiency virus (HIV)

Lydia asks the nurse, ‘how could this have happened?” the nurse responds to the
question based on the most frequent mode of HIV transmission, which is

a) Hugging an HIV positive sexual partner without using barrier precautions
b) Inhaling cocaine or other recreational drugs
c) Sharing a drink bottle with an HIV positive person
d) Sexual intercourse with an HIV positive person without using a condom

d) Sexual intercourse with an HIV positive person without using a condom

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The physician prescribes zidovudine (AZT) a drug that acts to help

a) Destroy the virus
b) Enhance the body’s antibody production
c) Slow replication of the virus
d) Neutralise toxin; produced by the causative organism

c) Slow replication of the virus

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Lydia acquires herpes genitalis and is counselled by the nurse concerning follow up
care. Women who have this disease are at risk of developing

a) Sterility
b) Cervical cancer
c) Uterine fibroid rumours
d) Irregular menses

d) Irregular menses

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Which of the following nursing diagnosis categories would most likely be a priority
for a client with herpes genitalis

a) Alteration in sleep; sleep pattern disturbance
b) Nutritional deficit
c) Alteration in comfort pain
d) Alteration in breathing patterns

c) Alteration in comfort pain

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The primary reason that a herpes simplex infection is a serious concern to a client
with HIV infection is that herpes simplex

a) Is an acquired immunodeficiency virus (AIDS) defining illness
b) Is curable only after 1 year of antiviral therapy
c) Can lead to cervical cancer
d) Causes severe electrolyte imbalances

a) Is an acquired immunodeficiency virus (AIDS) defining illness

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In providing education to Lydia, the nurse should take into account the fact that the
most effective method known to control the spread to HIV infection is

a) Premarital serologic screening
b) Prophylactic treatment of exposed people
c) Laboratory screening of pregnant women
d) Ongoing sex education about preventive behaviours

d) Ongoing sex education about preventive behaviours

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Lydia becomes depressed about her diagnosis and tells the nurse “I have nothing
worth living for now.” Which of the following statements would be the best response
by the nurse

a) There is much to live for; you may not develop AIDS for years
b) You should not be too depressed; we are searching to find a cure for AIDS
c) You are right; it is very depressing to have HIV
d) Tell me more about how you are feeling at being HIV positive

d) Tell me more about how you are feeling at being HIV positive

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James, a 34 year old man attending a sexual health clinic, is diagnosed with syphilis.

The organism responsible for causing syphilis is classified as a

a) Virus
b) Fungus
c) Rickettsia
d) Spirochete

d) Spirochete

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The typical chancre of syphilis appears as

a) A grouping of small, tender pimples
b) An elevated wart
c) A painless moist ulcer
d) An itching, crusted area

c) A painless moist ulcer

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When interviewing James, the nurse should anticipate that the most difficult problem
is likely to be

a) Motivating the client to undergo treatment
b) Obtaining a list of the clients sexual contacts
c) Increasing the clients knowledge of the disease
d) Assuring the client that records are confidential

b) Obtaining a list of the clients sexual contacts

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Probenecid is prescribed in conjunction with penicillin as treatment for syphilis
because probenecid helps

a) Delay detoxification of penicillin
b) Inhibit excretion of penicillin
c) Maintain sensitivity of organisms to penicillin
d) Decrease the likelihood of an allergic reaction to penicillin

b) Inhibit excretion of penicillin

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A priority nursing diagnosis for a James would likely be

a) High risk for infection transmission related to lack of knowledge about mode of
spread
b) Pain related to cutaneous skin lesions on palms and soles
c) Altered skin tissue perfusion related to a bleeding chancre
d) Image disturbance related to alopecia

a) High risk for infection transmission related to lack of knowledge about mode of
spread

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An 18 year old female college student is seen at the university health centre. She
undergoes a pelvic examination and is diagnosed with gonorrhoea

Which of the following responses by the nurse would be best when the client says that
she is nervous about the upcoming pelvic examination

a) can you tell me more about how you’re feeling
b) you’re not alone. Most women feel uncomfortable about this examination
c) do not worry about Dr smith. He’s a specialist in female problems
d) we’ll do everything we can to avoid embarrassing you

a) can you tell me more about how you’re feeling

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in education this client, the nurse should emphasise that in women gonorrhoea

a) is often marked by symptoms of dysuria or vaginal bleeding
b) does not lead to serious complications
c) can be treated but not cured
d) may not cause symptoms until complications occur

d) may not cause symptoms until complications occur

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the client informs the nurse that she has had sexual intercourse with her boyfriend and
asks the nurse ‘would he have any symptoms?’ the nurse responds that in males,
symptoms of gonorrhoea include

a) impotence
b) scrotal swelling
c) urine retention
d) dysuria

b) scrotal swelling

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A 24 year old female client, who is on her honeymoon, comes to an ambulatory care
clinic in moderate distress with a probable diagnosis of acute cystitis

Which of the following symptoms would the nurse expect the client to report during
the assessment

a) fever and chills
b) frequency and burning on urination
c) suprapubic pain and nausea
d) dark, concentrated urine

b) frequency and burning on urination

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The client asks the nurse, ‘how did I get this infection?’ the nurse should explain that
in most instances, cystitis is caused by

a) congenital strictures in the urethra
b) an infection elsewhere in the body
c) urine stasis in the urinary bladder
d) an ascending infection from the urethra

d) an ascending infection from the urethra

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The physician tells the client that the infection has likely been precipitated by sexual
intercourse and that an antibiotic will be prescribed. The client becomes upset, and
tearfully asks the nurse if this means she should abstain from intercourse for the rest
of her honeymoon. What advice should the nurse offer her

a) avoid intercourse until you’ve completed the antibiotic therapy and then limit
intercourse to once a week
b) limit intercourse to once a day in the early morning after your bladder has rested
c) as long as you’re comfortable you can have intercourse as often as you wish; but
be sure to urinate within 15 minutes after intercourse
d) you and your husband can enjoy intercourse as often as you wish. Just make sure
he wears a condom and uses a spermicide

c) as long as you’re comfortable you can have intercourse as often as you wish; but
be sure to urinate within 15 minutes after intercourse

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25. The client is given a prescription for co trimoxazole (bactrim) for her infection. Which of the following statements would indicate that she understands the principles of antibiotic therapy a) I’ll take the pills until I feel better and keep the rest for recurrences b) I’ll take all the pills as directed on the label c) I’ll take the pills until the symptoms pass, then reduce the dose by half d) I’ll take all the pills and then have the prescription renewed once

b) I’ll take all the pills as directed on the label

Winston, a 22 year old man, is brought to the emergency room with an apparent head injury after being involved in a motor vehicle accident. He is unconscious on arrival and exhibits signs of increasing intracranial pressure. His fiancée and his older sister accompany him 26. On Winston’s arrival in the emergency room, which of the following considerations should receive the highest priority a) establishing an airway b) replacing blood losses c) stopping bleeding from open wounds d) determining whether he has a neck fracture

a) establishing an airway

27. Which of the following methods would be best, from a legal standpoint, for obtaining permission to treat Winston a) having his sister sign the consent form b) having two independent doctors agree on the need for treatment c) obtaining a verbal consent by telephone from his mother d) obtaining written consent from his fiancée

b) having two independent doctors agree on the need for treatment

28. As Winston’s condition worsens, his rising intracranial pressure would be indicated by a) rising blood pressure and falling pulse rate b) rising pulse rate and falling blood pressure c) rising blood pressure and rising pulse rate d) falling pulse rate and falling blood pressure

a) rising blood pressure and falling pulse rate

29. the nurse assesses the client frequently for signs of intracranial pressure, including a) unequal pupil size b) decreasing systolic blood pressure c) tachycardia d) decreasing body temperature

a) unequal pupil size

30. which of the following respiratory signs would indicate increasing intracranial pressure in the brain stem a) slow, irregular respirations b) rapid, shallow respirations c) asymmetric chest expansion d) nasal flaring

b) rapid, shallow respirations

During the past few months, Elizabeth, a 56 year old woman has felt brief twinges of chest pain while working, in her garden and has had frequent episodes of indigestion. She comes to the hospital after experiencing severe anterior chest pain while raking leaves. Her evaluation confirms a diagnosis of stable angina pectoris 31. Elizabeth states, ‘I really thought I was having a heart attack. How can you tell the difference?’ which response by the nurse would provide the client with the most accurate information about the difference between the pain of angina and that of myocardial infarction a) The pain associated with a heart attack is much more severe b) The pain associated with a heart attack radiates into the jaw and down the left arm c) It is impossible to differentiate angina pain from that of a heart attack without an ECG d) The pain of angina is usually relieved by resting or lying down

d) The pain of angina is usually relieved by resting or lying down

32. As an initial step in treating elizabeths angina, the physician prescribes nitro-glycerine tablets, 0.3 mg given sublingual. This drugs principal effects are produced by a) Antispasmodic effects on the pericardium b) Stimulation of a- and 13- receptor sites c) Vasodilation of peripheral vasculature d) Improved conductivity in the myocardium

c) Vasodilation of peripheral vasculature

33. The nurse teaches Elizabeth that which of the following meals would be best for her low cholesterol diet a) Hamburger, salad, and milkshake b) Baked liver, green beans, and coffee c) Spaghetti with tomato sauce, salad, and coffee d) Fried chicken, green beans, and skim milk

c) Spaghetti with tomato sauce, salad, and coffee

34. Which of the following symptoms should the nurse teach Elizabeth to report immediately to her physician a) A change in the pattern of her pain b) Pain during sexual activity c) Pain during an argument with her husband d) During or after an activity such as lawn moving

a) A change in the pattern of her pain

35. After stabilisation and treatment, Elizabeth is discharged from the hospital. At her follow up appointment, she is discouraged because she is experiencing pain with increasing frequency. She states that she visits an invalid friend twice a week and now cannot walk up the second flight of steps to the friends apartment without pain. Which action can the nurse could suggest that would most likely help the client deal with this problem a) Visit her friend early in the day b) Rest for at least an hour before climbing the stairs c) Take a nitro-glycerine tablet before climbing the stairs d) Lie down once she reaches the friends apartment

c) Take a nitro-glycerine tablet before climbing the stairs

36. The nurse teaches Elizabeth that common expected side effects of nitro-glycerine include a) Headache, hypotension, and dizziness b) Hypertension, flushing and forgetfulness c) Hypotension, diplopia and shortness of breath d) Stomach cramps, constipation and urinary frequency

a) Headache, hypotension, and dizziness

37. Sublingual nitro-glycerine tablets begin to work within 1 to 2 minutes. How should the nurse instruct the client to use the drug when chest pain occurs a) Take one tablet every 2 to 5 minutes until the pain stops b) Take one tablet; and rest for 10 minutes. Call the physician if pain persists after 10 minutes c) Take one tablet, then an additional tablet every 5 minutes for a total of three tablets. Call the physician if pain persists after 3 tablets d) Take one tablet; if pain persists after 5 minutes, take two tablets. If pain still persists 5 minutes later, call the physician

c) Take one tablet, then an additional tablet every 5 minutes for a total of three tablets. Call the physician if pain persists after 3 tablets

38. Which of the following points should the nurse include when instructing the client with angina about sublingual nitro-glycerine a) The drug will cause your urine to turn bright orange b) Store the tablets in a tight, light resistant container c) Use the tablets only when the pain is severe d) The shelf life of nitro-glycerine is up to 2 years Josie, a 38 year old woman is admitted to the emergency room after being found unconscious at the wheel of her car in the hospital car park. Josie is comatosed and does not respond to stimuli. A drug overdose is suspected

b) Store the tablets in a tight, light resistant container

39. Which of the following assessment findings would lead the nurse to suspect that the coma is a result of a toxic drug overdose a) Hypertension b) Hyperpyrexia c) Dilated pupils d) Facial asymmetry

c) Dilated pupils

40. Blood and urine analysis confirm a diagnosis of salicylate overdose. Josie is treated with activated charcoal, which would be administered by a) Intravenous infusion b) Nasogastric tube c) Rectal infusior d) Oral tablets

b) Nasogastric tube

41. What specific potential adverse effect of charcoal administration to josie must the nurse be aware and guard against a) Anaphylaxis b) Renal failure c) Aspiration d) Cardiac arrest

c) Aspiration

42. The nurse observes that josie’s right eye does not close totally. Based on this finding, which of the following nursing interventions would be most appropriate a) Making sure josie wears dark glasses to avoid photosensitivity b) Irrigate her right eye with saline each duty to avoid dryness c) Instilling neomycin eye drops to prevent conjunctivitis d) Tape the eyelid down to keep it closed between cares

b) Irrigate her right eye with saline each duty to avoid dryness

43. The nursing goal for performing passive range of motion exercises for an unconscious client such as josie would be to a) Preserve muscle mass b) Prevent bone demineralisation c) Increase muscle tone d) Maintain joint mobility

d) Maintain joint mobility

44. When the nurse performs oral hygiene for josie, whilst she is still unconscious, which of the following actions would be most appropriate a) Use manual instead of mechanical ventilation b) Keep suction apparatus available c) Place josie in a prone position d) Wear sterile gloves

b) Keep suction apparatus available

45. When assessing josies respiratory status, which of the following symptoms may be an early indicator of hypoxia a) Cyanosis b) Decreased respirations c) Restlessness d) Hypotension

c) Restlessness

A 34 year old Japanese tourist, takayuki hamadi, is admitted to the hospital after experiencing multiple trauma as a result of an automobile accident. He has three fractured ribs, a hairline fracture of the pelvis, a compound fracture of his right tibia and fibula, and soft tissue injuries. He is in severe pain when he arrives on the unit after emergency surgery 46. Takayuki reports severe pain and requests frequent medication. A nursing assistant expresses her surprise, saying, ‘I thought asian people were very stoic about pain. ‘ your initial course of action should be a) Reprimand her immediately and apologise to takayuk’s family b) Discuss her behaviour with her after you leave the room c) Do nothing as takayuk’s understanding of English is poor d) Report her to the charge nurse

b) Discuss her behaviour with her after you leave the room

STATE EXAMS 2 1. According to eriksons theory of emotional development, infants will develop a sense of trust when a) They can identify their mother and father b) They feel a sense of belonging, accepted as part of the family c) They can predict what is coming and needs are consistently met d) Nutritional and hygiene needs are provided on a daily basis

c) They can predict what is coming and needs are consistently me

2. Baby john was admitted with streptococcal pharyngitis. Upon discharge his mother was told to return to the doctors in 2 weeks with a urine specimen. The urine would mostly be examined a) For fat and lipids to see if the kidneys are working b) For protein to determine if acute glomerulonephritis is developing c) To determine if the child is developing otitis media d) To determine if the child should be kept on a liquid diet or progressed to a soft

b) For protein to determine if acute glomerulonephritis is developing

3. Reduction of complications of rheumatic fever can be accomplished through which of the following interventions a) Administration of penicillin to children with strep throat or impetigo b) Beginning speech therapy to reserve damage after antibiotics are completed c) Pushing children with chorea to perform activities requiring fine motor movement to strengthen muscles d) Withholding salicylates to prevent joint haemorrhage

a) Administration of penicillin to children with strep throat or impetigo

4. Newborns with heart disease are frequently brought to health professionals initially because the infant is having a) Difficulty sleeping b) Irritability and restlessness c) Difficulty feeding d) Cyanotic spells

c) Difficulty feeding

5. In heart defects in which a connection exists between the right and left heart, the blood through the connective structure flows most commonly a) Right to left b) Left to right c) Bi directionally d) Through the mitral and tricuspid valves

b) Left to right

6. Amy is 3 months old, with a 2 day history of vomiting. Which of the following is NOT indicative of a decreased hydration status a) Sunken fontanelle b) Decreased number of wet nappies c) Skin that is hot to the touch d) Increased heart rate

c) Skin that is hot to the touch

7. Erikson’s theory of human development describes a) Eight psychosocial crises all people are thought to face b) Four psychosocial stages and a period of latency c) The same number of stages as Freud but with different names d) A stage theory that is not psychoanalytic

a) Eight psychosocial crises all people are thought to face

8. According to Piaget, the stage of cognitive development that generally characterises pre school children is the a) Preoperational stage b) Sensorimotor stage c) Oral stage d) Psychosocial stage

a) Preoperational stage

9. The cephalo-caudal and proximo-distal patterns of development apply to a) The upper extremities only b) Physical growth, but not to motor skills c) Variations in the timing of motor skills acquisition d) Motor abilities as well as physical growth

d) Motor abilities as well as physical growth

10. An infant who weighs 4kg is prescribed 0.2mg/kg (IV) of morphine sulphate. You have an ampoule of 10mg in 1ml. the volume to be administered is a) 8 mls b) 0.8 mls c) 0.08 mls d) 0.8 mgs

c) 0.08 mls

11. Pediculosis is common childhood infestation. It is commonly known as a) Pin worms b) Foot eczema c) Head lice d) Scabies

c) Head lice

12. A child who weighs 20 kgs is prescribed 300 mg of paracetamol. The stock supply is 120 mg in 5 mls. The volume to be administered is a) 1.25mls b) 125mls c) 125mgs d) 12.5mls

d) 12.5mls

13. Match the following sequence of milligrams to micrograms 10.0mg, 0.012mg, 0.40mg, 0.08mg a) 1000.0 micrograms, 120.0 micrograms, 400.0 micrograms, 8.0 micrograms b) 10000 micrograms, 12.0 micrograms, 40.0 micrograms, 80.0 micrograms c) 10000 micrograms, 12.0 micrograms, 400 micrograms, 80.0 micrograms d) 1000 micrograms, 1.2 micrograms, 4.0 micrograms, 0.08 micrograms

c) 10000 micrograms, 12.0 micrograms, 400 micrograms, 80.0 micrograms

14. All infants should have their head circumference measured at health visits. This measurement is made from a) Just above the eyebrows through the prominent part of the occiput b) The center of the forehead to the base of the occiput c) The hairline in front to the hairline in back d) The middle of the forehead through the parietal prominence

a) Just above the eyebrows through the prominent part of the occiput

15. While caring for a child recovering from viral pneumonia, you examine his lungs for evidence of exudate and fluid. Which finding would suggest cause for concern a) A respiratory rate of 20 heard on auscultation b) Dullness of his lower lobes heard on percussion c) A longer inspiratory than expiratory rate noticed on inspection d) Fine rhonchi heart in the upper lobe on auscultation

b) Dullness of his lower lobes heard on percussion

16. To straighten an infant’s ear canal to examine it, you would pull the pinna a) Down and back b) Down and forward c) Up and back d) Up and forward

a) Down and back

17. A child who has an arterial blood gas that depicts respiratory acidosis will show a) pH is acidic, PaO2 is raised and PaCO2 is raised b) pH is acidic, PaO2 is raised and PaCO is lowered c) pH is acidic, PaO2 is lowered and PaCO2 is raised d) pH is alkalotic, PaO2 is lowered and Pa CO2 is raised

c) pH is acidic, PaO2 is lowered and PaCO2 is raised

18. You take an infant’s apical pulse before administering digoxin. What is the usually accepted level of pulse rate considered safe for administering digoxin to an 8 month old baby a) 60 bpm b) 80 bpm c) 100 bpm d) 150 bpm

c) 100 bpm

19. Which of the following nursing diagnosis would best apply to a child with rheumatic fever a) Ineffective breathing pattern related to cardiomegaly b) Activity intolerance related to inability of heart to sustain extra workload c) Sleep pattern disturbance related to hyperexcitability d) High risk of violence related to development of cerebral anoxia

b) Activity intolerance related to inability of heart to sustain extra workload

20. Bronchiolitis is a common __________ infection, which peaks in incidence in children aged __________. Symptoms usually peak around day __________ a) Viral, less than two years of age, three to five b) Viral, less than six months, ten c) Bacterial, less than two years, three to five d) Bacterial, less than six months, three to five

a) Viral, less than two years of age, three to five

21. Generally, the child most likely to ingest a poison is a) 10 months to 18 months b) 1 to 4 years c) 4 to 5 years d) 13 to 15 years

b) 1 to 4 years

22. The responsibility of the nurse caring for a victim of child abuse in the emergency room would include which of the following a) Prohibiting her parents from visiting with the child until more facts are obtained b) Asking the parents if they have been abusing their child c) Suggesting to the medical staff that the child be admitted for observation d) Asking the child what they were doing that led to abuse

c) Suggesting to the medical staff that the child be admitted for observation

23. Which of the following statements is NOT true a) Health professionals recommend exclusive breast feeding until the age of 4 months b) Uterine involution is slowed by breast feeding c) Almost all drugs are excreted to some extent in breast mild d) Oxytocin is released by breastfeeding

b) Uterine involution is slowed by breast feeding

24. Which of the following statements is NOT true of Reyes syndrome a) Most commonly occurs In young school age children b) Most commonly occurs after a viral infection c) Symptoms include severe vomiting, irritability, lethargy and confusion d) Aspirin is the treatment of choice

d) Aspirin is the treatment of choice

25. Which of the following statements is NOT true of bacterial meningitis a) Bacterial meningitis often presents with flu like symptoms initially b) A rash may or may not be present c) There is usually no associated temperature rise d) A rash, if present, does not blanch under direct pressure

c) There is usually no associated temperature rise

26. Fill in the gaps in the following statement Type I (insulin dependent) diabetes is characterised by almost no __________ secretion. This contributes to a build up of __________ in the blood stream. If exogenous insulin is not administered __________ and __________ will develop a) Insulin, glucose, hyperglycaemia and ketoacidosis b) Glucose, insulin, hyperglycaemia and ketoacidosis c) Glucose, insulin, hypoglycaemia, and unconsciousness d) Insulin, hormones, ketoacidosis and unconsciousness

a) Insulin, glucose, hyperglycaemia and ketoacidosis

27. The grandmother has brought an infant to the clinic for a check up and has signed the consent for immunization administration. Which of the following would the nurse do first a) ask who the infants legal guardian is b) notify the physician immediately c) administer the immunizations ordered d) call the infant’s mother for verbal consent

a) ask who the infants legal guardian is

28. Which of the following would the nurse explain to the mother of a child receiving digoxin (lanoxin) as the primary reason for giving this drug a) To relax the walls of the hearts arteries b) To improve the strength of the heartbeat c) To prevent irregularities in ventricular contractions d) To decrease inflammation of the heart wall

b) To improve the strength of the heartbeat

29. Paralysis in an individual with a meningomyelocele usually occurs a) In the motor sphere below the level of the deformity b) In the motor and sensory spheres below the level of the deformity c) In the motor sphere above the deformity d) In the motor and sensory spheres above the deformity

b) In the motor and sensory spheres below the level of the deformity

30. During the acute state of meningitis, a 3 year old child is restless and irritable. Which of the following would be most appropriate to institute a) Hemorrhagic skin rash b) Edema c) Cyanosis d) Dyspnea on exertion

a) Hemorrhagic skin rash

31. Which of the following would first alert the nurse to suspect that a child with severe gastroenteritis who has been receiving intravenous therapy for the past several hours may be developing circulatory overload a) A drop in blood pressure b) Change to slow, deep respirations c) Auscultation of moist crackles d) Marked increase in urine output

c) Auscultation of moist crackles

32. The causative organism for rheumatic fever is a) Haemophilus influenzae b) Staphylococcus bacteria c) Syncytial virus d) Group A streptococcal bacteria

d) Group A streptococcal bacteria

33. The most serious complication of rheumatic fever is a) Endocarditis b) Pneumonia c) Arthritis d) Meningitis

a) Endocarditis

34. When preparing the teaching plan for the mother of a child with asthma, which of the following would the nurse include as signs to alert the mother that her child is having an asthma attack a) Secretion of this, copious mucous b) Tight, productive cough c) Wheezing on expiration d) Temperature of 37.4oC

c) Wheezing on expiration

35. A 10 year old child with a history of asthma uses an inhaled bronchodilator only when needed. He takes no other medications routinely. His best peak expiratory flow rate is 270 L/min. The child's current peak flow reading is 180 L/min. the nurse interprets this reading as indicating which of the following a) The child’s asthma is under good control, so the routine treatment plan should continue b) The child needs to start a short acting inhaled B2 agonist medication c) This is medical emergency requiring a trip to the emergency department for treatment d) The child needs to begin treatment with inhaled cromolyn sodium (intal) for asthma control

d) The child needs to begin treatment with inhaled cromolyn sodium (intal) for asthma control

36. An 8 year old child with asthma states, I want to play some sports like my friends. What can I do. The nurse responds to the child based on the understanding of which of the following a) Physical activities are inappropriate for children with asthma b) Children with asthma must be excluded from team sports c) Vigorous physical exercise frequently precipitates an asthmatic episode d) Most children with asthma can participate in sports if the asthma is controlled

d) Most children with asthma can participate in sports if the asthma is controlled

37. After instructing a mother about normal reflexes of term neonates, the nurse determines that the mother understands the instructions when she describes the tonic neck reflex as occurring when the neonate does which of the following a) Steps briskly when held upright near a firm, hard surface b) Pulls both arms and does not move the chin beyond the point of the elbows c) Turns head to the left, extends left extremities, and flexes right extremities d) Extends and abducts the arms and legs with the toes fanning open

c) Turns head to the left, extends left extremities, and flexes right extremities

38. After talking with the parents of a child with down’s syndrome, which of the following would the nurse identify as an appropriate goal for care of the child a) Encouraging self care skills in the child b) Teaching the child something new every day c) Encouraging more lenient behaviour limits for the child d) Achieving age appropriate social skills

d) Achieving age appropriate social skills

39. After teaching a group of school teachers about seizures, the teachers’ role play a scenario involving a child experiencing a generalised tonic clonic seizure. Which of the following actions, when performed first, indicates that the nurses teaching has been successful a) Asking the other children what happened before the seizure b) Moving the child to the nurses office for privacy c) Removing any nearby objects that could harm the child d) Placing a padded tongue blade between the child’s teeth

c) Removing any nearby objects that could harm the child

40. Which of the following statements obtained from the nursing history of a toddler would alert the nurse to suspect the child has had a febrile seizure a) The child has had a low grade fever for several weeks b) The family history is negative for convulsions c) The seizure resulted in respiratory arrest d) The seizure occurred when the child had a respiratory infection

d) The seizure occurred when the child had a respiratory infection

41. Which of the following, if described by the parents of a child with cystic fibrosis, indicates that the parents understand the underlying problem of the disease a) An abnormality in the body’s mucus secreting glands b) Formation of fibrous cysts in various body organs c) Failure of the pancreatic ducts to develop properly d) Reaction to the formation of antibodies against streptococcus

a) An abnormality in the body’s mucus secreting glands

42. The nurse judges that the mother understands the term cerebral palsy when she describes it as a term applied to impaired movement resulting from which of the following a) Injury to the cerebrum caused by viral infection b) Malformed blood vessels in the ventricles caused by inheritance c) Non progressive brain damage caused by injury d) Inflammatory brain disease caused by metabolic imbalances

c) Non progressive brain damage caused by injury

43. The mother asks the nurse whether her child with hemiparesis due to spastic cerebral palsy will be able to walk normally because he can pull himself to a standing position. Which of the following responses by the nurse would be most appropriate a) Ask the doctor what he thinks at your next appointment b) Maybe, maybe not. How old were you when you first walked c) It’s difficult to predict but his ability to bear weight is a positive factor d) If he really wants to walk, and works hard, he probably will eventually

c) It’s difficult to predict but his ability to bear weight is a positive factor

44. A father brings his 3 month old infant to the clinic, reporting that the infant has a cold, is having trouble breathing and just doesn’t seem to be acting right. Which of the following actions would the nurse do first a) Check the infants heart rate b) Weight the infant c) Assess the infants oxygen saturation d) Obtain more information from the father

c) Assess the infants oxygen saturation

45. In preparation for discharge, the nurse teaches the mother of an infant diagnosed with bronchiolitis about the condition and its treatment. Which of the following statements by the mother indicates successful teaching a) I need to be sure to take my child’s temperature everyday b) I hope I don’t get a cold from my child c) Next time my child gets a cold I need to listen to the chest d) I need to wash my hands more often

d) I need to wash my hands more often

46. When developing the plan for care for a child with early duchennes muscular dystrophy, which of the following would the nurse identify as the primary nursing goal for the child a) Encouraging early wheelchair use b) Fostering social interactions c) Maintaining function of unaffected muscles d) Prevent circulatory impairment

c) Maintaining function of unaffected muscles

47. Which of the following would be an important assessment finding for an 8 month old infant admitted with severe diarrhoea a) Absent bowel sounds b) Pale yellow urine c) Normal skin elasticity d) Depressed anterior fontanel

d) Depressed anterior fontanel

48. When obtaining the initial health history from a 10 year old child with abdominal pain and suspected appendicitis, which of the following questions would be most helpful in eliciting data to help support the diagnosis a) Where did the pain start b) What did you do for the pain c) How often do you have a bowel movement d) Is the pain continuous or does it let up

a) Where did the pain start

49. Which of the following would first alert the nurse to suspect that a child with severe gastroenteritis who has been receiving intravenous therapy for the past several hours may be developing circulatory overload a) A drop in blood pressure b) Change to slow, deep respirations c) Auscultation of moist crackles d) Marked increase in urine output

c) Auscultation of moist crackles

50. The stool culture of a child with profuse diarrhoea reveals salmonella bacilli. After teaching the mother about the course of salmonella enteritis, which of the following statements by the mother indicates effective teaching a) Some people become carriers and stay infectious for a long time b) After the acute state passes, the organism is usually not present in the stool c) Although the organism may be alive indefinitely, in time it will be of no danger to anyone d) If my child continues to have the organism in the stool, an antitoxin can help destroy the organism

a) Some people become carriers and stay infectious for a long time

51. A mother of a 1 month old infant state that she is curious as to whether her infant is developing normally. Which of the following developmental milestones would the nurse expect the infant to perform a) Smiling and laughing out loud b) Rolling from side to side c) Holding a rattle briefly d) Turning the head from side to side

d) Turning the head from side to side

52. A child is to receive Trilafon 24 mg po BD. The medication is available as 16 mg/5ml. how may ml will you administer a) 3.3 b) .75 c) 7.5 d) 0.3

c) 7.5

53. Which of the following age groups are most susceptible to meningococcal meningitis a) Children below 5 years of age b) Children between 3.6 years (preschool) c) School age children d) Adolescents

a) Children below 5 years of age

54. A parent asks, can I get head lice too. The nurse indicates that adults can also be infested with head lice but that Pediculosis is more common among school children, primarily for which of the following reasons a) An immunity to Pediculosis usually is established by adulthood b) School aged children tend to be more neglectful of frequent hand washing c) Pediculosis usually is spread by close contact with infected children d) The skin of adults is more capable of resisting the invasion of lice

c) Pediculosis usually is spread by close contact with infected children

55. When developing the postoperative plan of care for an adolescent who has undergone an appendicectomy for a ruptured appendix, in which of the following positions would the nurse expect to place the client during the early postoperative period a) The semi fowlers position b) Supine c) Lithotomy position d) Prone

a) The semi fowlers position

STATE EXAMS 3 1. Mental status assessment using the ‘batomi’ formation is a useful nursing assessment tool because it tells you a) Whether or not a client has a mental illness b) Details about an individual’s feeling state and cognitive functioning c) Whether a mental illness is organic or functional in origin d) The history of a clients symptoms and his response to stress

b) Details about an individual’s feeling state and cognitive functioning

2. Persons with an acute psychotic illness have most difficulty in a) Meeting dependency needs b) Maintaining grooming and personal hygiene c) Distinguishing between reality and unreality d) Displaying personal feelings

c) Distinguishing between reality and unreality

3. People who have a personality disorder a) Frequently progress to a psychotic illness b) Become psychotic under severe stress c) Are known as borderline personalities d) Have ongoing difficulties in relating to others

d) Have ongoing difficulties in relating to others

4. Neurotic disorders are associated with a) Inadequacy and poor stress management b) Maladaptive behaviour related to anxiety c) Inability to cope with demands and perceived stress d) Family patterns of inappropriate behaviour

b) Maladaptive behaviour related to anxiety

5. Which of the following statements about tardive dyskinesia is true a) Symptoms are often permanent and do not improve with antiparkinsonian medication b) Symptoms will diminish as the client adjusts to long term treatment c) Clients are seldom concerned about features of tardive dyskinesia d) Antiparkinsonian medication will suppress the main features of tardive dyskinesia

a) Symptoms are often permanent and do not improve with antiparkinsonian medication

6. Memory loss associated with old age a) Has a sudden onset and affects both long term and short term memory b) Has a gradual onset and affects mainly long term memory c) Has a gradual onset and affects mainly short term memory d) Has a sudden onset and affects mainly short term memory

c) Has a gradual onset and affects mainly short term memory

7. persons who have a neurotic disorder a) have a minor disorder that will diminish with time and maturity b) respond well to electro convulsive therapy c) do not develop psychotic features d) frequently have insight into their behaviour

d) frequently have insight into their behaviour

8. a social factor contributing to the incidence of eating disorders is a) economic disadvantage b) educational disadvantage c) gender stereotyping d) unemployment

c) gender stereotyping

9. the most common features of chronic organic psychosis are a) fluctuating confusion and disorientation b) persistent elated mood and hyperactivity c) thought blocking and concrete thinking d) social withdrawal and paranoid ideation

d) social withdrawal and paranoid ideation

10. phobia is best described as a) a fear related to an identifiable traumatic event in one’s life b) an irrational fear of a specific situation or object c) a series of repetitive behaviours designed to relieve anxiety d) a general sense of impending doom

b) an irrational fear of a specific situation or object

11. the most appropriate treatment for phobias is a) anxiolytic drugs b) cognitive restructuring c) relaxation exercises d) systematic desensitisation

b) cognitive restructuring

12. the best definition of a crisis is a) any event which causes anxiety b) a life event which is perceived as a threat to self esteem c) a traumatic event for which coping behaviours are inadequate d) a situation which is traumatic and involves a significant loss

b) a life event which is perceived as a threat to self esteem

13. forensic psychiatry is the area of mental health care which is concerned with individuals who a) have been committed to hospital because they would not voluntarily accept treatment b) are not considered to be capable of caring for themselves in a non custodial environment c) have been charged with an offence to undergo a psychiatric examination or treatment d) are mentally ill and considered to be a danger to themselves or to the public

c) have been charged with an offence to undergo a psychiatric examination or treatment

14. anxiety is best described as a) mild form of psychosis b) disorder of mood c) response to stress d) distorted sense of perception

c) response to stress

15. Which of the following is common feature of anxiety a) Paranoid delusions b) Social withdrawal c) Impaired concentration d) Auditory hallucinations

c) Impaired concentration

16. A comparison of Maori and non Maori suicide rates shows that a) Maori are less likely to commit suicide b) Maori are much more likely to commit suicide c) There is no difference between Maori and non Maori suicide rates d) There are differences but they are not statistically significant

17. A person who is currently acutely depressed expresses an intention to self harm. Your initial response would be to a) Distract the client by talking about less depressing thoughts or ideas b) Encourage the client to discuss their ideas of suicide to establish potential for self harm c) Suggest the client involves themselves with other clients to establish supportive relationships d) Ask the client to explain their reasons for contemplating self harm

b) Encourage the client to discuss their ideas of suicide to establish potential for self harm

18. A depressed client is prescribed amitriptyline. This would have the effect of a) Clarifying his thought processes b) Helping to raise his mood c) Eliminating negative ideas d) Promoting greater self awareness

b) Helping to raise his mood

19. While watching television in the lounge a client says quickly and abruptly to the nurse, the sun is shining in Virginia. My son is in Virginia. Who’s afraid of Virginia wolf. Which of the following is this statement an example of a) Concrete thinking b) Flight of ideas c) Word salad d) Depersonalisation

b) Flight of ideas

20. In planning the care of for the elated client a primary aim is to a) Encourage interpersonal contact b) Provide a non stimulating environment c) Demand that the client follow rules d) Accept and understand the behaviour

d) Accept and understand the behaviour

21. For a client suffering from mania who is unable to sleep the best approach is to a) Fully involve the client in physical activities and exercise programmes during daytime b) Encourage the client to talk about underlying feelings or stressors c) Nurse in low stimulus environment and administer prescribed antipsychotic medication d) Place in seclusion using medication only as a last resort

c) Nurse in low stimulus environment and administer prescribed antipsychotic medication

22. For a client suffering from mania who is expressing delusional ideas the best approach is to a) Explain to the client the distinction between rational and irrational thinking b) Acknowledge his ideas but distract him by focusing on reality based ideas c) Ignore him because to do otherwise will only reinforce his ideas d) Encourage him to stop thinking like that, as it is a symptom of his illness

b) Acknowledge his ideas but distract him by focusing on reality based ideas

23. A client who is subject to a community treatment order section 29 of the mental health act (1992) must a) Accept prescribed medication and attend any specified treatment center b) Report on a weekly basis to a community mental health centre c) Return to hospital after a period of three months for a psychiatric assessment d) Name a primary caregiver who will accept responsibility for the clients care and supervision

a) Accept prescribed medication and attend any specified treatment center

24. In preparation for living in the community a client may spend a period of time living in a half way house. The main objective of living in a half way house is to a) Save sufficient money in order to set up a house or flat b) Spend time looking for a suitable job on leaving hospital c) Assess whether the client still has any symptoms of mental illness d) Provide the client with the opportunity to adjust to a more independent lifestyle

d) Provide the client with the opportunity to adjust to a more independent lifestyle

25. Following an automobile accident involving a fatality and a subsequent arrest for speeding, a client has amnesia for the events surrounding the accident. This is an example of the defence mechanism known as a) Projection b) Repression c) Dissociation d) Suppression

c) Dissociation

26. The group most at risk for developing an eating disorder is young women a) Who are high achievers b) With a history of disturbed behaviour c) Who have conflict with their parents d) With a history of mental illness

d) With a history of mental illness

27. Support for a client with an eating disorder involves a) Avoidance of family conflicts b) Discussion of health ways of losing weight c) Encouragement to explore issues of concern d) Daily checks for changes in weight

c) Encouragement to explore issues of concern

28. The personality disorder associated with an inability to make decisions and the need for constant reassurance is commonly classified as a) Obsessive compulsive b) Dependent c) Cyclothymic d) Antisocial

b) Dependent

29. People who have a personality disorder a) Frequently progress to a psychotic illness b) Become psychotic under severe stress c) Are known as borderline personalities d) Have ongoing difficulties in relating to others

d) Have ongoing difficulties in relating to others

30. A side effect resulting from long term use of antipsychotic medication is tardive dyskinesia. Features of tardive dyskinesia include a) Involuntary lip smacking and tongue movements b) Dry mouth and blurred vision c) Muscular rigidity and shuffling gait d) Nausea and vomiting

a) Involuntary lip smacking and tongue movements

31. A nurse working in a long term ward becomes aware that they are becoming institutionalised. Which of the following behaviours would they be most likely to have noticed a) An excessive and unrealistic concern for the welfare of clients b) A tendency to become involved in new activities c) A lack of satisfaction with existing methods of work d) Resistance to new ideas and change

d) Resistance to new ideas and change

32. One reason for ordering an individual charged with an offence to have psychiatric examination is to determine whether that person a) Is likely to have committed the offence he is charged with b) Has a previous personal or family history of psychiatric illness c) Was suffering from a mental illness at the time of the alleged offence d) Has a mental illness which would respond to a programmed of treatment

c) Was suffering from a mental illness at the time of the alleged offence

33. Cultural considerations in the use of seclusion include a) Use of seclusion only after consent has been obtained from the appropriate cultural representatives b) Listening to advice from staff of the clients culture or form the clients family c) Having an appropriate cultural representative available each time the seclusion room is entered d) Ensuring that only staff from the clients culture participate in caring for any client in seclusion

a) Use of seclusion only after consent has been obtained from the appropriate cultural representatives

34. Cross cultural studies on mental illness show that a) The symptoms of mental illness are the same in all cultures b) The incidence of mental illness the same in all cultures c) Mental illness has culturally specific characteristics d) Mental illness is more common amongst cultural minorities

d) Mental illness is more common amongst cultural minorities

35. The drug most commonly used in the long term treatment of bi polar disorder is a) Diazepam b) Lithium carbonate c) Clozapine d) Sodium Amytal

b) Lithium carbonate

36. Anticholinergic side effects are common with all the following except a) Diazepam b) Benztropine c) Amitriptyline d) Thioridazine

d) Thioridazine

37. Chlorpromazine is an antipsychotic medication used in the treatment of a) Anxiety states b) Schizophrenia c) Depressive disorders d) Dementia

b) Schizophrenia

38. Which of the following is the main reason for giving depot injections of antipsychotic medication a) They are more effective than oral medication b) They overcome the problem of non adherence c) Side effects are not as common d) They are easier to administer than oral medication

b) They overcome the problem of non adherence

39. A client who is committed under the mental health act (1992) is discharged from hospital on leave. When visited by the community mental health nurse he refused his injection of antipsychotic medication which is due that day. The best initial approach to this would be to a) Explain that this will mean his immediate return to hospital b) Visit again the next day and attempt to persuade the client to accept his medication c) Inform the medical staff so that the clients legal status can be changed d) Explore with the client alternative forms of treatment to medication

a) Explain that this will mean his immediate return to hospital

40. Long term use of benzodiazepine drugs (minor tranquillisers) such as diazepam (valium) can lead to a) Tardive dyskinesia b) Dependence c) Renal impairment d) Akathisia

b) Dependence

41. A client expresses the belief that he is the illegitimate son of a famous family. This is an example of a) Paranoid thinking b) Pressure of speech c) A delusion of grandeur d) Ideas of reference

c) A delusion of grandeur

42. The best response to this statement (in previous question) is to a) Involve the client in a group activity b) Inform the client that he is wrong in his belief c) Talk to the client without confirming or denying his belief d) Spend some time with the client in an attempt to meet his need to feel important

c) Talk to the client without confirming or denying his belief

43. At an art group a client shows the group the painting he has done. It consists of knives and blood, with the words ‘death’ and ‘peace’ written on it. The client tells the group that this represents his own death and release from suffering. The best response to this is a) Thank him for his participation and then focus the discussion on another client b) Acknowledge his contribution and ensure that you discuss this further with him after the group has finished c) Request that the client use the opportunity to explore more positive aspects of his life d) Insist the client explain this feelings to the group and then point out positive aspects of his life

b) Acknowledge his contribution and ensure that you discuss this further with him after the group has finished

44. A client who has been admitted for treatment of a depressive illness says he doesn’t want to attend group activities. The reason such a client would be encouraged to attend is that a) He is less likely to dwell on depressive ideas while he is involved in a group activity b) It is an expectation that all clients attend group activities while in hospital c) Involvement in group activities is the only way to overcome feelings of depression d) Attendance at group activities is essential to monitor the effectiveness of medication

a) He is less likely to dwell on depressive ideas while he is involved in a group activity

45. A client with post traumatic stress disorder says ‘I should have been killed with the rest of them. Why am I alive’ this statement is best described as an example of a) Suicidal thinking b) Survivor guilt c) Depressive preoccupation d) Neurotic conflict

b) Survivor guilt

46. The best way to report the clients statement (in previous question) in the nursing notes would be a) Client has no insight into their situation b) Client is questioning why they are still alive c) Client is expressing suicidal ideas d) Client feels responsible for death of others

b) Client is questioning why they are still alive

47. Long acting intramuscular antipsychotic medication is used in the treatment of schizophrenia because it a) Has fewer side effects than oral medication b) Has a greater antipsychotic action c) Is more rapidly absorbed than oral medication d) Ensures that clients receive their medication

c) Is more rapidly absorbed than oral medication

48. Which of the following statements related to the treatment, with lithium carbonate, of person with bipolar disorder is true a) Most will need to take lithium carbonate for an extended period of time, perhaps for life b) Once the persons mood becomes euthymic, treatment can be discontinued in most cases c) Because of the need to maintain constant blood levels, long term injections is the preferred form of treatment d) Treatment is most effective in the acute stage of the illness although some people will need long term treatment

d) Treatment is most effective in the acute stage of the illness although some people will need long term treatment

49. An acutely ill client with the diagnosis of schizophrenia has just been admitted to the mental health unit. When working with this client initially the nurses most therapeutic action would be to a) Use diversional activity and involve the client in occupational therapy b) Build trust and demonstrate acceptance by spending some time with the client c) Delay one to one interactions until medications reduce the psychotic symptoms d) Involve the client in multiple small group discussions to distract attention from the fantasy world

b) Build trust and demonstrate acceptance by spending some time with the client

50. You are caring for a client who talks in a regretful way about the past. The best response is to a) Help them find something positive in their past b) Help them move their thoughts to the future c) Tell them that focusing on the past is not helpful d) Acknowledge the clients feelings then focus on the present

d) Acknowledge the clients feelings then focus on the present

51. Intervention with an angry client who is threatening violence involves a) Asking the client to express their feelings verbally b) Maintaining silence to avoid any escalation of anger c) Asking the client what has happened to make them so angry d) Giving brief, clear messages about what you want the client to do

d) Giving brief, clear messages about what you want the client to do

52. Mr w is committed under section 11 o the mental health act 1992. He sneaks out at night and returns to his former home. He calls the staff and tells them he is not coming back. The staffs responsibility is to a) Make sure he has discharged b) Tell him to take his medication c) Ask to have someone else talk to him d) Notify the police and crisis team

d) Notify the police and crisis team

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

a) Orientation to reality

54. The use of silence during an interview is therapeutic if a) The person is overcome with emotion b) The person appears uncomfortable with the current discussion c) The nurse wishes to terminate the communication session d) The patient wishes to terminate the communication session

b) The person appears uncomfortable with the current discussion

55. To facilitate communication the nurse should convey a) Accurate empathy b) Authenticity c) Unconditional positive regard d) All of the above

d) All of the above

56. The parents of a young man experiencing a schizophrenic illness ask if he is likely to become violent. The best answer the nurse can make is that the vast majority of mentally ill individuals a) Are more dangerous than normal people b) Are not more dangerous than other individuals in the population c) Are unpredictable and therefore more dangerous than normal individuals d) Are about as violent and unpredictable as more individuals in the population

d) Are about as violent and unpredictable as more individuals in the population

57. While interviewing Mr. d, the nurse notes he uses neologisms and has losses associations. This would most likely indicate the presence of a) Mania b) Depression c) Defensive coping d) Schizophrenia or psychosis

c) Defensive coping

58. When monoamine oxide inhibitors (MAOIs) are prescribed, the client should be cautioned against a) Prolonged exposure to the sun b) Ingesting wines and aged cheeses c) Engaging in active physical exercise d) The use of medications with an elixir base

a) Prolonged exposure to the sun

59. A characteristic feature of the elated client is a) Retarded speech b) Increased motor and thought activity c) Delusions of sin and guilt d) Depressed mood

b) Increased motor and thought activity

60. To give effective nursing care to a client who is using ritualistic behaviour, the nurse must first recognize that the client a) Should be prevented from performing the rituals b) Needs to realise that the rituals serve no purpose c) Must immediately be diverted when performing the ritual d) Does not want to repeat the ritual, but feels compelled to do so

d) Does not want to repeat the ritual, but feels compelled to do so

STATE EXAMS 4 1. Culturally safe nursing care can best be achieved when the nurse has a) An in depth knowledge of the treaty of Waitangi b) An awareness of Maori perspectives of health c) An awareness and acceptance of your own limits in meeting someone’s else’s health and cultural needs d) A knowledge of Maori protocol

c) An awareness and acceptance of your own limits in meeting someone’s else’s health and cultural needs

2. Imagine a new virus infecting a human population for the first time. Which of the following is most likely to lead to a rapid increase in cases worldwide a) Severe disease with high mortality b) Lack of hand hygiene c) Air travel d) High transmissibility

d) High transmissibility

3. The school nurse is caring for a child with haemophilia who is actively bleeding from the leg. Which of the following would the nurse apply a) Direct pressure, checking every few minutes to see if the bleeding has stopped b) Ice to the injured leg area several times a day c) Direct pressure to the injured area continuously for 10 minutes d) Ice bag with elevation of the leg twice a day

c) Direct pressure to the injured area continuously for 10 minutes

4. Home health nurses visit a blind diabetic patient who lives alone to monitor the patients glucose level and administer the patients daily insulin. Evaluation of outcome management for this patient would include a) An absence of complications of diabetes b) A reduction in hospitalizations for glycemic control c) The ability of the patient to learn to use adaptive syringes d) The patients evaluation of the services provided by the nurses

b) A reduction in hospitalizations for glycemic control

5. The nurse consults with the physician to arrange a referral for hospice care for a patient with end stage liver disease based on the knowledge that hospice care is indicated when a) Family members can no longer care for dying patients at home b) Patients and families are having difficulty coping with grief reactions c) Preparation for death with palliative care and comfort are the goals of care d) Patients have unmanageable pain and suffering as a result of their condition

c) Preparation for death with palliative care and comfort are the goals of care

6. When teaching a patient who smokes about the relationship of smoking to the development of cancer, the nurse explains that tobacco smoke is a complete carcinogen because a) Exposure to the smoke always causes cellular changes b) Tobacco smoke is capable of both initiating and promoting cancer growth c) Cancer will always develop when people who smoke are exposed to other carcinogens d) Tobacco smoke serves as a vehicle for the spread of cancer cells during the progression stage of cancer

b) Tobacco smoke is capable of both initiating and promoting cancer growth

7. In teaching about cancer prevention, the nurse stresses promotion of exercise, normal body weight, and low fat diet because a) General aerobic health is an important defence against cellular mutation b) Obesity is a factor that promotes cancer growth; if it is reversed, the risk of cancer can be decreased c) People who are overweight usually consume large amounts of fat, which is a chemical carcinogen d) The development of fatty tumours, such as lipomas, is increased when there is an abundance of fatty tissue

b) Obesity is a factor that promotes cancer growth; if it is reversed, the risk of cancer can be decreased

8. A 40 year old divorced mother of four school children is hospitalized with metastatic cancer of the ovary. The nurse finds the patient crying, and she tells the nurse that she does not know what will happen to her children when she dies. The most appropriate response by the nurse is a) Why don’t we talk about the options you have for the care of your children b) You are going to live for a long time yet, and your children will be just fine c) I wouldn’t worry about that right now. You need to concentrate on getting well d) Wont your ex husband take the children when you can’t care for them anymore

a) Why don’t we talk about the options you have for the care of your children

9. During the primary assessment of a trauma victim, the nurse determines that the patient has a patent airway. The next assessment the nurse makes includes a) The level of consciousness b) Observation for external bleeding c) The status of the patients respiration d) The rate and character of carotid or femoral pulses

c) The status of the patients respiration

10. Which of the following viruses is usually transmitted by airborne droplets a) Varicella zoster virus b) Cytomegalovirus c) Herpes simplex virus d) Hepatitis a virus

a) Varicella zoster virus

11. Which of the following has made the biggest impact on mortality from infectious diseases in the 20th century a) Vaccination b) Better housing and provision of clean water, sewerage systems c) Antimicrobials d) Infection control

d) Infection control

12. in addition to providing informational support, which of the following nursing activities is an integral part of the role of the nurse advocate a) maintaining the patient in a dependent role b) assuming responsibility for directing the patients care c) assisting the patient to make sound health care decisions d) persuading the patient to choose exactly what the health care team recommends

c) assisting the patient to make sound health care decisions

13. Steve, 15 years old, is admitted with suspected meningitis. Nuchal rigidity will not be seen in which of the following a) intracranial haematoma b) meningitis c) cerebral concussion d) intracranial tumour

c) cerebral concussion

14. a positive Mantoux test indicates a) the client has active tuberculosis b) the client has been exposed to mycobacterium c) the client will never have tuberculosis d) the client has been infected with mycobacterium tuberculosis

b) the client has been exposed to mycobacterium

15. Which of the following would the nurse do when suspecting that a child has been abused by the mother a) Continue to collect information until there is no doubt in the nurses mind that abuse has occurred b) Ensure that any and all findings are reported to the proper state and legal authorities c) Keep the finding confidential, because they represent legal privileged communication between the nurse and the mother d) Report the findings to the physician because that falls within the responsibilities of medical practise

b) Ensure that any and all findings are reported to the proper state and legal authorities

16. Several high school seniors are referred to the school nurse because of suspected alcohol misuse. When the nurse assesses the situation, which of the following would be most important to determine a) What they know about the legal implications of drinking b) The type of alcohol they usually drink c) The reasons they choose to use alcohol d) When and with whom they use alcohol

c) The reasons they choose to use alcohol

17. When a trauma victim expresses fear that AIDS may develop as a result of a blood transfusion, the nurse should explain that a) Blood is treated with radiation to kill the virus b) Screening for HIV antibodies has minimised the risk c) The ability to directly identify HIV has eliminated this concern d) Consideration should be given to donating own blood for transfusion

b) Screening for HIV antibodies has minimised the risk

18. A client asks the nurse, should I tell my husband I have AIDS. The nurses most appropriate response would be a) This is a decision alone you can make b) Don not tell him anything unless he asks c) You are having difficulty deciding what to say d) Tell him you feel you contracted AIDS from him

c) You are having difficulty deciding what to say

19. When a disaster occurs, the nurse may have to treat mass hysteria first. The person or persons to be cared for immediately would be those in a) Panic b) Coma c) Euphoria d) Depression

a) Panic

20. A child was bitten on the hand by a dog who had recently received a rabies shot. The nursing priority for this child would be directed toward ensuring that the a) Suture line remains red and dry b) Child does not develop a fear of dogs c) Rabies antibodies develop within 48 hours d) Mobility of the injured hand returns to a preinjury state in 1 week

c) Rabies antibodies develop within 48 hours

21. The school nurse is invited to attend a meeting with several parents who express frustration with the amount of time their adolescents spend in front of the mirror and the length of time it takes them to get dressed. The nurse explains that this behaviour is indicative of which of the following a) An abnormal narcissism b) A method of procrastination c) A way of testing the parents limit setting d) A result of developing self concept

d) A result of developing self concept

22. A parent asks the nurse about head lice (Pediculosis capitis) infestation during a visit to the clinic. Which of the following symptoms would the nurse tell the parent is most common in a child infected with head lice a) Itching of the scalp b) Scaling of the scalp c) Serous weeping of the scalp surface d) Pinpoint hemorrhagic spots on the scalp surface

a) Itching of the scalp

23. After teaching the parents about the cause of ringworm of the scalp (tinea capitis), which of the following, if stated by the father, indicates successful teaching a) Over exposure to the sun b) Infestation with a mite c) Fungal infection of the scalp d) An allergic reaction

c) Fungal infection of the scalp

24. A mother tells the nurse that one of her children has chicken pox and asks what she should do to care for that child. When teaching the mother, which of the following would be most important to prevent a) Acid base imbalance b) Malnutrition c) Skin infection d) Respiratory infection

c) Skin infection

25. One litre of intravenous fluid is to be given over 4 hours. The giving set delivers 60 drops per ml. how many drops per minute should be given a) 150 b) 250 c) 300 d) 160

b) 250

26. The nurse discusses the eating habits of school aged children with their parents, explaining that these habits are most influenced by which of the following a) Food preference of their peers b) Smell and appearance of foods offered c) Examples provided by parents at mealtimes d) Parental encouragement to eat nutritious foods

c) Examples provided by parents at mealtimes

27. Which of the following is an offence under the Hydatids act 1959 a) Failure to report stray, unregistered dogs b) Feeding raw offal to any dogs in your care c) Tenuicollis worms in lambs at the time of killing d) Tenuicollis cysts in any purged material from dogs

b) Feeding raw offal to any dogs in your care

28. What is the responsibility of the nurse who, for two days, has observed the nurse manager putting several syringes into her pocket a) Report the matter to another nurse manager b) Discuss the matter with your nursing colleagues c) Watch the nurse manager to see if it happens again d) Ignore the incident as a nurse manager is a responsible person

a) Report the matter to another nurse manager

29. Neil, a 17 year old, is hit on the head by a cricket ball while playing with a friend at home. He fell against the glasshouse, severely lacerating his right wrist. He as unconscious for about 5 minutes. The initial first aid treatment for Neil would be to a) Wrap a handkerchief tightly on the wrist b) Check for breathing c) Elevate the wrist d) Wash the wrist to examine it

a) Wrap a handkerchief tightly on the wrist

30. You are taking nails recordings when he appears to have a seizure. What nursing intervention would best assist Neil a) Describing and recording the seizure activity observed b) Restraining Neil in order to prevent self harm c) Placing a tongue blade between his teeth d) Suctioning Neil to prevent aspiration

a) Describing and recording the seizure activity observed

31. Following a petit mal seizure a person is likely to be a) Confused b) Hostile c) Hyperactive d) Euphoric

c) Hyperactive

32. On a follow up outpatient. Neil enquires about his anticonvulsant medication. He needs to know that following a head injury a) The medication must be taken for at least 1 year b) The physician must be seen when the prescription is finished c) The medication will be discontinued as soon as his seizures are under control d) The medication will be necessary for the rest of his life

b) The physician must be seen when the prescription is finished

33. If you are with someone who has a grand mal seizure, you should a) Loosen the clothing about their neck and wrist b) Turn their head to the side to facilitate drainage of secretions c) Remove nearby objects to protect their extremities from injury d) All of the above

d) All of the above

34. The school nurse is caring for a child with haemophilia who is actively bleeding from the leg. Which of the following would the nurse apply a) Direct pressure, checking every few minutes to see if the bleeding has stopped b) Ice to the injured leg area several times a day c) Direct pressure to the injured area continuously for 10 minutes d) Ice bag with elevation of the leg twice a day

c) Direct pressure to the injured area continuously for 10 minutes

35. When performing a cultural assessment with a patient of a different culture, it is important for the nurse to first ask about the patients a) Racial heritage b) Use of cultural healers c) Language spoken at home d) Affiliation with a cultural group

c) Language spoken at home

36. After being bitten by an unknown insect, a patient allergic to wasp stings is brought to a clinic by a co worker. Upon arrival the patient is anxious and is having difficulty breathing. The first action by the nurse is to a) Administer oxygen b) Maintain the patients airway c) Remove the stinger from the site d) Place the patient in recumbent position with his legs elevated

b) Maintain the patients airway

37. During immediate care of a victim of a bite or sting to the hands or fingers, it is most important for the nurse to a) Elevate the affected extremity b) Scrub the wound with an antibacterial solution c) Apply ice to the site with ice water or ice packs d) Remove rings and watches from the affected extremity

d) Remove rings and watches from the affected extremity

38. A young man seeks medical care after a friend with whom he shared needles during illicit drug use develops hepatitis B. to provide immediate protection from infection, the nurse expects to administer a) Corticosteroids b) Gamma globulin c) Hepatitis b vaccine d) Fresh frozen plasma

c) Hepatitis b vaccine

39. A 63 year old man has terminal cancer of the liver and is cared for by his wife at home. His abdominal pain has become increasingly severe, and he now says it is intense most of the time. The nurse recognizes that teaching regarding pain management has been effective when the patient a) Limits the use of opiate analgesics to prevent addiction b) Resigns himself to the fact that pain is an inevitable consequence of cancer c) Uses pain medication only when the pain becomes more than he can tolerate d) Takes analgesics around the clock on a regular schedule, using additional doses for the breakthrough pain

d) Takes analgesics around the clock on a regular schedule, using additional doses for the breakthrough pain

40. A patient is treated at a clinic with an injection of long acting penicillin for a streptococcal throat infection. Her history reveals that she has received penicillin before with no allergic responses. When the penicillin injection is administered, the nurse should inform the patient that a) She must wait in the clinic area for 20 minutes before she is discharged b) Since she has taken penicillin before without problems, she can safely take it now c) She would have immediate symptoms if she had developed an allergy to penicillin d) She should monitor for fever and skin rash typical of serum sickness after taking penicillin

a) She must wait in the clinic area for 20 minutes before she is discharged

41. A parent asks why it is recommended that the second dose of the measles, mumps, rubella (MMR) vaccine be given by 12 years of age. The nurse responds based on which of the following as the most important reason a) The risks to a foetus are high if a girl receiving the vaccine becomes pregnant b) The chance of contracting the disease is much lower after puberty than before it c) The dangers associated with a strong reaction to the vaccine are increased after puberty d) The changes that occur in the immunologic system may affect the rhythm of the menstrual cycle

a) The risks to a foetus are high if a girl receiving the vaccine becomes pregnant

42. Mrs Simmon states she is not feeling well, that she cannot breathe and asks you to please do something. Your initial response to the client is a) You will be alright, just calm down b) Don’t worry, the doctors have everything under control c) I will ring the doctor to come and see you d) I will take your recordings and ring the doctor to see you

d) I will take your recordings and ring the doctor to see you

43. For the nursing council to find a registered nurse guilty of negligence, it would have to prove that the nurse a) Failed to do what another careful registered nurse would have done in a similar situation b) Did not give competent care as defined by colleagues with the same level of experience c) Did not give an appropriate level of care as defined by the NZNO standards for nursing practice d) Did not give an appropriate level of care as defined by the NZNO code of practice for nurses

c) Did not give an appropriate level of care as defined by the NZNO standards for nursing practice

44. Ageism is an important concept for the nurse to understand because it a) May damage the self esteem of the elderly b) Increases social awareness of the needs of the elderly c) Provides statistical information regarding the elderly population d) Promotes consideration of the diversity of the elderly population

a) May damage the self esteem of the elderly

45. A middle aged woman enjoys orienting new young women and men at work. She enjoys being a teacher and mentor and feels she should pass down her legacy of knowledge and skills to the younger generation. The nurse recognizes that the woman is involved in the behaviour described by Erikson as a) Generativity b) Ego integrity c) Identification d) Valuing wisdom

a) Generativity

46. For the nursing council to find a registered nurse guilt of malpractice following an assault on a client, it would have to prove that the nurse a) Intended to cause bodily harm to the client b) Actually assaulted the client c) Did not establish a therapeutic relationship with the client d) Committed a felony against the client

a) Intended to cause bodily harm to the client

47. Emergency interventions for a victim with upper torso injuries or face, head, or neck trauma include a) Suctioning to clear the airway b) Immobilization of the cervical spine c) Administration of supplemental oxygen d) Ensuring venous access with at least two large bore IV lines

b) Immobilization of the cervical spine

48. An employee spilled industrial acids on his arms and legs at work. The appropriate action by the occupational nurse at the facility is to a) Apply cool compresses to the area of exposure b) Apply an alkaline solution to the affected area c) Cover the affected area with dry, sterile dressings d) Flush the substance with large amounts of tap water

d) Flush the substance with large amounts of tap water

49. According to the privacy act 1993, when collecting health information from a client the nurse must a) Ensure the client is aware that health information is being collected b) Tell the client why health information is being collected c) Inform the client about their rights of access and correction d) All of the above

d) All of the above

50. An example of the use of primary prevention for family violence is a) Working to eliminate the glamorisation of violence on television b) Counselling a woman living in an abusive relationship about available shelter programs c) Calling child protective services regarding a school age child who has reported sexual attacks by her stepfather d) Carefully examining the skin of an elder who has just returned to an extended care facility following a weekend with his children

a) Working to eliminate the glamorisation of violence on television

51. With a patient who is homosexual, the nurses most appropriate initial action during the preinteraction phase of the relationship should be to a) Assist the patient in changing sexual values b) Examine own feelings and anxieties with regard to the patient c) Review the literature pertaining to the human sexual response d) Attempt to identify the underlying reasons for the patients values

b) Examine own feelings and anxieties with regard to the patient

52. The nurse judges that the mother understands the term cerebral palsy when she describes it as a term applied to impaired movement resulting from which of the following a) Injury to the cerebrum caused by viral infection b) Malformed blood vessels in the ventricles caused by inheritance c) Non progressive brain damage caused by injury d) Inflammatory brain disease caused by metabolic imbalances

c) Non progressive brain damage caused by injury

53. The first symptom of gonorrhoea is usually a) Lower abdominal pain b) A sore or ulcer on the genitals c) Purulent vaginal discharge in the female d) Urethral discharge in the male

d) Urethral discharge in the male

54. The first symptom of syphilis is a) A generalised rash all over the body b) A sore or ulcer on the genitals c) Abdominal pain in the male d) Purulent vaginal discharge

b) A sore or ulcer on the genitals

55. When obtaining a nursing history from parents who are suspected of abusing their child, which of the following characteristics about the parents would the nurse typically find a) Attentiveness to the child’s needs b) Self blame for the injury to the child c) Ability to relate child’s developmental achievements d) Evidence of little concern over the extent of the injury

d) Evidence of little concern over the extent of the injury

56. A colleague comments: what is the relevance of the treaty of Waitangi to Maori health a) Maori people view the treaty of Waitangi as a health document b) Nursing practice in new Zealand is congruent with the treaty of Waitangi c) The right to health is guaranteed to Maori under article two of the treaty of Waitangi d) The right to Maori involvement in health is guaranteed

b) Nursing practice in new Zealand is congruent with the treaty of Waitangi

57. The long term consequences of Chlamydia is most likely to be a) Menorrhagia b) Chronic vaginitis c) Chronic cervicitis d) Sterility

c) Chronic cervicitis

58. When describing the effects of insulin on the body to a patient newly diagnosed with diabetes mellitus, the best explanation by the nurse is a) Insulin promotes the breakdown of fatty tissue into triglycerides, which can be used for energy b) When proteins are taken into the body, insulin promotes their breakdown and conversion to fats c) Insulin stimulates the conversion of stored sugars into blood glucose and the conversion of proteins into glucose d) When carbohydrates, fats, and proteins are eaten, insulin promotes cellular transport and storage of all these nutrients

d) When carbohydrates, fats, and proteins are eaten, insulin promotes cellular transport and storage of all these nutrients

59. A serious complication of acute malaria is a) Congested lungs b) Impaired peristalsis c) Anaemia and cachexia d) Fluid and electrolyte imbalance

c) Anaemia and cachexia

60. A registered nurse stops to assist at the scene of an accident but the injured man dies before the ambulance arrives. The nurse should understand that she a) Should leave the scene before the ambulance arrives b) Will be covered by her actions by the good Samaritan laws c) Has a legal duty of care to perform at a competent level as a registered nurse d) Should pronounce the person dead at the scene

c) Has a legal duty of care to perform at a competent level as a registered nurse

STATE EXAMS 5 1. John is admitted with neutropenia, what does the nurse assess in determining his risk for infection a) Length of time neutropenia has existed b) Health status before neutropenia c) Body build and weight d) Resistance to infection in childhood

b) Health status before neutropenia

2. What nursing action would be important in preventing cross contamination a) Change gloves immediately after use b) Stand two feet from the patient c) Speak minimally when in the room d) Wear long sleeved shirts

a) Change gloves immediately after use

3. What would you teach john and his family to avoid a) Using suppositories or enemas b) Using a high efficiency particulate air filter mask c) Performing perineal care after every bowel movement d) Performing oral care after every meal

a) Using suppositories or enemas

4. 24 hours after john has a bone marrow aspiration, the nurse evaluates which of the following as an appropriate client outcome a) The client maintains bed rest b) There is redness and swelling at the aspiration site c) The client requests morphine sulphate 2mg IM every 2 hours d) There is no bleeding at aspiration site

d) There is no bleeding at aspiration site

5. During the induction stage for treatment of leukaemia, the nurse should remove which items that the family has brought into the room a) A bible b) A picture c) A sachet of lavender d) A hairbrush

c) A sachet of lavender

6. The goal of nursing care for a client with acute myeloid leukaemia is to prevent a) Cardiac arrhythmias b) Liver failure c) Renal failure d) Haemorrhage

d) Haemorrhage

7. The nurse is evaluating the clients learning about combination chemotherapy. Which of the following statements about reasons for using combination chemotherapy indicates the need for further explanation a) Combination chemotherapy is used to interrupt cell growth cycle at different points b) Combination chemo is used to destroy cancer cells and treat side effects simultaneously c) Combination chemo is used to decrease resistance d) Combination chemo is used to minimise the toxicity from using high doses of single agent

a) Combination chemotherapy is used to interrupt cell growth cycle at different points

8. In providing care to the client with leukaemia who has developed thrombocytopenia, the nurse assessed the most common sites for bleeding. Which of the following is not a common site a) Biliary system b) Gastrointestinal tract c) Brain and meninges d) Pulmonary system

a) Biliary system

9. The nurses best explanation for why the severely neutropenic client is place in reverse isolation is that reverse isolation helps prevent the spread of organisms a) To the client from sources outside the clients environment b) From the client to health care personnel, visitors and other clients c) By using special techniques to dispose of contaminated material d) By using special techniques to hand the clients linens and personal items

a) To the client from sources outside the clients environment

10. A client has received 25ml of packed red blood cells when she began to experience low back pain and mild itching. After stopping the transfusion the nurse should a) Administer prescribed aspirin and antihistamines b) Collect blood and urine samples to be sent to the laboratory c) Administer prescribed diuretics, oxygen and morphine d) Administer prescribed vasopressors

a) Administer prescribed aspirin and antihistamines

11. The nurse in the preoperative period is preparing a female client for surgery and notices that the client looks sad. The client says, ‘I’m scared of having cancer. It’s so horrible and I brought it on myself. I should have quit smoking years ago’. What would be the nurses best response to the client a) It’s okay to be scared. What is it about cancer that you’re afraid of b) It’s normal to be scared. I would be too. Well help you through it c) Don’t be hard on yourself. You don’t know if your smoking caused the cancer d) Do you feel guilty because you smoked

a) It’s okay to be scared. What is it about cancer that you’re afraid of

12. Following mastectomy the client is now due to have radiation therapy. She should be taught to care for the skin at the therapy site by a) Washing the area with water b) Exposing the area to dry heat c) Applying an ointment to the area d) Using talcum powder on the area

a) Washing the area with water

13. A 42 year old woman is interested in making dietary changes to reduce her risk of colon cancer. What dietary selections would the nurse suggest a) Croissant, peanut butter, sandwiches, whole milk b) Bran muffin, skim milk, sir fried broccoli c) Bagel with cream cheese, cauliflower salad d) Oatmeal, baked potato, turkey sandwich

b) Bran muffin, skim milk, sir fried broccoli

14. The nurse is teaching a 19 year old client and the client’s family about what to expect with high dose chemotherapy and the effects of neutropenia. What should the nurse teach as the most reliable early indicator of infection in a neutropenic client a) Fever b) Chills c) Tachycardia d) Dyspnoea

a) Fever

15. The client is being discharged with oral chemotherapy, in teaching the client and family how to manage nausea and vomiting at home, which of the following should be discussed a) Eating frequent, small meals throughout the day b) Eating three normal meals a day c) Eating only cold food but no salads d) Limiting the amount of fluid intake

a) Eating frequent, small meals throughout the day

16. In setting up a syringe driver to administer analgesia which of the following factors would be most important for the nurse to consider when determining the angle at which to insert the needle a) Size of the syringe b) Tissue turgor c) Length of the needle d) Amount of subcutaneous tissue

d) Amount of subcutaneous tissue

17. A client is diagnosed with metastatic bone cancer. Which of the following abnormal laboratory values would the nurse expect to see a) Hypocalcaemia b) Elevated serum alkaline phosphatase c) Hypokalemia d) Hypoglycaemia

b) Elevated serum alkaline phosphatase

18. Mrs Johnson has had a recurrence of breast cancer and has been managed at home with support from the palliative care nurse specialist. This morning when visiting her, the nurse noted she was experiencing severe low back pain especially when lying down. Which of the following assessments would be the priority a) Bowel and bladder b) Respiratory c) Neurological d) Skin and pressure sore risk

d) Skin and pressure sore risk

19. The nurse would teach the client that a normal local tissue response to radiation is a) Atrophy of the skin b) Scattered pustule formation c) Redness of the surface tissue d) Sloughing of two layers of skin

c) Redness of the surface tissue

20. The husband of a client with cervical cancer says to the nurse, ‘the doctor told my wife that her cancer is curable. Is he just trying to make us feel better.’ Which would be the nurses most accurate response a) When cervical cancer is detected early and treated aggressively, the cure rate is almost 100% b) The 5 year survival rate is about 75%, which makes the odds pretty good c) Saying a cancer is curable means that 50% of all women with cancer survive at least 5 years d) Cancers of the female reproductive tract tend to be slow growing and respond well to treatment

a) When cervical cancer is detected early and treated aggressively, the cure rate is almost 100%

21. A priority nursing diagnosis for a client with cervical cancer who has an internal radium implant would be a) Pain related to cervical tumour b) Anxiety related to self care deficit from imposed immobility during radiation c) Impaired health maintenance related to surgery d) Disturbed sleep pattern related to interruptions by health care personnel

b) Anxiety related to self care deficit from imposed immobility during radiation

22. The nurse should carefully observe a client with internal radium implants for typical side effects associated with radiation therapy to the cervix. These effects include a) Severe vaginal itching b) Confusion c) High fever in the afternoon or evening d) Nausea and a foul vaginal discharge

d) Nausea and a foul vaginal discharge

23. A terminally ill client’s husband tells the nurse, ‘I wish we had taken that trip to Europe last year. We just kept putting it off, and now I’m furious that we didn’t go.’ The nurse interprets that husbands statement as indicating which of the following stages of adapt ion to dying a) Anger b) Denial c) Bargaining d) Depression

a) Anger

24. A client is newly diagnosed with cancer and is beginning a treatment plan. Which of the following nursing interventions will be most effective in helping the client cope a) Assume decision making for the client b) Encourage strict compliance with all treatment regimens c) Inform the client of all possible adverse treatment effects d) Identify available resources

d) Identify available resources

25. Mr Green has been admitted terminally ill and in need of pain management. He has now been commenced on oral morphine. What would you also ensure the doctor prescribe at this time a) Antiemetics b) Subcutaneous fluids c) Aperients d) Sedatives

a) Antiemetics

STATE EXAMS 6 1. A client sustained an open fracture of the femur from an automobile accident. For which of the following types of shock should the client be assessed a) Cardiogenic b) Neurogenic c) Hypovolaemic d) Anaphylactic

c) Hypovolaemic

2. What is the primary goal for the care of a client who is in shock a) Preserve renal function b) Prevent hypostatic pneumonia c) Maintain adequate vascular tone d) Achieve adequate tissue perfusion

d) Achieve adequate tissue perfusion

3. Which of the following findings would the nurse most likely note in the client who is in the compensatory stage of shock a) Decreased urinary output b) Significant hypotension c) Mental confusion d) Tachycardia

d) Tachycardia

4. Two days after the fracture of his femur, a client suddenly complains of chest pain and dyspnoea. The nurse also notes some confusion and an elevated temperature. Based on these assessment findings, the nurse suspects which of the following complications a) Osteomyelitis b) Fat embolism syndrome c) Venous thrombosis d) Compartment syndrome

b) Fat embolism syndrome

5. When the nurse asked her client and partner what type of birth control they were planning to use, they stated that since she is breast feeding, they don’t need to have to worry about birth control. The nurse should tell them that a) They can decide on a method when Cindy stops breast feeding b) No birth control is necessary until after the first menstrual period c) Ovulation can occur when a woman is breast feeding d) Since Cindy has become pregnant once, it will be much easier for her to become pregnant now

c) Ovulation can occur when a woman is breast feeding

6. During the post partum period many women experience mood swings which are referred to as a) Psychosis b) Post partum blues c) Detachment from infant d) Attachment to the infant

b) Post partum blues

7. According to Erikson, an infant is in the psychosocial stage that is characterised by the conflict of a) Trust vs mistrust b) Initiative vs guilt c) Intimacy vs isolation d) Autonomy vs shame and doubt

a) Trust vs mistrust

8. Mrs Cindy Jackson, para 1, gravid 1, had a vaginal delivery of a full term baby yesterday. Because of the soreness of her perineum, Cindy states that she is afraid to have a bowel movement. The nurse should encourage Cindy to a) Ambulate frequently, eat fresh fruits and vegetables, and drink 6 – 8 glasses water per day b) Ask her doctor to prescribe a laxative to stimulate defecation c) Drink 2 glasses of warm water after every meal, then try to defecate d) Do kegel exercises twice a day, eat a low roughage diet, and drink ten glasses of water per day

a) Ambulate frequently, eat fresh fruits and vegetables, and drink 6 – 8 glasses water per day

9. Mrs Frederick is scheduled for exploratory and palliative surgery the next day. Results of blood tests show that she has a microcytic anaemia Likely causes of microcytic anaemia is 1. A diet low in iron 2. A diet low in vitamin C 3. Chronic blood loss 4. Acute blood loss 5. Haemolytic streptococcal infection a) 1, 3 and 5 b) 1, 2 and 5 c) 1, 2 and 4 d) 1, 2 and 5

c) 1, 2 and 4

10. Mrs Frederick is to have a blood transfusion of two units of packed cells, prior to surgery. She is charted 350 mls over three hours through a blood giving set with a drip factor of 15 How many drops per minute will you run the blood at a) 20 b) 25 c) 30 d) 35

c) 30

11. If Mrs. Frederick were to receive blood with which she is incompatible, the signs and symptoms we would see, would include 1. Restlessness and anxiety 2. Generalised tingling sensations 3. Nausea and vomiting 4. Elevated temperature 5. Decreased blood pressure a) 1, 2 and 3 b) 1, 4 and 5 c) 2, 3 and 5 d) All of the above

b) 1, 4 and 5

12. If a client who suffers from cancer of the colon, the most common site of metastases is the a) Bladder b) Liver c) Spleen d) Pancreas

b) Liver

13. Which of the following post operative complications may be avoided by pre operative teaching a) Wound infection b) Wound dehiscence c) Hypostatic pneumonia d) Hypovolaemic shock

c) Hypostatic pneumonia

14. Haemorrhage during the first 12 hours post operatively is termed a) Primary b) Secondary c) Intermediary d) Reactionary

c) Intermediary

15. Mary aged 45 years is admitted to the ward for planned surgery. Mary smokes 20 cigarettes a day and drinks three glasses of wine every evening The significance of this information for you is so that you a) May teach deep breathing and coughing and relaxation techniques in preparation for surgery b) Be aware of a potentially addictive personality when planning her pain relief post operatively c) Can assist her to break her smoking and drinking habits when in hospital d) May plan to include cigarettes and alcohol in her post operative regime

c) Can assist her to break her smoking and drinking habits when in hospital

16. Two days later, Mary has a cholecystectomy performed, successfully. On her return to the ward, Mary has an upper abdominal wound with a redivac, a T tube, A naso gastric tube and an intravenous infusion in situ When carrying out Marys post operative exercise regime, which aspect should receive the highest priority a) Ensuring Mary has privacy and freedom from interruption b) That Mary knows how to breathe and cough and why it is important c) That she knows how to support her wound and that her pain is under control d) That there be no interruption by Marys family and friends when they visit

c) That she knows how to support her wound and that her pain is under control

17. Mr Evere, a 69 year old retired musician was admitted to the intensive care unit with a diagnosis of Adams stokes syndrome The nurse notes mr everes pulse pressure is decreasing. Pulse pressure is the a) Difference between the apical and radial rates b) Force exerted against an arterial wall c) Degree of ventricular contraction in relation to output d) Difference between systolic and diastolic readings

d) Difference between systolic and diastolic readings

18. The physician suspects cardiogenic shock. Shock is a) A failure of peripheral circulation b) An irreversible phenomenon c) Always caused by decreased blood volume d) A fleeting reaction to tissue injury

a) A failure of peripheral circulation

19. The physical law explaining the greatly increased venous return accompanying mild vasoconstriction underlies the use of a) Adrenaline in treating shock b) Rotating tourniquets in pulmonary oedema c) Sympathetomy in treating hypertension d) Digoxin to increase cardiac output

a) Adrenaline in treating shock

20. Culturally safe nursing care can best be achieved when the nurse has a) An in depth knowledge of the treaty of Waitangi b) An awareness of Maori perspectives of health c) An awareness and acceptance of your own limits in meeting someone else’s health and cultural needs d) A knowledge of Maori protocol

c) An awareness and acceptance of your own limits in meeting someone else’s health and cultural needs

21. Imagine a new virus infecting a human population for the first time. Which of the following is most likely to lead to a rapid increase in cases worldwide a) Severe disease with high mortality b) Lack of hand hygiene c) Air travel d) High transmissibility

d) High transmissibility

22. The school nurse is caring for a child with haemophilia who is actively bleeding from the leg. Which of the following would the nurse apply a) Direct pressure, checking every few minutes to see if the bleeding has stopped b) Ice to the injured leg area several times a day c) Direct pressure to the injured area continuously for 10 minutes d) Ice bag with elevation of the leg twice a day

c) Direct pressure to the injured area continuously for 10 minutes

23. Home health nurses visit a blind diabetic patient who lives along to monitor the patient’s glucose level and administer the patient’s daily insulin. Evaluation of outcome management for this patient would include a) An absence of complications of diabetes b) A reduction in hospitalizations for glycemic control c) The ability of the patient to learn to use adaptive syringes d) The patients evaluation of the services provided by the nurses

b) A reduction in hospitalizations for glycemic control

24. The nurse consults with the physician to arrange a referral for hospice care for a patient with end stage liver disease based on the knowledge that hospice care is indicated when a) Family members can no longer care for dying patients at home b) Patients and families are having difficulty coping with grief reactions c) Preparation for death with palliative care and comfort are the goals of care d) Patients have unmanageable pain and suffering as a result of their condition

c) Preparation for death with palliative care and comfort are the goals of care

25. To better understand fluid balance the nurse needs to recognise that a) Glomerular filtration occurs in the glomerular which are small arteries in the kidneys b) The volume of urine secreted is regulated mainly by mechanisms that control the glomerular filtration rate c) An increase in the hydrostatic pressure in bowman’s capsule tends to increase the glomerular filtration rate d) A decrease in blood protein concentration tends to increase the glomerular filtration rate

c) An increase in the hydrostatic pressure in bowman’s capsule tends to increase the glomerular filtration rate

26. The client with unresolved oedema is most likely to develop a) Thrombus formation b) Tissue ischaemia c) Proteinaemia d) Contractures

b) Tissue ischaemia

27. Women are more susceptible to urinary tract infection because of a) Poor hygienic practices b) Length of urethra c) Continuity of the mucous membrane d) Inadequate fluid intakes

b) Length of urethra

28. The most important electrolyte of intracellular fluid is a) Calcium b) Sodium c) Potassium d) Chloride

c) Potassium

29. In encouraging hospitalised clients to void the most basic methods for the nurse to employ is a) Having the client listen to running water b) Warming a bedpan c) Placing the clients hand in warm water d) Providing privacy

d) Providing privacy

30. Since Mr. Saul has right hemiplegia the nurse contributes to his rehabilitation by a) Making a referral to the physio therapist b) Not moving the affected arm and leg unless necessary c) Beginning active exercise d) Positioning Mr. Saul to prevent deformity and decubiti

d) Positioning Mr. Saul to prevent deformity and decubiti

31. Mr Saul's emotions responses to his illness would probably be determined by a) His premobid personality b) The location of his lesion c) The care he is receiving d) His ability to understand his illness

d) His ability to understand his illness

32. Mrs Olin, a retired school teacher with rheumatoid arthritis, is admitted to hospital with severe pain and swelling of the joints in both hands Mrs Olin’s condition would indicate that a primary consideration of her care is a) Motivation b) Education c) Control of pain d) Surgery

c) Control of pain

33. While taking a nursing history from Mrs. Olin, the nurse promotes communication by a) Asking questions that can be answered by a simple ‘yes’ or ‘no’ b) Telling Mrs. Olin there’s no cause for alarm c) Asking ‘why’ and ‘how’ questions’ d) Using broad, open ended statements

d) Using broad, open ended statements

34. Mr and Mrs. B were emotionally upset when their baby girl, sue, was born with a cleft palate and double cleft lip The nurse, in order to give the most support to the parents, should a) Discourage them from talking about the baby b) Encourage them to express their worries and fears c) Tell them not to worry because the defect can be repaired d) Show them post operative photographs of babies who had similar defects

b) Encourage them to express their worries and fears

35. The most critical factor in the immediate care of sue, after repair of the lip is a) Maintenance of airway b) Administration of drugs to reduce secretions c) Administration of fluids d) Preventing of vomiting

a) Maintenance of airway

36. Additional nursing care for sue after the original lip repair would include a) Placing the baby in a semi sitting position b) Keeping the infant from crying c) Spoon feeding for the first two days after surgery d) Keeping the baby nil per mouth

a) Placing the baby in a semi sitting position

37. Seven year old Johnny has been admitted for a tonsillectomy. The nurse suspects haemorrhage post operatively when Johnny a) Snores noisily b) Becomes pale c) Complains of thirst d) Swallows frequently

d) Swallows frequently

38. Pitting oedema in the lower extremities occurs with this problem because of the a) Increase in tissue colloid osmotic pressure b) Increase in the tissue hydrostatic pressure at the arterial end of the capillary bed c) Decrease in the plasma colloid osmotic pressure d) Increase in the plasma hydrostatic pressure at the venous end of the capillary beds

d) Increase in the plasma hydrostatic pressure at the venous end of the capillary beds

39. The nurse can best assess the degree of oedema in an extremity by a) Checking for pitting b) Weighing the client c) Measuring the affected area d) Observing intake and output

a) Checking for pitting

40. Mrs Smith is hospitalised with coronary heart disease. She is receiving IV fluids, her vital signs are checked 4 hourly. She is on bed rest. She was also prescribed digoxin. She does not seem to be acutely sick but her prognosis is guarded. Mrs Smith asks what the coronary arteries have to do with her angina. In determining the answer, the nurse should take into consideration that coronary arteries a) Carry reduced oxygen content blood to the lungs b) Carry blood from aorta to the myocardium c) Supply blood to the endocardium d) Carry high oxygen blood from the lungs towards the heart

b) Carry blood from aorta to the myocardium

41. After activity Mrs. Smith states she has angina pain. The nurse should realise that angina pectoris is a sign of a) Myocardial ischemia b) Myocardial infarction c) Coronary thrombosis d) Mitral insufficiency

a) Myocardial ischemia

STATE EXAMS 7 1. During therapy with salbutamol (venolin) Mr. Peters complains of palpitation, chest pain, and a throbbing headache. In view of these symptoms which of the following statements represent the most appropriate nursing action a) Reassure Mr. peters that these effects are temporary and will subside as he becomes accustomed to the drug b) Withhold the drug until additional orders are obtained from the physician c) Tell him not to worry, he is experiencing expected side effects of medicine d) Ask him to relax, then instruct him to breath slowly for several minutes

b) Withhold the drug until additional orders are obtained from the physician

2. Mr Peters pulmonary function studies are abnormal. The nurse should realise that one of the most common complication of chronic asthma is A) Athelectasis B) Emphysema C) Pneumothorax D) Pulmonary fibrosis

C) Pneumothorax

3. Emphysema causes a failure in oxygen supply because of a) Infectious obstructions b) Respiratory muscle paralysis c) Pleural effusion d) Loss of aerating surface

b) Respiratory muscle paralysis

4. When the alveoli loose normal elasticity, the nurse teaches Mr. peters exercises that lead to effective use of the diaphragm because a) Mr peters has an increase in the vital capacity of the lungs b) The residual capacity of the lungs has been increased c) Inspiration has been markedly prolonged and difficult d) Abdominal breathing is an effective compensatory mechanism that is spontaneously initiated

d) Abdominal breathing is an effective compensatory mechanism that is spontaneously initiated

5. Mr hurt has developed acute renal failure and uraemia. Metabolic acidosis develops in renal failure as a result of a) depression of respiratory rate by metabolic wastes causing carbon dioxide retention b) inability of renal tubules to secrete hydrogen ions and conserve bicarbonate c) inability of renal tubules to reabsorb water to achieve dilution of acid contents of the blood d) impaired glomerular filtration causing retention of sodium and metabolic waste products

c) inability of renal tubules to reabsorb water to achieve dilution of acid contents of the blood

6. of the following, which is most important in maintaining the fluid and electrolyte balance of the body a) urinary system b) respiratory system c) antidiuretic hormone (ADH) d) aldosterone

a) urinary system

7. to prevent laryngeal spasms and respiratory arrest in a patient who is at risk for hypocalcaemia, an early sign of hypocalcaemia the nurse should assess for is a) tetany b) confusion c) constipation d) numbness and tingling around the lips or in the fingers

d) numbness and tingling around the lips or in the fingers

8. A 36 year old woman has been admitted to the hospital for knee surgery. Information obtained by the nurse during the preoperative assessment that should be reported to the surgeon before surgery is performed includes the patients a) lack of knowledge about postoperative pain control b) knowledge of the possibility of an early, unplanned pregnancy c) history of a postoperative infection following a prior cholecystectomy d) concern that she will be physically limited in caring for her children for a period postoperatively

b) knowledge of the possibility of an early, unplanned pregnancy

9. in is especially important for the nurse to determine the patients current use of medications during the preoperative assessment because a) these medications may alter the patients perceptions about surgery b) anaesthetics alter renal and hepatic function, causing toxicity by other drugs c) other medications may cause interactions with anaesthetics, altering the potency and effect of the drugs d) routine medications are usually withheld the day of surgery, requiring dosage and schedule adjustments

c) other medications may cause interactions with anaesthetics, altering the potency and effect of the drugs

10. A client with type 1 diabetes mellitus is scheduled to have surgery. The client has been nil per mouth since midnight in preparation for the surgery. In the morning before sending the client to the operating room, the nurse notices that the client’s daily insulin has not been ordered. Which of the following interventions would be most appropriate for the nurse at this time a) obtain the clients blood glucose values and evaluate the clients need for insulin b) contact the physician for further orders regarding insulin administration c) give the clients usual morning dose of insulin d) notify the recovery room staff to obtain an order for insulin after the surgery

b) contact the physician for further orders regarding insulin administration

11. the nurse monitors a patient receiving high doses of broad spectrum antibiotics for treatment of endocarditis for the development of a) erysipelas b) candidiasis c) tinea corporis d) verruca vulgaris

b) candidiasis

12. The nurse is evaluating the effectiveness of fluid resuscitation during the emergent period of burn management. Which of the following indicates that adequate fluid replacement has been achieved in the client a) an increase in body weight b) fluid intake is less than urinary output c) urinary output greater than 35 ml/hr d) blood pressure of 90/60 mm Hg

c) urinary output greater than 35 ml/hr

13. Cimetidine (tagamet) is prescribed for a patient with major burns. In teaching the patient about the drug, the nurse explains that it is used to prevent the development of a) diarrhoea b) constipation c) adynamic ileus d) curling’s ulcer

d) curling’s ulcer

14. A client who has had a transurethral resection of the prostate (TURP) 1 day earlier has a three way foley catheter inserted for continuous bladder irrigation. Which of the following statements best explains why continuous irrigation is used after a TURP a) to control bleeding in the bladder b) to instil antibiotics into the bladder c) to keep the catheter free from clot obstruction d) to prevent bladder distention

c) to keep the catheter free from clot obstruction

15. A patient in severe respiratory distress is admitted to the medical unit at the hospital. During the admission assessment of the patient, the nurse should a) perform a comprehensive health history with the patient to determine the extent of prior respiratory problems b) complete a full physical examination to determine the effect of the respiratory distress on other body functions c) delay any physical assessment of the patient and ask family members about the patients history of respiratory problems d) perform a physical assessment of the respiratory system and ask specific questions related to this episode of respiratory distress

d) perform a physical assessment of the respiratory system and ask specific questions related to this episode of respiratory distress

16. spinal anaesthesia effects all of the following systems except a) the sympathetic nervous system b) the sensory system c) the parasympathetic nervous system d) the motor system

c) the parasympathetic nervous system

17. Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway clearance. The nurse bases this nursing diagnosis on the finding of a) SpO2 of 85% b) Respiratory rate of 28 c) Presence of greenish sputum d) Crackles in the right and left lower lobes

d) Crackles in the right and left lower lobes

18. To protect susceptible patients in the hospital from aspiration pneumonia, the nurse a) Turns and repositions immobile patients every 2 hours b) Positions patients with altered consciousness in lateral positions c) Monitors for respiratory symptoms in those patients who are immunosuppressed d) Plans room assignments to prevent patients with infections from being placed with surgical or chronically ill patients

b) Positions patients with altered consciousness in lateral positions

19. A patient experiences a flail chest as a result of an automobile accident. Which finding during a respiratory assessment would the nurse expect a) Bloody sputum b) Laryngeal stridor c) Deep, irregular respirations d) Paradoxic chest movement

d) Paradoxic chest movement

20. A client is admitted to the emergency room with crushing chest injuries sustained in a car accident. Which of the following signs would indicate a possible pneumothorax a) Cheyne stokes breathing b) Increased noisy breath sounds c) Diminished or absent breath sounds on the affected side d) A decreased sensation on the affected side

c) Diminished or absent breath sounds on the affected side

21. Joan Murray, aged 40 years, discovers a lump in the upper and outer quadrant of her left breast when she is showering one morning. One week later, after being seen by a surgeon, she is admitted to the ward for a biopsy of the lump and possible left radical mastectomy. In establishing a relationship with Joan, what is the most important factor for the nurse to consider. That a) The diagnosis has not yet been established and the breast lump is not necessarily malignant b) Joan will have many questions about the possible effects of a mastectomy on her sexual identity c) At this time of uncertainty, Joan will need a lot of time to be alone to consider her choices d) Joan will be full of fear about the mass and its possible effects on her being

b) Joan will have many questions about the possible effects of a mastectomy on her sexual identity

22. Part of Joan's pre operative preparation is practising arm and shoulder exercises. The reason for these exercises are a) She can be assured of maximum function of her arm and shoulder if these exercises are carried out properly b) That they help reduce the pain and the swelling in the area, after surgery c) To assist peripheral venous return and thus reduce the potential for pulmonary embolus d) By being involved in activities related to her care, Joan is less likely to worry

c) To assist peripheral venous return and thus reduce the potential for pulmonary embolus

23. The reason we position Joan’s affected arm with her elbow at the level of the right atrium and her hand higher than her elbow is to a) Minimise the development of oedema b) Assist venous return c) Reduce her pain and discomfort d) Ensure that the area is supported

b) Assist venous return

24. The primary ossification center of long bone is located in which of the following structures a) Epiphysis b) Epiphyseal plate c) Diaphysis d) Endosteum

c) Diaphysis

25. The body tissue affected by rheumatoid arthritis is a) Adipose b) Muscular c) Connective d) Epithelial

c) Connective

26. The pattern of rheumatoid arthritis is best describe by its a) Chronicity b) Remissions and exacerbations c) Little relief from aches and pains d) A progressive increase in disability

b) Remissions and exacerbations

27. Rheumatoid arthritis is characterized by a) Bone pain b) Sharp tingling sensations c) Inflammation of the joints d) Pain and swelling of joints

c) Inflammation of the joints

28. Synovial joints are characterized by a) articular cartilage b) fibrous capsule c) joint cavity d) all of these

d) all of these

29. the major support that the muscular system gets from the cardiovascular system a) a direct response by controlling the heart rate and the respiratory rate b) constriction of blood vessels and decrease in heart rate for thermoregulatory control c) nutrient and oxygen delivery and carbon dioxide removal d) decreased volume of blood and rate of flow for maximal muscle contraction

c) nutrient and oxygen delivery and carbon dioxide remova

30. as the nurse assesses jack for increased intracranial pressure, she would be concerned if she observed a) change in level of consciousness b) anorexia and thirst c) increased pulse and respiration rates d) blurred vision and halos around lights

a) change in level of consciousness

31. A person has just been involved in an accident that affected the medulla oblongata. The body process most directly affected by this would be a) slight b) hearing c) muscular coordination d) respiration

d) respiration

32. if you are dealing with a person whose phrenic nerve has been damaged, what would you expect to observe a) reduced diaphragm function b) less mucous secreted by the goblet cells c) decreased elasticity of the lung tissue d) increased coughing

a) reduced diaphragm function

33. the spinal cord extends through the vertebral canal from the foramen magnum to the a) 7th cervical vertebra b) 12th thoracic vertebra c) 2nd lumbar vertebra d) 1st sacral vertebra

c) 2nd lumbar vertebra

34. Synaptic conduction of a nerve impulse can be affected by a) Certain diseases b) Drugs c) Changes in Ph d) All of these

d) All of these

35. Lack of muscle coordination is called a) Monoplegia b) Ataxia c) TIA d) None of these

b) Ataxia

36. Inability of chew might result from damage to which cranial nerve a) Facial b) Trigeminal c) Abducens d) Vagus

b) Trigeminal

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

a) Spoken and written language

38. Which of the following is true concerning the limbic system a) It is comprised of parts of the cerebrum and diencephalon b) It assumes a primary function in emotions c) Both a and b d) Neither a nor b

c) Both a and b

39. Coordination of muscular activity is a function of the a) Cerebral peduncles b) Cerebellum c) Thalamus d) Medulla oblongata

b) Cerebellum

40. Which of the following statements is correct a) Appetite control is a function of the thalamus b) The midbrain is a conduction pathway and reflex center c) The cerebellum has sensory centres for thirst and speech d) Respiratory centres are located in the basal ganglia

b) The midbrain is a conduction pathway and reflex center

41. The structure that connects the cerebral hemispheres and facilitates the sharing of cerebral information is the a) Corpus callosum b) Cingulated sulcus c) Fourth ventricle d) Aqueduct of sylvius

a) Corpus callosum

42. The portion of bone laid down first in bone formation is the a) Matrix b) Calcium salts c) Trabeculae d) Marrow

b) Calcium salts

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

a) C3 – C7

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

b) Talus

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

d) The blood supply to the region is relatively delicate

46. The purpose of myoglobin in skeletal muscle cells is a) Assist anaerobic reactions b) Store oxygen for use during vigorous exercise c) Catabolise pyruvic acid d) All of these

b) Store oxygen for use during vigorous exercise

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

c) Calcium and manganese

48. Protein should be eaten as it a) Reduces the risk of anaemia b) Ensures an adequate supply of energy c) Assists the body to produce new tissues d) Maintains the body’s protein stores

c) Assists the body to produce new tissues

49. Risk factors of CVA that cannot be altered are a) Sex, race, and raised blood cholesterol levels b) High BP, previous TIA c) Race, prior stroke and overweight d) High BP, previous TIA and increased blood cholesterol levels

a) Sex, race, and raised blood cholesterol levels

50. A person who has experienced a right CVA may present with a) Receptive or expressive aphasia b) Right hemiplegia c) Left hemiplegia d) Deficit of new language information

c) Left hemiplegia

51. Where and what is the circle of Willis a) A capillary meshwork found in bowman’s capsule of the nephron b) A vascular network at the base of the brain c) A roundabout at the top of bank st d) The capsule membrane of a malignant growth

b) A vascular network at the base of the brain

52. List the 3 main causes of stroke a) Cerebral haemorrhage, thrombosis, embolism b) Cerebral thrombosis, infarction, aneurysm c) Cerebral embolism, metastatic lesions, coagulopathy d) Cerebral ischemia, vascular spasms, hypoxia

b) Cerebral thrombosis, infarction, aneurysm

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

d) Shortness of breath, sweating, nausea and tiredness

54. Emphysema is a) An alveolar disease b) Due to hypertrophy and hyperplasia of bronchial glands c) Persistent episodes of productive cough d) An airway disease

a) An alveolar disease

STATE EXAMS 8 1. Circulatory shock can best be described as a condition in which there is a) A state of hypotension b) Loss of blood c) Loss of consciousness due to blood loss d) Inadequate blood flow to meet the metabolic needs of the body tissues

d) Inadequate blood flow to meet the metabolic needs of the body tissues

2. Causes of hypovolemic shock include a) Vomiting and los of body fluids b) Allergic reactions to drugs c) Cardiac failure d) Hypoglycaemia

a) Vomiting and los of body fluids

3. Early signs of hypovolemic shock include a) Restlessness, thirst, and increased heart rate b) Decreased blood pressure and apathy c) Increase in heart rate and increased pulse pressure d) Decreased blood pressure and unconsciousness

a) Restlessness, thirst, and increased heart rate

4. In shock, one of the best indicators of blood flow to vital organs is a) Rate of blood and fluid administration b) Blood pressure c) The colour and temperature d) Urine output

d) Urine output

5. Oliguria, an early sign of shock, occurs for what reason a) Cessation of glomerular filtration b) Acute tubular necrosis c) Metabolic acidosis d) Sympathetic stimulation

b) Acute tubular necrosis

6. A person admitted to the emergency room with trauma and an estimated blood loss of 1200 to 1400 mls has a blood pressure of 110/70 mmHg and a heart rate of 120 beats per minute. The best explanation for these observations would be that a) The persons actual blood loss was less than the originally estimated loss b) The person was normally hypertensive and hence did not have as great a drop in blood pressure as a normotensive person c) The cause of the bleeding is now under control and the increased heart rate is due to anxiety d) An increase in heart rate is compensating for the loss of blood volume

d) An increase in heart rate is compensating for the loss of blood volume

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

b) Body’s attempt to shunt blood to vital organs by constricting skin vessels

8. ____________________ is generally relieved by sitting up in a forward leaning position a) Hyperpnoea b) Orthopnoea c) Apnoea d) Dyspnoea on exertion

b) Orthopnoea

9. In a client with emphysema, hypoventilation could initially cause a) Respiratory alkalosis b) Respiratory acidosis c) Metabolic acidosis d) Metabolic alkalosis

b) Respiratory acidosis

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

d) Have the client breathe into a paper bag

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

b) Enlargement of the right ventricle

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

c) Respiratory acidosis

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

b) Loosely bound to his haemoglobin

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

b) Retention of tracheobronchial secretions

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

b) Emphysema obstruction results from changes in lung tissues

16. The tissue change most characteristic of emphysema is a) Accumulation of pus in the pleural space b) Constriction of capillaries by fibrous tissue c) Filling of air passages by inflammatory coagulum d) Over distension, in elasticity, and rupture of alveoli

c) Filling of air passages by inflammatory coagulum

17. Which of the following results of emphysema is primarily responsible for cardiomegaly a) Hypertrophy of muscles encircling the bronchi b) Increased pressure in the pulmonary circulation c) Decreased number of circulating red blood cells d) Secretion of excessive amounts of pericardial fluids

b) Increased pressure in the pulmonary circulation

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

c) Nausea and vomiting and cool, clammy pale skin

19. Teaching for the client taking GT or glycerol with nitrate for angina would include a) Instructing the client to take the nitro-glycerine regularly b) Explain to the client that a subsequent headache indicates ineffective medication c) Instructing the client to put the tablet on the tongue and swallow after the tablet dissolves d) Teaching the client to take a tablet every 5 minutes (3x) when chest pain occurs

d) Teaching the client to take a tablet every 5 minutes (3x) when chest pain occurs

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

d) Fear due to knowledge deficit

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

a) Take sublingual nitro-glycerine and lie down

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

b) May lead to ventricular tachycardia or fibrillation

23. A client is admitted to ED following a car accident. He complains of abdominal discomfort. The nurse encourages the client to lie down. The reason for this action is a) To decrease abdominal pain b) To decrease the risk of dislodging an intra abdominal clot c) To facilitate peristalsis d) To decrease the risk of peritoneal infection

a) To decrease abdominal pain

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

d) Decrease stimuli, monitor vital signs and neurological status elevate the head of the bed 30 degrees, positioning the client on his side

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

b) Local bone tenderness, soft tissue swelling and inability to use extremity

26. Monitoring for compartment syndrome is done by checking for a) Active movement of the limb b) Colour, warmth, sensation and movement of the extremity c) Pulse and blood pressure changes d) The tightness of the plaster cast

b) Colour, warmth, sensation and movement of the extremity

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

a) Severe pain, motor compromise and a ‘pins and needles’ sensation

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

c) An injury in which the bone is broken into two or more pieces

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

c) May go undetected for years

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

c) If left uncontrolled, this can lead to DKA in type 1 or HNK in type 2

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

b) Affects coronary, peripheral and cerebral circulation

32. For relief of angina, the client may a) Call 111 b) Take a dose of glyceryl trinitrate up to 3 times, 5 minutes apart until the pain subsides c) Slowly exercise to the individuals tolerance level d) Take only one dose of glyceryl trinitrate, if this has no effect, call 111

b) Take a dose of glyceryl trinitrate up to 3 times, 5 minutes apart until the pain subsides

33. Ways to minimise precipitating effects of angina are a) Avoid over exertion b) Reduce stress c) Avoid overeating d) All above

d) All above

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

d) Needs immediate medical attention

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

b) Mental confusion or restlessness

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

a) Notify the doctor immediately and prepare to bivalve the cast

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

c) Level of consciousness

38. Pupillary dilation occurs when herniating brain tissue a) Compresses the occulomotor nerve b) Chokes the optic disks c) Stretches the optic nerve d) Paralyses the ocular muscles

a) Compresses the occulomotor nerve

39. Changes in vital signs with increasing intracranial pressure would include a) Hypotension and tachycardia b) Narrowing pulse pressure and tachypnea c) Hypotension and a pulse deficit d) Widening pulse pressure and bradycardia

d) Widening pulse pressure and bradycardia

40. Bleeding within the skull results in increased intracranial pressure because a) Arteries bleed rapidly and profusely b) Bleeding from veins goes undetected c) Spinal fluid is produced more rapidly d) The cranium is a closed, rigid vault

d) The cranium is a closed, rigid vault

41. What is the most common cause of heart failure (HF) a) Smoking b) Diabetes c) Coronary artery disease d) Family history

c) Coronary artery disease

42. The action of ACE inhibitors (angiotensin converting enzyme) is a) Increased urinary output, therefore decreased blood pressure b) Relax blood vessels, therefore decreased vascular resistance c) Strengthens cardiac contraction, therefore increase cardiac output d) Relax cardiac muscle therefore decrease heart rate

a) Increased urinary output, therefore decreased blood pressure

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

a) Increased serum potassium levels

44. Manifestations of heart failure are a) Hepatomeglia, pitted dependant edema b) Increased serum glucose levels c) Increased appetite and weight gain d) Decreased respiration and dyspnoea

d) Decreased respiration and dyspnoea

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

c) Blood pressure and urinary output

46. Loop diuretics act by a) Increasing the blood flow to the glomerular network b) Decreasing the blood flow to the kidneys therefore decreased urinary output c) Increased H2O reabsorption in the distal convoluted tubules of the nephron d) Inhibition complex active pump mechanism therefore increase excretion of electrolytes

d) Inhibition complex active pump mechanism therefore increase excretion of electrolytes

47. Blood pressure control is carried out by regulation of smooth muscles via a) Parasympathetic stimulation b) Parasympathetic and sympathetic stimulation c) Sympathetic stimulation d) None of these

b) Parasympathetic and sympathetic stimulation

48. The areas of the body that sense blood pressure are known as a) Baroreceptors b) Chemoreceptors c) Viscoreceptors d) None of these

a) Baroreceptors

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

d) Peak systolic pressure

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

c) 71%

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

a) There is an increased blood carbon dioxide

52. Gregory, aged 70, was admitted with congestive heart failure. Which of these changes in physiology is present in congestive heart failure a) Heart muscle degeneration due to old age b) A decrease of blood flow through the heart c) An abnormality in the structure of the heart d) A blood clot forms in one of the heart chambers

b) A decrease of blood flow through the heart

53. Manifestations of right sided heart failure are a) Fatigue, cyanosis, blood tinged sputum b) Anorexia, complaints of gastrointestinal distress, fatigue and pitted edema c) Dyspnea, Orthopnoea and cyanosis d) Fatigue dependant edema and cough

d) Fatigue dependant edema and cough

54. Nursing intervention necessary prior to the administration of digoxin is a) Palpation of arterial pulse less than 60 bpm b) Palpation of venous pulse less than 60 bpm c) Palpation of arterial pulse greater than 60 bpm d) Palpation of pedal pulse less than 60 bpm

c) Palpation of arterial pulse greater than 60 bpm

55. Left sided heart failure affects directly the a) Liver and extremities b) Lungs c) Levels of consciousness d) Lungs and extremities

b) Lungs

56. Basic nursing objectives in the treatment of HF are a) Start heparinization immediately b) Nursing the client in trendlenberg position c) Promote rest therefore decrease workload on heart and decrease H20 accumulation d) Assess levels of consciousness and give 02 61/min via Hudson mask

c) Promote rest therefore decrease workload on heart and decrease H20 accumulation

57. Define a cerebral vascular accident (CVA) a) Sudden loss of consciousness due to a decreased contractility of the cardia b) Loss of brain function due to disruption of blood supply to the brain c) Intermittent spasms of blood vessels interrupting blood flow to the brain d) Neurologic dysfunction due to diminished blood flow to the cranium

b) Loss of brain function due to disruption of blood supply to the brain

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

a) Most common cause of a stroke

59. The term blue bloater refers to a) Decreased erythropoietin production therefore decreased 02 carrying capability of the RBC b) Polycythemia and cyanosis from right ventricular failure c) Cyanosis due to decreased RBC production d) Increased BP due to high blood volume or fluid overload

b) Polycythemia and cyanosis from right ventricular failure

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

a) Results from a breakdown in the normal lung defence mechanisms

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

b) Unproductive cough and pursed lip breathing

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

e) Encourage exercise to test tolerance levels

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

c) Include aminophylline for the acute exacerbation

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

d) Used during the acute exacerbation of CORD

65. Pursed lip and diaphragmatic breathing a) Calms the anxious client b) Speed up slow respirations and used to promote effective coughing c) Prevents bronchiolar collapse and air trapping d) Encourages longer inhalation and faster exhalation

c) Prevents bronchiolar collapse and air trapping

66. Percussion, vibration and postural drainage a) Is effective management of nursing frustrations b) Promotes loosening secretions and movement out of airway c) Increases blood supply to area therefore increased expectoration d) Should be done prior to all meals

b) Promotes loosening secretions and movement out of airway

67. A normal blood sugar level (BSL) is a) 7.35 – 7.45 b) 120 – 160 mm dL c) 4 - 7 mmol/l d) +/- 2 mmEq

c) 4 - 7 mmol/l

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

c) An endocrine disorder

69. Type I diabetics are characterised by a) Non insulin dependence b) Majority of the diabetic population c) Require hypoglycaemic agents to maintain glucose levels d) Need insulin to maintain normal BSL

d) Need insulin to maintain normal BSL

State exams Flashcards

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