PRACTICE TEST QUESTIONS

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1. Mr. Epstein, 58 years old, is recovering from a suprapubic

prostatectomy. His urinary output in the past 2 days has been
satisfactory; however the nurse now notices that it is becoming
increasingly bloody. The initial action of the nurse should be to:
A. Irrigate the Foley catheter
B. Notify the physician
C. Take vital signs
D. Empty the drainage bag

2. Dianne, a 28-year old female, is admitted to the hospital with a

diagnosis of anorexia nervosa. She is 5'6" tall and weighs 90 pounds..
She appears weak and lethargic, with very poor skin color. Dianne is
placed on a high-protein, high-carbohydrate diet. The primary function
of carbohydrates in the body is to:
A. Develop a cushion around vital organs
B. Break down and transport proteins
C. Supply energy to the body
D. Maintain fluid balances

3. Jean Thomas is a 25-year-old secretary admitted to the emergency

room with diaphoresis, hyperventillation, palpitations, and trembling.
Jean tells the nurse that she has been "very upset and nervous" over a
poor employment evaluation. A tentative diagnosis or acute anxiety
episode is made. Which of the following acid-base imbalances would
likely occur as a result of Jean's hyperventillation?
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis

4. Amy Stevens is a 17-year-old student admitted for evaluation of

lower abdominal pain. She tells the nurse, "I wish my friends would
come to visit me. I don't like being alone." Which of the following
would be the most appropriate response of the nurse?

A. "You sound very lonely. Shall I stay with you for awhile?"
B. "I'm sure your friends will come to see you soon."
C. "It's a little too early for visiting hours. You'll have to wait until this
afternoon."
D. "It's hard to be alone. Would you like me to stay with you?"
5. Samuel Davidson is a 68-year-old being treated for metastatic
prostate carcinoma. He says "you may as well give up on me, nurse.
I'll never get better." The nurse would appropriately respond:
A. "But you really are improving. Try to keep a positive attitude."
B. "I won't give up on you Mr. Davidson. I know you'll get better."
C. "I'm not sure what you are saying. You feel you're not improving?"
D. "Recovering from cancer takes a while. Be patient."

6. Joyce Lisle is a patient on a medical-surgical unit who has

undergone biopsy for abnormal uterine bleeding. Joyce questions the
nurse about the procedure and then says, "Do you think I have
cancer?" The nurse should respond to Joyce's question with which of
the following statements?
A. "It's impossible to know for sure until your biopsy report is
complete."
B. "Often biopsies are negative."
C. "I can understand how you must feel. I'd be frightened, too."
D. "I really can't say. Are you concerned about what the biopsy will
show?"

7. Mrs. Durham is recovering from a colon resection for removal of a

malignant mass in the large bowel. Following breakfast one morning
she told the nurse, "I'm tired of waiting, I want my bath now. You're
never here when I need you." Which of the following responses by the
nurse is most appropriate?
A. "What do you mean, I'm never here? I spent 3 hours with you
yesterday, Mrs. Durham."
B. "I'm sorry you've been waiting Mrs. Durham. Let's get you
comfortable now, and I'll be back in 20 minutes to give you a bath."
C. "I'm doing my best, Mrs. Durham. You know I have three other
patients to take care of today, besides you."
D. "I must see Mrs. Jones right now Mrs. Durham. She's really sick
today. I'll be back soon as I can."

8. Jerry is a 32-year-old white male. He has been married for 10

months, and he and his wife, Sue, are expecting their first child in 6
months. Prior to marrying Sue, Jerry was sexually active and
nonmonogamous. He has been sexually active since the age of 18.
Recently Jerry has complained of persistent dry cough, night sweats,
and a temperature over 100ْF. Although Jerry is concerned about his
weight and watches his diet, he has lost 15 pounds without even
trying. Upon assessing Jerry, he admits to have had sexual intercourse
with prostitutes, both male and female, during the last 10 years.
Jerry's symptoms of elevated temperature, chills, and dry cough are
probably related to which undiagnosed condition?
A. Alteration in tissue perfusion
B. An infection, etiology unknown
C. Indigestion from too frequent traveling
D. Lack of knowledge related to frequent travel

9. Mr. Smith is a 44-year-old iron worker, who is admitted through the

emergency room with a flushed face, irritability, and the following vital
signs:
Temp: 99.1°F
Resp: 20
Pulse: 108
BP: 280/114
A diagnosis of hypertensive crisis is made. Signs and symptoms of
hypernatremia would include all of the following, except:
A. Restlessness
B. Muscular weakness
C. Tachycardia
D. Thirst

10. Molly Flannery is a 67-year-old female chronic congestive heart

failure and hypertension. She is being evaluated for complaints of
muscular weakness and general fatigue. Molly's serum electrolyte
studies reveal a K+ level of 2.9. Which of the following medications
taken by the patient at home contributed most of her hypokalemic
state?
A. Digoxin, 0.125mg, PO, daily
B. Lasix, 80mg, PO, daily
C. Aldomet, 250mg, PO, did
D. Aspirin, 10 grains, bid

11. Margaret O'Hara, a 30-year-old known diabetic, is brought to the

emergency department by ambulance. The paramedic team reports
symptoms of apparent hyperglycemia. Stat blood glucose is 640. The
nurse is aware that excess serum glucose acts to draw fluids
osmotically with resultant polyuria. In addition to increased urinary
output, the nurse should expect to observe which of the following sets
of symptoms in Margaret?
A. Polydipsia, diaphoresis, bradycardia
B. Thirst, dry mucous membranes, hot dry skin
C. Hypotension, bounding pulse, headache
D. Nervousness, rapid respirations, diarrhea

12. Loberta Jackson, a 21-year-old college student, is admitted to a

medical unit with with diagnosis of uncontrolled diabetes, acute
hypoglycemic reaction. Loberta explains to the admitting nurse that
she had been feeling "sick to my stomach, like I was coming down
with the flu" for the past 48 hours. She has continued to take her
usual daily dosage of insulin. Noting that Loberta has been admitted
with a blood-glucose value of 53, which of the following assessment
questions would provide the most valuable information about Loberta's
status?
A. "Have you been under a great deal of stress lately, Loberta?"
B. "Were you having difficulty sleeping after this illness started?"
C. "Have you eaten anything in the past 48 hours?"
D. "Did you take any medications for this illness other than your
insulin?"

ANSWER KEY:
Question 1: C. Take vital signs
Rationale: The immediate goal is to determine if the increase in
bleeding is causing a life threat to the patient and if it is threatening
his stability. Taking the vital signs is the only action that will give you
information on Mr. Epsteins's physiological status. The nurse should
not notify the physician until she can provide further assessment of
the patient's condition.

Question 2: C. Supply energy to the body

Rationale: Since carbohydrates break down into sugars, which furnish
the body with energy. A refers to a function of fats. B and D refer to
functions of proteins.

Question 3: B. Respiratory Alkalosis

Rationale: Since hyperventilation will cause an increased loss of CO2,
leading to a decrease in acid in arterial blood, resulting in an alkalotic
state.

Question 4: D. "It's hard to be alone. Would you like me to stay with

you?"
Rationale: This response acknowledges the patient's feelings, and
offers support. A tends to catastrophize the patient's situation by
saying "you must be very lonely. B provides false reassurance. C does
not respond to the patient's feelings and only based on facts.

Question 5: C. "I'm not sure what you are saying. You feel you're not
improving?"
Rationale: The nurse is clarifying the patient's intended message and
at once is offering to listen to him further, thus facilitating his
expression of his concerns and feelings.

Question 6: D. "I really can't say. Are you concerned about what the
biopsy will show?"
Rationale: This answer is honest, and at the same time, encourages
further expression by the patient. A is a factual statement, yet it does
not respond to the patient's unspoken sense of concern over the
biopsy results. B may be a correct statement, but it does not address
the patient's unique situation, and may be false reassurance. Response
C both assumes that the nurse does have an understanding of his
patient's unique perceptions and experiences as well as catastrophizes
by focusing on the issue of fear by stating "I'd be frightened too." This
response sends the message to the patient that she should be
frightened about the results of the biopsy, which is clearly an
undesired effect in this situation.

Question 7: B. "I'm sorry you've been waiting Mrs. Durham. Let's get
you comfortable now, and I'll be back in 20 minutes to give you a
bath."
Rationale: This is the only appropriate response, because it
acknowledges her feelings and gives her a clear, factual response to
her concern. Never challenge a patient's statements and don't be
defensive. Don't reprimand the patient unnessecarily or talk about the
needs of the other patients. In this case you did not need to know a lot
about colon resections to answer this question. Yo udid need to have
skill in basic communication and human interaction.

Question 8: B. An infection, enology unknown

Rationale: Classic signs and symptoms of infection are fever, chills,
loss of appetite, generalized myalgias, or localized pain and
discomfort. The dry cough and Jerry experiences can be associated
with the system of involvement. Pulmonary etiology should be
assessed and evaluated.

Question 9: B. Muscular weakness

Rationale: Since Na+ levels cause excitability of nerve transmission,
creating restlessness and tachycardia. This is included as high salt
levels create a need for fluids. Muscular weakness evident in
hyponatremia because of low levels of Na+ in the blood causing
decreased nerve transmission.

Question 10: B. Lasix, 80mg, PO, daily

Rationale: Since Lasix, in addition to its diuretic action, also wastes K+
by increasing urinary excretion. Digoxin contributes to K+ loss by
enhancing urinary output, but Lasix is much more directly related to
the development of hypokalemia. An anti-hypertensive that is not
related to K+ loss; and aspirin, may have been prescribed as
myocardial infraction prophylaxis, and is not related to K+ loss.

Question 11: B. Thirst, dry mucous membranes, hot dry skin

Rationale: All of these symptoms are associated with the dehydration
that occurs in hyperglycemia. Although polydipsia is expected,
diaphoresis does not occur in the body's effort to compensate by
holding back fluid. The patient would experience tachycardia as a
cardiac compensatory mechanism, causing a rapid, thready pulse.
Headache and nervousness are symptoms associated with
hypoglycemia.
Question 12: C. "Have you eaten anything in the past 48 hours?"
Rationale: It is highly probably Loberta, feeling "sick to her stomach,"
has not taken in adequate foods and fluids, and coupled with taking
her usual dosage of daily insulin, has brought about an acute
hypoglycemic reaction. A, focusing on increased stress, would more
than likely stimulate a hyperglycemic reaction. Since stress causes
elevations of blood glucose. D, focusing on other medications the
patient has taken, would probably not trigger a hypoglycemic reaction.
B is unrelated to her current status.