Question 1

A nurse working with clients with sickle cell disease (SCD) teaches about self-management to
prevent exacerbation and sickle cell crises. A client communicates the need for additional
teaching by which of the following statements.

A) “I will avoid extreme stress.”
B) “I will avoid exercise.”
C) “I will drink adequate fluid to avoid dehydration.”
D) I will avoid high altitudes.”

Question 2

A client experiencing a severe asthma attack has the following arterial blood gas results: Ph
7.33; PCO2 48 mm Hg: HCO3 26 mEq/L. Which order should the nurse implement first?

A) Sputum culture
B) Ipratropium inhaler
C) Albuterol nebulizer
D) Chest x-ray

Question 3

A client receiving a heparin infusion demonstrates signs of acute bleeding. Which of the
following should the nurse anticipate the provider to prescribe for to his client?

A) Aspirin
B) Protamine Sulfate
C) Naloxone
D) Vitamin K

Question 4

A nurse is completing the admission assessment of a client who has suspected Pulmonary
edema. Which of the following clinical infestations are expected? (select all that apply.)

A) Thick, yellow sputum
B) Tachypnea
C) Orthopnea
D) Increased urinary output
E) Persistent cough

Question 5

A client is diagnosed with acute peripheral arterial occlusion. The nurse should prepare to
provide which of the following interventions for this client?

A) Apply sequential compression devices (SCDS)
B) Place on a fluid restriction
C) Assist with ambulation
D) Administer heparin as prescribed

Question 6

The post-anesthesia care nurse is caring for a client who just has an aortic valve replacement
surgery. The client’s arterial gases are pH 72..; HCRO3 21 mEQ/L; PCO2 65 mm Hg; and PO2
58 mm Hg. Which is the priority action by the nurse?

A) Increasing the client’s oxygen flow rate
B) Auscultating lung sounds
C) Notifying the provider
D) Documenting the findings

Question 7

A client is receiving spironolactone to treat bilateral lower extremity edema. The nurse should
instruct the client to make which nutritional modification to prevent electrolyte imbalance?

A) Increase intake of milk and milk products
B) Restrict fluid intake to 1,000 ml/day
C) Do not use a salt substitute
D) Increase foods high in sodium

Question 8

A client has a history of heart failure and has been prescribed, digoxin, and potassium chloride.
The client has nausea, blurred vision, headache, and weakness. The nurse notes that the client
is confused, refusing to eat, and complaining of nausea. The nurse should assess the client for
signs of:

A) Pulmonary edema
B) Fluid deficit
C) Hyperkalemia
D) Digoxin toxicity

Question 9

Which action by a client with asthma indicates a good understanding of the nurse’s teaching
about peak flow meter use?

A) The client uses the albuterol metered -dose inhaler for peak flows in the yellow zone
B) The client calls the healthcare provider when the peak flows is in the green zone
C) The client records an average of five peak flow reading every day
D) The client inhales rapidly through the peak flow meter mouthpiece

QUestion 10

A nurse assesses a client in preparation for receiving a blood transfusion. Pre transfusing vitals
are temperature at 98.2 F, heart rate 82 beats/minute, respirations 18 breaths/minute, blood
pressure 1027 mm Hg, and oxygen saturation 96% on room air, fifteen minutes after starting the
transfusion, the nurse measures the following vital signs. Which of the following is the highest
priority of action?

A) Heart rate 112 beats/minute
B) Oxygen saturation 94% on room air
C) Temperature 98.6 F
D) Blood pressure 108/78 mm Hg

Question 11

A client is admitted with an abdominal aortic aneurysm (AAA). For which of the following
complications should the nurse be most concerned?

A) Loss of bowel sounds
B) Cardiac arrhythmias
C) Hypotension
D) ANeurysm rupture

Question 12

Which of the following statements should the nurse teach a client receiving heparin infusion?

A) Vitamin K is used to reverse the effects of heparin
B) International normalized ratio (INR) is use to assess its effectiveness
C) Heparin with facilitate clotting of the blood
D) Partial thromboplastin time value determine the dosage of heparin

Question 13

The nurse is caring for a group of clients on a pulmonary unit. The nurse can delegate which
task to unlicensed assistive personnel (UAP)?

A) Providing oral care
B) Monitoring client response to ambulation
C) Asserting pain level
D) Teaching the client how to use the incentive spirometer

Question 14

Isoniazid and rifampin have been prescribed for a client with tuberculosis. A nurse reviews the
medical record of the client. Which of the following notes would require the nurse to question the
order for these medications?

A) History of kidney stones
B) Triglyceride level of 142
C) Allergy of penicillin
D) Elevated AST and ALT levels

Question 15

Which of the following conditions is most commonly responsible for left heart failure?

A) Murmur
B) Tricuspid valve regurgitation
C) Hypertension
D) Pulmonary valve stenosis

Question 16

Which laboratory test will be most useful to the nurse in determining whether a client admitted
with acute shortness of breath has heart failure?

A) B-type natriuretic peptide (BNP)
B) Cholesterol
C) Serum creatine kinase (CK)
D) Arterial blood gases (ABGs)

Question 17

Which finding requires immediate intervention when planning care for an adolescent with cystic
fibrosis (CF)?

A) Chest pain with dyspnea
B) Delayed puberty
C) Poor weight gain

D) Large foul-smelling bulky stools

Question 18

A young adult is admitted to the emergency department after an automobile accident. The client
has severe pain in the right chest from contract with the steering wheel. What should the nurse
do first?

A) Perform a focused respiratory assessment
B) Reduce the client’s anxiety
C) Maintain adequate circulating volume
D) Administer pain medication

Question 19

A client who underwent a lobectomy and has a water seal chest drainage system appears to
have an increased work of breathing and a faster respiratory rate than 1 hour ago. The client’s
pulse rate is also increased. The nurse should do which of the following?

A) Check the tubing to ensure that the client is not lying on it or kinking it
B) Ensure that the chest tube has two clamps on it to prevent air leaks
C) Lower the drainage system 2 or 3 feet below the level on the client’s chest
D) Increase the section q

Question 20

The nurse is preparing a teaching plan for a client who is being discharged after being admitted
for atherosclerosis. The client has been taking simvastatin 40 mg for the last two years. The lab
results for the clients lipid panel result are total cholesterol 195 mg/dl; triglycerides 106 mg/dl;
and high-density lipoprotein (HDL) 69 mg/dl. Which action should the nurse take?

A) Tell the client that the cholesterol level are within normal limits
B) Review the chart for lab reports of hemoglobin and hematocrit
C) Instruct the client to lower the saturated fat in their diet
D) Ask if the client is taking the simvastatin regularly

Question 21

A client is experiencing an acute asthmatic attack. The client is noted to have respirations of 40
oxygen saturation 86% on room air, and lungs sounds with audible wheezing. Which arterial
blood response to treatment with albuterol?

A) pH: 7.27, CO2: 41 mm Hg, HCO3: 14 mm Hg
B) pH: 7.6, CO2: 34 mm Hg, HCO3: 24 Hg
C) pH: 7.12, CO2: 47 mm Hg, HCO3: 32 mm Hh
D) pH: 7.39, CO2: 36 mm Hg, HCO3: 23 mm Hg

Question 22

A nurse evaluates the following arterial blood gas and vital sign results for a client with chronic
Arterial Blood Gas REsults
paO2=46mm Hg
hCO3= 28 mEq/L vital signs
Respiratory rate = 10 breath/min
Blood pressure= 145/65 mm Hg
Heart rate= 110 beats/min
Oxygen saturation= 76% on room air
Which action should the nurse take first

A) Document finding as expected for a client with COP
B) Teach the client diaphragmatic breathing techniques
C) Administer a short-acting beta 2 agonist inhaler
D) Initiate oxygenation therapy and titrate oxygen to achieve a target oxygen saturation of


Question 23

The health care provider has just prescribed warfarin sodium for a client with a deep vein
thrombosis (DVT). The nurse knows that his client is still receiving intravenous heparin. Which is
the nurse’s best action?

A) Discontinue the heparin drip completely before warfarin sodium administration.
B) Turn off the heparin drip for 1 hour before administering the warfarin sodium.
C) Hold the dose of warfarin sodium
D) Administer the medication as prescribed

Question 24

A client with chronic bronchitis who has a new prescription for fluticasone and salmeterol
combination inhaler asks the nurse the purpose of using tw drugs. Which is the best response
by the nurse?

A) The combination of two drugs work more quickly in an acute asthma attack
B) One drug decreases inflammation, and the other is a bronchodilator.
C) The two drugs work together to block the effects of histamine of the bronchioles
D) It is a combination of long-acting and slow-acting bronchodilators

Question 25

Which assessment finding for a client receiving furosemide 40 mg, twice daily to treat stage 2
hypertension is most important to

A) Blood glucose level of 180 mg/dl
B) Early morning blood pressure reading of 164/90 mm Hg
C) Orthostatic systolic blood pressure decrease of 30 mm Hg
D) Blood potassium level of 4.2 mEq/L

Question 26

Which findings are significant data to gather from a client who has been diagnosed with
pneumonia? ( select all that apply.)

A) Color of nail beds
B) Amount of peripheral edema
C) Occurrence of chest pain
D) Quality of breath sounds
E) Presence of bowel sounds

Question 28

The provider ordered normal Saline with 20 mEQ of KcL to infuse at 100 mL/hr. The first liter
bag was hung at 1500. What time does the nurse anticipate needing to hang the second bag of
Iv fluids? (record answer in military time.)

Answer: 0100

Question 29

A client is undergoing diagnostic testing for infective endocarditis. Which of the following
laboratory tests would be most useful in diagnosis?

A) Reticulocyte count
B) Blood cultures
C) Basic Metabolic panel
D) Prothrombin time

Question 30

Which of the following statements indicated a client’s understanding of managing their
obstructive apnea?

A) “It is possible that my sleep apnea can be corrected if I exercise and watch my diet.”
B) “Using modafinil can cure my obstructive sleep apnea.”

C) “I should wait to take my sleep aid until I am ready for bed.”
D) “I will stop using my continuous positive airway pressure machine if it makes too much


Question 31

When a client with hypertension with a new prescription for atenolol returns to the health clinic
after two weeks for a follow-up visit, the blood pressure is unchanged from the previous visit.
Which action should the nurse take first?

A) Remind the client that lifestyle changes also are essential in blood pressure control
B) Teach the client about the reason for a possible change in drug therapy
C) Question the client about whether the medication is actually being taken
D) Provide information about the use of multiple drugs to treat hypertension

Question 32

A client with an acute exacerbation of chronic obstructive pulmonary disease (COPD) is
admitted to the hospital. How can the nurse best position the client to improve gas exchange?

A) Resting in bed in a semi-fowler’s position with the knees flexed.
B) Resting in bed with the head elevated 45 to 60 degrees.
C) In the Trendelenburg position with several pillows behind the head.
D) Sitting up at the bedside or in a chair and leaning slightly forward.

Question 33

A nurse is caring for a client who has valvular heart disease and is at risk of developing
left-sided heart failure. Which of the following manifestations should alert the nurse the client is
developing this condition?

A) Anorexia
B) Dependent edema
C) Orthopnea
D) Weight gain

Question 34

A nurse is assessing a male client who has a diagnosis of acute arterial occlusion. Which of the
following findings should the nurse expect to find on the affected extremity? (select all that

A) Pallor
B) Paralysis

C) Paresthesia
D) Petechiae
E) Pulselessness
F) Pain

Question 35

Which of the following would the nurse most likely assess in a client diagnosed with right-sided
heart failure?

A) Syncope
B) Hepatomegaly
C) Crackles
D) Cough with frothy blood-tinged sputum

Question 36

The nurse is caring for a client diagnosed with chronic obstructive pulmonary disease. Which of
the following interventions require extra care by the nurse?

A) Teaching the client diaphragmatic breathing
B) Encouraging fluids
C) Apply a cardiac monitor
D) Administering pain medications

Question 37

A client is having a laboratory test conducted to confirm a diagnosis of atherosclerosis. Which of
the following laboratory values would support this client’s medical diagnosis? (select all that

A) Triglycerides 175 mg/dL
B) Blood glucose 115 mg/dL
C) High-density lipoprotein (HDL) 50 mg/dL
D) Serum-cholesterol 195 mg/dL
E) Low-density lipoprotein (LDL) 145 mg/dL
F) Potassium 5.9 mEq/L

Question 38

Of the following client assignments made by the charge nurse, which would be questioned?

A) The RN with 1 year of experience caring for a post-appendectomy client
B) The LPN with 5 years of experience changing a chronic foley

C) The RN with eight years of experience caring for a client with peripheral vascularisation
disease and total cholesterol of 390 mg/dL

D) The LPN with ten years of experience caring for a client with new complaints of chest

Question 39

Which arterial blood gas (ABG) values are expected with hyperventilation?

A) pH 7.249; PaCO2 64 mmHg
B) pH 7.56; PaC02 25 mmHg
C) pH 7.50; paC02 50 mmHg
D) pH 7.28; PaCO2 28 mmHg

Question 40

The nurse is assessing a client with chronic obstructive pulmonary disease (COPD). Which
requires immediate intervention?

A) Pursed-lip breathing
B) Inability to speak
C) Diminished lung sounds
D) Distant heart sounds

Question 41

A client with a history of aortic valve stenosis tell s the healthcare provider. “I don't have a lot of
energy anymore, and I have to sleep on 3 pillows at night.” Which of these problems does the
healthcare provider conclude is likely the cause of these clinical findings?

A) Left-sided heart failure
B) Right-sided heart failure
C) Peripheral venous disease

Question 42

A client is admitted to the hospital with a diagnosis of chronic venous insufficiency. Which of
these statements by the client is most consistent with the diagnosis?

A) “I can never seem to get my feet warm enough”
B) “I have pain in my legs after I walk three blocks”
C) “I should elevate my legs”
D) “I wake up during the night because my legs hurt”

Question 43

Which of the following medications should be used with caution in clients with asthma or chronic
obstructive pulmonary disease (COPD) due to their potential to cause bronchoconstriction?

A) Calcium channel blockers
B) Thiazide diuretics
C) Beta-blocker
D) ACE Inhibitors

Question 44
Which of the following should the nurse instruct a client newly diagnosed with hypertension on?

A) It can be managed easily
B) It is a short term problem
C) It is a lifelong process
D) It happens only in the very poor, and treatment is expensive

Question 45

The nurse assessing a client diagnosed with an abdominal aortic aneurysm (AAA). WHich of the
following sounds did the nurse likely auscultate during the assessment?

A) Bruit
B) Pleural rub
C) Crackles
D) Hyperactive bowel sounds

Question 46

A client is receiving an intravenous infusion of heparin sodium at 1,770 units/hr. The drug
concentration is heparin sodium 25,000 units/250ml. What is the rate (in mL/hr) the nurse must
infuse the medication at? (round the answer to the nearest whole number. Do not use a trailing

Question 47

The nurse is assessing a 48-year-old client with a history of smoking during a routine clinic visit.
The client, who exercises regularly, reports having pain in the calf during the exercise that
disappears at rest. Which finding requires further evaluation?

A) Ankle-brachial index of 0.99
B) Oxygen saturation of 94% on room air
C) Diminished right pedal pulse
D) Heart rate 60 beats/minute

Question 48

The nurse is notifying the healthcare provider via telephone of a change in the condition of a
client diagnosed with exacerbation of asthma. Arrange the nursing statements in order as they
would by communicated using the SBAR method.
1.Mr.Smith was admitted yesterday with an exacerbation of asthma. He typically controls his
asthma with oral medication and inhaler at home. He orders albuterol treatments twice daily.
Oxygen is prescribed for a 2L nasal cannula.
2. I am notifying you because Bob Smith has become increasingly short of breath with audible
wheezing this afternoon.
3. I recommend that we increase his oxygen dose and prescribe an extra albuterol treatment.
4. Hello. My name is Nurse Jones from Unit D.
5. Respirations are now 32/minute. The pulse oximeter is 89% on 2 L nasal cannula. Lungs
reveal wheezing in all lung fields.

A) 4,5,1,2,3
B) 4,2,1,5,3
C) 4,1,2,5,3
D) 4,5,2,1,3

Question 49

The nurse is reviewing a medical record for a client with hypertension. Which of the following
medications may be used in the management of hypertension? (select all that apply)

A) Carvedilol
B) Hydrochlorothiazide
C) Ticagrelor
D) Loratadine
E) Verapamil
F) Valsartan

Question 50

Order for dobutamine to infuse at 20 mcg/kg/min. The client weighs 182 Ib. The pharmacy
supplied a bag of dobutamine 250 mg/250ml. What is the rate (in mL/hr) the nurse infuses the
medication at? (Round the answer to the nearest whole number. Do not use a trailing zero.)?