VerA Ok-Prelim Ncm104 (Autosaved)Vera

7/22/2019 VerA Ok-Prelim Ncm104 (Autosaved)Vera

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UNIVERSITY OF LA SALETTECOLLEGE OF NURSING

NCM 104- PRELIMINARY EXAMINATION

Direction: Direction: Choose the correct answer for each of the following question. Shade the

letter of your choice on the answer sheet provided. ERASURES WILL BE MARKED WRONG.

NEUROLOGIC DISORDER:1. A feeling of pleasantness or unpleasantness, varying degree from mild to intense occurs when

sensory impulses reach the:a. Thalamus

b. Basal gangliac. Hypothalamusd. Cerebral Cortex

2. The medulla has centers for:a. Control of sexual development

b. Voluntary movement, taste, skin sensationsc. Control of breathing, heartbeat, blood vessel diameter d. Fat metabolism, temperature regulation, water balance

3. The fact that the client cannot close the right eye can be explained by nonconduction of:a. The 2 nd cranial nerve

b. The 3 rd cranial nervec. The 4 th cranial nerved. The 7 th cranial nerve

4. A clients mouth is drawn over to the left. This suggests injury to the:a. Left facial nerve

b. Right facial nerve

c. Left abducent nerved. Right trigeminal nerve5. A client, who has a history of seizures, is scheduled for an Arteriogram at 10 AM and is to

have nothing by mouth before the test. The client is scheduled to receive phenytoin (Dilantin)at 9 AM. The nurse should:a. Omit the 9 AM dose of the drug

b. Give the same dose of the drug rectallyc. Ask the physician if the drug can be given IVd. Administer the drug with 30 ml of water at 9AM

6. A physician performs a lumbar puncture. To do this procedure a needle must be inserted intothe:a. Pia mater

b. Foramen Ovalec. Aqueduct of sylviusd. Subarachnoid space

7. This diagnostic study uses a nuclear scan that provides information on blood flow, oxygenuptake, glucose transport, and on the function of the braina. Myelography

b. Cerebral Arteriographyc. Magnetic Resonance Imagingd. Positron Emission Tomography

8. The nurse should be aware that a common misconception about autonomic nervous system isthat:a. Both sympathetic and parasympathetic impulses continually affect most visceral effectors

b. The autonomic nervous system is regulated by impulses from the hypothalamus and other parts of the brain

c. Sympathetic impulses stimulate while parasympathetic impulses inhibit the functioningof any visceral effector.

d. Visceral effectors (e.g., cardiac muscle, smooth muscle) receive impulses only viaautonomic neurons


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9. This cranial nerve is assessed by asking the client to stick out tongue and observe for symmetry, deviation to side; and having the client push tongue against tongue depressor andmove tongue from side to side.a. CN IX

b. CN X

c. CN XId. CN XII10. When a client is unconscious, the nurse should expect the person to be unable to:

a. Hear voices b. Control eliminationc. Move spontaneouslyd. React to painful stimuli

11. A client regains consciousness and has expressive aphasia. As part of the long-range planningthe nurse should:a. Provide positive feedback when the client uses a word correctly

b. Wait for the client to verbally state needs regardless of how long it may take

c. Suggest that the client get help at home because the disability is permanentd. Help the family to accept the fact that the client cannot participate in verbalcommunication.

12. Of the following combinations of symptoms, the most indicative of increased intracranial pressure is:

a. Weak rapid pulse, normal blood pressure, intermittent fever, lethargy b. Rapid weak pulse, fall in blood pressure, low temperature, restlessnessc. Slow bounding pulse, rising blood pressure, elevated temperature, stupor d. Slow bounding pulse, fall in blood pressure, temperature below 97 o F(36 o C), stupor.

13. Which of the following s a priority when suctioning a client with increased intracranial pressure?

a. Limit the suction passes to 30 seconds b. Suction the client as neededc. Suction the client at least every hour d. Schedule the suctioning with other nursing tasks

14. The nurse is caring for a client with increased intracranial pressure. Which of the followingassessment findings should the nurse immediately report?a. Nausea

b. Headachec. Fever d. Absence of papillary response

15. The nurse should implement which of the following methods of assisting during a seizure?a. Turn the client on the side and open the airway with a padded tongue depressor

b. Restrain the client and observe the seizure activityc. Open the airway with a padded tongue depressor and restrain the clientd. Turn the client on the side and observe the seizure activity

16. A client who is receiving phenytoin phenytoin (Dilantin) to control seizures questions thenurse regarding the medication after discharge. The nurse should explain that this medication:a. Will prevent the occurrence of seizure

b. Will probably have to be continued for lifec. Need to be taken only in periods of emotional stressd. Can usually be stopped after a years absence of seizures.

17. Which of the following statements indicates the family of a child with a seizure disorder hasfollowed the nurses discharge instructions?a. Our child has had a growth spurt, so we made an appointment to review the medication

to prevent seizures. b. We remind our child every day of what activities should be restricted.c. Most of our time is spent with our child who ha seizures, so we have little time for the

other children.d. Our child knows to take a dose of seizure medicine after remembering a dose that was

accidentally forgotten.


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18. The nurse should assess a client with headache and receiving ergotamine tartrate (Ergomar)for which of the following adverse reaction?a. Nausea, urinary retention, and hypertension

b. Urinary retention, Constipation, and dry mouthc. Nausea, Hypertension, and Tachycardia

d. Dry mouth, Urinary retention, and Tachycardia19. The nurse is caring for a client who has aphasia following a Cerebrovascular accident. Whichof the following nursing interventions should the nurse include in the plan of care?a. Assume that the client cannot understand what is said

b. Establish a long term goals with the clientc. Attempt repetition with phrases when speaking to the clientd. Speak to the client in a louder than usual voice

20. Developing independence is a primary goal for a client with hemiplegia. The nurse plants tofacilitate this by:a. Establishing long-range goals for the client

b. Reinforcing success in tasks accomplished

c. Pointing out errors and helping to correct themd. Demonstrating ways the client can regain independence21. Urinary retention and overflow, a frequent problem of a client after a stroke, is evidenced by:

a. Frequent voiding b. Oliguria and edemac. Continual incontinenced. Decreased urine production

22. The nurse is teaching a class on the prevention of Cerebrovascular accidents. Which of thefollowing risks factors should the nurse identify as the most important factor contributing to astroke?a. Sedentary lifestyle

b. Hypertensionc. Smokingd. Obesity

23. The nurse is admitting a client diagnosed to have a cerebrovascular accident involving left- brain damage. The nurse evaluates which of the following to be the clinical manifestations of a cerebrovascular involving left-brain damage?a. Paralyzed right side, Aphasia, and Depression

b. Left-sided neglect, Paralyzed left side, and denial of deficitsc. Paralyzed left side, Denial of deficits and Aphasiad. Depression, Paralyzed right side and Left-sided neglect

24. The physician tells a client with Multiple sclerosis that it is a chronic progressive neurologiccondition. The client asks the nurse, Will I experience pain? The most appropriate response

by the nurse isa. Tell me about your fears regarding pair

b. Analgesic will be ordered to control the pain.c. Pain is not a characteristic symptom of this disease process.d. Lets make a list of the things you need to ask your physician.

25. The nurse should expect a client with an exacerbation of Multiple sclerosis to experience:a. Double vision

b. Resting tremorsc. Flaccid paralysisd. Mental retardation

26. Which statement made by the spouse of a client with multiple sclerosis indicates to the nursean understanding of the home-care needs for this client?a. Im going to feed my spouse from now on.

b. Ive learned how to take care of a foley catheter.c. I will put up handrails in the shower.d. I will make my spouse stay in bed as much as possible.


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27. The nurse is caring for a client with Myasthenia gravis who has become progressively weaker.Endrophonium chloride (Tensilon) has been prescribed for which of the following purposes?a. Treat the clients muscle weakness

b. Differentiate between a cholinergic and myasthenic crisisc. Increase the skeletal muscle relaxation

d. Decrease difficulty breathing28. The prognosis for the client with myasthenia gravis is most likely to be:a. Excellent with proper treatment

b. Slowly progressive without remissionsc. Chronic, with exacerbations and remissionsd. Poor, with death occurring in a few months

29. A client with myasthenia gravis has been receiving neostigmine (Prostigmin). This drug acts by:

a. Stimulating the cerebral cortex b. Blocking the cholinesterase actionc. Replacing the deficient neurotransmitters

d. Accelerating transmission along he neural sheaths30. The nurse is caring for a client with Gullain-Barre syndrome. Which of the following wouldindicate the clients condition is deteriorating?a. weakness and paresthesia

b. pain and muscle achesc. Urinary retentiond. Respiratory infection

31. The nurses plan of care for a client with Gullain-Barre syndrome is based on anunderstanding of which of the following disease processes?a. Decreased secretion of acetylcholine and an increase cholinesterase at the myoneural

junction b. Segmental demyelination of the ventral and dorsal roots in the spinal cordc. Chronic inflammation, demyelination, and scarring of the CNSd. Decreased secretion of dopamine with an anticholinergic effect.

32. An elderly female client with Alzheimers disease frequently switches from being pleasantand happy to being hostile and sad without apparent external cause. The nurse can best carefor the client by:a. Trying to point out reality to the client

b. Avoiding the client when she is angry and sadc. Encouraging he client to talk about her feelingsd. Attempting to give nursing care when the client is in a pleasant mood

33. The nurse knows that Alzheimers disease is characterized by:a. Transient ischemic attack

b. Remissions and exacerbationsc. Slowly progressive deficits in intellect, which may not be noted for a long timed. Rapid deterioration of mental functioning because of arteriosclerosis

34. The nurse is admitting a client suspected of Parkinsons diseases. Which of the following doesthe nurse observe that supports the diagnosis?a. Chorea movements, tremor noticeable at rest and paresthesia

b. Rigidity, muscle wasting and bradykinesiac. Paresthesia, tremor notiable at rest, and muscle wastingd. Rigidity, bradykinesia and tremor noticeable at rest

35. Levodopa appears to be useful in treating Parkinsons disease because it can:a. Improve myelination of neurons

b. Increase acetylcholine productionc. Replace the dopamine in the brain cellsd. Cause regeneration of injured thalamic cells


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36. The nurse would expect a client with Parkinsons disease to exhibit:a. A flattened affect

b. Tonic-clonic seizuresc. Decreased in intelligenced. Changes in pain tolerance

37. The following are true about Huntingtons disease except:a. This is an inherited disorder, considered autosomal recessive b. It is a progressive atrophy of the basal ganglia and some portions of the cerebral cortex.c. Symptoms include uncontrolled jerky movements of the extremities, trunk, face and

tongued. Fifty percent of children with a parent with the disorder will likely inherit the disorder

38. When planning nursing care for a client with trigeminal neuralgia (tic douloureux), the nurseshould specifically:a. Apply iced compresses to the affected area

b. Be alert to prevent dehydration or starvationc. Initiate exercises of the jaw and facial muscles

d. Emphasize the importance of brushing the teeth39. To prevent precipitating a painful attack in a client with tic doloureux the nurse shoulda. Avoid walking swiftly past the client

b. Keep the client in the prone positionc. Discontinue oral hygiene temporarilyd. Massage both sided of the face frequently

40. When developing a teaching plan for a client with trigeminal neuralgia, the nurse shouldinclude an explanation that the medication used to treat this disorder is:a. Ascorbic acid

b. Morphine sulphatec. Allopurinol (Zyloprim)d. Carbamazepine

41. The nurse should expect a client with trigeminal neuralgia to demonstrate:a. prolonged period of sleep due to anxiety

b. Hyperactivity due to medications receivedc. Exhaustion and fatigue due to extreme paind. Excessive talkativeness due to apprehension

42. Bells palsy is a disorder of which cranial nerve?a. Cranial Nerve V

b. Cranial Nerve VIc. Cranial Nerve VIId. Cranial nerve VIII

43. The following are all findings in clients with Bells palsy except:a. Decreased lacrimation

b. Diminished blink reflexc. Painful sensations in the faced. Facial paralysis involving the eye

44. Following head trauma a client complains of hearing noises. The nurse recognizes that thisassessment suggests injury of the:a. Frontal lobe

b. Occipital lobec. Sixth cranial nerved. Eight cranial nerve

45. A nurse providing discharge instructions to the parents of a child who suffered a head injurysix hours ago. Which statement by the parents indicates additional teaching is needed?a. We will call the doctor immediately if vomiting occurs.

b. We wont give anything stronger than paracetamol for headache.c. We will provide uninterrupted sleep when we get homed. I know continued amnesia regarding the events of the injury is expected.


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46. When caring for a client who had sustained a head injury, the nurse should assess for:a. Decreased carotid pulse

b. Bleeding fro the oral cavityc. Altered level of consciousnessd. Absence of deep tendon reflexes

47. A client has been receiving dexamethasone (Decadron) during the past 3 weeks for control of cerebral edema. The planned effect of the drug is to:a. Suppress production of antibodies

b. Increase fluid removal from the tissuesc. Increase elasticity of the ventricle wallsd. Reduce CSF secretion by the choroids plexus

48. When caring for a client who has possible skull fracture as a result of trauma the nurse should:a. Observe the client for sign of brain injury

b. Check for haemorrhaging from the oral cavityc. Elevate the foot of the bed if the client develops symptoms of shock d. Observe for symptoms of decreased intracranial pressure and temperature.

49. Which of the following actions is a priority for the nurse to perform first in a client with aspinal cord injury who complains of headache?a. Administer a beta adrenergic blocker

b. Take the blood pressurec. Assess the papillary reactiond. Insert a foley catheter

50. Immediately following a spinal cord injury, a clients family asks the nurse, Is the damage theclient presents with in the emergency room as bad as it seems? The most appropriateresponse by the nurse isa. Because of edema around the spinal cord, it is difficult to evaluate the extent of the

injury for up to one week. b. Unfortunately yes, the injury is exactly as it appears.c. Probably not, because the client will probably regain a lot of function.d. The injury is so severe that death is imminent within days.

ENDOCRINE DISORDER:

51. What portion of the adrenal gland secretes aldosterone and androgens?a. adrenal cortex

b. adrenal medullac. parafollicular cellsd. pituitary gland

52. Which of the following is true about Parathormone?a. it is secreted when the serum calcium level is low

b. it deposits calcium into bonesc. It causes oliguriad.it lowers serum calcium

53. The source of glucose for maintaining normal levels when the blood glucose begins to fall is:a. Ingested food

b. Gluconeogenesisc. Liver glycogend. Intestinal hydrolysis

54. Ketone bodies appear in he blood and urine when fats are being oxidized in great amounts. Thiscondition is associated with:

a. Starvation b. Alcoholismc. Bone healingd. Positive Nitrogen Balance


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55. The primary treatment of diabetic acidosis administration of:a. IV fluids

b. Potassiumc. NPH Insulind. Sodium polystyrene sulfonate (Kayaxalate)

56. A difference between diabetic coma and hyperosmolar nonketotic coma is that clients in diabeticcoma experience:a. Fluid loss

b. Glycosuriac. Kussmaul respirationsd. Increased blood glucose

57. A client with insulin-dependent DM is being considered for the tight-control program. Indetermining if the client is a candidate for this program, the nurse and health care team evaluatesthe:

a. Clients daily dietary requirements b. Clients family support system

c. Clients previous compliance historyd. Length of time the client has had DM58. Which of the following diagnosis would be most appropriate for a client newly diagnosed withnon-insulin dependent DM?

a. Risk for Infection related to newly diagnosed diabetes b. Altered Nutrition: More than Body Requirements related to overproduction

of insulinc. Pain related to elevated blood glucose

levels.d. Altered Health Maintenance related to lack of knowledge of proper foot care.

59. What is the most important reason why is it vital to recognize and treat hypoglycemia promptlyin the client with DM?

a. The client may become dehydrated quicklyb. Hypoglycemia can cause brain damagec. Hypoglycemia necessitates increased insulin dosage.d. The client may become confused

60. The nurse assesses which of the following assessments in a client with severe anterior pituitarydeficiency caused by the growth of a tumor?

a. Intolerance to heat and hypergycemia b. Bradycardia and Hypoglycemiac. Polyuria and dehydrationd. Intolerance to heat and dehydration

61. The nurse should include which of the following in the preoperative instructionsfor a client with an anterior pituitary tumor who is scheduled for a total hypophysectomy

using the transsphenoid approach?a. Avoid sneezing or blowing the nose after surgery

b. Drink 10 glasses of fluids the day before surgeryc. Do not rinse the mouth with any solutions until the packing is removedd. Support the neck when getting out of bed

62. For the past 6 months, Apple, 25 year old female has been experiencing menstrual irregularitiesand odd sensation of her hand and feet. She noticed coarsening of her facial features and somevisual changes. But it was the insidious onset of milk production that prompted a clinical consult.The most likely pathology behinds Apples case would be?

a. hypopituitarism: dwarfism b. hypopituitarism: sheehans syndromec. hyperpituitarism: acromegalyd. hyperpituitarism: gigantism


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63. Trans-sphenoidal Hypophysectomy was performed. Post operative nursing consideration wouldinclude all of the following except:

a. discouraging forceful nasal blowing b. suggesting the use of soft bristled brushc. keeping the client in a semi-fowlers position

d. having the client gargle with warm saline64. A patient diagnosed with diabetes insipidus is receiving chlorpropamide. The action of the drugis to:a. inhibit the action of ADH

b. increase the action of ADHc. increase urine outputd. increase blood glucose level

65. The following are signs and symptoms of diabetes insipidus except:a. polyuria

b. dilute urinec. dehydration

d. high specific gravity of urine66. Green, A 21 year old male client has been rushed to emergency department following atraumatic blow to the head at a sports bar brawl. Admitting diagnosis: Diabetes Insipidus [DI].The primary pathology in Greens situation is the undersecretion of antidiuretic hormone [ADH],which leads to:

a. impaired CHO, CHON, Fat catabolism b. poor cathecholamine activityc. potassium retention & water wastingd. excessive sodium retention & fluid loss

67. A major goal in the care for Green is:a. watching for signs of hyperkalemiab. ensuring that diabetic diet is followedc. accurate administration of insulind. maintaining adequate fluid balance

68. Hypotension associated with Addisons disease involves a disturbance in the production of:a. Estrogens

b. Androgensc. Glucocorticoidsd. Mineralocorticoids

69. The nurse should observe a client with Addisons disease closely for signs of infectiouscomplications because there is a disturbance in:a. Metabolic process

b. Respiratory functionc. Electrolytic imbalancesd. Inflammatory effects

70. The emaciation, muscular weakness, and fatigue associated with Addisons disease are due to adisturbance in:

a. Fluid balance b. Electrolyte levelsc. Protein anabolismd. Masculinizing effects

71. The treatment of a client with Addisons disease includes a high protein diet, high calorie dietwith extra salt. AS a means of encouraging the client to eat, the nurse explains that:a. Increased amounts of potassium are needed to replace renal losses

b. Increased protein is needed to heal the adrenal tissue and thus cure the disease.c. Increased vitamins are needed to supply energy to assist in regaining lost weightd. Extra salt is needed to replace the amount being lost due to lack of sufficient aldosterone

to conserve sodium


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72. Cushings disease results from an excessive glucucorticoid production. Cortisol, aglucocorticoid. Influence the metabolism of nutrients. Rapid metabolism can lead to thefollowing manifestations except:

a. blood glucose level of 200 mg/dl b. BP 180/100 mmHg

c. Bone ossificationd. Muscle wasting73. A nursing instructor asks a student to describe the pathophysiology that occurs in Cushings

disease. Which statement by the student indicates an accurate understanding of this disorder?a. It is characterized by an oversecretion of glucocorticoid hormones.

b. It is characterized by an undersecretion of glucocorticoid hormones.c. It is characterized by an oversecretion of insulin.d. It is characterized by an undersecretion of corticotropic hormones.

74. A patient diagnosed with diabetes insipidus is receiving chlorpropamide. The action of the drugis to:

a. inhibit the action of ADH

b. increase the action of ADHc. increase urine outputd. increase blood glucose level

75. When assessing a client with Cushings syndrome the nurse expect:a. dehydration and menorrhagia

b. buffalo hump and hypertensionc. pitting edema and frequent coldsd. migraine headache and dysmenorrhea

76. Which of the following medications should be available to provide emergency treatment if aclient develops tetany after a subtotal thyroidectomy?

a. sodium phosphate b. calcium gluconatec. echothiophate iodided. sodium bicarbonate

77. A nurse is preparing the bedside for a post-operative parathyroidectomy client. The nurseensures that which piece of medical equipment is at clients bedside?

a. underwater seal chest drainage b. tracheostomy setc. cardiac monitor d. intermittent gastric suction

78. A hyperparathyroid clients extremities should be handled gently because?a. hypertension can lead to residual stroke and paralysis

b. polyuria can lead to dry skin and mucous membrane that can breakdownc. edema can cause tissues to tear easilyd. decreased calcium bone deposits can lead to pathologic fractures

79. A 34 year old client is admitted with the diagnosis of hypoparathyroidism. The nurse is prompted to assess for hypocalcemia, if present she would observe;

a. generalized edema b. spasms of the hands and feetc. hyperventilationd. a negative chovstek sign

80. The nurse assesses the client for sign of hypocalcemia by tapping the pre-auricular facial area toelicit?

a. Chovsteks sign b. Trosseaus signc. Levines signd. Cullens sign


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81. Which of the following manifestations does the nurse expect in a client with myxedema?a. increased heart rate

b. edemac. weight lossd. intolerance to heat

82. Which of the following are most important to monitor in a client who had undergone totalthyroidectomy?a. pulse and temperature

b. serum electrolyte levelsc. weight and food intaked. hoarseness of the voice and ability to swallow

83. Which of the following should be included when giving health teachings to a client withhyperthyroidism.a. wear long-sleeved clothing

b. use artificial tears to the eyes as necessaryc. increase fibers in the diet

d. take medications with milk 84. A client complains of tingling in his fingers. He has (+) Trousseaus and Chvosteks signs.Choose the most likely serum Ca value for this client.

a. 11 mg/dl b. 9 mg/dlc. 7 mg/dld. 4 mg/dl

Situation: Maria, 48 years old, is a known diabetic type 1. She has often consulted her internist for medication. She asks you if she can get well.

85. If Maria asks you what to take for medication , you would answer that she;a. must try other alternativeb. could consult other doctorsc. can't take a herbal medicined. has to follow doctor's prescription

86. One party time, you saw Maria eating a big piece of cake. As a concerned nurse you wouldtell her

a. It's okay Maria, it's party time anywayb. Why are you hard-headed Maria?c. Maria stop eating the cake!d. Maria, remember that you are taking medicine for diabetes

87. The next morning Maria said she did not feel well, you would saya. See your doctor onceb. Come let me assess your health statusc. I told you sod. Have your blood sugar checked

88. Upon checking, Maria was having hyperglycemia, you tell Maria to;a. drink plenty of water b. have a good restc. take her prescribed insulind. see her doctor right away

89. The following are nursing interventions when administering insulin except:a. administer insulin at room temperatureb. rotate site of injectionc. aspirate cloudy insulin before clear insulin to combine in one syringed. shake insulin vial gently to redistribute insulin particles
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90. To prevent lipodystrophy due to insulin injection, the nurse should do the following except:a. inject insulin at room temperatureb. rotate the site of injectionc. inject insulin between layer of fats and musclesd. introduce insulin rapidly

91. Among the topics you will include as priority in health teaching to Mario is:a. nutrition and diet therapyb. daily foot carec. good exercise dailyd. prevention of complication

92. Which of the following laboratory test best indicate compliance of the diabetic client and insulintherapy?

a. 2-hour postprandial blood glucoseb. fasting blood glucosec. glycosylated hemoglobind. oral glucose tolerance test

93. The diabetic client is having ketoacidosis. Which of the following is the appropriate initialnursing action?a. start an intravenous glucoseb. administer insulin per IVc. give a glass of orange juiced. give a cup of skim milk

94. The client has been diagnosed to have NIDDM (non-insulin dependent diabetes mellitus).Which of the following signs and symptoms characterize the disease?Select all that apply.

a. occurs after 30 years of ageb. obesityc. requires lifetime insulin injectiond. can be controlled by diet, exercise, and druge. prone to diabetic ketoacidosisf. experience weight lossg. may require insulin in case of stress, surgery, pregnancy

95. Which of the following is the appropriate initial action by the nurse when preparing insulin administration?

a. injecting air into the regular insulinb. withdrawing the cloudy insulin first before the clear insulinc. injecting air into the cloudy insulin but withdrawing the clear insulin firstd. withdrawing the clear insulin and cloudy insulin in separate syringes

96. The following are characteristics of type I DM. Select all that apply:a. the client is thinb. it requires lifelong insulinc. the client may take sulfonylureasd. the client is at risk to develop diabetic ketoacidosise. onset of the disease is after 30 years of agef. there is insulin secretion, but the body's demands are increased

97. An adolescent client with type I diabetes mellitus is admitted to the emergency department for treatment of diabetic ketoacidosis. Which assessment findings should the nurse expect to note?

a. sweating and tremorsb. hunger and hypertensionc. cold, clammy skin and irritabilityd. fruity breath and decreasing level of consciousness

98. The following are signs and symptoms that indicate hyperglycemia in a client with diabetesmellitus. Select all that apply


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a. elevated blood sugar levelb. cold, clammy skinc. increased urinationd. tremorse. deep, rapid respiration

f. excessive thirstg. metabolic acidosis99. The client with insulin-dependent diabetes mellitus (IDDM) has been brought to the

emergency room. What should the nurse watch for if blood pH is 7.28a. lactic acidosisb. ketoacidosisc. metabolic alkalosisd. respiratory acidosis

100. Which of the following questions should the nurse ask during an admission interview for aclient admitted with a diagnosis of pheochromocytoma

a. Do you ever notice or feel an increase in your heart beating?

b. Do you suddenly feel warm and flushed when you get out of bed?c. Do your symptoms subside when you eat simple sugar?d. Do the attacks make you feel like you want to rest a while and sleep?

PREPARED BY:

Mrs. Veramay G. Cando, RN, MSN Mr. Ronnie Ammugauan, RN, RM, MSNMrs. Rosemarie Torres, RN, MSN Mr. Jesper Bayaua, RNMs. Pristine Joy Eileen Gonzales, RN, MSN Mr. Joey G. Corpuz, RN, MSNMs. Susan Santiago, RN, MAN Mr. Virgilio Ganadin, RN, MSNMrs. Bella Fontanilla, RN, MSN Ms. Arabelle Ria Ilagan, RN, MSNMrs. Erella Palo, RN, MSN Mr. Abs Aeiron Gonzales, RN, MSNMrs. Josette Liwanag, RN, MSN Mr. John Darvin Tan, RN, MANMrs. Pablo Winnie, RN,MAN Mr. Jonard Fernandez, RN, MSN

UNIVERSITY OF LA SALETTECOLLEGE OF NURSING


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NCM 104- MIDTERM EXAMINATION

Direction: Choose the correct answer for each of the following question. Shade the letter of your choice on the answer sheet provided. ERASURES WILL BE MARKED WRONG.

EYES AND EARS DISORDER:

1. Which of the following should the nurse include in the assessment of the clients cranialnerves and extraocular eye muscles?a. red reflexb. six cardinal fields of gazec. disc characteristicsd. macular characteristics

2. When completing a measurement of the clients visual acuity, which of the following would be appropriate?a. Ophthalmoscope

b.Penlightc. Visual fieldd.Snellen chart

3. The nurse collects a history from a client suspected of a sensorineural hearing loss. Which of the following findings supports the diagnosis and should be reported?

a. the ability to hear high-pitched sounds b. Frequent ear irrigations for dry, hard cerumenc. A history of exposure to excessive noise over a period of timed. The client speaks softly

4. Which of the following nursing measures should be the priority in the clients plan of careafter eye surgery?

a. prevent increased intraocular pressure and infection b. instruct on the importance of follow upc. Instruct on how to perform the valsalva manuever d. Pain management

5. The nurse implements which of the following interventions to reduce intraocular pressurefollowing eye surgery?a. applies hot compresses

b. provides bright lighting in the roomc. applies gentle pressure on the affected eyed. keeps the head of bed elevated

6. The ear bones that transmit vibrations to the oval windows of the cochlea are found in the:

a. Inner ear

b. Outer ear

c. Middle ear

d. Eustachian tube

7. Nerve deafness would most likely result from an injury or infection that damaged the:

a. Vagus nerve

b. Cochlear nerve

c. Vestibular nerve

d. Trigeminal nerve

8. Labyrinthectomy can be performed to treat Menieres syndrome. This procedure results in:


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a. Anosmia

b. Absence of pain

c. Reduction of cerumen

d. Permanent deafness

9. A client who complains of tinnitus is describing a symptom that is:

a. Objective

b. Functional

c. Prodromal

d. Subjective

10. The nurse is aware that the optic chiasm:

a. Forms a cavity in which the eyeball is fixed

b. Receives nerve impulses from the optic tracts

c. Is a crossing of some optic nerves in the cranial cavity

d. Is the space posterior to the lens with the consistency of jelly

11. When the ciliary muscles contract they:

a. Close the eyelids

b. Focus the lens on near objects

c. Focus the lens on distant objects

d. Bring about convergence of both eyes

12. The first symptom a client with open-angle glaucoma is most likely to exhibit is:

a. Constant blurred vision

b. Sudden attacks of acute pain

c. Impairment of peripheral vision

d. A sudden, complete loss of vision

13. When a client with a detached retina asks about the condition, the nurse should explainthat retinal detachment is a:

a. Consequence of optic-retinal atrophy

b. Degeneration of the choroids and optic chiasm

c. Division between the photoreceptor and neural layers of the retina

d. Separation between the sensory portion of the retina and the pigment layer


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14. The goal of surgery for the treatment of a detached retina is to:a. Promote growth of new retinal cells

b. Adhere the sclera to the choroids layer

c. Graft a healthy piece of retina in place

d. Create a scar that aids in healing retinal holes

15. The nurse is reviewing the normal limits of a hearing asesment for a client who presentswith decreased hearing. Which of the following findings would indicate the need for additional investigation?

a. Sound heard equally in both ears with the Weber test

b. Whispered words are repeated at two feet

c. Bone conduction is heard twice as long as air conduction with the Rinne test

d. Pearly gray tympanic membrane with otoscope

16. The nurse evaluates which of the following assessment findings to be normal in an older adult client?

a. Hordeolum

b. Exophthalmos

c. Presbyopia

d. Tinnitus

17. A client with Menieres disease asks the nurse why meclizine hydrochloride (Antivert) is being administered. The most appropriate response by the nurse is:

a. It will control the vertigo.

b. It will help you sleep.

c. It will decrease your pain.

d. It will alleviate your nausea.

18. The clinic nurse is preparing to test the visual acuity of a client using a Snellens chart.Which of the following identifies the accurate procedure for this visual acuity test?

a. Both eyes are assessed together, followed by the assessment of the right and then the lefteye.

b. The right eye is tested followed by the left eye, and then both eyes are tested

c. The client is asked to stand at a distance of 40ft. from the chart and is asked to read the

largest line on the chart.

d. The client is asked to stand at a distance of 40ft from the chart and to read the line thancan be read 200 ft away by an individual with unimpaired vision.

19. The clients vision is tested with a Snellens chart. The results of the tests are documentedas 20/60. The nurse interprets this as:

a. The client can read at a distance of 60 feet what a client with normal vision canread at 20 feet.


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b. The client is legally blind.c. The clients vision is normald. The client can read only at a distance of 20 feet what a client with normal vision can

read at 60 feet.20. In preparation for cataract surgery, the nurse is to administer prescribed eye drops. The

nurse reviews the physicians orders, expecting which type of eye drops to be instilled?a. An osmotic diureticb. A miotic agentc. A mydriatic medicationd. A thiazide diuretic

21. Which of the following interventions is the priority for the nurse to implement when aclient with glaucoma receiving betaxolol (Betoptic) experiences bradycardia, headache,depression?

a. Report these adverse reactions as systemicb. Decrease the dosec. Take the vital signs prior to administration

d. Refer the client for treatment of the depression22. When admitting a new client with glaucoma, the nurse should question this order becauseatropine?

a. Causes a moistening effectb. Is likely to cause respiratory depressionc. Causes an increase in intraocular pressured. May cause diuresis

23. The client arrives in the emergency room after sustaining a chemical eye injury from asplash of battery acid. The initial nursing action is to:

a. Begin visual acuity testingb. Irrigate the eye with sterile normal saline

c. Swab the eye with antibiotic ointmentd. Cover the eye with a pressure patch.24. On testing, a 3-year old boy is found to have left esotropia. The physician directs the

nurse to instruct the parent on Patching to treat the strabismus. The nurse should instruct the parent to place

a. The patch on the right eyeb. The patch on the left eyec. Patches on both eyes for a short period of time each day.d. The patch on the right and left alternately throughout the day.

25. Which of the following is essential that the nurse include in the assessment of a clientwho works evenings and takes pilocarpine (Pilocar)??

a. Hypotensionb. Urinary retentionc. Constipationd. Decreased dark adaptation

26. After the nurse instills atropine drops into both eyes for a client undergoing ophthalmicexamination, which of the following instructions would be given to the client?

a. Be careful because the blink reflex is paralyzed.b. Avoid wearing your regular glasses when driving.c. Be aware that the pupils may be unusually small.d. Wear dark glasses in bright light because the pupils are dilated.

27. Which of the following procedures or assessments must the nurse perform when preparing

a client for eye surgery?a. Clipping the clients eyelashesb. Verifying the affected eye has been patched 24 hours before surgeryc. Verifying the client has been NPO since midnight, or at least 8 hours before

surgery.d. Obtaining informed consent with the clients signature and placing the forms on the

chart.


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28. The nurse is collecting a health history from a client who is to begin taking acetazolamide(Diamox). Which of the following questions should the nurse ask to determine the safety of this drug?

a. Do you operate dangerous equipment?b. Have you ever had an allergy to sulfa?

c. Have you had any chest pains or a heart attack?d. Have you had any frequent diarrhea?29. Which of the following symptoms would occur in a client with a detached retina?

a. Flashing lights and floatersb. Homonymous hemianopiac. Loss of central visiond. Ptosis

30. The clinic nurse is preparing to test the visual acuity of a patient using a Snellen chart.Which of the following identifies the accurate procedure for this visual acuity test?

a. The right eye is tested, followed by the left and then both eyes are tested. b. Both eyes are assessed together, followed by the right eye and then the left.

c. The client is asked to stand at a distance of 40 feet from the chart and is askedto read the largest line on the chart.d. The client is asked to stand at a distance of 40 feet from the chart and read the

line that can be read at 200 feet away by a person with normal vision.31. The nurse evaluates which of the following laboratory tests and pathogens to cause acuteotitis media in children?

a. Group A beta-hemolytic streptococcus b. Escherichia colic. Haemophilus influenzae and Streptococcus pneumoniaed. Staphylococcus aureus

32. The nurse is to administer timolol (Timoptic) 1 drop in each eye. Which of the following

comments by the client indicates the need for further teaching?a. I must wash my hand before putting in my drops.b. This drug will decrease the fluid in my eye.c. Ill need to take this until my eye pressure is normal.d. Adverse reactions include dizziness and double vision.

33. Ear drops are prescribed to an infant with otitis media. The most appropriate method toadminister medication to the infant is to:

a. Pull up and back on the pinna and direct the solution onto the eardrum. b. Pull down and back on the pinna and direct the solution onto the eardrum.c. Pull down and back on the pinna and direct the solution toward the wall of

the ear canal.

d. Pull up and back on the pinna and direct the solution toward the wall of the ear canal.

INTEGUMENTARY DISORDER 34. Which of the following is a priority to include when instructing a client to perform a skinassessment?

a. Evaluate the evenness of skin color, moisture, and texture. b. Look for any changes in moles, especially color and size.

c. Begin performing skin examinations after age 40.d. Assess the entire body and look for changes in skin or moles.35. The nurse is discharging a client who developed a skin tear while hospitalized for surgery.The nurse instructs the client in wound care for skin tear. Which of the following would beessential to include in the wound care instructions for this client?

a. Cover the skin tear with a transparent dressingb. Use a nonadherent dressing over the woundc. Eat a high fat diet to help the wound heal more quickly


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d. Drink 3Liters of water every day to keep the skin hydrated36. The nurse is teaching a class on the treatment of psoriasis with methotraxate. Which of thefollowing should the nurse include in her teaching?

a. Methotrexate is recommended only for those over the age of 50. b. It is important to monitor the serum albumin, total protein, and blood glucose.

c. An effective birth control for both men and women must be taken.d. Topical steroids used with methotrexate provide the most effective therapy.37. The nurse is instructing a client with herpes zoster on self-care. Which of the followingstatements by the client indicates the teaching has been successful?

a. I will stay away from my young grandchildren. b. Frequent cool baths will help my herpes heal more quickly.c. I will use a topical diphenhydramine to dry up the lesions.d. I will avoid using fabric softener in the laundry.

38. When assessing for changes in skin color in an African-American client, the nurse shouldassess which of the following first?

a. Soles of the feet

b. Palms of the handc. Conjunctiva or sclerad. Nail beds or oral mucosa

39. A client with chronic skin lesions on the face and arms admits to the nurse of being unableto look at the mirror. Based on this information, which of the following nursing diagnoseswould the nurse identify?

a. Anxiety related to personal appearanceb. Disturbed body image related to perception of unsightly lesions.c. Social isolation related to poor self-image.d. Deficient knowledge related to lack of understanding of use of cover-up techniques.

40. Which of the following instructions should the nurse include in the teaching plan or a 16-year-old client with comedonal acne being treated with topical Retin-A?

a. Avoid sun exposure b. Severe headaches may be experiencedc. Improvement will be seen in 24 hoursd. Scrub the skin prior to application.

41. Which of the following should the nurse include when instructing the mother of a child with pediculosis capitis on the use of permethrin 1% (Nix)?

a. Apply the Nix and cover the hair with a shower capb. After rinsing the hair, comb to remove the nitsc. Apply the Nix at bedtimed. Leave the Nix on for 8-14 hours

42. The nurse should instruct a client taking an oral retinoid to avoid which of the followinga. Dairy products

b. Carbonated drinksc. Extremely cold air d. Vitamin A supplements

43. The nurse assesses the skin of a client a diagnosis of psoriasis. The nurse understands thatthe characteristics of this disease is manifested by:

a. Clear, thin nail beds b. Red-purplish scaly lesionsc. Oily skin with pruritic episodesd. Silvery white scaly patches on the scalp, elbows, knees and sacral regions.

44. After instructing a client on the application of anthralin, the client states, I want to applythe medication to the nonaffected areas to prevent other lesions from developing. Which of the following responses by the nurse is most appropriate?

a. The medication can cause chemical burns, so it should be used on thepsoriatic lesions only.

b. Anthralin is very expensive, so limit its use to the psoriatic lesions. .c. As long as you it on for a maximum of two hours, it should be all right.


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d. Because anthralin promotes fluid and electrolyte loss, you should limit the areasthat are treated.

45. The nurse prepares to assist the physician to examine the clients skin with a Woods light.The nurse includes which of the following in the plan for this procedure?

a. Prepare a local anesthetic.

b. Obtain an informed consent.c. Darken the room for examination.d. Shave the skin and scrub with povidone-iodine solution.

46. The nurse is assigned to care for a client with herpes zoster (shingles). Which of thefollowing characteristics would the nurse expect to note when assessing the lesions of thisinfection?

a. Clustered skin vesicles b. A generalized body rashc. Small blue-white spots with a red base.d. A fiery, red, edematous rash on the cheeks.

47. A client with seborrheic dermatitis of the face is being treated with topical ketoconazole

(Nizoral). Which of the following behaviors by the client indicate that teaching has beeneffective?a. Application of a thick layer of cream, washing the area once a week

b. Removal of any dry scales prior to application of the cream to aid abso rptionc. Applying an emollient before applying the ketoconazoled. Applying moisturizing cream sparingly after applying the ketoconazole

48.Which of the following nursing intervention should the nurse include in the plan of care for a child with tinea pedis?

a. Apply warm soaks to the feetb. Keep the feet dryc. Wear wool socksd. Administer oral steroids

49. All of these are fluid-filled skin lesions except:a. Bullaeb. Nodulec. Pustuled. Cyst

50.This is secondary lesion where the layers of the skin become thickened and rough as aresult of rubbing over a prolonged period of time

a. Scales b. Crustc. Lichenificationd. Excoriation

MIDTERM EXAMINATION ONCOLOGY

51 When explaining the purpose of radiation to a client with multiple myeloma, whichtreatment goal should be described?

a. Enhancing the effects of chemotherapy

b. Killing metastatic cells

c. Shrinking invasive tumor masses

d. Preventing invasion of bone by cells


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52 What is the early sign of cancer of the larynx that would be important for the nurse to teach?

a. Hemoptysis

b. Hoarseness

c. Persistent cough

d. Difficulty Swallowing

53 The nurse has been caring for a client on the oncology unit who is receiving chemotherapytreatments. The nurse knows that this client is at high risk for:

a. Skin breakdown

b. Confusion

c. Insomnia

d. Nosocomial Infections

54 The nurse plans to teach a client who is receiving radiation therapy how to care for his skinat home. The nurses instruction should include:

a. Apply a heating pad to the area to relieve the pain

b. You may use deodorant soap if you wish to cleanse the area

c. Put baby oil on the area after each treatment to keep it from getting dry

d. Keep the area covered when you go outdoors

55 What activity orders would be appropriate for a client with an internal radium implant for cervical cancer?

a. Out of bed as tolerated within the room

b. Bed rest with bathroom privileges

c. Bed rest in position of comfort

d. Bed rest with the head of the bed flat

56 Which of the following positions is the one of choice for palpating tissues during beast self-examination?

a. Sitting in a chair with a pillow under both shoulders to elevate the chest

b. Standing facing a mirror

c. Flat on the back with a pillow under the head and arms raised over the head

d. Flat on the back with a pillow under the shoulder of the side being examined

57 After examination and diagnostic testing, the client is diagnosed with cancer of the cervix insitu. A conization is scheduled. Which of the following nursing interventions would take

priority during the first 24 postoperative hours?


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a. Monitoring vital signs hourly

b. Maintaining strict bed rest

c. Monitoring vaginal bleeding

d. Maintaining electrolyte balance

58 Which of the following is a priority nursing goal for the client with laryngeal cancer immediately after a total laryngectomy?

a. Maintain a patent airway

b. Provide nutrition

c. Prevent strain on suture line

d. Prevent hemorrhage59 In providing discharge teaching for a breast cancer patient after a modified radical

mastectomy, the nurse should instruct the client that she might need to modify or avoidwhich of the following activities?

a. Shampooing her dog

b. Caring for her tropical fish

c. Working in her rose and cactus garden

d. Taking a late-evening swim.

60 A nurse with testicular cancer is scheduled for a right orchiectomy. The day before surgery,the client tells the nurse that he is concerned about the effect that losing a testicle will haveon his manhood. Which of the following facts about orchiectomy should the basis for thenurses response?

a. Testosterone levels are decrease

b. Sexual drive and libido are unchanged

c. Sperm count increases in the remaining testicle

d. Secondary sexual characteristics change.

61 When collaborating with the physician in the development of a drug regimen for a clientwith cancer, the nurse would expect which of the following medications to be avoided in thetreatment of cancer pain?

a. Meperidine (Demerol)

b. Morphine

c. Acetaminophen (Tylenol)

d. Hydromorphone (Dilaudid)

62 After a mastectomy for breast cancer, the nurse teaches the client how to avoid thedevelopment of lymphedema. Which of the following instructions would be included?


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a. Applying an elastic bandage to the affected extremity

b. Limiting range of motion exercises in the shoulder and elbow

c. Elevating the affected arm on pillow

d. Taking diuretics as necessary to decrease swelling

63 A nurse is assessing a client with metastatic breast cancer who reports nocturia, weakness,nausea and vomiting. The clients serum electrolytes include potassium 4.2 mEq/L, Sodium135 mEq/L, Calcium 7.0 mEq/L, and Magnesium 2.9 mEq/L. Bases on the assessementfindings, the priority action for the nurse is to:

a. Start client on fluid restriction

b. Administer calcium gluconate

c. Increase the clients IV Fluids

d. Administer Allopurinol

64 A nurse is caring for four (4) clients on the oncology unit. After receiving a report, whichclient should the nurse see first?

a. A 42 year old male with colon cancer who is refusing to go for a diagnostic test

b. A 38 year old female recovering from a bilateral mastectomy who did not sleepand was crying most of the night

c. A client with lung cancer who reports edema of the face and hands anddyspnea

d. A 52 year old female receiving chemotherapy for breast cancer who reportsnausea and fatigue

65 The nurse on the oncology unit enters the room of the client with lung cancer. Which actionis most appropriate for the nurse to do first?

a. Check the clients IV infusion pump fluid and rate.

b. Take the clients blood pressure and pulse

c. Assess the clients mental status

d. Elevate the clients head of the bed

66 The nurse on the oncology unit is planning care for the client with colon cancer who isrefusing a diagnostic test. Which action is most appropriate for the nurse to take first?

a. Call the radiology department to let them know the client will not be going for thetest

b. Speak with the client to determine the reason for refusing the test

c. Inform the health care provider that the client is refusing the test

d. Ask the clients spouse why the client is refusing the test


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67 A nurse from the OB unit is assigned to work on the oncology unit. Which of the followingclients is MOST appropriate for the charge nurse to assign to the OB nurse?

a. A 54 year old client receiving chemotherapy for breast cancer

b. A 32 year old client who has undergone cryosurgery for surgical cancerc. A 68 year old client with lung cancer who is having dyspnea and swelling of the

face

d. A 72 year old client who is receiving continuous bladder irrigation

68 The nurse in a college setting is conducting a healthy living class for the freshman andteaching the young men about self testicular examination. Which information should thenurse include in the discussion?

a. Self testicular examination should be performed once a month by all men

b. The procedure is difficult to learn and should be practiced on a mannequin beforedoing it on ones self

c. The term self testicular exam is really a misnomer, the exam is best done bysomeone else, such as a nurse or provider

d. Frequency of examination should be increased as a person ages.

69 The client who has cervical cancer is scheduled to receive internal radiation therapy using avaginal implant for 72 hours. The nurse caring for the client should plan to:

a. Wear latex gloves at all times while in the room

b. Spend no more than 30 minutes each shift performing bedside care

c. Sit at the clients bedside for 15-minute periods several times daily

d. Wear a led apron while providing physical care to the client70 The home care nurse is caring for a client who has cancer. The client has been hospitalized

several times due to infections and the side effects of chemotherapy and radiation therapy.In developing a plan of care to improve the management of this client, a goal should be to:

a. Prevent readmission and manage the client at home

b. Teach the family to care for the client

c. Have weekly family meetings to evaluate progress

d. Perform personal care for the client

71 The client is receiving chemotherapy for cancer and is in protective isolation. His wifecomes to visit. She asks the nurse if she really has to put the mask on since she has coldsand it is hard for her to breathe with the mask. The nurse should recommend that the

woman:a. Must put the mask on before entering the room

b. Speak to her husband from the doorway, but not enter the room even with amask

c. Does not need to put on a mask if it is uncomfortable for her


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d. Put on a mask and change it frequently while in the room

72 The client is the mother of a four-year-old child with leukemia. Which of the followingresponses would indicate to the nurse that the client understands the prognosis?

a. Shes lost so much weight b. Will hospice help us care for her?

c. I want to transfer her to another hospital

d. When does the next course of chemotherapy begin?

73 The nurse is planning a community class on the prevention and early detection of breastcancer. Which one of the following instructions should the nurse include?

a. A breast self examination should be done in order to determine normal from

abnormal conditions

b. Breasts should be examined every month, about five to seven days after the onsetof the menstrual period

c. Annual mammogram for all women of reproductive age is recommended

d. With breast self examination and periodic mammogram, yearly clinical breastexams are not needed.

74 . A client was newly diagnosed of Hodgkins disease. The nurse caring for this client knows

that the most distinguishing mark of this type of cancer is:

a. Presence of Bence-Jones protein in the clients urine

b. Presence of Reed-Sternberg cells

c. Cancer of the lymph nodes

d. Alopecia even without chemotherapy

75 . The client is receiving chemotherapy for leukemia. The nurse notes the followinglaboratory values for the client: WBC, 900/mm3; Hgb, 5.9 mg/dl; Hct, 24.3%; platelets,16,000/mm3. Which of the following actions by the nurse would be appropriate in the careof this client?

a. Spacing venipuncture for laboratory test at least two hours apart, to obtain acurrent sample on rapidly changing blood values.

b. Cautioning against forceful noseblowing to minimize nasal trauma

c. Recommending firm-bristle toothbrushes and frequent oral care to promote goodoral hygiene

d. Taking frequent rectal temperature to assess for development of fever.

76. The nurse is collecting a health history on a client admitted for colon cancer. Which of thefollowing questions would be a priority to ask this client?

a. Have you noticed any blood in the stool?


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b. Have you been experiencing nausea?

c. Do you have any back pain?

d. Have you noticed your abdomen has swollen?

77. The nurse evaluates chemotherapy to be most effective in which of the following clients?

a. A client who is well nourished

b. A client who has had chemotherapy before

c. A 40-year-old male with lung cancer

d. A 30-year-old woman with breast cancer

78. A client asks the nurse what was meant when the physician stated, There has been a

partial remission of the cancer. Which of the following is the appropriate response bythe nurse?

a. The cancer has regressed 50% or more.

b. The cancer has progressed by 25%.

c. The cancer has spread to lymph nodes.

d. The cancer has disappeared.

79. The client asks, Why do I need to receive all these chemotherapy medicines on the sameday? The nurses appropriate response is based on the understanding that chemotherapygiven in combination;

a. Is the only way that it will be paid for by insurance.

b. Achieves the greatest tumor cell kill.

c. Shortens the length of administration.

d. Decreases the chance of allergic reaction.

80. The nurse is teaching a class on the various types of chemotherapy agents. Which of thefollowing examples of chemotherapy agents should the nurse include in the cycle-specificgroup?

a. Cyclophosphamide (Cytoxan)

b. Methotrexate

c. Doxorubicin (Doxil)

d. Nitrogen Mustard

81. The nurse should administer which of the following cell cycle-nonspecific chemotherapyagents to a client?

a. Paclitaxel (Taxol)

b. 5-fluorouracil


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c. Cisplatin

d. Vincristine (Oncovin)

82. Which of the following should the nurse consider before preparing to administer

chemotherapy to a client?a. Wears disposable gown, mask, and gloves

b. Wait for the chemotherapy to be prepared by the physician

c. Do not assign a nurse who is pregnant to this client

d. Prime the tubing with the chemotherapy agent

83. The nurse should include which of the following when preparing to select the clients IVsite for chemotherapy administration? Choose an IV site

a. Distal to other venipuncture sites on the extremity.

b. On the same side as the cancer surgery.

c. Between the antecubital space and wrist

d. With a large-diameter vein.

84. Prior to the initiating chemotherapy administration for a client, the nurse should consider which of the following principles?

a. All chemotherapy drugs must be administered by an infusion pump

b. Vesicant drugs should be infused before nonvesicant drugs

c. The clients arm should be elevated throughout administration

d. The IV line should be flushed with 20ml of D5W between drugs

85. Which of the following is the priority nursing action when a client states, My IV site

hurts! during chemotherapy administration?

a. Reposition the needle

b. Notify the physician

c. Stop the infusion

d. Apply a cold pack to the IV site

86. The nurse is caring for a 30-year-old female with ovarian cancer who is receiving cisplatin


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(Platinol). Which of the following is a priority to include in this clients plan on care?

a. Monitor the BUN and creatinine

b. Instruct the client to report tinnitus

c. Maintain IV hydration

d. Instruct the client to use a reliable method of birth control

87. Which of the following is a priority for the nurse to monitor for a client receiving

ifisfamide (Ifex) for testicular cancer?

a. Hemorrhagic cystitis

b. Alopecia

c. Phlebitis

d. Liver dysfunction

88. The nurse is planning to care for the adverse reactions in a client receiving chemotherapy.

Which adverse reaction should take priority in this plan of care?

a. Depression

b. Headache

c. Fatigue

d. Rash

89. A clients family asks the nurse, Why cant the chemotherapy be given once instead of in

multiple cycles? The nurses response is based on the following?

a. Certain chemotherapy works best during certain phases of the cell cycle

b. No one can tolerate the entire dose in one administration

c. Chemotherapy is only covered by insurance if given in mall doses

d. Most clients prefer several doses over one dose

90. The nurse is admitting a client with vaginal cancer. Which of the following questions

should the nurse ask to elicit the most likely causative factor?

a. Did you experience your first menses before the age of 11 years?

b. Did your mother take diethylstilbestrol (DES) during pregnancy?

c. Have you ever taken tamoxifen?

d. Do you have a history of a sexually transmitted disease?

91. Which of the following findings on a female breast exam should the nurse report assuspicious of breast cancer?


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a. multiple bilateral, round, lumpy tissue that is tender

b. A soft, mobile, single lobular nodule that is nontender

c. A poorly defined, firm lump that is nontender and fixed to the skin

d. A single soft lump that is well defined and tender

92. When planning care for a client being treated for cervical cancer, it would be a priority for the nurse to include which of the following in the plan of care?

a. Instruction on birth control methods

b. Vigorous fluid administration

c. Assessment of sexual function

d. Daily weighs

93. A client states, Im worried about being burned by radiation therapy. The mostappropriate response is based on the nurses understanding that

a. applying hand lotion to the area being radiated will reduce the chance of burns

b. darker-skinned persons burn more easily during radiation therapy

c. burns are very rare with todays technology.

d. Washing the radiated area with strong soap will reduce the chance of burns.

94. The client with cancer states, My pain is a 10! on a 0 to 10 scale (10 being worst possible pain). Which of the following is the appropriate nursing intervention?

a. instruct the client that no more narcotic analgesia can be given at this time inorder to prevent addiction.

b. Ask the client if the pain is really that bad, since narcotic analgesia will be givenas a last resort for severe pain

c. Assure that a strong opioid, nonopioid, and adjuvant are ordered and administer per order

d. Administer another dose of meperidine (Demerol) as prescibed

95. In planning the care of a client experiencing fatigue related to chemotherapy, which of thefollowing is the most appropriate nursing intervention?

a. prioritize and administer nursing care throughout the day b. accomplish all the nursing cares early in the day so the client can rest the

remainder of the day

c. perform all nursing cares during the evening shift when the client is most rested.

d. Limit the number of visitors, promoting a maximum opportunity for sleep


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96. The nurse is caring for a client who underwent a bone marrow transplant 10 days ago. Thenurse should monitor the client for which of the following clinical manifestations thatindicates a potentially life-threatening situation

a. mucositis

b. confusion

c. depression

d. mild temperature elevation

97. Six days after receiving chemotherapy, the clients reports that, My mouth feels like itson fire! Which of the following is the priority nursing action?

a. encourage rinsing the mouth several times per day with an over-the-counter mouthwash

b. administer analgesics as ordered

c. assess the oral mucosa for signs of infection and tissue breakdown

d. instruct the client to eat small, frequent meals of soft food such as apple sauce

98. While caring for a client with superior vena cava syndrome, the nurse should includewhich of the following interventions?

a. restrict visitors, since the client will be anxious

b. withhold chemotherapy until the syndrome resolves

c. instruct the client in Valsalvas maneuver

d. elevate the head of the bed

99. Which of the following should the nurse include in the preoperative care pan of a clientwith head and neck cancer?

a. Instruct the client and family in communicating with a picture board

b. Assess the clients favorite foods to assure these are provided postoperatively

c. Plan for a volunteer to take the client outside for a cigarette breaks

d. Provide frequent oral care, including rinsing with mouthwash

100. While performing a nursing assessment, a female client informs the nurse of vague abdominal discomfort, bloating, and unexplained indigestion and flatulence for thelast few months. What should the nurse ask in order to elicit the most important

information for completing the assessment?

a. Do you often eat spicy food?

b. Tell me about your familys medical history.

c. Have you had weight loss recently?


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d. Are you experiencing unusual menstrual bleeding?

PREPARED BY:

Mrs. Veramay G. Cando, RN, MSN Mr. Ronnie Ammugauan, RN, RM, MSNMrs. Rosemarie Torres, RN, MSN Mr. Jesper Bayaua, RNMs. Pristine Joy Eileen Gonzales, RN, MSN Mr. Joey G. Corpuz, RN, MSNMs. Susan Santiago, RN, MAN Mr. Virgilio Ganadin, RN, MSNMrs. Bella Fontanilla, RN, MSN Ms. Arabelle Ria Ilagan, RN, MSNMrs. Erella Palo, RN, MSN Mr. Abs Aeiron Gonzales, RN, MSNMrs. Josette Liwanag, RN, MSN Mr. John Darvin Tan, RN, MANMrs. Pablo Winnie, RN,MAN Mr. Jonard Fernandez, RN, MSN

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