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1. Question
Category: Reduction of Risk Potential
During a community health assessment at a local school’s parent-teacher conference, the nurse
encounters several parents and caregivers. Based on their shared histories and lifestyles, the
nurse determines the risk factors for hypertension among them. Which of the following
individuals is at the HIGHEST risk for developing hypertension?
A. A 45-year-old African-American attorney with a family history of hypertension, who has a sedentary lifestyle, consumes a diet high in sodium, and recently had a significant weight gain.
B. A 60-year-old Asian-American shop owner with a BMI of 28, who has well-managed type 2 diabetes, takes medications for high cholesterol, and engages in regular physical activity.
C. A 40-year-old Caucasian nurse who is a vegetarian, has a healthy BMI, is a non-smoker but reports high levels of work-related stress and consumes excessive amounts of caffeine.
D. A 55-year-old Hispanic teacher who smokes occasionally, has a healthy BMI, participates in a moderate-intensity exercise program, and recently started taking oral contraceptives.
E. A 50-year-old Middle Eastern engineer with a BMI of 26, who has a family history of cardiovascular diseases, does not engage in any form of exercise, and has recently been diagnosed with obstructive sleep apnea.
F. A 52-year-old Native American artist with a family history of kidney disease, who smokes a pack of cigarettes daily, drinks alcohol excessively, and reports infrequent physical activity.
G. A 43-year-old European baker who has a BMI of 30, often deals with job-related stress, consumes a diet rich in pastries and sweets, and has a sedentary lifestyle due to long work hours.
The correct answer is:
A. A 45-year-old African-American attorney with a family history of hypertension, who has a sedentary lifestyle, consumes a diet high in sodium, and recently had a significant weight gain.
Rationale:
To identify the individual at the highest risk for developing hypertension, we consider modifiable and non-modifiable risk factors , including:
Race/Ethnicity : African Americans have the highest prevalence of hypertension in the U.S. and tend to develop it earlier and more severely. Family history : Strongly contributes to risk.
Lifestyle factors : o Sedentary behavior and obesity are major contributors.
o High sodium intake is directly linked to elevated blood pressure. o Recent weight gain suggests worsening risk.
2. Question
Category: Pharmacological and Parenteral Therapies
A 15-year-old female with a history of depression is brought to the emergency department.
Nurse’s Notes: 1115: A 15-year-old female with a history of depression and recent relationship troubles with her close friends is brought to the emergency department by her concerned parents after they found an empty bottle of maximum-strength acetaminophen in her room. Upon questioning, the patient tearfully admits to ingesting 15 tablets of the medication 45 minutes ago. She is visibly anxious and frequently looks at the marks on her wrists, which seem to be superficial scratches.
Vital signs as of 1115:
Blood pressure: 120/
Heart rate: 88 bpm Respiratory rate: 18 bpm
Oxygen saturation: 98% on room air
As the nurse prepares to address the situation, several orders from the primary care provider come in. Which of the following orders should the nurse prioritize and carry out first?
A. Perform gastric lavage
B. Administer acetylcysteine (Mucomyst) orally
C. Start an IV with Dextrose 5% and 0.33% normal saline
D. Have the patient drink activated charcoal mixed with water
E. Conduct a psychiatric evaluation.
After a cardiac catheterization , especially one involving the femoral or radial artery , a critical post- procedure complication the nurse must monitor for is vascular compromise at the access site — including thrombus formation , hematoma , or arterial occlusion.
4. Question
Category: Basic Care and Comfort
A 43-year-old male with a history of recurrent renal calculi is admitted to the emergency department presenting with severe left flank pain radiating to the groin, nausea, and an episode of vomiting. He also reports burning and urgency during urination. His vital signs reveal a temperature of 100.8ºF (38.2ºC), blood pressure of 145/90 mmHg, pulse of 100 beats/min, and respiratory rate of 20 breaths/min. The client is visibly anxious and uncomfortable due to the severity of the pain. The nurse is assigned to care for the patient and must prioritize the nursing goals to ensure optimal care. Which nursing goal should be the top priority for this client?
A. Maintain fluid and electrolyte balance
B. Control nausea
C. Manage pain
D. Prevent urinary tract infection
The correct answer is:
C. Manage pain
Rationale:
Managing pain is always a priority because it ultimately improves the quality of life. The cornerstone of ureteral colic management is analgesia, which can be achieved most expediently with parenteral narcotics or nonsteroidal anti-inflammatory drugs (NSAIDs).
Option A: IV hydration in the setting of acute renal colic is controversial. Whereas some authorities believe that IV fluids hasten the passage of the stone through the urogenital system, others express concern that additional hydrostatic pressure exacerbates the pain of renal colic.
Option B: Because nausea and vomiting frequently accompany acute renal colic, antiemetics often play a role in renal colic therapy. Several antiemetics have a sedating effect that is often helpful.
Option D: Overuse of the more effective antibiotic agents leaves only highly resistant bacteria, but failure to adequately treat a UTI complicated by an obstructing calculus can result in potentially life- threatening urosepsis and pyonephrosis.
5. Question
Category: Health Promotion and Maintenance
During a school screening program for children aged 6-12, a nurse is tasked with evaluating their growth parameters. She encounters a 9-year-old girl who is shorter than her peers and seems to have less muscle development. To align her observations with typical growth expectations for school-age children, what would the nurse expect to see?
A. Decreasing amounts of body fat and muscle mass
B. Little change in body appearance from year to year
C. Progressive height increase of 4 inches each year
D. Yearly weight gain of about 5.5 pounds per year
The correct answer is:
D. Yearly weight gain of about 5.5 pounds per year
Rationale:
For school-age children (ages 6–12 years) , growth is steady and predictable, even though it's slower than in infancy and adolescence. The nurse should be familiar with expected growth parameters to identify potential concerns like delayed growth or development.
6. Question
Category: Health Promotion and Maintenance
A 62-year-old client arrives at a community health fair where the nurse is offering blood pressure screenings. Upon assessment, the nurse notes that the client’s blood pressure is 160/96 mmHg. The client claims that their blood pressure is “usually much lower” and they recently started new medication for arthritis. What would the nurse advise the client to do?
A. Go get a blood pressure check within the next 15 minutes
B. Check blood pressure again in two (2) months
C. See the healthcare provider immediately
D. Visit the health care provider within one (1) week for a BP check
The correct answer is:
A. Go get a blood pressure check within the next 15 minutes
Rationale:
8. Question
Category: Pharmacological and Parenteral Therapies
A 25-year-old male is seen in the endocrinology clinic for unexplained fatigue, weight gain, and low energy levels. After a series of diagnostic tests, he is diagnosed with hypothyroidism. The healthcare provider prescribes levothyroxine (Synthroid) 50 mcg/day by mouth. As the nurse educates the client about this medication, which point should be emphasized?
A. Should be taken in the morning
B. May decrease the client’s energy level
C. Must be stored in a dark container
D. Will decrease the client’s heart rate
The correct answer is:
A. Should be taken in the morning
Rationale:
Levothyroxine (Synthroid) is a synthetic thyroid hormone used to treat hypothyroidism. For maximum effectiveness and proper absorption , it must be:
Taken in the morning ,
On an empty stomach (ideally 30–60 minutes before breakfast), With a full glass of water , and
Separate from other medications or supplements (especially calcium or iron, which impair absorption).
9. Question
Category: Physiological Adaptation
A 3-year-old child was brought to the pediatric clinic after the sudden onset of findings that include irritability, thick muffled voice, croaking on inspiration, hot to touch, sit leaning forward, tongue protruding, drooling, and suprasternal retractions. What should the nurse do first?
A. Prepare the child for X-ray of upper airways
B. Examine the child’s throat
C. Collect a sputum specimen
D. Notify the healthcare provider of the child’s status
The correct answer is:
D. Notify the healthcare provider of the child’s status
Rationale:
The child is exhibiting classic signs of acute epiglottitis , a life-threatening pediatric emergency caused most commonly by Haemophilus influenzae type B (Hib). Key features include:
Sudden onset
Drooling Muffled or "hot potato" voice
Stridor/croaking on inspiration Tripod positioning (sitting forward with tongue out)
Irritability High fever
Suprasternal retractions
These signs point to imminent airway obstruction , and any further manipulation of the airway can lead to complete blockage.
The FIRST priority is to notify the healthcare provider immediately to secure the airway safely. Intubation or tracheostomy may be needed urgently.
The child should be kept calm — crying or agitation can worsen airway obstruction. Emergency equipment (oxygen, intubation kit) should be at the bedside.
10. Question
Category: Physiological Adaptation
A school nurse is assessing 8-year-old Timmy, who was brought to the school health office by his teacher due to concerns about his recent behavior. The teacher reports that Timmy has been asking to go to the bathroom frequently during class, appears tired, and has been caught sneaking snacks during lessons. Upon further questioning, Timmy’s mother, who was called to the school, mentions that he has been drinking more water than usual at home, has an increased appetite, and has had a few episodes of bedwetting in the past month. She also notes that despite eating more, he seems to have lost some
C. Staphylococcus
D. Streptococcus
E. Gonorrhea
F. Escherichia coli
The correct answer is:
B. Chlamydia
Rationale:
Pelvic Inflammatory Disease (PID) is a serious infection of the upper female reproductive tract (uterus, fallopian tubes, ovaries) that often results from sexually transmitted infections (STIs). The two most common causative agents are:
Chlamydia trachomatis Neisseria gonorrhoeae
Of these, Chlamydia trachomatis is most frequently associated with recurrence of PID due to:
Often being asymptomatic , leading to delayed treatment
Causing chronic inflammation , which increases risk for repeated infections High prevalence in sexually active young women with multiple partners and inconsistent condom use
12. Question
Category: Management of Care
An experienced registered nurse, specialized in spinal rehabilitation, is floated to the busy emergency department for a shift. The emergency department is currently short-staffed, and there’s a power outage in the adjacent building, causing a surge of patients. Among the patients waiting, which client should the charge nurse most appropriately assign to this RN, keeping in mind her expertise and the current situation?
A. A middle-aged client who says “I took too many diet pills” and “my heart feels like it is racing out of my chest.”
B. A young adult who says “I hear songs from heaven. I need money for beer. I quit drinking two (2) days ago for my family. Why are my arms and legs jerking?”
C. An adolescent who has been on pain medications terminal cancer with an initial assessment finding pupils and a relaxed respiratory rate of 11.
D. An elderly client who reports having taken a “large crack hit” 10 minutes prior to walking into the emergency room.
E. A pregnant woman in her third trimester complaining of sudden sharp pain in her lower abdomen.
The correct answer is:
C. An adolescent who has terminal cancer on pain medications with an initial assessment finding of pinpoint pupils and a relaxed respiratory rate of 11.
Rationale:
The RN’s specialization in spinal rehabilitation means she has strong skills in managing complex neurological and pain-related conditions , including:
Assessment and care for patients with chronic pain and opioid use
Monitoring neurological status and respiratory function Providing palliative care support
Why C is appropriate:
The adolescent with terminal cancer on pain medications likely requires close neurological monitoring , respiratory assessment, and pain management expertise.
The pinpoint pupils and low respiratory rate (11 breaths/min) suggest possible opioid overdose or side effects — a critical situation that fits the nurse’s specialty in neurological and pain care. The nurse’s experience with spinal rehab likely includes familiarity with opioid management, respiratory depression, and neurological assessments.
13. Question
Category: Health Promotion and Maintenance
A 60-year-old male client is admitted to the cardiology ward following an angioplasty for coronary artery disease. Nutrition education is a part of his discharge planning. What dietary advice should the nurse prioritize?
A. Eating three (3) balanced meals a day
F. The patient's blood pressure has dropped significantly since the last reading.
The correct answer is:
C. The level of the drug is 100 ml at 8 AM and is 80 ml at noon, despite the patient's frequent requests for PRN doses.
Rationale:
The pump is set to deliver a basal rate of 10 ml per hour. From 8 AM to noon, which is 4 hours, the pump should have delivered 40 ml (10 ml x 4 hours). If the level of the drug was 100 ml at 8 AM, it should be 60 ml at noon (100 ml – 40 ml). The fact that it’s 80 ml at noon indicates that only 20 ml has been delivered over 4 hours, suggesting the pump may not be functioning correctly, especially given the patient’s frequent requests for PRN doses.
15. Question
Category: Health Promotion and Maintenance
During a community meeting on health promotion in a small town with a significant elderly population, the nurse is approached by a group of senior citizens. They express concerns about their chronic back pain and have heard about alternative treatments. One of them asks about the effectiveness of chiropractic treatments for their age group and associated ailments. Considering the demographic and the context, in responding, what should be the focus of the nurse’s answer?
A. Electrical energy fields and their role in pain management.
B. Spinal column manipulation and its potential benefits for chronic back pain.
C. Mind-body balance and its holistic approach to health.
D. Exercise of joints and its importance in maintaining mobility.
E. Acupuncture and its role in pain relief.
F. The importance of regular medical check-ups alongside alternative treatments.
The correct answer is:
B. Spinal column manipulation and its potential benefits for chronic back pain.
Rationale:
Chiropractic care primarily focuses on the diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially the spine. Spinal column manipulation is a central component of chiropractic treatments. Given the context of the question, where elderly individuals are specifically
inquiring about chronic back pain, the nurse should focus on explaining the potential benefits and considerations of spinal column manipulation for their specific ailments.
16. Question
Category: Physiological Adaptation
A 55-year-old client, who is a renowned pianist, is admitted to the neurology unit after a right-sided cerebrovascular accident (CVA) following a high-pressure concert performance. The client’s family is anxious about the potential implications on his career. The nurse is performing a neurological assessment while considering the client’s profession and the family’s concerns. Amidst the assessment, which finding should prompt the nurse to take immediate action and possibly escalate care?
A. Decrease in the level of consciousness
B. Loss of bladder control
C. Altered sensation to stimuli, especially in the fingers
D. Emotional lability, with episodes of sudden crying
E. Difficulty in coordinating finger movements
F. Complaints of a persistent headache
The correct answer is:
A. Decrease in the level of consciousness
Rationale:
A decrease in the level of consciousness is a critical sign that indicates potential deterioration in a client’s neurological status, especially after a cerebrovascular accident (CVA). It can suggest increasing intracranial pressure, further brain injury, or other serious complications. Immediate action and escalation of care are essential when there’s a decline in consciousness to prevent further complications and potentially life-threatening situations.
17. Question
Category: Physiological Adaptation
A 6-year-old child, who has recently moved to a high-altitude region with his family, has been diagnosed with cystic fibrosis. The parents bring him to a pediatric clinic for an initial assessment and are concerned about how the altitude might impact his condition. They also mention that he has been more active and playing outside with new friends. Considering the early stage of this disease and the child’s
D. Instruct the client’s wife to monitor his condition and to call the doctor if symptoms worsen, providing her with emergency numbers.
E. Assess for other signs of head trauma like pupil dilation, irregular breathing, or fluid drainage from ears or nose.
F. Keep the client in a calm and quiet environment, away from the children, to reduce stimulation.
G. Check the home environment for potential hazards that could lead to further injury.
The correct answers are:
✅ A. Place a call to the client’s health care provider for instructions, even if it means driving to a location with better reception.
✅ B. Arrange for immediate transport or send him to the nearest emergency room for evaluation.
✅ E. Assess for other signs of head trauma like pupil dilation, irregular breathing, or fluid drainage from ears or nose.
✅ F. Keep the client in a calm and quiet environment, away from the children, to reduce stimulation.
Rationale:
Following a fall, especially with a delayed presentation of symptoms like lethargy and confusion, there’s a concern for a potential traumatic brain injury or intracranial bleeding. Immediate medical evaluation is crucial. The nurse should contact the healthcare provider for guidance and prioritize sending the client to the emergency room. Assessing for other signs of head trauma can provide valuable information about the client’s condition. Given the scenario, keeping the client calm and reducing stimulation is also essential.
19. Question
Category: Reduction of Risk Potential
A 72-year-old client with a history of recurrent urinary tract infections and recent complaints of flank pain is scheduled for KUB (Kidney, Ureter, Bladder) radiography in an outpatient setting. The client is anxious and mentions reading various preparation methods online. Given the client’s age, history, and concerns, which of the following actions should the nurse take to adequately prepare the client for the test?
Select all that apply.
A. Instruct the client that they must be NPO for 6 hours before the examination.
B. Administer an enema the evening before the examination to ensure clear imaging.
C. Administer furosemide 20 mg IV half an hour before the examination to enhance visualization.
D. Reassure the client and inform them that no special preparation is needed for this examination.
E. Ask the client to drink fluids and empty the bladder just prior to the examination to ensure a clear view.
F. Check for any allergies to contrast, even though it's not typically used in a standard KUB.
G. Advise the client to wear loose-fitting clothing without any metal objects for the examination.
The correct answers are:
✅ D. Reassure the client and inform them that no special preparation is needed for this examination.
✅ E. Asking the client to drink fluids and void before exam – This is not needed. In fact, a full bladder may help visualize certain structures better.
Rationale:
A KUB radiography is a diagnostic imaging test that provides a view of the kidneys, ureters, and bladder. Typically, no special preparation is needed for this examination. However, asking the client to drink fluids and then empty the bladder just before the test can help ensure a clear view of the urinary structures. The other options, such as being NPO, administering an enema, or giving furosemide, are not standard preparations for a KUB.
20. Question
Category: Health Promotion and Maintenance
The nurse is giving discharge teaching to a 45-year-old client, a professional athlete, seven (7) days post- myocardial infarction. The client, anxious about returning to his normal life and activities, asks the nurse why he must wait six (6) weeks before having sexual intercourse. He also inquires about the impact on his athletic performance. Given his profession and concerns, what is the best response by the nurse to this question?
A. “You need to regain your strength before attempting such exertion, especially considering your profession.”
B. “When you can climb 2 flights of stairs without problems or feeling short of breath, it is generally safe to engage in activities like sex.”
C. “Have a glass of wine to relax you, then you can try to have sex.”
D. “Your heart needs time to heal, and premature exertion can risk another cardiac event.”
This client is in the greatest danger with a potential of respiratory distress. Any client with singed facial hair has been exposed to heat or fire in close range that could have caused serious damage to the interior of the lungs. Note that the interior lining of the lungs has no nerve fibers so the client will not be aware of swelling.
22. Question
Category: Health Promotion and Maintenance
You’re a pediatric nurse working with a family who has recently adopted a 2-year-old child named Mia. This is the family’s first time adopting, and they are particularly concerned about ensuring they provide the right environment for her developmental needs. Mia is an active toddler who loves exploring but has had minor falls. During your nursing education session, you emphasized the importance of balancing safety, exploration, and skill development at this stage of Mia’s life. Which of the following statements made by Mia’s mother indicates that she has a clear understanding of her daughter’s developmental needs at this age?
A. “I want to protect my child from any falls.”
B. “I will set limits on exploring the house.”
C. “I understand the need to use those new skills.”
D. “I intend to keep control over our child.”
The best answer is:
C. “I understand the need to use those new skills.”
Rationale:
Erikson describes the stage of the toddler as being the time when there is normally an increase in autonomy. The child must use motor skills to explore the environment and develop autonomy.
Option A: The statement in Option A is correct but pertains to the risks associated with a toddler. Option B: Setting limits on a toddler may cause frustration instead of independence.
Option D: Controlling the child may harm her development as toddlers should develop autonomy at this stage.
23. Question
Category: Basic Care and Comfort
In a specialized medical-surgical unit, you’re assigned to care for Mr. Johnson, a 72-year-old male who recently suffered a cerebrovascular accident (stroke) that has led to dysphagia. He is being temporarily nourished through a nasogastric (NG) feeding tube. His current medications include anticoagulants, and he has a history of peptic ulcer disease. Given the patient’s complex medical condition, what is the most important action for the nurse to take before administering an enteral feeding via the nasogastric feeding tube?
A. Verify the correct placement of the tube
B. Check that the feeding solution matches the dietary order
C. Aspirate abdominal contents to determine the amount of last feeding remaining in stomach
D. Ensure that feeding solution is at room temperature
The most important action is:
A. Verify the correct placement of the tube
Rationale:
Proper placement of the tube prevents aspiration and entrance of food content into the lungs. Ensuring the correct placement of the NG tube is critical to prevent complications such as aspiration, which can be life-threatening, especially given Mr. Johnson’s history of stroke and anticoagulant use. The definitive way to ascertain the position of the nasogastric tube is through visualization by an x-ray. Another method is to aspirate stomach contents and check their pH (usually pH 1 to 5). Aspirated stomach content can also be tested for bilirubin to confirm it is placed in the stomach.
Option B: It is also important to check that the feeding solution matches the dietary order to ensure the client gets proper nutrition. Option C: Aspirating the gastric contents is one of the methods used to determine the last feeding amount in the stomach, but it is not the most important action the nurse should take. Option D: Keep it at room temperature so it will not upset the stomach.
24. Question
Category: Pharmacological and Parenteral Therapies
You are a nurse in the cardiac care unit caring for Mrs. Thompson, a 62-year-old female with a history of chronic kidney disease and hypertension. She has been admitted for acute heart failure and has a serum potassium level of 3.5 mEq/L, on the lower end of the normal range (3.5-5.0 mEq/L). Considering her clinical history and current condition, she is placed on a cardiac monitor and starts receiving an infusion of 40 mEq potassium chloride in 1000 ml of 5% dextrose in water IV. While monitoring her EKG, which of the following patterns should prompt you to discontinue the potassium infusion immediately?
