PRACTICE TEST 3: High Risk AdultRESPIRATORY 1. A home health care nurse is instructing a client with chronic obstructive pulmonary disease (COPD) how to perform breathing techniques that will assist in exhaling carbon dioxide and open the airways. The nurse teaches the client which technique?A. Pursed-lip breathing C. Abdominal breathingB. Intercostal chest expansion D. Chest physical therapy

2. A nurse is teaching a client with chronic obstructive pulmonary disease (COPD) how to purse lip breathe. The nurse tells the client:A. That inhalation should be twice as long as exhalation.B. To loosen the abdominal muscles while breathing out.C. That exhalation should be twice as long as inhalationD. To inhale with pursed lips and exhale with mouth open wide.

3. A client with emphysema should receive only 1-3 L/min of oxygen, if needed, or he may lose his hypoxic drive. Which of the following statements is correct about hypoxic drive?A. The client doesn’t notice he needs to breathe.B. The client breathes only when his oxygen levels climb above a certain point.C. The client breathes only when his oxygen levels dip below a certain pointD. The client breathes only when his carbon dioxide level dips below a certain point.

4. A client with a chest tube has accidentally removed it. What should be done first?A. Lie the client down on his left side B. Lie the client down on his right sideC. Apply an occlusive dressing over the siteD. Reinsert the chest tube that fell out

5. A client’s arterial blood gas (ABG) analysis reveals a pH of 7.18, PaCO2 of 73mm Hg, PaO2 of 77mm Hg, and HCO3- of 24mEq/L. What do these values indicate? A. Metabolic acidosis C. Metabolic alkalosisB. Respiratory alkalosis D Respiratory acidosis

ENDOCRINE METABOLIC6. A client is admitted to the hospital in metabolic acidosis caused by diabetic ketoacidosis (DKA). The nurse prepares to administer which of the following medications as a primary initial treatment for this problem?A. Sodium bicarbonate C. PotassiumB. Calcium gluconate D. Insulin

7. A clinic nurse instructs a client with diabetes mellitus about how to prevent diabetic ketoacidosis (DKA) on days when the client is feeling ill. Which statement if made by the client, indicates a need for further education?A. “I need to stop my insulin if I am vomiting.”B. “I need to call my physician if I am ill for more than 24 hours.”C. “I need to eat 10-15 grams of carbohydrates every 1-2 hours.”D. “I need to drink small quantities of fluid every 15-30 minutes.”

8. While a nurse is admitting a client with myxedema to the hospital, the client reports having a lack of energy, cold intolerance, and puffiness around the eyes and face. The nurse knows that these symptoms are caused by a lack of production of which hormone or hormones?A. Luteinizing hormone (LH)B. Adrenocorticotropic hormone (ACTH)C. Triiodothyronine (T3) and thyroxine (T4)D. Prolactin (PRL) and growth hormone (GH)

9. A nurse undergoes a thyroidectomy. The nurse monitors the client for signs of damage to the parathyroid glands postoperatively. Which of the following findings would indicate damage to the parathyroid glands?A. Hoarseness C. Respiratory distressB. Tingling around the mouth D. Neck pain

10. Which of the following forms of severe hyperthyroidism is life threatening and produces high fever, extreme tachycardia, and altered mental status?A. Hepatic coma B. Myxedema comaC. Thyroid stormD. Hyperosmolar hyperglycemic nonketotic syndrome

11. Laboratory findings indicating decreased levels of glucose and sodium and increased levels of potassium and white blood cells (WBCs) would correlate with which disease?A. Addison’s disease C. Diabetes mellitusB. Cushing’s syndrome D. Hypothyroidism

12. A client has thin extremities but an obese truncal area and a “buffalo hump” at the shoulder area. The client also complains of weakness and disturbed sleep. Which of the following disorders is the most likely diagnosis?A. Addison’s disease C. Grave’s diseaseB. Cushing’s syndrome D. Hyperparathyroidism

13. When a client who has a liver disorder is having an invasive procedure, the nurse helps assure safety by assessing the results of which of the following tests?A. Coagulation studies C. Serum chemistriesB Liver enzyme levels D. White blood cell count

14. A nurse is assisting the client with hepatic encephalopathy to fill out the dietary menu. The nurse advises the client to avoid which of the following entrée items that could aggravate the client’s condition?A. Fresh fruit plate C. Vegetable lasagna B. Tomato soup D. Ground beef patty

15. A nurse has assisted the physician with a liver biopsy that was done at the bedside. On completion of the procedure, the nurse assists the client into which of the following positions?A. Left-side lying with a small pillow or towel under the puncture siteB. Right side lying with a small pillow or towel under the puncture siteC. Left side lying with the right arm elevated above the headD. Right side lying with the left arm elevated above the head

RENAL16. A client has been admitted to the hospital with a diagnosis of acute glomerulonephritis. On assessment, the nurse first asks the client about a recent history of A. Bleeding ulcer C. Fungal infectionB. Hypertension D. Streptococcal infection

17. A fluid restriction of 1500 ml per day is ordered for a client with acute renal failure. The nurse best plans to assist the client with maintaining the restriction by:A. Prohibiting beverages with sugar to minimize thirstB. Using mouthwash with alcohol for mouth careC. Asking the client to calculate the IV fluids into the total daily allotmentD. Removing the water pitcher from the bedside

18. A nurse is admitting a client with chronic renal failure (CRF) to the nursing unit. The nurse assesses for which of the following most frequent cardiovascular signs that occurs in the client with CRF?A. Hypertension C.Tachycardia

27. A client is experiencing pulmonary edema as an exacerbation of chronic left-sided heart failure. The nurse assesses this client for which of the following manifestations?A. Distended neck veins C. Weight lossB. Peripheral pitting edema D. Bilateral crackles

B. Hypotension D. Bradycardia

19. A client receiving hemodialysis suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale and anxious. The nurse, suspecting an air embolism, should:A. Continue dialysis at a slower rate after checking the lines for airB. Discontinue dialysis and notify the physician.C. Monitor vital signs every 15 minutes for the next hourD. Administer a 500-ml bolus of normal saline to break up the air embolus

20. A nurse is assessing a client who has begun using peritoneal dialysis. The nurse would determine that which of the following manifestations noted in the client would most likely indicate the onset of peritonitis?A. Temperature of 37.5 degrees CB. History of GI upset 1 week agoC. Cloudy dialysate outputD. Presence of crystals in dialysate output

CARDIOVASCULAR21. Which of the following blood tests is most indicative of cardiac damage? A. Lactic dehydrogenase C. Creatinine phosphokinaseB. Complete blood count D. Blood chemistry

22. Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage?A. Cardiac catheterization C. EchocardiogramB. Cardiac enzymes D. Electrocardiogram

23. Cardiac monitoring leads are placed on a client who is at risk for premature ventricular contractions (PVCs). The nurse assesses the client’s rhythm to detect PVCs by looking forA. Premature beats followed by a compensatory pauseB. QRS complexes are short and narrowC. Inverted P waves before the QRS complexesD. A P wave preceding every QRS complex

24. A nurse in the emergency room is assessing a client with chest pain. Which of the following observations by the nurse helps to determine that this pain is due to myocardial infarction?A. The pain, unrelieved by nitroglycerin, was relieved with morphine sulfateB. The pain was described as substernal and radiating to the left armC. The client experienced no nausea or vomitingD. The client reports that the pain began while the client was going up the stairs

25. A nurse suspects that cardiogenic shock is developing in a client who had a myocardial infarction. The nurse assesses for which of the following peripheral vascular manifestations of this complication?A. Flushed, dry skin with bounding pedal pulsesB. Warm, moist skin with irregular pedal pulsesC. Cool, dry skin with alternating weak and strong pedal pulsesD. Cool, clammy skin with weak or thready pedal pulses

26. Toxicity from which of the following medications may cause a client to see a green halo around lights?A. Digoxin C. FurosemideB. Metoprolol D. Enalapril

28. Thrombophlebitis has been diagnosed in a hospitalized client. A nurse should avoid doing which of the following during the care of this client?A. Maintaining the client on bed restB. Applying moist heat to the legC. Elevating the feet above heart levelD. Placing a pillow under the client’s knees

BURNS29. A client has been admitted to the burn unit with extensive full-thickness burns. Which of the following considerations has priority?A. Fluid status C. Level of painB. Body image D. Risk of infection

30. An adult client arrives in the emergency department with burns to both legs and perineal areas. Using the Rule of Nines, the nurse would determine that approximately what percentage of the client’s body surface has been burned?A. 19% C. 37%B. 46% D. 65%

31. A client with a burn injury is transferred to the nursing unit, and a regular diet has been prescribed. Which dietary items should the nurse encourage the client to eat in order to promote wound healing?A. Beef, potatoes, gelatine, orange juiceB. Peanut butter and jelly, cantaloupe, teaC. Chicken breast, broccoli, strawberries, milkD. Spaghetti with tomato sauce, garlic bread, ginger ale

32. Skin closure with heterograft is performed on the burn client. The client asks the nurse about the meaning of a heterograft. The nurse tells the client that a heterograft is skin fromA. Another species C. The burned clientB. A cadaver D. A skin bank

33. A client suffers a second-degree burn on the entire surface of the upper left arm. Which nursing action is most important when assessing circulation?A. Monitoring blood pressure in the left armB. Evaluating the strength of the left handC. Assessing capillary refill in the left handD. Measuring circumference of the left arm

34. A client involved in a house fire is experiencing respiratory distress and an inhalation injury is suspected. The nurse monitors which of the following for the presence of carbon monoxide poisoning?A. Pulse oximetry C. Sputum carbon levelsB. Urine myoglobin D. Serum carboxyhemoglobin levels