UNIVERSITY OF LA SALETTE COLLEGE 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. 1. NEUROLOGIC DISORDER: A feeling of pleasantness or unpleasantness, varying degree from mild to intense occurs when sensory impulses reach the: a. Thalamus b. Basal ganglia c. Hypothalamus d. Cerebral Cortex The medulla has centers for: a. Control of sexual development b. Voluntary movement, taste, skin sensations c. Control of breathing, heartbeat, blood vessel diameter d. Fat metabolism, temperature regulation, water balance The fact that the client cannot close the right eye can be explained by nonconduction of: a. The 2nd cranial nerve b. The 3rd cranial nerve c. The 4th cranial nerve d. The 7th cranial nerve 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 nerve d. Right trigeminal nerve 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 rectally c. Ask the physician if the drug can be given IV d. Administer the drug with 30 ml of water at 9AM A physician performs a lumbar puncture. To do this procedure a needle must be inserted into the: a. Pia mater b. Foramen Ovale c. Aqueduct of sylvius d. Subarachnoid space This diagnostic study uses a nuclear scan that provides information on blood flow, oxygen uptake, glucose transport, and on the function of the brain a. Myelography b. Cerebral Arteriography c. Magnetic Resonance Imaging d. Positron Emission Tomography The nurse should be aware that a common misconception about autonomic nervous system is that: 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 functioning of any visceral effector. d. Visceral effectors (e.g., cardiac muscle, smooth muscle) receive impulses only via autonomic neurons

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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 and move tongue from side to side. a. CN IX b. CN X c. CN XI d. CN XII When a client is unconscious, the nurse should expect the person to be unable to: a. Hear voices b. Control elimination c. Move spontaneously d. React to painful stimuli A client regains consciousness and has expressive aphasia. As part of the long-range planning the 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 permanent d. Help the family to accept the fact that the client cannot participate in verbal communication. 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, restlessness c. Slow bounding pulse, rising blood pressure, elevated temperature, stupor d. Slow bounding pulse, fall in blood pressure, temperature below 97o F(36o C), stupor. 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 needed c. Suction the client at least every hour d. Schedule the suctioning with other nursing tasks The nurse is caring for a client with increased intracranial pressure. Which of the following assessment findings should the nurse immediately report? a. Nausea b. Headache c. Fever d. Absence of papillary response 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 activity c. Open the airway with a padded tongue depressor and restrain the client d. Turn the client on the side and observe the seizure activity A client who is receiving phenytoin phenytoin (Dilantin) to control seizures questions the nurse 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 life c. Need to be taken only in periods of emotional stress d. Can usually be stopped after a years absence of seizures. Which of the following statements indicates the family of a child with a seizure disorder has followed 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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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 mouth c. Nausea, Hypertension, and Tachycardia d. Dry mouth, Urinary retention, and Tachycardia The nurse is caring for a client who has aphasia following a Cerebrovascular accident. Which of 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 client c. Attempt repetition with phrases when speaking to the client d. Speak to the client in a louder than usual voice Developing independence is a primary goal for a client with hemiplegia. The nurse plants to facilitate this by: a. Establishing long-range goals for the client b. Reinforcing success in tasks accomplished c. Pointing out errors and helping to correct them d. Demonstrating ways the client can regain independence Urinary retention and overflow, a frequent problem of a client after a stroke, is evidenced by: a. Frequent voiding b. Oliguria and edema c. Continual incontinence d. Decreased urine production The nurse is teaching a class on the prevention of Cerebrovascular accidents. Which of the following risks factors should the nurse identify as the most important factor contributing to a stroke? a. Sedentary lifestyle b. Hypertension c. Smoking d. Obesity The nurse is admitting a client diagnosed to have a cerebrovascular accident involving leftbrain 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 deficits c. Paralyzed left side, Denial of deficits and Aphasia d. Depression, Paralyzed right side and Left-sided neglect The physician tells a client with Multiple sclerosis that it is a chronic progressive neurologic condition. The client asks the nurse, Will I experience pain? The most appropriate response by the nurse is a. 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. The nurse should expect a client with an exacerbation of Multiple sclerosis to experience: a. Double vision b. Resting tremors c. Flaccid paralysis d. Mental retardation Which statement made by the spouse of a client with multiple sclerosis indicates to the nurse an 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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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 crisis c. Increase the skeletal muscle relaxation d. Decrease difficulty breathing The prognosis for the client with myasthenia gravis is most likely to be: a. Excellent with proper treatment b. Slowly progressive without remissions c. Chronic, with exacerbations and remissions d. Poor, with death occurring in a few months A client with myasthenia gravis has been receiving neostigmine (Prostigmin). This drug acts by: a. Stimulating the cerebral cortex b. Blocking the cholinesterase action c. Replacing the deficient neurotransmitters d. Accelerating transmission along he neural sheaths The nurse is caring for a client with Gullain-Barre syndrome. Which of the following would indicate the clients condition is deteriorating? a. weakness and paresthesia b. pain and muscle aches c. Urinary retention d. Respiratory infection The nurses plan of care for a client with Gullain-Barre syndrome is based on an understanding 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 cord c. Chronic inflammation, demyelination, and scarring of the CNS d. Decreased secretion of dopamine with an anticholinergic effect. An elderly female client with Alzheimers disease frequently switches from being pleasant and happy to being hostile and sad without apparent external cause. The nurse can best care for the client by: a. Trying to point out reality to the client b. Avoiding the client when she is angry and sad c. Encouraging he client to talk about her feelings d. Attempting to give nursing care when the client is in a pleasant mood The nurse knows that Alzheimers disease is characterized by: a. Transient ischemic attack b. Remissions and exacerbations c. Slowly progressive deficits in intellect, which may not be noted for a long time d. Rapid deterioration of mental functioning because of arteriosclerosis The nurse is admitting a client suspected of Parkinsons diseases. Which of the following does the nurse observe that supports the diagnosis? a. Chorea movements, tremor noticeable at rest and paresthesia b. Rigidity, muscle wasting and bradykinesia c. Paresthesia, tremor notiable at rest, and muscle wasting d. Rigidity, bradykinesia and tremor noticeable at rest Levodopa appears to be useful in treating Parkinsons disease because it can: a. Improve myelination of neurons b. Increase acetylcholine production c. Replace the dopamine in the brain cells d. Cause regeneration of injured thalamic cells

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The nurse would expect a client with Parkinsons disease to exhibit: a. A flattened affect b. Tonic-clonic seizures c. Decreased in intelligence d. Changes in pain tolerance 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 tongue d. Fifty percent of children with a parent with the disorder will likely inherit the disorder When planning nursing care for a client with trigeminal neuralgia (tic douloureux), the nurse should specifically: a. Apply iced compresses to the affected area b. Be alert to prevent dehydration or starvation c. Initiate exercises of the jaw and facial muscles d. Emphasize the importance of brushing the teeth To prevent precipitating a painful attack in a client with tic doloureux the nurse should a. Avoid walking swiftly past the client b. Keep the client in the prone position c. Discontinue oral hygiene temporarily d. Massage both sided of the face frequently When developing a teaching plan for a client with trigeminal neuralgia, the nurse should include an explanation that the medication used to treat this disorder is: a. Ascorbic acid b. Morphine sulphate c. Allopurinol (Zyloprim) d. Carbamazepine The nurse should expect a client with trigeminal neuralgia to demonstrate: a. prolonged period of sleep due to anxiety b. Hyperactivity due to medications received c. Exhaustion and fatigue due to extreme pain d. Excessive talkativeness due to apprehension Bells palsy is a disorder of which cranial nerve? a. Cranial Nerve V b. Cranial Nerve VI c. Cranial Nerve VII d. Cranial nerve VIII The following are all findings in clients with Bells palsy except: a. Decreased lacrimation b. Diminished blink reflex c. Painful sensations in the face d. Facial paralysis involving the eye Following head trauma a client complains of hearing noises. The nurse recognizes that this assessment suggests injury of the: a. Frontal lobe b. Occipital lobe c. Sixth cranial nerve d. Eight cranial nerve A nurse providing discharge instructions to the parents of a child who suffered a head injury six 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 home d. I know continued amnesia regarding the events of the injury is expected.

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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 cavity c. Altered level of consciousness d. Absence of deep tendon reflexes 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 tissues c. Increase elasticity of the ventricle walls d. Reduce CSF secretion by the choroids plexus 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 cavity c. Elevate the foot of the bed if the client develops symptoms of shock d. Observe for symptoms of decreased intracranial pressure and temperature. Which of the following actions is a priority for the nurse to perform first in a client with a spinal cord injury who complains of headache? a. Administer a beta adrenergic blocker b. Take the blood pressure c. Assess the papillary reaction d. Insert a foley catheter Immediately following a spinal cord injury, a clients family asks the nurse, Is the damage the client presents with in the emergency room as bad as it seems? The most appropriate response by the nurse is a. 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:

What portion of the adrenal gland secretes aldosterone and androgens? a. adrenal cortex b. adrenal medulla c. parafollicular cells d. 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 bones c. It causes oliguria d.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. Gluconeogenesis c. Liver glycogen d. Intestinal hydrolysis 54. Ketone bodies appear in he blood and urine when fats are being oxidized in great amounts. This condition is associated with: a. Starvation b. Alcoholism c. Bone healing d. Positive Nitrogen Balance

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55. The primary treatment of diabetic acidosis administration of: a. IV fluids b. Potassium c. NPH Insulin d. Sodium polystyrene sulfonate (Kayaxalate) 56. A difference between diabetic coma and hyperosmolar nonketotic coma is that clients in diabetic coma experience: a. Fluid loss b. Glycosuria c. Kussmaul respirations d. Increased blood glucose 57. A client with insulin-dependent DM is being considered for the tight-control program. In determining if the client is a candidate for this program, the nurse and health care team evaluates the: a. Clients daily dietary requirements b. Clients family support system c. Clients previous compliance history d. Length of time the client has had DM 58. Which of the following diagnosis would be most appropriate for a client newly diagnosed with non-insulin dependent DM? a. Risk for Infection related to newly diagnosed diabetes b. Altered Nutrition: More than Body Requirements related to overproduction of insulin c. 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 promptly in the client with DM? a. The client may become dehydrated quickly b. Hypoglycemia can cause brain damage c. 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 pituitary deficiency caused by the growth of a tumor? a. Intolerance to heat and hypergycemia b. Bradycardia and Hypoglycemia c. Polyuria and dehydration d. Intolerance to heat and dehydration 61. The nurse should include which of the following in the preoperative instructions for 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 surgery c. Do not rinse the mouth with any solutions until the packing is removed d. Support the neck when getting out of bed 62. For the past 6 months, Apple, 25 year old female has been experiencing menstrual irregularities and odd sensation of her hand and feet. She noticed coarsening of her facial features and some visual 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 syndrome c. hyperpituitarism: acromegaly d. hyperpituitarism: gigantism

63. Trans-sphenoidal Hypophysectomy was performed. Post operative nursing consideration would include all of the following except: a. discouraging forceful nasal blowing b. suggesting the use of soft bristled brush c. keeping the client in a semi-fowlers position d. having the client gargle with warm saline 64. A patient diagnosed with diabetes insipidus is receiving chlorpropamide. The action of the drug is to: a. inhibit the action of ADH b. increase the action of ADH c. increase urine output d. increase blood glucose level 65. The following are signs and symptoms of diabetes insipidus except: a. polyuria b. dilute urine c. dehydration d. high specific gravity of urine 66. Green, A 21 year old male client has been rushed to emergency department following a traumatic 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 activity c. potassium retention & water wasting d. excessive sodium retention & fluid loss 67. A major goal in the care for Green is: a. watching for signs of hyperkalemia b. ensuring that diabetic diet is followed c. accurate administration of insulin d. maintaining adequate fluid balance 68. Hypotension associated with Addisons disease involves a disturbance in the production of: a. Estrogens b. Androgens c. Glucocorticoids d. Mineralocorticoids 69. The nurse should observe a client with Addisons disease closely for signs of infectious complications because there is a disturbance in: a. Metabolic process b. Respiratory function c. Electrolytic imbalances d. Inflammatory effects 70. The emaciation, muscular weakness, and fatigue associated with Addisons disease are due to a disturbance in: a. Fluid balance b. Electrolyte levels c. Protein anabolism d. Masculinizing effects 71. The treatment of a client with Addisons disease includes a high protein diet, high calorie diet with 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 weight d. Extra salt is needed to replace the amount being lost due to lack of sufficient aldosterone to conserve sodium

72. Cushings disease results from an excessive glucucorticoid production. Cortisol, a glucocorticoid. Influence the metabolism of nutrients. Rapid metabolism can lead to the following manifestations except: a. blood glucose level of 200 mg/dl b. BP 180/100 mmHg c. Bone ossification d. Muscle wasting 73. 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 drug is to: a. inhibit the action of ADH b. increase the action of ADH c. increase urine output d. increase blood glucose level 75. When assessing a client with Cushings syndrome the nurse expect: a. dehydration and menorrhagia b. buffalo hump and hypertension c. pitting edema and frequent colds d. migraine headache and dysmenorrhea 76. Which of the following medications should be available to provide emergency treatment if a client develops tetany after a subtotal thyroidectomy? a. sodium phosphate b. calcium gluconate c. echothiophate iodide d. sodium bicarbonate 77. A nurse is preparing the bedside for a post-operative parathyroidectomy client. The nurse ensures that which piece of medical equipment is at clients bedside? a. underwater seal chest drainage b. tracheostomy set c. 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 breakdown c. edema can cause tissues to tear easily d. 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 feet c. hyperventilation d. a negative chovstek sign 80. The nurse assesses the client for sign of hypocalcemia by tapping the pre-auricular facial area to elicit? a. Chovsteks sign b. Trosseaus sign c. Levines sign d. Cullens sign

81. Which of the following manifestations does the nurse expect in a client with myxedema? a. increased heart rate b. edema c. weight loss d. intolerance to heat 82. Which of the following are most important to monitor in a client who had undergone total thyroidectomy? a. pulse and temperature b. serum electrolyte levels c. weight and food intake d. hoarseness of the voice and ability to swallow 83. Which of the following should be included when giving health teachings to a client with hyperthyroidism. a. wear long-sleeved clothing b. use artificial tears to the eyes as necessary c. 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/dl c. 7 mg/dl d. 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 alternative b. could consult other doctors c. can't take a herbal medicine d. has to follow doctor's prescription 86. One party time, you saw Maria eating a big piece of cake. As a concerned nurse you would tell her a. It's okay Maria, it's party time anyway b. 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 say a. See your doctor once b. Come let me assess your health status c. I told you so d. 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 rest c. take her prescribed insulin d. see her doctor right away 89. The following are nursing interventions when administering insulin except: a. administer insulin at room temperature b. rotate site of injection c. aspirate cloudy insulin before clear insulin to combine in one syringe d. shake insulin vial gently to redistribute insulin particles

90. To prevent lipodystrophy due to insulin injection, the nurse should do the following except: a. inject insulin at room temperature b. rotate the site of injection c. inject insulin between layer of fats and muscles d. introduce insulin rapidly 91. Among the topics you will include as priority in health teaching to Mario is: a. nutrition and diet therapy b. daily foot care c. good exercise daily d. prevention of complication 92. Which of the following laboratory test best indicate compliance of the diabetic client and insulin therapy? a. 2-hour postprandial blood glucose b. fasting blood glucose c. glycosylated hemoglobin d. oral glucose tolerance test 93. The diabetic client is having ketoacidosis. Which of the following is the appropriate initial nursing action? a. start an intravenous glucose b. administer insulin per IV c. give a glass of orange juice d. 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 age b. obesity c. requires lifetime insulin injection d. can be controlled by diet, exercise, and drug e. prone to diabetic ketoacidosis f. experience weight loss g. 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 insulin b. withdrawing the cloudy insulin first before the clear insulin c. injecting air into the cloudy insulin but withdrawing the clear insulin first d. 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 thin b. it requires lifelong insulin c. the client may take sulfonylureas d. the client is at risk to develop diabetic ketoacidosis e. onset of the disease is after 30 years of age f. 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 tremors b. hunger and hypertension c. cold, clammy skin and irritability d. fruity breath and decreasing level of consciousness

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

a. elevated blood sugar level b. cold, clammy skin c. increased urination d. tremors e. deep, rapid respiration f. excessive thirst g. metabolic acidosis 99. 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 7.28 a. lactic acidosis b. ketoacidosis c. metabolic alkalosis d. respiratory acidosis 100. Which of the following questions should the nurse ask during an admission interview for a client 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 Mrs. Rosemarie Torres, RN, MSN Ms. Pristine Joy Eileen Gonzales, RN, MSN Ms. Susan Santiago, RN, MAN Mrs. Bella Fontanilla, RN, MSN Mrs. Erella Palo, RN, MSN Mrs. Josette Liwanag, RN, MSN Mrs. Pablo Winnie, RN,MAN Mr. Ronnie Ammugauan, RN, RM, MSN Mr. Jesper Bayaua, RN Mr. Joey G. Corpuz, RN, MSN Mr. Virgilio Ganadin, RN, MSN Ms. Arabelle Ria Ilagan, RN, MSN Mr. Abs Aeiron Gonzales, RN, MSN Mr. John Darvin Tan, RN, MAN Mr. Jonard Fernandez, RN, MSN

UNIVERSITY OF LA SALETTE COLLEGE OF NURSING

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 cranial nerves and extraocular eye muscles? a. red reflex b. six cardinal fields of gaze c. disc characteristics d. macular characteristics 2. When completing a measurement of the clients visual acuity, which of the following would be appropriate? a. Ophthalmoscope b.Penlight c. Visual field d.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 cerumen c. A history of exposure to excessive noise over a period of time d. The client speaks softly 4. Which of the following nursing measures should be the priority in the clients plan of care after eye surgery? a. prevent increased intraocular pressure and infection b. instruct on the importance of follow up c. Instruct on how to perform the valsalva manuever d. Pain management 5. The nurse implements which of the following interventions to reduce intraocular pressure following eye surgery? a. applies hot compresses b. provides bright lighting in the room c. applies gentle pressure on the affected eye d. 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:

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 explain that 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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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 presents with 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.
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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 left

eye.
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 than can 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 documented as 20/60. The nurse interprets this as: a. The client can read at a distance of 60 feet what a client with normal vision can read at 20 feet.

b. The client is legally blind. c. The clients vision is normal d. 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 diuretic b. A miotic agent c. A mydriatic medication d. A thiazide diuretic 21. Which of the following interventions is the priority for the nurse to implement when a client with glaucoma receiving betaxolol (Betoptic) experiences bradycardia, headache, depression? a. Report these adverse reactions as systemic b. Decrease the dose c. Take the vital signs prior to administration d. Refer the client for treatment of the depression 22. When admitting a new client with glaucoma, the nurse should question this order because atropine? a. Causes a moistening effect b. Is likely to cause respiratory depression c. Causes an increase in intraocular pressure d. May cause diuresis 23. The client arrives in the emergency room after sustaining a chemical eye injury from a splash of battery acid. The initial nursing action is to: a. Begin visual acuity testing b. Irrigate the eye with sterile normal saline c. Swab the eye with antibiotic ointment d. 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 eye b. The patch on the left eye c. 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 client who works evenings and takes pilocarpine (Pilocar)?? a. Hypotension b. Urinary retention c. Constipation d. Decreased dark adaptation 26. After the nurse instills atropine drops into both eyes for a client undergoing ophthalmic examination, 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 eyelashes b. Verifying the affected eye has been patched 24 hours before surgery c. 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.

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 floaters b. Homonymous hemianopia c. Loss of central vision d. 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 asked to 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 acute otitis media in children? a. Group A beta-hemolytic streptococcus b. Escherichia coli c. Haemophilus influenzae and Streptococcus pneumoniae d. 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 to administer 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 skin assessment? 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 be essential to include in the wound care instructions for this client? a. Cover the skin tear with a transparent dressing b. Use a nonadherent dressing over the wound c. Eat a high fat diet to help the wound heal more quickly

d. Drink 3Liters of water every day to keep the skin hydrated 36. The nurse is teaching a class on the treatment of psoriasis with methotraxate. Which of the following 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 following statements 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 should assess which of the following first? a. Soles of the feet b. Palms of the hand c. Conjunctiva or sclera d. Nail beds or oral mucosa 39. A client with chronic skin lesions on the face and arms admits to the nurse of being unable to look at the mirror. Based on this information, which of the following nursing diagnoses would the nurse identify? a. Anxiety related to personal appearance b. 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 16year-old client with comedonal acne being treated with topical Retin-A? a. Avoid sun exposure b. Severe headaches may be experienced c. Improvement will be seen in 24 hours d. 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 cap b. After rinsing the hair, comb to remove the nits c. Apply the Nix at bedtime d. Leave the Nix on for 8-14 hours 42. The nurse should instruct a client taking an oral retinoid to avoid which of the following a. Dairy products b. Carbonated drinks c. Extremely cold air d. Vitamin A supplements 43. The nurse assesses the skin of a client a diagnosis of psoriasis. The nurse understands that the characteristics of this disease is manifested by: a. Clear, thin nail beds b. Red-purplish scaly lesions c. Oily skin with pruritic episodes d. 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 apply the 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 the psoriatic 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.

d. Because anthralin promotes fluid and electrolyte loss, you should limit the areas that 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 the following characteristics would the nurse expect to note when assessing the lesions of this infection? a. Clustered skin vesicles b. A generalized body rash c. 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 been effective? 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 absorption c. Applying an emollient before applying the ketoconazole d. 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 feet b. Keep the feet dry c. Wear wool socks d. Administer oral steroids 49. All of these are fluid-filled skin lesions except: a. Bullae b. Nodule c. Pustule d. Cyst 50.This is secondary lesion where the layers of the skin become thickened and rough as a result of rubbing over a prolonged period of time a. Scales b. Crust c. Lichenification d. Excoriation

MIDTERM EXAMINATION ONCOLOGY 51 When explaining the purpose of radiation to a client with multiple myeloma, which treatment 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

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 chemotherapy treatments. 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 skin at 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 selfexamination? 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 in situ. A conization is scheduled. Which of the following nursing interventions would take priority during the first 24 postoperative hours?

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 hemorrhage 59 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 avoid which 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 have on his manhood. Which of the following facts about orchiectomy should the basis for the nurses 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 client with cancer, the nurse would expect which of the following medications to be avoided in the treatment 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 the development of lymphedema. Which of the following instructions would be included?

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, Sodium 135 mEq/L, Calcium 7.0 mEq/L, and Magnesium 2.9 mEq/L. Bases on the assessement findings, 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, which client 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 sleep and was crying most of the night c. A client with lung cancer who reports edema of the face and hands and dyspnea d. A 52 year old female receiving chemotherapy for breast cancer who reports nausea and fatigue 65 The nurse on the oncology unit enters the room of the client with lung cancer. Which action is 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 is refusing 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 the test 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

67 A nurse from the OB unit is assigned to work on the oncology unit. Which of the following clients 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 cancer c. 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 and teaching the young men about self testicular examination. Which information should the nurse 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 before doing it on ones self c. The term self testicular exam is really a misnomer, the exam is best done by someone 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 a vaginal 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 client 70 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 wife comes to visit. She asks the nurse if she really has to put the mask on since she has colds and 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 a mask c. Does not need to put on a mask if it is uncomfortable for her

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 following responses 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 breast cancer. 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 onset of the menstrual period c. Annual mammogram for all women of reproductive age is recommended d. With breast self examination and periodic mammogram, yearly clinical breast exams 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 following laboratory 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 care of this client? a. Spacing venipuncture for laboratory test at least two hours apart, to obtain a current 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 good oral 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 the following questions would be a priority to ask this client? a. Have you noticed any blood in the stool?

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 by the 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 same day? The nurses appropriate response is based on the understanding that chemotherapy given 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 the following examples of chemotherapy agents should the nurse include in the cycle-specific group? a. Cyclophosphamide (Cytoxan) b. Methotrexate c. Doxorubicin (Doxil) d. Nitrogen Mustard 81. The nurse should administer which of the following cell cycle-nonspecific chemotherapy agents to a client? a. Paclitaxel (Taxol) b. 5-fluorouracil

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 IV site 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

(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 as suspicious of breast cancer?

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 most appropriate 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 in order to prevent addiction. b. Ask the client if the pain is really that bad, since narcotic analgesia will be given as 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 the following 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

96. The nurse is caring for a client who underwent a bone marrow transplant 10 days ago. The nurse should monitor the client for which of the following clinical manifestations that indicates 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 its on 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 include which 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 client with 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 the last 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?

d. Are you experiencing unusual menstrual bleeding?

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