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1. Which of the following complications is thought to be the most common cause of appendicitis?
A. A fecalith
B. Bowel kinking
C. Internal bowel occlusion
D. Abdominal bowel swelling

2. Which of the following terms best describes the pain associated with appendicitis?
A. Aching
B. Fleeting
C. Intermittent
D. Steady

3. Which of the following nursing interventions should be implemented to manage a client with appendicitis?
A. Assessing for pain
B. Encouraging oral intake of clear fluids
C. Providing discharge teaching
D. Assessing for symptoms of peritonitis

4. Which of the following definitions best describes gastritis?

A. Erosion of the gastric mucosa
B. Inflammation of a diverticulum
C. Inflammation of the gastric mucosa
D. Reflux of stomach acid into the esophagus

5. Which of the following substances is most likely to cause gastritis?

A. Milk
B. Bicarbonate of soda, or baking soda
C. Enteric coated aspirin
D. Nonsteriodal anti-imflammatory drugs

6. Which of the following definitions best describes diverticulosis?

A. An inflamed outpouching of the intestine
B. A noninflamed outpouching of the intestine
C. The partial impairment of the forward flow of intestinal contents
D. An abnormal protrusion of an organ through the structure that usually holds it.

7. Which of the following types of diets is implicated in the development of diverticulosis?

A. Low-fiber diet
B. High-fiber diet
C. High-protein diet
D. Low-carbohydrate diet

8. Which of the following mechanisms can facilitate the development of diverticulosis into diverticulitis?
A. Treating constipation with chronic laxative use, leading to dependence on laxatives
B. Chronic constipation causing an obstruction, reducing forward flow of intestinal contents
C. Herniation of the intestinal mucosa, rupturing the wall of the intestine
D. Undigested food blocking the diverticulum, predisposing the area to bacterial invasion.

9. Which of the following symptoms indicated diverticulosis?

A. No symptoms exist
B. Change in bowel habits
C. Anorexia with low-grade fever
D. Episodic, dull, or steady midabdominal pain

10. Which of the following tests should be administered to a client suspected of having diverticulosis?
A. Abdominal ultrasound
B. Barium enema
C. Barium swallow
D. Gastroscopy
11. Which of the following conditions can cause a hiatal hernia?
A. Increased intrathoracic pressure
B. Weakness of the esophageal muscle
C. Increased esophageal muscle pressure
D. Weakness of the diaphragmatic muscle

12. Risk factors for the development of hiatal hernias are those that lead to increased abdominal pressure. Which
of the following complications can cause increased abdominal pressure?
A. Obesity
B. Volvulus
C. Constipation
D. Intestinal obstruction

13. Which of the following symptoms is common with a hiatal hernia?

A. Left arm pain
B. Lower back pain
C. Esophageal reflux
D. Abdominal cramping

14. Which of the following tests can be performed to diagnose a hiatal hernia?
A. Colonoscopy
B. Lower GI series
C. Barium swallow
D. Abdominal x-rays

15. Which of the following measures should the nurse focus on for the client with esophageal varices?
A. Recognizing hemorrhage
B. Controlling blood pressure
C. Encouraging nutritional intake
D. Teaching the client about varices

16. Which of the following tests can be used to diagnose ulcers?

A. Abdominal x-ray
B. Barium swallow
C. Computed tomography (CT) scan
D. Esophagogastroduodenoscopy (EGD)

17. Which of the following best describes the method of action of medications, such as ranitidine (Zantac),
which are used in the treatment of peptic ulcer disease?
A. Neutralize acid
B. Reduce acid secretions
C. Stimulate gastrin release
D. Protect the mucosal barrier

18. The hospitalized client with GERD is complaining of chest discomfort that feels like heartburn following a
meal. After administering an ordered antacid, the nurse encourages the client to lie in which of the following
A. Supine with the head of the bed flat
B. On the stomach with the head flat
C. On the left side with the head of the bed elevated 30 degrees
D. On the right side with the head of the bed elevated 30 degrees.

19. The nurse is caring for a client following a Billroth II procedure. On review of the post-operative orders,
which of the following, if prescribed, would the nurse question and verify?
A. Irrigating the nasogastric tube
B. Coughing a deep breathing exercises
C. Leg exercises
D. Early ambulation
20. The nurse is providing discharge instructions to a client following gastrectomy. Which measure will the
nurse instruct the client to follow to assist in preventing dumping syndrome?
A. Eat high-carbohydrate foods
B. Limit the fluids taken with meals
C. Ambulate following a meal
D. Sit in a high-Fowler’s position during meals

21. A client is complaining of severe flank and abdominal pain. A flat plate of the abdomen shows urolithiasis.
Which of the following interventions is important?
A. Strain all urine
B. Limit fluid intake
C. Enforce strict bed rest
D. Encourage a high calcium diet

22. A client is receiving a radiation implant for the treatment of bladder cancer. Which of the following
interventions is appropriate?
A. Flush all urine down the toilet
B. Restrict the client’s fluid intake
C. Place the client in a semi-private room
D. Monitor the client for signs and symptoms of cystitis

23. A client has just received a renal transplant and has started cyclosporine therapy to prevent graft rejection.
Which of the following conditions is a major complication of this drug therapy?
A. Depression
B. Hemorrhage
C. Infection
D. Peptic ulcer disease

24. A client received a kidney transplant 2 months ago. He’s admitted to the hospital with the diagnosis of acute
rejection. Which of the following assessment findings would be expected?
A. Hypotension
B. Normal body temperature
C. Decreased WBC count
D. Elevated BUN and creatinine levels

25. The client is to undergo kidney transplantation with a living donor. Which of the following preoperative
assessments is important?
A. Urine output
B. Signs of graft rejection
C. Signs and symptoms of rejection
D. Client’s support system and understanding of lifestyle changes.

26. A client had a transurethral prostatectomy for benign prostatic hypertrophy. He’s currently being treated
with a continuous bladder irrigation and is complaining of an increase in severity of bladder spasms. Which of
the interventions should be done first?
A. Administer an oral analgesic
B. Stop the irrigation and call the physician
C. Administer a belladonna and opium suppository as ordered by the physician.
D. Check for the presence of clots, and make sure the catheter is draining properly.

27. A client is admitted with a diagnosis of hydronephrosis secondary to calculi. The calculi have been removed
and postobstructive diuresis is occurring. Which of the following interventions should be done?
A. Take vital signs every 8 hours
B. Weigh the client every other day
C. Assess for urine output every shift
D. Monitor the client’s electrolyte levels.
28. A client has passed a renal calculus. The nurse sends the specimen to the laboratory so it can be analyzed for
which of the following factors?
A. Antibodies
B. Type of infection
C. Composition of calculus
D. Size and number of calculi

29. Which of the following symptoms indicate acute rejection of a transplanted kidney?
A. Edema, nausea
B. Fever, anorexia
C. Weight gain, pain at graft site
D. Increased WBC count, pain with voiding

30. Adverse reactions of prednisone therapy include which of the following conditions?
A. Acne and bleeding gums
B. Sodium retention and constipation
C. Mood swings and increased temperature
D. Increased blood glucose levels and decreased wound healing.

31. A postpartum nurse is preparing to care for a woman who has just delivered a healthy newborn infant. In the
immediate postpartum period the nurse plans to take the woman’s vital signs:
A. Every 30 minutes during the first hour and then every hour for the next two hours.
B. Every 15 minutes during the first hour and then every 30 minutes for the next two hours.
C. Every hour for the first 2 hours and then every 4 hours
D. Every 5 minutes for the first 30 minutes and then every hour for the next 4 hours.

32. A postpartum nurse is taking the vital signs of a woman who delivered a healthy newborn infant 4 hours
ago. The nurse notes that the mother’s temperature is 100.2*F. Which of the following actions would be most
A. Retake the temperature in 15 minutes
B. Notify the physician
C. Document the findings
D. Increase hydration by encouraging oral fluids

33. The nurse is assessing a client who is 6 hours PP after delivering a full-term healthy infant. The client
complains to the nurse of feelings of faintness and dizziness. Which of the following nursing actions would be
most appropriate?
A. Obtain hemoglobin and hematocrit levels
B. Instruct the mother to request help when getting out of bed
C. Elevate the mother’s legs
D. Inform the nursery room nurse to avoid bringing the newborn infant to the mother until the feelings of
lightheadedness and dizziness have subsided.

34. A nurse is preparing to perform a fundal assessment on a postpartum client. The initial nursing action in
performing this assessment is which of the following?
A. Ask the client to turn on her side
B. Ask the client to lie flat on her back with the knees and legs flat and straight.
C. Ask the mother to urinate and empty her bladder
D. Massage the fundus gently before determining the level of the fundus.

35. The nurse is assessing the lochia on a 1 day PP patient. The nurse notes that the lochia is red and has a foul-
smelling odor. The nurse determines that this assessment finding is:
A. Normal
B. Indicates the presence of infection
C. Indicates the need for increasing oral fluids
D. Indicates the need for increasing ambulation
36. When performing a PP assessment on a client, the nurse notes the presence of clots in the lochia. The nurse
examines the clots and notes that they are larger than 1 cm. Which of the following nursing actions is most
A. Document the findings
B. Notify the physician
C. Reassess the client in 2 hours
D. Encourage increased intake of fluids.

37. A nurse in a PP unit is instructing a mother regarding lochia and the amount of expected lochia drainage.
The nurse instructs the mother that the normal amount of lochia may vary but should never exceed the need for:
A. One peripad per day
B. Two peripads per day
C. Three peripads per day
D. Eight peripads per day

38. A PP nurse is providing instructions to a woman after delivery of a healthy newborn infant. The nurse
instructs the mother that she should expect normal bowel elimination to return:
A. One the day of the delivery
B. 3 days PP
C. 7 days PP
D. within 2 weeks PP

***** (check) 39. Which of the physiological are maternal changes that occur during the PP period.
i. Cervical involution ceases immediately
ii. Vaginal distention decreases slowly
iii. Fundus begins to descend into the pelvis after 24 hours
iv. Cardiac output decreases with resultant tachycardia in the first 24 hours
A. i and ii
B. i, ii, and iii
C. ii, iii and iv
D. i, ii, iii and iv

40. A nurse is caring for a PP woman who has received epidural anesthesia and is monitoring the woman for the
presence of a vulva hematoma. Which of the following assessment findings would best indicate the presence of
a hematoma?
A. Complaints of a tearing sensation
B. Complaints of intense pain
C. Changes in vital signs
D. Signs of heavy bruising

41. A 32-year-old male patient is to undergo radiation therapy to the pelvic area for Hodgkin’s lymphoma. He
expresses concern to the nurse about the effect of chemotherapy on his sexual function. The best response by the
nurse to the patient’s concerns is
A. “Radiation does not cause the problems with sexual functioning that occur with chemotherapy or surgical
procedures used to treat cancer.”
B. “It is possible you may have some changes in your sexual function, and you may want to consider
pretreatment harvesting of sperm if you want children.”
C. “The radiation will make you sterile, but your ability to have sexual intercourse will not be changed by the
D. “You may have some temporary impotence during the course of the radiation, but normal sexual function
will return.”

42. A 40-year-old divorced mother of four school-age children is hospitalized with metastatic cancer of the
ovary. The nurse finds the patient crying, and she tells the nurse that she does not know what will happen to her
children when she dies. The most appropriate response by the nurse is
A. “Why don’t we talk about the options you have for the care of your children?”
B. “Many patients with cancer live for a long time, so there is time to plan for your children.”
C. “For now you need to concentrate on getting well, not worry about your children.”
D. “Perhaps your ex-husband will take the children when you can’t care for them.”
43. A patient who has terminal cancer of the liver and is cared for by family members at home tells the nurse, “I
have intense pain most of the time now.” The nurse recognizes that teaching regarding pain management has
been effective when the patient
A. uses the ordered opioid pain medication whenever the pain is greater than 5 on a 10-point scale.
B. states that nonopioid analgesics may be used when the maximal dose of the opioid is reached without
adequate pain relief.
C. agrees to take the medications by the IV route to improve effectiveness.
D. takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain

44. Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. The nurse
teaches the patient that the purpose of therapy with this agent is to
A. protect normal kidney cells from the damaging effects of chemotherapy.
B. enhance the patient’s immunologic response to tumor cells.
C. stimulate malignant cells in the resting phase to enter mitosis.
D. prevent the bone marrow depression caused by chemotherapy.

45. The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of
cancer. Which statement by the patient may indicate a need for a change in treatment?
A. “I have frequent muscle aches and pains.”
B. “I rarely have the energy to get out of bed.”
C. “I take acetaminophen (Tylenol) every 4 hours.”
D. “I experience chills after I inject the interferon.”

46. Which information noted by the nurse reviewing the laboratory results of a patient who is receiving
chemotherapy is most important to report to the health care provider?
A. Hemoglobin of 10 g/L
B. WBC count of 1700/µl
C. Platelets of 65,000/µl
D. Serum creatinine level of 1.2 mg/dl

47. A bone marrow transplant is being considered for treatment of a patient with acute leukemia that has not
responded to chemotherapy. In discussing the treatment with the patient, the nurse explains that
A. hospitalization will be required for several weeks after the hematopoietic stem cell transplant (HSCT).
B. the transplant of the donated cells is painful because of the nerves in the tissue lining the bone.
C. donor bone marrow cells are transplanted immediately after an infusion of chemotherapy.
D. the transplant procedure takes place in a sterile operating room to minimize the risk for infection.

48. The nurse teaches a patient with cancer of the liver about high-protein, high-calorie diet choices. Which
snack choice by the patient indicates that the teaching has been effective?
A. Fresh fruit salad
B. Orange sherbet
C. Strawberry yogurt
D. French fries

49. The nurse has identified the nursing diagnosis of imbalanced nutrition: less than body requirements related
to altered taste sensation in a patient with lung cancer who has had a 10% loss in weight. An appropriate nursing
intervention that addresses the etiology of this problem is to
A. provide foods that are highly spiced to stimulate the taste buds.
B. avoid presenting foods for which the patient has a strong dislike.
C. add strained baby meats to foods such as soups and casseroles.
D. teach the patient to eat whatever is nutritious since food is tasteless.

50. After the nurse has explained the purpose of and schedule for chemotherapy to a 23-year-old patient who
recently received a diagnosis of acute leukemia, the patient asks the nurse to repeat the information. Based on
this assessment, which nursing diagnosis is most likely for the patient?
A. Acute confusion related to infiltration of leukemia cells into the central nervous system
B. Knowledge deficit: chemotherapy related to a lack of interest in learning about treatment
C. Risk for ineffective health maintenance related to anxiety about new leukemia diagnosis
D. Risk for ineffective adherence to treatment related to denial of need for chemotherapy
51. While being prepared for a biopsy of a lump in the right breast, the patient asks the nurse what the difference
is between a benign tumor and a malignant tumor. The nurse explains that a benign tumor differs from a
malignant tumor in that benign tumors
A. do not cause damage to adjacent tissue.
B. do not spread to other tissues and organs.
C. are simply an overgrowth of normal cells.
D. frequently recur in the same site.

52. A patient who has been told by the health care provider that the cells in a bowel tumor are poorly
differentiated asks the nurse what is meant by “poorly differentiated.” Which response should the nurse make?
A. “The cells in your tumor do not look very different from normal bowel cells.”
B. “The tumor cells have DNA that is different from your normal bowel cells.”
C. “Your tumor cells look more like immature fetal cells than normal bowel cells.”
D. “The cells in your tumor have mutated from the normal bowel cells.”

53. A patient who smokes tells the nurse, “I want to have a yearly chest x-ray so that if I get cancer, it will be
detected early.” Which response by the nurse is most appropriate?
A. “Chest x-rays do not detect cancer until tumors are already at least a half-inch in size.”
B. “Annual x-rays will increase your risk for cancer because of exposure to radiation.”
C. “Insurance companies do not authorize yearly x-rays just to detect early lung cancer.”
D. “Frequent x-rays damage the lungs and make them more susceptible to cancer.”

54. In teaching about cancer prevention to a community group, the nurse stresses promotion of exercise, normal
body weight, and low-fat diet because
A. most people are willing to make these changes to avoid cancer.
B. dietary fat and obesity promote growth of many types of cancer.
C. people who exercise and eat healthy will make other lifestyle changes.
D. obesity and lack of exercise cause cancer in susceptible people.

55. During a routine health examination, a 30-year-old patient tells the nurse about a family history of colon
cancer. The nurse will plan to
A. teach the patient about the need for a colonoscopy at age 50.
B. ask the patient to bring in a stool specimen to test for occult blood.
C. schedule a sigmoidoscopy to provide baseline data about the patient.
D. have the patient ask the doctor about specific tests for colon cancer.

56. When reviewing the chart for a patient with cervical cancer, the nurse notes that the cancer is staged as Tis,
N0, M0. The nurse will teach the patient that
A. the cancer cells are well-differentiated.
B. it is difficult to determine the original site of the cervical cancer.
C. further testing is needed to determine the spread of the cancer.
D. the cancer is localized to the cervix.

57. Which statement by a patient who is scheduled for a needle biopsy of the prostate indicates that the patient
understands the purpose of a biopsy?
A. “The biopsy will tell the doctor whether the cancer has spread to my other organs.”
B. “The biopsy will help the doctor decide what treatment to use for my enlarged prostate.”
C. “The biopsy will determine how much longer I have to live.”
D. “The biopsy will indicate the effect of the cancer on my life.”

58. The nurse is teaching a postmenopausal patient with breast cancer about the expected outcomes of her
cancer treatment. The nurse evaluates that the teaching has been effective when the patient says
A. “After cancer has not recurred for 5 years, it is considered cured.”
B. “I will need to have follow-up examinations for many years after I have treatment before I can be considered
C. “Cancer is considered cured if the entire tumor is surgically removed.”
D. “Cancer is never considered cured, but the tumor can be controlled with surgery, chemotherapy, and
59. A patient with a large stomach tumor that is attached to the liver is scheduled to have a debulking procedure.
The nurse explains that the expected outcome of this surgery is
A. control of the tumor growth by removal of malignant tissue.
B. promotion of better nutrition by relieving the pressure in the stomach.
C. relief of pain by cutting sensory nerves in the stomach.
D. reduction of the tumor burden to enhance adjuvant therapy.

60. External-beam radiation is planned for a patient with endometrial cancer. The nurse teaches the patient that
an important measure to prevent complications from the effects of the radiation is to
A. test all stools for the presence of blood.
B. inspect the mouth and throat daily for the appearance of thrush.
C. perform perianal care with sitz baths and meticulous cleaning.
D. maintain a high-residue, high-fat diet.

61. Nurse Berlinda is assigned to a 41-year-old client who has a diagnosis of chronic pancreatitis. The nurse
reviews the laboratory result, anticipating a laboratory report that indicates a serum amylase level of:
A. 45 units/L
B. 100 units/L
C. 300 units/L
D. 500 units/L

62. A male client who is recovering from surgery has been advanced from a clear liquid diet to a full liquid diet.
The client is looking forward to the diet change because he has been “bored” with the clear liquid diet. The
nurse would offer which full liquid item to the client?
A. Tea
B. Gelatin
C. Custard
D. Popsicle

63. Nurse Juvy is caring for a client with cirrhosis of the liver. To minimize the effects of the disorder, the nurse
teaches the client about foods that are high in thiamine. The nurse determines that the client has the best
understanding of the dietary measures to follow if the client states an intention to increase the intake of:
A. Pork
B. Milk
C. Chicken
D. Broccoli

64. Nurse Oliver checks for residual before administering a bolus tube feeding to a client with a nasogastric tube
and obtains a residual amount of 150 mL. What is appropriate action for the nurse to take?
A. Hold the feeding
B. Reinstill the amount and continue with administering the feeding
C. Elevate the client’s head at least 45 degrees and administer the feeding
D. Discard the residual amount and proceed with administering the feeding

65. A nurse is inserting a nasogastric tube in an adult male client. During the procedure, the client begins to
cough and has difficulty breathing. Which of the following is the appropriate nursing action?
A. Quickly insert the tube
B. Notify the physician immediately
C. Remove the tube and reinsert when the respiratory distress subsides
D. Pull back on the tube and wait until the respiratory distress subsides

66. Nurse Ryan is assessing for correct placement of a nasogastric tube. The nurse aspirates the stomach
contents and check the contents for pH. The nurse verifies correct tube placement if which pH value is noted?
A. 3.5
B. 7.0
C. 7.35
D. 7.5
67. A nurse is preparing to remove a nasogastric tube from a female client. The nurse should instruct the client
to do which of the following just before the nurse removes the tube?
A. Exhale
B. Inhale and exhale quickly
C. Take and hold a deep breath
D. Perform a Valsalva maneuver

68. Nurse Joy is preparing to administer medication through a nasogastric tube that is connected to suction. To
administer the medication, the nurse would:
A. Position the client supine to assist in medication absorption
B. Aspirate the nasogastric tube after medication administration to maintain patency
C. Clamp the nasogastric tube for 30 minutes following administration of the medication
D. Change the suction setting to low intermittent suction for 30 minutes after medication administration

69. A nurse is preparing to care for a female client with esophageal varices who has just has a Sengstaken-
Blakemore tube inserted. The nurse gathers supplies, knowing that which of the following items must be kept at
the bedside at all times?
A. An obturator
B. Kelly clamp
C. An irrigation set
D. A pair of scissors

70. Dr. Smith has determined that the client with hepatitis has contracted the infection from contaminated
food. The nurse understands that this client is most likely experiencing what type of hepatitis?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D

71. During preparation for bowel surgery, a male client receives an antibiotic to reduce intestinal bacteria.
Antibiotic therapy may interfere with synthesis of which vitamin and may lead to hypoprothrombinemia?
A. vitamin A
B. vitamin D
C. vitamin E
D. vitamin K

72. When evaluating a male client for complications of acute pancreatitis, the nurse would observe for:
A. increased intracranial pressure.
B. decreased urine output.
C. bradycardia.
D. hypertension.

73. A male client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the
nurse position the client for this test initially?
A. Lying on the right side with legs straight
B. Lying on the left side with knees bent
C. Prone with the torso elevated
D. Bent over with hands touching the floor

74. A male client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to the
emergency department. His wife reports that he has been “spitting up blood.” A Mallory-Weiss tear is
suspected, and the nurse begins taking a client history from the client’s wife. The question by the nurse that
demonstrates her understanding of Mallory-Weiss tearing is:
A. “Tell me about your husband’s alcohol usage.”
B. “Is your husband being treated for tuberculosis?”
C. “Has your husband recently fallen or injured his chest?”
D. “Describe spices and condiments your husband uses on food.”
75. Which of the following nursing interventions should the nurse perform for a female client receiving enteral
feedings through a gastrostomy tube?
A. Change the tube feeding solutions and tubing at least every 24 hours.
B. Maintain the head of the bed at a 15-degree elevation continuously.
C. Check the gastrostomy tube for position every 2 days.
D. Maintain the client on bed rest during the feedings.

76. A male client is recovering from a small-bowel resection. To relieve pain, the physician prescribes
meperidine (Demerol), 75 mg I.M. every 4 hours. How soon after administration should meperidine onset of
action occur?
A. 5 to 10 minutes
B. 15 to 30 minutes
C. 30 to 60 minutes
D. 2 to 4 hours

77. The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has
deficient vitamin K absorption caused by this hepatic disease?
A. Dyspnea and fatigue
B. Ascites and orthopnea
C. Purpura and petechiae
D. Gynecomastia and testicular atrophy

78. Which condition is most likely to have a nursing diagnosis of fluid volume deficit?
A. Appendicitis
B. Pancreatitis
C. Cholecystitis
D. Gastric ulcer

79. While a female client is being prepared for discharge, the nasogastric (NG) feeding tube becomes cloggeD.
To remedy this problem and teach the client’s family how to deal with it at home, what should the nurse do?
A. Irrigate the tube with cola.
B. Advance the tube into the intestine.
C. Apply intermittent suction to the tube.
D. Withdraw the obstruction with a 30-ml syringe.

80. A male client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine
(Demerol) instead of morphine to relieve pain because:
A. meperidine provides a better, more prolonged analgesic effect.
B. morphine may cause spasms of Oddi’s sphincter.
C. meperidine is less addictive than morphine.
D. morphine may cause hepatic dysfunction.

81. A 39 year old multigravida client asks the nurse for information about female sterilization with a tubal
ligation. Which of the following client statements indicates effective teaching?
A. “My fallopian tubes will be tied off through a small abdominal incision.”
B. “Reversal of a tubal ligation is easily done, with a pregnancy success rate of 80%.”
C. “After this procedure, I must abstain from intercourse for at least 3 weeks.”
D. “Both of my ovaries will be removed during the tubal ligation procedure.”

82. A multigravida client will be using medroxyprogesterone acetate (Depo-Provera) as a family planning
method. After the nurse instructs the client about this method, which of the following client statements
indicates effective teaching?
A. “This method of family planning requires monthly injections.”
B. “I should have my first injection during my menstrual cycle.”
C. “One possible adverse effect is absence of menstrual period.”
D. “This drug will be given by subcutaneous injections.”
83. When developing a teaching plan for an 18 year old client who asks about treatments for sexually
transmitted diseases, the nurse should explain that:
A. Acyclovir (Zovirax) can be used to cure herpes genitalis.
B. Chlamydia trachomatis infections are usually treated with penicillin.
C. Ceftriaxone sodium (Rochephin) may be used to treat Neisseria gonorrhoeae infections.
D. Metronidazole (Flagyl) is used to treat condylomata acuminate.

84. A primigravid client at 16 weeks gestation has had an amniocentasis and has received teaching concerning
signs and symptoms to report. Which statement indicates that the client needs further teaching?
A. “I need to call if I start to leak fluid from my vagina.”
B. “If I start bleeding, I will need to call back.”
C. “If my baby does not move, I need to call my health care provider.”
D. “If I start running a fever, I should let the office know.”

85. When measuring the fundal height of a primigravid client at 20 weeks gestation, the nurse will locate the
fundal height at which of the following points?
A. Halfway between the client’s symphysis pubis and umbilicus.
B. At about the level of the client’s umbilicus.
C. Between the client’s umbilicus and xiphoid process.
D. Near the client’s xiphoid process and compressing the diaphragm.

86. After instructing a primigravid client about desired with gain during pregnancy, the nurse determines that
the teaching is has been successful when the client states which of the following?
A. “A total weight gain of approximately 20lb (9 kg) is recommended.”
B. “A weight gain of 6.6 lb (3 kg) in the second and third trimesters is considered normal.”
C. “A weight gain of about 12 lb (5.5 kg) every trimester is recommended.”
D. “Although it varies, a gain of 25 to 35 lb (11.4 to 14.5 kg) is about average.”

87. A 34 year old multiparous client at 16 weeks gestation who received regular prenatal care for all of her
previous pregnancies tells the nurse that she has already felt the baby move. The nurse interprets this as which
of the following?
A. The possibility that the client is carrying twins.
B. Unusual because most multiparous clients do not experience quickening until 30 weeks gestation.
C. Evidence that the client’s estimated date of delivery is probably off by a few weeks.
D. Normal because multiparous clients can experience quickening between 14 and 20 weeks gestation.

88. A primigravid client at 28 weeks gestation tells the nurse that she and her husband wish to drive to visit
relatives who live several hundred miles away. Which of the following recommendations by the nurse would be
A. “Try to avoid travelling anywhere in the car during your third trimester.”
B. “Limit the time you spend in the car to a maximum of 4 to 5 hours.”
C. “Taking the trip is okay if you stop every 1 to 2 hours and walk.”
D. “Avoid wearing your seat belt in the car to prevent injury to the fetus.”

89. When teaching a primigravid client how to do Kegel exercises, the nurse explains that the expected outcome
of these exercises is to:
A. Prevent vulvar edema.
B. Alleviate lower back discomfort.
C. Strengthen the perineal muscles.
D. Strengthen the abdominal muscles.

90. A primigravid client at 36 weeks gestation tells the nurse that she has been experiencing insomnia for the
past 2 weeks. Which of the following suggestions would be most helpful?
A. Practice relaxation techniques before bedtime.
B. Drink a cup of hot chocolate before bedtime.
C. Drink a small glass of wine with dinner.
D. Exercise for 30 minutes just before bedtime.
91. A laboring client with preeclampsia is prescribed magnesium sulfate 2g/h IV piggyback. The pharmacy
sends the IV to the unit labelled magnesium sulfate 20g/500 ml normal saline. To deliver the correct dose, the
nurse should set the pump to deliver how many milliliters per hour? _____________________________ml.

92. The primary health care provider prescribes 1,000 ml of Ringer’s Lactate intravenously over an 8 hour
period for a 29 year old primigravid client at 16 weeks gestation with hyperemesis. The drip factor is 12
gtts/mL. The nurse should administer the IV infusion at how many drops per minute?

93. At which of the following locations would the nurse expect to palpate the fundus of a primiparous client
immediately after delivery of a neonate?
A. Halfway between the umbilicus and the symphysis pubis.
B. At the level of the umbilicus.
C. Just below the level of the umbilicus.
D. Above the level of the umbilicus.

94. Four hours after delivering a viable neonate by spontaneous vaginal delivery under epidural anesthesia, the
client states she needs to urinate. The nurse should next:
A. Catheterize the client to obtain an accurate measurement.
B. Palpate the bladder to determine distention.
C. Assess the fundus to see if it is at the midline.
D. Measure the first two voiding and record the amount.

95. In preparation for discharge, the nurse discusses sexual issues with a primiparous client who had a routine
virginal delivery with a midline episiotomy. The nurse should instruct the client that she can resume sexual
A. In 6 weeks when the episiotomy is completely healed.
B. After a postpartum check by the health care provider.
C. Whenever the client is feeling amorous and desirable.
D. When lochia flow and episiotomy pain have stopped.

96. While caring for a multiparous client 4 hours after vaginal delivery of a term neonate, the nurse notes that
the mother’s temperature is (37.20 C), the pulse is 66bpm, and the respirations are 18 breaths/min. Her fundus is
firm, midline, and at the level of the umbilicus. The nurse should:
A. Continue to monitor the client’s vital signs.
B. Assess the client’s lochia for large clots.
C. Notify the client’s physician about the findings.
D. Offer the mother an ice pack for her forehead.

97. A primiparous client, 48 hours after a vaginal delivery, is to be discharged with a prescription for vitamins
with iron because she is anemic. To maximize absorption of the iron, the nurse instructs the client to take the
medication with which of the following?
A. Orange juice
B. Herbal tea
C. Milk
D. Grape juice

98. Twelve hours after a vaginal delivery with epidural anesthesis, the nurse palpates the fundus of a
primiparous client and finds it to be firm, above the umbilicus, and deviated to the right. Which of the
following would the nurse do next?
A. Document this as normal findings in the client’s record.
B. Contact the physician for a prescription for methylergonovine (Methergine).
C. Encourage the client to ambulate to the bathroom and void.
D. Gently massage the fundus to expel the clots.
99. A primiparous client 3 days postpartum is to be discharged on heparin therapy. After teaching her about
possible adverse effects of heparin therapy, the nurse determines that the client needs further instruction when
she stated that the adverse effects include which of the following?
A. Epistaxis
B. Bleeding gums
C. Slow pulse
D. Petechiae

100. The nurse explains to the mother of a neonate diagnosed with erythroblastosis fetalis that the exchange
transfusion is necessary to prevent damage primarily to which of the following organs in the neonate?
A. Kidneys
B. Brain
C. Lungs
D. Liver


1. A 36. B 71. D
2. D 37. D 72. B
3. D 38. B 73. B
4. C 39. A 74. A
5. D 40. C 75. A
6. B 41. B 76. B
7. A 42. A 77. C
8. D 43. D 78. B
9. A 44. B 79. A
10. B 45. B 80. B
11. D 46. B 81. A
12. A 47. A 82. C
13. C 48. C 83. C
14. C 49. B 84. C
15. A 50. C 85. B
16. D 51. B 86. S
17. B 52. C 87. S
18. C 53. A 88. C
19. A 54. B 89. C
20. B 55. D 90. A
21. A 56. D 91.
22. D 57. B 92.
23. C 58. D 93. A
24. D 59. D 94. D
25. D 60. C 95. D
26. D 61. C 96. A
27. D 62. C 97. A
28. C 63. A 98. C
29. D 64. A 99. C
30. D 65. D 100. A
31. B 66. A
32. D 67. C
33. B 68. C
34. C 69. D
35. D 70. A