Practice MCQs Flashcards by Bianca Mingoti

Mental status assessment using the ‘batomi’ formation is a useful nursing assessment tool because it tells you:

a) Whether or not a client has a mental illness
b) Details about an individual’s feeling state and cognitive functioning
c) Whether a mental illness is organic or
functional in origin
d) The history of a client’s symptoms and his response to stress

b) Details about an individual’s feeling state and cognitive functioning

Mental status assessment evaluates current cognitive and emotional functioning.

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Persons with an acute psychotic illness have most difficulty in:

a) Meeting dependency needs
b) Maintaining grooming and personal hygiene
c) Distinguishing between reality and unreality
d) Displaying personal feelings

c) Distinguishing between reality and unreality

Acute psychosis primarily affects reality testing

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People who have a personality disorder:

a) Frequently progress to a psychotic illness
b) Become psychotic under severe stress
c) Are known as borderline personalities
d) Have ongoing difficulties in relating to others

d) Have ongoing difficulties in relating to others

Personality disorders are characterized by persistent interpersonal difficulties.

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Neurotic disorders are associated with:

a) Inadequacy and poor stress management
b) Maladaptive behaviour related to anxiety
c) Inability to cope with demands and perceived stress
d) Family patterns of inappropriate behaviour

b) Maladaptive behaviour related to anxiety

Neurotic disorders are anxiety-based conditions with maladaptive coping.

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Which of the following statements about tardive dyskinesia is true

a) Symptoms are often permanent and do not improve with antiparkinsonian medication
b) Symptoms will diminish as the client adjusts to long term treatment
c) Clients are seldom concerned about features of tardive dyskinesia
d) Antiparkinsonian medication will suppress the main features of tardive dyskinsesia

a) Symptoms are often permanent and do not improve with antiparkinsonian medication

Tardive dyskinesia is often irreversible and doesn’t respond to antiparkinsonian drugs

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Memory loss associated with old age:

a) Has a sudden onset and affects both long term and short-term memory
b) Has a gradual onset and affects mainly long term memory
c) Has a gradual onset and affects mainly short term memory
d) Has a sudden onset and affects mainly short term memory

c) Has a gradual onset and affects mainly short term memory

Age-related memory loss typically affects recent memory first

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Persons who have a neurotic disorder

a) have a minor disorder that will diminish with time and maturity
b) respond well to electro convulsive therapy
c) do not develop psychotic features
d) frequently have insight into their behaviour

d) Frequently have insight into their behaviour

Unlike psychotic disorders, neurotic disorders typically preserve insight

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A social factor contributing to the incidence of eating disorders is

a) economic disadvantage
b) educational disadvantage
c) gender stereotyping
d) unemployment

c) Gender stereotyping

Cultural pressure and gender role expectations contribute to eating disorders.

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The most common features of chronic organic psychosis are

a) fluctuating confusion and disorientation
b) persistent elated mood and hyperactivity
c) thought blocking and concrete thinking
d) social withdrawal and paranoid ideation

a) Fluctuating confusion and disorientation

Chronic organic psychosis presents with cognitive impairment and confusion.

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Phobia is best described as

a) a fear related to an identifiable traumatic event in ones life
b) an irrational fear of a specific situation or object
c) a series of repetitive behaviours designed to relieve anxiety
d) a general sense of impending doom

b) An irrational fear of a specific situation or object

Phobias are characterized by excessive, irrational fears.

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The most appropriate treatment for phobias is

a) anxiolytic drugs
b) cognitive restructuring
c) relaxation exercises
d) systematic desensitisation

d) Systematic desensitisation

Gradual exposure therapy is the most effective treatment for phobias

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The best definition of a crisis is

a) any event which causes anxiety
b) a life event which is perceived as a threat to self esteem
c) a traumatic event for which coping behaviours are inadequate
d) a situation which is traumatic and involves a significant loss

c) A traumatic event for which coping behaviours are inadequate

Crisis occurs when usual coping mechanisms fail.

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Forensic psychiatry is the area of mental health care which is concerned with individuals who

a) have been committed to hospital because they would not voluntarily accept treatment
b) are not considered to be capable of caring for themselves in a non custodial environment
c) have been charged with an offence to undergo a psychiatric examination or treatment
d) are mentally ill and considered to be a danger to themselves or to the public

c) Have been charged with an offence to undergo a psychiatric examination or treatment

Forensic psychiatry deals with legal and mental health intersection.

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Anxiety is best described as

a) mild form of psychosis
b) disorder of mood
c) response to stress
d) distorted sense of perception

c) Response to stress

Anxiety is a normal response to perceived threat or stress.

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Which of the following is common feature of anxiety

a) Paranoid delusions
b) Social withdrawal
c) Impaired concentration
d) Auditory hallucinations

c) Impaired concentration

Concentration difficulties are a common feature of anxiety.

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A comparison of maori and non maori suicide rates shows that

a) Maori are less likely to commit suicide
b) Maori are much more likely to commit suicide
c) There is no difference between Maori and non-Maori suicide rates
d) There are differences but they are not
statistically significant

b) Maori are much more likely to commit suicide

Statistics show higher suicide rates among Maori populations.

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A person who is currently acutely depressed expresses an intention to self harm. Your initial response would be to:

a) Distract the client by talking about less
depressing thoughts or ideas
b) Encourage the client to discuss their ideas of suicide to establish potential for self harm
c) Suggest the client involves themselves with other clients to establish supportive
relationships
d) Ask the client to explain their reasons for contemplating self harm

b) Encourage the client to discuss their ideas of suicide to establish potential for self harm

Direct assessment of suicidal ideation is essential for safety planning.

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A depressed client is prescribed Amitriptyline. This would have the effect of:

a) Clarifying his thought processes
b) Helping to raise his mood
c) Eliminating negative ideas
d) Promoting greater self-awareness

b) Helping to raise his mood

Amitriptyline is an antidepressant that elevates mood.

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While watching television in the lounge a client says quickly and abruptly to the nurse, the sun is shining in Virginia. My son is in Virginia. Who’s afraid of Virginia wolf. Which of the following is this statement an example of

a) Concrete thinking
b) Flight of ideas
c) Word salad
d) Depersonalisation

b) Flight of ideas

Rapid shifting between loosely connected thoughts.

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In planning the care for the elated client a primary aim is to

a) Encourage interpersonal contact
b) Provide a non stimulating environment
c) Demand that the client follow rules
d) Accept and understand the behaviour

b) Provide a non stimulating environment

Reducing stimulation helps manage elevated mood states.

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For a client suffering from mania who is unable to sleep the best approach is to

a) Fully involve the client in physical activities and exercise programmes during daytime
b) Encourage the client to talk about underlying feelings or stressors
c) Nurse in low stimulus environment and
administer prescribed antipsychotic medication
d) Place in seclusion using medication only as a last resort

c) Nurse in low stimulus environment and administer prescribed antipsychotic medication

Reducing stimulation and medication management are key for mania.

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For a client suffering from mania who is expressing delusional ideas the best approach is to

a) Explain to the client the distinction between rational and irrational thinking
b) Acknowledge his ideas but distract him by focusing on reality based ideas
c) Ignore him because to do otherwise will only reinforce his ideas
d) Encourage him to stop thinking like that, as it is a symptom of his illness

b) Acknowledge his ideas but distract him by focusing on reality based ideas

Acknowledge without reinforcing, then redirect to reality.

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A client who is subject to a community treatment order Section 29 of the Mental Health Act (1992) must

a) Accept prescribed medication and attend any specified treatment centre
b) Report on a weekly basis to a community mental health centre
c) Return to hospital after a period of three months for a psychiatric assessment
d) Name a primary caregiver who will accept responsibility for the clients care and supervision

a) Accept prescribed medication and attend any specified treatment centre

Community treatment orders mandate treatment compliance.

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In preparation for living in the community a client may spend a period of time living in a half way house. The main objective of living in a half way house is to

a) Save sufficient money in order to set up a house or flat
b) Spend time looking for a suitable job on leaving hospital
c) Assess whether the client still has any symptoms of mental illness
d) Provide the client with the opportunity to adjust to a more independent lifestyle

d) Provide the client with the opportunity to adjust to a more independent lifestyle

Halfway houses facilitate transition to independent living.

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Following an automobile accident involving a fatality and a subsequent arrest for speeding, a client has amnesia for the events surrounding the accident. This is an example of the defence mechanism known as a) Projection b) Repression c) Dissociation d) Suppression

b) Repression Unconscious blocking of traumatic memories.

The group most at risk for developing an eating disorder is young women a) Who are high achievers b) With a history of disturbed behaviour c) Who have conflict with their parents d) With a history of mental illness

a) Who are high achievers Perfectionism and high achievement are risk factors.

Support for a client with an eating disorder involves a) Avoidance of family conflicts b) Discussion of health ways of losing weight c) Encouragement to explore issues of concern d) Daily checks for changes in weight

c) Encouragement to explore issues of concern Therapeutic support addresses underlying issues.

The personality disorder associated with an inability to make decisions and the need for constant reassurance is commonly classified as a) Obsessive compulsive b) Dependent c) Cyclothymic d) Antisocial

b) Dependent Dependent personality disorder involves excessive need for reassurance.

People who have a personality disorder a) Frequently progress to a psychotic illness b) Become psychotic under severe stress c) Are known as borderline personalities d) Have ongoing difficulties in relating to others

d) Have ongoing difficulties in relating to others Persistent interpersonal problems characterize personality disorders.

A side effect resulting from long term use of antipsychotic medication is tardive dyskinesia. Features of tardive dyskinesia include a) Involuntary lip smacking and tongue movements b) Dry mouth and blurred vision c) Muscular rigidity and shuffling gait d) Nausea and vomiting

a) Involuntary lip smacking and tongue movements Tardive dyskinesia causes orofacial involuntary movements.

A nurse working in a long term ward becomes aware that they are becoming institutionalised. Which of the following behaviours would they be most likely to have noticed a) An excessive and unrealistic concern for the welfare of clients b) A tendency to become involved in new activities c) A lack of satisfaction with existing methods of work d) Resistance to new ideas and change

d) Resistance to new ideas and change Institutionalization leads to rigidity and resistance to change.

One reason for ordering an individual charged with an offence to have psychiatric examination is to determine whether that person: a) Is likely to have committed the offence he is charged with b) Has a previous personal or family history of psychiatric illness c) Was suffering from a mental illness at the time of the alleged offence d) Has a mental illness which would respond to a programmed of treatment

c) Was suffering from a mental illness at the time of the alleged offence Psychiatric examination determines mental state during offense.

Cultural considerations in the use of seclusion include a) Use of seclusion only after consent has been obtained from the appropriate cultural representatives b) Listening to advice from staff of the clients culture or form the clients family c) Having an appropriate cultural representative available each time the seclusion room is entered d) Ensuring that only staff from the clients culture participate in caring for any client in seclusion

b) Listening to advice from staff of the clients culture or from the clients family Cultural consultation ensures appropriate care.

Cross cultural studies on mental illness show that a) The symptoms of mental illness are the same in all cultures b) The incidence of mental illness the same in all cultures c) Mental illness has culturally specific characteristics d) Mental illness is more common amongst cultural minorities

c) Mental illness has culturally specific characteristics Cultural context influences symptom expression.

The drug most commonly used in the long term treatment of bi polar disorder is a) Diazepam b) Lithium carbonate c) Clozapine d) Sodium Amytal

b) Lithium carbonate Lithium is the primary mood stabilizer for bipolar disorder.

Anticholinergic side effects are common with all the following except a) Diazepam b) Benztropine c) Amitriptyline d) Thioridazine

a) Diazepam Benzodiazepines don't typically cause anticholinergic effects.

Chlorpromazine is an antipsychotic medication used in the treatment of a) Anxiety states b) Schizophrenia c) Depressive disorders d) Dementia

b) Schizophrenia Chlorpromazine is an antipsychotic for psychotic disorders.

Which of the following is the main reason for giving depot injections of antipsychotic medication a) They are more effective than oral medication b) They overcome the problem of non-adherence c) Side effects are not as common d) They are easier to administer than oral medication

b) They overcome the problem of non adherence Depot injections ensure medication compliance.

A client who is committed under the MHA (1992) is discharged from hospital on leave. When visited by the community mental health nurse, he refused his injection of antipsychotic medication which is due that day. The best initial approach to this would be to a) Explain that this will mean his immediate return to hospital b) Visit again the next day and attempt to persuade the client to accept his medication c) Inform the medical staff so that the clients legal status can be changed d) Explore with the client alternative forms of treatment to medication

d) Explore with the client alternative forms of treatment to medication Initial response should be therapeutic exploration.

Long term use of benzodiazepine drugs (minor tranquillisers) such as diazepam (valium) can lead to a) Tardive dyskinesia b) Dependence c) Renal impairment d) Akathisia

b) Dependence Benzodiazepines carry risk of physical and psychological dependence.

A client expresses the belief that he is the illegitimate son of a famous family. This is an example of a) Paranoid thinking b) Pressure of speech c) A delusion of grandeur d) Ideas of reference

c) A delusion of grandeur False belief of special status or importance.

The best response to a client who expresses the belief that he is the illegitimate son of a famous family is to a) Involve the client in a group activity b) Inform the client that he is wrong in his belief c) Talk to the client without confirming or denying his belief d) Spend some time with the client in an attempt to meet his need to feel important

c) Talk to the client without confirming or denying his belief Maintain therapeutic relationship without reinforcing delusion.

At an art group a client shows the group the painting he has done. It consists of knives and blood, with the words ‘death’ and ‘peace’ written on it. The client tells the group that this represents his own death and release from suffering. The best response to this is a) Thank him for his participation and then focus the discussion on another client b) Acknowledge his contribution and ensure that you discuss this further with him after the group has finished c) Request that the client use the opportunity to explore more positive aspects of his life d) Insist the client explain this feelings to the group and then point out positive aspects of his life

b) Acknowledge his contribution and ensure that you discuss this further with him after the group has finished Address safety concerns privately while acknowledging participation.

A client who has been admitted for treatment of a depressive illness says he doesn’t want to attend group activities. The reason such a client would be encouraged to attend is that a) He is less likely to dwell on depressive ideas while he is involved in a group activity b) It is an expectation that all clients attend group activities while in hospital c) Involvement in group activities is the only way to overcome feelings of depression d) Attendance at group activities is essential to monitor the effectiveness of medication

a) He is less likely to dwell on depressive ideas while he is involved in a group activity Activity provides distraction and social engagement.

A client with post traumatic stress disorder says ‘I should have been killed with the rest of them. Why am I alive’ this statement is best described as an example of a) Suicidal thinking b) Survivor guilt c) Depressive preoccupation d) Neurotic conflict

b) Survivor guilt Feeling guilty about surviving when others died.

The best way to report the clients statement of ‘I should have been killed with the rest of them. Why am I alive', in the nursing notes would be a) Client has no insight into their situation b) Client is questioning why they are still alive c) Client is expressing suicidal ideas d) Client feels responsible for death of others

b) Client is questioning why they are still alive Objective documentation of client's statement.

Long acting intramuscular antipsychotic medication is used in the treatment of schizophrenia because it a) Has fewer side effects than oral medication b) Has a greater antipsychotic action c) Is more rapidly absorbed than oral medication d) Ensures that clients receive their medication

d) Ensures that clients receive their medication Long-acting injections guarantee medication adherence.

Which of the following statements related to the treatment, with lithium carbonate, of person with bipolar disorder is true: a) Most will need to take lithium carbonate for an extended period of time, perhaps for life b) Once the persons mood becomes euthymic, treatment can be discontinued in most cases c) Because of the need to maintain constant blood levels, long term injections is the preferred form of treatment d) Treatment is most effective in the acute stage of the illness although some people will need long term treatment

a) Most will need to take lithium carbonate for an extended period of time, perhaps for life Bipolar disorder typically requires long-term maintenance.

An acutely ill client with the diagnosis of schizophrenia has just been admitted to the mental health unit. When working with this client initially the nurses most therapeutic action would be to a) Use diversional activity and involve the client in occupational therapy b) Build trust and demonstrate acceptance by spending some time with the client c) Delay one to one interactions until medications reduce the psychotic symptoms d) Involve the client in multiple small group discussions to distract attention from the fantasy world

b) Build trust and demonstrate acceptance by spending some time with the client Therapeutic relationship is foundation of care.

You are caring for a client who talks in a regretful way about the past. The best response is to: a) Help them find something positive in their past b) Help them move their thoughts to the future c) Tell them that focusing on the past is not helpful d) Acknowledge the clients feelings then focus on the present

d) Acknowledge the clients feelings then focus on the present Validate emotions while redirecting to current reality.

Intervention with an angry client who is threatening violence involves: a) Asking the client to express their feelings verbally b) Maintaining silence to avoid any escalation of anger c) Asking the client what has happened to make them so angry d) Giving brief, clear messages about what you want the client to do

d) Giving brief, clear messages about what you want the client to do Clear, directive communication during crisis.

Mr W is committed under Section 11 of the MHA 1992. He sneaks out at night and returns to his former home. He calls the staff and tells them he is not coming back. The staffs responsibility is to: a) Make sure he’s discharged b) Tell him to take his medication c) Ask to have someone else talk to him d) Notify the police and crisis team

d) Notify the police and crisis team Client under commitment requires safe return.

The highest priority nursing action relative to alcohol withdrawal delirium would be a) Orientation to reality b) Application of restraints c) Identification and social supports d) Replacement of fluids and electrolytes

d) Replacement of fluids and electrolytes Medical stabilization is priority in alcohol withdrawal.

The use of silence during an interview is therapeutic if a) The person is overcome with emotion b) The person appears uncomfortable with the current discussion c) The nurse wishes to terminate the communication session d) The patient wishes to terminate the communication session

a) The person is overcome with emotion Silence allows processing of strong emotions.

To facilitate communication the nurse should convey a) Accurate empathy b) Authenticity c) Unconditional positive regard d) All of the above

d) All of the above All three qualities facilitate therapeutic communication.

The parents of a young man experiencing a schizophrenic illness ask if he is likely to become violent. The best answer the nurse can make is that the vast majority of mentally ill individuals a) Are more dangerous than normal people b) Are not more dangerous than other individuals in the population c) Are unpredictable and therefore more dangerous than normal individuals d) Are about as violent and unpredictable as more individuals in the population

b) Are not more dangerous than other individuals in the population Mental illness doesn't increase violence risk for most individuals.

While interviewing Mr D, the nurse notes he uses neologisms and has losses associations. This would most likely indicate the presence of: a) Mania b) Depression c) Defensive coping d) Schizophrenia or psychosis

d) Schizophrenia or psychosis Neologisms and loose associations indicate thought disorder.

When monoamine oxidase inhibitors (MAOIs) are prescribed, the client should be cautioned against a) Prolonged exposure to the sun b) Ingesting wines and aged cheeses c) Engaging in active physical exercise d) The use of medications with an elixir base

b) Ingesting wines and aged cheeses MAOIs require tyramine-restricted diet.

A characteristic feature of the elated client is a) Retarded speech b) Increased motor and thought activity c) Delusions of sin and guilt d) Depressed mood

b) Increased motor and thought activity Elation involves psychomotor acceleration.

To give effective nursing care to a client who is using ritualistic behaviour, the nurse must first recognize that the client a) Should be prevented from performing the rituals b) Needs to realise that the rituals serve no purpose c) Must immediately be diverted when performing the ritual d) Does not want to repeat the ritual, but feels compelled to do so

d) Does not want to repeat the ritual, but feels compelled to do so Rituals are driven by anxiety, not choice.

Culturally safe nursing care can best be achieved when the nurse has a) An in depth knowledge of the treaty of Waitangi b) An awareness of Maori perspectives of health c) An awareness and acceptance of your own limits in meeting someone else’s health and cultural needs d) A knowledge of Maori protocol

c) An awareness and acceptance of your own limits in meeting someone else's health and cultural needs Cultural safety begins with self-awareness and humility.

Imagine a new virus infecting a human population for the first time. Which of the following is most likely to lead to a rapid increase in cases worldwide a) Severe disease with high mortality b) Lack of hand hygiene c) Air travel d) High transmissibility

d) High transmissibility Easy person-to-person transmission causes rapid spread.

The school nurse is caring for a child with haemophilia who is actively bleeding from the leg. Which of the following would the nurse apply a) Direct pressure, checking every few minutes to see if the bleeding has stopped b) Ice to the injured leg area several times a day c) Direct pressure to the injured area continuously for 10 minutes d) Ice bag with elevation of the leg twice a day

c) Direct pressure to the injured area continuously for 10 minutes Continuous pressure is needed for clotting in haemophilia.

Home health nurses visit a blind diabetic patient who lives alone to monitor the patients glucose level and administer the patients daily insulin. Evaluation of outcome management for this patient would include; a) An absence of complications of diabetes b) A reduction in hospitalizations for glycaemic control c) The ability of the patient to learn to use adaptive syringes d) The patients evaluation of the services provided by the nurses

b) A reduction in hospitalizations for glycaemic control Outcome management focuses on reducing complications and hospitalizations.

The nurse consults with the physician to arrange a referral for hospice care for a patient with end stage liver disease based on the knowledge that hospice care is indicated when: a) Family members can no longer care for dying patients at home b) Patients and families are having difficulty coping with grief reactions c) Preparation for death with palliative care and comfort are the goals of care d) Patients have unmanageable pain and suffering as a result of their condition

c) Preparation for death with palliative care and comfort are the goals of care Hospice focuses on comfort care when cure is no longer possible.

When teaching a patient who smokes about the relationship of smoking to the development of cancer, the nurse explains that tobacco smoke is a complete carcinogen because a) Exposure to the smoke always causes cellular changes b) Tobacco smoke is capable of both initiating and promoting cancer growth c) Cancer will always develop when people who smoke are exposed to other carcinogens d) Tobacco smoke serves as a vehicle for the spread of cancer cells during the progression stage of cancer

b) Tobacco smoke is capable of both initiating and promoting cancer growth Complete carcinogens can both start and accelerate cancer.

In teaching about cancer prevention, the nurse stresses promotion of exercise, normal body weight, and low fat diet because: a) General aerobic health is an important defence against cellular mutation b) Obesity is a factor that promotes cancer growth; if it is reversed, the risk of cancer can be decreased c) People who are overweight usually consume large amounts of fat, which is a chemical carcinogen d) The development of fatty tumours, such as lipomas, is increased when there is an abundance of fatty tissue

b) Obesity is a factor that promotes cancer growth; if it is reversed, the risk of cancer can be decreased Obesity promotes cancer through hormonal and inflammatory mechanisms.

A 40 year old divorced mother of four school 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) You are going to live for a long time yet, and your children will be just fine c) I wouldn’t worry about that right now. You need to concentrate on getting well d) Won’t your ex-husband take the children when you can’t care for them anymore

a) Why don't we talk about the options you have for the care of your children Therapeutic response that addresses concerns and explores solutions.

During the primary assessment of a trauma victim, the nurse determines that the patient has a patent airway. The next assessment the nurse makes includes: a) The level of consciousness b) Observation for external bleeding c) The status of the patients respiration d) The rate and character of carotid or femoral pulses

c) The status of the patients respiration After airway, breathing is the next priority (ABC approach).

Which of the following viruses is usually transmitted by airborne droplets: a) Varicella zoster virus b) Cytomegalovirus c) Herpes simplex virus d) Hepatitis a virus

a) Varicella zoster virus Chickenpox spreads through airborne droplets.

Which of the following has made the biggest impact on mortality from infectious diseases in the 20th century: a) Vaccination b) Better housing and provision of clean water and sewerage systems c) Antimicrobials d) Infection control

b) Better housing and provision of clean water, sewerage systems Public health infrastructure had the greatest impact on mortality.

In addition to providing informational support, which of the following nursing activities is an integral part of the role of the nurse advocate: a) maintaining the patient in a dependent role b) assuming responsibility for directing the patients care c) assisting the patient to make sound health care decisions d) persuading the patient to choose exactly what the health care team recommends

c) Assisting the patient to make sound health care decisions Advocacy involves supporting informed decision-making.

Steve, 15 years old, is admitted with suspected meningitis. Nuchal rigidity will not be seen in which of the following a) intracranial haematoma b) meningitis c) cerebral concussion d) intracranial tumour

c) Cerebral concussion Nuchal rigidity (neck stiffness) is not typical of concussion.

A positive Mantoux test indicates: a) the client has active tuberculosis b) the client has been exposed to mycobacterium c) the client will never have tuberculosis d) the client has been infected with mycobacterium tuberculosis

d) The client has been infected with mycobacterium tuberculosis Positive Mantoux indicates TB exposure/infection, not necessarily active disease.

Which of the following would the nurse do when suspecting that a child has been abused by the mother: a) Continue to collect information until there is no doubt in the nurses mind that abuse has occurred b) Ensure that any and all findings are reported to the proper state and legal authorities c) Keep the finding confidential, because they represent legal privileged communication between the nurse and the mother d) Report the findings to the physician because that falls within the responsibilities of medical practice

b) Ensure that any and all findings are reported to the proper state and legal authorities Mandatory reporting of suspected child abuse.

Several high school seniors are referred to the school nurse because of suspected alcohol misuse. When the nurse assesses the situation, which of the following would be most important to determine: a) What they know about the legal implications of drinking b) The type of alcohol they usually drink c) The reasons they choose to use alcohol d) When and with whom they use alcohol

c) The reasons they choose to use alcohol Understanding motivation is key to intervention.

When a trauma victim expresses fear that AIDS may develop as a result of a blood transfusion, the nurse should explain that a) Blood is treated with radiation to kill the virus b) Screening for HIV antibodies has minimised the risk c) The ability to directly identify HIV has eliminated this concern d) Consideration should be given to donating own blood for transfusion

b) Screening for HIV antibodies has minimised the risk Blood supply screening has greatly reduced transfusion-related HIV.

A client asks the nurse, “Should I tell my husband I have AIDS?” The nurses most appropriate response would be: a) This is a decision alone you can make b) Do not tell him anything unless he asks c) You are having difficulty deciding what to say d) Tell him you feel you contracted AIDS from him

c) You are having difficulty deciding what to say Therapeutic response that reflects feelings and encourages discussion.

When a disaster occurs, the nurse may have to treat mass hysteria first. The person or persons to be cared for immediately would be those in: a) Panic b) Coma c) Euphoria d) Depression

a) Panic Panic in mass hysteria can spread and interfere with rescue efforts.

A child was bitten on the hand by a dog who had recently received a rabies shot. The nursing priority for this child would be directed toward ensuring that the: a) Suture line remains red and dry b) Child does not develop a fear of dogs c) Rabies antibodies develop within 48 hours d) Mobility of the injured hand returns to a preinjury state in 1 week

d) Mobility of the injured hand returns to a preinjury state in 1 week Hand function is priority after dog bite treatment.

The school nurse is invited to attend a meeting with several parents who express frustration with the amount of time their adolescents spend in front of the mirror and the length of time it takes them to get dressed. The nurse explains that this behaviour is indicative of which of the following: a) An abnormal narcissism b) A method of procrastination c) A way of testing the parents limit setting d) A result of developing self concept

d) A result of developing self concept Adolescent preoccupation with appearance is normal developmental behavior.

A parent asks the nurse about head lice (pediculosis capitis) infestation during a visit to the clinic. Which of the following symptoms would the nurse tell the parent is most common in a child infected with head lice: a) Itching of the scalp b) Scaling of the scalp c) Serous weeping of the scalp surface d) Pinpoint haemorrhagic spots on the scalp surface

a) Itching of the scalp Pruritus is the primary symptom of head lice.

After teaching the parents about the cause of ringworm of the scalp (tinea capitis), which of the following, if stated by the father, indicates successful teaching: a) Over exposure to the sun b) Infestation with a mite c) Fungal infection of the scalp d) An allergic reaction

c) Fungal infection of the scalp Tinea capitis is caused by fungal infection.

A mother tells the nurse that one of her children has chicken pox and asks what she should do to care for that child. When teaching the mother, which of the following would be most important to prevent: a) Acid base imbalance b) Malnutrition c) Skin infection d) Respiratory infection

c) Skin infection Secondary bacterial infection from scratching is the main complication.

One litre of intravenous fluid is to be given over 4 hours. The giving set delivers 60 drops per mL. How many drops per minute should be given: a) 150 b) 250 c) 300 d) 160

b) 250 Calculation: 1000mL ÷ 4 hours = 250mL/hour; 250mL × 60 drops/mL ÷ 60 min = 250 drops/min.

The nurse discusses the eating habits of school aged children with their parents, explaining that these habits are most influenced by which of the following: a) Food preference of their peers b) Smell and appearance of foods offered c) Examples provided by parents at mealtimes d) Parental encouragement to eat nutritious foods

c) Examples provided by parents at mealtimes Parental modeling is the strongest influence on eating habits.

What is the responsibility of the nurse who, for two days, has observed the nurse manager putting several syringes into her pocket: a) Report the matter to another nurse manager b) Discuss the matter with your nursing colleagues c) Watch the nurse manager to see if it happens again d) Ignore the incident as a nurse manager is a responsible person

a) Report the matter to another nurse manager Suspected drug diversion must be reported through proper channels.

Neil, a 17 year old, is hit on the head by a cricket ball while playing with a friend at home. He fell against the glasshouse, severely lacerating his right wrist. He as unconscious for about 5 minutes. The initial first aid treatment for Neil would be to: a) Wrap a handkerchief tightly on the wrist b) Check for breathing c) Elevate the wrist d) Wash the wrist to examine it

b) Check for breathing Airway and breathing are first priorities in trauma.

Neil, a 17 year old, is hit on the head by a cricket ball while playing with a friend at home. He fell against the glasshouse, severely lacerating his right wrist. He was unconscious for about 5 minutes. You are taking Neil’s recordings when he appears to have a seizure. What nursing intervention would best assist Neil: a) Describing and recording the seizure activity observed b) Restraining Neil in order to prevent self-harm c) Placing a tongue blade between his teeth d) Suctioning Neil to prevent aspiration

a) Describing and recording the seizure activity observed Accurate observation and documentation guide treatment.

Following a petit mal seizure a person is likely to be a) Confused b) Hostile c) Hyperactive d) Euphoric

a) Confused Post-ictal confusion is common after petit mal seizures.

On a follow up outpatient. Neil enquires about his anticonvulsant medication. He needs to know that following a head injury: a) The medication must be taken for a least 1 year b) The physician must be seen when the prescription is finished c) The medication will be discontinued as soon as his seizures are under control d) The medication will be necessary for the rest of his life

b) The physician must be seen when the prescription is finished Anticonvulsant therapy after head injury requires medical follow-up.

If you are with someone who has a grand mal seizure, you should: a) Loosen the clothing about their neck and wrist b) Turn their head to the side to facilitate drainage of secretions c) Remove nearby objects to protect their extremities from injury d) All of the above

d) All of the above All actions protect the patient during grand mal seizure.

The school nurse is caring for a child with haemophilia who is actively bleeding from the leg. Which of the following would the nurse apply: a) Direct pressure, checking every few minutes to see if the bleeding has stopped b) Ice to the injured leg area several times a day c) Direct pressure to the injured area continuously for 10 minutes d) Ice bag with elevation of the leg twice a day

c) Direct pressure to the injured area continuously for 10 minutes Continuous pressure needed for clotting in haemophilia.

When performing a cultural assessment with a patient of a different culture, it is important for the nurse to first ask about the patients': a) Racial heritage b) Use of cultural healers c) Language spoken at home d) Affiliation with a cultural group

d) Affiliation with a cultural group Starting with self-identification respects patient autonomy.

After being bitten by an unknown insect, a patient allergic to wasp stings is brought to a clinic by a co-worker. Upon arrival the patient is anxious and is having difficulty breathing. The first action by the nurse is to: a) Administer oxygen b) Maintain the patients airway c) Remove the stinger from the site d) Place the patient in recumbent position with his legs elevated

b) Maintain the patients airway Airway is always the first priority in anaphylaxis.

During immediate care of a victim of a bite or sting to the hands or fingers, it is most important for the nurse to: a) Elevate the affected extremity b) Scrub the wound with an antibacterial solution c) Apply ice to the site with ice water or ice packs d) Remove rings and watches from the affected extremity

d) Remove rings and watches from the affected extremity Prevents constriction as swelling occurs.

A young man seeks medical care after a friend with whom he shared needles during illicit drug use develops Hepatitis B. To provide immediate protection from infection, the nurse expects to administer: a) Corticosteroids b) Gamma globulin c) Hepatitis b vaccine d) Fresh frozen plasma

b) Gamma globulin Passive immunity provides immediate protection.

A 63 year old man has terminal cancer of the liver and is cared for by his wife at home. His abdominal pain has become increasingly severe, and he now says it is intense most of the time. The nurse recognizes that teaching regarding pain management has been effective when the patient: a) Limits the use of opiate analgesics to prevent addiction b) Resigns himself to the fact that pain is an inevitable consequence of cancer c) Uses pain medication only when the pain becomes more than he can tolerate d) Takes analgesics around the clock on a regular schedule, using additional doses for the breakthrough pain

d) Takes analgesics around the clock on a regular schedule, using additional doses for the breakthrough pain Around-the-clock dosing provides best pain control in terminal cancer.

A patient is treated at a clinic with an injection of long acting penicillin for a streptococcal throat infection. Her history reveals that she has received penicillin before with no allergic responses. When the penicillin injection is administered, the nurse should inform the patient that: a) She must wait in the clinic area for 20 minutes before she is discharged b) Since she has taken penicillin before without problems, she can safely take it now c) She would have immediate symptoms if she had developed an allergy to penicillin d) She should monitor for fever and skin rash typical of serum sickness after taking penicillin

a) She must wait in the clinic area for 20 minutes before she is discharged Anaphylaxis monitoring required even with negative history.

A parent asks why it is recommended that the second dose of the measles, mumps, rubella (MMR) vaccine be given by 12 years of age. The nurse responds based on which of the following as the most important reason: a) The risks to a foetus are high if a girl receiving the vaccine becomes pregnant b) The chance of contracting the disease is much lower after puberty than before it c) The dangers associated with a strong reaction to the vaccine are increased after puberty d) The changes that occur in the immunologic system may affect the rhythm of the menstrual cycle

a) The risks to a foetus are high if a girl receiving the vaccine becomes pregnant MMR is contraindicated in pregnancy due to teratogenic effects.

Mrs Simon states she is not feeling well, that she cannot breathe and asks you to please do something. Your initial response to the client is: a) You will be alright, just calm down b) Don’t worry, the doctors have everything under control c) I will ring the doctor to come and see you d) I will take your recordings and ring the doctor to see you

d) I will take your recordings and ring the doctor to see you Appropriate response that assesses and communicates with medical team.

For the nursing council to find a registered nurse guilty of negligence, it would have to prove that the nurse: a) Failed to do what another careful registered nurse would have done in a similar situation. b) Did not give competent care as defined by colleagues with the same level of experience c) Did not give an appropriate level of care as defined by the NZNO standards for nursing practice d) Did not give an appropriate level of care as defined by the NZNO code of practice for nurses

a) Failed to do what another careful registered nurse would have done in a similar situation Negligence is judged by standard of care.

Ageism is an important concept for the nurse to understand because it: a) May damage the self-esteem of the elderly b) Increases social awareness of the needs of the elderly c) Provides statistical information regarding the elderly population d) Promotes consideration of the diversity of the elderly population

a) May damage the self-esteem of the elderly Ageism negatively impacts elderly persons' dignity and self-worth.

A middle aged woman enjoys orienting new young women and men at work. She enjoys being a teacher and mentor and feels she should pass down her legacy of knowledge and skills to the younger generation. The nurse recognizes that the woman is involved in the behaviour described by Erikson as: a) Generativity b) Ego integrity c) Identification d) Valuing wisdom

a) Generativity Erikson's generativity vs stagnation stage involves mentoring next generation.

For the nursing council to find a registered nurse guilt of malpractice following an assault on a client, it would have to prove that the nurse: a) Intended to cause bodily harm to the client b) Actually assaulted the client c) Did not establish a therapeutic relationship with the client d) Committed a felony against the client

b) Actually assaulted the client Malpractice requires proof that the act occurred.

Emergency interventions for a victim with upper torso injuries or face, head, or neck trauma include: a) Suctioning to clear the airway b) Immobilization of the cervical spine c) Administration of supplemental oxygen d) Ensuring venous access with at least two large bore IV lines

b) Immobilization of the cervical spine C-spine protection is critical in head/neck trauma.

An employee spilled industrial acids on his arms and legs at work. The appropriate action by the occupational nurse at the facility is to: a) Apply cool compresses to the area of exposure b) Apply an alkaline solution to the affected area c) Cover the affected area with dry, sterile dressings d) Flush the substance with large amounts of tap water

d) Flush the substance with large amounts of tap water Immediate dilution and removal of chemical is priority.

According to the Privacy Act 1993, when collecting health information from a client the nurse must: a) Ensure the client is aware that health information is being collected b) Tell the client why health information is being collected c) Inform the client about their rights of access and correction d) All of the above

d) All of the above Privacy Act requires all these elements of informed consent.

An example of the use of primary prevention for family violence is: a) Working to eliminate the glamorisation of violence on television b) Counselling a woman living in an abusive relationship about available shelter programs c) Calling child protective services regarding a school age child who has reported sexual attacks by her stepfather d) Carefully examining the skin of an elder who has just returned to an extended care facility following a weekend with his children

a) Working to eliminate the glamorisation of violence on television Primary prevention addresses root causes before violence occurs.

With a patient who is homosexual, the nurses most appropriate initial action during the pre-interaction phase of the relationship should be to: a) Assist the patient in changing sexual values b) Examine own feelings and anxieties with regard to the patient c) Review the literature pertaining to the human sexual response d) Attempt to identify the underlying reasons for the patients values

b) Examine own feelings and anxieties with regard to the patient Self-awareness is essential in pre-interaction phase.

The nurse judges that the mother understands the term cerebral palsy when she describes it as a term applied to impaired movement resulting from which of the following: a) Injury to the cerebrum caused by viral infection b) Malformed blood vessels in the ventricles caused by inheritance c) Non progressive brain damage caused by injury d) Inflammatory brain disease caused by metabolic imbalances

c) Non progressive brain damage caused by injury Cerebral palsy is non-progressive neurological impairment.

The first symptom of gonorrhoea is usually: a) Lower abdominal pain b) A sore or ulcer on the genitals c) Purulent vaginal discharge in the female d) Urethral discharge in the male

d) Urethral discharge in the male Males typically present with urethral discharge first.

The first symptom of syphilis is a) A generalised rash all over the body b) A sore or ulcer on the genitals c) Abdominal pain in the male d) Purulent vaginal discharge

b) A sore or ulcer on the genitals Primary syphilis presents with painless chancre.

When obtaining a nursing history from parents who are suspected of abusing their child, which of the following characteristics about the parents would the nurse typically find: a) Attentiveness to the child’s needs b) Self-blame for the injury to the child c) Ability to relate child’s developmental achievements d) Evidence of little concern over the extent of the injury.

d) Evidence of little concern over the extent of the injury Abusive parents often minimize injury severity.

A colleague comments: What is the relevance of the Treaty of Waitangi to Maori health? a) Maori people view the Treaty of Waitangi as a health document b) Nursing practice in New Zealand is congruent with the Treaty of Waitangi c) The right to health is guaranteed to Maori under article two of the Treaty of Waitangi d) The right to Maori involvement in health is guaranteed

c) The right to health is guaranteed to Maori under article two of the Treaty of Waitangi Article Two protects Maori health rights

The long term consequences of Chlamydia is most likely to be: a) Menorrhagia b) Chronic vaginitis c) Chronic cervicitis d) Sterility

d) Sterility Untreated Chlamydia can cause pelvic inflammatory disease and infertility.

When describing the effects of insulin on the body to a patient newly diagnosed with diabetes mellitus, the best explanation by the nurse is: a) Insulin promotes the breakdown of fatty tissue into triglycerides, which can be used for energy b) When proteins are taken into the body, insulin promotes their breakdown and conversion to fats c) Insulin stimulates the conversion of stored sugars into blood glucose and the conversion of proteins into glucose d) When carbohydrates, fats, and proteins are eaten, insulin promotes cellular transport and storage of all these nutrients

d) When carbohydrates, fats, and proteins are eaten, insulin promotes cellular transport and storage of all these nutrients Insulin facilitates cellular uptake and storage of all nutrients.

A serious complication of acute malaria is: a) Congested lungs b) Impaired peristalsis c) Anaemia and cachexia d) Fluid and electrolyte imbalance

c) Anaemia and cachexia Malaria destroys red blood cells causing severe anaemia.

A registered nurse stops to assist at the scene of an accident but the injured man dies before the ambulance arrives. The nurse should understand that she: a) Should leave the scene before the ambulance arrives b) Will be covered by her actions by the good Samaritan laws c) Has a legal duty of care to perform at a competent level as a registered nurse d) Should pronounce the person dead at the scene

c) Has a legal duty of care to perform at a competent level as a registered nurse Once care is initiated, professional standard applies.

A client sustained an open fracture of the femur from an automobile accident. For which of the following types of shock should the client be assessed: a) Cardiogenic b) Neurogenic c) Hypovolaemic d) Anaphylactic

c) Hypovolaemic Open fractures cause blood loss leading to hypovolemic shock.

What is the primary goal for the care of a client who is in shock: a) Preserve renal function b) Prevent hypostatic pneumonia c) Maintain adequate vascular tone d) Achieve adequate tissue perfusion

d) Achieve adequate tissue perfusion Primary goal is restoring oxygen delivery to tissues.

Which of the following findings would the nurse most likely note in the client who is in the compensatory stage of shock: a) Decreased urinary output b) Significant hypotension c) Mental confusion d) Tachycardia

d) Tachycardia Compensatory stage shows increased heart rate to maintain cardiac output.

Two days after the fracture of his femur, a client suddenly complains of chest pain and dyspnoea. The nurse also notes some confusion and an elevated temperature. Based on these assessment findings, the nurse suspects which of the following complications: a) Osteomyelitis b) Fat embolism syndrome c) Venous thrombosis d) Compartment syndrome

b) Fat embolism syndrome Classic triad: chest pain, dyspnea, confusion after long bone fracture.

When the nurse asked her client and partner what type of birth control they were planning to use, they stated that since she is breast feeding, they don’t need to have to worry about birth control. The nurse should tell them that: a) They can decide on a method when Cindy stops breast feeding b) No birth control is necessary until after the first menstrual period c) Ovulation can occur when a woman is breast feeding d) Since Cindy has become pregnant once, it will be much easier for her to become pregnant now

c) Ovulation can occur when a woman is breast feeding Breastfeeding is not reliable contraception; ovulation can occur.

During the post-partum period many women experience mood swings which are referred to as: a) Psychosis b) Post partum blues c) Detachment from infant d) Attachment to the infant

b) Post partum blues Temporary mood swings in early postpartum period.

According to Erikson, an infant is in the psychosocial stage that is characterised by the conflict of: a) Trust vs mistrust b) Initiative vs guilt c) Intimacy vs isolation d) Autonomy vs shame and doubt

a) Trust vs mistrust Erikson's first stage occurs in infancy.

Mrs Cindy Jackson, para 1, gravid 1, had a vaginal delivery of a full term baby yesterday. Because of the soreness of her perineum, Cindy states that she is afraid to have a bowel movement. The nurse should encourage Cindy to: a) Ambulate frequently, eat fresh fruits and vegetables, and drink 6 – 8 glasses water per day b) Ask her doctor to prescribe a laxative to stimulate defecation c) Drink 2 glasses of warm water after every meal, then try to defecate d) Do kegel exercises twice a day, eat a low roughage diet, and drink ten glasses of water per day

a) Ambulate frequently, eat fresh fruits and vegetables, and drink 6 – 8 glasses water per day Natural methods to promote bowel function.

Mrs Fredericks is scheduled for exploratory and palliative surgery the next day. Results of blood tests show that she has a microcytic anaemia. Likely causes of microcytic anaemia is: 1. A diet low in iron 2. A diet low in vitamin C 3. Chronic blood loss 4. Acute blood loss 5. Haemolytic streptococcal infection a) 1, 3 and 5 b) 1, 2 and 5 c) 1, 2 and 4 d) 1, 2 and 5

a) 1, 3 and 5 Microcytic anemia caused by iron deficiency, chronic blood loss, and certain infections.

Mrs Fredericks is to have a blood transfusion of two units of packed cells, prior to surgery. She is charted 350mL over three hours through a blood giving set with a drip factor of 15. How many drops per minute will you run the blood at? a) 20 b) 25 c) 30 d) 35

c) 30 Calculation: 350mL ÷ 180 min × 15 drops/mL = 29.2, rounded to 30 drops/min.

If Mrs Frederick’s were to receive blood with which she is incompatible, the signs and symptoms we would see, would include: 1. Restlessness and anxiety 2. Generalised tingling sensations 3. Nausea and vomiting 4. Elevated temperature 5. Decreased blood pressure a) 1, 2 and 3 b) 1, 4 and 5 c) 2, 3 and 5 d) All of the above

d) All of the above Transfusion reaction includes all listed symptoms.

If a client who suffers from cancer of the colon, the most common site of metastases is the: a) Bladder b) Liver c) Spleen d) Pancreas

b) Liver Colon cancer commonly metastasizes to liver via portal circulation.

Which of the following post operative complications may be avoided by pre operative teaching: a) Wound infection b) Wound dehiscence c) Hypostatic pneumonia d) Hypovolaemic shock

c) Hypostatic pneumonia Teaching deep breathing and coughing prevents respiratory complications.

Haemorrhage during the first 12 hours post operatively is termed: a) Primary b) Secondary c) Intermediary d) Reactionary

d) Reactionary Hemorrhage in first 12 hours is reactionary (can also be called primary).

Mary aged 45 years is admitted to the ward for planned surgery. Mary smokes 20 cigarettes a day and drinks three glasses of wine every evening. The significance of this information for you is so that you: a) May teach deep breathing and coughing and relaxation techniques in preparation for surgery b) Be aware of a potentially addictive personality when planning her pain relief post operatively c) Can assist her to break her smoking and drinking habits when in hospital d) May plan to include cigarettes and alcohol in her post-operative regime

a) May teach deep breathing and coughing and relaxation techniques in preparation for surgery Smoking increases respiratory complications; requires preoperative teaching.

Two days later, Mary has a cholecystectomy performed, successfully. On her return to the ward, Mary has an upper abdominal wound with a redivac, a T tube, a nasogastric tube and an intravenous infusion in situ. When carrying out Mary's post-operative exercise regime, which aspect should receive the highest priority: a) Ensuring Mary has privacy and freedom from interruption b) That Mary knows who to breathe and cough and why it is important c) That she knows how to support her wound and that her pain is under control d) That there be no interruption by Mary's family and friends when they visit

c) That she knows how to support her wound and that her pain is under control Wound support and pain control essential for effective postoperative exercises.

Mr Evere, a 69 year old retired musician was admitted to the intensive care unit with a diagnosis of Adams Stokes Syndrome. The nurse notes Mr Evere's pulse pressure is decreasing. Pulse pressure is the: a) Difference between the apical and radial rates b) Force exerted against an arterial wall c) Degree of ventricular contraction in relation to output d) Difference between systolic and diastolic readings

d) Difference between systolic and diastolic readings Pulse pressure = systolic minus diastolic pressure.

The physician suspects cardiogenic shock. Shock is: a) A failure of peripheral circulation b) An irreversible phenomenon c) Always caused by decreased blood volume d) A fleeting reaction to tissue injury

a) A failure of peripheral circulation Shock is circulatory failure resulting in inadequate tissue perfusion.

The physical law explaining the greatly increased venous return accompanying mild vasoconstriction underlies the use of: a) Adrenaline in treating shock b) Rotating tourniquets in pulmonary oedema c) Sympathectomy in treating hypertension d) Digoxin to increase cardiac output

b) Rotating tourniquets in pulmonary oedema Mild vasoconstriction increases venous return.

Culturally safe nursing care can best be achieved when the nurse has: a) An in depth knowledge of the Treaty of Waitangi b) An awareness of Maori perspectives of health c) An awareness and acceptance of your own limits in meeting someone else’s health and cultural needs d) A knowledge of Maori protocol

c) An awareness and acceptance of your own limits in meeting someone else's health and cultural needs Cultural safety begins with self-awareness.

Imagine a new virus infecting a human population for the first time. Which of the following is most likely to lead to a rapid increase in cases worldwide: a) Severe disease with high mortality b) Lack of hand hygiene c) Air travel d) High transmissibility

d) High transmissibility Easy transmission causes rapid worldwide spread.

c) Direct pressure to the injured area continuously for 10 minutes Continuous pressure needed for clotting in hemophilia.

Home health nurses visit a blind diabetic patient who lives along to monitor the patients glucose level and administer the patients daily insulin. Evaluation of outcome management for this patient would include: a) An absence of complications of diabetes b) A reduction in hospitalizations for glycaemic control c) The ability of the patient to learn to use adaptive syringes d) The patients evaluation of the services provided by the nurses

b) A reduction in hospitalizations for glycaemic control Outcome management focuses on reducing complications.

c) Preparation for death with palliative care and comfort are the goals of care Hospice provides comfort-focused end-of-life care.

To better understand fluid balance the nurse needs to recognise that: a) Glomerular filtration occurs in the glomerular which are small arteries in the kidneys b) The volume of urine secreted is regulated mainly by mechanisms that control the glomerular filtration rate c) An increase in the hydrostatic pressure in bowman’s capsule tends to increase the glomerular filtration rate d) A decrease in blood protein concentration tends to increase the glomerular filtration rate

d) A decrease in blood protein concentration tends to increase the glomerular filtration rate Lower plasma protein reduces osmotic pressure, increasing GFR.

The client with unresolved oedema is most likely to develop: a) Thrombus formation b) Tissue ischaemia c) Proteinaemia d) Contractures

b) Tissue ischaemia Prolonged edema impairs tissue perfusion and oxygenation.

Women are more susceptible to urinary tract infection because of: a) Poor hygienic practices b) Length of urethra c) Continuity of the mucous membrane d) Inadequate fluid intakes

b) Length of urethra Shorter female urethra allows easier bacterial access to bladder.

The most important electrolyte of intracellular fluid is: a) Calcium b) Sodium c) Potassium d) Chloride

c) Potassium Potassium is the major intracellular cation.

In encouraging hospitalised clients to void the most basic methods for the nurse to employ is: a) Having the client listen to running water b) Warming a bedpan c) Placing the clients hand in warm water d) Providing privacy

d) Providing privacy Privacy is the most basic need for normal voiding.

Since Mr Saul has right hemiplegia the nurse contributes to his rehabilitation by: a) Making a referral to the physio therapist b) Not moving the affected arm and leg unless necessary c) Beginning active exercise d) Positioning Mr Saul to prevent deformity and decubiti

d) Positioning Mr Saul to prevent deformity and decubiti Proper positioning prevents complications in hemiplegia.

Mr Sauls emotions responses to his illness would probably be determined by: a) His premobid personality b) The location of his lesion c) The care he is receiving d) His ability to understand his illness

a) His premorbid personality Pre-existing personality influences coping with illness.

Mrs Olin, a retired school teacher with rheumatoid arthritis, is admitted to hospital with severe pain and swelling of the joints in both hands. Mrs Olin’s condition would indicate that a primary consideration of her care is: a) Motivation b) Education c) Control of pain d) Surgery

c) Control of pain Pain management is priority in acute rheumatoid arthritis exacerbation.

While taking a nursing history from Mrs Olin, the nurse promotes communication by: a) Asking questions that can be answered by a simple ‘yes’ or ‘no’ b) Telling Mrs Olin there’s no cause for alarm c) Asking ‘why’ and ‘how’ questions’ d) Using broad, open ended statements

d) Using broad, open ended statements Open-ended questions promote communication and information gathering.

Mr and Mrs B were emotionally upset when their baby girl was born with a cleft palate and double cleft lip. The nurse, in order to give the most support to the parents, should: a) Discourage them from talking about the baby b) Encourage them to express their worries and fears c) Tell them not to worry because the defect can be repaired d) Show them post operative photographs of babies who had similar defects

b) Encourage them to express their worries and fears Therapeutic support allows parents to process emotions.

The most critical factor in the immediate care of the baby born with a cleft palate and double cleft lip, after repair of the lip is: a) Maintenance of airway b) Administration of drugs to reduce secretions c) Administration of fluids d) Preventing of vomiting

a) Maintenance of airway Airway is always the critical priority post-cleft lip repair.

Additional nursing care for a baby born with a cleft palate and double cleft lip, after the original lip repair would include: a) Placing the baby in a semi sitting position b) Keeping the infant from crying c) Spoon feeding for the first two days after surgery d) Keeping the baby nil per mouth

a) Placing the baby in a semi sitting position Semi-upright position reduces swelling and protects airway.

Seven year old Johnny has been admitted for a tonsillectomy. The nurse suspects haemorrhage post operatively when Johnny: a) Snores noisily b) Becomes pale c) Complains of thirst d) Swallows frequently

d) Swallows frequently Frequent swallowing indicates blood trickling down throat.

Pitting oedema in the lower extremities occurs with this problem because of the: a) Increase in tissue colloid osmotic pressure b) Increase in the tissue hydrostatic pressure at the arterial end of the capillary bed c) Decrease in the plasma colloid osmotic pressure d) Increase in the plasma hydrostatic pressure at the venous end of the capillary beds

d) Increase in the plasma hydrostatic pressure at the venous end of the capillary beds.

The nurse can best assess the degree of oedema in an extremity by: a) Checking for pitting b) Weighing the client c) Measuring the affected area d) Observing intake and output

c) Measuring the affected area Circumferential measurements provide objective edema assessment.

Mrs Smith is hospitalised with coronary heart disease. She is receiving IV fluids, her vital signs are checked 4 hourly. She is on bed rest. She was also prescribed digoxin. She does not seem to be acutely sick but her prognosis is guarded. Mrs Smith asks what the coronary arteries have to do with her angina. In determining the answer, the nurse should take into consideration that coronary arteries: a) Carry reduced oxygen content blood to the lungs b) Carry blood from aorta to the myocardium c) Supply blood to the endocardium d) Carry high oxygen blood from the lungs towards the heart

b) Carry blood from aorta to the myocardium Coronary arteries supply oxygenated blood to heart muscle.

After activity Mrs Smith states she has angina pain. The nurse should realise that angina pectoris is a sign of: a) Myocardial ischemia b) Myocardial infarction c) Coronary thrombosis d) Mitral insufficiency

a) Myocardial ischemia Angina indicates inadequate oxygen supply to heart muscle.

During therapy with salbutamol (Ventolin) Mr Peters complains of palpitations, chest pain, and a throbbing headache. In view of these symptoms which of the following statements represent the most appropriate nursing action: a) Reassure Mr Peters that these effects are temporary and will subside as he becomes accustomed to the drug b) Withhold the drug until additional orders are obtained from the physician c) Tell him not to worry, he is experiencing expected side effects of medicine d) Ask him to relax, then instruct him to breathe slowly for several minutes

b) Withhold the drug until additional orders are obtained from the physician Palpitations, chest pain, and headache indicate serious adverse effects requiring medical review.

Mr Peters pulmonary function studies are abnormal. The nurse should realise that one of the most common complication of chronic asthma is: A) Atelectasis B) Emphysema C) Pneumothorax D) Pulmonary fibrosis

b) Emphysema Chronic asthma can lead to emphysema from chronic airway inflammation.

Emphysema causes a failure in oxygen supply because of: a) Infectious obstructions b) Respiratory muscle paralysis c) Pleural effusion d) Loss of aerating surface

d) Loss of aerating surface Emphysema destroys alveoli, reducing gas exchange surface area.

When the alveoli loose normal elasticity, the nurse teaches Mr Peters exercises that lead to effective use of the diaphragm because: a) Mr Peters has an increase in the vital capacity of the lungs b) The residual capacity of the lungs has been increased c) Inspiration has been markedly prolonged and difficult d) Abdominal breathing is an effective compensatory mechanism that is spontaneously initiated

b) The residual capacity of the lungs has been increased Loss of elasticity traps air, increasing residual volume; diaphragmatic breathing helps.

Mr Hurt has developed acute renal failure and uraemia. Metabolic acidosis develops in renal failure as a result of: a) depression of respiratory rate by metabolic wastes causing carbon dioxide retention b) inability of renal tubules to secrete hydrogen ions and conserve bicarbonate c) inability of renal tubules to reabsorb water to achieve dilution of acid contents of the blood d) impaired glomerular filtration causing retention of sodium and metabolic waste products

b) Inability of renal tubules to secrete hydrogen ions and conserve bicarbonate Kidneys cannot regulate acid-base balance in renal failure.

Of the following, which is most important in maintaining the fluid and electrolyte balance of the body: a) urinary system b) respiratory system c) antidiuretic hormone (ADH) d) aldosterone

a) Urinary system Kidneys are primary regulators of fluid and electrolyte balance.

To prevent laryngeal spasms and respiratory arrest in a patient who is at risk for hypocalcaemia, an early sign of hypocalcaemia the nurse should assess for is: a) tetany b) confusion c) constipation d) numbness and tingling around the lips or in the fingers

d) Numbness and tingling around the lips or in the fingers Early paresthesias indicate developing hypocalcemia.

A 36 year old woman has been admitted to the hospital for knee surgery. Information obtained by the nurse during the preoperative assessment that should be reported to the surgeon before surgery is performed includes the patients: a) lack of knowledge about postoperative pain control b) knowledge of the possibility of an early, unplanned pregnancy c) history of a postoperative infection following a prior cholecystectomy d) concern that she will be physically limited in caring for her children for a period postoperatively.

b) Knowledge of the possibility of an early, unplanned pregnancy Pregnancy affects surgical planning and anesthesia risk.

A client with Type 1 Diabetes Mellitus is scheduled to have surgery. The client has been nil per mouth since midnight in preparation for the surgery. In the morning before sending the client to the operating room, the nurse notices that the clients daily insulin has not been ordered. Which of the following interventions would be most appropriate for the nurse at this time: a) obtain the clients blood glucose values and evaluate the clients need for insulin b) contact the physician for further orders regarding insulin administration c) give the clients usual morning dose of insulin d) notify the recovery room staff to obtain an order for insulin after the surgery

b) Contact the physician for further orders regarding insulin administration NPO diabetic patients require modified insulin orders.

The nurse monitors a patient receiving high doses of broad spectrum antibiotics for treatment of endocarditis for the development of: a) erysipelas b) candidiasis c) tinea corporis d) verruca vulgaris

b) Candidiasis Broad-spectrum antibiotics disrupt normal flora, allowing fungal overgrowth.

The nurse is evaluating the effectiveness of fluid resuscitation during the emergent period of burn management. Which of the following indicates that adequate fluid replacement has been achieved in the client: a) an increase in body weight b) fluid intake is less than urinary output c) urinary output greater than 35 ml/hr d) blood pressure of 90/60 mm Hg

c) Urinary output greater than 35 ml/hr Adequate urine output (30-50 ml/hr) indicates effective fluid resuscitation,

Cimetidine (tagamet) is prescribed for a patient with major burns. In teaching the patient about the drug, the nurse explains that it is used to prevent the development of: a) diarrhoea b) constipation c) adynamic ileus d) curling’s ulcer

d) Curling's ulcer Cimetidine prevents stress ulcers in burn patients.

A client who has had a transurethral resection of the prostate (TURP) 1 day earlier has a three way foley catheter inserted for continuous bladder irrigation. Which of the following statements best explains why continuous irrigation is used after a TURP: a) to control bleeding in the bladder b) to instill antibiotics into the bladder c) to keep the catheter free from clot obstruction d) to prevent bladder distention

c) To keep the catheter free from clot obstruction Continuous irrigation prevents clot formation and catheter blockage.

A patient in severe respiratory distress is admitted to the medical unit at the hospital. During the admission assessment of the patient, the nurse should: a) perform a comprehensive health history with the patient to determine the extent of prior respiratory problems b) complete a full physical examination to determine the effect of the respiratory distress on other body functions c) delay any physical assessment of the patient and ask family members about the patients history of respiratory problems d) perform a physical assessment of the respiratory system and ask specific questions related to this episode of respiratory distress

d) Perform a physical assessment of the respiratory system and ask specific questions related to this episode of respiratory distress Focus on immediate problem while patient is in distress.

Spinal anaesthesia effects all of the following systems except: a) the sympathetic nervous system b) the sensory system c) the parasympathetic nervous system d) the motor system

c) The parasympathetic nervous system Spinal anesthesia affects sympathetic, sensory, and motor but not parasympathetic.

Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway clearance. The nurse bases this nursing diagnosis on the finding of: a) SpO2 of 85% b) Respiratory rate of 28 c) Presence of greenish sputum d) Crackles in the right and left lower lobes

d) Crackles in the right and left lower lobes Crackles indicate fluid/secretions in airways.

To protect susceptible patients in the hospital from aspiration pneumonia, the nurse: a) Turns and repositions immobile patients every 2 hours b) Positions patients with altered consciousness in lateral positions c) Monitors for respiratory symptoms in those patients who are immunosuppressed d) Plans room assignments to prevent patients with infections from being placed with surgical or chronically ill patients

b) Positions patients with altered consciousness in lateral positions Side-lying position prevents aspiration.

A patient experiences a flail chest as a result of an automobile accident. Which finding during a respiratory assessment would the nurse expect: a) Bloody sputum b) Laryngeal stridor c) Deep, irregular respirations d) Paradoxic chest movement

d) Paradoxic chest movement Flail chest causes paradoxical movement during respiration.

A client is admitted to the emergency room with crushing chest injuries sustained in a car accident. Which of the following signs would indicate a possible pneumothorax: a) Cheyne stokes breathing b) Increased noisy breath sounds c) Diminished or absent breath sounds on the affected side d) A decreased sensation on the affected side

c) Diminished or absent breath sounds on the affected side Pneumothorax prevents air entry to affected lung.

Joan Murray, aged 40 years, discovers a lump in the upper and outer quadrant of her left breast when she is showering one morning. One week later, after being seen by a surgeon, she is admitted to the ward for a biopsy of the lump and possible left radical mastectomy. In establishing a relationship with Joan, what is the most important factor for the nurse to consider. That: a) The diagnosis has not yet been established and the breast lump is not necessarily malignant b) Joan will have many questions about the possible effects of a mastectomy on her sexual identity c) At this time of uncertainty, Joan will need a lot of time to be alone to consider her choices d) Joan will be full of fear about the mass and its possible effects on her being

d) Joan will be full of fear about the mass and its possible effects on her being Acknowledging fear and uncertainty is most important for therapeutic relationship.

Part of Joan’s pre-operative preparation for a left radical mastectomy is practising arm and shoulder exercises. The reason for these exercises are: a) She can be assured of maximum function of her arm and shoulder if these exercises are carried out properly b) That they help reduce the pain and the swelling in the area, after surgery c) To assist peripheral venous return and thus reduce the potential for pulmonary embolus d) By being involved in activities related to her care, Joan is less likely to worry

a) She can be assured of maximum function of her arm and shoulder if these exercises are carried out properly Exercises prevent complications and restore function post-mastectomy.

The reason we position Joan’s affected arm (for a biopsy of the lump and possible left radical mastectomy) the with her elbow at the level of the right atrium and her hand higher than her elbow is to: a) Minimise the development of oedema b) Assist venous return c) Reduce her pain and discomfort d) Ensure that the area is supported

a) Minimise the development of oedema Elevation prevents lymphedema after lymph node removal.

The primary ossification centre of long bone is located in which of the following structures: a) Epiphysis b) Epiphyseal plate c) Diaphysis d) Endosteum

c) Diaphysis Primary ossification occurs in the shaft (diaphysis) of long bones.

The body tissue affected by rheumatoid arthritis is: a) Adipose b) Muscular c) Connective d) Epithelial

c) Connective Rheumatoid arthritis is a connective tissue disease.

The pattern of rheumatoid arthritis is best describe by its: a) Chronicity b) Remissions and exacerbations c) Little relief from aches and pains d) A progressive increase in disability

b) Remissions and exacerbations RA characterized by periods of flare-ups and remissions.

Rheumatoid arthritis is characterized by: a) Bone pain b) Sharp tingling sensations c) Inflammation of the joints d) Pain and swelling of joints

d) Pain and swelling of joints Joint pain and swelling are hallmark symptoms.

Synovial joints are characterized by: a) articular cartilage b) fibrous capsule c) joint cavity d) all of these

d) All of these Synovial joints have articular cartilage, fibrous capsule, and joint cavity.

The major support that the muscular system gets from the cardiovascular system: a) a direct response by controlling the heart rate and the respiratory rate b) constriction of blood vessels and decrease in heart rate for thermoregulatory control c) nutrient and oxygen delivery and carbon dioxide removal d) decreased volume of blood and rate of flow for maximal muscle contraction

c) Nutrient and oxygen delivery and carbon dioxide removal Cardiovascular system provides metabolic support to muscles.

As the nurse assesses Jack for increased intracranial pressure, she would be concerned if she observed: a) change in level of consciousness b) anorexia and thirst c) increased pulse and respiration rates d) blurred vision and halos around lights

a) Change in level of consciousness LOC changes are earliest sign of increased ICP.

A person has just been involved in an accident that affected the medulla oblongata. The body process most directly affected by this would be: a) sight b) hearing c) muscular coordination d) respiration

d) Respiration Medulla oblongata controls vital functions including respiration.

If you are dealing with a person whose phrenic nerve has been damaged, what would you expect to observe: a) reduced diaphragm function b) less mucous secreted by the goblet cells c) decreased elasticity of the lung tissue d) increased coughing

a) Reduced diaphragm function Phrenic nerve innervates the diaphragm.

The spinal cord extends through the vertebral canal from the foramen magnum to the: a) 7th cervical vertebra b) 12th thoracic vertebra c) 2nd lumbar vertebra d) 1st sacral vertebra

c) 2nd lumbar vertebra Spinal cord terminates at L1-L2 level.

Synaptic conduction of a nerve impulse can be affected by: a) Certain diseases b) Drugs c) Changes in pH d) All of these

d) All of these Diseases, drugs, and pH changes all affect synaptic transmission.

Lack of muscle coordination is called: a) Monoplegia b) Ataxia c) TIA d) None of these

b) Ataxia Ataxia is the term for lack of muscle coordination.

Inability of chew might result from damage to which cranial nerve: a) Facial b) Trigeminal c) Abducens d) Vagus

b) Trigeminal Trigeminal nerve (CN V) controls muscles of mastication.

In most people, the left cerebral hemisphere is more important for which of the following: a) Spoken and written language b) Space and pattern perception c) Musical and artistic awareness d) Imagination

a) Spoken and written language Left hemisphere dominant for language in most people.

Which of the following is true concerning the limbic system: a) It is comprised of parts of the cerebrum and diencephalon b) It assumes a primary function in emotions c) Both a and b d) Neither a nor b

c) Both a and b Limbic system includes cerebrum/diencephalon parts and controls emotions.

Coordination of muscular activity is a function of the: a) Cerebral peduncles b) Cerebellum c) Thalamus d) Medulla oblongata

b) Cerebellum Cerebellum coordinates muscular activity and balance.

Which of the following statements is correct: a) Appetite control is a function of the thalamus b) The midbrain is a conduction pathway and reflex centre c) The cerebellum has sensory centres for thirst and speech d) Respiratory centres are located in the basal ganglia

b) The midbrain is a conduction pathway and reflex centre Midbrain serves as pathway and reflex center.

The structure that connects the cerebral hemispheres and facilitates the sharing of cerebral information is the: a) Corpus callosum b) Cingulated sulcus c) Fourth ventricle d) Aqueduct of sylvius

a) Corpus callosum Corpus callosum connects cerebral hemispheres.

The portion of bone laid down first in bone formation is the: a) Matrix b) Calcium salts c) Trabeculae d) Marrow

a) Matrix Organic matrix is laid down first, then mineralized.

The area of the greatest degree of flexibility along with the vertebral column is found from: a) C3 – C7 b) T1 – T6 c) T7 – T12 d) L1 – L5

d) L1 – L5 Lumbar spine has greatest flexibility.

The only ankle bone that articulates with the tibia and the fibula is the: a) Calcaneus b) Talus c) Navicular d) Cuboid

b) Talus Talus articulates with tibia and fibula at ankle.

Severe fractures of the femoral neck have the highest complication rate of any fracture because: a) Primary limits are imposed by the surrounding muscles b) Of the restrictions imposed by ligaments and capsular fibres c) Of the thickness and length of the bone d) The blood supply to the region is relatively delicate

d) The blood supply to the region is relatively delicate Femoral neck has tenuous blood supply, increasing AVN risk.

The purpose of myoglobin in skeletal muscle cells is: a) Assist anaerobic reactions b) Store oxygen for use during vigorous exercise c) Catabolise pyruvic acid d) All of these

b) Store oxygen for use during vigorous exercise Myoglobin binds and stores oxygen in muscle cells.

With a milk product free diet, which of the following supplements would you need: a) Vitamin C and iron b) Iron and phosphorous c) Calcium and manganese d) Vitamin c and riboflavin

c) Calcium and manganese Milk products provide calcium; supplementation needed without dairy.

Protein should be eaten as it: a) Reduces the risk of anaemia b) Ensures an adequate supply of energy c) Assists the body to produce new tissues d) Maintains the body’s protein stores

c) Assists the body to produce new tissues Protein essential for tissue growth and repair.

Risk factors of CVA that cannot be altered are: a) Sex, race, and raised blood cholesterol levels b) High BP, previous TIA c) Race, prior stroke and overweight d) High BP, previous TIA and increased blood cholesterol levels

a) Sex, race, and raised blood cholesterol levels These are non-modifiable risk factors (note: cholesterol listed here is debatable).

A person who has experienced a right CVA may present with: a) Receptive or expressive aphasia b) Right hemiplegia c) Left hemiplegia d) Deficit of new language information

c) Left hemiplegia Right CVA causes left-sided weakness.

Where and what is the Circle of Willis: a) A capillary meshwork found in bowman’s capsule of the nephron b) A vascular network at the base of the brain c) A roundabout at the top of Bank St d) The capsule membrane of a malignant growth

b) A vascular network at the base of the brain Circle of Willis provides collateral circulation to brain.

List the 3 main causes of stroke: a) Cerebral haemorrhage, thrombosis, embolism b) Cerebral thrombosis, infarction, aneurysm c) Cerebral embolism, metastatic lesions, coagulopathy d) Cerebral ischemia, vascular spasms, hypoxia

a) Cerebral haemorrhage, thrombosis, embolism Three main causes of stroke.

Angina symptoms include: a) Radiating pain, decreased BP and increased pulse b) Shortness of breath, loss of consciousness and these effects may last indefinitely c) Ringing in the ears, anxiety and cramping in the extremities d) Shortness of breath, sweating, nausea and tiredness

d) Shortness of breath, sweating, nausea and tiredness Classic angina presentation with associated symptoms.

Emphysema is: a) An alveolar disease b) Due to hypertrophy and hyperplasia of bronchial glands c) Persistent episodes of productive cough d) An airway disease

a) An alveolar disease Emphysema destroys alveolar walls.

Circulatory shock can best be described as a condition in which there is: a) A state of hypotension b) Loss of blood c) Loss of consciousness due to blood loss d) Inadequate blood flow to meet the metabolic needs of the body tissues

d) Inadequate blood flow to meet the metabolic needs of the body tissues Shock is circulatory failure causing inadequate tissue perfusion.

Causes of hypovolemic shock include: a) Vomiting and loss of body fluids b) Allergic reactions to drugs c) Cardiac failure d) Hypoglycaemia

a) Vomiting and loss of body fluids Hypovolemic shock results from fluid volume loss.

Early signs of hypovolemic shock include: a) Restlessness, thirst, and increased heart rate b) Decreased blood pressure and apathy c) Increase in heart rate and increased pulse pressure d) Decreased blood pressure and unconsciousness

a) Restlessness, thirst, and increased heart rate Early compensatory signs of hypovolemic shock.

In shock, one of the best indicators of blood flow to viral organs is: a) Rate of blood and fluid administration b) Blood pressure c) The colour and temperature d) Urine output

d) Urine output Urine output reflects renal perfusion and tissue perfusion.

Oliguria, an early sign of shock, occurs for what reason: a) Cessation of glomerular filtration b) Acute tubular necrosis c) Metabolic acidosis d) Sympathetic stimulation

d) Sympathetic stimulation Sympathetic response shunts blood from kidneys, reducing urine output.

A person admitted to the emergency room with trauma and an estimated blood loss of 1200 to 1400 mls has a blood pressure of 110/70 mmHg and a heart rate of 120 beats per minute. The best explanation for these observations would be that: a) The persons actual blood loss was less than the originally estimated loss b) The person was normally hypertensive and hence did not have as great a drop in blood pressure as a normotensive person c) The cause of the bleeding is now under control and the increased heart rate is due to anxiety d) An increase in heart rate is compensating for the loss of blood volume

d) An increase in heart rate is compensating for the loss of blood volume Tachycardia maintains cardiac output despite volume loss.

The pale, cool, clammy skin that is often observed in an individual with shock, can be explained in terms of: a) Loss of red blood cells b) Body’s attempt to shunt blood to vital organs by constricting skin vessels c) Decreased metabolic needs that accompany shock d) Body’s attempt to conserve heat loss

b) Body's attempt to shunt blood to vital organs by constricting skin vessels Peripheral vasoconstriction redirects blood to vital organs.

____________________ is generally relieved by sitting up in a forward leaning position a) Hyperpnoea b) Orthopnoea c) Apnoea d) Dyspnoea on exertion

b) Orthopnoea Orthopnea is relieved by sitting upright or leaning forward.

In a client with emphysema, hypoventilation could initially cause: a) Respiratory alkalosis b) Respiratory acidosis c) Metabolic acidosis d) Metabolic alkalosis

b) Respiratory acidosis Hypoventilation causes CO2 retention and acidosis.

A client is anxious and is hyperventilating. In order to prevent respiratory alkalosis the nurse will: a) Administer oxygen b) Instruct the client to pant c) Have the client breathe deeply and slowly d) Have the client breathe into a paper bag

d) Have the client breathe into a paper bag Rebreathing CO2 corrects respiratory alkalosis from hyperventilation.

A district nurse is sent to assess a new client with cor pulmonale. This term refers to: a) Enlargement of the pulmonary artery b) Enlargement of the right ventricle c) Atrophy of the right ventricle d) Giant bullae growth on the lung

b) Enlargement of the right ventricle Cor pulmonale is right ventricular hypertrophy from lung disease.

Tony Buffer, 54 years old, has a long history of smoking. He decides to have lung and blood studies done because he is very tired, is short of breath, and just does not feel good. His blood gases reveal the following findings: pH 7.3; HCO3 27; CO2 58. Tony’s condition may be: a) Respiratory alkalosis b) Metabolic acidosis c) Respiratory acidosis d) Metabolic alkalosis

c) Respiratory acidosis Low pH (7.3), elevated CO2 (58) indicates respiratory acidosis.

Approximately 1000ml (1L) of oxygen is transported to cells each minute. Most of the oxygen is transported: a) Dissolved in his plasma b) Loosely bound to its haemoglobin c) In the form of CO2 d) As a free floating molecule

b) Loosely bound to his haemoglobin Most oxygen transported bound to hemoglobin.

Mary a 46 year old woman, is admitted to your ward with a chest infection due to an exacerbation of chronic obstructive pulmonary disease. A person with emphysema is susceptible to respiratory infections primarily because: a) Failure of his bone marrow to produce phagocytic white blood cells b) Retention of tracheobronchial secretions c) Decreased detoxification of body fluids by compressed liver cells d) Persistent mouth breathing associated with dyspnoea

b) Retention of tracheobronchial secretions Mucus retention provides medium for bacterial growth.

Emphysema differs from chronic bronchitis in that: a) Emphysema obstruction results from mucous production and inflammation b) Emphysema obstruction results from changes in lung tissues c) Chronic bronchitis obstruction results from changes in lung tissue d) There are no visual difference between the two conditions

b) Emphysema obstruction results from changes in lung tissues Emphysema involves tissue destruction, bronchitis involves mucus/inflammation.

The tissue change most characteristic of emphysema is: a) Accumulation of pus in the pleural space b) Constriction of capillaries by fibrous tissue c) Filling of air passages by inflammatory coagulum d) Over distension, in elasticity, and rupture of alveoli

d) Over distension, in elasticity, and rupture of alveoli Alveolar destruction is hallmark of emphysema.

Which of the following results of emphysema is primarily responsible for cardiomegaly: a) Hypertrophy of muscles encircling the bronchi b) Increased pressure in the pulmonary circulation c) Decreased number of circulating red blood cells d) Secretion of excessive amounts of pericardial fluids

b) Increased pressure in the pulmonary circulation Pulmonary hypertension causes right heart enlargement.

A 48 year old complains of chest pain. Signs and symptoms that would support a diagnosis of myocardial infarction would include: a) Jugular vein distension and hepatomegaly b) Fever and petechiae over the chest area c) Nausea and vomiting and cool, clammy pale skin d) Pericardial friction rub and absent apical pulse

c) Nausea and vomiting and cool, clammy pale skin Classic MI presentation with autonomic symptoms.

Teaching for the client taking GTN or glycerol with nitrate for angina would include: a) Instructing the client to take the nitro-glycerine regularly b) Explain to the client that a subsequent headache indicates ineffective medication c) Instructing the client to put the tablet on the tongue and swallow after the tablet dissolves d) Teaching the client to take a tablet every 5 minutes (3x) when chest pain occurs

d) Teaching the client to take a tablet every 5 minutes (3x) when chest pain occurs Standard GTN protocol: one tablet every 5 minutes, up to 3 doses.

A female client is diagnosed with unstable angina. The nurse finds her crying because she fears she will become a burden to her husband. Which of the following nursing diagnosis would be most appropriate: a) Impaired verbal communication b) Ineffective family coping c) Relationship difficulties d) Fear due to knowledge deficit

b) Ineffective family coping Fear of being burden indicates coping concerns.

Which of the following steps should a client with periodic angina pain take first when pain occurs at home: a) Take sublingual nitro-glycerine and lie down b) Do mild breathing exercises c) Take an extra long lasting nitrate tablet d) Sit down and relax

a) Take sublingual nitro-glycerine and lie down Immediate GTN use with rest is first action for angina.

The nurse detects premature ventricular contractions and (PVC’s) on the ECG of a client who had a mitral valve replacement 2 days ago. PVC’s may be dangerous because they: a) Significantly increase cardiac workload b) May lead to ventricular tachycardia or fibrillation c) Are the most common cause of myocardial infarction d) Decreased heart rate and blood pressure

b) May lead to ventricular tachycardia or fibrillation PVCs can progress to life-threatening arrhythmias.

A client is admitted to ED following a car accident. He complains of abdominal discomfort. The nurse encourages the client to lie down. The reason for this action is: a) To decrease abdominal pain b) To decrease the risk of dislodging an intra-abdominal clot c) To facilitate peristalsis d) To decrease the risk of peritoneal infection

b) To decrease the risk of dislodging an intra abdominal clot Lying down prevents clot disruption in abdominal injury.

A client sustained moderate concussion. He has a Glasgow Coma Scale score of 7. Which of the following interventions would you include in your care plan: a) Decrease stimuli, monitor vital signs and neurological status nurse him flat on his back b) Gradually increase stimuli, monitor vital signs and neurological status, elevate the head of the bed 60 degrees c) Encourage family involvement, reduce monitoring at night to allow client to rest, elevate the head of the bed 60 degrees d) Decrease stimuli, monitor vital signs and neurological status elevate the head of the bed 30 degrees, positioning the client on his side

d) Decrease stimuli, monitor vital signs and neurological status elevate the head of the bed 30 degrees, positioning the client on his side Proper positioning and monitoring for moderate head injury.

James has sustained a fracture of his left lower leg in a car accident. Classical signs of a fracture may include: a) Intermittent pain, flushing of surrounding tissues and vascular spasm b) Local bone tenderness, soft tissue swelling and inability to use extremity c) Neural compromise, sharp stabbing pain and obvious ischaemia of the extremity d) Blanching, hyperextension and paraesthesia

b) Local bone tenderness, soft tissue swelling and inability to use extremity Classic fracture signs: pain, swelling, loss of function.

Monitoring for compartment syndrome is done by checking for: a) Active movement of the limb b) Colour, warmth, sensation and movement of the extremity c) Pulse and blood pressure changes d) The tightness of the plaster cast

b) Colour, warmth, sensation and movement of the extremity Neurovascular assessment monitors for compartment syndrome.

On assessment the nurse suspects that James is developing compartment syndrome because he complains of: a) Severe pain, motor compromise and a ‘pins and needles’ sensation b) A radiating pain and loss of two point discrimination c) Swelling, muscle atrophy and intermittent paraesthesia d) Dull aching, spasms and lack of fine co ordination

a) Severe pain, motor compromise and a 'pins and needles' sensation Pain, motor deficit, and paresthesias indicate compartment syndrome.

A comminuted fracture is characterised by: a) A partial break in bone continuity b) Injury in which two bones are crushed together c) An injury in which the bone is broken into two or more pieces d) An injury in which the bone fragments have broken through the skin

c) An injury in which the bone is broken into two or more pieces Comminuted fracture has multiple bone fragments.

Type 2 Diabetics: a) Need insulin to maintain homeostasis b) May develop ketoacidosis easily c) May go undetected for years d) Are usually very slim and malnourished

c) May go undetected for years Type 2 diabetes often asymptomatic initially.

Hyperglycaemia: a) Is alright only once in a while b) Due to an over medication of insulin c) If left uncontrolled, this can lead to DKA in Type 1 or HNK in Type 2 d) Also called insulin shock reaction

c) If left uncontrolled, this can lead to DKA in type 1 or HNK in type 2 Uncontrolled hyperglycemia leads to serious complications.

Macrovascular complications of diabetes: a) Occur shortly after the onset of the disease b) Affects coronary, peripheral and cerebral circulation c) Affects the eyes and the kidneys d) Affects sensorimotor and autonomic nerves

b) Affects coronary, peripheral and cerebral circulation Macrovascular complications involve large vessels.

For relief of angina, the client may: a) Call 111 b) Take a dose of glyceryl trinitrate up to 3 times, 5 minutes apart until the pain subsides c) Slowly exercise to the individuals tolerance level d) Take only one dose of glyceryl trinitrate, if this has no effect, call 111

b) Take a dose of glyceryl trinitrate up to 3 times, 5 minutes apart until the pain subsides Standard GTN protocol for angina relief.

Ways to minimise precipitating effects of angina are: a) Avoid over exertion b) Reduce stress c) Avoid overeating d) All above

d) All above Avoiding exertion, stress, and overeating all help prevent angina.

Angina: a) May be referred to as angina majoralis b) Not relieved by rest c) Include chest pain which may radiate down the arms, neck, jaw and back d) Needs immediate medical attention

c) Include chest pain which may radiate down the arms, neck, jaw and back Angina presents with radiating chest pain

A client with multiple fractures is at risk for a fat embolism. What early sign should you monitor for: a) Haematuria b) Mental confusion or restlessness c) Sudden temperature elevation d) Pallor and discoloration at the fracture site

b) Mental confusion or restlessness Early fat embolism sign is altered mental status.

Following an application of a full arm cast a client complains of deep throbbing elbow pain. You note diminished capillary refill in the fingers. You should: a) Notify the doctor immediately and prepare to bivalve the cast b) Cut a window in the cast over the elbow area and check for infection c) Elevate the arm, apply ice packs and assess hourly d) Administer prescribed analgesics and notify the doctor

a) Notify the doctor immediately and prepare to bivalve the cast Diminished perfusion requires immediate cast release.

When assessing a patient at risk for increased intracranial pressure, the first thing you would check is: a) Reaction to pain stimuli b) Papillary function c) Level of consciousness d) Motor function

c) Level of consciousness LOC is earliest and most sensitive indicator of increased ICP.

Papillary dilation occurs when herniating brain tissue: a) Compresses the occulomotor nerve b) Chokes the optic disks c) Stretches the optic nerve d) Paralyses the occulare muscles

a) Compresses the occulomotor nerve Herniation compresses CN III causing pupillary dilation.

Changes in vital signs with increasing intracranial pressure would include: a) Hypotension and tachycardia b) Narrowing pulse pressure and tachypnea c) Hypotension and a pulse deficit d) Widening pulse pressure and bradycardia

d) Widening pulse pressure and bradycardia Cushing's triad includes widening pulse pressure and bradycardia.

Bleeding within the skull results in increased intracranial pressure because: a) Arteries bleed rapidly and profusely b) Bleeding from veins goes undetected c) Spinal fluid is produced more rapidly d) The cranium is a closed, rigid vault

d) The cranium is a closed, rigid vault Rigid skull cannot accommodate increased volume.

What is the most common cause of heart failure (HF): a) Smoking b) Diabetes c) Coronary artery disease d) Family history

c) Coronary artery disease CAD is the leading cause of heart failure.

The action of ACE inhibitors (angiotensin converting enzyme) is: a) Increased urinary output, therefore decreased blood pressure b) Relax blood vessels, therefore decreased vascular resistance c) Strengthens cardiac contraction, therefore increase cardiac output d) Relax cardiac muscle therefore decrease heart rate

b) Relax blood vessels, therefore decreased vascular resistance ACE inhibitors cause vasodilation reducing afterload.

Hyperkalaemia is: a) Increased serum potassium levels b) Increased serum calcium levels c) Increased red blood cell count d) Increased serum chloride levels

a) Increased serum potassium levels Hyperkalemia means elevated potassium.

Manifestations of heart failure are: a) Hepatomegalia, pitted dependant oedema b) Increased serum glucose levels c) Increased appetite and weight gain d) Decreased respiration and dyspnoea

a) Hepatomegalia, pitted dependant oedema Right heart failure causes venous congestion and edema.

Nursing interventions associated with your clients taking loop diuretics such as frusemide are: a) Blood sugar levels, dietary fibre b) Monitoring of weight and K+ levels c) Blood pressure and urinary output d) Make sure your client eats ½ hour following administration

b) Monitoring of weight and K+ levels Loop diuretics cause potassium loss requiring monitoring.

Loop diuretics act by: a) Increasing the blood flow to the glomerular network b) Decreasing the blood flow to the kidneys therefore decreased urinary output c) Increased H2O reabsorption in the distal convoluted tubules of the nephron d) Inhibition complex active pump mechanism therefore increase excretion of electrolytes

d) Inhibition complex active pump mechanism therefore increase excretion of electrolytes Loop diuretics inhibit sodium-potassium-chloride pump.

Blood pressure control is carried out by regulation of smooth muscles via: a) Parasympathetic stimulation b) Parasympathetic and sympathetic stimulation c) Sympathetic stimulation d) None of these

c) Sympathetic stimulation Sympathetic nervous system controls vascular smooth muscle.

The areas of the body that sense blood pressure are known as: a) Baroreceptors b) Chemoreceptors c) Visceroceptors d) None of these

a) Baroreceptors Baroreceptors detect blood pressure changes.

When taking a blood pressure, the first sound picked up by the stethoscope as blood pulses through the artery is the: a) Mean arterial pressure b) Pulse pressure c) Diastolic pressure d) Peak systolic pressure

d) Peak systolic pressure First Korotkoff sound represents systolic pressure.

At any given moment, the systemic circulation contains about _________________ of the total blood volume: a) 10% b) 51% c) 71% d) 91%

c) 71% About 70-75% of blood volume in systemic circulation.

The nurse gets the arterial blood gases report and it shows that a person has hypercapnia. This means that: a) There is an increased blood carbon dioxide b) The blood oxygen level is reduced c) Carbon dioxide has been lost d) There is respiratory alkalosis

a) There is an increased blood carbon dioxide Hypercapnia means elevated CO2 levels.

Gregory, aged 70, was admitted with congestive heart failure. Which of these changes in physiology is present in congestive heart failure: a) Heart muscle degeneration due to old age b) A decrease of blood flow through the heart c) An abnormality in the structure of the heart d) A blood clot forms in one of the heart chambers

b) A decrease of blood flow through the heart CHF involves reduced cardiac output.

Manifestations of right sided heart failure are: a) Fatigue, cyanosis, blood tinged sputum b) Anorexia, complaints of gastrointestinal distress, fatigue and pitted edema c) Dyspnoea, orthopnoea and cyanosis d) Fatigue dependant edema and cough

b) Anorexia, complaints of gastrointestinal distress, fatigue and pitted edema Right-sided failure causes systemic venous congestion.

Nursing intervention necessary prior to the administration of digoxin is: a) Palpation of arterial pulse less than 60 bpm b) Palpation of venous pulse less than 60 bpm c) Palpation of arterial pulse greater than 60 bpm d) Palpation of pedal pulse less than 60 bpm

c) Palpation of arterial pulse greater than 60 bpm Hold digoxin if heart rate below 60 bpm.

Left sided heart failure affects directly the: a) Liver and extremities b) Lungs c) Levels of consciousness d) Lungs and extremities

b) Lungs Left-sided failure causes pulmonary congestion.

Basic nursing objectives in the treatment of HF are: a) Start heparinisation immediately b) Nursing the client in trendlenberg position c) Promote rest therefore decrease workload on heart and decrease H20 accumulation d) Assess levels of consciousness and give 02 61/min via Hudson mask

c) Promote rest therefore decrease workload on heart and decrease H20 accumulation Rest and fluid management are basic HF interventions.

Define a cerebral vascular accident (CVA): a) Sudden loss of consciousness due to a decreased contractility of the cardia b) Loss of brain function due to disruption of blood supply to the brain c) Intermittent spasms of blood vessels interrupting blood flow to the brain d) Neurologic dysfunction due to diminished blood flow to the cranium

b) Loss of brain function due to disruption of blood supply to the brain CVA is interrupted cerebral blood flow.

Cerebral thrombosis is: a) Most common cause of a stroke b) Originates from a large vessel and lodges in the brain c) May be caused by an arterial spasm in the brain d) Usually occurs during strenuous exercise

a) Most common cause of a stroke Thrombosis is the most common stroke etiology.

The term blue bloater refers to: a) Decreased erythropoietin production therefore decreased 02 carrying capability of the RBC b) Polycythaemia and cyanosis from right ventricular failure c) Cyanosis due to decreased RBC production d) Increased BP due to high blood volume or fluid overload

b) Polycythaemia and cyanosis from right ventricular failure Blue bloater describes chronic bronchitis with cor pulmonale.

Bronchitis is: a) Results from a breakdown in the normal lung defence mechanisms b) Destruction of alveolar c) Due to enlarged terminal non respiratory bronchioles and alveolar walls d) History of daily productive cough that last at least 3 months, for 2 years

d) History of daily productive cough that last at least 3 months, for 2 years Classic definition of chronic bronchitis.

Emphysema is characterised by: a) Fat people due to decreased activity tolerance b) Unproductive cough and pursed lip breathing c) Pursed lip breathing and productive cough d) Blue bloater, normal skin colour and rapid respirations

b) Unproductive cough and pursed lip breathing Emphysema typically has dry cough and pursed-lip breathing.

Nursing interventions for the CORD patient include everyone of these except: a) Improve ventilation b) Remove secretions c) Prevent complications d) Promote cooperation and understanding e) Encourage exercise to test tolerance levels

e) Encourage exercise to test tolerance levels Exercise within tolerance, not to test limits.

Bronchodilators: a) Aid the movement of secretions b) Liquefy the sputum therefore increase expectoration c) Include aminophylline for the acute exacerbation d) Are only used in emergency cases

c) Include aminophylline for the acute exacerbation Aminophylline is a bronchodilator used acutely.

Corticosteroids are used: a) Prophylactically in most cases b) To aid in vitamin D synthesis c) To aid the liquefaction and expectoration of sputum d) Used during the acute exacerbation of COPD

d) Used during the acute exacerbation of CORD Corticosteroids treat acute COPD exacerbations.

Pursed lip and diaphragmatic breathing: a) Calms the anxious client b) Speed up slow respirations and used to promote effective coughing c) Prevents bronchiolar collapse and air trapping d) Encourages longer inhalation and faster exhalation

c) Prevents bronchiolar collapse and air trapping Pursed-lip breathing maintains positive airway pressure.

Percussion, vibration and postural drainage: a) Is effective management of nursing frustrations b) Promotes loosening secretions and movement out of airway c) Increases blood supply to area therefore increased expectoration d) Should be done prior to all meals

b) Promotes loosening secretions and movement out of airway Chest physiotherapy mobilizes secretions.

A normal blood sugar level (BSL) is a) 7.35 – 7.45 b) 120 – 160 mm dL c) 4 - 8 mmol/l d) +/- 2 mmEq

c) 4 - 8 mmol/l Normal blood glucose range in mmol/L.

Diabetes is: a) An exocrine disorder b) Decreased production of insulin by the liver c) An endocrine disorder d) Decreased secretion of insulin by the alpha cells in the pancreas

c) An endocrine disorder Diabetes is an endocrine disorder of insulin regulation.

Type I Diabetics are characterised by: a) Non-Insulin dependence b) Majority of the diabetic population c) Require hypoglycaemic agents to maintain glucose levels d) Need insulin to maintain normal BSL

d) Need insulin to maintain normal BSL Type 1 diabetes requires insulin replacement.

Angina is: a) Caused by a sudden blockage of one of the coronary arteries b) Caused by anaerobic metabolism exciting pain receptors c) Causes cardiac tissue necrosis and scaring d) Interferes with cardiac contractility

b) Caused by anaerobic metabolism exciting pain receptors Angina pain results from anaerobic metabolism during ischemia.

Myocardial infarction (MI): a) Causes irreversible tissue damage b) The final extent of the damage depends on the ability of the surrounding tissue to recruit collateral circulation c) 15% of all MIs are silent d) All the above

d) All of the above MI causes irreversible damage, extent depends on collateral circulation, and 15% are silent.

MIs may be caused by: a) A formation of a thrombus in a coronary artery b) Sudden progression of atherosclerotic changes c) Prolong constriction of the arteries d) All of the above

d) All of the above MI can be caused by thrombus, atherosclerotic progression, or arterial constriction.

Manifestations of an MI are: a) Bradycardia b) Necrosis of a portion of the myocardium c) Treated only by bypass surgery d) Not seen on an ECG for 24 hours

b) Necrosis of a portion of the myocardium MI results in myocardial tissue death.

Medications which are of the utmost importance for a patient following an MI are: a) 02 b) Stool softeners c) Morphine d) All of the above

d) All of the above Oxygen, stool softeners (prevent straining), and morphine (pain relief) all important post-MI.

Antidiuretic hormone is: a) Secreted by the posterior pituitary b) Increases glomerular filtration rate c) Increases urinary output d) Secreted by the hypothalamus

a) Secreted by the posterior pituitary ADH is produced in hypothalamus but secreted by posterior pituitary.

The renal system maintains homeostasis by: a) Maintaining electrolyte balances b) Maintenance of blood volume c) Conversion of vitamin D for calcium reabsorption d) All of the above

d) All of the above Kidneys regulate electrolytes, blood volume, and activate Vitamin D.

Prerenal failure may be caused by: a) Burns b) Nephrotoxic drugs c) Multiple transfusions d) Renal calculi

a) Burns Burns cause prerenal failure through hypovolemia.

Acute renal failure (ARF) is a) Incurable b) Only curable by kidney transplantation c) Occurs suddenly and may be reversible d) Characterised by polyuria

c) Occurs suddenly and may be reversible ARF has acute onset and is potentially reversible.

Chronic renal failure (CRF) a) Occurs suddenly and is reversible b) Occurs over a long period of time and is reversible c) Occurs over a long period of time and is irreversible d) Is a nuisance by not fatal

c) Occurs over a long period of time and is irreversible CRF is progressive and irreversible kidney damage.

Chronic renal failure may be characterised by: a) Lethargy, mental confusion b) Headaches, GI symptoms c) General weakness and bleeding tendencies d) All of the above

d) All of the above CRF causes lethargy, confusion, headaches, GI symptoms, weakness, and bleeding.

Problems associated with Chronic Renal Failure (CRF) are a) Polycythaemia b) Metabolic alkalosis c) Accentuated sex drive d) Reduced healing, susceptibility to infections

d) Reduced healing, susceptibility to infections CRF impairs immune function and healing.

Nursing interventions with a client with renal failure includes: a) Increase dietary protein b) Increase fluid intake c) Increase potassium intake d) Maintain adequate nutritional status and decrease the metabolic demands

d) Maintain adequate nutritional status and decrease the metabolic demands Nutrition support while reducing metabolic waste production.

Malignant tumours have: a) Irregular shapes with poorly defined borders b) Cells similar to their parent cells c) Expansive growth d) Fibrous capsule

a) Irregular shapes with poorly defined borders Malignant tumors have irregular, infiltrative borders.

Which of the following are not malignant: a) Sarcoma b) Metastases c) Neoplasm d) Benign

d) Benign Benign tumors are not malignant.

Side effects of radiotherapy include: a) Burns, lethargy b) Alopecia c) Increased rate of cell division d) Increased WBC production

a) Burns, lethargy Common radiotherapy side effects include skin burns and fatigue.

Cytotoxic therapy: a) Is used only as a last resort – a palliative care b) May be used in conjunction with radiotherapy c) Not to be given if radiotherapy is anticipated d) Is used if surgery is impossible

b) May be used in conjunction with radiotherapy Chemotherapy often combined with radiation therapy.

Chemotherapy acts by: a) Attacking existing malignant cells and kills tumours b) Decreases the blood supply to the tumour c) Interferes with the cell division d) Increases the clients feelings of wellness therefore giving a boost to cancer patients

c) Interferes with the cell division Chemotherapy disrupts cell division process.

Cancer clients pain is assessed by: a) The doctor b) The health care team c) The client d) The family

c) The client Pain is subjective; client is best assessor.

If paracetamol is no longer effective in the treatment of malignant pain: a) Strong opioids are prescribed b) The end is near c) Weak opioids and/or NSAIDS may be prescribed d) The client needs hospitalisation for pain control

c) Weak opioids and/or NSAIDS may be prescribed WHO ladder progresses from simple to weak to strong analgesics.

Important components of pain assessment include: a) Site of pain b) Onset and patterns c) Current therapy and effect d) All of the above

d) All of the above Comprehensive pain assessment includes site, onset/patterns, and current therapy.

The world health organisations (WHO) analgesia ladder is: a) A systematic tool used for the identification of medications to prescribe for patients with cancer pain b) Initial treatment includes simple analgesics, to progression of mild opioids to strong opioids c) Opioids may be used in conjunction with anticonvulsant and antidepressant drugs to promote effectiveness d) All of the above

d) All of the above WHO ladder is systematic approach from simple to strong opioids with adjuvants.

If your client is experiencing break through pain: a) They are not administering their medications correctly b) Morphine should only be taken when pain is experienced c) They may require a quick release morphine titrated to alleviate their pain d) Start an IV and double the dose of morphine

c) They may require a quick release morphine titrated to alleviate their pain Breakthrough pain requires immediate-release opioids.

Potential side effects of morphine administration for the alleviation of malignant pain are a) Addiction b) Constipation, nausea and vomiting c) Antisocial behaviour d) Once the maximum dose of morphine is reached, the pain may no longer be controlled

b) Constipation, nausea and vomiting Common morphine side effects; addiction not concern in pain management.

When an arterial blood gas (ABG) sample is taken, the initial nursing intervention should be: a) Assessing the movement of the extremity b) Applying pressure to prevent an arterial bleed c) Calming and educating the client to alleviate anxiety d) All the above

b) Applying pressure to prevent an arterial bleed Immediate pressure prevents arterial bleeding after ABG.

Normal oxygen saturation values are: a) 80-100% saturation b) 70-90% saturation c) 90-100% saturation d) 100% saturation

c) 90-100% saturation Normal oxygen saturation range.

Which patient is at highest risk for pulmonary embolus: a) A 25 year old man with a history of alcohol abuse recuperating from a gastric ulcer b) A 36 year old woman on a liquid diet beginning an exercise programme c) A 40 year old, obese, pregnant woman place on bed rest d) A 90 year old man with no identified health problems

c) A 40 year old, obese, pregnant woman place on bed rest Multiple risk factors: obesity, pregnancy, immobility.

b) Local bone tenderness, soft tissue swelling and inability to use extremity Classic fracture presentation.

b) Colour, warmth, sensation and movement of the extremity Neurovascular assessment monitors compartment syndrome.

On assessment, the nurse suspects that James is developing compartment syndrome because he complains of: a) Severe pain, motor compromise and a ‘pins and needles’ sensation b) A radiating pain and loss of two point discrimination c) Swelling, muscle atrophy and intermittent paraesthesia d) Dull aching, spasms and lack of fine co-ordination

a) Severe pain, motor compromise and a 'pins and needles' sensation Classic compartment syndrome signs.

Uraemia is a clinical syndrome associated with: a) Retention of urea and other nitrogenous wastes b) The presence of urine in the blood c) The presence of blood in the urine d) High ammonia excretion

a) Retention of urea and other nitrogenous wastes Uremia is accumulation of waste products.

Spinal anaesthesia is inserted into the: a) Intravenous space b) Sacral canal c) Dural membrane d) Subarachnoid space

d) Subarachnoid space Spinal anesthesia injected into subarachnoid space.

To monitor abdominal distension, you would: a) Assess bowel sounds every shift b) Measure abdominal girth at the umbilicus every 24 hours c) Measure abdominal girth every shift, using two fixed points d) Weigh the patient every shift

c) Measure abdominal girth every shift, using two fixed points Consistent measurement points ensure accuracy.

The fluid outside the vascular system, which surrounds tissue cells, and which includes lymph is called: a) Interstitial fluid b) Extracellular fluid c) Intravascular fluid d) Intracellular fluid

a) Interstitial fluid Fluid surrounding tissue cells is interstitial fluid.

When there is a decrease in blood volume (as in dehydration or blood loss), the body reacts by retaining sodium and thus water. This occurs mainly as a result of adrenal gland secretion of: a) Aldosterone b) Antidiuretic hormone (ADH) c) Cortisol d) Parathyroid hormone

a) Aldosterone Aldosterone promotes sodium and water retention.

Which of the following is a defining characteristic for a nursing diagnosis of ‘fluid volume deficit’: a) Distended neck veins b) Weak, rapid pulse c) Moist rales in lungs d) Bounding, full pulse

b) Weak, rapid pulse Fluid volume deficit causes compensatory tachycardia.

The nurse should assess carefully for hypervolaemia, (fluid volume excess) when working with the client with: a) Nausea and vomiting b) Kidney failure c) Decreased fluid intake d) Blood loss

b) Kidney failure Renal failure causes fluid retention and overload.

Which is probably the most accurate indication of a client's fluid balance status: a) Intake and output record b) Skin turgor c) Daily weight d) Complete blood count

c) Daily weight Weight is most accurate fluid balance indicator.

When you check the time tape on your clients IV bag, you note that the proper amount has not been infused. The prescribed rate is 200 ml/hour, but in the past hour only 100 ml have infused. Your first action should be to: a) Call the physician for a new order b) Adjust the roller clamp and increase the rate to 300 ml/hour to ‘catch up’ c) Restart the IV at a different site d) Count the drops per minute to be sure it is running at a rate of 200 ml/hour

d) Count the drops per minute to be sure it is running at a rate of 200 ml/hour First assess and correct current rate before other actions.

In evaluating for complications of IV therapy, which of the following are evidence that the IV has infiltrated: a) In the past hour, only 50 ml of fluid have infused b) The insertion site is red, hot and swollen c) The clients temperature has gone up to 38.0C d) The site is pale, cool, swollen and painful

d) The site is pale, cool, swollen and painful Classic infiltration signs.

Swelling and paleness of the skin at the venepuncture site could be indicative of: a) Infiltration b) Phlebitis c) Infection d) Air embolism

a) Infiltration Pale, swollen site indicates IV infiltration.

Mr Smith is to have one litre of normal saline IV over 6 hours. The giving set has a drop factor of 10. The correct flow rate would be: a) 14 dpm b) 28 dpm c) 140 dpm d) 280 dpm

b) 28 dpm Calculation: 1000mL ÷ 360min × 10 drops/mL = 27.8, rounded to 28 dpm.

John has been prescribed dextrose/saline 125 mL per hour IV. The giving set has a drop factor of 60. The correct flow rate would be: a) 125 dpm b) 120 dpm c) 60 dpm d) 65 dpm

a) 125 dpm Calculation: 125mL/hr × 60 drops/mL ÷ 60min = 125 dpm.

Hone has been prescribed Plasmolyte 500 mL over 2 hours IV. The giving set has a drop factor of 10. The correct flow rate would be: a) 24 dpm b) 42 dpm c) 84 dpm d) 48 dpm

b) 42 dpm Calculation: 500mL ÷ 120min × 10 drops/mL = 41.7, rounded to 42 dpm.

The optimal position for the comatose patient is: a) Prone b) Supine c) Semi fowlers d) Side lying e) High semi fowlers

d) Side lying Side-lying position protects airway in comatose patients.

Which of the following would a nurse be testing if she asked a 65 year old patient questions like, ‘what day is it’, ‘what time is it’, ‘what month is it’: a) Intelligence b) Perception c) Orientation d) Personality

c) Orientation Questions about time and place assess orientation.

When a person experiences loss or decreased sensation of pain, temperature and touch, the major nursing concern will be meeting their need for: a) Communication b) Nutrition c) Safety d) Belonging

c) Safety Loss of protective sensation creates safety risk.

When caring for a patient with aphasia, you should: a) Talk loudly so she can hear you b) Refrain from giving explanations about procedures c) Provide as much environmental stimuli as possible to prevent feelings of isolation d) Consider the type that the person has and adapt communications methods accordingly

d) Consider the type that the person has and adapt communications methods accordingly Communication adapted to specific aphasia type.

Narcotics are given as pre anaesthetic medications to: a) Decrease oral secretions b) Reduce the risk of intra operation DUT c) Decrease postoperative pain d) Reduce postoperative nausea and vomiting

c) Decrease postoperative pain Narcotics provide preemptive analgesia.

Clinical manifestations of hypovolaemic shock include all except: a) A fall in blood pressure b) A decreased urinary output c) A weak, rapid, thread pulse d) Warm, moist skin

d) Warm, moist skin Hypovolemic shock causes cool, clammy skin not warm, moist.

Your client's physician writes an order for antibiotics stat that you feel is too high a dosage for that client. What should your reaction to this order be: a) Administer the drug as prescribed since the physician is legally responsible for any mistakes in the order b) Check with the prescribing physician before administering the drug c) Administer the drug first since it is a stat drug, and then check with the physician d) Check with the client about dosages administered to him in the past and compare this response to the ordered dosage

b) Check with the prescribing physician before administering the drug Question inappropriate orders before administration.

Miss Blake has suddenly had a cardiac arrest. What is the critical time period that the nurse must keep in mind before irreversible brain damage occurs: a) 1-3 minutes b) 8-10 minutes c) 2-4 minutes d) 4-6 minutes

d) 4-6 minutes Brain damage begins after 4-6 minutes without oxygen.

David white is in the hospital with a medical diagnosis of viral pneumonia. He is getting oxygen via a simple face mask. Why must it fit snugly over the client's face: a) Prevents mask movement and consequent skin breakdown b) Helps the client feel secure c) Maintains carbon dioxide retention d) Aids in maintaining expected oxygen delivery

d) Aids in maintaining expected oxygen delivery Proper fit ensures correct oxygen concentration.

The Heimlich manoeuvre is described in which of the following statements: a) Arms encircling persons waist from behind with firm abdominal thrusts b) Quick, forceful blow with fist on clients sternum c) Sweeping out foreign objects from clients mouth with fingers d) Sharp blow on centre of clients back

a) Arms encircling persons waist from behind with firm abdominal thrusts Heimlich maneuver description.

In teaching a patient about foods that affect his fluid balance, the nurse will keep in mind that the electrolyte which primarily controls water distribution throughout the body is: a) Sodium b) Potassium c) Calcium d) Magnesium

a) Sodium Sodium is primary electrolyte controlling water distribution.

Mrs Zikes is receiving frequent medication. Which of the following would be the correct identification procedure: a) Check the identification bracelet and call Mrs Zikes by name b) Check the name on the foot of the bed, and check the identification bracelet c) Call Mrs Zikes by name, this is all that is needed d) Ask Mrs Zikes her name, and check her identification bracelet

d) Ask Mrs Zikes her name, and check her identification bracelet Two identifiers verify correct patient.

When you answer the clients call light, you note that he has suffered a wound evisceration. Your response will be to: a) Call the physician immediately for offers. Do not touch the wound b) Cover the wound with sterile dressing, call the lab to do a culture and then call the physician c) Cover the wound with sterile, saline soaked towels and immediately notify the physician d) Take the clients vital signs, cover the wound with a sterile towel and call the physician

c) Cover the wound with sterile, saline soaked towels and immediately notify the physician Evisceration requires moist sterile covering and immediate medical attention.

Which surgical consent would NOT be considered legal: a) Consent signed by a 36 year old lady one hour after receiving her preoperative medication of morphine b) Consent signed by 21 year old man who has fractured leg due to an auto accident c) Telephone consent from the father to perform an emergency surgery on a 17 year old girl d) Consent signed by a 60 year old man the evening prior to surgery and prior to his evening sedative

a) Consent signed by a 36 year old lady one hour after receiving her preoperative medication of morphine Cannot give informed consent after premedication.

Which statement by the nurse would be most therapeutic when the client says, ‘My friend has a terrible scar from her surgery’: a) Don’t worry, your surgeon is very good b) You need the surgery, and a little scarring is okay c) Are you concerned about how your surgical scar will look d) I wouldn’t worry about that right now, all people are different

c) Are you concerned about how your surgical scar will look Therapeutic response explores patient's concerns.

Several screening tests are performed on clients preoperatively. Which test demonstrates the presence of bleeding or anaemia: a) An elevated white blood cell count b) Decreased haemoglobin and haematocrit c) Elevated blood urea nitrogen d) Hypokalaemia

b) Decreased haemoglobin and haematocrit Low H&H indicates bleeding or anemia.

Leg exercises are taught to clients in order to increase venous return and prevent thrombophlebitis. Which step of this procedure is incorrect: a) Alternately dorsiflex and plantar flex toes b) Flex and extend the knee c) Raise and lower each leg d) Repeat exercise every one to two hours

d) Repeat exercise every one to two hours Should be more frequent than every 1-2 hours.

Two days post-surgery Ms Daniels continues to complain of pain. There are a number of interventions available for pain relief. Which comfort measure has the potential of increasing Ms Daniels risk for cardiovascular complications: a) Turn Ms D every two hours b) Place pillows under Ms D’s knees c) Splint Ms D’s abdomen when she coughs d) Encourage ambulation as tolerated

b) Place pillows under Ms D's knees Pillows under knees can impair circulation and increase DVT risk.

Your client develops a fever and complaints of calf pain over an area that is red and swollen. Nursing interventions for thrombophlebitis will include all except: a) Elevate the affected leg to heart level b) Maintain bedrest as ordered c) Measure bilateral calf circumference every shift d) Massage the affected calf

d) Massage the affected calf Never massage thrombophlebitis; may dislodge clot.

Which of the following is an autonomic nervous system response to acute pain: a) Decreased heart rate b) Decreased depth of respiration c) Pupil constriction d) Increased blood pressure

d) Increased blood pressure Acute pain activates sympathetic response increasing BP.

Which of the following is a natural opiate of the brain involved in the analgesic system: a) Endorphins b) Histamine c) Collagenase d) Neurotensin

a) Endorphins Endorphins are natural opiates in the brain.

Judgement and caution must be used when non-pharmacologic interventions are applied in the treatment of acute pain because: a) No proof exists that they work b) They are very expensive to implement c) They are outside the scope of nursing practice d) They do not guarantee pain relief

d) They do not guarantee pain relief Non-pharmacologic methods adjunct but not guaranteed.

If morphine is given intravenously, regularly as post-operative analgesia for 10 days to a multiple trauma patient, what is the possibility that this patient would become addicted to the narcotic: a) Almost never b) Sometimes c) Often d) Almost always

a) Almost never Addiction rare when opioids used for legitimate pain management.

A malignant neoplasm: a) Grows very slowly b) Is usually surrounded by a well defined capsule c) Consists of cells that only form tissues in a very disorganised manner d) Is composed of goblet cells

c) Consists of cells that only form tissues in a very disorganised manner Malignant cells lack normal organization.

Which of the following characteristics generally differentiate malignant tumours from benign tumours: 1. Lack of a capsule 2. More rapid growth 3. Infiltrates normal tissues 4. Respects other cells boundaries a) 1, 2 and 3 b) 1, 2 and 4 c) 1, 3 and 4 d) 2, 3 and 4

a) 1, 2 and 3 Malignant tumors lack capsule, grow rapidly, infiltrate tissues.

Malignant tumours and leukaemias may be treated with chemotherapy. The primary aims of this therapy is to: 1. Attack newly developing cancer cells 2. Reduce the size of a tumour 3. Build up a person’s defence system 4. Reduce the oxygen bearing capacity of the blood 5. Destroy cancer cells and leave normal cells a) 1, 2 and 3 b) 1, 2 and 5 c) 2, 3 and 4 d) 2, 3 and 5

b) 1, 2 and 5 Chemotherapy aims to attack cancer cells, reduce tumor size, destroy cancer while sparing normal cells.

During chemotherapy, soreness of the mouth and anus may develop because: a) The effects of the chemotherapeutic agents concentrate in these body areas b) These tissues normally divide rapidly and are damaged by chemotherapeutic agents c) The entire GI tract is involved because of the direct irritating effects of chemotherapy d) The tissues have become damaged from prolonged vomiting and diarrhoea

b) These tissues normally divide rapidly and are damaged by chemotherapeutic agents Rapidly dividing normal cells (mouth, GI tract) affected by chemotherapy.

Which of the following should be considered in order to avoid skin reactions following radiotherapy: 1. Not to apply ointments or lotions 2. Not to vigorously dry the skin 3. To apply powder p.r.n 4. To keep the skin area dry, open to air 5. To avoid exposure to sunlight a) 1, 2 and 3 b) 2, 3 and 5 c) 3, 4 and 5 d) 1, 2, 4 and 5 e) 2, 3, 4 and 5

d) 1, 2, 4 and 5 Avoid lotions, vigorous drying, keep dry, avoid sun exposure.

A common problem after open cholecystectomy is shallow breathing. This is mainly due to: a) The site of the incision making breathing painful b) Damage to the phrenic nerves during surgery c) The obese state of most patients pre operatively d) Inadequate preoperative instruction

a) The site of the incision making breathing painful Upper abdominal incisions make deep breathing painful.

Chest problems may best be prevented after cholecystectomy by: 1. Giving the patient oxygen 2. Regular deep breathing and coughing 3. Keeping the patients pain minimised 4. Prophylactic antibiotic therapy 5. Keeping the patient rested and warm a) 1 and 3 b) 1 and 4 c) 2 and 3 d) 2 and 4

c) 2 and 3 Deep breathing/coughing and pain control prevent respiratory complications.

Your client suffers from nausea and vomiting in the early post operative period. Vomiting at this time is most likely due to: a) Volvulus b) Phrenic irritation c) Effect of anaesthetic d) Paralytic ileus

c) Effect of anaesthetic Early postoperative nausea typically from anesthesia.

Mrs S is scheduled for a cholecystectomy and asks you how she will manage without a gallbladder. Your best reply is: a) Dilute bile will still pass into your digestive tract but will be less efficient at digesting fat b) Your liver will no longer produce bile now so you must stay strictly off fatty foods c) Your gallbladder was not a very important organ and you will not miss it d) You can take a bile supplement in your diet to compensate

a) Dilute bile will still pass into your digestive tract but will be less efficient at digesting fat Bile flows directly from liver without concentration.

An intravenous infusion of 500 ml dextrose/saline through a metriset infusion set (60 drops per ml) is ordered to run over 6 hours. Calculate the drops per minute: a) 137 b) 36 c) 60 d) 83

d) 83 Calculation: 500mL ÷ 360min × 60 drops/mL = 83.3, rounded to 83 dpm.

An injection of morphine 7.5 mg is required – on hand are ampoules containing 10 mg per ml. Calculate the volume to be drawn up: a) 0.5 ml b) 0.6 ml c) 0.65 ml d) 0.7 ml e) 0.75 ml

e) 0.75 ml Calculation: 7.5mg ÷ 10mg/mL = 0.75mL.

Your patient is charted 1 L normal saline 12 hourly via an IV line (drop factor 10). Calculate the correct drops per minute (d.p.m): a) 8 b) 12 c) 14 d) 20 e) 24

c) 14 Calculation: 1000mL ÷ 720min × 10 drops/mL = 13.9, rounded to 14 dpm.

If the drop factor is 15, how fast should an infusion of 1000 ml normal saline run over 10 hours: a) 15 dpm b) 20 dpm c) 25 dpm d) 40 dpm

c) 25 dpm Calculation: 1000mL ÷ 600min × 15 drops/mL = 25 dpm.

Mrs Graham is an active, retired 62 year old. She has been admitted for investigation of possible renal calculi. Which of the following investigations would be most useful in confirming Mrs G’s provisional diagnosis of renal calculi: a) Cystoscopy b) Intravenous pyelogram c) Renal biopsy d) Urinary electrolytes

b) Intravenous pyelogram IVP best visualizes kidney stones.

Mrs S, aged 56, has undergone elective abdominal surgery. In the evening of the day of surgery she feels that she wants to pass urine but is unable to do so. The nurse could best assist her to micturate by: 1. Applying manual pressure to the suprapubic region 2. Assisting her to sit at the edge of the bed and use a pan 3. Encouraging her to increase her fluid intake 4. Changing her position, ensuring comfort and giving pain relief 5. Emptying her bladder to give relief by use of a urinary catheter a) 1 and 3 b) 1 and 4 c) 2 and 3 d) 2 and 4

d) 2 and 4 Position change, comfort, and pain relief promote voiding.

Critical thinking skills that assist the nurse in appropriately setting priorities are which type of nursing skill: a) Intellectual b) Interpersonal c) Technical d) Mechanical

a) Intellectual Critical thinking is an intellectual nursing skill.

Which of the following peripheral pulses is the most common site for obtaining a pulse in an emergency: a) Carotid artery b) Radial artery c) Brachial artery d) Temporal artery

a) Carotid artery Carotid pulse most accessible in emergency.

Culturally safe nursing practice involves: a) Relating to all clients in a neutral manner regardless of their cultural heritage b) Asking clients about knowledge of their own cultural heritage c) Ensuring clients are nursed by nurses from their own culture d) Using appropriate resources to meet clients identified needs

d) Using appropriate resources to meet clients identified needs Cultural safety involves meeting identified cultural needs.

The nurse notifies the physician when it is determined that an adult male client's pulse is 52 beats per minute because the client is experiencing: a) Cardiovascular collapse b) Bradycardia c) Tachycardia d) Dysrhythmia

b) Bradycardia Pulse <60 bpm is bradycardia.

Potential sources of client data useful to the nurse for a comprehensive assessment include: a) client b) family c) medical records d) all of the above

d) All of the above Client, family, and medical records all provide assessment data.

Vital signs are measured in order to: a) regulate the client's condition within a narrow range b) provide clues to the physiologic functioning of the body c) comply with the doctor's order for vital signs to be taken at prescribed intervals d) assess the psychological status of the client

b) Provide clues to the physiologic functioning of the body Vital signs indicate physiological status.

In effective communication, the course sends a message to the receiver. Which of the following describes the process by which reception and comprehension of the message are verified: a) noise b) feedback c) channel d) decoder

b) Feedback Feedback verifies message reception and comprehension.

The frequency of assessing vital signs depends upon the: a) doctor's orders b) nurse's discretion c) availability of personnel d) patient's condition

d) Patients condition Frequency determined by patient needs.

Where should the stethoscope be placed upon the: a) fifth intercostals space at left midclavicular line b) the epigastric area at the tip of the sternum c) third intercostals space over the right ventricle d) between the aortic and tricuspid areas

a) Fifth intercostals space at left midclavicular line Apical pulse location.

Which of the following best indicates good blood circulation to the extremities: a) blood pressure in normal range b) dorsalis pedis pulses strong and equal bilaterally c) mucous membranes pink and moist d) venous patterns readily identifiable

b) Dorsalis pedis pulses strong and equal bilaterally Strong pedal pulses indicate good circulation.

Measuring the client's response to nursing interventions and the clients progress toward achieving goals is done during which phase of the nursing process: a) planning b) nursing diagnosis c) evaluation d) assessment

c) Evaluation Evaluation phase measures response to interventions.

The primary source of data for evaluation is the: a) physician b) client c) nurse d) medical record

b) Client Client is primary data source for evaluation.

The criteria for determining the effectiveness of nursing actions are based on the: a) nursing diagnosis b) expected outcome c) client's satisfaction d) nursing interventions

b) Expected outcome Outcomes provide criteria for effectiveness.

The planning step of the nursing process includes which of the following activities: a) assessing and diagnosing b) evaluating goal achievement c) performing nursing actions and documenting them d) setting goals and selecting interventions

d) Setting goals and selecting interventions Planning involves goals and interventions.

The nursing care plan is: a) a written guideline for implementation and evaluation b) a documentation of client care c) a projection of potential alterations in client behaviours d) a tool to set goals and project outcomes

a) A written guideline for implementation and evaluation Care plan guides implementation and evaluation.

The Nurses Act is administered by the: a) New Zealand Nurses Organisation b) Nursing Council of New Zealand c) Division of Nursing (department of health) d) all of the above

b) Nursing Council of New Zealand Nursing Council administers the Nurses Act.

The Nursing Council is: a) bureau in the department of health b) a sub committee of the nurses organisation c) an incorporated society d) a statutory body

d) A statutory body Nursing Council is a statutory body.

The Nursing Council does all of the following except: a) administer the Nurses Act b) administer the Hospitals Act c) approve schools of nursing d) issue practising certificates

b) Administer the Hospitals Act Nursing Council does not administer Hospitals Act.

The act which provides for the nursing council to have disciplinary jurisdiction over the conduct of registered and enrolled nurses is: a) The Nurses Act of 1977 b) The Nurses Regulation Act of 1977 c) The Hospital Act of 1951 d) The Area Health Board Act of 1989

a) The Nurses Act of 1977 Nurses Act provides disciplinary jurisdiction.

Nurses employed in any setting can be formal complaint is made against them. By law to whom should these complaints be addressed: a) the medical superintendent b) the registrar of the Nursing Council c) the medical officer of health d) the executive director of the nurses organisation

b) The registrar of the Nursing Council Complaints addressed to Nursing Council registrar.

The maintenance of standards, discipline, examinations are administered by the nursing council under which act of Parliament: a) Crimes Act 1961 b) Nurses Act 1977 c) Accident Rehabilitation and Compensation Insurance Act d) Official Information Act 1982

b) Nurses Act 1977 Standards and discipline under Nurses Act.

If a client is admitted and dies within 24 hours following surgery must be notified by law: a) Significant others b) Doctor c) Medical superintendent d) Coroner

d) Coroner Death within 24 hours of surgery is coroner's case

All of the following are a coroners case except: a) An unexpected death of client 24 hours after admission b) Death of a client with an infectious disease c) An unexpected death 24 hours after surgery d) No established cause of death

b) Death of a client with an infectious disease Infectious disease death not automatically coroner's case.

Richard, a 25 year old mildly retarded person, was admitted to Accident and Emergency due to multiple fractures after a motor bike accident. Richard is to have an emergency laparotomy due to internal bleeding. The Crimes Act states that consent in the above case is: a) Implied from the circumstances surrounding the case and the need to take immediate action for the welfare of the individual b) Written and must be freely given and fully understood if major surgery was to be performed c) Mentally ill and demented clients must have a consent of a parent or a guardian or significant others representing them d) Valid only if the client is 16 years and over or if married

a) Implied from the circumstances surrounding the case and the need to take immediate action for the welfare of the individual Emergency consent implied for life-saving treatment.

Whilst in theatre, a friend who knew Richard very well, rings to inquire about the client's condition. You are the staff nurse on duty. The Privacy Act allows you to: a) Give the full information as he is a very close friend of the client b) Give him the information as he is a member of the health profession c) Give him information in general terms concerning the condition of the client d) None of the above

d) None of the above Cannot disclose patient information without consent.

After surgery Richard is taken to the intensive care unit but dies shortly thereafter. A legal responsibility in cases of unexplained death up to 24 hours after surgery is to: a) Lay the body out so that the family and friends can see the client b) Send a coroner's referral for investigation c) Make sure the clients name and address and the circumstances surrounding the death are written in the 24 hours census book d) Ensure that personal belonging are inspected and signed for by the family

b) Send a coroner's referral for investigation Death within 24 hours post-op requires coroner referral.

Debbie a 16-year-old student, is admitted in a semi-conscious state with a history of a 58-pound weight loss in 3 months. Preliminary diagnosis is acute anorexia nervosa. Which of the following admissions lab values should the nurse caring for Debbie consider to most critical: a) Glucose 80 b) Potassium 3.0 c) Sodium 144 d) Haemoglobin 10

b) Potassium 3.0 Low potassium (hypokalemia) is critical.

Which vital sign would provide the most essential information in light of Debbie’s current lab values, which are, Glucose 80, Potassium 3.0, Sodium 144 and Haemoglobin 10: a) Temperature b) Pulse c) Respirations d) Blood pressure

b) Pulse Pulse most affected by potassium levels.

Which approach would be most therapeutic in working with Claire: a) Teaching the patient about banking procedures, then extending this approach to everyday issues b) Confronting the patient about all her inappropriate behaviour c) Kindly but firmly guiding the patient into such activities such as bathing and eating d) Showing the patient that she is in a controlled environment so that no difficulties arise later

c) Kindly but firmly guiding the patient into such activities such as bathing and eating Gentle guidance appropriate for withdrawn patient.

Claire lost 15lb last week and now weights 100lb. The nurse formulates a nursing diagnosis based on the diagnostic category altered nutrition: less than body requirements. Which goal is most appropriate initially: a) The patient will consume an adequate diet b) The patient will maintain her current weight of 100lb c) The patient will gain 1lb per week d) The patient will remain adequately hydrated

b) The patient will maintain her current weight of 100lb Initial Goal: Stabilize weight before gaining.

The best approach to meeting Claire’s (who has lost 15lb last week) hydration and nutrition needs would be to: a) Leave finger foods and liquids in her room and let her eat and drink as she moves about b) Bring her to the dining room and encourage her to sit and eat with calm, quiet companions c) Explain mealtime routines and allow her to make own decisions about eating d) Provide essential nutrition through high calorie gavage (nasogastric) feedings

a) Leave finger foods and liquids in her room and let her eat and drink as she moves about Allows autonomy while providing nutrition.

The physician decides to start Claire on Lithium therapy. Which of the following best describes her dietary requirements while she is receiving this medication: a) A high calorie diet with reduced sodium and adequate fluid intake b) A regular diet with normal sodium and adequate intake c) A low calorie diet with reduced sodium and increased fluid intake d) A regular diet with reduced sodium and adequate fluid intake

b) A regular diet with normal sodium and adequate intake Normal sodium needed for Lithium therapy.

Michelle aged 25 is found sitting on the floor of the bathroom in treatment clinic with moderate lacerations to both wrists. Accompanied with broken glass she sits staring blankly at her bleeding wrists while staff members call for an ambulance.How should the nurse approach Michelle initially? a) Enter the room quietly and move beside Michelle to assess her injuries b) Call for staff backup before entering the room and restraining Michelle c) Move as much glass away from Michelle as possible and quietly sit next to her d) Approach Michelle slowly while speaking in a calm voice, calling her mane and telling her that the nurse is here to help her

d) Approach Michelle slowly while speaking in a calm voice, calling her name and telling her that the nurse is here to help her Calm, clear approach for crisis situation.

Michelle is taken to the hospital and admitted on an emergency basis for 5 days compulsory assessment and treatment. Michelle says to the admitting nurse, "I’m not staying here. I was a little upset and did a stupid thing. I want to leave". Which response is most appropriate: a) Unfortunately, you have no right to leave at this time. You must be evaluated further b) Cutting your wrists certainly was a stupid thing to do. What were you trying to accomplish anyway c) You have been admitted on an emergency basis and can be held you have the right to consult a lawyer about your admission d) I can see you’re upset. Why don’t you try to relax. You can explain to the doctor what upset you. If what you say is true, you’ll be released sooner.

c) You have been admitted on an emergency basis and can be held you have the right to consult a lawyer about your admission Informs patient of rights and legal status.

Determining Michelle’s suicide potential during the mental status examination, involves assessing several factors, the most significant of which is her: a) History of previous suicide attempts b) Suicide plan c) Emotional state d) Self esteem

b) Suicide plan Specific plan indicates higher risk.

Michelle is placed on suicide precautions, which include constant observation. When the nurse accompanies her to the bathroom. Michelle complains, "I can’t believe this. I can’t even go to the bathroom without being watched. How would you like to have me watching you go to the toilet". Which response by the nurse is best: a) I’m sure I wouldn’t like it very much, but then I didn’t try to hurt myself b) I’m sorry but these are the rules. Someone must be with you at all times c) If it’s more comfortable for you, I can stand right outside as long as the door is open. Would you agree to that? d) I would probably feel uncomfortable too, but ensuring your safety is my first priority. I must stay in the room with you

d) I would probably feel uncomfortable too, but ensuring your safety is my first priority. I must stay in the room with you Empathetic but maintains safety protocol.

After 5 days of hospitalisation. Michelle (who has been admitted following moderate wrist lacerations) is to be discharged and an outpatient basis at the day of treatment clinic. During discharge planning, the nurse should set as a priority short term goals Michelle will: a) Identify support systems to help manage stress b) Verbalise feelings of shame regarding her suicide attempt c) Demonstrate an uplifted mood and optimism about the future d) Admit that her wrist slashing was an attention seeking behaviour and not a true suicide attempt

a) Identify support systems to help manage stress Support systems priority for discharge planning.

Upon transfer to the psychiatric unit Megan is informed by the admitting nurse that it will be necessary to check her belongings for any unsafe or banned items. She begins to scream angrily, "What’s the matter with you. I’m upset. Get away from me". The nurse should first: a) Administer emergency tranquillizers as ordered b) Place Megan in seclusion and restraints c) Eliminate the belongings search so as to avoid upsetting her d) Set verbal limits on her behaviour

d) Set verbal limits on her behaviour Establish boundaries on inappropriate behavior.

Megan requests a weekend pass two days after transfer to the psychiatric unit. Her primary nurse informs her following the treatment team meeting that the pass has not been approved. Megan responds angrily, "They all hate me, they’re so mean. I know you’d have let me go. You’re the only decent nurse here". The nurse's best response is: a) I would have approved it, but you’re right I’m only one voice b) I don’t think the others realise how hard you’ve been trying c) Megan you’ll never get a pass behaving this way d) This was the team's decision. Let’s talk about why we feel it’s not appropriate now

d) This was the teams decision. Let's talk about why we feel it's not appropriate now Addresses splitting behavior therapeutically.

Megan requests a weekend pass two days after transfer to the psychiatric unit. Her primary nurse informs her following the treatment team meeting that the pass has not been approved. Megan responds angrily, "They all hate me, they’re so mean. I know you’d have let me go. You’re the only decent nurse here". Megan’s behaviour in this situation illustrates the use of which defence mechanism: a) Splitting b) Reaction formation c) Conversion d) Repression

a) Splitting Idealizing some staff while devaluing others.

Megan’s doctor resumes her regular dosage of Amitriptyline. Which effect of this medication might the staff and patient expect to see first: a) Elevated mood b) Improved reality testing c) Improved sleep pattern d) Fewer hallucinations and delusions

c) Improved sleep pattern Sedative effects of amitriptyline appear first.

Wilfred a 42-year-old executive, is admitted for treatment of his alcoholism. The most important factor in Wilfred’s rehabilitation is: a) His emotional or motivational readiness b) The qualitative level of his physical state c) His family’s accepting attitude d) The availability of community resources

a) His emotional or motivational readiness Motivation most important for recovery.

Which one of the following remarks of Wilfred, made prior to discharge from hospital would show the most realistic assessment of his situation in relation to avoiding future drinking problems: a) I promise I’ll never get drunk again b) I will cut down my drinking so I drink only socially c) I can stop drinking providing my wife keeps off my back d) I’m going to try hard to stay away from that first drink

d) I'm going to try hard to stay away from that first drink Shows realistic understanding of recovery.

John is a 32-year-old man with a 5-year history of psychiatric admissions. He is escorted to the mental health unit by the police. He is dishevelled, confused and his records state that he has been diagnosed as chronic undifferentiated schizophrenic. The nurse observes john sitting in the hall looking frightened. He is curled up in a corner of the bench with his arms over his head and covering his face. How should the nurse approach the patient: a) Walk over to the bench, sit beside him quietly, and place an arm around his shoulders, then say I’m the nurse and wait for a response b) Allow him to remain alone on the bench, where he can observe the unit for a half hour or so until he is more comfortable c) Greet him warmly saying hi I’m the nurse. This is a very nice unit. I think you’ll like it here. Let me show you around d) Sit about 3 or 4 feet from him on the bench and say hello john I’m a nurse on this unit. You appear frightened then wait for a response

d) Sit about 3 or 4 feet from him on the bench and say hello john I'm a nurse on this unit. You appear frightened then wait for a response Respects space while offering presence.

John is a 32-year-old man with a 5-year history of psychiatric admissions. He is escorted to the mental health unit by the police. He is dishevelled, confused and his records state that he has been diagnosed as chronic undifferentiated schizophrenic. The nurse observes john sitting in the hall looking frightened. He is curled up in a corner of the bench with his arms over his head and covering his face. John responds to the nurse by curling up on the bench even tighter. His arms still cover his head and his hands are clasped tightly over his ears. The nurse should: a) Show acceptance of John's behaviour by remaining with him and reassuring him, gently stroking his arms and shoulders b) Tell John that she will leave him for a while and will return later when he feels more relaxed c) Say gently, "John, I'll just sit here quietly with you for a while", then remain seated nearby d) Say, "John, most people feel uncomfortable in hospitals. You shouldn’t be afraid. I’m here to help you."

c) Say gently, "John, I'll just sit here quietly with you for a while", then remain seated nearby Non-threatening presence.

Later that evening, the nurse finds John crouched in the corner of his room, with a curtain covering him. His roommate is sitting on the bed laughing and saying, "This guy is really a nut. He should be in a padded cell." How should the nurse respond to the roommate: a) Say, "I’m sure John's behaviour is frightening to you. I understand that you are trying to cover up how you really feel by laughing." b) Say, "I'd appreciate it if you’d step outside for awhile. I’d like to talk with you after I help John". c) Say nothing and attend to John d) Say in a neutral tone, "I think your laughing is making John feel worse. How would you feel if you were John?"

b) Say, "I'd appreciate it if you’d step outside for awhile. I’d like to talk with you after I help John". Address John first, then educate roommate

Later that evening, the nurse finds John crouched in the corner of his room, with a curtain covering him. His roommate is sitting on the bed laughing and saying, "This guy is really a nut. He should be in a padded cell." What is the least threatening approach to John while he sits huddled under the curtain: a) Sit next to him on the floor without speaking, and wait for him to acknowledge the nurse b) Gently remove the curtain and say, "John this is the nurse: What happened?" c) Approach John slowly and say, "John this is the nurse. You appear to be very frightened. Can you tell me what you are experiencing?" d) Call for assistance and do not approach John until at least two other staff members are present

c) Approach John slowly and say, "John this is the nurse. You appear to be very frightened. Can you tell me what you are experiencing?" Acknowledges feelings while offering support.

Because John has previously responded well to treatment with Haloperidol (serenace), the doctor orders Haloperidol 10mg orally twice a day. Which adverse effect is most common with this medication: a) Extrapyramidal symptoms b) Hypotension c) Drowsiness d) Tardive dyskinesia

a) Extrapyramidal symptoms Most common haloperidol side effect.

During the next several days, John is observed laughing, yelling and talking to himself. His behaviour is characteristic of: a) Delusion b) Looseness of association c) Illusion d) Hallucination

d) Hallucination Laughing and talking to self indicates hallucinations.

John tells the nurse, "The earth is doomed, you know. The ozone is being destroyed by hair spray. You should get away before you die". John appears frightened as he says this. The most helpful response is to: a) Say, "John I think you are overreacting. I know that some concern about the earth’s ozone layer, but there is no immediate danger to anyone." b) Say, "I’ve heard about the destruction of the ozone and its effect on the earth. Why don’t you tell me more about it?" c) Ignore John's statement and redirect his attention to activity on the unit d) Say, "John, are you saying you feel as though sometimes will happen to you? I don’t believe we are in danger right now."

d) Say, "John, are you saying you feel as though sometimes will happen to you? I don’t believe we are in danger right now." Acknowledges feelings while orienting to reality.

After a half hour, John continues to ramble about the ozone layer being doomed to die. He paces in an increasingly agitated mood he begins to speak more loudly. At this time, the nurse should: a) Check to see whether the doctor ordered Haloperidol b) Allow John to continue pacing but observe him closely c) Try to involve John in a current events discussion group that is about to start d) Tell John to go to his room for a while

a) Check to see whether the doctor ordered Haloperidol Increasing agitation may require PRN medication.

Henry is brought to the mental health unit by his wife who states for the past week her husband has refused all meals and accused her of poisoning him, he has become withdrawn, forgetful and inattentive and has frequent mood swings. Henry appears suspicious. His speech which is only partly comprehensible reveals that his thoughts are controlled by delusions of possession by the devil. He claims the devil told him that people around him are trying to destroy him. The doctor diagnoses Paranoid Schizophrenia. Schizophrenia is best described as a disorder characterised by: a) Disturbed relationships related to an inability to communicate and think clearly b) Severe mood swings and periods of low to high activity c) Multiple personalities, one of which is more destructive than the others d) Auditory and visual hallucinations

a) Disturbed relationships related to an inability to communicate and think clearly Core feature of schizophrenia.

The nursing assessment of Henry (who has been diagnosed with Paranoid Schizophrenia) should include careful observation of his: a) Thinking, perceiving and decisions making skills b) Verbal and nonverbal communication processes c) Affect and behaviour d) Psychomotor activity

c) Affect and behaviour Comprehensive assessment includes affect and behavior.

When communicating with Henry (who has been diagnosed with Paranoid Schizophrenia), the nurse should initially: a) Remain silent and wait for Henry to speak first b) Talk with henry as one would talk with a healthy person c) Allow Henry to do all the talking d) Speak to Henry using simple, concrete language

d) Speak to Henry using simple, concrete language Clear communication important with thought disorder.

The patient's thought content can be evaluated on the basis of which assessment area: a) Presence or absence of delusions b) Unbiased information from the patients psychiatric history c) Degree of orientation to person, place and time d) Ability to think abstractly

a) Presence or absence of delusions Delusions indicate thought content abnormality.

Henry mentions that voices are telling him that he is in danger and that he will be safe only if he stays in his room and avoids ‘zoids’. How should the nurse respond: a) I understand that these voices are real to you, but I want you to know that I do not hear them b) Don’t worry. I won’t let anything happen to you here c) What else can you tell me about the voices? d) Many patients hear voices when they come here. The voices will go away when you get better.

a) I understand that these voices are real to you, but I want you to know that I do not here them Acknowledges experience without reinforcing hallucination.

The innermost layer of the eye is: a) Sclera b) Retina c) Choroid d) Conjunctive

b) Retina Retina is innermost eye layer.

The nurse observes henry pacing in his room. He is alone but in an angry tone. When asked what he was experiencing he reply’s the devil is yelling in my ear. He says people here want to leave. The nurse's best response is: a) Can you tell me more about what the devil is saying b) How do you feel when the devil says such things to you c) I don’t hear any voices. Henry, are you feeling afraid now? d) Henry the devil cannot talk to you

c) I don't hear any voices. Henry are you feeling afraid now? Presents reality and addresses emotions.

Mary is admitted under Section 11 of the Mental Health (Compulsory Assessment and Treatment Act 1992). The definition of mental disorder under the act includes all of the following except: a) A seriously diminished ability to care for yourself b) Mental handicap and substance abuse c) An abnormal state of mind d) A serious danger to self or others

b) Mental handicap and substance abuse Excluded from Mental Health Act definition.

Mary's rights under the Mental Health Act include the right: a) To information about her status, to respect of her culture identity, to seek legal representation b) To respect as a human being, to respect of her cultural values, to receive visitors and make phone calls c) To information about her status, to receive treatment to health care, to change her treatment at her request d) To receive visitors and make telephone calls, to refuse seclusion on cultural grounds, to seek a judicial inquiry

a) To information about her status, to respect of her culture identity, to seek legal representation Key patient rights under MH Act.

Mary (who has been admitted under Section 11) asks for review of her legal status. Your action would be: a) Explain that her status will be reviewed by the responsible clinician before the end of five days b) Reassure her that you understand how frustrating it must be to be in hospital against her will c) Offer to phone the client advocate on Mary’s behalf d) Explain Section 16 to Mary and allow her to phone the district inspector

d) Explain section 16 to Mary and allow her to phone the district inspector Patient right to seek review.

Under section 30 of the Mental Health Act (1992), the inpatient treatment order lasts for: a) 2 months b) 4 months c) 6 months d) 12 months

c) 6 months Inpatient treatment order lasts 6 months.

Under Section 111 of the Mental Health Act (1992), a person admitted to hospital, not already subject to any assessment and treatment can be detained, for how long, if considered mentally disordered: a) 24 hours b) 12 hours c) 6 hours d) 3 hours

c) 6 hours Section 111 allows 6-hour detention.

Lisa tell the nurse that she has gained 2kg in a month and plans to diet by skipping lunches. Which of the following responses would be the most appropriate: a) Have you noticed that your hands and feet have become swollen? b) You should cut down on high calorie foods like cake and candy, but you shouldn’t skip lunch c) Your weight gain is just right for you for this period of your pregnancy. You are doing fine d) You’re supposed to gain a lot of weight its good for the baby. You’ll lose it after the baby is born.

c) Your weight gain is just right for you for this period of your pregnancy. You are doing fine 2kg/month appropriate pregnancy weight gain.

50mg is equal to: a) 0.05 gram b) 5 grams c) 5000 micrograms d) 50,000 micrograms

a) 0.05 gram 50mg / 1000 = 0.05g

The drugs used to treat Parkinson’s disease act by: a) Increasing cholinergic activity and increasing dopamine b) Reducing cholinergic activity and increasing dopamine c) Increasing cholinergic activity and reducing dopamine d) Reducing cholinergic activity and reducing dopamine

b) Reducing cholinergic activity and increasing dopamine Parkinson's treatment increases dopamine, reduces acetylcholine.

Recent research indicates that Arthritis may be an autoimmune disease. Which of the following statements most accurately describes the process of autoimmunity: a) A rare complication of vaccination when the body reacts to the vaccine by producing symptoms of the disease b) An inherent factor in the blood which renders the person susceptible to certain diseases c) Lack of antitoxins in the blood which render the person susceptible to the certain diseases d) Formation of antibodies in the blood which destroy certain healthy cells in the individual

d) Formation of antibodies in the blood which destroy certain healthy cells in the individual Autoimmunity definition.

Patients with rheumatoid arthritis commonly have a raised ESR (erythrocyte sedimentation rate). This is because: a) Arthritic patients usually have a degree of anaemia b) Rheumatoid factor decreases the viscosity of the cells c) Protein changes result in the erythrocytes becoming heavier d) There is an increase in leucocyte numbers

c) Protein changes result in the erythrocytes becoming heavier Inflammation causes protein changes affecting ESR.

Before administering a dose of digoxin the patient's pulse (apex beat) should be taken. Which is the correct action for the nurse to take if the pulse is found to be under 60 beats per minute: a) Give the drug and take the pulse again an hour later b) Give the drug and notify the staff nurse that the pulse is slow c) Do not give the drug and report the slow pulse to the doctor d) Omit the drug and make a note on the nursing care plan

c) Do not give the drug and report the slow pulse to the doctor Hold Digoxin if pulse <60 bpm.

Which of the following can be causes of anaemia in the elderly: 1. Apathy and repression 2. Ill fitting dentures 3. A physiological inability to utilise food properly a) 3 only b) 1 and 2 c) 1 and 3 d) 1, 2 and 3

d) 1, 2 and 3 All can contribute to elderly anemia.

Old people are inevitably a burden on the community (assertion) because old people cannot work because they are slow and cannot be relied on (reason). With reference to the above statement which of the following is true: a) Both assertion and reason are true statements but the reason is not a correct explanation of assertion b) The assertion is true but the reason is a false statement c) The assertion is false but the reason is a true statement d) Both the assertion and reason are false statements

d) Both the assertion and reason are false statements Stereotypes about elderly are false.

A common problem with the elderly is their reluctance to drink adequate amounts of fluid. The most probable reason for this is that they are: a) Frightened of being incontinent b) More likely to sweat than younger people c) Unable to afford adequate fluids d) Afraid of developing diarrhoea

a) Frightened of being incontinent Fear of incontinence limits fluid intake.

Haemorrhage into the anterior chamber of the eye following a cataract extraction is called: a) Hyaemia b) Hyphaema c) Hyfever d) Hyena

b) Hyphaema Hyphaema is blood in anterior chamber.

Mrs Adams suffers from dementia and requires a dressing to a shin wound. The nurse suspects the wound is the result of a non-accidental injury. What is the main cause of non-accidental injury in an elderly person suffering from dementia? a) A dependent person being more prone to injury b) A long-standing pattern of domestic violence c) The home not being a suitable place for a dependent person d) The increased stress in caring for a dependent person at home

d) The increased stress in caring for a dependent person at home Caregiver stress contributes to elder abuse.

Mrs Adams suffers from dementia and requires a dressing to a shin wound. The nurse suspects the wound is the result of a non-accidental injury. When dressing the shin wound the nurses most appropriate remark is: a) How did you scrape your shin Mrs Adams? b) How did you scrape your wife’s shin Mr Adams? c) This shin must hurt. Was it really an accident? d) A shin is easy to hurt. How did this injury happen?

d) A shin is easy to hurt. How did this injury happen Non-judgmental inquiry.

Mrs Adams suffers from dementia and requires a dressing to a shin wound. The nurse suspects the wound is the result of a non-accidental injury. The most appropriate way to help Mr and Mrs Adams at the first visit is to: a) Express professional concern at the cause of the injury b) Conceal feelings about the possible cause of the injury c) Reassure Mrs Adams that this injury will not occur again d) Acknowledge the stress of Mr Adams in caring for his wife

d) Acknowledge the stress of Mr Adams in caring for his wife Address caregiver stress therapeutically.

An increased incidence of vaginal infections occurs when contraceptive pills are taken because there is: a) A shift in the vaginal pH b) Drying of the vagina mucosa c) An increase in vaginal fluids d) A reduction in white cell numbers

a) A shift in the vaginal pH Hormonal changes alter vaginal pH.

What action should the nurse take when on three home visits the mother of a nine-month-old baby prevents him from being seen as ‘he is sleeping’: a) Notify the social welfare of the situation b) Notify the family doctor in writing of this occurrence c) Insist on seeing the child and refuse to leave the home d) Respect the patients right to accept or refuse treatment

c) Insist on seeing the child and refuse to leave the home Child safety concern requires assessment.

Which is the major pathophysiological abnormality occurring in asthma: a) Cardiac arrhythmias b) Bronchiole dysplasia c) Spasm of the smooth muscles of the bronchi d) Inflammation of the alveoli

c) Spasm of the smooth muscles of the bronchi Bronchospasm is primary asthma pathology.

Which of the following signs/symptoms would indicate mumps: a) Swelling of the lymph nodes b) Tenderness of the parotid gland c) Enlargement of the prostate gland d) Ulceration of vesicular stomatitis

b) Tenderness of the parotid gland Parotid involvement characteristic of mumps.

Which option is important for the nurse to know with regard to prevention of the spread of mumps: a) Safe disposal of all bodily excretions b) No specific isolation measures are needed c) Control of all food stuffs prepared for sale d) Isolation for ten days after the last notified case

b) No specific isolation measures are needed Mumps spread by droplet; standard precautions sufficient.

Which of the following is the best description of a vaccine: a) Dead modified bacilli b) Live attenuated virus c) Dead virus given orally d) Antibodies suspended in serum

b) Live attenuated virus Most vaccines contain attenuated organisms.

Mrs Shaw brings her 8-year-old daughter Jane to the clinic. Jane has eczema. Jane's eczema is most likely the result of: a) Inadequate skin care and hygiene b) Excretion of acids through sweat pores c) An inherited predisposition to skin infections d) Sensitivity to a substance in her external environment

d) Sensitivity to a substance in her external environment Eczema often allergic/sensitivity reaction.

Eczema is the term used to describe a: a) Acute, contagious inflammation of the skin b) Non-contagious inflammatory response of the skin c) Fungal infection more commonly seen in childhood d) Condition marked by the appearance of erythematous wheals

b) Non-contagious inflammatory response of the skin Eczema is inflammatory, not infectious.

Which statement best describes ‘vesicle’: a) Reddened, pinprick like rash b) Small round area of discolouration c) Small area of swelling on the skin d) Small blister filled with serous fluid

d) Small blister filled with serous fluid Vesicle definition.

You are employed as a practice nurse. A friend telephones and asks if her boyfriend has been to see the doctor this week. Your most appropriate response is: a) I don’t know b) I’ll have to ask the doctor c) I am not able to tell you that d) Just a moment, I'll check the files

c) I am not able to tell you that Maintain patient confidentiality.

Aminophylline 350mg is prescribed. Each ampoule contains 250mg in 10ml. How much should be added to the intravenous solution: a) 12ml b) 14ml c) 16ml d) 35ml

b) 14ml Calculation: 350mg ÷ 250mg × 10mL = 14mL.

Jillian’s intravenous infusion of 300ml normal saline is due to run over 4 hours. The drop factor is 60. How many drops per minute must be given for the IV to be completed on time? a) 42dpm b) 60dpm c) 75dpm d) 84dpm

c) 75dpm

A client is charted Nitrazepam (Mogadon) tablets to sleep. She refuses to take them at 9pm. She tells you that the other nurses always leave the tablets on the locker and she takes them when she is ready. What should you do? a) Put them back in the container b) Give her the tablets and let her take them later c) Tell the patient to ring when she is ready for them d) Tell her if she doesn’t take them now she may not get them later

c) Tell the patient to ring when she is ready for them Medication must be administered by nurse.

Hyperventilation may initially cause: a) Metabolic acidosis b) Metabolic alkalosis c) Respiratory acidosis d) Respiratory alkalosis

d) Respiratory alkalosis Hyperventilation causes CO2 loss and alkalosis.

Your neurologic assessment indicates increased ICP (intracranial pressure), so you raise the head of the bed 15 to 30 degrees in order to: a) Improve arterial flow to the brain b) Promote venous drainage from the brain c) Improve respirations d) Increase cardiac output

b) Promote venous drainage from the brain Elevation promotes venous drainage, reducing ICP.

Pulse pressure is defined as the: a) Pressure felt at the radial artery over the wrist b) Pressure of the heart beating against arterial walls c) Difference between the apical and radial pulses d) Difference between the systolic and diastolic blood pressures

d) Difference between the systolic and diastolic blood pressures Pulse pressure = systolic - diastolic.

Lucy is charted 5mls of Augmentin 125 TDS. You notice the doctor hasn’t signed the order form. A senior colleague tells you to give it. You respond by: a) Giving the medication as ordered b) Contacting the doctor to sign the order c) Asking Lucy if the doctor told her she would have this d) Signing the form for the doctor

b) Contacting the doctor to sign the order Medication orders must be signed by a doctor before administration. It's illegal to give medication without a valid, signed prescription.

The Augmentin is given to Lucy. She is found to be allergic when she exhibits: a) Tinnitus and vertigo b) Wheezing and urticaria c) Abdominal cramps and diarrhoea d) Blurred vision and ataxia

b) Wheezing and urticaria These are classic signs of an allergic reaction to antibiotics like augmentin (hives/urticaria and respiratory symptoms/wheezing).

Jack is 15 years old. He is admitted to the hospital after briefly losing consciousness when tackled during a rugby game. Which of the following is an indication increasing intracranial pressure: a) Change in his level of consciousness b) Anorexia and thirst c) Increased pulse and respiration rates d) Blurred vision and halos around lights

a) Change in his level of consciousness The first and most important sign of increasing intracranial pressure is a change in level of consciousness.

Jack has had two seizures while hospitalised. These have been controlled by anticonvulsant medications. Jack and his family must understand: a) The medication must be taken for at least one year b) The doctor should be seen when the prescription has finished c) The medication will be discontinued on discharge d) The medication will be necessary for the rest of his life

d) The medication will be necessary for the rest of his life Post-traumatic seizures typically require lifelong anticonvulsant therapy to prevent recurrence.

Jack is prescribed Rivotril 8 mgs daily. He weighs 68 kgs. The initial doses for 2-3 days should not exceed 0.01 mgs/kg/day. Your nursing responsibility is to: a) Observe for any side effects after giving the drug b) Contact the doctor to reassess the dose prescribed c) Consider his weight loss and administer the dose prescribed d) Check with the charge nurse prior to administration

b) Contact the doctor to reassess the dose prescribed 8mg daily for 68kg = 0.117mg/kg/day, which exceeds the 0.01mg/kg/day initial dose limit. The nurse must question this order.

Lucy Rogers, 5 years old, has had a recent upper respiratory tract infection. Now she is febrile and complains of a painful left ear. Acute Otitis Media is diagnosed. The typical appearance of the tympanic membrane in acute otitis media is: a) Red and bulging b) Grey and concave c) Yellow and retracted d) Red and concave

a) Red and bulging Acute otitis media causes inflammation and fluid buildup, making the tympanic membrane appear red and bulge outward.

Lucy’s symptoms of Otitis Media may be relieved most effectively by: a) Warm compresses b) Paracetamol elixir c) Ice packs d) Warm olive oil drops

b) Paracetamol elixir Pain relief is the most effective way to relieve symptoms of acute otitis media in children.

Children are more likely to develop acute Otitis Media from an upper respiratory infection than adults because of their: a) Inadequate resistance to infection b) Eustachian tubes size and shape c) Lack of acquired immunity to the causative organism d) Increased susceptibility to colds

b) Eustachian tubes size and shape Children's eustachian tubes are shorter, wider, and more horizontal, allowing easier bacterial migration from the throat to the middle ear.

The organism most commonly responsible for Acute Otitis media is: a) Streptococcus pyogenes b) Staphylococcus albus c) Haemophilus influenza d) Escherichia coli

c) Haemophilus influenza This is the most common bacterial cause of acute otitis media, along with Streptococcus pneumoniae.

Kevin aged 19 is admitted with an acute attack of Asthma. During an asthmatic attack, the reaction to excessive histamine release would be: 1. Bronchospasm 2. Bronchodilation 3. Excessive mucous production 4. Production of I.G.E antibodies a) 1,3 and 4 b) 1,3 and 5 c) 1,4 and 5 d) 2,3 and 4

a) 1,3 and 4 Histamine release causes bronchospasm, excessive mucus production, and triggers IgE antibody production.

The hypersensitive reaction in asthma is due to the: a) Antigen – antibody response b) Antigen – histamine release c) Inhalation of pollens d) Release of histamine

a) Antigen – antibody response Explanation: Asthma is a hypersensitivity reaction involving antigen-antibody interactions that trigger histamine release.

Which of the following signs would a person admitted to hospital with an acute attack of asthma present with: a) Dyspnoea, tachycardia, anxiety b) Dyspnoea, bradycardia, frothy sputum c) Tachycardia, chest pain, pallor d) Increased anxiety, sweating, chest pain

a) Dyspnoea, tachycardia, anxiety These are classic signs of acute asthma - difficulty breathing, rapid heart rate, and anxiety from respiratory distress.

A primiparous woman, one day postpartum, calls the nurse into her room the woman explains that while breastfeeding, she experienced uterine cramps and a heavy gush that soaked through her pad to the bed. The nurse should: a) Palpate the woman’s fundus b) Tell the woman that this often happens when breastfeeding c) Administer PRN ergometrine medication d) Assist the woman with perineal care and changing her pad

a) Palpate the woman's fundus First assess for uterine atony (the most common cause of postpartum hemorrhage) by checking fundal firmness.

The lochia of the postpartum woman second day after birth should exhibit each of the following except: a) Deep red and thick blood b) A few large clots c) Fleshy odour d) Moderate amount – 15cm on pad after 1 hour

b) A few large clots Large clots are abnormal on day 2 and may indicate retained placental fragments or excessive bleeding.

The risk for constipation in the postpartum period is related to all except: a) Tenderness of the episiotomy b) Decreasing levels of oestrogen c) Decreased abdominal muscle tone d) Fear of pain and of ripping sutures during a bowel movement

b) Decreasing levels of oestrogen Oestrogen levels don't directly affect constipation. Other factors listed do contribute to postpartum constipation.

Primary sites for postpartum infections would include all of the following except: a) Respiratory tract b) Endometrium c) Urinary tract d) Breasts

a) Respiratory tract Primary postpartum infection sites are the reproductive tract (endometrium), urinary tract, and breasts - not respiratory tract.

When caring for a postpartum woman with a uterine infection the nurse should: a) Administer an antipyretic when the temperature rises above 37.5oC b) Provide at least 2000mls of fluid a day c) Obtain specimens for cultures before initiating antibiotic treatment d) Reassure the woman that future reproduction will not be affected

c) Obtain specimens for cultures before initiating antibiotic treatment Cultures must be taken before antibiotics to identify the causative organism.

A definition of cor pulmonale is: a) L) sided heart failure secondary to disease of the lungs b) L) sided heart failure secondary to R) sided heart failure c) R) sided heart failure secondary to severe lung disease d) Disease of the lungs secondary to R) sided heart failure

c) R) sided heart failure secondary to severe lung disease Explanation: Cor pulmonale is right ventricular failure caused by pulmonary hypertension from chronic lung disease.

The main function of alveoli is: a) Bacterial filtration b) Exchange of gases c) Conduction of gases d) Pleural attachment

b) Exchange of gases Explanation: Alveoli are the primary site for oxygen and carbon dioxide exchange between air and blood.

The patency of the trachea is maintained by: a) Incomplete rings of cartilage b) Circular smooth muscle fibres c) Thickly layered pseudostratified epithelium d) Elastic connective tissue

a) Incomplete rings of cartilage C-shaped cartilage rings keep the trachea open while allowing flexibility for swallowing.

Human milk is preferable to cow’s milk because: a) Human milk is a non-laxative effect b) Human milk has more calories per ml c) Human milk is great mineral content d) Human milk offers greater immunologic benefits

d) Human milk offers greater immunologic benefits Breast milk contains antibodies and immune factors that protect infants from infections.

Which of the following neonates will most likely need additional respiratory support at birth: a) The infant born by normal vaginal delivery b) The infant born by caesarean birth c) The infant born vaginally after 12 hours of labour d) The infant born with high levels of surfactant

b) The infant born by caesarean birth Explanation: C-section babies don't experience chest compression during vaginal delivery, which helps clear lung fluid.

During the transition from foetal to neonatal circulation, the newborn cardiovascular system accomplishes which of the following anatomic and physiologic alterations: 1. Closure of the ductus venosus 2. Closure of the foramen ovale 3. Closure of the doctus arteriosis 4. Increased systemic pressure and decreased pulmonary artery pressure a) 1,2,3 and 4 b) 1,2 and 3 c) 2,3 and 4 d) 1,3 and 4

a) 1,2,3 and 4 All four changes occur during transition to neonatal circulation.

A woman diagnosed with marginal placenta praevia gave birth vaginally 15 minutes ago. She is at greatest risk for: a) Haemorrhage b) Infection c) Urinary retention d) Thrombophlebitis

a) Haemorrhage With placenta previa, the placental implantation site is in the lower uterus where contraction is less effective, increasing hemorrhage risk.

The primary nursing focus of the fourth stage of labour would be to: a) Prevent infection b) Facilitate newborn – parent interaction c) Enhance maternal comfort and rest d) Prevent haemorrhage and shock

d) Prevent haemorrhage and shock The fourth stage of labor (first hour postpartum) focuses on preventing hemorrhage through fundal massage and monitoring.

b) Increased pressure in the pulmonary circulation Emphysema increases pulmonary vascular resistance, causing right ventricular hypertrophy (cor pulmonale).

d) Overdistention, inelasticity and rupture of alveoli Emphysema destroys alveolar walls, causing them to lose elasticity and rupture, creating larger air spaces.

Which of the following positions is most comfortable for a person with emphysema: a) Lying flat in bed b) Reclining on his/her left side c) Sitting of the edge of the bed d) Lying flat on their back (supine)

c) Sitting of the edge of the bed Sitting upright with arms supported allows maximum lung expansion and easier breathing.

A person of the following factors commonly predisposes to emphysematous lung changes: a) Chemical irritation of bronchiolar and alveolar linings b) Sudden increase in intrapulmonary pressure coincident with hypertension c) Obstruction of air passages by spasms of bronchiolar muscles d) Senile degenerative changes in the vertebral bodies and intervertebral discs

a) Chemical irritation of bronchiolar and alveolar linings Smoking and pollutants cause chronic inflammation leading to emphysema.

Oxygen therapy is administered at low concentrations (below 35%), for people with chronically elevated pCO2 levels, as for some people with chronic obstructive respiratory disease, in order to prevent: a) Depression of the respiratory centre b) Decrease in red blood cell formation c) Rupture of emphysematous bullae d) Excessive drying of respiratory mucosa

a) Depression of the respiratory centre COPD patients depend on hypoxic drive for breathing; high O2 can suppress this drive.

A newborns birth weight is 3400gm. The maximum expected weight loss for this newborn would be: a) 170 gm b) 340 gm c) 510 gm d) 680 gm

b) 340 grms Normal weight loss in newborns is up to 10% of birth weight (3400 x 0.10 = 340g)

The birth weight of a breast feed newborn was 3600 gm. On the third day the newborns weight was 3350 gm. The nurse should: a) Encourage the mother to continue breast feeding as her baby’s nutrient and fluid needs are being met b) Suggest that the mother switch to bottle feeding as breastfeeding is ineffective in meeting her baby’s needs c) Notify the doctor as the baby has lost too much weight d) Refer the mother to a lactation consultant to improve her breastfeeding technique

a) Encourage the mother to continue breast feeding as her baby's nutrient and fluid needs are being met Weight loss of 250g (7%) is within normal limits for day 3.

Which of the following would be an unexpected sign of dehydration in the newborn: a) Weight loss b) Reduced turgor c) Concentrated urine d) Decreased frequency and amount of urine

d) Decreased frequency and amount of urine This is EXPECTED in dehydration, not unexpected. All others are expected signs.

The nurse would recognise that a new mother understood breastfeeding instructions when she explains: a) I feed my baby every two hours around the clock b) I always start feeding on my right breast, as my baby feeds best on that breast c) I use both the football and the traditional positions for feeding d) I let my baby continue to suck for a while on the second breast once its empty

c) I use both the football and the traditional positions for feeding Varying positions helps prevent nipple soreness and ensures complete breast emptying.

Which of the following actions of a breastfeeding mother indicate the need for further instruction: a) Holds breast with four fingers along the bottom and thumb at the top b) Leans forward to bring breast towards the baby c) Stimulates the rooting reflex than inserts nipple and areola into newborns open mouth d) Puts her finger into newborns mouth before removing breast

b) Leans forward to bring breast towards the baby The baby should be brought to the breast, not the breast to the baby, to prevent back strain and poor latch

Characteristically, respirations of the client in diabetic acidosis are: a) Shallow and irregular b) Uneven in rate and depth c) Deep, rapid, with acetone breath (kussmaul) d) Rapid and shallow

c) Deep, rapid, with acetone breath, (Kussmaul) Kussmaul respirations are the body's attempt to blow off CO2 and correct metabolic acidosis

The most important feature of foot care for a diabetic would be to: a) Cut nails straight across b) Maintain adequate blood flow to the lower limbs c) Wear sandals at all times d) Avoid wearing garters

b) Maintain adequate blood flow to the lower limbs Good circulation is essential to prevent ulcers and promote healing in diabetic feet.

Excessive thirst for people with diabetes mellitus is a result of: a) Need for increased amounts of water to hydrolyse food during digestion b) Loss of excessive body water due to increased daily urine volume c) Reflex adaption to a sustained elevation of body temperature d) Compensatory adjustment to decreased production of posterior pituitary hormone

b) Loss of excessive body water due to increased daily urine volume Polyuria causes dehydration, triggering the thirst mechanism (polydipsia)

For people with diabetes mellitus polyuria is the result of: a) Increased glomerular permeability due to generalized vascular damage b) Increased glomerular filtration due to decreased serum albumin concentration c) Increased volume of glomerular filtrate due to elevated blood pressure d) Decreased water resorption due to high tubular osmotic pressure

d) Decreased water resorption due to high tubular osmotic pressure Excess glucose in urine creates osmotic diuresis, pulling water into the tubules.

A normal CBG (capillary blood glucose) reading is within the range of: a) 1-5 mmol/L b) 4-7 mmol/L c) 6-12 mmol/L d) 3-10 mmol/L

b) 4-7 mmol/L Normal fasting blood glucose is 4-6 mmol/L; postprandial can be up to 7 mmol/L.

The foetal presenting part is described as vertex when the: a) Face enters the pelvis first b) Buttocks emerge with legs extended over the abdomen c) Flexed head enters pelvis first d) Foetal lie is longitudinal

c) Flexed head enters pelvis first Vertex presentation is when the baby's head is flexed with the chin tucked to the chest.

When examining the umbilical cord immediately after birth the nurse should expect to observe: a) One artery b) Two veins c) Whitish grey colouration d) Slight odour

c) Whitish grey colouration Normal umbilical cord appears whitish-grey or bluish-white and contains 2 arteries and 1 vein.

Vitamin K is given to the newborn to: a) Reduce bilirubin levels b) Increase the production of red blood cells c) Stimulate the formation of surfactant d) Enhance the ability of the blood to clot

d) Enhance the ability of the blood to clot Vitamin K is necessary for synthesis of clotting factors; newborns lack intestinal bacteria to produce it.

The nurse is performing a 5-minute APGAR on a newborn. Which of the following observations is included in the APGAR score: a) Blood pressure b) Temperature c) Muscle tone d) Weight

c) Muscle tone APGAR scores: Appearance, Pulse, Grimace, Activity (muscle tone), Respirations.

At birth the major cause of heat loss is by: a) Evaporation b) Radiation c) Conduction d) Convection

a) Evaporation Wet newborns lose heat rapidly through evaporation of amniotic fluid from skin.

The newborn would respond most effectively to feeding in which state: a) Drowsy b) Quiet alert c) Active alert d) Crying

b) Quiet alert In this state, babies are calm, focused, and most ready to feed effectively.

A pregnant woman at 30-weeks gestation exhibits a rise in her baseline systolic blood pressure of 32mmHg, a weight gain of 4 kgs since last week and difficulty removing rings she normally wears. This is suggestive of: a) Gestational hypertension b) Pre-eclampsia c) Eclampsia d) Elevated liver enzymes

b) Pre-eclampsia The triad of hypertension (BP rise >30 systolic), edema (ring tightness, weight gain), and proteinuria indicates pre-eclampsia.

The primary pathophysiologic basis for the clinical manifestations of pregnancy induced hypertension (PIH) is: a) Fluid retention related to excessive salt intake b) Ineffective excretion of fluid by the kidneys c) Cardiac decompensation d) Ineffective dilatation of the vascular network to accommodate the expanding blood volume of pregnancy

d) Ineffective dilatation of the vascular network to accommodate the expanding blood volume of pregnancy Vasospasm causes increased vascular resistance and reduced placental perfusion in PIH.

Which measure would be least effective in relieving the signs and symptoms of mild pre-eclampsia: a) Low salt diet b) Period of bed rest c) Balanced diet with protein d) Relaxation techniques

a) Low salt diet Salt restriction is no longer recommended for pre-eclampsia as it can worsen the condition.

A woman with severe pre-eclampsia is being monitored for assessment findings indicative of cerebral oedema and venospasm. Which of the following would you not expect to find: a) Hypotonic deep tendon reflexes b) Headache c) Vision changes including blurring and spots before the eyes d) Insomnia

a) Hypotonic deep tendon reflexes HYPERtonic (not hypotonic) reflexes indicate cerebral irritability in severe pre-eclampsia.

Newly expectant parents, ask the nurse how they can prepare their 3yr old preschool daughter for the new baby. All of the following would be useful except: a) Tell the child about the pregnancy as soon as mother begins to look pregnant b) Arrange for a few sleep overs with the person who will care for the child at the time of the birth c) Transfer their child to her new room and bed just before the expected birth of the baby d) Introduce their child to preschool as soon as possible

c) Transfer their child to her new room and bed just before the expected birth of the baby Major changes should be made well before baby arrives, not immediately before, to avoid resentment.

A patient with a diagnosis of schizophrenia says to the nurse "I’m like a fallen star. But I won’t go to the bar… it would be mar on my family, on the tar’. This is an example of: a) A loose association b) A delusion c) Word salad d) Clang association

d) Clang association Clang associations involve rhyming words (star/bar/mar/tar) rather than logical connections.

A person diagnosed with schizophrenia tells the nurse that ‘the voices have told me I’m in danger’. He stays in his room, wears the same clothes, and avoids cracks on the floor. The nurses best initial response to this information is: a) I know that these voices are real to you, but I don’t hear them b) Don’t worry, you’re safe here. I won’t let anything happen to you c) You need to get out of your room and get your mind occupied d) Would you like some prn medication

a) I know that these voices are real to you, but I don't hear them Acknowledge the patient's reality while presenting your own perception without arguing.

Mr P a new client on the ward, allows himself to be escorted to the day room. However, he does not speak in response to you. The most therapeutic nursing intervention is to: a) Ignore his silence and talk about superficial topics such as the weather b) Involve him in group psychotherapy so other patients can encourage him to talk c) Point out that he is making others uncomfortable with his silences d) Plan time to spend with him, in silence, if that is his choice

d) Plan time to spend with him, in silence, if that is his choice Therapeutic presence and acceptance without forcing conversation builds trust.

In communicating with a client experiencing delusions, what is it best to do: a) Logically explain the delusions b) Tell the client that they aren’t real c) Acknowledge his belief, but state your own understanding d) Ignore this topic when it is brought up

c) Acknowledge his belief, but state your own understanding Don't argue with or reinforce delusions; acknowledge feelings while presenting reality.

Mr P is prescribed clozapine tablets, initially at 50mg mane and 100 mg nocte. What is the most likely side effect that will be first noted: a) Neutropenia b) Akathesia c) Sedation d) Agranulycytocis

c) Sedation Sedation is the most common early side effect of clozapine at these initial doses

On discharge what is the most important piece of information you must give to Mr P, who has recently started on Clozapine treatments: a) Report any flu like symptoms immediately b) Ensure no doses of clozapine are missed c) Don’t take clozapine with alcohol d) Visit your GP regularly

a) Report any flu like symptoms immediately Flu-like symptoms may indicate agranulocytosis, a potentially fatal side effect of clozapine requiring immediate attention.

Which of the following represents a positive change of pregnancy: a) Morning sickness b) Quickening c) Positive pregnancy test d) Foetal heartbeat auscultated with Doppler

d) Foetal heart beat auscultated with Doppler This is a positive (definite) sign of pregnancy; others are presumptive or probable signs.

Which of the following statements can be used as a guideline for planning diets during pregnancy: a) An increase of 300 calories per day beginning in the first trimester b) A ten percent increase in protein above daily requirements c) Iron supplementation is recommended for women whose diets are lacking in iron d) The requirement for folic acid is increased by 50 percent

c) Iron supplementation is recommended for women whose diets are lacking in iron Iron supplementation is generally recommended during pregnancy to prevent anemia

In order to percent infection of Hepatitis B virus, the pregnant woman should: a) Receive gamma globulin during the first trimester b) Carefully wash hands before eating or preparing food c) Receive the hepatitis B vaccine d) Take AZT during the second and third trimester

c) Receive the hepatitis B vaccine Vaccination is the most effective prevention against hepatitis B transmission.

Which of the following represents a recommended weight gain during pregnancy: a) 6-11 kgs b) 11-16 kgs c) 13-18 kgs d) 18-20 kgs

b) 11-16 kgs Recommended weight gain for normal BMI women is 11.5-16 kg (25-35 lbs).

John's behaviour are increasingly annoying to other patients. The best nursing approach is to: a) Explain that he must try to conserve his energy b) Set limits on his behaviours and be consistent in approach c) Tell him he is annoying to others and ask him to stay in his room d) Ask him to walk to town to burn off energy

b) Set limits on his behaviours and be consistent in approach Clear, consistent limits help manage manic behavior and provide structure.

John also has been described as having flight of ideas. These would be likely present when John: a) Asks for a cup of tea, but tells you later he doesn’t want it b) Takes a long time to make his point in conversation c) Rapidly changes topic in conversation, sometimes without apparent connection d) Speaks in a staccato voice and says words you don’t understand

c) Rapidly changes topic in conversation, sometimes without apparent connection

John has been prescribed Chlorpromazine (Largactil) tablets 50mg nocte since being on the ward. The most likely reason for this is to: a) Cause a deep dreamless sleep b) To reduce agitation, anxiety and tension c) To reduce external stimuli d) To prevent long term mood swings

b) To reduce agitation, anxiety and tension Chlorpromazine is an antipsychotic that calms agitation in manic episodes.

John tells you he feels faint when he first gets out of bed, since taking the Largactil. Which response would best assist John: a) Tell him not to get until the nurse is present b) Suggest he does not get up until he has taken the medication c) Tell him to discuss this with the doctor d) Explain he should sit on the bed for a time before standing

d) Explain he should sit on the bed for a time before standing Orthostatic hypotension is common with antipsychotics; sitting before standing prevents falls.

John has also been taking lithium carbonate capsules. Creatinine clearance tests ordered during lithium carbonate therapy determines the functioning of the: a) Liver b) Pancreas c) Renal system d) Thyroid gland

c) Renal system Lithium is excreted by the kidneys; creatinine clearance assesses kidney function.

Mihi means traditional greetings and is normally extended to: 1. The Land 2. The Meeting House 3. The Dead 4. The People Present 5. The Reason for the Hui a) 1,2 and 5 b) 1,3 and 4 c) 2,3 and 4 d) All of the above

d) All of the above Mihi (traditional greetings) acknowledges the land, meeting house, deceased, people present, and purpose of gathering.

The internal migration of Maori people from rural to urban life since the mid-1940s has adversely affected Maori health. What is the most likely reason for this: a) Overcrowding within urban communities b) Increased exposure to infectious diseases c) Dietary changes from naturally produced to processed food d) Loss of cultural, social, and spiritual ties

d) Loss of cultural, social, and spiritual ties Urban migration disrupted traditional support systems and cultural practices essential to Māori wellbeing.

Maori communities are encouraging Maori to be involved in health research with their own people. What is the most likely reason for this? a) That ownership of the information will remain with Maori b) Previously there has been little feedback which has been useful to Maori c) Non-Maori promote themselves on Maori research d) Non-Maori researchers are unaware of Maori values

b) Previously there has been little feedback which has been useful to Maori Research often didn't benefit Māori communities; Māori-led research ensures relevant, useful outcomes.

Which of the following interventions would be most helpful for David in dealing with his impending death: a) Distract him by initiating conversation that does not deal with his disease b) Encourage him to reach out and spend more time with his wife and children c) Listen and encourage David to reminisce about his life d) Help him to spend much of his time sleeping

c) Listen and encourage David to reminisce about his life Life review helps people find meaning and achieve closure as death approaches.

David tells the nurse that he does not want his wife and children to know that his is dying. What would be the most helpful response? a) They would not want you to upset yourself by worrying about them b) You are concerned that they will be distressed c) I think we should talk about something less stressful for you d) Sit quietly and say nothing

b) You are concerned that they will be distressed Reflecting feelings opens dialogue without judgment or advice.

Which of the following interventions is the most effective in helping David’s wife and children deal with David’s impending death? a) Try to keep all the family at the same stage in the grieving process b) Encourage the family to verbalise their grief to the nurse c) Encourage the family to spend as much time as possible with David d) Encourage the family to cry but not in the presence of David

c) Encourage the family to spend as much time as possible with David Time together facilitates grieving process and creates final meaningful memories.

Your client has cancer, nobody can tell him until his surgeon arrives from 5 days away. However, in the meantime his anxiety is increasing. What should you do? a) Contact a social worker/chaplain to spend time with him b) Give him relaxation tapes to listen to c) Tell him his results are not back yet d) Speak with the doctor who is acting in the surgeons place

d) Speak with the doctor who is acting in the surgeons place The attending physician should discuss results/concerns; family shouldn't be lied to.

Your patient, who is a voluntary admission to a mental health unit, leaves the following day without telling anyone. Legally, what is required to staff? a) Provide care for him at home b) Re admit him under a compulsory order c) Get police to bring him in to sign a statement d) Do nothing, the patient has rights to leave health care at any time

d) Do nothing, the patient has rights to leave health care at any time Voluntary patients can leave at any time; no legal obligation to pursue them.

Pepe a 26 year old, developmentally delayed Maori man, who at aged two years contracted meningitis. He has been cared for in an institution, and is now to be moved to the community. Pepe is able to live in the community. What action should be taken now? a) Ring his whanau to advise them of his discharge b) Ask the social worker to tell the family pepe is to be discharged c) Arrange for pepe to visit with his whanau d) Organise a conference with the whanau

d) Organise a conference with the whanau Collaborative approach respects whānau involvement in decision-making.

Pepe a 26 year old, developmentally delayed Maori man, who at aged two years contracted meningitis. He has been cared for in an institution, and is now to be moved to the community. Pepe is able to live in the community. What statement would best describe your next action: a) Organise regular meetings between nursing staff and whanau prior to discharge b) Support Pepe's whanau in being able to visit and to be involved in his discharge planning c) Invite the whanau in to explain what will be required of them in caring for pepe d) Make sure the whanau understand pepe limitations in self care

b) Support Pepe's whanau in being able to visit and to be involved in his discharge planning Partnership with whānau ensures culturally appropriate, supported transition

Pape has been discharged to a marae based community house. How would you ensure his continued well being? a) Set up regular appointments to monitor Pepe's wellbeing b) Explain to the community workers Pepe's requirements c) Arrange for pepe to attend the local sheltered workshop d) Ensure pepe and his whanau have on going support and access to resources

d) Ensure pepe and his whanau have on going support and access to resources Ongoing support ensures successful community integration and wellbeing

Blake a 65 year old kaumatua (elder) is admitted with urinary retention. He is quiet and appears withdrawn. Blake’s whanau arrived. A female doctor tells them he needs a urinary catheter inserted. Blake’s son refuses to have a young woman doctor catheterise his father. What is your most appropriate response? a) Let us talk about this together b) I will contact the Maori support person for you c) I will inform the doctor of your decision d) Tell him that this is the only doctor available

a) Let us talk about this together Opening dialogue respects cultural concerns while exploring solutions

Blake falls in the shower sustaining a laceration to his right elbow. His family are angry and upset. What is the most appropriate action to take in this situation? a) Enquire of the whanau if Blake has had previous falls b) Offer for them to take to the doctor c) Acknowledge their anger and discuss ways to prevent further falls d) Acknowledge their anger and ensure the whanau it will not happen again

c) Acknowledge their anger and discuss ways to prevent further falls Validate emotions, take responsibility, and focus on prevention without making impossible promises

Charlie a 62 year old who identifies as Maori is admitted to your ward with shortness of breath. He is very anxious and has no family with him. What is the most appropriate initial action to take? a) Introduce Charlie to others in the room b) Telephone his whanau to come and visit c) Carry out a physical assessment on Charlie d) Acknowledge Charlie’s anxiety and ask how you can help

d) Acknowledge Charlie's anxiety and ask how you can help Address immediate emotional needs first, showing respect and building trust.

Iris condition deteriorates and she dies. What is the most appropriate nursing action to help the whanau? a) Ensure privacy for the family to have karakia (prayers) b) Allow a spokesperson to contact the rest of the family c) Move iris body to a side room d) Offer the whanau to go to a quiet room for a cup of tea

a) Ensure privacy for the family to have karakia (prayers) Spiritual practices are essential in Māori death rituals; privacy shows respect.

The doctor asks the whanau for the corneas of iris for transplantation. The whanau cannot make a decision right now. What is the most appropriate action you should take in support of the whanau? a) Tell the doctor that this is not culturally appropriate b) Listen to them and support them in their decision c) Explain to the whanau why corneas are transplanted d) Suggest the whanau talk to the hospital chaplain

b) Listen to them and support them in their decision Support whānau autonomy without pressure; organ donation conflicts with tikanga around body integrity.

Stanley progresses well. His chest tube is removed. He still does not have much of an appetite and is concerned about his diet. Which of these responses would be of help? a) Eat three large meals a day that are high in carbohydrates b) Eat three large meals a day that are high in protein c) Eat six small meals a day that are high in carbohydrates d) Eat six small meals a day that are high in protein

d) Eat six small meals a day that are high in protein Small frequent meals prevent breathlessness from full stomach; protein aids healing and muscle maintenance.

Select the most appropriate nursing intervention to assist Stanley to mobilise without becoming breathless: 1. Gradually increase mobility 2. Assess respiratory function related to mobility 3. Administer oxygen prior to mobilising 4. Increase time up by 10 minutes per day 5. Continually assess respiratory function a) 1 and 5 b) 4 and 5 c) 1 and 2 d) 3 and 5

c) 1 and 2 Gradual mobilization with respiratory assessment ensures safe activity progression without distress.

Tom a 38 year old businessman, voluntarily admits himself to a detoxification unit. He admits to drinking one large bottle of vodka each day. Which of the following ego defense mechanisms is a top and continuing priory in dealing with alcoholic clients? a) Dependency b) Denial c) Paranoia d) Projection

b) Denial Explanation: Denial is the primary defense mechanism in alcoholism, preventing recognition of the problem.

Of the following approaches to the treatment of alcoholism, which has been found to be the most effective to date? a) Membership in alcoholics anonymous b) Family systems approach c) Treatment alcoholism as a chronic disease d) Individual psychotherapy

a) Membership in alcoholics anonymous AA's peer support and 12-step program has the highest long-term success rate for alcoholism treatment.

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