RN Practice Test 2

1. A patient is reported to have a serum calcium of 7.9 mg/dL. The proper interventions for the nurse to take include all of the following EXCEPT:

a. Initiate seizure precautions
b. Monitor vital signs
c. Provide a quiet environment
d. Administer Metamucil

2. A patient with hypocalcemia may exhibit all of the following symptoms EXCEPT:

a. tachycardia
b. twitching
c. hypertension
d. paresthesias

3. A RN works in a family practitioners office. A 71-year old client is complaining of chronic constipation, headache, anorexia and occasional nausea. The RN would expect the physician to make all of the following recommendations EXCEPT:

a. Encourage the client to increase his fluid intake up to 3000mL per day unless it is detrimental to his health.
b. Increase intake of high fiber foods and roughage in his diet.
c. Prescribe a stool softener to use as needed.
d. Order an abdominal CT scan to rule out cancer of the bowel.

4. A pediatric RN works with a pediatrician at the health clinic. A child is accompanied by his mother to the clinic. The child is 12 months old and has been visiting the clinic regularly to receive his immunizations. The nurse expects to administer what following immunizations?

a. DTaP, IPV, Hib, MMR
b. Hepatitis B, Varicella zoster, MMR
c. Hib, MMR, PCV
d. DTaP, IPV, MMR

5. The nurse understands that unless contraindicated, in the United States, all newborns receive the following immunization:

a. Varicella zoster
b. Rubella
c. DTaP
d. Hepatitis B

6. A mother accompanies her 12 month old child to the health clinic for his scheduled immunizations. What statement by the mother would cause the nurse to question immunization administration at this visit?

a. “My child has had a runny nose for the past week.”
b. “Joey hates getting these shots, it makes him so mad- watch yourself.”
c. “Joey had a slight temperature this morning but it went away after I gave him some Tylenol.”
d. “Last time Joey got a shot, his little thigh was red and sore afterwards for two days!”

7. The nurse is caring for a client following an appendectomy. The client reports nausea and complains of surgical site pain at a 6 on a 0 to 10 scale. The clients employer is present in the room and states he is paying for the insurance and wants to know what pain medication has been prescribed by the physician. Which of the following is the appropriate nurse response?

a. Answer any questions the employer may have as he pays for the insurance.
b. Tell the employer his question is inappropriate and that the information is none of his business.
c. Explain to the employer that you cannot release private information and ask the employer to step out while you conduct your assessment of the client.
d. Ask the employer to leave and wait until the client returns home to visit.

8. The nurse is caring for a client with a history of advanced chronic obstructive pulmonary disease (COPD). The client had conventional gallbladder surgery 2 days previously. Which intervention has priority for preventing respiratory complications?

a. Incentive spirometry every 4 hours.
b. Coughing and deep breathing four times daily.
c. Getting the client out of bed 4 times daily as ordered by the physician.
d. Giving oxygen at 4 L/minute according to the physician's order.

9. When educating a pregnant client about home safety, which of the following information is appropriate for the nurse to include in the teaching plan? Select all that apply.

a. When taking a shower, place a non-skid mat on the floor of the tub or shower.
b. Avoid climbing stairs.
c. Avoid wearing high heels.
d. Use non-slip rugs on the floors.

10. A client had a C5 spinal cord contusion that resulted in quadriplegia. Two days after the injury occurred, the nurse sees his mother crying in the waiting room. The mother asks the nurse whether her son will ever play football again. Which of the following is the best initial response?

a. “Given time and motivation, your son can return to normal function.”
b. “Im not sure, but Ill call the physician to talk to you right away.”
c. “What do you know about your sons injury?”
d. “Getting upset isn't in you sons best interest.”

Answer Key and Explanations

1. D: Administer Metamucil. This patient is hypocalcemic. This may actually be caused by excessive use of laxatives. A laxative should be avoided as it will only decrease the calcium in this clients body. All of the other nursing actions are appropriate in this patient. A patient who has hypocalcemia may have a predisposition to develop seizure activity.

2. C: Hypertension. A patient with hypocalcemia will be likely to have hypotension. The patient may also experience diarrhea, hyperactive bowel sounds, cramps, tetany and a prolonged QT interval.

3. D: Order an abdominal CT scan to rule out cancer of the bowel. All of the other recommendations should be tried to address the most likely diagnosis of constipation. If the patient continues to complain of symptoms after constipation has been addressed, then the doctor would decide the next diagnostic step. It would be highly unlikely that the next step would be an abdominal CT scan.

4. C: Hib, MMR, PCV. These vaccines include: Hib- Haemophilus influenzae type b- This protects the child against bacterial meningitis, bacterial pneumonia, sepsis, and epiglottitis. MMR- This protects the child against measles, mumps and rubella (German measles). PCV- This protects the child against pneumococcal pneumonia. These are the typical vaccines given at 12-15 months of age. (The Varicella Zoster vaccine may also be given at the same time but some physicians opt to give separately.) The DTaP is given at 2, 4,6, 15-18 months of age and also again at 4-6, and 11-12 years of age. It protects the child against diphtheria, tetanus, and accellular pertussis The Hepatitis B vaccine is given at birth, 1, and 6 months of age. It protects the child against Hepatitis B virus. The IPV is given at 2,4,and 6 months, and again at 4-6 years of age. It protects the child against poliovirus.

5. D: Hepatitis b. This is the only required immunization to be given at birth unless contraindicated.

6. C: “Joey had a slight temperature this morning but it went away after I gave him some Tylenol.” A child should not receive immunizations generally if he/she has been running a fever or there are signs of moderate to severe illness even without a fever. Choice “A” would not be a contraindication for the immunizations if there are no other signs and symptoms of illness. Choice “B” would not be a contraindication for the immunization, most children do not like shots and object to them. Choice “D” is not a contraindication as this is considered a mild reaction to the injection.

7. C: Explaining to the employer that the nurse cannot release information and asking the employer to step out while conducting an assessment allows the client privacy while still being respectful of the employer. Although the employer is paying for the insurance, this does not given him a right to confidential information. Providing information to the clients employer without permission is a violation of the right to privacy under HIPAa. Speaking rudely to a visitor by saying something is “none of his business” is never appropriate. Asking the person to leave and to wait until the client returns home to visit wrongly assumes the nurse has the right to speak for the patient.

8. C: Getting the client out of bed prevents pooling of secretions in the lungs and promotes better lung expansion. An incentive spirometer (a device that measures air movement into the lungs and encourages the client to breathe deeply), coughing, and deep breathing are important, but the client needs to perform these more frequently (every 1 to 2 hours) instead of every 4 hours or 4 times daily. Giving oxygen at 4 L/minute could decrease the client's respiratory drive.

9. A, C, and D: A womans center of gravity changes during pregnancy, increasing her risk of falls. She should use a non-skid mat in the tub or shower. Wearing high heels will increase unbalance and can contribute to falls. Non-slip rugs will prevent tripping and falling. There is no reason that a pregnant woman in good health should avoid climbing stairs; in fact, stair climbing is good exercise.

10. C: Asking the mother what she knows about her sons injury is a good way to encourage the mother to express her feelings. It also allows the nurse to gather more data about the mother's understanding of the injury. Providing reassurance that the womans son will return to normal function may be incorrect because, in many cases, spinal cord contusion results in permanent loss of function. A definitive prognosis isn't possible so soon after a spinal cord contusion, so referring the mother to the doctor would not be helpful. The mother needs to be allowed to voice her concerns without being made to feel guilty.

Last Updated: 05/19/2014

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