BIOLOGY 100 exam
A nurse is providing follow-up care for a client who sustained a compound fracture three weeks
ago. The nurse should recognize that an unexpected finding for which of the following
laboratory values is a manifestation of osteomyelitis and should be reported to the provider
A nurse is caring for a client who has hypothyroidism. Which of the following manifestations
should the nurse expect
A nurse at an urgent care clinic is caring for a client who is experiencing an anaphylactic
reaction. After ensuring a patent Airway which of the following interventions is the priority
Where would you palpate to assess for an inguinal hernia
A nurse is checking the ECG Rhythm strip for a client who has a temporary pacemaker the nurse
notes a spike or a pacemaker artifact followed by a QRS complex. Which of the following
actions should the nurse take
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A nurse is caring for a client who is eight hours post-operative following a total hip arthroplasty
the client is unable to void on the bed pan Which of the following actions should the nurse take
first
A nurse is caring for a client who is receiving tpn a new bag is not available when the current
infusion is nearly completed which of the following actions should the nurse take
A nurse is providing teaching to a client who has a gastric ulcer and a new prescription for
Omeprazole. The nurse should instruct the client that the medication provides Relief by which of
the following actions
A nurse is providing discharge teaching to a client who is to self administer heparin
subcutaneously. Which of the following responses by the client indicates an understanding of the
teaching
a nurse is caring for a client following excavation of her endotracheal tube 10 minutes ago.
Which of the following findings should the nurse report to the provider immediately
a nurse is caring for a client who had a nephrostomy tube inserted 12 hours ago. Which of the
following findings should the nurse report to the provider
A nurse is assessing a client while suctioning the clients tracheostomy tube which of the
following findings should indicate to the nurse that the client is experiencing hypoxia
A nurse is planning teaching for a client who has bladder cancer and is to undergo a cutaneous
diversion procedure to establish and ureterostomy. Which of the following statements should the
nurse include in the teaching
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A nurse is teaching a client who has atrial fibrillation about the purpose of wearing a Holter
monitor. Which of the following information should the nurse include in the teaching
A nurse is providing discharge teaching to a client who has heart failure and a new prescription
for potassium sparing diuretic which of the following information should the nurse include in the
teaching
A nurse is caring for a client who has chronic glomerulonephritis with oliguria which of the
following findings should the nurse identify as a manifestation of chronic glomerulonephritis
A nurses in an acute care facility is caring for a client who is at risk for seizures which of the
following precautions should the nurse implement
A nurse is caring for a client who has bilateral pneumonia and an spo2 of 88% the client is
dyspneic and productive cough and is using accessory muscles to breathe which of the following
actions should the nurse take first
A nurse is caring for a client who has a new diagnosis of hyperthyroidism which of the following
is the priority assessment finding that the nurse should report to the provider
A nurse is reviewing the medication history of a client who is to undergo allergy testing the
nurse should instruct the client to discontinue which of the following medications before testing
A nurse is caring for a client who has an arterial line. Which of the following actions should the
nurse take?
A nurse is caring for a client who has a new prescription for tpn the client is to receive 2,000
kcalories per day the t-pn solution has 500 kcalories per liter the IV pump should be set at how
many milliliters per hour
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A nurse is providing teaching to a client who has AIDS which of the following statements by the
client indicates an understanding of the teaching
A nurse is assessing a client who has peripheral artery disease which of the following findings
should the nurse expect
A nurse is providing teaching to an older adult client who has cancer and a new prescription for
an opioid analgesic for pain management which of the following information should the nurse
include in the teaching
A nurse is planning care for a client who is scheduled for a thoracentesis which of the following
interventions should the nurse include in the plan
A nurse is caring for a client who has a prescription for Enalapril the nurse should identify which
of the following findings as an adverse effect of the medication
A charge nurse is instructing a newly licensed nurse about caring for a client who has MRSA
which of the following statements by the newly licensed nurse indicates an understanding of the
teaching
A nurse is caring for a client who recently had a stroke of the right hemisphere which of the
following manifestations should the nurse expect
A nurse is caring for a client who is exhibiting manifestations of a febrile reaction while
receiving a blood transfusion which of the following medications should the nurse administer
A nurse is assessing a client who has hypokalemia which of the following manifestations should
the nurse expect
a nurse is caring for a client who is experiencing supraventricular tachycardia upon assessing the
client the nurse observes the following findings heart rate 200 per minute blood pressure 78 over
40 and respiratory rate 30 per minute which of the following actions should the nurse take
A nurse is providing dietary teaching to a client who is post-operative following a thyroidectomy
with removal of the parathyroid glands the nurse should instruct the client to include which of
the following foods that has the greatest amount of calcium in her diet
A nurse is caring for a client who has dka which of the following findings should indicate to the
nurse at the client's condition is improving
A nurse is performing a dressing change for a client who is recovering from a hemicolectomy
when removing the dressing with the nurse notes that a large part of the bowel is protruding
through the abdomen which of the following actions should the nurse take first
A nurse is caring for a client who presents to a clinic for a one-week follow-up visit after
hospitalization for heart failure based on the information in the clients chart which of the
following findings should the nurse report to the provider
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A nurse is assessing for compartment syndrome in a client who has a short leg cast which of the
following findings should the nurse identify as a manifestation of this condition
A nurse is planning care for a client who is post-operative following a laparotomy and has a
closed suction drain which of the following actions should the nurse take to manage the drain
A pacu nurse is assessing a client who is post-operative following a right nephrectomy the
client's initial vital signs for heart rate 80 permanent blood pressure 130 over 70 respiratory rate
16 and temperature 96.8 which of the following Vital sign changes should alert the nurse the
client might be hemorrhaging
A nurse is assessing a client following the completion of hemodialysis which of the following
findings is the nurses priority to report to the provider
A nurse is caring for a client who is having a seizure which of the following interventions is the
nurses priority
A nurse is obtaining a medication history from a client who is scheduled to undergo cataract
surgery the nurse should recognize that which of the following client medications is a
contraindication for the surgery and notify the provider
A nurse is providing teaching to a female client who has a history of urinary tract infections
which of the following information should the nurse include in the teaching
A nurse is assessing a client who has had a suspected cerebrovascular accident the nurse should
place the priority on which of the following findings
A nurse is planning care for a client who is post-operative following a parathyroidectomy which
of the following actions should the nurse identify as the priority
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A nurse is providing teaching to a client who has Type 1 diabetes mellitus and a new prescription
for insulin lispro which of the following statements by the client indicates an understanding of
the teaching
A nurse is providing medication teaching to a group of clients who have seizure disorders which
of the following information should the nurse include about phenytoin
A nurse is providing discharge instructions to a client who has active tuberculosis which of the
following information should the nurse include in the instructions
A nurse is planning care for a client who was having a modified radical mastectomy of the right
breast which of the following interventions should the nurse include in the plan of care
And your sis reading teaching to a client who has hypertension and a new prescription for
Verapamil. Which of the following juices should the nurse instruct the client to avoid
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A nurse is providing teaching to a client who has asthma about the use of a metered dose inhaler
the nurse should identify that which of the following client actions indicates an understanding of
the teaching
A nurse is providing instructions to a client who has Type 2 diabetes mellitus and a new
prescription for metformin which of the following statements by the client indicates an
understanding of the teaching
A nurse is providing teaching to a client who has irritable bowel syndrome which of the
following instructions should the nurse include in teaching
A nurse in an emergency department is assessing an older adult client who has a fractured wrist
following a fall during the assessment the client states last week I crashed my car because my
vision suddenly became blurry which of the following actions is the nurses priority
A nurse is providing teaching to a client who has a new prescription for psyllium which of the
following information should the nurse include in the teaching
A nurse on a medical-surgical unit is receiving change of shift report on four clients which of the
following clients should the nurse identify as having the greatest risk for developing an infection
A nurse is planning discharge teaching for a client who has an external fixation device for a
fracture of the lower extremity which of the following instructions should the nurse include in
the plan of care
A nurse in an emergency department is caring for a client who has full thickness Burns over 20%
of his total body surface area after ensuring a patent Airway and administering oxygen which of
the following items should the nurse prepared to administer first
A nurse is reviewing the medical record of a client who has osteomyelitis and a prescription for
Gentamicin which of the following findings from the client's medical record should indicate to
the nurse the need to withhold the medication and notify the provider
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A nurse is reviewing the laboratory results of a client who has a new diagnosis of acute leukemia
which of the following findings should the nurse identify as an expected finding
A nurse in an emergency department is caring for a client who reports vomiting and diarrhea for
the past 3 days which of the following findings should indicate to the nurse that the client is
experiencing fluid volume deficit
A nurse is providing preoperative teaching for a client who is scheduled for an open
cholecystectomy which of the following actions should the nurse take
A nurse is caring for a client who is receiving mechanical ventilation via a tracheostomy to the
nurse should recognize that which of the following complications is associated with long-term
mechanical ventilation
A nurse is providing discharge instructions to a client who has laryngeal cancer and received is
receiving radiation treatment which of the following statements by the client indicates an
understanding of the teaching
A nurse is caring for a client who has a positive culture for Clostridium difficile which of the
following actions should the nurse take
A nurse in a provider's office is assessing a client who has migraine headaches and is taking
Feverfew to prevent her headaches the nurse should identify that which of the following client
medications interact with Feverfew
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A nurse in an emergency department is planning care for a client who has a flail chest on the
right side following a motor vehicle crash which of the following actions should the nurse plan to
take
A nurse is preparing to assist with the insertion of a non tunneled percutaneous central venous
catheter into a client's subclavian vein the nurse should plan to place the client in which of the
following positions
A nurse is teaching an older adult client about osteoporosis prevention the nurse should instruct
the client that which of the following medications can increase her risk for developing
osteoporosis
A nurse is teaching a client who has end-stage kidney disease about organ donation which of the
following information should the nurse include in the teaching
A client is admitted to the ER with anxiety loss of muscle coordination and skin is hot and dry
the client had been working on the yard prior to coming to the hospital which of the following
actions should the nurse anticipate taking first
A nurse is caring for a client who has an arteriovenous fistula for dialysis which of the following
requires intervention by the nurse
a nurse is caring for a client who had an open thoracotomy with chest tube insertion which of the
following actions should the nurse take
A nurse is providing instruction about traveling for a client who has a new diagnosis of type 1
diabetes mellitus and is planning a trip by airplane which of the following should the nurse
A nurse is providing teaching to a client who has hypothyroidism and is receiving Levothyroxine
the nurse should instruct the client that which of the following could interfere with the absorption
of the medication
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A nurse is caring for a client with a history of congestive heart failure at risk for development of
fluid volume excess. The nurse should monitor for which of the following that is a manifestation
of left sided heart failure?
Which client problem should receive highest priority when a client is admitted with an acute
exacerbation of rheumatoid arthritis?
A nurse is caring for a client with hypoparathyroidism. Because of the potential electrolyte
disturbance associated with this diagnosis, the nurse should observe the client for evidence of
which of the following?
A client with glaucoma is admitted for surgery the following day. The client is to continue
treating the glaucoma with pilocarpine (Pilocar) 2% 1 drop 4 times a day. While instilling this
medication, an appropriate nursing action is which of the following?
A client has sprained an ankle while playing soccer. For the first 24 hr following the injury, the
nurse should instruct the client to do which of the following?
A nurse is assisting with the discharge of a client newly diagnosed with diabetes. When
reviewing information about proper foot care, which of the following would be appropriate to
include?
Following a transient ischemic attack (TIA), a client is alert, slightly confused, and has a blood
pressure of 204/102 mm Hg. The client is also incontinent of urine. When contributing to the
client's plan of care, which nursing action would be appropriate?
A nurse is reinforcing teaching to a client recently diagnosed with systemic lupus erythematosus
(SLE). Which statement made by the client indicates to the nurse an accurate understanding of
the home management of SLE?
A nurse is caring for a client who has undergone a hip arthroplasty. The nurse reminds the client
that the purpose of an abduction pillow following arthroplasty is to do which of the following?
A client who is admitted to the hospital after experiencing a tonic clonic seizure is scheduled for
a routine electroencephalogram (EEG). In preparing the client for the EEG, the nurse should
explain that the client will undergo which of the following?
A client is experiencing stomatitis as a result of chemotherapy and radiation therapy. Which
statement made by the client indicates to the nurse that reinforcement of teaching is necessary?
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A client is returning from surgery with a radium implant for the treatment of endometrial cancer.
In planning this client's care, which action would be consistent with the client's diagnosis?
A client who works in carpentry is seen by the triage nurse. The client complains of severe right
eye pain with a gritty sensation. When obtaining a history from this client, which question has
the highest priority?
A client who had a craniotomy is sitting in a chair with the nurse present in the room. While the
client is sitting, he begins to experience a grand mal seizure. At this time, the most important
nursing intervention is which of the following?
Lower the client to the floor.
A client has a platelet count of 18,000 cells/mL. An appropriate nursing intervention is to do
which of the following?
A nurse asks a client who is diagnosed with asthma about the pathophysiology of the disorder.
Further reinforcement of teaching is indicated when the client states that the cause of airway
obstruction is due to which of the following?
A client diagnosed with viral encephalitis secondary to West Nile Virus is admitted to the
hospital for treatment. When assisting in the development of a nursing care plan, which
interventions are consistent with the client's diagnosis? (Select all that apply.)
Placing the client on respiratory isolation is incorrect.
While reviewing an admission assessment for a client with an exacerbation of asthma, the nurse
learns the client has several food allergies. The most important nursing action in promoting this
client's safety is to do which of the following?
A client who had a traumatic amputation of the arm at the elbow is reporting pain in the hand of
the amputated limb. The client has dressing changes prescribed twice daily, hydrocodone
(Vicodin) and gabapentin (Neurontin) PRN, and cefuroxime sodium (Ceftin) 750 mg 3 times
daily IV. Which of the following actions by the nurse is appropriate?
A nurse is caring for a client who underwent a transurethral resection of the prostate (TURP) for
benign prostatic hypertrophy (BPH). The client's bladder is continuously irrigated with saline via
a three-way catheter PRN. Which of the following findings should be reported immediately to
the provider?
A nurse is caring for a client with arteriosclerosis. When reviewing the client's chart, which of
the following factors should the nurse realize is associated with the development of
arteriosclerosis?
At the start of the night shift, an assistive personnel (AP) brings the nurse a list of client reports.
Which client does the nurse need to check first?
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A client in a community clinic tests positive on a Mantoux skin test but does not demonstrate
active lesions on a chest x-ray. When assisting with the development of the plan of care for this
client, the nurse should reinforce that isoniazid (INH) therapy will have to be taken for which of
the following time frames?
Supportive therapy provided by the nurse for a client during a sickle cell crisis would include
which of the following?
The client's arterial blood gas (ABG) levels are pH 7.5, pCO2 32, bicarbonate (HCO3) 24. The
nurse interprets that the client is in which of the following?
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A client is brought to the emergency department following a fall. The nurse, suspecting a basilar
skull fracture, should check the client for which of the following signs specific to a basilar skull
fracture?
A client with chronic renal failure is undergoing peritoneal dialysis. Which nursing measure will
be helpful in promoting outflow drainage of the dialyzing solution?
A nurse is completing the evening observations on a client in balanced skeletal traction admitted
the previous evening for a fractured left femur. Which observation should the nurse report to the
charge nurse?
In preparation for a sigmoid colon resection, the nurse is reinforcing information about the
colostomy that will be performed. Which statement by the client will require further
clarification?
A client is diagnosed with endocarditis following rheumatic heart disease. Which comment made
by the client indicates to the nurse that she understands discharge teaching in relation to
endocarditis?
A nurse is caring for a client in acute renal failure. Which of the following manifestations should
the nurse expect the client to exhibit?
A client with type 1 diabetes mellitus has a capillary blood glucose reading of 48 mg/dL. Which
of the following should the nurse expect to find?
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A middle-adult assistive personnel (AP) is assigned to give a bath to a client with herpes zoster
(shingles). The AP asks if this disease is contagious because there is an isolation sign on the
client's door. Which response by the nurse would be appropriate at this time?
When reinforcing health teaching to a group of clients, it is important for the nurse to emphasize
that melanoma is characterized by lesions that have which of the following appearances?
Following a total gastrectomy, which medication should the nurse anticipate that the client will
need to take for the rest of the client's life?
A client is diagnosed with active pulmonary tuberculosis and begins a treatment regimen of
rifampin (Rifadin) and ethambutol (Myambutol). The nurse should reinforce with the client the
need to report which of the following adverse effects to the provider?
When a nurse brings a hospitalized client with AIDS (acquired immune deficiency syndrome)
the morning dose of zalcitabine (Hivid), the client states, "I have this awful burning sensation in
my fingers and toes. They are numb and tingling." What response by the nurse is appropriate at
this time
A nurse is preparing to administer an intramuscular injection. The most important action by the
nurse to prevent direct injection of the medication into the venous system is to do which of the
following?
An assistive personnel (AP) discovers a fire in the utility room. Which action by the AP would
require the nurse to intervene?
A client diagnosed with emphysema is being prepared for discharge. Which instruction
reinforced by the nurse would be beneficial for improving the client's gas exchange?
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A client questions the nurse concerning the usual course of multiple sclerosis (MS). Which of the
following is an appropriate response by the nurse?
A client has just received a cardiac pacemaker. Which statement by the client demonstrates to the
nurse an understanding of the pacemaker's purpose?
A client returns to the nursing unit post-thoracotomy with two chest tubes in place connected to a
drainage device. The client's spouse asks the nurse the reason for having two chest tubes. The
nurse's response is based on the knowledge that the lower chest tube is placed to do which of the
following?
A nurse is caring for a client admitted with a diagnosis of hyperthyroidism caused by an
adenoma of the thyroid gland. Twelve hours following the thyroidectomy, which of the
following findings should the nurse report to the charge nurse? (Select all that apply.)
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Which nursing action is appropriate when trying to control epistaxis?
A provider prescribes a confused and combative client to be placed in a jacket restraint and wrist
restraints. To prevent injury to the client, the most important nursing action is which of the
following?
A nurse making rounds finds a client in the waiting room who is confused, has clammy skin, and
his hands are tremoring. The nurse should do which of the following?
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A nursing assistant asks the nurse what type of precautions are necessary when caring for a client
newly diagnosed with tuberculosis. The nurse instructs the nursing assistant to do which of the
following? (Select all that apply.)
Giving the client an impermeable paper bag for used tissues is correct. A paper bag that is
impermeable to leakage of its contents should be used for tissues that contain sputum.
A nurse is assisting in admitting a client to the burn treatment center following the client's rescue
from a house fire. Which observation takes the highest priority?
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A provider is planning to remove a client's chest tube. Which instruction should the nurse give
the client to ensure understanding regarding the removal procedure?