SITUATION: Nurse Charmaine is in charge of a client who was admitted for management of acute episode of cholecystitis.

1. Nurse Charmaine did her admission assessment. She understands that the pain is characterized as:
A. Tenderness that is generalized in the upper epigastric area
B. Pain of the left upper quadrant radiating to the left shoulder
C. Tenderness and rigidity at the left epigastric area radiating to the back
D. Tenderness and rigidity of the upper right abdomen radiating to the midsternal area

2. To confirm the diagnosis of cholecystitis, the attending physician ordered the procedure that can detect gallstones as small as 1
to 2 cm and inflammation. Nurse Charmaine would prepare the client for which specific diagnostic procedure?
A. Cholangiography B. Gall bladder series C. Ultrasonography D. Oral
cholecystogram

3. The diagnosis was confirmed as cholecystitis with gallstones. The doctor prepared the client for the removal of his gallbladder.
The client asks the nurse “how will this procedure affect my digestion?” The nurse’s most correct response would be:
A. “The removal of the gall bladder would significantly interfere only with the digestion of fatty foods.”
B. “The removal of the gallbladder does not usually interfere only with the digestion.”
C. “Your body system will adjust in due time.”
D. “The removal of the gallbladder usually interferes with digestion but can be remedied n dietary modifications.”

4. Reviewing the laboratory findings of the client, the nurse found which findings are elevated?
1. White blood cell count 4. Red blood cell count
2. Total serum bilirubin 5. Cholesterol
3. Alkaline phosphatase 6. Serum amylase
A. 1, 2, 3 B. 2, 3, 4 C. 3, 5, 6 D. 1, 2, 6

5. A T-tube was inserted and the doctor ordered: “Monitor the amount color, consistency and odor of drainage.” Which of the
following procedures can the nurse perform without the doctor’s order?
A. Clamping B. Irrigating C. Aspirating D.
Emptying the drainage

SITUATION: Clarie, 16 years old, is admitted to the hospital for observation due to vague epigastric pain. The doctor’s impression is
appendicitis.
6. Based on the initial assessment on admission the nurse is looking for positive manifestations of appendicitis, which includes the
following except:
A. Abdominal tenderness on palpation C. Thrombocytopenia
B. Low grade fever D. Nausea and vomiting

7. A positive sign of appendicitis is localized and rebound tenderness on palpation at which quadrant on the abdomen?
A. Left upper quadrant B. Left lower quadrant C. Right upper quadrant D. Right
lower quadrant

8. Clarie is scheduled to undergo appendectomy includes the following. Select all that apply.
1. Intravenous infusion 4. Enema
2. Laxative 5. Shower
3. Pubic area shaving 6. Pain medication
A. 2, 3, 4 B. 1, 3, 5 C. 1, 2, 3 D. 1, 5, 6

9. The nurse would monitor for signs of peritonitis, a potential postoperative complications. The manifestations include the following
except:
A. Fever B. Tachycardia C. Abdominal tenderness D. Soft
abdomen

10. Intravenous therapy was prescribed to Clarie. Which of the following is not an indication of the therapy?
A. To replace blood and fluid loss C. For parenteral nutrition
B. For antibiotic therapy D. To promote renal function

SITUATION: Mang Rolando was long diagnosed with Chronic Renal Failure. You are his nurse and the following questions will assess
your knowledge on the different fluid and electrolyte imbalances associated with chronic renal failure.
11. Mang Rolando's CRF was caused by a crush injury to the lower leg brought about by a vehicular accident. His condition started
as acute renal failure, which later progressed to chronic renal failure. The nurse is correct in determining that the cause of the
client's acute renal failure before was:
A. Prerenal B. Postrenal C. Intrarenal D.
Extrarenal
B.
12. Mang Rolando is scheduled for hemodialysis. The main indicator for the need for hemodialysis is:
A. Ascites B. Acidosis C. Hypertension D.
Hyperkalemia
13. Mang Rolando misses two sessions of hemodialysis. Blood was drawn and is sent for analysis. Which electrolyte disturbance is
expected in a client with CRF?
A. Hyponatremia B. Hyperkalemia C. Hypomagnesemia D.
Hypercalcemia

14. In Mang Rolando's ECG tracing, you would expect to find:

A. Depressed T wave B. Presence of U wave C. A peaked T wave D.
Inverted T wave

15. As Mang Rolando's condition continues to worsen, the client undergoes renal transplant. Mang Rolando is started on
Cyclosporine therapy to prevent graft rejection. Which of the following is a major complication of this drug therapy?
A. Depression B. Hemorrhage C. Infection D. Peptic
ulcer disease

SITUATION: Nurse Farah admitted Harold for management of acromegaly.

16. Nurse Farah is aware that acromegaly is a condition when growth hormone occurs in excess in adulthood of after epiphyses of
the long bone shave fused. The following are the typical features of the disorder, except:
A. The soft tissues continue to grow C. The client grows taller
B. Hands and feet are enlarged D. Broad and bulbous nose

17. The client was prescribed ocreotide acetate (Sandostatin). Nurse Farah would monitor for which of the following side effects?
A. Abdominal pain B. Dysuria C. Hypotension D.
Constipation

18. For effective dosing, ocreotide acetate must be administered by which appropriate route, three times weekly?
A. Intravenously B. Orally C. Intramuscularly D. Subcutaneously

19. Priority discharge plans should include which of the following? Select all that apply.
1. Fasting blood sugar 3. Intake and output
2. Bone assessment 4. Urine output
A. 2 and 3 B. All except 1 C. 1, 2 and 3 D. 1 and
2

20. Acromegaly often develops insidiously that nurses should understand that the client with this disorder would seek medical care
because of:
A. Alteration in fat and carbohydrate metabolism C. Changes in appearance
B. Changes in blood sugar level D. Alteration in their voice

SITUATION: A 34 year-old female client with Graves’s disease was admitted for treatment. The physician prescribed propylthiouracil
to treat the disorder.
21. Before the nurse administers the medication, which of the following is not relevant for the nurse to ask?
A. “Do you experience gastric discomforts?” C. “When was your last menstruation?”
B. “When was the last time you took alcohol? ” D. “Do you prefer a liquid form of medication?”
22. The client is prepared for surgery in about ten days’ time. Lugol’s solution 4 gtts PO was prescribed for 10 days. The client asked
the nurse for the purpose of the drug. Which response of the nurse is correct?
A. It decreases the risk of bleeding C. It stabilizes your immune system
B. It eliminates the need to take hormone replacement D. It decreases the risk for thyroid crisis
23. When the client returns to the unit after surgery, which technique is most appropriate to monitor bleeding from the incision?
A. Weigh all gauze dressing before and after changing wound dressings
B. Assess for dampness at the back of the client’s neck
C. Pass a flashlight across the incision wound on top of the dressings
D. Remove the dressings to directly inspect the incision wound
24. Which of the following is indicative of a thyroid crisis?
A. Falling blood pressure C. High fever
B. Regular and noisy breathing D. Spasm in the hand
25. At the start of thyroid replacement post total thyroidectomy, the nurse must monitor for side effects. Which side effects would the
nurse expect to assess? Select all that apply.
1. Hypertension 4. Insomnia
2. Tremors 5. Tachycardia
3. Hirsutism 6. Hyperglycemia
A. 3, 4, 5, 6 B. 1, 2, 3 ,6 C. 1, 3, 4, 5 D. 1, 2, 4,
5

SITUATION: Nurse Katana admitted Lindsey, 33, married for thyroid work up.
26. Which admission assessment would make you suspect that Lindsey has hypothyroidism? Select all that apply.
1. Heat intolerance 4. Coarse and dry skin
2. Diarrhea 5. Somnolence
 3. Bradycardia 6. Decreased appetite

A. 3, 4, 5 and 6 B. 2, 3, 5 and 6 C. All except 5 D. 1, 2, 3

and 4
27. Lindsey was ordered to undergo radioactive iodine uptake the following day. The nurse understands that this test determines
which of the following?
A. Absorption of the Iodine Isotope ` C. Ingestion of the Iodine Isotope
B. Stimulation of the Iodine Isotope D. Reaction of the Iodine Isotope
28. If the doctor will prescribe Basal Metabolic Rate (BMR) to Lindsey, which of the following preparations is NOT indicated?
A. Nothing by mouth for 10-12 hours C. A good night’s sleep of 8-10 hours
B. Instruct client not to get out of bed until the test is over D. Blood extraction upon waking up
29. Cytomel (Liothyronine) was prescribed to Lindsey. Before administering the drug, Nurse Katana should not only verify the doctor’s
order but also:
A. Take the BP and the pulse rate C. Advise the client to stay in bed
B. Take the weight of the client D. Take the temperature and respiratory rate
30. Lindsey asked the nurse which diet is most appropriate to her. The correct response of the nurse would be:
A. Low calorie and high fiber C. High calorie and high fiber
B. Low salt and low fat D. High protein but low residue

SITUATION: Jupiter, a 40 year old teacher, just returned to the ward from the Post Anesthesia Care Unit (PACU). Jupiter underwent
subtotal thyroidectomy in the morning.
31. Jupiter was assisted from the stretcher to the bed. The nurse would assist the client to assume which of the following comfortable
positions?
A. Semi-Fowler’s with head and neck supported with pillow C. Dorsal recumbent with sandbags on both sides
of the neck
B. High Fowler’s with neck supported with rolled towel D. Recumbent with neck supported with pillow
32. The nurse assessed the client for possible laryngeal nerve damage. The MOST appropriate way to assess is to:
A. Observe any difficulty in swallowing C. Let the client cough three times
B. Palpate for the laryngeal nerves on both sides of the neck D. Talk with the client and note change in voice
33. From the laboratory results, the nurse noted the serum calcium to be 5.0 mg/dl. Which of the following will the nurse do first?
A. Refer to the physician C. Validate results with laboratory
B. Take vital signs D. Assess for signs of tetany
34. Patient complaints of tightness of dressings. Which of the following is a priority nursing intervention?
A. Assess dressings for drainage C. Change position of the patient
B. Check vital signs D. Remove neck support
35. The watcher asks the nurse, “When can Jupiter start to eat? His last food intake was last supper.” The correct response of the
nurse is:
A. “Jupiter can start on clear liquids as soon as he is fully conscious “
B. “The doctor will evaluate the client when he is ready to eat.”
C. “Jupiter is still on intravenous fluids, and is doing fine.”
D. “As soon as bowel sounds are present.”

SITUATION: Antonio, age 52, was admitted to the hospital with acute adrenal insufficiency. He has a history of Addison’s disease for
which he has been taking hydrocortisone. Over the past week, he has flulike symptoms accompanied by nausea and vomiting. When
he awoke this morning, his wife noticed that he was confused and extremely weak, so she brought him to the hospital for evaluation.
36. The nurse would assess for which signs and symptoms for a client diagnosed with addisonian crisis?
A. Polyuria, polydipsia, and polyphagia C. Hypotension, rapid respirations, and pallor
B. Tremors, tachycardia, and headache D. Positive Chvostek's sign, photophobia, and
numbness
37. Antonio’s blood pressure is 90/58 mmHg, his heart rate is 116 bpm, and his temperature if 101 oF. The nurse should expect to
start an IV infusion of:
A. Insulin B. Hydrocortisone C. Potassium D.
Hypotonic saline
38. Which is an appropriate measure for a patient with addisonian crisis?
A. IV fluid replacement B. IV corticosteroids C. Blood glucose management D. All of
the above
39. During the initial 24 hours after admission, the nurse should frequently:
A. Weigh the patient C. Assess vital signs
B. Test the patient’s urine for ketones D. Administer oral hydrocortisone
40. The patient in addisonian crisis is unable to respond to stress. Before discharge, the nurse should instruct Antonio and his family
that during stress it’ll be necessary to:
A. Administer cortisone IM C. Perform capillary blood glucose monitoring four
times daily
B. Drink 8 oz of fluids D. Continue to take his usual dose of
hydrocortisone

SITUATION: Technology and patient’s education has dramatically improved the management of the diabetic client.
41. The current insulin pumps available in the market have the following capability, EXCEPT:
A. Prevent unexpected saving in blood glucose measurements
 B. Detect sign and symptoms of hypoglycemia and hypercalcemia
C. Deliver a pre-meal bolus dose of insulin before each meal
D. Deliver a continuous basal rate of insulin at 0.5 units to 2.0 per hour
42. Discharge plan of diabetic client include injection-site-rotation. You should emphasize that the space between sites should be.
A. 6 cm B. 2.5 cm C. 5 cm D. 4 cm
43. It is critical also that a diabetic client should be educated in the possible site if regular insulin injection. The fastest absorption
rate happens at the tissue area of:
A. Gluteal area B. Deltoid area C. Anterior thigh D.
Abdominal area
44. Self-monitoring of blood glucose (SMBG) is recommended for patient’s use. You will recommend this technology in the following
diabetic patient, EXCEPT
A. Client with proliferative retinopathy C. Unstable diabetes
B. Hypoglycemia without warning D. Abdominal renal glucose threshold
45. It is necessary for a diabetic client to exercise regularly. What is the effect of regular exercise to a diabetic client?
A. It burns excess glucose
B. It improves insulin utilization and lowers blood glucose
C. It lowers glucose, improves utilization, decrease total triglycerides levels
D. It will make you fit and energized

SITUATION: A 42-year old business woman visits her physician. A tentative diagnosis of Grave’s disease is made.
46. Which symptom related to the client’s menstrual cycle would she likely report during initial assessment?
A. Dysmenorrheal B. Metrorrhagia C. Oligomenorrhagia D.
Menorrhagia
47. Propylthiouracil is prescribed for the client. The nurse should teach the client to report immediately which of the following signs
and symptoms?
A. Sore throat and fever C. Constipation and abdominal distention
B. Painful and excessive menstruation D. Increased urine output and itchy skin
48. Exopthalmos is noted. Measures to prevent eye damage include:
A. Massaging the eyes at regular intervals C. Taping the eyelids closed with non-irritating
tape
B. Instilling an ophthalmic anesthetic as ordered D. Covering both eyes with moistened gauze pads
49. After a subtotal thyroidectomy, the nurse asks the client to state her name, as soon as she regains consciousness then repeats
this request from time to time. The nurse does this primarily to monitor for:
A. Internal hemorrhage C. Laryngeal nerve damage
B. Decreasing level of consciousness D. Upper airway obstruction
50. After the surgery, the patient develops peripheral numbness and tingling with muscle spasms. The nurse should expect to
administer?
A. Levothyroxine B. Propantheline bromide C. Morphine sulfate D.
Calcium gluconate