Colegio de Sta. Lourdes of Leyte Foundation, Inc.

COLLEGE OF NURSING
Tabontabon, Leyte
TEST DRILL IN ACUTE BIOLOGIC CRISIS
NAME
SCORE

DATE
_

DIRECTION: Write the letter of your choice on the space provided for in each item after you have
scrutinized the question impeccably. Admissible inks are black and blue alone and
numbers/letters should be written in their uppercase state. Erasures and superimpositions will
most likely result to deduction of scores, thereby, should be avoided.
CONCEPT: MYOCARDIAL INFARCTION, ANGINA
1. Which of the following is the most common symptom of myocardial infarction (MI)?
A. Chest pain
B. Dyspnea
C. Edema
D. Palpitations
2. Which of the following symptoms is the most likely origin of pain the client described as
knifelike chest pain that increases in intensity with inspiration?
A. Cardiac
B. Gastrointestinal
C. Musculoskeletal
D. Pulmonary
3. Which of the following blood tests is most indicative of cardiac damage?
A. Lactate dehydrogenase
C. Troponin I
B. CBC
D. Creatine kinase
4. What is the primary reason for administering morphine to a client with an MI?
A. To sedate the client
D. To decrease oxygen demand on the
B. To decrease the clients pain
clients heart
C. To decrease the clients anxiety
5. Which of the following conditions is most commonly responsible for myocardial infarction?
A. Aneurysm
C. Coronary artery thrombosis
B. Heart failure
D. Renal failure
6. After an anterior wall MI, which of the following problems is indicated by auscultation of
crackles in the lungs?
A. Left-sided heart failure
C. Right-sided heart failure
B. Pulmonic valve malfunction
D. Tricuspid valve malfunction
7. What is the first intervention for a client experiencing MI?
A. Administer morphine
C. Administer sublingual nitroglycerin
B. Administer oxygen
D. Obtain an ECG
8. What is the most common complication of an MI?
A. Cardiogenic
B. Heart failure
D. Pericarditis
shock
C. arrhythmias
9. Which of the following symptoms is most commonly associated with left-sided heart failure?
A. Crackles
C. Hepatic
D. Hypotension
B. Arrhythmias
engorgement
10. Which of the following classes of medications maximizes cardiac performance in clients with
heart failure by increasing ventricular contractility?
A. B-adrenergic
B. Ca channel
C. Diuretics
blockers
blockers
D. Inotropic agents
11. Which condition is most closely associated with weight gain, nausea, and a decrease in urine
output?
A. Angina pectoris
C. Left-sided heart failure
B. Cardiomyopathy
D. Right-sided heart failure
12. Which of the following conditions is associated with a predictable level of pain that occurs as
a result of physical or emotional stress?
A. Anxiety
B. Stable angina
C. Unstable angina
D. Variant angina
13. Which of the following types of angina is most closely related with an impending MI?

A. Angina
decubitus

B. Chronic stable
angina

C. Nocturnal
angina

D. Unstable angina

14. Which of the following conditions is the predominant cause of angina?

A. Increased preload
D. Inadequate oxygen supply to the
B. Decreased afterload
myocardium
C. Coronary artery spasm
15. Which of the following results is the primary treatment goal for angina?
A. Reversal of ischemia
C. Reduction of stress and anxiety
B. Reversal of infarction
D. Reduction of associated risk factors
16. Which of the following interventions should be the first priority when treating a client
experiencing chest pain while walking?
A. Sit the client down
B. Get the client back to bed
C. Obtain an ECG
D. Administer sublingual nitroglycerin
17. Which of the following is a compensatory response to decreased cardiac output?
A. Decreased BP
C. Decreased BP and diuresis
B. Alteration in LOC
D. Increased BP and fluid retention
18. A client admitted with angina complains of severe chest pain and suddenly becomes
unresponsive. After establishing unresponsiveness, which of the following actions should the
nurse take first?
A. Activate the resuscitation team
C. Check for breathing
B. Open the clients airway
D. Check for signs of circulation
19. A 55-year-old client is admitted with an acute inferior-wall MI. During the admission interview,
he says he stopped taking his metoprolol 5 days ago because he was feeling better. Which
nursing diagnosis takes priority for this client?
A. Anxiety
C. Acute pain
B. Ineffective tissue perfusion;
D. Ineffective therapeutic regimen
cardiopulmonary
management
20. A client comes into the E.R. with acute SOB and a cough that produces pink, frothy sputum.
Admission assessment reveals crackles and wheezes, a BP of 85/46, a HR of 122 BPM, and a
respiratory rate of 38 breaths/minute. The clients medical history included DM, HTN, and heart
failure. Which of the following disorders should the nurse suspect?
A. Pulmonary
B. Pneumothorax
C. Cardiac
D. Pulmonary
edema
tamponade
embolus
21. A nurse is conducting a health history with a client with a primary diagnosis of heart failure.
Which of the following disorders reported by the client is unlikely to play a role in exacerbating
the heart failure?
A. Recent URI
B. Nutritional
C. Peptic ulcer
D. A-Fib
anemia
disease
22. A client with angina complains that the angina pain is prolonged and severe and occurs at
the same time each day, most often in the morning, on further assessment a nurse notes that
the pain occurs in the absence of precipitating factors. This type of anginal pain is best described
as:
A. Stable angina
C. Variant angina
D. Non-anginal
B. Unstable angina
pain
23. The physician orders continuous intravenous nitroglycerin infusion for the client with MI.
Essential nursing actions include which of the following?
A. Obtaining an infusion pump for the
C. Monitoring urine output hourly
medication
D. Obtaining serum potassium levels daily
B. Monitoring BP q4h
24. Aspirin is administered to the client experiencing an MI because of its:
A. Antipyretic action
B. Antithrombotic
C. Antiplatelet action
action
D. Analgesic action

25. Which of the following is an expected outcome for a client on the second day of
hospitalization after an MI?
A. Has severe chest pain
B. Can identify risks factors for MI
C. Agrees to participate in a cardiac rehabilitation walking program
D. Can perform personal self-care activities without pain
26. Which of the following reflects the principle on which a clients diet will most likely be based
during the acute phase of MI?
A. Liquids as ordered
C. Three regular meals per day
B. Small, easily digested meals
D. NPO
27. Captopril may be administered to a client with HF because it acts as a:
A. Vasopressor
B. Volume
C. Vasodilator
expander

D. K-sparing
diuretic

CONCEPT: STROKE
28. What is a priority nursing assessment in the first 24 hours after admission of the client with a
thrombotic stroke?
A. Echocardiogram
C. Vowel sounds
B. Pupil size and papillary response
D. Cholesterol level
29. The nurse and unlicensed assistive personnel (UAP) are caring for a client with right-sided
paralysis. Which action by the UAP requires the nurse to intervene?
A. The assistant praises the client for attempting to perform ADLs independently.
B. The assistant places a gait belt around the clients waist prior to ambulating.
C. The assistant places the client on the back with the clients head to the side.
D. The assistant places her hand under the clients right axilla to help him/her move up in bed.
30. What is the expected outcome of thrombolytic drug therapy?
A. Dissolved emboli.
C. Vasoconstriction.
B. Increased vascular permeability.
D. Prevention of hemorrhage
31. During the first 24 hours after thrombolytic therapy for ischemic stroke, the primary goal is to
control the clients:
A. Temperature
B. Pulse
C. Blood pressure
D. Respirations
32. Which client would the nurse identify as being most at risk for experiencing a CVA?
A. An 84-year-old Japanese female.
C. A 55-year-old African American male.
B. A 39-year-old pregnant female.
D. A 67-year-old Caucasian male.
33. Which assessment data would indicate to the nurse that the client would be at risk for a
hemorrhagic stroke?
A. A blood pressure of 220/120 mm Hg.
C. A right-sided carotid bruit.
B. The presence of bronchogenic carcinoma.
D. A blood glucose level of 480 mg/dl.
34. Regular oral hygiene is an essential intervention for the client who has had a stroke. Which of
the following nursing measures is inappropriate when providing oral hygiene?
A. Opening the clients mouth with a padded tongue blade.
B. Cleaning the clients mouth and teeth with a toothbrush.
C. Keeping portable suctioning equipment at the bedside.
D. Placing the client on the back with a small pillow under the head.
35. A client arrives in the emergency department with an ischemic stroke and receives tissue
plasminogen activator (t-PA) administration. Which is the priority nursing assessment?
A. Time of onset of current stroke.
C. Current medications.
B. Complete physical and history.
D. Upcoming surgical procedures.
36. A 78-year-old client is admitted to the emergency department with numbness and weakness
of the left arm and slurred speech. Which nursing intervention is priority?
A. Notify the speech pathologist for an emergency consult.
B. Schedule for A STAT computer tomography (CT) scan of the head.
C. Prepare to administer recombinant tissue plasminogen activator (rt-PA).
D. Discuss the precipitating factors that caused the symptoms.
37. The client diagnosed with atrial fibrillation has experienced a transient ischemic attack (TIA).
Which medication would the nurse anticipate being ordered for the client on discharge?

A. An oral anticoagulant medication.

B. A beta-blocker medication.

C. An anti-hyperuricemic medication.
D. A thrombolytic medication.

38. Mr. S is admitted to the hospital for observation after a transient cerebral ischemic attack
with the following symptoms: aphasia, dizziness, and numbness of left arm. His care plan should
include provision for:
A. physical safety measures
C. seizure precautions
B. suctioning
D. positioning q2hrs
39. A CT-Scan is ordered for Mr. S. Preparation for the procedure should include:
A. not allowing him anything per mouth postC. instructing him concerning importance of
midnight
lying still
B. administering sedation as ordered
D. explaining that a lumbar puncture will be
necessary
CONCEPT: DKA/HHNK
40. After a thorough assessment and laboratory works shall shows serum ketones and serum
glucose level above 300 mg/dl, what condition would be diagnosed to patient?
A. Diabetes
B. DKA
D. Somogyi
insipidus
C. Hypoglycemia
phenomena
41. Which of the following combinations of adverse effects must be carefully monitored when
administering I.V. insulin to a client diagnosed with diabetic ketoacidosis?
A. Hypokalemia and hypoglycemia
C. Hyperkalemia and hyperglycemia
B. Hypocalcemia and Hyperkalemia
D. Hypernatremia and hypercalcemia
42. Which of the following method of insulin administration would be used in the initial treatment
of hyperglycemia in a client with diabetic ketoacidosis?
A. Subcutaneous
C. I.V bolus only
B. Intramuscular
D. I.V. bolus followed by continuous infusion
43. Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) can be differentiated from
diabetic ketoacidosis by which of the following conditions?
A. Hyperglycemia
B. Serum
C. Absence of
D. Hypokalemia
osmolarity
ketosis
44. Another patient was brought to the emergency room in an unresponsive state and a
diagnosis of hyperglycaemic hyperosmolar nonketotic syndrome is made. The nurse immediately
prepare to initiate which of the following anticipated physicians order?
A. Endotracheal intubation
D. Intravenous infusion of sodium
B. 100 units of insulin
bicarbonate
C. Intravenous infusion of normal saline
45. Jane eventually developed DKA and is being treated in the emergency room. Which finding
would the nurse expect to note as confirming this diagnosis?
A. Comatose state
D. Elevated blood glucose level and plasma
B. Decreased urine output
bicarb level
C. Increased respiration and increase in pH
46. The nurse teaches Jane to know the difference between hypoglycaemia and ketoacidosis.
Jane demonstrates understanding of the teaching by stating that glucose will be taken of which
of the following symptoms develops?
A. Heavy breathing
B. Shakiness
C. Blurred vision
D. Foul breath odor
47. Jane has been scheduled to have a FBS taken in the morning. The nurse tells Jane to eat or
drink after midnight. Prior to taking the blood specimen, the nurse noticed that Jane is holding a
bottle of distilled water. The nurse asked Jane if she drink any, and she said yes. Which of the
following is the best nursing action?
A. Administer syrup of ipecac to remove the distilled water from the stomach.
B. Suction the stomach content using NGT prior to specimen collection
C. Advice to physician to reschedule to diagnostic examination next day
D. Continue as usual and have the FBS analysis performed and specimen be taken.
48. Which of the following methods of insulin administration would be used in the initial
treatment of hyperglycemia in a client with diabetic ketoacidosis?
A. Subcutaneous
C. IV bolus only
B. IV bolus, followed by continuous infusion
D. Intramuscular

49. Insulin forces which of the following electrolytes out of the plasma and into the cells?
A. Magnesium
B. Calcium
C. Phosphorus
D. Potassium
50. A nurse is caring for a client in the ER with DKA. In the acute phase the priority nursing action
is to prepare to:
A. Administer 5% dextrose intravenously
C. Correct the acidosis
B. Administer regular insulin intravenously
D. Apply an electrocardiogram monitor
51. A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which
finding would a nurse expect to note as confirming this diagnosis?
A. Decreased urine output
C. Elevated blood glucose level and a low
B. Increased respirations and an increase in
plasma bicarb
pH
D. Comatose state
52. When a client is first admitted with HHNS, the nurses priority is to provide:
A. Carbohydrates
B. Fluid
C. Dietary
D. Oxygen
replacement
instruction
53. A client is in DKA, secondary to infection. As the condition progresses, which of the following
symptoms might the nurse see?
A. Cheyne-stokes respirations and foul-smelling urine
B. Kussmauls respirations and a fruity odor on the breath
C. Decreased respirations and increased urine output
D. Shallow respirations and severe abdominal pain
54. Which of the following causes of HHNS is most common?
A. Insulin overdose
C. Removal of the adrenal gland
B. Undiagnosed, untreated diabetes mellitus
D. Undiagnosed, untreated hyperpituitarism
55. A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is:
A. Blurred vision
B. Diaphoresis
C. Weakness
D. Nausea
56. Which adaptations should the nurse caring for a client with diabetic ketoacidosis expect the
client to exhibit? Select all that apply:
A. Elevated serum
B. Retinopathy
D. Acetone breath
bicarbonate
C. Low PCO2
E. Sweating
57. A clients blood gases reflect diabetic acidosis. The nurse should expect:
A. Increased PCO2
C. Decreased
D. Increased pH
B. Decreased PO2
HCO3
CONCEPT: INCREASED ICP
58. Mark has a compound fracture of the temporal bone. The nurse notices bleeding from the
orifice of the ear. Which actions can be safely used to determine CSF?
A. Swab ear with sterile applicator and send specimen to lab
B. Blot drainage with sterile gauze and look for clear wet halo around spot of blood
C. Gently suction the ear and send specimen to lab
D. obtain (-) reading for sugar after testing CSF with Tes-Tape
59. The NCP states Observe for early signs of increased ICP. Early signs would include:
A. widening pulse pressure and dilated pupils
C. elevated temperature and decerebrate
B. rising BP and bradycardia
posturing
D. restlessness and change in LOC
60. During the initial period after injury, nursing intervention for Mark would include:
A. packing car with cotton balls to stop
C. placing client in Trendelenburgs to
bleeding
combat shock
B. awakening client q2hrs to determine LOC
D. forcing fluids to restore hydration
61. Neil, 52, has been complaining of headache for the past few months. He is relieved by
aspirin. Lately, he complained of double vision. Part of the neurologic assessment includes taking
v/s. Which signs is associated with increased ICP?
A. rapid pulse
C. pulse deficit
B. widening pulse pressure
D. decrease in systolic arterial pressure
CONCEPT: ACUTE RENAL FAILURE

62. Mike, 54, is admitted with a diagnosis of renal failure, acute. The physician orders a specific
gravity after each urine. Results came back as 1.010. This indicates:
A. severe damage to the kidney tubules
B. destruction to the filtration mechanism of the glomerulus
C. that the ability to concentrate and dilute urine is within normal limits
D. that the nephrons are intact but hypertrophied
63. Mike is given Amphojel 40mL p.c. and h.s. The primary purpose of this drug is to:
A. prevent metabolic acidosis
C. prevent GI ulcer formation
B. relive gastric irritation
D. bind phosphates in the intestinal tract
64. A complication of ARF is hyperkalemia. Its greatest danger is:
A. cardiac arrest
C. fluid overload
D. internal
B. tetany
bleeding
65. The physician orders Kayexalate 15g qid for Mike. The expected outcome of this drug is:
A. lower K+ serum levels
C. prevent bleeding tendencies
B. promote diuresis
D. reduce BP
66. Mike was placed on a low CHON, low K+, low Na+ diet. A teaching plan should include:
A. encouraging the consumption of snacks, such as raw celery, carrots, broccoli, and tomatoes
B. emphasizing liberal use of high-calorie foods, such as sugar, jams, honey, hard candy, butter
C. pointing out that canned fruits have higher K+ content than fresh raw fruits and should be
avoided
D. recommending that beans and legumes be used in place of animal protein like eggs, poultry
and meat
67. The physician orders regular insulin 10 U added to 50 mL of 50% dextrose per IV. The
expected outcome is:
A. lower the blood sugar
C. reduce cerebral edema
B. decrease the serum K+
D. prevent tetany
68. During the first peritoneal dialysis exchange, the fluid that drains from the outflow tubing is
blood-tinged. You would:
A. realize that this is a common occurrence for the first few exchanges
B. apply a pressure dressing to the insertion site
C. recognize that the abdominal blood vessels have been inadvertently punctured
D. check the urine output for hematuria
69. To prevent pain during peritoneal dialysis, the nurse should:
A. instruct the client to lie flat during entire exchange cycle
B. reduce rate of inflow to 50 gtts/min
C. warm the dialysate to 37 deg C before initiating flow
D. unclamp the outflow tubing as soon as the inflow period is completed
70. To promote drainage of fluid during outflow period, the nurse should:
A. keep HOB flat
C. turn client from side to side
B. attach outflow tubing to low intermittent
D. remove the outflow tubing and insert a
suction
new one
71. While caring for a client on dialysis who has an AV fistula, the nurse should recognize that:
A. the use of stethoscope for auscultating the fistula is contraindicated
B. the client feels best immediately after the dialysis
C. taking BP on the affected arm can cause clotting of fistula
D. no pain should be experienced during the initiation of dialysis
72. Following dialysis, the nurse would anticipate:
A. weight loss
B. polyuria

C. increased BP

D. glycosuria

73. In response to hemodialysis, the expected outcome should be a decrease in the serum:
A. bicarbonate
B. creatinine
C. proteins
D. sodium
74. The NCP states to observe for disequilibrium syndrome. Symptoms of it would include:
A. HA, confusion and seizures
C. fever, joint pain, and chills
B. ankle edema, rales and weight gain
D. decreased BP, rapid pulse, and chest pain

75. The nurse is infusing dialysate during peritoneal dialysis. What is the nursing action to make
the client more comfortable at this time?
A. increase the rate of flow
C. turn the client from side to side
B. raise the HOB
D. refrigerate the fluid before insertion
76. During PD, the nurse continually evaluates the client for retention of dialysate.This
complication be identified by:
A. fractional urine of 50%
C. an increase in Na+ transfer to serum
B. return of fecal material in the outflow
D. outflow of <100mL of inflow
77. A client with renal failure has an internal venous site for hemodialysis on her left forearm.
What action will the nurse take to protect this access site?
A. irrigate with heparin and NSS q8hrs
C. do not use left arm to take BP readings
B. apply warm moist packs to area after
D. keep the arm elevated above level of the
hemodialysis
heart
78. What nursing measures are included in the plan of care for a client with ARF?
A. observe for signs of a secondary infection
C. in and out catheterization for residual
B. provide a high-CHON, low-CHO diet
urine
D. force fluids to 2L in 24 hrs
79. The nurse is evaluating a clients response to hemodialysis. The lab values reflect that the
dialysis is achieving positive results. Which lab value would not reflect changes resulting from
dialysis?
A. serum creatinine
C. serum K+
B. dissolved pressure of CO2
D. Hgb levels
80. A client with ARF has been prescribed with Ca carbonate. What is the rationale for this?
A. diminishes incidence of ulcer formation
C. binds with phosphorus to eliminate it from
B. alleviates constipation
the body
D. increases tubular reabsorption of Na+
CONCEPT: EMERGENCY NURSING
81. You are the charge nurse in an emergency department (ED) and must assign two staff
members to cover the triage area. Which team is the most appropriate for this assignment?
A. An advanced practice nurse and an experienced LPN/LVN
B. An experienced LPN/LVN and an inexperienced RN
C. An experienced RN and an inexperienced RN
D. An experienced RN and a nursing assistant
82. You are working in the triage area of an ED, and four patients approach the triage desk at the
same time. List the order in which you will assess these patients.
A. An ambulatory, dazed 25-year-old male with a bandaged head wound
B. An irritable infant with a fever, petechiae, and nuchal rigidity
C. A 35-year-old jogger with a twisted ankle, having pedal pulse and no deformity
D. A 50-year-old female with moderate abdominal pain and occasional vomiting
_____, _____, _____, _____
83. In conducting a primary survey on a trauma patient, which of the following is considered one
of the priority elements of the primary survey?
A. Complete set of vital signs
C. Brief neurologic assessment
B. Palpation and auscultation of the abdomen
D. Initiation of pulse oximetry
84. A 56-year-old patient presents in triage with left-sided chest pain, diaphoresis, and dizziness.
This patient should be prioritized into which category?
A. High urgent
B. Urgent
C. Non-urgent
D. Emergent
85. The physician has ordered cooling measures for a child with fever who is likely to be
discharged when the temperature comes down. Which of the following would be appropriate to
delegate to the nursing assistant?
A. Assist the child to remove outer clothing.
B. Advise the parent to use acetaminophen instead of aspirin.
C. Explain the need for cool fluids.
D. Prepare and administer a tepid bath.

86. It is the summer season, and patients with signs and symptoms of heat-related illness
present in the ED. Which patient needs attention first?
A. An elderly person complains of dizziness and syncope after standing in the sun for several
hours to view a parade
B. A marathon runner complains of severe leg cramps and nausea. Tachycardia, diaphoresis,
pallor, and weakness are observed.
C. A previously healthy homemaker reports broken air conditioner for days. Tachypnea,
hypotension, fatigue, and profuse diaphoresis are observed.
D. A homeless person, poor historian, presents with altered mental status, poor muscle
coordination, and hot, dry, ashen skin. Duration of exposure is unknown.
87. You respond to a call for help from the ED waiting room. There is an elderly patient lying on
the floor. List the order for the actions that you must perform.
A. Perform the chin lift or jaw thrust
D. Call for help and activate the code team.
maneuver.
E. Instruct a nursing assistant to get the
B. Establish unresponsiveness.
crash cart.
C. Initiate cardiopulmonary resuscitation
(CPR).
_____, _____, _____, _____, _____
88. The emergency medical service (EMS) has transported a patient with severe chest pain. As
the patient is being transferred to the emergency stretcher, you note unresponsiveness,
cessation of breathing, and no palpable pulse. Which task is appropriate to delegate to the
nursing assistant?
A. Chest compressions
C. Assisting with oral intubation
B. Bag-valve mask ventilation
D. Placing the defibrillator pads
89. An anxious 24-year-old college student complains of tingling sensations, palpitations, and
chest tightness. Deep, rapid breathing and carpal spasms are noted. What priority nursing action
should you take?
A. Notify the physician immediately.
D. Obtain an order for an anxiolytic
B. Administer supplemental oxygen.
medication.
C. Have the student breathe into a paper
bag.
90. An experienced traveling nurse has been assigned to work in the ED; however, this is the
nurses first week on the job. Which area of the ED is the most appropriate assignment for the
nurse?
A. Trauma team
C. Ambulatory or fast track clinic
B. Triage
D. Pediatric medicine team
91. A tearful parent brings a child to the ED for taking an unknown amount of childrens
chewable vitamins at an unknown time. The child is currently alert and asymptomatic. What
information should be immediately reported to the physician?
A. The ingested childrens chewable vitamins contain iron.
B. The child has been treated several times for ingestion of toxic substances.
C. The child has been treated several times for accidental injuries.
D. The child was nauseated and vomited once at home.
92. In caring for a victim of sexual assault, which task is most appropriate for an LPN/LVN?
A. Assess immediate emotional state and physical injuries
B. Collect hair samples, saliva swabs, and scrapings beneath fingernails.
C. Provide emotional support and supportive communication.
D. Ensure that the chain of custody is maintained.
93. You are caring for a victim of frostbite to the feet. Place the following interventions in the
correct order.
A. Apply a loose, sterile, bulky dressing.
B. Give pain medication.
C. Remove the victim from the cold environment.
D. Immerse the feet in warm water 100o F to 105o F (40.6o C to 46.1o C)
_____, _____, _____, _____
94. A patient sustains an amputation of the first and second digits in a chainsaw accident. Which
task should be delegated to the LPN/LVN?

A. Gently cleanse the amputated digits with Betadine solution.

B. Place the amputated digits directly into ice slurry.
C. Wrap the amputated digits in sterile gauze moistened with saline.
D. Store the amputated digits in a solution of sterile normal saline.
95. A 36-year-old patient with a history of seizures and medication compliance of phenytoin
(Dilantin) and carbamazepine (Tegretol) is brought to the ED by the MS personnel for repetitive
seizure activity that started 45 minutes prior to arrival. You anticipate that the physician will
order which drug for status epilepticus?
A. PO phenytoin and carbamazepine
C. IV carbamazepine
B. IV lorazepam (Ativan)
D. IV magnesium sulfate
96. You are preparing a child for IV conscious sedation prior to repair of a facial laceration. What
information should you immediately report to the physician?
A. The parent is unsure about the childs tetanus immunization status.
B. The child is upset and pulls out the IV.
C. The parent declines the IV conscious sedation.
D. The parent wants information about the IV conscious sedation.
97. An intoxicated patient presents with slurred speech, mild confusion, and uncooperative
behavior. The patient is a poor historian but admits to drinking a few on the weekend. What is
the priority nursing action for this patient?
A. Obtain an order for a blood alcohol level.
B. Contact the family to obtain additional history and baseline information.
C. Administer naloxone (Narcan) 2 4 mg as ordered.
D. Administer IV fluid support with supplemental thiamine as ordered.
98. When an unexpected death occurs in the ED, which of the following tasks is most appropriate
to delegate to the NA?
A. Escort the family to a place of privacy.
C. Assist with postmortem care.
B. Go w/ the organ donor specialist to talk to
D. Assist the family to collect belongings.
the family.
99. Following emergency endotracheal intubation, you must verify tube placement and secure
the tube. List in order the steps that are required to perform this function?
A. Obtain an order for a chest x-ray to document tube placement.
B. Secure the tube in place.
C. Auscultate the chest during assisted ventilation.
D. Confirm that the breath sounds are equal and bilateral.
_____, _____, _____, _____
100. A teenager arrives by private car. He is alert and ambulatory, but this shirt and pants are
covered with blood. He and his hysterical friends are yelling and trying to explain that that they
were goofing around and he got poked in the abdomen with a stick. Which of the following
comments should be given first consideration?
A. There was a lot of blood and we used three bandages.
B. He pulled the stick out, just now, because it was hurting him.
C. The stick was really dirty and covered with mud.
D. Hes a diabetic, so he needs attention right away.
101. A prisoner, with a known history of alcohol abuse, has been in police custody for 48 hours.
Initially, anxiety, sweating, and tremors were noted. Now, disorientation, hallucination, and
hyper-reactivity are observed. The medical diagnosis is delirium tremens. What is the priority
nursing diagnosis?
A. Risk for Injury related to seizures
B. Risk for Other-Directed Violence related to hallucinations
C. Risk for Situational Low Self-esteem related to police custody
D. Risk for Nutritional Deficit related to chronic alcohol abuse
102. You are assigned to telephone triage. A patient who was stung by a common honey bee
calls for advice, reports pain and localized swelling, but denies any respiratory distress or other
systemic signs of anaphylaxis. What is the action that you should direct the caller to perform?
A. Call 911.
C. Apply a cool compress.
B. Remove the stinger by scraping.
D. Take an oral antihistamine.
103. In relation to submersion injuries, which task is most appropriate to delegate to an LPN/LVN?

A. Talk to a community group about water safety issues.

B. Stabilize the cervical spine for an unconscious drowning victim.
C. Remove wet clothing and cover the victim with a warm blanket.
D. Monitor an asymptomatic near-drowning victim.
104. You are assessing a patient who has sustained a cat bite to the left hand. The cat is up-todate immunizations. The date of the patients last tetanus shot is unknown. Which of the
following is the priority nursing diagnosis?
A. Risk for Infection related to organisms specific to cat bites
B. Impaired Skin Integrity related to puncture wounds
C. Ineffective Health Maintenance related to immunization status
D. Risk for Impaired Mobility related to potential tendon damage
105. These patients present to the ED complaining of acute abdominal pain. Prioritize them in
order of severity.
A. A 35-yr-old male complaining of severe, intermittent cramps with 3 episodes of watery
diarrhea, 2 hours after eating
B. An 11-year-old boy with a low-grade fever, left lower quadrant tenderness, nausea, and
anorexia for the past 2 days
C. A 40-yr-old female with moderate LUQ pain, vomiting small amounts of yellow bile, and
worsening symptoms over the past week
D. A 56-year-old male with a pulsating abdominal mass and sudden onset of pressure-like pain in
the abdomen and flank within the past hour
_____, _____, _____, _____
106. The nursing manager decides to form a committee to address the issue of violence against
ED personnel. Which combination of employees is best suited to fulfill this assignment?
A. ED physicians and charge nurses
B. Experienced RNs and experienced paramedics
C. RNs, LPN/LVNs, and nursing assistants
D. At least one representative from each group of ED personnel
107. In a multiple-trauma victim, which assessment finding signals the most serious and lifethreatening condition?
A. A deviated trachea
C. Decreased bowel sounds
B. Gross deformity in a lower extremity
D. Hematuria
108. A patient in a one-car rollover presents with multiple injuries. Prioritize the interventions
that must be initiated for this patient.
A. Secure/start two large-bore IVs with
D. Give supplemental oxygen per mask.
normal saline
E. Obtain a full set of vital signs.
B. Use the chin lift or jaw thrust method to
F. Remove patients clothing.
open the airway.
G. Insert a Foley catheter if not
C. Assess for spontaneous respirations
contraindicated.
_____, _____, _____, _____, ____, ____, ____
109. In the work setting, what is your primary responsibility in preparing for disaster
management that includes natural disasters or bioterrorism incidents?
A. Knowledge of the agencys emergency response plan
B. Awareness of the signs and symptoms for potential agents of bioterrorism
C. Knowledge of how and what to report to the CDC
D. Ethical decision-making about exposing self to potentially lethal substances
110. You are giving discharge instructions to a woman who has been treated for contusions and
bruises sustained during an episode of domestic violence. What is your priority intervention for
this patient?
A. Transportation arrangements to a safe
C. Advice about contacting the police
house
D. Follow-up appointment for injuries
B. Referral to a counselor
CONCEPT: LEADERSHIP AND MANAGEMENT
111. Ms. Caputo is newly-promoted to a patient care manager position. She updates her
knowledge on the theories in management and leadership in order to become effective in her
new role. She learns that some managers have low concern for services and high concern for
staff. Which style of management refers to this?

A. Organization Man
B. Impoverished Management

C. Country Club Management

D. Team Management

112. Her former manager demonstrated passion for serving her staff rather than being served.
She takes time to listen, prefers to be a teacher first before being a leader, which is
characteristic of
A. Transformational leader
C. Servant leader
B. Transactional leader
D. Charismatic leader
113. On the other hand, Ms. Caputo notices that the Chief Nurse Executive has charismatic
leadership style. Which of the following behaviors best describes this style?
A. Possesses inspirational quality that makes followers gets attracted of him and regards him
with reverence
B. Acts as he does because he expects that his behavior will yield positive results
C. Uses visioning as the core of his leadership
D. Matches his leadership style to the situation at hand.
114. Which of the following conclusions of Ms. Caputo about leadership characteristics is TRUE?
A. There is a high correlation between the communication skills of a leader and the ability to get
the job done.
B. A manager is effective when he has the ability to plan well.
C. Assessment of personal traits is a reliable tool for predicting a managers potential.
D. There is good evidence that certain personal qualities favor success in managerial role.
115. She reads about Path Goal theory. Which of the following behaviors is manifested by the
leader who uses this?
A. Recognizes staff for going beyond expectations by giving them citations
B. Challenges the staff to take individual accountability for their own practice
C. Admonishes staff for being laggards.
D. Reminds staff about the sanctions for nonperformance.
116. One leadership theory states that leaders are born and not made, which refers to which of
the following theories?
A. Trait
B. Charismatic
C. Great Man
D. Situational
117. She came across a theory which states that the leadership style is effective dependent on
the situation. Which of the following styles best fits a situation when the followers are selfdirected, experts and are matured individuals?
A. Democratic
B. Authoritarian
C. Laissez faire
D. Bureaucratic
118. She surfs the internet for more information about leadership styles. She reads about shared
leadership as a practice in some magnet hospitals. Which of the following describes this style of
leadership?
A. Leadership behavior is generally determined by the relationship between the leaders
personality and the specific situation
B. Leaders believe that people are basically good and need not be closely controlled
C. Leaders rely heavily on visioning and inspire members to achieve results
D. Leadership is shared at the point of care.
119. Ms. Caputo learns that some leaders are transactional leaders. Which of the following does
NOT characterize a transactional leader?
A. Focuses on management tasks
C. Uses trade-offs to meet goals
B. Is a caretaker
D. Inspires others with vision
120. She finds out that some managers have benevolent-authoritative style of management.
Which of the following behaviors will she exhibit most likely?
A. Have condescending trust and confidence in their subordinates
B. Gives economic or ego awards
C. Communicates downward to the staff
D. Allows decision making among subordinates
121. Henry is a Unit Manager I the Medical Unit. He is not satisfied with the way things are going
in his unit. Patient satisfaction rate is 60% for two consecutive months and staff morale is at its
lowest. He decides to plan and initiate changes that will push for a turnaround in the condition of
the unit. Which of the following actions is a priority for Henry?
A. Call for a staff meeting and take this up in the agenda.
B. Seek help from her manager.

C. Develop a strategic action on how to deal with these concerns.

D. Ignore the issues since these will be resolved naturally.
122. He knows that there are external forces that influence changes in his unit. Which of the
following is NOT an external force?
A. Memo from the CEO to cut down on electrical consumption
B. Demands of the labor sector to increase wages
C. Low morale of staff in his unit
D. Exacting regulatory and accreditation standards
123. After discussing the possible effects of the low patient satisfaction rate, the staff started to
list down possible strategies to solve the problems head-on. Should they decide to vote on the
best change strategy, which of the following strategies is referred to this?
A. Collaboration
B. Majority rule
C. Dominance
D. Compromise
124. One staff suggests that they review the pattern of nursing care that they are using, which is
described as a:
A. job description
C. manual of procedure
B. system used to deliver care
D. rules to be followed
125. Which of the following is TRUE about functional nursing?
A. Concentrates on tasks and activities
B. Emphasizes use of group collaboration
C. One-to-one nurse-patient ratio
D. Provides continuous, coordinated and comprehensive nursing services
126. Functional nursing has some advantages, which one is an EXCEPTION?
A. Psychological and sociological needs are
C. Most economical way of delivering nursing
emphasized.
services.
B. Great control of work activities.
D. Workers feel secure in dependent role
127. He raised the issue on giving priority to patient needs. Which of the following offers the best
way for setting priority?
A. Assessing nursing needs and problems
B. Giving instructions on how nursing care needs are to be met
C. Controlling and evaluating the delivery of nursing care
D. Assigning safe nurse: patient ratio
128. Which of the following is the best guarantee that the patients priority needs are met?
A. Checking with the relative of the patient
C. Consulting with the physician
B. Preparing NCP in collaboration with the
D. Coordinating with other members of the
patient
team
129. When Henry uses team nursing as a care delivery system, he and his team need to assess
the priority of care for a group of patients, which of the following should be a priority?
A. Each patient as listed on the worksheet
C. Medications and treatments required for
B. Patients who needs least care
all patients
D. Patients who need the most care
130. He is hopeful that his unit will make a big turnaround in the succeeding months. Which of
the following actions of Henry demonstrates that he has reached the third stage of change?
A. Wonders why things are not what it used
C. Integrate the solutions to his day-to-day
to be
activities
B. Finds solutions to the problems
D. Selects the best change strategy
131. Joey is a newly-appointed nurse manager of The Holy Spirit Medical Center, a tertiary
hospital located within the heart of the metropolis. He thinks of scheduling planning workshop
with his staff in order to ensure an effective and efficient management of the department. Should
he decide to conduct a strategic planning workshop, which of the following is NOT a
characteristic of this activity?
A. Long-term goal-setting
C. Focuses on routine tasks
B. Extends to 3-5 years in the future
D. Determines directions of the organization
132. Which of the following statements refer to the vision of the hospital?
A. The Holy Spirit Medical Center is a trendsetter in tertiary health care in the next five year
B. The officers and staff of The Holy Spirit Medical Center believe in the unique nature of the
human person

C. All the nurses shall undergo continuing competency training program.

D. The Holy Spirit Medical Center aims to provide a patient-centered care in a total healing
environment.
133. The statement, The Holy Spirit Medical Center aims to provide patient-centered care in a
total healing environment refers to which of the following?
A. Vision
B. Goal
C. Philosophy
D. Mission
134. Joey plans to revisit the organizational chart of the department. He plans to create a new
position of a Patient Educator who has a coordinating relationship with the head nurse in the unit.
Which of the following will likely depict this organizational relationship?
A. Box
B. Solid line
C. Broken line
D. Dotted line
135. He likewise stresses the need for all the employees to follow orders and instructions from
him and not from anyone else. Which of the following principles does he refer to?
A. Scalar chain
C. Unity of
D. Order
B. Discipline
command
136. Joey orients his staff on the patterns of reporting relationship throughout the organization.
Which of the following principles refer to this?
A. Span of control
C. Esprit d corps
D. Unity of
B. Hierarchy
direction
137. He emphasizes to the team that they need to put their efforts together towards the
attainment of the goals of the program. Which of the following principles refers to this?
A. Span of control
C. Unity of command
D. Command
B. Unity of direction
responsibility
138. Joey stresses the importance of promoting esprit d corps among the members of the unit.
Which of the following remarks of the staff indicates that they understand what he pointed out?
A. Lets work together in harmony; we need to be supportive of one another
B. In order that we achieve the same results; we must all follow the directives of Julius and not
from other managers.
C. We will ensure that all the resources we need are available when needed.
D. We need to put our efforts together in order to raise the bar of excellence in the care we
provide to all our patients.
139. He discusses the goal of the department. Which of the following statements is a goal?
A. Increase the patient satisfaction rate
C. Establish rapport with patients.
B. Eliminate the incidence of delayed giving
D. Reduce response time to two minutes.
of meds
140. He wants to influence the customary way of thinking and behaving that is shared by the
members of the department. Which of the following terms refer to this?
A. Organizational chart
C. Organizational structure
B. Cultural network
D. Organizational culture
141. He asserts the importance of promoting a positive organizational culture in their unit. Which
of the following behaviors indicate that this is attained by the group?
A. Proactive and caring with one another
C. Powerful and oppositional
B. Competitive and perfectionist
D. Obedient and uncomplaining
142. Stephanie is a new Staff Educator of a private tertiary hospital. She conducts orientation
among new staff nurses in her department. Joseph, one of the new staff nurses, wants to
understand the channel of communication, span of control and lines of communication. Which of
the following will provide this information?
A. Organizational structure
C. Job description
B. Policy
D. Manual of procedures
143. Stephanie is often seen interacting with the medical intern during coffee breaks and after
duty hours. What type of organizational structure is this?
A. Formal
B. Informal
C. Staff
D. Line
144. She takes pride in saying that the hospital has a decentralized structure. Which of the
following is NOT compatible with this type of model?
A. Flat organization
B. Participatory
C. Shared
D. Tall organization
approach
governance

145. Centralized organizations have some advantages. Which of the following statements are
TRUE?
1. Highly cost-effective
3. Reflects the interest of the worker
2. Makes management easier
4. Allows quick decisions or actions.
A. 1 & 2

B. 2 & 4

C. 2, 3& 4

D. 1, 2, & 4

146. Stephanie delegates effectively if she has authority to act, which is BEST defined as:
A. having responsibility to direct others
C. having legitimate right to act
B. being accountable to the organization
D. telling others what to do

147. Regardless of the size of a work group, enough staff must be available at all times to
accomplish certain purposes. Which of these purposes is NOT included?
A. Meet the needs of patients
B. Provide a pair of hands to other units as needed
C. Cover all time periods adequately.
D. Allow for growth and development of nursing staff.
148. Which of the following guidelines should be least considered in formulating objectives for
nursing care?
A. Written nursing care plan
B. Holistic approach
C. Prescribed standards
D. Staff preferences
149. Stephanie considers shifting to transformational leadership. Which of the following
statements best describes this type of leadership?
A. Uses visioning as the essence of leadership.
B. Serves the followers rather than being served.
C. Maintains full trust and confidence in the subordinates
D. Possesses innate charisma that makes others feel good in his presence.
150. As a manager, she focuses her energy on both the quality of services rendered to the
patients as well as the welfare of the staff of her unit. Which of the following management styles
does she adopt?
A. Country club management
B. Organization man management
C. Team management
D. Authority-obedience management