Practice Test 13

1. A child is admitted to the hospital with a diagnosis of Wilms tumor, stage II. Which of
the following statements most accurately describes this stage?
A. The tumor is less than 3 cm. in size and requires no chemotherapy.
B. The tumor did not extend beyond the kidney and was completely resected.
C. The tumor extended beyond the kidney but was completely resected.
D. The tumor has spread into the abdominal cavity and cannot be resected.
2. A teen patient is admitted to the hospital by his physician who suspects a diagnosis of
acute glomerulonephritis. Which of the following findings is consistent with this diagnosis?
Note: More than one answer may be correct.
A. Urine specific gravity of 1.040.
B. Urine output of 350 ml in 24 hours.
C. Brown (tea-colored) urine.
D. Generalized edema.
3. Which of the following conditions most commonly causes acute glomerulonephritis?
A. A congenital condition leading to renal dysfunction.
B. Prior infection with group A Streptococcus within the past 10-14 days.
C. Viral infection of the glomeruli.
D. Nephrotic syndrome.
4. An infant with hydrocele is seen in the clinic for a follow-up visit at 1 month of age. The
scrotum is smaller than it was at birth, but fluid is still visible on illumination. Which of the
following actions is the physician likely to recommend?
A. Massaging the groin area twice a day until the fluid is gone.
B. Referral to a surgeon for repair.
C. No treatment is necessary; the fluid is reabsorbing normally.
D. Keeping the infant in a flat, supine position until the fluid is gone.
5. A nurse is caring for a patient with peripheral vascular disease (PVD). The patient
complains of burning and tingling of the hands and feet and cannot tolerate touch of any
kind. Which of the following is the most likely explanation for these symptoms?
A. Inadequate tissue perfusion leading to nerve damage.
B. Fluid overload leading to compression of nerve tissue.
C. Sensation distortion due to psychiatric disturbance.
D. Inflammation of the skin on the hands and feet.
6. A nurse is assessing a clinic patient with a diagnosis of hepatitis A. Which of the
following is the most likely route of transmission?
A. Sexual contact with an infected partner.
B. Contaminated food.
C. Blood transfusion.
D. Illegal drug use.

7. A leukemia patient has a relative who wants to donate blood for transfusion. Which of
the following donor medical conditions would prevent this?
A. A history of hepatitis C five years previously.
B. Cholecystitis requiring cholecystectomy one year previously.
C. Asymptomatic diverticulosis.
D. Crohns disease in remission.
8. A physician has diagnosed acute gastritis in a clinic patient. Which of the following
medications would be contraindicated for this patient?
A. Naproxen sodium (Naprosyn).
B. Calcium carbonate.
C. Clarithromycin (Biaxin).
D. Furosemide (Lasix).
9. The nurse is conducting nutrition counseling for a patient with cholecystitis. Which of
the following information is important to communicate?
A. The patient must maintain a low calorie diet.
B. The patient must maintain a high protein/low carbohydrate diet.
C. The patient should limit sweets and sugary drinks.
D. The patient should limit fatty foods.
10. A patient admitted to the hospital with myocardial infarction develops severe
pulmonary edema. Which of the following symptoms should the nurse expect the patient to
exhibit?
A. Slow, deep respirations.
B. Stridor.
C. Bradycardia.
D. Air hunger.
11. A nurse is evaluating a postoperative patient and notes a moderate amount of serous
drainage on the dressing 24 hours after surgery. Which of the following is the appropriate
nursing action?
A. Notify the surgeon about evidence of infection immediately.
B. Leave the dressing intact to avoid disturbing the wound site.
C. Remove the dressing and leave the wound site open to air.
D. Change the dressing and document the clean appearance of the wound site.
12. A patient returns to the emergency department less than 24 hours after having a
fiberglass cast applied for a fractured right radius. Which of the following patient
complaints would cause the nurse to be concerned about impaired perfusion to the limb?
A. Severe itching under the cast.
B. Severe pain in the right shoulder.
C. Severe pain in the right lower arm.
D. Increased warmth in the fingers.

13. An older patient with osteoarthritis is preparing for discharge. Which of the following
information is correct?
A. Increased physical activity and daily exercise will help decrease discomfort associated with
the condition.
B. Joint pain will diminish after a full night of rest.
C. Nonsteroidal anti-inflammatory medications should be taken on an empty stomach.
D. Acetaminophen (Tylenol) is a more effective anti-inflammatory than ibuprofen (Motrin).
14. Which patient should NOT be prescribed alendronate (Fosamax) for osteoporosis?
A. A female patient being treated for high blood pressure with an ACE inhibitor.
B. A patient who is allergic to iodine/shellfish.
C. A patient on a calorie restricted diet.
D. A patient on bed rest who must maintain a supine position.
15. Which of the following strategies is NOT effective for prevention of Lyme disease?
A. Insect repellant on the skin and clothes when in a Lyme endemic area.
B. Long sleeved shirts and long pants.
C. Prophylactic antibiotic therapy prior to anticipated exposure to ticks.
D. Careful examination of skin and hair for ticks following anticipated exposure.
16. A nurse is performing routine assessment of an IV site in a patient receiving both IV
fluids and medications through the line. Which of the following would indicate the need for
discontinuation of the IV line as the next nursing action?
A. The patient complains of pain on movement.
B. The area proximal to the insertion site is reddened, warm, and painful.
C. The IV solution is infusing too slowly, particularly when the limb is elevated.
D. A hematoma is visible in the area of the IV insertion site.
17. A hospitalized patient has received transfusions of 2 units of blood over the past few
hours. A nurse enters the room to find the patient sitting up in bed, dyspneic and
uncomfortable. On assessment, crackles are heard in the bases of both lungs, probably
indicating that the patient is experiencing a complication of transfusion. Which of the
following complications is most likely the cause of the patients symptoms?
A. Febrile non-hemolytic reaction.
B. Allergic transfusion reaction.
C. Acute hemolytic reaction.
D. Fluid overload.
18. A patient in labor and delivery has just received an amniotomy. Which of the following
is correct? Note: More than one answer may be correct.
A. Frequent checks for cervical dilation will be needed after the procedure.
B. Contractions may rapidly become stronger and closer together after the procedure.
C. The FHR (fetal heart rate) will be followed closely after the procedure due to the possibility of
cord compression.
D. The procedure is usually painless and is followed by a gush of amniotic fluid.

19. A nurse is counseling the mother of a newborn infant with hyperbilirubinemia. Which
of the following instructions by the nurse is NOT correct?
A. Continue to breastfeed frequently, at least every 2-4 hours.
B. Follow up with the infants physician within 72 hours of discharge for a recheck of the serum
bilirubin and exam.
C. Watch for signs of dehydration, including decreased urinary output and changes in skin
turgor.
D. Keep the baby quiet and swaddled, and place the bassinet in a dimly lit area.
20. A nurse is giving discharge instructions to the parents of a healthy newborn. Which of
the following instructions should the nurse provide regarding car safety and the trip home
from the hospital?
A. The infant should be restrained in an infant car seat, properly secured in the back seat in a
rear-facing position.
B. The infant should be restrained in an infant car seat, properly secured in the front passenger
seat.
C. The infant should be restrained in an infant car seat facing forward or rearward in the back
seat.
D. For the trip home from the hospital, the parent may sit in the back seat and hold the newborn.

Answers and Rationale 13

1. Answer: C. The tumor extended beyond the kidney but was completely resected.
The staging of Wilms tumor is confirmed at surgery as follows: Stage I, the tumor is limited to
the kidney and completely resected; stage II, the tumor extends beyond the kidney but is
completely resected; stage III, residual non hematogenous tumor is confined to the abdomen;
stage IV, hematogenous metastasis has occurred with spread beyond the abdomen; and stage V,
bilateral renal involvement is present at diagnosis.
2. Answers: A, B, and C
Acute glomerulonephritis is characterized by high urine specific gravity related to oliguria as
well as dark tea colored urine caused by large amounts of red blood cells. There is periorbital
edema, but generalized edema is seen in nephrotic syndrome, not acute glomerulonephritis.
3. Answer: B. Prior infection with group A Streptococcus within the past 10-14 days.
Acute glomerulonephritis is most commonly caused by the immune response to a prior upper
respiratory infection with group A Streptococcus. Glomerular inflammation occurs about 10-14
days after the infection, resulting in scant, dark urine and retention of body fluid. Periorbital
edema and hypertension are common signs at diagnosis.
4. Answer: C. No treatment is necessary; the fluid is reabsorbing normally.
A hydrocele is a collection of fluid in the scrotum that results from a patent tunica vaginalis.
Illumination of the scrotum with a pocket light demonstrates the clear fluid. In most cases the
fluid reabsorbs within the first few months of life and no treatment is necessary. Massaging the
area or placing the infant in a supine position would have no effect. Surgery is not indicated.
5. Answer: A. Inadequate tissue perfusion leading to nerve damage.
Patients with peripheral vascular disease often sustain nerve damage as a result of
inadequate tissue perfusion. Fluid overload is not characteristic of PVD. There is nothing to
indicate psychiatric disturbance in the patient. Skin changes in PVD are secondary to
decreased tissue perfusion rather than primary inflammation.
6. Answer: B. Contaminated food.
Hepatitis A is the only type that is transmitted by the fecal-oral route through contaminated food.
Hepatitis B, C, and D are transmitted through infected bodily fluids.
7. Answer: A. A history of hepatitis C five years previously.
Hepatitis C is a viral infection transmitted through bodily fluids, such as blood, causing
inflammation of the liver. Patients with hepatitis C may not donate blood for transfusion due to
the high risk of infection in the recipient. Cholecystitis (gallbladder disease), diverticulosis, and
history of Crohns disease do not preclude blood donation.
8. Answer: A. Naproxen sodium (Naprosyn).
Naproxen sodium is a nonsteroidal anti-inflammatory drug that can cause inflammation of the
upper GI tract. For this reason, it is contraindicated in a patient with gastritis. Calcium carbonate
is used as an antacid for the relief of indigestion and is not contraindicated. Clarithromycin is an

antibacterial often used for the treatment of Helicobacter pylori in gastritis. Furosemide is a loop
diuretic and is contraindicated in a patient with gastritis.
9. Answer: D. The patient should limit fatty foods.
Cholecystitis, inflammation of the gallbladder, is most commonly caused by the presence of
gallstones, which may block bile (necessary for fat absorption) from entering the intestines.
Patients should decrease dietary fat by limiting foods like fatty meats, fried foods, and creamy
desserts to avoid irritation of the gallbladder.
10. Answer: D. Air hunger.
Patients with pulmonary edema experience air hunger, anxiety, and agitation. Respiration is fast
and shallow and heart rate increases. Stridor is noisy breathing caused by laryngeal swelling or
spasm and is not associated with pulmonary edema.
11. Answer: D. Change the dressing and document the clean appearance of the wound site.
A moderate amount of serous drainage from a recent surgical site is a sign of normal healing.
Purulent drainage would indicate the presence of infection. A soiled dressing should be changed
to avoid bacterial growth and to examine the appearance of the wound. The surgical site is
typically covered by gauze dressings for a minimum of 48-72 hours to ensure that initial healing
has begun.
12. Answer: C. Severe pain in the right lower arm.
Impaired perfusion to the right lower arm as a result of a closed cast may cause neurovascular
compromise and severe pain, requiring immediate cast removal. Itching under the cast is
common and fairly benign. Neurovascular compromise in the arm would not cause pain in the
shoulder, as perfusion there would not be affected. Impaired perfusion would cause the fingers to
be cool and pale. Increased warmth would indicate increased blood flow or infection.
13. Answer: A. Increased physical activity and daily exercise will help decrease discomfort
associated with the condition.
Physical activity and daily exercise can help to improve movement and decrease pain in
osteoarthritis. Joint pain and stiffness are often at their worst during the early morning after
several hours of decreased movement. Acetaminophen is a pain reliever, but does not have antiinflammatory activity. Ibuprofen is a strong anti-inflammatory, but should always be taken with
food to avoid GI distress.
14. Answer: D. A patient on bed rest who must maintain a supine position.
Alendronate can cause significant gastrointestinal side effects, such as esophageal irritation, so it
should not be taken if a patient must stay in supine position. It should be taken upon rising in the
morning with 8 ounces of water on an empty stomach to increase absorption. The patient should
not eat or drink for 30 minutes after administration and should not lie down. ACE inhibitors are
not contraindicated with alendronate and there is no iodine allergy relationship.
15. Answer: C. Prophylactic antibiotic therapy prior to anticipated exposure to ticks.
Prophylactic use of antibiotics is not indicated to prevent Lyme disease. Antibiotics are used
only when symptoms develop following a tick bite. Insect repellant should be used on skin and
clothing when exposure is anticipated. Clothing should be designed to cover as much exposed

area as possible to provide an effective barrier. Close examination of skin and hair can reveal the
presence of a tick before a bite occurs.
16. Answer: B. The area proximal to the insertion site is reddened, warm, and painful.
An IV site that is red, warm, painful and swollen indicates that phlebitis has developed and the
line should be discontinued and restarted at another site. Pain on movement should be managed
by maneuvers such as splinting the limb with an IV board or gently shifting the position of the
catheter before making a decision to remove the line. An IV line that is running slowly may
simply need flushing or repositioning. A hematoma at the site is likely a result of minor bleeding
at the time of insertion and does not require discontinuation of the line.
17. Answer: D. Fluid overload.
Fluid overload occurs when then the fluid volume infused over a short period is too great for the
vascular system, causing fluid leak into the lungs. Symptoms include dyspnea, rapid respirations,
and discomfort as in the patient described. Febrile non-hemolytic reaction results in fever.
Symptoms of allergic transfusion reaction would include flushing, itching, and a generalized
rash. Acute hemolytic reaction may occur when a patient receives blood that is incompatible
with his blood type. It is the most serious adverse transfusion reaction and can cause shock and
death.
18. Answer: B, C, and D
Uterine contractions typically become stronger and occur more closely together following
amniotomy. The FHR is assessed immediately after the procedure and followed closely to detect
changes that may indicate cord compression. The procedure itself is painless and results in the
quick expulsion of amniotic fluid. Following amniotomy, cervical checks are minimized because
of the risk of infection
19. Answer: D. Keep the baby quiet and swaddled, and place the bassinet in a dimly lit
area.
An infant discharged home with hyperbilirubinemia (newborn jaundice) should be placed in a
sunny rather than dimly lit area with skin exposed to help process the bilirubin. Frequent
feedings will help to metabolize the bilirubin. A recheck of the serum bilirubin and a physical
exam within 72 hours will confirm that the level is falling and the infant is thriving and is well
hydrated. Signs of dehydration, including decreased urine output and skin changes, indicate
inadequate fluid intake and will worsen the hyperbilirubinemia.
20. Answer: A. The infant should be restrained in an infant car seat, properly secured in
the back seat in a rear-facing position.
All infants under 1 year of age weighing less than 20 lbs. should be placed in a rear-facing infant
car seat secured properly in the back seat. Infant car seats should never be placed in the front
passenger seat. Infants should always be placed in an approved car seat during travel, even on
that first ride home from the hospital.