SECTION 1: FUNDAMENTALS OF NURSING
1. A nurse is assessing a client prior to performing a blood draw. The nurse
should identify that an allergy to which food can indicate that the client has
an allergy to latex?
A. Peanuts
B. Shellfish
C. Avocados
D. Eggs
Answer: C. Avocados – Clients with latex allergies often have cross-
reactivity to bananas, avocados, kiwis, and chestnuts.
2. A nurse is caring for a client who had a partial laryngectomy and is
receiving continuous enteral feedings at 65 mL/hr through a gastrostomy
tube. Which finding requires immediate intervention?
A. The infusion pump is turned off
B. The client is lying in a supine position
C. The client reports nausea
D. The gastrostomy tube is not draining gastric contents
Answer: B. Supine position – Increases aspiration risk.
3. A nurse is assessing a client who has a magnesium level of 4.4 mEq/L.
Which finding should the nurse expect?
A. Hypertension
B. Hyperreflexia
C. Hypotension
D. Tachycardia
Answer: C. Hypotension – Hypermagnesemia causes hypotension,
bradycardia, and decreased reflexes.
,4. A nurse is providing dietary teaching to a client who has an increased
cholesterol level. Which food should the nurse recommend?
A. Egg yolks
B. Egg whites
C. Whole milk
D. Butter
Answer: B. Egg whites – Low in cholesterol and fat.
5. A nurse is caring for a toddler who has respiratory syncytial virus.
Which action should the nurse plan to take?
A. Use a designated stethoscope when caring for the toddler
B. Wear an N95 respirator
C. Place the toddler in a negative pressure room
D. Restrict all visitors
Answer: A. Use a designated stethoscope – RSV requires contact
precautions; designated equipment prevents spread.
6. A nurse is caring for a client who has a chest tube following a
thoracotomy. Which finding requires intervention?
A. 1 cm of water present in the water seal chamber
B. Fluctuation of fluid in the water seal chamber with respiration
C. Continuous bubbling in the suction control chamber
D. Drainage of 50 mL in 8 hours
Answer: A. 1 cm of water – Water seal should be at 2 cm.
7. A nurse is reviewing the medical history of a client taking a garlic
supplement. Which finding is a contraindication?
A. The client takes aspirin daily
B. The client has hypertension
C. The client has high cholesterol
D. The client takes vitamin C
Answer: A. Takes aspirin daily – Garlic + aspirin increases bleeding
risk.
,8. A nurse is caring for a client who has a vented NG tube set to low
intermittent suction and has vomited. Which action should the nurse
perform first?
A. Administer an antiemetic medication
B. Evaluate functioning of the suction device
C. Provide oral hygiene care
D. Replace the NG tube
Answer: B. Evaluate functioning of the suction device – Assess
equipment function first to determine cause of vomiting.
9. While performing a routine assessment, a nurse notices fraying on the
electrical cord of a client's continuous passive motion device. Which action
should the nurse take first?
A. Report the damaged equipment to biomedical engineering
B. Remove the device from use immediately
C. Document the finding in the client's chart
D. Apply electrical tape to the frayed area
Answer: B. Remove the device from use immediately – Safety is the
priority; remove hazardous equipment.
10. A nurse is planning to provide community education about viral
hepatitis. Which should the nurse include?
A. A series of four hepatitis vaccines is recommended to prevent viral
hepatitis
B. Hepatitis B is transmitted by contaminated food
C. Chronic hepatitis can lead to renal cell cancer
D. Clients who have a history of viral hepatitis are unable to donate blood
Answer: A. Series of four hepatitis vaccines is recommended
11. A nurse is reviewing the history and physical of a client who has right
ventricular heart failure. Which is an expected finding?
A. Decreased pulmonary artery pressure
B. Elevated pulmonary artery pressure
C. Decreased jugular venous pressure
, D. Increased urine output
Answer: B. Elevated pulmonary artery pressure
12. A nurse is caring for a client who has a new prescription for lithium
carbonate. Prior to administering the first dose, which lab value should the
nurse evaluate?
A. Sodium
B. Potassium
C. Calcium
D. Magnesium
Answer: A. Sodium – Lithium toxicity risk increases with low sodium
levels.
13. A nurse is caring for a client who has typical depression and is taking
phenelzine. What can the client eat?
A. Aged cheese
B. Low-fat yogurt
C. Red wine
D. Smoked fish
Answer: B. Low-fat yogurt – Phenelzine (MAOI) requires tyramine
restriction; low-fat yogurt is safe.
14. A nurse is caring for a client who has cirrhosis of the liver. What should
the nurse monitor for?
A. Abdominal ascites
B. Hyperglycemia
C. Increased albumin
D. Polyuria
Answer: A. Abdominal ascites – Cirrhosis leads to portal hypertension
and ascites.
15. A nurse is caring for a client who has end-stage liver disease. The
daughter asks about her father's DNR request. What is the nurse's best
response?
A. "Your father has the right to make that decision"