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    Exam Review

    1. Mr. Green has poor nutrition. He has to be encouraged to have a well-balanced meal which includes having high fiber. What does high fiber help prevent?
      A)
      Urinary retention
      B)
      Constipation
      C)
      Stress incontinence
      D)
      Hiatal hernia
    2. According to current guidelines, which of the following reflects a normal adult blood pressure reading?
      A)
      90/80
      B)
      95/60
      C)
      180/60
      D)
      120/80
    3. Which of these vital signs—BP would you report to the doctor?
      A)
      90/60
      B)
      125/68
      C)
      144/76
      D)
      150/70
    4. One of the main methods to obtain a good health assessment is to obtain vital signs. Of which of the listed descriptions below is not a use of obtaining vital signs?
      A)
      Pain rating is often included as a vital sign that is subjective in nature.
      B)
      In the less stable client, it is advised to check the vital signs once a day or as needed.
      C)
      Vital signs help assess the effectiveness of the client’s circulatory, neurological, endocrine, and respiratory systems.
      D)
      Vital signs include temperature, pulse, respirations, blood pressure, and pulse oximeter.
    Page 1 of 15

    Exam Review

    1. During a gastrointestinal assessment, the nurse detects rebound tenderness in the right lower quadrant (RLQ). What does this finding most likely indicate?
      A)
      Appendicitis
      B)
      Pancreatitis
      C)
      Cholecystitis
      D)
      Diverticulitis
    2. Which of the following are not functions of the gastrointestinal tract?
      A)
      Provision of oxygen to the organs
      B)
      Elimination of waste
      C)
      Digestion of food
      D)
      Remove water-soluble waste
    3. What is not a social determinant of health in the below?
      A)
      Gender
      B)
      Physical environment
      C)
      Economic stability
      D)
      Access to health care
    4. Which quadrant is the liver located for assessment?
      A)
      Left lower quadrant (LLQ)
      B)
      Right upper quadrant (RUQ)
      C)
      Left upper quadrant (LUQ)
      D)
      Right lower quadrant (RLQ)
    Page 2 of 15

    Exam Review

    1. Which is not a risk factor for pressure injuries?
      A)
      Limited ability to reposition
      B)
      Requires stand-by assistance for ADLs
      C)
      Poor nutritional state
      D)
      Presence of moisture due to incontinence, wound drainage, or perspiration
    2. Which of the following is an unexpected respiratory system assessment?
      A)
      Bilateral lung sounds clear
      B)
      No cough
      C)
      Patient is using the incentive spirometer after surgery
      D)
      Oxygen set at 2 liters via nasal cannula and oxygen saturation is 90%
    3. During lung auscultation, the nurse hears a continuous low-pitched sound that resembles snoring. What is this sound called?
      A)
      Crackles.
      B)
      Wheezing.
      C)
      Rhonchi.
      D)
      Pleural friction rub.
    4. Which of these best describes the step of the nursing process of assessment?
      A)
      Gather data from the client through interview, physical exam, and observation to make judgments.
      B)
      Use problem-solving and decision-making skills to prioritize outcomes and goals, and develop interventions to meet those goals.
      C)
      Assess the effectiveness and achievability of the goals and the need for the interventions to be adjusted.
      D)
      Use clinical judgment to evaluate data collected to formulate the client’s problems, including actual and potential problems.
      E)
      The correct answer is: a) Gather data from the client through interview, physical exam, and observation to make judgments.
    Page 3 of 15

    Exam Review

    1. In a patient’s chart, it notes that the patient has a stage 1 pressure injury. Which of the following findings would you expect to see when you do your assessment?
      A)
      Full thickness skin loss with visible bone.
      B)
      Intact skin with localized erythema.
      C)
      Full thickness skin loss with visible adipose tissue.
      D)
      Partial-thickness skin loss with red tissue in wound bed.
    2. Select the closed-ended question below.
      A)
      Describe what you felt before you had a seizure?
      B)
      What symptoms did you experience before your urinary tract infection?
      C)
      When did you have your first stroke?
      D)
      What type of work have you done in your past?
    3. Which of the following techniques is used with palpation?
      A)
      Palpate the tender areas before other areas.
      B)
      Use the palmar side of the hands or the pads of the fingers.
      C)
      Short, quick taps is the technique used with percussion, not palpation.
      D)
      Use the stethoscope during palpation.
    4. What is an unexpected finding for the integumentary system assessment?
      A)
      Skin is warm and dry.
      B)
      IV site is clear and no drainage.
      C)
      Stage 1 pressure injury to right heel.
      D)
      Skin color is consistent with person’s racial heritage.
    Page 4 of 15

    Exam Review

    1. A patient experiencing burning while urinating, cloudy urine, and pain in their urethra can be experiencing signs and symptoms of:
      A)
      A urinary tract infection (UTI).
      B)
      Kidney obstruction.
      C)
      A stroke.
      D)
      Heart failure.
    2. A patient who has been in the hospital for 3 months starts to experience white patches on their tongue and roof of their mouth, they also have trouble swallowing, what do they likely have?
      A)
      Oral thrush.
      B)
      Bad breath.
      C)
      An ulcer.
      D)
      Nothing.
    3. The definition of medication reconciliation is?
      A)
      An accurate record of the client’s current medications including prescribed medications and all supplements, herbal compounds, and regular use of over-the-counter (OTC) medications.
      B)
      An accurate list of the medications that were prescribed at the point of discharge.
      C)
      An accurate list of the patient’s medication allergies.
      D)
      Obtaining the list of medication interactions of the current medications the patient is taking.
    4. Which assessment is subjective as it relates to the musculoskeletal system?
      A)
      Vital signs: Temperature 98.2, Pulse 92 bpm, Respirations 18/min, BP 136/84 mm Hg, Oximeter reading 98%.
      B)
      Patient has been taking nonsteroidal anti-inflammatory drugs (NSAIDs) for his right elbow pain.
      C)
      Pain 7 to 8.
      D)
      Grimacing and holding affected body part.
    Page 5 of 15

    Exam Review

    1. Which of the below items are expected variations in an older adult?
      A)
      Head protrusions.
      B)
      Asymmetry of facial features.
      C)
      Thinning hair.
      D)
      Vertigo.
    2. Which of these is not a part of the nursing process?
      A)
      Provides a blueprint for delivering patient-centered care.
      B)
      Involves care that is holistic and enhances patient outcomes.
      C)
      Problem-solving approach used in the provision of care to complex clients.
      D)
      Development of a medication prescription that will benefit the patient and their current illness.
    3. To assess for cranial nerve XI, we would instruct the client to:
      A)
      Swallow water.
      B)
      Say light, tight, dynamite.
      C)
      Identify a smell.
      D)
      Shrug their shoulders, and look left to right against resistance.
    4. You are assessing a client and note a pressure injury on the client’s sacrum. The lesion is a deep depression below the level of skin and into the muscle and there appears to be a spot where the bone is visible. What stage of the pressure injury would you document for this wound?
      A)
      Stage 4.
      B)
      Stage 3.
      C)
      Stage 1.
      D)
      Stage 2.
    Page 6 of 15