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1. The nurse is monitoring a client following a lung resection. The hourly output from the chest tube was 300mL. The nurse should give priority to:

• Turning the client to the left side
• Milking the tube to ensure patency
• Slowing the intravenous infusion
• Notifying the physician

2. A 52-year-old man is admitted to a hospital after sustaining a severe head injury in an automobile accident. When the patient dies, the nurse observes the patient’s wife comforting other family members. Which of the following interpretations of this behavior is MOST justifiable?

• She has already moved through the stages of the grieving process.
• She is repressing anger related to her husband’s death.
• She is experiencing shock and disbelief related to her husband’s death.
• She is demonstrating resolution of her husband’s death.

3. A newly diagnosed patient with Cancer says “I hate Cancer, why did God give it to me”. Which stage of grief process is this?

• Denial
• Anger
• Bargaining
• Depression

4. Susan’s passed away. Susan handled this death by crying and withdrawing from friend and family. As A nurse you would notice that sue’s intensified grief is most likely a sign of which type of grief?

• Distorted or exaggerated Grief
• Anticipatory Grief
• Chronic or Prolonged Grief
• Delayed or Inhibited Grief

5. A client with an abdominal cholecystectomy returns from surgery with a Jackson-Pratt drain. The chief purpose of the Jackson-Pratt drain is to:

• Prevent the need for dressing changes
• Reduce edema at the incision
• Provide for wound drainage
• Keep the common bile duct open

6. What is the main aim of the End of Life Care Strategy (DH 2008)?

• Identify a patient’s preferred place of care
• An assessment is used to identify how and where patients wish to be cared for at the end of life

7. When breaking bad news over phone which of the following statement is appropriate

• I am sorry to tell you that your mother died
• I am sorry to tell you that your mother has gone toheaven
• I am sorry to tell you that your mother is no more
• I am sorry to tell you that your mother passed away

8. Which of the following foods would the nurse encourage the client in sickle cell crisis to eat?

• Steak
• Cottage cheese
• Popsicle
• Lima beans

9. In which of the following situations might nitrous oxide (Entonox) be considered?

• A wound dressing change for short term pain relief or the removal of a chest drain for reduction of anxiety.
• Turning a patient who has bowel obstruction because there is an expectation that they may have pain from pathological fractures
• For pain relief during the insertion of a chest drain for the treatment of a pneumothorax.
• For pain relief during a wound dressing for a patient who has had radical head and neck cancer that involved the jaw.

10. The 4 year old son of a deceased male is asking questions about his father. Which of the following activities would be beneficial for this young child to participate in?

• Nothing because he too young to understand death
• Tell him his father has gone away, never to return
• Tell him his father is sleeping
• Explain that his father has died and give him the option of attending the funeral

11. A 25-year-old male is admitted in sickle cell crisis. Which of the following interventions would be of highest priority for this client?

• Taking hourly blood pressures with mechanical cuff
• Encouraging fluid intake of at least 200ml per hour
• Position in high Fowler’s with knee gatch raised
• Administering Tylenol as ordered

12. A 43-year-old African American male is admitted with sickle cell anemia. The nurse plans to assess circulation in the lower extremities every two hours. Which of the following outcome criteria would the nurse use?

• Body temperature of 99°F or less
• Toes moved in active range of motion
• Sensation reported when soles of feet are touched
• Capillary refill of < 3 seconds

13. The hospice nurse has been working for two weeks without a day off. During this time, she has been present at the deaths of seven of her clients. Which of the following might be beneficial for this nurse?

• Nothing
• Provide her with an assistant
• Suggest she take a few days off
• Assign her to clients that aren’t going to die for awhile

14. After breaking bad news of expected death to a relative over phone , she says thanks for letting us know and becomes silent. Which of the following statements made by nurse would be more empathetic

• Say I will ask the doctor to call you
• You seem stunned. You want me to help you think what you want to do next
• Call me back if you have got any questions
• Say can I help you with funeral arrangements

15. A client is diagnosed with cancer and is told by surgery followed by chemotherapy will be necessary, the client states to the nurse, "I have read a lot about complementary therapies. Do you think I should try it?". The nurse responds by making which most appropriate statement?

• It is a tendency to view one's own ways as best"
• You need to ask your physician about it"
• I would try anything that I could if I had cancer
• There are many different forms of complementary therapies, let's talk about these therapies

16. The physician has ordered a minimal-bacteria diet for a client with neutropenia. The client should be taught to avoid eating:

• Fruits
• Salt
• Pepper
• Ketchup

17. The nurse is instructing a client with iron-deficiency anemia. Which of the following meal plans would the nurse expect the client to select?

• Roast beef, gelatin salad, green beans, and peach pie
• Chicken salad sandwich, coleslaw, French fries, ice cream
• Egg salad on wheat bread, carrot sticks, lettuce salad, raisin pie
• Pork chop, creamed potatoes, corn, and coconut cake

18. The nurse is providing discharge teaching for the client with leukemia. The client should be told to avoid:

• Using oil or cream-based soaps
• Flossing between the teeth
• The intake of salt
• Using an electric razor

19. Karen has been diagnosed with Hepatic Adenoma. Her results are as follows - benign tumor as shown on triphasic CT Scan and alpha feto proteins within normal range. She is asymptomatic and does not appear jaundice, but she appears to be very anxious. As a nurse, what will you initially do?

• Sit down with Karen and discuss about her fears; use therapeutic communication to alleviate anxiety
• Refer her to a psychiatrist for treatment
• Discuss invasive procedure with patient, and show her videos of the operation
• Take her to the surgeon’s clinic and discuss about consent for invasive procedure

20. A client is diagnosed with cancer what is your response?

• Take her to another room and allow her to discuss with the husband
• Tell them to wait in the room and I will come and talk to u after my duty

21. The nurse is assisting the physician with removal of a central venous catheter. To facilitate removal, the nurse should instruct the client to:

• Perform the Valsalva maneuver as the catheter is advanced
• Turn his head to the left side and hyperextend the neck
• Take slow, deep breaths as the catheter is removed
• Turn his head to the right while maintaining a sniffing position

22. A fully alert & competent 89 year old client is in end stage liver disease. The client says , “I’m ready to die,” & refuses to take food or fluids . The family urges the client to allow the nurse to insert a feeding tube. What is the nurse’s moral responsibility?

• The nurse should obtain an order for a feeding tube
• The nurse should encourage the client to reconsider the decision
• The nurse should honour client’s decision
• The nurse must consider that the hospital can be sued if she honours the client’s request

23. Mrs B has developed Stevens - Johnson syndrome whilst on Carbamazepine. She is now being transferred from the ITU to a bay in a Medicine Ward. Which patients can Mrs B share a bay with?

• A patient with MRSA
• A patient with diarrhoea
• A patient with fever of unknown origin
• A patient with Stevens-Johnson Syndrome

24. A client who is admitted with an above-the-knee amputation tells the nurse that his foot hurts and itches. Which response by the nurse indicates understanding of phantom limb pain?

• “The pain will go away in a few days.”
• “The pain is due to peripheral nervous system interruptions. I will get you some pain medication.”
• “The pain is psychological because your foot is no longer there.”
• “The pain and itching are due to the infection you had before the surgery.”

25. A newly admitted client has sickle cell crisis. He is complaining of pain in his feet and hands. The nurse’s assessment findings include a pulse oximetry of 92. Assuming that all the following interventions are ordered, which should be done first?

• Adjust the room temperature
• Give a bolus of IV fluids
• Start O2
• Administer meperidine (Demerol) 75mg IV push

26. After the death of a 46 year old male client, the nurse approaches the family to discuss organ donation options. The family consents to organ donation and the nurse begins to process. Which of the following would be most helpful to the grieving family during this difficult time?

• Calling the client, a donor
• Provide care to the deceased client in a careful and loving way
• Encourage the family to make a quick decision
• Tell them that there is no time to all other family members for advice

27. The nurse cares for a client diagnosed with conversion reaction. The nurse identifies the client is utilizing which of the following defense mechanisms?

• Introjection
• Displacement
• Identification
• Repression

28. One of your residents has been transferred from the hospital to your nursing home after having been admitted for a week due to a chest infection. On transfer, you have noted that he had several dressings on his thighs, which he has not had before. What should you do?

• If the dressings are intact, document it on the nursing notes and indicate that the dressings need to be changed after 48 hours.
• Change the dressings if they look soiled and document this on the wound assessment form.
• Remove the dressings whether they are intact or not, assess the wounds, document this on the wound assessment form and redress the wounds.
• All of the above.

29. Is not included in Palliative Care?

• Psychological support
• Spiritual support
• Resuscitation
• Pain management

30. A patient who has had Parkinson’s Disease for 7 years has been experiencing aphasia. Which health professional should you make a referral to with regards to his aphasia?

• Occupational Therapist
• Community Matron
• Psychiatrist
• Speech and Language Therapist

31. Mr Bond has been diagnosed with Multiple Sclerosis 20 years ago. Due to impaired mobility, he has developed a Grade 4 pressure sore on his sacrum. Which health professional can provide you prescriptions for his dressing?

• Dietician
• Tissue Viability Nurse
• Social Worker
• Physiotherapist

32. A nurse should be able to show awareness of his/her role in health promotion and supporting a healthy lifestyle. Whilst providing health education to a group of patients with cancer about management of their non-healing wounds, it is important for one to:

• Consider individual wound management priorities
• Review the patient’s treatment plan
• Determine the locations of the wounds
• Verify the types of cancer

33. A critically ill client asks the nurse to help him die. Which of the following would be an appropriate response for the nurse to give this client?

• Tel me why you feel death is your only option
• How would you like to do this
• Everyone dies sooner or later
• Assisted suicide is illegal in this state

34. While providing care to a terminally ill client, the nurse is asked questions about death. Which of the following would be beneficial to support the client’s spiritual needs?

• Nothing
• Ask if they want to die
• Ask if they want anything special before they die
• Provide support, compassion, and love

35. Mrs B has been admitted in the hospital due to Oedema of her thighs. One of her medications was Furosemide 40 mg tablets to be administered once daily. What should be done prior to administering Furosemide?

• Check patient’s blood pressure, and withhold Furosemide if it is low
• Check patient’s pupils, and withhold Furosemide if it is constricted
• Swab your patient’s wound and send the sample to pathology
• Assess each of your patient’s thighs by measuring its girth

36. A slow and progressive disease with no definite cure, only symptomatic Management?

• Acute
• Chronic
• Terminal

37. A patient who refuses to believe a terminal diagnosis is exhibiting

• Regression
• Mourning
• Denial
• Rationalization

38. A 30-year-old male from Haiti is brought to the emergency department in sickle cell crisis. What is the best position for this client?

• Side-lying with knees flexed
• Knee-chest
• High Fowler’s with knees flexed
• Semi-Fowler’s with legs extended on the bed

39. A client with cancer of the pancreas has undergone a Whipple procedure. The nurse is aware that during the Whipple procedure, the doctor will remove the:

• Head of the pancreas
• Stomach and duodenum
• Esophagus and jejunum

40. You are dispending Morphine Sulphate in the treatment room, which has been witnessed by another qualified nurse. Your patient refuses the medication when offered. What will you do next?

• Go back to the treatment room and write a line across your documentation on the CD book; sign it as refused
• Dispose the medication using the denaturing kit, document as refused and disposed on the MARS, and write it on the nurse’s notes.
• Dispose the medication and document it on the patient’s care plan
• Store the medication in the CD pod for an hour, and then ask your patient again if he/she wants to take his medication

41. A 42 year old female has been widowed for 3 years yet she becomes very anxious, sad, and tearful on a specific day in June. Which of the following is this widow experiencing?

• Preparatory depression
• Psychological isolation
• Acceptance
• Anniversary reaction

42. An adult is offered the opportunity to participate in research on a new therapy. The researcher ask the nurse to obtain the patient’s consent. What is most appropriate for the nurse to take?

• Be sure the patient understands the project before signing the consent form
• Read the consent form to the patient & give him or her an opportunity to ask questions
• Refuse to be the one to obtain the patient’s consent
• Give the form to the patient & tell him or her to read it carefully before signing it.

43. A resident is due for discharge from your nursing home. You have been his keyworker for the last five years, and his family has been appreciative of the care you have provided. One of the relatives has offered you cash in an envelope after saying goodbye. What should you do?

• Say thank you, but refuse the offer politely.
• Say thank you and accept the offer.
• Accept the offer, and share it to your colleagues.
• Accept the offer and keep it to yourself.

44. After death, who can legally give permission for a patient's body to be donated to medical science?

• Only the patient, if they left instructions for this
• The patient's spouse or next-of-kin
• The patient's GP
• The doctor in charge at the time of death

45. The nurse is discussing problem-solving strategies with a client who recently experienced the death of a family member and the loss of a full- time job. The client says to the nurse. 'I hear what you're saying to me, but it just isn't making any sense to me. I can't think straight now." The client is expressing feelings of:

• Rejection
• Overload
• Disqualification
• Hostility

46. The wife of a recently deceased male is contacting individuals to inform them of her husband’s death. She decides, however, to drive to her parent’s home to tell them in person instead of using the telephone. Of what benefit did this communication approach serve?

• She needed to get out of the house
• For the family to gain support from each other
• No benefit
• She was having a pathological grief response

47. Which of the following senses is to fade last when a person dies?

• hearing
• smelling
• seeing
• speaking

48. As the nurse on duty, you have noted that there has been an increasing number of cases of pressure sored in your nursing home. Which of the following is the best intervention?

• Collaboration with the Multidisciplinary Team
• Patient Advocacy
• Reduce fragmentation and costs
• Identify opportunities and develop policies to improve nursing practice

49. The nurse is preparing a client for cataract surgery. The nurse is aware that the procedure will use:

• Mydriatics to facilitate removal
• Miotic medications such as Timoptic
• A laser to smooth and reshape the lens
• Silicone oil injections into the eyeball

50. Lisa is 23 years old and looking forward to being married the following day. Lisa’s mother feels happy that her daughter is starting a new phase in her life but is feeling a little bit sad as well. When talking to Lisa’s mother you would explain this feeling to her as a sign of what?

• Anticipated Grief
• Lifestyle Loss
• Situational Loss
• Maturational Loss
• Self Loss
• All of the above