"can you believe we graduate in a year"
8. A patient reports seeing 'halos' around lights and has elevated intraocular pressure. Which condition is most likely?
**Correct Answer:** C
**Rationale:** Glaucoma involves increased IOP and symptoms such as halos around lights and vision changes.
1. What is a key characteristic of critical thinking in nursing?
**Correct Answer:** C
**Rationale:** Critical thinking involves open-mindedness, continual inquiry, and analyzing each unique patient situation.
11. What is third-spacing?
Answer: C
Rationale: Third-spacing involves fluid being trapped in non-functional spaces such as tissues, reducing circulating volume.
8. What fluid movement process is driven by hydrostatic pressure in capillaries?
Answer: C
Rationale: Filtration is driven by hydrostatic pressure and occurs in the capillaries and kidneys.
7. Select all that apply: What are symptoms of hypokalemia?
Answer: A, C, D
Rationale: Hypokalemia presents with cardiac issues, lethargy, urinary retention, and muscle weakness (not twitching).
Q5. Which intervention is used as a last resort for managing severe constipation?
Answer: C. Digital stool removal
Rationale: Digital removal is the last resort if enemas and other methods fail.
Which are common symptoms of hypoxia?
Answers: A. Restlessness, C. Cyanosis
Rationale: Symptoms of hypoxia include restlessness and cyanosis; increased LOC is not typical—hypoxia often decreases LOC.
Q3. Which organisms can cause infection?
Answer: All of the above
Rationale: All listed organisms—bacteria, viruses, fungi, and protozoa—can cause infections.
5. Which hormone is most responsible for regulating serum calcium levels?
Answer: C
Rationale: Parathyroid hormone (PTH) is crucial in maintaining calcium balance in the body.
Q1. Which of the following best defines an infection?
Answer: A process where a pathogen invades tissue and grows within the host
Rationale: Infection results when a pathogen invades tissue and begins growing within the host, unlike colonization which lacks tissue invasion.
10. Which of the following describes the difference between physical dependence and addiction?
**Correct Answer:** C
**Rationale:** Addiction includes behavioral signs such as hoarding or doctor shopping, whereas physical dependence is physiological.
4. Which of the following sensory disorders is characterized by sudden episodes of vertigo and tinnitus?
**Correct Answer:** B
**Rationale:** Ménière’s disease affects the inner ear and leads to symptoms such as vertigo, tinnitus, and fluctuating hearing loss.
Which node is responsible for initiating the electrical impulse in the heart?
Answer: B. SA node
Rationale: The SA node, also known as the sinoatrial node, acts as the natural pacemaker of the heart, initiating electrical impulses.
A nurse is assessing a client who is suspected to have hypovolemia. Which of the following findings would the nurse expect?
A. Bounding pulse
B. Neck vein distention
C. Dry mucous membranes
D. Increased blood pressure
Correct Answer: C. Dry mucous membranes
Rationale:
Dry mucous membranes are a common sign of fluid volume deficit (hypovolemia) due to decreased circulating fluid.
A & B are signs of fluid overload (hypervolemia).
D is incorrect because hypovolemia typically causes hypotension, not hypertension.
3. A patient with obstructive sleep apnea might benefit most from which intervention?
**Correct Answer:** A
**Rationale:** CPAP provides continuous airway pressure, helping prevent airway collapse in obstructive sleep apnea.
13. What solution is used to rapidly expand circulatory volume?
Answer: C
Rationale: D10W is a hypertonic solution that helps rapidly increase blood volume.
4. Which reasoning approach moves from the general to the specific?
**Correct Answer:** B
**Rationale:** Deductive reasoning moves from general principles to specific situations.
6. Which condition results in cells swelling due to fluid movement?
Answer: B
Rationale: Hypotonic solutions cause water to enter cells, making them swell.
Q8. Select all that apply: What are treatments for infection?
Answer: ['Antibiotics for bacteria', 'Antifungals for fungi', 'Antimicrobials for protozoans', 'Antipyretics for symptom relief']
Rationale: These treatments are specific to pathogen types. Antihistamines are not used to treat bacterial infections.
The nurse is caring for a patient with hypervolemia. Which assessment findings support this diagnosis?
Select all that apply:
A. Crackles in the lungs
B. Weight gain
C. Increased hematocrit
D. Peripheral edema
E. Bradycardia
Correct Answers: A, B, D
Rationale:
A (Crackles): Caused by fluid accumulation in the lungs.
B (Weight gain): Due to fluid retention.
D (Peripheral edema): Common in fluid overload.
C is incorrect: Hematocrit usually decreases in hypervolemia due to hemodilution.
E is incorrect: Tachycardia, not bradycardia, is more commonly seen.
Which conditions can affect chest wall movement?
Answers: A. Pregnancy, B. Obesity, D. Trauma
Rationale: Pregnancy, obesity, and trauma physically restrict chest wall movement, impairing effective respiration.
12. What electrolyte imbalance is most associated with chronic alcoholism?
Answer: B
Rationale: Chronic alcoholism commonly leads to low magnesium levels (hypomagnesemia).
Q5. Healthcare-associated infections (HAIs) are commonly caused by which of the following?
Answer: Antibiotic administration
Rationale: HAIs often result from invasive procedures, antibiotic administration, MDROs, and breaks in infection control.
3. What is a common cause of hyperkalemia?
Answer: C
Rationale: Renal disease reduces potassium excretion, leading to elevated serum K+.
14. Which electrolytes are commonly monitored for cardiac dysrhythmias?
Answer: A, B, C
Rationale: Imbalances in Ca, K, and Mg can all affect heart rhythm; sodium is more associated with fluid balance.
Which of the following are considered hypertonic solutions?
A. 3% sodium chloride
B. D5W (5% dextrose in water)
C. D5NS (5% dextrose in 0.9% normal saline)
D. 0.45% sodium chloride
E. D10W (10% dextrose in water)
Correct Answers: A, C, E
Rationale:
A: 3% sodium chloride is a hypertonic solution used to treat severe hyponatremia.
C: D5NS is hypertonic because dextrose is added to isotonic saline.
E: D10W is hypertonic and provides calories as well as free water.
B: D5W is isotonic in the bag but becomes hypotonic in the body as dextrose is metabolized.
D: 0.45% NS is a hypotonic solution.
Q2. Which of the following are potential complications of chronic urinary catheterization? (Select all that apply)
Answer: A, B, D
Rationale: Chronic catheter use can lead to infection (urosepsis), renal disease, and bladder stones. Retention is typically managed, not caused. Hypotension is unrelated.
A nurse is caring for a patient with sensorineural pain due to peripheral neuropathy. Which of the following descriptions best characterizes this type of pain?
A. Aching and cramping in the muscles after activity
B. Sharp, burning pain along a nerve pathway
C. Dull, localized joint pain worsened with movement
D. Pain relieved by repositioning and rest
Correct Answer: B. Sharp, burning pain along a nerve pathway
Rationale:
Sensorineural pain is often described as sharp, burning, tingling, or shooting, and it follows the path of affected nerves—common in conditions like diabetic neuropathy or sciatica.
A describes muscular pain.
C refers to somatic pain from joints or musculoskeletal issues.
D aligns more with mechanical pain like pressure or ischemic pain, not sensorineural.
Q10. Passive immunity involves:
Answer: Receiving antibodies from another source
Rationale: Passive immunity is gained through transfer of antibodies, such as through placenta or immunoglobulin administration.
1. Which of the following best describes the function of the circadian rhythm in relation to sleep?
**Correct Answer:** B
**Rationale:** The circadian rhythm is regulated by the hypothalamus and aligns the sleep-wake cycle with the 24-hour day-night cycle.
What is the primary purpose of inflammation?
Answer: To localize and eliminate the injurious agent
Rationale: Inflammation is the body's localized response to injury or infection to contain and remove the threat.
1. Which of the following is a characteristic of intracellular fluid (ICF)?
Answer: D
Rationale: ICF is high in potassium and found within cells, especially in skeletal muscle mass.
2. Which of the following are components of the nursing process? (Select all that apply)
**Correct Answer:** A, B, D, E
**Rationale:** The nursing process includes Assessment, Diagnosis, Planning, Implementation, and Evaluation. Reflection is a tool used in developing critical thinking but not a step in the process.
Which condition is characterized by inadequate alveolar ventilation?
Answer: C. Hypoventilation
Rationale: Hypoventilation refers to insufficient air entering the alveoli, which can lead to elevated CO2 and decreased O2.
The nurse is caring for a client with chronic obstructive pulmonary disease (COPD). Which nursing intervention is most appropriate to promote effective gas exchange?
A. Encourage the client to lie flat during rest periods
B. Administer high-flow oxygen via non-rebreather mask
C. Instruct the client in pursed-lip breathing techniques
D. Limit fluid intake to prevent pulmonary congestion
Correct Answer: C. Instruct the client in pursed-lip breathing techniques
Rationale:
C: Pursed-lip breathing helps improve gas exchange by promoting airway opening and reducing air trapping, a key issue in COPD.
A: Lying flat can impair lung expansion and worsen dyspnea in COPD patients.
B: High-flow oxygen can suppress the hypoxic respiratory drive in some COPD patients—oxygen should be titrated carefully.
D: Adequate hydration helps loosen mucus secretions; limiting fluids is not generally recommended unless otherwise indicated (e.g., heart failure).
5. Which medication would be most appropriate for managing mild pain due to inflammation?
**Correct Answer:** C
**Rationale:** Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) effective for mild to moderate inflammatory pain.
10. Select all that apply: What are symptoms of hypercalcemia?
Answer: A, B, D
Rationale: Hypercalcemia can cause muscle weakness, bone pain, and kidney stones. Tetany is a symptom of hypocalcemia.
Q1. Which layer of the skin is responsible for producing melanin?
Answer: C. Epidermis
Rationale: Melanin is produced in the epidermis, giving the skin its color.
5. Select all the ways a nurse can develop critical thinking skills:
**Correct Answer:** A, C, D
**Rationale:** Reflective journaling, collaboration with colleagues, and concept mapping are effective ways to enhance critical thinking.
Which factors can affect oxygenation?
Answers: A. Age, B. Stress, C. Medications
Rationale: Age, stress, and medications can influence oxygenation, while sun exposure does not directly affect cardiopulmonary function.
Q10. Which are appropriate nursing interventions for maintaining healthy elimination in patients? (Select all that apply)
Answer: A, C, D
Rationale: Exercise, bowel training, and cautious use of medications are important. Low fluid intake and ignoring incontinence are inappropriate.
A nurse is caring for a postoperative patient who suddenly becomes restless and anxious. Which of the following should the nurse suspect?
A. Hypoglycemia
B. Hyperkalemia
C. Hypoxia
D. Hypervolemia
Correct Answer: C. Hypoxia
Rationale:
Restlessness and anxiety are early signs of hypoxia, as the brain is very sensitive to changes in oxygen levels.
A (Hypoglycemia) can cause similar symptoms but usually also includes shakiness, diaphoresis, and confusion.
B (Hyperkalemia) more commonly affects cardiac rhythm and causes muscle weakness.
D (Hypervolemia) may cause signs like crackles, edema, and hypertension—not acute anxiety or restlessness.
Q9. Which practice is essential to prevent infection transmission in healthcare?
Answer: Hand hygiene
Rationale: Hand hygiene is one of the most effective practices in preventing the spread of infections in healthcare settings.
Q4. Which of the following are functions of the skin? (Select all that apply)
Answer: A, C, D, E
Rationale: Skin helps in sensing, regulating temperature, protecting organs, and assisting in vitamin D activation. It does not directly regulate blood pressure.
6. Select all that apply: Which factors can influence a patient's sensory function?
**Correct Answer:** A, B, C, E
**Rationale:** Sensory function is influenced by age, presence of meaningful stimuli, the environment, and social interaction.
7. What is the primary goal of using a pain assessment tool?
**Correct Answer:** C
**Rationale:** Pain is subjective, and assessment tools help understand the patient's personal experience with pain.
Q6. Which of the following is NOT a factor influencing infection prevention and control?
Answer: Weather
Rationale: Age, stress, and nutritional status are personal health factors. Weather, while indirectly relevant, is not a primary factor.
Which of the following statements about the flow of blood through the heart are true?
A. The pulmonary vein carries oxygenated blood to the heart.
B. Blood in the right atrium is oxygen-rich.
C. The left ventricle pumps blood into the systemic circulation.
D. The tricuspid valve lies between the left atrium and left ventricle.
E. Blood moves from the lungs to the heart via the pulmonary vein.
Correct Answers: A, C, E
Rationale:
A: Correct – the pulmonary vein is one of the few veins that carries oxygenated blood, bringing it from the lungs to the left atrium.
C: Correct – the left ventricle pumps oxygen-rich blood into the aorta and systemic circulation.
E: Correct – pulmonary veins return blood from the lungs to the heart.
B: Incorrect – the right atrium contains deoxygenated blood.
D: Incorrect – the tricuspid valve is between the right atrium and right ventricle; the mitral (bicuspid) valve is between the left atrium and left ventricle.
What is the intrinsic rate of the SA node?
Answer: B. 60-100 bpm
Rationale: The SA node generates impulses at a normal rate of 60-100 beats per minute under resting conditions.
2. Select all that apply: Which of the following are examples of isotonic solutions?
Answer: A, B, C
Rationale: D10W is a hypertonic solution; the others are isotonic and help maintain fluid balance.
4. What does the P wave in a normal ECG represent?
Answer: B
Rationale: The P wave indicates atrial contraction as part of the normal cardiac cycle.
Q9. Which of the following is a risk factor for pressure ulcers?
Answer: C. Bony prominence
Rationale: Pressure ulcers commonly develop over bony prominences.
Q6. A patient with an ileostomy is at greatest risk for:
Answer: A. Skin breakdown around the stoma
Rationale: Stoma care is critical in ileostomy patients to prevent skin complications.
Q7. What is colonization?
Answer: Presence of microorganisms without tissue damage
Rationale: Colonization refers to the presence and growth of microorganisms without tissue invasion or damage.
Which of the following are expected assessment findings in a patient with hypokalemia?
A. Muscle weakness
B. Abdominal cramping
C. Flat or inverted T waves
D. Irregular heartbeat
E. Hyperactive reflexes
Correct Answers: A, C, D
Rationale:
A: Correct – muscle weakness is a classic symptom of hypokalemia.
C: Correct – flat or inverted T waves are an ECG sign of hypokalemia.
D: Correct – arrhythmias are a serious risk in hypokalemia.
B: Incorrect – abdominal cramping is more common in hyperkalemia.
E: Incorrect – hypokalemia often leads to hyporeflexia, not hyperreflexia.
A patient is admitted with dehydration. The provider orders 0.9% normal saline (NS) IV. What is the primary reason for administering this solution?
A. To provide free water and promote renal excretion
B. To replace electrolytes rapidly
C. To expand the intravascular volume without altering serum osmolality
D. To reduce cellular edema by shifting fluid into the intravascular space
Correct Answer: C
Rationale: 0.9% normal saline is an isotonic solution, which means it has the same osmolality as blood plasma. It is used to expand intravascular volume without causing fluid shifts into or out of cells.
(A) Describes hypotonic solutions like 0.45% NS.
(B) While NS contains sodium and chloride, it's not considered an electrolyte replacement solution like LR.
(D) Refers to hypertonic solutions, not isotonic.
Q3. Which type of wound healing involves delayed closure, often due to infection or poor circulation?
Answer: C. Tertiary intention
Rationale: Tertiary intention healing is delayed closure, typically for infected or high-risk wounds.
Q2. Select all that apply: Which are symptoms of infection?
Answer: ['Fever', 'Nasal congestion', 'Sore throat', 'Vomiting']
Rationale: These are common symptoms of infection. Joint flexibility is not typically a sign of infection.
9. Which intervention is least appropriate for postoperative care following a corneal transplant?
**Correct Answer:** B
**Rationale:** Ice packs should not be used directly on the eye after corneal transplant due to the risk of increased IOP.
2. Select all that apply: Which conditions can be complications of chronic sleep deprivation?
**Correct Answer:** A, C, D
**Rationale:** Chronic sleep deprivation has been linked to multiple health risks including hypertension, stroke, and obesity.
Q8. Which maneuver may be used by clients with chronic urinary retention to promote voiding?
Answer: B. Valsalva maneuver
Rationale: The Valsalva and Crede’s maneuvers may assist in voiding.
What is the major muscle of inspiration?
Answer: C. Diaphragm
Rationale: The diaphragm is the primary muscle involved in inspiration, and it is controlled by the phrenic nerve.
Which of the following best describes the correct order of blood flow through the heart starting from the vena cava?
A. Right atrium → Right ventricle → Pulmonary artery → Lungs → Pulmonary vein → Left atrium → Left ventricle → Aorta
B. Right atrium → Pulmonary artery → Right ventricle → Lungs → Pulmonary vein → Left atrium → Aorta → Left ventricle
C. Vena cava → Right atrium → Right ventricle → Pulmonary vein → Lungs → Pulmonary artery → Left atrium → Left ventricle
D. Vena cava → Right atrium → Right ventricle → Aorta → Lungs → Pulmonary vein → Left atrium → Left ventricle
Correct Answer: A
Rationale: Blood returns from the body via the vena cava into the right atrium, flows to the right ventricle, and is pumped through the pulmonary artery to the lungs. Oxygenated blood returns via the pulmonary vein to the left atrium, then to the left ventricle, and finally through the aorta to the rest of the body.
3. At the 'Commitment' level of critical thinking, a nurse:
**Correct Answer:** C
**Rationale:** The 'Commitment' level is characterized by independent decision-making and accountability.
Which of the following can decrease lung compliance?
Answers: A. Pulmonary fibrosis, B. Emphysema
Rationale: Both pulmonary fibrosis and emphysema can impair the lung's ability to expand, reducing compliance.
Q7. Which of the following are true regarding second intention wound healing? (Select all that apply)
Answer: B, C, D
Rationale: Secondary intention involves longer healing, greater risk of infection, and more scarring. Edges are not approximated.
15. Which type of fluid solution includes blood products like albumin and packed RBCs?
Answer: C
Rationale: Colloid solutions consist of large molecules like blood products that do not dissolve completely.
9. A positive Chvostek's sign is indicative of which electrolyte imbalance?
Answer: B
Rationale: Chvostek's sign indicates neuromuscular irritability seen in hypocalcemia.
What is the primary goal of ventilation?
Answer: C. To maintain PaCO2 between 35-45mmHg and PaO2 between 95-100mmHg
Rationale: Proper ventilation ensures normal blood gas levels, vital for tissue oxygenation and acid-base balance.
Which artery supplies blood to the right side of the heart?
Answer: C. Right coronary artery
Rationale: The right coronary artery specifically supplies the right side of the heart including the right atrium and ventricle.