Pre-Board Exam Drill: Fundamentals of Nursing D

This is a 30 point Pre-Board Exam Drill on Fundamentals of Nursing SET D.

Test your knowledge on nursing concepts, test your test-taking skills and develop your attitude in attacking board exam questions. Answer these questions on a piece of paper. Check your answers and don't forget to review the rationale behind the correct answer. Good luck with your exam!

1. Before administering a nasogastric feeding, the nurse aspirate the stomach contents and obtain 50 cc of residual. the next action is to:
a. discard aspirate and begin tube feeding
b. replace aspirate and begin tube feeding
c. discard aspirate and hold the tube feeding
d. replace aspirate and hold the tube feeding

2. You are assigned to a client with a central vein IV infusing hyperalimentation solution. The most important nursing intervention is:
a. preparing the next bottle of solution prior to use
b. maintaining the exact amount of solution administered hourly by adjusting the flow rate
c. checking urine specific gravity, sugar, and acetone every for hours
d. changing the IV filter and tubing with each bottle change

3. You have been assigned to a female patient who needs to have a sterile urine specimen sent to the laboratory for a culture and sensitivity. After inserting the catheter, you find that urine is not flowing. Your next action is to:
a. remove the catheter, check the meatus, and reinsert the catheter
b. obtain a new, larger sized catheter and insert it
c. reassess if the catheter is in the vagina; if so, remove it and reinsert into meatus
d. insert the catheter a little farther, wait a few seconds, and if urine does not flow, reassess placement


4. When the urine begins to flow through catheter, your next action is to:
a. inflate the catheter balloon with sterile water
b. place the catheter tip into the specimen container
c. connect the catheter into the drainage tubing
d. place the catheter tip into the urine collection receptacle


5. Following application of a leg cast, you will first check the toes for:
a. increase in temperature
b. change in color
c. edema
d. movement


96. The client is unable to feel you apply pressure on his toes and complains of tingling. These signs indicate:
a. pressure on a nerve
b. phantom pain syndrome
 c. overmedication of an analgesic
d. improper alignment of the fracture


7. From your knowledge of the casting procedure, you understand that a wet cat should be:
a. placed on a firm surface for the first few hours
b. handled only with the palms of the hands
c. left alone to set for at least three hours
d. pelated to lessen chance of irritation to the client

8. During a retention catheter insertion or bladder irrigation, the nurse must use:
a. sterile equipment and wear sterile gloves
b. clean equipment and maintain surgical asepsis
c. sterile equipment and maintain medical asepsis
d. clean equipment and technique


9. Care for a client following a bronchoscopy will include:
a. withholding food and liquids until the gag reflex returns
b. providing throat irrigations every four hours
c. having the client refrain from talking for several days
d. suctioning frequently, as ordered


10. Reviewing the lab tests of a client scheduled for surgery, you find that the white blood cell count is 9800/mm3. The most appropriate intervention is to:
a. call the operating room and cancel the surgery
b. notify the surgeon immediately
c. take on action as your recognize that it is a normal value
d. call the lab and have the test repeated

11. If the client with psoriasis complains about pruritus, the nurse should suggest using:
a. drying soaps or agents
b. hot water when bathing
c. emollient lubricants
d. a towel to provide vigorous drying after bathing


12. You are supervising a student nurse giving an IM injection to a client with right hip arthroplasty. You will know the SN requires further instruction if she:
a. administers the injection in the left deltoid muscle
b. turns the client on her right hip to administer the injection
c. keeps the abduction pillow in place and turns the client 10 degrees to administer the injection on the unaffected side
d. administers the injection after turning the client to her left thigh, keeping the abduction pillow in place


13. You are assisting a client to choose a meal that follows his dietary orders of high calorie, high protein, decreased sodium, and low potassium. You will know the understands his dietary guidelines when he chooses:
a. crab, beets and spinach, baked potato, and milk
b. halibut, salad, rice, and instant coffee
c. sirloin steak, salad, baked potato with butter, and chocolate ice cream
d. salmon, rice, green beans, sourdough bread, coffee, and ice cream


14. The best rationale for introducing your-self to a blind client and telling him exactly what you are doing is that these actions:
a. illustrate the principle of open communication
b. decrease the client’s anxiety and fear of the unknown
c. are the accepted procedure for beginning a nurse-client relationship
d. encourage and utilize clear communication

15. Sitting down at the client’s bedside to talk with the client with convey a sense of:
a. sympathy 
b. communication
c. empathy
d. encouragement

16. While assessing a client who has orders for a hot-water bottle, heating pad, or hot compress, the first sign of possible thermal injury is:
a. tingling sensation in the extremities c. edema
b. redness in the are d. pain


17. When charting the procedure for applying restraints to a client, you will include:
a. what the client says about the restraint
b. procedure for applying the restraint
c. physician’s orders regarding the restraint
d. condition of the extremity following application


18. To perform the skill “turning to the side-lying position,” you would lower the head of the bed, elevate bed to working height, move client to your side of the bed, and flex client’s knees. The next intervention, would be to:
a. roll the client on his side
b. reposition client
c. place one hand on client’s hip and other on shoulder
d. reposition client’s arms so they are not under his body

19. Your client insists on being discharged from the hospital against medical advice. From a legal standpoint, the most important nursing action is to:
a. notify the supervisor and hospital administration
b. determine exactly why the client wants to leave
c. put all appropriate forms in the client’s chart before he leaves the hospital
d. request that the client sign the against medical advice (AMA) form


20. You are moving the client from the bed to a chair. The first appropriate intervention is to:
a. dangle the client at his bedside
b. put nonslip shoes or slippers on client’s feet
c. rock the client and pivot
d. position client so that he is comfortable.

21. The nurse answers the phone in the emergency room, a woman states that she has a nosebleed that has not stopped for the past two hours. The nurse tells her that she should come to the ER immediately but do which of the following first?
a. put pressure on the bridge of the nose for 5 to 30 minutes, applying an icepack and sit with the head forward
b. apply heat to the bridge of the nose and do not eat
c. sit with the head back and use a towel to blot blood drainage
d. when blood is felt in the nose, lightly blow the nose into a tissue
 

22. A male client has been diagnosed with chronic obstructive pulmonary disease (COPD) for the last 10 years. He continues to smoke 2 packs of cigarettes a day. He requires oxygen to perform his daily activities. Which of the following therapeutic management modalities is necessary?
a. low flow of oxygen is usually ordered
b. oxygen flow is adjusted to a higher level if shortness of breath occurs
c. petroleum jelly should be applied around the nares to prevent irritation
d. oxygen flow rate is not a concern since he will feel better if the rate is high


23. Mrs. X has been diagnosed with acute asthma. she has been admitted to the hospital and all of the following instructions to the nurse are correct, except:
a. the head of the bed should be in the high position to facilitate drainage and breathing
b. a cool and dry environment should be maintained
c. air conditioner filter should be changed often
d. oxygen should never be used as it could restrict airways more


24. A female patient has had a partial gastrectomy with a vagotomy and pyloroplasty today. She has a nasogastric tube in her nares connected to low intermittent suction. The nurse should take which of the following precautions?
a. do not irrigate or reposition the NG tube because the stomach sutures can be ruptured
b. always use wrist restraints to assure placement of NGT
c. the NG tube should not be taped to the nose
d. expect copious amount of bright red blood from the NG tube postoperatively


25. A man complains of cramping abdominal pain. He has been diagnosed with acute diverticulitis. What nursing interventions are likely to be ordered?
a. increase activity and regular diet as tolerated
b. advise bed rest, clear liquids and meperidine (Demerol), 50 mg IM every 3-4 hours as needed 
c. use ice packs on the abdomen and place the client in the trendelenburg position
d. use a K-pad (a temperature controlled heating pad) on the abdomen and allow regular diet as tolerated


26. has been diagnosed with esophageal varices. The physician notes there is active bleeding and orders the nurse to insert NG tube. The nurse should do which of the following?
a. insert the NG tube immediately
b. question the order because a varix might be perforated during insertion
c. use copious amount of K-Y jelly to insert the NG tube
d. refuse the order because a varix might be perforated during insertion


27. A 30-year-old patient has been diagnosed with folic acid deficiency. The client asks the nurse which foods are high in folic acid, and the nurse correctly responds:
a. green leafy vegetables, organ meats, nuts and eggs
b. fresh shrimp and oysters
c. dried fruits and oatmeal
d. tofu and tuna


28. Which of the following is an example of pica?
a. a craving for sweets
b. a craving for laundry starch and ice
 c. a craving for shellfish
d. craving for pickles


29. An 82-year-old woman living in a long-term care facility develops urinary incontinence. After ruling out the presence of urinary retention or a urinary tract infection (UTI), the nurse should:
a. establish a 3-hour prompted voiding schedule
b. insert a foley catheter or teach the client to self-catheterize
c. restrict her fluid intake to 1500 ml/day
d. use adult diapers and change them frequently


30. Client education for the individual with gout includes:
a. dietary instructions to limit meat, poultry, organ meats and alcohol
b. dietary instructions to limit complex carbohydrates such as flat bread, rice and pasta
c. instructions for proper cast care
d. signs and symptoms of compartment syndrome, a major complication

“If A is a success in life, then A equals x plus y plus z. Work is x; y is play; and z is keeping your mouth shut” - A. Eistein

Pre-Board Exam Dill: Fundamentals of Nursing C

This is a 30 point Pre-Board Exam Drill on Fundamentals of Nursing SET C.

Test your knowledge on nursing concepts, test your test-taking skills and develop your attitude in attacking board exam questions. Answer these questions on a piece of paper. Check your answers and don't forget to review the rationale behind the correct answer. Good luck with your exam!

1. When a client responds to a crisis situation or an acute injury, the sympathetic nervous system will respond in which of the following ways?
a. it will increase blood flow to the abdominal organs
b. it will decrease blood flow to the vital organs
c. it will stimulate the adrenals to release epinephrine


2. During the clonic phase of a generalized seizure, you may expect to see:
a. pupil dilatation, tachycardia and muscle spasms
b. bladder incontinence, elevated blood pressure and diaphoresis
c. loss of consciousness, cessation of breathing and cyanosis
d. contracted throat muscles, hyperventilation and salivation


3. The physician orders ice for the scrotum of a client diagnosed with epididymitis. The nurse correctly assumes that:
a. ice slows circulation and decreases peripheral edema
b. ice should be applied in intervals, not continuously
c. ice is placed on the scrotum continuously until the physician orders otherwise
d. ice will not stop the pain, and it has a placebo effect

4. The best time for menstruating women to perform a breast self-examination is:
a. right before the menstrual period
b. during the menstrual period
c. a few days after the menstrual period
d. 14 days after the menstrual period


5. Which of the following procedures is most effective for preventing hemolytic blood transfusion reactions?
a. administer the blood through 5% dextrose in water (D5W)
b. administration of a steroid prior to the transfusion
c. careful identification of the client and the blood product
d. using a leukocyte-poor filter during the transfusion


6. A superficial partial-thickness burn should heal in:
a. one week c. six weeks
b. three weeks d. two months
Answer A: Healing of superficial partial-thickness burns usually occurs within a week.

7. The setting that is most suitable for the treatment of a client with a full thickness burn is:
a. admission to a burn unit
b. admission to a medical unit
c. treatment in an emergency room or ambulatory care setting
d. home health care
Answer A: Full-thickness burns usually require hospitalization in a burn unit with comprehensive care by a burn team. The age of a client and the body area involved determine the need for emergency attention.

8. A full thickness burn would appear:
a. red, as if client were sunburned
b. bright red and weeping fluid
c. mottled without weeping fluid
d. brown and leather-like


9. In a patient with full thickness burn of the face, the nurse must immediately address:
a. airway management and hypovolemic shock
b. moderate discomfort and minor fluid loss
c. pain management with intravenous morphine
d. wound care


10. A full thickness burn of the face should heal in:
a. one week c. six weeks
b. three weeks d. months


11. If the client with psoriasis complains about pruritus, the nurse should suggest using:
a. drying soaps or agents
b. hot water when bathing
c. emollient lubricants
d. a towel to provide vigorous drying after bathing


12. You are supervising a student nurse giving an IM injection to a client with right hip arthroplasty. You will know the SN requires further instruction if she:
a. administers the injection in the left deltoid muscle
b. turns the client on her right hip to administer the injection
c. keeps the abduction pillow in place and turns the client 10 degrees to administer the injection on the unaffected side
d. administers the injection after turning the client to her left thigh, keeping the abduction pillow in place


13. You are assisting a client to choose a meal that follows his dietary orders of high calorie, high protein, decreased sodium, and low potassium. You will know the understands his dietary guidelines when he chooses:
a. crab, beets and spinach, baked potato, and milk
b. halibut, salad, rice, and instant coffee
c. sirloin steak, salad, baked potato with butter, and chocolate ice cream
d. salmon, rice, green beans, sourdough bread, coffee, and ice cream


14. The best rationale for introducing your-self to a blind client and telling him exactly what you are doing is that these actions:
a. illustrate the principle of open communication
b. decrease the client’s anxiety and fear of the unknown
c. are the accepted procedure for beginning a nurse-client relationship
d. encourage and utilize clear communication

15. Sitting down at the client’s bedside to talk with the client with convey a sense of:
a. sympathy 
b. communication
c. empathy
d. encouragement

16. While assessing a client who has orders for a hot-water bottle, heating pad, or hot compress, the first sign of possible thermal injury is:
a. tingling sensation in the extremities c. edema
b. redness in the are d. pain


17. When charting the procedure for applying restraints to a client, you will include:
a. what the client says about the restraint
b. procedure for applying the restraint
c. physician’s orders regarding the restraint
d. condition of the extremity following application


18. To perform the skill “turning to the side-lying position,” you would lower the head of the bed, elevate bed to working height, move client to your side of the bed, and flex client’s knees. The next intervention, would be to:
a. roll the client on his side
b. reposition client
c. place one hand on client’s hip and other on shoulder
d. reposition client’s arms so they are not under his body

19. Your client insists on being discharged from the hospital against medical advice. From a legal standpoint, the most important nursing action is to:
a. notify the supervisor and hospital administration
b. determine exactly why the client wants to leave
c. put all appropriate forms in the client’s chart before he leaves the hospital
d. request that the client sign the against medical advice (AMA) form


20. You are moving the client from the bed to a chair. The first appropriate intervention is to:
a. dangle the client at his bedside
b. put nonslip shoes or slippers on client’s feet
c. rock the client and pivot
d. position client so that he is comfortable.

21. The primary purpose of client education is to:
a. collect client data
b. determine readiness to learn
c. assess degree of compliance
d. increase client’s knowledge that will affect health status

22. Your initial instruction to a client on the use of crutches to move upstairs should be to:
a. start with crutches and the unaffected leg on the same level
b. start with crutches and the affected leg on the same level
c. place crutches on the step after the affected leg is moved up the stair
d. place crutches on the stair and then move the affected leg to the stair


23. When a client experiences a severe anaphylactic reaction to a medication, your initial action is to:
a. start an IV 
b. assess vital signs
c. place the client in a supine position
d. prepare equipment for intubation


24. If a blood transfusion reaction occurs, the first intervention is to:
a. place the client in high-fowler’s position
b. call the physician
c. slow the rate of transfusion to “keep open” rate
d. shut off the transfusion


25. The correct action for instilling eye drops is to instill the drops:
a. at the outer canthus of the eye
b. over the conjunctiva
c. directly on the cornea
d. into the center of conjunctival sac


26. Assessing a client for hypovolemic shock, the sign that you would expect to note if this complication occurs is:
a. hypertension 
b. cyanosis
c. oliguria
d. tachypnea


27. When evaluating the client’s understanding of a low potassium diet, you will know he understands if he tells you that he will avoid:
a. pasta 
b. raw apples
c. dry cereal
d. french bread


28. Irrigating a nasogastric tube should be carried out using which one of the following protocols?
a. gently instill 20 cc normal saline and then withdraw solution
b. instill 30 cc sterile water and then withdraw solution
c. instill 30 cc sterile saline, forcefully if necessary, and allow fluid to flow into basin for return
d. gently instill 20 cc sterile water and then allow fluid to flow into basin for return


29. The morning of the second postoperative day, a female patient is to be ambulated. Your first intervention is to:
a. get her up in a chair
b. use a walker when getting her up
c. have her put minimal weight on the affected side
d. practice getting her out of bed by slightly flexing her lips


30. You are assigned a client who has just had a nasogastric tube inserted postoperatively. During your evaluation of his status, you will check for:
a. electrolyte imbalance
b. gastric distention
c. ulcerative colitis
d. infection

Nursing Leader: Sanger and Breckinridge

This is a series of post regarding notable nursing leaders who have given many contribution to nursing and their influence uplifted the nursing profession.


Nursing Leaders
Florence Nightingale, Clara Barton, Lillian Wald, Lavinia Dock, Margaret Sanger, and Mary Breckinridge are among the leaders who have made notable contributions both to nursing's history and to women's history. These women were all politically astute pioneers. Their skills at influencing others and bringing about change remain models for political nurse activists today. Contemporary nursing leaders, such as Virginia Henderson, who created a modern worldwide definition of nursing, and Martha Rogers, a catalyst for theory  development.

Sanger (1879-1966)
Margaret Biggins Sanger, a public health nurse in New York, has had a lasting impact on women's health care. Imprisoned for opening the first birth control information clinic in America, she is considered the founder of Planned Parenthood. Her experience with the large number of unwanted pregnancies among the working poor was instrumental in addressing this problem.

Breckinridge (1881-1965)
After World War I, Mary Breckinridge, a notable pioneer nurse, established the Frontier Nursing Service (FNS). In 1918, she worked with the American Committee for Devastated France, distributing food, clothing, and supplies to rural villages and taking care of sick children. In 1921, Breckinridge returned to the United States with plans to provide health care to the people of rural America. In 1925, Breckinridge and two other nurses began the FNS in Leslie County, Kentucky. Within this organization, Breckinridge started one of the first midwifery training schools in the United States.

Nursing Leader: Lavinia Dock

This is a series of post regarding notable nursing leaders who have given many contribution to nursing and their influence uplifted the nursing profession.


Nursing Leaders
Florence Nightingale, Clara Barton, Lillian Wald, Lavinia Dock, Margaret Sanger, and Mary Breckinridge are among the leaders who have made notable contributions both to nursing's history and to women's history. These women were all politically astute pioneers. Their skills at influencing others and bringing about change remain models for political nurse activists today. Contemporary nursing leaders, such as Virginia Henderson, who created a modern worldwide definition of nursing, and Martha Rogers, a catalyst for theory  development.


Dock (1858-1956)
Lavinia L. Dock was a feminist, prolific writer, political activist, suffragette, and friend- of Wald. She participated in protest movements for women's rights that resulted in the 1920 passage of the 19th Amendment to the U.S. Constitution, which granted women the right to vote. In addition, Dock campaigned for legislation to allow nurses rather than physicians to control their profession. In 1893, Dock, with the assistance of Mary Adelaide Nutting and Isabel Hampton Robb, founded the American Society of Superintendents of Training Schools for Nurses of the United States and Canada, a precursor to the current National League for Nursing.

Biography

 Lavinia Dock was born in Harrisburg, Pennsylvania in 1858. She graduated from the Bellevue Training School for Nurses in 1886. In 1889 she helped in the disaster relief effort following the devastating flood in Johnstown, Pennsylvania. In 1890 she became Isabel Hampton's assistant superintendent at the Johns Hopkins Hospital Training School for Nurses, where she was in charge of instruction . The same year, her textbook Materia Medica for Nurses which quickly became a standard in Nursing curriculum was published. She spoke at the Columbian Exposition at the World's Fair in Chicago in 1893. In 1907, along with Mary Adelaide Nutting she wrote the illustrated A History of Nursing. She went on to write more books on the history of nursing, including A Short History of Nursing with Isabel M. Stewart in 1920, and History of American Red Cross Nursing with Sarah E. Pickett in 1922. She was a member of the Nurses' Settlement in New York, Secretary of the American Federation of Nurses and of the International Council of Nurses. She was also a member of the National Women's Party which campaigned for the equal rights amendment introduced in 1923. She served as secretary for the International Council of Nurses from 1899 to 1922. From 1900 to 1923 she was a contributing editor for the American Journal of Nursing's "Foreign Department". She was made an honorary member of the Johns Hopkins Nurses' Alumnae Association at its founding in 1892. In 1976 she was inducted into the American Nurses Association Hall of Fame.

Nursing Leader: Lillian Wald

This is a series of post regarding notable nursing leaders who have given many contribution to nursing and their influence uplifted the nursing profession.


Nursing Leaders
Florence Nightingale, Clara Barton, Lillian Wald, Lavinia Dock, Margaret Sanger, and Mary Breckinridge are among the leaders who have made notable contributions both to nursing's history and to women's history. These women were all politically astute pioneers. Their skills at influencing others and bringing about change remain models for political nurse activists today. Contemporary nursing leaders, such as Virginia Henderson, who created a modern worldwide definition of nursing, and Martha Rogers, a catalyst for theory  development


Wald (1867-1940)
Lillian Wald (Figure 1-13 •) is considered the founder of public health nursing. Wald and Mary Brewster were the first to offer trained nursing services to the poor in the New York slums. Their home among the poor on the upper floor of a tenement, called the Henry Street Settlement and Visiting Nurse Service,provided nursing services, social services, and organized educational and cultural activities. Soon after the founding of the

Lillian Wald invented public health nursing in 1893, making this year the field's centennial. One of nursing's visionaries, Wald secured reforms in health, industry, education, recreation, and housing. This historical inquiry examines three of Wald's critical experiments, each of which illuminates the past of public health nursing and its contemporary dilemmas: invention of public health nursing itself, establishment of a nationwide system of insurance payments for home-based care, and creation of a national public health nursing service.

Lllian Wald was born into a comfortable Jewish family in 1867, but chose to work in the tenements of New York City. She coined the phrase “public health nursing” and is considered to be the founder of that profession.

Lillian was educated at a private boarding school. She had graduated from a two-year nursing program and was taking classes at the Women’s Medical College when she became involved in organizing a class in home nursing for poor immigrants on New York’s Lower East Side. Lillian, distressed by the conditions in the multi-story walk-up, cold-water flats, moved to the neighborhood and, along with her classmate and colleague Mary Brewster, volunteered her services as a visiting nurse. With the aid of a couple of wealthy patrons, the operation quickly grew in size. The Henry Street Settlement (otherwise known as the VNS, or Visiting Nurse Service) grew from 2 nurses in 1893 to 27 in 1906, and to 92 in 1913.

The nurses educated the tenement residents about infection control, disease transmission, and personal hygiene. They stressed the importance of preventative care, but also provided acute and long-term care for the ill. They received fees based on the patient’s ability to pay. The organization also eventually incorporated housing, employment, and educational assistance and recreational programs as well. In 1912, Wald helped found the National Organization for Public Health Nursing, which would set professional standards and share information. She served as its first president.

Her other accomplishments included:
• Persuading President Theodore Roosevelt to create a Federal Children’s Bureau to protect children from abuse, especially exploitation such as improper child labor.
• Lobbying for health inspections of the workplace to protect workers from unsafe conditions and encouraging employers to have nursing or medical professionals on-site.
• Convincing the New York Board of Education to hire its first nurse, which lead to the standard practice within in the U.S. of having a nurse on duty at schools.
• Persuading Columbia University to appoint the first professor of nursing in the country, and initiating a series of lectures for prospective nurses at Columbia’s Teachers College. This became the basis a few years later for the University’s Department of Nursing and Health and caused nursing education to shift away from solely hospital-taught training to university courses augmented by hospital fieldwork.

Wald wrote two books about her experiences, The House on Henry Street, and Windows on Henry Street. She died in Westport, Connecticut, on September 1, 1940. Wald’s legacy is seen in the lasting good of her many accomplishments in the areas of public health and social services, not the least of which is her founding of the VNS. The New York Visiting Nurse Service continued to grow and thrive, increasing to 3,000 employees, with the number of people served annually now totaling 700,000. The original VNS is still a model for the 13,000 visiting nurse groups which exist today.

Wald said, “Nursing is love in action, and there is no finer manifestation of it than the care of the poor and disabled in their own homes.”

Summary
Wald coined the term "public health nurse" in 1893 for nurses who worked outside hospitals in poor and middle-class communities. Specializing in both preventative care and the preservation of health, these nurses responded to referrals from physicians and patients, and received fees based on the patient's ability to pay. In response to growing demand from all sides, Wald helped to initiate a series of lectures to educate prospective nurses at Columbia University's Teachers College in 1899. Students attended classes at Columbia and received their field training at Henry Street. This series led to the formation of the University's Department of Nursing and Health in 1910. By 1912, public health nurses—sometimes called visiting or district nurses—had begun to have significant impact. Wald and her colleagues in the public health movement recognized the need for the establishment of professional standards for public health nurses. Like other professional organizations, the National Organization of Public Health Nurses (NOPHN) was designed to set professional standards, share techniques and protect the reputations of its members. Wald was elected as the organization's first president.

Nursing Leader: Mary Mahoney

This is a series of post regarding notable nursing leaders who have given many contribution to nursing and their influence uplifted the nursing profession.


Nursing Leaders
Florence Nightingale, Clara Barton, Lillian Wald, Lavinia Dock, Margaret Sanger, and Mary Breckinridge are among the leaders who have made notable contributions both to nursing's history and to women's history. These women were all politically astute pioneers. Their skills at influencing others and bringing about change remain models for political nurse activists today. Contemporary nursing leaders, such as Virginia Henderson, who created a modern worldwide definition of nursing, and Martha Rogers, a catalyst for theory  development


Mahoney (1845-1926)
Mary Mahoney  was the first African American professional nurse. She graduated from the New England Hospital for Women and Children in 1879. She constantly worked for the acceptance of African Americans in nursing and for the promotion of equal opportunities (Donahue, 1996, p. 271). The American Nurses Association (2006b) gives a Mary Mahoney Award biennially in recognition of significant contributions in
interracial relationships.

Gastrointestinal-Hepatobillary NCLEX-RN DRILL

This is a 30 point drill on concepts regarding Management of Clients with Gastrointestinal-Hepatobillary Disorders. Use this to serve as your pretest and post test on the subject Mattter

Test your knowledge on nursing concepts, test your test-taking skills and develop your attitude in attacking board exam questions. Answer these questions on a piece of paper. Check your answers and don't forget to review the rationale behind the correct answer. Good luck with your exam!

1. During preparation for bowel surgery, a male client receives an antibiotic to reduce intestinal bacteria. Antibiotic therapy may interfere with synthesis of which vitamin and may lead to hypoprothrombinemia?

a. vitamin A

b. vitamin D

c. vitamin E

d. vitamin K

2. When evaluating a male client for complications of acute pancreatitis, the nurse would observe for:

a. increased intracranial pressure.

b. decreased urine output.

c. bradycardia.

d. hypertension.

3. A male client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse position the client for this test initially?

a. Lying on the right side with legs straight

b. Lying on the left side with knees bent

c. Prone with the torso elevated

d. Bent over with hands touching the floor

4. A male client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to the emergency department. His wife reports that he has been “spitting up blood.” A Mallory-Weiss tear is suspected, and the nurse begins taking a client history from the client’s wife. The question by the nurse that demonstrates her understanding of Mallory-Weiss tearing is:

a. “Tell me about your husband’s alcohol usage.”

b. “Is your husband being treated for tuberculosis?”

c. “Has your husband recently fallen or injured his chest?”

d. “Describe spices and condiments your husband uses on food.”

5. Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube?

a. Change the tube feeding solutions and tubing at least every 24 hours.

b. Maintain the head of the bed at a 15-degree elevation continuously.

c. Check the gastrostomy tube for position every 2 days.

d. Maintain the client on bed rest during the feedings.

6. A male client is recovering from a small-bowel resection. To relieve pain, the physician prescribes meperidine (Demerol), 75 mg I.M. every 4 hours. How soon after administration should meperidine’s onset of action occur?

a. 5 to 10 minutes

b. 15 to 30 minutes

c. 30 to 60 minutes

d. 2 to 4 hours

7. The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease?

a. Dyspnea and fatigue

b. Ascites and orthopnea

c. Purpura and petechiae

d. Gynecomastia and testicular atrophy

8. Which condition is most likely to have a nursing diagnosis of fluid volume deficit?

a. Appendicitis

b. Pancreatitis

c. Cholecystitis

d. Gastric ulcer

9. While a female client is being prepared for discharge, the nasogastric (NG) feeding tube becomes clogged. To remedy this problem and teach the client’s family how to deal with it at home, what should the nurse do?

a. Irrigate the tube with cola.

b. Advance the tube into the intestine.

c. Apply intermittent suction to the tube.

d. Withdraw the obstruction with a 30-ml syringe.

10. A male client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine (Demerol) instead of morphine to relieve pain because:

a. meperidine provides a better, more prolonged analgesic effect.

b. morphine may cause spasms of Oddi’s sphincter.

c. meperidine is less addictive than morphine.

d. morphine may cause hepatic dysfunction.

11. Mandy, an adolescent girl is admitted to an acute care facility with severe malnutrition. After a thorough examination, the physician diagnoses anorexia nervosa. When developing the plan of care for this client, the nurse is most likely to include which nursing diagnosis?

a. Hopelessness

b. Powerlessness

c. Chronic low self esteem

d. Deficient knowledge

12. Which diagnostic test would be used first to evaluate a client with upper GI bleeding?

a. Endoscopy

b. Upper GI series

c. Hemoglobin (Hb) levels and hematocrit (HCT)

d. Arteriography

13. A female client who has just been diagnosed with hepatitis A asks, “How could I have gotten this disease?” What is the nurse’s best response?

a. “You may have eaten contaminated restaurant food.”

b. “You could have gotten it by using I.V. drugs.”

c. “You must have received an infected blood transfusion.”

d. “You probably got it by engaging in unprotected sex.”

14. When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?

a. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture.

b. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.

c. The appendix may develop gangrene and rupture, especially in a middle-aged client.

d. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.

15. A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are:

a. whole blood and albumin.

b. platelets and packed red blood cells.

c. fresh frozen plasma and whole blood.

d. cryoprecipitate and fresh frozen plasma.

16. To prevent gastroesophageal reflux in a male client with hiatal hernia, the nurse should provide which discharge instruction?

a. “Lie down after meals to promote digestion.”

b. “Avoid coffee and alcoholic beverages.”

c. “Take antacids with meals.”

d. “Limit fluid intake with meals.”

17. The nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first?

a. Administering pain medication

b. Obtaining a blood sample for laboratory studies

c. Preparing to insert a nasogastric (NG) tube

d. Administering I.V. fluids

18. A female client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge?

a. The client doesn’t exhibit rectal tenesmus.

b. The client is free from esophagitis and achalasia.

c. The client reports diminished duodenal inflammation.

d. The client has normal gastric structures.

19. A male client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client’s nasogastric (NG) tube has stopped draining. How should the nurse respond?

a. Notify the physician

b. Reposition the tube

c. Irrigate the tube

d. Increase the suction level

20. What laboratory finding is the primary diagnostic indicator for pancreatitis?

a. Elevated blood urea nitrogen (BUN)

b. Elevated serum lipase

c. Elevated aspartate aminotransferase (AST)

d. Increased lactate dehydrogenase (LD)

21. A male client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note:

a. yellow sclerae.

b. light amber urine.

c. circumoral pallor.

d. black, tarry stools.

22. Nurse Hannah is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention:

a. a sedentary lifestyle and smoking.

b. a history of hemorrhoids and smoking.

c. alcohol abuse and a history of acute renal failure.

d. alcohol abuse and smoking.

23. While palpating a female client’s right upper quadrant (RUQ), the nurse would expect to find which of the following structures?

a. Sigmoid colon

b. Appendix

c. Spleen

d. Liver

24. A male client has undergone a colon resection. While turning him, wound dehiscence with evisceration occurs. The nurse’s first response is to:

a. call the physician.

b. place saline-soaked sterile dressings on the wound.

c. take a blood pressure and pulse.

d. pull the dehiscence closed.

25. The nurse is monitoring a female client receiving paregoric to treat diarrhea for drug interactions. Which drugs can produce additive constipation when given with an opium preparation?

a. Antiarrhythmic drugs

b. Anticholinergic drugs

c. Anticoagulant drugs

d. Antihypertensive drugs

26. A male client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of:

a. increasing fluid intake to prevent dehydration.

b. wearing an appliance pouch only at bedtime.

c. consuming a low-protein, high-fiber diet.

d. taking only enteric-coated medications.

27. The nurse is caring for a female client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission?

a. Regular diet

b. Skim milk

c. Nothing by mouth

d. Clear liquids

28. A male client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:

a. severe abdominal pain radiating to the shoulder.

b. anorexia, nausea, and vomiting.

c. eructation and constipation.

d. abdominal ascites.

29. A female client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should:

a. place the client in a private room.

b. wear a mask when handling the client’s bedpan.

c. wash the hands after touching the client.

d. wear a gown when providing personal care for the client.

30. Which of the following factors can cause hepatitis A?

a. Contact with infected blood

b. Blood transfusions with infected blood

c. Eating contaminated shellfish

d. Sexual contact with an infected person

"In order to succeed, your desire for success should be greater than your fear of failure."

NCLEX-RN DRILL 1

Test your knowledge in nursing concepts. Improve our test taking skills. Develop your attitude in attacking board type questions. Answer this NCLEX-RN DRILL and review the rationale behind the correct answer.

Tip!: Practice doesn't make your perfect but practice makes you better

1 A client is being discharged and needs instructions on wound care.When planning to teach the client, the nurse should:
a. identify the client’s learning needs and learning ability.
b. identify the client’s learning needs and advise him what to do.
c. identify the client’s problems and make the appropriate referral.
d. provide pamphlets or videotapes for ongoing learning.

2 A client is requesting a second opinion. The nurse who supports and promotes the client’s rights is acting as the client’s:
a. teacher.
b. adviser.
c. supporter.
d. advocate.

3 The client tells the nurse she has been smoking one pack of cigarettes a day for the past 20 years. The nurse recognizes this is what part of the nursing process?
a. assessment
b. planning
c. implementation
d. evaluation

4 During the assessment step of the nursing process, the nurse collects subjective and objective data. The nurse uses the information to identify:
a. medical diagnoses.
b. actual or potential problems.
c. client’s response to illness.
d. need for community support groups.

5 The nurse performs daily, routine equipment checks to detect possible malfunction. This is part of the nurse’s role in the:
a. nursing process.
b. quality assurance plan.
c. care management.
d. assessment plan.

6 The nurse is developing a nursing diagnosis for a client who has pneumonia. The nurse recognizes
the diagnosis describes an actual or potential problem that:
a. the nurse can treat independently
b. the nurse can treat with a physician’s order.
c. requires physician’s intervention.
d. relates to the clients’ primary diagnosis.

7 After administering pain medication, the nurse returns to check the client’s level of comfort. This stage
of the nursing process is known as:
a. assessment.
b. planning.
c. implementation.
d. evaluation.

8 A client has lost 10 pounds related to nausea and vomiting. The nurse identifies an appropriate expected
outcome: The client will:
a. gain weight.
b. gain 2 pounds within 1 week.
c. not lose weight.
d. gain 10 pounds in 2 days.

9 A problem-solving process that requires empathy, knowledge, divergent thinking, discipline, and creativity is known as:
a. critical thinking.
b. nursing process.
c. framework for nurses.
d. care management.

10 At the end of the shift, the nurse is ready to leave but has not been relieved by the oncoming shift nurse. The nurse’s responsibility to provide care for clients is part of the nurse’s:
a. Code of Ethics.
b. nursing process.
c. critical thinking.
d. quality assurance.

“A thinker sees his own actions as experiments and questions--as attempts to find out something. Success and failure are for him answers above all.” - Nietzche