PREBOARDS: NP3 → Presence of both antigens = Type AB

→ Absence of both antigens = Type O

1. One of the physical characteristic of blood is its → Either A and B = Type A or Type B
temperature being → Rh blood groups are named because one of the
A. Higher than the normal body temperature eight Rh antigens which is agglutinogen D was originally
B. Same as the normal body temperature identified in Rhesus monkeys that was later found in
C. Lower than the normal body temperature humans as Rh positive meaning their RBCs carry Rh
D. Varies according to body temperature antigen

RATIONALE: 4. Hemophilia is a defect in clotting mechanism, wherein

Answer is A. Higher than the normal body temperature. the blood does not clot properly. This can lead to
Physical Characteristics and Volume spontaneous bleeding as well as bleeding following
a. Blood is a sticky, opaque fluid with a characteristic injuries or surgery. What type of genetic disorder?
metallic taste. a.) X - linked dominant
b. Color. Depending on the amount of oxygen it is b.) Autosomal dominant
carrying, the color of blood varies from scarlet (oxygen c.) Autosomal recessive
rich) to a dull red (oxygen-poor). d.) X- linked recessive pattern
c. Weight. Blood is heavier than water and about five
times thicker, or more Viscous, largely because of its RATIONALE:
formed elements. Answer is D: X link recessive
d. pH. Blood is slightly alkaline, with a pH between 7.35 → In males who only have one X chromosome, a variant
and 7.45. in the only copy of the gene in each cell causes the
e. Temperature. Its temperature (38 degrees Celsius, or disorder. In females who have two X chromosomes, a
100.4 degrees Fahrenheit) is always slightly higher than variant in one of the two copies of the gene is sufficient
body temperature. to cause the disorder.
→ Females may experience less severe symptoms than
2. Larges part of the WBC’s when they migrate into the males.
tissues they transform into macrophages that are very → Males are usually affected, while females are usually
important in fighting off chronic infections carriers
a.) Lymphocytes
b.) Megakaryocytes 5. SLL is an indolent non-Hodgkin lymphoma that affects
c.) Monocytes what type of cell?
d.) Basophils a.) T Lymphocytes
b.) B Lymphocytes
RATIONALE: c.) Plasma cells
Answer is C. d.) Red blood cells
Lymphocytes: Lymphocytes have a large, dark purple
nucleus that occupies most of the cell volume; they RATIONALE:
tend to take up residence in lymphatic tissues, where Answer is B: B cells or B lymphocytes.
they play an important role in the immune response. → SLL is an indolent (slow growing) non-Hodgkin
Platelets: Platelets are not cells in the strict sense; they lymphoma that affects B cells.
are fragments of bizarre multinucleate cells called → B cells (also known as B lymphocytes) are specialized
megakaryocytes, which pinch off thousands of white blood cells.
anucleate platelet “pieces” that quickly seal themselves → Under normal conditions they produce
off from surrounding fluids; platelets are needed for the immunoglobulins (also called antibodies) that help
clotting process that occurs in plasma when blood protect our bodies against infection and disease.
vessels are ruptured or broken.
Basophils: Basophils, the rarest of the WBCs, contain 6. A type of sickle cell disease in which hemoglobin S
large, histamine-containing granules that stain dark gene is inherited from one parent and a gene for a
blue; histamine is an inflammatory chemical that makes different type of abnormal hemoglobin called C from
blood vessels leaky and attract other WBCs to the the other parent.
inflammatory site. a.) HbCS
b.) HbSC
3. The ABO blood groups are based on two antigens c.) HbSS
which is d.) HbS beta thalassemia
a.) A & B
b.) A & O RATIONALE:
c.) B & O Answer is B: HbSC. People who have this form of SC
d.) Rh positive & Rh negative inherit a hemoglobin "S" gene from one parent and a
gene for a different type of abnormal hemoglobin
RATIONALE: called "C" from the other parent. This is usually a milder
Answer is A: Type A & B form of SCD.
7. Most common cause of anemia worldwide? a.) IgA
a.) Sickle cell anemia b.) IgG
b.) Hemolytic anemia c.) IgM
c.) Pernicious Anemia d.) IgE
d.) Iron-deficiency Anemia
RATIONALE:
RATIONALE: Answer is B. IgG: 75%, lgA: 15%, IgM: 10%, IgD: 0.2%, IgE:
Answer is D. The most common cause of anemia 0.004%
worldwide is iron deficiency, which results in microcytic
and hypochromic red cells on the peripheral smear. 12. Humoral immune response begins with B
lymphocytes, which transform themselves into plasma
8. What factor directly stimulates the release of EPO cells that manufacture antibodies while; cellular immune
production response involves T lymphocytes which can turn into
a.) pO2 special cytotoxic (killer) T cells that attacks pathogen.
b.) Red blood cells Which of the following is not mediated by cellular
c.) Hemoglobin response
d.) White blood cells a.) Anaphylaxis
b.) Delayed Hypersensitivity
RATIONALE: c.) Transplant rejection
Answer is A. The partial pressure of oxygen (pO2) d.) Viral, fungal or parasitic infections
directly regulates EPO production. The lower the pO2,
the greater the production of EPO. Indirectly, low RATIONALE:
hemoglobin levels stimulate EPO production. Answer is A.
→ Humoral Responses: 1) Bacterial phagocytosis and
9. EPO is a glycoprotein hormone, naturally produced lysis, 2) Anaphylaxis, 3) Allergic hay fever and asthma, 4)
by what part of the kidney? Immune complex disease, 5) Bacterial and some viral
a.) Renal cortex peritubular cells infections
b.) Loops of Henle → Cellular Responses: 1) Transplant rejection, 2)
c.) Renal Medulla Delayed Hypersensitivity (Tuberculin test), 3) Graft versus
d.) Renal Tubule Host Tumor destruction, 4) Viral, fungal or parasitic
infections
RATIONALE:
Answer is A. Erythropoietin (EPO) is a glycoprotein 13. In the past two decades research revealed that
hormone, naturally produced by the peritubular cells of these hormones play definitive roles in lymphocyte
the kidney that stimulates red blood cell production. maturation, activation and synthesis of antibodies and
Renal cortex peritubular cells produce most EPO in the cytokines. In autoimmune diseases, expression of these
human body. hormones is altered and this change contributes to
immune dysregulation.
10. Myeloid progenitor cells are precursors to all of the a.) Growth hormones
following cells except? b.) Thyroid hormones
a.) Red blood cells c.) Sex hormones
b.) Mast cell d.) Cortisol
c.) NK – cells
d.) Monocytes RATIONALE:
Answer is C. Health History - Gender (Sex Hormones),
RATIONALE: Most autoimmune disease have a higher incidence in
Answer is C. females than in males.
→ Myeloid progenitor cells are precursors to the
following types of blood cells: 1) Red blood 14. HIV life cycle in which the new viral DNA enters the
cells/erythrocytes, 2) Platelets, 3) Mast cells, 4) nucleus of the CD4 T cell and through action of
Osteoclasts, 5) Granulocytes, 6) Monocyte- integrase is blended with the DNA of the CD4 T cell,
macrophages, 7) Dendritic cells resulting in permanent lifelong infection.
→ Lymphoid progenitor cells (also known as a.) Stage III DNA synthesis
lymphoblasts) are precursors to other mature blood cell b.) Stage IV Integration
types, including: 1) T-cells/T-lymphocytes, 2) B-cells/B- c.) Stage V Transcription
lymphocytes, 3) NK-cells/Natural. killer cells, 4) Dendritic d.) Stage VII Cleavage
cells
15. Small proteins that are released by Helper T cell also
11. Antibodies are large proteins that are produced by known as CD4+ cells upon recognition of antigens.
plasma cells which help the body fight infections. What These proteins are crucial in controlling the activity of
is the Major immunoglobulin in the body that assumes a other immune system cells
major role in blood borne and tissue infections a.) NK Cells
b.) B cells of T and B cells; infant is healthy at birth but
c.) Cytotoxic T cells highly susceptible to infections
d.) Cytokines Common Variable Immunodeficiency (VID): genetic
abnormalities resulting in defective ability of immune
RATIONALE: cells to produce normal amounts of antibodies resulting
Answer is D: Cytokines. Attracts and activated B cells, into frequent bacterial and viral infections of upper and
cytotoxic T cells, NK cells, macrophages, and other cells lower airways
of the immune system. Congenital Neutropenia Syndrome: low levels of
neutrophils from birth
16. Complement cascade may be activated by any of
the three pathways, which pathway is triggered after 19. Which of the following Antiretroviral agents is not a
antibodies bind to the microbes or other antigens and is Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
also a part of the humoral type of adaptive immunity? a.) Abacavir
a.) Classic b.) Lamivudine
b.) Lectin c.) Zidovodine
c.) Alternative d.) Ritonavir
d.) Interferons
RATIONALE:
RATIONALE: Answer is D: Ritonavir - Protease Inhibitor
Three Pathway:
1) Classic: triggered after antibodies bind to microbes or 20. When allergen made contact with the body, it
other antigens; triggers the B cell to make immunoglobulin E antibody,
2) Lectin: activated when a plasma protein binds to which attaches to the mast cell. When the allergen
terminal manose residue on the surface glycoproteins of reappears it binds to the immunoglobulin E and triggers
microbes; the mast cell to release it chemicals. What is the first
3) Alternative: triggered when complement proteins are chemical mediator to be released in immune and
activated on microbial surfaces inflammatory responses?
a.) Eosinophil Chemotactic Factor of Anaphylaxis
17. Stems cells are capable of self-renewal and b.) Prostaglandins
differentiation; they continually replenish the body’s c.) Bradykinin
entire supply of both RBC and WBCs. Some stem cells d.) Histamine
can give rise to numerous cell type to form new tissues
are called? RATIONALE:
a.) Pluripotent Primary Mediators: 1) Histamine: first chemical to be
b.) Totipotent released, potent vasodilation, smooth muscle
c.) Oligopotent contraction and increased vascular permeability and
d.) Multipotent increased mucus secretions; 2) Eosinophils; 3) Platelet
aggravating factor; 4) Prostaglandins
RATIONALE: Secondary: 1) Leukotrienes; 2) Bradykinin; 3) Serotonin
Answer is A: Pluripotent.
Totipotent: tremendous capacity of self-renew and SITUATION:
differentiate cells Sucrose is an incoming 4th year nursing student. To
Oligopotent: self renew and form 2 or more lineages prepare herself for an even more difficult year ahead,
within a specific tissue she sets herself to read about the basics of oncology.
Multipotent: can develop into one or more than cell
type, but are more limited than pluripotent cells 21. Where do bone and soft tissue sarcomas most
commonly metastasize to?
18. One of the selected primary immune deficiency A. Liver
disorders (PIDDs)in which problems with B and T cells and B. Lungs
platelets causes prolonged episodes of bleeding, C. Heart
recurrent bacterial and fungal infections and increased D. Kidneys
risk of cancers and autoimmune diseases
a.) Wiskott-Aldrich Sydrome (WAS) RATIONALE:
b.) Severe Combined Immune Deficiency (SCID) Answer is B. Soft tissue tumors occur most often in the
c.) Common Variable Immunodeficiency (CVID) extremities and can also be found in the head, neck,
d.) Congenital Neutropenia Syndrome and retroperitoneal areas. Bone and soft tissue
sarcomas most commonly metastasize. to the lungs. This
RATIONALE: is theorized to be a phenomenon in which there is
Answer is A: Wiskott-Aldrich Sydrome (WAS) microinvasion of cancer cells into the venous system,
Severe Combined Immune Deficiency (SCID): group of and subsequent circulation to other lungs.
rare life-threatening disorders caused by mutations in
different genes involved in development and functions
22. In 2009, the American Cancer Society (ACS) B. 25-45 years old
estimated that 106,100 people developed which C. 50-64 years old
cancer? D. 65 and above
A. Breast cancer
B. Colon cancer RATIONALE:
C. Lung cancer Answer is C. Unfortunately, despite the fact that
D. Cervical cancer adherence to colorectal cancer screening
recommendations is improving, 2005 screening data for
RATIONALE: adults aged 50 to 64 years showed that 44.2% had had
Answer is B. In 2009, the American Cancer Society (ACS) a recent screening (an increase from 37.6%) and 56.4%
estimated that 106,100 people developed colon cancer (from 48.7%) of persons aged 65 or older had
(52,010 men and 54,090 women), and 40,870 developed undergone a recent screening. 42 The prevalence of
rectal cancer (23,580 men and 17,290 women). The ACS colonoscopy increased to 39.2% from 20%.
expected 49,920 people to die of colon and rectal
cancers in 2009: 25,240 men and 24.680 women. SITUATION:
Most bladder cancers are diagnosed at an early stage
23. The most common mutated genes in colon cancer when the cancer is still treatable. Patient Red submits
include the adenomatous poluposis coli (APC) genes, herself to additional testing for confirmation and for early
the K-ras oncogene, the P53 tumor suppressor gene, the treatment after repeatedly seeing blood in her urine,
deleted-in-colon-cancer tumor suppressor gene, and along with pain upon urination, frequency and urgency.
the DNA mismatched pair genes. Which of the following
is true about the epidermal growth factor receptor 26. Patient Red is told about TURBT or Transurethral
(EGFR)? resection of the bladder tumor. She asks Nurse Blue
A. An overexpression inhibits apoptosis and leads to the about additional facts regarding this surgical therapy.
formation of new blood vessels and metastatic spread. Nurse Blue is correct when he says:
B. Is associated with colon cancer recurrence and poor A. This is specifically used to treat deep lesions of the
outcomes. bladder’s inner lining.
C. It is a cyclin-dependent kinase inhibitor that helps B. No recurrence of bladder cancer will occur once
balance acive cell division with no cells division based patient is done with TURBT.
on the body’s needs. C. Fulguration is used on the base to kill the cancer
D. It kills all tumor suppressor genes. cells. A high energy laser can be used as well.
D. Patient will not have to worry about any scarring or
RATIONALE: limitations in holding urine after this procedure because
Answer is A. Colon and rectal cancers overexpress the it will only be done once in their lifetime.
EGFR, prompting cells to continually divide, become
invasive, block apoptosis (programmed cell death), and RATIONALE:
make new blood vessels. Answer is C. Fulguration burns the base of the tumor
which kills the cancer cells.
24. What medication is given against EGFR, a molecular Option A: TURBT is used for superficial lesions of the
characteristic associated with other aggressive bladder's lining.
phenotypes? Option B and D: The primary disadvantages of this
A. Cetuximab approach are reoccurrence of the bladder cancer at
B. Alectinib another site and potential for scarring and/or limited
C. Nivolumab ability to hold urine with repeated TURBT procedures.
D. Ipilimumab
27. Before the start of Patient Red’s chemotherapy with
RATIONALE: local instillation by a urethral catheter, the nurse should
Answer is A. Cetuximab (Erbitux), a monoclonal be concerned when Patient Red makes which of the
antibody directed against EGFR, when given in following remarks?
combination with irinotecan resulted in an improved A. The drug will be instilled directly into my bladder and
response in previously treated, refractory patients with will be retained for 2 hours.”
advanced colon and rectal cancers. Patients must test B. “This intravesical therapy will be done weekly for 6 to
positive to receive the drug, but the NCCN Guidelines 12 weeks.”
state that no patient should be denied the drug based C. “I will remain still throughout the entire procedure in
on EGFR testing and a K-Ras wildtype genotype. order to lessen or avoid nausea and vomiting during the
instillation.”
25. Due to the fact that adherence to colorectal D. “After this therapy, I may experience irritative voiding
cancer screening is approving, a data from 2005 symptoms and hemorrhagic cystitis.”
showed that this age group that had undergone recent
screening showed an increase in prevalence from 37.6% RATIONALE:
to 44.24%. Which age group belongs of these results? Answer is C. Change the patient's position every 15
A. 5-25 years old
minutes during the instillation for maximum contact in all RATIONALE:
areas of the bladder. Answer is C. The defect in cellular immunity is evidenced
by an absent or decreased reaction to skin sensitivity
SITUATION: tests (eg, Candida, mumps), which is known as anergy.
Nurse Martin is an aspiring oncology nurse. He starts his Life-threatening infections are common, particularly with
first day at St. Theresa’s Hospital in the oncology unit. advanced disease.

28. Nurse Martin knows that this common malignancy in 31. Nurse Martin is asked about the different types of
older adults has an average diagnosis of 72 years old chemotherapy drugs and their mechanisms of action.
and has affected more than 120,000 people in the US Nurse Martin is correct when he says that alkalyting
and Europe. This is called: agents in chemotherapy such as Busulfan works
A. Chronic lymphocytic leukemia through:
B. Multiple myeloma A. Acting directly on DNA, causing cross-linking of DNA
C. Acute myeloid leukemia strands, abnormal base pairing, or DNA strand breaks,
D. Hodgkin’s lymphoma this preventing the cell from dividing.
B. Replacing natural substances as building blocks in
RATIONALE: DNA molecules, thereby altering the function of
Answer is A: CLL is a common malignancy of older enzymes required for cell metabolism and protein
adults; the average age at diagnosis is 72 years (ACS, synthesis.
2007). CLL is the most common form of leukemia in the C. Binding with DNA and preventing RNA synthesis, a
United States and Europe, affecting more than 120,000 key step in the creation of proteins, which are necessary
people. It is rarely seen in Native Americans and for cell survival. These cause the strands of the genetic
infrequently among persons of Asian descent. On materials that make up the DNA to uncoil, thereby
average patients with CLL survive 15 years (early-stage preventing the cell from reproducing.
CLL); this period may be as low as 3 to 4 years (late- D. Blocking the ability of a cancer cell to divide and
stage CLL) (Montserrat, 2006). come two cells. Although they act throughout the cell-
cycle, some are more effective during the S and M
29. What are Nurse Martin’s expected clinical phases, making these cell specific.
manifestation and lab values in older patients with the
type of cancer mentioned in above? RATIONALE:
A. Lower lymphocyte count than 100,000/mm3 Answer is A. Alkylating agents work by destroying the
B. Absence of lymphadenopathy since the lymphocytes DNA in cancer cells. This is done by replacing alkyl
are small and can easily travel through the vessels groups with hydrogen atoms in the DNA so the cells
C. Presence of the protein beta 2-microglobulin in the can't repair themselves. As a result, the lack of
serum functioning DNA prevents cancer cell division and
D. Increasing confusion and pulmonary problems like replication. To help minimize the risk of side effects,
dyspnea oncologists typically give the lowest, most effective
dosage. While many alkylating agents are administered
RATIONALE: intravenously (through an IV) or via injection, some types
Answer is C. More sophisticated prognostic markers are given orally.
have recently been identified (Montserrat, 2006). Beta2-
microglobulin, a protein found on the surface of 32. Nurse Martin is then asked about antitumor
lymphocytes, can be measured in the serum; an antibiotics and about their mechanism of action. He is
elevated level correlates with more advanced clinical knowledgeable about the matter when he says:
stage and poorer prognosis. Cytogenetic analysis is also A. Acting directly on DNA, causing cross-linking of DNA
useful. strands, abnormal base pairing, or DNA strand breaks,
Option A: It should be more than 100,000/mm3 this preventing the cell from dividing.
Option B: Lymphadenopathy occurs as the lymphocytes B. Replacing natural substances as building blocks in
are trapped within the lymph nodes. The nodes can DNA molecules, thereby altering the function of
become very large and are sometimes painful. enzymes required for cell metabolism and protein
Option D: These complications can be seen in those with synthesis.
Chronic myeloid leukemia C. Binding with DNA and preventing RNA synthesis, a
key step in the creation of proteins, which are necessary
30. Patients with this the type of cancer mentioned for cell survival. These cause the strands of the genetic
above have defects in their humoral and cell-mediated materials that make up the DNA to uncoil, thereby
immune systems. What do you call the defect in cellular preventing the cell from reproducing.
immunity that is evidenced by an absent or decreased D. Blocking the ability of a cancer cell to divide and
reaction to skin sensitivity tests? come two cells. Although they act throughout the cell-
A. Amorbius cycle, some are more effective during the S and M
B. Amediated phases, making these cell specific.
C. Anergy
D. Ahumoral
RATIONALE: HPV infection has been found in 70% to 80% of women
Answer is C. Antitumor antibiotics are cell cycle with VIN, but concomitant occurrence of HPV infection
nonspecific. They act by binding with DNA and decreases to 10% to 50% in women with invasive
preventing RNA (ribonucleic acid) synthesis, a key step disease. The second type of vulvar cancer more often
in the creation of proteins, which are necessary for cell affects older women who generally have a history of
survival. They are not the same as antibiotics used to vulvar inflammation or lichen sclerosis. Their tumors are
treat bacterial infections. Rather, these drugs cause the usually unifocal, well-differentiated, and keratinizing.
strands of genetic material that make up DNA to uncoil,
thereby preventing the cell from reproducing. 35. What do you call the relatively new technique that
Doxorubicin, mitoxantrone, and bleomycin are some uses a systemic or topical application of photosensitizing
examples of antitumor antibiotics. compound that accumulates preferentially in neoplastic
tissues where the affected area is then exposed to
33. Another chemotherapeutic agent that Nurse Martin nonthermal light, and oxygen induced cell-death
knows are called plant alkaloids. These are derived from occurs?
plants and its examples include Actinomycin D, A. Cavitational ultrasonic surgical aspiration
Doxorubicin, and Mitomycin. Their mechanism of action B. Photodynamic therapy
are as follows: C. Nonthermal intervention
A. Blocking the ability of a cancer cell to divide and D. Vulvar photochemotherapy
come two cells. Although they act throughout the cell-
cycle, some are more effective during the S and M RATIONALE:
phases, making these cell specific. Answer is B. Photodynamic therapy is appropriate for
B. Acting directly on DNA, causing cross-linking of DNA unifocal nonpigmented lesions. It has the advantages of
strands, abnormal base pairing, or DNA strand breaks, not causing ulceration or scarring and of a short healing
this preventing the cell from dividing. time, with only a few side effects, including erythema
C. Blocking the ability of a cancer cell to divide and and pain.
come two cells. Although they act throughout the cell-
cycle, some are more effective during the S and M 36. Mammogram is both a screening and diagnostic
phases, making these cell specific. test. It is recommended to have a baseline
D. Acting directly on DNA, causing cross-linking of DNA mammogram at 30-35 years old. Which of the following
strands, abnormal base pairing, or DNA strand breaks, statements are false regarding the additional facts
this preventing the cell from dividing. about mammograms?
A. The patient needs to have an annual mammogram
RATIONALE: starting at 50 years old.
Answer is C. Plant alkaloids are antitumor agents B. High risk patients are advised to do their check up
derived from plants. These drugs act specifically by every year.
blocking the ability of a cancer cell to divide and C. Low risk patients can do a check up 2 years.
become two cells. Although they act throughout the D. Baseline mammogram need to be repeated twice for
cell cycle, some are more effective during the S-and M- confirmation.
phases, making these drugs cell cycle specific.
Examples of plant alkaloids used in chemotherapy are RATIONALE:
actinomycin D, doxorubicin, and mitomycin. Answer is D. Baseline mammogram is only done onçe.

34. Mrs. Madamba asks Nurse Dean about the 37. Mr. Simon, 55 years old is recommended to undergo
difference between vulvular cancer Type 1 and Type 2. Guiac testing. What should kind of food should Nurse
Nurse Dean is correct in differentiating the two types of Michelle instruct Mr. Simon to avoid in order to get an
squamous cell carcinoma of the vulva when he states accurate result?
that: A. Green leafy vegetables
A. Type 1 is more associated with the older generation B. Orange juice
while Type 2 (55 to 85 years old) is more seen in the C. Bananas
younger generation (35 to 55 years old). D. Avocado
B. The histopathology of type 1 is well differentiated,
keratinizing while Type 2’s is poorly differentiated, non- RATIONALE:
keratinizing. Answer is B. Citrus fruits/Vit. C can cause false negative
C. Type 1 is not associated with any HPV infection while results due to its wound healing properties.
type 2 is associated with any HPV infection.
D. Type 1’s pre-existing disease is called vulvar 38. In administering vinca alkaloids such as Vincristine,
intraepithelial neoplasia (VIN) while type 2 includes what medication route should be avoided by the nurse?
Lichen sclerosis, and vulvar inflammation. A. IV
B. IM
RATIONALE: C. SQ
Answer is D. The first type is caused by the HPV, most D. Intrathecal
commonly HPV type 16, and is associated with VIN.9
RATIONALE: RATIONALE:
Answer is D. Accidental intrathecal administration of Answer is B. BUN-to-Creatinine Ratio is about 10:1 and
vincristine induces an ascending paralysis resulting in evaluates hydration status. An elevated ratio is seen in
death. hypovolemia. GFR is the test that is measured in
mL/min/1.73m2 [Bruner & Suddarth's Textbook of
39. In using Paclitaxel with Cisplatin, what should the Medical Surgical Nursing].
nurse remember in order to ensure safe medication
administration? 44. All but one are contraindications to kidney biopsy:
A. Paclitaxel should be given first followed by Cisplatin. a. Bleeding tendencies
B. Both medications should not be given together. b. Severe hypotension
C. Cisplatin should be given first and then followed by c. Solitary kidney
Paclitaxel. d. Morbid obesity
D. There should be a week’s interval between the two
medications. RATIONALE:
Answer is B. Biopsy of the kidney is used to help
RATIONALE: diagnose and evaluate the extent of kidney disease.
Answer is A. Paclitaxel clearance is reduced by as much Indications for biopsy include unexplained acute renal
as 30% when given following cisplatin. This interaction failure, persistent-proteinuria or hematuria, transplant
results in increased peak plasma concentrations of rejection, and glomerulopathies. Before the biopsy is
paclitaxel and more severe myelotoxicity than is seen carried out, coagulation studies are conducted to
with the reverse administration schedule. For routine use identify any risk of post-biopsy bleeding.
with cisplatin or carboplatin, paclitaxel should be given Contraindications to kidney biopsy include bleeding
first, followed by the platinum compound. tendencies, uncontrolled hypertension, a solitary kidney,
and morbid obesity (Morton, Fontaine, Hudak, et al.,
40. Podophyllotoxin, an antimitotic drug that binds to 2005).
tubulin and inhibits microtubuling formation, is an extract
of which plant? 45. Which of the following is NOT an expected change
A. Oahu stenogyne in a patient with chronic glomerulonephritis?
B. Mandrake a. Hypokalemia
C. Corpseflower b. Metabolic acidosis
D. Wisteria c. Hypoalbuminemia
d. Hypocalcemia
41. Which of the following is a common risk factor in
developing cystitis, ureter fibrosis, and urinary tract RATIONALE:
fistula? Answer is A. Hyperkalemia (not hypokalemia) is
a. Systemic lupus erythematosus expected in CGN due to decreased potassium
b. Gout excretion, acidosis, catabolism, and excessive
c. Benign prostatic hyperplasia potassium intake from food and medications. Metabolic
d. Pelvis radiation therapy acidosis is from the decreased acid secretion by the
kidney and inability to regenerate bicarbonate.
42. It is important for Nurse Gouty to determine the Hypoalbuminemia with edema is secondary to protein
different origins of genitourinary pain. What could be the loss through the damaged glomerular membrane.
possible etiology of a severe, sharp, stabbing flank pain, Decreased serum calcium level is also expected as
and is colicky in nature? calcium binds to phosphorus to compensate for
a. Ureteral stone or blood clot elevated serum phosphorus levels.
b. Kidney stones → radiating to the suprapubic and
groin 46. Renal cancer accounts for about 3% of all cancers in
c. Acute pyelonephritis adult men and 2% in adult women. Which biologic
d. Interstitial nephritis response modifier is effective to treat renal cancer,
specifically a a protein that regulates cell growth, and is
43. Which of the following renal function tests is paired used alone or in combination with lymphokine-
incorrectly? activated killer cells?
a. Specific Gravity: Evaluates ability of kidneys to a. Interleukin-1
concentrate solutes in urine. b. Interleukin-2
b. BUN-to-Creatinine Ratio: Measured in mL/min/1.73 m2 c. Temsirolimus (Torisel)
c. 24-Hour Urine Test Creatinine Clearance: Detects and d. Interferon
evaluates progression of renal disease, provides an
approximation of GFR. RATIONALE:
d. Urine Osmolality: Concentrating ability is lost early in Answer is B. WBCs that have been stimulated by IL-2 to
kidney disease; hence, these test findings may disclose increase their ability to kill cancer cells. IL-1 is irrelevant in
early defects in renal function. renal cancer. Interferon, another biologic response
modifier, appears to have a direct antiproliferative
effect on renal tumors, but is not what is asked vascular calcifications due to retention of phosphorus,
specifically in the question. Temsirolimus (Torisel) is low serum calcium levels, abnormal vitamin D
administered by IV infusion on a weekly basis to treat metabolism, and elevated aluminum levels [Bruner &
advanced renal cell carcinoma (Aschenbrenner, 2007). Suddarth's Textbook of Medical Surgical Nursing]:

47. There are four phases of Acute Renal Failure: 50. Which of the following drugs is contraindicated in the
initiation, oliguria, diuresis, and recovery. Identify which treatment of ESRD?
of the following statements is incorrect. a. Calcium and phosphorus binders
a. The initiation period begins with the initial insult and b. Digoxin or dobutamine
ends when oliguria develops. c. Epogen
b. The oliguria period is accompanied by an increase in d. None of the above
the serum concentration of substances usually excreted
by the kidneys (urea, creatinine, uric acid, or- ganic RATIONALE:
acids, and the intracellular cations [potassium and Answer is D. All options from AC are standard
magnesium]). pharmacologic therapy for patients with ESRD. Option A
c. The diuresis period is marked by a gradual increase in is used to treat Hyperphosphatemia and hypocalcemia.
urine output, which signals that glomerular filtration has Option B is used to treat heart failure from ESRD. Option
started to recover. Cis used to treat anemia associated with ESRD [Brunner
d. The recovery period signals the improvement of renal & Suddarth's Textbook of Medical Surgical Nursing].
function and may take 3 to 12 months. Laboratory
values return to the patient’s normal level. Permanent 51. All but one are principles on which hemodialysis is
1% to 3% reduction in the GFR is common, it is clinically based.
significant. a. Diffusion → solute: high to low concentration
b. Active transport
RATIONALE: c. Osmosis
Answer is D. Although a permanent 1% to 3% reduction d. Ultrafiltration
in the GFR is common in the recovery phase of ARF, it is
NOT clinically significant [Brunner & Suddarth's Textbook 52. Prior to either receiving or donating a kidney, an
of Medical Surgical Nursing]. extensive medical evaluation is performed. Not
everyone is suitable for a kidney transplant, and there
48. Causes of acute renal failure can be categorized as are contraindications that the nurse needs to consider.
prerenal failure, intrarenal failure, and postrenal failure. The following are contraindications of kidney
How would the nurse categorize the cause of ARF if the transplantation except:
patient said that he has been taking NSAIDs for over 5 a. Body mass index of 30 → at least > 35
years? b. Active autoimmune disease
a. Prerenal Failure → before the kidneys (heart failure, c. Inability to give informed consent
shock, dhn, bleeding) – dec blood flow to the kidneys → d. History to treatment regimen
dec UO → Renal failure
b. Intrarenal Failure 53. Which of the following medications used to treat UTIs
c. Postrenal Failure and pyelonephritis is not commonly used due to E. Coli
d. All of the above resistance?
a. Cephalexin
49. Chronic renal failure poses several potential b. Amoxicillin → type of penicillin
complications that concern the nurse and necessitate a c. Cotrimoxazole
collaborative approach to care. Which of the following d. Ciprofloxacin
is not a complication of CRF?
a. Hyperkalemia 54. Which of the following non-neurogenic disorders
b. Pericarditis, pericardial effusion, and pericardial refer to inability to initiate voiding in public bathrooms?
tamponade a. Bashful bladder
c. Hypotension b. Overactive bladder
d. Bone disease c. Post-prostatectomy
d. Stress incontinence
RATIONALE:
Answer is C. Hypertension, not hypotension, is a 55. Neurogenic bladder is a dysfunction that results from
complication of CRF from the sodium and water a lesion of the nervous system and leads to urinary
retention and malfunction of the renin-angiotensin- incontinence. The nurse employs a strategy wherein he
aldosterone system. Hyperkalemia is due to decreased taught the patient that: “After each voiding, please
excretion, metabolic acidosis, catabolism, and remain on the toilet, relax for 1 to 2 minutes, and then
excessive intake (diet, medications, fluids). Pericarditis, attempt to urinate again.” What bladder retraining
pericardial effusion, and pericardial tamponade are program is the nurse trying to employ?
due to retention of uremic waste products and a. Relax-and-wait void
inadequate dialysis. Bone disease and metastatic and b. Double void → spastic or flaccid bladder
c. Minute void
d. Neuro-void 62. What is the drug of choice and first-line diuretic drug
therapy for patients with ascites?
56. Urinary catheterization is performed to achieve the a. Spironolactone (Aldactone) → potassium sparing
following except: b. Furosemide (Lasix)
a. Relieve urinary tract obstruction c. Ammonium chloride
b. Assist with postoperative drainage in urologic and d. Acetazolamide (Diamox)
other surgeries
c. Provide a means to monitor accurate urine output in 63. Drug-induced liver disease is the most common
stable patients → critically ill cause of acute liver failure. Manifestations of sensitivity
d. Prevent urinary leakage in patients with stage III to IV to a medication may occur on the first day of its use or
pressure ulcers not until several months later. Which of the following
drugs is the leading cause of drug-induced hepatitis?
57. Fluid intake is the mainstay of most medical therapy a. Spironolactone
for renal stones. A urine output exceeding ___L/day is b. Acetaminophen → paracetamol: hepatotoxic
advisable. c. Morphine
a. 1 d. Atorvastatin
b. 2
c. 3 64. In autopsy reports of people who died from
d. 4 hyperinsulinism, what is commonly found?
a. Hyperplasia of the pituitary gland
58. What type of kidney stones would the nurse expect if b. Hyperplasia of the liver
the patient is placed on a low-purine diet? c. Hyperplasia of the islets of Langerhans → insulin
a. Calcium stones produced in pancreas/islet of Langerhans (beta cells)
b. Cystine stones d. Gingival hyperplasia
c. Uric acid stones → or urate stones; gout (avoid organ
meats: liver, intestines, sweetbread) 65. Some tumors of the islets of Langerhans are
d. Oxalate stones associated with hypersecretion of gastric acid that
produces ulcers in the stomach, duodenum, and
59. Which of the following risk factor could lead to jejunum. What syndrome may be expected?
developing urinary tract cancers? a. Creutzfeldt-Jakob Disease
a. Soda b. Cushing’s Syndrome
b. High sodium diet c. Zollinger-Ellison Syndrome → excessive
c. A habit of holding urinary urge hypersecretion of gastric acid
d. Smoking → universal risk factor: cancer, HPN, DM, d. Turner Syndrome
COPD
66. What classification of diabetes occurs in 90-95% of all
60. When teaching the patient how to perform self- diabetic patients?
catheterization, the nurse must use aseptic technique to a. Juvenile diabetes
minimize the risk of cross-contamination. However, the b. Adult diabetes → DM type 2 (NIDDM)
patient may use a “clean” (nonsterile) technique at c. Secondary diabetes
home, where the risk of cross-contamination is reduced. d. Abnormality of glucose tolerance
Which of the following when done by the patient
requires further teaching? 67. Which of the following is false regarding the criteria
a. Use an antibacterial soap or povidone-iodine solution for the diagnosis of diabetes mellitus, according to the
for cleaning urinary catheters at home American Diabetes Association?
b. Use tap water for cleaning urinary catheters at home a. Symptoms of diabetes plus casual plasma glucose
→ to clean povidone-iodine; to rinse tap water con- centration equal to or greater than 200 mg/dL
c. The catheter is kept in its own container, such as a (11.1 mmol/L). Casual is defined as any time of day
plastic food storage bag. without regard to time since last meal. The classic
d. Catheter is dry before use symptoms of diabetes include polyuria, polydipsia, and
unexplained weight loss.
61. In patients with ascites, a low sodium diet is b. Fasting plasma glucose greater than or equal to 126
prescribed to reduce fluid retention in the peritoneal mg/dL (7.0 mmol/L). Fasting is defined as no caloric
cavity. It may take 2 to 3 months for the patient’s taste intake for at least 4 hours. → must be 8 hours
buds to adjust to unsalted foods. As a nurse, what would c. Two-hour postload glucose equal to or greater than
you advise for the patient with ascites to improve the 200 mg/dL (11.1 mmol/L) during an oral glucose
taste of unsalted foods? - except tolerance test. The test should be performed as
a. Add lemon juice to their food → low sodium described by the World Health Organization, using a
b. Add oregano to their food → low sodium glucose load containing the equivalent of 75 g
c. Add thyme to their food → low sodium anhydrous glucose dissolved in water.
d. Add cumin to their food → high sodium
68. Caloric distribution is important in managing A. Respiratory acidosis
diabetes. A meal plan for diabetes focuses on the B. Respiratory alkalosis
percentages of calories that come from carbohydrates, C. Metabolic acidosis
proteins, and fats. Among the choices, which of the D. Metabolic alkalosis
following is recommended by the American Dietetic
Association? 75. Mechanical ventilation is a form of life support that
a. 40% to 50% of calories should be derived from uses positive pressure to help patients who are unable to
carbohydrates, 30% to 40% from fat, and the remaining breathe on their own. This mode describes how the
5% to 10% from protein. mechanical ventilator assists the patient with taking a
b. 60% to 70% of calories should be derived from breath. It is a specific setting on the machine that
carbohydrates, 10% to 20% from fat, and the remaining determines the characteristic soft breath that are
5% to 10% from protein. delivered to the patient.
c. 30% to 40% of calories should be derived from A. Volume control mode → for adult
carbohydrates, 10% to 20% from fat, and the remaining B. Pressure control mode → for pedia
30% to 40% from protein. C. Volume support mode
d. 50% to 60% of calories should be derived from D. Ventilator mode → AC/CMV, SIMV, CPAP, SPONT
carbohydrates, 20% to 30% from fat, and the remaining
10% to 20% from protein. 76. Asthma triggers allergic stimuli, which produces a
cascade of events leading to chronic airway
69. Which is not included in the main clinical features of inflammation, such as the following except:
Diabetic Ketoacidosis? A. House dust mites
a. Hyperglycemia B. Cockroach residue
b. Obesity → must be fruity breath odor, metabolic C. Exposure to tobacco smoke → non-allergic
acidosis, kussmaul’s breathing D. Pollens
c. Dehydration and electrolyte loss
d. Acidosis 77. Asthma triggers non- allergic stimuli, which produces
a cascade of events leading to chronic airway
70. Complications of diabetes that contribute to the inflammation, such as the following except:
increased risk of foot problems and infections include A. Viral infections
the following except: B. Cold air
a. Retinopathy C. House molds → allergic
b. Neuropathy D. Exercise
c. Peripheral Vascular Disease
d. Immunocompromise 78. The term _____________ implies a familial tendency to
manifest such conditions as asthma, rhinitis, urticaria,
71. This mechanical ventilator mode provides full and eczematous dermatitis.
ventilatory support, therefore it is often used when A. tropical allergy
mechanical ventilation is first initiated. B. atopic allergy → hypersensitivity: type 1 IgE-
A. SIMV mode → synchronized intermittent mech. Vent. mediated, allergy, severe: anaphylaxis
B. AC mode → assist/control C. sensitization
C. CPAP mode → continuous positive airway pressure D. exocytosis
D. CMV mode → continuous mandatory vent.
72. This ventilator mode indicated when a patient only 79. Inhaled corticosteroids are the most effective anti-
needs partial ventilatory support. This allows the patient inflammatory medications available for the treatment of
to initiate spontaneous breaths between the preset asthma and represent the mainstay of therapy. What is
breaths. the most common local adverse effect associated with
A. SIMV mode inhaled corticosteroid therapy?
B. AC mode A. dry mouth, urinary retention, and glaucoma
C. CPAP mode B. muscle tremor and palpitations
D. CMV mode C. nausea and vomiting, and headaches
D. hoarseness (dysphonia) and oral candidiasis → nc:
73. This mechanical ventilator mode used when a gargle after use
mechanically ventilated patient is capable of breathing
on their own. 80. Which of the following drug is NOT available as
A. CPAP mode metered-dose inhaler (MDI?
B. Spontaneous mode A. salbutamol → option a, b, c → SABA (short acting
C. Pressure support mode beta agonist); nc: assess HR (tachycardia)
D. Volume support mode B. terbutaline
C. albuterol
74. What acid- base imbalance would a patient be D. Aminophylline → bronchodilator (xanthines:
predisposed to if he is placed in an Assist/ Control (AC) theophylline, doxofulline); IV
mode?
SITUATION: B. “What types of food do you usually eat?”
Verbal communication is extremely important C. “You need to limit the intake of food on this list.”
especially when the Nurse is exploring problems and D. “Do you understand why you have these food
disorders with the clients in any age group. Nurse Dante restrictions?” → health education, assess learning needs
is assigned to different clients in the ward.
87. Nurse Diana is preparing a nursing care plan to a
81. A client is hospitalized with a diagnosis of possible client with Diabetes Mellitus (D.M.) that includes before
Cancer of the pancreas. On admission the client asks discharge to know how to self-administer insulin, adjust
the nurse, “Do you think I have anything serious like the insulin dosage, understand the diet, and test the
cancer?” What is the nurse’s best reply? serum for glucose level. The client progresses well and is
A. “What makes you think you have cancer? discharge 5 days following admission. Legally the:
B. “I don’t know if you do, but let’s talk about it.” → A. Nurse was properly functioning as a health teacher
encourage verbalization B. Visiting nurse should do health teaching in the client’s
C. “Why don’t you discuss this with your doctor?” home
D. “Don’t worry, we won’t know until all the test result C. Family members also should have been taught to
are back.” administer the insulin
D. Physician was responsible and the nurse should have
82. Nurse Dante approaches a male client and asks how cleared the care with the physician
he is feeling. The client states “I’m feeling a bit nervous
today.” Which of the following is the Nurse’s best reply? 88. Which teaching method has been evaluated as
A. Please explain what you mean by the word nervous most effective in a new diabetic client?
→ encourage verbalization, promote broad openings A. Utilizing breaks after each unit of the teaching session
B. What is making you feel nervous? B. Having the client repeat the steps of insulin
C. Would a backrub ease your nervousness? administration
D. You do look like you’re nervous C. Encouraging the client to ask many questions
D. Confirming that the client is able to give his own
83. When assessing a client what statement would insulin → return demonstration with feedback
indicate negative self-talk?
A. Everyone has to learn something new sometime 89. Which of the following statements by a client would
B. I am looking forward to making home visits, but I am alert the Nurse that further teaching on the idea of a
also nervous restful sleep is indicated?
C. This is going to be difficult, but I know I can do it A. I don’t take naps throughout the day
D. Who can ever have enough experience to prepare B. I go to bed and get up routinely at the same time
for that job? each day
C. I have a small snack and take a bath before going to
84. While receiving a preoperative enema a client starts bed each day
to cry and says. “I’m sorry you have to do this messy D. I went to bed earlier than usual and I rested and
thing me,” what is the best response by the nurse? watched television until I fall asleep → change in sleep
A. “I don’t mind it.” pattern, distractions
B. “You seem to be upset.” → making observations
C. “This is part of my job.” 90. What can the Nurse do to support the client’s ability
D. “Nurses get used to this.” to sleep in the hospital setting?
85. “But you don’t understand” is a common statement A. Assess the client’s towards the end of the shift, closer
associated with adolescent. The best response by the to the normal awakening time
nurse when communicating with an adolescent is to B. Darken the room as much as possible by keeping the
say: lights off
A. “I don’t understand.” C. Limit the noise and distraction on the unit → noise:
B. “I would like to understand, let’s talk.” → encourage machines, nurses activity, other patients
verbalization, offer self D. Provide a bath or shower before bedtime
C. “I don’t understand. I was a teenager once too.”
D. “I’m not sure have to I believe it’s you who has to SITUATION:
understand.” Benjie, a charge nurse, is attending to the client with an
intravenous fluid.
SITUATION:
One of the important roles of the Nurses is being a 91. What does Nurse Benjie identify as the most likely
Health Educator. Clients would always seek information cause of the infiltration of a client’s IV?
on Health maintenance to prevent illness. A. Excessive height of the IV solution
B. Failure to a adequately secure the catheter
86. Nurse Diana, daughter of Hippolita and the princess C. Lack of asepsis during catheter insertion
of Themycera, is teaching a client about prescribe D. Infusion of chemically irritating medication
restricted diet. What is the Nurse’s best initial comment?
A. “You can eat only the on this list.”
92. Another client has an IV infusion. If the IV infusion C. "After 12 weeks, the placenta protects the fetus from
infiltrates, what should Nurse Benjie do first? teratogens."
A. Elevate the IV site. D. "Exposure to teratogens poses the greatest risk during
B. Discontinue the infusion. → reinsert after in other arm the first eight weeks."
C. Attempt to flush the tube.
D. Apply a warm, moist compress. 97. Anna had her menstruation last April 12, 2014. She
has a 27-day cycle. Given the scenario, the expected
93. The Physician orders the application of a warm soak date of next ovulation is:
to an IV site that has infiltrated. Nurse Benjie understands A. April 25, 2014 → 27-14 = 13; 12 + 13 = 25
that the application of local heat transfer temperature B. April 26, 2014
to the body via the principles of: C. May 25, 2014
A. Radiation → noncontact D. May 26, 2014
B. Insulation
C. Convection → air current: warm to cool 98. Following an ultrasound at 6 weeks gestation, the
D. Conduction → contact client comments, "The embryo doesn't look human." She
asks, "When will it begin to look like a baby?" The nurse's
94. A Physician orders 2000 ml of 5% dextrose and ½ best response is:
Normal Saline to infuse over 24 hours. The drop factor is A. "In one more week the embryo will take on a human
15 drops per ml. Nurse Benjie sets the flow rate at how appearance."
many drops per minute? B. "The embryo looks like a baby already. Let me show
A. 15 drops per minute you again."
B. 17 drops per minute C. "The embryo becomes a fetus and looks human after
C. 21 drops per minute 8 weeks gestation." → fetus – human-like, 8 weeks
D. 28 drops per minute D. "You are right, the embryo doesn't look human. Is this
important to you?"
95. A Physician has ordered 1000 ml of intravenous fluid
to another client to run at 45 drops per minute. Using 15 99. Carla another patient in the clinic just found out that
drops per cc dropper, approximately how long should she is pregnant. She asks when would be her delivery
the IVF run? date. What is the expected date of confinement (EDC)
A. 4 hours of a pregnant woman whose menstruation was from
B. 4.5 hours April 10 to April 13?
C. 5 hours A. January 17
D. 5.5 hours B. January 20
C. July 17
SITUATION: D. July 20
The goals of perinatal education are to help parents
become knowledgeable consumers take active role in 100. The nurse noted the Fundic height of Anna is at the
maintaining health during pregnancy. Anna a 25 year level of the umbilicus. In documenting the data using
old Gravida 3 Para 2 seeks prenatal consultation. Bartholomew’s rule, the most probable age of gestation
(AOG) in week is:
96. Nurse Yolly discusses Teratogens with a client during A. 12 weeks
pre-conceptual counseling. The client demonstrates B. 16 weeks
understanding by stating: C. 20 weeks → cm = wks (mcdonald’s)
A. "I should stop taking all my medications while I am D. 32 weeks
pregnant."
B. "The fetus is at greatest risk for developing anomalies
during the first 16 weeks of pregnancy."