RENR REVIEW RAS PRACTICE TEST 5 AMM 3

1. A patient arrives at the emergency room with a heart rate of 58 and irregular. After
assessment by the physician the patient is found to have a cardiac conduction.
problem. Which of the following nursing diagnoses best suits this patient?
A. Pain related to imbalance between myocardial oxygen supply and demand
B. Ineffective tissue perfusion related to interruption of blood flow
C. Activity intolerance related to imbalance between oxygen demand and supply
D. Impaired physical mobility related to fear of movement or death

2. A patient is being seen by the doctor because the patient states he has developed
oedema in his lower extremities. He has had hypertension for ten years. The doctor
tells the patient that he has developed a nephrotic syndrome. Which of the following
will be the most likely prescribed diuretic in the treatment of this disorder?
A. Furosemide (loop diuretic)
B. Polythiazide (thiazide diuretic)
C. Metolazone (sulfonamide diuretic)
D. Spironolactone (potassium-sparing diuretic)

3. A 68-year-old patient who has had a myocardial infarction ten years ago is admitted
to the unit with shortness of breath for the last week. Mrs. Elaine recently received
treatment for a respiratory infection. Upon auscultation of the lungs the nurse hears
crackles in both lungs. She has oedema of both lower extremities. The nurse
understands that Mrs. Elaine is exhibiting signs of systolic failure which include all
but

A. An ejection fraction of less than 50%.

B. Hypertrophy of the cardiac wall.
C. Left sided heart failure.
D. Right sided heart failure.

4. A patient with an AIDS related opportunistic infection develops Pneumocystis

carinii pneumonia. The nurse tells the patient that
A. “This infection is the first stage of the disease and is contained with antibiotics”
B. “This infection is considered as Stage 3 of the AIDS disease classification”
C. “This infection is a toxic effect of the virus”
D. “This infection results from damage to the body’s immune system”

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5. The nurse manager has developed a staff protocol for peer evaluation. The nurses on her
surgical unit are nervous about using her instrument. If the nurse manager continues to
implement the new strategy, which of the following critical thinking attitudes is she
portraying?
A. Humility
B. Risk-taking
C. Accountability
D. Independent thinking

6. There are a variety of levels of critical thinking. An example of critical thinking at the
complex level is
A. Giving medication at the time prescribed
B. Reviewing all client’s medical records thoroughly
C. Following a procedure for catheterization step-by-step
D. Discussing various alternative pain management techniques

7. The family of a 14-year-old teenage boy brings him to see the doctor because he has
become lethargic and withdrawn. The boy himself denies any reason for the visit. As the
nurse assesses the patient she notes a decrease in blood pressure, impaired attention span,
memory loss and paranoia. In addition, the patient has an unexplained 25-30 lbs. weight
gain. The doctor orders blood work and an ECG. What is the most likely cause of these
symptoms?
A. Hyperparathyroidism
B. Addison’s disease
C. Thyroid Storm
D. Hypothyroidism

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8. The community nurse made a proposal that people plant vegetables and fruits in their
backyard. He specified that the objective is to save money from fluctuating and cyclical
prices. Which step in the community organizing process did he utilize?
A. Fact finding
B. Determination of needs
C. Education and interpretation
D. Program formation

9. An elderly client was placed in a side-lying position after internal fixation for fracture to
the right hip. Which of the following is the BEST reason for placing a pillow or splint
between the legs of the client?
A. Enhances flexion of the knees
B. Promotes adduction of the thigh
C. Prevents adduction of the hip joint
D. Prevents abduction of the hip joint

10. Following surgery the surgeon suspects that the patient has developed a right
atelectasis. He orders arterial blood gas (ABG) examination. The nurse understands this
test will show all of the following except
A. Metabolic acidosis
B. Respiratory acidosis
C. Hypoxemia
D. Partial pressure of arterial carbon dioxide (PaCO₂)

11. In a client in renal failure, which assessment finding may indicate hypocalcemia?
A. Headache
B. Serum calcium level of 5 mEq/L
C. Increased blood coagulation
D. Diarrhea

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12. Which of the following findings would confirm the client's diagnosis of myocardial
infarction?
A. Elevated T wave, ST inversion, normal QRS
B, Elevated T wave, elevated P wave, abnormal QRS
C. Elevated R wave, normal QRS, elevated ST-segment
D. Inverted T wave, elevated ST-segment, abnormal QRS

13. After examining her client’s abdomen and noting assessment of significant findings,
even though the client says it doesn’t hurt, the nurse says to a colleague, “I think something
is going on here; I am going to investigate further.” The nurse is using
A. Deductive reasoning
B. Intuition
C. Inductive reasoning
D. Modified scientific method

14. After teaching parents of a 4-year-old child about the cause of tinea capitis of the scalp,
which of the following, if stated by the father, indicates successful teaching?
A. “It’s a fungal infection of the scalp”
B. “It’s an allergic reaction on the scalp”
C, “It’s caused by infestation with a mite”
D. “It results from infestation with ticks”

15. Griseofulvin (Grisactin) was prescribed to treat a child’s ringworm of the scalp. The
nurse instructs the parents to use the medication for several weeks for which of the
following reasons?
A. A sensitivity to the drug is less likely if it is used over a period of time
B. The growth of the causative organism into new cells is prevented with long-term use
C. Fewer side effects occur as the body slowly adjusts to a new substance
D. Fewer allergic reactions occur if the drug is maintained at the same level long-term

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16. A 20-year old college student has been brought to the psychiatric hospital by her
parents. Her admitting diagnosis is borderline personality disorder. When talking with the
parents, which information would the nurse expect to be included in the client’s history?
i. Impulsiveness
ii. Ritualistic behaviour
iii. Lability of mood
iv. Psychomotor retardation
A. I, ii
B. I, iii
C. ii, iii
D. iii, iv

17. A mother brought her 5-year-old daughter to the clinic for her second dose of her
measles, mumps, and rubella (MMR) vaccine. The mother asks the nurse, “Why is it
recommended that the second dose of MMR vaccine be given at 4 to 6 years of age?” the
nurse should explain to the parent that the second dose is given at this age for which of the
following reason?
A. A serious complication from the vaccine is swelling of the joints
B. The initial dose administered is not highly effective
C. The dangers associated with a strong reaction to the vaccine are increased at this age
D. The chance of contracting the disease is much lower at this age

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18. the nurse teaches the parents of an 18-month-old who was treated for a foreign body
obstruction, about the three cardinal signs of choking. Which of the following indicates that
the teaching was successful?
i. The child turns blue
ii. The child gasps
iii. The child collapses
iv. The child cannot speak
a. i. ii, and iii
b. I, ii, and iv
c. I, iii, and iv
d. Ii, iii, and iv

19. A patient with septic shock is receiving norepinephrine for hypotension. Despite the
vasopressor, the patient’s blood pressure remains low, and the skin is cold and mottled.
Which action should the nurse take next?

A. Administer another vasopressor as prescribed

B. Increase the rate of the intravenous fluids
C. Check the patient’s blood glucose level to rule out hypoglycemia
D. Prepare for insertion of a central venous line to monitor fluid status

20. An 88-year old male client was admitted to the surgical ward for management of a
fractured hip. He has internal fixation of a pin. Which of the following is the reason for the
pin as the treatment choice?
A. Is the simplest procedure
B. Promotes rapid healing
C. Carries less danger of infection
D. Makes earlier mobilization possible

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21. The nurse is caring for a client diagnosed with tuberculosis who is prescribed
Pyrazinamide (PZA). Which of the following is a common side-effect of taking
Pyrazinamide?
A. Peripheral neuritis
B. Orange-colored urine
C. Hyperuricemia
D. Blurring of vision

22. All of the following are true regarding tetanus toxoid except
A. The usual dose is 0.5 ml
B. A pregnant woman must receive 2 doses one month before delivery
C. Three booster shots are needed to complete the 5 doses of tetanus toxoid
D. Tetanus toxoid is administered intradermal

23. A 32-years-old female suffers partial and full thickness burns to the anterior trunk,
upper limbs and anterior thighs while cooking this morning. The gas cylinder exploded.
She is admitted to the emergency department at 11:30am. Which of the following is the
priority of care for the patient?
A. Prevention of infection
B. Fluid resuscitation
C. Airway protection
D. Pain management

24. Which intravenous fluid would most likely be prescribed for the client?
A. Hartmann’s solution
B. 5% dextrose in water
C. 0.9% sodium chloride
D. 5% dextrose, 0.9% saline
RAS

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25. Using the rule of nines, what is the percentage of burns sustained by the client?
A. 27
B. 36
C. 45
D. 72

26. Calculation of fluids for resuscitation of the patient in the first eight hours should begin
A. From the time of IV access
B. From the time of injury
C. Within ten minutes of the burn
D. Within the first hour after the burn

27. The client weights 30kgs. The doctor has ordered fluids at 4mls/kg/BSA % burns. How
much fluids should she receive in the first eight (8) hours?
A. 2700
B. 3600
C. 4500
D. 7200

28. A patient with chronic kidney disease has an arteriovenous fistula for haemodialysis.
The nurse notices that the patient’s arm around the fistula is swollen and red. What should
the nurse do first?

A. Elevate the affected arm to reduce swelling

B. Palpate for a thrill and auscultate for bruit at fistula site
C. Immediately notify the nephrologist about your findings
D. Apply a cold compress to reduce the swelling and pain

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29. A child is admitted to the pediatric unit with viral pharyngitis. Which of the following
nursing interventions should be carried out for this client?
i. Offer a soft-to-liquid diet
ii. Administer acetaminophen as prescribed
iii. Use of a cool mist humidifier
iv. Administer amoxicillin as prescribed
A. I, ii, and iii
B. I, ii, and iv
C. Ii, iii, and iv
D. I, ii, iii, and iv

30. A diagnosis of latent tuberculosis (TB) is made. Which of the following is the preferred
drug of choice?
A. Rifampin
B. Isoniazid
C. Ethambutol
D. Streptomycin

31. Stacey is an 8-month-old child who is admitted to the pediatric ward with a diagnosis of
cystic fibrosis. Stacey is receiving gentamycin as prescribed. Which of the following nursing
interventions is MOST important at this time?
A. Obtaining daily weights
B. Monitoring intake and output
C. Obtaining stool samples for occult blood
D. Monitoring the child for signs of constipation

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32. Stacey’s mother tells the nurse that her child makes “snoring” sounds when breathing.
The nurse is aware that many children with cystic fibrosis have
A. Nasal polyps
B. Choanal atresia
C. Septal deviations
D. Enlarged adenoids

33. After being discharged, Stacey was brought to the clinic for a follow-up appointment.
Her mother complained to the nurse about problems with the stools passed. Which of the
following description of the stool should the nurse interpret as indicative of continued
problems with malabsorption?
A. Soft with little odor
B. Large and foul-smelling
C. Loose with bits of undigested food
D. Hard with streaks of blood

34. Which of the following is a recombinant vaccine?

A. Measles
B. Hepatitis B
C. Tetanus toxoid
D. Diphtheria

35. The tetanus vaccine is a (an)

A. Antibody
B. Bacterial toxin
C. Live attenuated
D. Weakened microorganism

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Mr. Singh, a 76-year-old client who is a newly diagnosed diabetic is being discharged from
hospital. He is being referred to the diabetic educator. During the interaction with the
client, the nurse educator observed that client spoke loudly, leaned the head to one side and
constantly asked to have the questions repeated.
36. Based on the nurse’s observation, the most appropriate nursing action would be to
A. Speak more loudly at all times
B. Speak into the closest car
C. Ask if there are hearing difficulties
D. Face the client when speaking

37. What is the most appropriate strategy to enhance communication with Mr. Singh
during the teaching session?
A. Speak more loudly at all times
B. Speak distinctly with a normal pitch
C. Use material with highlighted graphics
D. Use laminated charts with large bold prints

38. A client who is in pain refuses to be repositioned. In making a decision about what to
do, which of the following should the nurse consider first?
A. What are the alternatives?
B. Why a decision is needed?
C. When a decision is needed?
D. Who actually gets to make the decision?

39. Which of the following best reflects the philosophy of critical thinking as taught by a
nurse educator to a nursing student?
A. “Don’t draw subjective inferences about your client, be more objective”
B. “Please think harder, there is a single solution for which I am looking”
C. “Think about several interventions that you could use with this patient”
D. “Trust your feelings, don’t be concerned about trying to find a rationale to support your
decision”

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40. The triage nurse in the Accident and Emergency Department of the Pediatric Hospital
is prioritizing children waiting to be seen by the Pediatrician. Which of the following
children is in the GREATEST need of emergency medical management?
A. A 6-year-old with a fever of 104⁰ F, a muffled voice, no spontaneous cough, and drooling
B. A 3-year-old with a fever of 103⁰ F, a barky cough, and mild intercostal retractions
C. A 4-year-old with a fever of 101⁰F, a hoarse cough, inspiratory stridor, and restlessness
D. A 13-year-old with a fever of 104⁰F, chills, and a cough with thick yellow secretions

41. The second component of critical thinking in the “Critical Thinking Model” is
A. Experience
B. Competencies
C. Specific knowledge
D. Diagnostic reasoning

42. A 56-year-old male refuses to take his insulin, stating that he is tired of sticking
himself. Which of the following is the BEST response from the nurse?
A. It’s your body and your decision
B. At your age you don’t need insulin
C. I will ask the doctor to prescribe tablets instead
D. I know it is difficult but you must comply with your medication

43. A client complains that he has difficulty seeing to drive at night. The doctor
recommends that he is seen by the ophthalmologist for possible cataract surgery.
Which of the following is the BEST response for the nurse to give?
A. Take your referral letter to the hospital
B. Keep eye pads on and instill eye drops
C. You will not be able to see for four days
D. Wear dark shades daily and avoid bright lights

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 44. The MAIN goal of treatment in the management of a diabetic hypoglycemic attack
is to
A. Relieve symptoms quickly
B. Evaluate to eliminate risk of injury
C. Administer insulin as ordered immediately
D. Detect and treat a low blood glucose level promptly

45. A mother attends clinic with her four-month-old baby for immunization. Which of
the following instructions should be given to the mother for aftercare of the baby?
I. The baby should not attend nursery for the rest of the week
Il. No ointment or cream is to be applied to the injection site
Ill. Observe the baby and seek medical attention immediately if a fever or rash appears
A. l and II only
B. l and Ill only
C. II and Ill only
D. I, II, and III

46. A 14-year-old female attended antenatal clinic for booking. During the booking
procedure the client informed the nurse that the person accompanying her was a
friend because she was afraid to tell her mother that she was pregnant. What action
should the nurse take next?
A. Accompany her to tell her mother
B. Inform her she cannot be seen at the clinic
C. Continue to book her with the friend as the guardian
D. Explain that her mother must be present, so she need to bring her

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 47. An 11-year-old female, unaccompanied by an adult, visited the family planning
clinic, requesting to have a method of contraception. The nurse told her she could
not have the contraception without the consent of an adult. The child insisted that
she was sexually active but did not want her parents to know and wanted to
safeguard herself against pregnancy. What is the BEST action for the nurse to take?
A. Call her parents and tell them
B. Encourage her to call her parents
C. Admonish her for being sexually active
D. Prescribe a method of contraception for her
RAS
48. The client with chronic renal failure tells the nurse he takes magnesium hydroxide
(milk of magnesium or MOM) at home for constipation. The nurse suggests that the
client switch to psyllium hydrophilic muccilloid (Metamucil) because
A. Milk of magnesium is high in sodium
B. Milk of magnesium can cause magnesium toxicity
C. Metamucil is more palatable than milk of magnesium
D. Milk of magnesium is too harsh on the bowel

49. Which of the following two vaccines are easily damaged by heat but not destroyed
by freezing?
A. DPT and Bacillus Calmette-Guerin (BCG)
B. BCG and Hepatitis B
C. Measles and Tetanus Toxoid
D. Oral polio vaccine (OPV) and measles

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 50. A 16-year-old male has been rushed from school with acute abdominal pain in right
iliac region, nausea and vomiting he was diagnosed with acute appendicitis and is
being prepared for an emergency appendectomy. He has expressed his concerns to
the nurse. What should the nurse say to the client to address his expected concerns?
i. The scar will be small
ii. Friends can visit him daily
iii. He will be back in school in one week
iv. Antibiotics will be given to prevent an infection
A. I, and ii only
B. I, and iii only
C. Ii, and iv only
D. Iii, and iv only

51. A student nurse observed a patient diagnosed with alcoholic withdrawal trying to
get out of bed. Which of the following is the BEST action for the student nurse to
take?
A. Assist the patient back to into the bed
B. Tell the patient to get back into the bed
C. Let the patient get out of bed as desired
D. Alert the nurse in charge of the patient’s behavior.

52. A hospital’s infection control team is working to reduce the incidence of catheter-
associated urinary tract infections. Which of the following actions should be included in the
infection prevention protocol?

A. Irrigate urinary catheters with normal saline once per shift

B. Discontinue urinary catheters as soon as clinically indicated
C. Ensure urinary catheters are inserted by experienced personnel only
D. Change urinary catheter systems every 48 hours to prevent contamination

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53. A nurse is developing a care plan for a patient with newly diagnosed hypertension.
Which nursing intervention should take priority in the care plan to reduce the risk of
stroke?

A. Teach the patient to measure their blood pressure at home

B. Recommend that the patient engage in regular exercise
C. Encourage the patient to eat a diet low in sodium and rich in potassium
D. Instruct the patient to take antihypertensive medications as prescribed

54. A newborn’s failure to pass meconium within 24 hours after birth may indicate which
of the following?
A. Celiac disease
B. Aganglionic megacolon
C. Intussusception
D. Abdominal wall defect

55. A 13-year-old client is dying of cancer. When providing care for this client, the nurse
should incorporate the developmental tasks for this age. According to Erikson’s
developmental model, the child normally is expected to be working on which of the
following psychosocial issues?
A. Lifetime vocation
B. Sense of competence
C. Social conscience
D. Personal values

56. The nurse conducts a retrospective study to determine the incidence and management
of chronic otitis media at her institution. This action BEST reflects which of the following
management functions?
A. Directing
B. Planning
C. Organizing
D. Controlling

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57. The nurse manager of the audiometric unit assigns a newly trained registered nurse to
conduct the preoperative care for a client scheduled for Myringotomy. Which of the
following management principles has the charge nurse delegated to the registered nurse?
A. Authority
B. Credibility
C. Accountability
D. Responsibility

58. A mother brings her two-year-old child to the wellness clinic with a history of three ear
infections in the past five months. The nurse should know that the child is at risk for
developing which of the following as a long-term complication?
A. Speech delays
B. Mastoiditis
C. Balance difficulties
D. Prolonged hearing loss

59. The nurse conducts an otoscopic exam on the child. The nurse is MOST likely to
document.
I. Obscured landmarks
II. Dull tympanic membrane
III. Pearly gray tympanic membrane
A. l and Il only
B. l and III only
C. Il and Ill only
D. I, II and III

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60. Before inserting the Otoscope in the child’s ear. The nurse sets a goal to reduce injury
while inserting the instrument. The nurse reduces injury to the child’s ear by
A. Pulling the ear up and back
B. Pulling the pinna straight out
C. Pulling the pinna down and back
D. Leaving the ear in its anatomical position

61. The nurse is preparing to use an otoscope to examine a 4-year-old child’s ear. What
should the nurse consider when using the otoscope to prevent damaging the eardrum?
A. Hold the otoscope with a hand between the otoscope and the head
B. Ask the parents to restrain the child to prevent movement
C. Instruct the child to hold absolutely still and not move during the exam
D. Defer the otoscopic exam to the doctor to prevent injury

62. The nurse performs the watch tick test on the child. In order to obtain the results, the
nurse understands that the correct sequence is to
I. Have the child occlude one ear
II. Ask the child to close his eyes
III. Place a ticking watch 1-2 inches from the child’s unoccluded ear
IV. Ask the child what he hears
A. I, II, III, IV
B. IV, III, Il, I
C. II, IV, 1 III
D. III, I, IV, II

63. Binaural interaction at the level of the brainstem permits

A. Interpretation and amplification of sound
B. Amplification and transmission of sound
C. Identification and location of the direction of the sound
D. Direction and amplification of sound toward the appropriate conduction pathway

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64. The child’s mother expresses to the nurse that the child reports sudden pain relief.
Which information should the nurse provide to the mother?
A. “Sudden pain relief indicates that the infection has cleared up”
B. “Sudden pain relief indicates that the tympanic membrane has ruptured”
C. “Sudden pain relief indicates that the external auditory canal is blocked”
D. “Sudden pain relief indicates that the antibiotic eardrops are effective”

65. During evaluation of a teaching session on otitis media, the child’s mother expresses a
desire to learn more than the audiometric nurse anticipated. Which of the following
wellness nursing diagnoses is MOST appropriate for the mother?
A. Readiness for enhanced hope
B. Readiness for enhanced coping
C. Readiness for enhanced learning
D. Readiness for enhanced communication

66.The nurse teaches the child’s mother about the anatomy and physiology of the ear. The
client demonstrates her understanding by explaining that the pharyngotympanic tube is
important because it
A. Protects blood vessels and nerves going to the middle ear
B. Amplifies sound waves going to the inner ear
C. Senses acceleration and forces of gravity
D. Aerates and drains the middle ear

67. Following a teaching session on the major complications of otitis media, a child’s
mother, demonstrates that her learning was successful by stating she would
A. Instill ear drops in the affected ear
B. Observe the child for balance problems
C. Keep the child’s appointment with the audiometrist
D. Position the child on the affected ear when lying down

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68.The environment in which nurses may advocate for vulnerable populations is the
A. Emergency room
B. Hospital ward
C. Government
D. Community

69. A 65-year-old patient presents with sudden onset of chest pain, dyspnoea, and
diaphoresis. His ECG shows ST-elevation in leads II, III, and aVF. Which intervention
should the nurse prioritize?
A. Administer nitroglycerin sublingually
B. Prepare for immediate defibrillation
C. Provide supplemental oxygen at 4 L/min via nasal cannula
D. Assist in preparing the patient for possible Percutaneous Coronary Intervention (PCI)

70. After the instillation of atropine drops into the eyes of a client undergoing ophthalmic
examination, which of the following instruction should the nurse give to the client?
A. Wear hard glasses as necessary
B. Continue to wear your soft contact lenses
C. Avoid wearing your regular glasses when driving
D. Wear dark glasses in bright light

71.The first step in succession planning is

A. Describe the skills and behaviors needed for the role
B. Develop a formal written succession plan
C. Outline the needs of the organization
D. Outline the vision and the mission of the organization

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72.A newborn is diagnosed with ophthalmia neonatorum. Which of the following pathogens
are associated with the cause of this condition?
i. Escherichia coli
ii. Neisseria gonorrhoeae
iii. Chlamydia trachomatis
iv Pseudomonas aeruginosa
A. I, ii, iii
B. I, iii, iv
C. Ii, iii, iv
D. I, ii, iii, iv

73.The nurse explains to the mother that the medical term for ‘cross-eye’ is which of the
following
A. Amblyopia
B. Nystagmus
C. Strabismus
D. Emmetropia
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74. A mother brings her 3-year-old daughter to the eye clinic because she is concerned that
her baby is cross-eyed.
Which of the following statements made by the nurse are likely to reassure the mother?

I. The esotropia may be corrected with glasses alone

II. Surgical treatment should be delayed until adolescence
III. Permanent vision loss can be prevented when treated
A. l and Il only
B. l and Ill only
C. II and III only
D.1, II and Ill

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75. A common refractive error of the eye caused by an irregular curvature of the cornea or
lens. This prevents light from focusing properly on the retina, leading to blurred vision at
all distances
A. Myopia
B. Astigmatism
C. Amblyopia
D. Hypermetropia
RAS

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