Prometric Exam – Practice Test for Nurses Test 2

1. Answer:  A

Rationale:

Angina pectoris is a substernal pain that radiates to the neck, jaw, back and arms and is relieved by rest. Lower abdominal pain may indicate other gastrointestinal problems.

2. Answer: A

Rationale:

50 mL/hr is the normal urine output. A normal urine output indicates that there is a good renal perfusion, and also connotes that the client is hemodynamically stable, therefore, the repair is successful.

3. Answer: A

Rationale:

In cardiac catheterization or coronary angiogram, a catheter is inserted into the heart via a vein to measure the ventricular function. A dye is used to provide further assessment of the structure and motion of the heart. Thallium is a radioactive isotope injected parenterally so that the scintillation camera can count the radioactive uptake. This is observed when a physician requests for a Nuclear Cardiology test. When performing a Transesophageal Echocardiogram (TEE), a probe with a transducer tip is swallowed by the client to visualize for valvular abnormalities, possible thrombus, bacterial endocarditis and any congenital heart defects. When performing an Intracoronary Ultrasound, a tiny ultrasound probe is inserted into the coronary artery to evaluate for plaque size and consistency, arterial walls and effectiveness of the treatment.

4. Answer: D

Rationale:

The central venous pressure is within the superior vena cava. The Normal CVP is 2-6 mmHg. A decrease in the CVP indicates a decrease in the circulating blood volume, which may be a result of hemorrhage or fluid imbalances. The right atrium is located at the midaxillary line at the fourth intercostal space, and the zero point on the transducer needs to be at the level of the right atrium. The client needs to be supine, with the head of the bed elevated at 45 degrees to correctly assess the CVP.

5. Answer: D

Rationale:

In hypokalemia, the electrocardiogram may show flattening and inversion of the T wave, the appearance of a U wave, and ST depression. Hypercalcemia can cause a shortened ST and widened T wave. The electrocardiogram of a hyperkalemic client shows tall peak T waves, widened QRS complexes, prolonged PR intervals or flat P waves.

6. Answer:  A, B, E

Rationale:

Loading of drug depends on the type of dry powder inhaler. Take note that some dry powder inhalers do not require loading. Dry powder inhalers are kept dry always and are place at room temperature. Never shake a dry powder inhaler. It is not a pressurized container. There is no propellant, only the client’s breath can pull the drug in. Because the drug is a dry powder and there is no propellant, the client will not feel, smell, or taste the drug during inhalation. The client’s breath will moisten the powder causing it to clump and not be delivered accurately. Immediately after inhalation of drug, the inhaler must be removed from the client’s mouth to prevent moisture.

7. Answer: C, D, E

Rationale:

Stripping is not allowed. Also when changing the drainage system or when checking air leaks, clamp the chest tube for short periods only. Emptying of collection chamber or changing the drainage system should be done before the drainage comes in contact with the bottom of the tube. Avoid kinks and dependent loops to allow effective drainage and prevent disrupting the system. Report excessive drainage that is cloudy or red. Drainage will often increase with position changes or coughing.

Bubbling is expected and indicates air drainage from the client. Absence of bubbling may mean that the chest tube is obstructed, the lungs have fully reexpanded and no more air is leaking into the pleural space. Keep drainage system lower than the level of the chest to allow effective drainage.

8. Answer: D

Rationale:

Sodium Bicarbonate should be slowly administered because fast infusion may result to abrupt reduction of serum potassium level which can eventually lead to arrhythmias. Diluting or mixing the drug with hypotonic solution (i.e. D5W) or isotonic solution (0.9% NaCl) can be ordered but not with hypertonic solution (I.e D10W).

9. Answer: D

Rationale:

Loosening tight clothing, applying warm blanket to prevent heat loss, and administering oxygen supply might help but is not the priority this time. Direct pressure over the bleeding site is a priority to prevent shock but placing a tourniquet on the artery is done by a surgeon. Because the client is showing signs of altered mental status, there is likely less perfusion in the brain, which calls for fluid resuscitation. At least two IV access allows administration of fluids – crystalloid, blood or clotting factors as necessary which is vital in correcting acidosis, hypothermia and coagulopathy, and to restore perfusion rapidly.

10. Answer: A

Rationale:

Cushing’s syndrome is clinically defined as the presence of excessive corticosteroids. Addison’s disease is clinically defined as adrenocortical insufficiency. Hypothyroidism is a condition wherein there is insufficient thyroid hormone produced by the thyroid glands while SIADH is characterized by excessive release of anti-diuretic hormone.

11. Answer: C

Rationale:

Facial tremors will occur even without performing a specific maneuver. Exaggerated reflexes such as hyperreflexia can be assessed by performing a different maneuver. Gentle tapping of the area below the zygomatic bone just in front of the ear is used to elicit Chvostek sign to assess the presence of hypocalcemia. Trousseau sign is characterized by spasm of the muscles of the hand and forearm upon inflation of a BP cuff on it.

12. Answer: A, B, C, D, E and F

Rationale:

The leaking of vesicant drugs into surrounding tissue causes local tissue damage like delayed healing, tissue necrosis, disfigurement, loss of function and even amputation.

13. Answer: B, C, E

Rationale:

Manual stimulation is recommended to evacuate impacted stool. Having the client sit up straight and raise his head so that he is looking ahead helps reduce the blood pressure as it allows gravitational pooling of blood in the lower extremities. Constrictive clothing may trigger an autonomic reaction that would cause the blood pressure to go up so this must be removed. Manual compression or tapping the bladder to allow urine to flow down the catheter should be avoided because this would trigger an increase in blood pressure. Administration of prescribed vasodilators is done to reduce high blood pressure.

14. Answer: D

Rationale:

Option A is ataxic breathing. Option B is apneustic breathing. Option C is central neurogenic hyperventilation. Cheyne-stokes breathing respirations are a pattern of breathing in which phases of hyperpnea regularly alternate with apnea in a crescendo-decrescendo pattern.

15. Answer: D

Rationale:

The lowest possible score for any response is 1. If a client is unresponsive to painful stimuli, the score is 1. A score lower than 8 indicates that the client is in a comatose state. The highest score for the GCS is 15. A score of 15 indicates an alert and oriented person. A score of 3-8 indicates severe head injury.

16. Answer: D

Rationale:

Helping the client maintain an exercise program is a therapeutic intervention to maintain joint mobility and good body alignment. This will also prevent venous stasis due to impaired mobility. Client encouragement will not only address the physical aspect of the disease but the client’s emotions and self-esteem as well. The safety of the client with impaired physical mobility should always be considered. Continuous physical activity is not recommended. There should be an alternate period of activity and rest to prevent excessive fatigue.

17. Answer: B

Rationale:

Receptive Aphasia refers to the inability to understand spoken words but can freely express and verbalize. Expressive Aphasia refers to the inability to speak and communicate formulated thoughts and sentiments. Global aphasia affects both expressive ability and auditory comprehension. Apraxia is characterized by loss of the ability to perform activities that a person is physically able and willing to do.

18. Answer: B

Rationale:

Graphesthesia is the ability to identify the writing on the skin even with the eyes closed. The client provides a verbal response, identifying the figure that was drawn. Option A is a test for stereognosis. Option C is a test used to assess the Romberg’s sign while option D is a test for Kernig’s sign.

19. Answer: D

Rationale:

Any deterioration of oxygen saturation may necessitate intubation. However, the priority this time is to maintain a patent airway. Infusion of IV fluids and administration of antibiotics are expected nursing actions but not the top priority this time. Completing vaccination at this time will not suffice or treat the underlying respiratory problem. The situation calls for a curative management and not preventive measures. Airway closure is the top priority. Throat examination is avoided as this increases the risk of laryngeal obstruction. Aggression or agitation can also compromise airway and breathing.

20. Answer: B

Rationale:

Absorption is the process when the drug is transferred from the site of origin into the bloodstream. Distribution occurs when the drug in the blood is distributed to different parts of the body and accumulates in specific tissues. Metabolism or biotransformation is the process wherein the drug is broken down into its inactive form. Excretion is the body’s response to eliminate all the inactive form of the drug.

21. Answer: D

Rationale:

The Ventrogluteal site is safe for most intramuscular injections because it only involves the gluteus medius and gluteus minimus muscles. The Vastus lateralis muscle is also a safe injection site for intramuscular medications because there are no adjacent large blood vessels and nerves. The deltoid muscle is a smaller muscle and is safe for administration of intramuscular medications less than 1 mL. The Dorsogluteal muscle is not recommended for intramuscular medications because of the potential damage to the sciatic nerve. Large blood vessels are also located near the dorsogluteal muscle and should be avoided.

22. Answer: B

Rationale:

Prescribing or stopping medications is the responsibility of the physician, thus the nurse must refer this first. Thiazide diuretics cause loss of blood potassium while conserving blood calcium, thus, the electrolyte level must be evaluated first.

23. Answer: D

The brandt-andrew maneuver is the proper extraction of the umbilical cord and placenta. McRobert’s maneuver is performed in case of shoulder dystocia during childbirth. The Schultz mechanism is used to describe placental delivery. The Ritgen’s maneuver is performed by applying pressure over the perineum and counter-pressure on the fetal head. The Ritgen’s maneuver controls the exit of the fetal head and prevents severe damage to maternal tissues.

24. Answer: B

Rationale:

The uterine fundus should start to descend after 24 hours of delivery. The normal rate of uterine descent is 1 cm/day.

25. Answer: B

Rationale:

In Somatoform Disorder, there is no real organ damage, but the client verbalizes symptoms of a disease in an unconscious manner. In Malingering, verbalization of symptoms of a disease is conscious and is used by the client to achieve a secondary gain or benefit. Anxiety comes in many forms panic attacks, phobia, and social anxiety and the distinction between a disorder and “normal” anxiety isn’t always clear. Amnesia refers to the loss of memories, such as facts, information and experiences.

26. Answer: D

Rationale:

Not all chemotherapeutic agents alter the molecular structure of DNA. Chemotherapy should slow down cell division not hasten it. All cells are sensitive to drug toxins. Chemotherapeutic agents act on all rapidly dividing cells – most action of chemotherapeutic agents is that it affects all rapidly dividing cells including the normal and cancer cells.

27. Answer: C

Rationale:

Ketoacidosis is associated with high levels of ketone bodies in the body brought by breakdown of fatty acids and is not related to vomiting. Metabolic acidosis happens when the body produces excessive quantity of acid. Severe vomiting will result to loss of HCL and acids coming from extracellular fluids which in turn lead to metabolic alkalosis. Respiratory alkalosis occurs when there is an increased respiration which elevates the blood pH beyond the normal range of 7.35-7.45.

28. Answer: D

Rationale:

2nd degree skin reactions are evident by scaly skin, an itchy feeling and dry desquamation. Reddening of the skin is not seen in 2nd degree skin reaction.

29. Answer: B

Rationale:

Tremor is clinically defined as the rhythmic and repetitive muscle movement. Chorea is clinically defined as brief and involuntary muscle twitching of the face or limbs which hinders the client’s mobility. Athetosis is clinically defined as the presence of irregular and slow twisting motions. Dystonia is similar to the definition of Athetosis but involves larger muscle areas.

30. Answer: C

Rationale:

Standing close to the working area is a proper body mechanic to prevent muscle fatigue. The nurse should adjust the bed to waist level in order to prevent stretching and muscle strain. Proper body mechanic includes turning the body as a whole unit when moving the client to avoid twisting the back. The knees are bent to support the body’s center of gravity and maintain body balance. Bending the knees will provide a wider base of support for effective leverage and use of energy.

Originally posted 2015-05-17 08:43:07. Republished by Blog Post Promoter

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About Jake

Jake is a Cum Laude graduate of Bachelor of Science in nursing and a registered nurse in the Philippines. Jake has passed foreign nursing licensure examination such as Prometric in Kingdom of Saudi Arabia and HAAD in the United Arab Emirates, with more than 3 years of hospital experience. He is an online medical blogger, SEO writer and Data entry specialist.