1. COLEGIO DE KIDAPAWAN
COMPETENCY APPRAISAL 2
Level 4
1. After a transphenoidal adenohypophysectomy, a client is likely to undergo hormone
replacement therapy. A transphenoidal adenopophysectomy is performed to treat which type of
cancer?
a. Esophageal carcinoma
b. Pituitary carcinoma
c. Laryngeal carcinoma
d. Colorectal carcinoma
2. Before a cancer client receiving total parenteral nutrition resumes a normal diet, the nurse
teaches him about dietary sources of minerals. Which foods are good source of zinc?
a. fruits and yellow vegetables
b.yeast and legumes
c. fruits and green vegetables
d. whole grains and meats
3. During a routine checkup, the nurse assseses a client with acquired immunodeficiency syndrome
(AIDS) for signs and symptoms of cancer. What is the most common AIDS- related cancer?
a. Squamous cell carcinoma
b. multiple myeloma
c. leukemia
d. Kaposi’s sarcoma
4. To treat cervical cancer, a client has had an applicator of radioactive material placed in the vagina.
Which observations by the nurse indicates a radiation hazard?
a. The client is maintained on strict bed rest
b. The head of the bed is at a 30- degree angle
c. The client receives a complete bed bath each morning
d. The nurse checks the applicator’s position every 4 hours
5. A client with metastatic ovarian cancer is prescribed cisplatin (Platinol). Before administering the first
dose, the nurse reviews the client ‘medication history for drugs that act with cisplastin. Which drug may
cause significant interactions when given concomitantly with cisplastin?
a. erythromycin
b. A tetracycline
C. A cephalosporin
d. An aminoglycoside
6. The nurse is teaching a group of women to perform breast self- examination. The nurse should
explain that the purpose of performing the is to discover.
A. cancerous lumps
b. areas of thickness of fullness
c. Changes from previous self- examinations
d. fibrocystic masses
7. The spouse of a client with gastric cancer expresses concern that the couple’s children may develop
this type of cancer when they’re older. When reviewing risk factors for gastic cancer with the client and
family, the nurse explains that a certain blood type increases the risk by 10%. The nurse is referring to:

2. A. Type A
b. Type B
c. Type AB
d. Type O
8. The ABCD method offers one way to asses skin lesions for possible skin cancer.
A. actinic
b. asymmetry
c. arcus
d. assessment
9. The nurse is interviewing a client about his past medical history. Which preexisting condition may lead
the nurse to suspect that a client has colorectal cancer
a. duodenal ulcers
b. hemorrhoids
c. weight gain
d. polyps
10. A client with advanced breast cancer prescribed tamoxifen ( Nolvadex ). When teaching the client
about this drug, the nurse should emphasized the importance of reporting which adverse reaction
immediately?
a. vision changes
b. hearing loss
c. headache
d. anorexia
11. The nurse is teaching a client who suspects that she has a lump in her breast. The nurse instructs
that a diagnosis of breast cancer is confirmed by:
a. breast-self examination
b. mammography
c. fine needle aspiration
d. chest x-ray
12. Which client has the highest risk of ovarian cancer?
a. A 30 –year- old woman taking oral contraceptives
b. 45-year-old woman with 3 children
d. 36 year-old woman who had her first child at age 22
13. A client with cancer is being evaluated for possible metastasis sites for cancer cells?
A. liver
b.colon
c. reproductive duct
d. white blood cells
14. The nurse is developing a plan of care for marrow suppression, the major dose limiting adverse
reaction to fluxuridine (FUDR). How long after drug administration does bone marrow suppression
become noticeable?
a.24 hours
b. 2 to 4 days
c. 7 to 14 days
d. 21 to 28 days
15. A client colon cancer requires a permanent colostomy because of the tumor location. After surgery,
the client must learn how to irrigate the colostomy. When irrigating, how far into the stoma should the
client insert the lubricated catheter?
a. 0.25”to 0.5”
b. 1” to 1.5”
c.2” to 4”
d. 5”to 7”

3. 16. A client hospitalized with oat cell carcinoma of the lung. To ,manage severe pain, the physician
prescribes a continous I.V. infusion of morphine. Which formula should the nurse use to check that the
morphine dose appropriate for the client?
a. 1 mg/kg of body weight
b. 5mg/kg of body weight
c. 5mg/ 70kg of body weight
d. 10 mg/70kg of body weight when given parenterally
17. Which nursing intervention is most appropriate for a client with multiple myeloma?
a. monitoring respiratory status
b. balancing rest and activity
c. restricting fluid intake
d. preventing bone injury
18. A cliet with cancer asks the nurse “ which is the most common type of cancer in women? The nurse
replies that’s breast cancer. Which type of cancer causes the most deaths in women?
a. breast cancer
b. lung cancer
c. brain cancer
d. colon and rectal cancer
19. A client with vaginal cancer asks the nurse “ What is the usual treatment for this type of cancer?”
Which treatment should the nurse name?
a. surgery
b.chemotherapy
c. radiation
d. immunotherapy
20. To combat the most common adverse effects of chemotherapy, The nurse would administer an: a.
antiemetic
b.antimetabolite
c. Antibiotic
d. anticoagulant
21. A client with cancer is scheduled for radiation therapy. The nurse knows that radiation at any
treatment site may cause a certain adverse effect. Therefore, the nurse should prepare the client to
expect:
a. hair loss
b. stomatitis
c. fatigue
d. vomiting
22. Which finding is an early indicator of bladder cancer?
a. painless hematuria
b. occasional polyuria
c. nocturia
d. dysuria
23. A client, age 42, visits the gynecologist after examining her, the physician suspect’s cervical cancer.
The nurse reviews the client’s history for risk factors for this disease. Which history finding is a risk factor
for cervical cancer?
a. onset of sporadic sexual activity at age 17
b. spontaneous abortion at age 19
c. pregnanacy complicated with eclampsia at age 27
d. human papillomavirus infection at age 32
24 A client with suspected lung cancer is scheduled for thoracentesis as part of the diagnostic work-up.
The nurse reviews the client’s history for conditions that might contraindicate this procedure. Which
condition is a contraindication for thoracentesis?

4. 25. As the nurse stands near the window in the client’s room, the client shout, “Come away from the
window! They”ll see you! Which of the following responses by the nurse would be the best?
a. “who are they?”
b. “no one will see me “
c. “you have no reason to be afraid”
d. “what will happen if they do see me ?”
26. A client with recurrent, endogenous depression has been hospitalized on the psychiatric unit for 3
days. He exhibits psychomotor retardation, anhedonia, indecision, and suicidal thoughts. Which goal of
nursing care should have highest priority?
a. provide for contact between the client and his wife.
b. use measures to protect the client from harming himself.
c. Reassure the client of his worthiness.
d. maintain a calm environment.
27. A client in an inpatient psychiatric unit tells the nurse, “I’m going to divorce my no-good husband. I
hope her rots in hell. But I miss him so bad. I love him. When he’s going to come get me out of here?”
the nurse interprets the client’s statements as indicative of which of the following?
a. Ambivalence
b. autistic thinking
c. associative looseness
d. auditory hallucination
28. a client with major depression states to the nurse, “my heart is turning to stone.” Which reply by the
nurse is most therapeutic?
a. “you are alive and breathing”
b.”your depression makes you think that way”
c. “what makes you say that?”
d. “you sound like you feel frightened.”
29. A client with bulimia binges twice a day. The nurse interprets these binges as most likely involving
which of the following for the client?
a. Feelings of euphoria and gratification.
b. Feeling out of control and disgusted with self.
c. Leaving traces of food around to attract attention
d. eating increasing amounts of food for substantial weight gain.
30. The family members of the victims of a three-car accident have arrived at the emergency
department. The wife of one accident victim is sitting away from the others and crying. Which of the
following actions by the nurse would be best?
a. leave the wife alone to cry
b. Sit next to the wife and offer her some tissues
c. Call the physician for a sedative.
d. Ask the wife if she would like to speak to the social worker
31. Which of the following medications is most likely to be prescribed for the client during withdrawal
from alcohol to provide sedation and to ease some of the anxiety and discomfort of the withdrawal
process?
a. Paraldehyde(paral)
b. Lorazepam (Ativan)
c. Phenytoin sodium (dilantin)
d. Temazepam (restoril)
32. In closed or locked units, the nurse judges the milieu as therapeutic because pririties are given to:
a. Socialization and self-understanding
b. Education and vocation counseling
c. Safety, structure, and support.
d. Developing communication,social, and leisure skills.

5. 33. The nurse is conducting a mental status examination on a client with a cognitive disorder. Which of
the following statements does the nurse judge to be an impairment in abstract thinking? The client’s :
a. ability to remember her wedding day
b. Inability to find a similarity between a bird and a butterfly
c. Memories regarding her vacation 5 years ago.
d. Inability to state her home address.
34. For the client experiencing delirium, the nurse prioritized interventions to first maintain:
a. Orientation
b. Physical safety
c. Optimal level of functioning
d. consistency in routine
35. A decision is made to not hospitalized a client with obsessive-compulsive disorder. Of the following
abilities the client has demonstrated, the one that probably most influenced the decision not to
hospitalize him is his ability to:
a. Hold a job
b. Relate to his peers
c. Perform activities of daily living
d. Behave in an outwardly normal manner
36. In terminating the relationship with the nurse, which client reaction should be considered the most
healthy?
a. A lack of response
b. A display of anger
c. An attempt at humor
d. An expression of grief
37. In direct expression of anger is more common than direct expression. Which of the following client
behaviors is most likely to be an indirect expression of anger?
a.Responding sarcastically to an invitation to join a unit activity
b. Refusing to take medication
c. Cursing at the Physician
d. Shouting at another client
38. The client states he washes his feet endlessly because they “are so dirty that I can’t put on my socks
and shoes.” The nurse recognizes the client is using ritualistic behavior primarily to relieve discomfort
associated with feelings of:
a. Intolerable anxiety
b. Depression
c. Ambivalence
d. Irrational fear
39. Which of the following health status assessments must be completed before the client starts taking
imipramine (tofranil)?
a. Electrocardiogram (ECG)
b. Urine sample for protein
c. Thyroid scan
d. Creatinine clearance test
40. The nurse will conduct a psychoeducational group for family members about depression. Which of
the following topics would be of little help to the family members?
a. Managing the depressed client at home
b. drug classifications
c. Support and self-help groups
d. Education about depression
41. A client with an obsessive-compulsive disorder washes his feet frequently. Which of the following
nursing diagnoses is specifically related to this behavior?
a. Self-care deficit

6. b. Ineffective coping
c. Risk for impaired skin integrity
d. Anxiety
43. A client’s face is flushed. He is swearing, yelling, and pushing chairs around the day room of a mental
health center. The nurse judges the client to be in which phase of the assault cyle?
a. Trigerring
b. Escalation
c. Crisis
d. Aggressive
44. A client has been taking lithium carbonate (lithobid) for hyperactivity, as prescribed by his physician.
while the client is taking this drug, the nurses should ensure that he has an adequate intake of:
a. sodium
b. iron
c. Iodine
d. calcium
45. The client is taking risperidone ( risperdal) to treat the positive and negative symptoms of
schizophrenia. Which of the following symptoms is negative?
a. Abnormal thought form
b. Hallucination and delusions
c. bizarre behavior
45. The client is to undergo a series of diagnostic tests to determine if her cognitive impairment is
treatable. Which of the following states can lead to nonreversible cognitive impairment?
a. Cerebral abcess
b. Multiple sclerosis
c. syphilitic meningitis
d. Electrolyte imbalance
46. As the nurse learns more about the abused client and her family, which of the following
characteristics is the nurse least likely to be true about the abuser?
a. Between episodes of abuse, he has a warm, empathetic relationship with his wife.
b. He grew up in abusive family
c. He is a college graduate and has a stable work history
d. He abuses alcohol
47. Which of the following methods of treatment would initially be least helpful to a client with
obsessive-compulsive disorder?
a.Relaxation exercises
b. Meditation
c. Listening to soothing music
d. Exposure therapy
48. The nurse judges a client to no longer need constant one-to-one observation for self-directed
violence when the client :
a. Begins to interact with the nurse
b. Stops putting his head in the toilet to drown himself
c. Displays a sudden elevation in mood.
d. Eats his meals in dining room.
49. A hospitalized client craves a drink while withdrawing from alcohol. Which of the following measures
is the best way to help him resist urge to drink?
a. A locked-door policy
b. A routine search of visitors
c. One-to-one supervision by the staff
d. Support from other alcoholic clients

7. 50. A client admits to using cocaine and says, “when I stop using, I feel bad.” Which of the following
effects is the client most likely to describe as occurring after he stops using cocaine?
a. depression
b. Palpitation
c. Flashback
51. Unresolved feelings related to loss may be mostly recognized during which phase of the therapeutic
nurse-client relationship?
a. Orientation
b. Working
c. Termination
d. Trusting
52. A client with diagnosis of major depression who attempted suicide says to the nurse “I should have
died. I’ve always been a failure. Nothing ever goes right for me.” The most therapeutic response to the
client is:
a. “I don’t see you a failure.”
b. “Feeling like this is all part of being ill.”
c. “You’ve been feeling like a failure for a while.”
d. “You have everything lo live for.”
53. A community health nurse visits a client at home. The client states, “I haven’t slept at all the last
couple of nights.” Which response by the nurse illustrates the most therapeutic communication
technique for this client?
a. “Go on…”
b. “Sleeping?”
c. “The last couple of nights?”
d. “You’re having difficulty in sleeping?”
54. A nurse is performing an admission assessment on a client and is attempting to obtain subjective
data about the client’s sexual and reproductive status. The client states, “I don’t want to discuss this; it’s
private and personal.” Which statement if made by the nurse, indicates that the nurse is therapeutic?
a. “I hate being asked these sorts of question too.”
b. “I am a professional nurse and as such I’ll have you know that all information is kept
confidential.”
c. “I know that some of this question is difficult for you but, as a professional nurse, I must legally
respect your confidentiality.
d. “This is difficult for you to speak about, but I am trying to perform a complete assessment and I
need this information.”
55. A nurse is caring for a Native American who says, “I don’t want you to touch me. I’ll take care of
myself.” Which nursing response is most therapeutic?
a. “Ok. If that’s what you want. I’ll just leave this cup for you to collect your urine in. After
breakfast, I will take more blood from you.”
b. “If you didn’t want our care, why did you come here?”
c. “Why are you being so difficult? I only want to help you.”
d. “It sounds as though you want to take care of yourself. Let’s work together so you can do things
for yourself.
56. A client admitted to the mental heal unit is experiencing Altered Thought Processes. The client
believes that the food is being poisoned. Which communication technique does the nurse plan to use to
encourage the client to express feelings?
a. Using open-ended questions and silence.
b. Offering opinions about the necessity of adequate nutrition.
c. Identify the reasons that the client may not want to eat.
d. Focusing on self-disclosure about food preferences.
57. A nurse is working with a client who has sought counseling after trying to rescue a neighbor
involved in a house fire. In spite of the client’s efforts, the neighbor died. Which action does the nurse
engage in with the client during the working phase of the nurse-client relationship?

8. a. Exploring the client’s potential for self-harm.
b. Exploring the client’s ability to function.
c. Inquiring about the client’s perception or appraisal of the neighbor’s death.
d. Inquiring about and examining the client’s feelings that may block adaptive coping.
58. A client who has just been sexually assaulted is very quiet and calm. The nurse analyzes this behavior
as indicative of what defense mechanism?
a. Denial
b. Projection
c. Rationalization
d. Intellectualization
59. A nurse completes the initial assessment of a client admitted to the mental health unit. The nurse
analyzes the data obtained on assessment and determines that which of the following presents a
priority concern?
a. The presence of bruises on the client’s body.
b. The client’s report of not eating and sleeping.
c. The client’s report of suicidal thoughts.
d. The significant other’s disapproving of the treatment.
60.) Laboratory work is prescribed for a client who has been experiencing delusions. When the nurse
approaches the client to obtain a specimen of the client’s blood, the client begins to shout, “You’re all
vampires. Let me out of here!” The most appropriate nursing response is which of the following?
a. “I am not going to hurt you; I am going to help you.”
b. “What makes you think that I am a vampire?”
c. “I’ll leave and come back later for your blood.”
d. “It must be fearful to think others want to hurt you.”
61.) An inebriated client is brought to the emergency department by the local police. The client is told
that the physician will be in to see the client in about 30 minutes. The client becomes very loud and
offensive and wants to be seen by the physician immediately. The most appropriate nursing intervention
is which of the following?
a. Attempt to talk with the client to deescalate behavior
b. Watch the behavior escalate before intervening
c. Inform the client that he or she will be asked to leave if the behavior continues
d. Offer to take the client to an examination room until he or she can be treated
62. A client is admitted to a mental health unit for treatment of psychotic behavior. The client is at the
locked exit door shouting, “Let me out. There’s nothing wrong with me. I don’t belong here.” The nurse
analyzes the behavior as:
a. Projection
b. Denial
c. Regression
d. Rationalization
63. A home health nurse is talking to the spouse of a client taking an antidepressant. The spouse says,
“Now that my husband is responding to the antidepressant, the suicidal risk is over and you can stop
making this home visits.” After analyzing this statement, which of the following is the most appropriate
nursing response?
a. “I agree with you. Clients who kill themselves are only suicidal for a limited time. No one can feel
self-destructive forever.
b. “I need to continue my visits. Your comment reflects lack of knowledge that this disease runs in
families.
c. “I agree with you. The suicidal threats were really attention seeking. Continuing to visit would
reinforce your husband’s use of manipulation.”
d. “I need to continue with my visits. Most suicides occur within 3 months after improvement
begins because the client now has the energy to carry out the suicidal intentions.”
64. A supervisor reprimands the nurse in charge of a nursing unit because the charge nurse has not
adhered the unit budget. Later that afternoon, the charge nurse accuses the nursing staff of wasting
supplies. The behavior is an example of:

9. a. Denial
b. Regression
c. Suppression
d. Displacement
65.) A client says to the nurse, “I’m going to die, and I wish my family would stop hoping for a cure! I get
so angry when they carry on lie this! After all, I’m the one who’s dying.” The most therapeutic response
by the nurse is:
a. “You’re feeling angry that your family continues to hope for you to be cured?”
b. “I think we should talk more about your anger with your family.”
c. “Well, it sounds like you’re being pretty pessimistic. After all, years ago people died f
pneumonia.”
d. “Have you shared your feelings with your family?”
ANSWERS AND RATIONALE
1.After a transphenoidal adenohypophysectomy, a client is likely to undergo hormone replacement
therapy. A transphenoidal adenopophysectomy is performed to treat which type of cancer?
e. Esophageal carcinoma
f. Pituitary carcinoma
g. Laryngeal carcinoma
Colorectal carcinoma
1.Answer B – Pituitary carcinoma most commonly arises in the anterior pituitary ( adenohypophysis)
and must be removed by way of a transphenoidal approach, using a bivalve speculum and rongeur.
2. Before a cancer client receiving total parenteral nutrition resumes a normal diet, the nurse
teaches him about dietary sources of minerals. Which foods are good source of zinc?
a. fruits and yellow vegetables
b.yeast and legumes
c. fruits and green vegetables
d. whole grains and meats
2. Answer D Good source of zinc include whole grains, meats and dairy products, and seafood. Fuits
are good source of vitamin c, and vegetables are a good source of many vitamins and minerals, but not
to zinc. Yeast is a good source of chromium, and legumes are a good source of copper, manganese, and
molybdenum.
3.During a routine checkup, the nurse assseses a client with acquired immunodeficiency syndrome
(AIDS) for signs and symptoms of cancer. What is the most common AIDS- related cancer?
a. Squamous cell carcinoma
b. multiple myeloma
c. leukemia
d. Kaposi’s sarcoma
3. Answer: D Kaposi’s sarcoma is the most common cancer associated with AIDS. Squamous cell
carcinoma, multiple myeloma, and leukemia may occur anyone and aren’t associated specifically with
age.
4. To treat cervical cancer, a client has had an applicator of radioactive material placed in the vagina.
Which observations by the nurse indicates a radiation hazard?

10. a. The client is maintained on strict bed rest
b. The head of the bed is at a 30- degree angle
c. The client receives a complete bed bath each morning
d. The nurse checks the applicator’s position every 4 hours
4. Answer C The client receive a complete bed bath while the applicator is in place. In fact she, shouldn’t
be bathed below the waist because of the risk of radiation exposure to the nurse. During this
treatment, the client should remain on strict bed rest,but the head of her bed may be raised to a 35-45
degree angle. The nurse should check the applicator’s position every 4 hours to ensure that It remains in
the proper place.
5. A client with metastatic ovarian cancer is prescribed cisplatin (Platinol). Before administering the first
dose, the nurse reviews the client ‘medication history for drugs that act with cisplastin. Which drug may
cause significant interactions when given concomitantly with cisplastin?
a. erythromycin
b. A tetracycline
C. A cephalosporin
d. An aminoglycoside
5. Answer D An aminoglycoside may cause nephrotoxicity and ototoxicity when given concomitantly
with cisplatin. No significant interactions occur when erythromycin, a tetracycline, or a cephalosporin is
given concomitantly with cisplatin.
6. The nurse is teaching a group of women to perform breast self- examination. The nurse should
explain that the purpose of performing the is to discover.
A. cancerous lumps
b. areas of thickness of fullness
c. Changes from previous self- examinations
d. fibrocystic masses
6.Answer C women are instructed to examine themselves to discover changes that have occured in the
breast. Only physician can diagnose lumps that are cancerous, areas of thickness or fullness the signal
the presence of a malignancy, or masses that are fibrocystic as opposed to malignant
7. The spouse of a client with gastric cancer expresses concern that the couple’s children may develop
this type of cancer when they’re older. When reviewing risk factors for gastic cancer with the client and
family, the nurse explains that a certain blood type increases the risk by 10%. The nurse is referring to:
A. Type A
b. Type B
c. Type AB
d. Type O
7. Answer People with type A blood have 10% greater risk for gastric cancer. Other risk factors for this
type of cancer include a history of gastritis with gastric atrophy and a family history of the diseases.
Blood types B, AB and O aren’t linked to gastric cancer.
8. The ABCD method offers one way to asses skin lesions for possible skin cancer.
A. actinic
b. asymmetry

11. c. arcus
d. assessment
8. Answer When following the ABCD method assessing skin lesions , the a stands for ” asymmetry”
The B for “ border irregularity” The C “ color variation” and the D for diameter
9. The nurse is interviewing a client about his past medical history. Which preexisting condition may lead
the nurse to suspect that a client has colorectal cancer
a. duodenal ulcers
b. hemorrhoids
c. weight gain
d. polyps
Answer D Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids
preexisting conditions of colorectal cancers. Weight loss- not gain- is an indication of colorectal cancer.
10. A client with advanced breast cancer prescribed tamoxifen ( Nolvadex ). When teaching the client
about this drug, the nurse should emphasized the importance of reporting which adverse reaction
immediately?
a. vision changes
b. hearing loss
c. headache
d. anorexia
10. Answer A the client report changes in visual acuity immediately because this adverse effect may be
irreversible. Tamoxifen isn’t associated with hearing loss. Although the drug may cause anorexia,
headache, and hot flashes, the client need not report these adverse effects immediately because they
don’t warrant a change in therapy.
11. The nurse is teaching a client who suspects that she has a lump in her breast. The nurse instructs
that a diagnosis of breast cancer is confirmed by:
a. breast-self examination
b. mammography
c. fine needle aspiration
d. chest x-ray
11. Answer C Fine needle aspiration and biopsy provide cells for histologic examination to confirm a
diagnosis of cancer. A breast self- examination, if done regularly, is the most reliable method for
detecting breast lumps early. Mammography is used to detect tumors that are too small to palpate.
Chest x-ray can be used to pinpoint rib metastasis.
12. Which client has the highest risk of ovarian cancer?
a. A 30 –year- old woman taking oral contraceptives
b. 45-year-old woman with 3 children
d. 36 year-old woman who had her first child at age 22
12. Answer The incidence of ovarian cancer increases in women who have never been pregnant, are
over age 40, are infertile, or have menstrual irregularities. Other risk factors include a family history of

12. breast, bowel, or endometrial cancer.The risk of ovarian cancer is reduced in women who have taken
oral contraceptives, have had multiple births, or have had a first child at a young age.
13. A client with cancer is being evaluated for possible metastasis sites for cancer cells?
A. liver
b.colon
c. reproductive duct
d. white blood cells
13. Answer The liver is one of the five most common cancer metastasis sites. The others are the lymph
nodes, lung, bone, and brain. The colon , reproductive tract, and QWBCs are occasional metastasis sites.
14. The nurse is developing a plan of care for marrow suppression, the major dose limiting adverse
reaction to fluxuridine (FUDR). How long after drug administration does bone marrow suppression
become noticeable?
a.24 hours
b. 2 to 4 days
c. 7 to 14 days
d. 21 to 28 days
14. Answer C Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine
administration. Bone marrow recovery occurs in 21 to 28 days.
15. A client colon cancer requires a permanent colostomy because of the tumor location. After surgery,
the client must learn how to irrigate the colostomy. When irrigating, how far into the stoma should the
client insert the lubricated catheter?
a. 0.25”to 0.5”
b. 1” to 1.5”
c.2” to 4”
d. 5”to 7”
15. Answer When irrigating a colostomy, the client should insert the catheter 2” to 4” into the stoma.
Inserting it less than 2” may cause leakage. Inserting it more than 4” may cause trauma to the intestinal
mucosa.
16. A client hospitalized with oat cell carcinoma of the lung. To ,manage severe pain, the physician
prescribes a continous I.V. infusion of morphine. Which formula should the nurse use to check that the
morphine dose appropriate for the client?
a. 1 mg/kg of body weight
b. 5mg/kg of body weight
c. 5mg/ 70kg of body weight
d. 10 mg/70kg of body weight when given parenterally
16. Answer D The usual adult dose of morphine sulfate is based on 1omg/70 kg of body weight when
given parenterally
17. Which nursing intervention is most appropriate for a client with multiple myeloma?

13. a. monitoring respiratory status
b. balancing rest and activity
c. restricting fluid intake
d. preventing bone injury
17. Answer D when caring a client with multiple myeloma, the nurse should focus on relieving pain,
preventing bone injury and infection, and maintaining hydration. Monitoring respiratory status and
balancing rest and activity are appropriate interventions for any client.
18. A cliet with cancer asks the nurse “ which is the most common type of cancer in women? The nurse
replies that’s breast cancer. Which type of cancer causes the most deaths in women?
a. breast cancer
b. lung cancer
c. brain cancer
d. colon and rectal cancer
18. Answer B Lung cancer is the most deadly type of cancer in both women and men. Breast cancer
ranks second in women, followed( in descending order) by colon and rectal cancer, pancreatic cancer,
ovarian, uterine cancer,lymphoma, leukemia, liver cancer,brain cancer, stomach cancer and multiple
myeloima.
19. A client with vaginal cancer asks the nurse “ What is the usual treatment for this type of cancer?”
Which treatment should the nurse name?
a. surgery
b.chemotherapy
c. radiation
d. immunotherapy
19. Answer C The usual treatment for vaginal cancer is external or intravaginal therapy. Less often,
surgery is performed. Chemotherapy typically is prescribed only if vaginal cancer is diagnosed in an early
stage, which is rare. Immunotherapy isn’t used to teat vaginal cancer.
20. To combat the most common adverse effects of chemotherapy, The nurse would administer an: a.
antiemetic
b.antimetabolite
c. Antibiotic
d. anticoagulant
20. Answer A Antiemetics are used to treat nausea and vomiting. Antihistamines and certain steroids
are also used to treat nausea and vomiting. Antimetabolites and tumor antibiotics are classes of
chemotherapeutic medications. Anticoagulants slow blood clotting time, thereby helping to prevent
thrombi and emboli.
21. A client with cancer is scheduled for radiation therapy. The nurse knows that radiation at any
treatment site may cause a certain adverse effect. Therefore, the nurse should prepare the client to
expect:
a. hair loss
b. stomatitis
c. fatigue

14. d. vomiting
21. Answer C Radiation Therapy may cause fatigue, skin toxicities and anorexia regardless of the
treatment site. Hair loss, stomatitis, and vomiting are site- specific, not generalized, adverse effects of
radiation therapy.
22. Which finding is an early indicator of bladder cancer?
a. painless hematuria
b. occasional polyuria
c. nocturia
d. dysuria
22. Answer A As cancer cells destroy normal bladder tissue, bleeding occurs and causes painless
hematuria. ( Pain is a late symptom of bladder cancer). The other options aren’t associated with bladder
cancer.
23. A client, age 42, visits the gynecologist after examining her, the physician suspect’s cervical cancer.
The nurse reviews the client’s history for risk factors for this disease. Which history finding is a risk factor
for cervical cancer?
a. onset of sporadic sexual activity at age 17
b. spontaneous abortion at age 19
c. pregnanacy complicated with eclampsia at age 27
d. human papillomavirus infection at age 32
23. Answer D Like other viral and bacterial venereal infections, human papillomavirus is a risk factor for
cervical cancer. Other risk factors for this disease include frequent sexual intercourse before age 16,
multiple sex partners and multiple pregnanacies.
24 A client with suspected lung cancer is scheduled for thoracentesis as part of the diagnostic work-up.
The nurse reviews the client’s history for conditions that might contraindicate this procedure. Which
condition is a contraindication for thoracentesis?
a. Seizure disorder
b. B. chronic obstructive pulmonary disease
c. C. anemia
d. D. bleeding disorder
24. Answer D A bleeding disorder is a contraindication for thoracentesis because a hemorrhage may
occur during or after this procedure, possibly causing death. Although a history of a seizure disorder,
chronic obstructive pulmonary disease, or anemia calls for caution, it does’t contraindicate
thoracentesis.
25
26. As the nurse stands near the window in the client’s room, the client shout, “Come away from the
window! They”ll see you! Which of the following responses by the nurse would be the best?
a. “who are they?”
b. “no one will see me “
c. “you have no reason to be afraid”
d. “what will happen if they do see me ?”
26. Answer: A. Asking the client who “they” are when he is fearful helps the nurse understand his
behavior and is least demanding of the client.

15. 27. A client with recurrent, endogenous depression has been hospitalized on the psychiatric unit for 3
days. He exhibits psychomotor retardation, anhedonia, indecision, and suicidal thoughts. Which goal of
nursing care should have highest priority?
a. provide for contact between the client and his wife.
b. use measures to protect the client from harming himself.
c. Reassure the client of his worthiness.
d. maintain a calm environment.
27. Answer. B. Whenever a client is suicidal, steps must be taken to prevent the client from self-harm.
Other goals of care are less important than being sure the client does not carry out the threat of suicide.
All suicide threats should be taken seriously, and proper precautions should be taken to protect the
client from self-harm.
28. A client in an inpatient psychiatric unit tells the nurse, “I’m going to divorce my no-good husband. I
hope her rots in hell. But I miss him so bad. I love him. When he’s going to come get me out of here?”
the nurse interprets the client’s statements as indicative of which of the following?
a. Ambivalence
b. autistic thinking
c. associative looseness
d. auditory hallucination
28. Answer. A. Ambivalence refers to strong conflicting attitudes or feelings toward an object, person,
goal, or situation evidenced in one instance by client stating she is going to divorce her husband then
stating that she misses and loves him.
29. a client with major depression states to the nurse, “my heart is turning to stone.” Which reply by the
nurse is most therapeutic?
a. “you are alive and breathing”
b.”your depression makes you think that way”
c. “what makes you say that?”
d. “you sound like you feel frightened.”
29. Answer . D. The nurse’s best response will be to focus on underlying meaning of the client’s remark
without focusing on or challenging the content.
30. A client with bulimia binges twice a day. The nurse interprets these binges as most likely involving
which of the following for the client?
a. Feelings of euphoria and gratification.
b. Feeling out of control and disgusted with self.
c. Leaving traces of food around to attract attention
d. eating increasing amounts of food for substantial weight gain.
30. Answer.B. for the client with bulimia, binges involve a loss of control that results in thought of self-
deprecation.
31. The family members of the victims of a three-car accident have arrived at the emergency
department. The wife of one accident victim is sitting away from the others and crying. Which of the
following actions by the nurse would be best?
a. leave the wife alone to cry

16. b. Sit next to the wife and offer her some tissues
c. Call the physician for a sedative.
d. Ask the wife if she would like to speak to the social worker
31. Answer.B Conveying warmth, empathy, and support to the wife to encourage the release of feelings
is a priority nursing action at this time.
32. Which of the following medications is most likely to be prescribed for the client during withdrawal
from alcohol to provide sedation and to ease some of the anxiety and discomfort of the withdrawal
process?
a. Paraldehyde(paral)
b. Lorazepam (Ativan)
c. Phenytoin sodium (dilantin)
d. Temazepam (restoril)
32. Answer.B. Antianxiety agents such as lorazepam (ativan) and chlordiazepoxide(Librium) are
commonly used to ease symptoms during alcohol withdrawal.
33. In closed or locked units, the nurse judges the milieu as therapeutic because pririties are given to:
a. Socialization and self-understanding
b. Education and vocation counseling
c. Safety, structure, and support.
d. Developing communication,social, and leisure skills.
33. Answer.C. Clients on a closed or locked inpatient psychiatric unit are typically acutely ill. Providing
safety, structure, and support are immediate priorities in the therapeutic milieu for clients with
cognitive impairement and inability to handle stress.
34. The nurse is conducting a mental status examination on a client with a cognitive disorder. Which of
the following statements does the nurse judge to be an impairment in abstract thinking? The client’s :
a. ability to remember her wedding day
b. Inability to find a similarity between a bird and a butterfly
c. Memories regarding her vacation 5 years ago.
d. Inability to state her home address.
34.Answer. B. impairment in abstract thinking is demonstrated by the client’s inability to find a similarity
between a bird and a butterfly.
35. For the client experiencing delirium, the nurse prioritized interventions to first maintain:
a. Orientation
b. Physical safety
c. Optimal level of functioning
d. consistency in routine
35. Answer.B. Nursing interventions that maintain physical safety are a priority for the client with
delirium, who, in a delirious state, is at increased risk of injury.

17. 36. A decision is made to not hospitalized a client with obsessive-compulsive disorder. Of the following
abilities the client has demonstrated, the one that probably most influenced the decision not to
hospitalize him is his ability to:
a. Hold a job
b. Relate to his peers
c. Perform activities of daily living
d. Behave in an outwardly normal manner
36.Answer. C. A client able to take care of his basic nutrition needs is probably not sufficiently
incapacitated by his illness to require hospitalization.
37. In terminating the relationship with the nurse, which client reaction should be considered the most
healthy?
a. A lack of response
b. A display of anger
c. An attempt at humor
d. An expression of grief
37. Answer.D. Grief is a direct and appropriate response to termination of a positive relationship. Grief
indicates acceptance of termination.
38. In direct expression of anger is more common than direct expression. Which of the following client
behaviors is most likely to be an indirect expression of anger?
a.Responding sarcastically to an invitation to join a unit activity
b. Refusing to take medication
c. Cursing at the Physician
d. Shouting at another client
38. Answer. A . Sarcasm is frequently used to express anger indirectly. Refusing medication is a direwct
expression of anger.
39. The client states he washes his feet endlessly because they “are so dirty that I can’t put on my socks
and shoes.” The nurse recognizes the client is using ritualistic behavior primarily to relieve discomfort
associated with feelings of:
a. Intolerable anxiety
b. Depression
c. Ambivalence
d. Irrational fear
39. Answer. A. The client with an obsessive-copulsive disorder has an uncontrollable and persistent need
to perform behavior that helps relieve intolerable anxiety.
40. Which of the following health status assessments must be completed before the client starts taking
imipramine (tofranil)?
a. Electrocardiogram (ECG)
b. Urine sample for protein
c. Thyroid scan

18. d. Creatinine clearance test
40. Answer. A. Because tricyclic antidepressants such as imipramine (Tofranil) cause tachycardias and
ECG changes, an ECG should be done before the client takes the medication.
41. The nurse will conduct a psychoeducational group for family members about depression. Which of
the following topics would be of little help to the family members?
a. Managing the depressed client at home
b. drug classifications
c. Support and self-help groups
d. Education about depression
41. Answer. B. Focusing on antidepressant medications would be helpful, but the topic of drug
classifications is too general.
42. A client with an obsessive-compulsive disorder washes his feet frequently. Which of the following
nursing diagnoses is specifically related to this behavior?
a. Self-care deficit
b. Ineffective coping
c. Risk for impaired skin integrity
d. Anxiety
42. Answer. C. The nursing diagnosis Risk for Impaired Skin Integrity related to frequent foot washing is
indicated. The skin of the feet can become red and raw, providing an entry for infection.
43. A client’s face is flushed. He is swearing, yelling, and pushing chairs around the day room of a mental
health center. The nurse judges the client to be in which phase of the assault cyle?
a. Trigerring
b. Escalation
c. Crisis
d. Aggressive
43. Answer. B. The escalation phase of the assault cycle involves agitation, swearing, screaming,
demanding, and provocative behaviors with loss of reasoning ability.
44. A client has been taking lithium carbonate (lithobid) for hyperactivity, as prescribed by his physician.
while the client is taking this drug, the nurses should ensure that he has an adequate intake of:
a. sodium
b. iron
c. Iodine
d. calcium
44. Answer. A. Sodium is necessary for renal excretion of lithium carbonate (lithobid). A low sodium
intake results in retention of lithium and eventual lithium toxicity.
45. The client is taking risperidone ( risperdal) to treat the positive and negative symptoms of
schizophrenia. Which of the following symptoms is negative?
a. Abnormal thought form
b. Hallucination and delusions

19. c. bizarre behavior
Asocial behavior and anergia
44. Answer. D. Asocial behavior , anergia, alogia, and effective flattering are some of the negative
symptoms of schizophrenia that may improve with risperidone therapy.
45. The client is to undergo a series of diagnostic tests to determine if her cognitive impairment is
treatable. Which of the following states can lead to nonreversible cognitive impairment?
a. Cerebral abcess
b. Multiple sclerosis
c. syphilitic meningitis
d. Electrolyte imbalance
45. Answer. B. Multiple sclerosis is a progressive chronic disease, it’s course cannot be reversed,
although clients may experience periodic remissions.
46. As the nurse learns more about the abused client and her family, which of the following
characteristics is the nurse least likely to be true about the abuser?
a. Between episodes of abuse, he has a warm, empathetic relationship with his wife.
b. He grew up in abusive family
c. He is a college graduate and has a stable work history
d. He abuses alcohol
46. Answer.A. Lack of empathy characterizes relationships in abusive families. It is more likely that the
relationship is built around the abuser’s need for power and control.
47. Which of the following methods of treatment would initially be least helpful to a client with
obsessive-compulsive disorder?
a.Relaxation exercises
b. Meditation
c. Listening to soothing music
d. Exposure therapy
47.Answer. B. Meditation would not be helpful for the client because of increased anxiety, which
interferes with concentration, thinking, and focusing. After obsessions and compulsions decrease, the
client may find meditation helpful and calming.
48. The nurse judges a client to no longer need constant one-to-one observation for self-directed
violence when the client :
a. Begins to interact with the nurse
b. Stops putting his head in the toilet to drown himself
c. Displays a sudden elevation in mood.
d. Eats his meals in dining room.
48. Answer. B. The nurse judges the client to no longer require constant one-to-one observation when
the client stops putting his head in the toilet to drown.
49. A hospitalized client craves a drink while withdrawing from alcohol. Which of the following measures
is the best way to help him resist urge to drink?

20. a. A locked-door policy
b. A routine search of visitors
c. One-to-one supervision by the staff
d. Support from other alcoholic clients
49. Answer. D. Group support has proved more successful than individual attention from the staff in
influencing positive behavior in alcoholics.
50. A client admits to using cocaine and says, “when I stop using, I feel bad.” Which of the following
effects is the client most likely to describe as occurring after he stops using cocaine?
a. depression
b. Palpitation c. Flashback
d. Double vision
50. Answer.A. Depression typically occurs after a person stops using cocaine. Some people experience
formication and describe bugs crawling under the skin.
Answers:
1.) C- In the termination phase, the relationship comes to a close. Ending treatment
can sometimes be traumatic for clients who have come to value the relationship
and the help. Since loss is an issue, any unresolved feelings related to loss may
resurface during this phase.
2.) C- Responding to the feelings expressed by a client is an effective therapeutic
communication technique. The correct option sis an example of restating. A, B,
and D block communication because they minimize the client’s experience and
do not facilitate exploration of the client’s expressed feelings.
3.) D- the most therapeutic nursing communication technique is restating. Although it
is a technique that has prompting component to it, it repeats the client major
theme, which assists the nurse to obtain a more specific perception of the
problem from the client.
4.) C- Option C is the only option that identifies a therapeutic response. In option A,
the nurse’s feelings are the focus. This response clearly ignores the fact that the
issue is about the client and the client’s discomfort, not about the nurse. In option
B, the nurse become pompous and a bit angry and supercilious, which is not
therapeutic? In option D, the nurse begins correctly with n empathic stance but
then becomes demanding.
5.) D- The Native American view touch very differently from other Americans. The
most therapeutic response is the one that reflects the client’s feelings and
empowers the client by offering self control over one’s own care.
6.) A- Open ended questions and silence are strategies used to encourage clients to
discuss their problem.
7.) D- The client must first deal with feelings and negative responses before being
able to work through the meaning of the crisis.

21. 8.) A- Denial is an adaptive and protective reaction and maybe a response by a
victim of sexual abuse.
9.) C- The clients thought are extremely important when verbalized. A client’s report
of suicidal thoughts is of the highest priority.
10.) D- option D helps the client to focus on the emotion underlying the delusion but
does not argue with it.
11.) D- safety of the client, other clients and staff is o prime concern.
12.) B- denial is refusal to admit to a painful reality, which is treated as if it does not
exist
13.) D- Most suicides occur within 3 months after the beginning of the improvement,
when the client has the energy to carry out the suicidal intentions.
14.) D- Ego defense mechanisms are operations outside a person’s awareness that
the ego calls into play to protect against anxiety. Displacement is the discharging
of pent-up feelings on persons less dangerous than those who initially aroused
the emotion.
15.) A- restating is the therapeutic communication technique in which the nurse
repeats the client says to show understanding and to review what was said.