NCM 112 VRLE EVALUATION EXAM

1) In a recumbent, immobilized patient, lung ventilation can become altered, leading to such respiratory
complications as:
A. Respiratory acidosis, ateclectasis, and hypostatic pneumonia
B. Appneustic breathing, atypical pneumonia and respiratory alkalosis
C. Cheyne-Strokes respirations and spontaneous pneumothorax
D. Kussmail’s respirations and hypoventilation

2) The nurse is preparing her plan of care for her patient diagnosed with pneumonia. Which is the most
appropriate nursing diagnosis for this patient?
A. Fluid volume deficit
B. Decreased tissue perfusion.
C. Impaired gas exchange.
D. Risk for infection

3) A 65-year-old patient with pneumonia is receiving garamycin (Gentamicin). It would be MOST

important for a nurse to monitor which of the following laboratory values in this patient?
A. Hemoglobin and hematocrit.
B. BUN and creatinine.
C. Platelet count and clotting time.
D. Sodium and potassium.

4) A client with bacterial pneumonia is admitted to the pediatric unit. What would the nurse expect the
admitting assessment to reveal?
A. High fever
B. Nonproductive cough
C. Rhinitis
D. Vomiting and diarrhea

5) A firefighter who was involved in extinguishing a house fire is being treated for smoke inhalation. He
develops severe hypoxia 48 hours after the incident, requiring intubation and mechanical ventilation.
Which of the following conditions has he most likely developed?
A. Acute respiratory distress syndrome (ARDS).
B. Atelectasis.
C. Bronchitis.
D. Pneumonia.

6) Using IMCI guidelines, you classify a child as having severe pneumonia. What is the best management
for the child?
A. Prescribe an antibiotic.
B. Refer him urgently to the hospital.
C. Instruct the mother to increase fluid intake.
D. Instruct the mother to continue breastfeeding.

7) Which order can be associated with the prevention of atelectasis and pneumonia in a client with
amyotrophic lateral sclerosis?
A. Active and passive range of motion exercises twice a day
B. Every 4 hours incentive spirometer
C. Chest physiotherapy twice a day
D. Repositioning every 2 hours around the clock

8) A client with pneumacystis carini pneumonia is receiving trimetrexate. The rationale for administering
leucovorin calcium to a client receiving Methotrexate is to:
A. Treat anemia.
B. Create a synergistic effect.
C. Increase the number of white blood cells.
D. Reverse drug toxicity.

9) Which of the following community-acquired pneumonias demonstrates the highest occurrence during
summer and fall?
A. Legionnaires’ disease
B. Streptococcal (pneumococcal) pneumonia
C. Mycoplasma pneumonia
D. Viral pneumonia
 NCM 112 VRLE EVALUATION EXAM
10) Braguda brought her 5-month old daughter in the nearest RHU because her baby sleeps most of the
time, with decreased appetite, has colds and fever for more than a week. The physician diagnosed
pneumonia. Based on this data given by Braguda, you can classify Braguda’s daughter to have:
A. Pneumonia: cough and colds
B. Severe pneumonia
C. Very severe pneumonia
D. Pneumonia moderate

11) A client is diagnosed with methicillin resistant staphylococcus aureus pneumonia. What type of
isolation is MOST appropriate for this client?
A. Reverse isolation
B. Respiratory isolation
C. Standard precautions
D. Contact isolation

12) The home health nurse is planning for the day’s visits. Which client should be seen first?
A. The 78-year-old who had a gastrectomy 3 weeks ago and has a PEG tube
B. The 5-month-old discharged 1 week ago with pneumonia who is being treated with amoxicillin
liquid suspension
C. The 50-year-old with MRSA being treated with Vancomycin via a PICC line
D. The 30-year-old with an exacerbation of multiple sclerosis being treated with cortisone via a
centrally placed venous catheter

13) An elderly client with pneumonia may appear with which of the following symptoms first?
A. Altered mental status and dehydration
B. fever and chills
C. Hemoptysis and dyspnea
D. Pleuretic chest pain and cough

14) While caring for an HIV-positive patient who is hospitalized with Pneumocystis carinii pneumonia,
you note that all of these drug therapies are scheduled for 10:00 AM. Which nursing action is most
essential to accomplish at the scheduled time?
A. Administer the protease inhibitor indinavir (Crixivan) 800 mg PO.
B. Infuse pentamidine (Pentam-300) 300 mg IV over 60 minutes.
C. Have the patient “swish and swallow” nystatin (Mycostatin) 5 mL.
D. Apply acyclovir (Zovirax) cream to oral herpes simplex lesions.

15) Which of the following signs will indicate that a young child is suffering from severe pneumonia?
A. Dyspnea
B. Wheezing
C. Fast breathing
D. Chest indrawing

16) A client with AIDS develops bacterial pneumonia is admitted in the emergency department. The
client’s arterial blood gases is drawn and the result is PaO2 80mmHg. then arterial blood gases are drawn
again and the level is reduced from 80 mmHg to 65 mmHg. The nurse should;
A. Have arterial blood gases performed again to check for accuracy.
B. Increase the oxygen flow rate.
C. Notify the physician.
D. Decrease the tension of oxygen in the plasma.

17) The nurse is caring for four clients on a stepdown intensive care unit. The client at the highest risk for
developing nosocomial pneumonia is the one who:
A. has a respiratory infection
B. is intubated and on a ventilator
C. has pleural chest tubes
D. is receiving feedings through a jejunostomy tube

18) You are evaluating an HIV-positive patient who is receiving IV pentamidine (Pentam) as a treatment
for Pneumocystis carinii pneumonia. Which information is most important to communicate to the
physician?
A. The blood pressure decreased to 104/76 during administration.
B. The patient is complaining of pain at the site of the infusion.
C. The patient is not taking in an adequate amount of oral fluids.
D. Blood glucose is 55 mg/dL after the medication administration.
 NCM 112 VRLE EVALUATION EXAM
19) For a 3-month old child to be classified to have Pneumonia (not severe), you would expect to find RR
of:
A. 60 bpm
B. 40 bpm
C. 70 bpm
D. 50 pbm

20) Nurse Betty is assessing tactile fremitus in a client with pneumonia. For this examination, nurse Betty
should use the:
A. Fingertips
B. Finger pads
C. Dorsal surface of the hand
D. Ulnar surface of the hand

21) A 20-year-old patient is being treated for pneumonia. He has a persistent cough and complains of
severe pain on coughing. What could you tell him to help him reduce his discomfort?
A. “Hold your cough as much as possible.”
B. “Place the head of your bed flat to help with coughing.”
C. “Restrict fluids to help decrease the amount of sputum.”
D. “Splint your chest wall with a pillow for comfort.”

22) A male client with pneumonia develops respiratory failure and has a partial pressure of arterial
oxygen of 55 mm Hg. He’s placed on mechanical ventilation with a fraction of inspired oxygen (FIO2) of
0.9. The nursing goal should be to reduce the FIO2 to no greater than:
A. 0.21
B. 0.35
C. 0.5
D. 0.7

23) Mr. Jose is admitted to the hospitalwith a diagnosis of pneumonia and COPD. The physician orders
an oxygen therapy for him. The most comfortable method of delivering oxygen to Mr. Jose is by:
A. Croupette
B. Nasal Cannula
C. Nasal catheter
D. Partial rebreathing mask

24) A male client with pneumococcal pneumonia is admitted to an acute care facility. The client in the
next room is being treated for mycoplasmal pneumonia. Despite the different causes of the various types
of pneumonia, all of them share which feature?
A. Inflamed lung tissue
B. Sudden onset
C. Responsiveness to penicillin.
D. Elevated white blood cell (WBC) count

25) The priority is postoperative respiratory toilet. This client will quickly develop profound atelectasis
and eventually pneumonia without adequate gas exchange. This will only be achieved with the
appropriate pain management.
A. Pallor
B. Increased temperature
C. Dyspnea
D. Involuntary muscle spasms

26) A client with pneumonia is receiving supplemental oxygen, 2 L/min via nasal cannula. The client’s
history includes chronic obstructive pulmonary disease (COPD) and coronary artery disease. Because of
these findings, the nurse closely monitors the oxygen flow and the client’s respiratory status. Which
complication may arise if the client receives a high oxygen concentration?
A. Apnea
B. Anginal pain
C. Respiratory alkalosis
D. Metabolic acidosis
 NCM 112 VRLE EVALUATION EXAM
27) A male elderly client is admitted to an acute care facility with influenza. The nurse monitors the client
closely for complications. What is the most common complication of influenza?
A. Septicemia
B. Pneumonia
C. Meningitis
D. Pulmonary edema

28) An 80-year-old male client is admitted to the hospital with a diagnosis of pneumonia. Nurse Oliver
learns that the client lives alone and hasn’t been eating or drinking. When assessing him for dehydration,
nurse Oliver would expect to find:
A. Hypothermia
B. Hypertension
C. Distended neck veins
D. Tachycardia

29) A male client admitted to an acute care facility with pneumonia is receiving supplemental oxygen, 2
L/minute via nasal cannula. The client’s history includes chronic obstructive pulmonary disease (COPD)
and coronary artery disease. Because of these history findings, the nurse closely monitors the oxygen flow
and the client’s respiratory status. Which complication may arise if the client receives a high oxygen
concentration?
A. Apnea
B. Anginal pain
C. Respiratory alkalosis
D. Metabolic acidosis

30) Which of the following would be an appropriate nursing diagnosis for a hospitalized client with
bacterial pneumonia and shortness of breath?
A. Ineffective cardiopulmonary tissue perfusion related to myocardial damage
B. Risk for self-care deficit related to fatigue
C. Deficient fluid volume related to nausea and vomiting
D. Disturbed thought processes related to inadequate relief of chest pain

31) Which of the following is not directly associated with the lymphatic pathway?
A. Lymphatic trunk
B. Collecting duct
C. Subclavian vein
D. Carotid arteries

32) The thymus is responsible for secreting _____ from epithelial cells.
A. Thymosin
B. Growth hormone
C. Macrophages
D. Plasma cells

33) Which of the following types of cytokines is responsible for the growth and maturation of B cells?
A. Interleukin-1
B. Interleukin-2
C. Interleukin-4
D. Interleukin-7

34) Which of the following types of immunoglobulins is the most responsible for promoting allergic
reactions?
A. IgA
B. IgM
C. IgD
D. IgE

35) Which of the following types of immunoglobulins is located on the surface of most B-lymphocytes?
A. IgA
B. IgM
C. IgD
D. IgE
 NCM 112 VRLE EVALUATION EXAM
36) Which of the following types of immunoglobulins does not cross the barrier between mother and
infant in the womb?
A. IgA
B. IgM
C. IgD
D. IgE

37) Which of the following is not an autoimmune disease?

A. Graves disease
B. Myasthenia gravis
C. Insulin-dependent diabetes mellitus
D. Alzheimer’s disease

38) T-cell activation requires a/an _______ cell.

A. Activation
B. Accessory
C. Plasma
D. Helper

39) The thymus is located with the _______.

A. Mediastinum
B. Peristinum
C. Epistinum
D. Endostinum

40) Which of the following statements is false regarding the spleen?

A. Divided up into lobules
B. Similar to a large lymph node
C. Contains macrophages
D. Limited blood within the lobules

41) Which of the following is not considered a central location of lymph nodes?
A. Cervical
B. Axillary
C. Inguinal
D. Tibial

42) Lymphocytes that reach the thymus become _____.

A. T-cells
B. B-cells
C. Plasma cells
D. Beta cells

43) Lymphocytes that do not reach the thymus become _____.

A. T-cells
B. B-cells
C. Plasma cells
D. Beta cells

44) Which of the following is associated with a B cell deficiency?

A. Job’s syndrome
B. Chronic granulomatous disease
C. Bruton’s agammaglobulinemia
D. Wiskott-Aldrich syndrome

45) Which of the following is the autoantibody for systemic lupus?

A. Anti-microsomal
B. Antinuclear antibodies
C. Anti-gliadin
D. Anti-histone

46) The TB skin test is an example of ______.

A. Delayed hypersensitivity
B. Serum sickness
C. Cytotoxic reaction
D. Arthus reaction
 NCM 112 VRLE EVALUATION EXAM
47) Which of the following types of cytokines is secreted by macrophages?
A. IL-1
B. IL-2
C. IL-3
D. IL-4

48) Which of the following types of immunoglobulins binds complement?

A. IgA
B. IgD
C. IgE
D. IgG
49) Which of the following is a key component of cytotoxic T cells?
A. CD2
B. CD4
C. CD8
D. CD10
50) Which of the following is not a primary target group of T cells?
A. Viruses
B. Toxins
C. Fungi
D. TB

51) The nurse should visit which of the following clients first?
A. The client with diabetes with a blood glucose of 95mg/dL
B. The client with hypertension being maintained on Lisinopril
C. The client with chest pain and a history of angina
D. The client with Raynaud’s disease

52) A 23 year old patient in the 27th week of pregnancy has been hospitalized on complete bed rest for 6
days. She experiences sudden shortness of breath, accompanied by chest pain. Which of the following
conditions is the most likely cause of her symptoms?
A. Myocardial infarction due to a history of atherosclerosis.
B. Pulmonary embolism due to deep vein thrombosis (DVT).
C. Anxiety attack due to worries about her baby’s health.
D. Congestive heart failure due to fluid overload.

53) What is the primary reason for administering morphine to a client with myocardial infarction?
A. To sedate the client
B. To decrease the client’s pain
C. To decrease the client’s anxiety
D. To decrease oxygen demand on the client’s heart

54) A patient arrives in the emergency department with symptoms of myocardial infarction, progressing
to cardiogenic shock. Which of the following symptoms should the nurse expect the patient to exhibit
with cardiogenic shock?
A. Hypertension.
B. Bradycardia.
C. Bounding pulse.
D. Confusion.

55) In order to be effective, Percutaneous Transluminal Coronary Angioplasty (PTCA) must be

performed within what time frame, beginning with arrival at the emergency department after diagnosis of
myocardial infarction?
A. 60 minutes
B. 30 minutes
C. 9 days
D. 6-12 months

56) Helen, a nurse from the maternity unit is floated to the critical care unit because of staff shortage on
the evening shift. Which client would be appropriate to assign to this nurse? A client with:
A. Dopamine drip IV with vital signs monitored every 5 minutes
B. a myocardial infarction that is free from pain and dysrhythmias
C. a tracheotomy of 24 hours in some respiratory distress
D. a pacemaker inserted this morning with intermittent capture
 NCM 112 VRLE EVALUATION EXAM
57) A female client is brought by ambulance to the hospital emergency room after taking an overdose of
barbiturates is comatose. Nurse Trish would be especially alert for which of the following?
A. Epilepsy
B. Myocardial Infarction
C. Renal failure
D. Respiratory failure

58) Tissue plasminogen activator (t-PA) is considered for treatment of a patient who arrives in the
emergency department following onset of symptoms of myocardial infarction. Which of the following is a
contraindication for treatment with t-PA?
A. Worsening chest pain that began earlier in the evening.
B. History of cerebral hemorrhage.
C. History of prior myocardial infarction.
D. Hypertension.

59) A patient admitted to the hospital with myocardial infarction develops severe pulmonary edema.
Which of the following symptoms should the nurse expect the patient to exhibit?
A. Slow, deep respirations.
B. Stridor.
C. Bradycardia.
D. Air hunger.

60) A 55-year-old client is admitted with chest pain that radiates to the neck, jaw and shoulders that
occurs at rest, with high body temperature, weak with generalized sweating and with decreased blood
pressure. A myocardial infarction is diagnosed. The nurse knows that the most accurate explanation for
one of these presenting adaptations is:
A. Catecholamines released at the site of the infarction causes intermittent localized pain.
B. Parasympathetic reflexes from the infarcted myocardium causes diaphoresis.
C. Constriction of central and peripheral blood vessels causes a decrease in blood pressure.
D. Inflammation in the myocardium causes a rise in the systemic body temperature.

61) Which of the following is the most common symptom of myocardial infarction?
A. Chest pain
B. Dyspnea
C. Edema
D. Palpitations

62) Nursing measures for the client who has had an MI include helping the client to avoid activity that
results in Valsalva’s maneuver. Valsalva’s maneuver may cause cardiac dysrhythmias, increased venous
pressure, increased intrathoracic pressure and thrombi dislodgement. Which of the following actions
would help prevent Valsalva’s maneuver? Have the client:
A. Assume a side-lying position
B. Clench her teeth while moving in bed
C. Drink fluids through a straw
D. Avoid holding her breath during activity

63) The nurse is giving discharge teaching to a client 7 days post myocardial infarction. He asks the nurse
why he must wait 6 weeks before having sexual intercourse. What is the best response by the nurse to this
question?
A. “You need to regain your strength before attempting such exertion.”
B. “When you can climb 2 flights of stairs without problems, it is generally safe.”
C. “Have a glass of wine to relax you, then you can try to have sex.”
D. “If you can maintain an active walking program, you will have less risk.”

64) Following myocardial infarction, a hospitalized patient is encouraged to practice frequent leg
exercises and ambulate in the hallway as directed by his physician. Which of the following choices
reflects the purpose of exercise for this patient?
A. Increases fitness and prevents future heart attacks.
B. Prevents bedsores.
C. Prevents DVT (deep vein thrombosis).
D. Prevent constipations.
 NCM 112 VRLE EVALUATION EXAM
65) Alzheimer’s disease is the secondary diagnosis of a client admitted with myocardial infarction. Which
nursing intervention should appear on this client’s plan of care?
A. Perform activities of daily living for the client to decease frustration.
B. Provide a stimulating environment.
C. Establish and maintain a routine.
D. Try to reason with the client as much as possible.

66) Which statement best describes the difference between the pain of angina and the pain of myocardial
infarction?
A. Pain associated with angina is relieved by rest.
B. Pain associated with myocardial infarction is always more severe.
C. Pain associated with angina is confined to the chest area.
D. Pain associated with myocardial infarction is referred to the left arm.

67) Patrick who is hospitalized following a myocardial infarction asks the nurse why he is taking
morphine. The nurse explains that morphine:
A. Decrease anxiety and restlessness
B. Prevents shock and relieves pain
C. Dilates coronary blood vessels
D. Helps prevent fibrillation of the heart

68) An early finding in the EKG of a client with an infarcted mycardium would be:
A. Disappearance of Q waves
B. Elevated ST segments
C. Absence of P wave
D. Flattened T waves

69) A nurse caring for several patients on the cardiac unit is told that one is scheduled for implantation of
an automatic internal cardioverter-defibrillator. Which of the following patients is most likely to have this
procedure?
A. A patient admitted for myocardial infarction without cardiac muscle damage.
B. A post-operative coronary bypass patient, recovering on schedule.
C. A patient with a history of ventricular tachycardia and syncopal episodes.
D. A patient with a history of atrial tachycardia and fatigue.

70) Twenty four hours after admission for an Acute MI, Jose’s temperature is noted at 39.3 C. The nurse
monitors him for other adaptations related to the pyrexia, including:
A. Shortness of breath
B. Chest pain
C. Elevated blood pressure
D. Increased pulse rate

71) Mr. Duffy is admitted to the CCU with a diagnosis of R/O MI. He presented in the ER with a typical
description of pain associated with an MI, and is now cold and clammy, pale and dyspneic. He has an IV
of D5W running, and is complaining of chest pain. Oxygen therapy has not been started, and he is not on
the monitor. He is frightened. During the first three days that Mr. Duffy is in the CCU, a number of
diagnostic blood tests are obtained. Which of the following patterns of cardiac enzyme elevation are most
common following an MI?
A. SGOT, CK, and LDH are all elevated immediately.
B. SGOT rises 4-6 hours after infarction with CK and LDH rising slowly 24 hours later.
C. CK peaks first (12-24 hours), followed by the SGOT (peaks in 24-36 hours) and then the LDH
(peaks 3-4 days).
D. CK peaks first and remains elevated for 1 to 2 weeks.

72) To prevent a valsalva maneuver in a client recovering from an acute myocardial infarction, the nurse
would
A. Assist the client to use the bedside commode
B. Administer stool softeners every day as ordered
C. Administer antidysrhythmics prn as ordered
D. Maintain the client on strict bed rest
 NCM 112 VRLE EVALUATION EXAM
73) A male client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial
infarction. Because the client is extremely weak and can’t produce an effective cough, the nurse should
monitor closely for:
A. Pleural effusion.
B. Pulmonary edema.
C. Atelectasis.
D. Oxygen toxicity.

74) A 42-year-old client admitted with an acute myocardial infarction asks to see his chart. What should
the nurse do first?
A. Allow the client to view his chart
B. Contact the supervisor and physician for approval
C. Ask the client if he has concerns about his care
D. Tell the client that he isn’t permitted to view his chart.

75) A client with a history of an anterior wall myocardial infarction is being transferred from the coronary
care unit (CCU) to the cardiac stepdown unit (CSU). While giving report to the CSU nurse, the CCU
nurse says, “His pulmonary artery wedge pressures have been in the high normal range.” The CSU nurse
should be especially observant for:
A. hypertension
B. high urine output
C. dry mucous membranes
D. pulmonary crackles

76) Which patient’s nursing care would be most appropriate for the charge nurse to assign to the LPN,
under the supervision of the RN team leader?
A. A 51-year-old patient with bilateral adrenalectomy just returned from the post-anesthesia care
unit
B. An 83-year-old patient with type 2 diabetes and chronic obstructive pulmonary disease
C. A 38-year-old patient with myocardial infarction who is preparing for discharge
D. A 72-year-old patient admitted from long-term care with mental status changes
77) During the second day of hospitalization of the client after a Myocardial Infarction. Which of the
following is an expected outcome?
A. Able to perform self-care activities without pain
B. Severe chest pain
C. Can recognize the risk factors of Myocardial Infarction
D. Can Participate in cardiac rehabilitation walking program

78) The client with an acute myocardial infarction is hospitalized for almost one week. The client
experiences nausea and loss of appetite. The nurse caring for the client recognizes that these symptoms
may indicate the:
A. Adverse effects of spironolactone (Aldactone)
B. Adverse effects of digoxin (Lanoxin)
C. Therapeutic effects of propranolol (Indiral)
D. Therapeutic effects of furosemide (Lasix)

79) Dr. Marquez orders a continuous intravenous nitroglycerin infusion for the client suffering from
myocardial infarction. Which of the following is the most essential nursing action?
A. Monitoring urine output frequently
B. Monitoring blood pressure every 4 hours
C. Obtaining serum potassium levels daily
D. Obtaining infusion pump for the medication

80) On the evening shift, the triage nurse evaluates several clients who were brought to the emergency
department. Which in the following clients should receive highest priority?
A. an elderly woman complaining of a loss of appetite and fatigue for the past week
B. A football player limping and complaining of pain and swelling in the right ankle
C. A 50-year-old man, diaphoretic and complaining of severe chest pain radiating to his jaw
D. A mother with a 5-year-old boy who says her son has been complaining of nausea and vomited
once since noon
 NCM 112 VRLE EVALUATION EXAM
81. Once a nurse assesses a client’s condition and identifies appropriate nursing diagnoses, a:
A. Plan is developed for nursing care.
B. Physical assessment begins
C. List of priorities is determined.
D. Review of the assessment is conducted with other team members.

82. Planning is a category of nursing behaviors in which:

A. The nurse determines the health care needed for the client.
B. The Physician determines the plan of care for the client.
C. Client-centered goals and expected outcomes are established.
D. The client determines the care needed.

83. Priorities are established to help the nurse anticipate and sequence nursing interventions when a client
has multiple problems or alterations. Priorities are determined by the client’s:
A. Physician
B. Non Emergent, non-life threatening needs
C. Future well-being.
D. Urgency of problems

84. A client centered goal is a specific and measurable behavior or response that reflects a client’s:
A. Desire for specific health care interventions
B. Highest possible level of wellness and independence in function.
C. Physician’s goal for the specific client.
D. Response when compared to another client with a like problem.

85. For clients to participate in goal setting, they should be:

A. Alert and have some degree of independence.
B. Ambulatory and mobile.
C. Able to speak and write.
D. Able to read and write.

86. The nurse writes an expected outcome statement in measurable terms. An example is:
A. Client will have less pain.
B. Client will be pain free.
C. Client will report pain acuity less than 4 on a scale of 0-10.
D. Client will take pain medication every 4 hours around the clock.

87. As goals, outcomes, and interventions are developed, the nurse must:
A. Be in charge of all care and planning for the client.
B. Be aware of and committed to accepted standards of practice from nursing and other disciples.
C. Not change the plan of care for the client.
D. Be in control of all interventions for the client.

88. When establishing realistic goals, the nurse:

A. Bases the goals on the nurse’s personal knowledge.
B. Knows the resources of the health care facility, family, and the client.
C. Must have a client who is physically and emotionally stable.
D. Must have the client’s cooperation.

89. To initiate an intervention the nurse must be competent in three areas, which include:
A. Knowledge, function, and specific skills
B. Experience, advanced education, and skills.
C. Skills, finances, and leadership.
D. Leadership, autonomy, and skills.

90. Collaborative interventions are therapies that require:

A. Physician and nurse interventions.
B. Nurse and client interventions.
C. Client and Physician intervention.
D. Multiple health care professionals.
 NCM 112 VRLE EVALUATION EXAM
91. Well formulated, client-centered goals should:
A. Meet immediate client needs.
B. Include preventative health care.
C. Include rehabilitation needs.
D. All of the above.

92. The following statement appears on the nursing care plan for an immunosuppressed client: The client
will remain free from infection throughout hospitalization. This statement is an example of a (an):
A. Nursing diagnosis
B. Short-term goal
C. Long-term goal
D. Expected outcome

93. The following statements appear on a nursing care plan for a client after a mastectomy: Incision site
approximated; absence of drainage or prolonged erythema at incision site; and client remains afebrile.
These statements are examples of:
A. Nursing interventions
B. Short-term goals
C. Long-term goals
D. Expected outcomes.

94. The planning step of the nursing process includes which of the following activities?
A. Assessing and diagnosing
B. Evaluating goal achievement.
C. Performing nursing actions and documenting them.
D. Setting goals and selecting interventions.

95. The nursing care plan is:

A. A written guideline for implementation and evaluation.
B. A documentation of client care.
C. A projection of potential alterations in client behaviors
D. A tool to set goals and project outcomes.

96. After determining a nursing diagnosis of acute pain, the nurse develops the following appropriate
client-centered goal:
A. Encourage client to implement guided imagery when pain begins.
B. Determine effect of pain intensity on client function.
C. Administer analgesic 30 minutes before physical therapy treatment.
D. Pain intensity reported as a 3 or less during hospital stay.

97. When developing a nursing care plan for a client with a fractured right tibia, the nurse includes in the
plan of care independent nursing interventions, including:
A. Apply a cold pack to the tibia.
B. Elevate the leg 5 inches above the heart.
C. Perform range of motion to right leg every 4 hours.
D. Administer aspirin 325 mg every 4 hours as needed.

98. Which of the following nursing interventions are written correctly? (Select all that apply.)
A. Apply continuous passive motion machine during day.
B. Perform neurovascular checks.
C. Elevate head of bed 30 degrees before meals.
D. Change dressing once a shift.

99. A client’s wound is not healing and appears to be worsening with the current treatment. The nurse
first considers:
A. Notifying the physician.
B. Calling the wound care nurse
C. Changing the wound care treatment.
D. Consulting with another nurse.
100. When calling the nurse consultant about a difficult client-centered problem, the primary nurse is sure
to report the following:
A. Length of time the current treatment has been in place.
B. The spouse’s reaction to the client’s dressing change.
C. Client’s concern about the current treatment.
D. Physician’s reluctance to change the current treatment plan.
 NCM 112 VRLE EVALUATION EXAM
1. A. Respiratory acidosis, ateclectasis, and hypostatic pneumonia . Because of restricted respiratory
movement, a recumbent, immobilize patient is at particular risk for respiratory acidosis from poor
gas exchange; atelectasis from reduced surfactant and accumulated mucus in the bronchioles, and
hypostatic pneumonia from bacterial growth caused by stasis of mucus secretions.

2. C. Impaired gas exchange. Pneumonia, which is an infection, causes lobar consolidation thus

impairing gas exchange between the alveoli and the blood. Because the patient would require
adequate hydration, this makes him prone to fluid volume excess.

3. B. BUN and creatinine. Question: Which lab values should you monitor for a patient receiving
Gentamicin? Needed Info: Gentamicin: broad spectrum antibiotic. Side effects: neuromuscular
blockage, ototoxic to eighth cranial nerve (tinnitus, vertigo, ataxia, nystagmus, hearing loss),
nephrotoxic. Nursing responsibilities: monitor renal function, force fluids, monitor hearing
acuity. Draw blood for peak levels 1 hr. after IM and 30 min
 – 1 hr. after IV infusion, draw blood for trough just before next dose.
 -Hemoglobin and hematocrit — can cause anemia; less common
 -BUN and creatinine — CORRECT: nephrotoxic; will see proteinuria, oliguria,
hematuria, thirst, increased BUN, decreased creatine clearance
 -Platelet count and clotting time — do not usually change
 -Sodium and potassium — hypokalemia infrequent problem
4.  A. High fever . If the child has bacterial pneumonia, a high fever is usually present. Bacterial
pneumonia usually presents with a productive cough, not a nonproductive cough, making answer
B incorrect. Rhinitis is often seen with viral pneumonia, and vomiting and diarrhea are usually
not seen with pneumonia,
5. A. Acute respiratory distress syndrome (ARDS). Severe hypoxia after smoke inhalation typically
is related to ARDS. The other choices aren’t typically associated with smoke inhalation.
6. B. Refer him urgently to the hospital. Severe pneumonia requires urgent referral to a hospital.
Other options are done for a client classified as having pneumonia.
7. C. Chest physiotherapy twice a day. These clients have a potential for an inability to have
voluntary and involuntary muscle movement or activity.Thus, active and passive range of motion
exercises twice a day and every 4 hours incentive spirometer are inadequate with this problem in
mind. Repositioning every 2 hours around the clock is not specific for prevention of
complications associated with the lung.
8. D. Reverse drug toxicity.
9. A. Legionnaires’ disease . Legionnaires’ disease accounts for 15% of community-acquired
pneumonias. Streptococcal pneumonia demonstrates the highest occurrence in winter
months.Mycoplasma pneumonia demonstrates the highest occurrence in fall and early
winter.Viral pneumonia demonstrates the greatest incidence during winter months.
10. B. Severe pneumonia . For a child aging 2months up to 5 years old can be classified to have
severe pneumonia when he have any of the following danger signs:
 Not able to drink
 Convulsions
 Abnormally sleepy or difficult to wake
 Stridor in calm child or
 Severe under-nutrition
11. D. Contact isolation . Contact or Body Substance Isolation (BSI) involves the use of barrier
protection (e.g. gloves, mask, gown, or protective eyewear as appropriate) whenever direct
contact with any body fluid is expected. When determining the type of isolation to use, one must
consider the mode of transmission. The hands of personnel continues to be the principal mode of
transmission for methicillin resistant staphylococcus aureus (MRSA). Because the organism is
limited to the sputum in this example, precautions are taken if contact with the patient”s sputum
is expected. A private room and BSI, along with good hand washing techniques, are the best
defense against the spread of MRSA pneumonia.
12. D. The 30-year-old with an exacerbation of multiple sclerosis being treated with cortisone via a
centrally placed venous catheter . The client at highest risk for complications is the client with
multiple sclerosis who is being treated with cortisone via the central line. The others are more
stable. MRSA is methicillin-resistant staphylococcus aureus. Vancomycin is the drug of choice
and is given at scheduled times to maintain blood levels of the drug.
13. A. Altered mental status and dehydration . Fever, chills, hemoptysis, dyspnea, cough, and pleuric
chest pain are the common symptoms of pneumonia, but elderly clients may first appear with
only an altered mental status and dehydration due to a blunted immune response.
14. A. Administer the protease inhibitor indinavir (Crixivan) 800 mg PO. Taking antiretroviral
medications such as indinavir on a rigid time schedule is essential for effective treatment of HIV
infection and to avoid development of drug resistant-strains of the virus. The other medications
should also be given within the time frame indicated in the hospital policy (usually within 30
minutes of the scheduled time).
 NCM 112 VRLE EVALUATION EXAM
15. D. Chest indrawing . In IMCI, chest indrawing is used as the positive sign of dyspnea, indicating
severe pneumonia.
16. C. Notify the physician. This decrease in PaO2 indicates respiratory failure; it warrants
immediate medical evaluation.
17. B. is intubated and on a ventilator . When clients are on mechanical ventilation, the artificial
airway impairs the gag and cough reflexes that help keep organisms out of the lower respiratory
tract. The artificial airway also prevents the upper respiratory system from humidifying and
heating air to enhance mucociliary clearance. Manipulations of the artificial airway sometimes
allow secretions into the lower airways. Whit standard procedures the other choices wouldn’t be
at high risk.
18. D. Blood glucose is 55 mg/dL after the medication administration. Pentamidine can cause fatal
hypoglycemia, so the low blood glucose level indicates a need for a change in therapy. The low
blood pressure suggests that the IV infusion rate may need to be slowed. The other responses
indicated need for independent nursing actions (such as obtaining a new IV site and encouraging
oral intake) but are not associated with pentamidine infusion.
19. D. 50 pbm. A child can be classified to have Pneumonia (not severe) if:
 the young infant is less than 2 months- 60 bpm or more
  if the child is 2 months up to less than 12 months- 50 bpm or more
 if the child is 12 months to 4 y/o- 40 bpm or more
20. D. Ulnar surface of the hand . The nurse uses the ulnar surface, or ball, of the hand to asses tactile
fremitus, thrills, and vocal vibrations through the chest wall. The fingertips and finger pads best
distinguish texture and shape. The dorsal surface best feels warmth.
21. D. “Splint your chest wall with a pillow for comfort.” Showing this patient how to splint his chest
wall will help decrease discomfort when coughing. Holding in his coughs will only increase his
pain. Placing the head of the bed flat may increase the frequency of his cough and his work of
breathing. Increasing fluid intake will help thin his secretions, making it easier for him to clear
them.
22. C. 0.5 . An FO2 greater than 0.5 for as little as 16 to 24 hours can be toxic and can lead to
decreased gas diffusion and surfactant activity. The ideal oxygen source is room air F IO 2 0.18
to 0.21.
23. B. Nasal Cannula. The nasal cannula is the most comfortable method of delivering oxygen
because it allows the patient to talk, eat and drink.
24. A. Inflamed lung tissue . The common feature of all types of pneumonia is an inflammatory
pulmonary response to the offending organism or agent. Although most types of pneumonia have
a sudden onset, a few (such as anaerobic bacterial pneumonia and mycoplasmal pneumonia) have
an insidious onset. Antibiotic therapy is the primary treatment for most types of pneumonia;
however, the antibiotic must be specific for the causative agent, which may not be responsive to
penicillin. A few types of pneumonia, such as viral pneumonia, aren’t treated with antibiotics.
Although pneumonia usually causes an elevated WBC count, some types, such as mycoplasmal
pneumonia, don’t.
25. C. Dyspnea. Client’s having the insertion of a central venous catheter are at risk for tension
pneumothorax. Dyspnea, shortness of breath and chest pain are indications of this complication.
26. A. Apnea . Hypoxia is the main breathing stimulus for a client with COPD. Excessive oxygen
administration may lead to apnea by removing that stimulus. Anginal pain results from a reduced
myocardial oxygen supply. A client with COPD may have anginal pain from generalized
vasoconstriction secondary to hypoxia; however, administering oxygen at any concentration
dilates blood vessels, easing anginal pain. Respiratory alkalosis results from alveolar
hyperventilation, not excessive oxygen administration. In a client with COPD, high oxygen
concentrations decrease the ventilatory drive, leading to respiratory acidosis, not alkalosis. High
oxygen concentrations don’t cause metabolic acidosis.
27. B. Pneumonia . Pneumonia is the most common complication of influenza. It may be either
primary influenza viral pneumonia or pneumonia secondary to a bacterial infection. Other
complications of influenza include myositis, exacerbation of chronic obstructive pulmonary
disease, and Reye’s syndrome. Myocarditis, pericarditis, transverse myelitis, and encephalitis are
rare complications of influenza. Although septicemia may arise when any infection becomes
overwhelming, it rarely results from influenza. Meningitis and pulmonary edema aren’t
associated with influenza.
28. D. Tachycardia . With an extracellular fluid or plasma volume deficit, compensatory mechanisms
stimulate the heart, causing an increase in heart rate.
29. A. Apnea . Hypoxia is the main breathing stimulus for a client with COPD. Excessive oxygen
administration may lead to apnea by removing that stimulus. Anginal pain results from a reduced
myocardial oxygen supply. A client with COPD may have anginal pain from generalized
vasoconstriction secondary to hypoxia; however, administering oxygen at any concentration
dilates blood vessels, easing anginal pain. Respiratory alkalosis results from alveolar
hyperventilation, not excessive oxygen administration. In a client with COPD, high oxygen
 NCM 112 VRLE EVALUATION EXAM
concentrations decrease the ventilatory drive, leading to respiratory acidosis, not alkalosis. High
oxygen concentrations don’t cause metabolic acidosis.
30. B. Risk for self-care deficit related to fatigue 

31. D. Carotid arteries 

32. A. Thymosin 
33. C. Interleukin-4
34. D. IgE 
35. C. IgD
36. A. IgA
37. D. Alzheimer’s disease
38. B. Accessory 
39. A. Mediastinum 
40. D. Limited blood within the lobules
41. D. Tibial 
42. A. T-cells 
43. B. B-cells
44. C. Bruton’s agammaglobulinemia 
45. B. Antinuclear antibodies 
46. A. Delayed hypersensitivity 
47. A. IL-1 
48. D. IgG 
49. C. CD8 
50. B. Toxins 

51. C. The client with chest pain and a history of angina . The client with chest pain should be seen
first because this could indicate a myocardial infarction. The client in answer A has a blood
glucose within normal limits. The client in answer B is maintained on blood pressure medication.
The client in answer D is in no distress.
52. B. Pulmonary embolism due to deep vein thrombosis (DVT). In a hospitalized patient on
prolonged bed rest, he most likely cause of sudden onset shortness of breath and chest pain is
pulmonary embolism. Pregnancy and prolonged inactivity both increase the risk of clot formation
in the deep veins of the legs. These clots can then break loose and travel to the lungs. Myocardial
infarction and atherosclerosis are unlikely in a 27-year-old woman, as is congestive heart failure
due to fluid overload. There is no reason to suspect an anxiety disorder in this patient. Though
anxiety is a possible cause of her symptoms, the seriousness of pulmonary embolism demands
that it be considered first.
53. D. To decrease oxygen demand on the client’s heart . Morphine is administered because it
decreases myocardial oxygen demand. Morphine will also decrease pain and anxiety while
causing sedation, but isn’t primarily given for those reasons.
54. D. Confusion. Cardiogenic shock severely impairs the pumping function of the heart muscle,
causing diminished blood flow to the organs of the body. This results in diminished brain
function and confusion, as well as hypotension, tachycardia, and weak pulse. Cardiogenic shock
is a serious complication of myocardial infarction with a high mortality rate.
55. A. 60 minutes . The sixty minute interval is known as “door to balloon time” for performance of
PTCA on a diagnosed MI patient.
56. B. a myocardial infarction that is free from pain and dysrhythmias. This client is the most stable
with minimal risk of complications or instability. The nurse can utilize basic nursing skills to care
for this client.
57. D. Respiratory failure . Barbiturates are CNS depressants; the nurse would be especially alert for
the possibility of respiratory failure. Respiratory failure is the most likely cause of death from
barbiturate over dose.
58. B. History of cerebral hemorrhage. A history of cerebral hemorrhage is a contraindication to tPA
because it may increase the risk of bleeding. TPA acts by dissolving the clot blocking the
coronary artery and works best when administered within 6 hours of onset of symptoms. Prior MI
is not a contraindication to tPA. Patients receiving tPA should be observed for changes in blood
pressure, as tPA may cause hypotension.
59. D. Air hunger. Patients with pulmonary edema experience air hunger, anxiety, and agitation.
Respiration is fast and shallow and heart rate increases. Stridor is noisy breathing caused by
laryngeal swelling or spasm and is not associated with pulmonary edema.
60. D. Inflammation in the myocardium causes a rise in the systemic body
temperature. . Temperature may increase within the first 24 hours and persist as long as a week.
61. A. Chest pain . The most common symptom of an MI is chest pain, resulting from deprivation of
oxygen to the heart. Dyspnea is the second most common symptom, related to an increase in the
 NCM 112 VRLE EVALUATION EXAM
metabolic needs of the body during an MI. Edema is a later sign of heart failure, often seen after
an MI. Palpitations may result from reduced cardiac output, producing arrhythmias.
62. D. Avoid holding her breath during activity 
63. B. “When you can climb 2 flights of stairs without problems, it is generally safe.” “When you can
climb 2 flights of stairs without problems, it is generally safe.” There is a risk of cardiac rupture
at the point of the myocardial infarction for about 6 weeks. Scar tissue should form about that
time. Waiting until the client can tolerate climbing stairs is the usual advice given by health care
providers.
64. C. Prevents DVT (deep vein thrombosis). Exercise is important for all hospitalized patients to
prevent deep vein thrombosis. Muscular contraction promotes venous return and prevents
hemostasis in the lower extremities. This exercise is not sufficiently vigorous to increase physical
fitness, nor is it intended to prevent bedsores or constipation.
65. C. Establish and maintain a routine. Establishing and maintaining a routine is essential to
decreasing extraneous stimuli. The client should participate in daily care as much as possible.
Attempting to reason with such clients isn’t successful, because they can’t participate in abstract
thinking.
66. A. Pain associated with angina is relieved by rest. Pain associated with angina is relieved by rest.
Answer B is incorrect because it is not a true statement. Answer Pain associated with angina is
confined to the chest area is incorrect because pain associated with angina can be referred to the
jaw, the left arm, and the back. Pain associated with myocardial infarction is referred to the left
arm is incorrect because pain from a myocardial infarction can be referred to areas other than the
left arm.
67. B. Prevents shock and relieves pain. Morphine is a central nervous system depressant used to
relieve the pain associated with myocardial infarction, it also decreases apprehension and
prevents cardiogenic shock.
68. B. Elevated ST segments . This is a typical early finding after a myocardial infarct because of the
altered contractility of the heart. The other choices are not typical of MI.
69. C. A patient with a history of ventricular tachycardia and syncopal episodes. . An automatic
internal cardioverter-defibrillator delivers an electric shock to the heart to terminate episodes of
ventricular tachycardia and ventricular fibrillation. This is necessary in a patient with significant
ventricular symptoms, such as tachycardia resulting in syncope. A patient with myocardial
infarction that resolved with no permanent cardiac damage would not be a candidate. A patient
recovering well from coronary bypass would not need the device. Atrial tachycardia is less
serious and is treated conservatively with medication and cardioversion as a last resort.
70. D. Increased pulse rate . Fever causes an increase in the body’s metabolism, which results in an
increase in oxygen consumption and demand. This need for oxygen increases the heart rate,
which is reflected in the increased pulse rate. Increased BP, chest pain and shortness of breath are
not typically noted in fever.
71. C. CK peaks first (12-24 hours), followed by the SGOT (peaks in 24-36 hours) and then the LDH
(peaks 3-4 days). Although the timing of initial elevation, peak elevation, and duration of
elevation vary with sources, current literature favors letter c.
72. B. Administer stool softeners every day as ordered . Administering stool softeners every day will
prevent straining on defecation which causes the Valsalva maneuver. If constipation occurs then
laxatives would be necessary to prevent straining. If straining on defecation produced the valsalva
maneuver and rhythm disturbances resulted then antidysrhythmics would be appropriate.
73. C. Atelectasis. In a client with COPD, an ineffective cough impedes secretion removal. This, in
turn, causes mucus plugging, which leads to localized airway obstruction — a known cause of
atelectasis. An ineffective cough doesn’t cause pleural effusion (fluid accumulation in the pleural
space). Pulmonary edema usually results from left-sided heart failure, not an ineffective cough.
Although many noncardiac conditions may cause pulmonary edema, an ineffective cough isn’t
one of them. Oxygen toxicity results from prolonged administration of high oxygen
concentrations, not an ineffective cough.
74. C. Ask the client if he has concerns about his care
75. D. pulmonary crackles . High pulmonary artery wedge pressures are diagnostic for left-sided
heart failure. With leftsided heart failure, pulmonary edema can develop causing pulmonary
crackles. In leftsided heart failure, hypotension may result and urine output will decline. Dry
mucous membranes aren’t directly associated with elevated pulmonary artery wedge pressures.
76. B. An 83-year-old patient with type 2 diabetes and chronic obstructive pulmonary disease . The
83-year-old patient has no complicating factors at the moment. Providing care for stable and
uncomplicated patients is within the LPN’s educational preparation and scope of practice, with
the care always being provided under the supervision and direction of the RN. The RN should
assess the newly post-operative patient and the new admission. The patient who is preparing for
discharge after MI may need some complex teaching. Focus: Delegation/supervision, assignment
77. A. Able to perform self-care activities without pain . By the 2nd day of hospitalization after
suffering a Myocardial Infarction, Clients are able to perform care without chest pain
 NCM 112 VRLE EVALUATION EXAM
78. B. Adverse effects of digoxin (Lanoxin) . Toxic levels of Lanoxin stimulate the medullary
chemoreceptor trigger zone, resulting in nausea and subsequent anorexia.
79. D. Obtaining infusion pump for the medication . Administration of Intravenous Nitroglycerin
infusion requires pump for accurate control of medication.
80. C. A 50-year-old man, diaphoretic and complaining of severe chest pain radiating to his
jaw . These are likely signs of an acute myocardial infarction (MI). An acute MI is a
cardiovascular emergency requiring immediate attention. Acute MI is potentially fatal if not
treated immediately.

81. A
82. C
83. D
84. B
85. A
86. C
87. B
88. B
89. A
90. D
91. D
92. B
93. D
94. D
95. A
96. D. This is measurable and objective. 
97. B. This does not require a physician’s order. (A & D require an order; C is not appropriate for a
fractured tibia)
98. C. It is specific in what to do and when.
99. B. Calling in the wound care nurse as a consultant is appropriate because he or she is a specialist
in the area of wound management. Professional and competent nurses recognize limitations and
seek appropriate consultation. (a. This might be appropriate after deciding on a plan of action
with the wound care nurse specialist. The nurse may need to obtain orders for special wound care
products. c. Unless the nurse is knowledgeable in wound management, this could delay wound
healing. Also, the current wound management plan could have been ordered by the physician. d.
Another nurse most likely will not be knowledgeable about wounds, and the primary nurse would
know the history of the wound management plan.)
100. A. This gives the consulting nurse facts that will influence a new plan.
(b, c, and d. These are all subjective and emotional issues/conclusions about the current treatment
plan and may cause a bias in the decision of a new treatment plan by the nurse consultant.)