RPN Integrated Post Test IV (A):
1. The PN is teaching a breastfeeding client how to care for breast engorgement. Which statement
indicates that the client has not understood the information?
a. ―I’ll use massage to soften my breast‖
b. ―I will use warm packs or take warm shower to ease my breast engorgement‖ – this is an
appropriate way of treating breast engorgement
c. ―If the baby only feeds on one side, I will express milk on the other side‖ – this is correct
d. ―If my breasts are uncomfortable, I will limit the time I breast the baby‖
Answer: A – breast engorgement is treated with warm compresses and emptying the breast if the mother is planning to breastfeed while cold compresses application if the mother is planning to breastfeed; breast binder or well-fitting bra are additional treatment for both breast and not breastfeeding mothers
th2. On the 10 post partum day, a breastfeeding primiparous client is diagnosed with mastitis. The PN
teaches her about self-care for this condition. Which statement indicates that the client understands
a. ―I should continue to breastfeed unless it becomes too painful‖—breastfeeding will help
open milk ducts which help decreased the swelling in mastitis
b. ―I should stop breastfeeding for several days‖ – the mother is allowed to breastfeed
c. ―I shouldn’t breast feed as long as I am on antibiotics‖ – the mother is allowed to breastfeed
even if taking antibiotics; the infant is well-protected from the antibodies transferred from the
mother during the last trimester of pregnancy and during placental separation
d. ―Mastitis may be associated with breast cancer in later life‖ – this is not correct
3. Which information must be communicated to the mother of a pyloric stenosis newborn:
a. Pyloric stenosis is due to a recessive gene carried by parents – pyloric stenosis is
b. Boys carry the gene and tend to develop the disease – both gender carry the gene; incidence is
higher in boys than girls
c. This disease can be cause by breastfeeding – this is not supported by science
d. Most cause of diarrhea among newborns – pyloric stenosis causes constipation
4. A high school suggests that there is no time to teach proper and safe sex education. How would the
PN promote sex education if high school has no time?
a. Distribute pamphlets to all grades
b. Initiate an after school program session –this will be a better time for students to attend
c. Tell an anonymous website
d. Program teaching to every first year high school class
5. A 72-year old mother, taken cared by her daughter at home, has incontinence episodes. Which of
the following health teachings on promoting skin integrity provided by the PN to the patient’s
daughter is most appropriate?
a. Teach the daughter to wash the patient with soap and water after each urination.—this
prevents skin breakdown
b. Instruct the daughter to wash and apply skin barrier and incontinent pad –skin barrier is not
applied to an intact skin
c. Encourage the daughter to frequently reposition the patient- this prevents skin breadown
d. Teach the daughter to wash, clean, dry, apply skin barrier, pads and reposition the patient.
6. A woman with a boyfriend diagnosed with gonorrhea got pregnant. She was concerned that her
boyfriend’s disease may greatly affect the growing fetus. What would be the best nursing
a. Pelvic inflammatory disease (PID) could predispose to preterm delivery.
b. It will cause abnormality and birth defects.
c. It would affect the pregnancy, you should consult the doctor.—gonorrhea may cause
damage to the growing fetus
d. It is a recurrent disease.
7. On her way to work, the nurse who is sitting at the back of the car, has witnessed a motor
vehicle accident. What would the nurse do?
a. Stop the car and assess the situation. – calling for help and assessment of the situation
would be the right initial intervention
b. Call 911 while attending to the most injured person.
c. Slow down the speed of the car and call 911.
d. Stop the car and attend to clients with head injuries.
8. The PN working in the community is teaching high school students and one of them says, ―Fuck
this‖ and points the pencil at the PN. How would the PN assure her safety? a. Report the student to the principal –the student is under the jurisdiction of the school
b. Reprimand the student
c. Confront the student about his unacceptable behavior
d. Get out of the classroom
9. Gary, with IDDM, was discharged to home, He left his medic alert card in the hospital. He has an
appointment in two weeks at the DM clinic. What should the PN do? a. call and tell him to pick up his card – the patient should be responsible for getting his
b. ask the home care nurse to give his card
c. send it by mail
d. forward the card to the outpatient clinic and instruct to give it to him at his clinic visit
10. At the Long Term Facility, the PN is performing a fall-risk assessment on an elderly client with
history of osteoporosis. The PN should collect related information on: a. Client’s gait and balance – unbalanced gait can be a common cause of fall among
b. The agency’s restraints policy
c. The family psychosocial history
d. The client’s dietary preferences
11. At the accident scene, top priority for the client who sustained blunt chest trauma after a motor
vehicle accident would be:
a. Assess client’s airway -- follow ABC when dealing with emergency
b. Place him in fowler’s position
c. Encourage deep breathing and coughing
d. Splint the chest
12. An obese client comes to the physician’s office for a routine physical examination. The PN
chooses a standard blood pressure cuff to monitor the patient’s BP. If a BP cuff is too small for the
client, BP readings taken with such cuff may do which of the following? a. Fail to show changes in the BP
b. Produce a false-high measurement -- more pressure is applied on the patient’s arm
when the smaller BP cuff is inflated, thus, BP is falsely high
c. Produce a false-low measurement
d. The patient will complain of arm discomfort
13. Which of the following sequence do components of the grieving process occur? a. Denial, acceptance, anger, bargaining, hopelessness, fear
b. Anger, denial, hopelessness, bargaining, acceptance
c. Denial, anger, bargaining, depression, acceptance – this is the correct sequence of the
d. Depression, denial, acceptance, bargaining, anger
14. Dad feels left out when mom is breastfeeding baby. What should PN do?
a. Tell Dad that he can help out in other ways – dad should get involved with the care of
the baby like changing diapers, ect
b. Tell dad that breastfeeding nutrients is important to baby nutrition
c. Tell dad he can bottle feed the baby with breast milk
d. Tell dad that it’s important for mom to bond with the baby
15. The PN is aware that immunization of infants does not begin until 2 months of age because:
a. The neonatal spleen is unable to produce efficient antibodies.
b. Infants under 2 months are rarely exposed to infectious diseases.
c. The immunization would attack the immature infant’s body and produce the disease.
d. Maternal antibodies interfere with the development of active antibodies by the infant.
Answer: D – passive antibodies received from the mother would be diminished by age 8 weeks and would not interfere with the development of active immunity after this time.
16. When teaching an 8-year-old child about insulin injection, what should the PN need to consider?
a. At this stage, children are curious to know how things work –―industry vs. inferiority‖
is the developmental stage of school age children
b. Children of this age believed that things are reversible
c. Education and supervision are key elements of preventing injury
d. Obesity is a risk in this age specially when on insulin
17. The mother brought her toddler for immunization. Before administering the drug, which important
question should be asked by the PN to the mother?
a. History of allergy
b. Any reactions to the vaccine.
c. Last immunization.
d. Preferred site of immunization.
Answer: A – MMR is given at 12 to 15 months. Allergic reaction to eggs must be assessed.
18. The mother brought her child to the clinic. Physical assessment reveals that the child is smaller and
underweight for his age. Which normal findings complement the physical assessment?
a. The boy is Asian
b. The boy is from Europe
c. The boy is Canadian
d. The boy is probably malnourished
Answer: A – Asians usually are smaller than North Americans and European
19. The RPN is teaching a group of women to perform breast self-examination. The PN is aware that
the purpose of performing the examination is to discover:
a. Cancerous lumps – the mass palpated can be malignant or non malignant
b. Areas of thickness or fullness
c. Changes from previous self-examination
d. Fibrocystic masses
20. Which of the following site for venipuncture?
a. Proximal part of the hand
b. Bifurcation site
c. Distal site of the extremity – starting at the distal part of the extremity is appropriate
d. Veins must be firmed and hard
21. What additional health teaching is required after the patient has received their flu shot?
a. Wash hands at home and at work – this is the single and most effective way of
preventing spread of infection
b. Have the patient take anti-flu medications, Vitamin C, and have adequate rest
c. Have the patient take anti-flu medications and sanitize hands
d. Have the patient take lots of fluids and take some rest
22. A teen-ager dad lives in a subsidized apartment. He has 4-year-old daughter and is working at the
same time. Which of the following health determinant affects the client and his daughter?
a. Physical environment
b. Social support
c. Income –the young dad lives in a subsidized housing and this is an implication of
23. Cynthia, 52 years old, has symptoms of menopause. She went to the clinic with complaints of pain
in her joints when walking and high blood pressure. Her family physician advised her to cut down
on her food intake. What food group will be appropriate for this client?
a. Soy beans, fruit, yogurt, bread – low fat, low cholesterol food is essential to patient with
high blood pressure
b. Liver spread sandwich, apple juice, skim milk, vegetables
c. Skim milk, canned salmon, brown rice, juice
d. Tossed vegetables, chopped chicken breast, ham salad
24. A female patient has ulcerative colitis. She lives with a partner for six months now and she’s
worried about her sex life. Which of the following actions made by the PN is appropriate?
a. Tell her to discuss her situation to her partner
b. Explore her concern about sexuality –ulcerative colitis is not contraindicated with sex
c. Explain to the patient that there’s nothing much she can do about it
d. Connect her to the ulcerative colitis society
25. A patient is discharge from the hospital to home with continuing care by the home care agency.
The PN forgot to give the most important information to the home care agency. What should the
a. Call the patient’s home
b. Fax the information or give a call to the home care agency –faxing is an accepted method
of sending information
c. Document in the patient’s chart; call the agency and follow up
d. Call the agency and leave a message in the voice mail
26. Which of the following children is required to use the booster seat when traveling?
a. the child weighs 18 kg (40 lbs) or over – this is the manufacturer’s recommendation
b. the child is 1 ? years old
27. The position and the type of car seat used by the child is primarily based on the child’s:
c. weight – this is the basis of car seat in infants and children
d. body mass
28. The child who is 12 years old and below should be seated in the
a. front seat of the car
b. back seat – this is recommended up to 12 years of age
c. based on the child’s choice
d. based on the parents’ choice
29. The patient with neurogenic bladder drinks 2 to 3 liters of fluids per day. He is catheterized Q6
hours and urine obtained for each catheterization is 600 – 900 cc. Which of the following suggestions will you recommend to avoid large amount of urine accumulated in the bladder?
a. encourage the patient to drink less amount of fluids
b. to have indwelling catheter
c. to perform straight cath Q 4 hours – increasing the frequency will prevent accumulation
of large amount of urine in the bladder
d. apply condom catheter
30. During the month of December, a woman came to the clinic without wearing and her children
sweater. What should the PN do?
a. Perform initial assessment – the weather and clothing are the main emphasis
b. Provide then information where they can buy cheap sweaters – this is good, however, based on
the presentation, the client has financial issue
c. Connect them to the social service for help in buying sweaters – this help the people with
d. Suspect that the family is financially incapable of buying winter clothes – this is assessment
31. A client who was newly diagnosed with Hepatitis A asks the PN and says, ―How can I have
gotten this disease?‖ What is best nursing response?
a. ―You could have contracted this by using IV drug needles‖ – this is not the mode of
b. ―You must have received an infected blood transfusion‖
c. ―You contracted this by engaging unprotected sex‖
d. ―You may have eaten contaminated restaurant food‖ -- the virus in Hepatitis A is
spread through poor hand washing (fecal-oral route)
32. The PN who is working in the community suggested a new code for safety for teen agers by using
gadgets like helmets. The creation of a new local code is included in:
a. Institutional - means institution like hospitals and other health organization
d. Public Health
Answer: D – this is a public health issue
33. A client, multi gravida at 24 weeks gestation, tells the PN that she has been experiencing
backache. The client explains that she’s a secretary and is seated most of the day at work. Which of
the following exercises should the PN recommend for relieving back ache?
a. Pelvic rock –Helps relieve backache during pregnancy & early labor by making the
spine more flexible
b. Keagel exercise – this strengthens the perineal muscles
c. Squatting exercises
d. Abdominal crunches – strengthens abdominal muscles
34. An employer has established a physical exercise area in the workplace and encourages all
employees to use it. This is an example of what level of health promotion?
a. Primary prevention – exercise is a good preventive measures against several medical
problems i.e. hypertension, stroke, heart attack, diabetes, ect
b. Secondary prevention
c. Tertiary prevention
d. Passive prevention
35. The PN is teaching high school students about human immunodeficiency virus (HIV)
transmission. Which comment by the student requires clarification by the PN? a. A man should wear a latex condom during intimate sexual contact
b. I’ve heard about people who’ve developed HIV after receiving blood transfusion
c. I won’t donate blood because I don’t want to get HIV – blood and all blood products are
now well-screened for HIV virus prior to transfusion
d. IV drugs users can get HIV from sharing needles
35. A 6-year-old has AIDS. The PN should emphasize that the parents not allow their child to come in contact with:
a. A school age child who has scoliosis
b. A 16-year-old who has just received a tetanus booster
c. A neonate who just received oral polio vaccine –this virus in the vaccine may cause
infection to a immunosuppressed patient
d. A toddler who has eczema
36. An 89-year-old client is suffering from Alzheimer’s. Which intervention would be most useful in
managing his dementia?
a. provide a safe environment –optimum safety is essential to patient’s with mental
b. provide a stimulating environment
c. avoid the use of touch
d. use restraints whenever necessary
37. The PN is providing prenatal instructions to a client with diabetes mellitus. Which instruction will best meet the needs of the client during her pregnancy?
a. restrict weight gain to 5 lb each trimester
b. continue taking her Tolbutamide (Orinase) daily
c. restrict fluid intake to 34 oz per day
d. attend all schedule prenatal visits – this is required to closely monitor the mother
38. A mother brought her infant to the well baby clinic for immunization. After giving the vaccine, the baby stopped breathing. What would be the most important nursing action? a. initiate CPR
b. palpate the child’s carotid artery and start CPR
c. cover the infant’s nose and mouth with nurse’s mouth when giving mouth-to-mouth
d. call the doctor immediately for help – calling for help is the first step when someone is
confirmed to be unresponsive
39. An elderly client came in for consultation. On examination, the PN noticed bruises and foul smelly wound around the client’s elbow. Which of the following documentation accurately reflects the finding?
a. The client came in for consultation of 5 cm X 10 cm bruise, foul odor around the elbow b. The patient came in for consultation of pear shape bruise, foul odor and smelly around the
c. The patient came in for consultation; noted 10 cm X 20 cm bruise, with foul odor
around the left elbow – this is more accurate
d. The client came in for consultation, noted pear shaped bruise with foul odor around the left
Answer: C – this the more accurate description
40. A 22-year-old male patient who had undergone above the knee amputation is for discharge to home. The patient’s mother called the unit and said that her son is going to live with her for quite sometime following discharge and wanted to find out other needs her son might have. What would be the best nursing response?
a. ―Tell her to call her son and speak to him about his needs‖ – the nurse cannot disclose
information without the patient’s consent
b. ―I will tell your son to call you‖
c. ―What do you think your son needs for his rehabilitation‖
d. ―What did your son tell you about the plan‖
41. The PN is facilitating a teaching session to a group of retired women. Part of other presentation covers the safe use of medications. Which one of the following statements best reflects an aspect of polypharmacy?
a. Always take as few medications as possible
b. There are possible interactions between prescribed and over-the-counter medications –
medications may potentiate or counteract each other
c. Some medications should be avoided if a person has high blood pressure
d. Always consult your physician before taking over-the-counter medications
42. Mrs. Collins, a 50-year-old woman, has just been diagnosed with diabetes. The PN at the Community Clinic has helped her prepare a plan of care to manage her disease and promote her overall health. How can the PN best facilitate Mrs. Collins’ participation in this plan of care?
a. Encourage her to organize her responsibilities so that she will have more time to focus on her
b. Introduce her to other people in the community who have diabetes so she can learn from them c. Encourage her to set realistic goals and meet regularly to reconsider her changing
priorities – the client is empowered and encouraged by allowing the client to get involve
in her care
d. Encourage her to prepare a separate meal for herself when eating with her family to make her
diet therapy easier
43. The daughter of diabetic mother has difficulty in measuring blood glucose level of her mother
into glucometer strip. What should the PN do?
a. Teach and demonstrate to her how to monitor blood glucose – this is an indication that she had
previous teaching session
b. Assess her knowledge about diabetes mellitus – this is not the issue
c. Let her demonstrate how to use glucometer test strips – she needs to be taught how to use the
d. Show her and let her demonstrate how to monitor blood glucose –good way of learning
44. A 60-year-old client informs the PN during his annual physical examination that he takes care of his wife who has Alzheimer’s disease. He appears tired and said, ―She doesn’t sleep at all and just wanders around in the house.‖ Which responses made by the PN is appropriate?
a. ―A daily exercise routine will be good for her‖
b. ―Perhaps she needs to be placed in a long term facility‖ - the husband is tired from
taking care of his wife and services in the long term facility will be of helped
c. ―Check with her physician perhaps she needed extra sedation at night‖
d. ―Just make sure all doors and windows are locked‖
45. The PN is providing feeding instructions to a postnatal client. The client states, ―At least I don’t have to worry about getting pregnant while I am breastfeeding‖. Which response made by the PN
a. ―To ensure contraception, you should resume taking birth control pills before leaving the
hospital if you’re breastfeeding‖
b. ―Although you may not have normal menstrual period while you breastfeed,
breastfeeding is not an effective contraceptive‖—the mother will still get pregnant even
if breastfeeding; the folliclec stimulating hormone returns within 6 to 10 weeks of
c. Breastfeeding prevents ovulation and provide contraception as long as you continue
breastfeeding at least once a day‖
d. ―Breastfeeding is effective in preventing pregnancy as long as you experience no menses‖
46. A patient with lower back pain is tentatively diagnosed of having a herniated intervertebral disc.
When assessing this patient’s back pain, the PN should ask:
a. ―Is there any tenderness in the calf of your leg?‖
b. ―Have you had any increase burning sensation on urination?‖
c. ―Do you have any increase in pain during bowel movement?‖
d. ―Does the pain begin in your flank and move around to the groin?‖
Answer: C-valsava maneuver raises CFS fluid pressure, thereby causing pain.
47. After a patient with multiple fractures of the left femur is admitted to the hospital for surgery, the
patient demonstrates cyanosis, tachycardia, dyspnea, and restlessness. Initially the PN should:
a. Administer oxygen by mask.
b. Immediately call the physician.
c. Place the patient in the supine position.
d. Place the patient in the high-fowler’s position.
Answer: A – the patient probably has fat embolus; oxygen reduces surface tension of the fat globules and reduces hypoxia.
48. A patient has been receiving a cardiac glycoside, a diuretic, and a vasodilator, and is on bedrest.
The patient’s apical pulse rate is 44. The PN concludes that this pulse rate is most likely a result of
c. Bedrest regimen
d. Cardiac glycoside
Answer: D – a cardiac glycoside such as digitalis decreases the conduction speed within the myocardium and slows the heart rate.
49. A 40-year-old woman with a history of type I DM develops confusion, slurred speech, and
headache. Her medications include Nifedipine, Propanolol, and NPH insulin 20 units and Regular
insulin 5 units every AM. Physical exam reveals a BP of 110/70, HR 110. The patient is lethargic
but arousable and diaphoretic. Her skin is pale. Plasma glucose level is 3mmOs/L. Which of the
following would be most appropriate as initial treatment?
a. 50 ml of 50% dextrose IV.
b. 50 ml of 10% dextrose IV
c. Orange juice
d. Hard candy.
Answer: A – the patient level of consciousness contradicts any po treatment; IV glucose is safer
50. When taking the BP of a patient who has AIDS the PN must:
a. Wear clean gloves.
b. Use barrier techniques.
c. Wear a mask and gown.
d. Wash hands thoroughly.
Answer: D – blood and body fluid precautions require that hands be washed before and after patient care to minimize the risk of transmission.
51. When teaching an athletic teenage patient about nutritional intake, the PN should explain that the
carbohydrate food that would provide the quickest source of energy is:
a. Glass of milk – fat in milk may take to digest
b. Slice of bread – this is complex CHO, takes time to digest
c. Chocolate candy bar – this is complex CHO, takes time to digest
d. Glass of orange juice
Answer: D – orange juice has a higher proportion of simple sugars, which are readily available for conversion to energy.
52. A patient is to have gastric gavage. When the gavage tube is inserted, the PN is aware that
appropriate position for the patient is the:
a. Supine position
b. Mid-fowler’s position
c. Low-fowler’s position
d. High fowler’s position
Answer: D – high-fowler’s position promotes optimal entry into the esophagus aided by gravity.
53. To limit symptoms of gastroesophageal reflux (GERD), the PN should advise the patient to:
a. Avoid heavy lifting.
b. Lie down after eating.
c. Increase fluid intake with meals.
d. Wear an abdominal binder or girdle.
Answer: A – heavy lifting increases intraabdominal pressure, allowing gastric contents to move up through the lower esophageal sphincter (regurgitation) causing heartburn (pyrosis).
54. The PN should recognize that further teaching is needed when a patient with glaucoma states, ―it
would be dangerous for me to:
a. use any sedatives.‖
b. become constipated.‖ - bearing down results to increased intraocular pressure (IOP)
c. use Atropine in any form.‖ – this dilate pupils
d. release my emotions by crying.‖
Answer: A – sedatives have no effect on the intraocular pressure.
55. Four hours ago, a client gave birth to a 9 lb baby boy. The PN formulated the following nursing
diagnoses for her care. Which diagnosis should be the priority?
a. Pain related to episiotomy
b. Risk for possible decreased cardiac output related to hemorrhage --
c. Risk for infection related to episiotomy
d. Impaired parenting related to unmet expectations about childbirth
Answer: B – 9 pound baby causes overstretching of uterine muscles that can result to post partum hemorrhage from uterine atony
56. Post partal psychosocial adaptation includes the dependent or taking-in phase. Which client action
best demonstrates this phase?
a. Recalling events of labor and birth
b. Asking the nurse about neonatal care
c. Planning for home management
d. Planning to accept the neonate
Answer: A – this is a psychological adaptation wherein the mother is more concern about self compare to the baby
57. When evaluating the client’s knowledge of symptoms to report during her pregnancy, which
statement made by the client shows good understanding of the information provided?
a. ―I will report increased frequency in urination‖
b. ―I will have blurred or double vision, I should call the clinic immediately‖
c. ―If I feel tired after resting, I should report immediately‖
d. ―Nausea should be reported immediately‖
Answer: B – double vision during pregnancy can be a sign of PIH
58. The following patients were assigned to the PN. Which patient should be seen first?
a. New patient admitted post-op
b. Patient who requires insulin before dinner
c. Patient who requires pain medication prior to removal to of central line
d. Patient who complains of nausea
Answer: A – post op patients must assessed closely for post op bleeding
59. The patient was admitted with a diagnosis of CHF. On physical assessment, the patient was noted
to have crackles. Which of the following is the most common complication of CHF?
a. Myocardial Infarction
b. Pulmonary edema
c. Pitting edema in legs
Answer: B – Pulmonary edema is the most common complication of CHF
60. Which information must be communicated to the mother of a pyloric stenosis newborn:
a. Pyloric stenosis is due to a recessive gene carried by parents
b. Boys carry the gene and tend to develop the disease
c. This disease can be cause by breastfeeding
d. Most cause of diarrhea among newborns
Answer: A – pyloric stenosis is hereditary
61. How would the PN inform a 5-year-old that his sister died from cancer?
he nurse should not tell the child for she is too young to understand
he nurse tells the child that his sister is sleeping
he nurse tells the child that his sister is dead
he nurse tells the child that his sister is going away
Answer: B – a 5 year old has an adult concept of death
62. Which of the following is a contributing factor of an early teenage pregnancy?
a. Early menarche
b. Early involvement of sexual activity
c. Rapid development of reproductive system
d. Disciplinarian parents
Answer: B – unprotected sexual intercourse may lead to pregnancy
63. The child with diarrhea from lactose intolerance is about to be discharged to home. Health teaching
on preventing diarrhea should include:
a. Avoid eating spaghetti with cheese
b. Avoid coffee with milk
c. Avoid drinking coke
d. Ice cream may cause diarrhea
Answer: D –ice cream contains milk, a common GI irritant