Adult Health I Exam 4 - NCLEX Practice Test

Question 1 of 100
Score: 0/0
Time: 00:00
TYPE: "type", MODIFICATION: "dietary" }, rationale: "Identifying the stone composition helps determine dietary modifications to prevent recurrence." }, { id: 4, type: "multiple-choice", question: "A patient with a new cast reports intense pain unrelieved by opioids. The foot is pale, cool, and without a palpable pulse. What is the nurse's next action?", options: [ "A. Apply a warm compress", "B. Reposition the extremity above heart level", "C. Call the provider for fasciotomy evaluation", "D. Give additional pain medication" ], correct: 2, rationale: "These are classic signs of compartment syndrome. Emergency fasciotomy may be needed to prevent permanent damage." }, { id: 5, type: "multiple-choice", question: "A 56-year-old patient post-cholecystectomy reports gray, clay-like stools. Which interpretation is most accurate?", options: [ "A. Normal postoperative finding", "B. Indication of iron supplementation", "C. Suggests bile duct obstruction", "D. Side effect of anesthesia" ], correct: 2, rationale: "Clay-colored stools indicate absence of bile in stool, suggesting bile duct obstruction - a serious post-cholecystectomy complication." }, { id: 6, type: "multiple-choice", question: "A patient with known osteoporosis presents with sudden-onset hematuria and flank pain. Labs reveal calcium 11.5 mg/dL and creatinine 2.1 mg/dL. What is the most likely complication?", options: [ "A. Nephritic syndrome", "B. Uric acid nephropathy", "C. Calcium-based kidney stone", "D. Bladder cancer" ], correct: 2, rationale: "Osteoporosis can lead to hypercalcemia from bone breakdown, increasing risk for calcium kidney stones." }, { id: 7, type: "drag-drop", question: "A nurse is caring for a patient receiving PEG tube feedings. Match each action with the correct step in care:", items: [ "Flush tube every 4 hours", "Check gastric residual", "Keep HOB elevated", "Monitor for diarrhea" ], categories: [ "Prevent aspiration", "Ensure patency", "Assess tolerance", "Check for delayed emptying" ], correct: { "Flush tube every 4 hours": "Ensure patency", "Check gastric residual": "Check for delayed emptying", "Keep HOB elevated": "Prevent aspiration", "Monitor for diarrhea": "Assess tolerance" }, rationale: "Each action serves a specific purpose in safe PEG tube management." }, { id: 8, type: "multiple-choice", question: "A nurse is evaluating a patient 1 hour after a cystoscopy. Which finding requires immediate provider notification?", options: [ "A. Pink-tinged urine", "B. Burning with first void", "C. Bright red clots in urine", "D. Voiding 100 mL/hr" ], correct: 2, rationale: "Bright red clots indicate active bleeding, not normal post-procedure findings." }, { id: 9, type: "multiple-choice", question: "A patient is receiving methocarbamol for fracture-related muscle spasms. Which assessment finding would most concern the nurse?", options: [ "A. Drowsiness", "B. Sedation", "C. Yellow sclera", "D. Dry mouth" ], correct: 2, rationale: "Yellow sclera suggests hepatotoxicity, a serious adverse effect requiring immediate attention." }, { id: 10, type: "multiple-choice", question: "A client with a small bowel obstruction is NPO with an NG tube to low intermittent suction. Which assessment warrants immediate attention?", options: [ "A. Potassium level of 3.2 mmol/L", "B. 200 mL green drainage over 6 hours", "C. Reports of thirst", "D. Mild abdominal distention" ], correct: 0, rationale: "Hypokalemia (K+ 3.2) from NG suction can cause dangerous cardiac arrhythmias." }, { id: 11, type: "drag-drop", question: "Match the stone type with the appropriate dietary instruction:", items: [ "Calcium oxalate", "Uric acid", "Cystine", "Struvite" ], categories: [ "Low purine (avoid organ meats, alcohol)", "Limit sodium intake, increase fluid", "Reduce spinach, nuts, tea", "Treat underlying infection" ], correct: { "Calcium oxalate": "Reduce spinach, nuts, tea", "Uric acid": "Low purine (avoid organ meats, alcohol)", "Cystine": "Limit sodium intake, increase fluid", "Struvite": "Treat underlying infection" }, rationale: "Each stone type requires specific dietary modifications to prevent recurrence." }, { id: 12, type: "multiple-choice", question: "A patient with GERD is prescribed famotidine. What is the best explanation to provide?", options: [ "A. This will neutralize existing stomach acid.", "B. This will block almost all acid production.", "C. This will block some acid production to reduce reflux.", "D. This will coat your stomach to prevent irritation." ], correct: 2, rationale: "Famotidine is an H2 blocker that reduces (but doesn't eliminate) acid production." }, { id: 13, type: "multiple-choice", question: "A trauma patient with a femur fracture suddenly becomes tachypneic and confused. Oxygen saturation is 84% on room air. Which action is priority?", options: [ "A. Administer high-flow oxygen", "B. Call the provider for CT scan", "C. Begin heparin drip", "D. Elevate legs and start IV fluids" ], correct: 0, rationale: "Symptoms suggest fat embolism syndrome. Immediate oxygenation is the priority." }, { id: 14, type: "multiple-choice", question: "A nurse is caring for a post-BKA patient who refuses to lie prone. What risk is the patient increasing?", options: [ "A. Pressure ulcer development", "B. Hip contracture", "C. Stump infection", "D. Phantom limb pain" ], correct: 1, rationale: "Prone positioning prevents hip flexion contractures in BKA patients." }, { id: 15, type: "dropdown", question: "A nurse is assessing a patient with pyelonephritis. The nurse gently thumps the lumbar spine. The patient reports tenderness on one side.", template: "This finding is referred to as [SIGN] and suggests involvement of the [ORGAN].", dropdowns: { SIGN: ["Murphy's sign", "CVA tenderness", "Costochondral pain"], ORGAN: ["liver", "bladder", "kidneys"] }, correct: { SIGN: "CVA tenderness", ORGAN: "kidneys" }, rationale: "Costovertebral angle (CVA) tenderness is a classic sign of kidney infection." }, { id: 16, type: "multiple-choice", question: "Which action is most appropriate while initiating a 24-hour urine collection?", options: [ "A. Discard all urine during the first hour", "B. Collect the first urine of the day", "C. Discard the first void and start the clock", "D. Include only nighttime samples" ], correct: 2, rationale: "The first void is discarded to ensure the collection starts with an empty bladder." }, { id: 17, type: "multiple-choice", question: "A patient with prolonged diarrhea due to enteral feeding has developed leg cramping, weakness, and cardiac PVCs on ECG. Which electrolyte imbalance should the nurse suspect?", options: [ "A. Hypocalcemia", "B. Hypernatremia", "C. Hypokalemia", "D. Hyperphosphatemia" ], correct: 2, rationale: "Diarrhea causes potassium loss. Symptoms include muscle cramps and cardiac arrhythmias (PVCs)." }, { id: 18, type: "multiple-choice", question: "A nurse notes the following: BP 88/52, HR 122, hemoglobin 8.2, abdominal distention, and rebound tenderness. Which complication is likely?", options: [ "A. Fat embolism", "B. Perforated ulcer", "C. Bowel obstruction", "D. Diverticulitis" ], correct: 1, rationale: "Hypotension, tachycardia, low hemoglobin, and rebound tenderness suggest perforated ulcer with hemorrhage." }, { id: 19, type: "multiple-choice", question: "A patient with suspected UTI presents with confusion and a new fall. Which diagnostic test should be done first?", options: [ "A. Renal ultrasound", "B. Urine culture", "C. Bladder scan", "D. Urinalysis" ], correct: 3, rationale: "Urinalysis is the quickest test to confirm UTI, which can cause confusion in elderly patients." }, { id: 20, type: "multiple-choice", question: "Which patient should the nurse assess first?", options: [ "A. A man with dull right-sided flank pain, vomiting, and hematuria", "B. A woman with osteoporosis scheduled for a DEXA scan", "C. A post-op patient with nausea requesting antiemetics", "D. A client with GERD needing medication education" ], correct: 0, rationale: "Flank pain, vomiting, and hematuria suggest kidney stones with possible obstruction - most urgent." }, { id: 21, type: "multiple-choice", question: "A patient is receiving sucralfate. Which statement by the patient indicates the medication is being used correctly?", options: [ "A. I take this with my famotidine every morning.", "B. I chew it thoroughly before swallowing.", "C. I take this on an empty stomach to coat the ulcer.", "D. I take it after meals to improve absorption." ], correct: 2, rationale: "Sucralfate should be taken on an empty stomach to properly coat and protect ulcers." }, { id: 22, type: "drag-drop", question: "Match the lab and symptom combination to the most likely complication:", items: [ "Hgb 7.8, BP 85/48, HR 120", "K+ 2.9, muscle cramps, U-waves", "WBC 16,000, flank pain, CVA tenderness", "Ca+ 11.2, hematuria, flank pain" ], categories: [ "UTI with pyelonephritis", "Hypokalemia", "Hemorrhage from ulcer", "Calcium-based renal calculi" ], correct: { "Hgb 7.8, BP 85/48, HR 120": "Hemorrhage from ulcer", "K+ 2.9, muscle cramps, U-waves": "Hypokalemia", "WBC 16,000, flank pain, CVA tenderness": "UTI with pyelonephritis", "Ca+ 11.2, hematuria, flank pain": "Calcium-based renal calculi" }, rationale: "Each lab/symptom combination points to a specific complication." }, { id: 23, type: "multiple-choice", question: "Which medication should be questioned if prescribed for a patient with BUN 45 mg/dL, Creatinine 2.8 mg/dL and renal colic?", options: [ "A. Morphine IV", "B. Ketorolac IM", "C. Allopurinol PO", "D. Acetaminophen PO" ], correct: 1, rationale: "Ketorolac (NSAID) is nephrotoxic and contraindicated with renal impairment." }, { id: 24, type: "multiple-choice", question: "A patient who just had skeletal traction placed is confused and keeps moving their leg. The traction weight is resting on the floor. What's the priority nursing action?", options: [ "A. Remove weights and stabilize leg manually", "B. Reposition the weights so they hang freely", "C. Administer PRN sedative", "D. Notify the orthopedic surgeon" ], correct: 1, rationale: "Weights must hang freely for traction to be effective. Never remove weights without orders." }, { id: 25, type: "multiple-choice", question: "Which discharge teaching should be included for a patient starting bisphosphonates for osteoporosis?", options: [ "A. Lie down for 30 minutes after taking the medication.", "B. Take with a full glass of water and remain upright.", "C. Take this on a full stomach to avoid GI upset.", "D. Take with calcium and vitamin C to enhance effect." ], correct: 1, rationale: "Bisphosphonates must be taken with water while remaining upright to prevent esophageal irritation." }, { id: 26, type: "dropdown", question: "A patient is on TPN and reports thirst, blurry vision, and is voiding frequently.", template: "The nurse should suspect [CONDITION] and should [ACTION].", dropdowns: { CONDITION: ["hyperkalemia", "hyperglycemia", "hypercalcemia"], ACTION: ["increase tube feedings", "check fingerstick glucose", "flush central line"] }, correct: { CONDITION: "hyperglycemia", ACTION: "check fingerstick glucose" }, rationale: "TPN can cause hyperglycemia. Symptoms include thirst, blurred vision, and polyuria." }, { id: 27, type: "multiple-choice", question: "Which finding indicates a complication of an EGD performed 30 minutes ago?", options: [ "A. Mild sore throat", "B. Absent bowel sounds", "C. Sudden abdominal rigidity", "D. Fatigue from sedation" ], correct: 2, rationale: "Abdominal rigidity suggests perforation, a serious EGD complication." }, { id: 28, type: "multiple-choice", question: "Which scenario most likely reflects functional incontinence?", options: [ "A. A woman leaks when laughing", "B. A man with BPH leaks urine at night", "C. A stroke patient fails to reach the bathroom in time", "D. A child urinates after drinking caffeinated soda" ], correct: 2, rationale: "Functional incontinence occurs when physical or cognitive impairment prevents timely toileting." }, { id: 29, type: "multiple-choice", question: "A patient is 1 hour post-op from renal biopsy and reports flank pain. Which finding would concern the nurse most?", options: [ "A. BP 100/70, HR 110", "B. Current Hgb: 12.5 g/dL (admission: 13.0 g/dL)", "C. Pink urine in Foley", "D. Fatigue and mild nausea" ], correct: 0, rationale: "Hypotension and tachycardia suggest hemorrhage post-biopsy." }, { id: 30, type: "multiple-choice", question: "A patient with known GERD complains of chest pain and has been taking antacids with little relief. What is the next best step?", options: [ "A. Administer morphine", "B. Switch to PPIs", "C. Reassure the patient and offer water", "D. Teach lifestyle changes again" ], correct: 1, rationale: "When antacids fail, stepping up to PPIs is appropriate for GERD management." }, { id: 31, type: "multiple-choice", question: "A patient with Paget's disease reports 'my legs feel bowed and it's hard to walk.' What nursing intervention is most appropriate?", options: [ "A. Refer to physical therapy", "B. Increase protein intake", "C. Apply warm compress", "D. Discontinue bisphosphonate therapy" ], correct: 0, rationale: "Physical therapy helps maintain mobility and manage deformities in Paget's disease." }, { id: 32, type: "multiple-choice", question: "A nurse is teaching a patient about NG tube care. Which statement requires correction?", options: [ "A. I will flush the tube every 4 hours.", "B. I should stay flat after feeding to rest.", "C. I will check for signs of distention.", "D. My blood sugar might go up from the formula." ], correct: 1, rationale: "Patients should remain elevated after feeding to prevent aspiration, not lie flat." }, { id: 33, type: "multiple-choice", question: "Which patient situation requires the most immediate intervention?", options: [ "A. Coughing after drinking through a straw post-stroke", "B. Pain level 6/10 in a casted leg", "C. Yellowing of urine while on Pyridium", "D. Complaints of early satiety and GERD symptoms" ], correct: 0, rationale: "Coughing while drinking post-stroke indicates aspiration risk - immediate intervention needed." }, { id: 34, type: "multiple-choice", question: "A client on TPN has a new order to begin enteral nutrition. What's the nurse's best action?", options: [ "A. Discontinue TPN immediately", "B. Start full-volume enteral feeding", "C. Gradually introduce enteral while tapering TPN", "D. Check bowel sounds and flush line" ], correct: 2, rationale: "Transition from TPN to enteral feeding should be gradual to prevent complications." }, { id: 35, type: "multiple-choice", question: "A nurse receives four new admissions. Which should be seen first?", options: [ "A. Suspected renal stone with vomiting", "B. Confused elderly woman with UTI", "C. Post-cholecystectomy patient needing pain meds", "D. PEG-tube patient with blood-tinged residual" ], correct: 3, rationale: "Blood-tinged residual in PEG tube suggests bleeding - most urgent assessment needed." }, { id: 36, type: "drag-drop", question: "Put the following GERD medications in correct order from least to most potent:", items: [ "Proton Pump Inhibitor", "H2 Blocker", "Antacid" ], categories: [ "1st (Least potent)", "2nd", "3rd (Most potent)" ], correct: { "Antacid": "1st (Least potent)", "H2 Blocker": "2nd", "Proton Pump Inhibitor": "3rd (Most potent)" }, rationale: "Antacids neutralize existing acid, H2 blockers reduce acid production, PPIs block most acid production." }, { id: 37, type: "multiple-choice", question: "A nurse is evaluating a patient's understanding of hiatal hernia management. Which statement indicates correct understanding?", options: [ "A. I'll take all meals lying down to help digestion.", "B. I should eat one large meal in the evening.", "C. I'll elevate my head after meals.", "D. I should eat spicy foods to stimulate acid production." ], correct: 2, rationale: "Elevating the head after meals helps prevent reflux in hiatal hernia." }, { id: 38, type: "multiple-choice", question: "A post-op orthopedic patient is receiving morphine. Which change most warrants immediate intervention?", options: [ "A. Sedation score of 2", "B. Oxygen saturation of 89%", "C. Respiratory rate of 14", "D. BP of 106/62" ], correct: 1, rationale: "O2 saturation below 90% indicates respiratory depression from opioids - immediate intervention needed." }, { id: 39, type: "dropdown", question: "A patient with urinary retention is prescribed bethanechol.", template: "The nurse monitors for [EFFECT] as a side effect of this medication.", dropdowns: { EFFECT: ["tachycardia", "diarrhea", "urinary retention"] }, correct: { EFFECT: "diarrhea" }, rationale: "Bethanechol is a cholinergic drug that can cause diarrhea as a side effect." }, { id: 40, type: "multiple-choice", question: "A nurse evaluates a patient for compartment syndrome. Which of the following must be reported immediately?", options: [ "A. Bruising around the cast site", "B. Pain unrelieved by medication", "C. Warm toes with 2+ pulses", "D. Mild edema near fracture site" ], correct: 1, rationale: "Pain unrelieved by medication is an early sign of compartment syndrome." }, { id: 41, type: "multiple-choice", question: "A nurse is teaching about cast care. Which instruction is appropriate?", options: [ "A. Insert gauze if the skin itches", "B. Use a blow dryer on cool to relieve itching", "C. Remove the cast if it gets wet", "D. Elevate the leg below the level of the heart" ], correct: 1, rationale: "Cool air from a blow dryer can safely relieve itching without damaging the cast." }, { id: 42, type: "multiple-choice", question: "A patient being treated for a small bowel obstruction with an NG tube has a new serum potassium level of 2.6. Which order should the nurse expect?", options: [ "A. Start 0.9% saline bolus", "B. Hang D5W at maintenance rate", "C. Administer potassium chloride IV", "D. Administer furosemide" ], correct: 2, rationale: "Severe hypokalemia (K+ 2.6) requires IV potassium replacement." }, { id: 43, type: "multiple-choice", question: "A patient asks why they need to strain their urine. Which response is most accurate?", options: [ "A. To reduce infection risk.", "B. To prevent retention.", "C. To identify the type of stone.", "D. To monitor hydration." ], correct: 2, rationale: "Straining urine captures stones for analysis to guide treatment and prevention." }, { id: 44, type: "multiple-choice", question: "A nurse is caring for a patient with struvite stones. What additional lab or history finding is most expected?", options: [ "A. Recent diarrhea", "B. Frequent UTIs", "C. High calcium intake", "D. Chronic liver failure" ], correct: 1, rationale: "Struvite stones are associated with UTIs caused by urease-producing bacteria." }, { id: 45, type: "multiple-choice", question: "A patient post-op is receiving lactated Ringer's IV fluids. What condition is being prevented?", options: [ "A. Respiratory alkalosis", "B. Hypovolemia", "C. Hyperkalemia", "D. Hypernatremia" ], correct: 1, rationale: "Lactated Ringer's is an isotonic solution used to prevent/treat hypovolemia." }, { id: 46, type: "multiple-choice", question: "Which teaching is correct for a patient prescribed allopurinol?", options: [ "A. Stop the medication if urine becomes dark yellow.", "B. I need to reduce my intake of citrus fruits.", "C. I'll limit liver and red meat in my diet.", "D. I will increase calcium to prevent stones." ], correct: 2, rationale: "Allopurinol treats uric acid stones; patients should limit purine-rich foods like organ meats." }, { id: 47, type: "multiple-choice", question: "A nurse is reviewing a renal ultrasound result that indicates hydronephrosis. Which finding supports this diagnosis?", options: [ "A. 30 mL/hour urine output", "B. Pink-tinged urine", "C. Flank pain and bladder distention", "D. BUN of 10" ], correct: 2, rationale: "Hydronephrosis causes flank pain from kidney swelling and may cause bladder distention from obstruction." }, { id: 48, type: "multiple-choice", question: "Which of the following reflects effective delegation?", options: [ "A. LPN assesses a new post-op patient's incision site", "B. CNA checks pedal pulses on traction patient", "C. RN teaches cast care to orthopedic patient", "D. LPN teaches insulin administration to new diabetic" ], correct: 2, rationale: "Patient teaching is an RN responsibility and cannot be delegated." }, { id: 49, type: "dropdown", question: "After a renal biopsy, a nurse notes BP: 85/50 mmHg, HR: 125 bpm, Hgb: 7.8 g/dL.", template: "These findings suggest [COMPLICATION] and require [ACTION].", dropdowns: { COMPLICATION: ["pain", "bleeding", "infection"], ACTION: ["monitoring", "reporting", "position change"] }, correct: { COMPLICATION: "bleeding", ACTION: "reporting" }, rationale: "These vital signs and lab values indicate hemorrhage requiring immediate provider notification." }, { id: 50, type: "multiple-choice", question: "Which of the following is the best reason to encourage a patient to void, wait, then try again?", options: [ "A. To evaluate renal function", "B. To decrease UTI risk", "C. To empty residual urine and reduce retention", "D. To reduce need for catheterization" ], correct: 2, rationale: "Double voiding helps empty residual urine, reducing retention and UTI risk." }, { id: 51, type: "multiple-choice", question: "A nurse is caring for a patient who underwent a cystoscopy. Which of the following should prompt immediate action?", options: [ "A. Pink-tinged urine", "B. Voiding every 2 hours", "C. Temperature of 101.8°F", "D. Dysuria after voiding" ], correct: 2, rationale: "Fever over 101°F post-cystoscopy suggests infection requiring immediate intervention." }, { id: 52, type: "multiple-choice", question: "A patient with renal calculi is NPO and rates their flank pain 10/10. They have a creatinine of 3.0 mg/dL. Which medication order should the nurse question?", options: [ "A. Morphine IV", "B. Ketorolac IM", "C. Acetaminophen PO", "D. Hydromorphone IV" ], correct: 1, rationale: "Ketorolac (NSAID) is contraindicated with elevated creatinine due to nephrotoxicity." }, { id: 53, type: "drag-drop", question: "A patient presents with severe, sudden flank pain radiating to the groin and hematuria. Match the actions:", items: [ "Non-contrast CT", "Urinalysis", "Assess pain level", "Ask about prior stone history" ], categories: [ "Pain management", "Diagnostic confirmation", "Symptom pattern", "History gathering" ], correct: { "Non-contrast CT": "Diagnostic confirmation", "Urinalysis": "Symptom pattern", "Assess pain level": "Pain management", "Ask about prior stone history": "History gathering" }, rationale: "Each assessment step serves a specific purpose in kidney stone evaluation." }, { id: 54, type: "multiple-choice", question: "A nurse receives handoff for four patients. Who should be assessed first?", options: [ "A. A man post-EGD with no bowel sounds", "B. A woman with dysuria and cloudy urine", "C. A man with recent femur fracture who reports dyspnea", "D. A patient 6 hours post-cystoscopy with pink urine" ], correct: 2, rationale: "Dyspnea post-femur fracture suggests fat embolism - life-threatening emergency." }, { id: 55, type: "multiple-choice", question: "A patient is scheduled for an EGD. Which statement requires follow-up?", options: [ "A. I haven't eaten since midnight.", "B. I took my warfarin this morning.", "C. I signed the consent form yesterday.", "D. I know I'll be a little drowsy afterward." ], correct: 1, rationale: "Warfarin increases bleeding risk during EGD and should be held before procedure." }, { id: 56, type: "drag-drop", question: "Match the patient finding to whether enteral feedings should continue or be held:", items: [ "Absent bowel sounds", "BG 212 mg/dL", "Nausea/vomiting", "Residual of 70 mL" ], categories: [ "Hold feeding", "Continue feeding" ], correct: { "Absent bowel sounds": "Hold feeding", "BG 212 mg/dL": "Continue feeding", "Nausea/vomiting": "Hold feeding", "Residual of 70 mL": "Continue feeding" }, rationale: "Feedings are held for GI dysfunction but continued for mild hyperglycemia and acceptable residuals." }, { id: 57, type: "multiple-choice", question: "A patient post-fracture has a splint in place and reports worsening tingling and pain. What is the nurse's next action?", options: [ "A. Administer prescribed opioid", "B. Elevate the limb", "C. Loosen or bivalve the splint", "D. Encourage movement of the fingers" ], correct: 2, rationale: "Worsening pain and tingling suggest compartment syndrome - loosen constricting devices immediately." }, { id: 58, type: "multiple-choice", question: "A patient prescribed mirabegron for urge incontinence should be monitored for:", options: [ "A. Dry mouth and blurred vision", "B. Constipation and dizziness", "C. Hypertension and urinary retention", "D. Sedation and liver toxicity" ], correct: 2, rationale: "Mirabegron can cause hypertension and urinary retention as side effects." }, { id: 59, type: "dropdown", question: "A patient with Paget's disease asks why they need calcium and vitamin D supplements.", template: "These help [PURPOSE] and reduce risk of [COMPLICATION].", dropdowns: { PURPOSE: ["stabilize bone metabolism", "improve kidney function", "increase GI motility"], COMPLICATION: ["fractures", "hypertension", "infection"] }, correct: { PURPOSE: "stabilize bone metabolism", COMPLICATION: "fractures" }, rationale: "Calcium and vitamin D help stabilize abnormal bone metabolism in Paget's disease." }, { id: 60, type: "multiple-choice", question: "Which patient action demonstrates proper cast care teaching?", options: [ "A. I'll use a coat hanger to scratch inside the cast.", "B. I'll keep the cast dry and elevated.", "C. I'll wrap it in a heating pad at night.", "D. I'll remove the cast when it starts to itch." ], correct: 1, rationale: "Keeping cast dry and elevated prevents complications and reduces swelling." }, { id: 61, type: "multiple-choice", question: "Which lab result would most concern the nurse in a patient with NG suction?", options: [ "A. Sodium 138", "B. Glucose 104", "C. Potassium 2.8", "D. BUN 20" ], correct: 2, rationale: "Severe hypokalemia (2.8) from NG suction can cause dangerous cardiac arrhythmias." }, { id: 62, type: "multiple-choice", question: "A patient recovering from a cholecystectomy says, 'I'm afraid to eat fat again.' What is the nurse's best response?", options: [ "A. Avoid all fat permanently.", "B. You can return to a normal diet immediately.", "C. You may eat small amounts of fat.", "D. You'll need enzyme supplements now." ], correct: 2, rationale: "Post-cholecystectomy, patients can gradually reintroduce small amounts of fat." }, { id: 63, type: "multiple-choice", question: "A nurse caring for a patient post-renal arteriogram should include which action in the care plan?", options: [ "A. Encourage early ambulation", "B. Monitor for bradycardia and hypertension", "C. Keep the patient NPO for 24 hours", "D. Monitor for signs of internal bleeding" ], correct: 3, rationale: "Post-arteriogram, monitor for bleeding at puncture site and internal hemorrhage." }, { id: 64, type: "dropdown", question: "A patient with a PEG tube has had 500 mL of formula and 0.9% NaCl at 75 mL/hr. At the end of the shift, output totals 1,200 mL.", template: "This may indicate [STATUS] and warrants [ACTION].", dropdowns: { STATUS: ["fluid retention", "adequate output", "fluid deficit"], ACTION: ["no action", "further monitoring", "IV fluid bolus"] }, correct: { STATUS: "adequate output", ACTION: "no action" }, rationale: "Output matches intake, indicating adequate fluid balance." }, { id: 65, type: "multiple-choice", question: "Which finding is most concerning in a patient on famotidine?", options: [ "A. Headache", "B. Constipation", "C. Confusion in elderly", "D. Mild diarrhea" ], correct: 2, rationale: "H2 blockers can cause confusion in elderly patients - serious adverse effect." }, { id: 66, type: "multiple-choice", question: "A patient newly diagnosed with GERD is prescribed omeprazole. Which instruction is correct?", options: [ "A. Take at bedtime with milk.", "B. Take 30 minutes before meals.", "C. Take with an antacid for best results.", "D. Stop taking if symptoms improve." ], correct: 1, rationale: "PPIs should be taken 30 minutes before meals for optimal acid suppression." }, { id: 67, type: "drag-drop", question: "Match each 'P' of compartment syndrome with the correct description:", items: [ "Pain", "Pallor", "Paresthesia", "Pulselessness", "Pressure", "Paralysis" ], categories: [ "Loss of motor function", "Tingling or numbness", "Severe, unrelieved discomfort", "No palpable distal pulse", "Pale skin", "Firm, tight compartment" ], correct: { "Pain": "Severe, unrelieved discomfort", "Pallor": "Pale skin", "Paresthesia": "Tingling or numbness", "Pulselessness": "No palpable distal pulse", "Pressure": "Firm, tight compartment", "Paralysis": "Loss of motor function" }, rationale: "The 6 P's are classic signs of compartment syndrome progression." }, { id: 68, type: "multiple-choice", question: "A patient with suspected UTI has UA results showing positive nitrites and leukocytes. Which order should be done next?", options: [ "A. Begin antibiotics immediately", "B. Send for culture and sensitivity", "C. Schedule cystoscopy", "D. Increase oral fluids only" ], correct: 1, rationale: "Culture and sensitivity should be obtained before starting antibiotics when possible." }, { id: 69, type: "multiple-choice", question: "A patient with NG decompression complains of dry mouth and thirst. What should the nurse do?", options: [ "A. Stop the suction temporarily", "B. Provide ice chips and oral care", "C. Increase the NG suction rate", "D. Decrease IV fluid rate" ], correct: 1, rationale: "Ice chips and oral care provide comfort without interfering with NG decompression." }, { id: 70, type: "multiple-choice", question: "A patient on allopurinol reports a rash and itching. What is the nurse's best response?", options: [ "A. This is normal, it will pass.", "B. Stop the medication and call your provider.", "C. Take diphenhydramine and monitor it.", "D. Continue taking it and drink more fluids." ], correct: 1, rationale: "Rash with allopurinol can indicate serious hypersensitivity reaction - stop immediately." }, { id: 71, type: "multiple-choice", question: "A client reports nausea and abdominal fullness. Which of the following suggests paralytic ileus?", options: [ "A. High-pitched bowel sounds", "B. Soft, non-distended abdomen", "C. Absent bowel sounds", "D. Green NG drainage" ], correct: 2, rationale: "Absent bowel sounds indicate paralytic ileus (non-mechanical obstruction)." }, { id: 72, type: "multiple-choice", question: "A patient with a recent lower leg fracture asks how to prevent blood clots. What is the best response?", options: [ "A. Take vitamin D daily.", "B. Avoid moving your leg.", "C. Ambulate early and often.", "D. Elevate only when sitting." ], correct: 2, rationale: "Early ambulation is the best prevention for DVT post-fracture." }, { id: 73, type: "multiple-choice", question: "A nurse notes orange urine in a patient being treated for dysuria. What should the nurse do?", options: [ "A. Stop all medications", "B. Notify the provider", "C. Document as expected", "D. Increase fluid restriction" ], correct: 2, rationale: "Orange urine is an expected side effect of phenazopyridine (Pyridium)." }, { id: 74, type: "dropdown", question: "You are collecting a 24-hour urine sample.", template: "Start by [ACTION] the first void, collect all urine for 24 hours, and keep the container [STORAGE].", dropdowns: { ACTION: ["discarding", "collecting"], STORAGE: ["at room temp", "on ice", "covered but warm"] }, correct: { ACTION: "discarding", STORAGE: "on ice" }, rationale: "24-hour collection starts with empty bladder (discard first void) and requires refrigeration." }, { id: 75, type: "multiple-choice", question: "Which of the following requires further teaching for a patient with GERD?", options: [ "A. I'll avoid alcohol and chocolate.", "B. I'll lie flat to rest after eating.", "C. I'll eat small, frequent meals.", "D. I'll elevate the head of my bed." ], correct: 1, rationale: "Lying flat after eating worsens GERD - patients should remain upright." }, { id: 76, type: "drag-drop", question: "Order the initial fracture response steps:", items: [ "Immobilize the limb", "Align bone fragments", "Assess neurovascular status", "Manage pain" ], categories: [ "1st", "2nd", "3rd", "4th" ], correct: { "Assess neurovascular status": "1st", "Immobilize the limb": "2nd", "Manage pain": "3rd", "Align bone fragments": "4th" }, rationale: "Always assess circulation first, then stabilize, manage pain, and alignment is done by provider." }, { id: 77, type: "multiple-choice", question: "Which finding best indicates a perforated ulcer?", options: [ "A. Melena and fatigue", "B. Pain with food relief", "C. Board-like abdomen and rebound tenderness", "D. GERD symptoms and mild nausea" ], correct: 2, rationale: "Board-like abdomen with rebound tenderness indicates peritonitis from perforation." }, { id: 78, type: "multiple-choice", question: "Which action would be inappropriate for a UAP assisting a patient with traction?", options: [ "A. Repositioning pillows under legs", "B. Notifying nurse if patient reports pain", "C. Lifting traction weights to change sheets", "D. Assisting with perineal care" ], correct: 2, rationale: "Traction weights must never be lifted or removed - disrupts alignment." }, { id: 79, type: "multiple-choice", question: "A patient with BKA asks about preventing hip contractures. Which instruction is correct?", options: [ "A. Sit in a chair most of the day.", "B. Elevate your stump constantly.", "C. Lie prone for short periods each day.", "D. Use a heating pad on the hip daily." ], correct: 2, rationale: "Prone positioning prevents hip flexion contractures in amputees." }, { id: 80, type: "multiple-choice", question: "A nurse observes an NG tube patient suddenly develop rapid shallow breathing and restlessness. What is the first action?", options: [ "A. Stop the feeding", "B. Check O2 saturation and raise HOB", "C. Reassure the patient and check vitals", "D. Flush the tube with water" ], correct: 0, rationale: "Stop feeding immediately if aspiration suspected, then assess and position." }, { id: 81, type: "dropdown", question: "A nurse notes BP: 88/52 mmHg, HR: 122 bpm, Hgb: 8.5 g/dL, Hct: 25% in a post-cholecystectomy patient.", template: "This pattern suggests [CONDITION] and warrants [ACTION].", dropdowns: { CONDITION: ["hypovolemia", "infection", "electrolyte imbalance"], ACTION: ["lab draw", "IV fluids", "immediate provider notification"] }, correct: { CONDITION: "hypovolemia", ACTION: "immediate provider notification" }, rationale: "These signs indicate hemorrhage post-surgery requiring immediate intervention." }, { id: 82, type: "multiple-choice", question: "A patient with GERD asks why famotidine is prescribed rather than a PPI. What is the best answer?", options: [ "A. It works faster and blocks 100% of acid.", "B. It prevents most acid production with fewer side effects.", "C. It neutralizes acid rather than blocking it.", "D. It's used only for emergencies." ], correct: 1, rationale: "H2 blockers like famotidine have fewer side effects than PPIs for mild-moderate GERD." }, { id: 83, type: "drag-drop", question: "Match the Tube Type to Purpose:", items: [ "Salem Sump", "Dobhoff (SBT)" ], categories: [ "Suction + Feeding", "Feeding Only" ], correct: { "Salem Sump": "Suction + Feeding", "Dobhoff (SBT)": "Feeding Only" }, rationale: "Salem Sump has dual lumen for suction/feeding; Dobhoff is small-bore for feeding only." }, { id: 84, type: "multiple-choice", question: "Which lab combination suggests a complication of bone loss?", options: [ "A. Calcium 11.2 mg/dL, Phosphorus 5.1 mg/dL", "B. Calcium 11.5 mg/dL, Phosphorus 2.2 mg/dL", "C. Calcium 8.2 mg/dL, Potassium 5.8 mEq/L", "D. Calcium 8.0 mg/dL, Magnesium 1.2 mg/dL" ], correct: 1, rationale: "Bone loss releases calcium while phosphorus typically decreases." }, { id: 85, type: "multiple-choice", question: "A patient receiving long-term enteral feeding is at risk for which complication?", options: [ "A. Refeeding syndrome", "B. Hypercalcemia", "C. Polycythemia", "D. Bradycardia" ], correct: 0, rationale: "Long-term enteral feeding can cause refeeding syndrome from rapid nutrition repletion." }, { id: 86, type: "multiple-choice", question: "A nurse notes frank hematuria 2 hours post-cystoscopy. What is the next best action?", options: [ "A. Document expected finding", "B. Irrigate the bladder", "C. Notify the provider", "D. Ask the patient to increase fluid intake" ], correct: 2, rationale: "Frank hematuria (bright red blood) post-cystoscopy is abnormal and requires provider notification." }, { id: 87, type: "dropdown", question: "A patient with GERD is told to avoid:", template: "Avoid [FOODS] and don't [ACTION].", dropdowns: { FOODS: ["chocolate, alcohol, coffee", "bread and rice", "soups and crackers"], ACTION: ["lie flat after eating", "eat with water", "sit too long before meals"] }, correct: {