ISPN & CGFNS Practice Test 1 — Questions and Answers

Question 1: An order for Bupropion (Wellbutrin) has been placed with a client. When is it appropriate for the nurse to give the order?

On an empty stomach
Early in the day (Correct answer)
Immediately before bed
When the patient requests it

Correct answer: Early in the day

Bupropion (Wellbutrin) is an antidepressant that can have stimulating effects on the central nervous system. To minimize the risk of insomnia and other sleep disturbances, it is typically advised to administer bupropion early in the day, often in the morning. Taking it later in the day could interfere with the patient's ability to fall asleep.

Question 2: A temperature of 101 degrees has been recorded in a patient with acquired immunodeficiency syndrome and pneumocystis jiroveci infection. Pentamidine is administered to the patient (pentam 300). Which of the following symptoms does a fever indicate?

Another infection developed as a result of the medication's leukopenic side effects. (Correct answer)
The patient's thermoregulation has become insufficient.
The drug is causing side effects in the patient.
The medication's dose is too low.

Correct answer: Another infection developed as a result of the medication's leukopenic side effects.

Pentamidine, used to treat Pneumocystis jiroveci infection in AIDS patients, can cause bone marrow suppression, leading to leukopenia (low white blood cell count). In an immunocompromised patient with leukopenia, a fever is a critical indicator of a new or worsening infection. Their compromised immune system makes them highly susceptible to opportunistic infections, and fever signals the body's struggle against pathogens.

Question 3: If a client is experiencing dizziness after receiving procainamide (Procanbid) intravenously, the first nursing action is to:

Obtain a blood pressure reading by auscultating the client's apical pulse. (Correct answer)
Obtain a 12-lead electrocardiogram as soon as possible.
Administer the nitroglycerin pills as directed.
Using a rhythm strip, record the heart rate.

Correct answer: Obtain a blood pressure reading by auscultating the client's apical pulse.

Procainamide is an antiarrhythmic medication that can cause hypotension as a significant side effect, especially with intravenous administration. Dizziness is a common symptom of hypotension. Therefore, the nurse's first and most crucial action is to assess the client's blood pressure to confirm hypotension and guide appropriate interventions to ensure patient safety.

Question 4: The therapy in which a client's feelings, attitudes, and behaviors are modified by focusing on the therapist-client relationship is called:

Family therapy
Behavior therapy
Cognitive therapy
Interpersonal psychotherapy (Correct answer)

Correct answer: Interpersonal psychotherapy

Interpersonal psychotherapy (IPT) is a focused, time-limited form of therapy that emphasizes the role of interpersonal relationships and social functioning in mental health. It aims to help clients improve their communication patterns and the way they relate to others, thereby modifying maladaptive feelings, attitudes, and behaviors that contribute to their psychological distress.

Question 5: When a client has been sexually abused, the nurse is in the preinteraction phase of the nurse-client relationship. During this time, the nurse should do:

Examine the personal beliefs, preconceptions, and biases as they relate to the nurse-client interaction. (Correct answer)
Determine how people react to termination and separation.
Actively listen to the client as he expresses his feelings and thoughts.
Identify themes in patient behavior patterns and potential coping methods.

Correct answer: Examine the personal beliefs, preconceptions, and biases as they relate to the nurse-client interaction.

The preinteraction phase of the nurse-client relationship occurs before the nurse physically meets the client. During this crucial phase, the nurse's primary task is self-reflection and self-assessment. This involves examining personal beliefs, preconceptions, and potential biases related to the client's situation to ensure the provision of non-judgmental, empathetic, and professional care.

Question 6: Which of the following is the most important assessment for a client receiving bumetanide (Bumex) intravenously for acute congestive heart failure?

Monitoring blood pressure (Correct answer)
Monitoring weight loss
Monitoring urine output
Monitoring potassium level

Correct answer: Monitoring blood pressure

Bumetanide (Bumex) is a potent loop diuretic used to treat fluid overload in conditions like acute congestive heart failure. Diuretics promote significant fluid excretion, which can lead to volume depletion and a dangerous drop in blood pressure (hypotension). Therefore, closely monitoring blood pressure is the most important assessment to ensure patient safety and prevent adverse cardiovascular events.

Question 7: The nurse expects the following laboratory tests to evaluate the therapeutic impact of heparin intravenously given to the client:

Hematocrit
Activated partial thromboplastin time (Correct answer)
Hemoglobin
Prothrombin time

Correct answer: Activated partial thromboplastin time

Heparin is an anticoagulant medication that works by enhancing the activity of antithrombin, which inhibits various clotting factors. The therapeutic effect of unfractionated heparin is primarily monitored by measuring the activated partial thromboplastin time (aPTT). The aPTT assesses the intrinsic and common pathways of coagulation, which are directly affected by heparin's action.

Question 8: Which one of the following is not a source of acquired immunity?

Animal serum
Antibodies received in response to disease
Prescribed multivitamins (Correct answer)
Antibodies received from the mother

Correct answer: Prescribed multivitamins

Acquired immunity refers to the immunity developed during an individual's lifetime, either actively (e.g., through exposure to disease or vaccination) or passively (e.g., through antibodies received from the mother or animal serum). Prescribed multivitamins provide essential nutrients that support overall health, but they do not directly confer or contribute to acquired immunity itself.

Question 9: Dextroamphetamine (Dexedrine) has been prescribed for an 10-year-old child who has been acting out in class. The nurse will tell the parents to do the:

Give the last dose at least 6 hours before going to bed. (Correct answer)
Ensure that the child consumes 6-8 glasses of water per day.
Unless otherwise directed, ensure that dosages are given consistently.
Make sure to take the prescription after a full meal.

Correct answer: Give the last dose at least 6 hours before going to bed.

Dextroamphetamine (Dexedrine) is a central nervous system stimulant used to treat ADHD. A common side effect of stimulants is insomnia or difficulty sleeping. To minimize sleep disturbances, parents are typically instructed to administer the last dose of the medication at least 6 hours before the child's bedtime, allowing the stimulating effects to wear off.

Question 10: A patient has voluntarily checked herself into the hospital's mental health unit. The nurse anticipates the following from the client:

The patient will be participating in the treatment and care planning. (Correct answer)
The client refuses to be treated.
The client's family is not going to cooperate.
The client will be angry and confrontational

Correct answer: The patient will be participating in the treatment and care planning.

A client who has voluntarily checked into a mental health unit has chosen to seek treatment and engage in their care. This implies a willingness to participate actively in their treatment and care planning. Voluntary admission grants the client more autonomy and rights regarding their treatment decisions compared to involuntary commitment.

Question 11: Methamphetamine (Desoxyn) was prescribed to a 8-year-old girl who was overly energetic at home. The nurse instructs the parents to do:

Establish that the child eats a low-sodium diet
Make sure to take the prescription after a full meal.
Give the last dose at least 6 hours before going to bed. (Correct answer)
Ensure that the child sleeps for at least 8 hours.

Correct answer: Give the last dose at least 6 hours before going to bed.

Methamphetamine (Desoxyn) is a central nervous system stimulant used for ADHD, similar to other amphetamines. Like other stimulants, it can cause insomnia and interfere with sleep. To prevent sleep disturbances, the last dose of the medication should be given at least 6 hours before bedtime, allowing its stimulating effects to diminish before the child attempts to sleep.

Question 12: A assistance group has been talking with a depressed hospital patient. Which behaviors suggest that the patient is on the verge of committing suicide?

The patient begins to give away his or her stuff. (Correct answer)
The patient has outbursts of anger
The patient expresses his dissatisfaction with the other members of the group to the nurse.
Because he dislikes the group leader, the patient requests to be placed in another group.

Correct answer: The patient begins to give away his or her stuff.

A critical warning sign of impending suicide, especially in a depressed individual, is the act of giving away cherished possessions or making final arrangements. This behavior often indicates that the person has made a decision to end their life and is 'tying up loose ends.' It suggests a shift from suicidal ideation to concrete planning and intent, requiring immediate and urgent intervention.

Question 13: An indwelling abdominal catheter is used by a client who is having peritoneal dialysis for chronic renal failure. If the client spills water over the catheter dressing, what should the nurse do?

Sterilize the catheter with povidone-iodine
Replace the catheter
Reinforce the dressing
Change the dressing (Correct answer)

Correct answer: Change the dressing

An indwelling abdominal catheter for peritoneal dialysis creates a direct pathway into the peritoneal cavity, making sterility paramount. Spilling water on the dressing compromises its sterile barrier and creates a moist environment conducive to bacterial growth. Changing the dressing immediately is crucial to prevent infection, which is a serious and potentially life-threatening complication of peritoneal dialysis.

Question 14: What might a nurse anticipate to see after transfusing platelets into a trauma patient who has several cuts?

Relief of fever and headache
Decreased blood flow from cuts (Correct answer)
Less clammy skin
Increase in energy level

Correct answer: Decreased blood flow from cuts

Platelets are crucial for hemostasis, the process of stopping bleeding by forming clots. In a trauma patient with cuts, a platelet transfusion directly addresses any deficiency in the body's ability to clot blood. Therefore, the anticipated therapeutic effect is improved clot formation and a reduction in active bleeding from the cuts.

Question 15: A 35-year-old male who has used cocaine is being assessed by an emergency room nurse. What are the signs that the client has overdosed?

Blank stare and tremors
Vomiting and disorientation
Myocardial infarction and ataxia (Correct answer)
Constricted pupils and hypotension

Correct answer: Myocardial infarction and ataxia

Cocaine is a powerful stimulant that causes severe vasoconstriction, increased heart rate, and elevated blood pressure. These effects significantly increase the risk of myocardial infarction (heart attack) due to coronary artery spasm and increased cardiac oxygen demand. Ataxia, or impaired coordination, is also a common neurological sign of severe cocaine intoxication or overdose, reflecting its impact on the central nervous system.

Question 16: The treatment of which symptom is the expected effect of omeprazole (Prilosec).

Flatulence
Heartburn (Correct answer)
Constipation
Diarrhea

Correct answer: Heartburn

Omeprazole (Prilosec) is a proton pump inhibitor (PPI) that works by irreversibly blocking the enzyme responsible for producing stomach acid. Heartburn is a primary symptom caused by stomach acid refluxing into the esophagus. By significantly reducing acid production, omeprazole effectively alleviates and prevents heartburn associated with gastroesophageal reflux disease (GERD).

Question 17: For a client using codeine sulfate, the nurse would specifically include the following in the treatment plan:

Monitor bowel activity (Correct answer)
Monitor for hypertension
Monitor peripheral pulses
Monitor fluid balance

Correct answer: Monitor bowel activity

Codeine sulfate is an opioid analgesic, and a very common and significant side effect of opioids is constipation. Opioids slow down gastrointestinal motility, leading to decreased peristalsis and hardened stools. Therefore, monitoring the client's bowel activity and implementing preventative measures for constipation are essential components of the nursing care plan.

Question 18: During a softball game, the client was hit by a wild pitch and incurred an eye injury. What is the nurse's initial response?

Perform visual acuity tests
Notify the doctor
Immediately apply ice to the affected area.
Put on an eye patch. (Correct answer)

Correct answer: Put on an eye patch.

The immediate priority for an eye injury is to protect the eye from further damage and prevent the client from inadvertently touching or rubbing it. Applying an eye patch immobilizes the eye, shields it from external irritants, and helps reduce pain. While other actions like visual acuity tests and notifying the doctor are important, immediate protection is the initial critical step.

Question 19: On Coumadin, the client had a prothrombin time of 20 seconds and a control time of 11 seconds. According to the nurse, this means:

Results are lower than the needed therapeutic level
The results are above the therapeutic range.
Within the therapeutic range (Correct answer)
Test needs to be repeated

Correct answer: Within the therapeutic range

Coumadin (warfarin) is an anticoagulant, and its therapeutic effect is monitored by the prothrombin time (PT) and International Normalized Ratio (INR). A common therapeutic range for PT when a client is on warfarin is 1.5 to 2.5 times the control value. With a client's PT of 20 seconds and a control of 11 seconds, the ratio is approximately 1.82 (20/11), which falls within this established therapeutic range.

Question 20: Which of the following conditions is metoclopramide prescribed for?

Ulcer disease
Chronic bronchitis
Vomiting after chemotherapy (Correct answer)
Tuberculosis

Correct answer: Vomiting after chemotherapy

Metoclopramide (Reglan) is a prokinetic agent and an antiemetic that blocks dopamine receptors in the chemoreceptor trigger zone (CTZ) in the brain, thereby reducing nausea and vomiting. It also increases gastrointestinal motility, which helps empty the stomach. These actions make it particularly effective in managing severe nausea and vomiting, such as that experienced after chemotherapy.

Question 21: A client suffering from ulcerative colitis is receiving instruction from the nurse. What kind of diet is the nurse going to recommend?

Low-residue, low-fiber diet (Correct answer)
High-calcium diet
High-calorie, high-protein diet
Carbohydrate-consistent diet

Correct answer: Low-residue, low-fiber diet

Ulcerative colitis is an inflammatory bowel disease characterized by inflammation and ulcers in the colon. A low-residue, low-fiber diet is often recommended during acute flares or to manage symptoms. This type of diet reduces the amount of undigested material passing through the colon, minimizing irritation to the inflamed bowel and potentially reducing abdominal pain, cramping, and diarrhea.

Question 22: When prescribing Allopurinol (Zyloprim) to a patient, the nurse should include the following instructions:

The medicine should be taken on an empty stomach.
a daily fluid intake of 3000 mL (Correct answer)
The medication's effect will be felt right away.
That swelling of the lips is a normal and expected reaction.

Correct answer: a daily fluid intake of 3000 mL

Allopurinol (Zyloprim) is prescribed to reduce uric acid levels, which helps prevent gout attacks and kidney stones. Maintaining a high fluid intake, typically around 3000 mL daily, is crucial when taking allopurinol. This increased hydration helps to promote the excretion of uric acid and its metabolites through the kidneys, thereby preventing the formation of uric acid kidney stones.

Question 23: A client with hypokalemia is receiving instruction from the nurse. What kind of diet will the nurse be introducing?

High-potassium diet (Correct answer)
Cardiac diet
Sodium-restricted diet
Fat-restricted diet

Correct answer: High-potassium diet

Hypokalemia is a condition characterized by lower-than-normal potassium levels in the blood, which can impair nerve and muscle function, including cardiac activity. To correct this electrolyte imbalance, the nurse would recommend a high-potassium diet. This involves incorporating foods rich in potassium, such as bananas, oranges, leafy green vegetables, and potatoes, to help restore normal potassium levels.

Question 24: The nurse will utilize an administration kit specifically intended for flood when preparing for a blood transfusion. The blood administration set with straight tubing will help with the following:

It makes acetaminophen premedication simple.
It's made to fit an 18- or 19-gauge IV needle.
It maintains blood temperature to guarantee patient compatibility.
It has a filter that collects fibrin clots. (Correct answer)

Correct answer: It has a filter that collects fibrin clots.

Blood administration sets are specifically designed with an in-line filter as a critical safety feature. This filter's purpose is to trap any small clots, cellular debris, or fibrin strands that may have formed in the blood product during collection or storage. This prevents these particles from entering the client's circulation and potentially causing adverse reactions or complications like pulmonary emboli.

Question 25: Which of the following reports would be useful to a nurse caring for a pyrazinamide-addicted client?

Sputum culture (Correct answer)
Lead test
Complete blood count
Blood culture

Correct answer: Sputum culture

Pyrazinamide is an antitubercular drug used in the treatment of tuberculosis (TB). A sputum culture is a diagnostic test that identifies the presence of Mycobacterium tuberculosis in respiratory secretions. Monitoring sputum cultures during treatment is essential to assess the effectiveness of the medication in eradicating the bacteria and to determine when the client is no longer infectious.

ISPN & CGFNS Practice Test 1

An order for Bupropion (Wellbutrin) has been placed with a client.
When is it appropriate for the nurse to give the order?