GCC 176 - 200

When assessing a patient with glaucoma, the nurse should expect which finding?

• Complaints of double vision
• Complaints of halos around lights
• An intraocular pressure (IOP) of 15 mm Hg
• A soft globe on palpation
• -

Answer explanation

Option 1: Complaints of double vision

Option 2: Complaints of halos around lights

Option 3: An intraocular pressure (IOP) of 15 mm Hg

Option 4: A soft globe on palpation

Option 5: -

Correct Option: Option 2 – Complaints of halos around lights

Explanation: Halos and increased IOP are common in glaucoma; double vision is not.

Jugular vein distention is most prominent in which disorder?

• Abdominal aortic aneurysm
• Heart failure
• MI
• Pneumothorax
• -

Answer explanation

Option 1: Abdominal aortic aneurysm

Option 2: Heart failure

Option 3: MI

Option 4: Pneumothorax

Option 5: -

Correct Option: Option 2 – Heart failure

Explanation: JVD indicates elevated venous pressure, commonly seen in heart failure.

Examination of a primigravid client complaining of increased vaginal secretions since becoming pregnant reveals clear, highly acidic vaginal secretions. The client denies any perineal itching or burning. The nurse interprets these findings as a response related to which of the following?

• A decrease in vaginal glycogen stores.
• Development of a sexually transmitted disease.
• Prevention of expulsion of the cervical mucus plug.
• Control of the growth of pathologic bacteria.
• -

Answer explanation

Option 1: A decrease in vaginal glycogen stores.

Option 2: Development of a sexually transmitted disease.

Option 3: Prevention of expulsion of the cervical mucus plug.

Option 4: Control of the growth of pathologic bacteria.

Option 5: -

Correct Option: Option 4 – Control of the growth of pathologic bacteria.

Explanation: High acidity of secretions during pregnancy helps resist pathogenic bacterial growth.

The nurse identifies ventricular tachycardia on the heart monitor. Which action should the nurse prepare to take?

• Administer atropine sulfate
• Check the potassium level
• Administer an antiarrhythmic medication such as Lidocaine
• Defibrillate at 360 joules
• -

Answer explanation

Option 1: Administer atropine sulfate

Option 2: Check the potassium level

Option 3: Administer an antiarrhythmic medication such as Lidocaine

Option 4: Defibrillate at 360 joules

Option 5: -

Correct Option: Option 3 – Administer an antiarrhythmic medication such as Lidocaine

Explanation: Lidocaine is used for treating VT; defibrillation is for pulseless VT/VF.

The LPN is reviewing the lab results of an elderly client when she notes a specific gravity of 1.025. The nurse recognizes that:

• The client has impaired renal function.
• The client has a normal specific gravity.
• The client has mild to moderate dehydration.
• The client has diluted urine from fluid overload.
• -

Answer explanation

Option 1: The client has impaired renal function.

Option 2: The client has a normal specific gravity.

Option 3: The client has mild to moderate dehydration.

Option 4: The client has diluted urine from fluid overload.

Option 5: -

Correct Option: Option 2 – The client has a normal specific gravity.

Explanation: Specific gravity of 1.010–1.025 is within normal range.

The nurse is assisting a client with a total hip replacement to a chair. Which type of chair is appropriate for the client following a total hip replacement?

• A recliner
• A rocking chair
• A straight chair
• A sofa chair
• -

Answer explanation

Option 1: A recliner

Option 2: A rocking chair

Option 3: A straight chair

Option 4: A sofa chair

Option 5: -

Correct Option: Option 1 – A recliner

Explanation: A recliner limits hip flexion to 60° or less, preventing prosthesis dislocation.

To maintain a therapeutic environment with a patient and his family, the nurse can use communication techniques such as clarification. An example of clarification is:

• How is it going?
• You say you aren't concerned, but you've asked me many questions on this same subject.
• What do you mean when you say ...?
• For now, I would like to concentrate on ...
• -

Answer explanation

Option 1: How is it going?

Option 2: You say you aren't concerned, but you've asked me many questions on this same subject.

Option 3: What do you mean when you say ...?

Option 4: For now, I would like to concentrate on ...

Option 5: -

Correct Option: Option 3 – What do you mean when you say ...?

Explanation: Option C reflects clarification — seeking to understand the patient clearly.

Preoperative teaching for the patient about to have surgery should focus on which area?

• Deciding if the patient should have the surgery
• Giving emotional support to the patient and his family
• Giving minute details of the surgery to the patient and his family
• Providing general information to reduce patient and family anxiety
• -

Answer explanation

Option 1: Deciding if the patient should have the surgery

Option 2: Giving emotional support to the patient and his family

Option 3: Giving minute details of the surgery to the patient and his family

Option 4: Providing general information to reduce patient and family anxiety

Option 5: -

Correct Option: Option 4 – Providing general information to reduce patient and family anxiety

Explanation: The nurse provides general info to reduce anxiety — not minute details or decisions.

Which hepatitis virus is most likely to be transmitted through the fecal-oral route?

• Hepatitis A.
• Hepatitis B.
• Hepatitis C.
• Hepatitis D.
• -

Answer explanation

Option 1: Hepatitis A.

Option 2: Hepatitis B.

Option 3: Hepatitis C.

Option 4: Hepatitis D.

Option 5: -

Correct Option: Option 1 – Hepatitis A.

Explanation: Hepatitis A spreads via contaminated food/water or direct contact.

A 24-year-old female client is scheduled for surgery in the morning. Which of the following is the primary responsibility of the nurse?

• Taking the vital signs
• Obtaining the permit
• Explaining the procedure
• Checking the lab work
• -

Answer explanation

Option 1: Taking the vital signs

Option 2: Obtaining the permit

Option 3: Explaining the procedure

Option 4: Checking the lab work

Option 5: -

Correct Option: Option 1 – Taking the vital signs

Explanation: Taking vital signs before surgery falls under nursing duties.