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Worksheets2121 Exam 1 OT pt.3
Total questions: 100
Worksheet time: 50mins
A school-age child has recurrent epistaxis during winter. Which factor is the most likely cause?
Dry nasal mucosa from low humidity
Esophageal varices
Ruptured cerebral aneurysm
Acute hemolytic transfusion reaction
A client with COPD is being assessed in the clinic. Which finding is most expected?
Sudden pleuritic chest pain after immobilization
Chronic productive cough with exertional dyspnea
Inspiratory stridor with drooling
High fever with stiff neck
A client’s total calcium is 7.4 mg/dL. Which assessment finding is most consistent with this value?
Flushed skin and constipation
Polyuria with renal stones
Perioral tingling and carpopedal spasm
Bounding pulses and hypertension
An older adult is suspected of fluid volume deficit. Which assessment finding supports hypovolemia?
Jugular venous distention
Crackles in lung bases
Bounding peripheral pulses
Orthostatic hypotension and tachycardia
Which situation places a client at highest risk for metabolic alkalosis?
Severe diarrhea for 3 days
Prolonged vomiting with nasogastric suction
Diabetic ketoacidosis
Septic shock with lactic acid buildup
A client receiving magnesium sulfate develops toxicity. Which finding is most concerning?
Hyperactive deep tendon reflexes
Abdominal cramping
Respiratory depression and decreasing RR
Diaphoresis and tremor
A postoperative client is somnolent after opioids. ABG: pH 7.28, PaCO2 58, HCO3− 26. Which imbalance is present?
Metabolic acidosis
Metabolic alkalosis
Respiratory alkalosis
Respiratory acidosis
Which statement by a client with obstructive sleep apnea (OSA) indicates correct understanding?
“Antibiotics will cure my airway collapse.”
“A bronchodilator is my long-term cure.”
“I should drink alcohol at bedtime to sleep deeper.”
“CPAP helps keep my airway open while I sleep.”
A client reports flashes of light and a “curtain” over one eye. What is the nurse’s priority action?
Arrange urgent ophthalmic evaluation
Apply warm compresses and reassess tomorrow
Teach to use lubricating drops only
Encourage rest and limit reading for 24 hours
ABG: pH 7.52, PaCO2 30, HCO3− 24. Which imbalance is present?
Metabolic alkalosis
Respiratory alkalosis
Respiratory acidosis
Metabolic acidosis
An older adult reports difficulty hearing in crowded rooms and trouble hearing high-pitched voices. This is most consistent with:
Acute otitis media
Presbycusis
Ménière’s disease
Impacted cerumen only
Which best describes the pathophysiology of primary open-angle glaucoma?
Sudden complete blockage of aqueous humor outflow
Infection causes rapid corneal scarring
Decreased aqueous humor outflow through the trabecular meshwork
Excess tear production increases intraocular pressure
A client’s sodium is 118 mEq/L and they are increasingly confused. Which action is the priority?
Encourage free-water intake
Administer hypotonic IV fluids
Place the client on seizure precautions
Give potassium chloride IV push
During a Rinne test, bone conduction is heard longer than air conduction in the affected ear. This suggests:
Normal hearing in that ear
Sensorineural loss in that ear
Central hearing loss
Conductive hearing loss in that ear
A child has fever, sore throat, and strawberry tongue. Which organism is most associated with this presentation?
Group A β-hemolytic streptococci
Respiratory syncytial virus
Candida albicans
Mycoplasma pneumoniae
A child is 6 hours post-tonsillectomy. Which finding is most concerning for hemorrhage?
White patches at the surgical site
Frequent swallowing and throat clearing
Mild throat pain
Refusal of cool liquids
A client has episodic vertigo, tinnitus, and ear fullness. Which condition is most likely?
Acute otitis externa
Allergic rhinitis
Ménière’s disease
Acute angle-closure glaucoma
A client is in an acute asthma exacerbation. Which medication provides the fastest relief?
Montelukast
Fluticasone inhaler
Salmeterol
Albuterol
A COPD client has thick secretions that are difficult to expectorate. Which order best supports thinning secretions?
Encourage increased oral fluids if not contraindicated
Restrict fluids to 1 L/day
Give scheduled antitussives around the clock
Avoid humidification to reduce infection risk
A client’s potassium is 6.5 mEq/L with peaked T waves. Which medication should the nurse anticipate FIRST to stabilize the myocardium?
Sodium bicarbonate
Regular insulin with dextrose
Sodium polystyrene sulfonate
A client develops tingling around the mouth and a positive Trousseau sign after thyroidectomy. Which complication is occurring?
Hypocalcemia
Hypernatremia
Hypermagnesemia
Respiratory alkalosis
Which client is at highest risk for metabolic acidosis?
Client with prolonged vomiting
Client with diabetic ketoacidosis
Client taking loop diuretics
Client receiving antacids daily
Which statement best explains Ménière’s disease manifestations?
Increased endolymph (inner ear fluid) disrupts hearing and balance
Middle ear infection ruptures the tympanic membrane
Cerumen blocks sound transmission permanently
Increased IOP damages the macula first
A client is prescribed a low-potassium diet. Which food should the client avoid?
Applesauce
White rice
Cucumbers
Baked potato
A client has potassium 2.8 mEq/L. Which discharge statement requires follow-up?
“I will report palpitations right away.”
“I’ll take potassium exactly as prescribed.”
“If I miss a dose, I’ll double the next one.”
“I’ll eat more potassium-rich foods as instructed.”
A client takes diphenhydramine for allergic rhinitis. Which adverse effect should the nurse emphasize?
Hypertension
Sedation and dry mouth
Tachypnea
Bronchodilation
Montelukast is most effective for which condition?
Acute asthma attack
Emergency bronchospasm
Chronic asthma and allergic rhinitis
Bacterial pneumonia
Cromolyn sodium helps prevent allergic symptoms by:
Blocking histamine receptors
Stimulating beta2 receptors
Suppressing the immune system systemically
Preventing release of inflammatory mediators from mast cells
Which patient should avoid systemic decongestants (e.g., pseudoephedrine/phenylephrine)?
Patient with hypertension
Patient with asthma
Patient with GERD
Patient with anemia
Fluticasone nasal spray works primarily by:
Immediate vasoconstriction
Local anti-inflammatory action
Bronchodilation
Systemic immune suppression
Albuterol is classified as a:
Rescue medication
Controller medication
Mucolytic
Antibiotic
A common adverse effect of albuterol is:
Bradycardia
Respiratory depression
Tremors and tachycardia
Hypotension
Ipratropium works by:
Stimulating beta2 receptors
Blocking acetylcholine in the airways
Breaking down mucus chemically
Suppressing inflammation systemically
Long-acting beta2 agonists (e.g., salmeterol) should be:
Used alone for asthma control
Used as rescue therapy
Avoided in COPD
Used with inhaled corticosteroids for asthma maintenance
Acetylcysteine helps patients primarily by:
Suppressing cough
Breaking down thick mucus
Relaxing airway smooth muscle
Reducing airway inflammation
A key nursing consideration for theophylline therapy is to:
Avoid all hydration
Expect absent deep tendon reflexes
Monitor serum drug levels
Use only at bedtime
A client with influenza symptoms started 24 hours ago. Which medication is most appropriate?
Oseltamivir
Amoxicillin
Guaifenesin
Diphenhydramine
A client is prescribed modafinil in the setting of OSA. The purpose is to:
Treat airway obstruction
Eliminate nighttime apnea
Reduce daytime sleepiness
Replace CPAP therapy
A child is to receive nirsevimab. It is best described as:
A live vaccine
An antiviral medication
A broad-spectrum antibiotic
A monoclonal antibody
A client with suspected fluid volume deficit has labs showing increased BUN. This finding most strongly supports:
Dehydration/hypovolemia
Heart failure fluid overload
SIADH
Acute glaucoma attack
A client’s calcium is 12.1 mg/dL. Which manifestation is most expected?
Perioral tingling and tetany
Constipation and lethargy
A client is receiving magnesium sulfate. Which finding indicates worsening toxicity?
Hyperactive reflexes
Respiratory rate 8/min
Diarrhea
Tingling in fingers
A postoperative client is at risk for respiratory acidosis. Which nursing assessment best helps detect this early?
Monitor for hypoventilation and rising PaCO2 on ABGs
Monitor for tetany and Chvostek sign
Monitor for photophobia and halos
Monitor for tinnitus and ear fullness
Which ABG set indicates metabolic acidosis?
pH 7.48, HCO3- 30, PaCO2 44
pH 7.31, HCO3- 16, PaCO2 34
pH 7.51, HCO3- 24, PaCO2 30
pH 7.29, HCO3- 24, PaCO2 58
A client with suspected OSA asks what is monitored during polysomnography. Which is included?
EEG activity
Serum calcium
BNP level
Throat culture
An older adult has presbycusis. Which communication strategy is best?
Speak loudly from behind the client
Face the client and reduce background noise
Use complex medical terms to avoid repeating
Speak quickly to shorten interaction
Which statement best describes open-angle glaucoma symptoms?
Sudden severe eye pain and vomiting
Rapid purulent drainage and crusting
Gradual peripheral vision loss over time
Abrupt “curtain” over vision with flashes
A client with sodium 120 mEq/L becomes increasingly restless. Which provider order should the nurse implement first?
Encourage free-water intake
Administer hypotonic IV fluids
Start potassium replacement
Initiate seizure precautions
Rinne test is used to:
Compare air conduction to bone conduction
Measure intraocular pressure
Detect retinal detachment
Diagnose influenza strain
A child with suspected GAS pharyngitis is started on antibiotics. What is the primary goal?
Prevent rheumatic fever
Prevent glaucoma
Prevent COPD
Prevent Ménière’s disease
Post-tonsillectomy discharge teaching should include:
Avoid coughing, throat clearing, and nose blowing
Use a straw to increase fluids
Gargle vigorously after meals
Take aspirin for pain control
Which finding best differentiates Ménière’s disease from benign positional vertigo?
Vertigo triggered by rolling over only
Tinnitus with ear fullness and hearing loss
Dizziness improved by standing quickly
No auditory symptoms present
A client with asthma has an order set during an acute attack. Which action should occur first?
Obtain a sputum culture
Administer albuterol via nebulizer
Encourage oral fluids
Teach long-term trigger avoidance
A COPD client asks why guaifenesin was prescribed. The best response is:
“It cures emphysema.”
“It prevents pneumonia permanently.”
“It suppresses your cough reflex.”
“It thins secretions to make coughing them out easier.”
A client has severe symptomatic hypocalcemia. Which provider order is most appropriate?
Oral calcium carbonate only
Vitamin D supplements only
IV calcium gluconate via infusion pump
Fluid restriction
A client with suspected hypovolemia from hemorrhage is unstable. Which fluid is most appropriate initially?
Isotonic IV fluids (0.9% NS or LR as ordered)
Hypotonic D5W
3% hypertonic saline for all clients
Free water only
Which scenario most commonly produces metabolic alkalosis in hospitalized clients?
Nasogastric suction
Acute renal failure with uremia
Shock with lactic acidosis
Diabetic ketoacidosis
A client receiving magnesium sulfate has absent patellar reflexes. What is the priority action?
Increase the infusion rate
Stop the infusion and prepare calcium gluconate
Give oral magnesium
Encourage ambulation
A client with COPD has chronic CO2 retention. Which ABG pattern most fits this?
Low PaCO2 with high pH
High PaCO2 with low pH (may show compensation)
High HCO3- with high pH and normal PaCO2
Low HCO3- with low pH and normal PaCO2
Which OSA statement requires follow-up teaching?
“Weight loss can improve symptoms.”
“Alcohol before bed can worsen apnea.”
“CPAP decreases daytime sleepiness.”
“Sleeping on my back always prevents airway collapse.”
A client with suspected retinal detachment should be instructed to:
Avoid strenuous activity and seek urgent care
Use OTC antihistamine drops and wait 48 hours
Apply warm compresses and rest the eyes
Increase fluids and reassess later
ABG: pH 7.18, PaCO2 38, HCO3− 15. Which imbalance is present?
Metabolic acidosis
Respiratory alkalosis
Respiratory acidosis
Metabolic alkalosis
An older adult with hearing loss is at higher risk for:
Social isolation and depression related to communication barriers
Acute glaucoma
Hyperkalemia
Tonsil hemorrhage
Which teaching is most appropriate for a client prescribed timolol eye drops?
“Expect severe diarrhea as a side effect.”
“This medication increases intraocular pressure.”
“Report wheezing or bradycardia; it can have systemic beta-blocker effects.”
“Use it only when your eye hurts.”
Which Rinne test result is normal?
Bone conduction louder than air conduction
Air conduction louder than bone conduction
No sound heard by either method
Equal air and bone conduction always
Which assessment finding suggests post-tonsillectomy hemorrhage?
Mild sore throat and decreased appetite
White fibrin tissue at the surgical site
Frequent swallowing with tachycardia
Ear pain referred from throat irritation
Ménière’s disease treatment teaching should include:
There is no cure; focus on symptom management and trigger control
Antibiotics are first-line long-term therapy
High-sodium diet prevents attacks
Stop all meds once vertigo improves
A COPD client has a flattened diaphragm on chest x-ray. This finding is most consistent with:
Acute pleural effusion
Late-stage COPD hyperinflation
Acute bacterial tonsillitis
Acute angle-closure glaucoma
A client is on a low-potassium diet. Which seasoning instruction is most important?
Avoid potassium-based salt substitutes
Use salt substitutes daily
Add tomato paste to meals
Add banana to smoothies
Which instruction is most important for a client taking oral potassium supplements for hypokalemia?
Stop the medication if stools darken
Take the medication on an empty stomach only
Crush sustained-release tablets for easier swallowing
Take with food and a full glass of water; report GI irritation
A client is receiving IV potassium for hypokalemia. Which action is required?
Administer via infusion pump; never IV push
Give undiluted IV push in emergencies
Mix with blood transfusion tubing
Run wide open to finish quickly
Which electrolyte medication is used to remove potassium via the GI tract in hyperkalemia?
IV calcium gluconate
Regular insulin with dextrose
Sodium polystyrene sulfonate (Kayexalate)
Potassium chloride
A client with COPD is taught pursed-lip breathing primarily to:
Increase expiratory time and reduce air trapping
Cure chronic bronchitis
Lower serum calcium
Treat acute strep infection
A client with suspected hypovolemia has cool clammy skin and delayed capillary refill. Which nursing priority is most appropriate?
Place in Trendelenburg and withhold IV access
Restrict fluids
Administer oxygen and prepare for isotonic fluid resuscitation per orders
Give diuretics
Which cause is most associated with metabolic alkalosis related to potassium depletion?
Loop diuretic use
Diarrhea
DKA
Renal failure
A client on magnesium sulfate becomes difficult to arouse. Which assessment is most critical?
Respiratory rate and depth
Hearing acuity
Pupillary light reflex only
Visual acuity only
An ABG shows pH 7.33, PaCO2 67, HCO3− 37. This is most consistent with:
Uncompensated respiratory alkalosis
Compensated respiratory acidosis
Uncompensated metabolic acidosis
Compensated metabolic alkalosis
Which finding is most consistent with COPD rather than asthma?
Episodic symptoms with symptom-free intervals
Onset in childhood with eczema history
Reversible symptoms triggered by allergens
Long smoking history with chronic productive cough
A client with hyponatremia is receiving 3% sodium chloride. Which complication must the nurse watch for?
Rapid correction causing neurologic injury (monitor closely)
Hyperactive reflexes from magnesium toxicity
Increased intraocular pressure
Conductive hearing loss
A client reports gradual peripheral vision loss over months. Which condition is most consistent?
Acute angle-closure glaucoma
Retinal detachment
Chronic open-angle glaucoma
Conjunctivitis
A child with epistaxis is actively bleeding. Which action is appropriate?
Sit upright and lean forward; pinch soft part of nose
Tilt head back and swallow blood
Pack nares tightly with dry gauze immediately
Encourage forceful nose blowing
A client with asthma uses salmeterol. Which statement indicates correct understanding?
“This is my rescue inhaler for sudden wheezing.”
“I should use it alone instead of inhaled steroids.”
“It’s for maintenance; I still need a rescue inhaler for attacks.”
“I only use it when I have pneumonia.”
A client with thick secretions is prescribed acetylcysteine. The expected effect is:
Break down and thin mucus
Block histamine receptors
Stimulate beta2 receptors for bronchodilation
Cure emphysema
Which medication is most associated with sedation and dry mouth?
Fluticasone nasal spray
Diphenhydramine
Guaifenesin
Montelukast
A client with OSA is prescribed CPAP. The best explanation is:
It provides continuous positive pressure to prevent airway collapse
It cures OSA permanently after 1 week
It treats infection causing OSA
It is used only to diagnose OSA
A nurse is teaching about ototoxicity risk. Which medication class is commonly associated with ototoxic effects in older adults?
Loop diuretics
Antacids
Stool softeners
Topical emollients
A client with severe hypocalcemia is receiving IV calcium gluconate. Which monitoring is priority?
Cardiac rhythm monitoring
Peak flow readings
Throat culture monitoring
Tympanometry
A client has metabolic acidosis risk from bicarbonate loss. Which condition fits?
Prolonged diarrhea
Prolonged vomiting
NG suction
Loop diuretics
A nurse reinforces low-potassium diet teaching. Which choice shows understanding?
“I’ll choose applesauce instead of orange juice.”
“I’ll eat baked potatoes more often.”
“I’ll use potassium salt substitutes.”
“I’ll snack on bananas daily.”
A client with hypokalemia is at greatest risk for:
Cardiac dysrhythmias
Peaked T waves
Sine-wave QRS pattern
Severe hypertension with bounding pulses
A client after thyroidectomy reports numbness/tingling and begins stridor. What is the priority concern?
Laryngospasm from hypocalcemia affecting airway
Hypernatremia
Fluid volume excess
OSA
A client with COPD asks about vaccines. Which instruction is correct?
Influenza and pneumococcal vaccines are recommended
Vaccines are avoided in COPD
Vaccines cure COPD
Vaccines replace inhalers
A client with suspected GAS pharyngitis is allergic to penicillin. Which alternative is appropriate?
Erythromycin
Amoxicillin
Ceftriaxone always first choice
Palivizumab
Which manifestation is most consistent with fluid volume deficit?
Weak, thready pulse and tachycardia
JVD and crackles
Bounding pulses and edema
Weight gain and elevated BNP
A nurse reviews PFT purpose. Which is an appropriate reason to obtain PFTs?
Evaluate response to bronchodilators by measuring airflow changes
Confirm pulmonary embolism by visualizing clot
Identify pleural effusion volume by ultrasound
Detect myocardial ischemia during activity
A client scheduled for bronchoscopy asks why it’s done. Best response?
It measures apnea-hypopnea index
It evaluates middle ear mobility
It visualizes the trachea/bronchi and can remove foreign objects or secretions
It confirms glaucoma
Which finding best supports Ménière’s disease?
Episodic vertigo with tinnitus and aural fullness
“Curtain” over vision with flashes
Wheezing relieved fully between episodes
Frequent swallowing after tonsillectomy
A client has respiratory alkalosis from hyperventilation. Which ABG pattern fits?
pH 7.50, PaCO2 28, HCO3- 24
pH 7.30, PaCO2 58, HCO3- 24
pH 7.18, PaCO2 38, HCO3- 15
pH 7.57, PaCO2 46, HCO3- 38
Which teaching best prevents childhood epistaxis recurrence?
Use humidifier/saline sprays and discourage nose picking
Encourage vigorous nose blowing hourly
Use aspirin for discomfort
Keep the room very dry
A client with COPD asks why CO2 can be high. The best explanation is:
Chronic air trapping and hypoventilation can lead to CO2 retention
CO2 rises only when potassium is low
CO2 rises only from tonsil bleeding
CO2 rises only from glaucoma
