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Worksheets2121 Exam 1 OT pt.4
Total questions: 99
Worksheet time: 50mins
A child has a nosebleed after playing outside in winter. Which factor most likely triggered the epistaxis?
Low humidity drying the nasal mucosa
Hypercalcemia causing fragile capillaries
Excess potassium intake from sports drinks
Increased intraocular pressure from crying
A client with COPD reports worsening shortness of breath. Which finding is most expected?
Sudden excruciating eye pain and fixed pupil
Chronic productive cough with exertional dyspnea
High fever with nuchal rigidity
Inspiratory stridor with drooling
A post-thyroidectomy client reports tingling around the mouth and hand spasms. Which electrolyte imbalance is most likely?
Hypernatremia
Hyperkalemia
Hypocalcemia
Hypermagnesemia
A client with suspected fluid volume deficit has BP 86/50, HR 132, and cool clammy skin. What is the nurse’s priority action?
Restrict fluids to prevent third spacing
Give a loop diuretic and monitor urine output
Delay IV access until orthostatics are rechecked
Administer oxygen and prepare for isotonic fluid resuscitation per orders
Which scenario is the most classic cause of metabolic alkalosis?
Prolonged vomiting or NG suction
Diarrhea for 3 days
Diabetic ketoacidosis
Septic shock with lactic acidosis
A client receiving magnesium sulfate becomes lethargic with decreased deep tendon reflexes and hypotension. Which medication should the nurse anticipate as the antidote?
Sodium bicarbonate
Calcium gluconate
Tolvaptan
Dextrose with insulin
A post-op client becomes increasingly confused and tachypneic. The provider orders ABGs. What is the best reason ABGs are obtained?
To identify the organism causing infection
To evaluate airway anatomy for obstruction
To assess oxygenation and acid–base balance
To measure lung volumes and airway resistance
A client asks what test confirms obstructive sleep apnea (OSA). Which response is correct?
Spirometry
Chest x-ray
Throat culture
Polysomnography
A client reports new floaters and “a curtain” over vision. What is the nurse’s best action?
Treat as urgent and prepare for prompt ophthalmic evaluation (possible retinal detachment)
Apply warm compresses and reassess tomorrow
Recommend oral antihistamines
Reassure this is expected with aging
ABG: pH 7.30, PaCO2 52, HCO3− 25. Which interpretation is most accurate?
Metabolic acidosis
Respiratory acidosis
Respiratory alkalosis
Metabolic alkalosis
An older adult says, “Everyone mumbles.” Which change is most consistent with presbycusis?
Conductive hearing loss from cerumen only
Sudden hearing loss with fever and ear pain
Age-related sensorineural loss (high-frequency, gradual)
Acute vestibular neuritis
Which best explains primary open-angle glaucoma pathophysiology?
Sudden complete blockage of aqueous outflow
Excess tear production increases IOP
Infection rapidly scars the cornea
Decreased aqueous outflow through the trabecular meshwork increases IOP
A client’s sodium is 118 mEq/L and they are confused. What is the safest priority nursing action?
Initiate seizure precautions and prepare for ordered hypertonic saline (3% NaCl)
Encourage free-water intake
Administer D5W rapidly
Give potassium chloride IV push
During a Rinne test, bone conduction is heard longer than air conduction on the right ear. What does this suggest?
Normal hearing
Right conductive hearing loss
Left sensorineural hearing loss
Bilateral normal hearing
A child with suspected Group A β-hemolytic streptococcal pharyngitis. Which diagnostic test is most appropriate?
CT scan of sinuses
Tympanometry
Throat culture or rapid antigen test
Bronchoscopy
Post-tonsillectomy, which finding is most concerning for hemorrhage?
Mild sore throat
White fibrin patches at the site
Decreased appetite
Frequent swallowing and throat clearing
A client reports episodic vertigo, tinnitus, and a feeling of fullness in one ear. Which condition is most likely?
Ménière’s disease
Allergic rhinitis
Otitis externa
Acute angle-closure glaucoma
A client in an acute asthma attack needs rapid symptom relief. Which medication is the best rescue choice?
Montelukast
Albuterol
Fluticasone
Salmeterol
A COPD client has thick secretions. Which medication best supports thinning bronchial secretions?
Oseltamivir
Timolol
Guaifenesin
Brimonidine
A client's potassium is 6.8 mEq/L with peaked T waves. Which provider order should the nurse anticipate FIRST to stabilize the cardiac membrane?
Sodium bicarbonate
Kayexalate
Regular insulin with dextrose
IV calcium gluconate
After total thyroidectomy, which assessment finding most strongly supports hypocalcemia?
Perioral tingling and carpopedal spasm
Hypertension and bounding pulses
Crackles and JVD
Dry mucous membranes and thirst
Which client has the highest risk for metabolic acidosis due to bicarbonate loss?
Persistent vomiting
Diarrhea for 3 days
NG suction
Loop diuretic therapy
In Ménière’s disease, what best explains the vertigo and hearing changes?
Cerumen blockage in the ear canal
Tympanic membrane rupture
Increased endolymph pressure disrupts balance/hearing
Decreased aqueous humor outflow
Which meal choice best fits a low-potassium diet teaching plan?
Baked potato with spinach
Orange juice and banana
Tomato soup and beans
White rice with grilled chicken and green beans
A client has potassium 2.9 mEq/L. Which statement by a new nurse requires correction?
“We can give IV potassium by IV push if the level is critical.”
“We should place the client on cardiac monitoring.”
“We should monitor for ileus and muscle weakness.”
“We’ll recheck potassium after replacement.”
A client is receiving diphenhydramine for allergic rhinitis. Which adverse effect should the nurse emphasize?
Bronchodilation
Sedation and dry mouth
Increased urine output
Hyperglycemia
Montelukast is most effective for which condition?
Acute asthma attack
Emergency bronchospasm
Chronic asthma/allergic rhinitis maintenance
Bacterial pneumonia
Cromolyn sodium prevents allergic symptoms by which mechanism?
Beta stimulation
Histamine receptor blockade
Systemic immune suppression
Preventing mast cell mediator release
Which patient should avoid systemic decongestants like pseudoephedrine/phenylephrine?
Patient with hypertension
Patient with anemia
Patient with eczema
Patient with iron deficiency
Fluticasone nasal spray works primarily by:
Immediate vasoconstriction
Local anti-inflammatory action
Rapid bronchodilation
Systemic immunosuppression
Albuterol is classified as a:
Controller medication
Antihistamine
Inhaled steroid
Rescue medication
A common adverse effect of albuterol is:
Bradycardia
Respiratory depression
Tremors and tachycardia
Severe constipation
Ipratropium works by:
Blocking acetylcholine in the airways (anticholinergic)
Stimulating beta receptors
Neutralizing stomach acid
Increasing respiratory drive
Ipratropium is often used in combination with:
Antibiotics
Short-acting beta agonists
Antivirals
Proton pump inhibitors
Long-acting beta agonists such as salmeterol should:
Be used alone for asthma control
Replace rescue inhalers
Be used PRN during acute attacks
Be combined with inhaled corticosteroids for asthma (not used alone)
Acetylcysteine helps patients by:
Suppressing cough reflex
Reducing fever
Improving appetite
Breaking down thick mucus
Which lab value is most important to monitor for a patient receiving theophylline?
Serum drug levels
INR
Sodium
Calcium
Broad-spectrum antibiotics are most appropriate when:
Symptoms are mild
The organism is confirmed and sensitivities are known
Viral infection is suspected
Culture results are pending and organism is unknown
Rimantadine is used to treat:
RSV
Influenza A
Pneumonia
Strep throat
Modafinil is prescribed for patients with obstructive sleep apnea primarily for:
Treating airway obstruction
Eliminating apnea events
Replacing CPAP
Reducing daytime sleepiness
Which medication can be given to a child with tonsillitis who is allergic to penicillin?
Amoxicillin
Erythromycin
Penicillin VK
Piperacillin–tazobactam
Which medication is considered first-line antiviral (within 24–48 hr) for influenza A & B?
Palivizumab
Guaifenesin
Oseltamivir
Amoxicillin
Oseltamivir is most effective when started:
Only if hospitalized
After fever resolves
At the end of illness
Within 24–48 hours of symptom onset
Nirsevimab is best described as:
A monoclonal antibody
A live vaccine
A broad-spectrum antibiotic
A decongestant
The primary purpose of nirsevimab is to:
Treat RSV infection
Prevent RSV-related lower respiratory disease
Treat influenza
Treat bacterial pneumonia
During PRBC transfusion, which IV fluid is appropriate to run with blood?
D5W
Lactated Ringers
0.9% normal saline only
0.45% normal saline
After obtaining PRBCs from the blood bank, blood must typically be started within:
10 minutes
30 minutes
1 hour
2 hours
A client develops back pain, fever, chills, and dark urine during a transfusion. What is the priority nursing action?
Stop the transfusion, keep line open with NS, and notify provider/blood bank
Slow the transfusion and reassess
Give acetaminophen and continue
Switch to platelets
A client has bleeding with abnormal coagulation factors. Which product is most appropriate?
Albumin
Fresh frozen plasma
PRBCs
Platelets
A client with severe hyponatremia is at highest risk for which complication?
Kidney stones
Polyuria
Seizures
Constipation
Sodium 152 mEq/L. Which nursing intervention is most appropriate?
Give 3% NaCl rapidly
Encourage hypotonic fluids as prescribed and monitor neuro status
Give sodium tablets
Restrict all fluids
Potassium 2.8 mEq/L and weak thready pulse. Which intervention is safest?
Replace KCl diluted via pump; never IV push
IV push potassium for fastest effect
Hold potassium and give Kayexalate
Discharge after giving a banana
Potassium 6.2 mEq/L. Which order best supports shifting K+ from ECF into ICF?
Insulin with dextrose
Kayexalate
Potassium chloride infusion
Oral potassium
A client with hyperkalemia has peaked T waves. Which action is essential?
Droplet precautions
Continuous cardiac monitoring
Encourage high-potassium foods
Restrict oxygen
A client with suspected fluid volume deficit. Which assessment finding best supports hypovolemia?
Bounding pulse
JVD
Crackles
Tachycardia with orthostatic hypotension
Which complication is the biggest immediate threat in hypovolemic shock?
Poor tissue perfusion and impaired oxygenation
Hearing loss
Glaucoma
Tonsil bleeding
Which vasopressor is commonly used for shock support after fluids (as ordered)?
Montelukast
Norepinephrine
Timolol
Acetylcysteine
A client has suspected fluid volume excess. Which lab/marker supports heart failure involvement?
Low PaCO2
Low potassium
Elevated BNP
Low sodium only
A client with fluid volume excess has crackles and JVD. What teaching is most appropriate?
Increase sodium intake
Encourage 3–4 L fluids daily
Avoid daily weights
Fluid restriction and sodium restriction as ordered + daily weights
A post-op client on opioids becomes drowsy with shallow respirations. What acid–base imbalance is most likely?
Respiratory acidosis
Respiratory alkalosis
Metabolic alkalosis
Metabolic acidosis
A client with COPD is on oxygen. Which order matches cautious COPD management?
15 L NRB continuously
2–4 L NC or Venturi mask as prescribed/titrated to target SpO2
No oxygen ever
Room air only regardless of saturation
Which finding is most consistent with late-stage COPD chest x-ray changes?
Pleural effusion only
Lobar consolidation only
Flattened diaphragm from hyperinflation
Enlarged tonsils
A client has COPD with cor pulmonale. What does cor pulmonale mean?
Left-sided HF from valve disease
Sudden airway collapse during sleep
Acute hemolytic reaction
Right-sided heart failure related to increased pulmonary pressures
A client with OSA says, “So CPAP is like a constant air splint?” Which response is best?
Yes—continuous pressure helps prevent airway collapse during sleep
No—CPAP treats lung infection
No—CPAP is only diagnostic
Yes—CPAP increases mucus production
Which OSA teaching statement shows correct understanding?
Sleeping flat on my back always prevents apnea
Alcohol at night can worsen my apnea
Antibiotics fix OSA
OSA only happens with pneumonia
Which finding is most typical of nighttime OSA?
Sudden severe eye pain and vomiting
Bright red bleeding after tonsillectomy
Loud snoring with pauses ≥10 sec followed by a loud snort
Wheezing only with exercise
A client has suspected glaucoma but says, “My eyes don’t hurt.” Which glaucoma type most fits slow, painless progression?
Acute angle-closure glaucoma
Conjunctivitis
Hordeolum
Primary open-angle glaucoma
Which medication class lowers IOP and can cause systemic bradycardia/bronchospasm?
Beta-adrenergic blockers (e.g., timolol)
Mucolytics (e.g., acetylcysteine)
Antivirals (e.g., oseltamivir)
Leukotriene modifiers (e.g., montelukast)
A client with open-angle glaucoma is prescribed acetazolamide. What is its purpose?
Bronchodilation
Carbonic anhydrase inhibitor that helps lower IOP
Mast cell stabilization
Antiviral therapy
A child with epistaxis is actively bleeding. Which action is best?
Tilt head back and swallow blood
Blow the nose forcefully to clear clots
Sit upright, lean forward, and pinch the soft part of the nose
Lie flat and place head lower than heart
A child with confirmed strep throat asks when they can return to school after starting antibiotics. What teaching is most appropriate?
Only after finishing the entire course
Immediately after the first dose
Only after a repeat culture is negative
After 24 hours of antibiotics if afebrile and improving
Post-tonsillectomy, which drink choice should be avoided initially?
Red-colored liquids (harder to detect bleeding)
Cool water
Ice chips
Clear non-red popsicle
A client with Ménière’s disease asks what lifestyle change helps most. Best answer?
Increase caffeine intake
Low-sodium diet to reduce inner ear fluid shifts
High-potassium diet
High-sodium diet
A client with vertigo is prescribed meclizine. What is the main goal?
Cure Ménière’s disease permanently
Treat bacterial pneumonia
Reduce dizziness/vertigo symptoms
Lower intraocular pressure
A client with asthma is prescribed salmeterol. Which statement requires immediate correction?
I’ll use it daily to prevent symptoms
I’ll still keep my rescue inhaler
It’s not for sudden attacks
I can use it alone for asthma control without steroids
A client with asthma is prescribed theophylline. Which finding is most concerning for toxicity?
Tachycardia and restlessness
Mild dry mouth
Slight nasal congestion
Temporary hoarseness
A client with pneumonia is about to receive the first antibiotic dose. What is the best nursing action when possible?
Delay antibiotics until fever resolves
Obtain ordered cultures (sputum/blood) first
Start antihistamines first
Encourage fluids but skip cultures
An older adult has pneumonia but no fever and is suddenly confused. Best interpretation?
Confusion rules out pneumonia
Confusion proves influenza only
Confusion can be an early sign of hypoxia in older adults
Confusion means stroke only
A client with influenza symptoms began 18 hours ago. Which medication is most appropriate?
Amoxicillin
Guaifenesin only
Diphenhydramine only
Oseltamivir
Which diagnostic study best evaluates conductive vs sensorineural hearing loss by measuring hearing thresholds?
Audiometry
Bronchoscopy
ABG
Mediastinoscopy
Tympanometry is primarily used to assess:
Middle ear pressure and tympanic membrane compliance
Cochlear hair cell function
Auditory cortex processing
Nasopharyngeal patency
Which medication is most directly used to break down thick mucus in COPD care?
Timolol
Tolvaptan
Acetylcysteine
3% NaCl
A client with hypokalemia asks what food is high in potassium. Best answer?
White rice
Apples
Cabbage
Potatoes
A client on a low-potassium diet asks which snack is safest.
Apple slices
Banana
Orange juice
Baked potato chips
A client has metabolic alkalosis from vomiting. Which electrolyte disturbance often co-exists?
Hyperkalemia
Hypokalemia
Hypercalcemia
Hypernatremia
A nurse is preparing to administer IV potassium. Which action is required?
Give IV push for fastest effect
Mix KCl into PRBC tubing
Use an infusion pump and dilute; never IV push/bolus
Run wide open to finish quickly
A client has hypernatremia and is restless with twitching. Which complication is most urgent to prevent?
Hypothermia
Bradycardia
Excess secretions
Seizures
Which teaching is safest for a client with glaucoma?
Report halos around lights and worsening peripheral vision changes
Stop drops when symptoms improve
Take OTC decongestants freely
Skip follow-up visits if pain is absent
A client has angle-closure glaucoma symptoms (severe eye pain, N/V, halos, red eye). Priority action?
Reassure and schedule routine follow-up
Treat as an emergency and prepare for rapid pressure-lowering interventions
Apply warm compresses and discharge
Give guaifenesin and reassess
With major fluid loss, what is the best concept of where fluid is pulled from to support circulation?
Fluid loss only occurs from the lungs
Fluid loss is always isolated to plasma only
Fluid shifts can pull from intracellular fluid (ICF) as the body tries to maintain circulation
Fluid loss only affects calcium levels
Which transfusion reaction is most associated with fever and chills WITHOUT hemolysis?
Acute hemolytic reaction
Anaphylactic reaction
TRALI
Febrile non-hemolytic reaction
A client develops dyspnea, crackles, and JVD during transfusion. Which reaction is most likely?
Circulatory overload (TACO)
Febrile non-hemolytic reaction
Acute hemolytic reaction
Anaphylaxis
Which action is correct if a transfusion reaction is suspected?
Document after the blood is complete
Stop transfusion and keep IV open with 0.9% NS using new tubing
Flush the blood with LR
Increase transfusion rate to finish quickly
A client with COPD asks why they’re encouraged to drink fluids (if not contraindicated). Best answer?
Fluids cure emphysema
Fluids increase mucus thickness
Hydration helps thin secretions so they’re easier to cough out
Fluids replace alveoli
A client with suspected OSA says, "My CO2 rises during episodes." Why?
Hyperventilation removes too much CO2
Mucus causes CO2 to be exhaled faster
CPAP causes CO2 production
Airflow obstruction decreases ventilation → CO2 builds up
Which finding best supports fluid volume excess rather than deficit?
Bounding pulse with crackles/pulmonary congestion
Orthostatic hypotension
Dry mucous membranes and thirst
Concentrated urine only
A client has hypocalcemia symptoms after thyroidectomy. What is the most appropriate immediate nursing focus?
Encourage high-sodium diet immediately
Airway/breathing safety—monitor for stridor/laryngospasm while treating calcium deficit
Start hypotonic fluids rapidly
Give potassium bolus
A client with suspected magnesium toxicity is becoming hard to arouse. Which assessment is most critical?
Skin turgor
Pupillary light reflex only
Respiratory rate and depth
Hearing thresholds only
A nurse is teaching childhood epistaxis prevention. Which instruction is best?
Encourage frequent vigorous nose blowing
Use aspirin for discomfort
Keep the room very dry
Use humidification/saline and discourage nose picking
