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Israel RN Licensure Exam study materials
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Israel RN Licensure Exam practice questions

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Question 1Internal Medicine Nursing (Adult Medical Nursing)

A patient with type 1 diabetes is admitted with nausea, vomiting, and abdominal pain. Blood glucose is 340 mg/dL, arterial pH is 7.18, and serum bicarbonate is 10 mEq/L. Which finding is most consistent with diabetic ketoacidosis rather than hyperosmolar hyperglycemic state?

  1. Arterial pH of 7.18 with bicarbonate of 10 mEq/L Correct answer.
  2. Mild abdominal pain with nausea
  3. History of type 1 diabetes
  4. Serum glucose of 340 mg/dL

Explanation

DKA is defined by the triad of hyperglycemia, ketosis, and a high anion gap metabolic acidosis, which manifests as a low arterial pH and low serum bicarbonate. Hyperosmolar hyperglycemic state typically shows marked hyperglycemia with minimal acidosis and little or no ketosis. Glucose level and abdominal pain overlap between both conditions and do not distinguish them.

Question 2Internal Medicine Nursing (Adult Medical Nursing)

A patient receiving a continuous insulin infusion for DKA has a serum potassium of 3.1 mEq/L. Which action should the nurse anticipate?

  1. Hold the insulin infusion until potassium normalizes
  2. Add potassium replacement to the intravenous fluids per protocol Correct answer.
  3. Continue the insulin infusion at the current rate without change
  4. Administer a bolus of sodium bicarbonate

Explanation

Insulin drives potassium into cells, so hypokalemia during DKA treatment can worsen and cause dangerous arrhythmias. Potassium replacement is indicated when serum potassium falls below roughly 5.2 mEq/L, and it should be given before or alongside continued insulin. Holding insulin entirely is not appropriate because acidosis must still be corrected.

Question 3Internal Medicine Nursing (Adult Medical Nursing)

Which clinical finding is most characteristic of acute decompensated heart failure with left ventricular failure?

  1. Orthopnea with bibasilar crackles Correct answer.
  2. Jugular venous distention with clear lungs
  3. Peripheral edema with warm extremities
  4. Hepatomegaly with ascites

Explanation

Left ventricular failure causes pulmonary congestion, producing dyspnea, orthopnea, and bibasilar crackles on auscultation. Right-sided failure is associated with systemic congestion such as peripheral edema, jugular venous distention, and hepatomegaly. Crackles reflect fluid in the alveoli from elevated left-sided filling pressures.

Question 4Internal Medicine Nursing (Adult Medical Nursing)

A patient with chronic heart failure is prescribed furosemide. Which laboratory value should the nurse monitor most closely?

  1. Serum magnesium
  2. Serum calcium
  3. Serum potassium Correct answer.
  4. Serum phosphate

Explanation

Loop diuretics such as furosemide increase renal potassium excretion and commonly cause hypokalemia, which can precipitate arrhythmias, especially in patients taking digoxin. Potassium assessment is the priority monitoring parameter. Other electrolytes may be affected but potassium is the most clinically significant and frequently monitored.

Question 5Internal Medicine Nursing (Adult Medical Nursing)

A patient with an acute exacerbation of asthma has a peak expiratory flow of 45% of personal best, speaks in partial sentences, and has accessory muscle use. Which classification best describes this presentation?

  1. Mild persistent asthma
  2. Moderate asthma exacerbation Correct answer.
  3. Severe asthma exacerbation
  4. Life-threatening asthma exacerbation

Explanation

Moderate exacerbations are characterized by peak expiratory flow of 40-69% of predicted, partial sentences, and accessory muscle use with a normal mental status. Severe exacerbations have PEF below 40%, speak in words only, and may show agitation or drowsiness. This patient's findings fit the moderate category.

Question 6Internal Medicine Nursing (Adult Medical Nursing)

A patient with COPD has an oxygen saturation of 84% on room air and a history of carbon dioxide retention. Which oxygen delivery approach is most appropriate?

  1. Intermittent oxygen only when the patient reports severe dyspnea
  2. No supplemental oxygen to avoid suppressing the respiratory drive
  3. High-flow oxygen titrated to maintain saturation above 98%
  4. Controlled low-flow oxygen titrated to a target saturation of 88-92% Correct answer.

Explanation

In patients with COPD and chronic hypercapnia, oxygen should be titrated to a target saturation of 88-92% to correct hypoxemia while avoiding worsening carbon dioxide retention. Controlled low-flow oxygen achieves this goal. High concentrations can worsen hypercapnia and are not the standard of care.

Question 7Internal Medicine Nursing (Adult Medical Nursing)

A patient presents with sudden pleuritic chest pain and dyspnea two weeks after total hip replacement. Which diagnostic test is most appropriate to confirm suspected pulmonary embolism?

  1. Chest radiograph
  2. Sputum culture
  3. Computed tomography pulmonary angiography Correct answer.
  4. Transthoracic echocardiogram

Explanation

CT pulmonary angiography is the diagnostic study of choice for suspected pulmonary embolism because it directly visualizes thrombus in the pulmonary arteries. It has high sensitivity and specificity and is widely available. Chest radiography is used to exclude alternative diagnoses rather than confirm PE.

Question 8Internal Medicine Nursing (Adult Medical Nursing)

A patient with a new diagnosis of deep vein thrombosis is started on a heparin infusion. Which laboratory test is used to monitor the therapeutic effect?

  1. Activated partial thromboplastin time Correct answer.
  2. Platelet count
  3. Prothrombin time with INR
  4. D-dimer

Explanation

Unfractionated heparin potentiates antithrombin III and prolongs the activated partial thromboplastin time, which is used to titrate the infusion to a therapeutic range. Prothrombin time and INR are used to monitor warfarin. Platelet counts monitor for heparin-induced thrombocytopenia but do not measure anticoagulant effect.

Question 9Internal Medicine Nursing (Adult Medical Nursing)

A patient with chronic kidney disease has a serum potassium of 6.4 mEq/L and peaked T waves on ECG. Which intervention should the nurse anticipate first?

  1. Hemodialysis initiation
  2. Subcutaneous insulin with glucose
  3. Oral sodium polystyrene sulfonate
  4. Intravenous calcium gluconate Correct answer.

Explanation

Severe hyperkalemia with ECG changes is a medical emergency, and intravenous calcium stabilizes the myocardial membrane to prevent arrhythmias immediately. It does not lower potassium but protects the heart while shifting and eliminating potassium is arranged. Insulin with glucose and dialysis follow as definitive measures.

Question 10Internal Medicine Nursing (Adult Medical Nursing)

A patient with acute kidney injury has a urine output of 15 mL/hour for the past six hours. Which finding most supports a prerenal cause?

  1. Muddy brown casts on urinalysis
  2. Urine sodium of 8 mEq/L with a urine osmolality of 650 mOsm/kg Correct answer.
  3. Serum creatinine rising after contrast administration
  4. Fractional excretion of sodium greater than 2%

Explanation

Prerenal azotemia reflects decreased renal perfusion, so the kidney avidly reabsorbs sodium and water, producing low urine sodium and high urine osmolality. A urine sodium below 20 mEq/L with concentrated urine supports a prerenal cause. Intrinsic renal injury typically shows higher urine sodium and casts.

Question 11Internal Medicine Nursing (Adult Medical Nursing)

A patient with cirrhosis and ascites is prescribed spironolactone. Which electrolyte imbalance is most likely?

  1. Hypernatremia
  2. Hypokalemia
  3. Hypocalcemia
  4. Hyperkalemia Correct answer.

Explanation

Spironolactone is a potassium-sparing aldosterone antagonist that retains potassium and can cause hyperkalemia, particularly when combined with other potassium-sparing agents or renal impairment. Loop diuretics, by contrast, typically cause hypokalemia. Monitoring serum potassium is essential during therapy.

Question 12Internal Medicine Nursing (Adult Medical Nursing)

A patient with cirrhosis has increasing confusion, asterixis, and a serum ammonia level of 120 mcg/dL. Which intervention should the nurse anticipate?

  1. Administer lactulose to promote ammonia elimination Correct answer.
  2. Give a benzodiazepine for agitation
  3. Restrict oral fluids to 1 L per day
  4. Increase dietary protein to promote healing

Explanation

Hepatic encephalopathy results from accumulation of ammonia and other neurotoxins, and lactulose acidifies the colon and traps ammonia for excretion in stool. It is the first-line treatment. Sedatives such as benzodiazepines should be avoided because they can worsen encephalopathy.

Question 13Internal Medicine Nursing (Adult Medical Nursing)

A patient with upper gastrointestinal bleeding is vomiting bright red blood and has a heart rate of 122 beats/min and blood pressure of 88/54 mm Hg. Which action should the nurse take first?

  1. Establish two large-bore intravenous lines and begin fluid resuscitation Correct answer.
  2. Administer oral proton pump inhibitor
  3. Obtain a full blood count and type and crossmatch
  4. Insert a nasogastric tube for lavage

Explanation

This patient is in hypovolemic shock from acute hemorrhage, so the priority is restoring circulating volume with large-bore intravenous access and isotonic fluid resuscitation. Blood typing and crossmatch follow immediately but access must be established first. Airway protection and monitoring are also essential.

Question 14Internal Medicine Nursing (Adult Medical Nursing)

A patient with acute pancreatitis reports severe epigastric pain radiating to the back. Which nursing intervention is most appropriate initially?

  1. Encourage ambulation to relieve pain
  2. Apply a heating pad to the abdomen
  3. Maintain nothing by mouth and provide intravenous fluids and analgesia Correct answer.
  4. Administer oral food and fluids to stimulate bowel function

Explanation

Acute pancreatitis is managed initially with bowel rest, intravenous fluid resuscitation, and analgesia to reduce pancreatic stimulation and maintain perfusion. Oral intake is withheld until pain and inflammation improve. Heat application and ambulation do not address the underlying inflammation.

Question 15Internal Medicine Nursing (Adult Medical Nursing)

A patient with type 2 diabetes taking metformin is scheduled for a contrast-enhanced CT scan. Which instruction is most appropriate?

  1. Stop metformin permanently
  2. Double the metformin dose after the scan
  3. Hold metformin at the time of the scan and resume after renal function is confirmed Correct answer.
  4. Continue metformin as prescribed on the day of the scan

Explanation

Contrast media can transiently impair renal function, and metformin accumulation with renal impairment increases the risk of lactic acidosis. Metformin is typically held at the time of contrast administration and resumed after renal function is confirmed stable. Permanent discontinuation is not required.

Question 16Internal Medicine Nursing (Adult Medical Nursing)

A patient with hypothyroidism is started on levothyroxine. Which instruction should the nurse include?

  1. Take the medication on an empty stomach 30 to 60 minutes before breakfast Correct answer.
  2. Take the medication only when symptoms worsen
  3. Take the medication with breakfast and calcium supplements
  4. Take the medication at bedtime with a glass of milk

Explanation

Levothyroxine absorption is reduced by food, calcium, and iron, so it should be taken on an empty stomach 30 to 60 minutes before breakfast with water. Consistent timing maintains stable thyroid hormone levels. It is a daily lifelong therapy, not an as-needed medication.

Question 17Internal Medicine Nursing (Adult Medical Nursing)

A patient with Addison disease is admitted with vomiting and hypotension. Which medication should the nurse anticipate administering immediately?

  1. Oral potassium binder
  2. Oral fludrocortisone alone
  3. Insulin infusion
  4. Intravenous hydrocortisone with isotonic saline Correct answer.

Explanation

Adrenal crisis is a life-threatening emergency requiring immediate intravenous glucocorticoid replacement along with isotonic fluid resuscitation for hypotension. Hydrocortisone provides both glucocorticoid and mineralocorticoid support. Fludrocortisone alone is insufficient in an acute crisis.

Question 18Internal Medicine Nursing (Adult Medical Nursing)

A patient with syndrome of inappropriate antidiuretic hormone has a serum sodium of 118 mEq/L and is having a seizure. Which intervention is most appropriate?

  1. Rapid correction with hypertonic saline to normal sodium within two hours
  2. Free water restriction alone
  3. Administration of intravenous furosemide alone
  4. Hypertonic saline infusion with careful monitoring of the rate of sodium correction Correct answer.

Explanation

Severe symptomatic hyponatremia with seizures requires hypertonic saline, but the correction must be gradual, generally no more than 8 to 10 mEq/L in 24 hours, to avoid osmotic demyelination. Careful monitoring of sodium levels during infusion is essential. Free water restriction alone is too slow for seizure activity.

Question 19Internal Medicine Nursing (Adult Medical Nursing)

A patient with a new diagnosis of HIV has a CD4 count of 180 cells/mm3. Which prophylactic measure should the nurse anticipate?

  1. Fluconazole for cryptococcal meningitis
  2. Acyclovir for herpes simplex virus
  3. Isoniazid for latent tuberculosis
  4. Trimethoprim-sulfamethoxazole for Pneumocystis jirovecii pneumonia Correct answer.

Explanation

Pneumocystis jirovecii pneumonia prophylaxis with trimethoprim-sulfamethoxazole is recommended when the CD4 count falls below 200 cells/mm3. This threshold reflects the increased risk of opportunistic infection. Other prophylactic agents are used for different pathogens and thresholds.

Question 20Internal Medicine Nursing (Adult Medical Nursing)

A patient with pneumonia has a respiratory rate of 30 breaths/min, temperature of 39.2°C, and blood pressure of 92/60 mm Hg. Which finding most strongly suggests the need for intensive monitoring?

  1. Crackles at the right base
  2. Temperature of 39.2°C
  3. Respiratory rate of 30 breaths/min with hypotension Correct answer.
  4. Productive cough with yellow sputum

Explanation

Tachypnea and hypotension are components of severity scoring for community-acquired pneumonia and suggest sepsis or impending respiratory failure requiring intensive monitoring. Fever, cough, and crackles are common findings that do not by themselves indicate critical illness. Hemodynamic instability is the key driver of escalation.

Question 21Internal Medicine Nursing (Adult Medical Nursing)

A patient with atrial fibrillation is prescribed warfarin. Which instruction is most important for the nurse to provide?

  1. Maintain a consistent intake of vitamin K-rich foods and monitor INR regularly Correct answer.
  2. Stop warfarin if bruising occurs
  3. Take aspirin daily along with warfarin
  4. Avoid all green vegetables permanently

Explanation

Warfarin interferes with vitamin K-dependent clotting factors, so a consistent dietary intake of vitamin K is important to keep the INR stable. Regular INR monitoring guides dose adjustments. Patients should not eliminate green vegetables entirely, as this can destabilize anticoagulation.

Question 22Internal Medicine Nursing (Adult Medical Nursing)

A patient with a suspected stroke has sudden right-sided weakness and slurred speech that began 45 minutes ago. Which action is the priority?

  1. Give oral fluids to assess swallowing
  2. Administer aspirin immediately
  3. Obtain urgent non-contrast head CT and assess for thrombolytic eligibility Correct answer.
  4. Lower blood pressure aggressively to normal

Explanation

Acute ischemic stroke within the thrombolytic window requires urgent non-contrast head CT to exclude hemorrhage before thrombolysis can be considered. Time is brain, so rapid imaging and eligibility assessment are priorities. Aspirin is given after hemorrhage is excluded, and blood pressure is not lowered aggressively in the acute phase.

Question 23Internal Medicine Nursing (Adult Medical Nursing)

A patient with myasthenia gravis reports increasing difficulty swallowing and weakness that worsens through the day. Which complication should the nurse monitor for most closely?

  1. Peripheral neuropathy
  2. Hyperthyroidism
  3. Nephrotic syndrome
  4. Respiratory muscle weakness and aspiration Correct answer.

Explanation

Myasthenia gravis causes fatigable weakness of skeletal muscle, and involvement of bulbar and respiratory muscles can lead to aspiration and respiratory failure. Monitoring respiratory status and swallowing safety is the priority. The disease does not directly cause thyroid, peripheral nerve, or renal disease.

Question 24Internal Medicine Nursing (Adult Medical Nursing)

A patient with a seizure disorder is found actively convulsing. Which action should the nurse take first?

  1. Restrain the limbs firmly
  2. Insert an oral airway between the teeth
  3. Protect the patient from injury and position safely Correct answer.
  4. Administer oral anticonvulsant immediately

Explanation

During an active seizure, the priority is protecting the patient from injury by clearing the area, cushioning the head, and positioning safely to maintain the airway. Nothing should be inserted into the mouth, and limbs should not be restrained. Medication is given after the seizure or per protocol for prolonged seizures.

Question 25Internal Medicine Nursing (Adult Medical Nursing)

A patient with rheumatoid arthritis is started on methotrexate. Which instruction is most important?

  1. Increase alcohol intake to reduce inflammation
  2. Avoid all vaccinations
  3. Take the medication daily at high dose
  4. Take folic acid supplementation and report signs of infection Correct answer.

Explanation

Methotrexate is a folate antagonist, and folic acid supplementation reduces mucositis and bone marrow suppression. Because it suppresses the immune system, patients should report signs of infection promptly. It is usually dosed weekly, not daily, and alcohol should be avoided because of hepatotoxicity risk.

Question 26Internal Medicine Nursing (Adult Medical Nursing)

A patient with heart failure is prescribed furosemide 40 mg IV. Which laboratory value should the nurse review before administration to detect the most characteristic adverse effect of this drug?

  1. Serum albumin
  2. Serum potassium Correct answer.
  3. Serum bilirubin
  4. Serum calcium

Explanation

Loop diuretics such as furosemide cause renal potassium wasting, so hypokalemia is the most characteristic and dangerous electrolyte disturbance, predisposing to arrhythmias and digoxin toxicity. Potassium should be checked before and after dosing, especially with concurrent digoxin or in patients with low oral intake.

Question 27Internal Medicine Nursing (Adult Medical Nursing)

A patient with an acute exacerbation of asthma has audible wheezing, a peak expiratory flow of 45% of personal best, and speaks in short phrases. After administering a short-acting beta-2 agonist by nebulizer, which finding best indicates a positive response to therapy?

  1. Decreased wheezing with improved peak expiratory flow Correct answer.
  2. Heart rate increasing from 96 to 118 beats/min
  3. Development of a fine tremor in both hands
  4. Sputum becoming thicker and more tenacious

Explanation

A clinical response to bronchodilator therapy is shown by reduced airflow obstruction: less wheezing, easier speaking, and a rise in peak expiratory flow toward the personal best. Tremor and tachycardia are beta-agonist side effects, not evidence of improved ventilation.

Question 28Internal Medicine Nursing (Adult Medical Nursing)

A patient with an acute ST-elevation myocardial infarction arrives 90 minutes after symptom onset at a hospital without catheterization facilities. Which action should the nurse anticipate as the priority?

  1. Obtaining a chest radiograph before any reperfusion therapy
  2. Arranging immediate transfer for primary percutaneous coronary intervention Correct answer.
  3. Starting a slow infusion of nitroglycerin for pain control
  4. Administering oral metoprolol to lower the heart rate

Explanation

Primary percutaneous coronary intervention is the preferred reperfusion strategy for STEMI when it can be delivered promptly, so transfer to a PCI-capable center should be arranged without delay. Fibrinolysis is considered only when timely PCI is not achievable and there are no contraindications.

Question 29Internal Medicine Nursing (Adult Medical Nursing)

A patient with an acute exacerbation of COPD has a pH of 7.28, PaCO2 of 68 mm Hg, and bicarbonate of 30 mEq/L. Which finding should the nurse expect on assessment?

  1. Kussmaul respirations with deep rapid breathing
  2. Carpopedal spasm with a positive Trousseau sign
  3. Bradycardia with hypertension and warm dry skin
  4. Flapping tremor of the outstretched hands Correct answer.

Explanation

These arterial blood gas values indicate acute-on-chronic respiratory acidosis with compensatory bicarbonate retention, and carbon dioxide narcosis produces asterixis, a flapping tremor. Asterixis is a classic bedside sign of hypercapnic encephalopathy in COPD exacerbation.

Question 30Internal Medicine Nursing (Adult Medical Nursing)

A patient with a permanent pacemaker set at 70 beats/min has a sudden onset of fatigue and dizziness. The ECG shows pacing spikes at a rate of 70 per minute with no QRS complexes following them. Which action should the nurse take first?

  1. Obtain a 12-lead ECG and await the provider's arrival
  2. Reposition the patient onto the left side and reassess
  3. Increase the pacemaker's lower rate limit on the programmer
  4. Apply transcutaneous pacing pads and notify the provider Correct answer.

Explanation

Pacing spikes without captured QRS complexes indicate failure to capture, a pacing emergency when the patient is symptomatic and has no intrinsic escape rhythm. Transcutaneous pacing provides immediate backup while definitive correction, such as lead repositioning or magnet application, is arranged.

Question 31Internal Medicine Nursing (Adult Medical Nursing)

A patient with decompensated heart failure has gained 3 kg in four days, has bibasilar crackles, and reports orthopnea. Which nursing action is most appropriate?

  1. Encourage oral fluids to thin respiratory secretions
  2. Withhold diuretics until the blood pressure is above 140/90 mm Hg
  3. Keep the patient flat and apply sequential compression devices
  4. Place the patient in high Fowler position and administer prescribed IV furosemide Correct answer.

Explanation

The findings reflect pulmonary congestion from fluid overload, so upright positioning improves ventilation and the prescribed loop diuretic promotes diuresis. Daily weights, strict intake and output, and monitoring of potassium and renal function accompany this intervention.

Question 32Internal Medicine Nursing (Adult Medical Nursing)

A patient with type 1 diabetes is admitted with nausea, abdominal pain, and a blood glucose of 480 mg/dL. The nurse notes deep rapid respirations and fruity breath. Which prescription should the nurse question?

  1. Intravenous 0.9% sodium chloride bolus
  2. Hourly monitoring of blood glucose and potassium
  3. Subcutaneous insulin sliding scale every six hours Correct answer.
  4. Continuous intravenous regular insulin infusion

Explanation

Diabetic ketoacidosis requires continuous IV regular insulin with frequent glucose and potassium monitoring, not intermittent subcutaneous sliding scale dosing every six hours. Subcutaneous absorption is unreliable in dehydration and acidosis, and the delay would allow ketogenesis to continue.

Question 33Internal Medicine Nursing (Adult Medical Nursing)

A patient with type 2 diabetes taking glipizide reports episodes of shakiness, sweating, and confusion that resolve after eating. Which instruction should the nurse give?

  1. Take the medication only when symptoms of high glucose appear
  2. Check the blood glucose when symptoms occur and carry fast-acting carbohydrate Correct answer.
  3. Increase the dose at the next scheduled meal to prevent spikes
  4. Skip breakfast on days when the glucose is below 150 mg/dL

Explanation

Glipizide is a sulfonylurea that stimulates insulin release independent of food intake, causing hypoglycemia that is confirmed by a low glucose reading and treated with 15 g of fast-acting carbohydrate. Symptoms should be verified whenever possible so that hyperglycemia is not mistakenly treated.

Question 34Internal Medicine Nursing (Adult Medical Nursing)

A patient with chronic kidney disease has a hemoglobin of 8.2 g/dL and is prescribed epoetin alfa. Which parameter should the nurse monitor most closely during therapy?

  1. Platelet count
  2. Serum calcium
  3. Blood pressure Correct answer.
  4. Serum amylase

Explanation

Erythropoiesis-stimulating agents raise hematocrit and blood viscosity, which can precipitate or worsen hypertension and increase the risk of stroke and seizures. Blood pressure must be tracked, and the hemoglobin target should not be exceeded.

Question 35Internal Medicine Nursing (Adult Medical Nursing)

A patient with hyperthyroidism has a temperature of 40.1°C, heart rate of 148 beats/min, agitation, and vomiting. Which medication should the nurse anticipate administering first?

  1. Propylthiouracil Correct answer.
  2. Radioactive iodine
  3. Methimazole suppository
  4. Levothyroxine

Explanation

These findings suggest thyroid storm, a life-threatening emergency treated with a thionamide such as propylthiouracil to block new hormone synthesis, together with beta-blockade, iodine given after the thionamide, fluids, and cooling. PTU is also preferred because it blocks peripheral conversion of T4 to T3.

Question 36Internal Medicine Nursing (Adult Medical Nursing)

A patient receiving a blood transfusion develops fever, chills, flank pain, and hypotension ten minutes into the infusion. Which action should the nurse take first?

  1. Stop the transfusion and maintain venous access with 0.9% sodium chloride Correct answer.
  2. Slow the transfusion rate and give acetaminophen
  3. Recheck the vital signs in 15 minutes before intervening
  4. Obtain a urine sample and continue the transfusion

Explanation

Fever with flank pain and hypotension during transfusion suggests an acute hemolytic reaction, often from ABO incompatibility, which requires immediate cessation of the transfusion. The tubing is kept for return to the blood bank, saline is infused through new tubing, and the provider and blood bank are notified.

Question 37Internal Medicine Nursing (Adult Medical Nursing)

A patient with neutropenia from chemotherapy has a temperature of 38.4°C. Which action should the nurse take first?

  1. Obtain a chest radiograph before any antimicrobial therapy
  2. Obtain blood cultures from two sites and notify the provider for antibiotics Correct answer.
  3. Give acetaminophen and reassess the temperature in four hours
  4. Place the patient in a private room and begin reverse isolation only

Explanation

Febrile neutropenia is an oncologic emergency in which infection can progress to sepsis within hours, so cultures are drawn promptly and broad-spectrum antibiotics started within about an hour. Antipyretics may mask the fever and should not delay evaluation.

Question 38Internal Medicine Nursing (Adult Medical Nursing)

A patient with an acute exacerbation of multiple sclerosis reports new blurred vision, numbness of both hands, and worsening leg weakness. Which nursing intervention is most appropriate?

  1. Notify the provider and prepare for high-dose intravenous corticosteroid therapy Correct answer.
  2. Apply warm compresses to the legs to improve circulation
  3. Encourage vigorous exercise to maintain muscle strength
  4. Restrict fluids to prevent worsening of neurologic symptoms

Explanation

New or worsening neurologic deficits suggest an acute relapse, which is treated with high-dose IV corticosteroids to shorten the attack. Heat can transiently worsen demyelination symptoms, and strenuous exercise during a relapse should be avoided.

Question 39Internal Medicine Nursing (Adult Medical Nursing)

A patient with Parkinson disease has been taking levodopa-carbidopa for several years and now reports involuntary writhing movements and unpredictable wearing-off between doses. Which nursing action is most appropriate?

  1. Document the dyskinesias and on-off fluctuations and report them to the provider Correct answer.
  2. Suggest a high-protein meal with each dose to stabilize absorption
  3. Administer an extra dose whenever involuntary movements occur
  4. Advise the patient to stop the medication until the movements resolve

Explanation

Dyskinesias and on-off phenomena are late motor complications of long-term levodopa therapy that require provider-guided adjustment of dose timing, formulation, or adjunctive agents. The nurse documents the pattern and timing rather than changing the regimen independently.

Question 40Internal Medicine Nursing (Adult Medical Nursing)

A patient with generalized myasthenia gravis is prescribed pyridostigmine. Which instruction is most important for the nurse to include?

  1. Stop the medication promptly if diarrhea develops
  2. Take the medication about 30 to 60 minutes before meals to improve swallowing and chewing Correct answer.
  3. Take the medication at bedtime to reduce daytime muscle weakness
  4. Double the dose on days when weakness is more pronounced

Explanation

Pyridostigmine is an acetylcholinesterase inhibitor that improves neuromuscular transmission, and timing doses before meals helps the patient chew and swallow safely. Diarrhea and cramping may indicate cholinergic excess and should be reported rather than managed by abrupt discontinuation.

Question 41Surgical Nursing (Perioperative and Postoperative Care)

A patient is scheduled for surgery and asks why they must fast before receiving general anesthesia. Which explanation by the nurse is most accurate?

  1. Fasting reduces the risk of aspiration of gastric contents during induction. Correct answer.
  2. Fasting lowers the dose of anesthetic agents required for sedation.
  3. Fasting improves the absorption of preoperative intravenous antibiotics.
  4. Fasting prevents postoperative wound infection from oral bacteria.

Explanation

The primary purpose of preoperative fasting is to reduce gastric volume and acidity so that if regurgitation occurs during induction or emergence, aspiration pneumonitis is less likely. Modern guidelines allow clear liquids up to about two hours before anesthesia, so prolonged fasting is not required.

Question 42Surgical Nursing (Perioperative and Postoperative Care)

During the surgical safety checklist, the nurse confirms the patient's identity, procedure, and site. Which additional element is verified in the 'time out' immediately before incision?

  1. That the family has been informed of the expected duration
  2. That the patient has signed the informed consent and that the site is marked Correct answer.
  3. That the pathology specimen containers are labeled
  4. That the anesthesia record has been completed and signed

Explanation

The time out is a final pause before incision where the team confirms patient identity, correct procedure and site, site marking, consent, and any special requirements such as antibiotic prophylaxis or imaging. This prevents wrong-site, wrong-procedure, and wrong-patient events.

Question 43Surgical Nursing (Perioperative and Postoperative Care)

A patient is positioned in the lithotomy position for a gynecologic procedure. Which nursing action best prevents a common complication of this position?

  1. Elevate the head of the bed to 45 degrees throughout the case.
  2. Apply firm pressure to the popliteal spaces to stabilize the legs.
  3. Support the legs in stirrups with padding and avoid prolonged hip flexion. Correct answer.
  4. Place the arms above the head to improve surgical access.

Explanation

Lithotomy positioning can cause nerve injury and compartment syndrome, so legs should be supported with padded stirrups and hip flexion limited in duration and degree. Sequential compression devices and careful padding further reduce risk.

Question 44Surgical Nursing (Perioperative and Postoperative Care)

A patient undergoing abdominal surgery receives a neuromuscular blocking agent. Which assessment indicates that the drug has been adequately reversed before extubation?

  1. Presence of a gag reflex alone
  2. Sustained head lift for five seconds and adequate tidal volume Correct answer.
  3. A blood pressure within 20 mmHg of baseline
  4. Pupils that are equal and reactive to light

Explanation

Adequate reversal of neuromuscular blockade is confirmed by clinical signs of muscle strength such as sustained head lift, strong hand grip, and adequate spontaneous ventilation, ideally supported by train-of-four monitoring. A gag reflex alone does not confirm sufficient respiratory muscle recovery.

Question 45Surgical Nursing (Perioperative and Postoperative Care)

During a laparoscopic cholecystectomy, the surgeon insufflates carbon dioxide into the abdomen. Which physiologic change should the circulating nurse anticipate?

  1. Increased tidal volume with reduced end-tidal CO2
  2. Decreased systemic vascular resistance with hypotension
  3. Increased peak airway pressure and reduced venous return Correct answer.
  4. Decreased heart rate and increased urine output

Explanation

Pneumoperitoneum raises intra-abdominal pressure, which decreases venous return and elevates the diaphragm, increasing peak airway pressures. Absorbed carbon dioxide also raises end-tidal CO2 unless ventilation is adjusted.

Question 46Surgical Nursing (Perioperative and Postoperative Care)

A patient is recovering in the post-anesthesia care unit and develops a temperature of 39.2°C with muscle rigidity and tachycardia shortly after receiving a volatile anesthetic and succinylcholine. Which action should the nurse take first?

  1. Stop the triggering agents and notify the surgeon and anesthesia team immediately. Correct answer.
  2. Apply a cooling blanket and recheck the temperature in 30 minutes.
  3. Administer an antipyretic and obtain blood cultures.
  4. Document the finding and continue routine monitoring.

Explanation

These findings suggest malignant hyperthermia, a life-threatening hypermetabolic crisis. The priority is to discontinue triggering agents and mobilize the team to administer dantrolene while providing supportive care.

Question 47Surgical Nursing (Perioperative and Postoperative Care)

A patient with diabetes is scheduled for surgery and has been NPO since midnight. Which preoperative order should the nurse question?

  1. Check blood glucose before transfer to the operating room.
  2. Continue the usual long-acting insulin dose unchanged despite fasting. Correct answer.
  3. Hold the morning short-acting insulin per sliding scale.
  4. Initiate an intravenous fluid with dextrose per protocol.

Explanation

Administering the full usual dose of long-acting insulin to a fasting patient increases the risk of intraoperative hypoglycemia. The regimen is typically adjusted based on glucose monitoring and the type of insulin.

Question 48Surgical Nursing (Perioperative and Postoperative Care)

A patient is admitted to the post-anesthesia care unit after general anesthesia. Which assessment finding should the nurse address first?

  1. A blood pressure of 138/86 mmHg
  2. A respiratory rate of 8 breaths per minute with oxygen saturation of 89% Correct answer.
  3. A temperature of 36.0°C
  4. A pain score of 7 out of 10 at the incision site

Explanation

Airway and breathing take priority in the immediate postoperative period. A low respiratory rate with desaturation suggests residual anesthetic effect or opioid-induced respiratory depression and requires immediate intervention.

Question 49Surgical Nursing (Perioperative and Postoperative Care)

Which intervention is most effective in preventing surgical site infection in the immediate postoperative period?

  1. Applying a heating pad to the incision site
  2. Changing the dressing every shift regardless of saturation
  3. Performing hand hygiene before and after wound care and keeping the dressing intact Correct answer.
  4. Irrigating the wound with hydrogen peroxide daily

Explanation

Hand hygiene and maintaining an intact, clean dressing are core evidence-based practices for preventing surgical site infection. Dressings are typically changed when soiled or per protocol rather than routinely each shift.

Question 50Surgical Nursing (Perioperative and Postoperative Care)

A patient who underwent major abdominal surgery has a nasogastric tube in place. Which nursing action best promotes recovery of bowel function?

  1. Keep the patient supine and restrict activity.
  2. Encourage early ambulation as tolerated once stable. Correct answer.
  3. Clamp the nasogastric tube to allow gas to accumulate.
  4. Administer opioid analgesia around the clock without a bowel regimen.

Explanation

Early ambulation stimulates peristalsis and reduces the risk of ileus and venous thromboembolism. Opioids slow motility, so a bowel regimen and multimodal analgesia are preferred.