CA Funda Prelim

$1. What is the main purpose of intravenous therapy (IVT)?
A. To improve appetite
B. To directly deliver fluids and medications into the bloodstream
C. To reduce the need for oral intake completely
D. To replace surgical procedures

B. To directly deliver fluids and medications into the bloodstream

2. Which IV solution is considered isotonic?
   A. 0.9% Sodium chloride
   B. 0.45% Sodium chloride
   C. 3% Sodium chloride
   D. 10% Dextrose in water

A. 0.9% Sodium chloride

3. Which IV solution causes cells to swell?
   A. Hypertonic
   B. Isotonic
   C. Hypotonic
   D. Colloids

C. Hypotonic

4. A patient on IV fluids suddenly develops dyspnea, crackles, and distended neck veins. What complication should the nurse suspect?
   A. Phlebitis
   B. Air embolism
   C. Circulatory overload
   D. Infiltration

C. Circulatory overload

5. Which IV cannula gauge is best for pediatric or elderly patients with small veins?
   A. 18G Green
   B. 20G Pink
   C. 22G Blue
   D. 24G Yellow

D. 24G Yellow

6. Which complication is characterized by heat, redness, tenderness, and decreased flow of IV?
   A. Infiltration
   B. Phlebitis
   C. Extravasation
   D. Hematoma

B. Phlebitis

7. Which is the safest immediate action if infiltration is suspected?
   A. Rub the IV site
   B. Remove the IV line
   C. Flush the IV tubing
   D. Increase the flow rate

B. Remove the IV line

8. Which crystalloid solution initially acts as isotonic but becomes hypotonic when metabolized?
   A. D5W
   B. D10W
   C. D5LR
   D. D5NS

A. D5W

9. A patient receiving 3% NaCl should be monitored for:
   A. Hypotension
   B. Hypervolemia
   C. Fluid volume overload
   D. Hypoglycemia

C. Fluid volume overload

10. Which piece of IV equipment regulates the flow of solution?
    A. Trocar
    B. Drip chamber
    C. Roller clamp
    D. Tourniquet

C. Roller clamp

11. A patient with IV infiltration complains of pain, swelling, and numbness at the site. What is the nurse’s next action?
    A. Reinsert IV at same site
    B. Elevate extremity and apply warm compress
    C. Massage the area
    D. Increase the infusion rate

B. Elevate extremity and apply warm compress

12. A nurse notes blood backflow in the IV chamber while inserting. What does this indicate?
    A. Phlebitis
    B. Proper vein entry
    C. Infiltration
    D. Air embolism

B. Proper vein entry

13. In IV therapy, patient consent is required and a nurse should attempt venipuncture how many times at most?
    A. 1
    B. 2
    C. 3
    D. 4

B. 2

14. Which patient is at highest risk for air embolism?
    A. Patient on hypotonic solution
    B. Patient with disconnected IV tubing
    C. Patient on long-term antibiotics
    D. Patient with infiltration

B. Patient with disconnected IV tubing

15. A patient receiving DKA management (Diabetic Ketoacidosis) is most likely to be prescribed which fluid?
    A. 0.45% NaCl
    B. 0.9% NaCl
    C. 3% NaCl
    D. Albumin

B. 0.9% NaCl

$16. Which blood group is considered the universal donor?
A. AB
B. O
C. A
D. B

B. O

17. Which blood group is the universal recipient?
    A. AB
    B. O
    C. A
    D. B

A. AB

18. A patient with type B blood can safely receive from which donor?
    A. Type A
    B. Type O
    C. Type AB
    D. Type B only

B. Type O

19. Which component is transfused to treat platelet deficiency?
    A. Whole blood
    B. Plasma
    C. Platelets
    D. PRBC

C. Platelets

20. What is the purpose of cross-matching before blood transfusion?
    A. To increase blood volume
    B. To check for allergic reactions
    C. To identify antigen-antibody compatibility
    D. To detect anemia

C. To identify antigen-antibody compatibility

21. During a blood transfusion, the patient develops fever, flank pain, and reddish urine. What should the nurse suspect?
    A. Allergic reaction
    B. Hemolysis
    C. Circulatory overload
    D. Sepsis

B. Hemolysis

22. What is the safest immediate action for a transfusion reaction?
    A. Stop the infusion
    B. Call the blood bank
    C. Give pain medication
    D. Flush with more saline

A. Stop the infusion

23. Which blood product provides clotting factors?
    A. PRBC
    B. Platelets
    C. Fresh frozen plasma
    D. Albumin

C. Fresh frozen plasma

24. Which transfusion complication is caused by contaminated blood?
    A. Hemolysis
    B. Allergic reaction
    C. Circulatory overload
    D. Sepsis

D. Sepsis

25. Packed red blood cells are mainly used to:
    A. Replace plasma proteins
    B. Treat anemia and increase oxygen-carrying capacity
    C. Correct electrolyte imbalances
    D. Reduce clotting factors

B. Treat anemia and increase oxygen-carrying capacity

26. Which action minimizes risk of CAUTI (catheter-associated UTI)?
    A. Using the smallest catheter size possible
    B. Emptying urine by disconnecting the bag
    C. Inserting catheter without gloves
    D. Inflating the balloon before insertion

A. Using the smallest catheter size possible

27. The nurse instructs a male patient to take deep breaths during catheter insertion to:
    A. Improve oxygenation
    B. Distract the patient
    C. Promote relaxation of urinary sphincter
    D. Increase urine flow

C. Promote relaxation of urinary sphincter

28. What position is best for female catheterization?
    A. Supine with legs extended
    B. Dorsal recumbent or lithotomy
    C. Prone with knees bent
    D. Side-lying

B. Dorsal recumbent or lithotomy

29. A nurse plans catheter insertion. What is the priority assessment?
    A. Pain level
    B. Allergies to latex, antiseptic, or iodine
    C. Urine color
    D. Fluid intake

B. Allergies to latex, antiseptic, or iodine

30. How often should an indwelling Foley catheter be replaced?
    A. Every week
    B. Every 3 months
    C. Every 6 months
    D. Only if infection develops

B. Every 3 months

31. A male client reports pain during insertion of an indwelling catheter. What should the nurse do first?
    A. Continue pushing the catheter
    B. Withdraw slightly and ask the client to relax
    C. Inflate the balloon immediately
    D. Remove catheter and avoid reattempt

B. Withdraw slightly and ask the client to relax

32. Which catheter is best used for bladder irrigation?
    A. Single lumen
    B. Two lumen
    C. Triple lumen
    D. Suprapubic tube

C. Triple lumen

33. Which catheter type is used for one-time evacuation of urine?
    A. Indwelling Foley
    B. Retention catheter
    C. Intermittent catheter
    D. Triple lumen

C. Intermittent catheter

34. Which enema solution can cause circulatory overload?
    A. Tap water (hypotonic)
    B. Soapsuds
    C. Hypertonic phosphate
    D. Oil retention

A. Tap water (hypotonic)

35. Which solution is safest for infants receiving an enema?
    A. Tap water
    B. Normal saline
    C. Hypertonic phosphate
    D. Soapsuds

B. Normal saline

36. Which enema is used to relieve gaseous distention?
    A. Cleansing
    B. Retention
    C. Return-flow (Harris flush)
    D. Carminative

D. Carminative

37. Which position is most appropriate for enema administration?
    A. Supine
    B. Right Sims
    C. Left Sims
    D. Lithotomy

C. Left Sims

38. Which enema requires 90–120 mL of oil to soften stool and lubricate mucosa?
    A. Soapsuds
    B. Oil retention
    C. Hypertonic phosphate
    D. Normal saline

B. Oil retention

39. What is the recommended rectal tube insertion depth for adults?
    A. 2–3 cm
    B. 5–7.5 cm
    C. 7.5–10 cm
    D. 12–15 cm

C. 7.5–10 cm

40. A nurse administers a return-flow enema. What is its main purpose?
    A. Soften stool
    B. Stimulate peristalsis and expel flatus
    C. Provide medication
    D. Lubricate rectal mucosa

B. Stimulate peristalsis and expel flatus

41. What is the FiO2 range for a nasal cannula at 2–6 L/min?
    A. 10–20%
    B. 24–45%
    C. 50–60%
    D. 70–100%

B. 24–45%

42. Which oxygen device delivers the most precise oxygen concentration?
    A. Simple mask
    B. Non-rebreather
    C. Nasal cannula
    D. Venturi mask

D. Venturi mask

43. Which device delivers the highest oxygen concentration (up to 100%)?
    A. Simple face mask
    B. Non-rebreather mask
    C. Venturi mask
    D. Nasal cannula

B. Non-rebreather mask

44. What flow rate is recommended for a simple face mask?
    A. 2–4 L/min
    B. 4–6 L/min
    C. 8–12 L/min
    D. 12–15 L/min

C. 8–12 L/min

45. A nurse notes a partial rebreather bag collapsing completely during inspiration. What should she do?
    A. Increase oxygen flow
    B. Decrease oxygen flow
    C. Remove the mask
    D. Switch to nasal cannula

A. Increase oxygen flow

46. Which mask uses color-coded jet adapters?
    A. Simple mask
    B. Non-rebreather
    C. Venturi mask
    D. Partial rebreather

C. Venturi mask

47. Which position should a patient be in during tracheostomy care?
    A. Prone
    B. Semi-Fowler’s
    C. Trendelenburg
    D. Lithotomy

B. Semi-Fowler’s

48. Which tracheostomy tube type prevents aspiration of secretions?
    A. Cuffed tube
    B. Uncuffed tube
    C. Fenestrated tube
    D. Inner cannula only

A. Cuffed tube

49. A newly created colostomy appears bluish and dusky. What should the nurse do?
    A. Document as normal
    B. Notify physician immediately
    C. Apply warm compress
    D. Flush with saline

B. Notify physician immediately

50. How soon does a colostomy usually begin functioning post-op?
    A. 12–24 hours
    B. 1–2 days
    C. 3–6 days
    D. 7–10 days

C. 3–6 days

51. Foods such as cabbage, beans, and eggs should be avoided after colostomy because they:
    A. Cause constipation
    B. Cause diarrhea
    C. Produce gas and odor
    D. Increase bleeding risk

C. Produce gas and odor

52. Which type of ostomy produces liquid fecal drainage with digestive enzymes harmful to skin?
    A. Ileostomy
    B. Transverse colostomy
    C. Descending colostomy
    D. Sigmoid colostomy

A. Ileostomy

53. Which traction is used for femoral fractures in children with buttocks slightly elevated?
    A. Buck’s traction
    B. Bryant’s traction
    C. Russell’s traction
    D. Pelvic traction

B. Bryant’s traction

54. Which traction includes both horizontal and vertical components for humerus fractures?
    A. Buck’s traction
    B. Dunlop’s traction
    C. Pelvic traction
    D. Russell’s traction

B. Dunlop’s traction

55. A nurse caring for a client in Buck’s traction should prioritize:
    A. Performing chest physiotherapy
    B. Assessing skin integrity frequently
    C. Checking bowel sounds
    D. Monitoring urine output hourly

B. Assessing skin integrity frequently

56. What is the purpose of a halo vest?
    A. To immobilize cervical spine
    B. To reduce hip fracture
    C. To treat scoliosis
    D. To support pelvic fracture

A. To immobilize cervical spine

57. When inserting an NG tube in an adult, measurement should be taken from:
    A. Nose to earlobe to xiphoid process
    B. Mouth to chin to sternum
    C. Nose to sternum directly
    D. Nose to clavicle

A. Nose to earlobe to xiphoid process

58. If resistance is met while inserting an NG tube, the nurse should:
    A. Forcefully push tube
    B. Withdraw, relubricate, and try other nostril
    C. Inflate tube balloon
    D. Ask patient to hyperextend head

B. Withdraw, relubricate, and try other nostril

59. Normal potassium level is:
    A. 2.5–3.0 mEq/L
    B. 3.5–5.0 mEq/L
    C. 6.0–7.0 mEq/L
    D. 7.5–9.0 mEq/L

B. 3.5–5.0 mEq/L

60. Normal hemoglobin in adult females is:
    A. 8–10 g/dL
    B. 10–12 g/dL
    C. 12–16 g/dL
    D. 14–20 g/dL

C. 12–16 g/dL

$61. A patient receiving IV therapy develops sudden chest pain, tachycardia, and cyanosis. What is the priority action?
A. Notify the physician
B. Clamp the tubing and place the patient in left Trendelenburg
C. Increase the IV flow rate
D. Remove the IV catheter immediately

B. Clamp the tubing and place the patient in left Trendelenburg

62. A nurse is calculating IV flow: 1000 mL NS to infuse over 10 hours, drop factor 20 gtts/mL. What is the flow rate?
    A. 20 gtts/min
    B. 25 gtts/min
    C. 30 gtts/min
    D. 35 gtts/min

C. 33 gtts/min (approx → 1000 ÷ 10 = 100 mL/hr; 100 × 20 ÷ 60 = 33 gtts/min)

63. A client on hypertonic solution complains of headache and shortness of breath. What should the nurse do first?
    A. Stop infusion immediately
    B. Slow the infusion rate
    C. Change to hypotonic solution
    D. Notify physician after documentation

B. Slow the infusion rate

64. Which solution is best for a patient with hypovolemic shock?
    A. D5W
    B. 0.9% NS
    C. 0.45% NS
    D. D10W

B. 0.9% NS

65. Which sign suggests infiltration at an IV site?
    A. Warmth and redness
    B. Coolness, swelling, and pain
    C. Bounding pulse
    D. Crackles in lungs

B. Coolness, swelling, and pain

66. A patient with CHF is ordered 1000 mL IV fluid over 4 hours. The nurse should:
    A. Run the infusion as ordered
    B. Question the order due to fluid overload risk
    C. Add electrolytes to balance fluid
    D. Increase flow to prevent clotting

B. Question the order due to fluid overload risk

67. Which IV solution is contraindicated for a patient with head trauma and cerebral edema?
    A. 3% NaCl
    B. 0.9% NaCl
    C. D5W
    D. LR

C. D5W

68. A patient receiving DKA therapy is on 0.9% NaCl. What is the rationale?
    A. To shift potassium into cells
    B. To replace sodium bicarbonate
    C. To restore intravascular volume without fluid shifts
    D. To prevent acidosis

C. To restore intravascular volume without fluid shifts

69. A nurse sees a patient’s IV site with redness, tenderness, and a palpable cord. The nurse should suspect:
    A. Phlebitis
    B. Hematoma
    C. Extravasation
    D. Infiltration

A. Phlebitis

70. Which solution is best to administer with blood transfusion?
    A. D5LR
    B. 0.9% NS
    C. 0.45% NS
    D. D5W

B. 0.9% NS

71. During transfusion, the patient develops flushing and urticaria without itching. What is this reaction?
    A. Hemolytic
    B. Allergic (mild)
    C. Sepsis
    D. Febrile

B. Allergic (mild)

72. A patient with anemia is prescribed blood transfusion. Which product is most appropriate?
    A. Fresh frozen plasma
    B. Packed RBCs
    C. Platelets
    D. Whole blood only

B. Packed RBCs

73. A patient receiving a transfusion develops dyspnea, orthopnea, and crackles. What complication is suspected?
    A. Circulatory overload
    B. Allergic reaction
    C. Sepsis
    D. Hemolysis

A. Circulatory overload

74. Which assessment is most critical 15 minutes after starting a transfusion?
    A. Urine output
    B. Lung sounds
    C. Vital signs
    D. Hemoglobin

C. Vital signs

75. The nurse is preparing to transfuse PRBCs. Which IV fluid should be hung concurrently?
    A. D5W
    B. 0.9% NS
    C. LR
    D. D10W

B. 0.9% NS

76. A patient asks why crossmatching is required. The best response is:
    A. “It checks your blood sugar.”
    B. “It ensures your blood is compatible with the donor’s.”
    C. “It increases your hemoglobin faster.”
    D. “It prevents dehydration.”

B. “It ensures your blood is compatible with the donor’s.”

77. Which patient is at highest risk for a febrile reaction?
    A. Elderly patient with CHF
    B. Patient with history of multiple transfusions
    C. Patient with trauma and hypovolemia
    D. Patient with burns

B. Patient with history of multiple transfusions

78. A nurse preparing a platelet transfusion should expect infusion within:
    A. 1 hour
    B. 2–4 hours
    C. 6 hours
    D. 24 hours

A. 1 hour

79. A patient receiving blood develops fever, nausea, and anxiety. Which reaction is most likely?
    A. Hemolysis
    B. Febrile reaction
    C. Allergic reaction
    D. Sepsis

B. Febrile reaction

80. The nurse finds that the patient’s urine is dark brown after transfusion. This indicates:
    A. Allergic reaction
    B. Sepsis
    C. Hemolysis
    D. Dehydration

C. Hemolysis

81. A patient requires one-time catheterization for urine sample. Which catheter is best?
    A. Foley catheter
    B. Intermittent catheter
    C. Triple-lumen catheter
    D. Condom catheter

B. Intermittent catheter

82. Which technique best prevents CAUTI during long-term catheterization?
    A. Frequent irrigation
    B. Daily antibiotics
    C. Maintaining a closed drainage system
    D. Disconnecting bag for emptying

C. Maintaining a closed drainage system

83. The nurse is preparing an enema for a child. Which solution is safest?
    A. Tap water
    B. Normal saline
    C. Soapsuds
    D. Hypertonic phosphate

B. Normal saline

84. An adult patient requires enema. What volume of solution should be used?
    A. 100–200 mL
    B. 200–400 mL
    C. 500–1000 mL
    D. 1500–2000 mL

C. 500–1000 mL

85. A patient receiving soapsuds enema develops cramping. What should the nurse do first?
    A. Stop the enema immediately
    B. Lower the enema container
    C. Increase flow rate
    D. Remove the rectal tube

B. Lower the enema container

86. Which enema provides lubrication for easier stool passage?
    A. Hypertonic
    B. Oil retention
    C. Return-flow
    D. Carminative

B. Oil retention

87. A nurse positions a patient in left Sims position for enema administration. The rationale is:
    A. To relax anal sphincter
    B. To improve comfort
    C. To facilitate flow along the descending colon
    D. To reduce abdominal pressure

C. To facilitate flow along the descending colon

88. Which complication may occur if hypotonic tap-water enemas are repeated?
    A. Water intoxication
    B. Hypotension
    C. Hypocalcemia
    D. Dehydration

A. Water intoxication

89. A COPD patient requires precise oxygen delivery. Which device is best?
    A. Nasal cannula
    B. Simple mask
    C. Non-rebreather
    D. Venturi mask

D. Venturi mask

90. The nurse observes a non-rebreather mask bag fully collapsing during inspiration. What should she do?
    A. Switch to Venturi mask
    B. Increase flow rate
    C. Decrease flow rate
    D. Remove mask

B. Increase flow rate

91. A patient with tracheostomy requires suctioning. Which position is best?
    A. Supine
    B. Semi-Fowler’s
    C. Prone
    D. Side-lying

B. Semi-Fowler’s

92. The purpose of the cuff in a tracheostomy tube is to:
    A. Keep tube in place
    B. Prevent aspiration and air leakage
    C. Facilitate swallowing
    D. Increase comfort

B. Prevent aspiration and air leakage

93. A nurse finds the tracheostomy tube dislodged. What should be kept at bedside for emergency reinsertion?
    A. Inner cannula
    B. Obturator
    C. Sterile gauze
    D. Suction catheter

B. Obturator

94. After colostomy surgery, which finding requires immediate action?
    A. Stoma is moist and red
    B. Stoma is beefy red on first day
    C. Stoma is bluish purple
    D. Stoma has small bleeding spots

C. Stoma is bluish purple

95. Which type of colostomy produces mushy, malodorous stool?
    A. Ileostomy
    B. Transverse colostomy
    C. Descending colostomy
    D. Sigmoid colostomy

B. Transverse colostomy

96. A nurse educates a patient with ileostomy. Which statement indicates understanding?
    A. “My stool will be hard and formed.”
    B. “I should expect liquid stool with digestive enzymes.”
    C. “I will irrigate daily to promote regularity.”
    D. “There will be no odor at all.”

B. “I should expect liquid stool with digestive enzymes.”

97. Normal serum sodium level is:
    A. 120–130 mEq/L
    B. 136–145 mEq/L
    C. 150–160 mEq/L
    D. 100–110 mEq/L

B. 136–145 mEq/L

98. Which lab result requires immediate attention?
    A. Potassium 4.0 mEq/L
    B. Sodium 140 mEq/L
    C. Hemoglobin 7 g/dL
    D. Calcium 9.5 mg/dL

C. Hemoglobin 7 g/dL

99. Which lab value is normal for WBC count?
    A. 2000/mm³
    B. 5000–10,000/mm³
    C. 12,000–15,000/mm³
    D. 20,000/mm³

B. 5000–10,000/mm³

100. Which cholesterol value is considered desirable?
     A. 250 mg/dL
     B. 220 mg/dL
     C. <200 mg/dL
     D. 300 mg/dL

C. <200 mg/dL