NCLEX-RN Exam Pack Set 1 (75 Questions And Answers Updated 2023), Exams of Nursing

Download NCLEX-RN Exam Pack Set 1 (75 Questions And Answers Updated 2023) and more Exams Nursing in PDF only on Docsity! NCLEX-RN Exam Pack Set 1 (75 Questions And Answers Updated 2023) 1.1. Question While assessing a one-month-old infant, which of the findings warrants further investigation by the nurse? Select all that apply. o A. Abdominal respirations o B. Irregular breathing rate o C. Inspiratory grunt o D. Increased heart rate with crying o E. Nasal flaring o F. Cyanosis o G. Asymmetric chest movement Option C. Grunting occurs when an infant attempts to maintain an adequate functional residual capacity in the face of poorly compliant lungs by partial glottic closure. As the infant prolongs the expiratory phase against this partially closed glottis, there is a prolonged and increased residual volume that maintains the airway opening and also an audible expiratory sound. Option E: Nasal flaring occurs when the nostrils widen while breathing and is a sign of troubled breathing or respiratory distress. Correct Answers: C, E, F, & G • 2. Question A nurse is to administer meperidine hydrochloride (Demerol) 100 mg, atropine sulfate (Atropisol) 0.4 mg, and promethazine hydrochloride (Phenergan) 50 mg IM to a preoperative client. List the order in which the nurse must carry out the following actions prior to the administration of preoperative medications. View Answers: o Place the call bell within reach o Raise the side rails on the bed o Have the client empty bladder o Instruct the client to remain in bed o Have the client empty the bladder. The first step in the process is to have the client void prior to administering the pre-operative medication. If the Correct order is shown above. o Option F: Cyanosis refers to the bluish discoloration of the skin and indicates a decrease in oxygen attached to the red blood cells in the bloodstream. o Option G: Asymmetric chest movement occurs when the abnormal side of the lungs expands less and lags behind the normal side. This indicates respiratory distress. o Option A: Abdominal respiration is normal among infants and young children. Since their intercostal muscles are not yet fully developed, they use their abdominal muscles much more to pull the diaphragm down for breathing. o Option B: Newborns can have irregular breathing patterns ranging from 30 to 60 breaths per minute with short periods of apnea (15 seconds). o Option D: An increase in heart rate is normal for an infant during activity (including crying). Fluctuations in heart rate follow the changes in the newborn’s behavioral state – crying, o B. 60-year-old Asian-American shop owner o C. 40-year-old Caucasian nurse o D. 55-year-old Hispanic teacher • 5. Question A 15-year-old female who ingested 15 tablets of maximum strength acetaminophen 45 minutes ago is rushed to the emergency department. Which of these orders should the nurse do first? o A. Gastric lavage o B. Administer acetylcysteine (Mucomyst) orally Option A: African-Americans develop high blood pressure at younger ages than other groups in the US. Researchers have uncovered that African-Americans respond differently to hypertensive drugs than other groups of people. They are also found out to be more sensitive to salt, which increases the risk of developing hypertension. Option B: The incidence of hypertension in Asian- Americans does not appear to be significantly higher than the general population, according to limited US data. Option C: The racial disparity in hypertension and hypertension- related outcomes has been recognized for decades with African- Americans with greater risks than Caucasians. Option D: Hypertension prevalence rates in Hispanics may vary by gender and country of origin. Hispanic Americans overall have relatively low levels of hypertension, despite elevated levels of diabetes and obesity. Correct Answer: A: 45-year-old African American attorney o C. Start an IV Dextrose 5% with 0.33% normal saline to keep the vein open o D. Have the patient drink activated charcoal mixed with water Correct Answer: A. Gastric lavage o Option A: Acetaminophen overdose is extremely toxic to the liver causing hepatotoxicity. Early symptoms of hepatic damage include nausea, vomiting, abdominal pain, and diarrhea. If not treated immediately, hepatic necrosis occurs and may lead to death. Removing as much of the drug as possible is the first step in treatment for acetaminophen overdose, this is best done through gastric lavage. Gastric lavage (irrigation) and aspiration consist of flushing the stomach with fluids and then aspirating the fluid back out. This procedure is done in life- threatening cases such as acetaminophen toxicity and only if less than one (1) hour has occurred after ingestion. o Option B: The oral formulation of acetylcysteine is the drug of choice for the treatment of acetaminophen overdose but should be done after GI decontamination with activated charcoal. Liver damage is minimized by giving acetylcysteine (Mucomyst), the antidote for acetaminophen. Acetylcysteine reduces injury by substituting for depleted glutathione in the reaction that converts the toxic metabolite of acetaminophen to its nontoxic form. When given within 8 hours of acetaminophen toxicity, acetylcysteine is effective in preventing severe liver injury. It is administered orally or intravenously. o Option C: Intermittent IV infusion with Dextrose 5% may be considered for late-presenting or chronic ingestion. o Option D: Oral activated charcoal (AC) avidly adsorbs acetaminophen and may be administered if the patient presents within 1 hour after ingesting a potentially toxic dose. Charcoal should not be administered immediately before or with antidotes since it can effectively adsorb it and neutralize the benefits. • 8. Question What would the nurse expect to see while assessing the growth of children during their school-age years? o A. Decreasing amounts of body fat and muscle mass o B. Little change in body appearance from year to year o C. Progressive height increase of 4 inches each year o D. Yearly weight gain of about 5.5 pounds per year Option A: IV hydration in the setting of acute renal colic is controversial. Whereas some authorities believe that IV fluids hasten the passage of the stone through the urogenital system, others express concern that additional hydrostatic pressure exacerbates the pain of renal colic. Option B: Because nausea and vomiting frequently accompany acute renal colic, antiemetics often play a role in renal colic therapy. Several antiemetics have a sedating effect that is often helpful. Option D: Overuse of the more effective antibiotic agents leaves only highly resistant bacteria, but failure to adequately treat a UTI complicated by an obstructing calculus can result in potentially life- threatening urosepsis and pyonephrosis. Managing pain is always a priority because it ultimately improves the quality of life. The cornerstone of ureteral colic management is analgesia, which can be achieved most expediently with parenteral narcotics or nonsteroidal anti- inflammatory drugs (NSAIDs). Correct Answer: D. Yearly weight gain of about 5.5 pounds per year School-age children gain about 5.5 pounds each year and increase about 2 inches in height. Between ages 2 to 10 years, a child will grow at a steady pace. • 9. Question At a community health fair, the blood pressure of a 62-year- old client is 160/96 mmHg. The client states “My blood pressure is usually much lower.” The nurse should tell the client to: o A. Go get a blood pressure check within the next 15 minutes o B. Check blood pressure again in two (2) months o C. See the healthcare provider immediately o D. Visit the health care provider within one (1) week for a BP check • 10. Question The hospital has sounded the call for a disaster drill on the evening shift. Which of these clients would the nurse put first on the list to be discharged in order to make a room available for a new admission? Correct Answer: A. Go get a blood pressure check within the next 15 minutes The blood pressure reading is moderately high with the need to have it rechecked after a few minutes to verify. The client states it is ‘usually much lower.’ Thus a concern exists for complications such as stroke. o Options B & D: Waiting 2 months or a week for follow-up is too long. o Option C: Immediate check by the provider of care is not warranted. o Option A: Decreasing amounts of body fat and muscle mass are common in toddlers. o Option B: A decrease in the change in body appearance occurs among young adults. o Option C: Growth spurts are common in o A. A middle-aged client with a history of being ventilator dependent for over seven (7) years and admitted with bacterial pneumonia five days ago. o B. A young adult with diabetes mellitus Type 2 for over ten (10) years and admitted with antibiotic-induced diarrhea 24 hours ago. o C. An elderly client with a history of hypertension, hypercholesterolemia, and lupus, and was admitted with Stevens-Johnson syndrome that morning. o D. An adolescent with a positive HIV test and admitted for acute cellulitis of the lower leg 48 hours ago. • 11. Question A 25-year-old male client has been newly diagnosed with Option B: The client with antibiotic-induced diarrhea still needs continuous strict monitoring as the blood sugar levels may become unstable and dehydration is still possible. Option C: Stevens-Johnson syndrome (SJS) is a rare, serious disorder of the skin and mucous membranes. It’s usually a reaction to medication that starts with flu-like symptoms, followed by a painful rash that spreads and blisters. Option D: Cellulitis is often an underestimated complication of HIV disease, but they are responsible for an appreciable morbidity. Correct Answer: A. A middle-aged client with a history of being ventilator dependent for over seven (7) years and admitted with bacterial pneumonia five days ago. The best candidate for discharge is one who has had a chronic condition and is most familiar with their care. This client in option A is most likely stable and could continue medication therapy at home. • 13. Question In children suspected to have a diagnosis of diabetes, which one of the following complaints would be most likely to prompt parents to take their school-age child for evaluation? o A. Polyphagia o B. Dehydration o C. Bedwetting o D. Weight loss • 14. Question Option A: If epiglottitis is seriously considered, no imaging studies are required. In less-clear cases, imaging studies are occasionally helpful in establishing the diagnosis or excluding epiglottitis. Option B: Examining the child’s throat should not be attempted because it may compromise respiratory effort. Option C: There are no indications for the collection of sputum specimens. These findings suggest a medical emergency and may be due to epiglottitis. Any child with an acute onset of an inflammatory response in the mouth and throat should receive immediate care. Option A: Polyphagia or extreme hunger is one of the most common symptoms of diabetes both among adults and children. Option B: Dehydration is not a symptom of type 1 diabetes, but it can be one of the many complications. Option D: Unintentional weight loss would develop gradually in a child with type 1 diabetes. Correct Answer: C. Bedwetting One of the first symptoms of type 1 diabetes in children is bedwetting. Bedwetting in a school-age child is readily detected by the parents. A client comes to the clinic for treatment of recurrent pelvic inflammatory disease. The nurse recognizes that this condition most frequently follows which type of infection? o A. Trichomoniasis o B. Chlamydia o C. Staphylococcus o D. Streptococcus • 15. Question A registered nurse who usually works in a spinal rehabilitation unit is floated to the emergency department. Which of these clients should the charge nurse assign to this RN? o A. A middle-aged client who says “I took too many diet pills” and “my heart feels like it is racing out of my chest.” o B. A young adult who says “I hear songs from heaven. I need money for beer. I quit drinking two (2) days ago for my family. Why are my arms and legs jerking?” o C. An adolescent who has been on pain medications terminal cancer with an initial assessment finding pupils and a relaxed Option B: Chlamydial infections are one of the most frequent causes of salpingitis or pelvic inflammatory disease. Chlamydial bacteria could travel up toward the vagina or cervix into the reproductive organs. Option A: Trichomoniasis is a very common sexually transmitted disease, but it rarely predisposes to pelvic inflammatory disease. Options C & D: Staphylococcus and streptococcus may cause PID but it rarely occurs. Correct Answer: B. Chlamydia respiratory rate of 11, The nurse is speaking at a community meeting about personal responsibility for health promotion. A participant asks about chiropractic treatment for illnesses. What should be the focus of the nurse’s response? o A. Electrical energy fields o B. Spinal column manipulation o C. Mind-body balance o D. Exercise of joints • 19. Question The nurse is performing a neurological assessment on a client post right cerebrovascular accident. Which finding, if observed by the nurse, would warrant immediate attention? o A. Decrease in the level of consciousness o B. Loss of bladder control o C. Altered sensation to stimuli o D. Emotional lability Option A: Too much exposure to electrical energy can become a hazard to one’s health. Option C: Mind-body balance refers to yoga. Option D: Low-impact aerobic exercises are easier on the joints but are not part of chiropractic medicine. Correct Answer: B. Spinal column manipulation The theory underlying chiropractic is that interference with the transmission of mental impulses between the brain and body organs produces diseases. Such interference is caused by the misalignment of the vertebrae. Manipulation reduces subluxation. Correct Answer: A. Decrease in the level of consciousness • 20. Question A child who has recently been diagnosed with cystic fibrosis is in a pediatric clinic where a nurse is performing an assessment. Which later finding of this disease would the nurse not expect to see at this time? o A. Positive sweat test o B. Bulky greasy stools o C. Moist, productive cough o D. Meconium ileus Option B: The patient post-stroke may have transient urinary incontinence due to inability to communicate needs, or impaired motor and postural control. Control of the urinary sphincter may also be lost or diminished. Option C: Altered sensation to stimuli is expected for a patient post CVA. This may include sensory impairment to touch, loss of proprioception, difficulty interpreting visual, tactile, and auditory stimuli. Option D: Depression and anxiety are common responses by a patient after a catastrophic event such as in stroke. Emotional lability (or pseudobulbar affect), refers to the involuntary and uncontrollable bursts of emotion without an emotional trigger. A further decrease in the level of consciousness may indicate an increase in intracranial pressure leading to inadequate oxygenation of the brain. A decrease in LOC may also reveal the presence of a transient ischemic attack which may warn of impending thrombotic CVA. Correct Answer: C. Moist, productive cough Noisy respirations and a dry non-productive cough are commonly the first of the respiratory signs to appear in a newly diagnosed client with cystic fibrosis (CF). The other options are the earliest findings. CF is an inherited (genetic) condition affecting the cells that produce mucus, sweat, saliva, and digestive juices. Normally, these secretions are thin and slippery, but in CF, a defective gene • 21. Question The home health nurse visits a male client to provide wound care and finds the client lethargic and confused. His wife states he fell down the stairs two (2) hours ago. The nurse should o A. Place a call to the client’s health care provider for instructions o B. Send him to the emergency room for evaluation o C. Reassure the client’s wife that the symptoms are transient o D. Instruct the client’s wife to call the doctor if his symptoms become worse Option A: A positive sweat test is one of the indications of cystic fibrosis. Option B: A patient with CF experiences frequent greasy, bulky stools or difficulty with bowel movements as the thick mucus blocks the intestines. Option D: Meconium ileus is one of the early signs of CF. causes the secretions to become thick and sticky. Instead of acting as a lubricant, the secretions plug up tubes, ducts, and passageways, especially in the pancreas and lungs. Respiratory failure is the most dangerous consequence of CF. Correct Answer: B. Send him to the emergency room for evaluation This client requires immediate evaluation. A delay in treatment could result in further deterioration and harm. Home care nurses must prioritize interventions based on assessment findings that are in the client’s best interest. o Option A: Waiting to call for instructions may delay the diagnosis of the patient. o Option C: Reassuring the wife is since it is not a transient symptom. o B. “When you can climb 2 flights of stairs without problems, it is generally safe.” o C. “Have a glass of wine to relax you, then you can try to have sex.” • 24. Question A triage nurse has these four (4) clients arrive in the emergency department within 15 minutes. Which client should the triage nurse send back to be seen first? o A. A 2-month-old infant with a history of rolling off the bed and has bulging fontanelle with crying o B. A teenager who got a singed beard while camping o C. An elderly client with complaints of frequent liquid brown colored stools o D. A middle-aged client with intermittent pain behind the right scapula Option A: The instruction in option A is vague and does not specifically tell the patient how to determine if the activity is already appropriate for him. Option C: Having a glass of wine is not recommended for a client who just had a myocardial infarction. Option D: Having an active walking program does not guarantee that the client has regained strength for strenuous activity. Correct Answer: B. “When you can climb 2 flights of stairs without problems, it is generally safe.” There is a risk of cardiac rupture at the point of the myocardial infarction for about six (6) weeks. Scar tissue should form about that time. Waiting until the client can tolerate climbing stairs is the usual advice given by healthcare providers. • 25. Question While planning care for a toddler, the nurse teaches the parents about the expected developmental changes for this age. Which statement by the mother shows that she understands the child’s developmental needs? o A. “I want to protect my child from any falls.” o B. “I will set limits on exploring the house.” o C. “I understand the need to use those new skills.” o D. “I intend to keep control over our child.” Option A: When an infant is crying, the fontanels may look like they are bulging. Option C: The client in Option C can wait to be seen within the first hour. Option D: The client in Option D does not have a life- threatening condition but will still require immediate pain relief. Correct Answer: B. A teenager who got a singed beard while camping This client is in the greatest danger with a potential of respiratory distress. Any client with singed facial hair has been exposed to heat or fire in close range that could have caused serious damage to the interior of the lungs. Note that the interior lining of the lungs has no nerve fibers so the client will not be aware of swelling. Option A: The statement in Option A is correct but pertains to the risks associated with a toddler. Option B: Setting limits on a toddler may cause frustration instead of independence. Correct Answer: C. “I understand the need to use those new skills.” Erikson describes the stage of the toddler as being the time when there is normally an increase in autonomy. The child needs to use motor skills to explore the environment and develop autonomy. • 26. Question The nurse is preparing to administer an enteral feeding to a client via a nasogastric feeding tube. The most important action of the nurse is: o A. Verify correct placement of the tube o B. Check that the feeding solution matches the dietary order o C. Aspirate abdominal contents to determine the amount of last feeding remaining in stomach o D. Ensure that feeding solution is at room temperature • 27. Question The nurse is caring for a client with a serum potassium level of 3.5 mEq/L. The client is placed on a cardiac monitor and receives Option B: It is also important to check that the feeding solution matches the dietary order to ensure that the client gets proper nutrition. Option C: Aspirating the gastric contents is one of the methods used to determine the last feeding amount in the stomach, but is not the most important action the nurse should do. Option D: Keep it at room temperature so it would not upset the stomach. Correct Answer: A. Verify correct placement of the tube Proper placement of the tube prevents aspiration and entrance of food content into the lungs. The definitive way to ascertain the position of the nasogastric tube is through visualization by an x- ray. Another method is to aspirate stomach contents and check its pH (usually pH 1 to 5). Aspirated stomach content can also be tested for bilirubin to confirm it is placed in the stomach. o Option D: Controlling the child may be harmful to her development as toddlers should be developing their autonomy at this stage. • 29. Question The nurse anticipates that for a family who practices Chinese medicine the priority goal would be to: o A. Achieve harmony o B. Maintain a balance of energy o C. Respect life o D. Restore yin and yang Option B: The cerebellum is not affected in rhabdomyosarcoma. Option C: The kidneys are not directly affected by the disease. Option D: Bones are not directly affected by the disease. Rhabdomyosarcoma is the most common children’s soft tissue sarcoma. It originates in striated (skeletal) muscles and can be found anywhere in the body. Symptoms of rhabdomyosarcoma include if the cancer is in the head or neck area: sudden bulging or swelling of the eyes, conjunctival chemosis, and headache. It can also affect the urinary or reproductive system. Its common site of metastasis is the lung. Option A: Living in harmony with one’s natural environment with the aim of keeping all aspects of a person-mind, body, and spirit- in a state of harmony and balance so that disease never has a chance to develop. Option B: This balance and a healthy lifestyle are the focus of Chinese medicine which empowers the individual to participate in his own health. Correct Answer: D. Restore yin and yang For followers of Chinese medicine, health is maintained through the balance between the forces of yin and yang. Traditional Chinese medicine is a medical system that began being developed in China about 5000 years ago, which makes it the oldest continuous medical system on the planet. • 30. Question During an assessment of a client with cardiomyopathy, the nurse finds that the systolic blood pressure has decreased from 145 to 110 mm Hg and the heart rate has risen from 72 to 96 beats per minute and the client complains of periodic dizzy spells. The nurse instructs the client to: o A. Increase fluids that are high in protein o B. Restrict fluids o C. Force fluids and reassess blood pressure o D. Limit fluids to non-caffeine beverages • 31. Question The nurse prepares the client for the insertion of a pulmonary artery catheter (Swan-Ganz catheter). The nurse teaches the client that the catheter will be inserted to provide information about: Correct Answer: C. Force fluids and reassess blood pressure Orthostatic hypotension, a decrease in systolic blood pressure of more than 15 mmHg, and an increase in heart rate of more than 15 percent usually accompanied by dizziness indicate volume depletion, inadequate vasoconstrictor mechanisms, and autonomic insufficiency. o Option A: Fluids may not be necessarily protein-rich. o Option B: Restricting fluids could aggravate the client’s dizziness. o Option D: There is no need to restrict the fluid o Option C: In Chinese medicine, the body, and indeed a human being, is not seen as a machine, living in isolation from the world around it. Human beings are seen as part of the whole of things, which includes our environments, nature, and the universe itself. o A. Stroke volume o B. Cardiac output o C. Venous pressure o D. Left ventricular functioning • 32. Question A nurse enters a client’s room to discover that the client has no pulse or respirations. After calling for help, the first action the nurse should take is: o A. Start a peripheral IV o B. Initiate high-quality chest compressions o C. Establish an airway o D. Obtain the crash cart Option A: Stroke volume is calculated using measurements of ventricle volumes from an echocardiogram and subtracting the volume of the blood in the ventricle at the end of a beat (called end- systolic volume) from the volume of blood just prior to the beat (called end-diastolic volume). Option B: Cardiac output is calculated by multiplying the stroke volume by the heart rate. Option C: The CVP can be measured either manually using a manometer or electronically using a transducer. Correct Answer: D. Left ventricular functioning The catheter is placed in the pulmonary artery. Information regarding left ventricular function is obtained when the catheter balloon is inflated. Correct Answer: B. Initiate high- quality chest compressions o B. “I just can’t ‘catch my breath’ over the past few minutes and I think I am in grave danger.” o C. “I have to use the bedpan to pass my water at least every 1 to 2 hours.” o D. “It seems that the pain medication is not working as well today.” Correct Answer: B. “I just can’t ‘catch my breath’ over the past few minutes and I think I am in grave danger.” The nurse would be concerned about all of these comments, however, the most life-threatening is option B. Clients who had hip or knee surgery are at higher risk for the development of postoperative pulmonary embolism. Sudden dyspnea and tachycardia are classic findings of pulmonary embolism. Without prophylaxis (e.g., anticoagulation medications), deep vein thrombosis can develop within 7 to 14 days following the surgery and can lead to pulmonary embolism. The nurse should be aware of the other signs of DVT which include: pain and tenderness at or below the area of the clot, skin discoloration, swelling, or tightness of the affected leg. Signs of pulmonary embolism include acute onset of dyspnea, tachycardia, confusion, and pleuritic chest pain. o Option A: Muscle spasms occur after total hip replacements and acute pain is expected after a surgical procedure. o Option C: May indicate urinary infection and needs further assessment by the nurse. o Option D: May require a reevaluation of pain and interventions to manage pain though does not need immediate action. • 36. Question A 33-year-old male client with heart failure has been taking furosemide for the past week. Which of the following assessment cues below may indicate the client is experiencing a negative side effect from the medication? o ¢ A. Weight gain of 5 pounds o B. Edema of the ankles o C. Gastric irritability o D. Decreased appetite • 37. Question The nurse is caring for a 27-year-old female client with venous stasis ulcer. Which nursing intervention would be most effective in promoting healing? o A. Apply dressing using sterile technique o B. Improve the client’s nutrition status o C. Initiate limb compression therapy o D. Begin proteolytic debridement Correct Answer: D. Decreased appetite Furosemide is a loop diuretic that is used for pulmonary edema, edema in heart failure, nephrotic syndrome, and hypertension. Furosemide causes a loss of potassium unless a supplement or a potassium-rich diet is taken. A decrease in appetite is caused by hypokalemia. Signs and symptoms of hypokalemia include anorexia, fatigue, nausea, decreased GI motility, muscle weakness, dysrhythmias, reduced urine osmolality, altered level of consciousness. o Option A: Weight gain is not a negative side effect of furosemide. o Option B: Edema of the ankles are indications for the administration of furosemide. o Option C: Gastric irritability is not a side effect of furosemide. Correct Answer: B. Improve the client’s nutrition status Venous stasis occurs when venous blood collects and stagnates in the lower leg due to incompetent venous valves. Eventually, little oxygen and nutrients are supplied to the cells of the lower o D. Performance goals should be higher than what is attainable • 39. Question The nurse is providing information to a client with multiple sclerosis on performing exercises and physical activities. The nurse determines the client needs additional teaching if the client makes which statements? Select all that apply. o A. “I can lift weights and do resistance training.” o B. “I should exercise to the point of exhaustion.” o C. “I can include aerobic exercises in my routine.” o D. “Proper stretching should be done before starting my routine.” o E. “I should exercise continuously without Option B: Positive feedback is most useful when given immediately. Option C: Negative statements are never helpful in any given situation. Option D: Every goal should always be attainable. Correct Answer: A. Specific feedback is given as close to the event as possible Feedback is most useful when given immediately. Positive behavior is strengthened through immediate feedback, and it is easier to modify problem behaviors if the standards are clearly understood. Option B: Patients with multiple sclerosis should not exercise to the point of fatigue as strenuous physical exercise raises body temperature and may aggravate symptoms. Option E: Continuous exercise with no rest periods is contraindicated for patients with multiple sclerosis Correct answers: B & E. rest.” • 40. Question During the evaluation of the quality of home care for a client with Alzheimer’s disease, the priority for the nurse is to reinforce which statement by a family member? o A. “At least two (2) full meals a day are eaten.” o B. “We go to a group discussion every week at our community center.” o C. “We have safety bars installed in the bathroom and have 24-hour alarms on the doors.” o D. “The medication is not a problem to have it taken three (3) times a day.” who wants to exercise. The patient should be advised to take short rest periods, preferably lying down. Again, extreme fatigue may contribute to the exacerbation of symptoms. o Option A: Exercises should include activities that would strengthen weak muscles because diminishing muscle strength is often a primary concern in multiple sclerosis. These activities include lifting weights and resistance exercises. o Option C: Aerobic exercises help promote muscle efficiency, increase flexibility, improves mood, and helps eliminate stress. o Option D: Muscle stretching should be included prior to exercise as this helps minimize muscle spasticity and contractures which is • 42. Question A nurse is reviewing a patient’s past medical history (PMH). The history indicates the patient has photosensitive reactions to medications. Which of the following drugs is associated with photosensitive reactions? Select all that apply. o A. Ciprofloxacin (Cipro) o B. Sulfonamide o C. Norfloxacin (Noroxin) o D. Sulfamethoxazole and Trimethoprim (Bactrim) o E. Isotretinoin (Accutane) o F. Nitro-Dur patch Correct Answer: A, B, C, D, and E. Photosensitivity is an extreme sensitivity to ultraviolet (UV) rays from the sun and other light sources. A type of photosensitivity called Phototoxic reactions are caused when medications in the prematurity, hemorrhage, and ocular defects when given anytime during pregnancy and fetal warfarin syndrome when given during the first trimester. o Option B: Finasteride (Propecia, Proscar). Also has a pregnancy category X which has a high risk of causing permanent damage to the fetus. o Option C: Celecoxib (Celebrex). Large doses cause birth defects in rabbits; Pregnancy category C. o Option D: Clonidine (Catapres). Crosses the placenta but no adverse fetal effects have been observed. o Option E: Transdermal nicotine (Habitrol). Nicotine replacement products have been assigned to pregnancy category C (nicotine gum) and category D (transdermal patches, body interact with UV rays from the sun. Anti-infectives are the most common cause of this type of reaction. o Option A: Ciprofloxacin is used to treat a variety of bacterial infections. Ciprofloxacin belongs to a class of drugs called quinolone antibiotics. It works by stopping the growth of bacteria. This antibiotic treats only bacterial infections. It will not work for virus infections (such as common cold, flu). Unnecessary use or overuse of any antibiotic can lead to its decreased effectiveness. o Option B: Sulfonamides are synthetic bacteriostatic antibiotics that competitively inhibit conversion of p- aminobenzoic acid to dihydropteroate, which bacteria need for folate synthesis and ultimately purine and DNA synthesis. Humans do not synthesize folate but acquire it in their diet, so their DNA synthesis is less affected. o Option C: Norfloxacin is an antibiotic in a group of drugs called fluoroquinolones. Norfloxacin fights bacteria in the body. Norfloxacin is used to treat different bacterial infections of the prostate or urinary tract (bladder and kidneys). Norfloxacin is also used to treat gonorrhea. o Option D: Sulfamethoxazole and trimethoprim combination is used to treat infections such as urinary tract infections, middle ear infections (otitis media), bronchitis, traveler’s diarrhea, and shigellosis (bacillary dysentery). This medicine is also used to prevent or treat Pneumocystis jiroveci pneumonia or Pneumocystis carinii pneumonia (PCP), a very serious kind of pneumonia. Sulfamethoxazole and trimethoprim combination is an antibiotic. It works by eliminating the bacteria that cause many kinds of infections. o Option E: Isotretinoin is a drug used to treat severe acne that hasn’t responded to other treatments. It may be prescribed for other uses, including other skin problems and certain kinds of cancer. This drug is a vitamin A derivative (retinoid), so your body reacts to it in a similar way that it does to vitamin A. • 43. Question A patient tells you that her urine is starting to look discolored. If you believe this change is due to medication, which of the following of the patient’s medication does not cause urine discoloration? o A. Sulfasalazine o B. Levodopa o C. Phenolphthalein o D. Aspirin Option A: Sulfasalazine may discolor the urine or skin to orange-yellow color. Sulfasalazine is used to treat ulcerative colitis (UC), and to decrease the frequency of UC attacks. Sulfasalazine will not cure ulcerative colitis, but it can reduce the number of attacks you have. Option B: Levodopa may discolor the urine, saliva, or sweat to a dark brown color. Levodopa is in a class of medications called central nervous system agents. It works by being converted to dopamine in the brain. Carbidopa is in a class of medications called decarboxylase inhibitors. It works by preventing levodopa from being broken down before it reaches the brain. Correct Answer: D. Aspirin Aspirin is not known to cause discoloration of the urine. Side effects and complications of taking aspirin include stroke caused by a burst blood vessel. The Food and Drug Administration doesn’t recommend aspirin therapy for the prevention of heart attacks in people who haven’t already had a heart attack, stroke or another cardiovascular condition. o Option F: Nitro-Dur patch is used to prevent chest pain or angina. Its side effects are headache, lightheadedness, nausea, and flushing. Secreted IgD appears to enhance mucosal homeostasis and • 46. Question A second-year nursing student has just suffered a needlestick while working with a patient that is positive for AIDS. Which of the following is the most significant action that the nursing student should take? o A. Immediately see a social worker o B. Start prophylactic AZT treatment o C. Start prophylactic Pentamidine treatment o D. Seek counseling Option A: Before reporting to a social worker, it is imperative to start a prophylaxis to reduce viral replication. Option C: Pentamidine is an antimicrobial medication given to prevent and treat pneumocystis pneumonia. Option D: It is natural to have strong emotions after an exposure to HIV in the workplace. The healthcare Correct Answer: B. Start prophylactic AZT treatment Azidothymidine (AZT) treatment is the most critical intervention. It is an antiretroviral medication used to prevent and treat HIV/AIDS by reducing the replication of the virus. Post- exposure prophylaxis (PEP) for HIV is a treatment to suppress the virus and prevent infection after exposure. PEP should be taken within 72 hours of possible exposure to HIV, so it is important to seek treatment quickly. immune surveillance by “arming” myeloid effector cells such as basophils and mast cells with IgD antibodies reactive against mucosal antigens, including commensal and pathogenic microbes. o Option C: IgE antibodies cause the body to react against foreign substances such as pollen, spores, animal dander. IgE antibodies are found in the lungs, skin, and mucous membranes. They are involved in allergic • 47. Question A thirty-five-year-old male has been an insulin-dependent diabetic for five years and now is unable to urinate. Which of the following would you most likely suspect? o A. Atherosclerosis o B. Diabetic nephropathy o C. Autonomic neuropathy o D. Somatic neuropathy Correct Answer: C. Autonomic neuropathy Autonomic neuropathy (also known as Diabetic Autonomic Neuropathy) affects the autonomic nerves, which control the bladder, intestinal tract, and genitals, among other organs. Paralysis of the bladder is a common symptom of this type of neuropathy, as manifested by bladder urgency and inability to start urination. o Option A: Atherosclerosis, or hardening of the arteries, is a condition in which plaque builds up inside the arteries. Plaque is made of cholesterol, fatty substances, cellular waste products, calcium, and fibrin (a clotting material in the blood). o Option B: Diabetic nephropathy (DN) is typically defined by macro albuminuria—that is, a urinary albumin excretion of more than 300 mg in a 24- hour collection—or macroalbuminuria and abnormal renal function as represented by an abnormality in serum creatinine, calculated creatinine clearance, or glomerular filtration rate (GFR). Clinically, diabetic nephropathy is characterized by a progressive increase in proteinuria and an increased need to urinate. worker might feel anger, fear, blame, or depression. During the difficult time of prevention treatment and waiting, they may want to seek support. Try an employee- assistance program or local mental health expert. o D. RH negative, RH negative Correct Answer: C. RH negative, RH positive Rhogam prevents the production of anti-RH antibodies in the mother that has an Rh-positive fetus. o Option A: RhoGAM is a prescription medicine that is used to prevent Rh immunization, a condition in which an individual with Rh-negative blood develops antibodies after exposure to Rh-positive blood. o Option B: If the father or baby is not conclusively shown to be Rh-negative, RhoGAM should be given to an Rh-negative mother in the following clinical situations to prevent Rh immunization: after delivery of an Rh-positive baby; routine prevention of Rh immunization at 26 to 28 weeks of pregnancy; maternal or fetal bleeding during pregnancy from certain conditions; or an actual or threatened pregnancy loss at any stage. o Option D: It isn’t until second and subsequent pregnancies when antibodies are already built up, that Rh incompatibility can cause problems. Indeed, these antibodies can cross the placenta and attack the baby’s red blood cells. This can cause the baby to develop anemia, and in severe cases, result in miscarriage. • 51. Question A new mother has some questions about phenylketonuria (PKU). Which of the following statements made by a nurse is not correct regarding PKU? o A. A Guthrie test can check the necessary lab values o B. The urine has a high concentration of phenyl pyruvic acid o C. Mental deficits are often present with PKU o D. The effects of PKU are reversible Correct Answer: D. The effects of PKU are reversible. Phenylketonuria (PKU) is an inherited disorder that increases the levels of phenylalanine (a building block of proteins) in the blood. If PKU is not treated, phenylalanine can build up to harmful levels in the body, causing intellectual disability and other serious health problems. The signs and symptoms of PKU vary from mild to severe. The most severe form of this disorder is known as classic PKU. Infants with classic PKU appear normal until they are a few months old. Without treatment, these children develop a permanent intellectual disability. Seizures, delayed development, behavioral problems, and psychiatric disorders are also common. Untreated individuals may have a musty or mouse-like odor as a side effect of excess phenylalanine in the body. Children with classic PKU tend to have lighter skin and hair than unaffected family members and are also likely to have skin disorders such as eczema. The effects of PKU stay with the infant throughout their life (via Genetic Home Reference). o Option A: The Guthrie test as a bacterial inhibition assay was formerly used, but now being replaced by tandem mass spectrometry. The Guthrie test, also called the PKU test, is a diagnostic tool to test infants for phenylketonuria a few days after birth. To administer the Guthrie test, doctors use Guthrie cards to collect capillary blood from an infant’s heel, and the cards are saved for later testing. o Option B: Phenylalanine is present in high concentrations in the urine because of its increased build up in the body. In addition to its role in protein production, phenylalanine is used to make other important molecules in the body, several of which send signals between different parts of the body. Phenylalanine has been studied as a treatment for several medical conditions, including skin disorders, depression, and pain o Option C: Without treatment, children affected with PKU develop a permanent intellectual disability. Seizures, delayed development, behavioral problems, and psychiatric disorders are also common. Untreated individuals may have a musty or mouse-like odor as a side effect of excess phenylalanine in the body. Children with classic PKU tend to have lighter skin and A 50-year-old blind and deaf patient has been admitted to your floor. As the charge nurse, your primary responsibility for this patient is? o A. Let others know about the patient’s deficits. o B. Communicate with your supervisor your patient safety concerns. o C. Continuously update the patient on the social environment. o D. Provide a secure environment for the patient. • 54. Question A patient is getting discharged from a skilled nursing facility (SNF). The patient has a history of severe COPD and PVD. The patient is primarily concerned about his ability to breathe easily. Which of the following would be the best instruction for this patient? Option A: Letting others know is correct, so that the other staff may become aware of the patient’s condition. However, this is not a priority. Option B: Before communication with the supervisor, the charge nurse must secure the environmental safety of the client first. Option C: Continuously updating the patient on the social environment is also correct, but this can come after securing the client’s safety. Correct Answer: D. Provide a secure environment for the patient. This patient’s safety is your primary concern. Patient safety protocols can help reduce medical mistakes and prevent adverse patient outcomes. When the goal is to help people, it seems obvious that it’s important to work to protect them from unintended or unexpected harm. o « A. Deep breathing techniques to increase oxygen levels. o B. Cough regularly and deeply to clear airway passages. o C. Cough following bronchodilator utilization. o D. Decrease CO2 levels by increased oxygen take output during meals. • 55. Question A nurse is caring for an infant that has recently been diagnosed with a congenital heart defect. Which of the following clinical signs would most likely be present? o A. Slow pulse rate o B. Weight gain Option A: Deep breathing exercises can help the client’s lungs from becoming more damaged. When one has healthy lungs, breathing is natural and easy. You breathe in and out with the diaphragm doing about 80 percent of the work to fill the lungs with a mixture of oxygen and other gases, and then send the waste gas out. Option B: Coughing may help clear the airway, however, it may not be as effective as taking bronchodilators. Coughing moves mucus out of the large airways. However, moving mucus out of the small airways requires airway clearance techniques (ACTs). This is why coughing should be done with other ACTs. Option D: Changing the level of oxygen at home without asking the healthcare provider is not recommended. Correct Answer: C. Cough following bronchodilator utilization The bronchodilator will allow a more productive cough. • 57. Question A client with myocardial infarction is receiving tissue plasminogen activator, alteplase (Activase, tPA). While on the therapy, the nurse plans to prioritize which of the following? o A. Observe for neurological changes o B. Monitor for any signs of renal failure o C. Check the food diary o D. Observe for signs of bleeding Correct Answer: D. Observe for signs of bleeding Bleeding is the priority concern for a client taking thrombolytic medication. The primary mechanism of all thrombolytics is the conversion of plasminogen to the active form, plasmin, which then degrades fibrin. This proteolysis can occur with fibrin- bound plasminogen on the surface of thrombi and the unbound form within the plasma. The unbound plasmin generated degrades fibrin but also fibrinogen, factor V, and factor VIII. o Option A: During therapy, perform a neurologic assessment every 15 minutes during the 1-hour infusion. After therapy, check every 15 minutes o Option A: Simian crease refers to a single crease across the palm of the hand and is prominent among those with Down’s syndrome. o Option B: Brachycephaly is described as a shortening of the occipitofrontal diameter (front to the back of the head) of the fetal head. Postnatally, it is well established that babies with Down syndrome often had signs of brachycephaly in utero. o Option D: Patients with Down syndrome have low muscle tone or hypotonia, and ligaments that are too loose (ligament laxity). It leaves • 58. Question A patient asks a nurse, “My doctor recommended I increase my intake of folic acid. What type of foods contain the highest concentration of folic acids?” o A. Green vegetables and liver o B. Yellow vegetables and red meat o C. Carrots o D. Milk Option B: Yellow vegetables are great sources of vitamins, such as vitamins A, B6, C, folate, magnesium, fiber, riboflavin, phosphorus, and potassium. Red meat is rich in protein, saturated fat, iron, zinc, and vitamin B. Option C: Carrots are a rich source of vitamin A from beta carotene, K1 (phylloquinone), and vitamin B6. Option D: Milk is a rich source of calcium. Milk is an excellent source of many vitamins and minerals, including vitamin B12, calcium, riboflavin, and phosphorus. It’s often fortified with other vitamins, especially vitamin D. Correct Answer: A. Green vegetables and liver Green vegetables and liver are a great source of folic acid. o Option B: Although current guidelines do not include renal dysfunction as a contraindication to tPA therapy, some clinicians hesitate to administer tPA because of a tendency of bleeding in these patients. o Option C: Having a food diary is not related to the use of medication. Thrombolytic therapy is indicated in patients with evidence of ST- segment elevation MI (STEMI) or presumably new left bundle-branch block (LBBB) presenting within 12 hours of the onset of symptoms if there are no contraindications to fibrinolysis. • 59. Question o B. The life span of RBC is 60 days o C. The life span of RBC is 90 days o D. The life span of RBC is 120 days Correct Answer: D. The life span of RBC is 120 days Red blood cells have a lifespan of 120 in the body. Today, RBC population studies are performed with a label that is placed on the RBC ex vivo, making it possible to study both donor and autologous RBC. o Option A: Human red blood cells (RBC), after differentiating from erythroblasts in the bone marrow, are released into the blood and survive in the circulation for approximately 115 days. In humans and some other species, RBC normally survives in a nonrandom manner. This means that all of the RBC in an age cohort are removed by the reticuloendothelial system at about the same time. o Option B: Accurate measurement of long-term survival requires determination of the amount of remaining labeled RBC for all or most of the RBC lifespan. Optimal determination of long-term survival also requires a steady-state situation, with the important variable depending on the label used. o Option C: Only recently with the introduction of the biotin label has a method become available that allows the detection, analysis, and isolation of aging RBC and thus detailed studies of their properties. • 61. Question A 65-year-old man has been admitted to the hospital for spinal stenosis surgery. When should the discharge training and planning begin for this patient? o A. Following surgery o B. Upon admission o C. Within 48 hours of discharge o D. Preoperative discussion • 62. Question A 5-year-old child and has been recently admitted to the hospital. According to Erik Erikson’s psychosocial development stages, the child is in which stage? o A. Trust vs. mistrust o B. Initiative vs. guilt o C. Autonomy vs. shame and doubt o D. Intimacy vs. isolation Option A: Preoperative instructions are important for discharge planning, so it must start not only after the surgery. Option C: Creating a discharge plan within 48 hours of discharge could cause the plan to be incomplete, as it would lack the preparations made before the surgery. Option D: Including the preoperative discussion in the discharge plan is correct, but this should also extend towards the admission and the data taken upon admission for comprehensive planning of the client’s discharge. Correct Answer: B. Upon admission Discharge education begins upon admission. Ideally, it involves the client and the family, as well as the hospital staff. Effective discharge planning can decrease the chances of the client being readmitted to the hospital, and also can help in recovery, ensure medications are prescribed and given correctly, and adequately prepare folks to take over the client’s care. Correct Answer: B. Initiative vs. guilt It is as children enter the preschool years (3-6 years old) that they begin the third stage of psychosocial development centered • 65. Question A nurse is making rounds taking vital signs. Which of the following vital signs is abnormal? o A. 11-year-old male: 90 BPM, 22 RPM, 100/70 mmHg o B. 13-year-old female: 105 BPM, 22 RPM, 105/50 mmHg o C. 5-year-old male: 102 BPM, 24 RPM, 90/65 mmHg o D. 6-year-old female: 100 BPM, 26 RPM, 90/70 mmHg Option A: Client’s heart rate and BP are within the normal range, respiratory rate slightly increased. Option C: Normal range of vital signs for 3-5-year- olds: Heart rate: 80- 120 BPM; Respiratory rate: 20-30 CPM; Blood pressure: 80-110 (systolic), 50-80 (diastolic). All vital signs are within the normal range. Option D: Normal range of vital signs for 6-10-year- olds: Heart rate: 70-110 BPM; Respiratory rate: 15-30 Correct Answer: B. 13-year-old female: 105 BPM, 22 RPM, 105/50 mmHg The normal range of vital signs for 11 to 14-year-olds: Heart rate: 60-105 BPM; Respiratory rate: 12-20 CPM; Blood pressure: Systolic-85-120, diastolic- 55-80 mmHg; Body temperature: 98.0 degrees Fahrenheit (36.6 degrees Celsius) to 98.6 degrees Fahrenheit (37 degrees Celsius). The client’s diastolic pressure is lower than the normal range. Both her respiratory rate and heart rate are slightly increased. versus guilt. It is important for the kids to learn that they can exert power over themselves and the world. o Option C: Autonomy vs Shame and doubt is the second stage of Erik Erikson’s stages of psychosocial development. This stage occurs between the ages of 18 months to 3 years. According to Erikson, children at this stage are focused on developing a greater sense of • 66. Question When you are taking a patient’s history, she tells you she has been depressed and is dealing with an anxiety disorder. Which of the following medications would the patient most likely be taking? o A. Amitriptyline (Elavil) o B. Calcitonin o C. Pergolide mesylate (Permax) o D. Verapamil (Calan) Correct Answer: A. Amitriptyline (Elavil) Amitriptyline (Elavil) is a tricyclic antidepressant and used to treat symptoms of depression. o Option B: Calcitonin is used to treat osteoporosis in women who have been in menopause. Calcitonin is a hormone that is produced in humans by the parafollicular cells (commonly known as C-cells) of the thyroid gland. Calcitonin is involved in helping to regulate levels of calcium and phosphate in the blood, opposing the action of the parathyroid hormone. o Option C: Permax (pergolide mesylate) is indicated as adjunctive treatment to levodopa/carbidopa in the management of the signs and symptoms of Parkinson†s disease. o Option D: Verapamil is used to treat high blood pressure and to control angina (chest pain). The immediate-release tablets are also used alone or with other medications to prevent and treat irregular heartbeats. Verapamil is in a class of medications called calcium-channel blockers. It works by relaxing the blood vessels so the heart does not have to pump as hard. It also increases the supply of blood and oxygen to the heart and slows electrical activity CPM; Blood pressure: 85-120 (systolic), 55-80 (diastolic). All vital signs are within the normal range. in the heart to control the heart rate. use as energy. When this occurs, the body starts burning fat and muscle for energy, causing a reduction in overall body weight. o Option A: Nausea and vomiting usually occur and may be associated with diffuse abdominal pain, decreased appetite, and anorexia. As the blood glucose levels rise and fall, the body’s metabolism can get interrupted and confused which can lead to a mixed feeling of nausea. o Option B: The incidence of increased water loss results in extreme thirst and dehydration. If our blood glucose levels are higher than they should be for prolonged periods of time, our kidneys will attempt to remove some of the excess glucose from the blood and excrete this as urine. Whilst the kidneys filter the blood in this way, water will also be removed from the blood and will need replenishing. This is why we tend to have increased thirst when our blood glucose levels run too high. o Option D: A characteristic sign of ketoacidosis is acetone (ketotic) breath or a fruity smell. When the body can’t get energy from glucose, it burns fat in its place. The fat-burning process creates a buildup of acids in the blood called ketones, which leads to DKA if untreated. Fruity-smelling breath is a sign of high levels of ketones in someone who already has diabetes. • 70. Question A patient’s chart indicates a history of meningitis. Which of the following would you expect to see with this patient if this condition were acute? o A. Increased appetite o B. Vomiting o C. Fever o D. Poor tolerance of light Correct Answer: A. Increased appetite Loss of appetite would be expected. Most cases of meningitis are caused by an infectious agent that has colonized or established a localized infection elsewhere in the host. Potential sites of colonization or infection include the skin, the nasopharynx, the respiratory tract, the gastrointestinal (GI) tract, and the genitourinary tract. The organism invades the submucosa at these sites by circumventing host defenses (eg, physical barriers, local immunity, and phagocytes or macrophages). o Option B: Vomiting occurs in 35% of patients with meningitis. The brain is naturally protected from the body’s immune system by the barrier that the meninges create between the bloodstream and the brain. Normally, this protection is an advantage because the barrier prevents the immune system from attacking the brain. However, in meningitis, the blood- brain barrier can become disrupted; once bacteria or other organisms have found their way to the brain, they are somewhat isolated from the immune system and can spread. o Option C: The classic triad of meningitis consists of fever, nuchal rigidity, and altered mental status. When the body tries to fight the infection, the problem can worsen; blood vessels become leaky and allow fluid, WBCs, and other infection-fighting particles to enter the meninges and brain. This process, in turn, causes brain swelling and can eventually result in decreasing blood flow to parts of the brain, worsening the symptoms of infection. o Option D: Other symptoms include photalgia (photophobia): discomfort when the patient looks into bright lights. Depending on the severity of bacterial meningitis, the inflammatory process may remain confined to the subarachnoid space. In less severe forms, the pial barrier is not penetrated, and the underlying parenchyma remains intact. However, in more severe forms of bacterial meningitis, the pial barrier is breached, and the underlying parenchyma is invaded by the inflammatory process. Thus, bacterial meningitis may lead to widespread cortical destruction, particularly when left untreated. • 71. Question o « A. CBC (Complete blood count) o B. ECG (electrocardiogram) o C. Thyroid function tests o D. CT scan Correct Answer: D. CT scan A CT scan would be performed for further investigation of the hemiparesis. Noncontrast CT scanning is the most commonly used form of neuroimaging in the acute evaluation of patients with apparent acute stroke. o Option A: A complete blood count (CBC) and a basic chemistry panel can be useful baseline studies. A CBC serves as a baseline study and may reveal a cause for the stroke (eg, polycythemia, thrombocytosis, thrombocytopenia, leukemia), identify evidence of concurrent illness (eg, anemia), or issues that may affect reperfusion strategies (thrombocytopenia). o Option B: Electrocardiogram may serve as baseline data upon entry into the ED. An electrocardiogram (ECG or EKG) records the electrical signal from the heart to check for different heart conditions. Electrodes are placed on the chest to record the heart’s electrical signals, which cause the heart to beat. The signals are shown as waves on an attached computer monitor or printer. o Option C: Testing can often be limited to blood glucose, plus coagulation studies if the patient is on warfarin, heparin, or one of the newer antithrombotic agents (eg, dabigatran, rivaroxaban), not including thyroid studies. • 74. Question An 85-year-old male has been losing mobility and gaining weight over the last two (2) months. The patient also has the heater running in his house 24 hours a day, even on warm days. Which of the following tests is most likely to be performed? o ¢ A. CBC (complete blood count)