Excelsior NUR 213 Practice Exam

1. A pre-op patient scheduled for a total hip replacement reports taking one of these medications this morning. Which finding requires immediate surgeon notification?

• A. Phenytoin 100mg with a sip of water
• B. Half their morning dose of insulin
• C. Metoprolol 25mg with a sip of water
• D. Warfarin 2.5mg with a sip of water

Answer: D. Warfarin is an anticoagulant, and taking it the morning of a major orthopedic surgery significantly increases bleeding risk; this finding requires immediate surgeon notification before proceeding.

2. A client with sepsis has these orders: rapid IV fluid infusion, lactate level, vasopressors, blood cultures, broad-spectrum antibiotics. What's the correct priority order?

• 1st: Lactate level AND blood cultures
• 2nd: Broad-spectrum antibiotics
• 3rd: Rapid IV fluid infusion
• 4th: Vasopressors

Why: The Surviving Sepsis Campaign's Hour-1 Bundle calls for obtaining blood cultures and a lactate level before starting antibiotics (so antibiotics don't affect culture results), followed promptly by antibiotics, then aggressive fluid resuscitation, with vasopressors reserved for persistent hypotension despite fluids.

3. A patient with a peptic ulcer is being placed on a proton pump inhibitor. Which medication should the nurse anticipate?

• A. Ranitidine
• B. Cimetidine
• C. Famotidine
• D. Pantoprazole

Answer: D. Pantoprazole is a proton pump inhibitor (PPI); ranitidine, cimetidine, and famotidine are all H2-receptor antagonists, a different drug class.

4. A nurse's glove tears while caring for a client with C. difficile. After removing the soiled gloves, what is the priority action?

• A. Wash hands with a bleach wipe
• B. Don a clean pair of nonsterile gloves
• C. Wash hands with soap and water
• D. Wash hands with alcohol-based hand sanitizer

Answer: C. C. difficile forms spores that are not killed by alcohol-based hand sanitizer, so hand hygiene must be performed with soap and water (mechanical removal of spores) before doing anything else, including regloving.

5. A patient has a positive TB skin test, a 2-month productive cough, and unintentional weight loss. Which orders assist with diagnosing active tuberculosis? (Select all that apply.)

• A. Vital signs every shift
• B. Admit to a negative pressure room
• C. Chest x-ray
• D. Heart healthy diet
• E. Collect specimen x3 mornings for acid-fast bacilli

Answer: C and E. A chest x-ray and three morning sputum specimens for acid-fast bacilli (AFB) smear/culture are the specific diagnostic tests used to confirm active TB; vital signs, a negative pressure room, and diet are supportive/infection-control measures, not diagnostic tools.

6. Which risk factors for peptic ulcer disease should a nurse include in patient education? (Select all that apply.)

• A. Six-month history of H. pylori
• B. Eating spicy foods and a laid-back attitude
• C. Occasional alcohol and cocaine use
• D. Alcohol abuse and smoking
• E. Active lifestyle and smoking

Answer: A and D. H. pylori infection and the combination of alcohol abuse and smoking are well-established risk factors for peptic ulcer disease; spicy food, "laid-back attitude," occasional use, and "active lifestyle" are not the evidence-based risk pattern.