NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION, Exams of Nursing

Download NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION and more Exams Nursing in PDF only on Docsity! NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION INCLUSE 100% 725 VERIFIED QUESTIONS AND ANSWERS. NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION INCLUSE 100% 725 VERIFIED QUESTIONS AND ANSWERS. NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION INCLUSE 100% 725 VERIFIED QUESTIONS AND ANSWERS. Topic break down Topic No. of Questions Topic 1: Questions Set A 100 Topic 2: Questions Set B 100 Topic 3: Questions Set C 100 Topic 4: Questions Set D 91 Topic 5: Questions Set E 91 Topic 6: Questions Set F 243 Best Solution to Pass Your Exam 5 NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION INCLUSE 100% 725 VERIFIED QUESTIONS AND ANSWERS. Question No : 5 - (Topic 1) Sodium and chloride are the major electrolytes in the extracellular fluid.Physiological Adaptation Best Solution to Pass Your Exam 6 NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION INCLUSE 100% 725 VERIFIED QUESTIONS AND ANSWERS. Question No : 6 - (Topic 1) NCLEX NCLEX-PN : Practice Test Which of the following nursing diagnoses might be appropriate as Parkinson’s disease progresses and complications develop? A. Impaired Physical Mobility B. Dysreflexia C. Hypothermia D. Impaired Dentition Answer: A Explanation: The client with Parkinson’s disease can develop a shuffling gait and rigidity, causing impaired physical mobility. The other diagnoses do not necessarily relate to a client with Parkinson’s disease.Reduction of Risk Potential Which of the following is an inappropriate item to include in planning care for a severely neutropenic client? A. Transfuse netrophils (granulocytes) to prevent infection. B. Exclude raw vegetables from the diet. C. Avoid administering rectal suppositories. D. Prohibit vases of fresh flowers and plants in the client’s room. Answer: A Explanation: Best Solution to Pass Your Exam 7 NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION INCLUSE 100% 725 VERIFIED QUESTIONS AND ANSWERS. Granulocyte transfusion is not indicated to prevent infection. Produced in the bone marrow, granulocytes normally comprise 70% of all WBCs. They are subdivided into three types based on staining properties: neutrophils, eosinophils, and basophils. They can be beneficial in a selected population of infected, severely granulocytopenic clients (less than 500/mm3) who do not respond to antibiotic therapy and Best Solution to Pass Your Exam 1 0 NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION INCLUSE 100% 725 VERIFIED QUESTIONS AND ANSWERS. A. lungs B. liver C. kidneys D. adrenal glands Answer: B Explanation: NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 8 Question No : 9 - (Topic 1) Question No : 10 - (Topic 1) NCLEX NCLEX-PN : Practice Test Acetaminophen is extensively metabolized in the liver. Choices 1, 3, and 4 are incorrect because prolonged use of acetaminophen might result in an increased risk of renal dysfunction, but a single overdose does not precipitate life-threatening problems in the respiratory system, renal system, or adrenal glands.Pharmacological Therapies All of the following factors, when identified in the history of a family, are correlated with poverty except: A. high infant mortality rate. B. frequent use of Emergency Departments. C. consultation with folk healers. D. low incidence of dental problems. Answer: D Explanation: Dental problems are prevalent because of the lack of preventive care and access to care. High infant mortality is one of the most significant problems correlated with poverty. Pregnant women who do not have access to care might come to the Emergency Department when in labor. Those in poverty are likely to use Emergency Departments because they may not be turned away. Those in poverty might also turn to folk healers or other persons in their community for care who might be easier to access and might not demand payment.Health Promotion and Maintenance NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 9 Question No : 11 - (Topic 1) NCLEX NCLEX-PN : Practice Test Acyclovir is the drug of choice for: A. HIV. B. HSV 1 and 2 and VZV. C. CMV. D. influenza A viruses. Answer: B Explanation: Acyclovir (Zovirax) is specific for treatment of herpes virus infections. There is no cure for herpes. Acyclovir is excreted unchanged in the urine and therefore must be used cautiously in the presence of renal impairment. Drugs that treat herpes inhibit viral DNA replication by competing with viral substrates to form shorter, ineffective DNA chains.Physiological Adaptation Ashley and her boyfriend Chris, both 19 years old, are transported to the Emergency Department after being involved in a motorcycle accident. Chris is badly hurt, but Ashley has no apparent injuries, though she appears confused and has trouble focusing on what is going on around her. She complains of dizziness and nausea. Her pulse is rapid, and she is hyperventilating. The nurse should assess Ashley’s level of anxiety as: A. mild. B. moderate. C. severe. D. panic. Answer: C Explanation: The person whose anxiety is assessed as severe is unable to solve problems and has a poor grasp of what’s happening in his or her environment. Somatic symptoms such as those described by Best Solution to Pass Your Exam 12 NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION INCLUSE 100% 725 VERIFIED QUESTIONS AND ANSWERS. Question No : 14 - (Topic 1) NCLEX NCLEX-PN : Practice Test Which fetal heart monitor pattern can indicate cord compression? A. variable decelerations B. early decelerations C. bradycardia D. tachycardia Answer: A Explanation: Variable decelerations can be related to cord compression. The other patterns are not.Reduction of Risk Potential The nurse teaching about preventable diseases should emphasize the importance of getting the following vaccines: A. human papilloma virus, genital herpes, measles. B. pneumonia, HIV, mumps. C. syphilis, gonorrhea, pneumonia. D. polio, pertussis, measles. Answer: D Explanation: Vaccines are one of the most effective methods of preventing and controlling certain communicable diseases. Best Solution to Pass Your Exam 13 NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION INCLUSE 100% 725 VERIFIED QUESTIONS AND ANSWERS. The smallpox vaccine is not currently in use because the smallpox virus has been declared eradicated from the world’s population. Diseases such as polio, diphtheria, pertussis, and measles are mostly controlled by routine childhood immunization. They have not, however, been eradicated, so children need to be immunized against these diseases.Physiological Adaptation Best Solution to Pass Your Exam 14 NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION INCLUSE 100% 725 VERIFIED QUESTIONS AND ANSWERS. Question No : 15 - (Topic 1) Question No : 16 - (Topic 1) NCLEX NCLEX-PN : Practice Test Which of the following conditions is mammography used to detect? A. pain B. tumor C. edema D. epilepsy Answer: B Explanation: Mammography is used to detect tumors or cysts in the breasts, not the other conditions.Reduction of Risk Potential When the nurse is determining the appropriate size of an oropharyngeal airway to insert, what part of a client’s body should she measure? A. corner of the mouth to the tragus of the ear B. corner of the eye to the top of the ear C. tip of the chin to the sternum D. tip of the nose to the earlobe Best Solution to Pass Your Exam 17 NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION INCLUSE 100% 725 VERIFIED QUESTIONS AND ANSWERS. Question No : 19 - (Topic 1) indicate none of these acid-base disturbances.Physiological Adaptation Best Solution to Pass Your Exam 18 NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION INCLUSE 100% 725 VERIFIED QUESTIONS AND ANSWERS. Which of the following is the primary force in sex education in a child’s life? Best Solution to Pass Your Exam 19 NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION INCLUSE 100% 725 VERIFIED QUESTIONS AND ANSWERS. Question No : 20 - (Topic 1) NCLEX NCLEX-PN : Practice Test A. school nurse B. peers C. parents D. media Answer: C Explanation: Parents are the primary force in sex education in a child’s life. The school nurse is involved with formal sex education and counseling. Peers become more important in sex education during adolescence but might lack correct information. The media play a powerful role in what children learn about sex through movies, TV, and video games.Health Promotion and Maintenance The nurse is assessing the dental status of an 18-month-old child. How many teeth should the nurse expect to examine? A. 6 B. 8 C. 12 D. 16 Answer: C Explanation: Best Solution to Pass Your Exam 22 NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION INCLUSE 100% 725 VERIFIED QUESTIONS AND ANSWERS. D. Morton’s neuroma. Answer: D Explanation: Morton’s neuroma is a small mass or tumor in a digital nerve of the foot. Hallux valgus is referred to in lay terms as abunion.Hammertoe is where one toe is cocked up over another toe. Plantar Best Solution to Pass Your Exam 23 NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION INCLUSE 100% 725 VERIFIED QUESTIONS AND ANSWERS. fasciitis is an inflammation Best Solution to Pass Your Exam 24 NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION INCLUSE 100% 725 VERIFIED QUESTIONS AND ANSWERS. Question No : 23 - (Topic 1) Question No : 24 - (Topic 1) NCLEX NCLEX-PN : Practice Test of, or pain in, the arch of the foot.Basic Care and Comfort For a client with suspected appendicitis, the nurse should expect to find abdominal tenderness in which quadrant? A. upper right B. upper left C. lower right D. lower left Answer: C Explanation: The nurse should expect to find abdominal tenderness in the lower-right quadrant in a client with appendicitis. Physiological Adaptation Assessment of a client with a cast should include: A. capillary refill, warm toes, no discomfort. B. posterior tibial pulses, warm toes. Best Solution to Pass Your Exam 27 NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION INCLUSE 100% 725 VERIFIED QUESTIONS AND ANSWERS. Question No : 25 - (Topic 1) Question No : 26 - (Topic 1) NCLEX NCLEX-PN : Practice Test Which of the following injuries, if demonstrated by a client entering the Emergency Department, is the highest priority? A. open leg fracture B. open head injury C. stab wound to the chest D. traumatic amputation of a thumb Answer: C Explanation: A stab wound to the chest might result in lung collapse and mediastinal shift that, if untreated, could lead to death. Treatment of an obstructed airway or a chest wound is a higher priority than hemorrhage. The principle of ABC (airway, breathing, and circulation) prioritizes care decisions.Physiological Adaptation Why must the nurse be careful not to cut through or disrupt any tears, holes, bloodstains, or dirt present on the clothing of a client who has experienced trauma? Best Solution to Pass Your Exam 28 NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION INCLUSE 100% 725 VERIFIED QUESTIONS AND ANSWERS. A. The clothing is the property of another and must be treated with care. B. Such care facilitates repair and salvage of the clothing. C. The clothing of a trauma victim is potential evidence with legal implications. D. Such care decreases trauma to the family members receiving the clothing. Answer: C Explanation: Best Solution to Pass Your Exam 29 NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION INCLUSE 100% 725 VERIFIED QUESTIONS AND ANSWERS. Trauma in any client, living or dead, has potential legal and/or forensic implications. Best Solution to Pass Your Exam 32 NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION INCLUSE 100% 725 VERIFIED QUESTIONS AND ANSWERS. and allows for drying. Best Solution to Pass Your Exam 33 NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION INCLUSE 100% 725 VERIFIED QUESTIONS AND ANSWERS. Question No : 28 - (Topic 1) NCLEX NCLEX-PN : Practice Test It also prevents wet or soiled diapers from coming into contact with the cord. Current recommendations include cleaning the area around the cord 3–4 times a day with a cotton swab but do not include putting alcohol or other antimicrobials on the cord. It is normal for the cord to turn dark as it dries.Health Promotion and Maintenance A middle-aged woman tells the nurse that she has been experiencing irregular menses for the past six months. The nurse should assess the woman for other symptoms of: A. climacteric. B. menopause. C. perimenopause. D. postmenopause. Answer: C Explanation: Perimenopause refers to a period of time in which hormonal changes occur gradually, ovarian function diminishes, and menses become irregular. Perimenopause lasts approximately five years. Climacteric is a term applied to the period of life in which physiologic changes occur and result in cessation of a woman’s reproductive ability and lessened sexual activity in males. The term applies to both genders. Climacteric and menopause are Best Solution to Pass Your Exam 34 NCLEX NCLEX-PN PRACTICE TEST UPDATED VERSION 2024. NATIONAL COUNCIL LICENSURE EXAMINATION INCLUSE 100% 725 VERIFIED QUESTIONS AND ANSWERS. interchangeable terms when used for females. Menopause is the period when permanent cessation of menses has occurred. Postmenopause refers to the period after the changes accompanying menopause are complete.Health Promotion and Maintenance NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 37 Question No : 31 - (Topic 1) Question No : 32 - (Topic 1) NCLEX NCLEX-PN : Practice Test folic acid, rest, diet, and support.Physiological Adaptation When a client needs oxygen therapy, what is the highest flow rate that oxygen can be delivered via nasal cannula? A. 2 liters/minute B. 4 liters/minute C. 6 liters/minute D. 8 liters/minute Answer: C Explanation: The highest flow rate that oxygen can be delivered via nasal cannula is 6 liters/minute. Higher flow rates must be delivered by mask.Reduction of Risk Potential The kind of man who beats a woman is: A. from a minority culture in a low-income group. B. from a majority culture in a middle-income group. C. one who was never allowed to compete as a child. D. from any walk of life, race, income group, or profession. Answer: D Explanation: Batterers cannot be predicted by demographic features related to age, ethnicity, race, religious denomination, NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 38 education, socioeconomic status, or class. Ninety-five percent of domestic abuse cases NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 39 Question No : 33 - (Topic 1) Question No : 34 - (Topic 1) NCLEX NCLEX-PN : Practice Test involve male perpetrators and female victims.Psychosocial Integrity All of the following should be performed when fetal heart monitoring indicates fetal distress except: A. increase maternal fluids. B. administer oxygen. C. decrease maternal fluids. D. turn the mother. Answer: C Explanation: Decreasing maternal fluids is the only intervention that shouldnotbe performed when fetal distress is indicated.Reduction of Risk Potential What interpersonal relief behavior is Ashley using? A. acting out B. somatizing C. withdrawal D. problem-solving Answer: B Explanation: Somatizing means one experiences an emotional conflict as a physical symptom. Ashley NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 42 mammography? NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 34 Question No : 37 - (Topic 1) NCLEX NCLEX-PN : Practice Test A. Be sure to use underarm deodorant. B. Do not use underarm deodorant. C. Do not eat or drink after midnight. D. Have a friend drive you home. Answer: B Explanation: Underarm deodorant should not be used because it might cause confusing shadows on the X-ray film. There are no restrictions on food or fluid intake. No sedation is used, so the client can drive herself home.Reduction of Risk Potential Teaching about the need to avoid foods high in potassium is most important for which client? A. a client receiving diuretic therapy B. a client with an ileostomy C. a client with metabolic alkalosis D. a client with renal disease Answer: D Explanation: Clients with renal disease are predisposed to hyperkalemia and should avoid foods high in potassium. Choices 1, 2, and 3 are incorrect because clients receiving diuretics with ileostomy or with metabolic alkalosis are at risk for hypokalemia and should be encouraged to eat foods high in potassium.Physiological Adaptation Question No : 38 - (Topic 1) NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 35 Question No : 39 - (Topic 1) NCLEX NCLEX-PN : Practice Test A diet high in fiber content can help an individual to: A. lose body weight fast. B. reduce diabetic ketoacidosis. C. lower cholesterol. D. reduce the need for folate. Answer: C Explanation: Fiber-rich foods (such as grains, apples, potatoes, and beans) can help lower cholesterol.Nonpharmacological Therapies When administering intravenous electrolyte solution, the nurse should take which of the following precautions? A. Infuse hypertonic solutions rapidly. B. Mix no more than 80 mEq of potassium per liter of fluid. C. Prevent infiltration of calcium, which causes tissue necrosis and sloughing. D. As appropriate, reevaluate the client’s digitalis dosage. He might need an increased dosage because IV calcium diminishes digitalis’s action. Answer: C Explanation: Preventing tissue infiltration is important to avoid tissue necrosis. Choice 1 is incorrect because hypertonic solutions should be infused cautiously and checked with the RN if there is a concern. Choice 2 is incorrect because potassium, mixed in the pharmacy per physician order, is mixed at a concentration no higher than 60 mEq/L. Physiological Adaptation NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 38 Question No : 44 - (Topic 1) Question No : 45 - (Topic 1) NCLEX NCLEX-PN : Practice Test A client has been diagnosed with Disseminated Intravascular Coagulation (DIC) and transferred to the medical intensive care unit (ICU) subsequent to an acute bleeding episode. In the ICU, continuous Heparin drip therapy is initiated. Which of the following assessment findings indicates a positive response to Heparin therapy? A. increased platelet count B. increased fibrinogen C. decreased fibrin split products D. decreased bleeding Answer: B Explanation: Effective Heparin therapy should stop the process of intravascular coagulation and result in increased availability of fibrinogen. Heparin administration interferes with thrombin-induced conversion of fibrinogen to fibrin. Bleeding should cease due to the increased availability of platelets and coagulation factors.Physiological Adaptation Which of the following is an appropriate nursing goal for a client at risk for nutritional problems? A. provide oxygen B. promote healthy nutritional practices C. treat complications of malnutrition D. increase weight Answer: B Explanation: Promoting healthy nutritional practices is an appropriate nursing goal for a client at risk for NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 39 nutritional NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 40 Question No : 46 - (Topic 1) Question No : 47 - (Topic 1) NCLEX NCLEX-PN : Practice Test problems. Choice 1 is incorrect because it is a nursing intervention, not a goal statement. Choice 3 is incorrect because it is a therapeutic treatment. Choice 4 is incorrect because weight gain is an appropriate goal only if the client is underweight.Basic Care and Comfort Major competencies for the nurse giving end-oflife care include: A. demonstrating respect and compassion, and applying knowledge and skills in care of the family and the client. B. assessing and intervening to support total management of the family and client. C. setting goals, expectations, and dynamic changes to care for the client. D. keeping all sad news away from the family and client. Answer: A Explanation: There are many competencies that the nurse must have to care for families and clients at the end of life. Demonstration of respect and compassion as well as using knowledge and skills in the care of the client and family are major competencies.Basic Care and Comfort Following a classic cholecystectomy resection for multiple stones, the PACU nurse observes a serosanguious drainage on the dressing. The most appropriate intervention is to: A. notify the physician of the drainage. NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 43 Question No : 50 - (Topic 1) NCLEX NCLEX-PN : Practice Test A. insertion of a Foley catheter. B. in and out catheter specimen for urinalysis. C. a voided urine specimen for urinalysis. D. a urologist consult. Answer: D Explanation: A urologist consult is appropriate for a client with visible blood at the urethral meatus and suspected trauma. Choices 1 and 2 are contraindicated. A urinalysis might be ordered by the physician, but the question does not provide enough information to make Choice 3 the correct answer.Physiological Adaptation A client with Kawasaki disease has bilateral congestion of the conjunctivae, dry cracked lips, a strawberry tongue, and edema of the hands and feet followed by desquamation of fingers and toes. Which of the following nursing measures is most appropriate to meet the expected outcome of positive body image? A. administering immune globulin intravenously B. assessing the extremities for edema, redness and desquamation every 8 hours C. explaining progression of the disease to the client and his or her family D. assessing heart sounds and rhythm Answer: C Explanation: Teaching the client and family about progression of the disease includes explaining when symptoms can be expected to improve and resolve. Knowledge of the course of the disease can help them understand that no permanent disruption in physical appearance will occur that could negatively affect body image. Clients with Kawasaki disease might receive immune globulin intravenously to reduce the incidence of coronary artery lesions NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 44 and aneurysms. Cardiac effects could be linked to body image, but Choice 3 is the most NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 45 Question No : 51 - (Topic 1) Question No : 52 - (Topic 1) NCLEX NCLEX-PN : Practice Test direct link to body image. The nurse assesses symptoms to assist in evaluation of treatment and progression of the disease.Health Promotion and Maintenance A client, age 28, was recently diagnosed with Hodgkin’s disease. After staging, therapy is planned to include combination radiation therapy and systemic chemotherapy with MOPP— nitrogen mustard, vincristine (Onconvin), prednisone, and procarbazine. In planning care for this client, the nurse should anticipate which of the following side effects to contribute to a sense of altered body image? A. cushingoid appearance B. alopecia C. temporary or permanent sterility D. pathologic fractures Answer: D Explanation: Pathologic fractures are not common to the disease process. Its treatment through osteoporosis is a potential complication of steroid use. Hodgkin’s disease most commonly affects young adults (males), is spread through lymphatic channels to contiguous nodes, and also might spread via the hematogenous route to extradal sites (GI, bone marrow, skin, and other organs). A working staging classification is performed for clinical use and care. Physiological Adaptation NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 48 Question No : 54 - (Topic 1) Question No : 55 - (Topic 1) NCLEX NCLEX-PN : Practice Test When helping a client gain insight into anxiety, the nurse should: A. help relate anxiety to specific behaviors. B. ask the client to describe events that precede increased anxiety. C. instruct the client to practice relaxation techniques. D. confront the client’s resistive behavior. Answer: B Explanation: To gain insight, the client needs to recognize causal events. The other activities focus on recognition of anxiety.Psychosocial Integrity A young boy is recently diagnosed with a seizure disorder. Which of the following statements by the boy’s mother indicates a need for further teaching by the nurse? A. “I should make sure he gets plenty of rest.” B. “I should get him a medic alert bracelet.” C. “I should lay him on his back during a seizure.” D. “I should loosen his clothing during a seizure.” Answer: C Explanation: A client having a seizure should be turned to the side to prevent aspiration of secretions. The other statements are correct and indicate adequate understanding of teaching.Reduction of Risk Potential NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 49 Question No : 56 - (Topic 1) Question No : 57 - (Topic 1) NCLEX NCLEX-PN : Practice Test To remove hard contact lenses from an unresponsive client, the nurse should: A. gently irrigate the eye with an irrigating solution from the inner canthus outward. B. grasp the lens with a gentle pinching motion. C. don sterile gloves before attempting the procedure. D. ensure that the lens is centered on the cornea before gently manipulating the lids to release the lens. Answer: D Explanation: To remove hard contact lenses, the upper and lower eyelids are gently maneuvered to help loosen the lens and slide it out of the eye. The lens must be situated on the cornea, not the sclera, before removal. An attempt to grasp a hard lens might result in a scratch on the cornea. Clean gloves are an option if drainage is present.Basic Care and Comfort Which of the following foods might a client with a hypercholesterolemia need to decrease his or her intake of? A. broiled catfish B. hamburgers C. wheat bread D. fresh apples Answer: B Explanation: Due to the high cholesterol content of red meats, such as hamburger, intake needs to be decreased. The other options do not have high cholesterol content, so they do not need to be NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 50 decreased.Reduction of Risk Potential NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 53 Question No : 60 - (Topic 1) Question No : 61 - (Topic 1) NCLEX NCLEX-PN : Practice Test actions include asking the child to explain what each family member is doing, encouraging him or her to tell as much as possible about the drawing, noting physical intimacy or distance, noting placement of family members in the drawing, noting facial expressions of family members and noting if they are facing each other or turned away. Choice 1 is initial instruction, not evaluation. Only general encouragement should be given to avoid suggesting themes to the child.Health Promotion and Maintenance A client with an ileus is placed on intestinal tube suction. Which of the following electrolytes is lost with intestinal suction? A. calcium B. magnesium C. potassium D. sodium chloride Answer: D Explanation: Duodenal intestinal fluid is rich in K+, NA+, and bicarbonate. Suctioning to remove excess fluids decreases the client’s K+ and NA+ levels.Basic Care and Comfort Which of the following terms refers to soft-tissue injury caused by blunt force? A. contusion B. strain NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 54 C. sprain NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 55 Question No : 62 - (Topic 1) Question No : 63 - (Topic 1) NCLEX NCLEX-PN : Practice Test D. dislocation Answer: A Explanation: A contusion is a soft-tissue injury caused by blunt force. It is an injury that does not break the skin, is caused by a blow and is characterized by swelling, discoloration, and pain. The immediate application of cold might limit the development of a contusion. A strain is a muscle pull from overuse, overstretching, or excessive stress. A sprain is caused by a wrenching or twisting motion. A dislocation is a condition in which the articular surfaces of the bones forming a joint are no longer in anatomic contact.Physiological Adaptation Which of the following indicates a hazard for a client on oxygen therapy? A. A No Smoking sign is on the door. B. The client is wearing a synthetic gown. C. Electrical equipment is grounded. D. Matches are removed. Answer: B Explanation: A synthetic gown might generate sparks of static electricity, which can be a fire hazard, particularly in the presence of oxygen. The client on oxygen therapy should wear a cotton gown. The remaining options are appropriate safety measures.Reduction of Risk Potential NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 58 Question No : 65 - (Topic 1) Question No : 66 - (Topic 1) NCLEX NCLEX-PN : Practice Test can be relieved by hormone replacement therapy.Health Promotion and Maintenance A pregnant Asian client who is experiencing morning sickness wants to take ginger to relieve the nausea. Which of the following responses by the nurse is appropriate? A. “I will call your physician to see if we can start some ginger.” B. “We don’t use home remedies in this clinic.” C. “Herbs are not as effective as regular medicines.” D. “Just eat some dry crackers instead.” Answer: A Explanation: This statement reveals cultural sensitivity. Ginger is sometimes used to relieve nausea. The other statements are culturally insensitive and do not show an awareness of herbal pharmacology.Physiological Adaptation Which of the following physical findings indicates that an 11–12-month-old child is at risk for developmental dysplasia of the hip? A. refusal to walk B. not pulling to a standing position C. negative Trendelenburg sign D. negative Ortolani sign Answer: B Explanation: NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 59 The nurse might be concerned about developmental dysplasia of the hip if an 11–12- NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 60 Question No : 67 - (Topic 1) Question No : 68 - (Topic 1) NCLEX NCLEX-PN : Practice Test month-old child doesn’t pull to a standing position. An infant who does not walk by 15 months of age should be evaluated. Children should start walking between 11–15 months of age. Trendelenberg sign is related to weakness of the gluteus medius muscle, not hip dysplasia. Ortolani sign is used to identify congenital subluxation or dislocation of the hip in infants.Health Promotion and Maintenance A client with which of the following conditions is at risk for developing a high ammonia level? A. renal failure B. psoriasis C. lupus D. cirrhosis Answer: D Explanation: A client with cirrhosis is at risk for developing a high ammonia level.Reduction of Risk Potential What is the primary nutritional deficiency of concern for a strict vegetarian? A. vitamin C B. vitamin B12 C. vitamin E NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 63 one week.” NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 64 Question No : 71 - (Topic 1) NCLEX NCLEX-PN : Practice Test D. “I can expect to be sleepy for several days after stopping the medicine.” Answer: C Explanation: Xanax, like other benzodiazepines, can cause withdrawal symptoms that include agitation, insomnia, hypertension, seizures, and abdominal pain. The drug must be slowly decreased to prevent withdrawal symptoms. Psychosocial Integrity A client is taking hydrocodone (Vicodin) for chronic back pain. The client has required an increase in the dose and asks whether this means he is addicted to Vicodin. The nurse should base her reply on the knowledge that: A. the client’s body has developed tolerance, requiring more drug to produce the same effect. B. the client is preoccupied with getting the drug and is experiencing loss of control, indicating drug dependence. C. addiction is the term used to describe physical dependence with withdrawal symptoms and tolerance. D. the client has a dual diagnosis of substance abuse and chronic back pain. Answer: A Explanation: Drug tolerance is characterized by the ability to ingest a larger dose without adverse effect and decreased sensitivity to the substance. Substance dependence is a severe condition indicating physical problems and disruption of the person’s social, family, and work life. The psychological behaviors related to substance use are termed addiction. Dual diagnosis is the coexistence of substance abuse and psychiatric disorders.Psychosocial Integrity NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 65 Question No : 72 - (Topic 1) Question No : 73 - (Topic 1) NCLEX NCLEX-PN : Practice Test A safety measure to implement when transferring a client with hemiparesis from a bed to a wheelchair is: A. standing the client and walking him or her to the wheelchair. B. moving the wheelchair close to client’s bed and standing and pivoting the client on his unaffected extremity to the wheelchair. C. moving the wheelchair close to client’s bed and standing and pivoting the client on his affected extremity to the wheelchair. D. having the client stand and push his body to the wheelchair. Answer: B Explanation: Moving the wheelchair close to client’s bed and having him stand and pivot on his unaffected extremity to the wheelchair is safer because it provides support with the unaffected limb.Basic Care and Comfort A client with dumping syndrome should while a client with GERD should . A. sit up 1 hour after meals; lie flat 30 minutes after meals B. lie down 1 hour after eating; sit up at least 30 minutes after eating C. sit up after meals; sit up after meals D. lie down after meals; lie down after meals Answer: B Explanation: NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 68 Huntington’s chorea is characterized by writhing, twisting movements of the face and limbs. NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 69 Question No : 76 - (Topic 1) NCLEX NCLEX-PN : Practice Test The remaining options are neurological disorders that do not have such movements as part of their disease process.Reduction of Risk Potential The nurse is teaching parents of a newborn about feeding their infant. Which of the following instructions should the nurse include? A. Use the defrost setting on microwave ovensto warm bottles. B. When refrigerating formula, don’t feed the baby partially used bottles after 24 hours. C. When using formula concentrate, mix two parts water and one part concentrate. D. If a portion of one bottle is left for the next feeding, go ahead and add new formula to fill it. Answer: A Explanation: Parents must be careful when warming bottles in a microwave oven because the milk can become superheated. When a microwave oven is used, the defrost setting should be chosen, and the temperature of the formula should be checked before giving it to the baby. Refrigerated, partially used bottles should be discarded after 4 hours because the baby might have introduced some pathogens into the formula. Returning the bottle to the refrigerator does not destroy pathogens. Formula concentrate and water are usually mixed in a 1:1 ratio of one part concentrate and one part water. Infants should be offered fresh formula at each feeding. Partially used bottles should not have fresh formula added to them. Pathogens can grow in partially used bottles of formula and be transferred to the new formula.Health Promotion and Maintenance NCLEX NCLEX-PN : Practice Test NCLEX NCLEX-PN : Practice Test Question No : 77 - (Topic 1) Best Solution to Pass Your Exam 70 Question No : 78 - (Topic 1) A client who is immobilized secondary to traction is complaining of constipation. Which of the following medications should the nurse expect to be ordered? A. Advil B. Anasaid C. Clinocil D. Colace Answer: D Explanation: Colace is a stool softener that acts by pulling more water into the bowel lumen, making the stool soft and easier to evacuate.Basic Care and Comfort The nurse explains to a client who underwent gastric resection that which of the following meals is most likely to cause rapid emptying of the stomach? A. a high-protein meal B. a high-fat meal C. a large meal regardless of nutrient content D. a high-carbohydrate meal Answer: D Explanation: Meals that are high in carbohydrates promote rapid gastric emptying. The other options are associated with decreased emptying time.Basic Care and Comfort NCLEX NCLEX-PN : Practice Test Question No : 85 - (Topic 1) Question No : 84 - (Topic 1) NCLEX NCLEX-PN : Practice Test A. inspection for visible pulsation. B. palpation of thrill. C. percussion for dullness. D. auscultation of blood pressure. Answer: B Explanation: Thrill should be present. The client should be taught to check this daily at home. Pulsation is not typically visible. Percussion gives no information about the patency of a fistula. Blood pressure is not auscultated in a limb with an AVF. Auscultation of the AVF, for a bruit, is part of an assessment for patency.Physiological Adaptation James returns home from school angry and upset because his teacher gave him a low grade on an assignment. After returning home from school, he kicks the dog. This coping mechanism is known as: A. denial. B. suppression. C. displacement. D. fantasy. Answer: C Explanation: Displacement is the transference of anger to another. Anger is displaced on the dog as a convenient object. Psychosocial Integrity Best Solution to Pass Your Exam 73 NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 74 Question No : 86 - (Topic 1) Question No : 87 - (Topic 1) NCLEX NCLEX-PN : Practice Test Which condition is associated with inadequate intake of vitamin C? A. rickets B. marasmus C. kwashiorkor D. scurvy Answer: D Explanation: Scurvy is associated with inadequate intake of vitamin C. The remaining choices refer to other nutritional deficiencies.Health Promotion and Maintenance Which is the proper hand position for performing chest percussion? A. cup the hands B. use the side of the hands C. flatten the hands D. spread the fingers of both hands Answer: A Explanation: The hands are cupped for performing percussion, producing a vibration that helps loosen respiratory secretions. The other hand positions do not accomplish this task.Reduction of Risk Potential Which of the following is likely to increase the risk of sexually transmitted disease? NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 75 Question No : 88 - (Topic 1) Question No : 89 - (Topic 1) NCLEX NCLEX-PN : Practice Test A. alcohol use B. certain types of sexual practices C. oral contraception use D. all of the above Answer: D Explanation: STDs affect certain groups in groups in greater numbers. Factors associated with risk include being younger than 25 years of age, being a member of a minority group, residing in an urban setting, being impoverished, and using crack cocaine.Physiological Adaptation Why might breast implants interfere with mammography? A. They might cause additional discomfort. B. They are contraindications to mammography. C. They are likely to be dislodged. D. They might prevent detection of masses. Answer: D Explanation: Breast implants can prevent detection of masses. Choices 1, 2, and 3 are not ways in which breast implants interfere with mammography.Reduction of Risk Potential A health care worker is concerned about a new mother being overwhelmed by caring for NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 78 Question No : 91 - (Topic 1) Question No : 92 - (Topic 1) NCLEX NCLEX-PN : Practice Test Which of the following lab values is associated with a decreased risk of cardiovascular disease? A. high HDL cholesterol B. low HDL cholesterol C. low total cholesterol D. low triglycerides Answer: A Explanation: High HDL cholesterol and low LDL cholesterol are associated with a decreased risk of cardiovascular disease.Reduction of Risk Potential When making an occupied bed, it is important for the nurse to: A. keep the bed in the low position. B. use a bath blanket or top sheet for warmth and privacy. C. constantly keep side rails raised on both sides. D. move back and forth from one side to the other when adjusting the linens. Answer: B Explanation: Using a bath blanket or top sheet keeps the client warm and provides privacy. Keeping the bed in the low position and working above raised side rails might strain the nurse’s back. Continually moving back and forth to tuck and arrange linen is time-consuming and disorganized.Basic Care and Comfort NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 79 Question No : 93 - (Topic 1) Question No : 94 - (Topic 1) NCLEX NCLEX-PN : Practice Test When a client informs the nurse that he is experiencing hypoglycemia, the nurse provides immediate intervention by providing: A. one commercially prepared glucose tablet. B. two hard candies. C. 4–6 ounces of fruit juice with 1 teaspoon of sugar added. D. 2–3 teaspoons of honey. Answer: D Explanation: The usual recommendation for treatment of hypoglycemia is 10–15 grams of a fast-acting simple carbohydrate, orally, if the client is conscious and able to swallow (for example, 3–4 commercially prepared glucose tablets or 4–6 oz of fruit juice). It is not necessary to add sugar to juice, even if it is labeled as unsweetened juice because the fruit sugar in juice contains enough simple carbohydrate to raise the blood glucose level. Addition of sugar might result in a sharp rise in blood sugar that could last for several hours.Physiological Adaptation A client is having a seizure; his blood oxygen saturation drops from 92% to 82%. What should the nurse do first? A. Open the airway. B. Administer oxygen. C. Suction the client. D. Check for breathing. Answer: A Explanation: NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 80 Question No : 95 - (Topic 1) Question No : 96 - (Topic 1) NCLEX NCLEX-PN : Practice Test The nurse needs to open the airway first when the oxygen saturation drops. The other actions might be appropriate, but the airway must be patent.Reduction of Risk Potential To remove a client’s gown when she has an intravenous line, the nurse should: A. temporarily disconnect the intravenous tubing at a point close to the client and thread it through the gown. B. cut the gown with scissors. C. thread the bag and tubing through the gown sleeve, keeping the line intact. D. temporarily disconnect the tubing from the intravenous container and thread it through the gown. Answer: C Explanation: Threading the bag and tubing through the gown sleeve keeps the system intact. Opening an intravenous line causes a break in a sterile system and introduces the potential for infection. Cutting a gown off is not an alternative except in an emergency. IV gowns, which open along sleeves, are widely available.Basic Care and Comfort Which of the following is most likely to impact the body image of an infant newly diagnosed with Hemophilia? A. immobility B. altered growth and development C. hemarthrosis NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 83 Question No : 98 - (Topic 1) Question No : 99 - (Topic 1) NCLEX NCLEX-PN : Practice Test A client with stress incontinence should be advised: A. to purchase absorbent undergarments. B. that Kegel exercises might help. C. that effective surgical treatments are nonexistent. D. that behavioral therapy is ineffective. Answer: B Explanation: Kegel exercises, tightening and releasing the pelvic floor muscles, might improve stress incontinence. Choice 1 is not an appropriate treatment for stress incontinence. Several effective surgical treatments exist. Lifestyle and dietary modifications can also be helpful.Physiological Adaptation Diagnostic genetic counseling, for procedures such as amniocentesis and chorionic villus sampling, allows clients to make all of the following choices except: A. terminating the pregnancy. B. preparing for the birth of a child with special needs. C. accessing support services before the birth. D. completing the grieving process before the birth. Answer: D Explanation: If findings are ominous, the grieving process will not be completed before birth. If the couple elects to terminate a pregnancy based on diagnostic tests, there will be grief and concerns for future NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 84 pregnancies. Couples NCLEX NCLEX-PN : Practice Test Best Solution to Pass Your Exam 85 Question No : 100 - (Topic 1) Question No : 101 - (Topic 2) NCLEX NCLEX-PN : Practice Test might choose to access support services and prepare for the birth of an infant with special needs. Some fetal conditions can be treated in utero.Health Promotion and Maintenance A client who is experiencing infertility says to the nurse, “I feel I will be incomplete as a man/woman if I cannot have a child.” Which of the following nursing diagnoses is likely to be appropriate for this client? A. Risk for Self Harm B. Body Image Disturbance C. Ineffective Role Performance D. Powerlessness Answer: B Explanation: Of the nursing diagnoses listed, the client’s statement most represents Body Image Disturbance because it directly refers to loss of the function of having a child. Nothing in the statement indicates that the client is at risk for harming herself. Ineffective Role Performance could be correct but is not the best choice because the statement does not reflect a disruption of the parent’s role. Powerlessness could be an appropriate nursing diagnosis if the client described feeling powerless about the infertility.Health Promotion and Maintenance Topic 2, Questions Set B