NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED, Exams of Nursing

Download NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED and more Exams Nursing in PDF only on Docsity! o Option B: Parathyroid hormone levels may be high or normal but not low. Patients with primary hyperparathyroidism and other causes of PTH- dependent hypercalcemia often have frankly elevated levels of PTH, while some will have values that fall within the reference range for the general population. It is uncommon for clinically occult malignancies to cause hypercalcemia. Most patients with malignancy- Correct Answer: A. Elevated serum calcium The parathyroid glands regulate the calcium level in the blood. In hyperparathyroidism, the serum calcium level will be elevated. A normal PTH in the presence of hypercalcemia is considered inappropriate and still consistent with PTH-dependent hypercalcemia. PTH levels should be very low in those patients with PTH-independent hypercalcemia. A comprehensive clinical evaluation complemented by routine laboratory and radiologic studies should be sufficient to establish a diagnosis of primary hyperparathyroidism in a patient with persistent hypercalcemia and an elevated serum level of parathyroid hormone. NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED 1.1. Question A patient is admitted to the hospital with a diagnosis of primary hyperparathyroidism. A nurse checking the patient’s lab results would expect which of the following changes in laboratory findings? o A. Elevated serum calcium o B. Low serum parathyroid hormone (PTH) o C. Elevated serum vitamin D o D. Low urine calcium o Option A: Addison’s disease is a rare condition. It develops when the adrenal glands, which are located above the kidneys, do not make enough of certain hormones. These hormones are important for normal body function. They help the body cope with stress, hold salt and water, and maintain blood pressure. The Correct Answer: D. A restricted sodium diet. A patient with Addison’s disease requires normal dietary sodium to prevent excess fluid loss. Do not reduce salt in the diet. The client may need to add extra salt to his food during hot and humid weather or after exercise to replace salt lost through sweating. Do not use salt substitutes. NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED • 2. Question A patient with Addison’s disease asks a nurse for nutrition and diet advice. Which of the following diet modifications is not recommended? o A. A diet high in grains. o B. A diet with adequate caloric intake. o C. A high protein diet. o D. A restricted sodium diet. associated hypercalcemia are known to have cancer, or cancer is readily detectable on initial evaluation, and PTH levels will be suppressed. o Option C: Parathyroid hormone levels may be high or normal but not low. The body will lower the level of vitamin D in an attempt to lower calcium. o Option D: Urine calcium may be elevated, with calcium spilling over from elevated serum levels. This may cause renal stones. A review of previous medical records can often be of significant value in establishing the cause of hypercalcemia. Most patients with hyperparathyroidism have persistent or NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED colonoscopy 18 hours previously. The patient reports increasing abdominal pain, fever, and chills. Which of the following conditions poses the most immediate concern? NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED o A. Bowel perforation o B. Viral gastroenteritis o C. Colon cancer o D. Diverticulitis Correct Answer: A. Bowel perforation Bowel perforation is the most serious complication of fiberoptic colonoscopy. Important signs include progressive abdominal pain, fever, chills, and tachycardia, which indicate advancing peritonitis. Bowel perforation results from insult or injury to the mucosa of the bowel wall resulting from a violation of the closed system. This exposes the structures within the peritoneal cavity to gastrointestinal contents. Patients presenting with abdominal pain and distension, especially in the appropriate historical setting, must be evaluated for this entity as delayed diagnosis can be life-threatening due to the risk of developing infections such as peritonitis. o Option B: Several different viruses including rotavirus, norovirus, adenovirus, and astroviruses account for most cases of acute viral gastroenteritis. Most are transmitted via the fecal-oral route, including contaminated food and water. Transmission has also been shown to occur via fomites, vomitus, and possibly airborne methods. Norovirus is more resistant to chlorine and ethanol inactivation than other viruses. Acute gastroenteritis is defined by loose or watery diarrhea that consists of 3 or more bowel movements in a day. Other symptoms may include nausea, vomiting, fever, or abdominal pain o Option C: Colon cancer does not cause these symptoms. Tumor location on clinical presentation can be separated on left-sided with more changes in bowel habits and hematochezia, and right-sided with obscured NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED anemia impacting on late stage at diagnosis. The provider should perform a thorough physical examination for signs of ascites, hepatomegaly, and lymphadenopathy. NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED Questi on A patient on the cardiac telemetry unit unexpectedly goes into ventricular fibrillation. The advanced cardiac life support team prepares to defibrillate. Which of the following choices indicates the correct placement of the conductive gel pads? NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED o A. The left clavicle and right lower sternum. o B. Right of midline below the bottom rib and the left shoulder. o C. The upper and lower halves of the sternum. o D. The right side of the sternum just below the clavicle and left of the precordium. Correct Answer: D. The right side of the sternum just below the clavicle and left of the precordium. One gel pad should be placed to the right of the sternum, just below the clavicle and the other just left of the precordium, as indicated by the anatomic location of the heart. To defibrillate, the paddles are placed over the pads. According to the ILCOR guidelines, the sternal paddle should be placed ‘just to the right of the upper sternal border below the clavicle’ and the apical paddle ‘to the left of the nipple with the centre of the electrode in the mid- axillary line’. o Option A: During the gel pad placement study it was noticed that about 50% of doctors placed the rectangular apical paddle vertically upwards, pointing towards the left armpit. The other 50% placed it in a horizontal position across the chest. The present ILCOR guidelines do not specify which orientation should be used for defibrillation. It was hypothesized that, with the paddle method for defibrillation, it would be more difficult to get good skin contact across the curved chest wall with the horizontal orientation, and in a small study this proved to be the case. o Option B: In theory, a paddle position that is too superomedial means that less current will traverse the myocardium. When 60 N (the median force used by defibrillator operators in clinical practice) is applied to both paddles, the NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED resulting TTI is 5% greater with the horizontal orientation. Thus, if paddles are used, it is recommended to use a vertical orientation. It is expected that their flexibility will allow better electrode/skin contact across the curved chest wall; however, in the absence of any evidence to the NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED neutralize chemical exposure as the exothermic reaction can lead to secondary thermal injuries. Irrigation should continue until the pH of the eye is between 7.0 to 7.4 and remains within this range for at least 30 minutes after the irrigation has been discontinued. • 9. Question A nurse is caring for a patient who has had hip replacement. The nurse should be most concerned about which of the following findings? o A. Complaints of pain during repositioning. o B. Scant bloody discharge on the surgical dressing. o C. Complaints of pain following physical therapy. o Option B: Fluorescein drops are used to check for scratches on the cornea due to their fluorescent properties and are not part of the initial care of a chemical splash. A topical anesthetic such as tetracaine can be applied directly to the eye, or 10 mL of 1% lidocaine can be added to a liter of irrigating fluid, taking care not to reach a toxic dose if copious irrigation is required. o Option C: Patching the eye would not remove the chemical. Severe burns may require upwards of ten liters of irrigation. Irrigation should be gentle, and care should be taken to avoid direct irrigation to the cornea to prevent further injury. Use of a commercial irrigation lens such as a Morgan lens may be helpful. o Option D: Following irrigation, visual acuity will be assessed. Ocular burns, particularly any chemical burns with corneal clouding or abrasions, should have prompt ophthalmology evaluation. Topical antibiotic ointment and possibly topical steroids may be prescribed for Correct Answer: D. Temperature of 101.8 F NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED o D. Temperature of 101.8 F (38.7 C). NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED Post-surgical nursing assessment after hip replacement should be principally concerned with the risk of neurovascular complications and the development of infection. A temperature of 101.8 F (38.7 C) postoperatively is higher than the low grade that is to be expected and should raise concern. The THA postoperative wound complication spectrum ranges from superficial surgical infections (SSIs) such as cellulitis, superficial dehiscence, and/or delayed wound healing, to deep infections resulting in full- thickness necrosis. Deep infections result in returns to the operating room for irrigation, debridement (incision and drainage) and depending on the timing of the infection, may require explanation of THA components. o Option A: Joint replacement surgery relieves the pain and stiffness of arthritis for most people. Some people may still have some symptoms of arthritis. For most people, surgery usually provides enough relief of symptoms for most people. Loosening of the new joint over time can cause pain, and sometimes another surgery is needed to fix the problem. o Option B: A small amount of bloody drainage on the surgical dressing is a result of normal healing. normal to lose blood during and after hip or knee replacement surgery. Some people need a blood transfusion during surgery or during their recovery period in the hospital. Some surgeries require you to donate blood before surgery. Much of the bleeding during surgery comes from the bone that has been cut. A bruise may occur if blood collects around the new joint or under the skin after surgery. o Option C: Some pain following physical therapy is to be expected and can be managed with analgesics. As in its counterpart TKA procedure, aseptic loosening is the result of a confluence of steps involving particulate debris formation, prosthesis micromotion, and macrophage- activated osteolysis. Treatment requires serial imaging and radiographs and/or CT imaging for preoperative planning. Persistent pain requires NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED not be used because they may splinter and break in the patient’s mouth. o Option D: Rectal diazepam may be a treatment ordered by the physician, who should be notified of the seizure. Diazepam may be used alone (or in o Option A: Application of granulocyte-colony stimulating factor (G-CSF) can improve neutrophil functions and number. Prophylactic use of antibiotics and antifungals is reserved for some forms of alteration in neutrophil function such as chronic granulomatous disease CGD). The utilization of antimicrobials is compulsory if recurrent infections exist. Interferon-gamma has been successfully used to improve the quality of life of the patient suffering from neutropenia. Correct Answer: B. An increase in hematocrit. Epoetin is a form of erythropoietin, which stimulates the production of red blood cells, causing an increase in hematocrit. Epoetin is given to patients who are anemic, often as a result of chemotherapy treatment. Epoetin alfa is 165 amino acid glycoprotein manufactured by recombinant DNA technology, which has similar biological effects as endogenous erythropoietin. Erythropoietin stimulates red blood cell production in-situ. It is a hormone produced in the kidney and augments the differentiation of erythroid progenitors in the bone marrow. NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED • 11. Question A patient who has received chemotherapy for cancer treatment is given an injection of Epoetin. Which of the following should reflect the findings in a complete blood count (CBC) drawn several days later? o A. An increase in neutrophil count. o B. An increase in hematocrit. o C. An increase in platelet count. o D. An increase in serum iron. combination with phenobarbital) to suppress status seizure activity. Diastat, a gel, may be administered rectally, even in the home setting, to reduce the frequency of seizures and need for additional medical care. Correct Answer: B, C, D & E Polycythemia vera is a condition in which the bone marrow produces too many red blood cells. This causes an increase in hematocrit and viscosity of the blood. Patients can experience headaches, dizziness, tinnitus, and visual disturbances. Cardiovascular effects include increased blood pressure and delayed clotting time. o Option A: Weight loss is not a manifestation of NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED • 12. Question A patient is admitted to the hospital with suspected polycythemia vera. Which of the following symptoms is consistent with the diagnosis? Select all that apply. o A. Weight loss o B. Increased clotting time o C. Hypertension o D. Headaches o E. Tinnitus o Option C: First-line treatment includes glucocorticoids and intravenous immune globulins; these agents inhibit autoantibody production and platelet degradation. Second- line treatment includes rituximab, immunosuppressive drugs, and splenectomy. Third-line agents are thrombopoietin receptor agonists, which stimulate platelet production. o Option D: Iron supplementation should be taken without food to increase absorption. Low gastric pH facilitates iron absorption. Rapid response to treatment is often seen in 14 days. It is manifested by the rise in hemoglobin levels. Iron supplementation is needed for at least three months to replenish tissue iron NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED o A. Observe for evidence of spontaneous bleeding. o B. Limit visitors to family only. o C. Give aspirin in case of headaches. o D. Impose immune precautions. Correct Answer: A. Observe for evidence of spontaneous bleeding. Platelet counts under 30,000/microliter may cause spontaneous petechiae and bruising, particularly in the extremities. When the count falls below 15,000, spontaneous bleeding into the brain and internal organs may occur. The blood clotting cascade is an integral system requiring intrinsic and extrinsic factors. Derangements in any factors can affect clotting ability. These laboratory tests provide important information about the patient’s coagulation status and bleeding potential. The specific laboratory values to be monitored will depend on the patient’s specific clinical condition. o Option B: There is no reason to limit visitors as long as any physical trauma is prevented. Educate the patient and family members about signs of bleeding that need to be reported to a health care provider. Early evaluation and treatment of bleeding by a health care provider reduce the risk for complications from blood loss. o Option C: Headaches may be a sign and should be watched for. Aspirin disables platelets and should never be used in the presence of thrombocytopenia. Educate the patient about over-the-counter drugs and avoid products that contain aspirin or NSAIDs such as ibuprofen and naproxen. These drugs not only decrease normal platelet aggregation but also decrease the integrity of gastric mucosa through inhibition of cyclooxygenase (COX)-1 inhibitor and therefore increase the risk for NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED gastrointestinal bleeding. o Option D: Thrombocytopenia does not compromise immunity. Educate the at-risk patient about precautionary measures to prevent tissue trauma or Option A: Corticosteroid use is associated with hypertension, hyperglycemia, obesity, and conflicting evidence exists for hyperlipidemia. Mineralocorticoid activity, which varies by corticosteroid, leads to retention of free water and sodium with excretion of potassium. Option B: Cushing syndrome can occur in patients taking corticosteroids through all routes of administration. Cushingoid features refer to the weight gain and the redistribution of adiposity (dorsocervical fat pad, aka “buffalo hump,” facial fat increase, aka “moon facies,” and truncal obesity) seen with excess Correct Answer: A, B, & D Side effects of corticosteroids include weight gain, fluid retention with hypertension, Cushingoid features, a low serum albumin, and suppressed inflammatory response. Patients are encouraged to eat a diet high in protein, vitamins, and minerals and low in sodium. NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED • 14. Question A nurse in the emergency department assesses a patient who has been taking long-term corticosteroids to treat renal disease. Which of the following is a typical side effect of corticosteroid treatment? Select all that apply. o A. Hypertension o B. Cushingoid features o C. Hyponatremia o D. Low serum albumin o E. Hypernatremia disruption of the normal clotting mechanisms. Information about precautionary measures lessens the risk for bleeding. Use a soft-bristled toothbrush and nonabrasive toothpaste. Avoid the use of toothpicks and dental floss. NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED o D. Minimize conversation with the patient. Correct Answer: B. Change gloves immediately after use. The neutropenic patient is at risk of infection. Changing gloves immediately after use protects patients from contamination with organisms picked up on hospital surfaces. This contamination can have serious consequences for an immunocompromised patient. Wear gloves when providing direct care; perform hand hygiene after properly disposing gloves. o Option A: Changing the respiratory mask is desirable, but not nearly as urgent as changing gloves. Wear personal protective equipment (PPE) properly. Use masks, goggles, face shields to protect the mucous membranes of your eyes, mouth, and nose during procedures and in direct-care activities (e.g., suctioning secretions) that may generate splashes or sprays of blood, body fluids, secretions, and excretions. o Option C: Place the patient in protective isolation if the patient is at high risk of infection. Protective isolation is set when the WBC indicates neutropenia. Provide surgical masks to visitors who are coughing and provide rationale to enforce usage. Instruct visitors to cover mouth and nose (by using the elbows to cover) during coughing or sneezing; use of tissues to contain respiratory secretions with immediate disposal to a no-touch receptacle; perform hand hygiene afterward. o Option D: Minimizing conversations are not necessary and may cause nursing staff to miss changes in the patient’s symptoms or condition. Educating visitors on the importance of preventing droplet transmission from themselves to others reduces the risk of infection. • 16. Question NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED A nurse is counseling patients at a health clinic on the importance of immunizations. Which of the following information is the most accurate regarding immunizations? NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED o A. All infectious diseases can be prevented with proper immunization. o B. Immunizations provide natural immunity from disease. o C. Immunizations are risk-free and should be universally administered. o D. Immunization provides acquired immunity from some specific diseases. Correct Answer: D. Immunization provides acquired immunity from some specific diseases. Immunization is available for the prevention of some, but not all, specific diseases. This type of immunity is “acquired” by causing antibodies to form in response to a specific pathogen. Live vaccines are more effective than killed vaccines because they retain more antigens of the microbes. However, toxoids, including those that cause tetanus and diphtheria, are the most effective bacterial vaccines of all because they are based on inactivated exotoxins that stimulate strong antibody production. Subunit vaccines, including hepatitis B, meningococcal, and Haemophilus influenzae B vaccines are effective when conjugated to carrier proteins such as tetanus toxoid. o Option A: Immunizations can prevent some, but not all, infectious diseases. The current immunizations protect against diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, rubella, pneumococcal pneumonia, smallpox, sepsis, meningitis, hepatitis B, varicella-zoster, tuberculosis, cholera, diarrhea caused by rotavirus, salmonellosis, and dengue. o Option B: Natural immunity is present at birth because the infant acquires maternal antibodies. Innate (natural) immunity is so named because it is present at birth and does not have to be learned through exposure to Correct Answer: A, B, D & E ADHD in children is frequently treated with CNS stimulant medications, which increase focus and improve NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED • 18. Question A mother calls the clinic to report that her son has recently started medication to treat attention-deficit/hyperactivity disorder (ADHD). The mother fears her son is experiencing side effects of the medicine. Which of the following side effects are typically related to medications used for ADHD? Select all that apply. o A. Poor appetite o B. Insomnia o C. Sleepiness o D. Agitation o E. Decreased attention span refractory initial anaphylaxis or aid in the prevention of recurrence and biphasic reactions. o Option C: The most urgent action is to maintain an airway, particularly with visible oral swelling, followed by the administration of epinephrine by subcutaneous injection. Epinephrine is given through intramuscular injection and at a dose of 0.3 to 0.5 mL of 1:1,000 concentration of epinephrine. Pediatric dosing is 0.01 mg/kg or 0.15 mg intramuscularly (IM) (epinephrine injection for pediatric dosage). Intramuscular delivery has proven to provide more rapid delivery and produce better outcomes than subcutaneous or intravascular. o Option D: Oral diphenhydramine is indicated for mild allergic reactions and is not appropriate for anaphylaxis. Antihistamines are often routinely used; most commonly is Hblocker administration of diphenhydramine 25 to 50 mg NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED Children often experience insomnia, agitation, and decreased appetite. ADHD treatment commonly uses a combination of dextroamphetamine and levoamphetamine, as well as pure dextroamphetamine and lisdexamfetamine. o Option A: Loss of appetite is among the most common side effects of stimulants for ADHD. Across studies, approximately 20% of patients with ADHD who were treated with stimulants reported a loss of appetite. Weight loss is also quite common, as are digestive problems. o Option B: Insomnia or delayed SOL greater than 30 minutes is one of the most common adverse events associated with stimulant medications. This should be distinguished from bedtime resistance, which is when the child refuses to go to bed. Insomnia is a frequent side effect of all stimulant medications, based on parent report or side effects scales completed side effects scales by parents. o Option C: Sleepiness is not a side effect of stimulants. Efron et al. compared twice-daily, immediate-release MPH and dextroamphetamine in 125 ADHD youth in a crossover study. Using the parent-completed, Barkley Side Effect Scale, dextroamphetamine, but not MPH, was associated with higher ratings of severe insomnia relative to baseline. o Option D: The immediate psychological effects of stimulant administration include a heightened sense of well-being, euphoria, excitement, heightened alertness, and increases in motor activity. Stimulants also reduce food intake, reduce sleep time, and may increase socialization activities. Stimulants may also enhance performance of certain types of psychomotor tasks. High doses may result in restlessness and agitation, and excessive doses may produce stereotypic behaviors (repetitive and automatic acts). o Option E: In people with ADHD, stimulants NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED produce a paradoxical calming effect. This results in a reduction in hyperactivity and an improvement in attention span in many patients. • 19. Question NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED • 20. Question A patient with newly diagnosed diabetes mellitus is learning to recognize the symptoms of hypoglycemia. Which of the following symptoms is indicative of hypoglycemia? o A. Polydipsia o B. Confusion o C. Blurred vision o D. Polyphagia Correct Answer: B. Confusion Hypoglycemia in diabetes mellitus causes confusion, indicating the need for carbohydrates. Neuroglycopenic signs and symptoms are signs and symptoms that result from direct central nervous system (CNS) deprivation of glucose. These include behavioral changes, confusion, fatigue, seizure, coma, and potential death if not immediately corrected. o Option A: Neurogenic signs and symptoms can either be adrenergic (tremor, palpitations, anxiety) or cholinergic (hunger, diaphoresis, paresthesias). Neurogenic symptoms and signs arise from sympathoadrenal involvement (either norepinephrine or acetylcholine release) in response to perceived hypoglycemia. o Option C: Patients with diabetes mellitus (DM) often experience subjective symptoms of blurred vision associated with hyperglycemia. The nature and origin of this phenomenon are still unclear. Blurred vision during hyperglycemia could be a result of transient refractive alterations due to changes in the lens, but it could also be caused by changes in the retina. o Option D: Polydipsia, blurred vision, and polyphagia are symptoms of hyperglycemia. NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED Symptoms of severe hyperglycemia include polyuria, polydipsia, and weight loss. As the patient’s blood glucose increases, neurologic symptoms can develop. The patient may experience lethargy, focal neurologic deficits, or Option A: This is not included in the staging of Wilms tumor. Imaging is particularly important in surgical planning. Surgical risk factors include larger tumor size, contralateral tumor extension, and displacement of the great vessels which typically result in longer surgical times, increased blood loss, and higher complication rates. Option B: This described stage I: the tumor is limited to the kidney and completely resected. Stage I indicates the tumor was completely contained within the kidney without any breaks or spillage outside the renal capsule and no vascular invasion. This stage accounts for 40% to 45% of all Wilms tumors. Correct Answer: C. The tumor extended beyond the kidney but was completely resected. Stage II, the tumor extends beyond the kidney but is completely resected. Stage II would be a tumor that has grown outside the kidney to some degree, such as into surrounding fatty tissue. Usually, the tumor would be completely removable by surgery, and regional lymph nodes are negative. About 20% of all Wilms tumors are at this stage. NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED • 21. Question A child is admitted to the hospital with a diagnosis of Wilms tumor, stage II. Which of the following statements most accurately describes this stage? o A. The tumor is less than 3 cm. in size and requires no chemotherapy. o B. The tumor did not extend beyond the kidney and was completely resected. o C. The tumor extended beyond the kidney but was completely resected. o D. The tumor has spread into the abdominal cavity and cannot be resected. altered mental status. The patient can progress to a comatose state. NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED Acute glomerulonephritis is most commonly caused by the immune response to a prior upper respiratory infection with group A Streptococcus. PSGN most commonly presents in children 1 to 2 weeks after a streptococcal throat infection, or within 6 weeks following a streptococcal skin infection. Group A Streptococcus (GAS) has been subtyped depending on the surface M protein and opacity factor, which are known to be nephrogenic and can cause PSGN. o Option A: Glomerulonephritis is not a congenital condition. Nephrogenic streptococci infection precedes PSGN, which initially affects skin or oropharynx. More recently, PSGN is associated with skin infections (impetigo) more frequently than throat infections (pharyngitis). o Option C: Glomerular lesions in acute GN are the result of glomerular deposition or in situ formation of immune complexes. Poor hygiene, overcrowding, and low socioeconomic status are important risk factors for streptococci outbreaks, and this explains the higher incidence of PSGN in impoverished countries. Genetic factors are expected to predispose to the condition since almost 40% of patients with PSGN gave a positive family history. There is no specific gene found to cause PSGN. o Option D: Nephrotic syndrome is the combination of nephrotic-range proteinuria with a low serum albumin level and edema. It is caused by increased permeability through the damaged basement membrane in the renal glomerulus, especially infectious or thrombo- embolic. It is the result of an abnormality of glomerular permeability that may be primary with a disease-specific to the kidneys or secondary to congenital infections, diabetes, systemic lupus erythematosus, neoplasia, or certain drug use. • 24. Question An infant with hydrocele is seen in the clinic for a follow-up NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED visit at 1 month of age. The scrotum is smaller than it was at birth, but fluid is still visible on illumination. Which of the following actions is the physician likely to recommend? NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED o A. Massaging the groin area twice a day until the fluid is gone. o B. Referral to a surgeon for repair. o C. No treatment is necessary; the fluid is reabsorbing normally. o D. Keeping the infant in a flat, supine position until the fluid is gone. Correct Answer: C. No treatment is necessary; the fluid is reabsorbing normally. A hydrocele is a collection of fluid in the scrotum that results from a patent tunica vaginalis. Illumination of the scrotum with a pocket light demonstrates the clear fluid. In most cases the fluid reabsorbed within the first few months of life and no treatment is necessary. o Option A: Congenital hydrocele tends to be intermittent as it usually reduces when lying flat due to drainage of hydrocele fluid into the peritoneum. However, applying pressure on the congenital hydrocele does not reduce it. At birth, around 80-90% of term male infants possess a patent processus vaginalis. This figure declines steadily to settle at approximately 25-40% at two years of age. o Option B: Surgery is the treatment of choice for hydrocele, and it is warranted when hydrocele becomes complicated or symptomatic. For congenital hydroceles, herniotomy is performed, provided they do not resolve spontaneously. On the other hand, acquired hydroceles subside when the primary underlying condition resolves. o Option D: Placing the infant in a supine position would have no effect. The majority of patients with hydrocele present with the complaint of painless scrotal swelling rendering the testes impalpable with positive NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED psychiatric disturbance in the patient. The overall prognosis of patients with peripheral vascular disease must take into account patient risk factors, cardiovascular health, and disease severity. In terms of limb health at 5 years, nearly 80% of patients will have stable claudication symptoms. Only 1% to 2% of patients will o Option A: Hepatitis B infection is a serious global healthcare problem. Often transmitted via body fluids like blood, semen, and vaginal secretions, the hepatitis B virus can cause liver injury. It involves the transmission of HBV through sexual contact or mucosal surface contact. Unprotected sex and Correct Answer: B. Contaminated food Hepatitis A is the only type that is transmitted by the fecal-oral route through contaminated food. Endemic rates are high in developing countries with low socioeconomic conditions and poor sanitation and hygiene practices. Exposure in these developing countries usually occurs in childhood. The incidence of HAV in a given population correlates with socioeconomic properties such as income, the density of housing, sanitation, and water quality. NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED • 26. Question A nurse is assessing a clinic patient with a diagnosis of hepatitis A. Which of the following is the most likely route of transmission? o A. Sexual contact with an infected partner o B. Contaminated food o C. Blood transfusion o D. Illegal drug use progress to critical limb ischemia in 5 years. Twenty to 30% of patients with PAD will die within 5 years, with 75% of those deaths attributed to cardiovascular causes. o Option D: Skin changes in PVD are secondary to decreased tissue perfusion rather than primary inflammation. Examination of the limbs should involve assessment for pulselessness, pallor, muscular atrophy, cool or cyanotic skin, or pain with palpation. Lower extremity ulcers may be arterial, venous, neuropathic, or a combination of two or more. Ulcers secondary to arterial insufficiency are tender and typically have ragged borders with a dry base Correct Answer: A. A history of hepatitis C five years previously. Hepatitis C is a viral infection transmitted through bodily fluids, such as blood, causing inflammation of the liver. Patients with hepatitis C may not donate blood for transfusion due to the high risk of infection in the recipient. Transmission can be parenteral, perinatal, and sexual, with the most common mode being the sharing of NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED • 27. Question A leukemia patient has a relative who wants to donate blood for transfusion. Which of the following donor medical conditions would prevent this? o A. A history of hepatitis C five years previously. o B. Cholecystitis requiring cholecystectomy one year previously. o C. Asymptomatic diverticulosis. o D. Crohn's disease in remission. injection drug use are major modes of transmission in low to intermediate prevalence areas. o Option C: The patients should be told not to donate blood or any organs as the risk of transmission is high. Hepatitis C is a serious infection that has high morbidity and mortality. The management of HCV is prohibitively expensive, and newer antivirals offer a potential cure for the disorder. o Option D: Hepatitis B, C, and D are transmitted through infected bodily fluids. Hepatitis D virus infection is an acute and chronic inflammatory process transmitted parenterally. Hepatitis D replicates independently within hepatocytes but requires hepatitis B surface antigen for propagation. Hepatic cell death occurs due to direct cytotoxic effects of hepatitis D virus or a NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED o D. furosemide (Lasix) Correct Answer: A. naproxen sodium (Naprosyn) Naproxen sodium is a nonsteroidal anti-inflammatory drug that can cause inflammation of the upper GI tract. For this reason, it is contraindicated in a patient with gastritis. COX- 1 and COX-2 inhibition lead to decreased prostaglandin synthesis in the gastric mucosa. The prostaglandins maintain mucosal integrity, therefore decreased synthesis causes reduced protection to the tissue. However, studies indicate COX-1 has a more significant effect on the integrity of the mucosa; consequently, selective COX-2 inhibitors such as Celecoxib do not have as much of an effect on gastric tissue. o Option B: Calcium carbonate is used as an antacid for the relief of indigestion and is not contraindicated. Calcium carbonate is an inorganic salt primarily used in the management and treatment of low calcium conditions, GERD, CKD, and a variety of other indicated conditions. It is classified as a calcium supplement, antacid, and as a phosphate binder. o Option C: Clarithromycin is an antibacterial often used for the treatment of Helicobacter pylori in gastritis. Clarithromycin is in a class of medications called macrolide antibiotics. It works by stopping the growth of bacteria. Clarithromycin is used to treat certain bacterial infections, such as pneumonia (a lung infection), bronchitis (infection of the tubes leading to the lungs), and infections of the ears, sinuses, skin, and throat. o Option D: Furosemide is a loop diuretic and is contraindicated in a patient with gastritis. The Food and Drug Administration (FDA) has approved the use of furosemide in the treatment of conditions with volume overload and edema secondary to congestive heart failure exacerbation, liver failure, or renal failure including nephrotic syndrome. NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED • 29. Question The nurse is conducting nutrition counseling for a patient with cholecystitis. Which of the following information is important to communicate? NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED o A. The patient must maintain a low calorie diet. o B. The patient must maintain a high protein/low carbohydrate diet. o C. The patient should limit sweets and sugary drinks. o D. The patient should limit fatty foods. Correct Answer: D. The patient should limit fatty foods. Cholecystitis, inflammation of the gallbladder, is most commonly caused by the presence of gallstones, which may block bile (necessary for fat absorption) from entering the intestines. Patients should decrease dietary fat by limiting foods like fatty meats, fried foods, and creamy desserts to avoid irritation of the gallbladder. o Option A: People who go on an extremely low- calorie diet are more likely to develop gallstones than people on a moderately low-calorie diet. Eating a healthy, well-balanced diet full of fruits and vegetables is the best way to improve and protect the gallbladder’s health. Fruits and vegetables are full of nutrients and fiber, the latter of which is essential to a healthy gallbladder. o Option B: A low-fat diet with lean proteins is recommended for patients with cholecystitis. Foods with trans fats, like those in processed or commercially baked products, can also be harmful to gallbladder health. o Option C: Moderate consumption of sweet drinks can be allowed. Avoiding refined white foods, like white pasta, bread, and sugar, can protect the gallbladder. Eat whole-grain cereals, whole-grain bread, whole- grain crackers, brown rice, or whole-grain pasta. Avoid high-fat foods such as croissants, scones, biscuits, waffles, doughnuts, muffins, granola, and high-fat bread. NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED crackles are usually heard at the bases of lungs bilaterally, and progress apically as the edema worsens. Ronchi and wheeze may also be presenting signs. • 31. Question NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED A nurse is evaluating a postoperative patient and notes a moderate amount of serous drainage on the dressing 24 hours after surgery. Which of the following is the appropriate nursing action? o A. Notify the surgeon about evidence of infection immediately. o B. Leave the dressing intact to avoid disturbing the wound site. o C. Remove the dressing and leave the wound site open to air. o D. Change the dressing and document the clean appearance of the wound site. Correct Answer: D. Change the dressing and document the clean appearance of the wound site. A moderate amount of serous drainage from a recent surgical site is a sign of normal healing. Serous drainage is clear, thin, and watery. The production of serous drainage is a typical response from the body during the normal inflammatory healing stage. o Option A: Purulent drainage would indicate the presence of infection. Purulent drainage is milky, typically thicker in consistency, and can be gray, green, or yellow in appearance. If the fluid becomes very thick, this can be a sign of infection. Yet, if there is a large amount of serous drainage, it can be the result of a high bioburden count. o Option B: A soiled dressing should be changed to avoid bacterial growth and to examine the appearance of the wound. Overall, it should be noted that the dressing selection should be based on the individual patient and wound characteristics. If the wound is not in the normal inflammatory phase of healing, the clinician must NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED investigate what is the root cause and how to manage the drainage. o Option C: The surgical site is typically covered by gauze dressings for a minimum of 48-72 hours to ensure that initial healing has begun. Changing the Correct Answer: D. A patient on bed rest who must maintain a supine position. Alendronate can cause significant gastrointestinal side effects, such as esophageal irritation, so it should not be taken if a patient must stay in supine position. It should be taken upon rising in the morning with 8 ounces of water on an empty stomach to increase absorption. The patient should not eat or drink for 30 minutes after NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED • 34. Question Which patient should not be prescribed alendronate (Fosamax) for osteoporosis? o A. A female patient being treated for high blood pressure with an ACE inhibitor. o B. A patient who is allergic to iodine/shellfish. o C. A patient on a calorie restricted diet. o D. A patient on bed rest who must maintain a supine position. improve joint function, hence consultation with a physical therapist is recommended. Further, many of these patients may benefit from a walking aid. o Option C: Ibuprofen is a strong anti- inflammatory, but should always be taken with food to avoid GI distress. NSAIDs are usually prescribed orally or topically and initially, should be started as needed rather than scheduled. Due to gastrointestinal toxicity, and renal and cardiovascular side effects, oral NSAIDs should be used very cautiously and with close monitoring long term. o Option D: Acetaminophen is a pain reliever, but does not have anti-inflammatory activity. Pharmacotherapy of OA involves oral, topical, and/or intra-articular options. Acetaminophen Correct Answer: C. Prophylactic antibiotic therapy prior to anticipated exposure to ticks. NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED • 35. Question Which of the following strategies is not effective for the prevention of Lyme disease? o A. Insect repellant on the skin and clothes when in a Lyme endemic area. o B. Long sleeved shirts and long pants. o C. Prophylactic antibiotic therapy prior to anticipated exposure to ticks. o D. Careful examination of skin and hair for ticks following anticipated exposure. o Option A: Contraindications to alendronate include patients with known hypersensitivity, esophageal abnormalities, delayed esophageal emptying, or achalasia. Severe risk of esophageal morbidity indicates avoidance in patients who are unable to sit or stand upright for at least 30 minutes. Avoid alendronate in patients with hypocalcemia. o Option B: ACE inhibitors are not contraindicated with alendronate and there is no iodine allergy relationship. Baseline concentrations of calcium and bone mineral density should be established before therapy begins, with follow-up testing at 6 to 12 months post-therapy. Calcium at baseline and continual monitoring is needed if hypocalcemia risk is recurring. o Option C: There is no restriction for alendronate on a patient taking a calorie restricted diet. The accumulation of alendronate in the kidney allows for persistent anti-fracture benefits even after cessation of NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED Prophylactic use of antibiotics is not indicated to prevent Lyme disease. Antibiotics are used only when symptoms develop following a tick bite. Specific treatment is dependent upon the age of the patient and stage of the disease. For patients older than 8 years of age with early, localized disease, doxycycline is recommended for 10 days. Patients under the age of 8 should receive amoxicillin or cefuroxime for 14 days to avoid the potential for tooth staining caused by tetracycline use in young children. o Option A: Insect repellant should be used on skin and clothing when exposure is anticipated. While there are many repellants on the market, it is best to avoid them as the risk of harm is greater than any benefit. If one is going to use a repellant, DEET is the one product that is safe, however, it is not 100% effective. o Option B: Clothing should be designed to cover as much exposed area as possible to provide an effective barrier. The outdoors person should be told to wear appropriate garments and be familiar with the skin features of the tick bite. The nurse should educate the patient on how to remove the tick from the skin and when to seek medical assistance. o Option D: Close examination of skin and hair can reveal the presence of a tick before a bite occurs. Nurses should educate parents on how to inspect their children for ticks at the end of an outdoor event, in an endemic area. Pets can also develop Lyme disease and carry the tick. Hence, pet owners should examine their pets on a regular basis and remove the tick. There is no risk of acquiring Lyme disease by removing the tick. • 36. Question A nurse is performing a routine assessment of an IV site in a patient receiving both IV fluids and medications through the line. Which of the following would indicate the need for discontinuation of the IV line as the next nursing action? NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED to find the patient sitting up in bed, dyspneic and uncomfortable. On assessment, crackles are heard in the bases of both lungs, probably indicating that the patient is experiencing a complication of transfusion. Which of the following complications is most likely the cause of the patient’s symptoms? NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED o A. Febrile non-hemolytic reaction o B. Allergic transfusion reaction o C. Acute hemolytic reaction o D. Fluid overload Correct Answer: D. Fluid overload Fluid overload occurs when the fluid volume infused over a short period is too great for the vascular system, causing fluid leak into the lungs. Symptoms include dyspnea, rapid respirations, and discomfort as in the patient described. Transfusion associated circulatory overload includes any four of the following occurring within 6 h of a BT – acute respiratory distress, tachycardia, increased blood pressure (BP), acute or worsening pulmonary edema and evidence of a positive fluid balance. o Option A: Febrile non-hemolytic reaction results in fever. Febrile non-hemolytic is generally thought to be caused by cytokines released from blood donor leukocytes (white blood cells). Transfusion reactions range in frequency from relatively common (mild allergic and febrile non-hemolytic reactions) to rare (anaphylaxis, acute hemolytic, and sepsis). o Option B: Symptoms of allergic transfusion reaction would include flushing, itching, and a generalized rash. Attributed to hypersensitivity to a foreign protein in the donor product. The severity and incidence vary depending on the type of transfusion reaction, the prevalence of disease in the donor population, and the extent of follow-up care the patient receives. o Option C: Acute hemolytic reaction may occur when a patient receives blood that is incompatible with his blood type. It is the most serious adverse transfusion reaction and can cause shock and death. Can result in intravascular or extravascular hemolysis, NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED depending on the specific etiology (cause). Immune-mediated reactions are often a result of recipient antibodies present to blood donor antigens. • 38. Question NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED o Option C: In the case of an unengaged fetal head, rupture of membranes may allow for the umbilical cord to precede the fetal head when the release of amniotic fluid occurs. This will allow the fetal head to compress the section of umbilical cord preceding the head, generally leading to fetal bradycardia and necessitating emergency cesarean section. This complication should be an easily avoidable, iatrogenic cause of emergency delivery. o Option D: The nurse plays a vital role during the procedure in monitoring the mother as well as the fetus, she also notes the color of the draining amniotic fluid and documents the findings in the medical chart. After the procedure, she assesses the maternal temperature every two hours and watches out for any signs of infection. The nurse also monitors the fetal heart rate via continuous electronic fetal monitoring and communicates the findings to the provider. o Option E: Pain is not associated with amniotomy. Practitioners have believed that artificial rupture of membranes either can assist in inducing labor or augmenting spontaneous labor. It is commonly felt that relieving the amniotic sac of amniotic fluid induces uterine contraction activity, increases the strength of contractions, and may augment labor by allowing direct pressure from the fetal scalp on the uterine cervix which may assist in dilating the cervix. • 39. Question A nurse is counseling the mother of a newborn infant with hyperbilirubinemia. Which of the following instructions by the nurse is not correct? o A. Continue to breastfeed frequently, at least every 2-4 hours. NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED o B. Follow up with the infant's physician within 72 hours of discharge for a recheck of the serum bilirubin and exam. o C. Watch for signs of dehydration, including decreased urinary output and changes in skin turgor. NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED o D. Keep the baby quiet and swaddled, and place the bassinet in a dimly lit area. Correct Answer: D. Keep the baby quiet and swaddled, and place the bassinet in a dimly lit area. An infant discharged home with hyperbilirubinemia (newborn jaundice) should be placed in a sunny rather than dimly lit area with skin exposed to help process the bilirubin. Phototherapy is started based on risk factors and the serum bilirubin level on the nomogram. Bilirubin absorbs light optimally in the blue-green range (460 to 490 nm) and is either photo isomerized and excreted in the bile or converted into lumirubin and excreted in the urine. During phototherapy, the eyes of the newborn must be covered, and the maximum body surface area exposed to the light. o Option A: Frequent feedings will help to metabolize the bilirubin. Breast milk jaundice occurs late in the first week, peaks in the second, and usually resolves by 12 weeks of age. It is due to inhibition of UGT activity and a factor in breast milk with a beta- glucuronidase-like activity that deconjugates conjugated bilirubin in the intestines leading to increased enterohepatic circulation. o Option B: A recheck of the serum bilirubin and a physical exam within 72 hours will confirm that the level is falling and the infant is thriving and is well hydrated. Bilirubin levels may be assessed using a transcutaneous measurement device or taking blood for total serum or plasma level determination. Transcutaneous measurement decreases the frequency of blood tests for bilirubin but is limited by dark skin tone and if the neonate has received phototherapy. o Option C: Signs of dehydration, including decreased urine output and skin changes, indicate inadequate fluid intake and will worsen hyperbilirubinemia. Breastfeeding jaundice, also Correct Answer: C. Decreased pain Furosemide, a loop diuretic, does not alter pain. The Food and Drug Administration (FDA) has approved the use of furosemide in the treatment of conditions with volume NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED • 41. Question A nurse is administering IV furosemide to a patient admitted with congestive heart failure. After the infusion, which of the following symptoms is not expected? o A. Increased urinary output o B. Decreased edema o C. Decreased pain o D. Decreased blood pressure Anderson, Silver, & Macinko, 2014; NCPSC, 2013). WV requires that children under 7 years be restrained in a car safety or booster seat, without specifying the timing of the transition. o Option C: The infant should always face rearward in the back seat while on a car seat. For side crashes, children < 24 months riding in forward-facing car seats were 5.5 times more likely to get injured as compared to those riding in rear-facing car seats. Accident data (such as from Sweden) indicate that increased duration of rear-facing car safety seat usage can decrease injuries and deaths relating to automobile accidents (SafetyBeltSafe USA, 2013). o Option D: Infants should always be placed in an approved car seat during travel, even on that first ride home from the hospital. Consistent with research, the American Academy of Pediatrics (AAP) and National Highway Traffic Safety Administration (NHTSA) have developed evidence-based practice guidelines for car safety seat use, which vary NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED secondary to congestive heart failure exacerbation, liver failure, or renal failure including the nephrotic syndrome. o Option A: Furosemide acts on the kidneys to increase urinary output. Furosemide inhibits tubular reabsorption of sodium and chloride in the proximal and distal tubules, as well as in the thick ascending loop of Henle by inhibiting sodium-chloride cotransport system resulting in excessive excretion of water along with sodium, chloride, magnesium, and calcium. o Option B: Fluid may move from the periphery, decreasing edema. Careful monitoring of the clinical condition of the patient, daily weight, fluids intake, and urine output, electrolytes, i.e., potassium and magnesium, kidney function monitoring with serum creatinine and serum blood urea nitrogen level is vital to monitor the response to furosemide. Replete electrolytes if indicated as diuresis with furosemide lead to electrolyte depletion, and adjust the dose or even hold off on furosemide if laboratory work shows signs of kidney dysfunction. o Option D: Fluid load is reduced, lowering blood pressure. Furosemide can be a second- line agent in heart failure patients with symptoms, and in patients with advanced kidney disease with an estimated glomerular filtration rate, less than 30 ml per minute the loop diuretics (furosemide) are preferred over thiazide diuretics to treat hypertension. • 42. Question There are a number of risk factors associated with coronary artery disease. Which of the following is a modifiable risk factor? o A. Obesity o B. Heredity Correct Answer: A. Obesity NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED o C. Gender o D. Age NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED o D. Hypertension. Correct Answer: B. History of cerebral hemorrhage. A history of cerebral hemorrhage is a contraindication to tPA because it may increase the risk of bleeding. Bleeding associated with alteplase therapy can be divided into two broad categories. Internal bleeding includes intracranial bleeding (0.4% to 15.4%), retroperitoneal bleeding (less than 1%), gastrointestinal (GI) bleeding (5%), genitourinary bleeding (4%), and respiratory bleeding. Superficial or surface bleeding is observed mainly at invaded or disturbed sites such as venous cutdowns, arterial punctures, and recent surgical intervention sites. o Option A: TPA acts by dissolving the clot blocking the coronary artery and works best when administered within 6 hours of onset of symptoms. Alteplase acts within the endogenous fibrinolytic cascade to convert plasminogen to plasmin by hydrolyzing the arginine- valine bond in plasminogen. The activated plasmin then degrades fibrin and fibrinogen, allowing for the dissolution of the clot and re-establishment of blood flow. o Option C: Prior MI is not a contraindication to tPA. FDA-approved indications for alteplase include pulmonary embolism, myocardial infarction with ST- segment elevation (STEMI), ischemic stroke when given within 3 hours of the start of symptoms, and re- establishment of patency in occluded intravenous (IV) catheters. o Option D: Patients receiving tPA should be observed for changes in blood pressure, as tPA may cause hypotension. There are no therapeutic drug monitoring recommendations that pertain to the efficacy of tPA therapy. If prolonged off-label therapy is occurring in the event of catheter-directed treatment or repeated dosing in valve thrombosis, serial imaging of the thrombus is reasonable. The safety profile is best NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED monitored by prothrombin time (PT), partial thromboplastin time (PTT), Hemoglobin, and hematocrit to assess ongoing bleeding. • 44. Question NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED Following myocardial infarction, a hospitalized patient is encouraged to practice frequent leg exercises and ambulate in the hallway as directed by his physician. Which of the following choices reflects the purpose of exercise for this patient? o A. Increases fitness and prevents future heart attacks. o B. Prevents bedsores. o C. Prevents DVT (deep vein thrombosis). o D. Prevent constipations. Correct Answer: C. Prevents DVT (deep vein thrombosis). Exercise is important for all hospitalized patients to prevent deep vein thrombosis. Muscular contraction promotes venous return and prevents hemostasis in the lower extremities. Encourage physical activity consistent with the patient’s energy levels. Helps promote a sense of autonomy while being realistic about capabilities. Walking down the hall 20 feet or walking through the house, then slowly progressing walking outside the house, saving energy for the return trip. o Option A: This exercise is not sufficiently vigorous to increase physical fitness. Encourage active ROM exercises. Encourage the patient to participate in planning activities that gradually build endurance. Exercise maintains muscle strength, joint ROM, and exercise tolerance. Physical inactive patients need to improve functional capacity through repetitive exercises over a long period of time. Strength training is valuable in enhancing endurance of many ADLs. o Option B: Inspect skin regularly, particularly over bony prominences. Gently massage any reddened areas and provide aids such as sheepskin pads as necessary. Pressure points over bony prominences are most at risk for Correct Answer: A. Family history of heart disease Family history of heart disease is an inherited risk factor that is not subject to a lifestyle change. Having a first-degree relative with heart disease has been shown to significantly increase risk. ASCVD is multifactorial etiology. The most common risk factors include hypercholesterolemia (LDL- cholesterol), hypertension, diabetes mellitus, cigarette smoking, age (male older than 45 years and female older than 55 years), male gender, and strong family history (male relative younger than 55 years and female relative younger than 65 years). o Option B: Also, a sedentary lifestyle, obesity, NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED • 46. Question A patient in the cardiac unit is concerned about the risk factors associated with atherosclerosis. Which of the following are hereditary risk factors for developing atherosclerosis? o A. Family history of heart disease o B. Overweight o C. Smoking o D. Age o Option B: Myocardial ischemia is further exacerbated by impaired myocardial perfusion due to hypotension and tachycardia. The presenting symptoms of cardiogenic shock are variable. The most common clinical manifestations of shock, such as hypotension, altered mental status, oliguria, and cold, clammy skin, can be seen in patients with cardiogenic shock o Option C: Peripheral pulses are rapid and faint and may be irregular if arrhythmias are present. Clinical criteria include a systolic blood pressure of less than or equal to 90 mm Hg for greater than or equal to 30 minutes or support Correct Answer: A, C, D, & E. NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED • 47. Question Claudication is a well-known effect of peripheral vascular disease. Which of the following facts about claudication is correct? Select all that apply. o A. It results when oxygen demand is greater than oxygen supply. o B. It is characterized by pain that often occurs during rest. o C. It is a result of tissue hypoxia. o D. It is characterized by cramping and weakness. o E. It is relieved after a short rest. of high-density lipoprotein (HDL)-cholesterol is considered a risk factor, pharmacological therapy increasing HDL-cholesterol has yielded negative results raising concerns about the role of HDL in ASCVD. o Option C: Smoking is a risk factor that is subject to lifestyle change and can reduce risk significantly. For the most part atherosclerosis and its pathology can be prevented. All healthcare workers who look after patients should educate patients on the need to exercise regularly, discontinue smoking, maintain healthy body weight, eat a healthy diet, and remain compliant with the medications used to lower lipids. o Option D: Advancing age increases the risk of atherosclerosis but is not a hereditary factor. It has been reported that 75% of acute myocardial infarctions occur from plaque rupture and the highest incidence of plaque NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED Claudication describes the pain experienced by a patient with peripheral vascular disease when oxygen demand in the leg muscles exceeds the oxygen supply. This most often occurs during activity when demand increases in muscle tissue, and usually relieved after rest. The tissue becomes hypoxic, causing cramping, weakness, and discomfort. o Option A: Intermittent claudication (IC) typically refers to lower extremity skeletal muscle pain that occurs during exercise. IC presents when there is insufficient oxygen delivery to meet the metabolic requirements of the skeletal muscles. o Option B: Pain occurs during activity when demand increases in muscle tissues, not when at rest. IC is commonly localized to the thigh, hip, buttock, and calf muscles. Pain within these muscle groups is reproducibly induced by walking and relieved with rest. The severity of pain can sometimes correlate with the degree of stenosis or blockage in arteries supplying the lower extremities. o Option C: The key feature of intermittent claudication is that the muscle discomfort is reproducible. The pain usually comes on during physical activity and subsides after a period of rest. The key reason for the pain is inadequate blood flow. o Option D: Physical examination of these patients may show evidence of arterial insufficiency. The affected limb may feel cool and have diminished pulses. The physical examination should include an assessment of femoral, popliteal, dorsalis pedis, and posterior tibial artery pulses. o Option E: Structured walking programs improve pain- free walking distance better than pharmacologic therapy alone. It is important to note that continued smoking with walking therapy restricts improvement in these patients. NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED and hypertension. • 49. Question NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED A patient who has been diagnosed with vasospastic disorder (Raynaud’s disease) complains of cold and stiffness in the fingers. Which of the following descriptions is most likely to fit the patient? o A. An adolescent male o B. An elderly woman o C. A young woman o D. An elderly man Correct Answer: C. A young woman Raynaud’s disease is most common in young women and is frequently associated with rheumatologic disorders, such as lupus and rheumatoid arthritis. Secondary Raynaud phenomenon is associated with different etiologies. It is most commonly associated with connective tissue disorders such as scleroderma, systemic lupus erythematosus, Sjogren syndrome, and antiphospholipid syndrome. o Option A: Primary Raynaud phenomenon usually occurs in the second or third decade of life, with a baseline prevalence rate of 8% in men. Occupations that result in overt vibrational exposure from vibrating machinery mostly affect males. This is known as hand- arm vibration syndrome. Exposure to polyvinyl chloride, cold injury from work, or ammunition work are other occupational-associated causes of secondary Raynaud phenomenon. o Option B: Primary Raynaud phenomenon usually occurs in the second or third decade of life. Secondary Raynaud phenomenon occur more frequently in women (about 20% to 30%), particularly in younger age populations (teens to 20s). The female to male ratio is 9 to 1. o Option D: Primary Raynaud phenomenon occurs more frequently in women than in men. In NCLEX-RN EXAM 2023 NEW UPDATED QUESTIONS WITH ANSWERS PLUS EXPLANATIONS A+ RATED the population of patients older than 60 years, obstructive vascular disease is a frequent cause of the Raynaud phenomenon. Obstructive vascular disease causes