NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) assured success, Exams of Nursing

Download NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) assured success and more Exams Nursing in PDF only on Docsity! Option C. Grunting occurs when an infant attempts to maintain an adequate functional residual capacity in the face of poorly compliant lungs by partial glottic closure. As the infant prolongs the expiratory phase against this partially closed glottis, there is a prolonged and increased residual volume that maintains the airway opening and also an audible expiratory sound. Option E: Nasal flaring occurs when the nostrils widen while breathing and is a sign of troubled breathing or respiratory distress. Correct Answers: C, E, F, & G NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) 1.1. Question While assessing a one-month-old infant, which of the findings warrants further investigation by the nurse? Select all that apply. o A. Abdominal respirations o B. Irregular breathing rate o C. Inspiratory grunt o D. Increased heart rate with crying o E. Nasal flaring o F. Cyanosis o G. Asymmetric chest movement NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) o Have the client empty the bladder. The first step in the process is to have the client void prior to administering the pre-operative medication. If the Correct order is shown above. o Option F: Cyanosis refers to the bluish discoloration of the skin and indicates a decrease in oxygen attached to the red blood cells in the bloodstream. o Option G: Asymmetric chest movement occurs when the abnormal side of the lungs expands less and lags behind the normal side. This indicates respiratory distress. o Option A: Abdominal respiration is normal among infants and young children. Since their intercostal muscles are not yet fully developed, they use their abdominal muscles much more to pull the diaphragm down for breathing. o Option B: Newborns can have irregular breathing patterns ranging from 30 to 60 breaths per minute with short periods of apnea (15 seconds). o Option D: An increase in heart rate is normal for an infant during activity (including crying). Fluctuations in heart rate follow the changes in • 2. Question A nurse is to administer meperidine hydrochloride (Demerol) 100 mg, atropine sulfate (Atropisol) 0.4 mg, and promethazine hydrochloride (Phenergan) 50 mg IM to a preoperative client. List the order in which the nurse must carry out the following actions prior to the administration of preoperative medications. View Answers: o Place the call bell within reach o Raise the side rails on the bed o Have the client empty bladder o Instruct the client to remain in bed NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Option A: African-Americans develop high blood pressure at younger ages than other groups in the US. Researchers have uncovered that African-Americans respond differently to hypertensive drugs than other groups of people. They are also found out to be more sensitive to salt, which increases the risk of developing hypertension. Option B: The incidence of hypertension in Asian- Americans does not appear to be significantly higher than the general population, according to limited US data. Option C: The racial disparity in hypertension and hypertension-related outcomes has been recognized for decades with African-Americans with greater risks than Caucasians. Option D: Hypertension prevalence rates in Hispanics may vary by gender and country of origin. Hispanic Americans overall have relatively low levels of hypertension, despite elevated levels of diabetes and obesity. Correct Answer: A: 45-year-old African American attorney o B. 60-year-old Asian-American shop owner o C. 40-year-old Caucasian nurse o D. 55-year-old Hispanic teacher • 5. Question A 15-year-old female who ingested 15 tablets of maximum strength acetaminophen 45 minutes ago is rushed to the emergency department. Which of these orders should the nurse do first? o A. Gastric lavage o B. Administer acetylcysteine (Mucomyst) orally o C. Start an IV Dextrose 5% with 0.33% normal saline to keep the vein open NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) o D. Have the patient drink activated charcoal mixed with water Correct Answer: A. Gastric lavage o Option A: Acetaminophen overdose is extremely toxic to the liver causing hepatotoxicity. Early symptoms of hepatic damage include nausea, vomiting, abdominal pain, and diarrhea. If not treated immediately, hepatic necrosis occurs and may lead to death. Removing as much of the drug as possible is the first step in treatment for acetaminophen overdose, this is best done through gastric lavage. Gastric lavage (irrigation) and aspiration consist of flushing the stomach with fluids and then aspirating the fluid back out. This procedure is done in life- threatening cases such as acetaminophen toxicity and only if less than one (1) hour has occurred after ingestion. o Option B: The oral formulation of acetylcysteine is the drug of choice for the treatment of acetaminophen overdose but should be done after GI decontamination with activated charcoal. Liver damage is minimized by giving acetylcysteine (Mucomyst), the antidote for acetaminophen. Acetylcysteine reduces injury by substituting for depleted glutathione in the reaction that converts the toxic metabolite of acetaminophen to its nontoxic form. When given within 8 hours of acetaminophen toxicity, acetylcysteine is effective in preventing severe liver injury. It is administered orally or intravenously. o Option C: Intermittent IV infusion with Dextrose 5% may be considered for late-presenting or chronic ingestion. o Option D: Oral activated charcoal (AC) avidly adsorbs acetaminophen and may be administered if the patient presents within 1 hour after ingesting a potentially toxic dose. Charcoal should not be administered immediately before or with antidotes NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) since it can effectively adsorb it and neutralize the benefits. • 6. Question NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Correct Answer: D. Yearly weight gain of about 5.5 pounds per year School-age children gain about 5.5 pounds each year and increase about 2 inches in height. Between ages 2 to 10 years, a child will grow at a steady pace. NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Correct Answer: A. Go get a blood pressure check within the next 15 minutes The blood pressure reading is moderately high with the need to have it rechecked after a few minutes to verify. The client states it is ‘usually much lower.’ Thus a concern exists for complications such as stroke. o Options B & D: Waiting 2 months or a week for follow-up is too long. o Option C: Immediate check by the provider of care is not warranted. o Option A: Decreasing amounts of body fat and muscle mass are common in toddlers. o Option B: A decrease in the change in body appearance occurs among young adults. o Option C: Growth spurts are common in • 9. Question At a community health fair, the blood pressure of a 62-year- old client is 160/96 mmHg. The client states “My blood pressure is usually much lower.” The nurse should tell the client to: o A. Go get a blood pressure check within the next 15 minutes o B. Check blood pressure again in two (2) months o C. See the healthcare provider immediately o D. Visit the health care provider within one (1) week for a BP check • 10. Question The hospital has sounded the call for a disaster drill on the NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) evening shift. Which of these clients would the nurse put first on the list to be discharged in order to make a room available for a new admission? NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Option A: If epiglottitis is seriously considered, no imaging studies are required. In less-clear cases, imaging studies are occasionally helpful in establishing the diagnosis or excluding epiglottitis. Option B: Examining the child’s throat should not be attempted because it may compromise respiratory effort. Option C: There are no indications for the collection of sputum specimens. These findings suggest a medical emergency and may be due to epiglottitis. Any child with an acute onset of an inflammatory response in the mouth and throat should receive immediate care. Option A: Polyphagia or extreme hunger is one of the most common symptoms of diabetes both among adults and children. Option B: Dehydration is not a symptom of type 1 diabetes, but it can be one of the many complications. Option D: Unintentional weight loss would develop gradually in a child with type 1 diabetes. Correct Answer: C. Bedwetting One of the first symptoms of type 1 diabetes in children is bedwetting. Bedwetting in a school-age child is readily detected by the parents. • 13. Question In children suspected to have a diagnosis of diabetes, which one of the following complaints would be most likely to prompt parents to take their school-age child for evaluation? o A. Polyphagia o B. Dehydration o C. Bedwetting o D. Weight loss • 14. Question NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Option B: Chlamydial infections are one of the most frequent causes of salpingitis or pelvic inflammatory disease. Chlamydial bacteria could travel up toward the vagina or cervix into the reproductive organs. Option A: Trichomoniasis is a very common sexually transmitted disease, but it rarely predisposes to pelvic inflammatory disease. Options C & D: Staphylococcus and streptococcus may cause PID but it rarely occurs. Correct Answer: B. Chlamydia A client comes to the clinic for treatment of recurrent pelvic inflammatory disease. The nurse recognizes that this condition most frequently follows which type of infection? o A. Trichomoniasis o B. Chlamydia o C. Staphylococcus o D. Streptococcus • 15. Question A registered nurse who usually works in a spinal rehabilitation unit is floated to the emergency department. Which of these clients should the charge nurse assign to this RN? o A. A middle-aged client who says “I took too many diet pills” and “my heart feels like it is racing out of my chest.” o B. A young adult who says “I hear songs from heaven. I need money for beer. I quit drinking two (2) days ago for my family. Why are my arms and legs jerking?” o C. An adolescent who has been on pain medications terminal cancer with an initial assessment finding pupils and a relaxed respiratory rate of 11, NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Correct Answer: C. Avoiding very heavy meals Eating large, heavy meals can pull blood away from the heart for digestion and is dangerous for the client with coronary artery disease. Too much plaque may accumulate in the arteries and block the delivery of blood and oxygen in major organs of the body. Option A: The client in option A might be experiencing an overdose. Option B: The client in option B is having withdrawal syndrome. Option D: The client in option D may experience a decrease in sensorium later on due to head trauma. Correct Answer: C. An adolescent who has been on pain medications terminal cancer with an initial assessment finding pupils and a relaxed respiratory rate of 10. Nurses who are floated to other units should be assigned to a client who has minimal anticipated immediate complications of their problem. This client exhibits opioid toxicity with the pinpoint pupils and has the least risk of complications to occur in the near future. o D. An elderly client who reports having taken a “large crack hit” 10 minutes prior to walking into the emergency room. • 16. Question When teaching a client with coronary artery disease about nutrition, the nurse should emphasize: o A. Eating three (3) balanced meals a day o B. Adding complex carbohydrates o C. Avoiding very heavy meals o D. Limiting sodium to 7 gms per day NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Correct Answer: C. Moist, productive cough Noisy respirations and a dry non-productive cough are commonly the first of the respiratory signs to appear in a newly diagnosed client with cystic fibrosis (CF). The other options are the earliest findings. CF is an inherited (genetic) condition affecting the cells that produce mucus, sweat, saliva, and digestive juices. Normally, these secretions are thin and slippery, but in CF, a defective gene Option B: The patient post-stroke may have transient urinary incontinence due to inability to communicate needs, or impaired motor and postural control. Control of the urinary sphincter may also be lost or diminished. Option C: Altered sensation to stimuli is expected for a patient post CVA. This may include sensory impairment to touch, loss of proprioception, difficulty interpreting visual, tactile, and auditory stimuli. Option D: Depression and anxiety are common responses by a patient after a catastrophic event such as in stroke. Emotional lability (or pseudobulbar affect), refers to the involuntary and uncontrollable bursts of emotion without an emotional trigger. A further decrease in the level of consciousness may indicate an increase in intracranial pressure leading to inadequate oxygenation of the brain. A decrease in LOC may also reveal the presence of a transient ischemic attack which may warn of impending thrombotic CVA. • 20. Question A child who has recently been diagnosed with cystic fibrosis is in a pediatric clinic where a nurse is performing an assessment. Which later finding of this disease would the nurse not expect to see at this time? o A. Positive sweat test o B. Bulky greasy stools o C. Moist, productive cough o D. Meconium ileus NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Option A: A positive sweat test is one of the indications of cystic fibrosis. Option B: A patient with CF experiences frequent greasy, bulky stools or difficulty with bowel movements as the thick mucus blocks the intestines. Option D: Meconium ileus is one of the early signs of CF. causes the secretions to become thick and sticky. Instead of acting as a lubricant, the secretions plug up tubes, ducts, and passageways, especially in the pancreas and lungs. Respiratory failure is the most dangerous consequence of CF. • 21. Question The home health nurse visits a male client to provide wound care and finds the client lethargic and confused. His wife states he fell down the stairs two (2) hours ago. The nurse should o A. Place a call to the client’s health care provider for instructions o B. Send him to the emergency room for evaluation o C. Reassure the client’s wife that the symptoms are transient o D. Instruct the client’s wife to call the doctor if his symptoms become worse NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Correct Answer: B. Send him to the emergency room for evaluation This client requires immediate evaluation. A delay in treatment could result in further deterioration and harm. Home care nurses must prioritize interventions based on assessment findings that are in the client’s best interest. o Option A: Waiting to call for instructions may delay the diagnosis of the patient. o Option C: Reassuring the wife is since it is not a transient symptom. NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Option A: When an infant is crying, the fontanels may look like they are bulging. Option C: The client in Option C can wait to be seen within the first hour. Option D: The client in Option D does not have a life- threatening condition but will still require immediate pain relief. Correct Answer: B. A teenager who got a singed beard while camping This client is in the greatest danger with a potential of respiratory distress. Any client with singed facial hair has been exposed to heat or fire in close range that could have caused serious damage to the interior of the lungs. Note that the interior lining of the lungs has no nerve fibers so the client will not be aware of swelling. Option A: The statement in Option A is correct but pertains to the risks associated with a toddler. Option B: Setting limits on a toddler may cause frustration instead of independence. Correct Answer: C. “I understand the need to use those new skills.” Erikson describes the stage of the toddler as being the time when there is normally an increase in autonomy. The child needs to use motor skills to explore the environment and develop autonomy. • 25. Question While planning care for a toddler, the nurse teaches the parents about the expected developmental changes for this age. Which statement by the mother shows that she understands the child’s developmental needs? o A. “I want to protect my child from any falls.” o B. “I will set limits on exploring the house.” o C. “I understand the need to use those new skills.” o D. “I intend to keep control over our child.” NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Option B: It is also important to check that the feeding solution matches the dietary order to ensure that the client gets proper nutrition. Option C: Aspirating the gastric contents is one of the methods used to determine the last feeding amount in the stomach, but is not the most important action the nurse should do. Option D: Keep it at room temperature so it would not upset the stomach. Correct Answer: A. Verify correct placement of the tube Proper placement of the tube prevents aspiration and entrance of food content into the lungs. The definitive way to ascertain the position of the nasogastric tube is through visualization by an x- ray. Another method is to aspirate stomach contents and check its pH (usually pH 1 to 5). Aspirated stomach content can also be tested for bilirubin to confirm it is placed in the stomach. o Option D: Controlling the child may be harmful to her development as toddlers should be developing their autonomy at this stage. • 26. Question The nurse is preparing to administer an enteral feeding to a client via a nasogastric feeding tube. The most important action of the nurse is: o A. Verify correct placement of the tube o B. Check that the feeding solution matches the dietary order o C. Aspirate abdominal contents to determine the amount of last feeding remaining in stomach o D. Ensure that feeding solution is at room temperature • 27. Question The nurse is caring for a client with a serum potassium level of 3.5 mEq/L. The client is placed on a cardiac monitor and receives 40 mEq potassium chloride in 1000 ml of 5% dextrose in water IV. NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Correct Answer: A. All striated muscles Option A: Narrow QRS complex indicates fast cardiac rhythms (generally more than 100 beats/min) with a QRS duration of 100 ms or less. Option B: A short PR interval (<120 ms) is seen with preexcitation syndromes and AV nodal (junctional) rhythm. Option D: Prominent U waves are characteristic of hypokalemia. Correct Answer: C. Tall peaked “T” waves A tall peaked T wave is a sign of hyperkalemia. The healthcare provider should be notified regarding discontinuing the medication. Which of the following EKG patterns indicates to the nurse that the infusions should be discontinued? o A. Narrowed QRS complex o B. Shortened “PR” interval o C. Tall peaked "T" waves o D. Prominent “U” waves • 28. Question A nurse prepares to care for a 4-year-old newly admitted for rhabdomyosarcoma. The nurse should alert the staff to pay more attention to the function of which area of the body? o A. All striated muscles o B. The cerebellum o C. The kidneys o D. The leg bones NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) pulmonary artery catheter (Swan-Ganz catheter). The nurse teaches the client that the catheter will be inserted to provide information about: NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Correct Answer: B. Initiate high- quality chest compressions Option A: Stroke volume is calculated using measurements of ventricle volumes from an echocardiogram and subtracting the volume of the blood in the ventricle at the end of a beat (called end- systolic volume) from the volume of blood just prior to the beat (called end-diastolic volume). Option B: Cardiac output is calculated by multiplying the stroke volume by the heart rate. Option C: The CVP can be measured either manually using a manometer or electronically using a transducer. Correct Answer: D. Left ventricular functioning The catheter is placed in the pulmonary artery. Information regarding left ventricular function is obtained when the catheter balloon is inflated. o A. Stroke volume o B. Cardiac output o C. Venous pressure o D. Left ventricular functioning • 32. Question A nurse enters a client’s room to discover that the client has no pulse or respirations. After calling for help, the first action the nurse should take is: o A. Start a peripheral IV o B. Initiate high-quality chest compressions o C. Establish an airway o D. Obtain the crash cart NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Correct Answer: A. Blood pressure 94/60 mm Hg Both medications decrease the heart rate. Metoprolol affects blood pressure. Therefore, the heart rate and blood pressure must be within the normal range (HR 60- 100; systolic BP over 100) in order to safely administer both medications. o Option B: A heart rate of 76 is within the normal range. Option A: Starting a peripheral IV can come after the C-A-B sequence. Option C: Establishing an airway comes after compressions. Option D: After performing the guidelines by the AHA, the crash cart can be obtained by another nurse responding to the scene. As per new guidelines, the American Heart Association recommends beginning CPR with chest compression (rather than checking for the airway first). Start CPR with 30 chest compressions before checking the airway and giving rescue breaths. Starting with chest compressions first applies to adults, children, and infants needing CPR, but not newborns. CPR can keep oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm. • 33. Question A client is receiving digoxin (Lanoxin) 0.25 mg daily. The health care provider has written a new order to give metoprolol (Lopressor) 25 mg B.I.D. In assessing the client prior to administering the medications, which of the following should the nurse report immediately to the health care provider? o A. Blood pressure 94/60 mm Hg o B. Heart rate 76 bpm o C. Urine output 50 ml/hour o D. Respiratory rate 16 bpm NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) o B. “I just can’t ‘catch my breath’ over the past few minutes and I think I am in grave danger.” o C. “I have to use the bedpan to pass my water at least every 1 to 2 hours.” o D. “It seems that the pain medication is not working as well today.” Correct Answer: B. “I just can’t ‘catch my breath’ over the past few minutes and I think I am in grave danger.” The nurse would be concerned about all of these comments, however, the most life-threatening is option B. Clients who had hip or knee surgery are at higher risk for the development of postoperative pulmonary embolism. Sudden dyspnea and tachycardia are classic findings of pulmonary embolism. Without prophylaxis (e.g., anticoagulation medications), deep vein thrombosis can develop within 7 to 14 days following the surgery and can lead to pulmonary embolism. The nurse should be aware of the other signs of DVT which include: pain and tenderness at or below the area of the clot, skin discoloration, swelling, or tightness of the affected leg. Signs of pulmonary embolism include acute onset of dyspnea, tachycardia, confusion, and pleuritic chest pain. o Option A: Muscle spasms occur after total hip replacements and acute pain is expected after a surgical procedure. o Option C: May indicate urinary infection and needs further assessment by the nurse. o Option D: May require a reevaluation of pain and interventions to manage pain though does not need immediate action. • 36. Question A 33-year-old male client with heart failure has been taking furosemide for the past week. Which of the following NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) assessment cues below may indicate the client is experiencing a negative side effect from the medication? o A. Weight gain of 5 pounds NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Correct Answer: D. Decreased appetite Furosemide is a loop diuretic that is used for pulmonary edema, edema in heart failure, nephrotic syndrome, and hypertension. Furosemide causes a loss of potassium unless a supplement or a potassium-rich diet is taken. A decrease in appetite is caused by hypokalemia. Signs and symptoms of hypokalemia include anorexia, fatigue, nausea, decreased GI motility, muscle weakness, dysrhythmias, reduced urine osmolality, altered level of consciousness. o Option A: Weight gain is not a negative side effect of furosemide. o Option B: Edema of the ankles are indications for the administration of furosemide. o Option C: Gastric irritability is not a side effect of furosemide. Correct Answer: B. Improve the client’s nutrition status Venous stasis occurs when venous blood collects and stagnates in the lower leg due to incompetent venous valves. Eventually, little oxygen and nutrients are supplied to the cells of the lower o B. Edema of the ankles o C. Gastric irritability o D. Decreased appetite • 37. Question The nurse is caring for a 27-year-old female client with venous stasis ulcer. Which nursing intervention would be most effective in promoting healing? o A. Apply dressing using sterile technique o B. Improve the client’s nutrition status o C. Initiate limb compression therapy o D. Begin proteolytic debridement NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Option B: Positive feedback is most useful when given immediately. Option C: Negative statements are never helpful in any given situation. Option D: Every goal should always be attainable. Correct Answer: A. Specific feedback is given as close to the event as possible Feedback is most useful when given immediately. Positive behavior is strengthened through immediate feedback, and it is easier to modify problem behaviors if the standards are clearly understood. Option B: Patients with multiple sclerosis should not exercise to the point of fatigue as strenuous physical exercise raises body temperature and may aggravate symptoms. Option E: Continuous exercise with no rest periods is contraindicated for patients with multiple sclerosis Correct answers: B & E. o D. Performance goals should be higher than what is attainable • 39. Question The nurse is providing information to a client with multiple sclerosis on performing exercises and physical activities. The nurse determines the client needs additional teaching if the client makes which statements? Select all that apply. o A. “I can lift weights and do resistance training.” o B. “I should exercise to the point of exhaustion.” o C. “I can include aerobic exercises in my routine.” o D. “Proper stretching should be done before starting my routine.” o E. “I should exercise continuously without rest.” NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) who wants to exercise. The patient should be advised to take short rest periods, preferably lying down. Again, extreme fatigue may contribute to the exacerbation of symptoms. o Option A: Exercises should include activities that would strengthen weak muscles because diminishing muscle strength is often a primary concern in multiple sclerosis. These activities include lifting weights and resistance exercises. o Option C: Aerobic exercises help promote muscle efficiency, increase flexibility, improves mood, and helps eliminate stress. o Option D: Muscle stretching should be included prior to exercise as this helps minimize muscle spasticity and contractures which is • 40. Question During the evaluation of the quality of home care for a client with Alzheimer’s disease, the priority for the nurse is to reinforce which statement by a family member? o A. “At least two (2) full meals a day are eaten.” o B. “We go to a group discussion every week at our community center.” o C. “We have safety bars installed in the bathroom and have 24-hour alarms on the doors.” o D. “The medication is not a problem to have it taken three (3) times a day.” NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Correct Answer: C. We have safety bars installed in the bathroom and have 24-hour alarms on the doors. Note all options are correct statements. However, safety is most important to reinforce. o Option C: Ensuring safety of the client with increasing memory loss is a priority of home NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) body interact with UV rays from the sun. Anti-infectives are the most common cause of this type of reaction. o Option A: Ciprofloxacin is used to treat a variety of bacterial infections. Ciprofloxacin belongs to a class of drugs called quinolone antibiotics. It works by stopping the growth of bacteria. This antibiotic treats only bacterial infections. It will not work for virus infections (such as common cold, flu). Unnecessary use or overuse of any antibiotic can lead to its decreased effectiveness. o Option B: Sulfonamides are synthetic bacteriostatic antibiotics that competitively inhibit conversion of p- aminobenzoic acid to dihydropteroate, which bacteria need for folate synthesis and ultimately purine and DNA synthesis. Humans do not synthesize folate but acquire it in their diet, so their DNA synthesis is less affected. o Option C: Norfloxacin is an antibiotic in a group of drugs called fluoroquinolones. Norfloxacin fights bacteria in the body. Norfloxacin is used to treat different bacterial infections of the prostate or urinary tract (bladder and kidneys). Norfloxacin is also used to treat gonorrhea. o Option D: Sulfamethoxazole and trimethoprim combination is used to treat infections such as urinary tract infections, middle ear infections (otitis media), bronchitis, traveler’s diarrhea, and shigellosis (bacillary dysentery). This medicine is also used to prevent or treat Pneumocystis jiroveci pneumonia or Pneumocystis carinii pneumonia (PCP), a very serious kind of pneumonia. Sulfamethoxazole and trimethoprim combination is an antibiotic. It works by eliminating the bacteria that cause many kinds of infections. o Option E: Isotretinoin is a drug used to treat severe acne that hasn’t responded to other treatments. It may be prescribed for other uses, including other skin problems and certain kinds of cancer. This drug is a vitamin A derivative (retinoid), NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) so your body reacts to it in a similar way that it does to vitamin A. NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Option A: Sulfasalazine may discolor the urine or skin to orange-yellow color. Sulfasalazine is used to treat ulcerative colitis (UC), and to decrease the frequency of UC attacks. Sulfasalazine will not cure ulcerative colitis, but it can reduce the number of attacks you have. Option B: Levodopa may discolor the urine, saliva, or sweat to a dark brown color. Levodopa is in a class of medications called central nervous system agents. It works by being converted to dopamine in the brain. Carbidopa is in a class of medications called decarboxylase inhibitors. It works by preventing levodopa from being broken down before it reaches the brain. Correct Answer: D. Aspirin Aspirin is not known to cause discoloration of the urine. Side effects and complications of taking aspirin include stroke caused by a burst blood vessel. The Food and Drug Administration doesn’t recommend aspirin therapy for the prevention of heart attacks in people who haven’t already had a heart attack, stroke or another cardiovascular condition. o Option F: Nitro-Dur patch is used to prevent chest pain or angina. Its side effects are headache, lightheadedness, nausea, and flushing. • 43. Question A patient tells you that her urine is starting to look discolored. If you believe this change is due to medication, which of the following of the patient’s medication does not cause urine discoloration? o A. Sulfasalazine o B. Levodopa o C. Phenolphthalein o D. Aspirin NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) o Option D: Epoetin alfa IV (Epogen) vials should be stored at 2°C to 8°C (36°F to 46°F); Do not freeze. Do not shake. Protect from light. • 45. Question A 34-year-old female has recently been diagnosed with an autoimmune disease. She has also recently discovered that she is pregnant. Which of the following is the only immunoglobulin that will provide protection to the fetus in the womb? o A. IgA o B. IgD o C. IgE o D. IgG Correct Answer: D. IgG IgG is the only immunoglobulin that can cross the placental barrier. About 70-80% of the immunoglobulins in the blood are IgG. Specific IgG antibodies are produced during an initial infection or other antigen exposure, rising a few weeks after it begins, then decreasing and stabilizing. The body retains a catalog of IgG antibodies that can be rapidly reproduced whenever exposed to the same antigen. IgG antibodies form the basis of long-term protection against microorganisms. o Option A: IgA antibodies protect body surfaces that are exposed to outside foreign substances. Immunoglobulin A (IgA) is the first line of defence in the resistance against infection, via inhibiting bacterial and viral adhesion to epithelial cells and by neutralisation of bacterial toxins and virus, both extra- and intracellularly. IgA also eliminates pathogens or antigens via an IgA-mediated excretory pathway where binding to IgA is followed by poly immunoglobulin receptor-mediated transport of NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) immune complexes. o Option B: IgD antibodies are found in small amounts in the tissues that line the belly or chest. Secreted IgD appears to enhance mucosal homeostasis and NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Option A: Before reporting to a social worker, it is imperative to start a prophylaxis to reduce viral replication. Option C: Pentamidine is an antimicrobial medication given to prevent and treat pneumocystis pneumonia. Option D: It is natural to have strong emotions after an exposure to HIV in the workplace. The healthcare Correct Answer: B. Start prophylactic AZT treatment Azidothymidine (AZT) treatment is the most critical intervention. It is an antiretroviral medication used to prevent and treat HIV/AIDS by reducing the replication of the virus. Post-exposure prophylaxis (PEP) for HIV is a treatment to suppress the virus and prevent infection after exposure. PEP should be taken within 72 hours of possible exposure to HIV, so it is important to seek treatment quickly. immune surveillance by “arming” myeloid effector cells such as basophils and mast cells with IgD antibodies reactive against mucosal antigens, including commensal and pathogenic microbes. o Option C: IgE antibodies cause the body to react against foreign substances such as pollen, spores, animal dander. IgE antibodies are found in the lungs, skin, and mucous membranes. They are involved in allergic • 46. Question A second-year nursing student has just suffered a needlestick while working with a patient that is positive for AIDS. Which of the following is the most significant action that the nursing student should take? o A. Immediately see a social worker o B. Start prophylactic AZT treatment o C. Start prophylactic Pentamidine treatment o D. Seek counseling NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Option A: Multiple sclerosis (MS) is a demyelinating disease in which the insulating covers of the nerve cells in the brain and spinal cord are damaged. Option C: On the other hand, bulimia nervosa features binge eating followed by a feeling of guilt, humiliation, and self-deprecation. These feelings cause the patient to engage in self-induced vomiting, use of laxatives, or diuretics. Option D: Systemic sclerosis or systemic scleroderma is an autoimmune disease of the connective tissue. Correct Answer: B. Anorexia nervosa All of the clinical signs and symptoms point to a condition of anorexia nervosa. The key feature of anorexia nervosa is self- imposed starvation, resulting from a distorted body image and an intense, irrational fear of gaining weight, even when the patient is emaciated. Anorexia nervosa may include refusal to eat accompanied by compulsive exercising, self-induced vomiting, or laxative or diuretic abuse. o Option D: Somatic neuropathy affects the whole body and presents with diverse clinical pictures, most common is the development of diabetic foot followed by diabetic ulceration and • 48. Question You are taking the history of a 14-year-old girl who has a (BMI) of 18. The girl reports inability to eat, induced vomiting and severe constipation. Which of the following would you most likely suspect? o A. Multiple sclerosis o B. Anorexia nervosa o C. Bulimia nervosa o D. Systemic sclerosis • 49. Question NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Option A: Diverticulosis is a condition that develops when pouches (diverticula) form in the wall of the large intestine; most people don’t have symptoms. Option C: Hypocalcemia is low calcium levels in the blood; it is asymptomatic in mild forms but can cause paresthesia, tetany, muscle cramps, and carpopedal spasms in severe hypocalcemia. Option D: Irritable bowel syndrome is a widespread condition involving recurrent abdominal pain and diarrhea or constipation, often associated with stress, depression, anxiety, or previous intestinal infection. Correct Answer: B. Hypercalcemia Hypercalcemia can cause polyuria, severe abdominal pain, and confusion. A 24-year-old female is admitted to the ER due to confusion. This patient has a history of a myeloma diagnosis, constipation, intense abdominal pain, and polyuria. Based on the presenting signs and symptoms, which of the following would you most likely suspect? o A. Diverticulosis o B. Hypercalcemia o C. Hypocalcemia o D. Irritable bowel syndrome • 50. Question Rhogam is most often used to treat mothers that have a infant. o A. RH positive, RH positive o B. RH positive, RH negative o C. RH negative, RH positive NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) o D. RH negative, RH negative Correct Answer: C. RH negative, RH positive Rhogam prevents the production of anti-RH antibodies in the mother that has an Rh-positive fetus. o Option A: RhoGAM is a prescription medicine that is used to prevent Rh immunization, a condition in which an individual with Rh-negative blood develops antibodies after exposure to Rh-positive blood. o Option B: If the father or baby is not conclusively shown to be Rh-negative, RhoGAM should be given to an Rh-negative mother in the following clinical situations to prevent Rh immunization: after delivery of an Rh-positive baby; routine prevention of Rh immunization at 26 to 28 weeks of pregnancy; maternal or fetal bleeding during pregnancy from certain conditions; or an actual or threatened pregnancy loss at any stage. o Option D: It isn’t until second and subsequent pregnancies when antibodies are already built up, that Rh incompatibility can cause problems. Indeed, these antibodies can cross the placenta and attack the baby’s red blood cells. This can cause the baby to develop anemia, and in severe cases, result in miscarriage. • 51. Question A new mother has some questions about phenylketonuria (PKU). Which of the following statements made by a nurse is not correct regarding PKU? o A. A Guthrie test can check the necessary lab values o B. The urine has a high concentration of phenyl pyruvic acid o C. Mental deficits are often present with PKU NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) problems, and psychiatric disorders are also common. Untreated individuals may have a musty or mouse-like odor as a side effect of excess phenylalanine in the body. Children with classic PKU tend to have lighter skin and NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) hair than unaffected family members and are also likely to have skin disorders such as • 52. Question A patient has taken an overdose of aspirin. Which of the following should a nurse must closely monitor for during acute management of this patient? o A. Onset of pulmonary edema o B. Metabolic alkalosis o C. Respiratory alkalosis o D. Parkinson’s disease type symptoms Correct Answer: A. Onset of pulmonary edema Aspirin overdose can lead to metabolic acidosis and cause pulmonary edema development. Early symptoms of aspirin poisoning also include tinnitus, hyperventilation, vomiting, dehydration, and fever. Late signs include drowsiness, bizarre behavior, unsteady walking, and coma. Abnormal breathing caused by aspirin poisoning is usually rapid and deep. Pulmonary edema may be related to an increase in permeability within the capillaries of the lung leading to “protein leakage” and transudation of fluid in both renal and pulmonary tissues. The alteration in renal tubule permeability may lead to a change in colloid osmotic pressure and thus facilitate pulmonary edema (via Medscape). o Option B: Aspirin overdose causes metabolic acidosis, not alkalosis. Metabolic alkalosis is a primary increase in serum bicarbonate (HCO3 -) concentration. o Option C: Respiratory alkalosis is a disturbance in acid and base balance due to alveolar hyperventilation. o Option D: Parkinson’s type symptoms include NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) tremors, bradykinesia, rigid muscles, impaired posture and balance, speech changes, and loss of automatic movements. • 53. Question NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Correct Answer: C. Oily skin The skin would be dry and not oily. Correct Answer: B. Weight gain Weight gain due to fluid accumulation is associated with heart failure and congenital heart defects. When the heart does not circulate blood normally, the kidneys receive less blood and filter less fluid out of the circulation into the urine. The extra fluid in the circulation builds up in the lungs, the liver, around the eyes, and sometimes in the legs. o Option A: One of the symptoms of congenital heart defect is a rapid heartbeat. The heart must work harder to pump blood and supply enough for all the body systems. o Option C: There is an increase in the systolic blood pressure to compensate for the decrease of sufficient oxygen. o Option D: Irregular WBC is not a symptom of a congenital heart defect. An elevated WBC count is directly associated with an increased incidence of coronary heart disease and ischemic stroke and mortality from cardiovascular disease in African- American and White men and women. An elevated total white blood cell (WBC) count is a risk factor for atherosclerotic vascular disease. • 56. Question A mother has recently been informed that her child has Down’s syndrome. You will be assigned to care for the child at shift change. Which of the following characteristics is not associated with Down’s syndrome? o A. Simian crease o B. Brachycephaly o C. Oily skin o D. Hypotonicity NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Correct Answer: D. Observe for signs of bleeding Bleeding is the priority concern for a client taking thrombolytic medication. The primary mechanism of all thrombolytics is the conversion of plasminogen to the active form, plasmin, which then degrades fibrin. This proteolysis can occur with fibrin- bound plasminogen on the surface of thrombi and the unbound form within the plasma. The unbound plasmin generated degrades fibrin but also fibrinogen, factor V, and factor VIII. o Option A: During therapy, perform a neurologic assessment every 15 minutes during the 1-hour infusion. After therapy, check every 15 minutes o Option A: Simian crease refers to a single crease across the palm of the hand and is prominent among those with Down’s syndrome. o Option B: Brachycephaly is described as a shortening of the occipitofrontal diameter (front to the back of the head) of the fetal head. Postnatally, it is well established that babies with Down syndrome often had signs of brachycephaly in utero. o Option D: Patients with Down syndrome have low muscle tone or hypotonia, and ligaments • 57. Question A client with myocardial infarction is receiving tissue plasminogen activator, alteplase (Activase, tPA). While on the therapy, the nurse plans to prioritize which of the following? o A. Observe for neurological changes o B. Monitor for any signs of renal failure o C. Check the food diary o D. Observe for signs of bleeding NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Option B: Yellow vegetables are great sources of vitamins, such as vitamins A, B6, C, folate, magnesium, fiber, riboflavin, phosphorus, and potassium. Red meat is rich in protein, saturated fat, iron, zinc, and vitamin B. Option C: Carrots are a rich source of vitamin A from beta carotene, K1 (phylloquinone), and vitamin B6. Option D: Milk is a rich source of calcium. Milk is an excellent source of many vitamins and minerals, including vitamin B12, calcium, riboflavin, and phosphorus. It’s often fortified with other vitamins, especially vitamin D. Correct Answer: A. Green vegetables and liver Green vegetables and liver are a great source of folic acid. o Option B: Although current guidelines do not include renal dysfunction as a contraindication to tPA therapy, some clinicians hesitate to administer tPA because of a tendency of bleeding in these patients. o Option C: Having a food diary is not related to the use of medication. Thrombolytic therapy is indicated in patients with evidence of ST- segment elevation MI (STEMI) or presumably new left bundle-branch block (LBBB) presenting within 12 hours of the onset of symptoms if there are no contraindications to fibrinolysis. • 58. Question A patient asks a nurse, “My doctor recommended I increase my intake of folic acid. What type of foods contain the highest concentration of folic acids?” o A. Green vegetables and liver o B. Yellow vegetables and red meat o C. Carrots o D. Milk • 59. Question NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) o A. Following surgery o B. Upon admission o C. Within 48 hours of discharge NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Correct Answer: B. Initiative vs. guilt It is as children enter the preschool years (3-6 years old) that they begin the third stage of psychosocial development centered Option A: Preoperative instructions are important for discharge planning, so it must start not only after the surgery. Option C: Creating a discharge plan within 48 hours of discharge could cause the plan to be incomplete, as it would lack the preparations made before the surgery. Option D: Including the preoperative discussion in the discharge plan is correct, but this should also extend towards the admission and the data taken upon admission for comprehensive planning of the client’s discharge. Correct Answer: B. Upon admission Discharge education begins upon admission. Ideally, it involves the client and the family, as well as the hospital staff. Effective discharge planning can decrease the chances of the client being readmitted to the hospital, and also can help in recovery, ensure medications are prescribed and given correctly, and adequately prepare folks to take over the client’s care. o D. Preoperative discussion • 62. Question A 5-year-old child and has been recently admitted to the hospital. According to Erik Erikson’s psychosocial development stages, the child is in which stage? o A. Trust vs. mistrust o B. Initiative vs. guilt o C. Autonomy vs. shame and doubt o D. Intimacy vs. isolation NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Correct Answer: C. Autonomy vs. shame and doubt Autonomy vs Shame and doubt is the second stage of Erik Erikson’s stages of psychosocial development. This stage occurs between the ages of 18 months to 3 years. According to Erikson, children at this stage are focused on developing a greater sense of control. o Option A: Trust vs Mistrust is the first stage of the psychosocial theory. This stage begins at Option A: Trust vs Mistrust is the first stage of the psychosocial theory. This stage begins at birth and continues to approximately 18 months of age. During this stage, children learn whether or not they can trust the people around them. Option C: Autonomy vs Shame and doubt is the second stage of Erik Erikson’s stages of psychosocial development. This stage occurs between the ages of 18 months to 3 years. According to Erikson, children at this stage are focused on developing a greater sense of control. Option D: Intimacy vs Isolation takes place during young adulthood between the ages of approximately 19 and 40. The major conflict at this stage of life centers on forming intimate, loving relationships with other people. on initiative versus guilt. It is important for the kids of this age to learn that they can exert power over themselves and the world. • 63. Question A toddler is 26 months old and has been recently admitted to the hospital. According to Erikson, which of the following stages is the toddler in? o A. Trust vs. mistrust o B. Initiative vs. guilt o C. Autonomy vs. shame and doubt o D. Intimacy vs. isolation NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) CPM; Blood pressure: 85-120 (systolic), 55-80 (diastolic). All vital signs are within the normal • 66. Question When you are taking a patient’s history, she tells you she has been depressed and is dealing with an anxiety disorder. Which of the following medications would the patient most likely be taking? o A. Amitriptyline (Elavil) o B. Calcitonin o C. Pergolide mesylate (Permax) o D. Verapamil (Calan) Correct Answer: A. Amitriptyline (Elavil) Amitriptyline (Elavil) is a tricyclic antidepressant and used to treat symptoms of depression. o Option B: Calcitonin is used to treat osteoporosis in women who have been in menopause. Calcitonin is a hormone that is produced in humans by the parafollicular cells (commonly known as C-cells) of the thyroid gland. Calcitonin is involved in helping to regulate levels of calcium and phosphate in the blood, opposing the action of the parathyroid hormone. o Option C: Permax (pergolide mesylate) is indicated as adjunctive treatment to levodopa/carbidopa in the management of the signs and symptoms of Parkinson†s disease. o Option D: Verapamil is used to treat high blood pressure and to control angina (chest pain). The immediate-release tablets are also used alone or with other medications to prevent and treat irregular heartbeats. Verapamil is in a class of medications called calcium-channel blockers. It works by relaxing NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) the blood vessels so the heart does not have to pump as hard. It also increases the supply of blood and oxygen to the heart and slows electrical activity in the heart to control the heart rate. NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Option A: Campylobacter infection, or campylobacteriosis, is caused by Campylobacter bacteria. It is the most common bacterial cause of diarrheal illness in the United States. Some people with, or at risk for, severe illness might need antibiotic treatment. Option B: Legionella bacteria can cause a serious type of pneumonia (lung infection) called Legionnaires’ disease. Legionnaires’ disease requires treatment with antibiotics. Option C: Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. Antibiotics are used to treat bacterial pneumonia. Correct Answer: D. Multiple Sclerosis Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (central nervous system). It cannot be treated by antibiotics. • 67. Question Which of the following conditions would a nurse not administer erythromycin? o A. Campylobacteriosis infection o B. Legionnaires disease o C. Pneumonia o D. Multiple Sclerosis • 68. Question A patient’s chart indicates a history of hyperkalemia. Which of the following would you not expect to see with this patient if this condition were acute? o A. Decreased HR NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Correct Answer: A. Increased appetite o D. Poor tolerance of light NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Loss of appetite would be expected. Most cases of meningitis are caused by an infectious agent that has colonized or established a localized infection elsewhere in the host. Potential sites of colonization or infection include the skin, the nasopharynx, the respiratory tract, the gastrointestinal (GI) tract, and the genitourinary tract. The organism invades the submucosa at these sites by circumventing host defenses (eg, physical barriers, local immunity, and phagocytes or macrophages). o Option B: Vomiting occurs in 35% of patients with meningitis. The brain is naturally protected from the body’s immune system by the barrier that the meninges create between the bloodstream and the brain. Normally, this protection is an advantage because the barrier prevents the immune system from attacking the brain. However, in meningitis, the blood- brain barrier can become disrupted; once bacteria or other organisms have found their way to the brain, they are somewhat isolated from the immune system and can spread. o Option C: The classic triad of meningitis consists of fever, nuchal rigidity, and altered mental status. When the body tries to fight the infection, the problem can worsen; blood vessels become leaky and allow fluid, WBCs, and other infection-fighting particles to enter the meninges and brain. This process, in turn, causes brain swelling and can eventually result in decreasing blood flow to parts of the brain, worsening the symptoms of infection. o Option D: Other symptoms include photalgia (photophobia): discomfort when the patient looks into bright lights. Depending on the severity of bacterial meningitis, the inflammatory process may remain confined to the subarachnoid space. In less severe forms, the pial barrier is not penetrated, and the underlying parenchyma remains intact. However, in more severe forms of bacterial meningitis, the pial barrier is breached, and the underlying parenchyma is invaded by the NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) inflammatory process. Thus, bacterial meningitis may lead to widespread cortical destruction, particularly when left untreated. • 71. Question NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) Option B: Group A Streptococcus (group A strep, Streptococcus pyogenes) can cause both noninvasive and invasive disease, as well as nonsuppurative sequelae. Option C: Anthrax is a serious infectious disease caused by gram-positive, rod-shaped bacteria known as Bacillus anthracis. Option D: Enterococcus faecalis and Enterococcus faecium are the most prevalent species cultured from humans, accounting for more than 90% of clinical isolates. Infections commonly caused by enterococci include urinary tract infection (UTIs), endocarditis, bacteremia, catheter-related infections, wound infections, and intra-abdominal and pelvic infections. Correct Answer: A. Borrelia burgdorferi Lyme disease is the most common vector-borne disease in the United States. Lyme disease is caused by the bacterium Borrelia burgdorferi and rarely, Borrelia mayonii. • 72. Question A nurse is reviewing a patient’s chart and notices that the patient suffers from Lyme disease. Which of the following microorganisms is related to this condition? o A. Borrelia burgdorferi o B. Streptococcus pyogenes o C. Bacillus anthracis o D. Enterococcus faecalis • 73. Question A fragile 87-year-old female has recently been admitted to the hospital with increased confusion and falls over the last two (2) weeks. She is also noted to have a mild left hemiparesis. Which of the following tests is most likely to be performed? o A. CBC (Complete blood count) NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) o B. ECG (electrocardiogram) o C. Thyroid function tests o D. CT scan Correct Answer: D. CT scan A CT scan would be performed for further investigation of the hemiparesis. Noncontrast CT scanning is the most commonly used form of neuroimaging in the acute evaluation of patients with apparent acute stroke. o Option A: A complete blood count (CBC) and a basic chemistry panel can be useful baseline studies. A CBC serves as a baseline study and may reveal a cause for the stroke (eg, polycythemia, thrombocytosis, thrombocytopenia, leukemia), identify evidence of concurrent illness (eg, anemia), or issues that may affect reperfusion strategies (thrombocytopenia). o Option B: Electrocardiogram may serve as baseline data upon entry into the ED. An electrocardiogram (ECG or EKG) records the electrical signal from the heart to check for different heart conditions. Electrodes are placed on the chest to record the heart’s electrical signals, which cause the heart to beat. The signals are shown as waves on an attached computer monitor or printer. o Option C: Testing can often be limited to blood glucose, plus coagulation studies if the patient is on warfarin, heparin, or one of the newer antithrombotic agents (eg, dabigatran, rivaroxaban), not including thyroid studies. • 74. Question An 85-year-old male has been losing mobility and gaining weight over the last two (2) months. The patient also has the heater running in his house 24 hours a day, even on warm days. Which of the following tests is most likely to be NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022) performed? o A. CBC (complete blood count) NCLEX-RN Exam Pack Set 1 (75 Questions & Answers Updated 2022)