NCLEX-RN Exam Pack Set 5 (75 Questions & Answers Updated 2022), Exams of Nursing

Download NCLEX-RN Exam Pack Set 5 (75 Questions & Answers Updated 2022) and more Exams Nursing in PDF only on Docsity! pg. 1 1 o Option A: Septic arthritis results from bacterial invasion of a joint and leads to inflammation of the synovial lining. o Option B: Traumatic arthritis results from blunt trauma to a joint or ligament. o Option C: Intermittent arthritis is a rare, benign condition marked by regular, recurrent joint effusions, especially in the knees. Correct Answer: D. Gouty arthritis Gouty arthritis, a metabolic disease, is characterized by urate deposits and pain in the joints, especially those in the feet and legs. Urate deposits don’t occur in septic or traumatic arthritis. NCLEX-RN Exam Pack Set 5 (75 Questions & Answers Updated 2022) 1. 1. Question Mr. Rodriguez is admitted with severe pain in the knees. Which form of arthritis is characterized by urate deposits and joint pain, usually in the feet and legs, and occurs primarily in men over age 30? o A. Septic arthritis o B. Traumatic arthritis o C. Intermittent arthritis o D. Gouty arthritis • 2. Question A heparin infusion at 1,500 units/hour is ordered for a 64-year-old client with stroke in evolution. The infusion contains 25,000 units of heparin in 500 ml of saline solution. How many milliliters per hour should be given? pg. 2 2 o Option A: 15 ml/hr is based on the computation used. o Option C: 45 ml/hr is more than the correct milliliters to be infused based on the computation. o Option D: 50 ml/hr is because it is way more than the correct milliliter to be infused. Correct Answer: B. 30 ml/hour An infusion prepared with 25,000 units of heparin in 500 ml of saline solution yields 50 units of heparin per milliliter of solution. The equation is set up as 50 units times X (the unknown quantity) equals 1,500 units/hour, X equals 30 ml/hour. Correct Answer: B. Loss of muscle contraction decreasing venous return In clients with hemiplegia or hemiparesis, loss of muscle contraction decreases venous return and may cause swelling of the affected extremity. o A. 15 ml/hour o B. 30 ml/hour o C. 45 ml/hour o D. 50 ml/hour • 3. Question A 76-year-old male client had a thromboembolic right stroke; his left arm is swollen. Which of the following conditions may cause swelling after a stroke? o A. Elbow contracture secondary to spasticity. o B. Loss of muscle contraction decreasing venous return. o C. Deep vein thrombosis (DVT) due to immobility of the ipsilateral side. o D. Hypoalbuminemia due to protein escaping from an inflamed glomerulus. pg. 5 5 o Option B: Using this dosage would be and may produce no effect on the client’s blood sugar level. o Option C: This is an insulin dose. administration can result in transient and serious hypoglycemia and hyperglycemia, wide glycemic excursions, and diabetic ketoacidosis. o Option D: This is an dosage for the prescribed insulin. Glycemic control is poorer in those who lacked confidence in their ability to choose correct doses. Correct Answer: A. 9 U regular insulin and 21 U neutral protamine Hagedorn (NPH). A 70/30 insulin preparation is 70% NPH and 30% regular insulin. Therefore, a correct substitution requires mixing 21 U of NPH and 9 U of regular insulin. • 7. Question A male client with type 1 diabetes is scheduled to receive 30 U of 70/30 insulin. There is no 70/30 insulin available. As a substitution, the nurse may give the client: o A. 9 U regular insulin and 21 U neutral protamine Hagedorn (NPH). o B. 21 U regular insulin and 9 U NPH. o C. 10 U regular insulin and 20 U NPH. o D. 20 U regular insulin and 10 U NPH. • 8. Question Nurse Len should expect to administer which medication to a client with gout? o A. Aspirin o Option A: If a single assisting hand helps to walk, then logically a cane might be of potential benefit. o Option B: A cane should be used on the unaffected side of the client. o Option D: The use of a cane is important to prevent further injury or falls. pg. 6 6 o Option A: Although aspirin is used to reduce joint inflammation and pain in clients with osteoarthritis and rheumatoid arthritis, it isn’t indicated for gout because it has no effect on urate crystal formation. o Option B: Furosemide, a diuretic, doesn’t relieve gout. It is a loop diuretic that prevents the body from absorbing too much salt. This allows the salt to be passed in the urine. o Option D: Calcium gluconate is used to reverse a negative calcium balance and relieve muscle cramps, not to treat gout. Correct Answer: C. Colchicines A disease characterized by joint inflammation (especially in the great toe), gout is caused by urate crystal deposits in the joints. The physician prescribes colchicine to reduce these deposits and thus ease joint inflammation. Correct Answer: A. Adrenal cortex Excessive secretion of aldosterone in the adrenal cortex is responsible for the client’s hypertension. This hormone acts on o B. Furosemide (Lasix) o C. Colchicines o D. Calcium gluconate (Kalcinate) • 9. Question Mr. Domingo with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client’s hypertension is caused by excessive hormone secretion from which of the following glands? o A. Adrenal cortex o B. Pancreas o C. Adrenal medulla o D. Parathyroid pg. 7 7 o Option A: Moist, transparent dressings contain exudate and provide a moist wound environment. o Option D: Hydrocolloid dressings prevent the entrance of microorganisms and minimize wound discomfort. o Option B: Dry sterile dressings protect the wound from mechanical trauma and promote healing. Correct Answer: C. They debride the wound and promote healing by secondary intention For this client, wet-to-dry dressings are most appropriate because they clean the foot ulcer by debriding exudate and necrotic tissue, thus promoting healing by secondary intention. • 10. Question For a diabetic male client with a foot ulcer, the doctor orders bed rest, a wet to- dry dressing change every shift, and blood glucose monitoring before meals and bedtime. Why are wet-to-dry dressings used for this client? o A. They contain exudate and provide a moist wound environment. o B. They protect the wound from mechanical trauma and promote healing. o C. They debride the wound and promote healing by secondary intention. o D. They prevent the entrance of microorganisms and minimize wound discomfort. o Option B: The pancreas mainly secretes hormones involved in fuel metabolism. o Option C: The adrenal medulla secretes the catecholamines — epinephrine and norepinephrine. o Option D: The parathyroids secrete parathyroid hormone. the renal tubule, where it promotes reabsorption of sodium and excretion of potassium and hydrogen ions. pg. 10 10 o Option A: At 10:00 am, the insulin given would not have reached its peak. o Option B: During noontime, risk for hypoglycemia would still be low. o Option D: 10:00 pm is already a late time for the peak action of insulin. Correct Answer: C. 4:00 pm NPH is an intermediate-acting insulin that peaks 8 to 12 hours after administration. Because the nurse administered NPH insulin at 7 a.m., the client is at greatest risk for hypoglycemia from 3 p.m. to 7 p.m. • 14. Question Nurse Trinity administered neutral protamine Hagedorn (NPH) insulin to a diabetic client at 7 a.m. At what time would the nurse expect the client to be most at risk for a hypoglycemic reaction? o A. 10:00 am o B. Noon o C. 4:00 pm o D. 10:00 pm • 15. Question The adrenal cortex is responsible for producing which substances? o A. Glucocorticoids and androgens o B. Catecholamines and epinephrine o C. Mineralocorticoids and catecholamines o D. Norepinephrine and epinephrine o Option C: Serum fructosamine levels provide information about blood glucose control over the past 2 to 3 weeks. pg. 11 11 Correct Answer: A. Hypocalcemia Hypocalcemia may follow thyroid surgery if the parathyroid glands were removed accidentally. Signs and symptoms of hypocalcemia may be delayed for up to 7 days after surgery. Thyroid surgery doesn’t directly cause serum sodium, potassium, or magnesium abnormalities. o Option B: Hyponatremia may occur if the client inadvertently received too much fluid; however, this can happen to any surgical client receiving I.V. fluid therapy, not just one recovering from thyroid surgery. • 16. Question On the third day after a partial thyroidectomy, Proserfina exhibits muscle twitching and hyperirritability of the nervous system. When questioned, the client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery? o A. Hypocalcemia o B. Hyponatremia o C. Hyperkalemia o D. Hypermagnesemia o Option B: Epinephrine, which is a catecholamines, is produced in the medulla. It causes smooth muscle relaxation in the airways or contraction of the smooth muscle in arterioles, which results in blood vessel constriction in kidneys, decreasing or inhibiting blood flow to the nephrons. o Option C: Catecholamines are produced in the medulla. They help the body respond to stress or fright and prepare the body for “fight-or-flight” reactions. o Option D: The medulla produces catecholamines — epinephrine and norepinephrine. Correct Answer: A. Glucocorticoids and androgens The adrenal glands have two divisions, the cortex, and medulla. The cortex produces three types of hormones: glucocorticoids, mineralocorticoids, and androgens. pg. 12 12 • 17. Question Which laboratory test value is elevated in clients who smoke and can’t be used as a general indicator of cancer? o A. Acid phosphatase level o B. Serum calcitonin level o C. Alkaline phosphatase level o D. Carcinoembryonic antigen level Correct Answer: D. Carcinoembryonic antigen level In clients who smoke, the level of carcinoembryonic antigen is elevated. Therefore, it can’t be used as a general indicator of cancer. However, it is helpful in monitoring cancer treatment because the level usually falls to normal within 1 month if treatment is successful. o Option A: An elevated acid phosphatase level may indicate prostate cancer. Prostatic acid phosphatase is a non-specific phosphomonoesterase synthesized in prostate epithelial cells and its level proportionally increases with prostate cancer progression. o Option C: An elevated alkaline phosphatase level may reflect bone metastasis. When abnormal bone tissue is being formed by cancer cells, levels of alkaline phosphatase increase. Therefore, high levels of this enzyme could suggest that a patient has bone metastasis. o Option B: An elevated serum calcitonin level usually signals thyroid cancer. Calcitonin can be measured as a blood test to help diagnose medullary thyroid cancer and its level can indicate the amount of medullary thyroid cancer present before thyroid surgery. o Option C: Hyperkalemia is not associated with thyroid surgery. It is usually found in patients with reduced renal excretion of potassium and magnesium. o Option D: Hypermagnesemia usually is associated with reduced renal excretion of potassium and magnesium, not thyroid surgery. pg. 15 15 • 21. Question Nurse Marie is caring for a 32-year-old client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client? o A. Pallor, bradycardia, and reduced pulse pressure o B. Pallor, tachycardia, and a sore tongue o C. Sore tongue, dyspnea, and weight gain o D. Angina, double vision, and anorexia Correct Answer: B. Pallor, tachycardia, and a sore tongue Pallor, tachycardia, and a sore tongue are all characteristic findings in pernicious anemia. Other clinical manifestations include anorexia; weight loss; a smooth, beefy red tongue; a wide pulse pressure; palpitations; angina; weakness; fatigue; and paresthesia of the hands and feet. o Option A: Tachycardia, instead of bradycardia, and reduced pulse pressure are present in a client with pernicious anemia. The heart may start to beat faster to make up for the reduced number of red blood cells in the body. o Option C: Weight loss, instead of weight gain, is a common symptom of pernicious anemia. A B12 deficiency can be counteracted with a dose of the vitamin, causing energy levels to regulate and the metabolism to work harder to burn up fuel. The result is weight loss when the deficiency is mitigated, but adding B12 to a body with sufficient levels doesn’t really increase natural effects. o Option D: Double vision isn’t a characteristic finding in pernicious anemia. However, vision loss associated with vitamin B12 deficiency can occur even in well- nourished individuals who can’t absorb enough B12 to support healthy vision. pg. 16 16 o Option A: The physician is likely to order additional medications, such as antihistamines and corticosteroids; if these medications don’t relieve the respiratory compromise associated with anaphylaxis, the nurse should prepare to intubate the client. o Option C: No antidote for penicillin exists; however, the nurse should continue to monitor the client’s vital signs. A client who remains hypotensive may need fluid resuscitation and fluid intake and output monitoring; however, administering epinephrine is the first priority. o Option D: An indwelling catheter is not needed in a client experiencing anaphylactic shock; however, IV fluids may be ordered by the physician after. Correct Answer: B. Administer epinephrine, as prescribed, and prepare to intubate the client if necessary. To reverse anaphylactic shock, the nurse first should administer epinephrine, a potent bronchodilator as prescribed. • 22. Question After receiving a dose of penicillin, a client develops dyspnea and hypotension. Nurse Celestina suspects the client is experiencing anaphylactic shock. What should the nurse do first? o A. Page an anesthesiologist immediately and prepare to intubate the client. o B. Administer epinephrine, as prescribed, and prepare to intubate the client if necessary. o C. Administer the antidote for penicillin, as prescribed, and continue to monitor the client’s vital signs. o D. Insert an indwelling urinary catheter and begin to infuse I.V. fluids as ordered. • 23. Question Mr. Marquez with rheumatoid arthritis is about to begin aspirin therapy to reduce inflammation. When teaching the client about aspirin, the nurse discusses adverse reactions to prolonged aspirin therapy. These include: pg. 17 17 o Option A: Aspirin does not cause weight gain. Weight only influenced the relationship between aspirin and long-term risks of colorectal cancer, with benefits lost at higher body weights. o Option B: Aspirin doesn’t lead to fine motor tremors. In a study, the proportion of aspirin users did not differ in essential tremor cases or controls. o Option C: Large or toxic salicylate doses may cause respiratory alkalosis, not respiratory acidosis. Direct stimulation of the cerebral medulla causes hyperventilation and respiratory alkalosis. Correct Answer: D. Bilateral hearing loss. Prolonged use of aspirin and other salicylates sometimes causes bilateral hearing loss of 30 to 40 decibels. Usually, this adverse effect resolves within 2 weeks after the therapy is discontinued. Correct Answer: D. Lymphocyte o A. Weight gain. o B. Fine motor tremors. o C. Respiratory acidosis. o D. Bilateral hearing loss. • 24. Question A 23-year-old client is diagnosed with human immunodeficiency virus (HIV). After recovering from the initial shock of the diagnosis, the client expresses a desire to learn as much as possible about HIV and acquired immunodeficiency syndrome (AIDS). When teaching the client about the immune system, the nurse states that adaptive immunity is provided by which type of white blood cell? o A. Neutrophil o B. Basophil o C. Monocyte o D. Lymphocyte pg. 20 20 o Option A: E-rosette immunofluorescence is used to detect viruses in general; it doesn’t confirm HIV infection. o Option B: Quantification of T-lymphocytes is a useful monitoring test but isn’t diagnostic for HIV. o Option C: The ELISA test detects HIV antibody particles but may yield inaccurate results; a positive ELISA result must be confirmed by the Western blot test. Correct Answer: D. Western blot test with ELISA. HIV infection is detected by analyzing blood for antibodies to HIV, which form approximately 2 to 12 weeks after exposure to HIV and denote infection. The Western blot test — electrophoresis of antibody proteins — is more than 98% accurate in detecting HIV antibodies when used in conjunction with the ELISA. It isn’t specific when used alone. been infected with the human immunodeficiency virus (HIV), the nurse expects the physician to order: o A. E-rosette immunofluorescence o B. Quantification of T-lymphocytes. o C. Enzyme-linked immunosorbent assay (ELISA). o D. Western blot test with ELISA. • 28. Question A complete blood count is commonly performed before Joe goes into surgery. What does this test seek to identify? o A. Potential hepatic dysfunction indicated by decreased blood urea nitrogen (BUN) and creatinine levels. o B. Low levels of urine constituents normally excreted in the urine. o C. Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels. pg. 21 21 o Option A: Possible renal failure is indicated by elevated BUN or creatinine levels. o Option B: Urine constituents aren’t found in the blood. They are found in urine specimens. o Option D: Coagulation is determined by the presence of appropriate clotting factors, not electrolytes. Correct Answer: C. Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels. Low preoperative HCT and Hb levels indicate the client may require a blood transfusion before surgery. If the HCT and Hb levels decrease during surgery because of blood loss, the potential need for a transfusion increases. Correct Answer: A. Platelet count, prothrombin time, and partial thromboplastin time The diagnosis of DIC is based on the results of laboratory studies of prothrombin time, platelet count, thrombin time, partial thromboplastin time, and fibrinogen level as well as client history and other assessment factors. o Option B: Blood glucose levels are not used to diagnose DIC. Fasting plasma glucose tests or the A1C test help diagnose diabetes. o D. Electrolyte imbalance that could affect the blood’s ability to coagulate properly. • 29. Question While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of what assessment parameters? o A. Platelet count, prothrombin time, and partial thromboplastin time o B. Platelet count, blood glucose levels, and white blood cell (WBC) count o C. Thrombin time, calcium levels, and potassium levels o D. Fibrinogen level, WBC, and platelet count pg. 22 22 o Option A: Bread is not a common allergen. Wheat, a common ingredient in some breads, may cause wheat allergy in some people. o Option B: Carrots rarely cause allergies. An allergic reaction to carrots can be one element of oral allergy syndrome, which is also known as pollen-food allergy syndrome. o Option C: Oranges rarely cause allergic reactions. If they do, the reaction is mild. Correct Answer: D. Strawberries Common food allergens include berries, peanuts, Brazil nuts, cashews, shellfish, and eggs. • 30. Question When taking a dietary history from a newly admitted female client, Nurse Len should remember which of the following foods is a common allergen? o A. Bread o B. Carrots o C. Orange o D. Strawberries • 31. Question Nurse John is caring for clients in the outpatient clinic. Which of the following phone calls should the nurse return first? o Option C: Calcium and potassium levels are not a part of assessment for DIC. A calcium blood test measures the amount of calcium in the blood. Potassium blood test is used to diagnose conditions including kidney disease, high blood pressure, and heart disease. o Option D: WBC count isn’t used to confirm a diagnosis of DIC. WBC count is used to diagnose autoimmune and inflammatory diseases. pg. 25 25 o Option A: Changing positions often might aggravate the pain felt by the client. o Option B: Demerol may be given if prescribed by the physician. o Option C: The client may be experiencing acute appendicitis; warm compresses may cause rupture of the inflamed appendix. Correct Answer: D. Use comfort measures and pillows to position the client. Using comfort measures and pillows to position the client is a non-pharmacological method of pain relief. Correct Answer: B. Warm the dialysate solution. • 34. Question Julius is admitted with complaints of severe pain in the lower right quadrant of the abdomen. To assist with pain relief, the nurse should take which of the following actions? o A. Encourage the client to change positions frequently in bed. o B. Administer Demerol 50 mg IM q 4 hours and PRN. o C. Apply warmth to the abdomen with a heating pad. o D. Use comfort measures and pillows to position the client. • 35. Question Nurse Tina prepares a client for peritoneal dialysis. Which of the following actions should the nurse take first? o A. Assess for a bruit and a thrill. o B. Warm the dialysate solution. o C. Position the client on the left side. o D. Insert a Foley catheter pg. 26 26 o Option A: The client should hold the cane with his left hand because this side provides more stable support than the injured side. o Option B: The right side should act as the weight- bearing side because the left side is weaker. Correct Answer: C. The client holds the cane with his left hand, moves the cane forward followed by the right leg, and then moves the left leg. The cane acts as a support and aids in weight-bearing for the weaker right leg. • 36. Question Nurse Jannah teaches an elderly client with right-sided weakness on how to use a cane. Which of the following behaviors, if demonstrated by the client to the nurse, indicates that the teaching was effective? o A. The client holds the cane with his right hand, moves the cane forward followed by the right leg, and then moves the left leg. o B. The client holds the cane with his right hand, moves the cane forward followed by his left leg, and then moves the right leg. o C. The client holds the cane with his left hand, moves the cane forward followed by the right leg, and then moves the left leg. o D. The client holds the cane with his left hand, moves the cane forward followed by his left leg, and then moves the right leg. o Option A: Assessing for bruit and thrill can be done to check for the patency of the fistula. o Option C: The client may resume a position that will be comfortable for him. o Option D: A Foley catheter is unnecessary during peritoneal dialysis. Cold dialysate increases discomfort. The solution should be warmed to body temperature in a warmer or heating pad; don’t use a microwave oven. pg. 27 27 o Option B: The client is often confused and may wander outside her room and easily get lost. o Option C: The client may take her meals with a roommate or in the dining hall. o Option D: This may lead to incidence of falls or injury because the client’s gait is unsteady. Assistance during ambulation is most appropriate. Correct Answer: A. Ask the woman’s family to provide personal items such as photos or mementos. Photos and mementos provide visual stimulation to reduce sensory deprivation. • 37. Question An elderly client is admitted to the nursing home setting. The client is occasionally confused and her gait is often unsteady. Which of the following actions, if taken by the nurse, is most appropriate? o A. Ask the woman’s family to provide personal items such as photos or mementos. o B. Select a room with a bed by the door so the woman can look down the hall. o C. Suggest the woman eat her meals in the room with her roommate. o D. Encourage the woman to ambulate in the halls twice a day. • 38. Question Nurse Evangeline teaches an elderly client how to use a standard aluminum walker. Which of the following behaviors, if demonstrated by the client, indicates that the nurse’s teaching was effective? o A. The client slowly pushes the walker forward 12 inches, then takes small steps forward while leaning on the walker. o Option D: Always move the affected leg first; in this case, the right leg. pg. 30 30 o Option B: Weight management reduces the strain on the heart. Being overweight puts extra strain on the heart, increasing the risk for developing hypertension and damage to the blood vessels. Correct Answer: A. Pain. Sharp, severe pain (renal colic) radiating toward the genitalia and thigh is caused by urethral distention and smooth muscle spasm; relief from pain is the priority. • 42. Question The immediate objective of nursing care for an overweight, mildly hypertensive male client with ureteral colic and hematuria is to decrease: o A. Pain. o B. Weight. o C. Hematuria. o D. Hypertension. o Option A: A BMI greater than 30kg/m2 indicates obesity, which has been linked to an increased risk for infection, poor wound healing, and rejection of the donated organ. o Option B: Polyuria is defined as the frequent passage of large volumes of urine. Polyuria does not indicate organ rejection. o Option D: The underlying illnesses causing organ failure combined with the surgical procedures and complications in the postoperative period predispose the client to an increased incidence and spectrum of infections. In some patients, the infection can lead to a dysregulated systemic inflammatory response with acute organ dysfunction (severe sepsis) and hypotension that is refractory to fluid resuscitation or septic shock. Correct Answer: C. Hypertension Hypertension, along with fever, and tenderness over the grafted kidney, reflects acute rejection. pg. 31 31 o Option A: Inorganic iodine used preoperatively substantially reduced the mortality rate to 1%. It causes lowering of the basal metabolic rate and heart rate and an increase in body weight. o Option B: This solution does not maintain the function of parathyroid gland and it does not affect them; it prepares the thyroid gland for surgical removal. o Option C: Iodine is needed to make the thyroid hormones, of which thyroxine is the main hormone, but it does not affect small changes in free thyroxine. Correct Answer: D. Decrease the size and vascularity of the thyroid gland. Lugol’s solution provides iodine, which aids in decreasing the vascularity of the thyroid gland, which limits the risk of hemorrhage when surgery is performed. • 43. Question Matilda, with hyperthyroidism, is to receive Lugol’s iodine solution before a subtotal thyroidectomy is performed. The nurse is aware that this medication is given to: o A. Decrease the total basal metabolic rate. o B. Maintain the function of the parathyroid glands. o C. Block the formation of thyroxine by the thyroid gland. o D. Decrease the size and vascularity of the thyroid gland. o Option C: Approximately 85% of all patients with renal colic demonstrate at least microscopic hematuria, which means that 15% of all patients with kidney stones do not have hematuria, but the lack of it does not exclude the diagnosis of acute renal colic. o Option D: Hypertension can be managed with lifestyle changes, such as increasing activities and smarter food choices. pg. 32 32 o Option B: The hemodynamic changes associated with hypoglycemia include an increase in heart rate and peripheral systolic blood pressure, a fall in the central blood pressure, reduced peripheral arterial resistance, and increased myocardial contractility, stroke volume, and cardiac output. o Option C: Type 2 diabetes is an islet paracrinopathy in which the reciprocal relationship between the glucagon-secreting alpha cell and the insulin-secreting beta-cell is lost, leading to hyperglucagonemia and hence the consequent hyperglycemia. o Option D: Hyperthyroidism is usually associated with poor blood glucose control and a need for additional insulin. An increased metabolism “clears” insulin from the system at a faster rate, and increased production and absorption of glucose can raise blood sugars. Correct Answer: A. Liver Disease The client with liver disease has a decreased ability to metabolize carbohydrates because of a decreased ability to form glycogen (glycogenesis) and to form glucose from glycogen. • 44. Question Ricardo was diagnosed with type I diabetes. The nurse is aware that acute hypoglycemia also can develop in the client who is diagnosed with: o A. Liver disease o B. Hypertension o C. Type 2 diabetes o D. Hyperthyroidism • 45. Question Tracy is receiving combination chemotherapy for treatment of metastatic carcinoma. Nurse Ruby should monitor the client for the systemic side effect of: o A. Ascites pg. 35 35 o Option B: Higher protein intake can increase intraglomerular pressure, which is useful in the short term when the client eats a large protein meal with high-protein content so that one can ensure effective clearance of nitrogenous end products that are produced from eating too much protein. o Option C: Phosphorus, which is abundant in dairy products, draws calcium out of the bones when it builds up in the blood. Clients with renal diseases may eat some of these foods in very small amounts. o Option D: Although 0.9% saline and balanced fluids can both lead to renal volume expansion, interstitial fluid retention, and adverse intra-renal microvascular effects are more pronounced with 0.9% saline infusion. Correct Answer: A. Administer Kayexalate Kayexalate, a potassium exchange resin, permits sodium to be exchanged for potassium in the intestine, reducing the serum potassium level. • 48. Question Patrick is in the oliguric phase of acute tubular necrosis and is experiencing fluid and electrolyte imbalances. The client is somewhat confused and complains of nausea and muscle weakness. As part of the prescribed therapy to correct this electrolyte imbalance, the nurse would expect to: o A. Administer Kayexalate o B. Restrict foods high in protein o C. Increase oral intake of cheese and milk. o D. Administer large amounts of normal saline via I.V. • 49. Question Mario has a burn injury. After 48 hours, the physician orders for Mario 2 liters of IV fluid to be administered q12 h. The drop factor of the tubing is 10 gtt/ml. The nurse should set the flow to provide: pg. 36 36 o Option A: This amount is inadequate according to the formula used. o Option C: 32 gtts/min is more than the prescribed gtts/min given. o Option D: This amount is according to the formula used to get the correct flow rate. Correct Answer: B. 28 gtt/min This is the correct flow rate; multiply the amount to be infused (2000 ml) by the drop factor (10) and divide the result by the amount of time in minutes (12 hours x 60 minutes) Correct Answer: D. Upper trunk The percentage designated for each burned part of the body using the rule of nines: Head and neck 9%; Right upper extremity 9%; Left upper extremity 9%; Anterior trunk 18%; Posterior trunk 18%; Right lower extremity 18%; Left lower extremity 18%; Perineum 1%. o Option A: The face and neck is 9%. o Option B: The right upper arm is 9% and the penis is only 1%. o Option C: The right thigh is 9% and the penis is 1%. o A. 18 gtt/min o B. 28 gtt/min o C. 32 gtt/min o D. 36 gtt/min • 50. Question Terence suffered from burn injury. Using the rule of nines, which has the largest percent of burns? o A. Face and neck o B. Right upper arm and penis o C. Right thigh and penis o D. Upper trunk pg. 37 37 • 51. Question Herbert, a 45-year-old construction engineer is brought to the hospital unconscious after falling from a 2-story building. When assessing the client, the nurse would be most concerned if the assessment revealed: o A. Reactive pupils o B. A depressed fontanel o C. Bleeding from ears o D. An elevated temperature Correct Answer: C. Bleeding from ears The nurse needs to perform a thorough assessment that could indicate alterations in cerebral function, increased intracranial pressures, fractures, and bleeding. Bleeding from the ears occurs only with basal skull fractures that can easily contribute to increased intracranial pressure and brain herniation. o Option A: The normal pupil size varies from 2 to 4 mm in diameter in bright light to 4 to 8 mm in the dark. The pupils are generally equal in size. They constrict to direct illumination and to illumination of the opposite eye. The pupil dilates in the dark. Both pupils constrict when the eye is focused on a near object. o Option B: The anterior fontanelle remains soft until about 18 months to 2 years of age. The posterior fontanelle usually closes first, during the first several months of an infant’s life. o Option D: Hypothermic trauma patients are less likely to survive their injuries when compared to similar patients who are normothermic. Hypothermia in conjunction with metabolic acidosis and impair coagulation creates a “lethal triad”, which significantly worsens the chances of recovery from a critical injury. pg. 40 40 Correct Answer: A. Food and fluids will be withheld for at least 2 hours. Prior to bronchoscopy, the doctors spray the back of the throat with anesthetic to minimize the gag reflex and thus facilitate the insertion of the bronchoscope. Giving the client food and drink after the procedure without checking on the return of the gag reflex can cause the client to aspirate. The gag reflex usually returns after two hours. o Option B: Warm saline gargles may help soothe the throat after bronchoscopy. • 55. Question Kristine is scheduled for a bronchoscopy. When teaching Kristine what to expect afterward, the nurse’s highest priority of information would be: o A. Food and fluids will be withheld for at least 2 hours. o B. Warm saline gargles will be done q 2h. o C. Coughing and deep-breathing exercises will be done q2h. o D. Only ice chips and cold liquids will be allowed initially. o Option A: This position may reduce the pressure on the surgical incision site, but it is not its priority. o Option C: Fowler’s position is associated with improvement of functional residual capacity, oxygenation, and reduction of work of breathing. o Option D: On the transition from sitting to standing, blood is pooled in the lower extremities as a result of gravitational forces. Venous return is reduced, which leads to a decrease in cardiac stroke volume, a decline in arterial blood pressure, and an immediate decrease in blood flow to the brain. Correct Answer: B. Facilitate ventilation of the left lung. Since only a partial pneumonectomy is done, there is a need to promote expansion of this remaining left lung by positioning the client on the opposite unoperated side. pg. 41 41 • 56. Question Nurse Tristan is caring for a male client with acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat: o A. Hypernatremia. o B. Hypokalemia. o C. Hyperkalemia. o D. Hypercalcemia. Correct Answer: C. Hyperkalemia. Hyperkalemia is a common complication of acute renal failure. It’s life-threatening if immediate action isn’t taken to reverse it. The administration of glucose and regular insulin, with sodium bicarbonate, if necessary, can temporarily prevent cardiac arrest by moving potassium into the cells and temporarily reducing serum potassium levels. o Option A: Hypernatremia is believed to be due to post-acute kidney injury diuresis in the face of inability to maximally concentrate the urine because of renal failure. The diuresis caused a disproportionate loss of water in excess of that of sodium in the absence of replenishment of the water loss. o Option B: Hypokalemia is related to increased use of diuretics, decreased use of RAS blockade, and malnutrition, all of which may impose additive deleterious effects on renal outcomes. o Option D: Hypocalcemia is a frequent accompaniment of acute renal failure, but paradoxically hypercalcemia also has been described in association with acute renal failure. This may be caused by dissolution of dystrophic calcifications in traumatized muscle and may lead to severe metastatic calcifications. o Option C: Coughing should not be done after bronchoscopy to avoid initiating bleeding. o Option D: The client should be on NPO status after bronchoscopy until gag reflex has returned. pg. 42 42 o Option B: Genital warts may be treated with imiquimod, podophyllin and podofilox, trichloroacetic acid, and sinecatechins. These are all topical treatments that the physician or even the client may apply. o Option C: Because condylomata acuminata can occur on the vulva, a condom won’t protect sexual partners. o Option D: HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx. Correct Answer: A. This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually. Women with condylomata acuminata are at risk for cancer of the cervix and vulva. Yearly Pap smears are very important for early detection. Because condylomata acuminata is a virus, there is no permanent cure. • 57. Question Ms. X has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client? o A. This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually. o B. The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days. o C. The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual intercourse. o D. The human papillomavirus (HPV), which causes condylomata acuminata, can’t be transmitted during oral sex. • 58. Question Maritess was recently diagnosed with a genitourinary problem and is being examined in the emergency department. When pg. 45 45 o Option A: It is suggested that the immune- suppression results in co-infection with the papilloma virus. The immunosuppression causes reduction in the effectiveness of the immune surveillance system resulting in growth of the tumor. o Option B: Multiple myeloma is a very uncommon neoplasm complicating HIV infection but when it occurs, it is associated with an aggressive course and a worse prognosis. o Option C: Untreated HIV infection causes AIDS and this major impairment in the immune system is associated with an increased risk of cancer, including a number of “solid tumor” cancers and non-Hodgkin Correct Answer: D. Kaposi’s sarcoma Kaposi’s sarcoma is the most common cancer associated with AIDS. • 61. Question During a routine checkup, Nurse Marianne assesses a male client with acquired immunodeficiency syndrome (AIDS) for signs and symptoms of cancer. What is the most common AIDS-related cancer? o A. Squamous cell carcinoma o B. Multiple myeloma o C. Leukemia o D. Kaposi’s sarcoma o Option A: The presence of completely undifferentiated tumor cells that don’t resemble cells of the tissues of their origin is called anaplasia. o Option B: An increase in the number of normal cells in a normal arrangement in a tissue or an organ is called hyperplasia. o Option C: Replacement of one type of fully differentiated cell by another in tissues where the second type normally isn’t found is called metaplasia. Dysplasia refers to an alteration in the size, shape, and organization of differentiated cells. pg. 46 46 o Option A: Anesthetics are well known to cause confusion, but this typically decreases as the body processes the medications and removes them from circulation. o Option B: Generalized seizure as a complication following epidural anesthesia has been reported, but rarely following spinal anesthesia. o Option D: The incidence of arrhythmias, as well as hypotension during spinal anesthesia, is higher for Cesarean section mostly. Correct Answer: C. To prevent cerebrospinal fluid (CSF) leakage The client receiving a subarachnoid block requires special positioning to prevent CSF leakage and headache and to ensure proper anesthetic distribution. • 62. Question Ricardo is scheduled for a prostatectomy, and the anesthesiologist plans to use a spinal (subarachnoid) block during surgery. In the operating room, the nurse positions the client according to the anesthesiologist’s instructions. Why does the client require special positioning for this type of anesthesia? o A. To prevent confusion. o B. To prevent seizures. o C. To prevent cerebrospinal fluid (CSF) leakage. o D. To prevent cardiac arrhythmias. • 63. Question A male client had a nephrectomy 2 days ago and is now complaining of abdominal pressure and nausea. The first nursing action should be to: o A. Auscultate bowel sounds. lymphoma, but also Hodgkin lymphoma, myeloma, and leukemia. pg. 47 47 o Option B: Palpation is the examination of the abdomen for crepitus of the abdominal wall, for any abdominal tenderness, or for abdominal masses. It may be used to assess the client but this will not be the first choice following a nephrectomy. o Option C: Changing positions would not diminish the client’s nausea and abdominal pressure. o Option D: If peristalsis is absent, inserting a rectal tube won’t relieve the client’s discomfort. Correct Answer: A. Auscultate bowel sounds. If abdominal distention is accompanied by nausea, the nurse must first auscultate bowel sounds. If bowel sounds are absent, the nurse should suspect gastric or small intestine dilation and these findings must be reported to the physician. o Option A: Lying on the right side with legs straight is not an appropriate position for this procedure. It would not allow proper visualization. Correct Answer: B. Lying on the left side with knees bent For a colonoscopy, the nurse initially should position the client on the left side with knees bent. o B. Palpate the abdomen. o C. Change the client’s position. o D. Insert a rectal tube. • 64. Question Wilfredo with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse Patricia position the client for this test initially? o A. Lying on the right side with legs straight. o B. Lying on the left side with knees bent. o C. Prone with the torso elevated. o D. Bent over with hands touching the floor. pg. 50 50 o Option B: During passive ROM exercises, the nurse moves each joint through its range of movement, which improves joint mobility and circulation to the affected area but doesn’t prevent pressure ulcers. o Option C: Adequate hydration is necessary to maintain healthy skin and ensure tissue repair. o Option D: A footboard prevents plantar flexion and foot drop by maintaining the foot in a dorsiflexed position. Correct Answer: A. Turn him frequently. The most important intervention to prevent pressure ulcers is frequent position changes, which relieve pressure on the skin and underlying tissues. If pressure isn’t relieved, capillaries become occluded, reducing circulation and oxygenation of the tissues and resulting in cell death and ulcer formation. • 68. Question Mr. Mendoza who has suffered a cerebrovascular accident (CVA) is too weak to move on his own. To help the client avoid pressure ulcers, Nurse Celia should: o A. Turn him frequently. o B. Perform passive range-of-motion (ROM) exercises. o C. Reduce the client’s fluid intake. o D. Encourage the client to use a footboard. o Option A: This client’s PaO2 value falls within the normal range (80 to 100 mm Hg). o Option C: White pulmonary secretions indicate the presence of large numbers of white blood cells, especially neutrophilic granulocytes. o Option D: The client’s rectal temperature isn’t significantly elevated and probably results from the fluid volume deficit. A urine output of less than 40 ml/hour in a client with burns indicates a fluid volume deficit. pg. 51 51 o Option A: This type of application may contaminate the areas which are clean and irritate the skin. o Option B: An upward motion does not increase blood supply to the affected area; the goal is to reduce irritation of the skin and follicles. o Option D: The strokes should be downward in the direction of hair growth. Correct Answer: C. In long, even, outward, and downward strokes in the direction of hair growth When applying a topical agent, the nurse should begin at the midline and use long, even, outward, and downward strokes in the direction of hair growth. This application pattern reduces the risk of follicle irritation and skin inflammation. • 69. Question Nurse Maria plans to administer dexamethasone cream to a female client who has dermatitis over the anterior chest. How should the nurse apply this topical agent? o A. With a circular motion, to enhance absorption. o B. With an upward motion, to increase blood supply to the affected area. o C. In long, even, outward, and downward strokes in the direction of hair growth. o D. In long, even, outward, and upward strokes in the direction opposite hair growth. • 70. Question Nurse Kate is aware that one of the following classes of medication protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation is: o A. Beta-adrenergic blockers o B. Calcium channel blocker o C. Narcotics pg. 52 52 o Option B: Calcium channel blockers reduce the workload of the heart by decreasing the heart rate. o Option C: Narcotics reduce myocardial oxygen demand, promote vasodilation, and decrease anxiety. o Option D: Nitrates reduce myocardial oxygen consumption but decrease left ventricular end- diastolic pressure (preload) and systemic vascular resistance (afterload). Correct Answer: A. Beta-adrenergic blockers Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines and sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing myocardial oxygen demand. o Option A: In high Fowler’s position, the veins would be barely discernible above the clavicle. o Option B: Increased pressure can’t be seen when the head of the bed is raised 10 degrees because the point that marks the pressure level is above the jaw (therefore, not visible). Correct Answer: C. Raised 30 degrees Jugular venous pressure is measured with a centimeter ruler to obtain the vertical distance between the sternal angle and the point of highest pulsation with the head of the bed inclined between 15 to 30 degrees. o D. Nitrates • 71. Question A male client has jugular distention. In what position should the nurse place the head of the bed to obtain the most accurate reading of jugular vein distention? o A. High Fowler’s o B. Raised 10 degrees o C. Raised 30 degrees o D. Supine position pg. 55 55 o Option A: Next, the nurse should make sure L.V. access is established. o Option D: If the client experiences symptomatic bradycardia, atropine is administered as ordered 0.5 to 1 mg every 3 to 5 minutes to a total of 3 mg. o Option C: Then the nurse should try to find the cause of the client’s arrest by obtaining an ABG sample. Amiodarone is indicated for ventricular tachycardia, ventricular fibrillation, and atrial flutter – not symptomatic bradycardia. Correct Answer: B. Check endotracheal tube placement. ET tube placement should be confirmed as soon as the client arrives in the emergency department. Once the airway is secured, oxygenation and ventilation should be confirmed using an end-tidal carbon dioxide monitor and pulse oximetry. • 75. Question A male client arriving in the emergency department is receiving cardiopulmonary resuscitation from paramedics who are giving ventilation through an endotracheal (ET) tube that they placed in the client’s home. During a pause in compressions, the cardiac monitor shows narrow QRS complexes and a heart rate of beats/minute with a palpable pulse. Which of the following actions should the nurse take first? o A. Start an L.V. line and administer amiodarone (Cordarone), 300 mg L.V. over 10 minutes. o B. Check endotracheal tube placement. o C. Obtain an arterial blood gas (ABG) sample. o D. Administer atropine, 1 mg L.V. o Option A: Anyone directly involved in his care (such as the telemetry nurse) has the right to information about his condition. o Option B: The on-call physician should be updated about the client’s condition. o Option D: Because the client requested that the nurse update his wife on his condition, doing so doesn’t breach confidentiality. pg. 56 56