NCLEX-RN Exam Pack Set 5 Questions & Answers 2023., Exams of Nursing

Download NCLEX-RN Exam Pack Set 5 Questions & Answers 2023. and more Exams Nursing in PDF only on Docsity! P a g e 1 | 56 1 o o o NCLEX-RN Exam Pack Set 5 Questions & Answers 2023 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? P a g e 2 | 56 2 o o o 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. P a g e 5 | 56 5 o o o • 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. P a g e 6 | 56 6 o o o 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 P a g e 7 | 56 7 o o o • 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 o o P a g e 10 | 56 10 o o o • 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. P a g e 11 | 56 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 o o P a g e 12 | 56 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. P a g e 15 | 56 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. P a g e 16 | 56 16 o o o • 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: P a g e 17 | 56 17 o o o 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 P a g e 20 | 56 20 o o o 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. P a g e 21 | 56 21 o o o 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 P a g e 22 | 56 22 o o o • 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. P a g e 25 | 56 25 o o o 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 P a g e 26 | 56 26 o o • 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 o o P a g e 27 | 56 27 o o o • 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. P a g e 30 | 56 30 o • 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 o o P a g e 31 | 56 31 o o o • 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. P a g e 32 | 56 32 o o o • 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 P a g e 35 | 56 35 o o o • 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: P a g e 36 | 56 36 o o o 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 P a g e 37 | 56 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. P a g e 40 | 56 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 o o P a g e 41 | 56 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. P a g e 42 | 56 42 o o o • 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 P a g e 45 | 56 45 o o o • 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 o o P a g e 46 | 56 46 o o o • 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. P a g e 47 | 56 47 o o o o 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. P a g e 50 | 56 50 o o o • 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 o o P a g e 51 | 56 51 o o o • 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 P a g e 52 | 56 52 o o o o o 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 P a g e 55 | 56 55 o o o • 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. P a g e 56 | 56 56