NCLEX-RN Exam Pack Set 6 (75 Questions & Answers Latest Updated 2023), Exams of Nursing

Download NCLEX-RN Exam Pack Set 6 (75 Questions & Answers Latest Updated 2023) and more Exams Nursing in PDF only on Docsity! 1 [Date] NCLEX-RN EXAM PACK SET 6 (75 QUESTIONS & ANSWERS LATEST UPDATED 2023) TOP RANKED ANSWERS.GUARANTEED SUCCESS. 1. 1. Question After cardiac surgery, a client’s blood pressure measures 126/80 mm Hg. Nurse Katrina determines that mean arterial pressure (MAP) is which of the following? o A. 46 mm Hg o B. 80 mm Hg o C. 95 mm Hg o D. 90 mm Hg Correct Answer: C. 95 mm Hg Use the following formula to calculate MAP MAP = systolic + 2 (diastolic) MAP = 126 mm Hg + 2 (80 mm Hg) MAP = 286 mm Hg MAP = 95 mm Hg o Option A: 46 mmHg is according to the calculations. o Option B: 80 mmHg is inadequate according to the formula used in the computation. o Option D: 90 mmHg is according to the computation using the formula of mean arterial pressure. 2 [Date] • 2. Question A female client arrives at the emergency department with chest and stomach pain and a report of black tarry stool for several months. Which of the following orders should the nurse Oliver anticipate? o A. Cardiac monitor, oxygen, creatine kinase and lactate dehydrogenase levels o B. Prothrombin time, partial thromboplastin time, fibrinogen and fibrin split product values o C. Electrocardiogram, complete blood count, testing for occult blood, comprehensive serum metabolic panel o D. Electroencephalogram, alkaline phosphatase, and aspartate aminotransferase levels, basic serum metabolic panel Correct Answer: C. Electrocardiogram, complete blood count, testing for occult blood, comprehensive serum metabolic panel. An electrocardiogram evaluates the complaints of chest pain, laboratory tests determine anemia, and the stool test for occult blood determines blood in the stool. o Option A: Cardiac monitoring, oxygen, and creatine kinase, and lactate dehydrogenase levels are appropriate for a cardiac primary problem. A basic metabolic panel and alkaline phosphatase and aspartate aminotransferase levels assess 5 [Date] A female client is scheduled to receive a heart valve replacement with a porcine valve. Which of the following types of transplant is this? o A. Allogeneic o B. Autologous o C. Syngeneic o D. Xenogeneic Correct Answer: D. Xenogeneic A xenogeneic transplant is between a human and another species. o Option A: Allogeneic transplant is between two humans, o Option B: Autologous is a transplant from the same individual. o Option C: A syngeneic transplant is between identical twins. • 6. Question Marco falls off his bicycle and injures his ankle. Which of the following actions shows the initial response to the injury in the extrinsic pathway? Correct Answer: B. Release of tissue thromboplastin Tissue thromboplastin is released when damaged tissue comes in contact with clotting factors. o A. Release of Calcium o B. Release of tissue thromboplastin o C. Conversion of factors XII to factor XIIa o D. Conversion of factor VIII to factor VIIIa 6 [Date] o Option A: Calcium is released to assist the conversion of factors X to Xa. o Option C: Conversion of factors XII to XIIa are part of the intrinsic pathway. o Option D: Conversion factors VIII to VIIIa are part of the intrinsic pathway. • 7. Question Instructions for a client with systemic lupus erythematosus (SLE) would include information about which of the following blood dyscrasias? o A. Dressler’s syndrome o B. Polycythemia o C. Essential thrombocytopenia o D. Von Willebrand’s disease Correct Answer: C. Essential thrombocytopenia Essential thrombocytopenia is linked to immunologic disorders, such as SLE and the human immunodeficiency virus. o Option A: Dressler’s syndrome is pericarditis that occurs after myocardial infarction and isn’t linked to SLE. o Option B: Moderate to severe anemia is associated with SLE, not polycythemia. It is found in about 50% of patients, with anemia of chronic disease being the most common form. o Option D: Von Willebrand disease is a blood disorder in which the blood doesn’t clot properly. Blood contains many proteins that help the body stop bleeding. One of these proteins is called von Willebrand factor. • 8. Question 7 [Date] The nurse is aware that the following symptom is most commonly an early indication of stage 1 Hodgkin’s disease? o A. Pericarditis o B. Night sweat o C. Splenomegaly o D. Persistent hypothermia Correct Answer: B. Night sweat In stage 1, symptoms include a single enlarged lymph node (usually), unexplained fever, night sweats, malaise, and generalized pruritus. o Option A: Pericarditis refers to the inflammation of the pericardium, two thin layers of a sac-like tissue that surround the heart, hold it in place, and help it work. Pericarditis isn’t associated with Hodgkin’s disease, nor is hypothermia. Moreover, splenomegaly and pericarditis aren’t symptoms. o Option C: The spleen is involved in 20%-30% of cases of Hodgkin’s disease. Patients are usually asymptomatic. o Option D: Persistent hypothermia is associated with Hodgkin’s but isn’t an early sign of the disease. • 9. Question Francis with leukemia has neutropenia. Which of the following functions must be frequently assessed? 10 [Date] Correct Answer: C. 10 years Epidemiologic studies show the average time from initial contact with HIV to the development of AIDS is 10 years. The interval from HIV infection to the diagnosis of AIDS ranges from about 9 months to 20 years or longer, with a median of 12 years. o Option A: Less than 5 years is too short a time for the development of AIDS. o Option B: 5 to 7 years is not the average time when an HIV infection develops into AIDS. o Option D: More than 10 years is more than the average time for HIV to develop into AIDS. • 12. Question An 18-year-old male client admitted with heat stroke begins to show signs of disseminated intravascular coagulation (DIC). Which of the following laboratory findings is most consistent with DIC? o A. Low platelet count o B. Elevated fibrinogen levels o C. Low levels of fibrin degradation products o D. Reduced prothrombin time Correct Answer: A. Low platelet count In DIC, platelets and clotting factors are consumed, resulting in microthrombi and excessive bleeding. As clots form, fibrinogen levels decrease and the prothrombin time increases. o Option B: Severe, rapidly evolving DIC is diagnosed by demonstrating thrombocytopenia, an elevated partial 11 [Date] thromboplastin time and prothrombin time, increased levels of plasma D-dimers, and a decreasing plasma fibrinogen level. o Option C: Fibrin degradation products increase as fibrinolysis takes place. o Option D: Both PT and aPTT seem prolonged in about 50% of DIC cases which is attributed to the consumption of coagulation factors but can also be prolonged in impaired synthesis of coagulation factors and in massive bleeding. • 13. Question Mario comes to the clinic complaining of fever, drenching night sweats, and unexplained weight loss over the past 3 months. Physical examination reveals a single enlarged supraclavicular lymph node. Which of the following is the most probable diagnosis? o A. Influenza o B. Sickle cell anemia o C. Leukemia o D. Hodgkin’s disease Correct Answer: D. Hodgkin’s disease Hodgkin’s disease typically causes fever night sweats, weight loss, and lymph node enlargement. o Option A: The incubation period ranges from 1 to 4 days. Peak virus shedding usually occurs from 1 day before the onset of symptoms to 3 days after. o Option B: Clients with sickle cell anemia manifest signs and symptoms of chronic anemia with pallor of the mucous membrane, fatigue, and decreased tolerance for exercise; they 12 [Date] don’t show fever, night sweats, weight loss or lymph node enlargement. o Option C: In some cases, the signs of leukemia may include noticeable swelling of the neck, armpit, or groin. This occurs when leukemia has spread to the lymph nodes. • 14. Question A male client with a gunshot wound requires an emergency blood transfusion. His blood type is AB negative. Which blood type would be the safest for him to receive? o A. AB Rh-positive o B. A Rh-positive o C. A Rh-negative o D. O Rh-positive Correct Answer: C. A Rh-negative Human blood can sometimes contain an inherited D antigen. Persons with the D antigen have Rh-positive blood type; those lacking the antigen have Rh-negative blood. It’s important that a person with Rh-negative blood receives Rh-negative blood. o Option A: A person with Rh-negative blood should also receive Rh-negative blood. o Option B: If Rh-positive blood is administered to an Rh-negative person, the recipient develops anti-Rh agglutinins, and subsequent transfusions with Rh- positive blood may cause serious reactions with clumping and hemolysis of red blood cells. o Option D: This blood type is still not compatible because it is Rh-positive. 15 [Date] color and texture. o Option A: It can be an option for the client to use a hat, but the nurse should be open about explanations regarding the side effects of chemotherapy. o Option B: Avoid reassuring the client. Statements of fact would be a good response. o Option C: The mother should be open and honest with the child, and providing an honest and true response would be a big help to both of them. • 17. Question Brittany who is undergoing chemotherapy for her throat cancer is experiencing stomatitis. To promote oral hygiene and comfort, the nurse-in-charge should: oProvide frequent mouthwash with normal saline. oA. Provide frequent mouthwash with normal saline. oB. Apply viscous Lidocaine to oral ulcers as needed. o C. Use lemon glycerine swabs every 2 hours. o D. Rinse mouth with Hydrogen Peroxide. Correct Answer: B. Apply viscous Lidocaine to oral ulcers as needed. Stomatitis can cause pain and this can be relieved by applying topical anesthetics such as lidocaine before mouth care. o Option A: Before providing oral care, ensure that the patient is comfortable with the procedure first. o Option C: Use saline solution mixed with equal parts of water or hydrogen peroxide or oral care. o Option D: When the patient is already 16 [Date] comfortable, the nurse can proceed with providing the patient with oral rinses of saline solution mixed with equal parts of water or hydrogen peroxide mixed water in 1:3 concentrations to promote oral hygiene. Every 2-4 hours. • 18. Question During the administration of chemotherapy agents, Nurse Oliver observed that the IV site is red and swollen when the IV is touched Stacy shouts in pain. The first nursing action to take is: o A. Notify the physician. o B. Flush the IV line with saline solution. o C. Immediately discontinue the infusion. o D. Apply an ice pack to the site, followed by warm compress. Correct Answer: C. Immediately discontinue the infusion. Edema or swelling at the IV site is a sign that the needle has been dislodged and the IV solution is leaking into the tissues causing the edema. The patient feels pain as the nerves are irritated by pressure and the IV solution. The first action of the nurse would be to discontinue the infusion right away to prevent further edema and other complications. o Option A: After discontinuing the infusion, the nurse should notify the physician. o Option B: Flushing may aggravate the edema since the IV cannula might be dislodged. o Option D: Compresses may be given as indicated by the physician. 17 [Date] • 19. Question The term “blue bloater” refers to a male client which of the following conditions? o A. Adult respiratory distress syndrome (ARDS) o B. Asthma o C. Chronic obstructive bronchitis o D. Emphysema Correct Answer: C. Chronic obstructive bronchitis Clients with chronic obstructive bronchitis appear bloated; they have large barrel chest and peripheral edema, cyanotic nail beds, and at times, circumoral cyanosis. o Option A: Clients with ARDS are acutely short of breath and frequently need intubation for mechanical ventilation and large amounts of oxygen. o Option B: Clients with asthma don’t exhibit characteristics of chronic disease. o Option D: Clients with emphysema appear pink and cachectic. • 20. Question The term “pink puffer” refers to the female client with which ofthe following conditions? 20 [Date] • 23. Question Norma has started a new drug for hypertension. Thirty minutes after she takes the drug, she develops chest tightness and becomes short of breath and tachypnea. She has a decreased level of consciousness. These signs indicate which of the following conditions? o A. Asthma attack o B. Pulmonary embolism o C. Respiratory failure o D. Rheumatoid arthritis Correct Answer: C. Respiratory failure The client was reacting to the drug with respiratory signs of impending anaphylaxis, which could lead to eventually respiratory failure. o Option A: The symptoms may look like an asthma attack, but it may change because of the new drug ingested. o Option B: Although the signs are also related to a pulmonary embolism, consider the new drug first. o Option D: Rheumatoid arthritis is an autoimmune and inflammatory disease, which means that the immune system attacks healthy cells in the body by mistake, causing inflammation in the affected parts of the body. • 24. Question Mr. Gonzales was admitted to the hospital with ascites and jaundice. To rule out cirrhosis of the liver which laboratory test indicates liver cirrhosis? 21 [Date] o A. Decreased red blood cell count o B. Decreased serum acid phosphatase level o C. Elevated white blood cell count o D. Elevated serum aminotransferase Correct Answer: D. Elevated serum aminotransferase Hepatic cell death causes the release of liver enzymes alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) into the circulation. Liver cirrhosis is a chronic and irreversible disease of the liver characterized by generalized inflammation and fibrosis of the liver tissues. o Option A: Decreased red blood cell count may indicate anemia. o Option B: Serum acid phosphatase is an enzyme that acts to liberate phosphate under acidic conditions. Until now, low values cannot be determined with certainty. o Option C: A high white blood cell count usually indicates increased production of white blood cells to fight infection. • 25. Question The biopsy of Mr. Gonzales confirms the diagnosis of cirrhosis. Mr. Gonzales is at increased risk for excessive bleeding primarily because of: o A. Impaired clotting mechanism o B. Varix formation o C. Inadequate nutrition o D. Trauma of invasive procedure Correct Answer: A. Impaired clotting mechanism 22 [Date] Cirrhosis of the liver results in decreased Vitamin K absorption and formation of clotting factors resulting in impaired clotting mechanism. o Option B: Esophageal varices sometimes form when blood flow to the liver is blocked, most often by scar tissue in the liver caused by liver disease. o Option C: Inadequate nutrition alone cannot cause excessive bleeding in cirrhosis. o Option D: An invasive procedure may cause trauma that may result in bleeding, but the client has not yet undergone any invasive procedure. • 26. Question Mr. Jay develops hepatic encephalopathy. Which clinical manifestation is most common with this condition? o A. Increased urine output o B. Altered level of consciousness o C. Decreased tendon reflex o D. Hypotension Correct Answer: B. Altered level of consciousness Changes in behavior and level of consciousness are the first signs of hepatic encephalopathy. Hepatic encephalopathy is caused by liver failure and develops when the liver is unable to convert protein metabolic product ammonia to urea. This results in accumulation of ammonia and other toxic in the blood that damages the cells. o Option A: The main cause of renal dysfunction in inpatients with liver disease is prerenal failure; 25 [Date] decreased RBC count, increased WBC count. Severe lower back pain indicates an aneurysm rupture, secondary to pressure being applied within the abdominal cavity. When rupture occurs, the pain is constant because it can’t be alleviated until the aneurysm is repaired. Blood pressure decreases due to the loss of blood. After the aneurysm ruptures, the vasculature is interrupted and blood volume is lost, so blood pressure wouldn’t increase. For the same reason, the RBC count has decreased – not increased. The WBC count increases as cells migrate to the site of injury. o Option A: The pain is severe due to the ruptured aneurysm; the blood pressure is decreased due to blood loss. o Option C: The increase in WBC count is due to the cells migrating to the site of the injury. o Option D: The pain in a ruptured aneurysm is constant and can only be alleviated if the aneurysm is repaired. • 29. Question After undergoing a cardiac catheterization, Tracy has a large puddle of blood under his buttocks. Which of the following steps should the nurse take first? o A. Call for help. o B. Obtain vital signs. o C. Ask the client to “lift up”. o D. Apply gloves and assess the groin site. Correct Answer: D. Apply gloves and assess the groin site. Observing 26 [Date] standard precautions is the first priority when dealing with any blood fluid. Assessment of the groin site is the second priority. This establishes where the blood is coming from and determines how much blood has been lost. The goal in this situation is to stop the bleeding. o Option A: The nurse would call for help if it were warranted after the assessment of the situation. o Option B: After determining the extent of the bleeding, vital signs assessment is important. o Option C: The nurse should never move the client, in case a clot has formed. Moving can disturb the clot and cause rebleeding. • 30. Question Which of the following treatments is a suitable surgical intervention for a client with unstable angina? o A. Cardiac catheterization o B. Echocardiogram o C. Nitroglycerin o D. Percutaneous transluminal coronary angioplasty (PTCA) Correct Answer: D. Percutaneous transluminal coronary angioplasty (PTCA) PTCA can alleviate the blockage and restore blood flow and oxygenation. o Option A: Cardiac catheterization is a diagnostic tool – not a treatment. It is a procedure used to diagnose and treat certain cardiovascular conditions. 27 [Date] o Option B: An echocardiogram is a non-invasive diagnostic test. It is a graphic outline of the heart’s movement. o Option C: Nitroglycerin is an oral sublingual medication. It is a vasodilatory drug used primarily to provide relief from anginal chest pain. • 31. Question The nurse is aware that the following terms used to describe reduced cardiac output and perfusion impairment due to ineffective pumping of the heart is: o A. Anaphylactic shock o B. Cardiogenic shock o C. Distributive shock o D. Myocardial infarction (MI) Correct Answer: B. Cardiogenic shock Cardiogenic shock is shock related to ineffective pumping of the heart. o Option A: Anaphylactic shock results from an allergic reaction. This severe reaction happens when an over- release of chemicals puts the person into shock. o Option C: Distributive shock results from changes in the intravascular volume distribution and is usually associated with increased cardiac output. o Option D: MI isn’t a shock state, though in most cases, a lack of oxygen to the heart, usually from a heart attack, damages its main pumping chamber. Without oxygen-rich blood circulating to that area of 30 [Date] o C. Pancytopenia, elevated antinuclear antibody (ANA) titer o D. Leukocytosis, elevated blood urea nitrogen (BUN) and creatinine levels Correct Answer: C. Pancytopenia, elevated antinuclear antibody (ANA) titer Laboratory findings for clients with SLE usually show pancytopenia, elevated ANA titer, and decreased serum complement levels. o Option A: Decreased levels of serum complement is usually associated with SLE. The cause of complement activation in SLE is the formation of immune complexes, which in turn activate complement, predominantly by means of the classical pathway. o Option B: Thrombocytopenia is one of the components of pancytopenia. It is a condition in which the platelet count is decreased. o Option D: Clients may have elevated BUN and creatinine levels from nephritis, but the increase does not indicate SLE. The part of the kidney most frequently troubled by SLE is part of the nephron called the glomerulus, a tuft of capillaries that functions to filter substances from the blood. For this reason, the type of kidney inflammation most commonly experienced in lupus is glomerulonephritis. • 35. Question Arnold, a 19-year-old client with a mild concussion is discharged from the emergency department. Before discharge, he complains of a headache. When offered acetaminophen, his mother tells the nurse the headache is severe and she would like her son to have something stronger. Which of the following responses by the nurse is appropriate? 31 [Date] o A. “Your son had a mild concussion, acetaminophen isstrong enough.” o B. “Aspirin is avoided because of the danger of Reye’s syndrome in children or young adults.” o C. “Narcotics are avoided after a head injury because they may hide a worsening condition.” o D. Stronger medications may lead to vomiting, whichincreases the intracranial pressure (ICP).” Correct Answer: C. Narcotics are avoided after a head injury because they may hide a worsening condition. Narcotics may mask changes in the level of consciousness that indicate increased ICP. o Option A: Acetaminophen is strong enough ignores the mother’s question and therefore isn’t appropriate. o Option B: Aspirin is contraindicated in conditions that may have bleeding, such as trauma, and for children or young adults with viral illnesses due to the danger of Reye’s syndrome. o Option D: Stronger medications may not necessarily lead to vomiting but will sedate the client, thereby masking changes in his level of consciousness. • 36. Question 32 [Date] When evaluating an arterial blood gas from a male client with a subdural hematoma, the nurse notes the Paco2 is 30 mm Hg. Which of the following responses best describes the result? o A. Appropriate; lowering carbon dioxide (CO2) reduces intracranial pressure (ICP). o B. Emergent; the client is poorly oxygenated. o C. Normal. o D. Significant; the client has alveolar hypoventilation. Correct Answer: A. Appropriate; lowering carbon dioxide (CO2) reduces intracranial pressure (ICP) A normal Paco2 value is 35 to 45 mm Hg CO2 has vasodilating properties; therefore, lowering Paco2 through hyperventilation will lower ICP caused by dilated cerebral vessels. o Option B: Oxygenation is evaluated through Pao2 and oxygen saturation. o Option C: The normal PaCO2 level is between 35 to 45 mmHg. PaCO2 or the partial pressure of carbon dioxide is the measure of carbon dioxide within arterial or venous blood. o Option D: Alveolar hypoventilation would be reflected in an increased Paco2. Alveolar hypoventilation is defined as insufficient ventilation leading to hypercapnia, which is an increase in the partial pressure of carbon dioxide as measured by arterial blood gas analysis. • 37. Question 35 [Date] downregulation of multiple inflammatory pathways and modulation of innate immunity. o Option D: Colchicine doesn’t decrease bone demineralization. The toxic effects of colchicine are related to this anti-mitotic activity within proliferating tissue such as skin, hair, and bone marrow. • 39. Question Norma asks for information about osteoarthritis. Which of the following statements about osteoarthritis is correct? o A. Osteoarthritis is rarely debilitating. o B. Osteoarthritis is a rare form of arthritis. o C. Osteoarthritis is the most common form of arthritis. o D. Osteoarthritis affects people over 60. Correct Answer: C. Osteoarthritis is the most common form of arthritis Osteoarthritis is the most common form of arthritis and can be extremely debilitating. It can afflict people of any age, although most are elderly. o Option A: Osteoarthritis is an extremely debilitating disease. The cartilage within a joint begins to break down and the underlying bone begins to change. o Option B: It is the most common form of arthritis. It affects over 32.5 million US adults. o Option D: Osteoarthritis can affect people of any age, but are most common among the elderly. Women are more likely to develop QA than men, especially after the age of 50. • 40. Question 36 [Date] Ruby is receiving thyroid replacement therapy, develops the flu, and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication will put the client at risk for developing which of the following life- threatening complications? o A. Exophthalmos o B. Thyroid storm o C. Myxedema coma o D. Tibial myxedema Correct Answer: C. Myxedema coma Myxedema coma, severe hypothyroidism, is a life-threatening condition that may develop if thyroid replacement medication isn’t taken. o Option A: Exophthalmos, protrusion of the eyeballs, is seen with hyperthyroidism. If a person’s immune system attacks the thyroid gland, it may react by producing extra hormones. The autoimmune antibodies can attack the muscles and soft tissue surrounding the eyes, which can cause them to protrude from the sockets. o Option B: Thyroid storm is life-threatening but is caused by severe hyperthyroidism. It is also referred to as thyrotoxic crisis, an acute, life-threatening hypermetabolic state induced by excessive release of thyroid hormones. o Option D: Tibial myxedema, peripheral mucinous edema involving the lower leg, is associated with hypothyroidism but isn’t life-threatening • 41. Question Nurse Sugar is assessing a client with Cushing’s syndrome. Which observation should the nurse report to the physician immediately? 37 [Date] o A. Pitting edema of the legs o B. An irregular apical pulse o C. Dry mucous membranes o D. Frequent urination Correct Answer: B. An irregular apical pulse Because Cushing’s syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician. o Option A: Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention. o Option C: Dry mucous membranes is not a symptom of Cushing’s syndrome. Thinning of the skin and mucous membranes occur because cortisol causes the breakdown of some dermal proteins along with the weakening of small blood vessels. o Option D: Frequent urination signals dehydration, which isn’t associated with Cushing’s syndrome. Short term administration of adrenocorticotropic hormone or glucocorticoids causes an increased glomerular filtration rate. Glomerular dysfunction leads to proteinuria and albuminuria. • 42. Question Cyrill with severe head trauma sustained in a car accident is admitted to the intensive care unit. Thirty-six hours later, the client’s urine output suddenly rises above 200 ml/hour, leading the nurse to suspect diabetes insipidus. Which laboratory findings support the nurse’s suspicion of diabetes insipidus? o A. Above-normal urine and serum osmolality levels. o B. Below- normal urine and serum osmolality levels. 40 [Date] going outdoors. Based on these assessment findings, the nurse would suspect which of the following disorders? o A. Diabetes mellitus o B. Diabetes insipidus o C. Hypoparathyroidism o D. Hyperparathyroidism Correct Answer: D. Hyperparathyroidism Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess parathyroid hormone (PTH). Clients also exhibit hypercalciuria- causing polyuria. o Option A: Common symptoms of diabetes mellitus include polyuria, polydipsia, and polyphagia o Option B: While clients with diabetes insipidus also have polyuria, they don’t have bone pain and increased sleeping. o Option C: Hypoparathyroidism is characterized by urinary frequency rather than polyuria. • 45. Question Nurse Lourdes is teaching a client recovering from Addisonian crisis about the need to take fludrocortisone acetate and hydrocortisone at home. Which statement by the client indicates an understanding of the instructions? o A. “I’ll take my hydrocortisone in the late afternoon, before dinner.” o B. “I’ll take all of my hydrocortisone in the morning, right after I wake up.” 41 [Date] o C. “I’ll take two-thirds of the dose when I wake up and one- third in the late afternoon.” o D. “I’ll take the entire dose at bedtime.” Correct Answer: C. “I’ll take two-thirds of the dose when I wake up and one-third in the late afternoon.” Hydrocortisone, a glucocorticoid, should be administered according to a schedule that closely reflects the body’s own secretion of this hormone; therefore, two-thirds of the dose of hydrocortisone should be taken in the morning and one-third in the late afternoon. This dosage schedule reduces adverse effects. o Option A: Taking the medicine at this schedule may cause adverse effects. o Option B: The dosage should be according to the imitation of when the body secretes glucocorticoids. o Option D: Taking an entire dose might cause severe adverse effects. • 46. Question Which of the following laboratory test results would suggest to the nurse Len that a client has a corticotropin-secreting pituitary adenoma? o A. High corticotropin and low cortisol levels o B. Low corticotropin and high cortisol levels o C. High corticotropin and high cortisol levels o D. Low corticotropin and low cortisol levels 42 [Date] Correct Answer: C. High corticotropin and high cortisol levels A corticotropin-secreting pituitary tumor would cause high corticotropin and high cortisol levels. o Option A: Cortisol levels should also be elevated in corticotropin-secreting pituitary adenoma. o Option B: Low corticotropin and high cortisol levels would be seen if there was a primary defect in the adrenal glands. o Option D: A low corticotropin level with a low cortisol level would be associated with hypocortisolism. • 47. Question A male client is scheduled for a transsphenoidal hypophysectomy to remove a pituitary tumor. Preoperatively, the nurse should assess for potential complications by doing which of the following? o A. Testing for ketones in the urine. o B. Testing urine specific gravity. o C. Checking temperature every 4 hours. o D. Performing capillary glucose testing every 4 hours. Correct Answer: D. Performing capillary glucose testing every 4 hours. The nurse should perform capillary glucose testing every 4 hours because excess cortisol may cause insulin resistance, placing the client at risk for hyperglycemia. o Option A: Urine ketone testing isn’t indicated because the client does secrete insulin and, therefore, isn’t at risk for ketosis. 45 [Date] minutes, then the client has no hyperthyroidism. o Option D: Below-normal levels of T3 and T4, as detected by radioimmunoassay, signal hypothyroidism. A below-normal T4 level also occurs in malnutrition and liver disease and may result from the administration of phenytoin and certain other drugs. • 50. Question Rico with diabetes mellitus must learn how to self-administer insulin. The physician has prescribed 10 U of U-100 regular insulin and 35 U of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction? o A. “Inject insulin into healthy tissue with large blood vessels and nerves.” o B. “Rotate injection sites within the same anatomic region, not among different regions.” o C. “Administer insulin into areas of scar tissue or hypertrophy whenever possible.” o D. “Administer insulin into sites above muscles that you plan to exercise heavily later that day.” 46 [Date] Correct Answer: B. “Rotate injection sites within the same anatomic region, not among different regions.” The nurse should instruct the client to rotate injection sites within the same anatomic region. Rotating sites among different regions may cause excessive day-to-day variations in the blood glucose level; also, insulin absorption differs from one region to the next. o Option A: Insulin should be injected only into healthy tissue lacking large blood vessels, nerves, or scar tissue, or other deviations. o Option C: Injecting insulin into areas of hypertrophy may delay absorption. The client shouldn’t inject insulin into areas of lipodystrophy (such as hypertrophy or atrophy); to prevent lipodystrophy, the client should rotate injection sites systematically. o Option D: Exercise speeds drug absorption, so the client shouldn’t inject insulin into sites above muscles that will be exercised heavily. • 51. Question Nurse Sarah expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate? o A. Elevated serum acetone level. o B. Serum ketone bodies. o C. Serum alkalosis. o D. Below-normal serum potassium level. 47 [Date] Correct Answer: D. Below-normal serum potassium level. A client with HHNS has an overall body deficit of potassium resulting from diuresis, which occurs secondary to the hyperosmolar, hyperglycemic state caused by the relative insulin deficiency. o Option A: An elevated serum acetone level is a symptom of diabetic ketoacidosis. Hepatic metabolism of free fatty acids as an alternative energy source results in accumulation of acidic intermediate and end metabolites (ie, ketones). Ketone bodies have generally included acetone, a true ketone. o Option B: Serum ketone bodies are characteristic of diabetic ketoacidosis. Ketone bodies are produced from acetyl coenzyme A mainly in the mitochondria within hepatocytes when carbohydrate utilization is impaired because of relative or absolute insulin deficiency, such that energy must be obtained from fatty acid metabolism. o Option C: Metabolic acidosis, not serum alkalosis, may occur in HHNS. A wide anion gap can be observed in patients with HHNS. The mild acidosis in HHNS is often multifactorial and results, in part, from the accumulation of minimal ketoacids in the absence of effective insulin activity. • 52. Question For a client with Graves’ disease, which nursing intervention promotes comfort? o A. Restricting intake of oral fluids. o B. Placing extra blankets on the client’s bed. o C. Limiting intake of high-carbohydrate foods. o D. Maintaining room temperature in the low- normal range. 50 [Date] o Option D: Sodium, in the form of sodium chloride, elevates urinary calcium excretion and, at prevailing calcium intakes, evokes compensatory responses that may lead to increased bone remodeling and bone loss. However, potassium was inversely associated with both urinary calcium excretion and intestinal calcium absorption, yielding no significant net change in calcium balance. • 55. Question Johnny, a firefighter, was involved in extinguishing a house fire and is being treated for smoke inhalation. He developed severe hypoxia 48 hours after the incident, requiring intubation and mechanical ventilation. He most likely has developed which of the following conditions? Correct Answer: A. Adult respiratory distress syndrome (ARDS) Severe hypoxia after smoke inhalation is typically related to ARDS. o Option B: Atelectasis is not associated with smoke inhalation. Inhaling harmful smoke can inflame the lungs and airway, causing them to swell and block oxygen. This can lead to acute respiratory distress syndrome and failure. o Option C: Bronchitis does not develop due to smoke inhalation. However, if the client already has bronchitis, inhalational injuries can worsen its condition. o Option D: Pneumonia isn’t typically associated with smoke inhalation and severe hypoxia. o A. Adult respiratory distress syndrome (ARDS ) o B. Atelectasis o C. Bronchitis o D. Pneumonia 51 [Date] • 56. Question A 67-year-old client develops acute shortness of breath and progressive hypoxia requiring right femur. The hypoxia was probably caused by which of the following conditions? o A. Asthma attack o B. Atelectasis o C. Bronchitis o D. Fat embolism Correct Answer: D. Fat embolism Long bone fractures are correlated with fat emboli, which cause shortness of breath and hypoxia. o Option A: Asthma attacks do not develop following a femoral fracture. o Option B: He could develop atelectasis but it typically doesn’t produce progressive hypoxia. o Option C: It’s unlikely the client has developed bronchitis without a previous history. • 57. Question A client with shortness of breath has decreased to absent breath sounds on the right side, from the apex to the base. Which of the following conditions would best explain this? o A. Acute asthma o B. Chronic bronchitis o C. Pneumonia 52 [Date] o D. Spontaneous pneumothorax Correct Answer: D. Spontaneous pneumothorax A spontaneous pneumothorax occurs when the client’s lung collapses, causing an acute decrease in the amount of functional lung used in oxygenation. The sudden collapse was the cause of his chest pain and shortness of breath. o Option A: An asthma attack would show wheezing breath sounds. o Option B: Bronchitis would have rhonchi. o Option C: Pneumonia would have bronchial breath sounds over the area of consolidation. • 58. Question A 62-year-old male client was in a motor vehicle accident as an unrestrained driver. He’s now in the emergency department complaining of difficulty of breathing and chest pain. On auscultation of his lung field, no breath sounds are present in the upper lobe. This client may have which of the following conditions? o A. Bronchitis o B. Pneumonia o C. Pneumothorax o D. Tuberculosis (TB) Correct Answer: C. Pneumothorax Pneumothorax is defined as the presence of air or gas in the pleural cavity, which can impair oxygenation and/or ventilation. 55 [Date] o A. Metabolic acidosis o B. Metabolic alkalosis o C. Respiratory acidosis o D. Respiratory alkalosis Correct Answer: D. Respiratory alkalosis A client with massive pulmonary embolism will have a large region and blow off large amounts of carbon dioxide, which crosses the unaffected alveolar-capillary membrane more readily than does oxygen and results in respiratory alkalosis. o Option A: Large amounts of carbon dioxide are blown off, removing the option of metabolic acidosis. o Option B: Respiratory, not metabolic, alkalosis is the result of a massive pulmonary embolism. o Option C: Acidosis does not occur with pulmonary embolism. Hypocapnia usually is present with an embolism. • 62. Question After a motor vehicle accident, Armand, a 22-year-old client, is admitted with a pneumothorax. The surgeon inserts a chest tube and attaches it to a chest drainage system. Bubbling soon appears in the water seal chamber. Which of the following is the most likely cause of the bubbling? o A. Air leak o B. Adequate suction o C. Inadequate suction o D. Kinked chest tube Correct Answer: A. Air leak Bubbling in the water seal chamber of a chest drainage system stems from 56 [Date] an air leak. In pneumothorax, an air leak can occur as air is pulled from the pleural space. o Option B: Inadequate suction does not cause bubbling. o Option C: Bubbling doesn’t normally occur with adequate suction or any preexisting bubbling in the water seal chamber. o Option D: A kinked chest tube does not cause bubbling in the water seal chamber. • 63. Question Nurse Michelle calculates the IV flow rate for a postoperative client. The client receives 3,000 ml of Ringer’s lactate solution IV to run over 24 hours. The IV infusion set has a drop factor of 10 drops per milliliter. The nurse should regulate the client’s IV to deliver how many drops per minute? o A. 18 o B. 21 o C. 35 o D. 40 Correct Answer: B. 21 3000 x 10 divided by 24 x 60. o Option A: 18 is according to the formula used. o Option C: 35 is more than the prescribed gtts/minute as calculated. o Option D: 40 is more than the correct gtts/minute as calculated. • 64. Question Mickey, a 6-year-old child with a congenital heart disorder is admitted with congestive heart failure. Digoxin (lanoxin) 0.12 mg is ordered for the child. The 57 [Date] bottle of Lanoxin contains .05 mg of Lanoxin in 1 ml of solution. What amount should the nurse administer to the child? o A. 1.2 ml o B. 2.4 ml o C. 3.5 ml o D. 4.2 ml Correct Answer: B. 2.4 ml .05 mg/ 1 ml = .12mg/ x ml, .05x = .12, x = 2.4 ml. o Option A: 1.2 ml is less than the correct dosage and may not produce the desired effects of the drug. o Option C: 3.5 ml is more than the correct dosage as calculated and may produce adverse effects. o Option D: 4.2 ml is an dosage according to the formula used. • 65. Question Nurse Alexandra teaches a client about elastic stockings. Which of the following statements, if made by the client, indicates to the nurse that the teaching was successful? o A. “I will wear the stockings until the physician tells me to remove them.” o B. “I should wear the stockings even when I am asleep.” o C. “Every four hours I should remove the stockings for a half hour.” o D. “I should put on the stockings before getting out of bed in the morning.” Correct Answer: D. “I should put on the stockings before getting out of 60 [Date] kidneys, removing waste materials, toxins, excess salt and fluids from the body. o Option A: In hemodialysis, an artificial kidney (hemodialyzer) is used to remove waste and extra chemicals and fluid from the blood. To get the blood into the artificial kidney, the doctor needs to make an access (entrance) into the blood vessels. This is done by minor surgery to the arm or leg. o Option B: The transfer of metabolic toxins through the membrane into the dialysis fluid is based on natural processes. This process is known as diffusion. When blood and dialysis fluid with different concentrations of molecules are separated by a semipermeable membrane, the molecules move through the membrane to the lower concentration. However, large proteins and blood cells are too big to pass through the small membrane- pores, so they remain in the blood. o Option C: A dialyzer is an artificial filter containing fine fibers. The fibers are hollow with microscopic pores in the wall, also known as semi-permeable dialysis membrane. To remove toxins during hemodialysis, a special dialysis-fluid flows through the filter, and bathes the fibers from the outside, while the blood flows through the hollow fiber. Due to the semi- permeable dialysis membrane, toxins, urea and other small particles can pass through the membrane. • 68. Question During a h ome visit, a client with AIDS tells the nurse that he has been exposed to measles. Which action by the nurse is most ap propriate? o A. Administer an antibiotic o o B. Contact the physician for an order for immune globulin C. Administer an antiviral 61 [Date] o D. Tell the client that he should remain in isolation for 2 weeks Correct Answer: B. Contact the physician for an order for immune globulin The client who is immunosuppressed and is exposed to measles should be treated with medications to boost his immunity to the virus. If the patient knows that he has been exposed to measles and his CD4 count is less than 200, he should talk to his doctor about whether post-exposure prophylaxis (PEP) with immunoglobulin may be an option. PEP may provide some protection or lessen the severity of infection if it occurs. If the CD4 count is 200 or greater, PEP can also include getting the MMR vaccine. Ideally, PEP should be administered within 72 hours of exposure to measles. o Option A: Antibiotics may not be an effective treatment. One important characteristic of measles infection is that it produces more serious illness and increased mortality among immunocompromised individuals, primarily those with defects in T-cell immunity. Because >90% of the human immunodeficiency virus (HIV)–infected children live in regions where measles is still endemic, achieving high rates of measles vaccine coverage is especially important among these populations to suppress excess measles-associated morbidity and mortality. o Option C: Antivirals would not be as effective as immunoglobulins for the client with AIDS. Early identification and antiretroviral treatment of HIV- infected infants and children are critical to maximizing measles vaccine immunogenicity and providing protection against other HIV- related complications. o Option D: The patient should remain in isolation, but the administration of immunoglobulin is a priority. The impact of HIVrelated immunocompromise and subsequent effects of antiretroviral therapy (ART) on immune reconstitution and, 62 [Date] ultimately, on vaccine immunogenicity is unclear. • 69. Question A client ho spitalized with MRSA (methicillin-resistant staph aureus) is placed on contact pre cautions. Which statement is true reg arding precautions for infections spread by contact? o A. The client should be placed in a room with negative pressure. o B. Infection requires close contact; therefore, the door may remain open. o C. Transmission is highly likely, so the client should wear a mask at all times. o D. Infection requires skin-to-skin contact and is prevented by hand washing, gloves, and a gown. 65 [Date] years. o Option D: Pain and itching are not symptoms of an infection due to surgery. During amputation, peripheral nerves are severed. This results in massive tissue and neuronal injury-causing disruption of the normal pattern of afferent nerve input to the spinal cord. This is followed by a process called deafferentation and the proximal portion of the severed nerve sprouts to form neuromas. There is an increased accumulation of molecules enhancing the expression of sodium channels in these neuromas that results in hype-excitability and spontaneous discharges. This abnormal peripheral activity is thought to be a potential source of stump pain, including phantom pain. • 71. Question A client with cancer of the pancreas has undergone a Whipple procedure. The nurse is aware that during the Whipple procedure, the doctor will remove the: o A. Head of the pancreas o B. Proximal third section of the small intestines o C. Stomach and duodenum o D. Esophagus and jejunum Correct Answer: A. Head of the pancreas During a Whipple procedure the head of the pancreas, which is a part of the stomach, the jejunum, and a portion of the stomach is removed and anastomosed. It is the most often used surgery to treat pancreatic cancer 66 [Date] that’s confined to the head of the pancreas. After performing the Whipple procedure, the surgeon reconnects the remaining organs to allow the client to digest food normally after surgery. o Option B: Small bowel resection is surgery to remove a part of the small bowel. It is done when part of the small bowel is blocked or diseased. o Option C: A gastrectomy is the surgical removal of all or part of the stomach. The stomach is a J-shaped organ in the upper abdomen. It is part of the digestive system, which processes nutrients ( vitamins, minerals, carbohydrates, fats, proteins, and water) in foods that are eaten and help pass waste material out of the body. A partial gastrectomy is the removal of only part of the stomach. The remaining portion then continues with its digestive role. If the entire stomach is removed, the esophagus is connected directly to the small intestine, where digestion now begins. Patients must make significant dietary changes when a gastrectomy is performed. o Option D: Jejunal interposition is a procedure in which surgeons replace the missing section of a child’s esophagus with a section of the jejunum (the middle part of the small intestine). It is used to treat children who have already undergone failed repair of long-gap esophageal atresia and for whom the Foker process isn’t an option. • 72. Question The physician has ordered a minimal-bacteria diet for a client with neutropenia. The client should be taught to avoid eating: o A. Packed fruits o B. Salt o C. Fresh raw pepper o D. Ketchup 67 [Date] Correct Answer: C. Fresh raw pepper Fresh raw or whole pepper is not allowed unless thoroughly cooked in food. A low-bacteria diet is designed to reduce exposure to bacteria and other pathogens that can make one sick. It’s often prescribed for people who are at a greater risk of infection because they’re currently not making enough white blood cells due to certain illnesses or medical treatments. o Option A: Canned fruits are allowed since they are processed and pasteurized. Fresh fruits and vegetables are fine as long as they are washed first or cooked thoroughly. Meat, fish, and eggs should also be fully cooked. Commercially prepared and packaged foods are acceptable but avoid buying foods indented and swollen cans or damaged packaging. o Option B: Salt is allowed. The keys to a low-bacteria diet are choosing foods that are less likely to carry bacteria while avoiding the foods that do. Frequent hand washing and paying particular attention to food safety practices are also essential. o Option D: Ketchup is also allowed. Bread, ready-to- eat cereals, pancakes, waffles, and crackers are safe to eat. Bottled beverages, hot beverages, and pasteurized fruit and vegetable juices are good as well. Cream cheese, sour cream, mayonnaise, margarine, commercial peanut butter, and chocolate are okay, too. • 73. Question A client is discharged home with a prescription for Coumadin (sodium warfarin). The client should be instructed to: o A. Have a Protime done monthly o B. Eat more fruits and vegetables o C. Drink more liquids o D. Avoid crowds 70 [Date] Option D: The patient’s head should be placed in a supine position with the head of the bed flat to reduce the risk of air embolism. Risk for air embolism increases when the catheter insertion site is above heart level (e.g., in a sitting position), if the patient is hypovolemic or during spontaneous inspiration. • 75. Question A client has an order for streptokinase. Before administering the medication, the nurse should assess the client for: o A. A history of streptococcal infections o B. Allergies to pineapples and bananas o C. Prior therapy with phenytoin o D. A history of alcohol abuse Correct Answer: A history of streptococcal infections Clients with a history of streptococcal infections could have antibodies that render the streptokinase ineffective. Due to streptokinase’s thrombolytic mechanisms of action, patients need monitoring for bleeding. The patient’s thrombin time, prothrombin time, partial thromboplastin time, complete blood count, and any signs of bleeding demand careful surveillance. Patients also need monitoring for signs and symptoms of reinfarction or vessel occlusion. o Option B: There is no reason to assess the client for allergies to pineapples or bananas. Streptokinase can precipitate an allergic reaction. Symptoms include fever, shivering, and rash. Patients in rare instances have developed nonfatal anaphylactic reactions. In cases of anaphylaxis, patients should be administered epinephrine immediately and discontinue streptokinase therapy. 71 [Date] The toxicity of streptokinase is believed to be because it is a polypeptide derivative of beta-hemolytic streptococci bacteria. o Option C: There is no correlation to the use of phenytoin and streptokinase. The thrombolytic nature of streptokinase makes it contraindicated in patients with active internal bleeding, as it can worsen bleeding in some patients. It is also contraindicated in patients with severe uncontrolled hypertension, intracranial neoplasms, surgery within two months, recent stroke, and intraspinal surgery. o Option D: A history of alcohol abuse is also not a factor in the order for streptokinase. Streptokinase administered with extreme caution to those who have experienced recent trauma, coagulopathies or hematologic diseases, gastrointestinal bleeding, infective endocarditis, obstetric deliveries, diabetic hemorrhagic retinopathy, organ biopsies, or previous puncture of a non-compressible vessel. Streptokinase is a pregnancy Category C medication. The effects of streptokinase on a fetus are unknown, and patients who are pregnant should only receive streptokinase to prevent life-threatening injury.