NCLEX NCLEX Certifications NCLEX-PN Questions & Answers

• Question 351:

  The physician wants to know if a client is tolerating his total parenteral nutrition.

  Which of the following laboratory tests is likely to be ordered?

  A. triglyceride level

  B. liver function tests

  C. a glucose tolerance test

  D. a complete blood count

  Correct Answer: B

  The liver is the primary organ for digestion. Liver function tests measure the blood level of enzymes produced by the liver: prothrombin time/partial prothrombin time, serum glutamic oxaloacetic and pyruvic transaminases, gamma glutamyl transpeptidase, albumin, and alkaline phosphatase. Triglyceride level measures the body's ability to clear triglycerides, the primary component of fats. Failure to clear triglycerides from the bloodstream indicates a problem with storage or the ingestion of too much fat. A glucose tolerance test measures the blood glucose at intervals after a glucose-rich solution is ingested; it is used for diagnosing diabetes.

  A complete blood count is used to evaluate blood components.

• Question 352:

  A client has a 10% dextrose in water IV solution running. He is scheduled to receive his antiepileptic drug, phenytoin (Dilantin), at this time.

  The nurse knows that the phenytoin __________.

  A. is given after the D10W is finished

  B. should be given at the time it is due in the medication port closest to the client

  C. can be piggybacked into the D10W solution now

  D. is incompatible with dextrose solutions

  Correct Answer: D

  Phenytoin and dextrose will precipitate.

  Normal saline is used to flush before and after phenytoin administration.

  The administration of an antiepileptic drug cannot be delayed to maintain a therapeutic blood level.

• Question 353:

  A client has been taking a drug (Drug A) that is highly metabolized by the cytochrome p-450 system. He has been on this medication for 6 months. At this time, he is started on a second medication (Drug B) that is an inducer of the cytochrome p-450 system.

  You should monitor this client for __________.

  A. increased therapeutic effects of Drug A

  B. increased adverse effects of Drug B

  C. decreased therapeutic effects of Drug A

  D. decreased therapeutic effects of Drug B

  Correct Answer: C

  Drug B induces the cytochrome p-450 enzyme system of the liver, thus increasing the metabolism of Drug

  A. Therefore, Drug A is broken down faster and exerts decreased therapeutic effects. Drug A is metabolized faster, thus reducing, not increasing, its therapeutic effect. Inducing the cytochrome p-450 system does not increase the adverse effects of Drug B. Drug B induces the cytochrome p-450 system but is not metabolized faster. Thus, the therapeutic effects of Drug B are not decreased.

• Question 354:

  Chemotherapeutic agents often produce a degree of myelosuppression including leukopenia.

  Leukopenia does not present immediately but is delayed several days or weeks because __________.

  A. the client's hemoglobin and hematocrit are normal

  B. red blood cells are affected first

  C. folic acid levels are normal

  D. the current white cell count is not affected by chemotherapy

  Correct Answer: D

  Time is required to clear circulating cells before the effect that chemotherapeutic drugs have on precursor

  cell maturation in the bone marrow becomes evident.

  Leukopenia is an abnormally low white blood cell count.

  "The client's hemoglobin and hematocrit are normal", "red blood cells are affected first" and "folic acid

  levels are normal" pertain to red blood cells.

• Question 355:

  An infection in a central venous access device is not eliminated by giving antibiotics through the catheter.

  How might bacterial glycocalyx contribute to this?

  A. It protects the bacteria from antibiotic and immunologic destruction.

  B. Glycocalyx neutralizes the antibiotic, rendering it ineffective.

  C. It competes with the antibiotic for binding sites on the microbe.

  D. Glycocalyx provides nutrients for microbial growth.

  Correct Answer: A

  Glycocalyx is a viscous polysaccharide or polypeptide slime that covers microbes. It enhances adherence to surfaces, resists phagocytic engulfment by the white blood cells, and prevents antibiotics from contacting the microbe. Glycocalyx does not have the effects described in Choices "Glycocalyx neutralizes the antibiotic, rendering it ineffective.", "It competes with the antibiotic for binding sites on the microbe." and "Glycocalyx provides nutrients for microbial growth."

• Question 356:

  A month after receiving a blood transfusion, an immunocompromised client develops fever, liver abnormalities, a rash, and diarrhea.

  The nurse should suspect this client has __________.

  A. nothing related to the blood transfusion

  B. graft-versus-host disease (GVHD)

  C. myelosuppression

  D. an allergic response to a recent medication

  Correct Answer: B

  GVHD occurs when white blood cells in donor blood attack the tissues of an immunocompromised recipient. This process can occur within a month of the transfusion. Choices "nothing related to the blood transfusion" and "an allergic response to a recent medication" are possible, but the nurse must remember that immunocompromised transfusion recipients are at risk for GVHD.

• Question 357:

  In infants and children, the side effects of firstgeneration over-the counter (OTC) antihistamines, such as diphenhydramine (Benedryl) and hydroxyzine (Atarax), can include __________.

  A. Reye's syndrome

  B. cholinergic effects

  C. paradoxical CNS stimulation

  D. nausea and diarrhea

  Correct Answer: C

  Typically, first-generation OTC antihistamines have a sedating effect because of passage into the CNS.

  However, in some individuals, especially infants and children, paradoxical CNS stimulation occurs and is

  manifested by excitement, euphoria, restlessness, and confusion. For this reason, use of first-generation

  OTC antihistamines has declined and second-generation product use has increased.

  Reye's syndrome is a systemic response to a virus.

  First-generation OTC antihistamines do not exhibit a cholinergic effect.

  Nausea and diarrhea are uncommon with first-generation OTC antihistamines.

• Question 358:

  Which of the following clients should refrain from therapy with the thiazide diuretic hydrochlorothiazide (HCTZ)?

  A. a client with renal impairment

  B. a client with hypertension

  C. a client with diabetes mellitus, type II

  D. a client with renal calculi (kidney stones)

  Correct Answer: C

  The thiazide class of diuretics cause metabolic abnormalities such as elevated blood glucose levels. This

  elevation is caused in part by diuretic-induced potassium deficiency.

  Hypokalemia reduces the secretion of insulin by pancreatic beta cells, thereby increasing plasma glucose

  levels.

  Thiazides have been used for many years in clients with the conditions described in choices "a client with

  renal impairment" and "a client with hypertension".

  Thiazides decrease calcium excretion, thus decreasing the likelihood of renal calculi.

• Question 359:

  Local anesthetics block the conduction of pain impulses to the spinal cord.

  Their duration of action __________.

  A. is always longer than general anesthesia

  B. is determined by the rate of diffusion and absorption at the site of administration

  C. is usually short (10 minutes)

  D. varies, depending on the client's weight

  Correct Answer: B

  Diffusion and absorption depend on the chemical properties of the anesthetic and other factors such as

  local pH and blood flow.

  Duration might or might not be longer than general anesthesia.

  Duration can be short if the type of local anesthetic is a short-acting agent.

  Client weight is not a factor.

• Question 360:

  When medications have an additive, synergistic, or antagonistic effect on a tissue, a __________ reaction has occurred.

  A. pharmaceutical

  B. pharmacodynamic

  C. pharmacokinetic

  D. drug incompatibility

  Correct Answer: B

  Pharmacodynamics pertain to the effect of a drug on receptors.

  Pharmaceutical reactions are chemical reactions between drugs prior to administration or absorption.

  Pharmacokinetic reactions refer to the body's effect on the drug.

  Drug incompatibilities are another term for pharmaceutical reactions.