NCLEX NCLEX-RN Online Practice Questions and Exam Preparation

NCLEX NCLEX-RN Online Questions & Answers

• Question 121:

  A 66-year-old female client has smoked 2 packs of cigarettes per day for 20 years. Her arterial blood gases on room air are as follows: pH 7.35; PO2 70 mm Hg; PCO2 55 mm Hg; HCO3 32 mEq/L. These blood gases reflect:

  A. Compensated metabolic acidosis
  B. Compensated respiratory acidosis
  C. Compensated respiratory alkalosis
  D. Uncompensated respiratory acidosis
  B. Compensated respiratory acidosis

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  (A) In compensated metabolic acidosis, the pH level is normal, the PCO2level is decreased, and the HCO3level is decreased. The client's primary alteration is an inability to remove excess acid via the kidneys. The lungs compensate by hyperventilating and decreasing PCO2. (B) In compensated respiratory acidosis, the pH level is normal, the PCO2level is elevated, and the HCO3level is elevated. The client's primary alteration is an inability to remove CO2from the lungs, so over time, the kidneys increase reabsorption of HCO3to buffer the CO2. (C) In compensated respiratory alkalosis, the pH level is normal, the PCO2level is decreased, and the HCO3level is decreased. The client's primary alteration is hyperventilation, which decreases PCO2. The client compensates by increasing the excretion of HCO3from the body. (D) In uncompensated respiratory acidosis, the pH level is decreased, the PCO2level is increased, and the HCO3level is normal. The client's primary alteration is an inability to remove CO2from the lungs. The kidneys have not compensated by increasing HCO3reabsorption.

• Question 122:

  A 74-year-old client seen in the emergency room is exhibiting signs of delirium. His family states that he has not slept, eaten, or taken fluids for the past 24 hours. The planning of nursing care for a delirious client is based on which of the following premises?

  A. The delirious client is capable of returning to his previous level of functioning.
  B. The delirious client is incapable of returning to his previous level of functioning.
  C. Delirium entails progressive intellectual and behavioral deterioration.
  D. Delirium is an insidious process.
  A. The delirious client is capable of returning to his previous level of functioning.

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  (A) This answer is correct. If the cause is removed, the delirious client will recover completely. (B) This answer is incorrect. The demented client is incapable of returning to previous level of functioning. The delirious client is capable of returning to previous functioning. (C) This answer is incorrect. The demented client, not the delirious client, has progressive intellectual and behavioral deterioration. (D) This answer is incorrect. Delirium develops rapidly, whereas dementia is insidious.

• Question 123:

  As the nurse assesses a male adolescent with chlamydia, the nurse determines that a sign of chlamydia is:

  A. Enlarged penis
  B. Secondary lymphadenitis
  C. Epididymitis
  D. Hepatomegaly
  C. Epididymitis

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  (A)

  An enlarged penis is not a sign of chlamydia. (B) Secondary lymphadenitis is a complication of lymphogranuloma venereum. (C) Untreated chlamydial infection can spread from the urethra, causing epididymitis, which presents as a tender, scrotal swelling.

  (D)

  Hepatomegaly is not a complication.

• Question 124:

  When planning care for a 9-year-old client, the nurse uses which of the most effective means of helping siblings cope with their feelings about a brother who is terminally ill?

  A. Open discussion and understanding
  B. Play-acting out feelings in different roles
  C. Storytelling
  D. Drawing pictures
  B. Play-acting out feelings in different roles

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  (A) When dealing with grief, siblings are usually most comfortable initially with open discussion. (B) Assuming different roles allows children to act out their feelings without fear of reprisals and to gain insight and control. (C) This method may be helpful, but having the child take an active part through role playing is more effective. (D) This technique may be helpful, but being an active participant through role playing is more effective.

• Question 125:

  Nursing interventions designed to decrease the risk of infection in a client with an indwelling catheter include:

  A. Cleanse area around the meatus twice a day
  B. Empty the catheter drainage bag at least daily
  C. Change the catheter tubing and bag every 48 hours
  D. Maintain fluid intake of 1200?500 mL every day
  A. Cleanse area around the meatus twice a day

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  (A) Catheter site care is to be done at least twice daily to prevent pathogen growth at the catheter insertion site. (B) Catheter drainage bags are usually emptied every 8 hours to prevent urine stasis and pathogen growth. (C) Tubing and collection bags are not changed this often, because research studies have not demonstrated the efficacy of this practice. (D) Fluid intake needs to be in the 2000?500 mL range if possible to help irrigate the bladder and prevent infection.

• Question 126:

  A 6-year-old child returned to the surgical floor 20 hours ago after an appendectomy for a gangrenous appendix. His mother tells the nurse that he is becoming more restless and is anxious. Assessment findings indicate that the child has atelectasis. Appropriate nursing actions would include:

  A. Allowing the child to remain in the position of comfort, preferably semi-or high-Fowler position
  B. Administering analgesics as ordered
  C. Having the child turn, cough, and deep breathe every 1 hours
  D. Remaining with the child and keeping as calm and quiet as possible
  C. Having the child turn, cough, and deep breathe every 1 hours

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  (A) Allowing the client to remain in the position of comfort will not resolve the atelectasis. This position, if left unchanged, over time may actually increase the atelectasis. (B) Analgesics will not resolve the atelectasis and may contribute to it if proper nursing actions are not taken to help resolve the atelectasis. (C) Having the client turn, cough, and deep breathe every 1 hours will aid in resolving the atelectasis. Surgery clients are at risk for postoperative respiratory complications because pulmonary function is reduced as a result of anesthesia and surgery. (D) Remaining with the client and keeping him calm and quiet will not affect the client's anxiety, restlessness, or help to resolve the atelectasis. The cause (atelectasis) needs to be treated, not the symptoms (anxiety and restlessness).

• Question 127:

  An 18-year-old client enters the emergency room complaining of coughing, chest tightness, dyspnea, and sputum production. On physical assessment, the nurse notes agitation, nasal flaring, tachypnea, and expiratory wheezing. These signs should alert the nurse to:

  A. A tension pneumothorax
  B. An asthma attack
  C. Pneumonia
  D. Pulmonary embolus
  B. An asthma attack

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  (A) A tension pneumothorax is an accumulation of air in the pleural space. Important physical assessment findings to confirm this condition include cyanosis, jugular vein distention, absent breath sounds on the affected side, distant heart sounds, and lowered blood pressure. (B) Asthma is a disorder in which there is an airflow obstruction in the bronchioles and smaller bronchi secondary to bronchospasm, swelling of mucous membranes, and increased mucus production.Physical assessment reveals some important findings: agitation, nasal flaring, tachypnea, and expiratory wheezing. (C) Pneumonia is an acute bacterial or viral infection that causes inflammation of the lung in the alveolar and interstitial tissue and results in consolidation. Specific assessment findings to confirm this condition include decreased chest expansion caused by pleuritic pain, dullness on percussion over consolidated areas, decreased breath sounds, and increased vocal fremitus. (D) A pulmonary embolus is the passage of a foreign substance (blood clot, fat, air, or amniotic fluid) into the pulmonary artery or its branches, with subsequent obstruction of blood supply to lung tissue. Specific assessment findings that confirm this condition include tachypnea, tachycardia, crackles (rales), transient friction rub, diaphoresis, edema, and cyanosis.

• Question 128:

  A 30-year-old client in the third trimester of her pregnancy asks the nurse for advice about upper respiratory discomforts. She complains of nasal stuffiness and epistaxis, most noticeable on the left side. Which reply by the nurse is correct?

  A. "It sounds as though you are coming down with a bad cold. I'll ask the doctor to prescribe a decongestant for relief of symptoms."
  B. "A good vaporizer will help; avoid the cool air kind. Also, try saline nose drops, and spend less time on your left side."
  C. "These discomforts are all a result of increased blood supply; one of the pregnancy hormones, estrogen, causes them."
  D. "This is most unusual. I'm sure your obstetrician will want you to see an ENT (ear, nose, throat) specialist."
  C. "These discomforts are all a result of increased blood supply; one of the pregnancy hormones, estrogen, causes them."

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  (A) Decongestants may exaggerate the nasal stuffiness associated with pregnancy. Judicious use of decongestants and nasal sprays is advocated during pregnancy. (B) Cool air vaporizers and saline drops may help to relieve the nasal stuffiness. Positioning on either lateral side does not decrease nasal stuffiness or prevent epistaxis. (C) Increased estrogen levels result in nasal mucosa edema with subsequent nasal stuffiness. Estrogen also promotes vasodilation, which contributes to epistaxis. The nurse may recommend cool air vaporizers and saline drops to help with the nasal stuffiness. (D) Increased estrogen levels result in nasal mucosa edema with subsequent nasal stuffiness. Estrogen also promotes

  vasodilation discomforts associated with pregnancy.

• Question 129:

  A client returns for her 6-month prenatal checkup and has gained 10 lb in 2 months. The results of her physical examination are normal. How does the nurse interpret the effectiveness of the instruction about diet and weight control?

  A. She is compliant with her diet as previously taught.
  B. She needs further instruction and reinforcement.
  C. She needs to increase her caloric intake.
  D. She needs to be placed on a restrictive diet immediately.
  B. She needs further instruction and reinforcement.

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  (A) She is probably not compliant with her diet and exercise program. Recommended weight gain during second and third trimesters is approximately 12 lb. (B) Because of her excessive weight gain of 10 lb in 2 months, she needs reevaluation of her eating habits and reinforcement of proper dietary habits for pregnancy. A 2200-calorie diet is recommended for most pregnant women with a weight gain of 27?0 lb over the 9-month period. With rapid and excessive weightgain, PIH should also be suspected. (C) She does not need to increase her caloric intake, but she does need to re-evaluate dietary habits. Ten pounds in 2 months is excessive weight gain during pregnancy, and health teaching is warranted. (D) Restrictive dieting is not recommended during pregnancy.

• Question 130:

  Newborns are routinely screened for phenylketonuria. The nursery nurse ensures that this screening test is performed:

  A. Immediately after birth, because the most accurate result is obtained at this time
  B. After 2 days of milk ingestion
  C. At 2 days of age regardless of amount of milk feedings
  D. At 1 month, because the biochemical buildup of phenylalanine takes 1 month to detect
  B. After 2 days of milk ingestion

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  (A) The infant has not ingested any protein immediately after birth, which is necessary to detect excessive serum phenylalanine. (B) It is important that the infant take in 2 full days of milk or formula feedings to preclude a false-negative reading. (C) At 2 days of age, inadequate milk could have been ingested owing to a delay in the initial feeding. (D) The biochemical buildup of serum phenylalanine is detectable after 2 days of milk or formula ingestion.