NCLEX NCLEX-RN Online Practice Questions and Exam Preparation

NCLEX NCLEX-RN Online Questions & Answers

• Question 241:

  A 47-year-old client comes to the emergency department complaining of moderate flank, abdominal, and testicular pain with nausea of 4 hours' duration. After physical examination and obtaining the client's history, the physician suspects urethral obstruction by calculi. The nurse realizes that the physician will order which one of the following diagnostic studies to best confirm the diagnosis?

  A. Cystoscopy
  B. Kidneys, ureter, bladder, x-ray of abdomen
  C. Intravenous pyelogram with excretory urogram
  D. Ureterolithotomy
  C. Intravenous pyelogram with excretory urogram

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  (A) Cystoscopy is an endoscopic procedure that uses an instrument (a cystoscope) to visualize the internal bladder and ureter structures and to capture and remove an obstructing stone. (B) Kidney, ureter, bladder x-ray is used to outline gross structural changes in the kidneys, ureter, and bladder and will determine the general location of a stone. (C) An intravenous pyelogram with excretory urogram is used to visualize the kidneys, kidney pelvis, ureters, and bladder. This procedure is used specifically to determine whether urethral obstruction is partial or complete; it shows the exact location of the stone and dilation of the ureter above the stone. (D) Ureterolithotomy is a surgical procedure in which the ureter is incised and the stone is manually removed because the stone is unable to pass through the ureter independently.

• Question 242:

  A psychotic client who believes that he is God and rules all the universe is experiencing which type of delusion?

  A. Somatic
  B. Grandiose
  C. Persecutory
  D. Nihilistic
  B. Grandiose

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  (A) These delusions are related to the belief that an individual has an incurable illness. (B) These delusions are related to feelings of self-importance and uniqueness. (C) These delusions are related to feelings of being conspired against. (D) These delusions are related to denial of self-existence.

• Question 243:

  A female client decides on hemodialysis. She has an internal vascular access device placed. To ensure patency of the device, the nurse must:

  A. Assess the site for leakage of blood or fluids
  B. Auscultate the site for a bruit
  C. Assess the site for bruising or hematoma
  D. Inspect the site for color, warmth, and sensation
  B. Auscultate the site for a bruit

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  (A) This is an internal device. Assessment of the site should include assessing for swelling, pain, warmth, and discoloration. This measure does not assess patency. (B) The presence of a bruit indicates good blood flow through the device. (C) The nurse should inspect the site for bruising or hematoma; however, this measure does not assure patency of the device. (D) The nurse should inspect the vascular access site frequently for signs of infection. However, this does not assure patency.

• Question 244:

  A 15-year-old client was diagnosed as having cystic fibrosis at 8 months of age. He is in the hospital for a course of IV antibiotic therapy and vigorous chest physiotherapy. He has a poor appetite. The nurse can best help him to meet the desired outcome of consuming a prescribed number of calories by:

  A. Including the client in planning sessions to select the type of meal plan and foods for his diet
  B. Working with the nutritionist to devise a diet with significantly increased calories
  C. Selecting foods for the client's diet that are high in calories and instituting a strict calorie count
  D. Constantly providing him with chips, dips, and candies, because the number of calories consumed is more important than the quality of foods
  A. Including the client in planning sessions to select the type of meal plan and foods for his diet

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  (A) The adolescent knows what he likes and will be more likely to eat if he has some control over his diet. (B) The nurses and nutritionist can plan an excellent diet, but it will not help the adolescent unless he eats it. (C) Eating is already a chore for this client. Adding a strict calorie count could make it even more burdensome. (D) Fats are particularly difficult for the cystic fibrosis client to digest. He does need a healthful diet, not just more calories.

• Question 245:

  A client is pregnant with her second child. Her last menstrual period began on January 15. Her expected date of delivery would be:

  A. October 8
  B. October 15
  C. October 22
  D. October 29
  C. October 22

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  (A) Incorrect application of N鋑ele's rule: correctly subtracted 3 months but subtracted 7 days rather than added. (B) Incorrect application of N鋑ele's rule: correctly subtracted 3 months but did not add 7 days. (C) Correct application of N

• Question 246:

  The nurse will be alert to the most potentially lifethreatening side effect associated with the administration of monoamine oxidase (MAO) inhibitor. This is:

  A. Oculogyric crisis
  B. Hypertensive crisis
  C. Orthostatic hypotension
  D. Tardive dyskinesia
  B. Hypertensive crisis

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  (A) Oculogyric crisis, involuntary upward deviation and fixation of the eyeballs, is usually associated with either postencephalitic parkinsonian or drug-induced extrapyramidal symptoms (EPS). (B) Hypertensive crisis is a potentially life-threatening side effect. This may occur if the client ingests foods, beverages, or medications containing tyramine. (C) Orthostatic hypotension, a drop in blood pressure resulting from a rapid change of body position, can occur with the administration of antidepressants. (D) Tardive dyskinesia, characterized by slow, rhythmical, automatic or stereotyped muscular movements, usually is associated with the administration of certain antipsychotic medications.

• Question 247:

  While the RN is assessing a mother's perineum on her 2nd postpartum day after having a vaginal delivery, the RN notes a large ecchymotic area located to the left of the mother's perineum. Which one of the following interventions should the RN initiate at this time?

  A. Have the client expose the area to air.
  B. Apply ice to the perineum.
  C. Encourage the client to take warm sitz baths.
  D. Inform the physician.
  C. Encourage the client to take warm sitz baths.

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  (A) The area is bruised and painful. This action would do nothing to help with the healing process of the perineum or to provide comfort. (B) Ice is effective immediately after birth to reduce edema and discomfort, but not on the 2nd postpartum day. (C) Sitz baths are useful if the perineum has been traumatized, because the moist heat increases circulation to the area to promote healing, relaxes tissue, and decreases edema. (D) The physician is not notified of bruising, but if a hematoma is present, then the physician is notified.

• Question 248:

  A 27-year-old man was diagnosed with type I diabetes 3 months ago. Two weeks ago he complained of pain, redness, and tenderness in his right lower leg. He is admitted to the hospital with a slight elevation of temperature and vague complaints of "not feeling well." At

  4:30

  PM on the day of his admission, his blood glucose level is 50 mg; dinner will be served at 5:00 PM. The best nursing action would be to:

  A. Give him 3 tbsp of sugar dissolved in 4 oz of grape juice to drink
  B. Ask him to dissolve three pieces of hard candy in his mouth
  C. Have him drink 4 oz of orange juice
  D. Monitor him closely until dinner arrives
  C. Have him drink 4 oz of orange juice

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  (A) The combination of sugar and juice will increase the blood sugar beyond the normal range. (B) Concentrated sweets are not absorbed as fast as juice; consequently, they elevate the blood sugar beyond the normal limit. (C) Four ounces of orange juice will act immediately to raise the blood sugar to a normal level and sustain it for 30 minutes until supper is served. (D) There is an increased potential for the client's blood sugar to decrease even further, resulting in diabetic coma.

• Question 249:

  A 2-day-old infant boy has been diagnosed with an atrial septal defect due to a persistent patent foramen ovale.

  When explaining the diagnosis to the mother, the nurse includes in the discussion the function of the foramen ovale. In fetal circulation, the foramen ovale allows a portion of the blood to bypass the:

  A. Left ventricle
  B. Pulmonary system
  C. Liver
  D. Superior vena cava
  B. Pulmonary system

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  (A) The foramen ovale permits a percentage of the blood to shunt from the right atrium to the left atrium. The blood then goes to the left ventricle, permitting systemic fetal circulation with blood containing a higher O2 saturation. (B) As the blood shunts from the right atrium to the left atrium, the pulmonary system is bypassed. The fetus receives O2 from the maternal circulation, thereby permitting the partial bypass of the pulmonary system. (C) The foramen ovale is locatedin the atrial septum of the heart and does not affect the liver. (D) The superior vena cava returns blood to the heart, bringing blood to the location of the foramen ovale.

• Question 250:

  The primary reason for sending a burn client home with a pressure garment, such as a Jobst garment, is that the garment:

  A. Decreases hypertrophic scar formation
  B. Assists with ambulation
  C. Covers burn scars and decreases the psychological impact during recovery
  D. Increases venous return and cardiac output by normalizing fluid status
  A. Decreases hypertrophic scar formation

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  (A) Tubular support, such as that received with a Jobst garment, applies tension of 10?0 mm Hg. This amount of uniform pressure is necessary to prevent or reduce hypertrophic scarring. Clients typically wear a pressure garment for 6?2 months during the recovery phase of their care. (B) Pressure garments have no ambulatory assistive properties. (C) Pressure garments can worsen the psychological impact of burn injury, especially if worn on the face. (D) Pressure garments do not normalize fluid status.