NCLEX NCLEX-RN Online Practice Questions and Exam Preparation

NCLEX NCLEX-RN Online Questions & Answers

• Question 291:

  A client has just received an epidural block. She is laboring on her right side. The nurse notes that her blood pressure has dropped from 132/68 to 78/42 mm Hg. The nurse's first action would be to:

  A. Call the physician immediately and give dopamine IM
  B. Turn her on her left side and recheck her blood pressure in 5 minutes
  C. Administer oxytocin (Pitocin) immediately and increase the rate of IV fluids
  D. Increase the rate of IV fluids and start O2 by mask
  D. Increase the rate of IV fluids and start O2 by mask

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  (A) Nursing measures to support fetal oxygenation and promote maternal blood pressure would precede calling the physician. (B) Systolic pressures below 100 mm Hg or a reduction in the systolic pressure of>30% necessitate treatment. Assessing the blood pressure in 5 minutes may allow for further fetal and/or maternal compromise. Turning the client on her left side will promote uteroplacental perfusion and is appropriate. (C) Oxytocin (Pitocin) increases the strength of uterine contractions and may cause maternal hypotension; thus it is an inappropriate drug for use in this clinical situation. IV fluids would be increased to expand the circulating blood volume and promote increased blood pressure. (D) Turning the mother to her left lateral side promotes uteroplacental perfusion. IV fluids are administered to increase the circulating blood volume, and O2 is administered to promote fetal oxygenation and decrease the nausea accompanying the hypotension.

• Question 292:

  A male client has asthma and his physician has prescribed beclomethasone (Vanceril) 3 puffs tid in addition to his other medications. After taking his beclomethasone, the client should be instructed to:

  A. Clean his inhaler with warm water and soak it in a 10% bleach solution
  B. Drink a glass of water
  C. Sit and rest
  D. Use his bronchodilator inhaler
  B. Drink a glass of water

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  (A) Inhalers should be cleaned once a day. They should be taken apart, washed in warm water, and dried according to manufacturer's instructions. Soaking in bleach is inappropriate. (B) A common side effect of inhaled steroid preparations is oral candidal infection. This can be prevented by drinking a glass of water or gargling after using a steroid inhaler. (C) There is nothing wrong with sitting and resting after using a steroid inhaler, but it is not necessary. (D) If a person is using a steroid inhaler as well as a bronchodilator inhaler, the bronchodilator shouldalways be used first. The reason for this is that the bronchodilator opens up the person's airways so that when the steroid inhaler is used next, there will be better distribution of medication.

• Question 293:

  A client has been admitted to the labor and delivery unit in active labor. After assessing her, the RN notes that the client's fetus position is left occipital posterior. Which of the following statements best describes what this means to the labor process:

  A. Decreases the overall time of the labor process
  B. Prolongs the client's first stage of labor
  C. Decreases the time of the client's first stage of labor
  D. Prolongs the client's third stage of labor
  B. Prolongs the client's first stage of labor

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  (A) Posterior position causes a larger diameter of the fetal head to enter the pelvis than an anterior position. Pressure on the sacral nerves is increased, and it takes the fetus a longer time to enter the pelvic inlet. (B) This position will prolong the first stage of labor. When the larger diameter of the fetal head enters the pelvis first, it will have a more difficult time accommodating to the pelvis; therefore, it will take a longer time for the fetus to move through the pelvis. (C) It will increase the time of labor because the larger diameter of the fetal head will have a more difficult time accommodating to the pelvic inlet and thus will move through the pelvis slower. (D) In the third stage of labor the placenta is delivered; therefore, the infant has been delivered.

• Question 294:

  Following a fracture of the left femur, a client develops symptoms of osteomyelitis. During the acute phase of osteomyelitis, nursing care is directed toward:

  A. Moving or turning the client's left leg carefully to minimize pain and discomfort
  B. Allowing the client out of bed only in a wheelchair or gurney to minimize weight bearing on the left leg
  C. Providing the client with a high-protein, high-fiber diet to promote healing
  D. Instituting physical therapy to ensure restoration of optimal functioning of the leg
  A. Moving or turning the client's left leg carefully to minimize pain and discomfort

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  (A) Any movement of his affected limb will cause discomfort to the child. (B) No weight bearing will be allowed until healing is well underway to avoid pathological fractures. (C) The child will be anorexic and may experience vomiting. Diet should be simple and high caloric until appetite returns and symptoms subside. (D) Physical therapy is instituted only after infection subsides.

• Question 295:

  A client has consented to have a central venous catheter placed. The best position in which to place the client is the Trendelenburg position. The reason is that the Trendelenburg position:

  A. Allows the physician to visualize the subclavian vein
  B. Reduces the possibility of air embolism
  C. Reduces the possibility of hematoma formation
  D. Makes the procedure more comfortable for the client
  B. Reduces the possibility of air embolism

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  (A) The subclavian vein is not visible during central line insertion regardless of the client's position. (B) The Trendelenburg position reduces the possibility of air embolism because it places slight positive pressure on the central veins. It also distends the veins, and distention facilitates insertion. (C) This response is untrue; it has no effect on hematoma formation. (D) This position is not necessarily more comfortable for the client, and many clients, especially those who may be short of breath, may find the position uncomfortable and difficult to maintain.

• Question 296:

  Parents of a child with rheumatic fever express concern that she will always be arthritic. The nurse discusses their concerns and tells them the joint pain usually:

  A. Subsides in
  B. Is relieved by aspirin
  C. Is responsive to ibuprofen (Motrin)
  D. Subsides in 3 days
  A. Subsides in

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  (A) Joints usually remain inflamed and tender until the disease runs its course in<3 weeks. (B) This response does not answer the question of whether she will always be arthritic. (C) This response does not answer the question asked. (D) The disease takes<3 weeks to run its course.

• Question 297:

  Which of the following risk factors associated with breast cancer would a nurse consider most significant in a client's history?

  A. Menarche after age 13
  B. Nulliparity
  C. Maternal family history of breast cancer
  D. Early menopause
  C. Maternal family history of breast cancer

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  (A) Women who begin menarche late (after 13 years old) have a lower risk of developing breast cancer than women who have begun earlier. Average age for menarche is 12.5 years. (B) Women who have never been pregnant have an increased risk for breast cancer, but a positive family history poses an even greater risk. (C) A positive family history puts a woman at an increased risk of developing breast cancer. It is recommended that mammography screening begin 5 years before the age at which an immediate female relative was diagnosed with breast cancer. (D) Early menopause decreases the risk of developing breast cancer.

• Question 298:

  A female client is concerned that she is in a "high-risk" group for the development of acquired immunodeficiency syndrome (AIDS). She wants to know about the advisability of donating blood. Which of the following responses is correct?

  A. "Individuals who donate blood are at risk of getting the AIDS virus. You should not donate."
  B. "It's OK for you to donate because the blood bank has a test that is 100% effective."
  C. "You should not donate since it takes time to develop antibodies to the AIDS virus. If you donate blood before you develop the antibody, you could pass it on in the blood."
  D. "It is not a good idea for you to donate. If you have AIDS, the information is made public and could destroy your personal life."
  C. "You should not donate since it takes time to develop antibodies to the AIDS virus. If you donate blood before you develop the antibody, you could pass it on in the blood."

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  (A) The AIDS virus cannot be transmitted to the donor through the blood donation procedure. (B) The test for the AIDS virus is not absolutely foolproof; therefore, it is not wise for a person with known risk factors to donate blood. (C) It takes time for antibodies to the AIDS virus to develop. An infected individual could donate contaminated blood without it testing positive for the virus. (D) For reasons of confidentiality, information about individuals infected with AIDS is not made public.

• Question 299:

  The nurse enters the playroom and finds an 8-year-old child having a grand mal seizure. Which one of the following actions should the nurse take?

  A. Place a tongue blade in the child's mouth.
  B. Restrain the child so he will not injure himself.
  C. Go to the nurses station and call the physician.
  D. Move furniture out of the way and place a blanket under his head.
  D. Move furniture out of the way and place a blanket under his head.

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  (A) The nurse should not put anything in the child's mouth during a seizure; this action could obstruct the airway. (B) Restraining the child's movements could cause constrictive injury. (C) Staying with the child during a seizure provides protection and allows the nurse to observe the seizure activity. (D) The nurse should provide safety for the child by moving objects and protecting the head.

• Question 300:

  A female client has married recently. A month ago she visited her physician with complaints of burning on urination. She was given a prescription for trimethoprim- sulfamethoxazole (Bactrim) DS bid for 10 days. She was admitted through the emergency room on Saturday evening complaining of flank pain. Her temperature was 104_F. A preliminary urinalysis revealed 31 bacteria along with red and white blood cells in the urine. A preliminary diagnosis of pyelonephritis was made. During a nursing admission assessment, which statement by the client demonstrates a possible cause for pyelonephritis?

  A. "I have not been drinking six to eight glasses of water each day as the nurse had instructed."
  B. "I'm afraid I may have something wrong with my bladder because I have been getting bladder infections frequently since I've been married."
  C. "I took the Bactrim for 6 or 7 days. The burning stopped, so I saved the rest of the medication for the next time."
  D. "I recently had the flu, which could be settling in my kidneys now."
  C. "I took the Bactrim for 6 or 7 days. The burning stopped, so I saved the rest of the medication for the next time."

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  (A) Although it is important that the client drink adequate fluids while treating a bladder infection with trimethoprimsulfamethoxazole, the failure to do so will not cause pyelonephritis. (B) A stricture or abnormality may cause the progression of bladder infection to urinary tract infection, but this is rare. There is no indication in this situation that this has occurred. (C) The most common cause of pyelonephritis is improper treatment of bladder infections. The client typically feels better after several days, discontinues the medication, and saves the remainder forthe next occurrence of a bladder infection. For this reason, it is imperative to provide client education related to completion of the prescribed medication. (D) There is no evidence that infection in another body system could cause pyelonephritis.