NCLEX NCLEX-RN Online Practice Questions and Exam Preparation

NCLEX NCLEX-RN Online Questions & Answers

• Question 351:

  A female client who has chronic obstructive pulmonary disease (COPD) has presented in the emergency department with cough productive of yellow sputum and increasing shortness of breath. On room air, her blood gases are as follows: pH

  7.30 mm Hg, PCO2 60 mm Hg, PO2 55 mm Hg, HCO3 32 mEq/L. These arterial blood gases reflect:

  A. Compensated respiratory acidosis
  B. Normal blood gases
  C. Uncompensated metabolic acidosis
  D. Uncompensated respiratory acidosis
  D. Uncompensated respiratory acidosis

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  (A) 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. (B) Normal ranges for arterial blood gases for adults and children are as follows: pH 7.35?.45, PO280?00 mm Hg, PCO235?5 mm Hg, HCO321?8 mEq/L. (C) In uncompensated metabolic acidosis the pH level is decreased, the PCO2level is normal, and the HCO3level is decreased. The client's primary alteration is an inability to remove excess acid via the kidneys. The lungs are unable to clear the increased acid. (D) In uncompensated respiratory acidosis, the pH level is decreased, the PCO2level is increased, and the HCO3level is normal. In a person with long-standing COPD, the HCO3level will rise gradually over time to compensate for the gradually increasing PCO2, and the person's pH level will be normal. When a person with COPD becomes acutely ill, the kidneys do not have time to increase the reabsorption of HCO3, so the person's pH level will reflect acidosis even though the HCO3is elevated.

• Question 352:

  A post-lung surgery client is placed on a chest tube drainage system. When explaining to the family how the system works, the nurse states that the water-seal bottle of a three- bottle chest drainage system serves which of the following purposes?

  A. Collection bottle for drainage
  B. Pressure regulator
  C. Preventing accumulation of blood around the heart
  D. Preventing air from entering the chest upon inspiration
  D. Preventing air from entering the chest upon inspiration

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  (A) There is a separate collection bottle for drainage as part of a chest drainage system. (B) In a three-bottle chest drainage system, one bottle serves only as a pressure regulator. (C) Mediastinal chest tubes prevent accumulation of blood around the heart immediately following heart surgery. (D) The purpose of the water-seal bottle in any chest drainage setup is to allow air out of the chest, but not back in. This negative pressure promotes lung expansion.

• Question 353:

  A 25-year-old lawyer who is married with three young children works long hours in an effort to become a partner in the law firm. Following a recent hospitalization for a bleeding ulcer, he was referred for therapy to treat this psychophysiological disorder. On meeting with the therapist, he informed him or her that he was a busy man and did not have much time for this "psych stuff." When guiding the client to ventilate his feelings, the therapist can expect him to express feelings of:

  A. Guilt
  B. Shame
  C. Despair
  D. Anger
  D. Anger

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  (A) Guilt relates to depression. (B) Shame is not associated with psychophysiological disorders. (C) Despair relates to depression. (D) Repressed anger is associated with psychophysiological disorders.

• Question 354:

  A client delivered her first-born son 4 hours ago. She asks the nurse what the white cheeselike substance is under the baby's arms. The nurse should respond:

  A. "This is a normal skin variation in newborns. It will go away in a few days."
  B. "Let me have a closer look at it. The baby may have an infection."
  C. "This material, called vernix, covered the baby before it was born. It will disappear in a few days."
  D. "Babies sometimes have sebaceous glands that get plugged at birth. This substance is an example of that condition."
  C. "This material, called vernix, covered the baby before it was born. It will disappear in a few days."

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  (A) This response identifies the fact that vernix is a normal neonatal variation, but it does not teach the client medical terms that may be useful in understanding other healthcare personnel. (B) This response may raise maternal anxiety and incorrectly identifies a normal neonatal variation. (C) This response correctly identifies this neonatal variation and helps the client to understand medical terms as well as the characteristics of her newborn. (D) Blocked sebaceous glands produce milia, particularly present on the nose.

• Question 355:

  A client sustained second- and third-degree burns to his face, neck, and upper chest. Which of the following nursing diagnoses would be given the highest priority in the first 8 hours' postburn?

  A. Fluid volume deficit secondary to alteration in skin integrity
  B. Alteration in comfort secondary to alteration in skin integrity
  C. Alteration in sensation secondary to third-degree burn
  D. Alteration in airway integrity secondary to edema of neck and face, which in turn is secondary to alteration in skin integrity
  D. Alteration in airway integrity secondary to edema of neck and face, which in turn is secondary to alteration in skin integrity

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  (A) Fluid deficit is a high priority not only during the first 8 hours postburn, but also during the first 36 hours postburn. (B) Alteration in comfort is a high priority during the entire length of the client's hospitalization and on discharge. (C) Alteration in sensation is a high priority during the first 48?2 hours postburn. Lack of sensation may be indicative of lack of circulation. (D) Alteration in airway integrity is the highest priority for this client in the first 8 hours postburn. Failure to continually assess this client's airway status could result in poor ventilation and oxygenation, in addition to an inability to intubate the client secondary to excessive edema formation in the neck.

• Question 356:

  For the past several months, an elderly female client with Alzheimer's disease has experienced paranoia; hallucinations; and aggressive, disruptive behavior. The family is utilizing haloperidol as needed to control her behavior. On nursing assessment, you note that the client demonstrates involuntary movements of the tongue and fingers. This may most likely indicate:

  A. Tardive dyskinesia, which may be a side effect of antipsychotic medication
  B. Early symptoms of Parkinson's disease
  C. A more advanced stage of Alzheimer's disease than previously experienced by the client
  D. The need to change her medication from haloperidol to another antipsychotic drug to lessen symptoms
  A. Tardive dyskinesia, which may be a side effect of antipsychotic medication

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  (A) Tardive dyskinesia is a common side effect of antipsychotic medications such as haloperidol. Discontinuing the medication can alleviate symptoms. (B) Although mild tremors are an early sign of Parkinson's disease, haloperidol must be discontinued first and the client further evaluated. (C) These symptoms do not necessarily indicate a more advanced stage of Alzheimer's disease. (D) Most antipsychotic drugs are chemically similar and will produce the same side effects.

• Question 357:

  On admission to the inpatient unit, a 34-year-old client is able to follow simple directions, but with great difficulty.

  He is worried about how he can keep clean in such a public place and repeatedly dusts his bureau, straightens his bed, and adjusts the clothes in his closet. The client is experiencing a severe level of anxiety. Which response by the nurse would be most therapeutic in initially attempting to reduce his anxiety?

  A. "You will not be allowed to remain in your room if you continue to bother things."
  B. "I can see how uncomfortable you are, but I would like you to walk with me so I can show you around the unit."
  C. "Tell me why your room needs to be so clean."
  D. "I've inspected this room and it is perfectly clean."
  B. "I can see how uncomfortable you are, but I would like you to walk with me so I can show you around the unit."

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  (A) This statement is punitive. (B) Acknowledging the anxiety and channeling it into some positive activity is therapeutic. (C) The client cannot say "why"; this statement puts the client on the defensive. (D) A rational approach, especially a judgmental one, is nontherapeutic.

• Question 358:

  A 35-year-old client has returned to her room following surgery on her right femur. She has an IV of D5 in onehalf normal saline infusing at 125 mL/hr and is receiving morphine sulfate 10?5 mg IM q4h prn for pain. She last voided 51/2 hours ago when she was given her preoperative medication. In monitoring and promoting return of urinary function after surgery, the nurse would:

  A. Provide food and fluids at the client's request
  B. Maintain IV, increasing the rate hourly until the client voids
  C. Report to the surgeon if the client is unable to void within 8 hours of surgery
  D. Hold morphine sulfate injections for pain until the client voids, explaining to her that morphine sulfate can cause urinary retention
  C. Report to the surgeon if the client is unable to void within 8 hours of surgery

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  (A) Provision of food and fluid promotes bowel elimination. Nutritional needs postoperatively are determined by the physician, not the client. (B) Increasing IV fluids postoperatively will not cause a client to void. Any change in rate of administration of IV fluids should be determined by the physician. (C) The postoperative client with normal kidney function who cannot void 8 hours after surgery is retaining urine. The client may need catheterization or medication. The physician must provide orders for both as necessary. (D) Although morphine sulfate can cause urinary retention, withholding pain medication will not ensure that the client will void. The client with uncontrolled pain will probably not be able to void.

• Question 359:

  A 7-year-old girl has been diagnosed with juvenile arthritis and has been placed on daily aspirin. Which statement made by the parent indicates a need for further teaching?

  A. "My daughter takes her aspirin with her meals."
  B. "Her gums have been bleeding frequently. Maybe she is brushing too hard."
  C. "I give her aspirin on a regular schedule every day."
  D. "One sign of aspirin toxicity can be ringing in the ears."
  B. "Her gums have been bleeding frequently. Maybe she is brushing too hard."

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  (A) Aspirin should not be given on an empty stomach because it is irritating to the mucosa. (B) Bleeding from decreased clotting capacity may be caused by aspirin toxicity. (C) A regular schedule of aspirin administration is important to maintain a satisfactory drug level in the body. (D) Aspirin toxicity may affect cranial nerve VIII, leading to tinnitus (ringing in the ears).

• Question 360:

  Following a bicycle accident, a 12-year-old client sustained a complete fracture of the left femur. He was placed in 90-90 skeletal traction with a pin in the distal end of the femur to achieve realignment and immobilization of the left femur. When providing nursing care, it is important for the nurse to remember that:

  A. The nurse may lift only the weights that are applying traction in order to reposition him in bed
  B. The client will need special skin care at the pin site according to hospital policy or the physician's preference
  C. The traction pull should result in an immediate increase in comfort and reduce the need for pain medication
  D. The client should be discouraged from participating in self-care activities to avoid the risk of disrupting the traction
  B. The client will need special skin care at the pin site according to hospital policy or the physician's preference

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  (A) Skeletal traction, including the weights that are applying the traction, is never released by the nurse. (B) It is necessary to keep the pin site clean and free from infection. (C) When first placed in traction, the client may experience increased discomfort as a result of the traction pull fatiguing the muscle. (D) When the child in traction is allowed to participate in his care, it gives him a measure of control and helps him to cope with the situation.