NCLEX NCLEX-RN Online Practice Questions and Exam Preparation

NCLEX NCLEX-RN Online Questions & Answers

• Question 381:

  Which of the following would have the physiological effect of decreasing intracranial pressure (ICP)?

  A. Increased core body temperature
  B. Decreased serum osmolality
  C. Administration of hypo-osmolar fluids
  D. Decreased PaCO2
  D. Decreased PaCO2

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  (A) An increase in core body temperature increases metabolism and results in an increase in ICP. (B) Decreased serum osmolality indicates a fluid overload and may result in an increase in ICP. (C) Hypo-osmolar fluids are generally voided in the neurologically compromised. Using IV fluids such as D5W results in the dextrose being metabolized, releasing free water that is absorbed by the brain cells, leading to cerebral edema. (D) Hypercapnia and hypoventilation, which cause retention of CO2 and lead to respiratory acidosis, both increase ICP. CO2 is the most potent vasodilator known.

• Question 382:

  Which of the following activities would be most appropriate during occupational therapy for a client with bipolar disorder?

  A. Playing cards with other clients
  B. Working crossword puzzles
  C. Playing tennis with a staff member
  D. Sewing beads on a leather belt
  C. Playing tennis with a staff member

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  (A) This activity is too competitive, and the manic client might become abusive toward the other clients. (B) During mania, the client's attention span is too short to accomplish this task. (C) This activity uses gross motor skills, eases tension, and expands excess energy. A staff member is better equipped to interact therapeutically with clients. (D) This activity requires the use of fine motor skills and is very tedious.

• Question 383:

  Which of the following would indicate the need for further teaching for the client with COPD? The client verbalizes the need to:

  A. Eat high-calorie, high-protein foods
  B. Take vitamin supplementation
  C. Eliminate intake of milk and milk products
  D. Eat small, frequent meals
  C. Eliminate intake of milk and milk products

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  (A) Protein is vital for the maintenance of muscle to aid in breathing. A high-calorie diet using higher fat than carbohydrate content is given because clients are unable to breathe off the excess CO2that is an end product of carbohydrate metabolism. (B) Inadequate nutritional status, in particular, deficiencies in vitamins A and C, decreases resistance to infection. (C) Milk does not make mucus thicker. It may coat the back of the throat and make it feel thicker. Rinsing the mouth with water after drinking milk will prevent this problem. (D) Small, frequent meals minimize a fullness sensation and reduce pressure on the diaphragm. The work of breathing and SOB are also reduced.

• Question 384:

  A 6-year-old girl is visiting the outpatient clinic because she has a fever and a rash. The doctor diagnoses chickenpox. Her mother asks the nurse how many baby aspirins her daughter can have for fever. The nurse should:

  A. Advise the mother not to give her aspirin
  B. Ask if the client is allergic to aspirin before giving further information
  C. Assess the function of the client's cranial nerve VIII
  D. Check the aspirin bottle label to determine milligrams per tablet
  A. Advise the mother not to give her aspirin

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  (A) Aspirin taken during a viral infection has been implicated as a predisposing factor to Reye's syndrome in children and adolescents. Children and adolescents should not be given aspirin. (B) Allergy to aspirin is not related to Reye's syndrome. (C) Tinnitus, caused by damage to the acoustic nerve, occurs with aspirin toxicity, but this is not related to Reye's syndrome. (D) A 6-year-old child should not be given any baby aspirin.

• Question 385:

  The client will be more comfortable and the results more accurate when the nurse prepares the client for Leopold's maneuvers by having her:

  A. Empty her bladder
  B. Lie on her left side
  C. Place her arms over her head
  D. Force fluids 1 hour prior to procedure
  A. Empty her bladder

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  (A) A full bladder would cause discomfort and possible urinary incontinence during the exam. (B) The left side-lying position would not accommodate the exam. The head of the exam table or bed can be slightly elevated to prevent supine hypotension. (C) Arms extended over the head would cause the abdomen to be tighter and less easily palpable. (D) Forcing fluids would encourage a full bladder, which is not desired for the exam.

• Question 386:

  An infant with a congenital heart defect is being discharged with an order for the administration of digoxin elixir every 12 hours. The parents need to be taught when administering digoxin to the infant that:

  A. If the infant vomits within 30 minutes of the digoxin administration, repeat the dose
  B. They need to mix it with formula so the infant swallows it easily
  C. If the infant vomits two or more consecutive doses or becomes listless or anorexic, notify the physician
  D. If a dose of digoxin is skipped for more than 6 hours, a new timetable for administration must be developed
  C. If the infant vomits two or more consecutive doses or becomes listless or anorexic, notify the physician

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  (A)

  Occasionally the child may vomit. They should not repeat the dose because the amount of digoxin that was absorbed is un-known, and serum levels of digoxin that are too high are more dangerous than those that are temporarily too low.

  (B)

  To ensure that the entire dose of digoxin is received, never mix it with food or formula. (C) Vomiting, anorexia, and listlessness are all signs of digoxin toxicity and should be reported to the physician immediately. (D) If a dose is forgotten for more than 6 hours, the nurse should advise the parents to skip that dose and to continue the next dose as scheduled.

• Question 387:

  Which of the following medications requires close observation for bronchospasm in the client with chronic obstructive pulmonary disease or asthma?

  A. Verapamil (Isoptin)
  B. Amrinone (Inocor)
  C. Epinephrine (Adrenalin)
  D. Propranolol (Inderal)
  D. Propranolol (Inderal)

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  (A) Verapamil has the respiratory side effect of nasal or chest congestion, dyspnea, shortness of breath (SOB), and wheezing. (B) Amrinone has the effect of increased contractility and dilation of the vascular smooth muscle. It has no noted respiratory side effects. (C) Epinephrine has the effect of bronchodilation through stimulation. (D) Propranolol, esmolol, and labetalol are all - blocking agents, which can increase airway resistance and cause bronchospasms.

• Question 388:

  Except for initial explosiveness on admission, a client diagnosed with schizophrenia stays in her room. She continues to believe other people are out to get her. A nursing intervention basic to improving withdrawn behavior is:

  A. Assigning her to occupational therapy
  B. Having her sit with the nurses while they chart
  C. Helping her to make friends
  D. Facilitating communication
  D. Facilitating communication

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  (A) The nurse does not make this assignment. (B) One-to-one observation is not appropriate. It does not focus on the client or encourage communication. (C) The client is too suspicious to accomplish this goal. (D) The withdrawn individual must learn to communicate on a one-to-one level before moving on to more threatening situations.

• Question 389:

  One of the medications that is prescribed for a male client is furosemide (Lasix) 80 mg bid. To reduce his risk of falls, the nurse would teach him to take this medication:

  A. On arising and no later than 6 PM
  B. At evenly spaced intervals, such as 8 AM and 8 PM
  C. With at least one glass of water per pill
  D. With breakfast and at bedtime
  A. On arising and no later than 6 PM

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  (A) This option provides adequate spacing of the medication and will limit the client's need to get up to go to the bathroom during the night hours, when he is especially at high risk for falls. (B) This option would result in the need to get up during the night to urinate and would thus increase the risk of falls. This option also does not take into consideration the client's usual daily routine. (C) Taking this medication with at least one glass of water would not have an impact on the risk of falls. (D) This option would result in the need to get up during the night to urinate and would thus increase the risk of falls.

• Question 390:

  A 25-year-old client believes she may be pregnant with her first child. She schedules an obstetric examination with the nurse practitioner to determine the status of her possible pregnancy. Her last menstrual period began May 20, and her estimated date of confinement using Nägele's rule is:

  A. March 27
  B. February 1
  C. February 27 D. January 3
  C. February 27 D. January 3

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  (A)March 27 is a miscalculation. (B) February 1 is a miscalculation. (C) February 27 is the correct answer. To calculate the estimated date of confinement using Nagele's rule, subtract 3 months from the date that the last menstrual cycle began and then add 7 days to the result. (D) January 3 is a miscalculation.