NCLEX NCLEX-RN Online Practice Questions and Exam Preparation

NCLEX NCLEX-RN Online Questions & Answers

• Question 451:

  Discharge teaching for the client who has a total gastrectomy should include which of the following?

  A. Need for the client to increase fluid intake to 3000 mL/day
  B. Follow-up visits every 3 weeks for the first 6 months
  C. B12 injections needed for the rest of the client's life
  D. Need to eat three full meals with plenty of fiber per day
  C. B12 injections needed for the rest of the client's life

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  (A) There will be no need to increase fluid intake excessively, because dumping syndrome could present a problem. (B) Followup visits every 3 weeks are not a standard recommendation. Follow-up visits will be highly individualized. (C) With removal of the stomach, intrinsic factor will no longer be produced. Intrinsic factor is necessary for vitamin B12 absorption. Parenteral injections of B12 will be needed on a monthly basis for the rest of the person's life. (D) Smaller, more frequent meals, rather than large, bulky meals, are recommended to prevent problems with dumping syndrome.

• Question 452:

  When the nurse is evaluating lab data for a client 18?4 hours after a major thermal burn, the expected physiological changes would include which of the following?

  A. Elevated serum sodium
  B. Elevated serum calcium
  C. Elevated serum protein
  D. Elevated hematocrit
  D. Elevated hematocrit

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  (A) Sodium enters the edema fluid in the burned area, lowering the sodium content of the vascular fluid. Hyponatremia may continue for days to several weeks because of sodium loss to edema, sodium shifting into the cells, and later, diuresis. (B) Hypocalcemia occurs because of calcium loss to edema fluid at the burned site (third space fluid). (C) Protein loss occurs at the burn site owing to increased capillary permeability. Serum protein levels remain low until healing occurs. (D) Hematocrit level is elevated owing to hemoconcentration from hypovolemia. Anemia is present in the postburn stage owing to blood loss and hemolysis, but it cannot be assessed until the client is adequately hydrated.

• Question 453:

  The nurse is aware that nutrition is an important aspect of care for a client with hepatitis. Which of the following diets would be most therapeutic?

  A. High protein and low carbohydrate
  B. Low calorie and low protein
  C. High carbohydrate and high calorie
  D. Low carbohydrate and high calorie
  C. High carbohydrate and high calorie

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  (A)

  Protein increases the workload of the liver. Increased carbohydrates provide needed calories and promote palatability. (B) Dietary intake should be adequate to ensure wound healing. (C) Increased carbohydrates provide needed calories.

  (D)

  A highcalorie diet is best obtained from carbohydrates because of their palatability. Fats increase the workload of the liver.

• Question 454:

  A 26-year-old male client is brought by his wife to the emergency department (ED) unconscious. Blood is drawn for a stat blood count (CBC), fasting blood sugar level, and electrolytes. An indwelling urinary catheter is inserted. He has a history of type 1 diabetes (insulindependent diabetes mellitus [IDDM]). A diagnosis of ketoacidosis is made. Stat lab values reveal a blood sugar level of 520 mg/dL. Which of the following should the nurse expect to administer in the ER?

  A. D50W by IV push
  B. NPH insulin SC
  C. Regular insulin by IV infusion
  D. Sweetened grape juice by mouth
  C. Regular insulin by IV infusion

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  (A) This action would further increase the client's blood sugar. (B) NPH insulin is an intermediate-acting insulin, with an average of 4? hours before onset of action. The client needs insulin that will act immediately. During a ketoacidotic state, the client is dehydrated, so any insulin administered SC will be poorly absorbed. (C) Regular insulin is the fastest acting-insulin; when given IV, it will immediately act to decrease blood sugar. Regular insulin is given to decrease blood glucose levels by promoting metabolism of glucose, inhibiting lipolysis and formation of ketone bodies. (D) This action would further increase the client's blood sugar.

• Question 455:

  Because a client is taking an MAO inhibitor, it is necessary to discuss the need for adherence to a low-tyramine diet. Which of the following are foods that she should avoid?

  A. Pickled, aged, smoked, and fermented foods
  B. Fresh vegetables
  C. Broiled fresh fish and fowl
  D. Fresh fruit such as apples and oranges
  A. Pickled, aged, smoked, and fermented foods

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  (A) These foods may produce elevation in blood pressure when consumed during MAO inhibition therapy. (B) These foods have not been pickled, fermented, smoked, or aged. They contain very little, if any, tyramine or tryptophan. (C) As long as the meat has not been aged or smoked, it is within the dietary regimen. (D) Fresh fruits can be consumed as desired. However, the consumption of bananas is limited.

• Question 456:

  Three weeks following discharge, a male client is readmitted to the psychiatric unit for depression. His wife stated that he had threatened to kill himself with a handgun. As the nurse admits him to the unit, he says, "I wish I were dead because I am worthless to everyone; I guess I am just no good." Which response by the nurse is most appropriate at this time?

  A. "I don't think you are worthless. I'm glad to see you, and we will help you."
  B. "Don't you think this is a sign of your illness?"
  C. "I know with your wife and new baby that you do have a lot to live for."
  D. "You've been feeling sad and alone for some time now?"
  D. "You've been feeling sad and alone for some time now?"

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  (A) This response does not acknowledge the client's feelings. (B) This is a closed question and does not encourage communication. (C) This response negates the client's feelings and does not require a response from the client. (D) This acknowledges the client's implied thoughts and feelings and encourages a response.

• Question 457:

  A 14-year-old boy fell off his bike while "popping a wheelie" on the dirt trails. He has sustained a head injury with laceration of his scalp over his temporal lobe. If he were to complain of headache during the first 24 hours of his hospitalization, the nurse would:

  A. Ask the physician to order a sedative
  B. Have the client describe his headache every 15 minutes
  C. Increase his fluid intake to 3000 mL/24 hr
  D. Offer diversionary activities
  D. Offer diversionary activities

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  (A) CNS depressants are not given for headache due to head injury because they would mask changes in neurological status and because they could further depress the CNS. (B) The client should not be asked to think about his headache every 15 minutes. (C) Fluid intake should be normal or restricted for a client with a head injury. Normal fluid intake for a 14 year old is about 2000?400 mL daily. (D) Diversion may help the child to focus on a pleasant activity instead of on his headache.

• Question 458:

  A pregnant client during labor is irritable and feels the urge to vomit. The nurse should recognize this as the:

  A. Fourth stage of labor
  B. Third stage of labor
  C. Transition stage of labor
  D. Second stage of labor
  C. Transition stage of labor

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  (A) The fourth stage begins after expulsion of the placenta. Client symptoms are: fatigue; chills; scant, bloody vaginal discharge; and nausea. (B) The third stage is from birth to expulsion of placenta. Client symptoms are uterine contractions, gush of blood, and perineal pain. (C) The transition stage is characterized by strong uterine contractions and cervical dilation. Clientsymptoms are irritability, restlessness, belching, muscle tremors, nausea, and vomiting. (D) The second stage is characterized by full dilation of cervix. Client symptoms are perineal bulge, pushing with contractions, great irritability, and leg cramps.

• Question 459:

  During the admitting mental health assessment, a client demonstrates involuntary muscular activity. He has a marked facial tic around the mouth that is distracting to the nurse during the interview. The nurse recognizes the behavior and documents it as:

  A. Dyskinesia
  B. Akathisia
  C. Echopraxia
  D. Echolalia
  A. Dyskinesia

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  (A) The client is demonstrating dyskinesia, which is involuntary muscular activity, such as tic, spasm, or myoclonus. (B) Akathisia is regular rhythmic movements usually of the lower limbs, such as constant motor restlessness. (C) Echopraxia is mimicking the movements of another person. (D) Echolalia is mimicking the speech of another person.

• Question 460:

  A male client is scheduled for a liver biopsy. In preparing him for this test, the nurse should:

  A. Explain that he will be kept NPO for 24 hours before the exam
  B. Practice with him so he will be able to hold his breath for 1 minute
  C. Explain that he will be receiving a laxative to prevent a distended bowel from applying pressure on the liver
  D. Explain that his vital signs will be checked frequently after the test
  D. Explain that his vital signs will be checked frequently after the test

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  (A) There is no NPO restriction prior to a liver biopsy. (B) The client would need to hold his breath for 5?0 seconds. (C) There is no pretest laxative given. (D) Following the test, the client is watched for hemorrhage and shock.