NCLEX NCLEX-RN Online Practice Questions and Exam Preparation

NCLEX NCLEX-RN Online Questions & Answers

• Question 521:

  A client has chronic obstructive pulmonary disease. She is slowly losing weight, and her daughter is very concerned about increasing her nutrition. The nurse helps the daughter devise a plan of care for her mother. The plan of care should include which of the following interventions to promote nutrition?

  A. Offer her oral hygiene before and after meals.
  B. Encourage her to consume milk products.
  C. Encourage her to engage in an activity before a meal to stimulate her appetite.
  D. Restrict her fluid intake to three glasses of water a day.
  A. Offer her oral hygiene before and after meals.

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  (A) Clients with respiratory diseases are generally mouth breathers. Cleaning the oral cavity may improve the client's appetite, increase her feelings of well-being, and remove the taste and odor of sputum. (B) Milk causes thick sputum; therefore, milk products would not be beneficial for this client. (C) Exercise prior to a meal would require increased O2 consumption and most likely would decrease the client's ability to eat. (D) Clients with respiratory diseases need increased fluid to liquefy secretions.

• Question 522:

  A client with IDDM is given IV insulin for a blood glucose level of 520 mg/dL. Life- threatening complications may occur initially, so the nurse will monitor him closely for serum:

  A. Chloride level of 99 mEq/L
  B. Sodium level of 136 mEq/L
  C. Potassium level of 3.1 mEq/L
  D. Potassium level of 6.3 mEq/L
  D. Potassium level of 6.3 mEq/L

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  (A) The chloride level is within acceptable limits. (B) The sodium level is within acceptable limits. (C) This value indicates hypokalemia, rather than the hyperkalemia that occurs during diabetic ketoacidosis. (D) When diabetic ketoacidosis exists, intracellular dehydration occurs and potassium leaves the cells and enters the vascular system, thus increasing the serum level beyond an acceptable range. When insulin and fluids are administered, cell walls are repaired and potassium is transported back into the cells. Normal serum potassium levels range from 3.5?.0 mEq/L.

• Question 523:

  Which of the following menu choices would indicate that a client with pressure ulcers understands the role diet plays in restoring her albumin levels?

  A. Broiled fish with rice
  B. Bran flakes with fresh peaches
  C. Lasagna with garlic bread
  D. Cauliflower and lettuce salad
  A. Broiled fish with rice

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  (A) Broiled fish and rice are both excellent sources of protein. (B) Fresh fruits are not a good source of protein. (C) Foods in the bread group are not high in protein. (D) Most vegetables are not high in protein; peas and beans are the major vegetables higher in protein.

• Question 524:

  A male client has heart failure. He has been instructed to gradually increase his activities. Which signs and symptoms of worsening heart failure should the nurse tell him to watch for that would indicate a need for him to lower his activity level?

  A. Pain in his legs when he walks
  B. Thirst, weight loss, and polyuria
  C. Drowsiness and lethargy after his activities
  D. Weight gain, edema in his lower extremities, and shortness of breath
  D. Weight gain, edema in his lower extremities, and shortness of breath

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  (A) Pain in the legs could be indicative of doing too much too quickly, but not of worsening heart failure. The client should be cautioned to increase his activities slowly. (B) Thirst, weight loss, and frequent urination are not indicative of heart failure. The client should report these symptoms to his physician. (C) Drowsiness and lethargy are not indicative of worsening heart failure. The client should report these symptoms to his physician. (D) All of these symptoms indicate a worsening cardiac condition possibly associated with too much activity. The client's activity level should be evaluated.

• Question 525:

  Prenatal clients are routinely monitored for early signs of pregnancy-induced hypertension (PIH). For the prenatal client, which of the following blood pressure changes from baseline would be most significant for the nurse to report as indicative of PIH?

  A. 136/88 to 144/93
  B. 132/78 to 124/76
  C. 114/70 to 140/88
  D. 140/90 to 148/98
  C. 114/70 to 140/88

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  (A) These blood pressure changes reflect only an 8 mm Hg systolic and a 5 mm Hg diastolic increase, which is insufficient for blood pressure changes indicating PIH. (B) These blood pressure changes reflect a decrease in systolic pressure of 8 mm Hg and diastolic pressure of 2 mm Hg; these values are not indicative of blood pressure increases reflecting PIH. (C) The definition of PIH is an increase in systolic blood pressure of 30 mm Hg and/or diastolic blood pressure of 15 mm Hg. These blood pressures reflect a change of 26 mm Hg systolically and 18mm Hg diastolically. (D) These blood pressures reflect a change of only 8 mm Hg systolically and 8 mm Hg diastolically, which is insufficient for blood pressure changes indicating PIH.

• Question 526:

  A 71-year-old client fell and injured her left leg while cooking in the kitchen. Her husband calls the ambulance, and she is taken to the emergency department at a local hospital. X- ray reports confirm that she has an intertrochanteric fracture of the left femur. Her left leg will require skeletal traction initially and then surgery. The nurse knows that this type of traction will be used:

  A. By inserting pins to provide steady pull on the bone
  B. To suspend the leg in a sling without pull on the extremity
  C. Intermittently to place a pull over the pelvis and lower spine
  D. With weights at both ends of the bed to maintain pull on the upper extremity
  A. By inserting pins to provide steady pull on the bone

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  (A) Skeletal traction is the application of traction directly to bone with the use of pins and wires or tongs for the purpose of providing a strong, steady, continuous longitudinal pull on the bone. It is indicated for preoperative immobilization and positioning of hip and femur fractures. (B) A type of skeletal traction (balanced suspension with a Thomas splint and Pearson attachment) uses a sling to support the extremity, but it also uses weights to provide a strong, steady continuouspull on the extremity. A sling is used instead of pins. (C) Pelvic traction provides an intermittent pull over the pelvis and bone, whereas skeletal traction is continuous. Pelvic traction does not use pins. (D) Skeletal traction uses weights at the end of the bed to provide a continuous pull on long bones. Weights are not applied to both ends of the bed.

• Question 527:

  One of the most dramatic and serious complications associated with bacterial meningitis is Waterhouse- Friderichsen syndrome, which is:

  A. Peripheral circulatory collapse
  B. Syndrome of inappropriate antiduretic hormone
  C. Cerebral edema resulting in hydrocephalus
  D. Auditory nerve damage resulting in permanent hearing loss
  A. Peripheral circulatory collapse

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  (A) Waterhouse-Friderichsen syndrome is peripheral circulatory collapse, which may result in extensive and diffuse intravascular coagulation and thrombocytopenia resulting in death. (B) Syndrome of inappropriate antidiuretic hormone is a complication of meningitis, but it is not Waterhouse-Friderichsen syndrome. (C) Cerebral edema resulting in hydrocephalus is a complication of meningitis, but it is not Waterhouse-Friderichsen syndrome. (D) Auditory nerve damage resulting in permanent hearing loss is a complication of meningitis, but it is not Waterhouse- Friderichsen syndrome.

• Question 528:

  Priapism may be a sign of:

  A. Altered neurological function
  B. Imminent death
  C. Urinary incontinence
  D. Reproductive dysfunction
  A. Altered neurological function

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  (A) Priapism in the trauma client is due to the neurological dysfunction seen in spinal cord injury. Priapism is an abnormal erection of the penis; it may be accompanied by pain and tenderness. This may disappear as spinal cord edema is relieved. (B) Priapism is not associated with death. (C) Urinary retention, rather than incontinence, may occur. (D) Reproductive dysfunction may be a secondary problem.

• Question 529:

  At 12 hours postvaginal delivery, a female client is without complications. Which of the following assessment findings would warrant further nursing interventions?

  A. Apical pulse of 52 bpm
  B. Uterine fundus palpable left of midline
  C. No bowel movement since delivery
  D. Oral temperature of 100.4F
  B. Uterine fundus palpable left of midline

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  (A) Bradycardia of 50?0 bpm may be considered normal postpartally because the heart compensates for the decreased resistance in the pelvis. (B) The uterus is displaced from the midline by a full bladder. This condition could lead to a boggy uterus and increased risk of postpartal hemorrhage; therefore, the bladder should be kept empty. (C) Re- establishment of normal bowel function is delayed into the first postpartum week. (D) A postpartum woman's oral temperature may go as high as 100.4_F within 24 hours of delivery resulting from muscular exertion, dehydration, and hormonal changes.

• Question 530:

  The nurse would need to monitor the serum glucose levels of a client receiving which of the following medications, owing to its effects on glycogenolysis and insulin release?

  A. Norepinephrine (Levophed)
  B. Dobutamine (Dobutrex)
  C. Propranolol (Inderal)
  D. Epinephrine (Adrenalin)
  D. Epinephrine (Adrenalin)

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  (A) Norepinephrine's side effects are primarily related to safe, effective care environment and include decreased peripheral perfusion and bradycardia. (B) Dobutamine's side effects include increased heart rate and blood pressure, ventricular ectopy, nausea, and headache. (C) Propranolol's side effects include elevated blood urea nitrogen, serum transaminase, alkaline phosphatase, and lactic dehydrogenase. (D) Epinephrine increases serum glucose levels by increasing glycogenolysis and inhibiting insulin release. Prolonged use can elevate serum lactate levels, leading to metabolic acidosis, increased urinary catecholamines, false elevation of blood urea nitrogen, and decreased coagulation time.