NCLEX NCLEX-RN Online Practice Questions and Exam Preparation

NCLEX NCLEX-RN Online Questions & Answers

• Question 551:

  A 40-year-old client has been admitted to the hospital with severe substernal chest pain radiating down his left arm. The nurse caring for the client establishes the following priority nursing diagnosis--Alteration in comfort, pain related to:

  A. Increased excretion of lactic acid due to myocardial hypoxia
  B. Increased blood flow through the coronary arteries
  C. Decreased stimulation of the sympathetic nervous system
  D. Decreased secretion of catecholamines secondary to anxiety
  A. Increased excretion of lactic acid due to myocardial hypoxia

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  (A) Anaerobic metabolism results because the decreased blood supply to the myocardium causes a release of lactic acid. Lactic acid is an irritant to the myocardial neural receptors, producing chest pain. (B) Chest pain is caused by a decrease in the O2 supply to the myocardial cells. Treatment modalities for chest pain are aimed toward increasing the blood flow through coronary arteries. (C) Chest pain causes an increase in the stimulation of the sympathetic nervous system. This stimulation increases the heart rate and blood pressure, causing an increase in myocardial workload aggravating the chest pain. (D) Chest pain and anxiety cause increased secretion of catecholamines by stimulating the sympathetic nervous system. This stimulation increases chest pain by increasing the workload of the heart.

• Question 552:

  A child is admitted with severe headache, fever, vomiting, photophobia, drowsiness, and stiff neck associated with viral meningitis. She will be more comfortable if the nurse:

  A. Dims the lights in her room
  B. Encourages her to breathe slowly and deeply
  C. Offers sips of warm liquids
  D. Places a large, soft pillow under her head
  A. Dims the lights in her room

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  (A) The discomfort of photophobia is alleviated by dimming the lights. (B) Helping the child to breathe slowly and deeply may help to reduce anxiety, but it will not alleviate other discomforts of viral meningitis. (C) It is important to maintain fluid balance, but sips of warm liquids do not alleviate the discomforts of meningitis. (D) A large, soft pillow under her head causing neck flexion is likely to increase her discomfort owing to stretching of the meninges.

• Question 553:

  A client is taught to eat foods high in potassium. Which food choices would indicate that this teaching has been successful?

  A. Pork chop, baked acorn squash, brussel sprouts
  B. Chicken breast, rice, and green beans
  C. Roast beef, baked potato, and diced carrots D. Tuna casserole, noodles, and spinach
  A. Pork chop, baked acorn squash, brussel sprouts

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  (A) Both acorn squash and brussels sprouts are potassium-rich foods. (B) None of these foods is considered potassium rich. (C) Only the baked potato is a potassium-rich food. (D) Spinach is the only potassium-rich food in this option.

• Question 554:

  A female client was recently diagnosed with gastric cancer. She entered the hospital and had a total gastrectomy with esophagojejunostomy. Her postoperative recovery was uneventful. On conducting discharge teaching, the nurse discusses changes in bodily function and lifestyle changes with the client. In order to prevent pernicious anemia, the nurse stresses that the client must:

  A. Receive monthly blood transfusions
  B. Increase the amount of iron in her diet
  C. Eat small quantities several times daily until she is able to tolerate food in moderate portions
  D. Understand the need for Vitamin B12 replacement therapy
  D. Understand the need for Vitamin B12 replacement therapy

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  (A) Monthly blood transfusions are not indicated postgastrectomy. (B) Increasing iron in the client's diet may cause irritation and will not alleviate pernicious anemia. (C) It may be necessary that the client eat small meals several times per day, but this measure has no relevance to prevention of pernicious anemia. (D) Pernicious anemia is caused by lack of Vitamin B12, and replacement therapy will be necessary because the client's stomach has been removed.

• Question 555:

  What is the most effective method to identify early breast cancer lumps?

  A. Mammograms every 3 years
  B. Yearly checkups performed by physician
  C. Ultrasounds every 3 years
  D. Monthly breast self-examination
  D. Monthly breast self-examination

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  (A) Mammograms are less effective than breast self-examination for the diagnosis of abnormalities in younger women, who have denser breast tissue. They are more effective forwomen older than 40. (B) Up to 15% of early-stage breast cancers are detected by physical examination; however, 95% are detected by women doing breast self- examination. (C) Ultrasound is used primarily to determine the location of cysts and to distinguish cysts from solid masses. (D) Monthly breast self-examination has been shown to be the most effective method for early detection of breast cancer. Approximately 95% of lumps are detected by women themselves.

• Question 556:

  A psychiatric client has been stabilized and is to be discharged. The nurse will recognize client insight and behavioral change by which of the following client statements?

  A. "When I get home, I will need to take my medicines and call my therapist if I have any side effects or begin to hear voices."
  B. "If I have any side effects from my medicines, I will take an extra dose of Cogentin."
  C. "When I get home, I should be able to taper myself off the Haldol because the voices are gone now."
  D. "As soon as I leave here, I'm throwing away my medicines. I never thought I needed them anyway."
  A. "When I get home, I will need to take my medicines and call my therapist if I have any side effects or begin to hear voices."

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  (A) The client verbalizes that he is responsible for compliance and keeping the treatment team member informed of progress. This behavior puts him at the lowest risk for relapse. (B) Noncompliance is a major cause of relapse. This statement reflects lack of responsibility for his own health maintenance. (C) This statement reflects lack of insight into the importance of compliance. (D) This statement reflects no insight into his illness or his responsibility in health maintenance.

• Question 557:

  A client is experiencing visual problems at school. She has complained of difficulty seeing the blackboard and squinting. She no longer likes to participate in physical activities such as softball. The client has displayed possible classic symptoms of which refractive error?

  A. Astigmatism
  B. Hyperopia
  C. Myopia
  D. Amblyopia
  C. Myopia

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  (A) Visual images are blurred and distorted. (B) Symptoms are headaches, burning eyes, fatigue, squinting, and difficulty reading. (C) These symptoms are classic for myopia. (D) Amblyopia is not a refractive error. It is a loss of vision in one or both eyes.

• Question 558:

  A husband asks if he can visit with his wife on her ECT treatment days and what to expect after the initial treatment. The nurse's best response is:

  A. "You'll have to get permission from the physician to visit. Clients are pretty sick after the first treatment."
  B. "Visitors are not allowed. We will telephone you to inform you of her progress."
  C. "There's really no need to stay with her. She's going to sleep for several hours after the treatment."
  D. "Yes, you may visit. She may experience temporary drowsiness, confusion, or memory loss after each treatment."
  D. "Yes, you may visit. She may experience temporary drowsiness, confusion, or memory loss after each treatment."

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  (A) It is within the nurse's realm of practice to grant visiting privileges according to hospital policy. ECT treatments do not make clients sick. (B) Visitors are allowed and encouraged, particularly family members. (C) Clients are usually awake within 1 hour posttreatment. Drowsiness wanes as the anesthetic wears off. (D) A family member is encouraged to stay with the client after return to the unit. The nurse has used an opportunity to do family teaching and allay fears by explaining temporary side effects of the treatment.

• Question 559:

  A 24-hours' postpartum client complains of discomfort at the episiotomy site. On assessment, the nurse notes the episiotomy is without signs of infection. To relieve the discomfort, the nurse should first:

  A. Assist her with a sitz bath
  B. Administer the prescribed medication for pain
  C. Teach her Kegel exercises
  D. Apply an ice pack
  A. Assist her with a sitz bath

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  (A) Warm, moist heat will promote circulation and provide comfort. A sitz bath should be tried before medication is given. (B) Pain medication can be given when other comfort measures such as a sitz bath and topical applications are ineffective. (C) Kegel exercises facilitate sitting by decreasing tension on the episiotomy. They will not be effective for pain control or sustained comfort level. (D) Ice packs are appropriate to apply in the first 12 hours postdelivery to produce vasoconstriction and to reduce edema to the area.

• Question 560:

  A client with a C-3? fracture has just arrived in the emergency room. The primary nursing intervention is:

  A. Stabilization of the cervical spine
  B. Airway assessment and stabilization
  C. Confirmation of spinal cord injury
  D. Normalization of intravascular volume
  B. Airway assessment and stabilization

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  (A) If cervical spine injury is suspected, the airway should be maintained using the jaw thrust method that also protects the cervical spine. (B) Primary intervention is protection of the airway and adequate ventilation. (C, D) All other interventions are secondary to adequate ventilation.