NCLEX NCLEX-RN Online Practice Questions and Exam Preparation

NCLEX NCLEX-RN Online Questions & Answers

• Question 581:

  A client's congestive heart failure has been treated, and he will soon be discharged. Discharge teaching should include instruction to call the physician if he notices a 2-lb weight gain in a 24-hour period. Increased weight gain may indicate:

  A. A diet too high in calories and saturated fat
  B. Decreasing cardiac output
  C. Decreasing renal function
  D. Development of diabetes insipidus
  B. Decreasing cardiac output

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  (A) Increased calories may result in weight gain, but there is no indication in this question that this man's diet has changed in a way that would result in increased calories. (B) Decreasing cardiac output stimulates the renin-angiotensinaldosterone cycle and results in fluid retention, which is reflected by weight gain. (C) Decreasing renal function may result in fluid retention, but this question gives no indication that this man has any renal problems. (D) Profound diuresis occurs with diabetes insipidus, which results in weight loss.

• Question 582:

  A client hospitalized with a medical diagnosis of adjustment disorder versus personality disorder states, "Nobody cares about the clients." The nurse's most effective response would be:

  A. "How can you say that I don't care? We just met."
  B. "What makes you think the nurses don't care?"
  C. "You will feel differently about us in a few days."
  D. "You seem angry. Tell me more about how you feel."
  D. "You seem angry. Tell me more about how you feel."

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  (A) This statement is a defensive response that places the nurse in a vulnerable countertransference position, and at the same time, fails to challenge the client's "splitting" behavior. (B) This statement is a defensive response by the nurse. In addition, this type of nontherapeutic statement requests that the client explain the reasons for her behavior, a difficult task for an individual with limited insight. (C) This statement is a nontherapeutic response that both ignores the intensity of the client's emotions and the dynamics underlying "splitting" behavior. (D) By simultaneously acknowledging the client's emotional intensity and gently challenging her "splitting" behavior, the nurse addresses the client's current distortions and prepares for further interventions with angry or ambivalent feelings.

• Question 583:

  A client is going to have a pneumonectomy in the morning. She had a previous negative surgical experience, is talking rapidly, and has an increased pulse and respiratory rate. Nursing interventions for this client should include:

  A. Providing opportunities to ask questions and talk about concerns
  B. Providing distractors such as reading or watching television
  C. Telling her that she should not be so nervous and assuring her that everything will be OK
  D. Reminding her that this surgery is not as extensive as her past surgery was
  A. Providing opportunities to ask questions and talk about concerns

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  (A) This intervention will help to clarify any misunderstandings about the surgery and give the client an opportunity to verbalize concerns about the surgery. (B) Distractors will not alleviate the preoperative anxiety that the client is experiencing. This response actually denies the client's anxiety. (C) This intervention is false assurance and denies that anxiety is a normal response to the threat of surgery. (D) Psychological responses are not directly related to the extent of the surgery, because they are influenced by the client's past experiences.

• Question 584:

  After a liver biopsy, the best position for the client is:

  A. High Fowler
  B. Prone
  C. Supine
  D. Right lateral
  D. Right lateral

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  (A) This position does not help to prevent bleeding. (B) This position does not help to prevent bleeding. (C) This position does not help to prevent bleeding. (D) The right lateral position would allow pressure on the liver to prevent bleeding.

• Question 585:

  A 5-year-old has just had a tonsillectomy and adenoidectomy. Which of these nursing measures should be included in the postoperative care?

  A. Encourage the child to cough up blood if present.
  B. Give warm clear liquids when fully alert.
  C. Have child gargle and do toothbrushing to remove old blood.
  D. Observe for evidence of bleeding.
  D. Observe for evidence of bleeding.

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  (A) The nurse should discourage the child from coughing, clearing the throat, or putting objects in his mouth. These may induce bleeding. (B) Cool, clear liquids may be given when child is fully alert. Warm liquids may dislodge a blood clot. The nurse should avoid red- or brown-colored liquids to distinguish fresh or old blood from ingested liquid should the child vomit. (C) Gargles and vigorous toothbrushing could initiate bleeding. (D) Postoperative hemorrhage, though unusual, may occur. The nurse should observe for bleeding by looking directly into the throat and for vomiting of bright red blood, continuous swallowing, and changes in vital signs.

• Question 586:

  During the active phase of rheumatic fever, the nurse teaches parents of a child with acute rheumatic fever to assist in minimizing joint pain and promoting healing by:

  A. Putting all joints through full range-of-motion twice daily
  B. Massaging the joints briskly with lotion or liniment after bath
  C. Immobilizing the joints in functional position using splints, rolls, and pillows
  D. Applying warm water bottle or heating pads over involved joints
  C. Immobilizing the joints in functional position using splints, rolls, and pillows

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  (A) Any movement of the joint causes severe pain. (B) Touching or moving the joint causes severe pain. (C) Immobilization in a functional position allows the joint to rest and heal. (D) Pressure from the warm water bottle or pads can cause severe pain or burning of the skin.

• Question 587:

  Nursing care of the infant prior to surgical closure of a meningomyelocele would include:

  A. Cover sac with dry sterile dressing
  B. Cover sac with saline-soaked sterile dressing
  C. Do not apply dressing; keep sac open to air
  D. Aspirate any fluid from sac
  B. Cover sac with saline-soaked sterile dressing

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  (A) A dry, sterile dressing would adhere to the sac, causing tissue damage. (B) A saline- soaked sterile dressing protects the sac from contamination by air and prevents drying. (C) A sac open to air causes drying and potential for contamination. (D) This intervention is not an independent nursing action.

• Question 588:

  A client presents to the emergency room with cyanosis, coughing, tachypnea, and tachycardia. She has a history of asthma. Arterial blood gas values are pH 7.28, PaO2 54, PaCO2 60, and HCO3 24. The nursing assessment of arterial blood gases indicate the presence of:

  A. Respiratory alkalosis
  B. Respiratory acidosis
  C. Metabolic alkalosis
  D. Metabolic acidosis
  B. Respiratory acidosis

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  (A) Respiratory alkalosis is determined by elevated pH and low PaCO2. (B) Respiratory acidosis is determined by low pH and elevated PaCO2. (C) Metabolic alkalosis is determined by elevated pH and HCO3. (D) Metabolic acidosis is determined by low pH and HCO3.

• Question 589:

  A 16-year-old student has a long history of bronchial asthma and has experienced several severe asthmatic attacks during the school year. The school nurse is required to administer 0.2 mL of 1/1000 solution of epinephrine SC during an asthma attack. How does the school nurse evaluate the effectiveness of this intervention?

  A. Increased pulse rate
  B. Increased expectorate of secretions
  C. Decreased inspiratory difficulty
  D. Increased respiratory rate
  C. Decreased inspiratory difficulty

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  (A) A side effect of epinephrine is fatal ventricular fibrillation owing to its effects on cardiac stimulation. (B) Medications used to treat asthma are designed to decrease bronchospasm, not to increase expectorate of secretions. (C) Epinephrine decreased inspiratory difficulty by stimulating -, 1, and 2-receptors causing sympathomimetic stimulation (e.g., bronchodilation). (D) The person with asthma fights to inspire sufficient air thus increasing respiratory rate.

• Question 590:

  A 30-year-old female client is receiving antineoplastic chemotherapy. Which of the following symptoms should especially concern the nurse when caring for her?

  A. Respiratory rate of 16 breaths/min
  B. Pulse rate of 80 bpm
  C. Complaints of muscle aches
  D. A sore throat
  D. A sore throat

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  (A) A respiratory rate of 16 breaths/min is normal and is not a cause for alarm. (B) A pulse rate of 80 bpm is normal and is not a cause for alarm. (C) Complaints of muscle aches are unrelated to her receiving chemotherapy. There may be other causes related to her hospital stay or the disease process. (D) A sore throat is an indication of a possible infection. A client receiving chemotherapy is at risk of neutropenia. An infection in the presence of neutropenia can result in a life-threatening situation.