NCLEX NCLEX Certifications NCLEX-RN Questions & Answers

• Question 611:

  A client's physician has prescribed theophylline (Theo- Dur) to help control the bronchospasm associated with the client's COPD. Instructions that should be given to the client include:

  A. "Call your physician if you develop palpitations, dizziness, or restlessness.''

  B. "Cigarette smoking may significantly increase the risk for theophylline toxicity.''

  C. "Take this medication on an empty stomach.''

  D. "Do not take your medicine if your pulse is less than 60 beats per minute.''

  Correct Answer: A

  (A) Indications of theophylline toxicity include palpitations, dizziness, restlessness, nausea, vomiting, shakiness, and anorexia. (B) Cigarette smoking significantly lowers theophylline plasma levels. (C) Theophylline should be taken with food to decrease stomach upset. (D) These instructions are appropriate for someone taking digoxin.

• Question 612:

  A client suspects that she is pregnant. She reports two missed menstrual periods. The first day of her last menstrual period was August 3. Her estimated date of confinement would be:

  A. November 7

  B. November 10

  C. May 7

  D. May 10

  Correct Answer: D

  (A) Wrong calculation (B) Wrong calculation (C) Wrong calculation (D) N鋑ele's rule is: Expected Date of Confinement = Last Menstrual Period - 3 months + 7 days + 1 year

• Question 613:

  Assessment of a newborn for Apgar scoring includes observation for:

  A. Pupil response

  B. Respiratory rate

  C. Heart rate

  D. Babinski's reflex

  Correct Answer: C

  (A) Pupil response should be assessed but is not part of Apgar scoring. (B) Respiratory effort is an essential part of Apgar scoring, not respiratory rate. (C) Heart rate is the most critical component of Apgar scoring. (D) Assessment of Babinski's reflex is not a component of Apgar scoring.

• Question 614:

  A newborn has been delivered with a meningomyelocele. The nursery nurse should position the newborn:

  A. Prone

  B. Supine C. Side lying

  D. Semi-Fowler

  Correct Answer: A

  (A) The prone position reduces pressure and tension on the sac. Primary nursing goals are to prevent trauma and infection of the sac. (B) The supine position exerts pressure on the sac. (C) Newborns usually cannot maintain side-lying position. (D) The semi- Fowler position exerts pressure on the sac.

• Question 615:

  A female client who has chronic obstructive pulmonary disease (COPD) has presented in the emergency department with cough productive of yellow sputum and increasing shortness of breath. On room air, her blood gases are as follows: pH

  7.30 mm Hg, PCO2 60 mm Hg, PO2 55 mm Hg, HCO3 32 mEq/L. These arterial blood gases reflect:

  A. Compensated respiratory acidosis

  B. Normal blood gases

  C. Uncompensated metabolic acidosis

  D. Uncompensated respiratory acidosis

  Correct Answer: D

  (A) In compensated respiratory acidosis, the pH level is normal, the PCO2level is elevated, and the HCO3level is elevated. The client's primary alteration is an inability to remove CO2from the lungs, so over time, the kidneys increase reabsorption of HCO3to buffer the CO2. (B) Normal ranges for arterial blood gases for adults and children are as follows: pH 7.35?.45, PO280?00 mm Hg, PCO235?5 mm Hg, HCO321?8 mEq/L. (C) In uncompensated metabolic acidosis the pH level is decreased, the PCO2level is normal, and the HCO3level is decreased. The client's primary alteration is an inability to remove excess acid via the kidneys. The lungs are unable to clear the increased acid. (D) In uncompensated respiratory acidosis, the pH level is decreased, the PCO2level is increased, and the HCO3level is normal. In a person with long-standing COPD, the HCO3level will rise gradually over time to compensate for the gradually increasing PCO2, and the person's pH level will be normal. When a person with COPD becomes acutely ill, the kidneys do not have time to increase the reabsorption of HCO3, so the person's pH level will reflect acidosis even though the HCO3is elevated.

• Question 616:

  A 60-year-old male client was hospitalized 3 days ago with the diagnosis of acute anterior wall myocardial infarction. Today he has been complaining of increasing weakness and shortness of breath. Crackles in both lung bases are audible on auscultation. He is developing:

  A. An extension of his myocardial infarction

  B. Pneumonia

  C. Pulmonary edema

  D. Pulmonary emboli

  Correct Answer: C

  (A) Extensions of his myocardial infarction would be chest pain unrelieved with nitroglycerin, cardiac enzyme elevations, and electrocardiographic changes. (B) Persons with pneumonia may complain of weakness and shortness of breath and have crackles in their lung bases. However, they would also have sputum production and leukocytosis. (C) Persons who have had myocardial infarctions (especially anterior wall) are at risk of developing left ventricular heart failure, which is a major cause of pulmonary edema. Pulmonary edema is manifest by shortness of breath, weakness, and crackles on auscultation of the lung fields. (D) Pulmonary emboli may be accompanied by shortness of breath, weakness, and crackles. However, the pulmonary hypertension that accompanies pulmonary emboli results in signs of increased systemic venous pressure as well.

• Question 617:

  A 40-year-old client is admitted to the hospital for tests to diagnose cancer. Since his admission, he has become dependent and demanding to the nursing staff. The nurse identifies this behavior as which defense mechanism?

  A. Denial

  B. Displacement

  C. Regression

  D. Projection

  Correct Answer: C

  (A) Denial is the disowning of consciously intolerable thoughts. (B) Displacement is the referring of a feeling or emotion from one person, object, or idea to another. (C) Regression is returning to an earlier stage of development. (D) Projection is attributing one's own thoughts, feelings, or impulses to another person.

• Question 618:

  On admission, the client has signs and symptoms of pulmonary edema. The nurse places the client in the most appropriate position for a client in pulmonary edema, which is:

  A. High Fowler

  B. Lying on the left side

  C. Sitting in a chair

  D. Supine with feet elevated

  Correct Answer: A

  (A) High Fowler position decreases venous return to the heart and permits greater lung expansion so that oxygenation is maximized. (B) Lying on the left side may improve perfusion to the left lung but does not promote lung expansion. (C) Sitting in a chair will decrease venous return and promote maximal lung expansion. However, clients with pulmonary edema can deteriorate quickly and require intubation and mechanical ventilation. If a client is sitting in achair when this deterioration happens, it will be difficult to intervene quickly. (D) The supine with feet elevated position increases venous return and will worsen pulmonary edema.

• Question 619:

  A client experiencing delusions states, "I came here because there were people surrounding my house that wanted to take me away and use my body for science." The best response by the nurse would be:

  A. "Describe the people surrounding your house that want to take you away."

  B. "I need more information on why you think others want to use your body for science."

  C. "There were no people surrounding your house, your relatives brought you here, and no one really wants your body for science."

  D. "I know that must be frightening for you; let the staff know when you are having thoughts that trouble you."

  Correct Answer: D

  (A) Focusing on the delusional content does not reinforce reality. (B) Pursuing details or more information on the delusion reinforces the false belief and further distances the client from reality. (C) Challenging the client's delusional system may force the client to defend it, and you cannot change the delusion through logic. (D) Focusing on the feeling can reinforce reality and discourage the false belief. Seeking out staff when thoughts are troublesome can help to decrease anxiety.

• Question 620:

  After the RN is finished the initial assessment of a newborn baby and after the initial bonding between the newborn and the mother has taken place in the delivery room, the RN will bring the newborn to the well-baby nursery. Before the newborn is taken from the delivery room and brought to the well-baby nursery, the RN makes sure that which of the following interventions was completed?

  A. The physician verifies the exact time of birth.

  B. The nurse counts the instruments and sponges with the scrub nurse.

  C. The nurse instills prophylactic ointment in the conjunctival sacs of the newborn's eyes.

  D. The nurse makes sure the mother and her newborn have been tagged with identical bands.

  Correct Answer: D

  (A) The delivery room personnel are responsible for verifying time of birth. (B) The scrub and circulating nurses count sponges and instruments. (C) This intervention is done in the nursery. (D) Tagging the mother and infant with identical bands is of utmost importance. The mother wears one band, and the newborn wears two. Identical numbers on the three bands provide identification for the newborn and the birth mother. Every time the newborn is brought to the mother after delivery, those bands are checked to be sure that the numbers are identical.