NCLEX NCLEX Certifications NCLEX-RN Questions & Answers

• Question 741:

  A client is being discharged with albuterol (Proventil) and beclomethasone dipropionate (Vanceril) to be administered via inhalation three times a day and at bedtime. Client teaching regarding the sequential order in which the drugs should be administered includes:

  A. Glucocorticoid followed by the bronchodilator

  B. Bronchodilator followed by the glucocorticoid

  C. Alternate successive administrations

  D. According to the client's preference

  Correct Answer: B

  (A) The client would not receive therapeutic effects of the glucocorticoid when it is inhaled through constricted airways. (B) Bronchodilating the airways first allows for the glucocorticoid to be inhaled through open airways and increases the penetration of the steroid for maximum effectiveness of the drug. (C) Inac- Inaccurate use of the inhalers will lead to decreased effectiveness of the treatment. (D) Client teaching regarding the use and effects of inhalers will promote client understanding and compliance.

• Question 742:

  A 23-year-old borderline client is admitted to an inpatient psychiatric unit following an impulsive act of self-mutilation. A few hours after admission, she requests special privileges, and when these are not granted, she stands up and angrily shouts that the people on the unit do not care, and she storms across the room. The nurse should respond to this behavior by:

  A. Placing her in seclusion until the behavior is under control

  B. Walking up to the client and touching her on the arm to get her attention

  C. Communicating a desire to assist the client to regain control, offering a one-to-one session in a quiet area

  D. Confronting the client, letting her know the consequences for getting angry and disrupting the unit

  Correct Answer: C

  (A)

  Threatening a client with punitive action is violating a client's rights and could escalate the client's anger. (B) Angry clients need respect for personal space, and physical contact may be perceived as a threatening gesture escalating anger.

  (C)

  Client lacks sufficient self- control to limit own maladaptive behavior; she may need assistance from staff. (D) Confronting an angry client may escalate her anger to further acting out, and consequences are for acting out anger aggressively, not for getting angry or feeling angry.

• Question 743:

  Nursing interventions designed to decrease the risk of infection in a client with an indwelling catheter include:

  A. Cleanse area around the meatus twice a day

  B. Empty the catheter drainage bag at least daily

  C. Change the catheter tubing and bag every 48 hours

  D. Maintain fluid intake of 1200?500 mL every day

  Correct Answer: A

  (A) Catheter site care is to be done at least twice daily to prevent pathogen growth at the catheter insertion site. (B) Catheter drainage bags are usually emptied every 8 hours to prevent urine stasis and pathogen growth. (C) Tubing and collection bags are not changed this often, because research studies have not demonstrated the efficacy of this practice. (D) Fluid intake needs to be in the 2000?500 mL range if possible to help irrigate the bladder and prevent infection.

• Question 744:

  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

  Correct Answer: C

  (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 745:

  A male client is started on IV anticoagulant therapy with heparin. Which of the following laboratory studies will be ordered to monitor the therapeutic effects of heparin?

  A. Partial thromboplastin time

  B. Hemoglobin

  C. Red blood cell (RBC) count

  D. Prothrombin time

  Correct Answer: A

  (A)

  Partial thromboplastin time is used to monitor the effects of heparin, and dosage is adjusted depending on test results. It is a screening test used to detect deficiencies in all plasma clotting factors except factors VII and XIII and platelets.

  (B)

  Hemoglobin is the main component of RBCs. Its main function is to carry O2from the lungs to the body tissues and to transport CO2back to the lungs. (C) RBC count is the determination of the number of RBCs found in each cubic millimeter of whole blood. (D) PT is used to monitor the effects of oral anticoagulants, e.g., coumarintype anticoagulants.

• Question 746:

  A 4-year-old child is being discharged from the hospital after being treated for severe croup. Which one of the following instructions should the nurse give to the child's mother for the home treatment of croup?

  A. Take him in the bathroom, turn on the hot water, and close the door.

  B. Give him a dose of antihistamine.

  C. Give large amounts of clear liquids if drooling occurs.

  D. Place him near a cool mist vaporizer and encourage crying.

  Correct Answer: A

  (A) Initial home treatment of croup includes placing the child in an environment of high humidity to liquefy and mobilize secretions. (B) Antihistamines should be avoided because they can cause thickening of secretions. (C) Drooling is a characteristic sign of airway obstruction and the child should be taken directly to the emergency room. (D) Crying increases respiratory distress and hypoxia in the child with croup. The nurse should promote methods that will calm the child.

• Question 747:

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

  A. High Fowler

  B. Prone

  C. Supine

  D. Right lateral

  Correct Answer: D

  (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 748:

  In assisting preconceptual clients, the nurse should teach that the corpus luteum secretes progesterone, which thickens the endometrial lining in which of the phases of the menstrual cycle?

  A. Menstrual phase

  B. Proliferative phase

  C. Secretory phase

  D. Ischemic phase

  Correct Answer: C

  (A) Menses occurs during the menstrual phase, during which levels of both estrogen and progesterone are decreased. (B) The ovarian hormone responsible for the proliferative phase, during which the uterine endometrium enlarges, is estrogen. (C) The ovarian hormone responsible for the secretory phase is progesterone, which is secreted by the corpus luteum and causes marked swelling in the uterine endometrium. (D) The corpus luteum begins to degenerate in the ischemic phase, causing a fall in both estrogen and progesterone.

• Question 749:

  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

  Correct Answer: D

  (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.

• Question 750:

  A client is admitted to the hospital for an induction of labor owing to a gestation of 42 weeks confirmed by dates and ultrasound. When she is dilated 3 cm, she has a contraction of 70 seconds. She is receiving oxytocin.

  The nurse's first intervention should be to:

  A. Check FHT

  B. Notify the attending physician

  C. Turn off the IV oxytocin

  D. Prepare for the delivery because the client is probably in transition

  Correct Answer: C

  (A) FHT should be monitored continuously with an induction of labor; this is an accepted standard of care. (B) The physician should be notified, but this is not the first intervention the nurse should do. (C) The standard of care for an induction according to the Association of Women's Health, Obstetric, and Neonatal Nurses and American College of Obstetrics and Gynecology is that contractions should not exceed 60 seconds in an induction. Inductions should simulate normal labor; 70-second contractions during the latent phase (3 cm) are not the norm. The next contractions can be longer and increase risks to the mother and fetus. (D) Contractions lasting 60?0 seconds during transition are typical; this provides a good distractor. The nurse needs to be knowledgeable of the phases and stages of labor.