NCLEX NCLEX Certifications NCLEX-RN Questions & Answers

• Question 761:

  A 68-year-old woman is admitted to the hospital with chronic obstructive pulmonary disease (COPD). She is started on an aminophylline infusion. Three days later she is breathing easier. A serum theophylline level is drawn. Which of the following values represents a therapeutic level?

  A. 14 μ g/mL

  B. 25 μ g/mL

  C. 4 μ g/mL

  D. 30 μ g/mL

  Correct Answer: A

  (A) The therapeutic blood level range of theophylline is 10

• Question 762:

  A pregnant client comes to the office for her first prenatal examination at 10 weeks. She has been pregnant twice before; the first delivery produced a viable baby girl at 39 weeks 3 years ago; the second pregnancy produced a viable baby boy at 36 weeks 2 years ago. Both children are living and well. Using the GTPAL system to record her obstetrical history, the nurse should record:

  A. 3-2-0-0-2

  B. 2-2-0-2-2

  C. 3-1-1-0-2

  D. 2-1-1-0-2

  Correct Answer: C

  (A) This answer is an incorrect application of the GTPAL method. One prior pregnancy was a preterm birth at 36 weeks (T =1, P= 1; not T = 2). (B) This answer is an incorrect application of the GTPAL method. The client is currently pregnant for the third time (G = 3, not 2), one prior pregnancy was preterm (T= 1, P= 1; not T= 2), and she has had no prior abortions (A =0). (C) This answer is the correct application of GTPAL method. The client is currently pregnant for the third time (G =3), her first pregnancy ended at term (>37 weeks) (T = 1), her second pregnancy ended preterm 20?3 weeks) (P = 1), she has no history of abortion (A=0), and she has two living children (L = 2). (D) This answer is an incorrect application of the GTPAL method. The client is currently pregnant for the third time (G =3, not 2).

• Question 763:

  The most important reason to closely assess circumferential burns at least every hour is that they may result in:

  A. Hypovolemia

  B. Renal damage

  C. Ventricular arrhythmias

  D. Loss of peripheral pulses

  Correct Answer: D

  (A) Hypovolemia could be a result of fluid loss from thermal injury, but not as a result of the circumferential injury. (B) Renal damage is typically seen because of prolonged hypovolemia or myoglobinuria. (C) Electrical injuries and electrolyte changes typically cause arrhythmias in the burn client. (D) Full-thickness circumferential burns are nonelastic and result in an internal tourniquet effect that compromises distal blood flow when the area involved is an extremity.Circumferential full-thickness torso burns compromise respiratory motion and, when extreme, cardiac return.

• Question 764:

  To appropriately monitor therapy and client progress, the nurse should be aware that increased myocardial work and O2 demand will occur with which of the following?

  A. Positive inotropic therapy

  B. Negative chronotropic therapy

  C. Increase in balance of myocardial O2 supply and demand

  D. Afterload reduction therapy

  Correct Answer: A

  (A) Inotropic therapy will increase contractility, which will increase myocardial O2 demand. (B) Decreased heart rate to the point of bradycardia will increase coronary artery filling time. This should be used cautiously because tachycardia may be a compensatory mechanism to increase cardiac output. (C) The goal in the care of the MI client with angina is to maintain a balance between myocardial O2 supply and demand. (D) Decrease in systemic vascular resistance by drug therapy, such as IV nitroglycerin or nitroprusside, or intra-aortic balloon pump therapy, would decrease myocardial work and O2 demand.

• Question 765:

  A client who has sustained a basilar skull fracture exhibits blood-tinged drainage from his nose. After establishing a clear airway, administering supplemental O2, and establishing IV access, the next nursing intervention would be to:

  A. Pass a nasogastric tube through the left nostril

  B. Place a 4 X 4 gauze in the nares to impede the flow

  C. Gently suction the nasal drainage to protect the airway

  D. Perform a halo test and glucose level on the drainage

  Correct Answer: D

  (A) Basilar skull fracture may cause dural lacerations, which result in CSF leaking from the ears or nose. Insertion of a tube could lead to CSF going into the brain tissue or sinuses. (B) Tamponading flow could worsen the problem and increase ICP. (C) Suction could increase brain damage and dislocate tissue. (D) Testing the fluid from the nares would determine the presence of CSF. Elevation of the head, notification of the medical staff, and prophylactic antibiotics are appropriate therapy.

• Question 766:

  Assessment of the client with pericarditis may reveal which of the following?

  A. Ventricular gallop and substernal chest pain

  B. Narrowed pulse pressure and shortness of breath

  C. Pericardial friction rub and pain on deep inspiration

  D. Pericardial tamponade and widened pulse pressure

  Correct Answer: C

  (A) No S3 or S4 are noted with pericarditis. (B) No change in pulse pressure occurs. (C) The symptoms of pericarditis vary with the cause, but they usually include chest pain, dyspnea, tachycardia, rise in temperature, and friction rub caused by fibrin or other deposits. The pain seen with pericarditis typically worsens with deep inspiration. (D) Tamponade is not typically seen early on, and no change in pulse pressure occurs.

• Question 767:

  During burn therapy, morphine is primarily administered IV for pain management because this route:

  A. Delays absorption to provide continuous pain relief

  B. Facilitates absorption because absorption from muscles is not dependable

  C. Allows for discontinuance of the medication if respiratory depression develops

  D. Avoids causing additional pain from IM injections

  Correct Answer: B

  (A) Absorption would be increased, not decreased. (B) IM injections should not be used until the client is hemodynamically stable and has adequate tissue perfusion. Medications will remain in the subcutaneous tissue with the fluid that is present in the interstitial spaces in the acute phase of the thermal injury. The client will have a poor response to the medication administered, and a "dumping" of the medication can occur when the medication and fluid are shifted back into the intravascular spaces in the next phase of healing. (C) IV administration of the medication would hasten respiratory compromise, if present. (D) The desire to avoid causing the client additional pain is not a primary reason for this route of administration.

• Question 768:

  A psychotic client who believes that he is God and rules all the universe is experiencing which type of delusion?

  A. Somatic

  B. Grandiose

  C. Persecutory

  D. Nihilistic

  Correct Answer: B

  (A) These delusions are related to the belief that an individual has an incurable illness. (B) These delusions are related to feelings of self-importance and uniqueness. (C) These delusions are related to feelings of being conspired against. (D) These delusions are related to denial of self-existence.

• Question 769:

  Which of the following ECG changes would be seen as a positive myocardial stress test response?

  A. Hyperacute T wave

  B. Prolongation of the PR interval

  C. ST-segment depression

  D. Pathological Q wave

  Correct Answer: C

  (A)

  Hyperacute T waves occur with hyperkalemia. (B) Prolongation of the P R interval occurs with first-degree AV block. (C) Horizontal ST-segment depression of>1 mm during exercise isdefinitely a positive criterion on the exercise ECG test.

  (D)

  Patho-logical Q waves occur with MI.

• Question 770:

  The therapeutic blood-level range for lithium is:

  A. 0.25

  Correct Answer: B

  (A) This range is too low to be therapeutic. (B) This is the therapeutic range for lithium. (C) This range is above the therapeutic level. (D) This range is toxic and may cause severe side effects.