NCLEX NCLEX-RN Online Practice Questions and Exam Preparation

NCLEX NCLEX-RN Online Questions & Answers

• Question 761:

  A 33-year-old client is diagnosed with bipolar disorder, acute phase. This is her first psychiatric hospitalization, and she is being evaluated for treatment with lithium. Which of the following diagnostic tests are essential prior to the initiation of lithium therapy with this client?

  A. Hematocrit, hemoglobin, and white blood cell (WBC) count
  B. Blood urea nitrogen, electrolytes, and creatinine
  C. Glucose, glucose tolerance test, and random blood sugar
  D. X-rays, electroencephalogram, and electrocardiogram (ECG)
  B. Blood urea nitrogen, electrolytes, and creatinine

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  (A) These are general diagnostic blood studies (usually done on admission), but they are not reliable indicators of lithium therapy clearance. (B) These are the primary diagnostic tests to determine kidney functioning. Because lithium is excreted through the kidneys and because it can be very toxic, adequate renal function must be ascertained before therapy begins. (C) These are diagnostic blood tests used to determine the presence of endocrine (not renal) dysfunction. (D) These are other types of diagnostic procedures used to determine musculoskeletal, neural, and cardiac (rather than renal) functioning.

• Question 762:

  The nurse is teaching a mother care of her child's spica cast. The mother states that he complains of itching under the edge of the cast. One nonpharmacological technique the nurse might suggest would be:

  A. "Blowing air under the cast using a hair dryer on cool setting often relieves itching."
  B. "Slide a ruler under the cast and scratch the area."
  C. "Guide a towel under and through the cast and move it back and forth to relieve the itch."
  D. "Gently thump on cast to dislodge dried skin that causes the itching."
  A. "Blowing air under the cast using a hair dryer on cool setting often relieves itching."

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  (A) Cool air will often relieve pruritus without damaging the cast or irritating the skin. (B) The nurse should never force anything under the cast, because the cast may become damaged and skin breakdown may occur. (C) Forcing an object under the cast could lead to cast damage and skin breakdown. The object may become lodged under the cast necessitating cast removal. (D) This technique does not dislodge skin cells. It could damage the cast and cause skin breakdown.

• Question 763:

  In assessing cardiovascular clients with progression of aortic stenosis, the nurse should be aware that there is typically:

  A. Decreased pulmonary blood flow and cyanosis
  B. Increased pressure in the pulmonary veins and pulmonary edema
  C. Systemic venous engorgement
  D. Increased left ventricular systolic pressures and hypertrophy
  D. Increased left ventricular systolic pressures and hypertrophy

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  (A) These signs are seen in pulmonic stenosis or in response to pulmonary congestion and edema and mitral stenosis. (B) These signs are seen primarily in mitral stenosis or as a late sign in aortic stenosis after left ventricular failure. (C) These signs are seen primarily in right-sided heart valve dysfunction. (D) Left ventricular hypertrophy occurs to increase muscle mass and overcome the stenosis; left ventricular pressures increase as left ventricular volume increases owing to insufficient emptying.

• Question 764:

  A pregnant woman at 36 weeks' gestation is followed for PIH and develops proteinuria. To increase protein in her diet, which of the following foods will provide the greatest amount of protein when added to her intake of 100 mL of milk?

  A. Fifty milliliters light cream and 2 tbsp corn syrup
  B. Thirty grams powdered skim milk and 1 egg
  C. One small scoop (90 g) vanilla ice cream and 1 tbsp chocolate syrup
  D. One package vitamin-fortified gelatin drink
  B. Thirty grams powdered skim milk and 1 egg

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  (A) This choice would provide more unwanted fat and sugar than protein. (B) Skim milk would add protein. Eggs are good sources of protein while low in fat and calories. (C) The benefit of protein from ice cream would be outweighed by the fat content. Chocolate syrup has caffeine, which is contraindicated or limited in pregnancy. (D) Although most animal proteins are higher in protein than plant proteins, gelatin is not. It loses protein during the processing for food consumption.

• Question 765:

  The nurse caring for a client who has pneumonia, which is caused by a gram-positive bacteria, inspects her sputum. Because the client's pneumonia is caused by a gram- positive bacteria, the nurse experts to find the sputum to be:

  A. Bright red with streaks
  B. Rust colored
  C. Green colored
  D. Pink-tinged and frothy
  B. Rust colored

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  (A) Bright red sputum with streaks is associated with pneumonia caused by gram-negative bacteria, such asKlebsiellapneumonia. (B) Pneumococcal pneumonia, caused by gram- positive bacteria, has a characteristic productive cough with green or rust-colored sputum. (C) Green-colored sputum is more characteristic ofPseudomonasthan of gram-positive bacterial pneumonia. (D) Pink-tinged and frothy sputum is more characteristic of pulmonary edema than of gram-positive bacterial pneumonia.

• Question 766:

  A client had a right below-the-knee amputation 4 days ago. He is complaining of pain in his right lower leg. The nurse should:

  A. Remind the client that he no longer has that part of his leg and assure him he will be OK
  B. Call the physician to request a psychological consultation for the client
  C. Turn on the television to distract the client's attention from his amputated leg
  D. Give the client his order of Demerol 50 mg IM prn
  D. Give the client his order of Demerol 50 mg IM prn

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  (A) The nurse is ignoring the client's pain. Telling the client that he will be OK will not relieve his phantom pain. (B) The client does not need a psychological consultation. Phantom pain is a normal sensation experienced by clients with amputations. (C) Using the television as a distractor will not relieve the client's phantom pain. (D) Phantom pain is a normal, very real experience for an amputee and should be treated with pain medication.

• Question 767:

  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
  C. Pericardial friction rub and pain on deep inspiration

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  (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 768:

  Following a gastric resection, which of the following actions would the nurse reinforce with the client in order to alleviate the distress from dumping syndrome?

  A. Eating three large meals a day
  B. Drinking small amounts of liquids with meals
  C. Taking a long walk after meals
  D. Eating a low-carbohydrate diet
  D. Eating a low-carbohydrate diet

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  (A) Six small meals are recommended. (B) Liquids after meals increase the time food empties from the stomach. (C) Lying down after meals is recommended to prevent gravity from producing dumping. (D) A low-carbohydrate diet will prevent a hypertonic bolus, which causes dumping.

• Question 769:

  A client is experiencing mucosal cell damage secondary to chemotherapy. Because of mucosal ulcers, eating has become increasingly uncomfortable for her. Which of the following interventions would be most effective in getting her to eat?

  A. Local anesthetics or mouth washes applied to ulcers 30 minutes prior to meals
  B. A bland, moist, soft diet
  C. Staying with the client and providing distraction during meals
  D. Cleaning the mouth carefully with lemon glycerin swabs and milk of magnesia before meals
  B. A bland, moist, soft diet

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  (A) Local anesthetics do temporarily relieve the pain but leave an unpleasant taste and numb feeling that are not conductive to eating. (B) Such a diet is less irritating to the damaged mucosa and is easier for the child to tolerate. (C) This intervention is helpful if the child has only anorexia. It does not work if the type and texture of the food increase oral discomfort. (D) Lemon glycerin swabs and milk of magnesia dry the oral mucosa and should be avoided.

• Question 770:

  A 74-year-old obese man who has undergone open reduction and internal fixation of the right hip is 8 days postoperative. He has a history of arthritis and atrial fibrillation. He admits to right lower leg pain, described as "a cramp in my leg." An appropriate nursing action is to:

  A. Assess for pain with plantiflexion
  B. Assess for edema and heat of the right leg
  C. Instruct him to rub the cramp out of his leg
  D. Elevate right lower extremity with pillows propped under the knee
  B. Assess for edema and heat of the right leg

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  (A) Calf pain with dorsiflexion of the foot (Homans' sign) can be a sign of a deep venous thrombosis; however, it is not diagnostic of the condition. (B) Swelling and warmth along the affected vein are commonly observed clinical manifestations of a deep venous thrombosis as a result of inflammation of the vessel wall. (C) Rubbing or massaging of the affected leg is contraindicated because of the risk of the clot breaking loose and becoming an embolus. (D) A pillow behind the knee can be constricting and further impair blood flow.