NCLEX NCLEX Certifications NCLEX-RN Questions & Answers

• Question 771:

  A 25-year-old client believes she may be pregnant with her first child. She schedules an obstetric examination with the nurse practitioner to determine the status of her possible pregnancy. Her last menstrual period began May 20, and her estimated date of confinement using Nägele's rule is:

  A. March 27

  B. February 1

  C. February 27 D. January 3

  Correct Answer: C

  (A)March 27 is a miscalculation. (B) February 1 is a miscalculation. (C) February 27 is the correct answer. To calculate the estimated date of confinement using Nagele's rule, subtract 3 months from the date that the last menstrual cycle began and then add 7 days to the result. (D) January 3 is a miscalculation.

• Question 772:

  The medication that best penetrates eschar is:

  A. Mafenide acetate (Sulfamylon)

  B. Silver sulfadiazine (Silvadene)

  C. Neomycin sulfate (Neosporin)

  D. Povidone-iodine (Betadine)

  Correct Answer: A

  (A) Mafenide acetate is bacteriostatic against gram-positive and gram-negative organisms and is the agent that best penetrates eschar. (B) Silver sulfadiazine poorly penetrates eschar. (C) Neomycin sulfate does not penetrate eschar. (D) Povidoneiodine does not penetrate eschar.

• Question 773:

  A 3-year-old child is hospitalized with burns covering her trunk and lower extremities. Which of the following would the nurse use to assess adequacy of fluid resuscitation in the burned child?

  A. Blood pressure

  B. Serum potassium level

  C. Urine output

  D. Pulse rate

  Correct Answer: C

  (A) Blood pressure can remain normotensive even in a state of hypovolemia. (B) Serum potassium is not reliable for determining adequacy of fluid resuscitation. (C) Urine output, alteration in sensorium, and capillary refill are the most reliable indicators for assessing adequacy of fluid resuscitation. (D) Pulse rate may vary for many reasons and is not a reliable indicator for assessing adequacy of fluid resuscitation.

• Question 774:

  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

  Correct Answer: B

  (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 775:

  Pregnant women with diabetes often have problems related to the effectiveness of insulin in controlling their glucose levels during their second half of pregnancy. The nurse teaches the client that this is due to:

  A. Decreased glomerular filtration and increased tubular absorption

  B. Decreased estrogen levels

  C. Decreased progesterone levels

  D. Increased human placental lactogen levels

  Correct Answer: D

  (A) There is a rise in glomerular filtration rate in the kidneys in conjunction with decreased tubular glucose reabsorption, resulting in glycosuria. (B) Insulin is inhibited by increased levels of estrogen. (C) Insulin is inhibited by increased levels of progesterone. (D) Human placental lactogen levels increase later in pregnancy. This hormonal antagonist reduces insulin's effectiveness, stimulates lipolysis, and increases the circulation of free fatty acids.

• Question 776:

  Which of the following procedures is necessary to establish a definitive diagnosis of breast cancer?

  A. Diaphanography

  B. Mammography

  C. Thermography

  D. Breast tissue biopsy

  Correct Answer: D

  (A) Diaphanography, also known as transillumination, is a painless, noninvasive imaging technique that involves shining a light source through the breast tissue to visualize the interior. It must be used in conjunction with a mammogram and physical examination. (B) Mammography is a useful tool for screening but is not considered a means of diagnosing breast cancers. (C) Thermography is a pictorial representation of heat patterns on the surface of the breast. Breast cancers appear as a "hot spot" owing to their higher metabolic rate. (D) Biopsy either by needle aspiration or by surgical incision is the primary diagnostic technique for confirming the presence of cancer cells.

• Question 777:

  Which of the following medications requires close observation for bronchospasm in the client with chronic obstructive pulmonary disease or asthma?

  A. Verapamil (Isoptin)

  B. Amrinone (Inocor)

  C. Epinephrine (Adrenalin)

  D. Propranolol (Inderal)

  Correct Answer: D

  (A) Verapamil has the respiratory side effect of nasal or chest congestion, dyspnea, shortness of breath (SOB), and wheezing. (B) Amrinone has the effect of increased contractility and dilation of the vascular smooth muscle. It has no noted respiratory side effects. (C) Epinephrine has the effect of bronchodilation through stimulation. (D) Propranolol, esmolol, and labetalol are all - blocking agents, which can increase airway resistance and cause bronchospasms.

• Question 778:

  The nurse practitioner determines that a client is approximately 9 weeks' gestation. During the visit, the practitioner informs the client about symptoms of physical changes that she will experience during her first trimester, such as:

  A. Nausea and vomiting

  B. Quickening

  C. A 6? lb weight gain

  D. Abdominal enlargement

  Correct Answer: A

  (A) Nausea and vomiting are experienced by almost half of all pregnant women during the first 3 months of pregnancy as a result of elevated human chorionic gonadotropin levels and changed carbohydrate metabolism. (B) Quickening is the mother's perception of fetal movement and generally does not occur until 18?0 weeks after the last menstrual period in primigravidas, but it may occur as early as 16 weeks in multigravidas. (C) During the first trimester there should be only a modest weight gain of 2? lb. It is not uncommon for women to lose weight during the first trimester owing to nausea and/or vomiting. (D) Physical changes are not apparent until the second trimester, when the uterus rises out of the pelvis.

• Question 779:

  The nurse notes hyperventilation in a client with a thermal injury. She recognizes that this may be a reaction to which of the following medications if applied in large amounts?

  A. Neosporin sulfate

  B. Mafenide acetate

  C. Silver sulfadiazine

  D. Povidone-iodine

  Correct Answer: B

  (A) The side effects of neomycin sulfate include rash, urticaria, nephrotoxicity, and ototoxicity. (B) The side effects of mafenide acetate include bone marrow suppression, hemolytic anemia, eosinophilia, and metabolic acidosis. The hyperventilation is a compensatory response to the metabolic acidosis. (C) The side effects of silver sulfadiazine include rash, itching, leukopenia, and decreased renal function. (D) The primary side effect of povidone- iodine is decreased renal function.

• Question 780:

  The physician has ordered that a daily exercise program be instituted by a client with type I diabetes following his discharge from the hospital. Discharge instructions about exercise should include which of the following?

  A. Exercise should be performed 30 minutes before meals.

  B. A snack may be needed before and/or during exercise.

  C. Hyperglycemia may occur 2? hours after exercise.

  D. The blood glucose level should be 100 mg or below before exercise is begun.

  Correct Answer: B

  (A) Exercise should not be performed before meals because the blood sugar is usually lower just prior to eating; therefore, there is an increased risk for hypoglycemia. (B) Exercise lowers blood sugar levels; therefore, a snack may be needed to maintain the appropriate glucose level. (C) Exercise lowers blood sugar levels. (D) Exercise lowers blood sugar levels. If the blood glucose level is 100 mg or below at the start of exercise, the potential for hypoglycemia is greater.