NCLEX NCLEX Certifications NCLEX-RN Questions & Answers

• Question 841:

  When administering phenytoin (Dilantin) to a child, the nurse should be aware that a toxic effect of phenytoin therapy is:

  A. Stephens-Johnson syndrome

  B. Folate deficiency

  C. Leukopenic aplastic anemia

  D. Granulocytosis and nephrosis

  Correct Answer: A

  (A) Stephens-Johnson syndrome is a toxic effect of phenytoin. (B) Folate deficiency is a side effect of phenytoin, but not a toxic effect. (C) Leukopenic aplastic anemia is a toxic effect of carbamazepine (Tegretol). (D) Granulocytosis and nephrosis are toxic effects of trimethadione (Tridione).

• Question 842:

  An 8-year-old child comes to the physician's office complaining of swelling and pain in the knees. His mother says, "The swelling occurred for no reason, and it keeps getting worse." The initial diagnosis is Lyme disease. When talking to the mother and child, questions related to which of the following would be important to include in the initial history?

  A. A decreased urinary output and flank pain

  B. A fever of over 103F occurring over the last 2? weeks

  C. Rashes covering the palms of the hands and the soles of the feet

  D. Headaches, malaise, or sore throat

  Correct Answer: D

  (A) Urinary tract symptoms are not commonly associated with Lyme disease. (B) A fever of 103F is not characteristic of Lyme disease. (C) The rash that is associated with Lyme diseasedoes not appear on the palms of the hands and the soles of the feet. (D) Classic symptoms of Lyme disease include headache, malaise, fatigue, anorexia, stiff neck, generalized lymphadenopathy, splenomegaly, conjunctivitis, sore throat, abdominal pain, and cough.

• Question 843:

  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

  Correct Answer: D

  (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 844:

  Clinical manifestations seen in left-sided rather than in right-sided heart failure are:

  A. Elevated central venous pressure and peripheral edema

  B. Dyspnea and jaundice

  C. Hypotension and hepatomegaly

  D. Decreased peripheral perfusion and rales

  Correct Answer: D

  (A, B, C) Clinical manifestations of right-sided heart failure are weakness, peripheral edema, jugular venous distention, hepatomegaly, jaundice, and elevated central venous pressure. (D) Clinical manifestations of left-sided heart failure are left ventricular dysfunction, decreased cardiac output, hypotension, and the backward failure as a result of increased left atrium and pulmonary artery pressures, pulmonary edema, and rales.

• Question 845:

  In a client with chest trauma, the nurse needs to evaluate mediastinal position. This can best be done by:

  A. Auscultating bilateral breath sounds

  B. Palpating for presence of crepitus

  C. Palpating for trachial deviation

  D. Auscultating heart sounds

  Correct Answer: C

  (A) No change in the breath sounds occurs as a direct result of the mediastinal shift. (B) Crepitus can occur owing to the primary disorder, not to the mediastinal shift. (C) Mediastinal shift occurs primarily with tension pneumothorax, but it can occur with very large hemothorax or pneumothorax. Mediastinal shift causes trachial deviation and deviation of the heart's point of maximum impulse. (D) No change in the heart sounds occurs as a result of the mediastinal shift.

• Question 846:

  The nurse assists a client with advanced emphysema to the bathroom. The client becomes extremely short of breath while returning to bed. The nurse should:

  A. Increase his nasal O2 to 6 L/min

  B. Place him in a lateral Sims' position

  C. Encourage pursed-lip breathing D. Have him breathe into a paper bag

  Correct Answer: C

  (A) Giving too high a concentration of O2 to a client with em-physema may remove his stimulus to breathe. (B) The client should sit forward with his hands on his knees or an overbed table and with shoulders elevated. (C) Pursed-lip breathing helps the client to blow off CO2 and to keep air passages open. (D) Covering the face of a client extremely short of breath may cause anxiety and further increase dyspnea.

• Question 847:

  When teaching a sex education class, the nurse identifies the most common STDs in the United States as:

  A. Chlamydia

  B. Herpes genitalis

  C. Syphilis

  D. Gonorrhea

  Correct Answer: A

  (A)

  Chlamydia trachomatis infection is the most common STD in the United States. The Centers for Disease Control and Prevention recommend screening of all high-risk women, such as adolescents and women with multiple sex partners.

  (B)

  Herpes simplex genitalia is estimated to be found in 5?0 million people in the United States and is rising in occurrence yearly. (C) Syphilis is a chronic infection caused by Treponema pallidum. Over the last several years the number of people infected has begun to increase. (D) Gonorrhea is a bacterial infection caused by the organism Neisseria gonorrhoeae. Although gonorrhea is common, chlamydia is still the most common STD.

• Question 848:

  A schizophrenic client has made sexual overtures toward her physician on numerous occasions. During lunch, the client tells the nurse, "My doctor is in love with me and wants to marry me." This client is using which of the following defense mechanisms?

  A. Displacement

  B. Projection

  C. Reaction formation

  D. Suppression

  Correct Answer: B

  (A) Displacement involves transferring feelings to a more acceptable object. (B) Projection involves attributing one's thoughts or feelings to another person. (C) Reaction formation involves transforming an unacceptable impulse into the opposite behavior. (D) Suppression involves the intentional exclusion of unpleasant thoughts or experiences.

• Question 849:

  A 55-year-old man is admitted to the hospital with complaints of fatigue, jaundice, anorexia, and clay-colored stools. His admitting diagnosis is "rule out hepatitis." Laboratory studies reveal elevated liver enzymes and bilirubin. In obtaining his health history, the nurse should assess his potential for exposure to hepatitis.

  Which of the following represents a high-risk group for contracting this disease?

  A. Heterosexual males

  B. Oncology nurses

  C. American Indians

  D. Jehovah's Witnesses

  Correct Answer: B

  (A) Homosexual males, not heterosexual males, are at high risk for contracting hepatitis. (B) Oncology nurses are employed in high-risk areas and perform invasive procedures that expose them to potential sources of infection. (C) The literature does not support the idea that any ethnic groups are at higher risk. (D) There is no evidence that any religious groups are at higher risk.

• Question 850:

  When evaluating a client with symptoms of shock, it is important for the nurse to differentiate between neurogenic and hypovolemic shock. The symptoms of neurogenic shock differ from hypovolemic shock in that:

  A. In neurogenic shock, the skin is warm and dry

  B. In hypovolemic shock, there is a bradycardia

  C. In hypovolemic shock, capillary refill is less than 2 seconds

  D. In neurogenic shock, there is delayed capillary refill

  Correct Answer: A

  (A) Neurogenic shock is caused by injury to the cervical region, which leads to loss of sympathetic control. This loss leads to vasodilation of the vascular beds, bradycardia resulting from the lack of sympathetic balance to parasympathetic stimuli from the vagus nerve, and the loss of the ability to sweat below the level of injury. In neurogenic shock, the client is hypotensive but bradycardiac with warm, dry skin. (B) In hypovolemic shock, the client ishypotensive and tachycardiac with cool skin. (C) In hypovolemic shock, the capillary refill would be>5 seconds. (D) In neurogenic shock, there is no capillary delay, the vascular beds are dilated, and peripheral flow is good.