- Details
- Category: NCLEX CAT
1. A client is scheduled for a pulmonary function test. The nurse explains that during the test one of the instructions the respiratory therapist will give the client is to breathe normally. What should the nurse teach is being measured when the client follows these directions?
- Tidal volume
- Vital capacity
- Expiratory reserve
- Inspiratory reserve
2. A spontaneous pneumothorax is suspected in a client with a history of emphysema. In addition to calling the health care provider, what action should the nurse take?
- Place the client on the unaffected side.
- Administer 60% oxygen via a Venturi mask.
- Prepare for IV administration of electrolytes.
- Give oxygen at 2L per minute via nasal cannula.
3. A client with a pulmonary embolus is intubated and placed on mechanical ventilation. What nursing action is important when suctioning the endotracheal tube?
- Apply negative pressure while inserting the suction catheter.
- Hyperoxygenate with 100% oxygen before and after suctioning.
- Suction 2 to 3 times in succession to effectively clear the airway.
- Use rapid movements of the suction catheter to loosen secretions.
4. A nurse assesses that several clients have low oxygen saturation levels. Which client would benefit the most from receiving oxygen via a nasal cannula?
- Has an upper respiratory infection
- Receives many visitors while sitting in a chair
- Has a nasogastric tube for gastric decompression
- Exhibits dry oral mucous membranes from mouth breathing
5. A chest tube is inserted into a client who was stabbed in the chest and is attached to a closed-drainage system. Which is an important nursing intervention when caring for this client?
- Observe for fluid fluctuations in the water-seal chamber.
- Obtain a prescription for morphine to minimize agitation.
- Apply a thoracic binder to prevent excessive tension on the tube.
- Clamp the tubing securely to prevent a rapid decline in pressure.
- Details
- Category: NCLEX CAT
1. A client describes abdominal discomfort following ingestion of milk. Which enzyme, as a result of a genetic deficiency, should the nurse consider to be the cause of the clients discomfort?
- Lactase
- Sucrase
- Maltase
- Amylase
2. A client with the diagnosis of cancer of the stomach expresses aversion to meals and eats only small amounts. What should the nurse provide?
- Nourishment between meals
- Small portions more frequently
- Supplementary vitamins to stimulate the client’s appetite
- Only foods the client likes in small portions at mealtimes
3. A client has a suspected peptic ulcer in the duodenum. What should the nurse expect the client to report when describing the pain associated with this disease?
- An ache radiating to the left side
- An intermittent colicky flank pain
- A gnawing sensation relieved by food
- A generalized abdominal pain intensified by moving
4. Which statement by a client who is scheduled for bariatric surgery indicates to the nurse that further preoperative teaching is necessary?
- “I need to eat more high-protein foods.”
- “I’m going to have a figure like a model in about a year.”
- “I’m going to be out of bed and sitting in a chair the first day after surgery.”
- “I will be limiting my intake to 600 to 800 calories a day once I start eating again.”
5. A nurse is teaching an athletic teenager about nutrients that provide the quickest source of energy. Which food selected from a menu indicates to the nurse that the adolescent understands the teaching?
- Glass of milk
- Slice of bread
- Chocolate candy bar
- Glass of orange juice
- Details
- Category: NCLEX CAT
1. A client with ulcerative colitis has experienced frequent severe exacerbations over the past several years. The client is admitted to the hospital with intense pain, severe diarrhea, and cachexia. Which therapeutic course should the nurse expect the health care provider to explore with this client?
- Intensive psychotherapy
- Continued medical therapy
- Surgical therapy (colectomy)
- Diet therapy (low-residue, high-protein diet)
2. A nurse obtains daily stool specimens for a client with chronic bowel inflammation. The nurse concludes that these stool examinations were ordered to determine:
- fat content
- occult blood
- ova and parasites
- culture and sensitivity
3. A client had a colon resection and formation of a colostomy 2 days ago. What color does the nurse expect the stoma to be when assessing its viability?
- Pink
- Gray
- Brick red
- Dark purple
4. A client had surgery for a perforated appendix with localized peritonitis. In which position should the nurse place this client?
- Sims
- Semi-Fowler
- Trendelenburg
- Dorsal recumbent
5. A nurse is teaching a client with an acute exacerbation of colitis about the most appropriate diet. Which food selected by the client indicates that the dietary teaching is effective?
- Orange juice
- Scrambled eggs
- Vanilla milkshake
- Creamed potato soup
- Details
- Category: NCLEX CAT
1. A client is diagnosed with Cushing syndrome. Which clinical manifestation does the nurse expect to increase in a client with Cushing syndrome?
- Urine output
- Glucose level
- Serum potassium
- Immune response
2. A client is admitted to the hospital with a diagnosis of diabetic ketoacidosis. What is the initial intervention that the nurse should expect the health care provider to prescribe for this client?
- IV fluids
- Potassium
- NPH insulin (Novolin N)
- Sodium polystyrene sulfonate (Kayexalate)
3. A nurse is monitoring for clinical manifestations of infection in a client with a diagnosis of Addison disease. Which body mechanism related to infectious processes does the nurse conclude is impaired as a result of this disease?
- Stress response
- Electrolyte balance
- Metabolic processes
- Respiratory function
4. After a head injury a client develops a deficiency of antidiuretic hormone (ADH). What should the nurse consider about the response to secretion of ADH before assessing this client?
- Serum osmolarity increases
- Urine concentration decreases
- Glomerular filtration decreases
- Tubular reabsorption of water increases
5. A client who has just had an adrenalectomy is told about a death in the family and becomes very upset. What concern about the client requires the nurse to notify the health care provider?
- Analgesia and mild sedation will be required to ensure rest.
- Steroid replacement medication therapy will have to be reduced.
- There is a decreased ability to handle stress despite steroid therapy.
- Feelings of exhaustion and lethargy may result from the emotional stress.
- Details
- Category: NCLEX CAT
1. A nurse is caring for a client who is admitted to the hospital with the diagnosis of primary hyperparathyroidism. Which action should be included in this clients plan of care?
- Ensuring a large fluid intake
- Providing a high-calcium diet
- Instituting seizure precautions
- Encouraging complete bed rest
2. A client with diabetes asks the nurse whether the new forearm stick glucose monitor gives the same results as a fingerstick. What is the nurse’s best response to this question?
- “There is no difference between readings.”
- “These types of monitors are meant for children.”
- “Readings are on a different scale for each monitor.”
- “Faster readings can be obtained from a fingerstick.”
3. A clients blood gases reflect diabetic ketoacidosis. Which clinical indicator should the nurse expect to identify when monitoring this client’s laboratory values?
- Increased pH
- Decreased PO2
- Increased PCO2
- Decreased HCO3
4. A client is scheduled to have a thyroidectomy. Which medication does the nurse anticipate the health care provider will prescribe to decrease the size and vascularity of the thyroid gland before surgery?
- Vasopressin (Pitressin)
- Propylthiouracil (PTU)
- Potassium iodide (SSKI)
- Levothyroxine (Synthroid)
5. For which client response should the nurse monitor when assessing for complications of hyperparathyroidism?
- Tetany
- Seizures
- Bone pain
- Graves disease
- Details
- Category: NCLEX CAT
1. A client who had an open reduction and internal fixation of a fractured ankle is being discharged. Which behavior indicates the need for further instruction about the use of crutches?
- Advancing both crutches with the weaker leg
- Leaning axillae on the crutches to support the body’s weight
- Transferring the crutches into one hand when sitting in a chair
- Moving the crutches before the unaffected leg when descending stairs
2. During an annual physical assessment a client reports not being able to smell coffee and most foods. Which cranial nerve function should the nurse assess?
- I
- II
- X
- VII
3. What should the nurse do for a client who just had cataract surgery?
- Instruct the client to avoid driving for several weeks.
- Teach the client coughing and deep-breathing techniques.
- Advise the client to refrain from vigorous brushing of the teeth and hair.
- Encourage the client to perform eye exercises to strengthen the ocular musculature.
4. A nurse should expect to identify a loss of which ability when assessing an unconscious client?
- Hearing voices
- Moving spontaneously
- Controlling elimination
- Reacting to painful stimuli
5. When caring for a client who has sustained a head injury, it is important that the nurse assess for which clinical indicator?
- Slowing of the heart rate
- Decreased carotid pulses
- Bleeding from the oral cavity
- Absence of deep tendon reflexes
