Practice Tests: NCLEX-PN Practice Exam #13 - 50 questions
All 50 questions are randomized each time you take the test, and do not appear in the same order here.
1. The LPN is taking care of a patient who is on Phenelzine (Nardil) for depression. Which meal would the nurse encourage the patient to avoid?
- orange juice and toast
- prosciutto and cheese plate
- carbonated water, shrimp and rice
- steak and potatoes
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2. A client needs to rapidly achieve a therapeutic plasma drug concentration of a medication. Rather than wait for steady state to be achieved, the physician might order:
- a maintenance dose
- a loading dose
- a medication with no first-pass effect
- the medication to be given intravenously
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3. The factor that most determines drug distribution is:
- vascular perfusion of the tissue or organ
- salt form
- drug interactions
- steady state
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4. Fat emulsions are frequently administered as a part of total parenteral nutrition. Which statement is true regarding fat emulsions?
- They have a high energy-to-fluid-volume ratio.
- Even though hypertonic, they are well tolerated.
- They are a basic solution secondary to the addition of sodium hydroxide (NaOH).
- The pH is alkaline, making them compatible with most medications.
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5. The LPN is about to give 100 mg Lopressor (metoprolol) to a patient. Before administering the drug, he takes the patient's vitals, which are as follows: Pulse: 58; Blood Pressure: 90/62; Respirations: 18/minute. What action should the LPN take?
- Give the patient half the prescribed dose and report the findings to the RN on duty.
- Hold the drug and report the findings to the RN on duty.
- Give the patient double the dose and report the findings to the RN on duty.
- Administer the drug and report the findings to the RN on duty.
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6. The LPN is taking care of a 176-pound patient who has recently been diagnosed with diabetes. The doctor has written an order for Lantus (insulin glargine injection) 100 Units/mL, using weight-based dosing of 0.2 units/kg per day. About what dosing should the patient receive each day?
- 9 units
- 12 units
- 35 units
- 16 units
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7. Narrow therapeutic index medications.
- are drug formulations with limited pharmacokinetic variability.
- have limited value and require no monitoring of blood levels.
- have less than a twofold difference in minimum toxic levels and minimum effective concentration in the blood.
- have limited potency and side effects.
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8. The physician orders the antibiotics ampicillin (Omnipen) and gentamicin (Garamycin) for a newly admitted client with an infection. The nurse should:
- administer both medications simultaneously.
- give the medications sequentially, and flush well between them.
- ask the physician or pharmacy which medication to give first and how long to wait before giving the other drug.
- start one medication now and begin the other medication in 2-4 hours.
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9. A month after receiving a blood transfusion, an immunocompromised client develops fever, liver abnormalities, a rash, and diarrhea. The nurse should suspect this client has:
- nothing related to the blood transfusion
- graft-versus-host disease (GVHD)
- myelosuppression
- an allergic response to a recent medication
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10. The tendency of a drug to combine with its receptor is called:
- potency
- efficacy
- kinetics
- affinity
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11. A chemical reaction between drugs prior to their administration or absorption is known as:
- a drug incompatibility
- a side effect
- an adverse event
- an allergic response
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12. A syringe pump is a type of electronic infusion pump used to infuse fluids or medications directly from a syringe. This device is commonly used for.
- solutions administered in obstetrics
- dilute antibiotics
- large volumes of IV solution
- the neonatal and pediatric populations
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13. When medications have an additive, synergistic, or antagonistic effect on a tissue, areaction has occurred:
- pharmaceutical
- pharmacodynamic
- pharmacokinetic
- drug incompatibility
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14. Why is it often necessary to draw a complete blood count and differential (CBC/differential) when a client is being treated with an antiepileptic drug (AED)?
- The hematocrit is adversely affected because of an increased vascular volume.
- AEDs affect immune modulators increasing the risk of infection.
- AEDs induce white blood cell reduction.
- A side effect of some AEDs is blood dyscrasia.
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15. A client's central venous access device (CVAD) becomes infected. Why might the physician order antibiotics to be given through the line rather than through a peripheral IV line?
- to prevent infiltration of the peripheral line
- to reduce the pain and discomfort associated with antibiotic administration in a small vein
- to lessen the chance of an allergic reaction to the antibiotic
- to attempt to eliminate microorganisms in the catheter and prevent having to remove it
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16. A client asks a nurse working in a dental office what type of drug the dentist uses to provide anesthesia during the extraction of the client's wisdom teeth. The dentist uses an anesthetic gas, also known as laughing gas. This agent is:
- nitrous oxide
- nitrogen
- nitric oxide
- nitrogen dioxide
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17. The intravenous route is potentially the most dangerous route of drug administration because:
- the IV might infiltrate
- it is expensive and nursing intensive
- rapid administration of a drug can lead to toxicity
- the client always has more side effects
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18. In infants and children, the side effects of first generation over-the counter (OTC) antihistamines, such as diphenhydramine (Benedryl) and hydroxyzine (Atarax), can include:
- Reye's syndrome
- cholinergic effects
- paradoxical CNS stimulation
- nausea and diarrhea
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19. When performing an abdominal assessment, what is the correct order of the tasks?
- inspect, palpate, auscultate, percuss
- inspect, palpate, percuss, auscultate
- inspect, auscultate, percuss, palpate
- inspect, percuss, palpate, auscultate
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20. Central venous access devices (CVADs) are frequently utilized to administer chemotherapy. What is an advantage of using CVADs for chemotherapeutic agent administration?
- CVADs are less expensive than a peripheral IV.
- Weekly administration is possible.
- Chemotherapeutic agents can be caustic to smaller veins.
- The client or family can administer the drug at home.
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21. Which of the following solutions is routinely used to flush an IV device before and after the administration of blood to a client?
- 0.9% sodium chloride
- 5% dextrose in water solution
- sterile water
- Heparin sodium
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22. Local anesthetics block the conduction of pain impulses to the spinal cord. Their duration of action:
- is always longer than general anesthesia
- is determined by the rate of diffusion and absorption at the site of administration
- is usually short (10 minutes)
- varies, depending on the client's weight
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23. Metformin (Glucophage) is administered to clients with type II diabetes mellitus. Metformin is an example of:
- an antihyperglycemic agent
- a hypoglycemic agent
- an insulin analogue
- a pancreatic alpha cell stimulant
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24. Chemotherapeutic agents often produce a degree of myelosuppression including leukopenia. Leukopenia does not present immediately but is delayed several days or weeks because:
- the client's hemoglobin and hematocrit are normal
- red blood cells are affected first
- folic acid levels are normal
- the current white cell count is not affected by chemotherapy
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25. Hormonal agents are used to treat some cancers. An example is:
- thyroxine to treat thyroid cancer.
- ACTH to treat adrenal carcinoma.
- estrogen antagonists to treat breast cancer.
- glucagon to treat pancreatic carcinoma.
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26. The LPN is checking for residual before administering enteral feeding through a PEG tube. Which of these steps is incorrect?
- If the residual is greater than 200mL, the LPN should not administer the enteral feeding.
- The residual should be discarded prior to administering the tube feeding.
- The residual pH level is tested to ensure appropriate placement.
- The LPN elevates the head of the bed at least 30 degrees.
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27. An allergic reaction is classified as what type of pharmacological effect?
- a side effect
- an adverse effect
- a therapeutic effect
- an incompatibility
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28. The LPN is caring for a patient with an NG tube, and the RN administers evening medications through the NG tube. The patient asks if he can lie down when the nurse leaves the room. What is the most appropriate response?
- Yes, feel free to lie down.
- You can lie down in 5 minutes if your NG residual is below 50 mLs.
- You can lie down in about 30 minutes.
- You can lie down in 1 hour.
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29. Distribution of a drug to various tissues is dependent on the amount of cardiac output to each type of tissue. Which tissue would receive the highest amount of cardiac output and thus the highest amount of a drug?
- skin
- adipose tissue
- skeletal muscle
- myocardium
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30. The PN is taking care of a patient with a documented allergy to Penicillin. After rounds, the PN notices that the patient has an order for Cefazolin. Which of the following actions would be the least appropriate?
- The PN discusses the order with the care team prior to administering Cefazolin.
- The PN administers all ordered medications except for the Cefazolin.
- The PN clarifies the severity of the Penicillin allergy.
- The PN monitors the patient after a test dose of Cefazolin is administered.
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31. Which of the following clients should refrain from therapy with the thiazide diuretic hydrochlorothiazide (HCTZ)?
- a client with renal impairment
- a client with hypertension
- a client with diabetes mellitus, type II
- a client with renal calculi (kidney stones)
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32. The physician wants to know if a client is tolerating his total parenteral nutrition. Which of the following laboratory tests is likely to be ordered?
- triglyceride level
- liver function tests
- a glucose tolerance test
- a complete blood count
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33. A client can receive the mumps, measles, rubella (MMR) vaccine if he or she.
- is pregnant
- is immunocompromised
- is allergic to neomycin
- has a cold
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34. Levothyroxine (Synthroid) is the drug of choice for thyroid replacement therapy in clients with hypothyroidism because:
- it is chemically stable, nonallergenic, and can be administered orally once a day
- it is available in a single 25mg tablet, which makes dosing simple
- it is not a prodrug
- it has a short half-life
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35. Some drugs are excreted into bile and delivered to the intestines. Prior to elimination from the body, the drug might be absorbed. This process is known as:
- hepatic clearance
- total clearance
- enterohepatic cycling
- first-pass effect
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36. A contraindication for topical corticosteroid use in a client with atopic dermatitis (eczema) is:
- parasite infection
- viral infection
- fungal infection
- spirochete infection
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37. While repositioning the patient, the LPN notices a shallow, open ulcer on the sacrum with partial-thickness skin loss. What is the classification stage of this ulcer?
- Stage IV
- Stage III
- Stage I
- Stage II
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38. A client asks the nurse if all donor blood products are cross-matched with the recipient to prevent a transfusion reaction. Which of the following always requires cross-matching?
- packed red blood cells
- platelets
- plasma
- granulocytes
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39. An infection in a central venous access device is not eliminated by giving antibiotics through the catheter. How might bacterial glycocalyx contribute to this?
- It protects the bacteria from antibiotic and immunologic destruction.
- Glycocalyx neutralizes the antibiotic, rendering it ineffective.
- It competes with the antibiotic for binding sites on the microbe.
- Glycocalyx provides nutrients for microbial growth.
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40. The chemotherapeutic DNA alkylating agents such as nitrogen mustards are effective because they:
- cross-link DNA strands with covalent bonds between alkyl groups on the drug and guanine bases on DNA
- have few, if any, side effects
- are used to treat multiple types of cancer
- are cell-cycle-specific agents
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41. In hanging a parenteral IV fluid that is to be infused by gravity, rather than with an infusion pump, the nurse notes that the IV tubing is available in different drop factors. Which tubing is a microdrop set?
- 15 drops per milliliter
- 60 drops per milliliter
- 20 drops per milliliter
- 10 drops per milliliter
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42. A client has a 10% dextrose in water IV solution running. He is scheduled to receive his antiepileptic drug, phenytoin (Dilantin), at this time. The nurse knows that the phenytoin"
- is given after the D10W is finished
- should be given at the time it is due in the medication port closest to the client
- can be piggybacked into the D10W solution now
- is incompatible with dextrose solutions
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43. The primary organ for drug elimination is the:
- skin
- lung(s)
- kidney(s)
- liver
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44. Medication bound to protein can have which of the following effects?
- enhancement of drug availability
- rapid distribution of the drug to receptor sites
- less availability to produce desired medicinal effects
- increased metabolism of the drug by the liver
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45. A client is given an opiate drug for pain relief following general anesthesia. The client becomes extremely somnolent with respiratory depression. The physician is likely to order the administration of:
- naloxone (Narcan)
- labetalol (Normodyne)
- neostigmine (Prostigmin)
- thiothixene (Navane)
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46. A complication of total parenteral nutrition (TPN) is the development of cholestasis. What is this condition?
- an inflammatory process of the extrahepatic bile ducts
- an arrest of the normal flow of bile
- an inflammation of the gallbladder
- the formation of gallstones
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47. A 50 milliliter (ml) bolus of normal saline fluid is ordered by the physician. The physician wants it to infuse in 30 minutes. The nurse should set the pump rate at:
- 100 ml per hour for one hour
- 60 ml per hour for one-half hour
- 120 ml per hour for one hour
- 50 ml per hour for one hour
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48. A teenage client is admitted to the hospital because of acetaminophen (Tylenol) overdose. In which of the following organs overdoses of acetaminophen can precipitate life-threatening abnormalities?
- lungs
- liver
- kidneys
- adrenal glands
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49. One drug can alter the absorption of another drug. One drug increases intestinal motility. Which effect does this have on the second drug?
- None; absorption of the second drug is not affected.
- The increased gut motility increases the absorption of the second drug.
- The absorption of the second drug cannot be predicted.
- Less of the second drug is absorbed.
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50. A client has been taking a drug (Drug A) that is highly metabolized by the cytochrome p-450 system. He has been on this medication for 6 months. At this time, he is started on a second medication (Drug B) that is an inducer of the cytochrome p-450 system. You should monitor this client for:
- increased therapeutic effects of Drug A
- increased adverse effects of Drug B
- decreased therapeutic effects of Drug A
- decreased therapeutic effects of Drug B
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