NCLEX-RN | QB2 | Practice Exam #31 (50 questions)
All 50 questions are randomized each time you take the test, and do not appear in the same order.
1. Which telephone call from a students mother should the school nurse take care of at once?
- A telephone call notifying the school nurse that the child' pediatrician has informed the mother that the child will need cardiac repair surgery within the next few weeks.
- A telephone call notifying the school nurse that the child's pediatrician has informed the mother that the child has head lice.
- A telephone call notifying the school nurse that a child has a temperature of 102°F and rash covering the trunk and upper extremities of the body.
- A telephone call notifying the school nurse that a child underwent an emergency appendectomy during the previous night.
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2. When a nurse in-charge causes an injury to a female patient and the injury caused becomes the proof of the negligent act, the presence of the injury is said to exemplify the principle of:
- Force majeure
- Respondeat superior
- Res ipsa loquitur
- Holdover doctrine
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3. Situation: Carbon Monoxide poisoning is said to be the 2nd leading cause of poison death. It is said to be the leading cause of inhalation poisoning. Mr. Edgardo was rushed to the hospital after being unconscious inside an enclosed parking lot Carbon monoxide poisoning is suspected.Q. If a client demonstrates psychoses, visual disturbance, ataxia, amnesia and confusion even after completion of resuscitation and the return of normal oxygenation, this will indicate that:
- The client suffered from an irreversible brain damage
- That the client still needs to be evaluated for this is evidence that resuscitation is not yet complete
- That the client will need a longer rehabilitation to go back to the previous functioning
- That the client is exhibiting secondary gains
4. Situation: As a nurse, you should be aware and prepared of the different roles you play.Q. Surgical pain might be minimized by which nursing action in the OR:
- Skill of surgical team and lesser manipulation
- Appropriate preparation For the scheduled procedure
- Use of modem technology in closing the wound
- Proper positioning and draping of clients
5. The nurse determines that a client is having a transfusion reaction. After the nurse stops the transfusion, which action should be taken next?
- Remove the intravenous (IV) line.
- Run a solution of 5% dextrose in water.
- Run normal saline at a keep-vein-open rate.
- Obtain a culture of the tip of the catheter device removed from the client.
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6. Which non-pharmacological measure is particularly useful for a client with acute pancreatitis?
- Diversional therapy such as playing cards or board games
- Massage of back and neck with warmed lotion
- Side-lying position with knees to chest and pillow against abdomen
- Transcutaneous electrical nerve stimulation (TENS)
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7. What are the three most important prognostic factors in determining long-term survival for children with acute leukemia?
- Histologic type of disease, initial platelet count, and type of treatment
- Type of treatment and Client's sex
- Histologic type of disease, initial WBC count, and clients age at diagnosis
- Progression of illness, WBC at the time of diagnosis, and clients age at the time of diagnosis.
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8. A health care provider has prescribed oxygen as needed for an infant with heart failure. In which situation should the nurse administer the oxygen to the infant?
- During sleep
- When changing the infant's diapers
- When the mother is holding the infant
- When drawing blood for electrolyte level testing
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9. Paul is admitted to the hospital due to metabolic acidosis caused by Diabetic ketoacidosis (DKA). The nurse prepares which of the following medications as an initial treatment for this problem?
- Regular insulin
- Potassium
- Sodium bicarbonate
- Calcium gluconate
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10. Myrna a public health nurse knows that to determine possible sources of sexually transmitted infections, the BEST method that may be undertaken is:
- Contact tracing
- Community survey
- Mass screening tests
- Interview of suspects
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11. Smoking is contraindicated in pregnancy because:
- Nicotine causes vasodilation of the mothers blood vessels
- Carbon monoxide binds with the hemoglobin of the mother reducing available hemoglobin for the fetus
- The smoke will make the fetus and the mother feel dizzy
- Nicotine will cause vasoconstriction of the fetal blood vessels
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12. Situation: Nurses attitudes toward the pain influence the way they perceive and interact with clients in pain.Q. Physical dependence occurs in anyone who takes opiods over a period of time. What do you tell a mother of a 'dependent' when asked for advice?
- Start another drug and slowly lessen the opioid dosage
- Indulge in recreational outdoor activities
- Isolate opioid dependent to a restful resort
- Instruct slow tapering of the drug dosage and alleviate physical withdrawal symptoms.
13. Situation: Still in your self-managed Child Health Nursing Clinic, your encounter these cases pertaining to the CARE OF CHILDREN WITH PULMONARY AFFECTIONS.Which of the following is the principal focus on the CARI program of the Department of Health?
- Enhancement of health team capabilities
- Teach mothers how to detect signs and where to refer
- Mortality reduction through early detection
- Teach other community health workers how to assess patients
14. A client tells the nurse that her co-workers are sabotaging the computer. When the nurse asks questions, the client becomes argumentative. This behavior shows personality traits associated with which of the following personality disorders?
- Antisocial
- Histrionic
- Paranoid
- Schizotypal
15. The mother of a male child with cystic fibrosis tells the nurse that she hopes her sons children wont have the disease. The nurse is aware that:
- There is a 25% chance that his children will have cystic fibrosis.
- Most of the males with cystic fibrosis are sterile.
- There is a 50% chance that his children will be carriers.
- Most males with cystic fibrosis are capable of having children so genetic counseling is advised.
16. A patient has peripheral vascular disease. The nursing diagnosis is ineffective tissue perfusion: peripheral.Which of the following is an appropriate goal?
- The patient will identify three factors to improve peripheral circulation
- The patient will have palpable peripheral pulses in 1 week
- The patients feet will be warm to touch
- The patient will ambulate the length of the hall way
17. A Patient has a dissection aortic aneurysm. The patients surgery would be categorized as:
- Elective
- Urgent
- Emergency
- Diagnostic
18. The nurse provides instructions to a client with a low potassium level about the foods that are high in potassium and tells the client to consume which foods? Select all that apply. 1.Peas. 2.Raisins. 3.Potatoes. 4.Cantaloupe. 5.Cauliflower. 6.Strawberries
- 1,2,4,6
- 2,3,4,6
- 1,3,4,5
- 1,2,3,4,5,6
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19. Food fortification is one of the strategies to prevent micronutrient deficiency conditions. R.A. 8976 mandates fortification of certain food items. Which of the following is among these food items?
- Sugar
- Bread
- Margarine
- Filled milk
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20. Situation: Records and Records management is one of the core of professional nursing practice.Q. Charting should be legible and include only standard abbreviations. Which of the following is NOT a standard abbreviation?
- PRN
- OD
- NNO
- NPO
21. Situation: The Gastrointestinal System is responsible for taking in and processing nutrients for all parts of the body any problem can quickly affect other body systems and, if not adequately treated, can affect overall health, growth, and development. The following questions are about gastrointestinal disorders in a child.In intussusceptions, children suddenly draw up their legs and cry as if they are in severe pain and possibly vomit. Another manifestation of such disease is the presence of blood in the stool. What is the characteristic stool of client with intussusception?
- Coffee ground
- Black and Tarry
- Currant jelly stool
- Watery stool
22. Situation: Mariah is a 31 year old lawyer who has been married for 6 moths. She is now pregnantShe consults you for guidance.You instruct Mariah to keep record of her basal temperature everyday, which of the following instructions is incorrect?
- if coitus has occurred, this should be reflected in the chart
- It is best to have coitus on the evening following a drop in BBT to become pregnant
- Temperature should be taken immediately after waking and before getting put of bed
- BBT is lowest during the secretory phase
23. Situation: Joanna Marie, a 40 year old client was diagnosed with breast cancer.Q. Anita, Joanna's sister is performing BSE and she stands in front of the Mirror. The rationale for standing in front of the mirror is to check for:
- Unusual discharges coming out from the breast
- Any obvious malignancy
- The Size and Contour of the breast
- Thickness and lumps in the breast
24. Cefuroxime sodium, 1 g in 50 mL normal saline (NS), is to be administered over 30 minutes. The drop factor is 15 drops (gtt)/1 mL. The nurse sets the flow rate at how many drops per minute?
- 25 drops per minute.
- 30 drops per minute.
- 18 drops per minute.
- 20 drops per minute.
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25. The nurse is caring for a client following a gastrojejunostomy (Billroth II procedure). Which postoperative prescription should the nurse question and verify?
- Leg exercises
- Early ambulation
- Irrigating the nasogastric tube
- Coughing and deep-breathing exercises
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26. A patient with conjunctivitis reports the presence of photophobia and moderate eye drainage. The nurse should teach patient to:
- Avoid touching the eye
- Use sterile gauze to remove the drainage
- Darken the room
- Rest in the prone position
27. The public health nurse takes an active role in community participation. What is the primary goal of community organizing?
- To educate the people regarding community health problems
- To mobilize the people to resolve community health problems
- To maximize the communitys resources in dealing with health problems
- None.
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28. A 25 year-old woman resents to the clinic with abdominal pain. She reports the last bowel movement was two days previously. There is no vomiting or diarrhea and her body temperature is normal. During percussion of the lower left quadrant the nurse hears tympanic sounds.What is the most likely underlying cause for the finding?
- Gas
- Tumor
- Liquid
- Feces
29. Situation: You are going to participate in a Cancer Consciousness Week You are assigned to take charge of the women to make them aware of cervical cancer. You reviewed its manifestations and management.Q. The following are risk factors for cervical Cancer EXCEPT:
- immunosuppressive therapy
- sex at an early age, multiple partners, exposure to socially transmitted diseases, male
- partner's sexual habits
- viral agents like the Human Papillomavirus
30. An elderly client with an abdominal surgery is admitted to the unit following surgery. In anticipation of complications of anesthesia and narcotic administration the nurse should:
- Administer oxygen via nasal cannula.
- Have narcan (naloxane) available.
- Prepare to administer blood products.
- Prepare to do cardioresuscitation.
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31. The nurse notes the following assessment findings regarding the clients peripheral vascular status: cramping leg pain relieved by rest; cool, pale feet; and delayed capillary refilling. Based on these data, the nurse would make a nursing diagnosis of:
- Impaired skin integrity
- Impaired gas exchange
- Ineffective peripheral tissue perfusion
- Impaired physical mobility
32. A 3-month-old client is in the pediatric unit. During assessment, the nurse is suspecting that the baby may have hypothyroidism when mother states that her baby does not:
- Sit up.
- Pick up and hold a rattle.
- Roll over.
- Hold the head up.
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33. The nurse is caring for a client with Lymes disease. The nurse should carefully monitor the client for signs of neurological complications which include:
- Complaints of a drawing sensation and paralysis on one side of the face
- Presence of an unsteady gait intention tremor and facial weakness
- Complaints of excruciating facial pain brought on by talking smiling or eating
- Presence of fatigue when talking dysphagia and involuntary facial twitching
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34. The nurse should report which assessment finding to the health care provider (HOP) before initiating thrombolytic therapy in a client with pulmonary embolism?
- Adventitious breath sounds
- Temperature of 99.4 °F (37.4 &C) orally
- Blood pressure of 198/110 mm Hg
- Respiratory rate of 28 breaths/minute
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35. The home health nurse is scheduled to visit four clients. Which client should she visit first?
- A client with acquired immunodeficiency syndrome with a cough and reported temperature of 101°F
- A client with peripheral vascular disease with an ulcer on the left lower leg
- A client with diabetes mellitus who needs a diabetic control index drawn
- A client with an autograft to burns of the chest and trunk
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36. On the other hand, Operation Timbang is prevention?
- Primary
- Secondary
- Intermediate
- Tertiary
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37. The nurse is conducted a community-based educational program about Diabetes mellitus. Which of the following statements by a participant would indicate correct understanding of the teaching?
- Lantus insulin can be mixed with other insulin
- It is necessary to wipe off the top the insulin vial with alcohol to prevent infection
- Insulin will changed color after opening
- Needles can be placed in a hard plastic container with a tightly secure lid
38. Situation: Mr. Santos, 50, is to undergo cystoscopy due to multiple problems like scantly urination, hematuria, and dysuria.Q. You are the nurse in charge of Mr. Santos. When asked what are the organs to be examined during cystoscopy, you will enumerate as follows:
- Urethra, Kidney, Bladder
- Urethra, Bladder wall, trigone, urethral opening
- Bladder wall, uterine wall and urethral opening
- Urethral opening, urethral opening bladder.
39. The nurse is assessing the casted extremity of a client. Which sign is indicative of infection?
- Dependent edema
- Diminished distal pulse
- Presence of a hot spot on the cast
- Coolness and pallor of the extremity
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40. Situation: Carbon Monoxide poisoning is said to be the 2nd leading cause of poison death. It is said to be the leading cause of inhalation poisoning. Mr. Edgardo was rushed to the hospital after being unconscious inside an enclosed parking lot Carbon monoxide poisoning is suspected.Q. Which of the following laboratory result is constantly checked in clients undergoing treatment for carbon monoxide poisoning?
- Oxygen saturation
- RBC count
- Skin color
- Carboxyhemoglobin level
41. Situation: You are assigned to take care of a group of patients across the lifespan. Priorities when caring for the elderly trauma patient:
- Circulation, airway, breathing
- Disability(Neurologic), airway, breathing
- Airway, Breathing, Disability(Neurologic),
- Airway, breathing, Circulation
42. At 11:00 pm the count of hydrocodone (Vicodin) is incorrect After several minutes of searching the medication cart and medication administration records, no explanation can be found. The primary nurse should notify the:
- Nursing unit manager
- Hospital administrator
- Quality control manager
- Physician ordering the medication
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43. The nurse is teaching a client with a history of atherosclerosis. To decrease the risk of atherosclerosis, the nurse should encourage the client to:
- Avoid focusing on his weight.
- Increase his activity level.
- Follow a regular diet.
- Continue leading a high-stress lifestyle.
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44. Which of the following is true about nutrition?
- It is the process in which food are broken down, for the body to use in growth and development
- It is a process in which digested proteins, fats, minerals, vitamins and carbohydrates are transported into the circulation
- It is a chemical process that occurs in the cell that allows for energy production, energy use, growth and tissue repair
- It is the study of nutrients and the process in which they are use by the body
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45. A client with psoriasis visits the dermatology clinic. When inspecting the affected areas, the nurse expects to see which type of secondary lesion?
- scale
- crust
- ulcer
- scar
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46. The nurse obtains a prescription from a health care provider to restrain a client and instructs an unlicensed assistive personnel (UAP) to apply the safety device to the client Which observation of unsafe application of the safety device would indicate that further instruction is required by the UAP?
- Placing a safety knot in the safety device straps
- Safely securing the safety device straps to the side rails
- Applying safety device straps that do not tighten when force is applied against them
- Securing so that 2 fingers can slide easily between the safety device and the client's skin
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47. Situation: The Gastrointestinal System is responsible for taking in and processing nutrients for all parts of the body any problem can quickly affect other body systems and, if not adequately treated, can affect overall health, growth, and development. The following questions are about gastrointestinal disorders in a child.Shey a 10 months old infant was admitted to the hospital for severe abdominal pain. The doctor found out that the distal ileal segment of the child's bowel has invaginated into the cecum. The nurse will suspect what disease condition?
- Intussusception
- Pyloric stenosis
- Hirschsprung's disease
- Vaginismus
48. A home health nurse has four clients assigned for morning visits. The nurse should give priority to visiting the client with:
- Diabetes mellitus with a nongranulated ulcer of the right foot
- Congestive heart failure who reports coughing up frothy sputum
- Hemiplegia with tenderness in the right flank and cloudy urine
- Rheumatoid arthritis with soft tissue swelling behind the right knee
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49. As soon as the placenta is delivered, the nurse must do which of the following actions?
- Inspect the placenta for completeness including the membranes
- Place the placenta in a receptacle for disposal
- Label the placenta properly
- Leave the placenta in the kidney basin for the nursing aide to dispose properly
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50. The nurse is making assignments for the day. Which client should be assigned to the pregnant nurse?
- The client receiving linear accelerator radiation therapy for lung cancer
- The client with a radium implant for cervical cancer
- The client who has just been administered soluble brachytherapy for thyroid cancer
- The client who returned from placement of iridium seeds for prostate cancer
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