NCLEX-RN | QB2 | Practice Exam #34 (50 questions)
All 50 questions are randomized each time you take the test, and do not appear in the same order.
1. Jose has undergone thoracentesis. The nurse in charge is aware that the best position for Jose is:
- Semi fowlers
- Low fowlers
- Side lying, unaffected side
- Side lying, affected side
2. A patient admitted to the hospital for pneumonia finishes a course of levofloxacin, lungs are clear and the patient is no longer coughing. Which of the following post-discharge laboratory results best indicates desired outcome?
- Normal white blood cell count
- Normal hematocrit count
- Normal platelet level
- Normal potassium level
3. The nurse is caring for a client scheduled for a surgical repair of a saccular abdominal aortic aneurysm. Which assessment is most crucial during the preoperative period?
- Assessment of the clients level of anxiety
- Evaluation of the clients exercise tolerance
- Identification of peripheral pulses
- Assessment of bowel sounds and activity
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4. Situation: With the increasing documented cases of CANCER the best alternative to treatment still remains to be PREVENTION. The following conditions apply.Which among the following is the primary focus of prevention of cancer?
- Elimination of conditions causing cancer
- Diagnosis and treatment
- Treatment at early stage
- Early detection
5. A client is to undergo a postcoital test for infertility. The nurse should include which of the following statements in the client's preprocedure counseling?
- "You will have the test the day after your menstruation ends”
- "You will have a dye put into your vein that will show up on x-ray”
- "You should refrain from having intercourse for the four days immediately prior to the test”
- "You should experience the same sensations you feel when your doctor does your Pap test”
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6. Because diet and exercise have faded to control a 63 yr-old clients blood glucose level, the client is prescribed glipizide (Glucotrol). After oral administration, the onset of action is:
- 15 to 30 minutes
- 30 to 60 minutes
- 1 to 1 1/2 hours
- 2 to 3 hours
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7. All of the following are clinical sign of fever except:
- Palled.
- Shivering.
- Decrease thirst.
- Increase heart rate.
8. Situation: Mastery of research design determination is essential in passing the Nurse Licensure Examination.Q. Ana researched on the development of a new way to measure intelligence by creating a 100 item questionnaire that will assess the cognitive skills of an individual. The design best suited for this study is:
- Historical
- Methodological
- Survey
- Case study
9. A natural body defense that plays an active role in preventing infection is:
- Yawning
- Body hair
- Rapid eye movements
- Hiccupping
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10. Mr Duffy is admitted to the CCU with a diagnosis of R/O MI. He presented in the ER with a typical description of pain associated with an Ml, and is now cold and clammy, pale and dyspneic. He has an IV of D5W running, and is complaining of chest pain. Oxygen therapy has not been started, and he is not on the monitor. He is frightened.Q. You also explain common eye changes associated with aging. One of these is presbyopia, which is:
- Refractive error that prevents light rays from coming to a single focus on the retina.
- Poor distant vision
- Poor near vision
- A gradual lessening of the power of accommodation
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11. Nurse Betty is assessing tactile fremitus in a client with pneumonia. For this examination, nurse Betty should use the:
- Fingertips
- Finger pads
- Dorsal surface of the hand
- Ulnar surface of the hand
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12. Of the following, which are the earliest signs of excessive pressure?
- Pale appearance of the skin
- Reddened appearance of the skin
- Ulcer formation on the skin
- Dark or cyanotic color to the skin
13. A client has been hospitalized with a diagnosis of laryngeal cancer. Which factor is most significant in the development of laryngeal cancer?
- A family history of laryngeal cancer
- Chronic inhalation of noxious fumes
- Frequent straining of the vocal cords
- A history of frequent alcohol and tobacco use
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14. To decrease the likelihood of seizures and visual hallucinations in a client with alcohol withdrawal the nurse should:
- Keep the room darkened by pulling the curtains.
- Keep the light over the bed on at all times.
- Keep the room quiet and dim the lights.
- Keep the television or radio turned on.
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15. A female client comes into the emergency room complaining of SOB and pain in the lung area. She states that she started taking birth control pills 3 weeks ago and that she smokes. Her VS are: BP: 140/80, Pulse: 110, R 40.The physician orders ABG's, results are as follows: pH: 7.50, PaCO2 29 mm Hg, PaO2 60 mm Hg, HCO3- 24 mEq/L, SaO2 86%.Considering these results, the first intervention is to:
- Place the client on oxygen
- Give the client sodium bicarbonate
- Begin mechanical ventilation
- Monitor for pulmonary embolism
16. A client has a history of chronic undifferentiated schizophrenia. Because she has a history of noncompliance with antipsychotic therapy, she'll receive fluphenazine decanoate (Prolixin Decanoate) injections every 4 weeks. Before discharge, what should the nurse include in her teaching plan?
- Asking the physician for droperidol ([napsine) to control any extrapyramidal symptoms that occur
- Sitting up for a few minutes before standing to minimize orthostatic hypotension
- Notifying the physician if her thoughts dont normalize within 1 week
- Expecting symptoms of tardive dyskinesia to occur and to be transient
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17. During a group therapy session, one of the clients ask a male client with the diagnosis of antisocial personality disorder why he is in the hospital. Considering this client's type of personality disorder, the nurse might expect him to respond:
- "I need a lot of help with my troubles"
- "Society makes people react in old ways"
- "I decided that its time I own up to my problems"
- "My fife needs straightening out and this might help"
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18. A client tells the nurse that the television newscaster is sending a secret message to her. The nurse suspects the client is experiencing:
- a delusion.
- flight of ideas.
- ideas of reference.
- a hallucination.
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19. A newborn diagnosed with bilateral choanal atresia is scheduled for surgery soon after delivery. The nurse recognizes the immediate need for surgery because the newborn:
- Will have difficulty swallowing
- Will be unable to pass meconium
- Will regurgitate his feedings
- Will be unable to breathe through his nose
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20. The nurse advised the pregnant woman that smoking and alcohol should be avoided during pregnancy. The nurse takes into account that the developing fetus is most vulnerable to environment teratogens that cause malformation during:
- The entire pregnancy.
- The third trimester.
- The first trimester
- The second trimester.
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21. Measure the leg circumference of a client with bipedal edema is best done in what position?
- Dorsal recumbent
- Sitting
- Standing
- Supine
22. The charge nurse witnesses the nursing assistant hitting the client in the long-term care facility. The nursing assistant can be charged with:
- Negligence
- Tort
- Assault
- Malpractice
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23. A patient with bowlegs due to abnormal bone formations and deformities has a calcium level of 7<5mg/100ml. Which of the following foods would the nurse MOST likely instruct the patients to add to a diet?
- Organ meats
- Whole grains
- Egg yolks
- Lean means
24. The nurse is providing instructions to a pregnant client who is scheduled for an amniocentesis. What instruction should the nurse provide?
- Strict bed rest is required after the procedure.
- Hospitalization is necessary for 24 hours after the procedure.
- An informed consent needs to be signed before the procedure.
- A fever is expected after the procedure because of the trauma to the abdomen.
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25. Situation: Nurse Anna is a new BSEN graduate and has just passed her Licensure Examination for Nurses in the Philippines. She has likewise been hired as a new Community Health Nurse in one of the Rural Health Units in their City which of the following conditions may be acceptable TRUTHS applied to Community Health Nursing PracticeJn community health nursing it is important to take into account the family health with an equally important need to perform ocular inspection of the areas activities which are powerful elements of:
- evaluation
- assessment
- implementation
- planning
26. A 45-year-old patient is in a lower body cast following a motor vehicle accident In order to minimize muscle strength loss while in the cast, the nurse will instruct the patient in the performance of:
- isometric exercises
- Passive range of motion exercises
- Active-assistive range of motion exercises
- Resistive range of motion exercises
27. A 24-year-old female client is scheduled for surgery in the morning. Which of the following is the primary responsibility of the nurse?
- Taking the vital signs
- Obtaining the permit
- Explaining the procedure
- Checking the lab work
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28. The ability of the infectious agent to cause a disease primarily depends on all of the following except:
- Pathogenicity
- Virulence
- Invasiveness
- Non Specificity
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29. The nurse is developing a teaching plan for a client with glaucoma. Which instruction should the nurse include in the plan of care?
- Avoid overuse of the eyes.
- Decrease the amount of salt in the diet.
- Eye medications will need to be administered for life.
- Decrease fluid intake to control the intraocular pressure.
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30. Which of the following indicates that learning has been achieved?
- Martin starts exercising every morning and eating a balance diet after you taught her mag HL tayo program
- Donya Delilah has been able to repeat the steps of insulin administration after you taught it to her
- Marsha said " I understand " after you a health teaching about family planning
- John rated 100% on your given quiz about smoking and alcoholism
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31. Jonas who is diagnosed with encephalitis is under the treatment of Mannitol Which of the following patient outcomes indicate to Nurse Ronald that the treatment of Mannitol has been effective for a patient that has increased intracranial pressure?
- Increased urinary output
- Decreased RR
- Slowed pupillary response
- Decreased level of consciousness
32. Which of the following findings is the best indication that fluid replacement for the client with hypovolemic shock is adequate?
- Urine output greater than 30ml/hr
- Respiratory rate of 21 breaths/minute
- Diastolic blood pressure greater than 90 mmhg
- Systolic blood pressure greater than 110 mmhg
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33. An infected patient has chills and begins shivering. The best nursing intervention is to:
- Apply iced alcohol sponges
- Provide increased cool liquids
- Provide additional bedclothes
- Provide increased ventilation
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34. Situation: Maintenance of sterility is an important function a nurse should perform in any OR setting.Q. All of these factors affect the sterility of the OR equipment, these are the following except:
- The material used for packaging
- The handling of the materials as well as its transport
- Storage
- The chemical or process used in sterilizing the material
35. A trauma client is admitted to the emergency room following a motor vehicle accident Examination reveals that the left side of the chest moves inward when the client inhales. The finding is suggestive of:
- Pneumothorax
- Mediastinal shift
- Pulmonary contusion
- Flail chest
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36. At which of the following ages would the nurse expect to administer the varicella zoster vaccine to child?
- At birth
- 2 months
- 6 months
- 12 months
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37. Which of the following is a live attenuated bacterial vaccine?
- BCG
- OPV
- Measles
- None of the above
38. The nurse is assigned to a client with catatonic schizophrenia. Which intervention should the nurse include in the client's plan of care?
- Meeting all of the clients physical needs
- Giving the client an opportunity to express concerns
- Administering lithium carbonate (Lithonate) as prescribed
- Providing a quiet environment where the client can be alone
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39. Situation: You are assigned at the surgical ward and clients have been complaining of post pain at varying degrees. Pain as you know is very subjective.Q. Inadequate anesthesia is said to be one of the common cause of pain both in intra and post-op patients. If general anesthesia is desired, it will involve loss of consciousness. Which of the following are the 2 general types of GA?
- Epidural and Spinal
- Subarachnoid block and intravenous
- Inhalation and Regional
- Intravenous and inhalation
40. A 58 year old client is suffering from acute phase of rheumatoid arthritis. Which of the following would the nurse in charge identify as the lowest priority of the plan of care?
- Prevent joint deformity
- Maintaining usual ways of accomplishing task
- Relieving pain
- Preserving joint function
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41. The coronary vessels, unlike any other blood vessels in the body respond to sympathetic stimulation by:
- Vasoconstriction
- Vasodilation
- Decreases force of contractility
- Decreases cardiac output
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42. A male client has suffered a motor accident and is now suffering from hypovolemic shock. Nurse Helen should frequency assess the client's vital signs during the compensatory stage of shock, because:
- Arteriolar constriction occurs
- The cardiac workload decreases
- Decreased contractility of the heart occurs
- The parasympathetic nervous system is triggered
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43. A 43-year-old African American male is admitted with sickle cell anemia. The nurse plans to assess circulation in the lower extremities every two hours. Which of the following outcome criteria would the nurse use?
- Body temperature of 99°F or less
- Toes moved in active range of motion
- Sensation reported when soles of feet are touched
- Capillary refill of < 3 seconds
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44. Situation Mrs. Pichay is admitted to your ward. The MD ordered Prepared for thoracentesis this pm to remove excess air from the pleural cavity. Q. Mrs. Pichay, who is for thoracentesis, is assisted by the nurse to any of the following positions, EXCEPT:
- straddling a chair with arms and head resting on the back of the chair
- lying on the unaffected side with the bed elevated 30-40 degrees
- lying prone with the head of the bed lowered 15-30 degrees
- sitting on the edge of the bed with her feet supported and arms and head on a padded overhead table
45. The nurse is caring for a patient with stage III pressure ulcer to the coccyx. Three days after initiating the plan of care, the nurse observes that the ulcer has hard black crust covering the center of the ulcer. The nurse should understand that this indicates:
- Healing
- Need for debridement
- Inadequate nutrition
- Infection
46. A client with a history of phenylketonuria is seen at the local family planning clinic. After completing the clients intake history the nurse provides literature for a healthy pregnancy. Which statement indicates that the client needs further teaching?
- I can help control my weight by switching from sugar to Nutrasweet.
- I need to resume my old diet before becoming pregnant.
- Fresh fruits and raw vegetables will make excellent between-meal snacks.
- I need to eliminate most sources of phenylalanine from my diet.
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47. An elderly client has sustained intertrochanteric fracture of the hip and has just returned from surgery where a nail plate was inserted for internal fixation. The client has been instructed that she should not flex her hip. The best explanation of why this movement would be harmful is:
- It will be very painful for the client
- The soft tissue around the site will be damaged
- Displacement can occur with flexion
- It will pull the hip out of alignment
48. A bed-bound patient has a care plan with interventions to include re positioning every 2 hours. The patient develops a stage 1 pressure sore on the right heel. What intervention should be added to the care plan?
- Massage the right heel four times per day
- Add a trapeze to the bed
- Float heels off bed with a pillow
- Add a bed cradle to the bed
49. A registered nurse reaches to answer the telephone on a busy pediatric unit, momentarily turning away from a 3 month-old infant she has been weighing. The infant falls off the scale, suffering a skull fracture. The nurse could be charged with:
- Defamation
- Assault
- Battery
- Malpractice
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50. A client has a neurological deficit involving the limbic system. On assessment, which finding is specific to this type of deficit?
- Is disoriented to person, place, and time
- Affect is flat, with periods of emotional lability
- Cannot recall what was eaten for breakfast today
- Demonstrates inability to add and subtract; does not know who is the president of the United States
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