NCLEX-RN | QB2 | Practice Exam #53 (50 questions)
All 50 questions are randomized each time you take the test, and do not appear in the same order.
1. The nurse has been teaching the role of diet in regulating blood pressure to a client with hypertension. Which meal selection indicates the client understands his new diet?
- Cornflakes whole milk banana and coffee
- Scrambled eggs bacon toast and coffee
- Oatmeal apple juice dry toast and coffee
- Pancakes ham tomato juice and coffee
Answer: Only for registered users. Please login!
2. Situation: Mr. Robertos condition continues to worsen and the doctor suggested Kidney Transplantation. Q. Immunosuppression following Kidney transplantation is continued:
- For life
- 24 hours after transplantation
- A week after transplantation
- Until the kidney is not anymore rejected
3. Although no cause has been determined for scleroderma, it is thought to be caused by:
- Autoimmunity
- Ocular motility
- Increased amino acid metabolism
- Defective sebaceous gland formation
4. These are nursing intervention that requires knowledge, skills and expertise of multiple health professionals.
- Dependent
- Independent
- Interdependent
- Intradependent
Answer: Only for registered users. Please login!
5. Mr. Marquez reports of losing his job, not being able to sleep at night, and feeling upset with his wife. Nurse John responds to the client, "You may want to talk about your employment situation in group today." The Nurse is using which therapeutic technique?
- Observations
- Restating
- Exploring
- Focusing
Answer: Only for registered users. Please login!
6. The nurse hears a mother telling a friend on the telephone about umbilical cord care. Which of the following statements by the mother indicates effective teaching?
- Daily soap and water cleansing is best
- Alcohol helps it dry and kills germs
- An antibiotic ointment applied daily prevents infection
- He can have a tub bath each day
Answer: Only for registered users. Please login!
7. The nurse is teaching a group about aerobics exercises. When discussing the target heart rate for exercise, the nurse should state that this is calculated by:
- Counting the number of the heart beats during exercise for 6 sections, then multiply this number by 10
- Subtracting the chronological age from the number 220
- Counting then number of heart beats during exercise for 10 seconds, then multiply by 6
- Subtracting he chronological age from 240
8. A client with a phobic disorder is treated by systematic desensitization. The nurse understands that this approach will do which of the following?
- Help the client execute actions that are feared
- Help the client develop insight into irrational fears
- Help the client substitutes one fear for another
- Help the client decrease anxiety
Answer: Only for registered users. Please login!
9. A 12 year old patient had a cast removed from the left leg after wearing it for 8 weeks. The patients wants to resume sports as soon as possible. In order to regain muscle strength lost while wearing the cast, the nurse will instruct the patient in the performance of:
- Resistive range of motion exercise
- passive range of motion exercise
- Active assistive range of motion exercise
- Active range of motion exercise
10. A patient is diagnosed with pulmonary hypertension. Which of the following nursing diagnoses should be the PRIORITY?
- Impaired gas exchanged related to altered blood flow secondary to pulmonary capillary constriction
- Fatigue related to hypoxia
- Anxiety related to illness and loss of control
- Activity intolerance related to imbalance between oxygen supply and demand due to right and left ventricular failure
11. A client with acquired immunodeficiency syndrome (AIDS) has histoplasmosis. The nurse should assess the client for which expected finding?
- Dyspnea
- Headache
- Weight gain
- Hypothermia
12. A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Laboratory results indicate that the child is neutropenic, and protective isolation procedures are initiated. The grandmother of the child visits and brings a fresh bouquet of flowers picked from her garden, and asks the nurse for a vase for the flowers. Which response should the nurse provide to the grandmother?
- "I have a vase in the utility room, and I will get it for you."
- "I will get the vase and wash it well before you put the flowers in it."
- "The flowers from your garden are beautiful, but should not be placed in the child's room at this time."
- "When you bring the flowers into the room, place them on the bedside stand as far away from the child as possible"
Answer: Only for registered users. Please login!
13. Nurse Wally knows that the most important aspect of the preoperative care for a child with Wilms' tumor would be:
- Checking the size of the child s liver
- Monitoring the child's blood pressure
- Maintaining the child in a prone position
- Collecting the child's urine for culture and sensitivity
Answer: Only for registered users. Please login!
14. Which purposes of placental functioning should the nurse include in a prenatal class? Select all that apply. 1. It cushions and protects the baby. 2. It maintains the temperature of the baby. 3. It is the way the baby gets food and oxygen. 4. ft prevents all antibodies and viruses from passing to the baby. 5. It provides an exchange of nutrients and waste products between the mother and developing fetus.
- 1,2,5
- 2,3,4
- 3,5
- 1,2,3,4,5
Answer: Only for registered users. Please login!
15. A Community health nurse is teaching a health class about infectious disease processes. The nurse instructs the class that rabies would be considered which of the following types of infection?
- Viral
- Protozoan
- Fungal
- Bacterial
16. A client with atrial fibrillation who is receiving maintenance therapy of warfarin sodium has a prothrombin time (PT) of 35 (35) seconds and an international normalized ratio (INR) of 3.5. On the basis of these laboratory values, the nurse anticipates which prescription?
- Adding a dose of heparin sodium
- Holding the next dose of warfarin
- Increasing the next dose of warfarin
- Administering the next dose of warfarin
Answer: Only for registered users. Please login!
17. Which symptom would indicate the Baby Alexandra was adapting appropriately to extra- uterine life without difficulty?
- Nasal flaring
- Light audible grunting
- Respiratory rate 40 to 60 breaths/minute
- Respiratory rate 60 to 80 breaths/minute
Answer: Only for registered users. Please login!
18. Which of the following Nursing diagnosis is INCORRECT?
- Fluid volume deficit R/T Diarrhea
- High risk for injury R/T Absence of side rails
- Possible ineffective coping R/T Loss of loved one
- Self esteem disturbance R/T Effects of surgical removal of the leg
19. Situation: A nurse is working with an aggressive client in the psychiatric unit Q. A patient in the ward suddenly slapped you in the face and spitted on your face and is obviously agitated and violent. Which of the following is the best nursing action?
- Tell the client: "Because of that, you are not going to eat your lunch, dinner and breakfast anymore"
- Slap the client back and say "I am your nurse, you are a patient and you have no right to hurt me"
- Prepare a 5 member team to restraint the client
- Respond by saying "You are losing control of yourself, you slapped me and you spitted on me and you are way out of control"
20. Situation: Please respond as a professional nurse in the other health situations through the following question. Q. Transmission of HIV from an infected individual to another person occurs:
- Most frequency in nurses with needles ticks.
- Only if there is a large viral load in the blood.
- Most commonly as a result of sexual contact.
- In a infants born to women with HIV infection.
21. A patient who sustained extensive abdominal injuries in a motor vehicle accident has developed a large stage II pressure ulcer on the coccyx. A new diagnosis of alteration in skin integrity is added to the care plan. What is the BEST short-term goal for the patient?
- Show evidence of healing within one week
- Have no discomfort from the pressure ulcer
- Eat at least 50% of each meal
- Verbalize strategies to prevent further skin breakdown
22. A nurse is caring for a client with a history of chronic obstructive pulmonary disease (COPD). What complications are most commonly associated with COPD?
- Cardiac problems
- Joint inflammation
- Kidney dysfunction
- Peripheral neuropathy
23. SITUATION: Alfred, a 40 year old construction worker developed cough, night sweats and fever. He was brought to the nursing unit for diagnostic studies. He told the nurse he did not receivea BCG vaccine during childhood Q. This is the name of the program of the DOH to control TB in the country
- DOTS
- National Tuberculosis Control Program
- Short Coursed Chemotherapy
- Expanded Program for Immunization
Answer: Only for registered users. Please login!
24. The physician has ordered an injection of RhoGam for the postpartum client whose blood type is A negative but whose baby is O positive. To provide postpartum prophylaxis RhoGam should be administered:
- Within 72 hours of delivery
- Within one week of delivery
- Within two weeks of delivery
- Within one month of delivery
Answer: Only for registered users. Please login!
25. A client with a history of diverticulitis complains of abdominal pain fever and diarrhea. Which food is responsible for the clients symptoms?
- Mashed potatoes
- Steamed carrots
- Baked fish
- Whole-grain cereal
Answer: Only for registered users. Please login!
26. The nurse is caring for a client in the late stages of Amyotrophic Lateral Sclerosis (A.L.S.). Which finding would the nurse expect?
- Confusion
- Loss of half of visual field
- Shallow respirations
- Tonic-clonic seizures
Answer: Only for registered users. Please login!
27. A technique in physical examination that is use to assess the movement of air through the tracheobronchial tree:
- Palpation
- Auscultation
- Inspection
- Percussion
Answer: Only for registered users. Please login!
28. A disturbed client is scheduled to begin group therapy. The client refuses to attend. Nurse Lola should:
- Accept the clients decision without discussion
- Have another client to ask the client to consider
- Tell the client that attendance at the meeting is required
- Insist that the client join the group to help the socialization process
Answer: Only for registered users. Please login!
29. Situation: Nurse Macarena is a Family Planning and Infertility Nurse Specialist and currently attends to FAMILY PLANNING CLIENTS AND INFERTILE COUPLES. The following conditions pertain to meeting the nursing needs of this particular population group. Another client named Cindy is diagnosed as having endometriosis. This condition interferes with fertility because:
- Endometrial implants can block the fallopian tubes
- The uterine cervix becomes inflamed and swollen
- The endometrial lining becomes inflamed leading to narrowing of the cervix.
- Inflammation of the endometrium causes release of substance P which kills the sperm.
30. A patient is planning to have an elective surgical procedure to repair an umbilical hernia. The patient is 68 years old. Weighs 136 kg (300 lbs.) Has diabetes mellitus. Which of the following approaches would be the MOST beneficial in order to reduce the patients surgical risk?
- Monitor blood glucose levels monthly
- Avoid fluid overload by restricting fluids
- Discourage any changes in routine before surgery
- Encourage weight reduction
31. Which of the following is TRUE about functional nursing?
- Concentrates on tasks and activities
- Emphasizes use of group collaboration
- One-to-one nurse-patient ratio
- Provides continuous, coordinated and comprehensive nursing services
Answer: Only for registered users. Please login!
32. Clarissa is 7 weeks pregnant Further examination revealed that she is susceptible to rubella. When would be the most appropriate for her to receive rubella immunization?
- At once
- During 2nd trimester
- During 3rd trimester
- After the delivery of the baby
33. The peak point of a uterine contraction is called the:
- Acceleration
- Acme
- Deceleration
- Axiom
Answer: Only for registered users. Please login!
34. A home health care nurse visits a patient diagnosed with rheumatoid arthritis. The nurse gathers information about the pain level after the use of prescribed pain medication to check on the effectiveness of the intervention. This phase of nursing process is called:
- Assessment
- Diagnosis
- Implementation
- Evaluation
35. The client is admitted for evaluation of aggressive behavior and diagnosed with antisocial personality disorder. A key part of the care of such clients is:
- Setting realistic limits
- Encouraging the client to express remorse for behavior
- Minimizing interactions with other clients
- Encouraging the client to act out feelings of rage
Answer: Only for registered users. Please login!
36. Kate who has undergone mitral valve replacement suddenly experiences continuous bleeding from the surgical incision during postoperative period. Which of the following pharmaceutical agents should Nurse Aiza prepare to administer to Kate?
- Protamine Sulfate
- Quinidine Sulfate
- Vitamin C
- Coumadin
Answer: Only for registered users. Please login!
37. A nurse makes a home visit to a patient recently diagnosed with chronic obstructive pulmonary disease (COPD), which of the following should the nurse teach the patient about managing COPD?
- Recognizing signs of impending respiratory infection
- Limiting fluids intake minimize bronchial secretions
- Correct technique to auscultate the lung fields
- Importance of starting antibiotic therapy
38. A client with a gastric ulcer is scheduled for surgery. The client cannot sign the operative consent form because of sedation from opioid analgesics that have been administered. The nurse should take which most appropriate action in the care of this client?
- Obtain a court order for the surgery.
- Have the charge nurse sign the informed consent immediately.
- Send the client to surgery without the consent form being signed.
- Obtain a telephone consent from a family member, following agency policy.
Answer: Only for registered users. Please login!
39. The physician has ordered continuous bladder irrigation for a client following prostatectomy. The nurse should:
- Hang the solution 2-3 feet above the clients abdomen.
- Allow air from the solution tubing to flow into the catheter.
- Use a clean technique when attaching the solution tubing to the catheter.
- Clamp the solution tubing periodically to prevent bladder distention.
Answer: Only for registered users. Please login!
40. It is the hair that lines the vestibule which function as a filtering mechanism for foreign objects
- Nares
- Carina
- Cilia
- Vibrissae
Answer: Only for registered users. Please login!
41. Situation: Survey and Statistics are important part of research that is necessary to explain the characteristics of the population. Q. Draw Lots, Lottery, Table of random numbers or a sampling that ensures that each element of the population has an equal and independent chance of being chosen is called:
- Cluster
- Simple
- Stratified
- Systematic
42. A child with cystic fibrosis is being treated with inhalation therapy with Pulmozyme (dornase alfa). A side effect of the medication is:
- Weight gain
- Hair loss
- Sore throat
- Brittle nails
Answer: Only for registered users. Please login!
43. A patient is one day post-operative repair of a large umbilical hernia. The patient complaints of abdominal pain and describe feeling the sutures give way. Upon assessment of the abdomen the nurse observes an evisceration. The nurse's IMMEDIATE response should be to:
- Medicate the patient for pain
- Instruct the patient to cough hard
- Have the patient perform the Valsalva maneuver
- Cover the abdomen with a sterile saline spiked dressing
44. Which of the following is NOT TRUE in steam inhalation?
- It is a dependent nursing action
- Spout is put 12-18 inches away from the nose
- Render steam inhalation for at least 60 minutes
- Cover the clients eye with wash cloth to prevent irritation
Answer: Only for registered users. Please login!
45. 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. Some of the diabetic clients are interested in understanding what is visualized during funduscopic examination. During your discussion you describe the macular area as:
- Head of the optic nerve, seen on the nasal side of the field, lighter in color than the retina.
- The area of central vision, seen on the temporal side of the optic disc, which is quite avascular.
- Area where the central retinal artery and vein appear on the retina.
- Reddish orange in color, sometimes stippled.
Answer: Only for registered users. Please login!
46. Which of the following conditions, reported to a nurse by a 20 year old male patient, would indicate a risk for development of testicular cancer?
- Genital Herpes
- Undescended testicle
- Measles
- Hydrocele
47. The nurse is monitoring a client with a history of stillborn infants. The nurse is aware that a nonstress test can be ordered for this client to:
- Determine lung maturity
- Measure the fetal activity
- Show the effect of contractions on fetal heart rate
- Measure the well-being of the fetus
Answer: Only for registered users. Please login!
48. The nurse notes documentation that a child is exhibiting an inability to flex the leg when the thigh is flexed anteriorly at the hip. Which condition does the nurse suspect?
- Men in gitis
- Spinal cord injury
- Intracranial bleeding
- Decreased cerebral blood flow
Answer: Only for registered users. Please login!
49. A client who receives general anesthesia returns from surgery. Postoperatively, which nursing diagnosis takes highest priority for this client?
- Pain related to the surgery
- Fluid volume deficit related to fluid and blood loss from surgery
- Impaired physical mobility related to surgery
- Risk for aspiration related to anesthesia
50. Situation: Nurse Joanna works as an OB-Gyn Nurse and attends to several HIGH-RISKPREGNANCIES: Particularly women with preexisting or newly acquired illness. The following conditions apply. Q. Bernadette received a laceration on her leg from her automotive accident Why are lacerations of lower extremities potentially more serious in pregnant women than others?
- Lacerations can provoke allergic responses because of gonadotropic hormone
- Increased bleeding can occur from uterine pressure on leg veins
- A woman is less able to keep the laceration clean because of her fatigue
- Healing is limited during pregnancy, so these will not heal until after birth