NCLEX-RN | QB3 | Practice Exam #28 (50 questions)
All 50 questions are randomized each time you take the test, and do not appear in the same order.
1. Situation: Because of the serious consequences of severe burns management requires a multidisciplinary approach. You have important responsibilities as a nurse. Q. During the first 24 hours after thermal injury, you should assess Sergio for:
- hypokalemia and hypernatremia
- hypokalemia and hyponatremia
- hyperkalemia and hyponatremia
- hyperkalemia and hypernatremia
2. A patient is admitted to the medical unit with a diagnosis of fluid volume deficit would the nurse expect the doctor to order?
- 0.9% Sodium chloride
- 0.45% Sodium chloride
- Dextran in normal saline
- 5% Sodium chloride
3. A nurse is reviewing the health care provider’s orders for a client who was admitted with dehydration as a result of prolonged watery diarrhea. Which order should the nurse question?
- Oral psyllium (Metamucil)
- Oral potassium supplement
- Parenteral half normal saline
- Parenteral albumin (Albuminar)
4. A client with acute leukemia develops a low white blood cell count. In addition to the institution of isolation the nurse should:
- Request that foods be served with disposable utensils.
- Ask the client to wear a mask when visitors are present.
- Prep IV sites with mild soap and water and alcohol.
- Provide foods in sealed single-serving packages.
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5. For an infant with hydrocephalus, a nurse should plan to monitor for what sign or symptom of increased intracranial pressure?
- High-pitched, shrill cry
- Decrease in systolic blood pressure
- Depressed fontanelle
- Increase in respirations
6. Nurse Trish is caring for a female client with a history of GI bleeding, sickle cell disease, and a platelet count of 22,000/pl. The female client is dehydrated and receiving dextrose 5% in half-normal saline solution at 150 ml/hr. The client complains of severe bone pain and is scheduled to receive a dose of morphine sulfate. In administering the medication, Nurse Trish should avoid which route?
- I.M
- I.V
- Oral
- S.C
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7. All of the following contributes to host susceptibility except:
- Creed
- Immunization
- Current medication being taken
- Color of the skin
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8. A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an adequate understanding of the peak action of NPH insulin and exercise?
- "I should not exercise since I am taking insulin.”
- "The best time for me to exercise is after breakfast.”
- "The best time for me to exercise is mid to late afternoon"
- "NPH is a basal insulin, so I should exercise in the evening.”
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9. Four days after delivery a client develops complications of postpartal hemorrhage. The most common cause of late postpartal hemorrhage is:
- Uterine atony
- Retained placental fragments
- Cervical laceration
- Perineal tears
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10. Situation: As a Nurse, you have specific responsibilities as professional. You have to demonstrate specific competencies. Q. Brenda, the Nursing Supervisor of the intensive care unit (ICU) is not on duty when a staff nurse committed a serious medication error. Which statement accurately reflects the accountability of the nursing supervisor?
- Brenda should be informed when she goes back on duty
- Although Brenda is not on duty, the nursing supervisor on duty decides to call her if time permits
- The nursing supervisor on duty will notify Brenda at home
- Brenda is not duty therefore it is not necessary to inform her
11. An elderly patient had surgery two days for an intestinal obstruction. Vital signs at 10 am are temperature 37.5c (99.5 f), heart rate 86, respiratory rate 16 blood pressure level 132/72 mm Hg, pain level of 4 on a scale of 0 to 10. The abdominal dressing is dry and intact. The nasal gastric tube to low intermittent suction. The patient is on strict input and output every two hours. At 12.20pm, the patient complains abdominal pain, upon assessment the vital signs are temperature 37.5 C, heart rate 98, respiration rate 24, blood pressure level 146/ 88 mm Hg, pain level is 8 out of 10. The patient abdomen is distended and rigid, the dressing remains dry and intact. The nurse should first:
- Reposition the patient on the right side
- Irrigate the nasal gastric tube to check patency
- Medicate the patient for pain as ordered
- Increase the suction on his nasal gastric tube to high intermittent suction
12. Nurse Fred is assessing a client who has just been admitted to the ER department. Which signs would suggest an overdose of an antianxiety agent?
- Suspiciousness, dilated pupils and incomplete BP
- Agitation, hyperactivity and grandiose ideation
- Combativeness, sweating and confusion
- Emotional lability, euphoria and impaired memory
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13. One month after starting new medications for hypertension, a patient returns to the clinic with blood pressure in the range. The patient admits to taking the medications only when "feeling bad" Which of the following actions would the nurse take?
- Assess further determine the reason the reason for the patient's Actions
- Add a new diagnosis of non-compliance
- Re-educate the patient about the importance of following his medication plan
- Reevaluate the need for daily medication since the blood pressure is acceptable
14. A child recently diagnosed with sickle cell anemia is being prepared for discharge. Which of the following statement by one of the parents would require ADDITIONAL teaching by the nurse?
- High altitudes can be beneficial
- Blood transfusion may be necessary in the future
- Strenuous physical activity should be avoided
- Increased fluid intake minimize pain
15. Situation: Some equipments and materials in our hospital are color coded, this is to increase the safety and proficiency of rendering patients care. Q. if the anaesthesiologist asked for a 22 gauge spinal set, the nurse knew that the color of the set that she will obtain is:
- Red
- Pink
- Yellow
- Blue
16. Nurse Maureen knows that the non-antipsychotic medication used to treat some clients with schizoaffective disorder is:
- phenelzine (Nardil)
- chlordiazepoxide (Librium)
- lithium carbonate (Lithane)
- imipramine (Tofranil)
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17. Mr. Cruz visits the physician's office to seek treatment for depression, feelings of hopelessness, poor appetite, insomnia, fatigue, low self esteem, poor concentration, and difficulty making decisions. The client states that these symptoms began at least 2 years ago. Based on this report, the nurse Tiffany suspects:
- Cyclothymic disorder.
- Atypical affective disorder.
- Major depression.
- Dysthymic disorder
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18. Situation: A nurse is working with an aggressive client in the psychiatric unit. Q. To encourage thought, which of the following approaches is NOT therapeutic?
- "Why do you feel angry?"
- "How do you usually express anger?"
- "When do you usually feel angry?"
- "What situations provoke you to be angry?"
19. On the third day after a partial thyroidectomy, Proserfina exhibits muscle twitching and hyperirritability of the nervous system. When questioned, the client reports numbness and tingling of the mouth and fingertips. Suspecting a lifethreatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery?
- Hypocalcemia
- Hyponatremia
- Hyperkalemia
- Hypermagnesemia
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20. A home health nurse visits a patient with diabetes and primary open-angle glaucoma. The patient takes metformin (Glucophage) 500 mg once a day for diabetes and timolol ophthalmic solution twice a day in each eye for glaucoma. Which of the following evaluations indicates that the patient is noncompliant with glaucoma management?
- Patient has not been taking Glucophage
- Patient has tearing of the eye
- Patient has not refilled prescription for timolol in 3 months
- Patient has yellow discharge from the eyes
21. SITUATION: Marvin, A male patient diagnosed with colon cancer was newly put in colostomy. Q. The nurse will start to teach Marvin about the techniques for colostomy irrigation. Which of the following should be included in the nurse's teaching plan?
- Use 500 ml to 1,000 ml NSS
- Insert the cone 4 cm in the stoma
- if cramping occurs, slow the irrigation
- Suspend the irrigant 45 cm above the stoma
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22. What would the nurse note as typical findings on the assessment of a client with acute pancreatitis?
- Steatorrhea, abdominal pain, fever
- Fever, hypoglycemia, DHN
- Melena, persistent vomiting, hyperactive bowel sounds
- Hypoactive bowel sounds, decreased amylase and lipase levels
23. She reads about Path Goal theory. Which of the following behaviors is manifested by the leader who uses this theory?
- Recognizes staff for going beyond expectations by giving them citations
- Challenges the staff to take individual accountability for their own practice
- Admonishes staff for being laggards.
- Reminds staff about the sanctions for non performance.
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24. What supplemental medication is most frequently ordered in conjuction with furosemide (Lasix)?
- Chloride
- Digoxin
- Potassium
- Sodium
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25. A client with Parkinsons disease is scheduled for stereotactic surgery. Which finding indicates that the surgery had its intended effect?
- The client no longer has intractable tremors.
- The client has sufficient production of dopamine.
- The client no longer requires any medication.
- The client will have increased production of serotonin.
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26. The nurse is inserting a nasogastric [NG) tube into patient as prescribed. The nurse has advanced the into the patient's posterior pharynx. The nurse show now ask the patient to?
- Hold the breath
- Stare upwards with the eyes towards the ceiling
- Perform the Valsalva maneuver
- Lower the chin towards the chest
27. A 30 year-old woman with type 1 diabetes mellitus receives mixed type of insulin in the morning and before bed time. She reports that the level of her fasting blood sugar is constantly high when she checks it every morning at home. Which dose of insulin is most likely causing this problem?
- Low morning, regular insulin
- High morning NPHI
- High evening regular insulin
- Low evening NPH insulin
28. The nurse caring for a client with a closed head injury obtains an intracranial pressure (ICP) reading of 17mmHg. The nurse recognizes that:
- The ICP is elevated and the doctor should be notified.
- The ICP is normal; therefore no further action is needed.
- The ICP is low and the client needs additional IV fluids.
- The ICP reading is not as reliable as the Glascow coma scale.
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29. The client is having electroconvulsive therapy for treatment of severe depression. Which of the following indicates that the clients ECT has been effective?
- The client loses consciousness.
- The client vomits.
- The clients ECG indicates tachycardia.
- The client has a grand mal seizure.
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30. A hospitalized schoolager states: "I'm not afraid of this place, I’m not afraid of anything." This statement is most likely an example of which of the following?
- Regression
- Repression
- Reaction formation
- Rationalization
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31. The nurse is giving a bed bath to an assigned client when an unlicensed assistive personnel (UAP) enters the client's room and tells the nurse that another assigned client is in pain and needs pain medication. Which is the most appropriate nursing action?
- Finish the bed bath and then administer the pain medication to the other client.
- Ask the UAP to find out when the last pain medication was given to the client.
- Ask the UAP to tell the client in pain that medication will be administered as soon as the bed bath is complete.
- Cover the client, raise the side rails, tell the client that you will return shortly, and administer the pain medication to the other client.
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32. The nurse is reviewing the record of a client with a diagnosis of cirrhosis and notes that there is documentation of the presence of asterixis. How should the nurse assess for its presence?
- Dorsiflex the clients foot.
- Measure the abdominal girth.
- Ask the client to extend the arms.
- Instruct the client to lean forward.
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33. You are pulled from the ED to the neurologic floor. Which action should you delegate to the nursing assistant when providing nursing care for a patient with SCI?
- Assess patient's respiratory status every 4 hours.
- Take patient's vital signs and record every 4 hours.
- Monitor nutritional status including calorie counts.
- Have patient turn, cough, and deep breathe every 3 hours.
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34. Which of the following statement is wrong:
- A nursing diagnosis is stated in terms of a problem and not a need
- A nursing diagnosis describes a patient's health problem
- A nursing process to the method of data gathering and diagnosing diseases
- A component of the nursing process that pertains to the organization of data and describes the nursing problem is the assessment
35. Which of the following is INCORRECT in assessing client's BP?
- Read the mercury at the upper meniscus, preferably at the eye level to prevent error of parallax
- Inflate and deflate slowly, 2-3 mmHg at a time
- The sound heard during taking BP is known as KOROTKOFF sound
- If the BP is taken on the left leg using the popliteal artery pressure, a BP of 160/80 is normal.
36. When teaching parents about typical toddler eating patterns, which of the following should be included?
- Food "jags"
- Preference to eat alone
- Consistent table manners
- Increase in appetite
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37. Using IMCI guidelines, you classify a child as having severe pneumonia. What is the best management for the child?
- Prescribe antibiotic
- Refer him urgently to the hospital
- Instruct the mother to increase fluid intake
- Instruct the mother to continue breastfeeding
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38. What is the most appropriate nursing response to a myocardial infarction client who is fearful of dying?
- "Tell me about your feeling right now"
- "When the doctor arrives, everything will be fine"
- 'This is a bad situation, but you'll feel better soon"
- "Please be assured we're doing everything we can to make you feel better"
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39. In assessing the clients chest, which position best show chest expansion as well as its movements?
- Sitting
- Prone
- Sidelying
- Supine
40. The nurse is caring for a client with heart failure who is receiving high doses of a diuretic. On assessment, the nurse notes that the client has flat neck veins, generalized muscle weakness, and diminished deep tendon reflexes. The nurse suspects hyponatremia. What additional signs would the nurse expect to note in a client with hyponatremia?
- Muscle twitches
- Decreased urinary output
- Hyperactive bowel sounds
- Increased specific gravity of the urine
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41. A patient who is 4 days postoperative after a total hip replacement surgery, is obese and has not been able to ambulate since the surgery. The patient is now diaphoretic, has chilis, and complains of pain in the thigh. There is tenderness over the anteromedial surface of the thigh. The MOST likely cause is:
- Wound infection
- Deep vein thrombosis (DVT)
- Pulmonary edema
- Dehydration
42. The physician has ordered a culture for the client with suspected gonorrhea. The nurse should obtain a culture of:
- Blood
- Nasopharyngeal secretions
- Stool
- Genital secretions
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43. A 7-week-old infant boy is admitted with projectile vomiting decreased urine output, decreased bowel movements and weight loss. He has poor turgor and appears hungry. The nurse observes left-to right peristaltic waves after he vomits. The nurse would expect to find which of the following during the physical assessment?
- Hepato-spleenomegaly
- A palpable pyloric mass
- Lymphadenopathy
- Bulging fontanelles
44. The nurse is caring for a client with manic depression. The care plan for a client in a manic state would include:
- offering high-calorie meals and strongly encouraging the client to finish all food.
- insisting that the client remain active throughout the day so that he'll sleep at night.
- allowing the client to exhibit hyperactive, demanding, manipulative behavior without setting limits.
- listening attentively with a neutral attitude and avoiding power struggles.
45. Situation: Nurse Joanna works as an OB-Gyn Nurse and attends to several HIGH- RISK PREGNANCIES: Particularly women with preexisting or newly acquired illness. The following conditions apply The cousin of Bernadette with sickle-cell anemia alerted Joanna that she may need further instruction on prenatal care. Which statement signifies this fact?
- I've stopped jogging so I don't risk becoming dehydrated
- I take an iron pull every day to help grow new red blood cells
- I am careful to drink at least eight glasses of fluid everyday
- I understand why folic acid is important for red cell formation
46. The nurse is creating a plan of care for a client in a crisis state. When developing the plan, the nurse should consider which factor?
- A crisis state indicates that the client has a mental illness.
- A crisis state indicates that the client has an emotional illness.
- Presenting symptoms in a crisis situation are similar for all clients experiencing a crisis.
- A client's response to a crisis is individualized and what constitutes a crisis for one client may not constitute a crisis for another client.
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47. The client is on NPO post midnight. Which of the following, if done by the client, is sufficient to cancel the operation in the morning?
- Eat a full meal at 10:00 PM
- Drink fluids at 11:50 PM
- Brush his teeth the morning before operation
- Smoke cigarette around 3:00 A.M
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48. An elderly client is diagnosed with interstitial cystitis. Which finding differentiates interstitial cystitis from other forms of cystitis?
- The client is asymptomatic.
- The urine is free of bacteria.
- The urine contains blood.
- Males are affected more often.
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49. Andy is admitted to the psychiatric unit with a diagnosis of borderline personality disorder. Nurse Hilary should expects the assessment to reveal:
- Coldness, detachment and lack of tender feelings
- Somatic symptoms
- Inability to function as responsible parent
- Unpredictable behavior and intense interpersonal relationships
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50. A patient has an order for a pneumatic compression device. Which of the following is an appropriate goal?
- Reduce the risk deep vein thrombosis
- Reduce lower extremity edema
- Reduce lower extremity pain
- Reduce the risk of phlebitis