NCLEX-RN | QB3 | Practice Exam #39 (50 questions)
All 50 questions are randomized each time you take the test, and do not appear in the same order.
1. Situation: You are assigned to take care of a group of patients across the lifespan. Administration of analgesics to the older persons require careful patient assessment because older people:
- Are more sensitive drugs
- Have increased hepatic, renal, and gastrointestinal function
- Have increased sensory perception
- Mobilize drugs more rapidly
2. A client is admitted to the labor and delivery unit complaining of vaginal bleeding with very little discomfort. The nurses first action should be to:
- Assess the fetal heart tones.
- Check for cervical dilation.
- Check for firmness of the uterus.
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3. As the client reaches 6cm dilation the nurse notes late decelerations on the fetal monitor. What is the most likely explanation of this pattern?
- The baby is sleeping.
- The umbilical cord is compressed.
- There is head compression.
- There is uteroplacental insufficiency.
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4. The nurse is caring for a client with epilepsy who is being treated with carbamazepine (Tegretol). Which laboratory value might indicate a serious side effect of this drug?
- BUN 10mg/dL
- Hemoglobin 13.0gm/dL
- WBC 4 000/mm3
- Platelets 200 000/mm3
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5. Nurse John is knowledgeable that usually individual twins will grow appropriately and at the same rate as singletons until how many weeks?
- 16 to 18 weeks
- 18 to 22 weeks
- 30 to 32 weeks
- 38 to 40 weeks
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6. The nurse notes that a client with sinus rhythm has a premature ventricular contraction that falls on the T wave of the preceding beat. The client's rhythm suddenly changes to one with no P waves, no definable QRS complexes, and coarse wavy lines of varying amplitude. How should the nurse correctly interpret this rhythm?
- Asystole
- Atrial fibrillation
- Ventricular fibrillation
- Ventricular tachycardia
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7. According to Margaret Shetland, the philosophy of public health nursing is based on which of the following?
- Health and longevity as birthrights
- The mandate of the state to protect the birthrights of its citizens
- Public health nursing as a specialized field of nursing
- The worth and dignity of man
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8. The nurse is planning care for a child with acute bacterial meningitis. Based on the mode of transmission of this infection, which precautionary intervention should be included in the plan of care?
- Maintain enteric precautions.
- Maintain neutropenic precautions.
- No precautions are required as long as antibiotics have been started.
- Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics.
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9. Ivy, who is on the psychiatric unit is copying and imitating the movements of her primary nurse. During recovery, she says, "I thought the nurse was my mirror. 1 felt connected only when 1 saw my nurse.” This behavior is known by which of the following terms?
- Modeling
- Echopraxia
- Ego-syntonicity
- Ritualism
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10. Since admission 4 days ago, a client has refused to take a shower, stating, "There are poison crystals hidden in the shower head. They'll kill me if I take a shower" Which nursing action is most appropriate?
- Dismantling the showerhead and showing the client that there is nothing in it
- Explaining that other clients are complaining about the client's body odor
- Asking a security officer to assist in giving the client a shower
- Accepting these fears and allowing the client to take a sponge bath
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11. A newborn has been diagnosed with hypothyroidism. In discussing the condition and treatment with the family, the nurse should emphasize
- They can expect the child will be mentally retarded
- Administration of thyroid hormone will prevent problems
- This rare problem is always hereditary
- Physical growth/development will be delayed
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12. The client with cancer is receiving chemotherapy and develops thrombocytopenia. The nurse identifies which intervention as the highest priority in the nursing plan of care?
- Ambulation three times a day
- Monitoring temperature
- Monitoring the platelet count
- Monitoring for pathological factors
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13. The nurse is performing a physical assessment on a newly admitted client. The last step in the physical assessment is:
- Inspection
- Auscultation
- Percussion
- Palpation
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14. The nurse is caring for a 70-year-old client with hypovolemia who is receiving a blood transfusion. Assessment findings reveal crackles on chest auscultation and distended neck veins. What is the nurses initial action?
- Slow the transfusion.
- Document the finding as the only action.
- Stop the blood transfusion and turn on the normal saline.
- Assess the clients pupils.
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15. Which of the following is a characteristic of an ominous periodic change in the fetal heart rate?
- A fetal heart rate of 120-130bpm
- A baseline variability of 6-10bpm
- Accelerations in FHR with fetal movement
- A recurrent rate of 90-100bpm at the end of the contractions
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16. Situation: NURSES are involved in maintaining a safe and healthy environment. This is part of quality care management. Q. Induction of vomiting is indicated for the accidental poisoning patient who has ingested.
- rust remover
- gasoline
- toilet bowl cleaner
- aspirin
17. Mickey, a 6-year-old child with a congenital heart disorder is admitted with congestive heart failure. Digoxin (lanoxin) 0.12 mg is ordered for the child. The bottle of Lanoxin contains .05 mg of Lanoxin in 1 ml of solution. What amount should the nurse administer to the child?
- 1.2 ml
- 2.4 ml
- 3.5 ml
- 4.2 ml
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18. During peritoneal dialysis the nurse observes that drainage of dialysate from the peritoneal cavity has ceased before the required amount has drained out The nurse should assist the client to:
- Turn from side to side
- Drink 8 ounces of water
- Deep breathe and cough
- Periodically rotate the catheter
19. A client has had diarrhea for the past three days. Which acid/base imbalance would the nurse expect the client to have?
- Respiratory alkalosis
- Metabolic acidosis
- Metabolic alkalosis
- Respiratory acidosis
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20. They are the proteins in the body that are produced in response to the invasion to pathogens and microorganisms.
- Antigen
- Amino Acids
- Agglutinogen
- Antibody
21. Breast self examination is best done by the woman on herself every month during
- The middle of her cycle to ensure that she is ovulating
- During the menstrual period
- Right after the menstrual period so that the breast is not being affected by the increase in hormones particularly estrogen
- Just before the menstrual period to determine if ovulation has occurred
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22. Which of the following parameters should be checked before administering digoxin?
- Apical pulse
- Blood pressure
- Radial pulse
- Respiratory rate
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23. Situation: Sexually Transmitted Diseases are important to identify during pregnancy because of their potential effect on the pregnancy, fetus, or newborn. The following questions pertain to STD's. Under the second level of prevention, you know that one of the focuses of care is the screening of diseases. What is the screening test for syphilis?
- VDRL
- Western blot
- PSA
- ELISA
24. The nurse is caring for a client just admitted to the mental health unit and diagnosed with catatonic stupor. The client is lying on the bed in a fetal position. Which is the most appropriate nursing intervention?
- Ask direct questions to encourage talking.
- Leave the client alone so as to minimize external stimuli.
- Sit beside the client in silence with occasional open-ended questions.
- Take the client into the dayroom with other clients so that they can help watch them.
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25. A client has refused to eat more than a few spoonfuls of breakfast. The health care provider has prescribed that tube feedings be initiated if the client fails to eat at least half of a meal because the client has lost a significant amount of weight during the previous 2 months. The nurse enters the room, looks at the tray, and states, "If you don't eat any more than that, I'm going to have to put a tube down your throat and get a feeding in that way." The client begins crying and tries to eat more. Based on the nurse's actions, the nurse may be accused of which violation?
- Assault
- Battery
- Slander
- Invasion of privacy
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26. The nurse is monitoring the status of a postoperative client in the immediate postoperative period. The nurse would become most concerned with which sign that could indicate an evolving complication?
- Increasing restlessness
- A pulse of 86 beats/minute
- Blood pressure of 110/70 mm Hg
- Hypoactive bowel sounds in all 4 quadrants
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27. The fetal heart beat should be monitored every 15 minutes during the 2nd stage of labor. The characteristic of a normal fetal heart rate is
- The heart rate will decelerate during a contraction and then go back to its pre contraction rate after the contraction
- The heart rate will accelerate during a contraction and remain slightly above the pre contraction rate at the end of the contraction
- The rate should not be affected by the uterine contraction.
- The heart rate will decelerate at the middle of a contraction and remain so for about a minute after the contraction
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28. A nurse admits a 3 week-old infant to the special care nursery with a diagnosis of bronchopulmonary dysplasia. As the nurse reviews the birth history, which data would be most consistent with this diagnosis?
- Gestational age assessment suggested growth retardation
- Meconium was cleared from the airway at delivery
- Phototherapy was used to treat Rh incompatibility
- The infant received mechanical ventilation for 2 weeks
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29. Which of the following is the best position to increase the brain perfusion (cerebral perfusion):
- Prone
- Supine
- Semi-Fowler's
- Trendelenburg’s
30. Situation: "Group Approach" in Nursing. Q. The goal of remotivation therapy is to facilitate:
- Insight
- Productivity
- Socialization
- Intimacy
31. The client is admitted to the hospital with hypertensive crises. Diazoxide (Hyperstat) is ordered. During administration the nurse should:
- Utilize an infusion pump.
- Check the blood glucose level.
- Place the client in Trendelenburg position.
- Cover the solution with foil.
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32. The client is admitted to the postpartum unit with an order to continue the infusion of Pitocin. The nurse is aware that Pitocin is working if the fundus is:
- Deviated to the left
- Firm and in the midline
- Boggy
- Two finger breadths below the umbilicus
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33. The physician has ordered an injection of morphine for a client with post-operative pain. Before administering the medication it is essential that the nurse assess the clients:
- Heart rate
- Respirations
- Temperature
- Blood pressure
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34. The nurse should know that the normal therapeutic level of lithium is:
- .6 to 1.2 meq/L
- 6 to 12 meq/L
- .6 to .12cc/ml
- .6 to .12 cc/L
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35. A male client is scheduled for a transsphenoidal hypophysectomy to remove a pituitary tumor. Preoperatively, the nurse should assess for potential complications by doing which of the following?
- Testing for ketones in the urine
- Testing urine specific gravity
- Checking temperature every 4 hours
- Performing capillary glucose testing every 4 hours
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36. The lochia on the first few days after delivery is characterized as:
- Pinkish with some blood clots
- Whitish with some mucus
- Reddish with some mucus
- Serous with some brown tinged mucus
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37. Which of the following characteristics of contractions would the nurse expect to find in a client experiencing true labor?
- Occurring at irregular intervals
- Starting mainly in the abdomen
- Gradually increasing intervals
- Increasing intensity with walking
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38. While caring for an edentulous patient with multiple pressure sores, the nurse asked by the patient's spouse to evaluate several menus, which of the following menus would be MOST therapeutic?
- Steamed carrots, milks and applesauce
- Tuna fish with mayonnaise, boiled eggs and yogurt
- Grilled steak, baked potato and peach pie
- Chicken noodle soup, banana and cocoa
39. Which of the following types of behavior is expected from a client diagnosed with paranoid personality disorder?
- Eccentric
- Exploitative
- Hypersensitive
- Seductive
40. Nurse Oliver is working in a out patient clinic. He has been alerted that there is an outbreak of tuberculosis (TB). Which of the following clients entering the clinic today most likely to have TB?
- A 16-year-old female high school student
- A 33-year-old daycare worker
- A 43-year-old homeless man with a history of alcoholism
- A 54-year-old businessman
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41. Which of the following aspects of psychosocial development is necessary for the nurse to keep in mind when providing care for the preschool child?
- The child can use complex reasoning to think out situations.
- Fear of body mutilation is a common preschool fear
- The child engages in competitive types of play
- Immediate gratification is necessary to develop initiative.
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42. Situation: If a child with diarrhea registers one sign in the pink row and one in the yellow; row in the 1MCI Chart A child who has had diarrhea for 14 days but has no sign of dehydration is classified as:
- severe persistent diarrhea
- dysentery
- severe dysentery
- persistent diarrhea
43. John, a suspicious client states that "I know you nurses are spraying my food with poison as you take it out of the cart." Which of the following would be the best response of the nurse?
- Giving the client canned supplements until the delusion subsides
- Asking what kind of poison the client suspects is being used
- Serving foods that come in sealed packages
- Allowing the client to be the first to open the cart and get a tray
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44. A nurse is working in an endoscopy recovery area. Many of the clients are administered midazolam (Versed) to provide conscious sedation. Which medication is important to have available as an antidote for Versed?
- Diazepam (Valium)
- Naloxone (Narcan)
- Flumazenil (Romazicon)
- Fiori nef (Fludrocortisone)
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45. A patient had a retinal detachment surgically repaired the nurse identifies that the detachment would most likely be corrected and unlikely to reoccur if the retina remains attached at least:
- Three days
- Two weeks
- Two months
- Three months
46. Mr. Duffy is admitted to the CCU with a diagnosis of R/0 Ml. 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. During the physical examination of the well adult client, the health care provider auscultates the heart. When the stethoscope is placed on the 5th intercostal space along the left sternal border, which valve closure is best evaluated?
- Tricuspid
- Pulmonic
- Aortic
- Mitral
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47. A 20 year-old woman takes cyclosporine 100 mg by mouth twice per day. She had a heart transplant two months ago and complains of dizziness, shortness of breath, light headedness and fatigue. Capillary refill >3. Blood pressure: 90/50 mmHg Heart rate, irregular: 100/min Respiratory rate: 28/mm Temperature: 38.0’C What is the most likely underlying cause of the patient's problem?
- Cyclosporine toxicity
- Hyperkalemia
- Organ rejection
- Infection
48. The Nurse is aware that the ability to enter into the life of another person and perceive his current feelings and their meaning is known:
- Belongingness
- Genuineness
- Empathy
- Respect
49. Which of the following health status assessments must be completed before the client starts taking imipramine (Tofranil)?
- Electrocardiogram (ECG).
- Urine sample for protein.
- Thyroid scan.
- Creatinine clearance test.
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50. Which route of administration is preferred if immediate analgesia and rapid titration are necessary?
- Intraspinal
- Patient-controlled analgesia (PCA)
- Intravenous (IV)
- Sublingual
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