NCLEX-RN | QB3 | Practice Exam #40 (50 questions)
All 50 questions are randomized each time you take the test, and do not appear in the same order.
1. SITUATION: John Lloyd, a 27 basketball player sustained inhalation burn that required him to have tracheostomy due to massive upper airway edema. Q. Which of the following method if used by Wilma will best assure that the tracheostomy ties are not too tightly placed?
- Wilma places 2 fingers between the tie and neck
- The tracheotomy can be pulled slightly away from the neck
- John Lloyd' neck veins are not engorged
- Wilma measures the tie from the nose to the tip of the earlobe and to the xiphoid process.
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2. A two-year-old toddler is admitted to the hospital. Which of the following nursing interventions would you expect?
- Ask the parent/guardian to leave the room when assessments are being performed.
- Ask the parent/guardian to take the child favorite blanket home because anything from the outside should not be brought into the hospital.
- Ask the parent/guardian to room-in with the child.
- If the child is screaming tell him this is inappropriate behavior.
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3. A 54 year-old woman presented to the Emergency Department with sharp upper right abdominal pain that radiates to the right scapula. While performing the admission assessment, the patient becomes nauseous and begins vomiting. She states that she has had pain in the upper right quadrant previously but that this time it was far worse. There's a positive Murphy's sign and an ultrasound confirms gallbladder wall thickening and pericholecystic fluid collections. Which of the following would most likely be associated with her clinical findings?
- Relief by drinking milk
- Alleviation with exercise
- Triggered by fatty meal
- Worsening on empty stomach
4. Situation: Mastery of research design determination is essential in passing the Nurse Licensure Examination. Q. Anton was always eating high fat diet. You want to determine if what will be the effect of high cholesterol food to Anton in the next 10 years. You will use:
- Comparative
- Correlational
- Historical
- Longitudinal
5. A mother is in the third stage of labor Which of the following signs will help the nurse determine the signs of placental separation?
- The uterus becomes globular
- The umbilical cord is shortened.
- The fundus appears at the introitus.
- Mucoid discharge is increased.
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6. Which of the following would the nurse use as the basis for the teaching plan when caring for a pregnant teenager concerned about gaining too much weight during pregnancy?
- 10 pounds per trimester
- 1 pound per week for 40 weeks
- 1/2 pound per week for 40 weeks
- A total gain of 25 to 30 pounds
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7. A bed-bound patient has a care plan with interventions to include re-positioning every 2 hours. The patient develops a stage I 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
8. Debbie is experiencing dystocia, a painful, difficult and prolonged delivery. The nurse is aware that the primary cause related to problems with all of these Except the:
- Power
- Prognosis
- Passenger
- Passageway
9. Sterile technique is used whenever:
- Strict isolation is required
- Terminal disinfection is performed
- Invasive procedures are performed
- Protective isolation is necessary
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10. The nurse is discussing meal planning with the mother of a two-year-old. Which of the following statements if made by the mother would require a need for further instruction?
- It is okay to give my child white grape juice for breakfast.
- My child can have a grilled cheese sandwich for lunch.
- We are going on a camping trip this weekend and I have bought hot dogs to grill for his lunch.
- For a snack my child can have ice cream.
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11. A pregnant mother is admitted to the hospital with the chief complaint of profuse vaginal bleeding, AOG 36 wks, not in labor. The nurse must always consider which of the following precautions:
- The internal exam is done only at the delivery under strict asepsis with a double set-up
- The preferred manner of delivering the baby is vaginal
- An emergency delivery set for vaginal delivery must be made ready before examining the patient
- Internal exam must be done following routine procedure
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12. A client with chronic schizophrenia receives 20 mg of fluphenazine decanoate (Prolixin Decanoate) by I.M. injection. Three days later, the client has muscle contractions that contort the neck. This client is exhibiting which extrapyramidal reaction?
- Dystonia
- Akinesia
- Akathisia
- Tardive dyskinesia
13. Which information obtained by assessment ensures that the client's respiratory efforts are currently adequate?
- The client is able to talk.
- The client is alert and oriented.
- The clients oxygen saturation is 97%.
- The clients chest movements are uninhibited
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14. The home health nurse is visiting a client for the first time. While assessing the client's medication history, it is noted that there are 19 prescriptions and several over-the-counter medications that the client has been taking. Which intervention should the nurse take first?
- Check for medication interactions.
- Determine whether there are medication duplications.
- Call the prescribing health care provider (HCP) and report polypharmacy.
- Determine whether a family member supervises medication administration.
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15. A newborn infant with Down syndrome is to be discharged today. The nurse is preparing to give the discharge teaching regarding the proper care at home. The nurse would anticipate that the mother is probably at the:
- 40 years of age.
- 20 years of age.
- 35 years of age.
- 30 years of age.
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16. A 6-month-old boy is admitted with a diagnosis of failure to thrive. According to the growth chart at 3 months of age the infant's weight is in which percentile?
- 25th
- 5th
- 10th
- Below the 5th
17. A six year-old patient has been diagnosed with acute rheumatic fever. The nurse knows that the antibiotic of choice for this illness is:
- Benzathine penicillin (Megacillin)
- Amoxicillin (Amoxil)
- Erythromycin (Erythrosine)
- Vancomycin (Vancocin)
18. Situation: The nurse is performing health education activities for Jane Segovia, a 30 years old Dentist with Insulin dependent diabetes Mellitus. Q. Jane complains of nausea, vomiting, diaphoresis and headache. Which of the following nursing intervention are you going to carry first?
- Withhold the client's next insulin injection
- Test the client's blood glucose level
- Administer Tylenol as ordered
- Offer fruit juice, gelatine and chicken bouillon
19. A neighbor tells nurse Maureen he has to have surgery and is reluctant to have any blood product transfusions because of a fear of contracting an infection. He asks the nurse what are his options. The nurse teaches the person that the safest blood product is:
- An allogeneic product.
- A directed donation product.
- An autologous product.
- A cross-matched product.
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20. David is diagnosed with panic disorder with agoraphobia is talking with the nurse in-charge about the progress made in treatment. Which of the following statements indicates a positive client response?
- "I went to the mall with my friends last Saturday"
- "I'm hyperventilating only when I have a panic attack"
- "Today I decided that I can stop taking my medication"
- "Last night I decided to eat more than a bowl of cereal"
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21. SITUATION: a 20 year old college student was rushed to the ER of PGH after he fainted during their ROTC drill. Complained of severe right iliac pain. Upon palpation of his abdomen, Ernie jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis. Q. If after surgery the patient's abdomen becomes distended and no bowel sounds appreciated, what would be the most suspected complication?
- Intussusception
- Paralytic Ileus
- Hemorrhage
- Ruptured colon
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22. Situation: Elvira is a 26 year old woman you admit to a birthing room. She's been having contractions 45 seconds long and 3 minutes apart for the last 6 hours. She tells you she wants to have her baby "naturally" without any analgesia or anesthesia. Her husband is in the Army and assigned overseas, so he is not with her. Although her sister lives only two blocks from the hospital, Elvira doesn't want her called. She asks if she can talk to her mother on the telephone instead. Elvira asks you which fetal position and presentation are ideal. Your best answer would be:
- Right occipitoanterior with fulid flexion.
- Left transverse anterior in moderate flexion
- Right occipitoposterior with no flexion
- Left sacroanterior with full flexion
23. The nurse is in charge of the client with cardiac complaints. As a part of the cardiac assessment, the nurse auscultates the mitral area which is located at:
- 2nd ICS, Right sternal horde
- 2nd ICS, Left sternal border
- 5th ICS, Left sternal horde
- 5th ICS, Medial to the midclavicular line
24. Nonverbal communication includes all of the following EXCEPT?
- Facial expression
- Grooming and crying
- Posture and mode of dress
- Speaking in low voice
25. Situation: A client is brought into the emergency department with brain stem contusion Q. Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) can be differentiated from diabetic ketoacidosis by which of the following conditions?
- Hyperglycemia
- Serum osmolarity
- Absence of ketosis
- Hypokalemia
26. The nurse notes that a client with schizophrenia and receiving an antipsychotic medication is moving her mouth, protruding her tongue, and grimacing as she watches television. The nurse determines that the client is experiencing which medication complication?
- Parkinsonism
- Tardive dyskinesia
- Hypertensive crisis
- Neuroleptic malignant syndrome
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27. Casssandra, a 22 year old grade agnostic, asked you, how many spikes of bones are there in my ribs? Your best response is which of the following?
- We have 13 pairs of ribs Cassandra
- We have 12 pairs of ribs Cassandra
- Humans have 16 pairs of ribs, and that was noted by Vesalius in 1543
- Humans have 8 pairs of ribs. 4 of which are floating
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28. A 25-year-old woman is in her fifth month of pregnancy. She has been taking 20 units of NPH insulin for diabetes mellitus daily for six years. Her diabetes has been well controlled with this dosage. She has been coming for routine prenatal visits, during which diabetic teaching has been implementeD. Which of the following statements indicates that the woman understands the teaching regarding her insulin needs during her pregnancy?
- "Are you sure all this insulin won't hurt my baby?"
- "I'll probably need my daily insulin dose raised.”
- "I will continue to take my regular dose of insulin.”
- "These finger sticks make my hand sore. Can I do them less frequently?"
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29. The doctor has ordered Percocet (oxycodone) for a client following abdominal surgery. The primary objective of nursing care for the client receiving an opiate analgesic is:
- Preventing addiction
- Alleviating pain
- Facilitating mobility
- Preventing nausea
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30. A nurse is assessing the blood pressure of a client diagnosed with primary hypertension. The nurse ensures accurate measurement by considering which of the following?
- Taking a blood pressure within 5 minutes after nicotine or caffeine ingestion.
- Measuring the blood pressure after the client has been seated quietly for 5 minutes.
- Using a cuff with a rubber bladder that encircles at least 30% of the limb.
- Seating the client with arm bared, supported, lower than heart level.
31. The nurse prepares to administer buccal medication. The medicine should be placed
- On the Ghent's skin
- Between the client's cheeks and gums
- Under the client's tongue
- On the client's conjunctiva
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32. A female client is experiencing painful and rigid abdomen and is diagnosed with perforated peptic ulcer. A surgery has been scheduled and a nasogastric tube is inserted. The nurse should place the client before surgery in
- Sims position
- Supine position
- Semi-fowlers position
- Dorsal recumbent position
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33. Situation: Dennis 40 y/o married man, an electrical engineer was admitted with the diagnosis of paranoid disorders. He has became suspicious and distrustful 2 months before admission. Upon admission, he kept on saying, "my wife has been planning to kill me." Q. A paranoid individual who can't accept the guilt demonstrate one of the following defense mechanism:
- Denial
- Projection
- Rationalization
- Displacement
34. The client has a nursing diagnosis of Constipation related to decreased mobility secondary to traction. A care plan that incorporates which of the following breakfasts would be most helpful in reestablishing a normal bowel routine?
- Eggs and bacon, buttered white toast, orange juice and coffee
- Corn flakes with sliced banana, milk and English muffin with jelly
- Orange juice, breakfast pastries (doughnut and Danish) and coffee
- An orange, raisin bran and milk, and wheat toast with butter
35. A patient recently underwent coronary artery graft (CABG) surgery. Which of the following nursing diagnose PRIORITY?
- Anxiety
- Impaired gas exchange
- Acute pain
- Sleep deprivation
36. Situation: You are actively practicing nurse who has just finished your graduate studies. You learned the value of research and would like to utilize the knowledge and skills gained in the application of research to the nursing service. The following questions apply to research. Q.Which type of research inquiry investigates the issue of human complexity (e.g. understanding the human expertise)?
- logical position
- natural inquiry
- positivism
- quantitative research
37. A patient is to receive heparin sodium, 5,000 U, subcutaneous on call to the operating room. Prior to administering this medication, the nurse should advise patient that this will help to prevent:
- Infections
- Atelectasis
- Thrombosis formation
- Positioning injuries
38. David with paranoid schizophrenia repeatedly uses profanity during an activity therapy session. Which response by the nurse would be most appropriate?
- "Your behavior won't be tolerated. Go to your room immediately."
- "You're just doing this to get back at me for making you come to therapy"
- "Your cursing is interrupting the activity. Take time out in your room for 10 minutes."
- "I'm disappointed in you. You can't control yourself even for a few minutes."
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39. Situation: Please continue responding as a professional nurse in varied health situations through the following questions. Which of the following would the nurse include when describing the pathophysiology of gestational diabetes?
- Glucose levels decrease to accommodate fetal growth
- Hypoinsulinemia develops early in the first trimester
- Pregnancy fosters the development of carbohydrate cravings
- There is progressive resistance to the effects of insulin
40. A patient schedule for a major surgery in one hour is very nervous and upset. Which of the following order medications would the nurse administer torelax this patient?
- Meperidine Hydrochloride(Demerol)
- Scopolamine (Transderm-Scop)
- Pentobarbital sodium(Nembutal sodium)
- Trazodone hydrochloride(Trazadone)
41. A 92-year-old client with prostate cancer and multiple metastases is in respiratory distress and is admitted to a medical unit from a skilled nursing facility. His advance directive states that he doesn't want to be placed on a ventilator or receive cardiopulmonary resuscitation. Based on the client's advance directive, the nursing plan of care should include which intervention?
- Check on the client once per shift.
- Provide mouth and skin care only if the family requests it.
- Turn the client only if he's uncomfortable.
- Provide emotional support and pain relief.
42. Mr. Duffy is admitted to the CCU with a diagnosis of R/O 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. You decide to discuss glaucoma prevention. Which of the following diagnostic tests should these clients request from their care provider?
- fluorescein stain
- snellen's test
- tonometry
- slit lamp
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43. A patient who had abdominal surgery 6 days ago, has been ambulating the halls without much difficulty. However, on day 7 postoperative the patient complains of increased pain at incisional site and is walking hunched over the MOST likely cause of the change is
- Over assertion the day before
- Pulmonary edema
- wound infection
- deep vein thrombosis
44. Which one of the following infants needs a further assessment of growth?
- Four-month-old: birth weight 7lb 6oz; current weight 14lb 4oz
- Two-week-old: birth weight 6lb 10oz; current weight 6lb 12oz
- Six-month-old: birth weight 8lb 8oz; current weight 15lb
- Two-month-old: birth weight 7lb 2oz; current weight 9lb 6oz
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45. The hormone responsible for a positive pregnancy test is:
- Estrogen
- Progesterone
- Human Chorionic Gonadotropin
- Follicle Stimulating hormone
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46. For a client who is taking aspirin, which laboratory value should be reported to the physician?
- Potassium 3.6 mEq/L
- Hematocrit 41%
- PT 14 seconds
- BUN 20 mg/dL
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47. Situation: A research study was under taken in order to identify and analyze a disabled boy's coping reaction pattern during stress. Q. This study which is a depth study of one boy is a:
- case study
- longitudinal study
- cross-sectional study
- evaluative study
48. The surgical nurse is preparing a patient for surgery on the lower abdomen. In which position would the nurse most likely place the client for surgery on this area?
- Lithotomy
- Sims
- Prone
- Trendelenburg
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49. Which of the following actions would be a priority for a client who has been in the postanesthesia care unit (PACU) for 45 minutes after an above the knee amputation and develops a dime size bright red spot on the ace bandage above the amputation site?
- Elevate the stump
- Reinforcing the dressing
- Calling the surgeon
- Drawing a mark around the site
50. A patient with chronic obstructive pulmonary disease complains of a frequent cough, bilateral wheezing is auscultated in the lung fields. The nurse administers albuterol nebulizer treatment, as ordered and educates the patient on way to decrease exacerbation. Which of the following actions indicate that the patient understands the instruction?
- The patient reduces number of cigarettes smoked per day
- The patient requested a pneumococcal vaccination
- The patient increases sodium and potassium intake
- The patent exercises whenever experiencing shortness of breath