NCLEX-RN | QB3 | Practice Exam #54 (50 questions)

All 50 questions are randomized each time you take the test, and do not appear in the same order.

 

1. The nurse is performing a history on a client admitted for surgery in the morning. Which long-term medication in the clients history would be most important to report to the physician?

• Prednisone
• Lisinopril (Zestril)
• Docusate (Colace)
• Oscal D

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2. Situation: Mr. Anthony Martinelli is a 54-year old truck driven He is admitted for possible gastric ulcer, He is a heavy smoker. Q. As the nurse preparing Mr. Martinelli for gastric analysis. You should know which of the following is not correct concerning this test

• The patient is fasting 12 hours prior to test
• Gastric contents are aspirated via a tube
• Smoking for 8 hours prior to test is not allowed
• Various position changes are necessary during the test

3. A male patient with blood type AB, Rh factor positive needs a blood transfusion. The Transfusion Service (blood bank) sends type O, Rh factor negative blood to the unit for the nurse to infuse into this patient. The nurse knows that:

• This donor blood is incompatible with the patient's blood.
• Premedicating the patient with diphenhydramine hydrochloride (Benadryl) and acetaminophen (Tylenol) will prevent any transfusion reactions or side effects.
• This is a compatible match.
• The patient is at minimal risk receiving this product since it is the first time he has been transfused with type 0, Rh negative blood.

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4. A hospitalized client with a history of alcohol abuse tells the nurse, "I am leaving now. I have to go. I don't want any more treatment. I have things that I have to do right away.'' The client has not been discharged and is scheduled for an important diagnostic test to be performed in 1 hour. After the nurse discusses the client's concerns with the client, the client dresses and begins to walk out of the hospital room. What action should the nurse take?

• Call the nursing supervisor.
• Call security to block all exit areas.
• Restrain the client until the health care provider (HCP) can be reached.
• Tell the client that the client cannot return to this hospital again if the client leaves now.

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5. A patient presents with a productive cough with a moderate amount of while Frothy sputum and dispend. The patient is anxious and the nurse notices on assessment that the patient is using accessory muscle including intercostals spaces to breathe and has jugular vein distention. The patient has a history of hypertension and heart failure. What should the nurse administer FIRST?

• Digoxin (lanoxin) to improve the ability of the heart to pump effectively
• Oxygen therapy to combat hypoxemia
• Furosemide (lasix) to reduce blood volume and pulmonary congestion
• Morphine sulface(Duramorph) to reduce anxiety

6. The client who had an open femoral fracture was discharged to her home, where she developed, fever, night sweats, chills, restlessness and restrictive movement of the fractured leg. The nurse interprets these finding as indicating which of the following?

• Pulmonary emboli
• Osteomyelitis
• Fat emboli
• Urinary tract infection

7. The procedure done to prevent ophthalmia neonatorum is:

• Marmet's technique
• Crede's method
• Ritgen's method
• Ophthalmic wash

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8. You are computing the crude rate of your municipality, with a total population o about 18,000 for last year. There were 94 deaths. Among those who died, 20 died because of diseases of the heart and 32 were aged 50 years or older. What is the crude death rate?

• 4.1/1000
• 5.2/1000
• 6.3/1000
• 7.3/1000

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9. An infants Apgar score is 9 at five minutes. The nurse is aware that the most likely cause for the deduction of one point is:

• The baby is hypothermic.
• The baby is experiencing bradycardia.
• The babys hands and feet are blue.
• The baby is lethargic.

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10. A school-age child with type 1 diabetes mellitus has soccer practice and the school nurse provides instructions regarding how to prevent hypoglycemia during practice. Which should the school nurse tell the child to do?

• Eat twice the amount normally eaten at lunchtime.
• Take half the amount of prescribed insulin on practice days.
• Take the prescribed insulin at noontime rather than in the morning.
• Eat a small box of raisins or drink a cup of orange juice before soccer practice.

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11. Situation: Carlo, 16 years old, comes to the ER with acute asthmatic attack. RR is 46/min and he appears to be in acute respiratory distress. Q. Aminophylline was ordered for acute asthmatic attack. The mother asked the nurse, what its indication the nurse will say is:

• Relax smooth muscles of the bronchial airway
• Promote expectoration
• Prevent thickening of secretions
• Suppress cough

12. What serves as sperm producers?

• epididymis
• Vas deferens
• prostate gland
• testes

13. One staff member in a psychiatric unit says to the nurse, “Why are we carrying out suicide precautions for someone who is dying? Its pointless and a waste of time." The nurse should:

• Assign the staff member to other clients.
• Ask the psychiatric clinical nurse specialist to meet with the staff member
• Agree with the staff member and discontinue suicide precautions.
• Call for a multidisciplinary staff meeting.

14. In a routine sputum analysis, which of the following indicates proper nursing action before sputum collection?

• Secure a clean container
• Discard the container if the outside becomes contaminated with the sputum
• Rinse the clients mouth with Listerine after collection
• Tell the client that 4 tablespoon of sputum is needed for each specimen for a routine sputum analysis

15. Raphael is interested to learn more about transcultural nursing because he is assigned at the family suites where most patients come from different cultures and countries. Which of the following designs is appropriate for this study?

• Grounded theory
• Ethnography
• Case study
• Phenomenology

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16. A client is admitted with the diagnosis of pulmonary embolism. While taking a history, the client tells the nurse he was admitted for the same thing twice before, the last time just 3 months ago. The nurse would anticipate the health care provider ordering

• Pulmonary embolectomy
• Vena caval interruption
• Increasing the coumadin therapy to an INR of 3-4
• Thrombolytic therapy

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17. The normal L:S Ratio to consider the newborn baby viable is

• 1:2
• 2:1
• 3:1
• 1:3

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18. If parents keep a toddler dependent in areas where he is capable of using skills, the toddle will develop a sense of which of the following?

• Mistrust
• Shame
• Guilt
• Inferiority

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19. Celia with a history of polysubstance abuse is admitted to the facility. She complains of nausea and vomiting 24 hours after admission. The nurse assesses the client and notes piloerection, pupillary dilation, and lacrimation. The nurse suspects that the client is going through which of the following withdrawals?

• Alcohol withdrawal
• Cannabis withdrawal
• Cocaine withdrawal
• Opioid withdrawal

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20. The nurse is caring for a client with acute pancreatitis and is monitoring the client for paralytic ileus. Which piece of assessment data should alert the nurse to this occurrence?

• Inability to pass flatus
• Loss of anal sphincter control
• Severe, constant pain with rapid onset
• Firm, nontender mass palpable at the lower right costal margin

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21. Joey who has a chronic user of cocaine reports that he feels like he has cockroaches crawling under his skin. His arms are red because of scratching. The nurse in charge interprets these findings as possibly indicating which of the following?

• Delusion
• Formication
• Flash back
• Confusion

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22. Before touching a resident who is crying to offer comfort, the nurse aide should consider

• the resident's recent vital signs.
• the resident's cultural background.
• whether the resident has been sad recently.
• whether the resident has family that visits routinely.

23. The nurse caring for a client in the neonatal intensive care unit administers adult-strength Digitalis to the three-pound infant. As a result of her actions the baby suffers permanent heart and brain damage. The nurse can be charged with:

• Negligence
• Tort
• Assault
• Malpractice

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24. A client is receiving haloperidol (Haldol) to reduce psychotic symptoms. As he watches television with other clients, the nurse notes that he has trouble sitting still. He seems restless, constantly moving his hands and feet and changing position. When the nurse asks what is wrong, he says he feels jittery. How should the nurse manage this situation?

• Ask the client to sit still or leave the room because he is distracting the other clients.
• Ask the client if he is nervous or anxious about something.
• Give an as needed dose of a prescribed anticholinergic agent to control akathisia.
• Administer an as needed dose of haloperidol to decrease agitation.

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25. A nurse is caring for an older adult who is taking acetaminophen (Tylenol) for the relief of chronic pain. Which substance is most important for the nurse to determine the client is taking because it intensifies the most serious adverse effect of acetaminophen?

• Alcohol
• Caffeine
• Saw palmetto
• St. John’s wort

26. The geriatric client presented with complaints of difficulty in swallowing, fatigue, alternating constipation and diarrhea, abdominal pain, and blood in the stools. Which of the following symptoms is NOT included in the warning signs of cancer?

• Irregular pattern of constipation and diarrhea
• Blood in the stools
• Difficulty in swallowing
• Frequent vomiting

27. The physician inserts a chest tube into a female client to treat a pneumothorax. The tube is connected to water-seal drainage. The nurse in-charge can prevent chest tube air leaks by:

• Checking and taping all connections.
• Checking patency of the chest tube.
• Keeping the head of the bed slightly elevated.
• Keeping the chest drainage system below the level of the chest.

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28. Gentamicin sulfate, 80 mg in 100 mL normal saline (NS), is to be administered over 30 minutes. The drop factor is 10 drops (gtt)/1 mL. The nurse sets the flow rate at how many drops per minute?

• 20 drops per minute.
• 26 drops per minute.
• 33 drops per minute.
• 40 drops per minute.

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29. A client who had a myocardial infarction has an order for digoxin (Lanoxin)0.25 mg po daily and furosemide (Lasix) 40 mg intravenously, stat Because the client is receiving these medications, the client should be assessed for which of the following manifestations?

• Tachycardia
• Hypokalemia
• Hypertension
• Oliguria

30. The nurse is caring for a six-year-old client admitted with the diagnosis of conjunctivitis. Before administering eyedrops the nurse should recognize that it is essential to consider which of the following?

• The eye should be cleansed with warm water removing any exudate before instilling the eyedrops.
• The child should be allowed to instill his own eyedrops.
• Allow the mother to instill the eyedrops.
• If the eye is clear from any redness or edema the eyedrops should be held.

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31. Which statement is true about crackles?

• They're grating sounds.
• They're high-pitched, musical squeaks.
• They're low-pitched noises that sound like snoring.
• They may be fine, medium, or coarse.

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32. An integrated method of functioning that is oriented towards maximizing one's potential within the limitation of the environment.

• Well being
• Health
• Low level Wellness
• High level Wellness

33. Shortly after the client was admitted to the postpartum unit the nurse notes heavy lochia rubra with large clots. The nurse should anticipate an order for:

• Methergine
• Stadol
• Magnesium sulfate
• Phenergan

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34. Patient experienced (eVA) one week ago. The doctor order the patient discharged from the hospital to home health care. The visiting nurse evaluates the patient and notes the patient has difficulty initiating speech and forming words. Which of the following types of aphasia is most likely in this patient?

• Receptive
• Expressive
• Fluent
• Conduction

35. Mrs. Hogan, a 43-year-old woman, is admitted to your unit for cholecystectomy. Q. When given IV, should always be given slowly.

• True
• False
• Partially False
• Partially True

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36. Situation: Maintenance of sterility is an important function a nurse should perform in any OR setting. Q. In using liquid sterilizer or autoclave machine, which of the following is true?

• Autoclave is better in sterilizing OR supplies versus liquid sterilizer
• They are both capable of sterilizing the equipments, however, it is necessary to soak supplies in the liquid sterilizer for a longer period of time.
• Sharps are sterilized using autoclave and not cidex.
• If liquid sterilizer sterilization process is used, rinsing it before using is not necessary.

37. When caring for a client with an anterior cervical discectomy the nurse should give priority to assessing for post-operative bleeding. The nurse should pay particular attention to:

• Drainage on the surgical dressing
• Complaints of neck pain
• Bleeding from the mouth
• Swelling in the posterior neck

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38. The physician prescribes a loop diuretic for a client. When administering this drug, the nurse anticipates that the client may develop which electrolyte imbalance?

• Hypernatremia
• Hyperkalemia
• Hypokalemia
• Hypervolemia

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39. Which of the following statements should the nurse teach the neutropenic client and his family to avoid?

• Performing oral hygiene after every meal
• Using suppositories or enemas
• Performing perineal hygiene after each bowel movement
• Using a filter mask

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40. A client with diabetes mellitus has a prescription for Glucotrol XL (glipizide). The client should be instructed to take the medication:

• At bedtime
• With breakfast
• Before lunch
• After dinner

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41. The mother of a six-year-old with autistic disorder tells the nurse that her son has been much more difficult to care for since the birth of his sister. The best explanation for changes in the childs behavior is:

• The child did not want a sibling.
• The child was not adequately prepared for the baby's arrival.
• The child's daily routine has been upset by the birth of his sister.
• The child is just trying to get the parents attention.

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42. A parent is concerned their 8-year-old child has 23kg (51b) over the past 2 weeks and has been urination up to 30 times per day. The child also seems to be eating and drinking constantly. Which test would be MOST helpful in evaluating the child's condition?

• Chest X-ray
• Body fat analysis
• Complete blood count
• Blood glucose level

43. Situation: For more than a month now, Cecilia is persistently feeling restless, worried and feeling as if something dreadful is going to happen. She fears being alone in places and situations where she thinks that no one might come to rescue her just in case something happens to her. Q. Cognitive therapy is indicated for Cecilia when she is already able to handle anxiety reactions. Which of the following should the nurse implement?

• assist her in recognizing irrational beliefs, and thoughts
• help find meaning in her behavior
• provide positive reinforcement for acceptable behavior
• administer anxiolytic drug

44. Giving instructions for breast self-examination is particularly important for clients with which of the following medical problems?

• Cervical dysplasia
• A dermoid cyst
• Endometrial polyps
• Ovarian cancer

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45. Patient came to emergency department with coughing and difficulty in breathing, you suspect patient has asthma attack, the sound you expect to hear is:

• Wheezing
• Chronic
• Crackle
• None of the above.

46. Chris asks the nurse whether all donor blood products are cross-matched with the recipient to prevent a transfusion reaction. Which of the following always require cross-matching?

• packed red blood cells
• platelets
• plasma
• granulocytes

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47. Situation: Consider the following hypothesis: "The Job turnover rate and job dissatisfaction levels of graduate nurses who have worked less than 2 years is higher than for those graduate nurses who have worked for more than 2 years" Q. The problem that a researcher would like to give emphasis "Is there a relationship between timing of the administration of psychological support and feelings of wellbeing among terminally ill patients". The appropriate null hypothesis for this problem is:

• Feelings of wellbeing of terminally ill patients who received psychological support is similar to the feelings of wellbeing of those terminally ill patients who did receive said psychological support.
• There is no relationship between the timing of administration of psychological support and feelings of well-being among terminally ill patients
• Factors are not appropriate to determine any desired results
• There is no relationship between the timing of the administration of psychological support and feelings of adequacy among terminally ill patients

48. A client has just returned from surgery after having his left leg amputated below the knee. Physician's orders include elevation of the foot of the bed for 24 hours. The nurse observes that the nursing assistant has placed a pillow under the client's amputated limb. The nursing action is to:

• Leave the pillow as his stump is elevated
• Remove the pillow and elevate the foot of the bed
• Leave the pillow and elevate the foot of the bed
• Check with the physician and clarify the orders

49. The nurse educator is providing in-service education to the nursing staff regarding transcultural nursing care; a staff member asks the nurse educator to provide an example of the concept of acculturation. The nurse educator should make which most appropriate

• "A group of individuals identifying as a part of the Iroquois tribe among Native Americans."
• "A person who moves from China to the United States (U.S.) and learns about and adapts to the culture in the U.S."
• "A group of individuals living in the Azores that identify autonomously but are a part of the larger population of Portugal."
• "A person who has grown up in the Philippines and chooses to stay there because of the sense of belonging to his or her cultural group.”

50. A client with an esophageal tamponade develops symptoms of respiratory distress including inspiratory stridor. The nurse should give priority to:

• Applying oxygen at 4L via nasal cannula
• Removing the tube after deflating the balloons
• Elevating the head of the bed to 45°
• Increasing the pressure in the esophageal balloon

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NCLEX-RN | QB3 | Practice Exam #54 (50 questions)