NCLEX-RN | QB1 | Practice Exam #37 (50 questions)
1. A healthcare worker is referred to the nursing office with a suspected latex allergy. The first symptom of latex allergy is usually:
- Oral itching after eating bananas
- Swelling of the eyes and mouth
- Difficulty in breathing
- Swelling and itching of the hands
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2. The local health clinic recommends vaccination against influenza for all its employees. The influenza vaccine is given annually in:
- November
- December
- January
- February
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3. Which intervention should the nurse Trish use when administering oxygen by face mask to a female client?
- Secure the elastic band tightly around the client's head.
- Assist the client to the semi-Fowler position if possible.
- Apply the face mask from the client's chin up over the nose.
- Loosen the connectors between the oxygen equipment and humidifier.
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4. A dystonic reaction can be caused by which of the following medications?
- diazepam (Valium)
- haloperidol (Haldol)
- amitriptyline (Elavil)
- clonazepam (Klonopin)
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5. Which of the following adverse effects is specific to the biguanide diabetic drug metformin (Giucophage) therapy?
- Hypoglycemia
- GI distress
- Lactic acidosis
- Somnolence
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6. A 50 year-old man is hospitalized after presenting with long-term fatigue, weight gain and hematemesis. On examination he is jaundiced and the abdomen distended and tense, and there is shifting dullness present Following treatment, the nurse provides discharge instructions. Which instructions would be most appropriate?
- Decrease daily iron intake
- Maintain constant bed rest
- Consume a low protein diet
- Restrict fluid intake
7. What kind of exudates is expected when there is an antibody-antigen reaction as a result of microorganism infection?
- Serous
- Serosanguinous
- Purulent
- Sanguinous
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8. When the nurse checks the fundus of a client on the first postpartum day she notes that the fundus is firm is at the level of the umbilicus and is displaced to the right The next action the nurse should take is to:
- Check the client for bladder distention.
- Assess the blood pressure for hypotension.
- Determine whether an oxytocic drug was given.
- Check for the expulsion of small clots.
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9. A client has returned to the unit following a renal biopsy. Which of the following nursing interventions is appropriate?
- Ambulate the client 4 hours after procedure
- Maintain client on NPO status for 24 hours
- Monitor vital signs
- Change dressing every 8 hours
10. The nurse is admitting a client with multiple trauma injuries to the nursing unit. The client has a leg fracture and had a plaster cast applied. Which position would be best for the casted leg?
- Elevated for 3 hours, then flat for 1 hour
- Flat for 12 hours, then elevated for 12 hours
- Flat for 3 hours, then elevated for 1 hour
- Elevated on pillows continuously for 24 to 48 hours
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11. The physician orders lisinopril (Zestril) and furosemide (Lasix) to be administered concomitantly to the client with hypertension. The nurse should:
- Question the order.
- Administer the medications.
- Administer separately.
- Contact the pharmacy.
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12. The nurse receives a telephone call from the post-anesthesia care unit stating that a client is being transferred to the surgical unit. The nurse plans to take which action first on arrival of the client?
- Assess the patency of the airway.
- Check tubes or drains for patency
- Check the dressing to assess for bleeding.
- Assess the vital signs to compare with preoperative measurements.
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13. A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?
- Infusing I.V. fluids rapidly as ordered
- Encouraging increased oral intake
- Restricting fluids
- Administering glucose-containing I.V. fluids as ordered
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14. A client with angina complains that the angina pain is prolonged and severe and occurs at the same time each day, most often in the morning. On further assessment a nurse notes that the pain occurs in the absence of precipitating factors. This type of anginal pain is best described as:
- Stable angina
- Unstable angina
- Variant angina
- Nonanginal pain
15. Situation: Mang Felix, a 79 year old man who is brought to the Surgical Unit from PACU after a transurethral resection. You are assigned to receive him. You noted that he has a 3- way indwelling catheter for continuous fast dip bladder irrigation which is connected to a straight drainage.Q. The purpose of the continuous bladder irrigation is to:
- Allow continuous monitoring of the fluid output status
- Provide continuous flushing of clots and debris from the bladder
- Allow for proper exchange of electrolytes
- Ensure accurate monitoring of intake and output
16. 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 Mi, 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. The pulmonic component of which heart sound is best heard at the 2nd LICS at the LSB?
- S1
- S2
- S3
- S4
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17. Which laboratory test value is elevated in clients who smoke and can't be used as a general indicator of cancer?
- Acid phosphatase level
- Serum calcitonin level
- Alkaline phosphatase level
- Carcinoembryonic antigen level
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18. The client with cancer refuses to care for herself. Which action by the nurse would be best?
- Alternate nurses caring for the client so that the staff Will not get tired of caring for this client.
- Talk to the client and explain the need for self-care.
- Explore the reason for the lack of motivation seen in the client.
- Talk to the doctor about the clients lack of motivation.
19. The nurse is making room assignments for four obstetrical clients. If only one private room is available it should be assigned to:
- A multigravida with diabetes mellitus
- A primigravida with preeclampsia
- A multigravida with preterm labor
- A primigravida with hyperemesis gravidarum
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20. Which of the following should the nurse suspect when noting that a 3-year-old is engaging in explicit sexual behavior during doll play?
- The child is exhibiting normal pre-school curiosity
- The child is acting out personal experiences
- The child does not know how to play with dolls
- The child is probably developmentally delayed.
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21. A patient is kept off food and fluids for 10 hours before surgery. His oral temperature at 8 a.m. is 99.8F (37.7C) This temperature reading probably indicates:
- Infection
- Hypothermia
- Anxiety
- Dehydration
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22. Situation: In a client with widespread colon cancer, A colectomy is the surgical procedure of choice instead of an Abdominal perineal resection.Q. When should the teaching about ileostomy care commence?
- Immediately after the operation, when the anesthesia is wearing off
- 72 hours after operation
- When readiness and interest is observed
- As soon as the patient is admitted
23. Situation: Brain tumor, whether malignant or benign, has serious management implications nurse, you should be able to understand the consequences of the disease and the treatments Keeping Conrad's head and neck in alignment results in:
- increased intrathoracic pressure
- increased venous outflow
- decreased venous outflow
- increased intra-abdominal pressure
24. Before a client whose left hand has been amputated can be fitted for a prosthesis, nurse Joy is aware that:
- Arm and shoulder muscles must be developed
- Shrinkage of the residual limb must be completed
- Dexterity in the other extremity must be achieved
- Full adjustment to the altered body image must have occurred
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25. Which of the following signs will distinguish threatened abortion from imminent abortion?
- Severity of bleeding
- Dilation of the cervix
- Nature and location of pain
- Presence of uterine contraction
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26. A two-year-old is hospitalized with a diagnosis of Kawasakis disease. A severe complication of Kawasakis disease is:
- The development of Brushfield spots
- The eruption of Hutchinsons teeth
- The development of coxa plana
- The creation of a giant aneurysm
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27. Situation: Pharmacological treatment was not effective for Johnny's hyperthyroidism and now he is scheduled for Thyroid ectomy. Q. If an instrument is classified as Semi Critical an acceptable method of making the instrument ready for surgery is through:
- Critical
- Decontamination
- Disinfection
- Cleaning
28. Nitrofurantoin is prescribed for a client with a urinary tract infection. The client contacts the nurse and reports a cough, chills, fever, and difficulty breathing. The nurse should make which interpretation about the client's complaints?
- The client may have contracted the flu.
- The client is experiencing anaphylaxis.
- The client is experiencing expected effects of the medication.
- The client is experiencing a pulmonary reaction requiring cessation of the medication.
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29. Situation: The body has regulatory mechanism to maintain the needed electrolytes. However there are conditions/surgical interventions that could compromise life. You have to understand how management of these conditions are done.Q. After surgery Leda develops peripheral numbness, tingling and muscle twitching and spasm. What would you anticipate to administer?
- Magnesium sulfate
- Calcium gluconate
- Potassium iodide
- Potassium chloride
30. 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 receive a BCG vaccine during childhood. Q. The nurse would inject the solution in what route?
- IM
- IV
- ID
- SC
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31. A client who has chosen to breastfeed tells the nurse that her nipples became very sore while she was breastfeeding her older child. Which measure will help her to avoid soreness of the nipples?
- Feeding the baby during the first 48 hours after delivery
- Breaking suction by placing a finger between the babys mouth and the breast when she terminates the feeding
- Applying hot moist soaks to the breast several times per day
- Wearing a support bra
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32. A child has fluid volume deficit The nurse performs an assessment and determines that the child is improving and the deficit is resolving if which finding is noted?
- The child has no tears.
- Urine specific gravity is 1.035.
- Capillary refill is less than 2 seconds.
- Urine output is less than 1 mL/kg/hour.
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33. A home care nurse makes a follow-up visit to a patient who had shingles. A month since the onset, the patient pain level is 6 on a scale of 1 to 10 where 1 is no pain and 10 is greater pain. Two weeks ago, the pain Level decreases without any caring. The patients condition has:
- Met the expected outcome
- Partially met the expected outcome
- Has not improved
- Has worsened
34. During the endorsement, which of the following clients should the on-duty nurse assess first?
- The 58-year-old client who was admitted 2 days ago with heart failure, blood pressure of 126/76 mm Hg, and a respiratory rate of 22 breaths/minute.
- The 89-year-old client with end-stage right-sided heart failure, blood pressure of 78/50mm Hg, and a "do not resuscitate" order
- The 62-year-old client who was admitted 1 day ago with thrombophlebitis and is receiving I.V. heparin
- The 75-year-old client who was admitted 1 hour ago with new-onset atrial fibrillation and is receiving I.V. dilitiazem (Cardizem)
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35. A patient withpulmonary emboli complains of pain, dyspnea, and a fear of dying.Which of the following interventions would MOST likely help to reduce the patients anxiety level?
- Administer oxygen asordered
- Administer pain medicationas ordered
- Observe closely for signs of pain and discomfort
- Listen to the patient's concerns
36. Which of the following nursing interventions would be most helpful in making the respiratory effort of a client with metastatic lung cancer more efficient?
- Teaching the client diaphragmatic breathing techniques
- Administering cough suppressants as ordered
- Teaching and encouraging pursed-lip breathing
- Placing the client in a low semi-Fowlers position
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37. A hospitalized patient has fallen from bed. The nurse notes shortening of the left leg. Pain upon movement of the left leg, and rapid, swallow respirations. What action should the nurse take FIRST?
- Call for help
- Immobilize the left leg
- Obtain blood pressure
- Evaluate lung sounds
38. A nurse is communicating with a moderately autistic child during a developmental and behavioral assessment. The nurse uses non-verbal techniques to engage the child’s cooperation. She uses facial expressions when responding and simple body language to communicate commends. What is the most likely age of the child?
- Three
- One
- Six
- Nine
39. A client treated for depression has developed symptoms of serotonin syndrome. The nurse recognizes that serotonin syndrome might result when the client takes both a prescribed antidepressant and
- St. John's wort
- Ginkgo biloba
- Black cohosh
- Saw palmetto
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40. You're performing an general assessment on patient who is 52 y.o. In which order do you proceed if the abdomen is not included in this session of assessment?
- Observation, percussion, palpation, auscultation
- Inspection, palpation, auscultation, percussion
- Percussion, palpation, auscultation, observation
- Inspection, percussion, observation, auscultation
41. SITUATION: Marvin, A male patient diagnosed with colon cancer was newly put in colostomy.Q. Marvin shows the BEST adaptation with the new colostomy if he shows which of the following?
- Look at the ostomy site
- Participate with the nurse in his daily ostomy care
- Ask for leaflets and contact numbers of ostomy support groups
- Talk about his ostomy openly to the nurse and friends
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42. The nurse is admitting a client with Guillain-Barre syndrome to the nursing unit The client has ascending paralysis to the level of the waist. Knowing the complications of the disorder, the nurse should bring which most essential items into the clients room?
- Nebulizer and pulse oximeter
- Blood pressure cuff and flashlight
- Flashlight and incentive spirometer
- Electrocardiographic monitoring electrodes and intubation tray
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43. A residents wife recently died. The resident is now staying in his room all the time and eating very little. The best response by the nurse aide is to:
- remind the resident to be thankful for the years he shared with his wife.
- tell the resident that he needs to get out of his room at least once a day.
- understand the resident is grieving and give him chances to talk.
- avoid mentioning his wife when caring for him.
44. A 15-year-old primigravida is admitted with a tentative diagnosis of HELLP syndrome. Which laboratory finding is associated with HELLP syndrome?
- Elevated blood glucose
- Elevated platelet count
- Elevated creatinine clearance
- Elevated hepatic enzymes
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45. SITUATION: Marvin, A male patient diagnosed with colon cancer was newly put in colostomy.Q. Marvin asked the nurse, what foods will help lessen the odor of his colostomy The nurse best response would be
- Eat eggs
- Eat cucumbers
- Eat beet greens and parsley
- Eat broccoli and spinach
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46. During surgery the pt has the following intake and output: IV fluid 650 cc, IV antibiotic 50 cc, 1 unit of packed red blood cells 350 cc, nasogastric output 120 cc, estimated blood loss 80 cc, and urine in the folyes catheter 240 cc. What is the patients total intake
- 650 cc
- 700cc
- 900 cc
- 1050 cc
47. Which of the following statements best explains the rationale for placing the client in Trendelenburg position during the insertion of a central line catheter?
- It will facilitate catheter insertion.
- It will make the client more comfortable during the insertion.
- It will prevent the occurrence of ventricular tachycardia.
- It will prevent the development of pulmonary emboli.
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48. After cardiac surgery, a patient has been prescribed low-sodium, low cholesterol diet Which of the following menus is BEST?
- Salami, rye bread, sanerkrant
- baked chicken thigh, iceberg lettuce, sliced tomatoes
- Pasta with canned tomato sauce, peas, wheat bread
- Bacon, lettuce and tomato sandwich with mayonnaise dressing
49. The nurse is caring for an adolescent female who reports amenorrhea, weight loss, and depression. Which additional assessment finding would suggest that the woman has an eating disorder?
- Wearing tight-fitting clothing
- Increased blood pressure
- Oily skin
- Excessive and ritualized exercise
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50. Which nutrient deficiency is associated with the development of Pellagra, Dermatitis and Diarrhea?
- Vitamin B1
- Vitamin B2
- Vitamin B3
- Vitamin B6
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NCLEX-RN | QB1 | Practice Exam #37 (50 questions)