NCLEX-RN | QB1 | Practice Exam #35 (50 questions)

 

1. The immediate objective of nursing care for an overweight, mildly hypertensive male client with ureteral colic and hematuria is to decrease:

• Pain
• Weight
• Hematuria
• Hypertension

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2. Nurse Gina is aware that the following is an advantage of a home visit?

• It allows the nurse to provide nursing care to a greater number of people.
• It provides an opportunity to do first hand appraisal of the home situation.
• It allows sharing of experiences among people with similar health problems.
• It develops the family's initiative in providing for health needs of its members.

3. During the first 4 hours after a male circumcision, assessing for which of the following is the priority?

• Infection
• Hemorrhage
• Discomfort
• Dehydration

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4. Nurse Lilly has been assigned to a client with Raynaud's disease. Nurse Lilly realizes that the etiology of the disease is unknown but it is characterized by:

• Episodic vasospastic disorder of capillaries
• Episodic vasospastic disorder of small veins
• Episodic vasospastic disorder of the aorta
• Episodic vasospastic disorder of the small arteries

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5. Situation: One important toot a community health nurse uses in the conduct of his/her activities is the CHN Bag. Which of the following BEST DESCRIBES the use of this vital facility for our practice? Q. What is the rationale in the use of bag technique during home visit?

• It helps render effective nursing care to clients or other members of the family
• It saves time and effort of the nurse in the performance of nursing procedures
• It should minimize or prevent the spread of infection from individuals to families
• It should not overshadow concerns for the patient

6. The parents of a newborn male with hypospadias want their child circumcised. The best response by the nurse is to inform them that

• Circumcision is delayed so the foreskin can be used for the surgical repair
• This procedure is contraindicated because of the permanent defect
• There is no medical indication for performing a circumcision on any child
• The procedure should be performed as soon as the infant is stable

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7. A client has an order for Demerol 75mg and atropine 0.4mg IM as a preoperative medication. The Demerol vial contains 50mg/mL and atropine is available 0.4mg/mL How much medication will the nurse administer in total?

• 1.0mL
• 1.7mLs
• 2.5mLs
• 3.0 mLs

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8. A patient has hepatitis B (HBV) and is now a chronic carrier In planning care, the nurse would explain an HBV carrier would MOST likely be at risk for developing a super infection with which other type of hepatitis?

• A
• C
• E
• D

9. Marco approached Nurse Trisha asking for advice on how to deal with his alcohol addiction. Nurse Trisha should tell the client that the only effective treatment for alcoholism is:

• Psychotherapy
• Alcoholics anonymous (A.A.)
• Total abstinence
• Aversion Therapy

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10. A client with an inflamed sciatic nerve is to have a conventional transcutaneous electrical nerve stimulation (TENS) device applied to the painful nerve pathway. When operating the TENS unit the nurse should

• Maintain the same dial setting everyday
• Turn the machine several times a day for 10 to 20 minutes
• Adjust the TENS dial until the client perceives pain relief and comfort
• Apply the color-coded electrodes anywhere it is comfortable for the client

11. What medication would probably be ordered for the acutely aggressive schizophrenic client?

• chlorpromazine (Thorazine)
• haloperidol (Haldol)
• lithium carbonate (Lithonate)
• amitriptyline (Elavil)

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12. Which of the following would Nurse Hazel expect to assess for a client who is exhibiting late signs of heroin withdrawal?

• Yawning & diaphoresis
• Restlessness & Irritability
• Constipation & steatorrhea
• Vomiting and Diarrhea

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13. The home health nurse Is visiting a client with autoimmune thrombocytopenic purpura (ATP). The clients platelet count currently is 80 000. It will be most important to teach the client and family about:

• Bleeding precautions
• Prevention of falls
• Oxygen therapy
• Conservation of energy

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14. Situation: The nurse is performing health education activities for Jane Segovia, a 30 years old Dentist with Insulin dependent diabetes Mellitus.Q. Another patient was brought to the emergency room in an unresponsive state and a diagnosis of hyperglycaemic hyperosmolar nonketotic syndrome is made. The nurse immediately prepare to initiate which of the following anticipated physician's order?

• Endotracheal intubation
• 100 units of insulin
• Intravenous infusion of normal saline
• Intravenous infusion of sodium bicarbonate

15. The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health that he would perform unaided if he has the necessary strength, will and knowledge, and do this in such a way as to help him gain independence as rapidly as possible.

• Henderson
• Abdellah
• Levin
• Peplau

16. A 67 year-old man is admitted to the Post-anesthesia Recovery unit following chest surgery The patient has a right chest tube that is attached to low suction. Three hours after admission to the unit, the nurse observes the drainage output from the chest tube is 300 milliliters. What is the most appropriate initial intervention?

• Notify the doctor
• Reduce IV infusion rate
• Strip tube with roller device
• Re-position in left lateral decubitus

17. Four clients are to receive medication. Which client should receive medication first?

• A client with an apical pulse of 72 receiving Lanoxin (digoxin) PO daily
• A client with abdominal surgery receiving Phenergan (promethazine) IM every four hours PRN for nausea and vomiting
• A client with labored respirations receiving a stat dose of IV Lasix (furosemide)
• A client with pneumonia receiving Polycillin (ampicillin) IVPB every six hours

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18. The ICU nurse is preparing the instruments needed for endotracheal intubation. The nurse is knowledgeable that clients in the 1CU often need mechanical assistance to maintain a patent airway. Which of the following is NOT an indication for endotracheal intubation?

• Respiratory distress
• Prolonged mechanical ventilation
• High risk of aspiration
• Ineffective clearance of secretions

19. Jeremy is brought to the emergency room by friends who state that he took something an hour ago. He is actively hallucinating, agitated, with irritated nasal septum.

• Heroin
• Cocaine
• LSD
• Marijuana

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20. An adult has chronic lower back pain and receives hot pack three times a week. The nurse knows that the treatment is given for which of the following reasons?

• To help remove debris from the wound
• To keep the client warm and raise his temperature
• To improve the clients general circulation
• To relieve muscle spasm and promote muscle relaxation

21. Which action (s) should you delegate to the experienced nursing assistant when caring for a patient with a thrombotic stroke with residual left-sided weakness? (Choose all that apply). A.Assist patient to reposition every 2 hours. B.Reapply pneumatic compression boots. C.Remind patient to perform active ROM. D.Check extremities for redness and edema.

• A,B&C
• B,C&D
• A,B,C&D
• A,C&D

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22. The client's jaw and cheekbone is sutured and wired. The nurse anticipates that the most important thing that must be ready at the bedside is:

• Suture set.
• Tracheostomy set.
• Suction equipment.
• Wire cutters.

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23. A client is admitted with a blood alcohol level of 180mg/dL. The nurse recognizes that the alcohol in the clients system should be fully metabolized within:

• Three hours
• Five hours
• Seven hours
• Nine hours

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24. A client is being admitted to the substance abuse unit for alcohol detoxification. As part of the intake interview, the nurse asks him when he had his last alcoholic drink. He says that he had his last drink 6 hours before admission. Based on this response, the nurse should expect early withdrawal symptoms to:

• begin after 7 days.
• not occur at all because the time period for their occurrence has passed.
• begin anytime within the next 1 to 2 days.
• begin within 2 to 7 days.

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25. Icheanne, ask you, her Nurse, about WBC Components. She got an injury yesterday after she twisted her ankle accidentally at her gymnastic class. She asked you, which WBC Component is responsible for proliferation at the injured site immediately following an injury. You answer:

• Neutrophils
• Basophils
• Eosinophils
• Monocytes

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26. A client diagnosed with tuberculosis asks the nurse when he can return to work. The nurse should tell the client that:

• He can return to work when he has three negative sputum cultures.
• He can return to work as soon as he feels well enough.
• He can return to work after a week of being on the medication.
• He should think about applying for disability because he will no longer be able to work.

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27. A nurse is planning dietary counseling for the client taking triamterene (Dyrenium). The nurse plans to include which of the following in a list of foods that are acceptable?

• baked potato
• bananas
• oranges
• pears canned in water

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28. The nurse has provided home care instructions to the parents of a child who is being discharged after cardiac surgery. Which statement made by the parents indicates a need for further instruction?

• "A balance of rest and exercise is important."
• "I can apply lotion or powder to the incision if it is itchy."
• "Activities in which my child could fall need to be avoided for 2 to 4 weeks."
• "Large crowds of people need to be avoided for at least 2 weeks after surgery"

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29. Situation: Milo, a 16-year-old male, has been diagnosed to have AIDS. He worked as entertainer in a cruise ship. What primary health teaching would you give to Milo?

• Daily exercise
• Prevent infection
• Reverse isolation
• Proper nutrition

30. A child is diagnosed with Reye's syndrome. The nurse creates a nursing care plan for the child and should include which intervention in the plan?

• Assessing hearing loss
• Monitoring urine output
• Changing body position every 2 hours
• Providing a quiet atmosphere with dimmed lighting

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31. The nurse is aware that the best way to prevent post-operative wound infection in the surgical client is to:

• Administer a prescribed antibiotic.
• Wash her hands for two minutes before care.
• Wear a mask when providing care.
• Ask the client to cover her mouth when she coughs.

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32. Situation: Ronald 23 years old was voluntarily admitted to the in-patient unit with a diagnosis of paranoid schizophrenia.Q. Ronald is pacing the hall and is agitated. The nurse hears him saying, "Those doctors are faying to commit me to the state hospital. The nurse's continued assessment should include:

• Clarifying information with the doctor
• Observing Ronald for rising anxiety
• Reviewing history of involuntary commitment
• Checking dosage of prescribed medication

33. Caring means that person, events, projects and things matter to people. It reveals stress and coping options. Caring creates responsibility. It is an inherent feature of nursing practice. It helps the nurse assist clients to recover in the face of the illness.

• Benner
• Watson
• Leininger
• Swanson

34. Situation: During surgical operation, it is inevitable to utilize sutures. The nurse should know the basic principles in suturing as well as knowledge in selecting sutures and caring for clients with sutures.Q. Sizes of sutures denotes the diameter. The physician will perform a corneal transplant and will suture the eye. The nurse will prepare which of the following suture size?

• 7
• 5
• 3
• 9-0

35. Situation: Miss Matias, found out that Mr. Carding, newly admitted patient, has terminal cancer and that his nurse has not yet informed him of the diagnosis.Q. On the second day, the wife of Mr. Carding shows signs of grieving, The stages of Grieving identified by Elisabeth Kubler-Ross Are:

• Numbness, Anger, Resolution and Reorganization
• Denial, Anger, Bargaining, Disorganization, Acceptance
• Denial, Anger, Bargaining, Depression, Resolution
• Denial, Anger, Bargaining, Depression, Detachment

36. Where in stages of GAS does a person moves back into HOMEOSTASIS?

• Stage of Alarm
• Stage of Resistance
• Stage of Homeostasis
• Stage of Exhaustion

37. A1-year old child is scheduled to receive an intravenous (IV) line. The most appropriate type of restraint to use for this client to prevent removal of the IV line would be a(n):

• Wrist restraint
• Jacket restraint.
• Elbow restraint
• Mummy restraint.

38. SITUATION: Mr. Roxas, an obese 35 year old MS Professor is admitted due to pain in his weight bearing joint The diagnosis was Osteoarthritis.Q. Mr. Roxas was discharged and 6 months later, he came back to the emergency room of the hospital because he suffered a mild stroke. The right side of the brain was affected. At the rehabilitative phase of your nursing care, you observed that Mr. Roxas uses a cane and you intervene if you see him

• moves the cane when the right leg is moved.
• leans on the cane when the right leg swings through.
• keeps the cane 6 inches out to the side of the right foot.
• holds the cane on the right side.

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39. Situation: Prevention of Dengue is an important nursing responsibility and controlling it's spread is priority once outbreak has been observed .An important role of the community health nurse in the prevention and control of Dengue H-fever includes:

• Advising the elimination of vectors by keeping water containers covered
• Conducting strong health education drives/campaign directed toward proper garbage disposal
• Explaining to the individuals, families, groups and community the nature of the disease and its causation.
• Practicing residual spraying with insecticides

40. The nurse is teaching a group of patient about hepatitis A(HAV). The nurse should state that HAV is MAINLY transmitted Via:

• Blood contact
• Food
• Sexual activity
• Saliva

41. On the other hand, Ms. Caputo notices that the Chief Nurse Executive has charismatic leadership style. Which of the following behaviors best describes this style?

• Possesses inspirational quality that makes followers gets attracted of him and regards him with reverence
• Acts as he does because he expects that his behavior will yield positive results
• Uses visioning as the core of his leadership
• Matches his leadership style to the situation at hand.

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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?

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

43. The nurse working in the emergency department (ED) is assessing a client who recently returned from Liberia and presented complaining of a fever at home, fatigue, muscle pain, and abdominal pain. Which action should the nurse take next?

• Check the client's temperature.
• Contact the health care provider.
• Isolate the client in a private room.
• Check a complete set of vital signs.

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44. As a manager, she focuses her energy on both the quality of services rendered to the patients as well as the welfare of the staff of her unit Which of the following management styles does she adopt?

• Country club management
• Organization man management
• Team management
• Authority-obedience management

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45. Which Identifies accurate nursing documentation notations? Select all that apply. 1.The client slept through the night. 2.Abdominal wound dressing is dry and intact without drainage. 3.The client seemed angry when awakened for vital sign measurement. 4.The client appears to become anxious when it is time for respiratory treatments. 5.The client's left lower medial leg wound is 3cm in length without redness, drainage, or edema.

• 1,2,5
• 1,2,4,5
• 3,4,5
• 1,2,3

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46. Situation: Nurse Macarena is a Family Planning and Infertility Nurse Specialist and currently attends to FAMILY PLANNING CLIENTS AND INFERTILE COUPLES. The following conditions pertain to meeting the nursing needs of this particular population group.The Stevens are a couple undergoing testing for infertility. Infertility is said to exist when:

• A woman has no uterus
• A woman has no children
• A couple has been trying to conceive for 1 year
• A couple has wanted a child for 6 months

47. The theorist the advocated that health is the ability to maintain dynamic equilibrium is

• Bernard
• Selye
• Cannon
• Rogers

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48. When developing the plan of care for a client receiving haloperidol, which of the following medications would nurse Monet anticipate administering if the client developed extra pyramidal side effects?

• Olanzapine (Zyprexa)
• Paroxetine (Paxil)
• Benztropine mesylate (Cogentin)
• Lorazepam (Ativan)

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49. The nurse wants to know if the mother of a toddler understands the Instructions regarding the administration of syrup of ipecac. Which of the following statement will help the nurse to know that the mother needs additional teaching?

• "I'll give the medicine if my child gets into some toilet bowl cleaner."
• "I'll give the medicine if my child gets into some aspirin."
• "I'll give the medicine if my child gets into some plant bulbs."
• "I'll give the medicine if my child gets into some vitamin pills."

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50. Which of the following clients would the nurse expect to be at highest risk for developing a urinary tract infection?

• Woman who has delivered two children vaginally
• Man with an indwelling urinary catheter for incontinence
• Man with a past medical history of renal calculi
• Woman with well-controlled diabetes mellitus

 

NCLEX-RN | QB1 | Practice Exam #35 (50 questions)