NCLEX-RN | QB1 | Practice Exam #32 (50 questions)
1. The nurse is monitoring a client who is receiving oxytocin to induce labor. Which assessment findings should cause the nurse to immediately discontinue the oxytocin infusion? Select all that apply. 1.Fatigue. 2.Drowsiness. 3.Uterine hyperstimulation. 4.Late decelerations of the fetal heart rate. 5.Early decelerations of the fetal heart rate
- 1,4,5
- 3,4
- 1,2,3,4,5
- 2,3,4
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2. When talking with a pregnant client who is experiencing aching swollen, leg veins, the nurse would explain that this is most probably the result of which of the following?
- Thrombophlebitis
- Pregnancy-induced hypertension
- Pressure on blood vessels from the enlarging uterus
- The force of gravity pulling down on the uterus
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3. A nurse is preparing to meet with an individual whose spouse recently diagnosed with Alzheimer's disease. The nurse should know that the primary goals of treatment are:
- Curing the Alzheimer's disease
- Maximizing the functional ability and improve quality of life
- Having the Alzheimer's patient placed in a safe controlled environment
- Making all decisions for the patient and confirming to home
4. Situation: Mariah is a 31 year old lawyer who has been married for 6 moths. She is now pregnant. She consults you for guidance. She wants to know the length of her menstrual cycle. Her periodic menstrual period is October 22 to 26. Her LMB is November 21. Which of the following number of days will be your correct response?
- 29
- 28
- 30
- 31
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5. The nurse is responsible for performing a neonatal assessment on a full-term infant At one minute the nurse could expect to find:
- An apical pulse of 100
- An absence of tonus
- Cyanosis of the feet and hands
- Jaundice of the skin and sclera
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6. Nurse Hazel teaches the client with angina about common expected side effects of nitroglycerin including:
- high blood pressure
- stomach cramps
- headache
- shortness of breath
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7. Situation: Celina age 25, a ramp model, suddenly became blind after her boyfriend broke off with her. A thorough workup did not reveal any pathological findings.Q. An effective modality of treatment for Celina would be:
- Milieu therapy
- Systematic desensitisation
- Cognitive-Behavioral therapy
- Psychopharmacology
8. The nurse provides home care instructions to the parents of a child with celiac disease. The nurse should teach the parents to include which food item in the child's diet?
- Rice
- Oatmeal
- Rye toast
- Wheat bread
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9. A nurse schedules a patient for a surgical procedure to take place in 1 week. When would the nurse MOST likely implement surgical education?
- After admission to the hospital
- Start during this visit
- Immediately prior to anesthesia
- After the operation
10. Situation: Jerome, a 37 years old man, was admitted to the hospital with periodic episode of manic behavior alternating with me depression. Diagnosis: Bipolar I disorder.Q. Which of the following statements is true and manic reaction? It is;
- A means of coping with frustrations and disappointments
- A Means of Ignoring reality
- An attempt toward off feeling of underlying depression.
- An expression of destructive impulse
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11. Situation: Human development is one of the important concepts that a nurse should learn to be able to deal appropriately with their clients of different developmental stages.An 18 year old woman in her 18th week of pregnancy is being evaluated. Which positive sign of pregnancy should the nurse expect to be present?
- Fetal heart tones detectable by Doppler stethoscope
- Fetal movement detectable by palpation
- Visualization of the fetus by ultrasound examination
- Fetal heart tones detectable by a fetoscope.
12. Which of the following criteria are acceptable for a rescuer to discontinue CPR?
- When it is obvious that the victim will not survive
- When the rescuer is exhausted
- After 30 minutes of CPR without a pulse rate
- When the family requests discontinuation
13. Situation: Nurse Nico is caring to a 38-year-old female, G3P3 client who has been diagnosed with hemorrhoids.Q. Which of the following factors would most likely be a primary cause of her hemorrhoids?
- Her age
- Three vaginal delivery pregnancies
- Her job as a school teacher
- Varicosities in the legs
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14. Situation: An entry level nurse should be able to apply theoretical knowledge in the performance of the basic nursing skills.Q. A client has an indwelling urinary catheter and she is suspected of having urinary infection. How should you collect a urine specimen for culture and sensitivity?
- Clamp tubing for 60 minutes and insert a sterile needle into the tubing above the clamp to aspirate urine.
- Drain urine from the drainage bag into the sterile container
- Disconnect the tubing from the urinary catheter and let urine floe into a sterile container
- Wipe the self sealing aspirations port with antiseptic solution and insert a sterile needle into the self sealing self-sealing port.
15. A man has sprained his ankle. The physician would order cold applied to the injured area to.
- Reduce the body's temperature
- Increase circulation to the area
- Aid in absorbing the edema
- Relieve pain and control bleeding.
16. The nurse would question the administration of which eye drop in a patient with increased ICP?
- Artificial tears
- Betaxolol (Betoptic)
- Acetazolamide (Diamox)
- Epinephrine HCL (Epirate)
17. Situation: Transurethral resection prostatectomy, (TURP) is performed to Mr. Recto, 60 years old, due to prostate enlargement. Post operatively he has continuous irrigation (Cystoclysis). Q.When should the nurse increase, the flow rate of cystoclysis of Mr.Recto?
- The drainage appear cloudy
- The drainage is continuous but slow
- The drainage is bright red
- The drainage has stopped
18. Situation: The national objective for maintaining the health of all Filipinos is a primary responsibility of the DOH. Assistance in physical therapy of a trauma patient is a:
- Primary level of prevention
- Secondary level of prevention
- Tertiary level of prevention
- Specialized level of prevention
19. Which of the following will help the nurse determine that the expression of hostility is useful?
- Expression of anger dissipates the energy.
- Energy from anger is used to accomplish what needs to be done.
- Expression intimidates others.
- Degree of hostility is less than the provocation.
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20. The nurse is conducting a group therapy session. During the session, a client diagnosed with mania consistently disrupts the group's interactions. Which intervention should the nurse initially implement?
- Setting limits on the client's behavior
- Asking the client to leave the group session
- Asking another nurse to escort the client out of the group session
- Telling the client that they will not be able to attend any future group sessions
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21. Nurse John is caring for clients in the outpatient clinic. Which of the following phone calls should the nurse return first?
- A client with hepatitis A who states, "My arms and legs are itching."
- A client with cast on the right leg who states, "I have a funny feeling in my right leg"
- A client with osteomyelitis of the spine who states, "I am so nauseous that I can't eat"
- A client with rheumatoid arthritis who states, "I am having trouble sleeping"
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22. Situation: Mrs. Andres brought his son, Juanito, age 3 to the Pediatric clinic. She noticed that her son is not speaking and tend to repeat everything she says. The mother also told the nurse that Juanito prefers to be alone, will cry when someone will come near him and tend to rock himself from morning till he will fell asleep. Q. The mother of Juanito asked the nurse, When is autism diagnose? The nurse will respond:
- Autism is diagnosed after 3 years old
- Autism is diagnosed after 6 years old
- At 4 years old, Autism is diagnosed
- Autism is diagnosed before 3 years old
23. The home care nurse provides instructions regarding basic infection control to the parent of an infant with human immunodeficiency virus (HIV) infection. Which statement, if made by the parent, indicates the need for further instruction?
- "I will clean up any spills from the diaper with diluted alcohol."
- "I will wash baby bottles, nipples, and pacifiers in the dishwasher"
- "I will be sure to prepare foods that are high in calories and high in protein."
- "I will be sure to wash my hands carefully before and after caring for my infant"
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24. The nurse is preparing a list of self-care instructions for a postpartum client who was diagnosed with mastitis. Which instructions should be included on the list? Select all that apply. 1.Wear a supportive bra. 2.Rest during the acute phase. 3.Maintain a fluid intake of at least 3000 mL/day. 4.Continue to breast-feed if the breasts are not too sore. 5.Take the prescribed antibiotics until the soreness subsides. 6.Avoid decompression of the breasts by breast-feeding or breast pump.
- 2,3,4,5
- 2,4,5
- 1,2,3,4
- 1,3,5
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25. A critically ill Hispanic client tells the nurse through an interpreter that she is Roman Catholic and firmly believes in the rituals and traditions of the Catholic faith. Based on the client's statements, which actions by the nurse demonstrate cultural sensitivity and spiritual support? Select all that apply. 1.Ensures that a close kin stays with the client. 2.Makes a referral for a Catholic priest to visit the client. 3.Removes the crucifix from the wall in the client's room. 4.Administers the sacrament of the sick to the client if death is imminent. 5.Offers to provide a means for praying the rosary if the client wishes. 6.Reminds the dietary department that meals served on Fridays during Lent do not contain meat.
- 2,3,4
- 1,5,6
- 4,5,6
- 1,2,5
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26. According to this theorist, in his modern stress theory, Stress is the non specific response of the body to any demand made upon it.
- Hans Selye
- Walter Cannon
- Claude Bernard
- Martha Rogers
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27. The nurse sustains a needle-stick injury after administrating an intramuscularinjection to a patient Jt is recommended that the nurse be tested for humanimmunodeficiency virus (HIV):
- Immediately with repeat testin 6 weeks
- If the patient refuses HIV testing
- If the patient has symptomsof HIV infection
- A month after takingprophylactic antiviral
28. You are preparing a child for IV conscious sedation prior to repair of a facial laceration. What information should you immediately report to the physician?
- The parent is unsure about the child's tetanus immunization status.
- The child is upset and pulis out the IV.
- The parent declines the IV conscious sedation.
- The parent wants information about the IV conscious sedation.
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29. A client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed?
- Echocardiography
- Electrocardiography
- Cervical radiography
- Pulmonary function studies
30. Situation: In a client with widespread colon cancer, A colectomy is the surgical procedure of choice instead of an Abdominal perineal resection.Q. For the clients stool to be more "formed" which of the following food are added to the clients diet?
- Boiled rice
- Spaghetti and macaroni
- Cheese
- Bran
31. Situation: There are other important basic knowledge in the performance of our task as Community Health Nurse in relation to IMMUNIZATION these include:Q. Which of the following dose of tetanus toxoid is given to the mother to protect her infant from neonatal tetanus and likewise provide 10 years protection for the mother?
- Tetanus toxoid 3
- Tetanus toxoid 2
- Tetanus toxoid 1
- Tetanus toxoid 4
32. The emergency medical service (EMS) has transported a patient with severe chest pain. As the patient is being transferred to the emergency stretcher, you note unresponsiveness, cessation of breathing, and no palpable pulse. Which task is appropriate to delegate to the nursing assistant?
- Chest compressions
- Bag-valve mask ventilation
- Assisting with oral intubation
- Placing the defibrillator pads
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33. Situation: A nurse is working with an aggressive client in the psychiatric unitQ. Which of the following will probably be most therapeutic for a patient on a behavioral modification ward?
- If the client is agitated, discuss the feelings especially anger
- Insist to stop obscene language by verbal reprimand
- Give client support and positive feedback for controlling use of obscene language
- Provide a punching bag as an alternative to express upset emotions
34. Situation: You are now working as a staff nurse in a general hospital. You have to be prepared to handle situations with ethico-legal and moral implications.Q. You are on morning duty in the medical ward. You have 10 patients assigned to you. During your endorsement rounds, you found out that one of your patients was not in bed. The patient next to him informed you that he went home without notifying the nurses. Which among the following will you do first?
- Make and incident report
- Call security to report the incident
- Wait for 2 hours before reporting
- Report the incident to your supervisor
35. A client is brought to the emergency department having experienced blood loss related to an arterial laceration. Which blood component should the nurse expect the health care provider to prescribe?
- Platelets
- Granulocytes
- Fresh-frozen plasma
- Packed red blood cells
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36. "Public health services are given free of charge". Is this statement true or false?
- The statement is true; it is the responsibility of government to provide haste services
- The statement is false; people pay indirectly for public health services
- The statement may be true or false; depending on the Specific service required
- The statement may be true or false; depending on policies of the government concerned.
37. Where will the CTT be inserted if we are to drain fluids accumulated in Mang dagul's pleura?
- 2nd ICS
- 4th ICS
- 5th ICS
- 8th ICS
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38. The LPN/LVN, under your supervision, is providing nursing care for a patient with GBS. What observation would you instruct the LPN/LVN to report immediately?
- Complaints of numbness and tingling
- Facial weakness and difficulty speaking
- Rapid heart rate of 102 beats per minute
- Shallow respirations and decreased breath sounds
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39. Spinnabarkeit is an indicator of ovulation which is characterized as:
- Thin watery mucus which can be stretched into a long strand about 10 cm
- Thick mucus that is detached from the cervix during ovulation
- Thin mucus that is yellowish in color with fishy odor
- Thick mucus vaginal discharge influence by high level of estrogen
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40. The nurse is caring for an eight-year-old following a routine tonsillectomy. Which finding should be reported immediately?
- Reluctance to swallow
- Drooling of blood-tinged saliva
- An axillary temperature of 99°F
- Respiratory stridor
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41. A patient is being prepared for a right breast biopsy under general anesthesia. The patient asks the nurse about the surgical scar and possible postoperative complications. Which of the following actions would be appropriate for the nurse to take?
- Review the post operative risks with the patient
- Notify surgeon about the patient's questions
- Complete the patient's preoperative check list
- Show the patient photos of breast surgical scars
42. A client with metastatic cancer of the lung has just been told the prognosis by the oncologist. The nurse hears the client state I dont believe the doctor; 1 think he has me confused with another patients This is an example of which of Kubler-Ross stages of dying?
- Denial
- Anger
- Depression
- Bargaining
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43. A patient is in the preoperative area to lumbar surgery. The patient reports anxiety about being intubated and expresses concern about waking up during the surgery. The nurse MUST discuss the patient's concern with the
- Anesthesia provider
- Surgeon
- Scrub nurse
- Charge nurse
44. A client with stomach cancer is admitted to the oncology unit after vomiting for 3 days. Physical assessment findings include irregular pulse, muscle twitching, and complaints of prickling sensations in the fingers and hands. Laboratory results include a potassium level of 2.9 mEq/L, a pH of 7.46, and a bicarbonate level of 29 mEq/L. The client is experiencing:
- Respiratory alkalosis
- Respiratory acidosis
- Metabolic alkalosis
- Metabolic acidosis
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45. A client who delivered this morning tells the nurse that she plans to breastfeed her baby. The nurse is aware that successful breastfeeding is most dependent on the:
- Mothers educational level
- Infants birth weight
- Size of the mothers breast
- Mothers desire to breastfeed
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46. Situation: Tony, 11 years old, has 'kissing tonsils' and is scheduled for tonsillectomy and adenoidectomy or T and A. Q. Mothers of children undergoing tonsillectomy and adenoidectomy usually ask what food prepared and give their children after surgery. You as the nurse will say:
- balanced diet when fully awake
- hot soup when awake
- ice cream when fully awake
- soft diet when fully awake
47. A patient who is receiving chemotherapy has a platelet count of 49,000/mm3 (normal value 150,000 to 400,000/mm3). Which of the following nursing action is necessary?
- Minimize invasive procedures
- Crush oral medications
- Limit intake of vitamin k rich foods
- Monitor the temperature every 4 hours
48. The nurse is caring for a client admitted with suspected myasthenia gravis. Which finding is usually associated with a diagnosis of myasthenia gravis?
- Visual disturbances including diplopia
- Ascending paralysis and loss of motor function
- Cogwheel rigidity and loss of coordination
- Progressive weakness that is worse at the days end
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49. The nurse in the labor room is caring for a client in the active stage of the first phase of labor. The nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. What is the most appropriate nursing action?
- Administer oxygen via face mask.
- Place the mother in a supine position.
- Increase the rate of the oxytocin intravenous infusion.
- Document the findings and continue to monitor the fetal patterns.
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50. After a long leg cast is removed, the male client should:
- Cleanse the leg by scrubbing with a brisk motion
- Put leg through full range of motion twice daily
- Report any discomfort or stiffness to the physician
- Elevate the leg when sitting for long periods of time.
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NCLEX-RN | QB1 | Practice Exam #32 (50 questions)