NCLEX-RN Exam Part 6 (376-450)

NCLEX-RN Exam Part 6

QUESTION 376

Several months after antibiotic therapy, a child is readmitted to the hospital with an exacerbation of osteomyelitis, which is now in the chronic stage. The mother appears anxious and asks what she could have done to prevent the exacerbation. The nurse’s response is based on the knowledge that chronic osteomyelitis:

A. Is caused by poor physical conditions or poor nutrition

B. Often results from unhygienic conditions or an unclean environment

C. Is directly related to sluggish circulation in the affected limb

D. May develop from sinuses in the involved bone that retain infectious material

 

QUESTION 377

The nurse is notified that a 27-year-old primigravida diagnosed with complete placenta previa is to be admitted to the hospital for a cesarean section. The client is now at 36 weeks’ gestation and is presently having bright red bleeding of moderate amount. On admission, the nursing intervention that the nurse should give the highest priority to is:

 

A. Shave the client’s abdomen and arrange her lab work

B. Determine the status of the fetus by fetal heart tones

C. Start an IV infusion in the client’s arm

D. Insert an indwelling catheter into her bladder

 

QUESTION 378

 

The parents of a 2-year-old child are ready to begin toilet training activities with him. His parents feel he is ready to train because he is now 2 years old. What would the nurse identify as readiness in this child?

A. Patience by the child when wearing soiled diapers

B. Communicating the urge to defecate or urinate

C. The child awakening wet from his naps

D. The age at which the child’s siblings were trained

 

QUESTION 379

The 4th of July holiday comes while a client is in the hospital being treated for schizophreni

 

A. She is taking chlorpromazine and has improved to the point of being allowed to go with a group to the park for a picnic. The side effect of chlorpromazine that the nurse needs to keep in mind during this outing is:

 

1. Hypotension
2. Photosensitivity
3. Excessive appetite
4. Dryness of the mouth

 

 

QUESTION 380

Parents of children receiving chemotherapy should be warned that alopecia is a side effect and that:

 

A. Children seldom show concern about losing their hair

B. The hair will come out gradually, and the loss will not be noticeable for some time

C. It is best for girls to choose a wig similar to their hair style and color before the hair falls out

D. The parents will soon get used to seeing their children without hair, and it will no longer bother them

 

QUESTION 381

A client had abdominal surgery this morning. The nurse notices that there is a small amount of bloody drainage

 

on his surgical dressing. The nurse would document this as what type of drainage?

 

1. Serosanguinous
2. Purulent
3. Sanguinous
4. Catarrhal

 

QUESTION 382

A neonate was admitted to the hospital with projectile vomiting. According to the parents,

 

the baby had experienced vomiting episodes after feeding for the last 2 days. A medical diagnosis of hypertrophic pyloric stenosis was made. On assessment, the infant had poor skin turgor, sunken eyeballs, dry skin, and weight loss. Identify the number-one priority nursing diagnosis.

 

A. Fluid volume deficit

B. Altered nutrition

C. Altered bowel elimination

D. Anxiety

 

QUESTION 383

 

A client has developed congestive heart failure secondary to his myocardial infarction. Discharge diet instructions should emphasize the reduction or avoidance of:

 

A. Fresh vegetables and fruit

B. Canned vegetables and fruit

C. Breads, cereals, and rice

D. Fish

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QUESTION 384

 

A depressed client is seen at the mental health center for follow-up after an attempted suicide 1 week ago. She has taken phenelzine sulfate (Nardil), a monoamine oxidase (MAO) inhibitor, for 7 straight days. She states that she is not feeling any better. The nurse explains that the drug must accumulate to an effective level before symptoms are totally relieved. Symptom relief is expected to occur within:

 

A. 10 days

B. 2–4 weeks

C. 2 months

D. 3 months

 

QUESTION 385

 

A client’s behavior is annoying other clients on the unit. He is meddling with their belongings and dominating the group. The best approach by the nurse is to:

 

A. Seclude him in his room.

B. Set limits on his behavior.

C. Have his medication increased.

 

D. Ignore him and tell the other clients that these behaviors are due to his illness and that they should understand.

 

QUESTION 386

 

A client is being treated for congestive heart failure. His medical regimen consists of digoxin (Lanoxin) 0.25 mg po daily and furosemide 20 mg po bid. Which laboratory test should the nurse monitor?

 

A. Intake and output

1. Calcium
2. Potassium
3. Magnesium

 

 

QUESTION 387

 

A male client is diagnosed with hypoparathyroidism. He has been on dialysis for several years. He is experiencing symptoms such as numbness of the lips, muscle weakness, carpopedal spasms, and wheezing. Given the client’s symptoms, nursing assessment would focus on:

 

A. Detection of tetany

B. Detection of hypocalcemia to prevent seizures

C. Evidence of depression

D. Detection of premature cataract formation

 

QUESTION 388

 

A client is placed on lithium therapy for her manicdepressive illness. When monitoring the client, the nurse assesses the laboratory blood values. Toxicity may occur with lithium therapy when the blood level is above:

 

A. 1.0 mEq/L

B. 2.2 mEq/L

C. 0.03 mEq/L

D. 1.5 mEq/L

 

QUESTION 389

 

A 17-year-old pregnant client who is gravida 1, para 0, is at 36 weeks’ gestation. Based on the nurse’s knowledge of the maternal physiological changes in pregnancy, which of these findings would be of concern?

 

A. Complaints of dyspnea

B. Edema of face and hands

C. Pulse of 65 bpm at 8 weeks, 73 bpm at 36 weeks

D. Hematocrit 39%

 

 

QUESTION 390

 

A 14-year-old client has a history of lying, stealing, and destruction of property. Personal items of peers have been found missing. After group therapy, a peer approaches the nurse to report that he has seen the 14- year-old with some of the missing items. The best response of the nurse is to:

 

A. Request that he explain to the group why he took personal items from peers

B. Approach him when he is alone to inquire about his involvement in the incident

C. Imply to him that you doubt his involvement in the incident and request his denial

D. Confront him openly in group and request an apology

 

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QUESTION 391

 

A 5-year-old child is hospitalized for an acute illness. The nurse encourages the family to bring her favorite objects from home. What is the nurse’s rationale?

 

A. To reduce fear of the unknown

B. To keep the child calm

C. To establish a trusting relationship

D. To prevent or minimize separation anxiety

 

 

QUESTION 392

 

A male client has experienced low back pain for several years. He is the primary support of his wife and six children. Although he would qualify for disability, he plans to continue his employment as long as possible. His back pain has increased recently, and he is unable to control it with non-steroidal anti-inflammatory agents. He

 

refuses surgery and cannot take narcotics and remain alert enough to concentrate at work. His physician has suggested application of a transcutaneous electrical nerve stimulation (TENS) unit. Which of the following is an appropriate rationale for using a TENS unit for relief of pain?

 

A. TENS units have an ultrasonic effect that relaxes muscles, decreases joint stiffness, and increases range of motion.

 

B. TENS units produce endogenous opioids that affect the central nervous system with analgesic potency comparable to morphine.

 

C. TENS units work on the gate-control theory of pain; biostimulation therapy of large fibers block painful stimuli.

D. TENS units prevent muscle spasms, decrease the potential for further injury, and minimize pressure on joints.

 

 

QUESTION 393

 

A client was admitted to the hospital for a TURP. Within 48 hours of admission and 12 hours postoperatively, both the blood pressure and pulse increased. He became agitated, thought snakes were crawling on his arms and legs, and generally became unmanageable. He pulled out his IV and urinary catheter in attempt to rid himself of the snakes. He was sweating profusely. The admission nurse’s notes indicated that the client admitted to “having a few drinks now and then.” He is probably experiencing which of the following?

 

A. Major psychotic depression

B. Delirium tremens

C. Generalized anxiety disorder

D. Adjustment disorder with mixed features

 

QUESTION 394

 

The mother of a 7-year-old mental health center client reports that the client has refused to attend gymnastics for the past 2 weeks. Prior to that time, the child liked going to this class and was attending 3 times a week. In talking with the client, the nurse would:

 

A. Ask her why she doesn’t like gymnastics anymore

B. Ask her to describe how things were at gymnastics before she started refusing to go

C. Tell her that it is OK to be afraid of this activity

D. Reassure her that things will get better once she begins the classes again

 

QUESTION 395

 

A 68-year-old client developed acute respiratory distress syndrome while hospitalized for pneumoni A. After a

 

respiratory arrest, an endotracheal tube was inserted. Several days later, numerous attempts to wean him from mechanical ventilation were ineffective, and a tracheostomy was created. For the first 24 hours following tracheostomy, it is important to minimize bleeding around the insertion site. The nurse can accomplish this by:

 

A. Deflating the cuff for 10 minutes every other hour instead of 5 minutes every hour

B. Avoiding manipulation of the tracheostomy including cuff deflation

C. Reporting any signs of crepitus immediately to the physician

 

D. Changing tracheostomy dressing only as necessary using one-half strength hydrogen peroxide to cleanse the site

 

QUESTION 396

 

A 60-year-old woman exhibits forgetfulness, emotional lability, confusion, and decreased concentration. She has been unable to perform activities of daily living without assistance. After a thorough medical evaluation, a diagnosis of Alzheimer’s disease was made. An appropriate nursing intervention to decrease the anxiety of this client would include:

 

A. Allowing the client to perform activities of daily living as much as possible unassisted

B. Confronting confabulations

C. Reality testing

D. Providing a highly stimulating environment

.QUESTION 397

 

A 22-year-old single woman was admitted to the psychiatric hospital by her mother, who reported bizarre behavior. Except for going to work, she spends all her time in her room and expresses concern over neighbors spying on her. She has fears of the telephone being “bugged.” Her diagnosis is schizophreni

 

A. One nurse per shift is assigned to work with the client. The primary reason for this plan would be to:

 

A. Protect her from suicide

B. Enable her to develop trust

C. Supervise her medication regimen

D. Involve her in groups for social interaction

 

QUESTION 398

 

The serial sevens test is often used to determine delirium and dementi A. This test aids in assessing which of the following?

 

A. Abstract thinking

B. Ability to focus and concentrate thoughts

1. Judgment
2. Memory

 

QUESTION 399

 

A mother called the physician’s office to ask if it would help relieve her small daughter’s abdominal pain if she gave an enema and placed a heating pad on the abdomen. Her daughter has a fever and has vomited twice. The nurse’s response is based on the knowledge that:

 

A. The symptoms could easily have been caused by constipation, which an enema would relieve B. Heat would help to relax the abdominal muscles and relieve her pain

 

C. Both heat and enemas stimulate intestinal motility and could increase the risk of perforation

D. Complaints of stomach ache are common in young children and are generally best ignored

QUESTION 400

 

A 58-year-old client on a general surgery unit is scheduled for transurethral resection of the prostate (TURP) in 2 hours. The nurse explains to the client that this procedure means:

 

A. Removal of the prostate tissue by way of a lower abdominal midline incision through the bladder and into the prostate gland

B. Removal of prostate tissue by a resectoscope that is inserted through the penile urethra

 

C. Removal of the prostate tissue by an open surgical approach through an incision between the ischial tuberosities, the scrotum, and the rectum

 

D. Removal of prostate tissue by an open surgical approach through a low horizontal incision, bypassing the bladder, to the prostate gland

 

QUESTION 401

What specific hormone must be present in serum or urine laboratory tests used to diagnose pregnancy?

 

A. Human chorionic gonadotropin

1. Estrogen
2. -fetoprotein
3. Sphingomyelin

 

QUESTION 402

A 27-year-old primigravida at 32 weeks’ gestation has been diagnosed with complete placenta previ

 

A. Conservative management including bed rest is the proper medical management. The goal for fetal survival is based on fetal lung maturity. The test used to determine fetal lung maturity is:

 

“

 

1. Dinitrophenylhydrazine
2. Metachromatic stain
3. Blood serum phenylalanine test
4. Lecithin-sphingomyelin ratio

 

 

QUESTION 403

 

A client was exhibiting signs of mania and was recently started on lithium carbonate. She has no known physical problems. A teaching plan for this client would include which of the following?

 

A. Regular foods should be eaten, including those that contain salt, such as bacon, ham, V-8 juice, and tomato juice.

B. Restrict fluids to 1000 mL/day.

C. Restrict foods that contain salt or sodium.

D. Discontinue the medication if nausea occurs.

 

QUESTION 404

 

A client is hyperactive and not sleeping. She will not remain at the table during mealtime. She is getting very limited calories and is using a lot of energy in her hyperactive state. The most therapeutic nursing action is to:

 

A. Insist that she remain at the table and eat a balanced diet.

B. Order a high-calorie diet with supplements.

C. Provide nutritious finger foods several times a day.

D. Offer to go to the dining room with her and allow her to open the food and inspect what she eats.

 

 

QUESTION 405

 

A 52-year-old client who underwent an exploratory laparotomy for a bowel obstruction begins to complain of hunger on the third postoperative day. His nasogastric (NG) tube was removed this morning, and he has an IV of D5W with 0.45% normal saline running at 125 mL/hr. He asks when he can get rid of his IV and start eating. The nurse recognizes that he will be able to begin taking oral fluids and nourishment when:

 

A. It is determined that he has no signs of wound infection

B. He is able to eat a full meal without evidence of nausea or vomiting

C. The nurse can detect bowel sounds in all four quadrants

D. His blood pressure returns to its preoperative baseline level or greater

 

QUESTION 406

 

A 22-year-old client who is being seen in the clinic for a possible asthma attack stops wheezing suddenly as the nurse is doing a lung assessment. Which one of the following nursing interventions is most important? C. Place the client in a supine position.

 

D. Draw a blood sample for arterial blood gases.

E. Start O2 at 4 L/min.

F. Establish a patent airway.

 

QUESTION 407

 

A 48-year-old client is being seen in her physician’s office for complaints of indigestion, heartburn, right upper quadrant pain, and nausea of 4 days’ duration, especially after meals. The nurse realizes that these symptoms

 

may be associated with cholecystitis and therefore would check for which specific sign during the abdominal assessment?

 

A. Cullen’s sign

B. Rebound tenderness

C. Murphy’s sign

D. Turner’s sign

.QUESTION 408

 

A 29-year-old client delivered her fifth child by the Lamaze method and developed a postpartal hemorrhage in the recovery room. What are the initial symptoms of shock that she may experience?

 

A. Marked elevation in blood pressure, respirations, and pulse

B. Decreased systolic pressure, cold skin, and anuria

C. Rapid pulse; narrowed pulse pressure; cool, moist skin

D. No urinary output, tachycardia, and restlessness

QUESTION 409

 

A client is a depressed, 48-year-old salesman. A serious concern for the nurse working with depressed clients is the potential of suicide. The time that suicide is most likely to occur is:

 

A. In the acutely depressed state

B. When the depression starts to lift

C. In the denial phase

D. During a manic episode

 

QUESTION 410

 

The nurse assesses a client on the second postpartum day and finds a dark red discharge on the peripad. The stain appears to be about 5 inches long. Which of the following correctly describes the character and amount of lochia?

 

A. Lochia alba, light

B. Lochia serosa, heavy

C. Lochia granulosa, heavy

D. Lochia rubra, moderate

 

QUESTION 411

 

A client sustained second- and third-degree burns to his face, neck, and upper chest. Which of the following nursing diagnoses would be given the highest priority in the first 8 hours’ postburn?

 

A. Fluid volume deficit secondary to alteration in skin integrity

B. Alteration in comfort secondary to alteration in skin integrity

C. Alteration in sensation secondary to third-degree burn

 

D. Alteration in airway integrity secondary to edema of neck and face, which in turn is secondary to alteration in skin integrity

 

QUESTION 412

 

A 9-month-old infant was diagnosed with nonorganic failure to thrive. During her hospitalization, primary nurses were assigned to initiate all infant feedings. The infant’s parents question why they cannot feed their own child. Which of the following responses would be most appropriate by the nurse?

 

A. By assigning the same nurses to the child, the nurses can begin to learn the infant’s cues and feeding behaviors.

B. The same nurses will prevent parental fatigue and frustration.

C. The same nurses will prevent infant fatigue and frustration.

D. Primary nurses will ensure privacy.

 

QUESTION 413

 

A client was admitted to the hospital after falling in her home. At the time of admission, her blood alcohol level was 0.27 mg%. Her family indicates that she has been drinking a fifth of vodka a day for the past 9 months. She had her last drink 30 minutes prior to admission.

 

Alcohol withdrawal symptoms would most likely be exhibited by her:

 

A. Two to 4 hours after the last drink

B. Six to 8 hours after the last drink

C. Immediately on admission

D. Twenty-four hours after the last drink

 

QUESTION 414

 

A client’s renal calculi are identified as consisting of calcium phosphate. Which of the following diets would be appropriate?

 

A. High calcium, low phosphorus

B. Low calcium, high phosphorus

C. Two-gram sodium diet

D. Low calcium and phosphorus, acid ash

 

 

QUESTION 415

 

A 47-year-old client comes to the emergency department complaining of moderate flank, abdominal, and testicular pain with nausea of 4 hours’ duration. After physical examination and obtaining the client’s history,

 

the physician suspects urethral obstruction by calculi. The nurse realizes that the physician will order which one of the following diagnostic studies to best confirm the diagnosis?

 

1. Cystoscopy
2. Kidneys, ureter, bladder, x-ray of abdomen
3. Intravenous pyelogram with excretory urogram
4. Ureterolithotomy

 

QUESTION 416

 

A male client was diagnosed 6 months ago with amyotrophic lateral sclerosis (ALS). The progression of the disease has been aggressive. He is unable to maintain his personal hygiene without assistance. Ambulation is most difficult, requiring him to use a wheelchair and rely on assistance for mobility. He recently has become severely dysphasic. Nursing interventions for dysphasia would be aimed toward prevention of:

 

A. Loss of ability to speak and communicate effectively

B. Aspiration and weight loss

C. Secondary infection resulting from poor oral hygiene

D. Drooling

 

QUESTION 417

 

A client had a ruptured abdominal aortic aneurysm that was repaired surgically. Her postoperative recovery progressed without complications, and she is ready for discharge. Client education in preparation for discharge began 7 days ago on her admission to the nursing unit. Evaluation of nursing care related to client education is based on evaluation of expected outcomes. Which statement made by the client would indicate that she is ready for discharge?

 

A. “I will not drive but ride in the front seat of the car with a seat belt on for my first doctor’s appointment.”

 

“

B. “When I bathe tomorrow morning, I will be very careful not to get soap on my incision.” C. “I am allowed to exercise by walking for short periods.”

D. “Teach my husband about the diet. He’ll be doing all the cooking now.”

 

QUESTION 418

 

A client has been diagnosed with congestive heart failure. His fluid intake and output are strictly regulated. For lunch, he drank 8 oz of milk, 4 oz of tea, and 6 oz of coffee. His intake would be recorded as:

 

A. 500 mL

B. 540 mL

C. 600 mL

D. 655 mL

 

QUESTION 419

 

A client takes warfarin (Coumadin) 15 mg po daily. To evaluate the medication’s effectiveness, the nurse should monitor the:

 

A. prothrombin time (PT)

B. partial thromboplastin time (PTT)

1. PTT-C
2. Fibrin split products

 

 

QUESTION 420

Following a bicycle accident, a 12-year-old client sustained a complete fracture of the left femur. He was placed

 

in 90-90 skeletal traction with a pin in the distal end of the femur to achieve realignment and immobilization of the left femur. When providing nursing care, it is important for the nurse to remember that:

 

A. The nurse may lift only the weights that are applying traction in order to reposition him in bed

 

B. The client will need special skin care at the pin site according to hospital policy or the physician’s preference C. The traction pull should result in an immediate increase in comfort and reduce the need for pain medication D. The client should be discouraged from participating in self-care activities to avoid the risk of disrupting the traction

QUESTION 421

A 65-year-old client who has a new colostomy is preparing for discharge from the hospital.

 

As part of the instructions on colostomy care, the nurse explains to the client that to regulate the bowel, colostomy irrigation should be performed at the same time each day. The best time is:

 

A. After meals

B. Before meals

C. Every 2 hours

D. At bedtime

 

QUESTION 422

 

A 48-year-old female client is going to have a cholecystectomy in the morning. In planning for her postoperative care, the nurse is aware that a priority nursing diagnosis for her will be high risk for:

 

A. Knowledge deficit

B. Urinary retention

C. Impaired physical mobility

D. Ineffective breathing pattern

 

QUESTION 423

A client has been admitted to the nursing unit with the diagnosis of severe anemi

A. She is slightly short of breath, has episodes of dizziness, and complains her heart sometimes

feels like it will “beat out of her chest.” The physician has ordered her to receive 2 U of packed red blood cells.

The most important nursing action to be taken is:

 

1. Starting an 18-gauge IV infusion
2. Having the consent form on the chart
3. Administering the correct blood product to the correctclient
4. Transfusing the blood in a 2-hour time frame

 

 

QUESTION 424

 

The physician has prescribed metoclopramide (Reglan). When assessing the client, the nurse would expect to find which of the following responses?

 

A. Increase in gastric secretions

B. Increase in peristalsis

1. Disorientation
2. Drowsiness

 

QUESTION 425

A client has received preoperative teaching for the vertical partial laryngectomy that he is scheduled to have in

the morning. The nurse determines that the teaching has been effective when the client states:

 

A. “I know I will need special swallowing training after my surgery.”

B. “The quality of my voice will be excellent after surgery.”

C. “I will have very little difficulty swallowing after surgery.”

D. “I may also have to have a radical neck dissection done.”

 

QUESTION 426

 

An 18-year-old client enters the emergency room complaining of coughing, chest tightness, dyspnea, and sputum production. On physical assessment, the nurse notes agitation, nasal flaring, tachypnea, and expiratory wheezing. These signs should alert the nurse to:

 

A. A tension pneumothorax

B. An asthma attack

1. Pneumonia
2. Pulmonary embolus

 

.QUESTION 427

 

When a client arrives on the labor and delivery unit, she informs the nurse that she has been having contractions for the last 5 hours. Now the pain is constant and not cyclical as it was earlier. The nurse considers the possibility of uterine rupture. Which of the following symptoms would be consistent with a uterine rupture?

 

A. A large gush of clear fluid from the vagina

B. Systolic hypertension

C. Abdominal rigidity

D. Increased fetal movements

QUESTION 428

 

The physician prescribes amitriptyline (Elavil) for a client. What does the patient need to know about this medication?

 

A. Prolonged use of this medication will result in extrapyramidal side effects.

B. When the medication is effective, he will experience no anxiety.

C. The medication should relieve his symptoms of depression.

D. Blood must be drawn weekly to test for toxicity.

 

QUESTION 429

 

A post-lung surgery client is placed on a chest tube drainage system. When explaining to the family how the system works, the nurse states that the water-seal bottle of a three-bottle chest drainage system serves which of the following purposes?

A. Collection bottle for drainage

B. Pressure regulator

C. Preventing accumulation of blood around the heart

D. Preventing air from entering the chest upon inspiration

 

QUESTION 430

 

A behavioral modification program is recommended by the multidisciplinary team working with a 15-year-old client with anorexia nervos

A. A nursing plan of care based on this modality would include:

1. Role playing the client’s eating behaviors
2. Restriction to the unit until she has gained 2 lb
3. Encouraging her to verbalize her feelings concerning food and food intake
4. Provision for a high-calorie, high-protein snack between meals

 

QUESTION 431

 

A client is now pregnant for the second time. Her first child weighed 4536 g at delivery. The client’s glucose tolerance test shows elevated blood sugar levels. Because she only shows signs of diabetes when she is pregnant, she is classified as having:<