NCLEX-RN Gratis Exam Part 1 (1-75)

QUESTION 1 A 25-year-old client believes she may be pregnant with her first child. She schedules an obstetric examination with the nurse practitioner to determine the status of her possible pregnancy. Her last menstrual period began May 20, and her estimated date of confinement using Nägele’s rule is:

A. March 27

B. February 1

C. February 27

D. January 3

QUESTION 2The nurse practitioner determines that a client is approximately 9 weeks’ gestation. During the visit, the practitioner informs the client about symptoms of physical changes that she will experience during her first trimester, such as:

A. Nausea and vomiting

B. Quickening

C. A 68 lb weight gain

D. Abdominal enlargement

QUESTION 3A 38-year-old pregnant woman visits her nurse practitioner for her regular prenatal checkup. She is 30 weeks’ gestation. The nurse should be alert to which condition related to her age?

A. Iron-deficiency anemia

B. Sexually transmitted disease (STD)

C. Intrauterine growth retardation

D. Pregnancy-induced hypertension (PIH)

QUESTION 4 A client returns for her 6-month prenatal checkup and has gained 10 lb in 2 months. The results of her physical examination are normal. How does the nurse interpret the effectiveness of the instruction about diet and weight control?

 QUESTION 5Diabetes during pregnancy requires tight metabolic control of glucose levels to prevent perinatal mortality. When evaluating the pregnant client, the nurse knows

the recommended serum glucose range during pregnancy is:

A. 70 mg/dL and 120 mg/dL

B. 100 mg/dL and 200 mg/dL

C. 40 mg/dL and 130 mg/dL

D. 90 mg/dL and 200 mg/dL

QUESTION 6When assessing fetal heart rate status during labor, the monitor displays late decelerations with tachycardia and decreasing variability. What action should the

nurse take?

A. Continue monitoring because this is a normal occurrence.

B. Turn client on right side.

C. Decrease IV fluids.

D. Report to physician or midwife.

QUESTION 7The predominant purpose of the first Apgar scoring of a newborn is to:

A. Determine gross abnormal motor function

B. Obtain a baseline for comparison with the infant’s future adaptation to the environment

C. Evaluate the infant’s vital functions

D. Determine the extent of congenital malformations

QUESTION 8A pregnant woman at 36 weeks’ gestation is followed for PIH and develops proteinuria. To increase protein in her diet, which of the following foods will provide the

greatest amount of protein when added to her intake of 100 mL of milk?

A. Fifty milliliters light cream and 2 tbsp corn syrup

B. Thirty grams powdered skim milk and 1 egg

C. One small scoop (90 g) vanilla ice cream and 1 tbsp chocolate syrup

D. One package vitamin-fortified gelatin drink

QUESTION 9Which of the following findings would be abnormal in a postpartal woman?

A. Chills shortly after delivery

B. Pulse rate of 60 bpm in morning on first postdelivery day

C. Urinary output of 3000 mL on the second day after delivery

D. An oral temperature of 101F (38.3C) on the third day after delivery

QUESTION 10What is the most effective method to identify early breast cancer lumps?

A. Mammograms every 3 years

B. Yearly checkups performed by physician

C. Ultrasounds every 3 years

D. Monthly breast self-examination

QUESTION 11Which of the following risk factors associated with breast cancer would a nurse consider most significant in a client’s history?

A. Menarche after age 13

B. Nulliparity

C. Maternal family history of breast cancer

D. Early menopause

QUESTION 12The nurse should know that according to current thinking, the most important prognostic factor for a client with breast cancer is:

A. Tumor size

B. Axillary node status

C. Client’s previous history of disease

D. Client’s level of estrogen-progesterone receptor assays

QUESTION 13A 30-year-old male client is admitted to the psychiatric unit with a diagnosis of bipolar disorder. For the last 2 months, his family describes him as being “on the

move,” sleeping 34 hours nightly, spending lots of money, and losing approximately 10 lb. During the initial assessment with the client, the nurse would expect him

to exhibit which of the following?

A. Short, polite responses to interview questions

B. Introspection related to his present situation

C. Exaggerated self-importance

D. Feelings of helplessness and hopelessness

QUESTION 14A client with bipolar disorder taking lithium tells the nurse that he has ringing in his ears, blurred vision, and diarrhea. The nurse notices a slight tremor in his left

hand and a slurring pattern to his speech. Which of the following actions by the nurse is appropriate?

A. Administer a stat dose of lithium as necessary.

B. Recognize this as an expected response to lithium.

C. Request an order for a stat blood lithium level.

D. Give an oral dose of lithium antidote.

QUESTION 15Which of the following activities would be most appropriate during occupational therapy for a client with bipolar disorder?

A. Playing cards with other clients

B. Working crossword puzzles

C. Playing tennis with a staff member

D. Sewing beads on a leather belt

QUESTION 16Three weeks following discharge, a male client is readmitted to the psychiatric unit for depression. His wife stated that he had threatened to kill himself with a

handgun. As the nurse admits him to the unit, he says, “I wish I were dead because I am worthless to everyone; I guess I am just no good.” Which response by the

nurse is most appropriate at this time?

A. “I don’t think you are worthless. I’m glad to see you, and we will help you.”

B. “Don’t you think this is a sign of your illness?”

C. “I know with your wife and new baby that you do have a lot to live for.”

D. “You’ve been feeling sad and alone for some time now?”

QUESTION 17Which of the following statements relevant to a suicidal client is correct?

A. The more specific a client’s plan, the more likely he or she is to attempt suicide.

B. A client who is unsuccessful at a first suicide attempt is not likely to make future attempts.

C. A client who threatens suicide is just seeking attention and is not likely to attempt suicide.

D. Nurses who care for a client who has attempted suicide should not make any reference to the word “suicide” in order to protect the client’s ego.

QUESTION 18The day following his admission, the nurse sits down by a male client on the sofa in the dayroom. He was admitted for depression and thoughts of suicide. He looks

at the nurse and says, “My life is so bad no one can do anything to help me.” The most helpful initial response by the nurse would be:

A. “It concerns me that you feel so badly when you have so many positive things in your life.”

B. “It will take a few weeks for you to feel better, so you need to be patient.”

C. “You are telling me that you are feeling hopeless at this point?”

D. “Let’s play cards with some of the other clients to get your mind off your problems for now.”

QUESTION 19A long-term goal for the nurse in planning care for a depressed, suicidal client would be to:

A. Provide him with a safe and structured environment.

B. Assist him to develop more effective coping mechanisms.

C. Have him sign a “no-suicide” contract.

D. Isolate him from stressful situations that may precipitate a depressive episode.

QUESTION 20After 3 weeks of treatment, a severely depressed client suddenly begins to feel better and starts interacting appropriately with other clients and staff. The nurse

knows that this client has an increased risk for:

A. Suicide

B. Exacerbation of depressive symptoms

C. Violence toward others

D. Psychotic behavior

QUESTION 21Nursing care for the substance abuse client experiencing alcohol withdrawal delirium includes:

A. Maintaining seizure precautions

B. Restricting fluid intake

C. Increasing sensory stimuli

D. Applying ankle and wrist restraints

QUESTION 22A psychotic client who believes that he is God and rules all the universe is experiencing which type of delusion?

A. Somatic

B. Grandiose

C. Persecutory

D. Nihilistic

QUESTION 23A client confides to the nurse that he tasted poison in his evening meal. This would be an example of what type of hallucination?

A. Auditory

B. Gustatory

C. Olfactory

D. Visceral

QUESTION 24A schizophrenic client has made sexual overtures toward her physician on numerous occasions. During lunch, the client tells the nurse, “My doctor is in love with

me and wants to marry me.” This client is using which of the following defense mechanisms?

A. Displacement

B. Projection

C. Reaction formation

D. Suppression

QUESTION 25Hypoxia is the primary problem related to near-drowning victims. The first organ that sustains irreversible damage after submersion in water is the:

A. Kidney (urinary system)

B. Brain (nervous system)

C. Heart (circulatory system)

D. Lungs (respiratory system)

QUESTION 26One of the most dramatic and serious complications associated with bacterial meningitis is Waterhouse- Friderichsen syndrome, which is:

A. Peripheral circulatory collapse

B. Syndrome of inappropriate antiduretic hormone

C. Cerebral edema resulting in hydrocephalus

D. Auditory nerve damage resulting in permanent hearing loss

QUESTION 27An 8-year-old child comes to the physician’s office complaining of swelling and pain in the knees. His mother says, “The swelling occurred for no reason, and it

keeps getting worse.” The initial diagnosis is Lyme disease. When talking to the mother and child, questions related to which of the following would be important to

include in the initial history?

A. A decreased urinary output and flank pain

B. A fever of over 103F occurring over the last 23 weeks

C. Rashes covering the palms of the hands and the soles of the feet

D. Headaches, malaise, or sore throat

QUESTION 28The most commonly known vectors of Lyme disease are:

A. Mites

B. Fleas

C. Ticks

D. Mosquitoes

QUESTION 29A laboratory technique specific for diagnosing Lyme disease is:

A. Polymerase chain reaction

B. Heterophil antibody test

C. Decreased serum calcium level

D. Increased serum potassium level

QUESTION 30The nurse would expect to include which of the following when planning the management of the client with Lyme disease?

A. Complete bed rest for 68 weeks

B. Tetracycline treatment

C. IV amphotericin B

D. High-protein diet with limited fluids

QUESTION 31A 3-year-old child is hospitalized with burns covering her trunk and lower extremities. Which of the following would the nurse use to assess adequacy of fluid

resuscitation in the burned child?

A. Blood pressure

B. Serum potassium level

C. Urine output

D. Pulse rate

QUESTION 32Proper positioning for the child who is in Bryant’s traction is:

A. Both hips flexed at a 90-degree angle with the knees extended and the buttocks elevated off the bed

B. Both legs extended, and the hips are not flexed

C. The affected leg extended with slight hip flexion

D. Both hips and knees maintained at a 90-degree flexion angle, and the back flat on the bed

QUESTION 33A child sustains a supracondylar fracture of the femur. When assessing for vascular injury, the nurse should be alert for the signs of ischemia, which include:

A. Bleeding, bruising, and hemorrhage

B. Increase in serum levels of creatinine, alkaline phosphatase, and aspartate transaminase

C. Pain, pallor, pulselessness, paresthesia, and paralysis

D. Generalized swelling, pain, and diminished functional use with muscle rigidity and crepitus

QUESTION 34When administering phenytoin (Dilantin) to a child, the nurse should be aware that a toxic effect of phenytoin therapy is:

A. Stephens-Johnson syndrome

B. Folate deficiency

C. Leukopenic aplastic anemia

D. Granulocytosis and nephrosis

QUESTION 35A six-month-old infant has been admitted to the emergency room with febrile seizures. In the teaching of the parents, the nurse states that:

A. Sustained temperature elevation over 103F is generally related to febrile seizures

B. Febrile seizures do not usually recur

C. There is little risk of neurological deficit and mental retardation as sequelae to febrile seizures

D. Febrile seizures are associated with diseases of the central nervous system

QUESTION 36A child is admitted to the emergency room with her mother. Her mother states that she has been exposed to chickenpox. During the assessment, the nurse would

note a characteristic rash:

A. That is covered with vesicular scabs all in the macular stage

B. That appears profusely on the trunk and sparsely on the extremities

C. That first appears on the neck and spreads downward

D. That appears especially on the cheeks, which gives a”slapped-cheek” appearance

QUESTION 37The priority nursing goal when working with an autistic child is:

A. To establish trust with the child

B. To maintain communication with the family

C. To promote involvement in school activities

D. To maintain nutritional requirements

QUESTION 38The child with iron poisoning is given IV deforoxamine mesylate (Desferal). Following administration, the child suffers hypotension, facial flushing, and urticaria. The

initial nursing intervention would be to:

A. Discontinue the IV

B. Stop the medication, and begin a normal saline infusion

C. Take all vital signs, and report to the physician

D. Assess urinary output, and if it is 30 mL an hour, maintain current treatment

QUESTION 39When teaching a mother of a 4-month-old with diarrhea about the importance of preventing dehydration, the nurse would inform the mother about the importance

of feeding her child:

A. Fruit juices

B. Diluted carbonated drinks

C. Soy-based, lactose-free formula

D. Regular formulas mixed with electrolyte solutions

QUESTION 40To appropriately monitor therapy and client progress, the nurse should be aware that increased myocardial work and O2 demand will occur with which of the

following?

A. Positive inotropic therapy

B. Negative chronotropic therapy

C. Increase in balance of myocardial O2 supply and demand

D. Afterload reduction therapy

QUESTION 41Which of the following medications requires close observation for bronchospasm in the client with chronic obstructive pulmonary disease or asthma?

A. Verapamil (Isoptin)

B. Amrinone (Inocor)

C. Epinephrine (Adrenalin)

D. Propranolol (Inderal)

QUESTION 42In the client with a diagnosis of coronary artery disease, the nurse would anticipate the complication of bradycardia with occlusion of which coronary artery?

A. Right coronary artery

B. Left main coronary artery

C. Circumflex coronary artery

D. Left anterior descending coronary artery

QUESTION 43When a client questions the nurse as to the purpose of exercise electrocardiography (ECG) in the diagnosis of cardiovascular disorders, the nurse’s response

should be based on the fact that:

A. The test provides a baseline for further tests

B. The procedure simulates usual daily activity and myocardial performance

C. The client can be monitored while cardiac conditioning and heart toning are done

D. Ischemia can be diagnosed because exercise increasesO2 consumption and demand

QUESTION 44The cardiac client who exhibits the symptoms of disorientation, lethargy, and seizures may be exhibiting a toxic reaction to:

A. Digoxin (Lanoxin)

B. Lidocaine (Xylocaine)

C. Quinidine gluconate or sulfate (Quinaglute,Quinidex)

D. Nitroglycerin IV (Tridil)

QUESTION 45Which of the following ECG changes would be seen as a positive myocardial stress test response?

A. Hyperacute T wave

B. Prolongation of the PR interval

C. ST-segment depression

D. Pathological Q wave

QUESTION 46Clinical manifestations seen in left-sided rather than in right-sided heart failure are:

A. Elevated central venous pressure and peripheral edema

B. Dyspnea and jaundice

C. Hypotension and hepatomegaly

D. Decreased peripheral perfusion and rales

QUESTION 47To ensure proper client education, the nurse should teach the client taking SL nitroglycerin to expect which of the following responses with administration?

A. Stinging, burning when placed under the tongue

B. Temporary blurring of vision

C. Generalized urticaria with prolonged use

D. Urinary frequency

QUESTION 48Which of the following would differentiate acute from chronic respiratory acidosis in the assessment of the trauma client?

A. Increased PaCO2

B. Decreased PaO2

C. Increased HCO3

D. Decreased base excess

QUESTION 49Hematotympanum and otorrhea are associated with which of the following head injuries?

A. Basilar skull fracture

B. Subdural hematoma

C. Epidural hematoma

D. Frontal lobe fracture

QUESTION 50A client with a C-34 fracture has just arrived in the emergency room. The primary nursing intervention is:

A. Stabilization of the cervical spine

B. Airway assessment and stabilization

C. Confirmation of spinal cord injury

D. Normalization of intravascular volume

QUESTION 51In a client with chest trauma, the nurse needs to evaluate mediastinal position. This can best be done by:

A. Auscultating bilateral breath sounds

B. Palpating for presence of crepitus

C. Palpating for trachial deviation

D. Auscultating heart sounds

QUESTION 52Priapism may be a sign of:

A. Altered neurological function

B. Imminent death

C. Urinary incontinence

D. Reproductive dysfunction

QUESTION 53

When evaluating a client with symptoms of shock, it is important for the nurse to differentiate between neurogenic and hypovolemic shock. The symptoms of

neurogenic shock differ from hypovolemic shock in that:

A. In neurogenic shock, the skin is warm and dry

B. In hypovolemic shock, there is a bradycardia

C. In hypovolemic shock, capillary refill is less than 2 seconds

D. In neurogenic shock, there is delayed capillary refill

QUESTION 54Which of the following would have the physiological effect of decreasing intracranial pressure (ICP)?

A. Increased core body temperature

B. Decreased serum osmolality

C. Administration of hypo-osmolar fluids

D. Decreased PaCO2

QUESTION 55A client who has sustained a basilar skull fracture exhibits blood-tinged drainage from his nose. After establishing a clear airway, administering supplemental O2,

and establishing IV access, the next nursing intervention would be to:

A. Pass a nasogastric tube through the left nostril

B. Place a 4 X 4 gauze in the nares to impede the flow

C. Gently suction the nasal drainage to protect the airway

D. Perform a halo test and glucose level on the drainage

QUESTION 56A client with a diagnosis of C-4 injury has been stabilized and is ready for discharge. Because this client is at risk for autonomic dysreflexia, he and his family

should be instructed to assess for and report:

A. Dizziness and tachypnea

B. Circumoral pallor and lightheadedness

C. Headache and facial flushing

D. Pallor and itching of the face and neck

QUESTION 57The initial treatment for a client with a liquid chemical burn injury is to:

A. Irrigate the area with neutralizing solutions

B. Flush the exposed area with large amounts of water

C. Inject calcium chloride into the burned area

D. Apply lanolin ointment to the area

QUESTION 58The most important reason to closely assess circumferential burns at least every hour is that they may result in:

A. Hypovolemia

B. Renal damage

C. Ventricular arrhythmias

D. Loss of peripheral pulses

QUESTION 59During burn therapy, morphine is primarily administered IV for pain management because this route:

A. Delays absorption to provide continuous pain relief

B. Facilitates absorption because absorption from muscles is not dependable

C. Allows for discontinuance of the medication if respiratory depression develops

D. Avoids causing additional pain from IM injections

QUESTION 60The medication that best penetrates eschar is:

A. Mafenide acetate (Sulfamylon)

B. Silver sulfadiazine (Silvadene)

C. Neomycin sulfate (Neosporin)

D. Povidone-iodine (Betadine)

QUESTION 61When the nurse is evaluating lab data for a client 1824 hours after a major thermal burn, the expected physiological changes would include which of the following?

A. Elevated serum sodium

B. Elevated serum calcium

C. Elevated serum protein

D. Elevated hematocrit

QUESTION 62The nurse notes hyperventilation in a client with a thermal injury. She recognizes that this may be a reaction to which of the following medications if applied in large

amounts?

A. Neosporin sulfate

B. Mafenide acetate

C. Silver sulfadiazine

D. Povidone-iodine

QUESTION 63The primary reason for sending a burn client home with a pressure garment, such as a Jobst garment, is that the garment:

A. Decreases hypertrophic scar formation

B. Assists with ambulation

C. Covers burn scars and decreases the psychological impact during recovery

D. Increases venous return and cardiac output by normalizing fluid status

QUESTION 64A client with emphysema is placed on diuretics. In order to avoid potassium depletion as a side effect of the drug therapy, which of the following foods should be

included in his diet?

A. Celery

B. Potatoes

C. Tomatoes

D. Liver

Correct Answer: B

Section: (none)

Explanation

Explanation/Reference:

Explanation:

(A) Celery is high in sodium. (B) Potatoes are high in potassium. (C) Tomatoes are high in sodium. (D) Liver is high in iron.

QUESTION 65

Which of the following would the nurse expect to find following respiratory assessment of a client with advanced emphysema?

A. Distant breath sounds

B. Increased heart sounds

C. Decreased anteroposterior chest diameter

D. Collapsed neck veins

QUESTION 66The nurse assists a client with advanced emphysema to the bathroom. The client becomes extremely short of breath while returning to bed. The nurse should:

A. Increase his nasal O2 to 6 L/min

B. Place him in a lateral Sims’ position

C. Encourage pursed-lip breathing

D. Have him breathe into a paper bag

QUESTION 67Signs and symptoms of an allergy attack include which of the following?

A. Wheezing on inspiration

B. Increased respiratory rate

C. Circumoral cyanosis

D. Prolonged expiration

QUESTION 68A 55-year-old man is admitted to the hospital with complaints of fatigue, jaundice, anorexia, and clay-colored stools. His admitting diagnosis is “rule out hepatitis.”

Laboratory studies reveal elevated liver enzymes and bilirubin. In obtaining his health history, the nurse should assess his potential for exposure to hepatitis.

Which of the following represents a high-risk group for contracting this disease?

A. Heterosexual males

B. Oncology nurses

C. American Indians

D. Jehovah’s Witnesses

QUESTION 69A diagnosis of hepatitis C is confirmed by a male client’s physician. The nurse should be knowledgeable of the differences between hepatitis A, B, and C. Which of

the following are characteristics of hepatitis C?

A. The potential for chronic liver disease is minimal.

B. The onset of symptoms is abrupt.

C. The incubation period is 226 weeks.

D. There is an effective vaccine for hepatitis B, but not for hepatitis C.

QUESTION 70The nurse is aware that nutrition is an important aspect of care for a client with hepatitis. Which of the following diets would be most therapeutic?

A. High protein and low carbohydrate

B. Low calorie and low protein

C. High carbohydrate and high calorie

D. Low carbohydrate and high calorie

QUESTION 71Which of the following nursing orders should be included in the plan of care for a client with hepatitis C?

A. The nurse should use universal precautions when obtaining blood samples.

B. Total bed rest should be maintained until the client is asymptomatic.

C. The client should be instructed to maintain a low semi-Fowler position when eating meals.

D. The nurse should administer an alcohol backrub at bedtime.

QUESTION 72A 27-year-old man was diagnosed with type I diabetes 3 months ago. Two weeks ago he complained of pain, redness, and tenderness in his right lower leg. He is

admitted to the hospital with a slight elevation of temperature and vague complaints of “not feeling well.” At 4:30 PM on the day of his admission, his blood glucose

level is 50 mg; dinner will be served at 5:00 PM. The best nursing action would be to:

A. Give him 3 tbsp of sugar dissolved in 4 oz of grape juice to drink

B. Ask him to dissolve three pieces of hard candy in his mouth

C. Have him drink 4 oz of orange juice

D. Monitor him closely until dinner arrives

QUESTION 73A male client receives 10 U of regular human insulin SC at 9:00 AM. The nurse would expect peak action from this injection to occur at:

A. 9:30 AM

B. 10:30 AM

C. 12 noon

D. 4:00 PM

QUESTION 74The physician has ordered that a daily exercise program be instituted by a client with type I diabetes following his discharge from the hospital. Discharge

instructions about exercise should include which of the following?

A. Exercise should be performed 30 minutes before meals.

B. A snack may be needed before and/or during exercise.

C. Hyperglycemia may occur 24 hours after exercise.

D. The blood glucose level should be 100 mg or below before exercise is begun.

QUESTION 75A 74-year-old female client is 3 days postoperative. She has an indwelling catheter and has been progressing well. While the nurse is in the room, the client states,

“Oh dear, I feel like I have to urinate again!” Which of the following is the most appropriate initial nursing response?

A. Assure her that this is most likely the result of bladder spasms.

B. Check the collection bag and tubing to verify that the catheter is draining properly.

C. Instruct her to do Kegel exercises to diminish the urge to void.

D. Ask her if she has felt this way before.