NCLEX- PN Practice Exam 1

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1. A client hospitalized with severe depression and suicidal ideation refuses to talk with the nurse. The nurse recognizes that the suicidal client has difficulty:

  1. Expressing feelings of low self-worth
  2. Discussing remorse and guilt for actions
  3. Displaying dependence on others
  4. Expressing anger toward others

2. A client receiving hydrochlorothiazide is instructed to increase her dietary intake of potassium. The best snack for the client requiring increased potassium is:

  1. Pear
  2. Apple
  3. Orange
  4. Banana

3. The nurse is caring for a client following removal of the thyroid. Immediately post-op, the nurse should:

  1. Maintain the client in a semi-Fowler’s position with the head and neck supported by pillows
  2. Encourage the client to turn her head side to side, to promote drainage of oral secretions
  3. Maintain the client in a supine position with sandbags placed on either side of the head and neck
  4. Encourage the client to cough and breathe deeply every 2 hours, with the neck in a flexed position

4. A client hospitalized with chronic dyspepsia is diagnosed with gastric cancer. Which of the following is associated with an increased incidence of gastric cancer?

  1. Dairy products
  2. Carbonated beverages
  3. Refined sugars
  4. Luncheon meats

5. A client is sent to the psychiatric unit for forensic evaluation after he is accused of arson. His tentative diagnosis is antisocial personality disorder. In reviewing the client’s record, the nurse could expect to find:

  1. A history of consistent employment
  2. A below-average intelligence
  3. A history of cruelty to animals
  4. An expression of remorse for his actions

6. The licensed vocational nurse may not assume the primary care for a client:

  1. In the fourth stage of labor
  2. Two days post-appendectomy
  3. With a venous access device
  4. With bipolar disorder

7. The physician has ordered dressings with Sulfamylon cream for a client with full-thickness burns of the hands and arms. Before dressing changes, the nurse should give priority to:

  1. Administering pain medication
  2. Checking the adequacy of urinary output
  3. Requesting a daily complete blood count
  4. Obtaining a blood glucose by finger stick

8. The nurse is teaching a group of parents about gross motor development of the toddler. Which behavior is an example of the normal gross motor skill of a toddler?

  1. She can pull a toy behind her.
  2. She can copy a horizontal line.
  3. She can build a tower of eight blocks.
  4. She can broad-jump.

9. A client hospitalized with a fractured mandible is to be discharged. Which piece of equipment should be kept on the client with a fractured mandible?

  1. Wire cutters
  2. Oral airway
  3. Pliers
  4. Tracheostomy set

10. The nurse is to administer digoxin elixir to a 6-month-old with a congenital heart defect. The nurse auscultates an apical pulse rate of The nurse should:

  1. Record the heart rate and call the physician
  2. Record the heart rate and administer the medication
  3. Administer the medication and recheck the heart rate in 15 minutes
  4. Hold the medication and recheck the heart rate in 30 minutes

11. A mother of a 3-year-old hospitalized with lead poisoning asks the nurse to explain the treatment for her daughter. The nurse’s explanation is based on the knowledge that lead poisoning is treated with:

  1. Gastric lavage
  2. Chelating agents
  3. Antiemetics
  4. Activated charcoal

12. An 18-month-old is scheduled for a cleft palate repair. The usual type of restraints for the child with a cleft palate repair are:

  1. Elbow restraints
  2. Full arm restraints
  3. Wrist restraints
  4. Mummy restraints

13. A client with glaucoma has been prescribed Timoptic (timolol) eyedrops. Timoptic should be used with caution in the client with a history of:

  1. Diabetes
  2. Gastric ulcers
  3. Emphysema
  4. Pancreatitis

14. An elderly client who experiences nighttime confusion wanders from his room into the room of another client. The nurse can best help decrease the client’s confusion by:

  1. Assigning a nursing assistant to sit with him until he falls asleep
  2. Allowing the client to room with another elderly client
  3. Administering a bedtime sedative
  4. Leaving a nightlight on during the evening and night shifts

15. Which of the following is a common complaint of the client with end-stage renal failure?

  1. Weight loss
  2. Itching
  3. Ringing in the ears
  4. Bruising

16. Which of the following medication orders needs further clarification?

  1. Darvocet 65mg PO q 4–6 hrs. PRN
  2. Nembutal 100mg PO at bedtime
  3. Coumadin 10mg PO
  4. Estrace 2mg PO q day

17. The best diet for the client with Meniere’s syndrome is one that is:

  1. High in fiber
  2. Low in sodium
  3. High in iodine
  4. Low in fiber

18. Which of the following findings is associated with right-sided heart failure?

  1. Shortness of breath
  2. Nocturnal polyuria
  3. Daytime oliguria
  4. Crackles in the lungs

19. An 8-year-old admitted with an upper-respiratory infection has an order for O2 saturation via pulse oximeter. To ensure an accurate reading, the nurse should:

  1. Place the probe on the child’s abdomen
  2. Recalibrate the oximeter at the beginning of each shift
  3. Apply the probe and wait 15 minutes before obtaining a reading
  4. Place the probe on the child’s finger

20. An infant with Tetralogy of Fallot is discharged with a prescription for lanoxin elixir. The nurse should instruct the mother to:

  1. Administer the medication using a nipple
  2. Administer the medication using the calibrated dropper in the bottle
  3. Administer the medication using a plastic baby spoon
  4. Administer the medication in a baby bottle with 1oz. of water

21. The client scheduled for electroconvulsive therapy tells the nurse, “I’m so afraid. What will happen to me during the treatment?” Which of the following statements is most therapeutic for the nurse to make?

  1. “You will be given medicine to relax you during the treatment.”
  2. “The treatment will produce a controlled grand mal seizure.”
  3.  “The treatment might produce nausea and headache.”
  4. “You can expect to be sleepy and confused for a time after the treatment.”

22. Which of the following skin lesions is associated with Lyme’s disease?

  1. Bull’s eye rash
  2. Papular crusts
  3. Bullae
  4. Plaques

23. Which of the following snacks would be suitable for the child with gluten-induced enteropathy?

  1. Soft oatmeal cookie
  2. Buttered popcorn
  3. Peanut butter and jelly sandwich
  4. Cheese pizza

24. A client with schizophrenia is receiving chlorpromazine (Thorazine) 400mg twice a day. An adverse side effect of the medication is:

  1. Photosensitivity
  2. Elevated temperature
  3. Weight gain
  4. Elevated blood pressure

25. Which information should be given to the client taking phenytoin (Dilantin)?

  1. Taking the medication with meals will increase its effectiveness.
  2. The medication can cause sleep disturbances.
  3. More frequent dental appointments will be needed for special gum care.
  4. The medication decreases the effects of oral contraceptives.
Answers and Rationales
  1. Answer D is correct. The suicidal client has difficulty expressing anger toward others. The depressed suicidal client frequently expresses feelings of low self-worth, feelings of remorse and guilt, and a dependence on others; therefore, answers A, B, and C are incorrect.
  2. Answer D is correct. Answers A, B, and C are incorrect because they contain lower amounts of potassium. (Note that the banana contains 450mg K+, the orange contains 235mg K+, the pear contains 208mg K+, and the apple contains 165mg K+.)
  3. Answer A is correct. Following a thyroidectomy, the client should be placed in semi-Fowler’s position to decrease swelling that would place pressure on the airway. Answers B, C, and D are incorrect because they would increase the chances of post-operative complications that include bleeding, swelling, and airway obstruction.
  4. Answer D is correct. Luncheon meats contain preservatives such as nitrites that have been linked to gastric cancer. Answers A, B, and C have not been found to increase the risk of gastric cancer; therefore, they are incorrect.
  5. Answer C is correct. A history of cruelty to people and animals, truancy, setting fires, and lack of guilt or remorse are associated with a diagnosis of conduct disorder in children, which becomes a diagnosis of antisocial personality disorder in adults. Answer A is incorrect because the client with antisocial personality disorder does not hold consistent employment. Answer B is incorrect because the IQ is usually higher than average. Answer D is incorrect because of a lack of guilt or remorse for wrong-doing.
  6. Answer C is correct. The licensed vocational nurse may not assume primary care of the client with a central venous access device. The licensed vocational nurse may care for the client in labor, the client post-operative client, and the client with bipolar disorder; therefore, answers A, B, and D are incorrect.
  7. Answer A is correct. Sulfamylon produces a painful sensation when applied to the burn wound; therefore, the client should receive pain medicationbefore dressing changes. Answers B, C, and D do not pertain to dressing changes for the client with burns, so they are incorrect.
  8. Answer A is correct. According to the Denver Developmental Screening Test, the child can pull a toy behind her by age 2 years. Answers B, C, and D are not accomplished until ages 4–5 years; therefore, they are incorrect.
  9. Answer A is correct. The client with a fractured mandible should keep a pair of wire cutters with him at all times to release the device in case of choking or aspiration. Answer B is incorrect because the wires would prevent insertion of an oral airway. Answer C is incorrect because it would be of no use in releasing the wires. Answer D is incorrect because it would be used only as a last resort in case of airway obstruction.
  10. Answer B is correct. The infant’s apical heart rate is within the accepted range for administering the medication. Answers A, C, and D are incorrect because the apical heart rate is suitable for giving the medication.
  11. Answer B is correct. Chelating agents are used to treat the client with poisonings from heavy metals such as lead and iron. Answers A and D are used to remove noncorrosive poisons; therefore, they are incorrect. Answer C prevents vomiting; therefore, it is an incorrect response.
  12. Answer A is correct. The least restrictive restraint for the infant with cleft lip and cleft palate repair is elbow restraints. Answers B, C, and D are more restrictive and unnecessary; therefore, they are incorrect.
  13. Answer C is correct. Beta blockers such as timolol (Timoptic) can cause bronchospasms in the client with chronic obstructive lung disease. Timoptic is not contraindicated for use in clients with diabetes, gastric ulcers, or pancreatitis; therefore, answers A, B, and C are incorrect.
  14. Answer D is correct. Leaving a nightlight on during the evening and night shifts helps the client remain oriented to the environment and fosters independence. Answers A and B will not decrease the client’s confusion. Answer C will increase the likelihood of confusion in an elderly client.
  15. Answer B is correct. Pruritis or itching is caused by the presence of uric acid crystals on the skin, which is common in the client with end-stage renal failure. Answers A, C, and D are not associated with end-stage renal failure.
  16. Answer C is correct. There is no specified time or frequency for the ordered medication. Answers A, B, and D contain specified time and frequency.
  17. Answer B is correct. A low-sodium diet is best for the client with Meniere’s syndrome. Answers A, C, and D do not relate to the care of the client with Meniere’s syndrome; therefore, they are incorrect.
  18. Answer B is correct. Increased voiding at night is a symptom of right-sided heart failure. Answers A and D are incorrect because they are symptoms of left-sided heart failure. Answer C does not relate to the client’s diagnosis; therefore, it is incorrect.
  19. Answer D is correct. The pulse oximeter should be placed on the child’s finger or earlobe because blood flow to these areas is most accessible for measuring oxygen concentration. Answer A is incorrect because the probe cannot be secured to the abdomen. Answer B is incorrect because it should be recalibrated before application. Answer C is incorrect because a reading is obtained within seconds, not minutes.
  20. Answer B is correct. The medication should be administered using the calibrated dropper that comes with the medication. Answers A and C are incorrect because part or all of the medication could be lost during administration. Answer D is incorrect because part or all of the medication will be lost if the child does not finish the bottle.
  21. Answer A is correct. The client will receive medication that relaxes skeletal muscles and produces mild sedation. Answers B and D are incorrect because such statements increase the client’s anxiety level. Nausea and headache are not associated with ECT; therefore, answer C is incorrect.
  22. Answer A is correct. Lyme’s disease produces a characteristic annular or circular rash sometimes described as a “bull’s eye” rash. Answers B, C, and D are incorrect because they are not symptoms associated with Lyme’s disease.
  23. Answer B is correct. The client with gluten-induced enteropathy experiences symptoms after ingesting foods containing wheat, oats, barley, or rye. Corn or millet are substituted in the diet. Answers A, C, and D are incorrect because they contain foods that worsen the client’s condition.
  24. Answer B is correct. Neuroleptic malignant syndrome is an adverse reaction that is characterized by extreme elevations in temperature. Answers A and C are incorrect because they are expected side effects. Elevations in blood pressure are associated with reactions between foods containing tyramine and MAOI; therefore, answer D is incorrect.
  25. Answer C is correct. Gingival hyperplasia is a side effect of phenytoin. The client will need more frequent dental visits. Answers A, B, and D do not apply to the medication; therefore, they are incorrect.