NCLEX- PN Practice Exam 4

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1. The nurse is caring for an 8-year-old following a routine tonsillectomy. Which finding should be reported immediately?

  1. Reluctance to swallow
  2. Drooling of blood-tinged saliva
  3. An axillary temperature of 99°F
  4. Respiratory stridor

2. The nurse is admitting a client with a suspected duodenal ulcer. The client will most likely report that his abdominal discomfort lessens when he:

  1. Skips a meal
  2. Rests in recumbent position
  3. Eats a meal
  4.  Sits upright after eating

3. Which of the following meal selections is appropriate for the client with celiac disease?

  1. Toast, jam, and apple juice
  2.  Peanut butter cookies and milk
  3.  Rice Krispies bar and milk
  4. Cheese pizza and Kool-Aid

4. A client with hyperthyroidism is taking lithium carbonate to inhibit thyroid hormone release. Which complaint by the client should alert the nurse to a problem with the client’s medication?

  1. The client complains of blurred vision.
  2. The client complains of increased thirst and increased urination.
  3. The client complains of increased weight gain over the past year.
  4. The client complains of ringing in the ears.

5. A 2-month-old infant has just received her first Tetramune injection. The nurse should tell the mother that the immunization:

  1. Will need to be repeated when the child is 4 years of age
  2. Is given to determine whether the child is susceptible to pertussis
  3. Is one of a series of injections that protects against dpt and Hib
  4. Is a one-time injection that protects against MMR and varicella

6. The nurse is caring for a client hospitalized with bipolar disorder, manic phase. Which of the following snacks would be best for the client with mania?

  1. Potato chips
  2. Diet cola
  3. Apple
  4. Milkshake

7. A 2-year-old is hospitalized with suspected intussusception. Which finding is associated with intussusception?

  1. “Currant jelly” stools
  2. Projectile vomiting
  3. “Ribbonlike” stools
  4. Palpable mass over the flank

8. A client is being treated for cancer with linear acceleration radiation. The physician has marked the radiation site with a blue marking pen. The nurse should:

  1. Remove the unsightly markings with acetone or alcohol
  2. Cover the radiation site with loose gauze dressing
  3. Sprinkle baby powder over the radiated area
  4. Refrain from using soap or lotion on the marked area

9. The nurse is caring for a client with acromegaly. Following a transphenoidal hypophysectomy, the nurse should:

  1. Monitor the client’s blood sugar
  2. Suction the mouth and pharynx every hour
  3. Place the client in low Trendelenburg position
  4. Encourage the client to cough

10. A client newly diagnosed with diabetes is started on Precose (acarbose). The nurse should tell the client that the medication should be taken:

  1. 1 hour before meals
  2. 30 minutes after meals
  3. With the first bite of a meal
  4. Daily at bedtime

11. A client with a deep decubitus ulcer is receiving therapy in the hyperbaric oxygen chamber. Before therapy, the nurse should:

  1. Apply a lanolin-based lotion to the skin
  2. Wash the skin with water and pat dry
  3. Cover the area with a petroleum gauze
  4. Apply an occlusive dressing to the site

12. A client with a laryngectomy returns from surgery with a nasogastric tube in place. The primary reason for placement of the nasogastric tube is to:

  1. Prevent swelling and dysphagia
  2. Decompress the stomach via suction
  3. Prevent contamination of the suture line
  4. Promote healing of the oral mucosa

13. The chart indicates that a client has expressive aphasia following a stroke. The nurse understands that the client will have difficulty with:

  1. Speaking and writing
  2. Comprehending spoken words
  3. Carrying out purposeful motor activity
  4. Recognizing and using an object correctly

14. A camp nurse is applying sunscreen to a group of children enrolled in swim classes. Chemical sunscreens are most effective when applied:

  1. Just before sun exposure
  2. 5 minutes before sun exposure
  3. 15 minutes before sun exposure
  4. 30 minutes before sun exposure

15. A post-operative client has an order for Demerol (meperidine) 75mg and Phenergan (promethazine) 25mg IM every 3–4 hours as needed for pain. The combination of the two medications produces a/an:

  1. Agonist effect
  2. Synergistic effect
  3. Antagonist effect
  4. Excitatory effect

16. Before administering a client’s morning dose of Lanoxin (digoxin), the nurse checks the apical pulse rate and finds a rate of 54. The appropriate nursing intervention is to:

  1. Record the pulse rate and administer the medication
  2. Administer the medication and monitor the heart rate
  3. Withhold the medication and notify the doctor
  4. Withhold the medication until the heart rate increases

17. What information should the nurse give a new mother regarding the introduction of solid foods for her infant?

  1. Solid foods should not be given until the extrusion reflex disappears, at 8–10 months of age.
  2. Solid foods should be introduced one at a time, with 4- to 7-day intervals.
  3. Solid foods can be mixed in a bottle or infant feeder to make feeding easier.
  4. Solid foods should begin with fruits and vegetables.

18. A client with schizophrenia is started on Zyprexa (olanzapine). Three weeks later, the client develops severe muscle rigidity and elevated temperature. The nurse should give priority to:

  1. Withholding all morning medications
  2. Ordering a CBC and CPK
  3. Administering prescribed anti-Parkinsonian medication
  4. Transferring the client to a medical unit

19. A client with human immunodeficiency syndrome has gastrointestinal symptoms, including diarrhea. The nurse should teach the client to avoid:

  1. Calcium-rich foods
  2. Canned or frozen vegetables
  3. Processed meat
  4. Raw fruits and vegetables

20. A 4-year-old is admitted with acute leukemia. It will be most important to monitor the child for:

  1. Abdominal pain and anorexia
  2. Fatigue and bruising
  3. Bleeding and pallor
  4. Petechiae and mucosal ulcers

21. A 5-month-old is diagnosed with atopic dermatitis. Nursing interventions will focus on:

  1. Preventing infection
  2. Administering antipyretics
  3. Keeping the skin free of moisture
  4. Limiting oral fluid intake

22. The nurse is caring for a client with a history of diverticulitis. The client complains of abdominal pain, fever, and diarrhea. Which food was responsible for the client’s symptoms?

  1. Mashed potatoes
  2. Steamed carrots
  3. Baked fish
  4. Whole-grain cereal

23. The physician has scheduled a Whipple procedure for a client with pancreatic cancer. The nurse recognizes that the client’s cancer is located in:

  1.  The tail of the pancreas
  2.  The head of the pancreas
  3.  The body of the pancreas
  4.  The entire pancreas

24. A child with cystic fibrosis is being treated with inhalation therapy with Pulmozyme (dornase alfa). A side effect of the medication is:

  1. Weight gain
  2. Hair loss
  3. Sore throat
  4. Brittle nails

25. The doctor has ordered Percocet (oxycodone) for a client following abdominal surgery. The primary objective of nursing care for the client receiving an opiate analgesic is to:

  1. Prevent addiction
  2.  Alleviate pain
  3.  Facilitate mobility
  4. Prevent nausea
Answers and Rationales
  1. Answer D is correct. Respiratory stridor is a symptom of partial airway obstruction. Answers A, B, and C are expected with a tonsillectomy; therefore, they are incorrect.
  2. Answer C is correct. Pain associated with duodenal ulcers is lessened if the client eats a meal or snack. Answer A is incorrect because it makes the pain worse. Answer B refers to dumping syndrome; therefore, it is incorrect. Answer D refers to gastroesophageal reflux; therefore, it is incorrect.
  3. Answer C is correct. Foods containing rice or millet are permitted on the diet of the client with celiac disease. Answers A, B, and D are not permitted because they contain flour made from wheat, which exacerbates the symptoms of celiac disease; therefore, they are incorrect.
  4. Answer B is correct. Increased thirst and increased urination are signs of lithium toxicity. Answers B and D do not relate to the medication; therefore, they are incorrect. Answer C is an expected side effect of the medication; therefore, it is incorrect.
  5. Answer C is correct. The immunization protects the child against diphtheria, pertussis, tetanus, and H. influenza b. Answer A is incorrect because a second injection is given before 4 years of age. Answer B is not a true statement; therefore, it is incorrect. Answer D is incorrect because it is not a one-time injection, nor does it protect against measles, mumps, rubella, or varicella.
  6. Answer D is correct. The milkshake will provide needed calories and nutrients for the client with mania. Answers A and B are incorrect because they are high in sodium, which causes the client to excrete the lithium. Answer C has some nutrient value, but not as much as the milkshake.
  7. Answer A is correct. The child with intussusception has stools that contain blood and mucus, which are described as “currant jelly” stools. Answer B is a symptom of pyloric stenosis; therefore, it is incorrect. Answer C is a symptom of Hirschsprung’s; therefore, it is incorrect. Answer D is a symptom of Wilms tumor; therefore, it is incorrect.
  8. Answer D is correct. The nurse should not use water, soap, or lotion on the area marked for radiation therapy. Answer A is incorrect because it would remove the marking. Answers B and C are not necessary for the client receiving radiation; therefore, they are incorrect.
  9. Answer A is correct. Growth hormone levels generally fall rapidly after a hypophysectomy, allowing insulin levels to rise. The result is hypoglycemia. Answer B is incorrect because it traumatizes the oral mucosa. Answer C is incorrect because the client’s head should be elevated to reduce pressure on the operative site. Answer D is incorrect because it increases pressure on the operative site that can lead to a leak of cerebral spinal fluid.
  10. Answer C is correct. Precose (acarbose) is to be taken with the first bite of a meal. Answers A, B, and D are incorrect because they specify the wrong schedule for medication administration.
  11. Answer B is correct. The client going for therapy in the hyperbaric oxygen chamber requires no special skin care; therefore, washing the skin with water and patting it dry are suitable. Lotions, petroleum products, perfumes, and occlusive dressings interfere with oxygenation of the skin; therefore, answers A, C, and D are incorrect.
  12. Answer C is correct. The primary reason for the NG to is to allow for nourishment without contamination of the suture line. Answer A is not a true statement; therefore, it is incorrect. Answer B is incorrect because there is no mention of suction. Answer D is incorrect because the oral mucosa was not involved in the laryngectomy.
  13. Answer A is correct. The client with expressive aphasia has trouble forming words that are understandable. Answer B is incorrect because it describes receptive aphasia. Answer C refers to apraxia; therefore, it is incorrect. Answer D is incorrect because it refers to agnosia.
  14. Answer D is correct. Sunscreens of at least an SPF of 15 should be applied 20–30 minutes before going into the sun. Answers A, B, and C are incorrect because they do not allow sufficient time for sun protection.
  15. Answer B is correct. The combination of the two medications produces an effect greater than that of either drug used alone. Agonist effects are similar to those produced by chemicals normally present in the body; therefore, answer A is incorrect. Antagonist effects are those in which the actions of the drugs oppose one another; therefore, answer C is incorrect. Answer D is incorrect because the drugs would have a combined depressing, not excitatory, effect.
  16. Answer C is correct. The medication should be withheld and the doctor should be notified. Answers A, B, and D are incorrect because they do not provide for the client’s safety.
  17. Answer B is correct. Solid foods should be added to the diet one at a time, with 4- to 7-day intervals between new foods. The extrusion reflex fades at 3–4 months of age; therefore, answer A is incorrect. Answer C is incorrect because solids should not be added to the bottle and the use of infant feeders is discouraged. Answer D is incorrect because the first food added to the infant’s diet is rice cereal.
  18. Answer C is correct. The client’s symptoms suggest an adverse reaction to the medication known as neuroleptic malignant syndrome. Answers A, B, and D are not appropriate.
  19. Answer D is correct. The client with HIV should adhere to a low-bacteria diet by avoiding raw fruits and vegetables. Answers A, B, and C are incorrect because they are permitted in the client’s diet.
  20. Answer C is correct. The child with leukemia has low platelet counts, which contribute to spontaneous bleeding. Answers A, B, and D, common in the child with leukemia, are not life-threatening.
  21. Answer A is correct. The nurse should prevent the infant with atopic dermatitis (eczema) from scratching, which can lead to skin infections. Answer B is incorrect because fever is not associated with atopic dermatitis. Answers C and D are incorrect because they increase dryness of the skin, which worsens the symptoms of atopic dermatitis.
  22. Answer D is correct. Symptoms associated with diverticulitis are usually reported after eating popcorn, celery, raw vegetables, whole grains, and nuts. Answers A, B, and C are incorrect because they are allowed in the diet of the client with diverticulitis.
  23.  Answer B is correct. The Whipple procedure is performed for cancer located in the head of the pancreas. Answers A, C, and D are not correct because of the location of the cancer.
  24. Answer C is correct. Side effects of Pulmozyme include sore throat, hoarseness, and laryngitis. Answers A, B, and C are not associated with Pulmozyme; therefore, they are incorrect.
  25. Answer B is correct. The nurse should be concerned with alleviating the client’s pain. Answers A, B, and C are not primary objectives in the care of the client receiving an opiate analgesic; therefore, they are incorrect.