NCLEX- RN Practice Exam 14

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1. A client with a history of abusing barbiturates abruptly stops taking the medication. The nurse should give priority to assessing the client for:

  1. Depression and suicidal ideation
  2. Tachycardia and diarrhea
  3. Muscle cramping and abdominal pain
  4. Tachycardia and euphoric mood

2. During the assessment of a laboring client, the nurse notes that the FHT are loudest in the upper-right quadrant. The infant is most likely in which position?

  1. Right breech presentation
  2. Right occipital anterior presentation
  3. Left sacral anterior presentation
  4.  Left occipital transverse presentation

3. The primary physiological alteration in the development of asthma is:

  1. Bronchiolar inflammation and dyspnea
  2. Hypersecretion of abnormally viscous mucus
  3. Infectious processes causing mucosal edema
  4. Spasm of bronchiolar smooth muscle

4. A client with mania is unable to finish her dinner. To help her maintain sufficient nourishment, the nurse should:

  1. Serve high-calorie foods she can carry with her
  2. Encourage her appetite by sending out for her favorite foods
  3. Serve her small, attractively arranged portions
  4. Allow her in the unit kitchen for extra food whenever she pleases

5. To maintain Bryant’s traction, the nurse must make certain that the child’s:

  1. Hips are resting on the bed, with the legs suspended at a right angle to the bed
  2. Hips are slightly elevated above the bed and the legs are suspended at a right angle to the bed
  3. Hips are elevated above the level of the body on a pillow and the legs are suspended parallel to the bed
  4. Hips and legs are flat on the bed, with the traction positioned at the foot of the bed

6. Which action by the nurse indicates understanding of herpes zoster?

  1. The nurse covers the lesions with a sterile dressing.
  2. The nurse wears gloves when providing care.
  3. The nurse administers a prescribed antibiotic.
  4. The nurse administers oxygen.
7. The client has an order for a trough to be drawn on the client receiving Vancomycin. The nurse is aware that the nurse should contact the lab for them to collect the blood:

  1. 15 minutes after the infusion
  2. 30 minutes before the infusion
  3. 1 hour after the infusion
  4. 2 hours after the infusion

8. The client using a diaphragm should be instructed to:

  1. Refrain from keeping the diaphragm in longer than 4 hours
  2. Keep the diaphragm in a cool location
  3. Have the diaphragm resized if she gains 5 pounds
  4. Have the diaphragm resized if she has any surgery

9. The nurse is providing postpartum teaching for a mother planning to breastfeed her infant. Which of the client’s statements indicates the need for additional teaching?

  1. “I’m wearing a support bra.”
  2. “I’m expressing milk from my breast.”
  3.  “I’m drinking four glasses of fluid during a 24-hour period.”
  4. “While I’m in the shower, I’ll allow the water to run over my breasts.”

10. Damage to the VII cranial nerve results in:

  1. Facial pain
  2. Absence of ability to smell
  3. Absence of eye movement
  4. Tinnitus

11. A client is receiving Pyridium (phenazopyridine hydrochloride) for a urinary tract infection. The client should be taught that the medication may:

  1. Cause diarrhea
  2. Change the color of her urine
  3. Cause mental confusion
  4. Cause changes in taste

12. Which of the following tests should be performed before beginning a prescription of Accutane?

  1. Check the calcium level
  2. Perform a pregnancy test
  3. Monitor apical pulse
  4. Obtain a creatinine level

13. A client with AIDS is taking Zovirax (acyclovir). Which nursing intervention is most critical during the administration of acyclovir?

  1. Limit the client’s activity
  2. Encourage a high-carbohydrate diet
  3. Utilize an incentive spirometer to improve respiratory function
  4. Encourage fluids

14. A client is admitted for an MRI. The nurse should question the client regarding:

  1. Pregnancy
  2. A titanium hip replacement
  3. Allergies to antibiotics
  4. Inability to move his feet

15. The nurse is caring for the client receiving Amphotericin B. Which of the following indicates that the client has experienced toxicity to this drug?

  1. Changes in vision
  2. Nausea
  3. Urinary frequency
  4. Changes in skin color

16. The nurse should visit which of the following clients first?

  1. The client with diabetes with a blood glucose of 95mg/dL
  2. The client with hypertension being maintained on Lisinopril
  3.  The client with chest pain and a history of angina
  4.  The client with Raynaud’s disease

17. A client with cystic fibrosis is taking pancreatic enzymes. The nurse should administer this medication:

  1. Once per day in the morning
  2. Three times per day with meals
  3. Once per day at bedtime
  4. Four times per day

18. Cataracts result in opacity of the crystalline lens. Which of the following best explains the functions of the lens?

  1. The lens controls stimulation of the retina.
  2. The lens orchestrates eye movement.
  3. The lens focuses light rays on the retina.
  4. The lens magnifies small objects.

19. A client who has glaucoma is to have miotic eyedrops instilled in both eyes. The nurse knows that the purpose of the medication is to:

  1. Anesthetize the cornea
  2. Dilate the pupils
  3. Constrict the pupils
  4. Paralyze the muscles of accommodation

20. A client with a severe corneal ulcer has an order for Gentamycin gtt. q 4 hours and Neomycin 1 gtt q 4 hours. Which of the following schedules should be used when administering the drops?

  1. Allow 5 minutes between the two medications.
  2. The medications may be used together.
  3. The medications should be separated by a cycloplegic drug.
  4. The medications should not be used in the same client.

21. The client with color blindness will most likely have problems distinguishing which of the following colors?

  1. Orange
  2. Violet
  3. Red
  4. White

22. The client with a pacemaker should be taught to:

  1. Report ankle edema
  2. Check his blood pressure daily
  3. Refrain from using a microwave oven
  4. Monitor his pulse rate

23. The client with enuresis is being taught regarding bladder retraining. The nurse should advise the client to refrain from drinking after:

  1. 1900
  2. 1200
  3. 1000
  4. 0700

24. Which of the following diet instructions should be given to the client with recurring urinary tract infections?

  1. Increase intake of meats.
  2. Avoid citrus fruits.
  3. Perform pericare with hydrogen peroxide.
  4. Drink a glass of cranberry juice every day.

25. The physician has prescribed NPH insulin for a client with diabetes mellitus. Which statement indicates that the client knows when the peak action of the insulin occurs?

  1. “I will make sure I eat breakfast within 2 hours of taking my insulin.”
  2. “I will need to carry candy or some form of sugar with me all the time.”
  3. “I will eat a snack around three o’clock each afternoon.”
  4. “I can save my dessert from supper for a bedtime snack.”
Answers and Rationales
  1. Answer B is correct. Barbiturates create a sedative effect. When the client stops taking barbiturates, he will experience tachycardia, diarrhea, and tachpnea. Answer A is incorrect even though depression and suicidal ideation go along with barbiturate use; it is not the priority. Muscle cramps and abdominal pain are vague symptoms that could be associated with other problems. Tachycardia is associated with stopping barbiturates, but euphoria is not.
  2. Answer A is correct. If the fetal heart tones are heard in the right upper abdomen, the infant is in a breech presentation. If the infant is positioned in the right occipital anterior presentation, the FHTs will be located in the right lower quadrant, so answer B is incorrect. If the fetus is in the sacral position, the FHTs will be located in the center of the abdomen, so answer C is incorrect. If the FHTs are heard in the left lower abdomen, the infant is most likely in the left occipital transverse position, making answer D incorrect.
  3. Answer D is correct. Asthma is the presence of bronchiolar spasms. This spasm can be brought on by allergies or anxiety. Answer A is incorrect because the primary physiological alteration is not inflammation. Answer B is incorrect because there is the production of abnormally viscous mucus, not a primary alteration. Answer C is incorrect because infection is not primary to asthma.
  4. Answer A is correct. The client with mania is seldom sitting long enough to eat and burns many calories for energy. Answer B is incorrect because the client should be treated the same as other clients. Small meals are not a correct option for this client. Allowing her into the kitchen gives her privileges that other clients do not have and should not be allowed, so answer D is incorrect.
  5. Answer B is correct. Bryant’s traction is used for fractured femurs and dislocated hips. The hips should be elevated 15° off the bed. Answer A is incorrect because the hips should not be resting on the bed. Answer C is incorrect because the hips should not be above the level of the body. Answer D is incorrect because the hips and legs should not be flat on the bed.
  6. Answer B is correct. Herpes zoster is shingles. Clients with shingles should be placed in contact precautions. Wearing gloves during care will prevent transmission of the virus. Covering the lesions with a sterile gauze is not necessary, antibiotics are not prescribed for herpes zoster, and oxygen is not necessary for shingles; therefore, answers A, C, and D are incorrect.
  7. Answer B is correct. A trough level should be drawn 30 minutes before the third or fourth dose. The times in answers A, C, and D are incorrect times to draw blood levels.
  8. Answer B is correct. The client using a diaphragm should keep the diaphragm in a cool location. Answers A, C, and D are incorrect. She should refrain from leaving the diaphragm in longer than 8 hours, not 4 hours. She should have the diaphragm resized when she gains or loses 10 pounds or has abdominal surgery.
  9. Answer C is correct. Mothers who plan to breastfeed should drink plenty of liquids, and four glasses is not enough in a 24-hour period. Wearing a support bra is a good practice for the mother who is breastfeeding as well as the mother who plans to bottle-feed, so answer A is incorrect. Expressing milk from the breast will stimulate milk production, making answer B incorrect. Allowing the water to run over the breast will also facilitate “letdown,” when the milk begins to be produced; thus, answer D is incorrect.
  10. Answer A is correct. The facial nerve is cranial nerve VII. If damage occurs, the client will experience facial pain. The auditory nerve is responsible for hearing loss and tinnitus, eye movement is controlled by the Trochear or C IV, and the olfactory nerve controls smell; therefore, answers B, C, and D are incorrect.
  11. Answer B is correct. Clients taking Pyridium should be taught that the medication will turn the urine orange or red. It is not associated with diarrhea, mental confusion, or changes in taste; therefore, answers A, C, and D are incorrect. Pyridium can also cause a yellowish color to skin and sclera if taken in large doses.
  12. Answer B is correct. Accutane is contraindicated for use by pregnant clients because it causes teratogenic effects. Calcium levels, apical pulse, and creatinine levels are not necessary; therefore, answers A, C, and D are incorrect.
  13. Answer D is correct. Clients taking Acyclovir should be encouraged to drink plenty of fluids because renal impairment can occur. Limiting activity is not necessary, nor is eating a high-carbohydrate diet. Use of an incentive spirometer is not specific to clients taking Acyclovir; therefore, answers A, B, and C are incorrect.
  14. Answer A is correct. Clients who are pregnant should not have an MRI because radioactive isotopes are used. However, clients with a titanium hip replacement can have an MRI, so answer B is incorrect. No antibiotics are used with this test and the client should remain still only when instructed, so answers C and D are not specific to this test.
  15. Answer D is correct. Clients taking Amphotericin B should be monitored for liver, renal, and bone marrow function because this drug is toxic to the kidneys and liver, and causes bone marrow suppression. Jaundice is a sign of liver toxicity and is not specific to the use of Amphotericin B. Changes in vision are not related, and nausea is a side effect, not a sign of toxicity; nor is urinary frequency. Thus, answers A, B, and C are incorrect.
  16. Answer C is correct. The client with chest pain should be seen first because this could indicate a myocardial infarction. The client in answer A has a blood glucose within normal limits. The client in answer B is maintained on blood pressure medication. The client in answer D is in no distress.
  17. Answer B is correct. Pancreatic enzymes should be given with meals for optimal effects. These enzymes assist the body in digesting needed nutrients. Answers A, C, and D are incorrect methods of administering pancreatic enzymes.
  18. Answer C is correct. The lens allows light to pass through the pupil and focus light on the retina. The lens does not stimulate the retina, assist with eye movement, or magnify small objects, so answers A, B, and D are incorrect.
  19. Answer C is correct. Miotic eyedrops constrict the pupil and allow aqueous humor to drain out of the Canal of Schlemm. They do not anesthetize the cornea, dilate the pupil, or paralyze the muscles of the eye, making answers A, B, and D incorrect.
  20. Answer A is correct. When using eyedrops, allow 5 minutes between the two medications; therefore, answer B is incorrect. These medications can be used by the same client but it is not necessary to use a cyclopegic with these medications, making answers C and D incorrect.
  21. Answer B is correct. Clients with color blindness will most likely have problems distinguishing violets, blues, and green. The colors in answers A, C, and D are less commonly affected.
  22. Answer D is correct. The client with a pacemaker should be taught to count and record his pulse rate. Answers A, B, and C are incorrect. Ankle edema is a sign of right-sided congestive heart failure. Although this is not normal, it is often present in clients with heart disease. If the edema is present in the hands and face, it should be reported. Checking the blood pressure daily is not necessary for these clients. The client with a pacemaker can use a microwave oven, but he should stand about 5 feet from the oven while it is operating.
  23. Answer A is correct. Clients who are being retrained for bladder control should be taught to withhold fluids after about 7 p.m., or 1 The times in answers B, C, and D are too early in the day.
  24. Answer D is correct. Cranberry juice is more alkaline and, when metabolized by the body, is excreted with acidic urine. Bacteria does not grow freely in acidic urine. Increasing intake of meats is not associated with urinary tract infections, so answer A is incorrect. The client does not have to avoid citrus fruits and pericare should be done, but hydrogen peroxide is drying, so answers B and C are incorrect.
  25. Answer C is correct. NPH insulin peaks in 8–12 hours, so a snack should be offered at that time. NPH insulin onsets in 90–120 minutes, so answer A is incorrect. Answer B is untrue because NPH insulin is time released and does not usually cause sudden hypoglycemia. Answer D is incorrect, but the client should eat a bedtime snack.