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NCLEX- PN Practice Exam 1 (PM)
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Question 1
The nurse is caring for a client following removal of the thyroid. Immediately post-op, the nurse should:
A
Encourage the client to turn her head side to side, to promote drainage of oral secretions
B
Maintain the client in a supine position with sandbags placed on either side of the head and neck
C
Maintain the client in a semi-Fowler’s position with the head and neck supported by pillows
D
Encourage the client to cough and breathe deeply every 2 hours, with the neck in a flexed position
Question 1 Explanation:
Following a thyroidectomy, the client should be placed in semi-Fowler’s position to decrease swelling that would place pressure on the airway. Other answer choices are incorrect because they would increase the chances of post-operative complications that include bleeding, swelling, and airway obstruction.
Question 2
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:
A
Record the heart rate and call the physician
B
Administer the medication and recheck the heart rate in 15 minutes
C
Hold the medication and recheck the heart rate in 30 minutes
D
Record the heart rate and administer the medication
Question 2 Explanation:
The infant’s apical heart rate is within the accepted range for administering the medication. Other answer choices are incorrect because the apical heart rate is suitable for giving the medication.
Question 3
A client with schizophrenia is receiving chlorpromazine (Thorazine) 400mg twice a day. An adverse side effect of the medication is:
A
Elevated temperature
B
Elevated blood pressure
C
Weight gain
D
Photosensitivity
Question 3 Explanation:
Neuroleptic malignant syndrome is an adverse reaction that is characterized by extreme elevations in temperature. Photosensitivity and weight gain are incorrect because they are expected side effects. Elevations in blood pressure are associated with reactions between foods containing tyramine and MAOI.
Question 4
Which of the following findings is associated with right-sided heart failure?
A
Daytime oliguria
B
Crackles in the lungs
C
Shortness of breath
D
Nocturnal polyuria
Question 4 Explanation:
Increased voiding at night is a symptom of right-sided heart failure. Shortness of breath and crackles in the lungs are incorrect because they are symptoms of left-sided heart failure. Daytime oliguria does not relate to the client’s diagnosis; therefore, it is incorrect.
Question 5
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:
A
Administering a bedtime sedative
B
Assigning a nursing assistant to sit with him until he falls asleep
C
Allowing the client to room with another elderly client
D
Leaving a nightlight on during the evening and night shifts
Question 5 Explanation:
Leaving a nightlight on during the evening and night shifts helps the client remain oriented to the environment and fosters independence. Assigning a nursing assistant to sit with him until he falls asleep and allowing the client to room with another elderly client will not decrease the client’s confusion. Administering a bedtime sedative will increase the likelihood of confusion in an elderly client.
Question 6
Which of the following is a common complaint of the client with end-stage renal failure?
A
Itching
B
Bruising
C
Ringing in the ears
D
Weight loss
Question 6 Explanation:
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. Other answer choices are not associated with end-stage renal failure.
Question 7
A client hospitalized with chronic dyspepsia is diagnosed with gastric cancer. Which of the following is associated with an increased incidence of gastric cancer?
A
Carbonated beverages
B
Refined sugars
C
Luncheon meats
D
Dairy products
Question 7 Explanation:
Luncheon meats contain preservatives such as nitrites that have been linked to gastric cancer. Other answer choices have not been found to increase the risk of gastric cancer; therefore, they are incorrect.
Question 8
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?
A
Pliers
B
Wire cutters
C
Oral airway
D
Tracheostomy set
Question 8 Explanation:
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. Oral airway is incorrect because the wires would prevent insertion of an oral airway. Pliers is incorrect because it would be of no use in releasing the wires. Tracheostomy set is incorrect because it would be used only as a last resort in case of airway obstruction.
Question 9
A client hospitalized with severe depression and suicidal ideation refuses to talk with the nurse. The nurse recognizes that the suicidal client has difficulty:
A
Displaying dependence on others
B
Discussing remorse and guilt for actions
C
Expressing feelings of low self-worth
D
Expressing anger toward others
Question 9 Explanation:
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.
Question 10
The licensed vocational nurse may not assume the primary care for a client:
A
In the fourth stage of labor
B
Two days post-appendectomy
C
With bipolar disorder
D
With a venous access device
Question 10 Explanation:
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.
Question 11
Which of the following medication orders needs further clarification?
A
Coumadin 10mg PO
B
Estrace 2mg PO q day
C
Darvocet 65mg PO q 4–6 hrs. PRN
D
Nembutal 100mg PO at bedtime
Question 11 Explanation:
There is no specified time or frequency for the ordered medication. Other answer choices contain specified time and frequency.
Question 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:
A
Wrist restraints
B
Full arm restraints
C
Mummy restraints
D
Elbow restraints
Question 12 Explanation:
The least restrictive restraint for the infant with cleft lip and cleft palate repair is elbow restraints. Other answer choices are more restrictive and unnecessary; therefore, they are incorrect.
Question 13
A client with glaucoma has been prescribed Timoptic (timolol) eyedrops. Timoptic should be used with caution in the client with a history of:
A
Pancreatitis
B
Gastric ulcers
C
Diabetes
D
Emphysema
Question 13 Explanation:
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.
Question 14
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:
A
Obtaining a blood glucose by finger stick
B
Administering pain medication
C
Checking the adequacy of urinary output
D
Requesting a daily complete blood count
Question 14 Explanation:
Sulfamylon produces a painful sensation when applied to the burn wound; therefore, the client should receive pain medication before dressing changes. Other answer choices do not pertain to dressing changes for the client with burns, so they are incorrect.
Question 15
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:
A
Place the probe on the child’s abdomen
B
Recalibrate the oximeter at the beginning of each shift
C
Place the probe on the child’s finger
D
Apply the probe and wait 15 minutes before obtaining a reading
Question 15 Explanation:
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. Placing the probe on the child’s abdomen is incorrect because the probe cannot be secured to the abdomen. Recalibrating the oximeter at the beginning of each shift is incorrect because it should be recalibrated before application. Applying the probe and wait 15 minutes before obtaining a reading is incorrect because a reading is obtained within seconds, not minutes.
Question 16
The best diet for the client with Meniere’s syndrome is one that is:
A
High in iodine
B
Low in fiber
C
High in fiber
D
Low in sodium
Question 16 Explanation:
A low-sodium diet is best for the client with Meniere’s syndrome. Other answer choices do not relate to the care of the client with Meniere’s syndrome; therefore, they are incorrect.
Question 17
An infant with Tetralogy of Fallot is discharged with a prescription for lanoxin elixir. The nurse should instruct the mother to:
A
Administer the medication using the calibrated dropper in the bottle
B
Administer the medication using a plastic baby spoon
C
Administer the medication in a baby bottle with 1oz. of water
D
Administer the medication using a nipple
Question 17 Explanation:
The medication should be administered using the calibrated dropper that comes with the medication. Administering the medication using a nipple and administering the medication using a plastic baby spoon are incorrect because part or all of the medication could be lost during administration. Administering the medication in a baby bottle with 1oz. of water is incorrect because part or all of the medication will be lost if the child does not finish the bottle.
Question 18
Which information should be given to the client taking phenytoin (Dilantin)?
A
Taking the medication with meals will increase its effectiveness.
B
The medication decreases the effects of oral contraceptives.
C
More frequent dental appointments will be needed for special gum care.
D
The medication can cause sleep disturbances.
Question 18 Explanation:
Gingival hyperplasia is a side effect of phenytoin. The client will need more frequent dental visits. Other answer choices do not apply to the medication; therefore, they are incorrect.
Question 19
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?
A
"You can expect to be sleepy and confused for a time after the treatment."
B
"The treatment will produce a controlled grand mal seizure."
C
"You will be given medicine to relax you during the treatment."
D
"The treatment might produce nausea and headache."
Question 19 Explanation:
The client will receive medication that relaxes skeletal muscles and produces mild sedation. "The treatment will produce a controlled grand mal seizure." and "You can expect to be sleepy and confused for a time after the treatment." statements are incorrect because it increase the client’s anxiety level. Nausea and headache are not associated with ECT.
Question 20
Which of the following skin lesions is associated with Lyme’s disease?
A
Bullae
B
Plaques
C
Bull’s eye rash
D
Papular crusts
Question 20 Explanation:
Lyme’s disease produces a characteristic annular or circular rash sometimes described as a "bull’s eye" rash. Other answer choices are incorrect because they are not symptoms associated with Lyme’s disease.
Question 21
A client receiving hydrochlorothiazide is instructed to increase her dietary intake of potassium. The best snack for the client requiring increased potassium is:
A
Banana
B
Orange
C
Pear
D
Apple
Question 21 Explanation:
Other answer choices 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+.)
Question 22
Which of the following snacks would be suitable for the child with gluten-induced enteropathy?
A
Peanut butter and jelly sandwich
B
Soft oatmeal cookie
C
Cheese pizza
D
Buttered popcorn
Question 22 Explanation:
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. Other answer choices are incorrect because they contain foods that worsen the client’s condition.
Question 23
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:
A
Gastric lavage
B
Activated charcoal
C
Chelating agents
D
Antiemetics
Question 23 Explanation:
Chelating agents are used to treat the client with poisonings from heavy metals such as lead and iron. Gastric lavage and activated charcoal are used to remove noncorrosive poisons; therefore, they are incorrect. Antiemetics prevents vomiting; therefore, it is an incorrect response.
Question 24
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:
A
A history of cruelty to animals
B
An expression of remorse for his actions
C
A below-average intelligence
D
A history of consistent employment
Question 24 Explanation:
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. The client with antisocial personality disorder does not hold consistent employment, IQ is usually higher than average and lack of guilt or remorse for wrong-doing.
Question 25
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?
A
She can broad-jump.
B
She can copy a horizontal line.
C
She can pull a toy behind her.
D
She can build a tower of eight blocks.
Question 25 Explanation:
According to the Denver Developmental Screening Test, the child can pull a toy behind her by age 2 years. Other answer choices are not accomplished until ages 4–5 years; therefore, they are incorrect.
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NCLEX- PN Practice Exam 1 (EM)
Choose the letter of the correct answer. You got 25 minutes to finish the exam .Good luck!
Start
Congratulations - you have completed NCLEX- PN Practice Exam 1 (EM).
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Question 1
Which of the following medication orders needs further clarification?
A
Coumadin 10mg PO
B
Darvocet 65mg PO q 4–6 hrs. PRN
C
Estrace 2mg PO q day
D
Nembutal 100mg PO at bedtime
Question 1 Explanation:
There is no specified time or frequency for the ordered medication. Other answer choices contain specified time and frequency.
Question 2
The best diet for the client with Meniere’s syndrome is one that is:
A
Low in sodium
B
High in fiber
C
Low in fiber
D
High in iodine
Question 2 Explanation:
A low-sodium diet is best for the client with Meniere’s syndrome. Other answer choices do not relate to the care of the client with Meniere’s syndrome; therefore, they are incorrect.
Question 3
Which of the following snacks would be suitable for the child with gluten-induced enteropathy?
A
Buttered popcorn
B
Cheese pizza
C
Soft oatmeal cookie
D
Peanut butter and jelly sandwich
Question 3 Explanation:
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. Other answer choices are incorrect because they contain foods that worsen the client’s condition.
Question 4
Which of the following findings is associated with right-sided heart failure?
A
Shortness of breath
B
Crackles in the lungs
C
Daytime oliguria
D
Nocturnal polyuria
Question 4 Explanation:
Increased voiding at night is a symptom of right-sided heart failure. Shortness of breath and crackles in the lungs are incorrect because they are symptoms of left-sided heart failure. Daytime oliguria does not relate to the client’s diagnosis; therefore, it is incorrect.
Question 5
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?
A
She can broad-jump.
B
She can pull a toy behind her.
C
She can copy a horizontal line.
D
She can build a tower of eight blocks.
Question 5 Explanation:
According to the Denver Developmental Screening Test, the child can pull a toy behind her by age 2 years. Other answer choices are not accomplished until ages 4–5 years; therefore, they are incorrect.
Question 6
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?
A
Pliers
B
Oral airway
C
Wire cutters
D
Tracheostomy set
Question 6 Explanation:
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. Oral airway is incorrect because the wires would prevent insertion of an oral airway. Pliers is incorrect because it would be of no use in releasing the wires. Tracheostomy set is incorrect because it would be used only as a last resort in case of airway obstruction.
Question 7
A client hospitalized with chronic dyspepsia is diagnosed with gastric cancer. Which of the following is associated with an increased incidence of gastric cancer?
A
Luncheon meats
B
Carbonated beverages
C
Refined sugars
D
Dairy products
Question 7 Explanation:
Luncheon meats contain preservatives such as nitrites that have been linked to gastric cancer. Other answer choices have not been found to increase the risk of gastric cancer; therefore, they are incorrect.
Question 8
A client with schizophrenia is receiving chlorpromazine (Thorazine) 400mg twice a day. An adverse side effect of the medication is:
A
Elevated temperature
B
Weight gain
C
Elevated blood pressure
D
Photosensitivity
Question 8 Explanation:
Neuroleptic malignant syndrome is an adverse reaction that is characterized by extreme elevations in temperature. Photosensitivity and weight gain are incorrect because they are expected side effects. Elevations in blood pressure are associated with reactions between foods containing tyramine and MAOI.
Question 9
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?
A
"You will be given medicine to relax you during the treatment."
B
"You can expect to be sleepy and confused for a time after the treatment."
C
"The treatment might produce nausea and headache."
D
"The treatment will produce a controlled grand mal seizure."
Question 9 Explanation:
The client will receive medication that relaxes skeletal muscles and produces mild sedation. "The treatment will produce a controlled grand mal seizure." and "You can expect to be sleepy and confused for a time after the treatment." statements are incorrect because it increase the client’s anxiety level. Nausea and headache are not associated with ECT.
Question 10
A client hospitalized with severe depression and suicidal ideation refuses to talk with the nurse. The nurse recognizes that the suicidal client has difficulty:
A
Expressing feelings of low self-worth
B
Displaying dependence on others
C
Discussing remorse and guilt for actions
D
Expressing anger toward others
Question 10 Explanation:
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.
Question 11
A client receiving hydrochlorothiazide is instructed to increase her dietary intake of potassium. The best snack for the client requiring increased potassium is:
A
Banana
B
Orange
C
Apple
D
Pear
Question 11 Explanation:
Other answer choices 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+.)
Question 12
Which of the following is a common complaint of the client with end-stage renal failure?
A
Bruising
B
Ringing in the ears
C
Weight loss
D
Itching
Question 12 Explanation:
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. Other answer choices are not associated with end-stage renal failure.
Question 13
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:
A
Mummy restraints
B
Wrist restraints
C
Full arm restraints
D
Elbow restraints
Question 13 Explanation:
The least restrictive restraint for the infant with cleft lip and cleft palate repair is elbow restraints. Other answer choices are more restrictive and unnecessary; therefore, they are incorrect.
Question 14
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:
A
Record the heart rate and call the physician
B
Hold the medication and recheck the heart rate in 30 minutes
C
Administer the medication and recheck the heart rate in 15 minutes
D
Record the heart rate and administer the medication
Question 14 Explanation:
The infant’s apical heart rate is within the accepted range for administering the medication. Other answer choices are incorrect because the apical heart rate is suitable for giving the medication.
Question 15
A client with glaucoma has been prescribed Timoptic (timolol) eyedrops. Timoptic should be used with caution in the client with a history of:
A
Emphysema
B
Diabetes
C
Gastric ulcers
D
Pancreatitis
Question 15 Explanation:
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.
Question 16
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:
A
An expression of remorse for his actions
B
A history of consistent employment
C
A below-average intelligence
D
A history of cruelty to animals
Question 16 Explanation:
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. The client with antisocial personality disorder does not hold consistent employment, IQ is usually higher than average and lack of guilt or remorse for wrong-doing.
Question 17
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:
A
Gastric lavage
B
Chelating agents
C
Activated charcoal
D
Antiemetics
Question 17 Explanation:
Chelating agents are used to treat the client with poisonings from heavy metals such as lead and iron. Gastric lavage and activated charcoal are used to remove noncorrosive poisons; therefore, they are incorrect. Antiemetics prevents vomiting; therefore, it is an incorrect response.
Question 18
The licensed vocational nurse may not assume the primary care for a client:
A
With bipolar disorder
B
In the fourth stage of labor
C
With a venous access device
D
Two days post-appendectomy
Question 18 Explanation:
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.
Question 19
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:
A
Obtaining a blood glucose by finger stick
B
Requesting a daily complete blood count
C
Checking the adequacy of urinary output
D
Administering pain medication
Question 19 Explanation:
Sulfamylon produces a painful sensation when applied to the burn wound; therefore, the client should receive pain medication before dressing changes. Other answer choices do not pertain to dressing changes for the client with burns, so they are incorrect.
Question 20
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:
A
Apply the probe and wait 15 minutes before obtaining a reading
B
Place the probe on the child’s finger
C
Place the probe on the child’s abdomen
D
Recalibrate the oximeter at the beginning of each shift
Question 20 Explanation:
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. Placing the probe on the child’s abdomen is incorrect because the probe cannot be secured to the abdomen. Recalibrating the oximeter at the beginning of each shift is incorrect because it should be recalibrated before application. Applying the probe and wait 15 minutes before obtaining a reading is incorrect because a reading is obtained within seconds, not minutes.
Question 21
Which of the following skin lesions is associated with Lyme’s disease?
A
Bull’s eye rash
B
Plaques
C
Bullae
D
Papular crusts
Question 21 Explanation:
Lyme’s disease produces a characteristic annular or circular rash sometimes described as a "bull’s eye" rash. Other answer choices are incorrect because they are not symptoms associated with Lyme’s disease.
Question 22
Which information should be given to the client taking phenytoin (Dilantin)?
A
More frequent dental appointments will be needed for special gum care.
B
Taking the medication with meals will increase its effectiveness.
C
The medication can cause sleep disturbances.
D
The medication decreases the effects of oral contraceptives.
Question 22 Explanation:
Gingival hyperplasia is a side effect of phenytoin. The client will need more frequent dental visits. Other answer choices do not apply to the medication; therefore, they are incorrect.
Question 23
An infant with Tetralogy of Fallot is discharged with a prescription for lanoxin elixir. The nurse should instruct the mother to:
A
Administer the medication using the calibrated dropper in the bottle
B
Administer the medication using a plastic baby spoon
C
Administer the medication in a baby bottle with 1oz. of water
D
Administer the medication using a nipple
Question 23 Explanation:
The medication should be administered using the calibrated dropper that comes with the medication. Administering the medication using a nipple and administering the medication using a plastic baby spoon are incorrect because part or all of the medication could be lost during administration. Administering the medication in a baby bottle with 1oz. of water is incorrect because part or all of the medication will be lost if the child does not finish the bottle.
Question 24
The nurse is caring for a client following removal of the thyroid. Immediately post-op, the nurse should:
A
Maintain the client in a semi-Fowler’s position with the head and neck supported by pillows
B
Encourage the client to turn her head side to side, to promote drainage of oral secretions
C
Encourage the client to cough and breathe deeply every 2 hours, with the neck in a flexed position
D
Maintain the client in a supine position with sandbags placed on either side of the head and neck
Question 24 Explanation:
Following a thyroidectomy, the client should be placed in semi-Fowler’s position to decrease swelling that would place pressure on the airway. Other answer choices are incorrect because they would increase the chances of post-operative complications that include bleeding, swelling, and airway obstruction.
Question 25
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:
A
Administering a bedtime sedative
B
Assigning a nursing assistant to sit with him until he falls asleep
C
Leaving a nightlight on during the evening and night shifts
D
Allowing the client to room with another elderly client
Question 25 Explanation:
Leaving a nightlight on during the evening and night shifts helps the client remain oriented to the environment and fosters independence. Assigning a nursing assistant to sit with him until he falls asleep and allowing the client to room with another elderly client will not decrease the client’s confusion. Administering a bedtime sedative will increase the likelihood of confusion in an elderly client.
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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:
Expressing feelings of low self-worth
Discussing remorse and guilt for actions
Displaying dependence on others
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:
Pear
Apple
Orange
Banana
3. The nurse is caring for a client following removal of the thyroid. Immediately post-op, the nurse should:
Maintain the client in a semi-Fowler’s position with the head and neck supported by pillows
Encourage the client to turn her head side to side, to promote drainage of oral secretions
Maintain the client in a supine position with sandbags placed on either side of the head and neck
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?
Dairy products
Carbonated beverages
Refined sugars
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:
A history of consistent employment
A below-average intelligence
A history of cruelty to animals
An expression of remorse for his actions
6. The licensed vocational nurse may not assume the primary care for a client:
In the fourth stage of labor
Two days post-appendectomy
With a venous access device
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:
Administering pain medication
Checking the adequacy of urinary output
Requesting a daily complete blood count
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?
She can pull a toy behind her.
She can copy a horizontal line.
She can build a tower of eight blocks.
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?
Wire cutters
Oral airway
Pliers
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:
Record the heart rate and call the physician
Record the heart rate and administer the medication
Administer the medication and recheck the heart rate in 15 minutes
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:
Gastric lavage
Chelating agents
Antiemetics
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:
Elbow restraints
Full arm restraints
Wrist restraints
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:
Diabetes
Gastric ulcers
Emphysema
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:
Assigning a nursing assistant to sit with him until he falls asleep
Allowing the client to room with another elderly client
Administering a bedtime sedative
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?
Weight loss
Itching
Ringing in the ears
Bruising
16. Which of the following medication orders needs further clarification?
Darvocet 65mg PO q 4–6 hrs. PRN
Nembutal 100mg PO at bedtime
Coumadin 10mg PO
Estrace 2mg PO q day
17. The best diet for the client with Meniere’s syndrome is one that is:
High in fiber
Low in sodium
High in iodine
Low in fiber
18. Which of the following findings is associated with right-sided heart failure?
Shortness of breath
Nocturnal polyuria
Daytime oliguria
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:
Place the probe on the child’s abdomen
Recalibrate the oximeter at the beginning of each shift
Apply the probe and wait 15 minutes before obtaining a reading
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:
Administer the medication using a nipple
Administer the medication using the calibrated dropper in the bottle
Administer the medication using a plastic baby spoon
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?
“You will be given medicine to relax you during the treatment.”
“The treatment will produce a controlled grand mal seizure.”
“The treatment might produce nausea and headache.”
“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?
Bull’s eye rash
Papular crusts
Bullae
Plaques
23. Which of the following snacks would be suitable for the child with gluten-induced enteropathy?
Soft oatmeal cookie
Buttered popcorn
Peanut butter and jelly sandwich
Cheese pizza
24. A client with schizophrenia is receiving chlorpromazine (Thorazine) 400mg twice a day. An adverse side effect of the medication is:
Photosensitivity
Elevated temperature
Weight gain
Elevated blood pressure
25. Which information should be given to the client taking phenytoin (Dilantin)?
Taking the medication with meals will increase its effectiveness.
The medication can cause sleep disturbances.
More frequent dental appointments will be needed for special gum care.
The medication decreases the effects of oral contraceptives.
Answers and Rationales
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.
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+.)
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.