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NCLEX- PN Practice Exam 4 (PM)
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Question 1
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:
A
Synergistic effect
B
Excitatory effect
C
Agonist effect
D
Antagonist effect
Question 1 Explanation:
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 incorrect. Antagonist effects are those in which the actions of the drugs oppose one another; therefore incorrect. Excitatory effect is incorrect because the drugs would have a combined depressing, not excitatory, effect.
Question 2
Which of the following meal selections is appropriate for the client with celiac disease?
A
Toast, jam, and apple juice
B
Rice Krispies bar and milk
C
Cheese pizza and Kool-Aid
D
Peanut butter cookies and milk
Question 2 Explanation:
Foods containing rice or millet are permitted on the diet of the client with celiac disease. Other answer choices are not permitted because they contain flour made from wheat, which exacerbates the symptoms of celiac disease; therefore, they are incorrect.
Question 3
A 5-month-old is diagnosed with atopic dermatitis. Nursing interventions will focus on:
A
Administering antipyretics
B
Keeping the skin free of moisture
C
Preventing infection
D
Limiting oral fluid intake
Question 3 Explanation:
The nurse should prevent the infant with atopic dermatitis (eczema) from scratching, which can lead to skin infections. Administering antipyretics is incorrect because fever is not associated with atopic dermatitis. Keeping the skin free of moisture and limiting oral fluid intake are incorrect because they increase dryness of the skin, which worsens the symptoms of atopic dermatitis.
Question 4
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:
A
Sprinkle baby powder over the radiated area
B
Remove the unsightly markings with acetone or alcohol
C
Cover the radiation site with loose gauze dressing
D
Refrain from using soap or lotion on the marked area
Question 4 Explanation:
The nurse should not use water, soap, or lotion on the area marked for radiation therapy. Removing the unsightly markings with acetone or alcohol is incorrect because it would remove the marking. Covering the radiation site with loose gauze dressing and Sprinkling baby powder over the radiated area are not necessary for the client receiving radiation; therefore, they are incorrect.
Question 5
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?
A
Apple
B
Diet cola
C
Potato chips
D
Milkshake
Question 5 Explanation:
The milkshake will provide needed calories and nutrients for the client with mania. Potato chips and diet cola are incorrect because they are high in sodium, which causes the client to excrete the lithium. Apple has some nutrient value, but not as much as the milkshake.
Question 6
The nurse is admitting a client with a suspected duodenal ulcer. The client will most likely report that his abdominal discomfort lessens when he:
A
Eats a meal
B
Rests in recumbent position
C
Skips a meal
D
Sits upright after eating
Question 6 Explanation:
Pain associated with duodenal ulcers is lessened if the client eats a meal or snack. Skipping a meal is incorrect because it makes the pain worse. Resting in recumbent position refers to dumping syndrome; therefore, it is incorrect. Siting upright after eating refers to gastroesophageal reflux; therefore, it is incorrect.
Question 7
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:
A
Prevent addiction
B
Facilitate mobility
C
Prevent nausea
D
Alleviate pain
Question 7 Explanation:
The nurse should be concerned with alleviating the client’s pain.Other answer choices are not primary objectives in the care of the client receiving an opiate analgesic; therefore, they are incorrect.
Question 8
A 2-month-old infant has just received her first Tetramune injection. The nurse should tell the mother that the immunization:
A
Is given to determine whether the child is susceptible to pertussis
B
Is a one-time injection that protects against MMR and varicella
C
Will need to be repeated when the child is 4 years of age
D
Is one of a series of injections that protects against dpt and Hib
Question 8 Explanation:
The immunization protects the child against diphtheria, pertussis, tetanus, and H. influenza b. A second injection is given before 4 years of age. Is given to determine whether the child is susceptible to pertussis is incorrect statement. It is not a one-time injection, nor does it protect against measles, mumps, rubella, or varicella.
Question 9
The nurse is caring for an 8-year-old following a routine tonsillectomy. Which finding should be reported immediately?
A
Drooling of blood-tinged saliva
B
Respiratory stridor
C
An axillary temperature of 99°F
D
Reluctance to swallow
Question 9 Explanation:
Respiratory stridor is a symptom of partial airway obstruction. Other answer choices are expected with a tonsillectomy; therefore, they are incorrect.
Question 10
The chart indicates that a client has expressive aphasia following a stroke. The nurse understands that the client will have difficulty with:
A
Recognizing and using an object correctly
B
Comprehending spoken words
C
Carrying out purposeful motor activity
D
Speaking and writing
Question 10 Explanation:
The client with expressive aphasia has trouble forming words that are understandable. Comprehending spoken words is incorrect because it describes receptive aphasia. Carrying out purposeful motor activity refers to apraxia; therefore, it is incorrect. Recognizing and using an object correctly is incorrect because it refers to agnosia.
Question 11
A camp nurse is applying sunscreen to a group of children enrolled in swim classes. Chemical sunscreens are most effective when applied:
A
30 minutes before sun exposure
B
5 minutes before sun exposure
C
Just before sun exposure
D
15 minutes before sun exposure
Question 11 Explanation:
Sunscreens of at least an SPF of 15 should be applied 20–30 minutes before going into the sun. Other answer choices are incorrect because they do not allow sufficient time for sun protection.
Question 12
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:
The client’s symptoms suggest an adverse reaction to the medication known as neuroleptic malignant syndrome. Other answer choices are not appropriate.
Question 13
A client with a deep decubitus ulcer is receiving therapy in the hyperbaric oxygen chamber. Before therapy, the nurse should:
A
Apply a lanolin-based lotion to the skin
B
Wash the skin with water and pat dry
C
Apply an occlusive dressing to the site
D
Cover the area with a petroleum gauze
Question 13 Explanation:
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 they are incorrect.
Question 14
A 4-year-old is admitted with acute leukemia. It will be most important to monitor the child for:
A
Fatigue and bruising
B
Bleeding and pallor
C
Petechiae and mucosal ulcers
D
Abdominal pain and anorexia
Question 14 Explanation:
The child with leukemia has low platelet counts, which contribute to spontaneous bleeding. Other answer choices are common in the child with leukemia, are not life-threatening.
Question 15
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?
A
Baked fish
B
Steamed carrots
C
Mashed potatoes
D
Whole-grain cereal
Question 15 Explanation:
Symptoms associated with diverticulitis are usually reported after eating popcorn, celery, raw vegetables, whole grains, and nuts. Other answer choices are incorrect because they are allowed in the diet of the client with diverticulitis.
Question 16
A client newly diagnosed with diabetes is started on Precose (acarbose). The nurse should tell the client that the medication should be taken:
A
With the first bite of a meal
B
Daily at bedtime
C
1 hour before meals
D
30 minutes after meals
Question 16 Explanation:
Precose (acarbose) is to be taken with the first bite of a meal. Other answer choices are incorrect because they specify the wrong schedule for medication administration.
Question 17
A client with human immunodeficiency syndrome has gastrointestinal symptoms, including diarrhea. The nurse should teach the client to avoid:
A
Processed meat
B
Calcium-rich foods
C
Canned or frozen vegetables
D
Raw fruits and vegetables
Question 17 Explanation:
The client with HIV should adhere to a low-bacteria diet by avoiding raw fruits and vegetables. Other answer choices are incorrect because they are permitted in the client’s diet.
Question 18
A child with cystic fibrosis is being treated with inhalation therapy with Pulmozyme (dornase alfa). A side effect of the medication is:
A
Sore throat
B
Weight gain
C
Brittle nails
D
Hair loss
Question 18 Explanation:
Side effects of Pulmozyme include sore throat, hoarseness, and laryngitis. Other answer choices are not associated with Pulmozyme; therefore, they are incorrect.
Question 19
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?
A
The client complains of increased thirst and increased urination.
B
The client complains of blurred vision.
C
The client complains of ringing in the ears.
D
The client complains of increased weight gain over the past year.
Question 19 Explanation:
Increased thirst and increased urination are signs of lithium toxicity. Blurring of vision and ringing in the ears do not relate to the medication; therefore, they are incorrect. Increased weight gain is an expected side effect of the medication; therefore, it is incorrect.
Question 20
The physician has scheduled a Whipple procedure for a client with pancreatic cancer. The nurse recognizes that the client’s cancer is located in:
A
The head of the pancreas
B
The tail of the pancreas
C
The body of the pancreas
D
The entire pancreas
Question 20 Explanation:
The Whipple procedure is performed for cancer located in the head of the pancreas. Other answer choices are not correct because of the location of the cancer.
Question 21
The nurse is caring for a client with acromegaly. Following a transphenoidal hypophysectomy, the nurse should:
A
Encourage the client to cough
B
Monitor the client’s blood sugar
C
Place the client in low Trendelenburg position
D
Suction the mouth and pharynx every hour
Question 21 Explanation:
Growth hormone levels generally fall rapidly after a hypophysectomy, allowing insulin levels to rise. The result is hypoglycemia. Suctioning the mouth and pharynx every hour is incorrect because it traumatizes the oral mucosa. Placing the client in low Trendelenburg position is incorrect because the client’s head should be elevated to reduce pressure on the operative site. Encouraging the client to cough is incorrect because it increases pressure on the operative site that can lead to a leak of cerebral spinal fluid.
Question 22
What information should the nurse give a new mother regarding the introduction of solid foods for her infant?
A
Solid foods should not be given until the extrusion reflex disappears, at 8–10 months of age.
B
Solid foods should be introduced one at a time, with 4- to 7-day intervals.
C
Solid foods should begin with fruits and vegetables.
D
Solid foods can be mixed in a bottle or infant feeder to make feeding easier.
Question 22 Explanation:
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. Solids should not be added to the bottle and the use of infant feeders is discouraged. The first food added to the infant’s diet is rice cereal.
Question 23
A 2-year-old is hospitalized with suspected intussusception. Which finding is associated with intussusception?
A
"Ribbonlike" stools
B
Projectile vomiting
C
Palpable mass over the flank
D
"Currant jelly" stools
Question 23 Explanation:
The child with intussusception has stools that contain blood and mucus, which are described as "currant jelly" stools. Projectile vomiting is a symptom of pyloric stenosis; therefore, it is incorrect. "Ribbonlike" stools is a symptom of Hirschsprung’s; therefore, it is incorrect. Palpable mass over the flank is a symptom of Wilms tumor; therefore, it is incorrect.
Question 24
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:
A
Prevent contamination of the suture line
B
Promote healing of the oral mucosa
C
Prevent swelling and dysphagia
D
Decompress the stomach via suction
Question 24 Explanation:
The primary reason for the NG to is to allow for nourishment without contamination of the suture line. Preventing swelling and dysphagia is not a true statement; therefore, it is incorrect. Decompressing the stomach via suction is incorrect because there is no mention of suction. Promoting healing of the oral mucosa is incorrect because the oral mucosa was not involved in the laryngectomy.
Question 25
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:
A
Withhold the medication until the heart rate increases
B
Administer the medication and monitor the heart rate
C
Record the pulse rate and administer the medication
D
Withhold the medication and notify the doctor
Question 25 Explanation:
The medication should be withheld and the doctor should be notified. Other answer choices are incorrect because they do not provide for the client’s safety.
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Exam Mode – Questions and choices are randomly arranged, time limit of 1min per question, answers and grade will be revealed after finishing the exam.
NCLEX- PN Practice Exam 4 (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 4 (EM).
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Question 1
A client with human immunodeficiency syndrome has gastrointestinal symptoms, including diarrhea. The nurse should teach the client to avoid:
A
Calcium-rich foods
B
Raw fruits and vegetables
C
Canned or frozen vegetables
D
Processed meat
Question 1 Explanation:
The client with HIV should adhere to a low-bacteria diet by avoiding raw fruits and vegetables. Other answer choices are incorrect because they are permitted in the client’s diet.
Question 2
A client with a deep decubitus ulcer is receiving therapy in the hyperbaric oxygen chamber. Before therapy, the nurse should:
A
Cover the area with a petroleum gauze
B
Apply an occlusive dressing to the site
C
Apply a lanolin-based lotion to the skin
D
Wash the skin with water and pat dry
Question 2 Explanation:
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 they are incorrect.
Question 3
A child with cystic fibrosis is being treated with inhalation therapy with Pulmozyme (dornase alfa). A side effect of the medication is:
A
Sore throat
B
Weight gain
C
Hair loss
D
Brittle nails
Question 3 Explanation:
Side effects of Pulmozyme include sore throat, hoarseness, and laryngitis. Other answer choices are not associated with Pulmozyme; therefore, they are incorrect.
Question 4
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?
A
Milkshake
B
Potato chips
C
Apple
D
Diet cola
Question 4 Explanation:
The milkshake will provide needed calories and nutrients for the client with mania. Potato chips and diet cola are incorrect because they are high in sodium, which causes the client to excrete the lithium. Apple has some nutrient value, but not as much as the milkshake.
Question 5
A camp nurse is applying sunscreen to a group of children enrolled in swim classes. Chemical sunscreens are most effective when applied:
A
30 minutes before sun exposure
B
5 minutes before sun exposure
C
15 minutes before sun exposure
D
Just before sun exposure
Question 5 Explanation:
Sunscreens of at least an SPF of 15 should be applied 20–30 minutes before going into the sun. Other answer choices are incorrect because they do not allow sufficient time for sun protection.
Question 6
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:
A
Excitatory effect
B
Agonist effect
C
Antagonist effect
D
Synergistic effect
Question 6 Explanation:
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 incorrect. Antagonist effects are those in which the actions of the drugs oppose one another; therefore incorrect. Excitatory effect is incorrect because the drugs would have a combined depressing, not excitatory, effect.
Question 7
The chart indicates that a client has expressive aphasia following a stroke. The nurse understands that the client will have difficulty with:
A
Recognizing and using an object correctly
B
Comprehending spoken words
C
Speaking and writing
D
Carrying out purposeful motor activity
Question 7 Explanation:
The client with expressive aphasia has trouble forming words that are understandable. Comprehending spoken words is incorrect because it describes receptive aphasia. Carrying out purposeful motor activity refers to apraxia; therefore, it is incorrect. Recognizing and using an object correctly is incorrect because it refers to agnosia.
Question 8
Which of the following meal selections is appropriate for the client with celiac disease?
A
Toast, jam, and apple juice
B
Rice Krispies bar and milk
C
Peanut butter cookies and milk
D
Cheese pizza and Kool-Aid
Question 8 Explanation:
Foods containing rice or millet are permitted on the diet of the client with celiac disease. Other answer choices are not permitted because they contain flour made from wheat, which exacerbates the symptoms of celiac disease; therefore, they are incorrect.
Question 9
A client newly diagnosed with diabetes is started on Precose (acarbose). The nurse should tell the client that the medication should be taken:
A
Daily at bedtime
B
With the first bite of a meal
C
30 minutes after meals
D
1 hour before meals
Question 9 Explanation:
Precose (acarbose) is to be taken with the first bite of a meal. Other answer choices are incorrect because they specify the wrong schedule for medication administration.
Question 10
The physician has scheduled a Whipple procedure for a client with pancreatic cancer. The nurse recognizes that the client’s cancer is located in:
A
The body of the pancreas
B
The entire pancreas
C
The head of the pancreas
D
The tail of the pancreas
Question 10 Explanation:
The Whipple procedure is performed for cancer located in the head of the pancreas. Other answer choices are not correct because of the location of the cancer.
Question 11
A 4-year-old is admitted with acute leukemia. It will be most important to monitor the child for:
A
Fatigue and bruising
B
Abdominal pain and anorexia
C
Bleeding and pallor
D
Petechiae and mucosal ulcers
Question 11 Explanation:
The child with leukemia has low platelet counts, which contribute to spontaneous bleeding. Other answer choices are common in the child with leukemia, are not life-threatening.
Question 12
The nurse is caring for a client with acromegaly. Following a transphenoidal hypophysectomy, the nurse should:
A
Suction the mouth and pharynx every hour
B
Place the client in low Trendelenburg position
C
Monitor the client’s blood sugar
D
Encourage the client to cough
Question 12 Explanation:
Growth hormone levels generally fall rapidly after a hypophysectomy, allowing insulin levels to rise. The result is hypoglycemia. Suctioning the mouth and pharynx every hour is incorrect because it traumatizes the oral mucosa. Placing the client in low Trendelenburg position is incorrect because the client’s head should be elevated to reduce pressure on the operative site. Encouraging the client to cough is incorrect because it increases pressure on the operative site that can lead to a leak of cerebral spinal fluid.
Question 13
The nurse is admitting a client with a suspected duodenal ulcer. The client will most likely report that his abdominal discomfort lessens when he:
A
Rests in recumbent position
B
Skips a meal
C
Sits upright after eating
D
Eats a meal
Question 13 Explanation:
Pain associated with duodenal ulcers is lessened if the client eats a meal or snack. Skipping a meal is incorrect because it makes the pain worse. Resting in recumbent position refers to dumping syndrome; therefore, it is incorrect. Siting upright after eating refers to gastroesophageal reflux; therefore, it is incorrect.
Question 14
A 2-year-old is hospitalized with suspected intussusception. Which finding is associated with intussusception?
A
"Currant jelly" stools
B
Palpable mass over the flank
C
Projectile vomiting
D
"Ribbonlike" stools
Question 14 Explanation:
The child with intussusception has stools that contain blood and mucus, which are described as "currant jelly" stools. Projectile vomiting is a symptom of pyloric stenosis; therefore, it is incorrect. "Ribbonlike" stools is a symptom of Hirschsprung’s; therefore, it is incorrect. Palpable mass over the flank is a symptom of Wilms tumor; therefore, it is incorrect.
Question 15
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:
A
Administer the medication and monitor the heart rate
B
Withhold the medication and notify the doctor
C
Withhold the medication until the heart rate increases
D
Record the pulse rate and administer the medication
Question 15 Explanation:
The medication should be withheld and the doctor should be notified. Other answer choices are incorrect because they do not provide for the client’s safety.
Question 16
A 5-month-old is diagnosed with atopic dermatitis. Nursing interventions will focus on:
A
Keeping the skin free of moisture
B
Preventing infection
C
Administering antipyretics
D
Limiting oral fluid intake
Question 16 Explanation:
The nurse should prevent the infant with atopic dermatitis (eczema) from scratching, which can lead to skin infections. Administering antipyretics is incorrect because fever is not associated with atopic dermatitis. Keeping the skin free of moisture and limiting oral fluid intake are incorrect because they increase dryness of the skin, which worsens the symptoms of atopic dermatitis.
Question 17
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:
A
Decompress the stomach via suction
B
Prevent contamination of the suture line
C
Prevent swelling and dysphagia
D
Promote healing of the oral mucosa
Question 17 Explanation:
The primary reason for the NG to is to allow for nourishment without contamination of the suture line. Preventing swelling and dysphagia is not a true statement; therefore, it is incorrect. Decompressing the stomach via suction is incorrect because there is no mention of suction. Promoting healing of the oral mucosa is incorrect because the oral mucosa was not involved in the laryngectomy.
Question 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:
The client’s symptoms suggest an adverse reaction to the medication known as neuroleptic malignant syndrome. Other answer choices are not appropriate.
Question 19
The nurse is caring for an 8-year-old following a routine tonsillectomy. Which finding should be reported immediately?
A
Respiratory stridor
B
An axillary temperature of 99°F
C
Drooling of blood-tinged saliva
D
Reluctance to swallow
Question 19 Explanation:
Respiratory stridor is a symptom of partial airway obstruction. Other answer choices are expected with a tonsillectomy; therefore, they are incorrect.
Question 20
A 2-month-old infant has just received her first Tetramune injection. The nurse should tell the mother that the immunization:
A
Is a one-time injection that protects against MMR and varicella
B
Will need to be repeated when the child is 4 years of age
C
Is one of a series of injections that protects against dpt and Hib
D
Is given to determine whether the child is susceptible to pertussis
Question 20 Explanation:
The immunization protects the child against diphtheria, pertussis, tetanus, and H. influenza b. A second injection is given before 4 years of age. Is given to determine whether the child is susceptible to pertussis is incorrect statement. It is not a one-time injection, nor does it protect against measles, mumps, rubella, or varicella.
Question 21
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?
A
Mashed potatoes
B
Whole-grain cereal
C
Steamed carrots
D
Baked fish
Question 21 Explanation:
Symptoms associated with diverticulitis are usually reported after eating popcorn, celery, raw vegetables, whole grains, and nuts. Other answer choices are incorrect because they are allowed in the diet of the client with diverticulitis.
Question 22
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:
A
Facilitate mobility
B
Prevent nausea
C
Prevent addiction
D
Alleviate pain
Question 22 Explanation:
The nurse should be concerned with alleviating the client’s pain.Other answer choices are not primary objectives in the care of the client receiving an opiate analgesic; therefore, they are incorrect.
Question 23
What information should the nurse give a new mother regarding the introduction of solid foods for her infant?
A
Solid foods should be introduced one at a time, with 4- to 7-day intervals.
B
Solid foods should begin with fruits and vegetables.
C
Solid foods should not be given until the extrusion reflex disappears, at 8–10 months of age.
D
Solid foods can be mixed in a bottle or infant feeder to make feeding easier.
Question 23 Explanation:
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. Solids should not be added to the bottle and the use of infant feeders is discouraged. The first food added to the infant’s diet is rice cereal.
Question 24
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?
A
The client complains of increased weight gain over the past year.
B
The client complains of blurred vision.
C
The client complains of increased thirst and increased urination.
D
The client complains of ringing in the ears.
Question 24 Explanation:
Increased thirst and increased urination are signs of lithium toxicity. Blurring of vision and ringing in the ears do not relate to the medication; therefore, they are incorrect. Increased weight gain is an expected side effect of the medication; therefore, it is incorrect.
Question 25
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:
A
Sprinkle baby powder over the radiated area
B
Cover the radiation site with loose gauze dressing
C
Refrain from using soap or lotion on the marked area
D
Remove the unsightly markings with acetone or alcohol
Question 25 Explanation:
The nurse should not use water, soap, or lotion on the area marked for radiation therapy. Removing the unsightly markings with acetone or alcohol is incorrect because it would remove the marking. Covering the radiation site with loose gauze dressing and Sprinkling baby powder over the radiated area are not necessary for the client receiving radiation; therefore, they are incorrect.
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1. The nurse is caring for an 8-year-old following a routine tonsillectomy. Which finding should be reported immediately?
Reluctance to swallow
Drooling of blood-tinged saliva
An axillary temperature of 99°F
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:
Skips a meal
Rests in recumbent position
Eats a meal
Sits upright after eating
3. Which of the following meal selections is appropriate for the client with celiac disease?
Toast, jam, and apple juice
Peanut butter cookies and milk
Rice Krispies bar and milk
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?
The client complains of blurred vision.
The client complains of increased thirst and increased urination.
The client complains of increased weight gain over the past year.
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:
Will need to be repeated when the child is 4 years of age
Is given to determine whether the child is susceptible to pertussis
Is one of a series of injections that protects against dpt and Hib
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?
Potato chips
Diet cola
Apple
Milkshake
7. A 2-year-old is hospitalized with suspected intussusception. Which finding is associated with intussusception?
“Currant jelly” stools
Projectile vomiting
“Ribbonlike” stools
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:
Remove the unsightly markings with acetone or alcohol
Cover the radiation site with loose gauze dressing
Sprinkle baby powder over the radiated area
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:
Monitor the client’s blood sugar
Suction the mouth and pharynx every hour
Place the client in low Trendelenburg position
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 hour before meals
30 minutes after meals
With the first bite of a meal
Daily at bedtime
11. A client with a deep decubitus ulcer is receiving therapy in the hyperbaric oxygen chamber. Before therapy, the nurse should:
Apply a lanolin-based lotion to the skin
Wash the skin with water and pat dry
Cover the area with a petroleum gauze
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:
Prevent swelling and dysphagia
Decompress the stomach via suction
Prevent contamination of the suture line
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:
Speaking and writing
Comprehending spoken words
Carrying out purposeful motor activity
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:
Just before sun exposure
5 minutes before sun exposure
15 minutes before sun exposure
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:
Agonist effect
Synergistic effect
Antagonist effect
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:
Record the pulse rate and administer the medication
Administer the medication and monitor the heart rate
Withhold the medication and notify the doctor
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?
Solid foods should not be given until the extrusion reflex disappears, at 8–10 months of age.
Solid foods should be introduced one at a time, with 4- to 7-day intervals.
Solid foods can be mixed in a bottle or infant feeder to make feeding easier.
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:
19. A client with human immunodeficiency syndrome has gastrointestinal symptoms, including diarrhea. The nurse should teach the client to avoid:
Calcium-rich foods
Canned or frozen vegetables
Processed meat
Raw fruits and vegetables
20. A 4-year-old is admitted with acute leukemia. It will be most important to monitor the child for:
Abdominal pain and anorexia
Fatigue and bruising
Bleeding and pallor
Petechiae and mucosal ulcers
21. A 5-month-old is diagnosed with atopic dermatitis. Nursing interventions will focus on:
Preventing infection
Administering antipyretics
Keeping the skin free of moisture
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?
Mashed potatoes
Steamed carrots
Baked fish
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:
The tail of the pancreas
The head of the pancreas
The body of the pancreas
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:
Weight gain
Hair loss
Sore throat
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:
Prevent addiction
Alleviate pain
Facilitate mobility
Prevent nausea
Answers and Rationales
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.
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.
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.
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.
Answer C is correct. The immunization protects the child against diphtheria, pertussis, tetanus, and H. influenzab. 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.