NCLEX- PN Practice Exam 5

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1. Which finding is the best indication that a client with ineffective airway clearance needs suctioning?

  1. Oxygen saturation
  2. Respiratory rate
  3. Breath sounds
  4. Arterial blood gases
2. A client with tuberculosis has a prescription for Myambutol (ethambutol HCl). The nurse should tell the client to notify the doctor immediately if he notices:
  1. Gastric distress
  2. Changes in hearing
  3. Red discoloration of bodily fluids
  4. Changes in color vision
3. The primary cause of anemia in a client with chronic renal failure is:
  1. Poor iron absorption
  2. Destruction of red blood cells
  3. Lack of intrinsic factor
  4. Insufficient erythropoietin
4. Which of the following nursing interventions has the highest priority for the client scheduled for an intravenous pyelogram?
  1. Providing the client with a favorite meal for dinner
  2. Asking if the client has allergies to shellfish
  3. Encouraging fluids the evening before the test
  4. Telling the client what to expect during the test
5. The doctor has prescribed aspirin 325mg daily for a client with transient ischemic attacks. The nurse knows that aspirin was prescribed to:
  1. Prevent headaches
  2. Boost coagulation
  3. Prevent cerebral anoxia
  4. Keep platelets from clumping together
6. A client with tuberculosis asks the nurse how long he will have to take medication. The nurse should tell the client that:
  1. Medication is rarely needed after 2 weeks.
  2. He will need to take medication the rest of his life.
  3. The course of therapy is usually 18–24 months.
  4. He will be re-evaluated in 1 month to see if further medication is needed.
7. Which development milestone puts the 4-month-old infant at greatest risk for injury?
  1. Switching objects from one hand to another
  2. Crawling
  3. Standing
  4. Rolling over
8. A client taking Dilantin (phenytoin) for grand mal seizures is preparing for discharge. Which information should be included in the client’s discharge care plan?
  1. The medication can cause dental staining.
  2.  The client will need to avoid a high-carbohydrate diet.
  3. The client will need a regularly scheduled CBC.
  4.  The medication can cause problems with drowsiness.
9. Assessment of a newborn male reveals that the infant has hypospadias. The nurse knows that:
  1. The infant should not be circumcised.
  2. Surgical correction will be done by 6 months of age.
  3. Surgical correction is delayed until 6 years of age.
  4. The infant should be circumcised to facilitate voiding.
10. The nurse is providing dietary teaching for a client with elevated cholesterol levels. Which cooking oil is not suggested for the client on a low-cholesterol diet?
  1. Safflower oil
  2. Sunflower oil
  3. Coconut oil
  4. Canola oil
11. The nurse is caring for a client with stage III Alzheimer’s disease. A characteristic of this stage is:
  1. Memory loss
  2. Failing to recognize familiar objects
  3. Wandering at night
  4. Failing to communicate
12. The doctor has prescribed Cortone (cortisone) for a client with systemic lupus erythematosis. Which instruction should be given to the client?
  1. Take the medication 30 minutes before eating.
  2. Report changes in appetite and weight.
  3. Wear sunglasses to prevent cataracts.
  4. Schedule a time to take the influenza vaccine.
13. The nurse is caring for a client with an above-the-knee amputation (AKA). To prevent contractures, the nurse should:
  1. Place the client in a prone position 15–30 minutes twice a day
  2. Keep the foot of the bed elevated on shock blocks
  3. Place trochanter rolls on either side of the affected leg
  4. Keep the client’s leg elevated on two pillows
14. The mother of a 6-month-old asks when her child will have all his baby teeth. The nurse knows that most children have all their primary teeth by age:
  1. 12 months
  2. 18 months
  3. 24 months
  4. 30 months
15. While caring for a client with cervical cancer, the nurse notes that the radioactive implant is lying in the bed. The nurse should:
  1. Place the implant in a biohazard bag and return it to the lab
  2. Give the client a pair of gloves and ask her to reinsert the implant
  3. Use tongs to pick up the implant and return it to a lead-lined container
  4. Discard the implant in the commode and double-flush
16. The nurse is preparing to discharge a client following a laparoscopic cholecystectomy. The nurse should:
  1. Tell the client to avoid a tub bath for 48 hours
  2. Tell the client to expect clay-colored stools
  3.  Tell the client that she can expect lower abdominal pain for the next week
  4. Tell the client that she can resume a regular diet in the next 24 hours
17. A high school student returns to school following a 3-week absence due to mononucleosis. The school nurse knows it will be important for the client:
  1. To drink additional fluids throughout the day
  2. To avoid contact sports for 1–2 months
  3. To have a snack twice a day to prevent hypoglycemia
  4. To continue antibiotic therapy for 6 months
18. A 6-year-old with cystic fibrosis has an order for Creon. The nurse knows that the medication will be given:
  1. At bedtime
  2. With meals and snacks
  3. Twice daily
  4. Daily in the morning
19. The doctor has prescribed a diet high in vitamin B12 for a client with pernicious anemia. Which foods are highest in B12?
  1. Meat, eggs, dairy products
  2. Peanut butter, raisins, molasses
  3. Broccoli, cauliflower, cabbage
  4. Shrimp, legumes, bran cereals
20. A client with hypertension has begun an aerobic exercise program. The nurse should tell the client that the recommended exercise regimen should begin slowly and build up to:
  1. 20–30 minutes three times a week
  2. 45 minutes two times a week
  3. 1 hour four times a week
  4. 1 hour two times a week
21. A client with breast cancer is returned to the room following a right total mastectomy. The nurse should:
  1. Elevate the client’s right arm on pillows
  2. Place the client’s right arm in a dependent sling
  3. Keep the client’s right arm on the bed beside her
  4. Place the client’s right arm across her body
22. A neurological consult has been ordered for a pediatric client with suspected petit mal seizures. The client with petit mal seizures can be expected to have:
  1. Short, abrupt muscle contraction
  2. Quick, bilateral severe jerking movements
  3. Abrupt loss of muscle tone
  4. A brief lapse in consciousness
23. A client with schizoaffective disorder is exhibiting Parkinsonian symptoms. Which medication is responsible for the development of Parkinsonian symptoms?
  1. Zyprexa (olanzapine)
  2. Cogentin (benzatropine mesylate)
  3. Benadryl (diphenhydramine)
  4. Depakote (divalproex sodium)
24. Which activity is best suited to the 12-year-old with juvenile rheumatoid arthritis?
  1. Playing video games
  2. Swimming
  3. Working crossword puzzles
  4. Playing slow-pitch softball
25. The glycosylated hemoglobin of a 40-year-old client with diabetes mellitus is 2.5%. The nurse understands that:
  1. The client can have a higher-calorie diet.
  2. The client has good control of her diabetes.
  3. The client requires adjustment in her insulin dose.
  4. The client has poor control of her diabetes.
Answers and Rationales
  1. Answer C is correct. Changes in breath sounds are the best indication of the need for suctioning in the client with ineffective airway clearance. Answers A, B, and D are incorrect because they can be altered by other conditions.
  2. Answer D is correct. An adverse reaction to Myambutol is change in visual acuity or color vision. Answer A is incorrect because it does not relate to the medication. Answer C is incorrect because it is an adverse reaction to Streptomycin. Answer C is incorrect because it is a side effect of Rifampin.
  3. Answer D is correct. Insufficient erythropoietin production is the primary cause of anemia in the client with chronic renal failure. Answers A, B, and C do not relate to the anemia seen in the client with chronic renal failure; therefore, they are incorrect.
  4. Answer B is correct. The contrast media used during an intravenous pyelogram contains iodine, which can result in an anaphylactic reaction. Answers A, C, and D do not relate specifically to the test; therefore, they are incorrect.
  5. Answer D is correct. Aspirin prevents the platelets from clumping together to prevent clots. Answer A is incorrect because the low-dose aspirin will not prevent headaches. Answers B and C are untrue statements; therefore, they are incorrect.
  6. Answer C is correct. The usual course of treatment requires that medication be given for 18 months to 2 years. Answers A and D are incorrect because the treatment time is too brief. Answer B is incorrect because the medication is not needed for life.
  7. Answer D is correct. At 4 months of age, the infant can roll over, which makes it vulnerable to falls from dressing tables or beds without rails. Answer A is incorrect because it does not prove a threat to safety. Answers B and C are incorrect because the 4-month-old is not capable of crawling or standing.
  8. Answer C is correct. Adverse side effects of Dilantin include agranulocytosis and aplastic anemia; therefore, the client will need frequent CBCs. Answer A is incorrect because the medication does not cause dental staining. Answer B is incorrect because the medication does not interfere with the metabolism of carbohydrates. Answer D is incorrect because the medication does not cause drowsiness.
  9. Answer A is correct. The infant with hypospadias should not be circumcised because the foreskin is used in reconstruction. Answer B and C are incorrect because reconstruction is done between 16 and 18 months of age, before toilet training. Answer D is incorrect because the infant with hypospadias should not be circumcised.
  10. Answer C is correct. Coconut oil is high in saturated fat and is not appropriate for the client on a low-cholesterol diet. Answers A, B, and D are incorrect because they are suggested for the client with elevated cholesterol levels.
  11. Answer B is correct. In stage III of Alzheimer’s disease, the client develops agnosia, or failure to recognize familiar objects. Answer A is incorrect because it appears in stage I. Answer C is incorrect because it appears in stage II. Answer D is incorrect because it appears in stage IV.
  12. Answer D is correct. The client taking steroid medication should receive an annual influenza vaccine. Answer A is incorrect because the medication should be taken with food. Answer B is incorrect because increased appetite and weight gain are expected side effects of the medication. Answer C is incorrect because wearing sunglasses will not prevent cataracts.
  13. Answer A is correct. The client with an above-the-knee amputation should be placed prone 15–30 minutes twice a day to prevent contractures. Answers B and D are incorrect because elevating the extremity after the first 24 hours will promote the development of contractures. Use of a trochanter roll will prevent rotation of the extremity but will not prevent contracture; therefore, answer D is incorrect.
  14. Answer D is correct. All 20 primary, or deciduous, teeth should be present by age 30 months. Answers A, B, and C are incorrect because the ages are wrong.
  15. Answer C is correct. The radioactive implant should be picked up with tongs and returned to the lead-lined container. Answer A is incorrect because radioactive materials are placed in lead-lined containers, not plastic ones, and are returned to the radiation department, not the lab. Answer B is incorrect because the client should not touch the implant or try to reinsert it. Answer D is incorrect because the implant should not be placed in the commode for disposal.
  16. Answer A is correct. Following a laparoscopic cholecystectomy, the client should avoid a tub bath for 48 hours. Answer B is incorrect because the stools should not be clay colored. Answer C is incorrect because pain is usually located in the shoulders. Answer D is incorrect because the client should not resume a regular diet until clear liquids have been tolerated.
  17. Answer B is correct. The client recovering from mononucleosis should avoid contact sports and other activities that could result in injury or rupture of the spleen. Answer A is incorrect because the client does not need additional fluids. Hypoglycemia is not associated with mononucleosis; therefore, answer C is incorrect. Answer D is incorrect because antibiotics are not usually indicated in the treatment of mononucleosis.
  18. Answer B is correct. Pancreatic enzyme replacement is given with each meal and each snack. Answers A, C, and D do not specify a relationship to meals; therefore, they are incorrect.
  19. Answer A is correct. Meat, eggs, and dairy products are foods high in vitamin B12. Answer B is incorrect because peanut butter, raisins, and molasses are sources rich in iron. Answer C is incorrect because broccoli, cauliflower, and cabbage are sources rich in vitamin K. Answer D is incorrect because shrimp, legumes, and bran cereals are high in magnesium.
  20. Answer A is correct. The client’s aerobic workout should be 20–30 minutes long three times a week. Answers B, C, and D exceed the recommended time for the client beginning an aerobic program; therefore, they are incorrect.
  21. Answer A is correct. A total mastectomy involves removal of the entire breast and some or all of the axillary lymph nodes. Following surgery, the client’s right arm should be elevated on pillows, to facilitate lymph drainage. Answers B, C, and D are incorrect because they would not help facilitate lymph drainage and would create increased edema in the affected extremity.
  22. Answer D is correct. Absence seizures, formerly known as petit mal seizures, are characterized by a brief lapse in consciousness accompanied by rapid eye blinking, lip smacking, and minor myoclonus of the upper extremities. Answer A refers to myoclonic seizure; therefore, it is incorrect. Answer B refers to tonic clonic, formerly known as grand mal, seizures; therefore, it is incorrect. Answer C refers to atonic seizures; therefore, it is incorrect.
  23. Answer A is correct. A side effect of antipsychotic medication is the development of Parkinsonian symptoms. Answers B and C are incorrect because they are used to reverse Parkinsonian symptoms in the client taking antipsychotic medication. Answer D is incorrect because the medication is an anticonvulsant used to stabilize mood. Parkinsonian symptoms are not associated with anticonvulsant medication.
  24. Answer B is correct. Exercises that provide light passive resistance are best for the child with rheumatoid arthritis. Answers A and C require movement of the hands and fingers that might be too painful for the child with juvenile rheumatoid arthritis; therefore, they are incorrect. Answer D is incorrect because it requires the use of larger joints affected by the disease.
  25. Answer B is correct. The client’s diabetes is well under control. Answer A is incorrect because it will lead to elevated glycosylated hemoglobin. Answer C is incorrect because the diet and insulin dose are appropriate for the client. Answer D is incorrect because the desired range for glycosylated hemoglobin in the adult client is 2.5%–5.9%

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