NCLEX- RN Practice Exam 17

1. What’s the first intervention for a patient experiencing chest pain and an 5p02 of 89%?

  1. Administer morphine.
  2. Administer oxygen.
  3. Administer sublingual nitroglycerin.
  4. Obtain an electrocardiogram (ECC)

2. Which of the following signs and symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm?

  1. Abdominal pain.
  2. Absent pedal pulses.
  3. Chest pain.
  4. Lower back pain.

3. In which of the following types of cardiomyopathy does cardiac output remain normal?

  1. Dilated.
  2. Hypertrophic.
  3. Obliterative.
  4. Restrictive.

4. Which of the following interventions should be your first priority when treating a patient experiencing chest pain while walking?

  1. Have the patient sit down.
  2. Get the patient back to bed.
  3. Obtain an ECG.
  4. Administer sublingual nitroglycerin.

5. Which of the following positions would best aid breathing for a patient with acute pulmonary edema?

  1. Lying flat in bed.
  2. Left side-lying position.
  3. High Fowler’s position.
  4. Semi-Fowler’s position.

6. A pregnant woman arrives at the emergency department (ED) with abruptio placentae at 34 weeks’ gestation. She’s at risk for which of the following blood dyscrasias?

  1. Thrombocytopenia.
  2. Idiopathic thrombocytopenic purpura (ITP).
  3. Disseminated intravascular coagulation (DIC).
  4. Heparin-associated thrombosis and thrombocytopenia (HATT).

7. A 16-year-old patient involved in a motor vehicle accident arrives in the ED unconscious and severely hypotensive. He’s suspected to have several fractures of his pelvis and legs. Which of the following parenteral fluids is the best choice for his current condition?

  1. Fresh frozen plasma.
  2. 0.9% sodium chloride solution.
  3. Lactated Ringer’s solution.
  4. Packed red blood cells.

8. Corticosteroids are potent suppressors of the body’s inflammatory response. Which of the following conditions or actions do they suppress?

  1. Cushing syndrome.
  2. Pain receptors.
  3. Immune response.
  4. Neural transmission.

9. A patient infected with human immunodeficiency virus (HIV) begins zidovudine therapy. Which of the following statements best describes this drug’s action?

  1. It destroys the outer wall of the virus and kills it.
  2. It interferes with viral replication.
  3. It stimulates the immune system.
  4. It promotes excretion of viral antibodies.

10. A 20-year-old patient is being treated for pneumonia. He has a persistent cough and complains of severe pain on coughing. What could you tell him to help him reduce his discomfort?

  1. “Hold your cough as much as possible.”
  2. “Place the head of your bed flat to help with coughing.”
  3. “Restrict fluids to help decrease the amount of sputum.”
  4.  “Splint your chest wall with a pillow for comfort.”

11. A 19-year-old patient comes to the ED with acute asthma. His respiratory rate is 44 breaths/minute, and he appears to be in acute respiratory distress. Which of the following actions should you take first?

  1. Take a full medical history.
  2. Give a bronchodilator by nebulizer.
  3. Apply a cardiac monitor to the patient.
  4. Provide emotional support for the patient.

12. A firefighter who was involved in extinguishing a house fire is being treated for smoke inhalation. He develops severe hypoxia 48 hours after the incident, requiring intubation and mechanical ventilation. Which of the following conditions has he most likely developed?

  1. Acute respiratory distress syndrome (ARDS).
  2. Atelectasis.
  3. Bronchitis.
  4. Pneumonia.

13. Which of the following measures best determines that a patient who had a pneumothorax no longer needs a chest tube?

  1. You see a lot of drainage from the chest tube.
  2. Arterial blood gas (ABG) levels are normal.
  3. The chest X-ray continues to show the lung is 35% deflated.
  4. The water-seal chamber doesn’t fluctuate when no suction is applied.

14. Which of the following nursing interventions should you use to prevent footdrop and contractures in a patient recovering from a subdural hematoma?

  1. High-top sneakers.
  2. Low-dose heparin therapy.
  3. Physical therapy consultation.
  4. Sequential compressive device.

15. Which of the following signs of increased intracranial pressure (ICP) would appear first after head trauma?

  1. Bradycardia.
  2. Large amounts of very dilute urine.
  3. Restlessness and confusion.
  4. Widened pulse pressure.

16. When giving intravenous (I.V.) phenytoin, which of the following methods should you use?

  1. Use an in-line filter.
  2. Withhold other anticonvulsants.
  3. Mix the drug with saline solution only.
  4. Flush the I.V. catheter with dextrose solution.

17. After surgical repair of a hip, which of the following positions is best for the patient’s legs and hips?

  1. Abduction.
  2. Adduction.
  3. Prone.
  4. Subluxated.

18. Which of the following factors should be the primary focus of nursing management in a patient with acute pancreatitis?

  1. Nutrition management.
  2. Fluid and electrolyte balance.
  3. Management of hypoglycemia.
  4. Pain control.

19. After a liver biopsy, place the patient in which of the following positions?

  1. Left side-lying, with the bed flat.
  2. Right side-lying, with the bed flat.
  3. Left side-lying, with the bed in semi-Fowler’s position.
  4. Right side-lying, with the bed in semi-Fowler’s position.

20. Which of the following potentially serious complications could occur with therapy for hypothyroidism?

  1. Acute hemolytic reaction.
  2. Angina or cardiac arrhythmia.
  3. Retinopathy.
  4.  Thrombocytopenia.

21. Adequate fluid replacement and vasopressin replacement are objectives of therapy for which of the following disease processes?

  1. Diabetes mellitus.
  2. Diabetes insipidus.
  3. Diabetic ketoacidosis.
  4. Syndrome of inappropriate antidiuretic hormone secretion (SIADH).

22. Patients with Type 1 diabetes mellitus may require which of the following changes to their daily routine during periods of infection?

  1. No changes.
  2. Less insulin.
  3. More insulin.
  4. Oral diabetic agents.

23. On a follow-up visit after having a vaginal hysterectomy, a 32-year-old patient has a decreased hematocrit level. Which of the following complications does this suggest?

  1. Hematoma.
  2. Hypovolemia.
  3. Infection.
  4. Pulmonary embolus (PE).

24. A patient has partial-thickness burns to both legs and portions of his trunk. Which of the following I.V. fluids is given first?

  1. Albumin.
  2. D5W.
  3. Lactated Ringer’s solution.
  4. 0.9% sodium chloride solution with 2 mEq of potassium per 100 ml.

25. Which of the following techniques is correct for obtaining a wound culture specimen from a surgical site?

  1. Thoroughly irrigate the wound before collecting the specimen.
  2. Use a sterile swab and wipe the crusty area around the outside of the wound.
  3. Gently roll a sterile swab from the center of the wound outward to collect drainage.
  4. Use a sterile swab to collect drainage from the dressing
Answers and Rationales
  1. B  Administering supplemental oxygen to the patient is the first priority.  Administer oxygen to increase SpO2 to greater than 90% to help prevent further cardiac damage.  Sublingual nitroglycerin and morphine are commonly administered after oxygen.
  2. D  Lower back pain results from expansion of the aneurysm.  The expansion applies pressure in the abdomen, and the pain is referred to the lower back.  Abdominal pain is the most common symptom resulting from impaired circulation.  Absent pedal pulses are a sign of no circulation and would occur after a ruptured aneurysm or in peripheral vascular disease.  Chest pain usually is associated with coronary artery or pulmonary disease.
  3. B  Cardiac output isn’t affected by hypertrophic cardiomyopathy because the size of the ventricle remains relatively unchanged.  Dilated cardiomyopathy, obliterative cardiomyopathy, and restrictive cardiomyopathy all decrease cardiac output.
  4. A The initial priority is to decrease oxygen consumption by sitting the patient down.  Administer sublingual nitroglycerin as you simultaneously do the ECG.  When the patient’s condition is stabilized, he can be returned to bed.
  5. C High Fowler’s position facilitates breathing by reducing venous return.  Lying flat and side-lying positions worsen breathing and increase the heart’s workload.
  6. C Abruptio placentae is a cause of DIC because it activates the clotting cascade after hemorrhage.  Thrombocytopenia results from decreased production of platelets.  ITP doesn’t have a definitive cause.  A patient with abruptio placentae wouldn’t get heparin and, as a result, wouldn’t be at risk for HATT.
  7. D  In a trauma situation, the first blood product given is unmatched (0 negative) packed red blood cells.  Fresh frozen plasma often is used to replace clotting factors.  Lactated Ringer’s solution or 0.9% sodium chloride is used to increase volume and blood pressure, but too much of these crystalloids will dilute the blood and won’t improve oxygen-carrying capacity.
  8. C  Corticosteroids suppress eosinophils, lymphocytes, and natural-killer cells, inhibiting the natural inflammatory process in an infected or injured part of the body.  This helps resolve inflammation, stabilizes lysosomal membranes, decreases capillary permeability, and depresses phagocytosis of tissues by white blood cells, thus blocking the release of more inflammatory materials.  Excessive corticosteroid therapy can lead to Cushing syndrome.
  9. Zidovudine inhibits DNA synthesis in HIV, thus interfering with viral replication.  The drug doesn’t destroy the viral wall, stimulate the immune system, or promote HIV antibody excretion.
  10. Showing this patient how to splint his chest wall will help decrease discomfort when coughing.  Holding in his coughs will only increase his pain.  Placing the head of the bed flat may increase the frequency of his cough and his work of breathing.  Increasing fluid intake will help thin his secretions, making it easier for him to clear them.
  11. The patient having an acute asthma attack needs more oxygen delivered to his lungs and body.  Nebulized bronchodilators open airways and increase the amount of oxygen delivered.  The patient may not need cardiac monitoring because he’s only 19 years old, unless he has a medical history of cardiac problems.
  12. Severe hypoxia after smoke inhalation typically is related to ARDS.  The other choices aren’t typically associated with smoke inhalation.
  13. D  The chest tube isn’t removed until the patient’s lung has adequately reexpanded and is expected to stay that way.  One indication of reexpansion is the cessation of fluctuation in the water-seal chamber when suction isn’t applied.  The chest X-ray should show that the lung is reexpanded.  Drainage should be minimal before the chest tube is removed.  An ABG test isn’t necessary if clinical assessment criteria are met.
  14. A  High-top sneakers are used to prevent footdrop and contractures in patients with neurologic conditions.  A consult with physical therapy is important to prevent footdrop, but you can use high-top sneakers independently.
  15. The earliest sign of increased ICP is a change in mental status.  Bradycardia and widened pulse pressure occur later.  The patient may void a lot of very dilute urine if his posterior pituitary is damaged.
  16. Phenytoin is compatible only with saline solutions; dextrose causes an insoluble precipitate to form.  You needn’t withhold additional anticonvulsants or use an in-line filter.
  17.  After surgical repair of the hip, keep the legs and hips abducted to stabilize the prosthesis in the acetabulum.
  18. Acute pancreatitis is commonly associated with fluid isolation and accumulation in the bowel secondary to ileus or peripancreatic edema.  Fluid and electrolyte loss from vomiting is a major concern.  Therefore, your priority is to manage hypovolemia and restore electrolyte balance.  Pain control and nutrition also are important.  Patients are at risk for hyperglycemia, not hypoglycemia.
  19. Positioning the patient on his right side with the bed flat will splint the biopsy site and minimize bleeding.  The other positions won’t do this and may cause more bleeding at the site or internally.
  20. Precipitation of angina or cardiac arrhythmia is a potentially serious complication of hypothyroidism treatment.  Acute hemolytic reaction is a complication of blood transfusions.  Retinopathy typically is a complication of diabetes mellitus.  Thrombocytopenia doesn’t result from treating hypothyroidism.
  21. Maintaining adequate fluid and replacing vasopressin are the main objectives in treating diabetes insipidus.  An excess of antidiuretic hormone leads to SIADH, causing the patient to retain fluid.  Diabetic ketoacidosis is a result of severe insulin insufficiency.
  22. During periods of infection or illness, patients with Type 1 diabetes may need even more insulin to compensate for increased blood glucose levels.
  23. A decreased hematocrit level is a sign of hematoma, a delayed complication of abdominal and vaginal hysterectomy.  Symptoms of hypovolemia include increased hematocrit and hemoglobin values.  Symptoms of a PE include dyspnea, chest pain, cough, hemoptysis, restlessness, and signs of shock.
  24. Lactated Ringer’s solution replaces lost sodium and corrects metabolic acidosis, both of which commonly occur following a burn.  Albumin is used as adjunct therapy, not primary fluid replacement.  Dextrose isn’t given to burn patients during the first 24 hours because it can cause pseudodiabetes.  The patient is hyperkalemic from the potassium shift from the intracellular space to the plasma, so potassium would be detrimental.
  25. Rolling a swab from the center outward is the right way to obtain a culture specimen from a wound.  Irrigating the wound washes away drainage, debris, and many of the colonizing or infecting microorganisms.  The outside of the wound and the dressing may be colonized with microorganisms that haven’t affected the wound, so specimens from these sites could give inaccurate results.