NCLEX- RN Practice Exam 5

2. There are a number of risk factors associated with coronary artery disease. Which of the following is a modifiable risk factor?

1. Obesity.
2. Heredity.
3. Gender.
4. Age.

3. Tissue plasminogen activator (t-PA) is considered for treatment of a patient who arrives in the emergency department following onset of symptoms of myocardial infarction. Which of the following is a contraindication for treatment with t-PA?

1. Worsening chest pain that began earlier in the evening.
2. History of cerebral hemorrhage.
3. History of prior myocardial infarction.
4.  Hypertension.

4. Following myocardial infarction, a hospitalized patient is encouraged to practice frequent leg exercises and ambulate in the hallway as directed by his physician. Which of the following choices reflects the purpose of exercise for this patient?

1. Increases fitness and prevents future heart attacks.
2. Prevents bedsores.
3. Prevents DVT (deep vein thrombosis).
4. Prevent constipations.

5. A patient arrives in the emergency department with symptoms of myocardial infarction, progressing to cardiogenic shock. Which of the following symptoms should the nurse expect the patient to exhibit with cardiogenic shock?

1. Hypertension.
2. Bradycardia.
3. Bounding pulse.
4. Confusion.

6. A patient with a history of congestive heart failure arrives at the clinic complaining of dyspnea. Which of the following actions is the first the nurse should perform?

1. Ask the patient to lie down on the exam table.
2. Draw blood for chemistry panel and arterial blood gas (ABG).
3. Send the patient for a chest x-ray.
4. Check blood pressure.

7. A clinic patient has recently been prescribed nitroglycerin for treatment of angina. He calls the nurse complaining of frequent headaches. Which of the following responses to the patient is correct?

1. “Stop taking the nitroglycerin and see if the headaches improve.”
2. “Go to the emergency department to be checked because nitroglycerin can cause bleeding in the brain.”
3. “Headaches are a frequent side effect of nitroglycerine because it causes vasodilation.”
4. “The headaches are unlikely to be related to the nitroglycerin, so you should see your doctor for further investigation.”

8. A patient received surgery and chemotherapy for colon cancer, completing therapy 3 months previously, and she is now in remission. At a follow-up appointment, she complains of fatigue following activity and difficulty with concentration at her weekly bridge games. Which of the following explanations could account for her symptoms?

1. The symptoms may be the result of anemia caused by chemotherapy.
2. The patient may be immunosuppressed.
3. The patient may be depressed.
4. The patient may be dehydrated.

9. A clinic patient has a hemoglobin concentration of 10.8 g/dL and reports sticking to a strict vegetarian diet. Which of the follow nutritional advice is appropriate?

1. The diet is providing adequate sources of iron and requires no changes.
2. The patient should add meat to her diet; a vegetarian diet is not advised.
3. The patient should use iron cookware to prepare foods, such as dark green, leafy vegetables and legumes, which are high in iron.
4. A cup of coffee or tea should be added to every meal.

10. A hospitalized patient is receiving packed red blood cells (PRBCs) for treatment of severe anemia. Which of the following is the most accurate statement?

1. Transfusion reaction is most likely immediately after the infusion is completed.
2. PRBCs are best infused slowly through a 20g. IV catheter.
3. PRBCs should be flushed with a 5% dextrose solution.
4. A nurse should remain in the room during the first 15 minutes of infusion.

11. A patient who has received chemotherapy for cancer treatment is given an injection of Epoetin. Which of the following should reflect the findings in a complete blood count (CBC) drawn several days later?

1. An increase in neutrophil count.
2. An increase in hematocrit.
3. An increase in platelet count.
4. An increase in serum iron.

12. A patient is admitted to the hospital with suspected polycythemia vera. Which of the following symptoms is consistent with the diagnosis?

1. Weight loss.
2. Increased clotting time.
3. Hypertension.
4. Headaches.

13. A nurse is caring for a patient with a platelet count of 20,000/microliter. Which of the following is an important intervention?

1. Observe for evidence of spontaneous bleeding.
2. Limit visitors to family only.
3. Give aspirin in case of headaches.
4. Impose immune precautions.

14. A nurse in the emergency department assesses a patient who has been taking long-term corticosteroids to treat renal disease. Which of the following is a typical side effect of corticosteroid treatment? Note: More than one answer may be correct.

1. Hypertension.
2. Cushingoid features.
3. Hyponatremia.
4. Low serum albumin.

15. A nurse is caring for patients in the oncology unit. Which of the following is the most important nursing action when caring for a neutropenic patient?

1. Change the disposable mask immediately after use.
2. Change gloves immediately after use.
3. Minimize patient contact.
4. Minimize conversation with the patient.

16. A patient is undergoing the induction stage of treatment for leukemia. The nurse teaches family members about infectious precautions. Which of the following statements by family members indicates that the family needs more education?

1. We will bring in books and magazines for entertainment.
2. We will bring in personal care items for comfort.
3. We will bring in fresh flowers to brighten the room.
4. We will bring in family pictures and get well cards.

17. A nurse is caring for a patient with acute lymphoblastic leukemia (ALL). Which of the following is the most likely age range of the patient?

1. 3-10 years.
2. 25-35 years.
3. 45-55 years.
4. over 60 years.

18. A patient is admitted to the oncology unit for diagnosis of suspected Hodgkin’s disease. Which of the following symptoms is typical of Hodgkin’s disease?

1. Painful cervical lymph nodes.
2. Night sweats and fatigue.
3. Nausea and vomiting.
4. Weight gain.

19. The Hodgkin’s disease patient described in the question above undergoes a lymph node biopsy for definitive diagnosis. If the diagnosis of Hodgkin’s disease were correct, which of the following cells would the pathologist expect to find?

1. Reed-Sternberg cells.
2. Lymphoblastic cells.
3. Gaucher’s cells.
4. Rieder’s cells

20. A patient is about to undergo bone marrow aspiration and biopsy and expresses fear and anxiety about the procedure. Which of the following is the most effective nursing response?

1. Warn the patient to stay very still because the smallest movement will increase her pain.
2. Encourage the family to stay in the room for the procedure.
3. Stay with the patient and focus on slow, deep breathing for relaxation.
4. Delay the procedure to allow the patient to deal with her feelings.

21. A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Laboratory results indicate that the child is neutropenic, and the nurse prepares to implement protective isolation procedures. Which interventions would the nurse initiate? Select all that apply.

1. Restrict all visitors.
2. Place the child on a low-bacteria diet.
3. Change dressings using sterile technique.
4. Encourage the consumption of fresh fruits and vegetables.
5. Perform meticulous hand washing before caring for the child.
6. Allow fresh-cut flowers in the room as long as they are kept in a vase with fresh water.

22. A 16-year-old child is brought to the emergency department by his mother with a complaint that the child just experienced a tonic-clonic seizure. On arrival in the emergency department no apparent seizures were occurring. The mother states that her son is taking medication for the seizure disorder. The nurse plans care, knowing that which of the following medications are used for long-term control of tonic-clonic seizures? Select all that apply.

1. Diazepam (Valium)
2. Alprazolam (Xanax)
3. Gabapentin (Neurontin)
4. Ethosuximide (Zarontin)
5. Carbamazepine (Tegretol)
6. Methylphenidate (Ritalin)

23. A child has been diagnosed with meningococcal meningitis. Which of the following isolation techniques is appropriate?

1. Enteric precautions
2. Neutropenic precautions
3. No precautions are required as long as antibiotics have been started.
4. Isolation precautions for at least 24 hours after the initiation of antibiotics

24. A client enters the emergency department confused, twitching, and having seizures. His family states he recently was placed on corticosteroids for arthritis and was feeling better and exercising daily. On data collection, he has flushed skin, dry mucous membranes, an elevated temperature, and poor skin turgor. His serum sodium level is 172 mEq/L. Choose the interventions that the health care provider would likely prescribe. Select all that apply.

1. Monitor intake and output.
2. Monitor vital signs.
3. Maintain sodium-reduced diet.
4. Monitor electrolyte levels.
5. Increase water intake orally.
6. Administer sodium replacements.

25. A client has died, and a nurse asks a family member about the funeral arrangements. The family member refuses to discuss the issue. The nurse’s appropriate action is to:

1. Show acceptance of feelings.
2. Provide information needed for decision making.
3. Suggest a referral to a mental health professional.
4. Remain with the family member without discussing funeral arrangements.

Answers and Rationales