NCLEX-RN Practice Exam #17 In Text Mode: All questions and answers are given for reading and answering at your own pace.
Question 1. Which of the following signs and symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm?
A). Abdominal pain..
B). Chest pain..
C). Absent pedal pulses..
D). Lower back pain..
Question 1 Answer: D). Lower back pain..
Question 1 Explanation: 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.
Question 2. When giving intravenous (I.V.) phenytoin, which of the following methods should you use?
A). Flush the I.V. catheter with dextrose solution..
B). Mix the drug with saline solution only..
C). Withhold other anticonvulsants..
D). Use an in-line filter..
Question 2 Answer: B). Mix the drug with saline solution only..
Question 2 Explanation: 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.
Question 3. 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?
A). Heparin-associated thrombosis and thrombocytopenia (HATT)..
C). Idiopathic thrombocytopenic purpura (ITP)..
D). Disseminated intravascular coagulation (DIC)..
Question 3 Answer: D). Disseminated intravascular coagulation (DIC)..
Question 3 Explanation: 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.
Question 4. Patients with Type 1 diabetes mellitus may require which of the following changes to their daily routine during periods of infection?
A). Oral diabetic agents..
B). Less insulin.
C). No changes.
D). More insulin.
Question 4 Answer: D). More insulin.
Question 4 Explanation: During periods of infection or illness, patients with Type 1 diabetes may need even more insulin to compensate for increased blood glucose levels.
Question 5. Which of the following positions would best aid breathing for a patient with acute pulmonary edema?
A). Left side-lying position..
B). Lying flat in bed..
C). High Fowler’s position.
D). Semi-Fowler’s position..
Question 5 Answer: C). High Fowler’s position.
Question 5 Explanation: High Fowler’s position facilitates breathing by reducing venous return. Lying flat and side-lying positions worsen breathing and increase the heart’s workload.
Question 6. Which of the following potentially serious complications could occur with therapy for hypothyroidism?
A). Acute hemolytic reaction..
C). Angina or cardiac arrhythmia.
Question 6 Answer: C). Angina or cardiac arrhythmia.
Question 6 Explanation: 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.
Question 7. Which of the following signs of increased intracranial pressure (ICP) would appear first after head trauma?
B). Widened pulse pressure..
C). Restlessness and confusion.
D). Large amounts of very dilute urine..
Question 7 Answer: C). Restlessness and confusion.
Question 7 Explanation: 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.
Question 8. Corticosteroids are potent suppressors of the body’s inflammatory response. Which of the following conditions or actions do they suppress?
A). Pain receptors..
B). Immune response..
C). Cushing syndrome..
D). Neural transmission..
Question 8 Answer: B). Immune response..
Question 8 Explanation: 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.
Question 9. Which of the following interventions should be your first priority when treating a patient experiencing chest pain while walking?
A). Get the patient back to bed..
B). Administer sublingual nitroglycerin..
C). Obtain an ECG..
D). Have the patient sit down..
Question 9 Answer: D). Have the patient sit down..
Question 9 Explanation: 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.
Question 10. 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?
A). 0.9% sodium chloride solution.
B). Packed red blood cells.
C). Lactated Ringer’s solution..
D). Fresh frozen plasma..
Question 10 Answer: B). Packed red blood cells.
Question 10 Explanation: 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.
Question 11. A patient has partial-thickness burns to both legs and portions of his trunk. Which of the following I.V. fluids is given first?
A). 0.9% sodium chloride solution with 2 mEq of potassium per 100 ml..
B). Lactated Ringer’s solution.
Question 11 Answer: B). Lactated Ringer’s solution.
Question 11 Explanation: 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.
Question 12. 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?
A). Pulmonary embolus (PE)..
Question 12 Answer: D). Hematoma.
Question 12 Explanation: 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.
Question 13. Which of the following nursing interventions should you use to prevent footdrop and contractures in a patient recovering from a subdural hematoma?
A). Physical therapy consultation.
B). Low-dose heparin therapy.
C). Sequential compressive device.
D). High-top sneakers.
Question 13 Answer: D). High-top sneakers.
Question 13 Explanation: 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
Question 14. Which of the following factors should be the primary focus of nursing management in a patient with acute pancreatitis?
A). Management of hypoglycemia.
B). Fluid and electrolyte balance.
C). Nutrition management..
D). Pain control..
Question 14 Answer: B). Fluid and electrolyte balance.
Question 14 Explanation: 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.
Question 15. After surgical repair of a hip, which of the following positions is best for the patient’s legs and hips?
Question 15 Answer: A). Abduction.
Question 15 Explanation: After surgical repair of the hip, keep the legs and hips abducted to stabilize the prosthesis in the acetabulum.
Question 16. A patient infected with human immunodeficiency virus (HIV) begins zidovudine therapy. Which of the following statements best describes this drug’s action?
A). It destroys the outer wall of the virus and kills it..
B). It stimulates the immune system..
C). It promotes excretion of viral antibodies..
D). It interferes with viral replication..
Question 16 Answer: D). It interferes with viral replication..
Question 16 Explanation: 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.
Question 17. Adequate fluid replacement and vasopressin replacement are objectives of therapy for which of the following disease processes?
A). Diabetes insipidus.
B). Syndrome of inappropriate antidiuretic hormone secretion (SIADH)..
C). Diabetes mellitus..
D). Diabetic ketoacidosis..
Question 17 Answer: A). Diabetes insipidus.
Question 17 Explanation: 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.
Question 18. 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?
A). Provide emotional support for the patient..
B). Take a full medical history..
C). Give a bronchodilator by nebulizer..
D). Apply a cardiac monitor to the patient..
Question 18 Answer: C). Give a bronchodilator by nebulizer..
Question 18 Explanation: 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.
Question 19. Which of the following measures best determines that a patient who had a pneumothorax no longer needs a chest tube?
A). You see a lot of drainage from the chest tube..
B). The water-seal chamber doesn’t fluctuate when no suction is applied..
C). The chest X-ray continues to show the lung is 35% deflated..
D). Arterial blood gas (ABG) levels are normal..
Question 19 Answer: B). The water-seal chamber doesn’t fluctuate when no suction is applied..
Question 19 Explanation: 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.
Question 20. 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?
B). Acute respiratory distress syndrome (ARDS)..
Question 20 Answer: B). Acute respiratory distress syndrome (ARDS)..
Question 20 Explanation: Severe hypoxia after smoke inhalation typically is related to ARDS. The other choices aren’t typically associated with smoke inhalation.
Question 21. What’s the first intervention for a patient experiencing chest pain and an 5p02 of 89%?
A). Administer oxygen..
B). Administer morphine..
C). Obtain an electrocardiogram (ECC).
D). Administer sublingual nitroglycerin..
Question 21 Answer: A). Administer oxygen..
Question 21 Explanation: 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.
Question 22. Which of the following techniques is correct for obtaining a wound culture specimen from a surgical site?
A). Use a sterile swab to collect drainage from the dressing.
B). Thoroughly irrigate the wound before collecting the specimen..
C). Gently roll a sterile swab from the center of the wound outward to collect drainage..
D). Use a sterile swab and wipe the crusty area around the outside of the wound..
Question 22 Answer: C). Gently roll a sterile swab from the center of the wound outward to collect drainage..
Question 22 Explanation: 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.
Question 23. 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?
A). “Place the head of your bed flat to help with coughing.”.
B). “Hold your cough as much as possible.”.
C). “Restrict fluids to help decrease the amount of sputum.”.
D). “Splint your chest wall with a pillow for comfort.”.
Question 23 Answer: D). “Splint your chest wall with a pillow for comfort.”.
Question 23 Explanation: 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.
Question 24. In which of the following types of cardiomyopathy does cardiac output remain normal?
Question 24 Answer: C). Hypertrophic.
Question 24 Explanation: 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.
Question 25. After a liver biopsy, place the patient in which of the following positions?
A). Right side-lying, with the bed in semi-Fowler’s position..
B). Left side-lying, with the bed in semi-Fowler’s position..
C). Left side-lying, with the bed flat..
D). Right side-lying, with the bed flat..
Question 25 Answer: D). Right side-lying, with the bed flat..
Question 25 Explanation: 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.