NCLEX RN Registered Nurses Quiz | Practice Test 07

NCLEX RN Registered Nurses Quiz | Practice Test 07

1 >>An 87-year-old man, who has been living independently, is entering a nursing home. To help him adjust, the most effective action is to: ?

• (A) Involve him in as many activities as possible so he can meet other residents.
• (B) Move him as quickly as possible so that he does not have time to think.
• (C) Restrict family visits for the first 2 weeks to give him time to adjust.
• (D) Suggest that he bring his favorite things from home to make his room seem familiar.

Solution it is important to create a familiar environment.

2 >>When preparing to perform discharge teaching with an older adult client, which nursing actions will facilitate learning? Select all that apply. ?

• (A) Involving family members in the teaching sessions.
• (B) Keeping the pace slow, presenting a small amount of material at a time.
• (C) Using repetition as well as providing reinforcement, such as written material.
• (D) Providing ample opportunity for repeated practice sessions.

Solution family members provide a source for reinforcement as well as valuable assessment information about the client's living situation and learning needs.

3 >>In preparing a health education presentation for older adults, a nurse should keep in mind that: ?

• (A) Older adults generally prefer group teaching.
• (B) Older adult learners need more than a single teaching session.
• (C) Presentations should use more written materials than lectures.
• (D) Videotapes and pamphlets ensure teaching effectiveness.

Solution a single teaching strategy is rarely adequate. Learning takes time. Follow-up sessions are important to building confidence in the client and to assess the effectiveness of prior teaching.

4 >>Which statement by the family caregiver of an older woman with incontinence requires teaching by a nurse? ?

• (A) "It is too bad incontinence occurs with aging."
• (B) "Incontinence has been so embarrassing for my mother."
• (C) "Mother says her incontinence is related to the number of children she had."
• (D) "I am relieved to know Mother's incontinence may be reversible."

Solution incontinence is not a normal consequence of aging. Age-related changes in the urinary tract predispose the older client to incontinence, but incontinence is a symptom of many possible disorders-not just aging.

5 >>A 63-year-old client is returning home after being hospitalized for injuries received during a home invasion and robbery. Although neighborhood robberies are rampant, the client has lived in the same house for 50 years and does not want to move. The client receives a monthly social security check in the mail. The most appropriate action by a home health nurse would be to: Select all that apply. ?

• (A) Advise the client to arrange for someone to visit regularly or move into the home.
• (B) Advise the client to have the social security check deposited directly to the bank.
• (C) Suggest the client get a dog.
• (D) Advise the client to get a locking mail box to prevent mail theft.

Solution removing the target (the Social Security check) reduces the risk. Answer 3 is correct because a dog will likely deter a robber.

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6 >>A nurse in a senior adult day care program observes that the participants have long toenails, corns, calluses, and other problems indicating a need for foot care. What is a nurse's correct action? ?

• (A) Schedule podiatry services at the site after a class on foot care.
• (B) Establish a regular foot care plan whereby the participants' toenails would be cut and corns and calluses removed.
• (C) Instruct family members in the proper methods of cutting toenails and using commercial foot care products.
• (D) Recommend that the participants soak their feet for 10 minutes before cutting their toenails, using safe toenail clippers.

Solution ideally foot care should be provided by podiatric care providers. The service is covered by insurance.

7 >>The incidence of tuberculosis in the older adult is significantly increased among individuals who: ?

• (A) Are physically inactive.
• (B) Are cigarette smokers.
• (C) Have received the bacille Calmette-Guerin (BCG) vaccine.
• (D) Reside in institutions.

Solution the spread of the infection increases in crowded, close living conditions since TB is spread from person to person by airborne transmission- droplets from talking, coughing, sneezing, laughing, or singing.

8 >>The daughter of a client with Alzheimer's disease becomes frustrated when talking to her father. What should a nurse suggest to improve communication? ?

• (A) Answer his questions simply even if the question is asked repeatedly.
• (B) Finish his sentences before he becomes agitated.
• (C) Focus the conversation on future events.
• (D) Play word games to stimulate his mind and slow progression of the disease.

Solution the client with Alzheimer's disease typically has lost short-term memory. Understanding of the father's disease will decrease the daughter's frustration.

9 >>Which suggestion would be most accurate for a nurse to make to the family of a client who has Alzheimer's disease? ?

• (A) Be sure to correct the client if the client is experiencing delusions.
• (B) Avoid getting upset in front of the client.
• (C) Repeat requests to the client in order to increase compliance.
• (D) Activities should be done quickly to reduce client anxiety.

Solution if the family becomes upset and angry, the client's agitation and anxiety will likely increase.

10 >>A family member asks a nurse about possible treatments for Stage III Alzheimer's disease (AD). Which statement by the nurse is correct? ?

• (A) High doses of vitamin E may slow disease progression.
• (B) The benefits of NSAIDs have been proven.
• (C) The risks of herbals, such as ginkgo biloba, are greater than any benefit.
• (D) Recent research has shown hormone replacement improves cognition.

Solution families are often desperate to find a treatment, and there may be serious side effects. They need to discuss alternative therapies with the physician.

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11 >>Which assessment findings are consistent with a diagnosis of Alzheimer's disease (AD)? Select all that apply. ?

• (A) Remote and recent memory impairment.
• (B) No memory impairment but the client is unable to recognize familiar persons.
• (C) Cognitive decline has been rapid.
• (D) B12 deficiency or thyroid disease is often present.

Solution there is recent and remote memory impairment, as well as anomia, agnosia, and aphasia.

12 >>A 76-year-old client with hypertension, type 2 diabetes, and a known allergy to seafood is scheduled for a cardiac catheterization. Which orders should a nurse recognize as appropriate for this client? Select all that apply. ?

• (A) Administration of methylprednisolone (Solu-Medrol).
• (B) Draw blood for a liver panel.
• (C) Draw blood for a renal panel.
• (D) Start NS IV at 125 mL/hr.

Solution antihistamines (Solu-Medrol) may be ordered before the procedure because of the known allergy to seafood.

13 >>A home health nurse is visiting an older client. The client asks the nurse about splitting the simvastatin tablet that has been ordered. Which response should client teaching include? ?

• (A) All medications can be split safely.
• (B) Let the pharmacy split an extended-release tablet.
• (C) Wash and dry the tablet-splitting device after each use.
• (D) If the drug is enteric-coated, splitting changes the therapeutic response.

Solution if splitting can be done, an approved device should be used. Clean between usages.

14 >>A home health nurse is making a follow-up visit to an older adult following discharge from a hospital. Which action by the nurse is most important regarding medication administration in the home setting? ?

• (A) Give the ordered medication during the visit.
• (B) Provide comprehensive teaching.
• (C) Count the number of pills remaining.
• (D) Prepare a list of medications for client.

Solution effectiveness of the discharge orders will depend on the client understanding the regimen.

15 >>A nursing priority when administering a blood transfusion is to: ?

• (A) Check the fibrinogen level before infusing.
• (B) Infuse blood slowly the first 20 minutes.
• (C) Warm the blood prior to administration.
• (D) Infuse the blood over 1 to 2 hours.

Solution a hemolytic reaction will most likely occur during the first 20 minutes.

16 >>Blood sugar management for a client who has type 2 diabetes with nausea and decreased appetite should include: ?

• (A) Continuing insulin even if the client is vomiting.
• (B) Continuing insulin if blood sugar is less than 80 mg/dL.
• (C) Stopping insulin until the client is able to tolerate food.
• (D) Non of the above

Solution during illness the cells still need insulin. Failure to give it will likely put the client into a hyperosmolar, if nonketotic state (type 1 diabetes is more likely to cause ketoacidosis). Since the client will not be eating very much, the insulin dose may be reduced, and it is hard to predict by how much. Clients with diabetes need to prepare a "sick day strategy," which will include checking blood sugar, and possibly ketone level, more frequently.

17 >>Which finding indicates that epoetin alfa (Epogen) has been effective? ?

• (A) Negative Homans' sign, aPTT of 35 to 55.
• (B) Guaiac-negative gastric secretions and stool.
• (C) Hematocrit of 33%.
• (D) Creatinine of 1.4.

Solution epoetin alfa (Epogen) stimulates the development of red blood cells (RBCs). It is given to anemic clients to increase hematocrit (Hct).

18 >>A nurse should locate and remove a client's clonidine patch if: ?

• (A) The client complains of numbness and tingling down the arm that is nearest to the patch.
• (B) The blood pressure is 80/50 mm Hg.
• (C) The client tells the nurse about being allergic to sulfa products.
• (D) The potassium level is 3.0 mg/dL.

Solution clonidine is an alpha-2 receptor stimulator, working at the presynaptic receptor of the sympathetic nervous system. Thus, it reduces the output of norepinephrine and is used to treat hypertension. If the BP is too low, antihypertensive medications should not be given. It is important for the nurse to remember that drugs in patches are in a constant state of "being given," and the patch would need to be removed.

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19 >>Managing a sodium level of 120 in a client with diabetic ketoacidosis is correctly accomplished with: ?

• (A) Oral salt tablets.
• (B) Intravenous 3% sodium chloride solution.
• (C) Fluid restriction.
• (D) Insulin and 0.9% sodium chloride.

Solution high blood sugar increases the osmolarity of the blood and stimulates the body to secrete antidiuretic hormone (ADH) to help the kidneys to retain free water, which dilutes the sodium. Obligate diuresis from the osmotic action of sugar in the tubules of the kidneys forces water and sodium loss even though the client is dehydrated. Clients in diabetic ketoacidosis need fluid replacement with normal saline and insulin to return the blood sugar to a normal level.

20 >>The correct time for a nurse to administer pancrelipase (Pancrease) is: ?

• (A) One hour after meals.
• (B) With meals.
• (C) At bedtime.
• (D) With insulin.

Solution this medication is replacing enzymes that would be released by the pancreas in response to food intake. Taking it with meals stimulates the normal pancreatic activity and helps with the digestion of proteins, starches, and fats.

21 >>Before administering furosemide (Lasix), a nurse should verify that: ?

• (A) The blood pressure is under 180/90 mm Hg.
• (B) The potassium is over 4 mg/dL.
• (C) There are no crackles in the lungs.
• (D) The client has an indwelling catheter in place.

Solution this diuretic will cause potassium to be lost in the urine. Clients receiving furosemide often need K+ replacement.

22 >>One hour after starting the insulin drip at 10 units/hr, the client's blood sugar has fallen from 899 to 750. Which action should a nurse take? ?

• (A) Increase the insulin drip rate to 20 units/hr.
• (B) Decrease the insulin drip rate to 7 units/hr.
• (C) Give a bolus of 10 units of regular insulin and increase the drip rate to 8 units/hr.
• (D) Keep the rate the same and do not bolus.

Solution rapid reduction in blood glucose reduces serum osmolarity and may shift fluids into cells, causing cerebral edema. The blood glucose should not fall by more than 15% an hour. Slow the insulin infusion rate.

23 >>Which IV fluid order is most appropriate for a client on dialysis? ?

• (A) D5 1 /2NS at 20 mL/hr.
• (B) NS at 150 mL/hr.
• (C) 1 /4NS with 20 mEq KCl at 75 mL/hr.
• (D) D10W with 40 mEq KCl at 50 mL/hr.

Solution clients on dialysis should receive minimal fluids and no potassium, since these agents cannot be removed until the next dialysis treatment.

24 >>Teaching for a client starting on spironolactone (Aldactone) should include: ?

• (A) The importance of removing the patch at bedtime.
• (B) Food sources to replace lost potassium.
• (C) The purpose of this drug is to prevent fibrosis in the heart.
• (D) Taking the medication just before bed.

Solution spironolactone has antiproliferative effects and prevents fibrotic remodeling of heart tissue. It is the only diuretic that reduces mortality in heart failure.

25 >>A nurse should hold administration of a nitrate if: ?

• (A) Pulse rate is under 60.
• (B) Client is allergic to sulfa.
• (C) Blood pressure is less than 90/50 mm Hg.
• (D) Drug therapy has exceeded 2 weeks.

Solution nitrates are potent vasodilators. This reduces the venous return, cardiac output, and BP. The drug should be held if the BP is too low.

26 >>A client has a blood pressure of 145/83 mm Hg and an ejection fraction of 50%. Before discharge from the hospital, the client will need instructions on taking which drug(s)? ?

• (A) A thiazide diuretic.
• (B) Digoxin and furosemide.
• (C) A beta blocker and an ACE inhibitor.
• (D) An anticoagulant.

Solution the ejection fraction is low, indicating a problem with cardiac output. The ejection fraction of a healthy heart is 60% to 70%. Beta blockers and ACE inhibitors reduce morbidity and mortality in heart failure.

27 >>A client with a sexually transmitted infection (STI) is to receive azithromycin. Before the medication is given, which nursing assessment is a priority? ?

• (A) Obtain a CBC.
• (B) Ask the client about allergies.
• (C) Check the blood pressure.
• (D) Ask the client about sexual contact.

Solution clients should always be questioned about allergies before medications are administered.

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28 >>Which intervention would most likely prevent nausea in a client receiving cisplatin chemotherapy? ?

• (A) Administering trimethobenzamide prn nausea.
• (B) Administering dexamethasone and ondansetron prior to chemotherapy.
• (C) Serving all food warm or hot.
• (D) Keeping client NPO 24 hours before chemotherapy.

Solution there is often specific matching of nausea treatments and chemotherapeutic agents. Nausea is better prevented than treated by giving the antiemetic before the chemotherapy.

29 >>The most important nursing assessment to make before a client is started on indomethacin is: ?

• (A) Asking if there is a history of sulfa allergies.
• (B) Asking if there is a history of gastric bleeding.
• (C) Checking blood pressure.
• (D) Checking blood sugar.

Solution a side effect of indomethacin is gastrointestinal bleeding. This risk is greater in clients with history of GI bleeding.

30 >>A client, who is postoperative, has the anesthetic bupivacaine infusing into an epidural catheter for pain control. On assessment, a nurse notes the client has decreased sensation and numbness in the lower abdomen. The pain level is 3/10. The nurse should: ?

• (A) Record this expected finding.
• (B) Increase the epidural infusion rate.
• (C) Turn the epidural infusion off and raise the head of bed.
• (D) Turn the epidural infusion off and lower the head of bed.

Solution bupivacaine blocks neuron transmission, numbing tissue and reducing pain. This is the desired effect and the data should be recorded.

31 >>A client who is postoperative needs to walk, but even turning in bed is very painful. A patient-controlled analgesia (PCA) pump is set with a lock-out of 6 minutes. A nurse notes 45 attempts to get medication and 2 injections received in the last 2 hours. The correct nursing action is to: ?

• (A) Get client out of bed now while pain level is low.
• (B) Teach client how and why to use the pump more effectively.
• (C) Record client's refusal to get out of bed.
• (D) Push pain button before getting client out of bed.

Solution with lock-out of 6 minutes, the client could have received 20 injections over the last 2 hours, yet only received 2. The high pain level will prevent the client from engaging in health promoting activities: 45 attempts indicates that the client wants more medicine. Teaching is required to help the client spread out the attempts.

32 >>A client is due to receive Novolog insulin. When should it be administered? ?

• (A) 60 minutes before the meal.
• (B) 15 minutes before the meal.
• (C) As soon as the meal is finished.
• (D) Without regard to meals.

Solution the "log" ending indicates this drug is one of the insulin analogues. Very small changes in the amino acid sequence facilitate rapid absorption of this drug.

33 >>A client with a duodenal ulcer has been taking sucralfate (Carafate). Which statement by the client would be a priority for a nurse to address? ?

• (A) "I don't like the taste, so I mix it in pudding."
• (B) "I wish I could take Carafate at the same time as my other pills."
• (C) "I have found that stewed prunes help prevent constipation from the drug."
• (D) "Taking Carafate with H2O has helped my fluid intake."

Solution Carafate should be given alone 30 to 60 minutes before mealtime. It is activated by stomach acid and coats a stomach ulcer.

34 >>A nurse is concerned that a client may be at risk for oversedation from opioid therapy using a patient-controlled analgesia pump. The most reliable assessment for possible oversedation would be to check: ?

• (A) Changes in the level of pain reported by the client.
• (B) The oxygen saturation level recorded by pulse oximetry.
• (C) How easily the client can be roused from sleeping.
• (D) The level of carbon dioxide in the blood using capnography.

Solution opioids will depress ventilation, causing a buildup of carbon dioxide in the blood. If hypoventilation is present, measuring the level of carbon dioxide is the most reliable indication of possible respiratory depression. Capnography measures breath by breath the level of CO2 and is most often used during anesthesia, in critical care, and in emergency medicine to prevent respiratory depression. If capnography is not available with the client who is on PCA, monitoring the client's respiratory rate and depth and assessing sedation levels is essential.

35 >>For optimal effects from thrombolytic therapy given for a brain attack (cerebrovascular accident [CVA]), treatment should be given: ?

• (A) Within 3 hours of the onset of symptoms.
• (B) When signs of increased intracranial pressure occur.
• (C) As pulse pressure begins to increase.
• (D) No later than 24 hours after the onset of symptoms.

Solution administration of therapy within 3 hours decreases the size of the stroke and improves client outcome.

36 >>What observation should indicate to a nurse that the therapeutic effect of calcium gluconate has been achieved? ?

• (A) Thyroid gland shrinks.
• (B) Blood loss is curtailed during surgery.
• (C) Trousseau's sign is absent.
• (D) Chvostek's sign is positive.

Solution Trousseau's sign is present with hypocalcemia. The carpal spasm will not occur if treatment has been effective.

37 >>Which common systemic side effect of chemotherapy will a nurse note in an oncology client? ?

• (A) Ascites.
• (B) Septicemia.
• (C) Polycythemia.
• (D) Leukopenia.

Solution chemotherapy causes myelosuppression (depression of bone marrow function). WBCs, RBCs and platelets are decreased.

38 >>Which order by a physician should a nurse question? ?

• (A) A client with COPD who is prescribed metoprolol (Lopressor).
• (B) A client with chronic renal failure receiving an aluminum hydroxide gel (Amphogel).
• (C) A client with an abdominal aortic aneurysm (AAA) taking diltiazem (Cardizem).
• (D) A client on long-term hemodialysis receiving epoetin alfa (Epogen).

Solution beta blockers (metoprolol) cause bronchoconstriction. Note that the client already has a respiratory problem.

39 >>Which prescribed drugs would a nurse most likely give the client for respiratory stridor, with wheezing, and hypotension after a bee sting? Select all that apply. ?

• (A) Epinephrine.
• (B) Diphenhydramine (Benadryl).
• (C) Corticosteroid (Solu-Medrol).
• (D) Furosemide (Lasix).

Solution subcutaneous epinephrine is the first line of treatment. Clients with bee sting allergies should carry an EpiPen.

40 >>During cardiopulmonary resuscitation (CPR) for ventricular fibrillation, which drug would an RN most likely prepare first? ?

• (A) Atropine sulfate.
• (B) Epinephrine.
• (C) Furosemide (Lasix).
• (D) Lidocaine.

Solution epinephrine (adrenalin) is a first-line drug used during CPR to stimulate cardiac activity.

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