Friday, August 19, 2016

NCLEX Practice Exam 4 (50 Items)

Guidelines
  • Follow the guidelines below to make the most out of this exam:
  • Read each question carefully and choose the best answer.
  • Answers and rationales are given below. Be sure to read them.

NCLEX Practice Exam 4 (50 Items)
Just Scroll Down For All questions and answers

1. The primary reason for rapid continuous rewarming of the area affected by frostbite is to:
A. Lessen the amount of cellular damage
B. Prevent the formation of blisters
C. Promote movement
D. Prevent pain and discomfort
2. A client recently started on hemodialysis wants to know how the dialysis will take the place of his kidneys. The nurse’s response is based on the knowledge that hemodialysis works by:
A. Passing water through a dialyzing membrane
B. Eliminating plasma proteins from the blood
C. Lowering the pH by removing nonvolatile acids
D. Filtering waste through a dialyzing membrane
3. During a home visit, a client with AIDS tells the nurse that he has been exposed to measles. Which action by the nurse is most appropriate?
A. Administer an antibiotic
B. Contact the physician for an order for immune globulin
C. Administer an antiviral
D. Tell the client that he should remain in isolation for 2 weeks
4. A client hospitalized with MRSA (methicillin-resistant staph aureus) is placed on contact precautions. Which statement is true regarding precautions for infections spread by contact?
A. The client should be placed in a room with negative pressure.
B. Infection requires close contact; therefore, the door may remain open.
C. Transmission is highly likely, so the client should wear a mask at all times.
D. Infection requires skin-to-skin contact and is prevented by hand washing, gloves, and a gown.
5. A client who is admitted with an above-the-knee amputation tells the nurse that his foot hurts and itches. Which response by the nurse indicates understanding of phantom limb pain?
A. “The pain will go away in a few days.”
B. “The pain is due to peripheral nervous system interruptions. I will get you some pain medication.”
C. “The pain is psychological because your foot is no longer there.”
D. “The pain and itching are due to the infection you had before the surgery.”
6. A client with cancer of the pancreas has undergone a Whipple procedure. The nurse is aware that during the Whipple procedure, the doctor will remove the:
A. Head of the pancreas
B. Proximal third section of the small intestines
C. Stomach and duodenum
D. Esophagus and jejunum
7. The physician has ordered a minimal-bacteria diet for a client with neutropenia. The client should be taught to AVOID eating:
A. Packed fruits
B. Salt
C. Fresh raw pepper
D. Ketchup
8. A client is discharged home with a prescription for Coumadin (sodium warfarin). The client should be instructed to:
A. Have a Protime done monthly
B. Eat more fruits and vegetables
C. Drink more liquids
D. Avoid crowds
9. The nurse is assisting the physician with removal of a central venous catheter. To facilitate removal, the nurse should instruct the client to:
A. Perform the Valsalva maneuver as the catheter is advanced
B. Turn his head to the left side and hyperextend the neck
C. Take slow, deep breaths as the catheter is removed
D. Turn his head to the right while maintaining a sniffing position
10. A client has an order for streptokinase. Before administering the medication, the nurse should assess the client for:
A. Allergies to pineapples and bananas
B. A history of streptococcal infections
C. Prior therapy with phenytoin
D. A history of alcohol abuse
11. The nurse is providing discharge teaching for the client with leukemia. The client should be told to avoid:
A. Using oil- or cream-based soaps
B. Flossing between the teeth
C. The intake of salt
D. Using an electric razor
12. The nurse is changing the ties of the client with a tracheotomy. The safest method of changing the tracheotomy ties is to:
A. Apply the new tie before removing the old one.
B. Have a helper present.
C. Hold the tracheotomy with the nondominant hand while removing the old tie.
D. Ask the doctor to suture the tracheostomy in place.
13. The nurse is monitoring a client following a lung resection. The hourly output from the chest tube was 300mL. The nurse should give priority to:
A. Turning the client to the left side
B. Milking the tube to ensure patency
C. Slowing the intravenous infusion
D. Notifying the physician
14. The infant is admitted to the unit with tetrology of falot. The nurse would anticipate an order for which medication?
A. Digoxin
B. Epinephrine
C. Aminophylline
D. Atropine
15. The nurse is educating the lady’s club in self-breast exam. The nurse is aware that most malignant breast masses occur in the Tail of Spence. On the diagram below, select where the Tail of Spence is.




16. The toddler is admitted with a cardiac anomaly. The nurse is aware that the infant with a ventricular septal defect will:
A. Tire easily
B. Grow normally
C. Need more calories
D. Be more susceptible to viral infections
17. The nurse is monitoring a client with a history of stillborn infants. The nurse is aware that a nonstress test can be ordered for this client to:
A. Determine lung maturity
B. Measure the fetal activity
C. Show the effect of contractions on fetal heart rate
D. Measure the wellbeing of the fetus
18. The nurse is evaluating the client who was admitted 8 hours ago for induction of labor. The following graph is noted on the monitor. Which action should be taken first by the nurse?

A. Instruct the client to push
B. Perform a vaginal exam
C. Turn off the Pitocin infusion
D. Place the client in a semi-Fowler’s position
19. The nurse notes the following on the ECG monitor. The nurse would evaluate the cardiac arrhythmia as:

A. Atrial flutter
B. A sinus rhythm
C. Ventricular tachycardia
D. Atrial fibrillation
20. A client with clotting disorder has an order to continue Lovenox (enoxaparin) injections after discharge. The nurse should teach the client that Lovenox injections should:
A. Be injected into the deltoid muscle
B. Be injected into the abdomen
C. Aspirate after the injection
D. Clear the air from the syringe before injections
21. The nurse has a preop order to administer Valium (diazepam) 10mg and Phenergan (promethazine) 25mg. The correct method of administering these medications is to:
A. Administer the medications together in one syringe
B. Administer the medication separately
C. Administer the Valium, wait 5 minutes, and then inject the Phenergan
D. Question the order because they cannot be given at the same time
22. A client with frequent urinary tract infections asks the nurse how she can prevent the reoccurrence. The nurse should teach the client to:
A. Douche after intercourse
B. Void every 3 hours
C. Obtain a urinalysis monthly
D. Wipe from back to front after voiding
23. Which task should be assigned to the nursing assistant?
A. Placing the client in seclusion
B. Emptying the Foley catheter of the preeclamptic client
C. Feeding the client with dementia
D. Ambulating the client with a fractured hip
24. The client has recently returned from having a thyroidectomy. The nurse should keep which of the following at the bedside?
A. A tracheotomy set
B. A padded tongue blade
C. An endotracheal tube
D. An airway
25. The physician has ordered a histoplasmosis test for the elderly client. The nurse is aware that histoplasmosis is transmitted to humans by:
A. Cats
B. Dogs
C. Turtles
D. Birds
26. What’s the first intervention for a patient experiencing chest pain and an p02 of 89%?
A. Administer morphine.
B. Administer oxygen.
C. Administer sublingual nitroglycerin.
D. Obtain an electrocardiogram (ECC)
27. Which of the following signs and symptoms usually signifies rapid expansion and
impending rupture of an abdominal aortic aneurysm?
A. Abdominal pain.
B. Absent pedal pulses.
C. Chest pain.
D. Lower back pain&nbsp
28. In which of the following types of cardiomyopathy does cardiac output remain normal?
A. Dilated.
B. Hypertrophic.
C. Obliterative.
D. Restrictive.
29. Which of the following interventions should be your first priority when treating a patient experiencing chest pain while walking?
A. Have the patient sit down.
B. Get the patient back to bed.
C. Obtain an ECG.
D. Administer sublingual nitroglycerin.
30. Which of the following positions would best aid breathing for a patient with acute pulmonary edema?
A. Lying flat in bed.
B. Left side-lying position.
C. High Fowler’s position.
D. Semi-Fowler’s position.
31. 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. Thrombocytopenia.
B. Idiopathic thrombocytopenic purpura (ITP).
C. Disseminated intravascular coagulation (DIC).
D. Heparin-associated thrombosis and thrombocytopenia (HATT).
32. 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. Fresh frozen plasma.
B. 0.9% sodium chloride solution.
C. Lactated Ringer’s solution.
D. Packed red blood cells.
33. Corticosteroids are potent suppressors of the body’s inflammatory response. Which of the following conditions or actions do they suppress?
A. Cushing syndrome.
B. Pain receptors.
C. Immune response.
D. Neural transmission.
34. 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 interferes with viral replication.
C. It stimulates the immune system.
D. It promotes excretion of viral antibodies.
35. 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. “Hold your cough as much as possible.”
B. “Place the head of your bed flat to help with coughing.”
C. “Restrict fluids to help decrease the amount of sputum.”
D. “Splint your chest wall with a pillow for comfort.”
36. 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. Take a full medical history.
B. Give a bronchodilator by nebulizer.
C. Apply a cardiac monitor to the patient.
D. Provide emotional support for the patient.
37. 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?
A. Acute respiratory distress syndrome (ARDS).
B. Atelectasis.
C. Bronchitis.
D. Pneumonia.
38. 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. Arterial blood gas (ABG) levels are normal.
C. The chest X-ray continues to show the lung is 35% deflated.
D. The water-seal chamber doesn’t fluctuate when no suction is applied.
39. Which of the following nursing interventions should you use to prevent footdrop and contractures in a patient recovering from a subdural hematoma?
A. High-top sneakers.
B. Low-dose heparin therapy.
C. Physical therapy consultation.
D. Sequential compressive device.
40. Which of the following signs of increased intracranial pressure (ICP) would appear first after head trauma?
A. Bradycardia.
B. Large amounts of very dilute urine.
C. Restlessness and confusion.
D. Widened pulse pressure.
41. When giving intravenous (I.V.) phenytoin, which of the following methods should you use?
A. Use an in-line filter.
B. Withhold other anticonvulsants.
C. Mix the drug with saline solution only.
D. Flush the I.V. catheter with dextrose solution.
42. After surgical repair of a hip, which of the following positions is best for the patient’s legs and hips?
A. Abduction.
B. Adduction.
C. Prone.
D. Subluxated.
43. Which of the following factors should be the primary focus of nursing management in a patient with acute pancreatitis?
A. Nutrition management.
B. Fluid and electrolyte balance.
C. Management of hypoglycemia.
D. Pain control.
44. After a liver biopsy, place the patient in which of the following positions?
A. Left side-lying, with the bed flat.
B. Right side-lying, with the bed flat.
C. Left side-lying, with the bed in semi-Fowler’s position.
D. Right side-lying, with the bed in semi-Fowler’s position.
45. Which of the following potentially serious complications could occur with therapy for hypothyroidism?
A. Acute hemolytic reaction.
B. Angina or cardiac arrhythmia.
C. Retinopathy.
D. Thrombocytopenia.
46. Adequate fluid replacement and vasopressin replacement are objectives of therapy for which of the following disease processes?
A. Diabetes mellitus.
B. Diabetes insipidus.
C. Diabetic ketoacidosis.
D. Syndrome of inappropriate antidiuretic hormone secretion (SIADH).
47. Patients with Type 1 diabetes mellitus may require which of the following changes to their daily routine during periods of infection?
A. No changes.
B. Less insulin.
C. More insulin.
D. Oral diabetic agents.
48. 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. Hematoma.
B. Hypovolemia.
C. Infection.
D. Pulmonary embolus (PE).
49. 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. Albumin.
B. D5W.
C. Lactated Ringer’s solution.
D. 0.9% sodium chloride solution with 2 mEq of potassium per 100 ml.
50. Which of the following techniques is correct for obtaining a wound culture specimen from a surgical site?
A. Thoroughly irrigate the wound before collecting the specimen.
B. Use a sterile swab and wipe the crusty area around the outside of the wound.
C. Gently roll a sterile swab from the center of the wound outward to collect drainage.
D. Use a sterile swab to collect drainage from the dressing.


Answers and Rationale


1. Answer: A. Lessen the amount of cellular damage
Rapid continuous rewarming of a frostbite primarily lessens cellular damage. It does not prevent formation of blisters. It does promote movement, but this is not the primary reason for rapid rewarming. It might increase pain for a short period of time as the feeling comes back into the extremity; therefore, answers B, C, and D are incorrect.

2. Answer: D. Filtering waste through a dialyzing membrane
Hemodialysis works by using a dialyzing membrane to filter waste that has accumulated in the blood. It does not pass water through a dialyzing membrane nor does it eliminate plasma proteins or lower the pH, so answers A, B, and C are incorrect.

3. Answer: B. Contact the physician for an order for immune globulin
The client who is immuno suppressed and is exposed to measles should be treated with medications to boost his immunity to the virus. An antibiotic or antiviral will not protect the client and it is too late to place the client in isolation, so answers A, C, and D are incorrect.

4. Answer: D. Infection requires skin-to-skin contact and is prevented by hand washing, gloves, and a gown.
The client with MRSA should be placed in isolation. Gloves, a gown, and a mask should be used when caring for the client and hand washing is very important. The door should remain closed, but a negative-pressure room is not necessary, so answers A and B are incorrect. MRSA is spread by contact with blood or body fluid or by touching the skin of the client. It is cultured from the nasal passages of the client, so the client should be instructed to cover his nose and mouth when he sneezes or coughs. It is not necessary for the client to wear the mask at all times; the nurse should wear the mask, so answer C is incorrect.

5. Answer: B. “The pain is due to peripheral nervous system interruptions. I will get you some pain medication.”
Pain related to phantom limb syndrome is due to peripheral nervous system interruption. Answer: A. is incorrect because phantom limb pain can last several months or indefinitely. Answer: C. is incorrect because it is not psychological. It is also not due to infections, as stated in answer D.

6. Answer: A. Head of the pancreas
During a Whipple procedure the head of the pancreas, which is a part of the stomach, the jejunum, and a portion of the stomach are removed and anastomosed. Answer: B. is incorrect because the proximal third of the small intestine is not removed. The entire stomach is not removed, as in answer C, and in answer D, the esophagus is not removed.

7. Answer: C. Fresh raw pepper
Fresh raw or whole pepper are not allowed unless thoroughly cooked in food. Canned fruits are allowed since they are processed and pasteurized. Salt, ketchup, and sugar are allowed.

8. Answer: A. Have a Protime done monthly
Coumadin is an anticoagulant. One of the tests for bleeding time is a Protime. This test should be done monthly. Eating more fruits and vegetables is not necessary, and dark-green vegetables contain vitamin K, which increases clotting, so answer B is incorrect. Drinking more liquids and avoiding crowds is not necessary, so answers C and D are incorrect.

9. Answer: A. Perform the Valsalva maneuver as the catheter is advanced
The client who is having a central venous catheter removed should be told to hold his breath and bear down. This prevents air from entering the line. Answers B, C, and D will not facilitate removal.

10. Answer: B. A history of streptococcal infections
Clients with a history of streptococcal infections could have antibodies that render the streptokinase ineffective. There is no reason to assess the client for allergies to pineapples or bananas, there is no correlation to the use of phenytoin and streptokinase, and a history of alcohol abuse is also not a factor in the order for streptokinase; therefore, answers A, C, and D are incorrect.

11. Answer: B. Flossing between the teeth
The client who is immune-suppressed and has bone marrow suppression should be taught not to floss his teeth because platelets are decreased. Using oils and cream-based soaps is allowed, as is eating salt and using an electric razor; therefore, answers A, C, and D are incorrect.

12. Answer: A. Apply the new tie before removing the old one.
The best method and safest way to change the ties of a tracheotomy is to apply the new ones before removing the old ones. Having a helper is good, but the helper might not prevent the client from coughing out the tracheotomy. Answer: C. is not the best way to prevent the client from coughing out the tracheotomy. Asking the doctor to suture the tracheotomy in place is not appropriate.

13. Answer: D. Notifying the physician
The output of 300 mL is indicative of hemorrhage and should be reported immediately. Answer: A. does nothing to help the client. Milking the tube is done only with an order and will not help in this situation, and slowing the intravenous infusion is not correct; thus, answers B and C are incorrect.

14. Answer: A. Digoxin
The infant with Tetralogy of Fallot involves four heart defects: A large ventricular septal defect (VSD), Pulmonary stenosis, Right ventricular hypertrophy and, An overriding aorta. He will be treated with digoxin to slow and strengthen the heart. Epinephrine, aminophylline, and atropine will speed the heart rate and are not used in this client; therefore, answers B, C, and D are incorrect.

15. Answer: A.
The Tail of Spence is located in the upper outer quadrant of the breast.

16. Answer: A. Tire easily
The toddler with a ventricular septal defect will tire easily. He will not grow normally but will not need more calories. He will be susceptible to bacterial infection, but he will be no more susceptible to viral infections than other children. Therefore, answers B, C, and D are incorrect.

17. Answer: B. Measure the fetal activity
A nonstress test determines periodic movement of the fetus. It does not determine lung maturity, show contractions, or measure neurological well-being, making answers A, C, and D incorrect.

18. Answer: C. Turn off the Pitocin infusion
The monitor indicates variable decelerations caused by cord compression. If Pitocin is infusing, the nurse should turn off the Pitocin. Instructing the client to push is incorrect because pushing could increase the decelerations and because the client is 8cm dilated, making answer A incorrect. Performing a vaginal exam should be done after turning off the Pitocin, and placing the client in a semi-Fowler’s position is not appropriate for this situation; therefore, answers B and D are incorrect.

19. Answer: C. Ventricular tachycardia
The graph indicates ventricular tachycardia. The answers in A, B, and D are not noted on the ECG strip.

20. Answer: B. Be injected into the abdomen
Lovenox injections should be given in the abdomen, not in the deltoid muscle. The client should not aspirate after the injection or clear the air from the syringe before injection. Therefore, answers A, C, and D are incorrect.

21. Answer: B. Administer the medication separately
Valium is not given in the same syringe with other medications, so answer A (Douche after intercourse) is incorrect. These medications can be given to the same client, so answer D (Ambulating the client with a fractured hip) is incorrect. In answer C (Feeding the client with dementia), it is not necessary to wait to inject the second medication. Valium is an antianxiety medication, and Phenergan is used as an antiemetic.

22. Answer: B. Void every 3 hours
Voiding every 3 hours prevents stagnant urine from collecting in the bladder, where bacteria can grow. Douching is not recommended and obtaining a urinalysis monthly is not necessary, making answers A and C incorrect. The client should practice wiping from front to back after voiding and bowel movements, so answer D is incorrect.

23. Answer: C. Feeding the client with dementia
Of these clients, the one who should be assigned to the care of the nursing assistant is the client with dementia. Only an RN or the physician can place the client in seclusion, so answer A (Placing the client in seclusion) is incorrect. The nurse should empty the Foley catheter of the preeclamptic client because the client is unstable, making answer B incorrect. A nurse or physical therapist should ambulate the client with a fractured hip, so answer D is incorrect.

24. Answer: A. A tracheotomy set
The client who has recently had a thyroidectomy is at risk for tracheal edema. A padded tongue blade is used for seizures and not for the client with tracheal edema, so answer B is incorrect. If the client experiences tracheal edema, the endotracheal tube or airway will not correct the problem, so answers C and D are incorrect.

25. Answer: D. Birds
Histoplasmosis is a fungus carried by birds. It is not transmitted to humans by cats, dogs, or turtles. Therefore, answers A, B, and C are incorrect.

26. Answer: B. Administer oxygen.
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.

27. Answer: D. Lower back pain.
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.
Option A: Abdominal pain is the most common symptom resulting from impaired circulation.
Option B: Absent pedal pulses are a sign of no circulation and would occur after a ruptured aneurysm or in peripheral vascular disease.
Option C: Chest pain usually is associated with coronary artery or pulmonary disease.

28. Answer: B. Hypertrophic
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.

29. Answer: A. Have the patient sit down.
The initial priority is to decrease oxygen consumption by sitting the patient down. Administer sublingual nitroglycerin (Option D) as you simultaneously do the ECG. When the patient’s condition is stabilized, he can be returned to bed (Option B).

30. Answer: C. High Fowler’s position.
High Fowler’s position facilitates breathing by reducing venous return. Lying flat and side-lying positions worsen breathing and increase the heart’s workload.

31. Answer: C. Disseminated intravascular coagulation (DIC).
Abruptio placentae is a cause of DIC because it activates the clotting cascade after hemorrhage.

Option A: Thrombocytopenia results from decreased production of platelets.
Option B: ITP doesn’t have a definitive cause.
Option D: A patient with abruptio placentae wouldn’t get heparin and, as a result, wouldn’t be at risk for HATT.

32. Answer: D. Packed red blood cells.
In a trauma situation, the first blood product given is unmatched (O negative) packed red blood cells.

Option A: Fresh frozen plasma often is used to replace clotting factors.
Options B and C: 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.

33. Answer: C. Immune response.
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’s syndrome.

34. Answer: B. It interferes with viral replication.
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.

35. Answer: D. “Splint your chest wall with a pillow for comfort.”
Showing this patient how to splint his chest wall will help decrease discomfort when coughing.
Option A: Holding in his coughs will only increase his pain.
Option B: Placing the head of the bed flat may increase the frequency of his cough and his work of breathing.
Option C: Increasing fluid intake will help thin the secretions, making it easier for him to clear them.

36. Answer: B. Give a bronchodilator by nebulizer.
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.
Option C: The patient may not need cardiac monitoring because he’s only 19 years old, unless he has a medical history of cardiac problems.
Options A and D: Important but not priority as of the moment; emotional support can help calm the patient but can be done after medical intervention.

37. Answer: A. Acute respiratory distress syndrome (ARDS).
Severe hypoxia after smoke inhalation typically is related to ARDS. The other choices aren’t typically associated with smoke inhalation.

38. Answer: D. The water-seal chamber doesn’t fluctuate when no suction is applied.
The chest tube isn’t removed until the patient’s lung has adequately re-expanded 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.

Option C: The chest X-ray should show that the lung is re-expanded.
Option A: Drainage should be minimal before the chest tube is removed.
Option B: An ABG test isn’t necessary if clinical assessment criteria are met.

39. Answer: A. High-top sneakers.
High-top sneakers are used to prevent foot drop and contractures in patients with neurologic conditions. Option C: A consult with physical therapy is important to prevent foot drop, but you can use high-top sneakers independently.

40. Answer: C. Restlessness and confusion.
The earliest sign of increased ICP is a change in mental status.

Option A: Bradycardia and widened pulse pressure occur later.
Option B: The patient may void a lot of very dilute urine if his posterior pituitary is damaged.

41. Answer: C. Mix the drug with saline solution only.
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 (Option B.).

42. Answer: A. Abduction
After surgical repair of the hip, keep the legs and hips abducted to stabilize the prosthesis in the acetabulum.

43. Answer: B. Fluid and electrolyte balance.
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.
Options A & D: Pain control and nutrition also are important, but not priority.
Option C: Patients are at risk for hyperglycemia, not hypoglycemia.

44. Answer: B. Right side-lying, with the bed flat.
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.

45. Answer: B. Angina or cardiac arrhythmia.
Precipitation of angina or cardiac arrhythmia is a potentially serious complication of hypothyroidism treatment.
Option A: Acute hemolytic reaction is a complication of blood transfusions.
Option C: Retinopathy typically is a complication of diabetes mellitus.
Option D: Thrombocytopenia doesn’t result from treating hypothyroidism.

46. Answer: B. Diabetes insipidus.
Maintaining adequate fluid and replacing vasopressin are the main objectives in treating diabetes insipidus.

Option A: Diabetes is a chronic condition associated with abnormally high levels of sugar (glucose) in the blood. Insulin produced by the pancreas lowers blood glucose.
Option C: Diabetic ketoacidosis is a result of severe insulin insufficiency.
Option D: An excess of antidiuretic hormone leads to SIADH, causing the patient to retain fluid.

47. Answer: C. More insulin.
During periods of infection or illness, patients with Type 1 diabetes may need even more insulin to compensate for increased blood glucose levels.

48. Answer: A. Hematoma.
A decreased hematocrit level is a sign of hematoma, a delayed complication of abdominal and vaginal hysterectomy.
Option B: Symptoms of hypovolemia include increased hematocrit and hemoglobin values.
Option C: Infection manifests with fever and high WBC count.
Option D: Symptoms of a PE include dyspnea, chest pain, cough, hemoptysis, restlessness, and signs of shock.

49. Answer: C. Lactated Ringer’s solution.
Lactated Ringer’s solution replaces lost sodium and corrects metabolic acidosis, both of which commonly occur following a burn.

Option A: Albumin is used as adjunct therapy, not primary fluid replacement.
Option B: Dextrose isn’t given to burn patients during the first 24 hours because it can cause pseudodiabetes.
Option D: The patient is hyperkalemic from the potassium shift from the intracellular space to the plasma, so potassium would be detrimental.

50. Answer: C. Gently roll a sterile swab from the center of the wound outward to collect drainage.
Rolling a swab from the center outward is the right way to obtain a culture specimen from a wound.
Option A: Irrigating the wound washes away drainage, debris, and many of the colonizing or infecting microorganisms.
Option B: 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.


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