NCSBN Practice Questions 91-105, (Answered) Latest update. 100% predictor quizzes

NCSBN Practice Questions 91-105, (Answered) Latest update. 100% predictor quizzes A client is admitted with low T3 and T4 levels and an elevated thyroid stimulating hormone (TSH) level. On initial assessment, the nu ...

NCSBN Practice Questions 91-105, (Answered) Latest update. 100% predictor quizzes A client is admitted with low T3 and T4 levels and an elevated thyroid stimulating hormone (TSH) level. On initial assessment, the nurse should anticipate which of these findings? A. Lethargy B. Diarrhea C. Heat intolerance D. Skin eruptions - ✔✔A In hypothyroidism the metabolic activity of all cells of the body decreases, reducing oxygen consumption, decreasing oxidation of nutrients for energy, and producing less body heat. Therefore, the nurse can expect the client to report being constipated, tired and unable to get warm. A neonate born 12 hours ago to a methadone-maintained woman is exhibiting a hyperactive Moro reflex and slight tremors. The newborn passed one loose, watery stool. Which of these actions is a nursing priority? A. Hold the infant at frequent intervals B. Offer fluids to prevent dehydration C. Administer paregoric to stop diarrhea D. Assess for neonatal withdrawal syndrome - ✔✔D Neonatal withdrawal syndrome is a cluster of findings that signal the withdrawal of the infant from the opiates. The findings seen in methadone withdrawal are often more severe than for other substances. Initial signs are central nervous system hyperirritability and gastrointestinal symptoms. If withdrawal signs are severe, there is an increased mortality risk. Scoring the infant ensures proper treatment during the periods of withdrawal. Nurse colleagues are discussing their nursing practice during lunch. Which statement is correct? A. Each state has specific regulations for licensed registered nurses (RNs) and licensed practical nurses (LPNs) B. The employing agency is ultimately responsible to provide practice guidelines for licensed nurses C. The federal government ensures the safety of clients by defining the scope of nursing practice D. National nurses' associations work collaboratively to update the social policy statement for nursing - ✔✔A Boards of nursing are state governmental agencies that are responsible for licensing nurses in each state/jurisdiction and enforcing the rules and regulations of the nurse practice act (NPA). The NPA is enacted by the state legislature. The NPA and rules define the scope of practice and responsibilities for nurses. The scope of practice for nurses, especially LPN/VNs, varies from state to state. An infant who has recently been diagnosed with cystic fibrosis (CF) is being assessed by the nurse. Which finding of this disease would the nurse not expect to see at this time? A. Bulky, greasy stools B. Positive sweat test C. Moist, productive cough D. Meconium ileus - ✔✔C Moist and productive cough is a later sign in CF. Noisy respirations and a dry nonproductive cough are commonly the first respiratory signs to appear in a newly diagnosed client with CF. The other options are the earlier findings. CF is an inherited (genetic) condition affecting the cells that produce mucus, sweat, saliva and digestive juices. Normally, these secretions are thin and slippery, but in CF a defective gene causes the secretions to become thick and sticky. Instead of acting as a lubricant, the secretions plug up tubes, ducts and passageways, especially in the pancreas and lungs. Respiratory failure is the most dangerous consequence of CF. The nurse is caring for a client with orders for complete bed rest. Which action by the nurse is most important in the prevention of the formation of deep vein thrombosis (DVT)? A. Prevent pressure at back of the knees B. Elevate the foot of the bed C. Encourage isometric leg muscle exercises D. Apply knee high support stockings - ✔✔A Prevention of popliteal pressure will minimize venous stasis and deep vein thrombosis. The other actions would also be implemented for clients with orders for bed rest. However, the correct option is the one action directly associated with DVT. The nurse is assessing a client with portal hypertension. Which findings should the nurse expect during the assessment? A. Expiratory wheezes B. Blurred vision C. Dilated pupils D. Ascites - ✔✔D Portal hypertension can occur in a client with right-sided heart failure or cirrhosis of the liver. Portal hypertension can lead to ascites from the increased portal pressure as well as a lowered colloid osmotic pressure because of low albumin. When liver functioning deteriorates, protein metabolism is decreased with the result of a low serum albumin. The nurse finds a client unconscious, following a tonic-clonic seizure. What should a nurse do first? A. Administer the ordered Ativan B. Place the client in a side-lying position C. Prepare for suctioning D. Check the pulse - ✔✔B Place the client in a side-lying position to maintain an open airway, drain secretions, and prevent aspiration if vomiting occurs. After that, any ordered medication should be given. A 16 year-old adolescent is admitted for Ewing's sarcoma of the tibia. In discussing the care with the parents, the nurse should understand that the initial treatment for this diagnosis usually includes which approach? A. Surgical excision of the mass B. Radiation with adjunctive chemotherapy C. Amputation above the tumor D. Bone marrow graft in the affected leg - ✔✔B The initial approach for the treatment of Ewing's sarcoma is usually a combination of radiation and chemotherapy to reduce the size of the tumor. A 2 day-old child with spina bifida and meningomyelocele is in the intensive care unit after the initial surgery. As the nurse accompanies the grandparents for a first visit, which response should the nurse anticipate of the grandparents? A. Disbelief B. Anger C. Frustration D. Depression - ✔✔A The first phase of the grieving process is shock, denial or disbelief. Then follows anger, bargaining, depression and acceptance. Each stage can take any amount of time to work through. Clients often go back and forth between the stages until acceptance is achieved. Some clients may get stuck in any one or two of the stages to never achieve acceptance. A client has a serum glucose of 385 mg/dL (21.4 mmol/L). Which of these verbal orders would be a priority for the nurse to question and call back the health care provider for a revision? A. Repeat glycosolated hemoglobin in 24 hours B. IV fluids of 0.9% normal saline at 125 mL per hour C. Document peripheral glucose sticks every four hours D. Humulin N 20 units IV push over 10 minutes - ✔✔D Short-acting insulin, such as regular or semilente insulin, is the only insulin that can be given by the intravenous route. Humulin insulin IV is the order to question. Repeating the glycohemoglobin should also be questioned, although it is not a priority because the client would not be harmed by this action. This lab test gives the average glucose on the hemoglobin molecule for the past two to three months; there would be no need to repeat it at this time. A fasting glucose in the morning would be a more appropriate assessment. The other orders are within expected actions in this situation. While discussing issues with colleagues on the unit, the novice nurse seems surprised when the other nurses state that the manager makes all decisions and rarely asks for staff input. What is the best description of the nurse manager's management style? A. Ultraliberal or communicative B. Laissez-faire or permissive C. Autocratic or authoritarian D. Participative or democratic - ✔✔C Autocratic leadership style is suggested in this situation. It is appropriate for groups with little education and experience who need strong direction. A Participative or democratic style is usually more successful on nursing units with a mix of staff of differing experience. An 89 year-old with impaired mental status is transferred from a nursing home to the hospital for surgery. When assisting the client with a clear liquid diet postoperatively, the client begins to cough forcefully. What action by the nurse is indicated? A. Refer the client for a swallowing assessment B. Add a thickening agent to the fluids C. Order a soft diet D. Call the nursing home for more information - ✔✔A The nurse should contact the health care provider to request a swallowing assessment for this client. Older adults with impaired mental status are at greater risk for aspiration pneumonia. Thickening fluids and other actions may be required following the swallowing assessment. Also, remember to apply the nursing process - if a new problem develops, then further assessment is indicated. A health care provider orders digoxin 0.125 mg by mouth daily and furosemide (Lasix) 40 mg daily by mouth. Which of these foods should the nurse reinforce for the client to eat at least one serving daily? A. Blueberries B. Wheat cereal C. Tomato juice D. Pear nectar - ✔✔C Tomato juice is highest in potassium per serving of the given foods. The other three foods are in a category of low potassium foods and will do little to replace potassium lost by the diuretic. Tomato juice (½ cup) has about 400 mg potassium; pear nectar (1 cup) has 33 mg; blueberries (½ cup) is 64 mg; and wheat cereal (1 cup) is 62 mg. The low potassium foods would be recommended for clients diagnosed with renal failure. A 64 year-old client scheduled for surgery with a general anesthetic refuses to remove a set of dentures prior to leaving the unit for the operating room. What would be the most appropriate intervention by the nurse? A. Notify the anesthesia department and the surgeon of the client's refusal B. Ask the client if the preference would be to remove the dentures in the operating room receiving area C. Explain to the client that the dentures must come out as they may get lost or broken in the operating room D. Ask the client if there are second thoughts about having the procedure - ✔✔B Clients anticipating surgery may experience a variety of fears. This choice allows the client control over the situation and fosters the client's sense of self-esteem and self-concept. A client with a documented pulmonary embolism has the following arterial blood gases (ABG): PaO2 70 mm Hg, PaCO2 30 mm Hg, pH 7.48, SaO2 87%, HCO3 22. Based on this data, what is the first nursing action? A. Have the client do slow, deep breathing B. Administer the PRN oxygen by nasal cannula C. Notify the health care provider of the results D. Review prior ABG data from the prior shift - ✔✔B The low PaO2, along with the low oxygen saturation, is a priority. The first priority should be to administer oxygen to the client. Then the client should be guided to do slow, deep breathing because the PaCo2 is low, reflecting a hyperventilation effect of an increased respiratory rate with slight respiratory alkalosis. Prior lab results should be reviewed before notifying the health care provider. The nurse is caring for the following clients. The nurse understands that which of these clients is at the highest risk for falling? A. The 59 year-old who had hip replacement surgery four days ago and is going to physical therapy B. The 67 year-old who is diabetic and has a draining ulcer on the right leg C. The 81 year-old who fell at home last week and is confused D. The 79 year-old who has arthritis and walks with the aid of a walker - ✔✔C Although all of the individuals might be at risk for falling, evidence shows that the greatest risk of falling is a person who is older than age 80, is confused, and has a history of falling. A client is admitted with a diagnosis of myocardial infarction (MI). Which lab value is most commonly used to confirm this diagnosis? A. Elevated C-reactive protein B. Elevated myoglobin C. Elevated creatine kinase (CK) D. Elevated troponin levels - ✔✔D All of these lab tests may be elevated during an MI. Although CK-MB (along with total CK) is a very good test, it has been replaced by troponin. Elevation of troponin is the most reliable because it is more specific to heart damage; it elevates within a few hours and remains elevated for about 10 days. CK-MB is one of three separate forms (isoenzymes) of the enzyme creatine kinase (CK); it is found mostly in heart muscle and rises when there is damage to the heart. An elevated C-reactive protein is associated with a risk of cardiovascular disease. The client is diagnosed with superficial thrombophlebitis of the left leg. Which nursing intervention should be given the highest priority? A. Elevate the affected leg B. Apply cool compresses C. Apply elastic support stockings D. Maintain complete bed rest - ✔✔A Unlike deep vein thrombosis, superficial venous thrombosis involves a sudden inflammatory reaction (redness, pain, swelling), but it rarely involves an embolism. Treatment involves elevating the leg because dangling the extremity will increase the swelling and the pain. Other treatment options include warm compresses and analgesics (aspirin or another NSAID); sometimes a low-molecular weight heparin is also prescribed. Clients do not need to be on bed rest but they should wear elastic support stockings (or multiple elastic bandages) when out of bed. The nurse must remove a fecal impaction in a 75 year-old client. During the procedure, the nurse should remember what critical information? A. Family members should be taught the procedure B. Cardiac dysrhythmias can result during the process C. Increased dietary fiber and fluids can minimize such problems D. The procedure is to be done prior to the bath - ✔✔B Cardiac dysrhythmias such as severe bradycardia can occur from vagal nerve stimulation during fecal impaction removal. The other actions are appropriate though they are not the priority consideration. A client is scheduled for a percutaneous transluminal coronary angioplasty (PTCA). What information should the nurse know about this procedure when teaching the client? A. The procedure compresses plaque against the wall of the diseased coronary artery to improve blood flow B. It is a surgical repair with an incision of a diseased coronary artery to improve blood flow C. Being a noninvasive radiographic examination of the heart, it has no invasive properties D. The placement of an automatic internal cardiac defibrillator is done - ✔✔A PTCA is performed to open blocked coronary arteries caused by coronary artery disease (CAD). It is performed during a cardiac catheterization. The balloon is inflated once the catheter is in place in the diseased artery and this compresses the fatty tissue, resulting in improved blood flow. Aorta coronary bypass (CABG) is the surgical procedure with incisions to repair diseased coronary arteries. While planning care for a preschool-aged child, the nurse takes developmental needs into consideration. Which of these behaviors would be of the most concern to the nurse? A. Identifying with family B. Playing imaginatively C. Exploring the playroom D. Expressing shame - ✔✔D Erikson describes the stage of the preschool child as being the time when there is normally an increase in initiative. The child should have resolved the sense of shame and doubt in the toddler stage. A mother calls the clinic, concerned that her 5 week-old infant is "sleeping more than her brother did." What is the best initial response by a nurse? A. "Do you remember his sleep patterns?" B. "How old is your other child?" C. "Why do you think this a concern?" D. "Does the baby sleep after feeding?" - ✔✔C Asking this client "why" allows her to focus on her concern about her newborn's sleep patterns - the reason for the call to the clinic. This is the most open-ended question and will encourage further discussion and conversation about the newborn, and not the other child. The nurse is teaching a client diagnosed with depression about a new prescription for nortriptyline. What information should the nurse emphasize? A. Episodes of diarrhea can be expected B. The medication must be stored in the refrigerator C. Alcohol use is to be avoided D. Symptom relief occurs in a few days - ✔✔C Alcohol enhances the effects of tricyclic antidepressants such as nortriptyline (Pamelor) and may result in dangerous side effects, including drowsiness, dizziness and suicidal thoughts. A client diagnosed with bipolar disorder is prescribed lithium. What should the nurse emphasize when teaching the client about this medication? A. Maintain adequate daily salt intake B. Reduce fluid intake to minimize diuresis C. Take the medication before meals D. Use antacids to prevent heartburn - ✔✔A Lithium levels need to be regularly monitored. Clients should be advised to drink 8 to 10 glasses of water or other liquids every day and keep their salt intake the same because too little salt may cause lithium levels to rise (and more salt may cause lithium levels to fall). Lithium is a naturally occurring mineral with an electrical charge similar to salt. A nurse is assessing a woman in early labor. When positioning her for a vaginal exam, the client reports feeling dizzy and nauseous. She appears pale and her blood pressure has dropped slightly. What should be the initial nursing action? A. Elevate the foot of the bed B. Turn her to her left side C. Call the health care provider D. Encourage deep breathing - ✔✔B The weight of the uterus can put pressure on the vena cava and aorta when a pregnant woman is lying flat on the back which results in supine hypotension. Action is needed to relieve the pressure on the vena cava and aorta. Turning the woman to the left side reduces this pressure and relieves postural hypotension. A 76 year-old client is prescribed an anticholinergic metered dose inhaler (MDI) for chronic obstructive pulmonary disease (COPD). Why would the nurse suggest the client use a spacer? A. Enhance the administration of the medication B. Prevent exacerbation of COPD C. Improve aerosol delivery in clients with poor coordination D. Increase client compliance - ✔✔C Spacers improve the medication delivery in clients who are unable to coordinate the movements for the administration of aersol medication with a MDI. The nurse is performing a prekindergarten physical on a 4 year-old child and will administer a series of scheduled vaccines, including the DTaP, IPV, MMR and VAR. What information does the nurse need to know about these vaccinations? (Select all that apply.) A. Either the deltoid muscle of the arm or anterolateral thigh muscle can be used B. A 20 gauge needle is used to administer the varicella (VAR) vaccine intramuscularly (IM) C. A 5/8 inch needle length is often used for subcutaneous (SubQ) injections D. The vaccines contain the preservative thimerosal E. Multiple immunizations should be administered a minimum of 1 inch apart F. The vaccines all contain weakened live viruses - ✔✔A,C,E A 4-6 year-old should get the Diphtheria-Tetanus-Pertussis (DTaP), Inactivated Polio (IPV), Measles-Mumps-Rubella (MMR), and Varicella (VAR) vaccines. DTaP is given IM; VAR and MMR are administered SubQ (using a 5/8 inch, 25-gauge needle); IPV can be given either SubQ or IM. The IPV contains inactivated viruses; the MMR and VAR contain live viruses and DTaP is made up of dead bacteria. Vaccines no longer contain thimerosal, which is a form of mercury. Multiple immunizations should be spaced a minimum of 1 inch apart. Either the deltoid muscle of the arm or the anterolateral thigh muscle can be used. At 3 months, the infant has cleft lip and soft palate repair. In the immediate postoperative period for a cleft lip repair, which action is the priority? A. Remove soft elbow/arm restraints every 2 hours under supervision B. Initiate clear liquid feedings by mouth when alert and acting hungry C. Position the infant on side or back D. Provide written instructions about care of the suture line - ✔✔A The goal after surgery is to protect the new repair and stitches, which requires some temporary changes in feeding, positioning and activity for the infant. The priority is to wear arm restraints (for the first 10 days after surgery) to keep him from putting his hands in his mouth; the restraints can be removed only for bathing or for exercising the arms. When the infant acts hungry, he will be given a clear liquid feeding using either a syringe fitted with a special soft tubing or a special cleft lip feeder. The infant can be positioned on his side or back to keep him from rubbing his face in the bed. The RN will provide instructions about care of the incision line prior to discharge. The nurse is caring for a client whose blood pressure is 90/58. Based on the client's mean arterial pressure (MAP), the nurse considers holding the client's scheduled dose of atenolol (Tenormin). Calculate the client's mean arterial pressure. (Round to the nearest whole number.) - ✔✔69 Mean arterial pressure must be 70-90 mm Hg to adequately perfuse the organs. MAP is calculated as (diastolic BP x 2 + systolic BP), which is divided by 3. ([58 X 2] + 90)/3 = 68.66 or 69 The nurse is caring for several 70 to 80 year-old clients on bed rest. What is the most important action to prevent skin breakdown? A. Turning at least every two hours B. Apply moist heat to reddened areas C. Lubricate skin with lotion or gel D. Massage the legs frequently - ✔✔A Frequent turning will prevent skin breakdown by relieving prolonged pressure on any one area. This approach works with any age and build of client. The nurse is teaching a group of clients who are all diagnosed with schizophrenia and are taking an atypical antipsychotic medication. What statement made by one of the clients needs to be corrected? A. "I'll probably gain a lot of weight on this medication and I may even develop diabetes." B. "I'm so glad that this medication won't cause any of the tremors or tics I had when I was taking my old medication." C. "I should be careful when I get out of bed because this medication can cause my blood pressure to drop." D. "I know I need to be patient but I wish it didn't take so long for this medication to really start working." - ✔✔B Although atypical antipsychotics may cause fewer extrapyramidal side effects, the client should know that they may still cause some of the same symptoms, like tics, slow speech, tremors or retarded movement. Most of these medications do take two to four weeks or more to take effect. In addition to weight gain and developing diabetes, there is a risk for higher cholesterol and triglyceride levels. A client was admitted to the eating disorder unit with a diagnosis of bulimia nervosa. A nurse should expect the client's history to include which of these findings? A. Bacterial gastric infections, spastic colon B. Respiratory distress, dysphagia C. Dental erosion, parotid gland enlargement D. Metabolic acidosis, ulcerative colitis - ✔✔C Dental erosion and parotid gland enlargement occur as a result of the purging. These are common complications of binge eating followed by self-induced vomiting. Often these clients will have a callous on one of the fingers on either hand. This is from the use of the finger to gag self until emesis occurs. The nurse is eating in the hospital cafeteria when a toddler at a nearby table chokes on a piece of food and turns slightly blue. What would be the most appropriate initial action taken by the nurse? A. Perform abdominal thrusts B. Begin mouth to mouth resuscitation C. Call for the emergency response team D. Give the child water to help in swallowing - ✔✔A At this age, the most effective way to clear the airway of food is to perform abdominal thrusts. As that is being done, calling for the rapid response team would be appropriate. The nurse is caring for a client undergoing chemotherapy for colon cancer. Which of the following statements made by the client would the nurse be most concerned about? A. "I take 10 multivitamin tablets daily to help my immune system fight the cancer." B. "I think the green tea I'm drinking is helping me to fight the cancer." C. "I am using relaxation techniques when I need to so I can cope with the stress of having cancer." D. "I pray several hours a day to God to help me deal with this cancer." - ✔✔A While the other common complementary and integrative health therapies may or may not have a direct beneficial effect on the cancer, the megadoses of vitamins may interfere with the chemotherapeutic agents and may have toxic effects. A practical nurse (LPN) from the pediatric unit is reassigned to work in an adult ortho-neuro unit. Which client assignment would be appropriate for this staff member? A. The client who is one day post total knee arthroplasty experiencing shortness of breath B. The client who experienced a cerebral vascular accident and is ready to be transferred to a long term care facility C. The client with a newly applied long leg cast experiencing uncontrolled pain D. The client in balanced traction admitted three days ago after a motor vehicle accident - ✔✔D The RN can assign clients to LPNs as long as the care required is not too complex and there is a low likelihood of an emergency. This is especially important reassigned workers. The most stable client is the one in balanced traction who was admitted three days ago. The clients experiencing SOB and uncontrolled pain are unstable and there is an increased risk of an emergency. Admitting or discharging a client is a complex process and requires the skills, knowledge and abilities of the RN. The client is scheduled to have a pulmonary artery catheter (PAC) inserted. Prior to the procedure, what basic information can the nurse teach the client about a PAC? A. "The catheter is inserted through the groin into the left side of the heart." B. "You will be unable to eat or drink anything for several hours after the procedure." C. "The procedure is performed under general anesthesia." D. "The catheter will measure different pressures in the heart and lungs." - ✔✔D A pulmonary artery catheter, also known as a Swan-Ganz catheter or right heart catheterization, is inserted into the right side of the heart and into the arteries that lead to the lungs. It is inserted either through the groin or neck, using conscious sedation and local anesthetic, at the bedside (usually in an intensive care unit.) PAC can measure right atrial pressure, pulmonary artery pressure, and pulmonary capillary wedge pressure; these measurements can be used to assess oxygenation of the blood in the right heart and overall cardiac output. Clients can eat or drink after the procedure. A practical nurse (PN) is assigned to care for a newborn with a neural tube defect. Which dressing, if applied by the PN, would be correct and need no further intervention by the charge nurse? A. Sterile occlusive pressure dressing B. Dry sterile dressing that is occlusive C. Moist, sterile nonadherent dressing D. Telfa dressing with antibiotic ointment - ✔✔C Before surgical closure, the sac is prevented from drying by the application of a sterile, moist, nonadherent dressing over the defect. Dressings are changed frequently to keep them moist. A dry sterile occlusive dressing is placed on a central line insertion site. The nurse is in a crowded shopping area in an urban setting when a radiologic dispersal device (RDD) explodes scattering radioactive dust and material into the environment. What should the nurse instruct the victims in proximity to the explosion to do first? A. Stay out of any buildings until help arrives B. Lie down flat and cover the head with anything available C. Keep the nose and mouth covered D. Remove all exposed clothing right away - ✔✔C An RRD, or "dirty bomb," generates radioactive dust and smoke, which can be dangerous if inhaled. The nurse should initiate measures to limit contamination, instructing victims to cover their noses and mouths. Neither lying down or covering the head does anything to limit exposure. Victims should move into a building where the walls and windows have not been broken and then remove their outer layer of clothing (sealing them in a plastic bag, if available) to help minimize exposure. The nurse is working with a client with anxiety. An appropriate treatment goal for this client would be which of these items? A. Establish contact with reality B. Ventilate anxious feelings to a nurse C. Become desensitized to past trauma D. Learn self-help techniques - ✔✔D Exploration of alternative coping mechanisms should decrease present anxiety to a manageable level. Assistance to the client for learning self-help techniques should enhance the abilities to cope with anxiety. A client has been diagnosed with Zollinger-Ellison syndrome. Which information is most important for the nurse to reinforce? A. Treatment consists of medications to reduce acid and heal any peptic ulcers and, if possible, surgery to remove any tumors B. With the average age of diagnosis at 50 years, the peptic ulcers may occur at unusual areas of the stomach or intestine C. It is a condition in which one or more tumors called gastrinomas form in the pancreas or in the upper part of the small intestine (duodenum)