NCLEX-PN Test Prep Questions and Answers with Explanations V3 PRACTICE EXAM 2 (2020/2021) (STUDY MODE)

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2020/2021 NCLEX-PN Test Prep Questions and Answers with Explanations V3 PRACTICE EXAM 2 (STUDY MODE) 1. Which finding is the best indication that a client with ineffective airway clearance needs... suctioning? A. Oxygen saturation B. Respiratory rate C. Breath sounds D. Arterial blood gases Answer C: Changes in breath sounds are the best indication of the need for suctioning in the client with ineffective airway clearance. Answers A, B, and D are incorrect because they can be altered by other conditions. 2. A client with tuberculosis has a prescription for Myambutol (ethambutol HCl). The nurse should tell the client to notify the doctor immediately if he notices: A. Gastric distress B. Changes in hearing C. Red discoloration of bodily fluids D. Changes in color vision Answer D: An adverse reaction to Myambutol is change in visual acuity or color vision. Answer A is incorrect because it does not relate to the medication. Answer C is incorrect because it is an adverse reaction to Streptomycin. Answer C is incorrect because it is a side effect of Rifampin. 3. The primary cause of anemia in a client with chronic renal failure is: A. Poor iron absorption B. Destruction of red blood cells C. Lack of intrinsic factor D. Insufficient erythropoietin Answer D: Insufficient erythropoietin production is the primary cause of anemia in the client with chronic renal failure. Answers A, B, and C do not relate to the anemia seen in the client with chronic renal failure; therefore, they are incorrect. 4. Which of the following nursing interventions has the highest priority for the client scheduled for an intravenous pyelogram? A. Providing the client with a favorite meal for dinner B. Asking if the client has allergies to shellfish C. Encouraging fluids the evening before the test D. Telling the client what to expect during the test Answer C: The contrast media used during an intravenous pyelogram contains iodine, which can result in an anaphylactic reaction. Answers A, B, and D do not relate specifically to the test; therefore, they are incorrect. 5. The doctor has prescribed aspirin 325mg daily for a client with transient ischemic attacks. The nurse knows that aspirin was prescribed to: A. Prevent headaches B. Boost coagulation C. Prevent cerebral anoxia D. Keep platelets from clumping together Answer D: Aspirin prevents the platelets from clumping together to prevent clots. Answer A is incorrect because the low-dose aspirin will not prevent headaches. Answers B and C are untrue statements; therefore, they are incorrect. 6. A client with tuberculosis who has been receiving combined therapy with INH and Rifampin asks the nurse how long he will have to take medication. The nurse should tell the client that: A. Medication is rarely needed after 2 weeks. B. He will need to take medication the rest of his life. C. The course of combined therapy is usually 6 months. D. He will be re-evaluated in 1 month to see if further medication is needed. Answer C: The usual course of treatment using a combined therapy with INH and Rifampin is 6 months. Answers A and D are incorrect because the treatment time is too brief. Answer B is incorrect because the medication is not needed for life. 7. Which development milestone puts the 4-month-old infant at greatest risk for injury? A. Switching objects from one hand to another B. Crawling C. Standing D. Rolling over Answer D: At 4 months of age, the infant can roll over, which makes it vulnerable to falls from dressing tables or beds without rails. Answer A is incorrect because it does not prove a threat to safety. Answers B and C are incorrect choices because the 4-month-old is not capable of crawling or standing. 8. A client taking Dilantin (phenytoin) for tonic-clonic seizures is preparing for discharge. Which information should be included in the client’s discharge care plan? A. The medication can cause dental staining. B. The client will need to avoid a high-carbohydrate diet. C. The client will need a regularly scheduled CBC. D. The medication can cause problems with drowsiness. Answer C: Adverse side effects of Dilantin include agranulocytosis and aplastic anemia; therefore, the client will need frequent CBCs. Answer A is incorrect because the medication does not cause dental staining. Answer B is incorrect because the medication does not interfere with the metabolism of carbohydrates. Answer D is incorrect because the medication does not cause drowsiness. 9. Assessment of a newborn male reveals that the infant has hypospadias. The nurse knows that: A. The infant should not be circumcised. B. Surgical correction will be done by 6 months of age. C. Surgical correction is delayed until 6 years of age. D. The infant should be circumcised to facilitate voiding. Answer A: The infant with hypospadias should not be circumcised because the foreskin is used in reconstruction. Answer B and C are incorrect because reconstruction is done between 16 and 18 months of age, before toilet training. Answer D is incorrect because the infant with hypospadias should not be circumcised. 10. The nurse is providing dietary teaching for a client with elevated cholesterol levels. Which cooking oil is not suggested for the client on a lowcholesterol diet? A. Safflower oil B. Sunflower oil C. Coconut oil D. Canola oil Answer C: Coconut oil is high in saturated fat and is not appropriate for the client on a low-cholesterol diet. Answers A, B, and D are incorrect because they are suggested for the client with elevated cholesterol levels. 11. The nurse is caring for a client with stage III Alzheimer’s disease. A characteristic of this stage is: A. Memory loss B. Failing to recognize familiar objects C. Wandering at night D. Failing to communicate Answer B: In stage III of Alzheimer’s disease, the client develops agnosia, or failure to recognize familiar objects. Answer A is incorrect because it appears in stage I. Answer C is incorrect because it appears in stage II. Answer D is incorrect because it appears in stage IV. 12. The doctor has prescribed Cortone (cortisone) for a client with systemic lupus erythematosis. Which instruction should be given to the client? A. Take the medication 30 minutes before eating. B. Report changes in appetite and weight. C. Wear sunglasses to prevent cataracts. D. Schedule a time to take the influenza vaccine. Answer D: The client taking steroid medication should receive an annual influenza vaccine. Answer A is incorrect because the medication should be taken with food. Answer B is incorrect because increased appetite and weight gain are expected side effects of the medication. Answer C is incorrect because wearing sunglasses will not prevent cataracts. 13. The nurse is caring for a client with an above-the-knee amputation (AKA). To prevent contractures, the nurse should: A. Place the client in a prone position 15–30 minutes twice a day B. Keep the foot of the bed elevated on shock blocks C. Place trochanter rolls on either side of the affected leg D. Keep the client’s leg elevated on two pillows Answer A: The client with an above-the-knee amputation should be placed prone 15–30 minutes twice a day to prevent contractures. Answers B and D are incorrect choices because elevating the extremity after the first 24 hours will promote the development of contractures. Use of a trochanter roll will prevent rotation of the extremity but will not prevent contractures; therefore, answer D is incorrect. 14. The mother of a 6-month-old asks when her child will have all his baby teeth. The nurse knows that most children have all their primary teeth by age: A. 12 months B. 18 months C. 24 months D. 30 months Answer D: All 20 primary, or deciduous, teeth should be present by age 30 months. Answers A, B, and C are incorrect because the ages are wrong. 115. While caring for a client with cervical cancer, the nurse notes that the radioactive implant is lying in the bed. The nurse should: A. Place the implant in a biohazard bag and return it to the lab B. Give the client a pair of gloves and ask her to reinsert the implant C. Use tongs to pick up the implant and return it to a lead-lined container D. Discard the implant in the commode and double-flush Answer C: The radioactive implant should be picked up with tongs and returned to the lead-lined container. Answer A is incorrect because radioactive materials are placed in lead-lined containers, not plastic ones, and are returned to the radiation department, not the lab. Answer B is incorrect because the client should not touch the implant or try to reinsert it. Answer D is incorrect because the implant should not be placed in the commode for disposal. 116. The nurse is preparing to discharge a client following a laparoscopic cholecystectomy. The nurse should: A. Tell the client to avoid a tub bath for 5 to 7 days B. Tell the client to expect clay-colored stools C. Tell the client that she can expect lower abdominal pain for the next week D. Tell the client that she can resume a regular diet immediately Answer A: Following a laparoscopic cholecystectomy, the client should avoid a tub bath for 5 to 7 days. Answer B is incorrect because the stools should not be clay colored. Answer C is incorrect because pain is usually located in the shoulders. Answer D is incorrect because the client should not resume a regular diet until clear liquids have been tolerated. 17. A high school student returns to school following a 3-week absence due to mononucleosis. The school nurse knows it will be important for the client: A. To drink additional fluids throughout the day B. To avoid contact sports for 1–2 months C. To have a snack twice a day to prevent hypoglycemia D. To continue antibiotic therapy for 6 months Answer B: The client recovering from mononucleosis should avoid contact sports and other activities that could result in injury or rupture of the spleen. Answer A is incorrect because the client does not need additional fluids. Hypoglycemia is not associated with mononucleosis; therefore, answer C is incorrect. Answer D is incorrect because antibiotics are not usually indicated in the treatment of mononucleosis. 18. A 6-year-old with cystic fibrosis has an order for pancreatic replacement. The nurse knows that the medication will be given: A. At bedtime B. With meals and snacks C. Twice daily D. Daily in the morning Answer B: Pancreatic enzyme replacement is given with each meal and each snack. Answers A, C, and D do not specify a relationship to meals; therefore, they are incorrect. 19. The doctor has prescribed a diet high in vitamin B12 for a client with pernicious anemia. Which foods are highest in B12? A. Meat, eggs, dairy products B. Peanut butter, raisins, molasses C. Broccoli, cauliflower, cabbage D. Shrimp, legumes, bran cereals Answer A: Meat, eggs, and dairy products are foods high in vitamin B12. Answer B is incorrect because peanut butter, raisins, and molasses are sources rich in iron. Answer C is incorrect because broccoli, cauliflower, and cabbage are all sources rich in vitamin K. Answer D is incorrect because shrimp, legumes, and bran cereals are high in magnesium. 20. A client with hypertension has begun an aerobic exercise program. The nurse should tell the client that the recommended exercise regimen should begin slowly and build up to: A. 20–30 minutes three times a week B. 45 minutes two times a week C. 1 hour four times a week D. 1 hour two times a week Answer A: The client’s aerobic workout should be 20–30 minutes long three times a week. Answers B, C, and D exceed the recommended time for the client beginning an aerobic program; therefore, they are incorrect. 21. A client with breast cancer is returned to the room following a right total mastectomy. The nurse should: A. Elevate the client’s right arm on pillows B. Place the client’s right arm in a dependent sling C. Keep the client’s right arm on the bed beside her D. Place the client’s right arm across her body Answer A: A total mastectomy involves removal of the entire breast and some or all of the axillary lymph nodes. Following surgery, the client’s right arm should be elevated on pillows, to facilitate lymph drainage. Answers B, C, and D are incorrect because they would not help facilitate lymph drainage and would create increased edema in the affected extremity. 22. A neurological consult has been ordered for a pediatric client with suspected absence seizures. The client with absence seizures can be expected to have: A. Short, abrupt muscle contraction B. Quick, bilateral severe jerking movements C. Abrupt loss of muscle tone D. A brief lapse in consciousness Answer D: Absence seizures, formerly known as petit mal seizures, are characterized by a brief lapse in consciousness accompanied by rapid eye blinking, lip smacking, and minor myoclonus of the upper extremities. Answer A refers to myoclonic seizures; therefore, it is incorrect. Answer B refers to tonic clonic, formerly known as grand mal, seizures; therefore, it is incorrect. Answer C refers to atonic seizures; therefore, it is incorrect. 23. A client with schizoaffective disorder is exhibiting Parkinsonian symptoms. Which medication is responsible for the development of Parkinsonian symptoms? A. Zyprexa (olanzapine) B. Cogentin (benzatropine mesylate) C. Benadryl (diphenhydramine) D. Depakote (divalproex sodium) Answer A: A side effect of antipsychotic medication, such as Zyprexa, is the development of Parkinsonian symptoms. Answers B and C are incorrect choices because they are used to reverse Parkinsonian symptoms in the client taking antipsychotic medication. Answer D is incorrect because the medication is an anticonvulsant used to stabilize mood. Parkinsonian symptoms are not associated with anticonvulsant medication. 24. Which activity is best suited to the 12-year-old with juvenile rheumatoid arthritis? A. Playing video games B. Swimming C. Working crossword puzzles D. Playing slow-pitch softball Answer B: Exercises that provide light passive resistance are best for the child with rheumatoid arthritis. Answers A and C require movement of the hands and fingers that might be too painful for the child with juvenile rheumatoid arthritis; therefore, they are incorrect. Answer D is incorrect because it requires the use of larger joints affected by the disease. 25. The glycosylated hemoglobin of a 40-year-old client with diabetes mellitus is 2.5%. The nurse understands that: A. The client can have a higher-calorie diet. B. The client has good control of her diabetes. C. The client requires adjustment in her insulin dose. D. The client has poor control of her diabetes. Answer B: The client’s diabetes is well under control. Answer A is incorrect because it will lead to elevated blood sugar levels and poorer control of the client’s diabetes. Answer C is incorrect because the diet and insulin dose are appropriate for the client. Answer D is incorrect because the desired range for glycosylated hemoglobin in the adult client is 2.5%–5.9%. 26. The physician has ordered Stadol (butorphanol) for a post-operative client. The nurse knows that the medication is having its intended effect if the client: A. Is asleep 30 minutes after the injection B. Asks for extra servings on his meal tray C. Has an increased urinary output D. States that he is feeling less nauseated Answer A: Stadol reduces the perception of pain, which allows the postoperative client to rest. Answers B and C are not affected by the medication; therefore, they are incorrect. Relief of pain generally results in less nausea, but it is not the intended effect of the medication; therefore, answer D is incorrect. 27. The mother of a child with cystic fibrosis tells the nurse that her child makes “snoring” sounds when breathing. The nurse is aware that many children with cystic fibrosis have: A. Choanal atresia B. Nasal polyps C. Septal deviations D. Enlarged adenoids Answer B: Children with cystic fibrosis are susceptible to chronic sinusitis and nasal polyps, which might require surgical removal. Answer A is incorrect because it is a congenital condition in which there is a bony obstruction between the nares and the pharynx. Answers C and D are not specific to the child with cystic fibrosis; therefore, they are incorrect. 28. A client is hospitalized with hepatitis A. Which of the client’s regular medications is contraindicated due to the current illness? A. Prilosec (omeprazole) B. Synthroid (levothyroxine) C. Premarin (conjugated estrogens) D. Lipitor (atorvastatin) Answer D: Lipid-lowering agents are contraindicated in the client with active liver disease. Answers A, B, and C are incorrect because they are not contraindicated in the client with active liver disease. 29. The nurse has been teaching the role of diet in regulating blood pressure to a client with hypertension. Which meal selection indicates that the client understands his new diet? A. Cornflakes, whole milk, banana, and coffee B. Scrambled eggs, bacon, toast, and coffee C. Oatmeal, apple juice, dry toast, and coffee D. Pancakes, ham, tomato juice, and coffee Answer C: Oatmeal is low in sodium and high in fiber. Limiting sodium intake and increasing fiber helps to lower cholesterol levels, which reduce blood pressure. Answer A is incorrect because cornflakes and whole milk are higher in sodium and are poor sources of fiber. Answers B and D are incorrect choices because they contain animal proteins that are high in both cholesterol and sodium. 30. An 18-month-old is being discharged following hypospadias repair. Which instruction should be included in the nurse’s discharge teaching? A. The child should not play on his rocking horse. B. Applying warm compresses to decrease pain. C. Diapering should be avoided for 1–2 weeks. D. The child will need a special diet to promote healing. Answer A: After hypospadias repair, the child will need to avoid straddle toys, such as a rocking horse, until allowed by the surgeon. Swimming and rough play should also be avoided. Answers B, C, and D do not relate to the post-operative care of the child with hypospadias; therefore, they are incorrect. 31. An obstetrical client calls the clinic with complaints of morning sickness. The nurse should tell the client to: A. Keep crackers at the bedside for eating before she arises B. Drink a glass of whole milk before going to sleep at night C. Skip breakfast but eat a larger lunch and dinner D. Drink a glass of orange juice after adding a couple of teaspoons of sugar Answer A: Symptoms of morning sickness might be alleviated by eating a carbohydrate source such as dry crackers or toast before arising. Answer B is incorrect because the additional fat might increase the client’s nausea. Answer C is incorrect because the client does not need to skip meals. Answer D is the treatment of hypoglycemia, not morning sickness; therefore, it is incorrect. 32. The nurse has taken the blood pressure of a client hospitalized with methicillin-resistant staphylococcus aureus. Which action by the nurse indicates an understanding regarding the care of clients with MRSA? A. The nurse leaves the stethoscope in the client’s room for future use. B. The nurse cleans the stethoscope with alcohol and returns it to the exam room. C. The nurse uses the stethoscope to assess the blood pressure of other assigned clients. D. The nurse cleans the stethoscope with water, dries it, and returns it to the nurse’s station. Answer A: The stethoscope should be left in the client’s room for future use. The stethoscope should not be returned to the exam room or the nurse’s station; therefore, answers B and D are incorrect. The stethoscope should not be used to assess other clients; therefore, answer C is incorrect. 33. The physician has discussed the need for medication with the parents of an infant with congenital hypothyroidism. The nurse can reinforce the physician’s teaching by telling the parents that: A. The medication will be needed only during times of rapid growth. B. The medication will be needed throughout the child’s lifetime. C. The medication schedule can be arranged to allow for drug holidays. D. The medication is given one time daily every other day. Answer B: The medication will be needed throughout the child’s lifetime. Answers A, C, and D contain inaccurate statements; therefore, they are incorrect. 34. A client with diabetes mellitus has a prescription for Glucotrol XL (glipizide). The client should be instructed to take the medication: A. At bedtime B. With breakfast C. Before lunch D. After dinner Answer B: Glucotrol XL is given once a day with breakfast. Answer A is incorrect because the client would develop hypoglycemia while sleeping. Answers C and D are incorrect choices because the client would develop hypoglycemia later in the day or evening. 35. The nurse is caring for a client admitted with suspected myasthenia gravis. Which finding is usually associated with a diagnosis of myasthenia gravis? A. Visual disturbances, including diplopia B. Ascending paralysis and loss of motor function C. Cogwheel rigidity and loss of coordination D. Progressive weakness that is worse at the day’s end Answer D: The client with myasthenia develops progressive weakness that worsens during the day. Answer A is incorrect because it refers to symptoms of multiple sclerosis. Answer B is incorrect because it refers to symptoms of Guillain Barre syndrome. Answer C is incorrect because it refers to Parkinson’s disease. 36. The nurse is teaching the parents of an infant with osteogenesis imperfecta. The nurse should tell the parents: A. That the infant will need daily calcium supplements B. To lift the infant by the buttocks when diapering C. That the condition is a temporary one D. That only the bones are affected by the disease Answer B: To prevent fractures, the parents should lift the infant by the buttocks rather than the ankles when diapering. Answer A is incorrect because infants with osteogenesis imperfecta have normal calcium and phosphorus levels. Answer C is incorrect because the condition is not temporary. Answer D is incorrect because the teeth and the sclera are also affected. 37. Physician’s orders for a client with acute pancreatitis include the following: strict NPO, NG tube to low intermittent suction. The nurse recognizes that these interventions will: A. Reduce the secretion of pancreatic enzymes B. Decrease the client’s need for insulin C. Prevent secretion of gastric acid D. Eliminate the need for analgesia Answer A: Placing the client on strict NPO status will stop the inflammatory process by reducing the secretion of pancreatic enzymes. The use of low, intermittent suction prevents release of secretion in the duodenum. Answer B is incorrect because the client requires exogenous insulin. Answer C is incorrect because it does not prevent the secretion of gastric acid. Answer D is incorrect because it does not eliminate the need for analgesia. 38. A client with diverticulitis is admitted with nausea, vomiting, and dehydration. Which finding suggests a complication of diverticulitis? A. Pain in the left lower quadrant B. Boardlike abdomen C. Low-grade fever D. Abdominal distention Answer B: A rigid or boardlike abdomen is suggestive of peritonitis, which is a complication of diverticulitis. Answers A, C, and D are common findings in diverticulitis; therefore, they are incorrect. 39. The diagnostic work-up of a client hospitalized with complaints of progressive weakness and fatigue confirms a diagnosis of myasthenia gravis. The medication used to treat myasthenia gravis is: A. Prostigmin (neostigmine) B. Atropine (atropine sulfate) C. Didronel (etidronate) D. Tensilon (edrophonium) Answer A: Prostigmin is used to treat clients with myasthenia gravis. Answer B is incorrect because atropine sulfate is used in the management of the client with cholinergic crisis. Answer C is incorrect because the drug is unrelated to the treatment of myasthenia gravis. Answer D is incorrect because it is the test for myasthenia gravis. 40. A client with AIDS complains of a weight loss of 20 pounds in the past month. Which diet is suggested for the client with AIDS? A. High calorie, high protein, high fat B. High calorie, high carbohydrate, low protein C. High calorie, low carbohydrate, high fat D. High calorie, high protein, low fat Answer D: The suggested diet for the client with AIDS is one that is high calorie, high protein, and low fat. Clients with AIDS have a reduced tolerance to fat because of the disease as well as side effects from some antiviral medications; therefore, answers A and C are incorrect. Answer B is incorrect because the client needs a high-protein diet. 41. The nurse is caring for a 4-year-old with cerebral palsy. Which nursing intervention will help ready the child for rehabilitative services? A. Patching one of the eyes to strengthen the muscles B. Providing suckers and pinwheels to help strengthen tongue movement C. Providing musical tapes to provide auditory training D. Encouraging play with a video game to improve muscle coordination Answer B: The nurse can help ready the child with cerebral palsy for speech therapy by providing activities that help the child develop tongue control. Most children with cerebral palsy have visual and auditory difficulties that require glasses or hearing devices rather than rehabilitative training; therefore, answers A and C are incorrect. Answer D is incorrect because video games are not appropriate for the age or developmental level of the child with cerebral palsy. 42. At the 6-week check-up, the mother asks when she can expect the baby to sleep all night. The nurse should tell the mother that most infants begin to sleep all night by age: A. 1 month B. 2 months C. 3–4 months D. 5–6 months Answer C: Most infants begin nocturnal sleep lasting 9–11 hours by 3–4 months of age. Answers A and B are incorrect because the infant is still waking for nighttime feedings. Answer D is incorrect because it does not answer the question. 43. Which of the following pediatric clients is at greatest risk for latex allergy? A. The child with a myelomeningocele B. The child with epispadias C. The child with coxa plana D. The child with rheumatic fever Answer A: The child with myelomenigocele is at greatest risk for the development of latex allergy because of repeated exposure to latex products during surgery and from numerous urinary catheterizations. Answers B, C, and D are much less likely to be exposed to latex; therefore, they are incorrect. 44. The nurse is teaching the mother of a child with cystic fibrosis how to do chest percussion. The nurse should tell the mother to: A. Use the heel of her hand during percussion B. Change the child’s position every 20 minutes C. Do percussion after the child eats and at bedtime D. Use cupped hands during percussion Answer D: The nurse or parent should use a cupped hand when performing chest percussion. Answer A is incorrect because the hand should be cupped. Answer B is incorrect because the child’s position should be changed every 5–10 minutes and the whole session should be limited to 20 minutes. Answer C is incorrect because chest percussion should be done before meals. 45. The nurse calculates the amount of an antibiotic for injection to be given to an infant. The amount of medication to be administered is 1.25mL. The nurse should: A. Divide the amount into two injections and administer in each vastus lateralis muscle B. Give the medication in one injection in the dorsogluteal muscle C. Divide the amount in two injections and give one in the ventrogluteal muscle and one in the vastus lateralis muscle D. Give the medication in one injection in the ventrogluteal muscle Answer A: No more than 1mL should be given in the vastus lateralis of the infant. Answers B, C, and D are incorrect because the dorsogluteal and ventrogluteal muscles are not used for injections in the infant. 46. A client with schizophrenia is receiving depot injections of Haldol Deconate (haloperidol decanoate). The client should be told to return for his next injection in: A. 1 week B. 2 weeks C. 4 weeks D. 6 weeks Answer C: Depot injections of Haldol are administered every 4 weeks. Answers A and B are incorrect because the medication is still in the client’s system. Answer D is incorrect because the medication has been eliminated from the client’s system, which allows the symptoms of schizophrenia to return. 47. A 3-year-old is immobilized in a hip spica cast. Which discharge instruction should be given to the parents? A. Keep the bed flat, with a small pillow beneath the cast B. Provide crayons and a coloring book for play activity C. Increase her intake of high-calorie foods for healing D. Tuck a disposable diaper beneath the cast at the perineal opening Answer D: Tucking a disposable diaper at the perineal opening will help prevent soiling of the cast by urine and stool. Answer A is incorrect because the head of the bed should be elevated. Answer B is incorrect because the child can place the crayons beneath the cast, causing pressure areas to develop. Answer C is incorrect because the child does not need high-calorie foods that would cause weight gain while she is immobilized by the cast. 48. The nurse is caring for a client following the reimplantation of the thumb and index finger. Which finding should be reported to the physician immediately? A. Temperature of 100°F B. Coolness and discoloration of the digits C. Complaints of pain D. Difficulty moving the digits Answer B: Coolness and discoloration of the reimplanted digits indicates compromised circulation, which should be reported immediately to the physician. The temperature should be monitored, but the client would receive antibiotics to prevent infection; therefore, answer A is incorrect. Answers C and D are expected following amputation and reimplantation; therefore, they are incorrect. 49. When assessing the urinary output of a client who has had extracorporeal lithotripsy, the nurse can expect to find: A. Cherry-red urine that gradually becomes clearer B. Orange-tinged urine containing particles of calculi C. Dark red urine that becomes cloudy in appearance D. Dark, smoky-colored urine with high specific gravity Answer A: Following extracorporeal lithotripsy, the urine will appear cherry red in color but will gradually change to clear urine. Answer B is incorrect because the urine will be red, not orange. Answer C is incorrect because the urine will be not be dark red or cloudy in appearance. Answer D is incorrect because it describes the urinary output of the client with acute glomerulonephritis. 50. The physician has prescribed Cognex (tacrine) for a client with dementia. The nurse should monitor the client for adverse reactions, which include: A. Hypoglycemia B. Jaundice C. Urinary retention D. Tinnitus Answer B: An adverse reaction to Cognex (tacrine) is drug-induced hepatitis. The nurse should monitor the client for signs of jaundice. Answers A, C, and D are incorrect because they are not associated with the use of Cognex (tacrine). 51. The physician has ordered a low-potassium diet for a child with acute glomerulonephritis. Which snack is suitable for the child with potassium restrictions? A. Raisins B. Oranges C. Apricots D. Bananas Answer C: Apricots are low in potassium; therefore, it is a suitable snack of the client on a potassium-restricted diet. Raisins, oranges, and bananas are all good sources of potassium; therefore, answers A, B, and C are incorrect choices. 52. The physician has ordered a blood test for H. pylori. The nurse should prepare the client by: A. Withholding intake after midnight B. Telling the client that no special preparation is needed C. Explaining that a small dose of radioactive isotope will be used D. Giving an oral suspension of glucose 1 hour before the test Answer B: No special preparation is needed for the blood test for H. pylori. Answer A is incorrect because the client is not NPO before the test. Answer C is incorrect because it refers to preparation for the breath test. Answer D is incorrect because glucose is not administered before the test. 53. The nurse is preparing to give an oral potassium supplement. The nurse should: A. Give the medication without diluting it B. Give the medication with 4oz. of juice C. Give the medication with water only D. Give the medication on an empty stomach Answer B: Oral potassium supplements should be given in at least 4oz. of juice or other liquid, to prevent gastric upset and to disguise the unpleasant taste. Answers A, C, and D are incorrect because they cause gastric upset. 54. The physician has ordered cultures for cytomegalovirus (CMV). Which statement is true regarding collection of cultures for cytomegalovirus? A. Stool cultures are preferred for definitive diagnosis. B. Pregnant caregivers may obtain cultures. C. Collection of one specimen is sufficient. D. Accurate diagnosis depends on fresh specimens. Answer D: Fresh specimens are essential for accurate diagnosis of CMV. Answer A is incorrect because cultures of urine, sputum, and oral swab are preferred. Answer B is incorrect because pregnant caregivers should not be assigned to care for clients with suspected or known infection with CMV. Answer C is incorrect because a convalescent culture is obtained 2–4 weeks after diagnosis. 55. A pediatric client with burns to the hands and arms has dressing changes with Sulfamylon (mafenide acetate) cream. The nurse is aware that the medication: A. Will cause dark staining of the surrounding skin B. Produces a cooling sensation when applied C. Can alter the function of the thyroid D. Produces a burning sensation when applied Answer D: The client should receive pain medication 30 minutes before the application of Sulfamylon. Answer A is incorrect because it refers to silver nitrate. Answer B is incorrect because it refers to Silvadene. Answer C is incorrect because it refers to Betadine. 56. The physician has ordered Dilantin (phenytoin) for a client with generalized seizures. When planning the client’s care, the nurse should: A. Maintain strict intake and output B. Check the pulse before giving the medication C. Administer the medication 30 minutes before meals D. Provide oral hygiene and gum care every shift Answer D: Gingival hyperplasia is a side effect of Dilantin; therefore, the nurse should provide oral hygiene and gum care every shift. Answers A, B, and C do not apply to the medication; therefore, they are incorrect. 57. A client receiving chemotherapy for breast cancer has an order for Zofran (ondansetron) to be given IV 30 minutes before induction of the chemotherapy. The purpose of the medication is to: A. Prevent anemia B. Promote relaxation C. Prevent nausea D. Increase neutrophil counts Answer C: Zofran (ondansetron) is given IV before chemotherapy to prevent nausea. Answers A, B, and D are not associated with the medication; therefore, they are incorrect. 58. The physician has ordered Cortisporin ear drops for a 2-year-old. To administer the ear drops, the nurse should: A. Pull the ear down and back B. Pull the ear straight out C. Pull the ear up and back D. Leave the ear undisturbed Answer A: When administering ear drops to a child under 3 years of age, the nurse should pull the ear down and back to straighten the ear canal. Answers B and D are incorrect positions for administering ear drops. Answer C is used for administering ear drops to an adult client. 59. A client with schizophrenia has been taking Thorazine (chlorpromazine) 200mg four times a day. Which finding should be reported to the doctor immediately? A. The client complains of thirst. B. The client has gained 4 pounds in the past 2 months. C. The client complains of a sore throat. D. The client naps throughout the day. Answer C: The nurse should carefully monitor the client taking Thorazine for signs of infection that can quickly become overwhelming. Answers A, B, and D are incorrect because they are expected side effects of the medication. 60. A client with iron-deficiency anemia is taking an oral iron supplement. The nurse should tell the client to take the medication with: A. Orange juice B. Water only C. Milk D. Apple juice Answer A: Iron is better absorbed when taken with ascorbic acid. Orange juice is an excellent source of ascorbic acid. Answer B is incorrect because the medication should be taken with orange juice or tomato juice. Answer C is incorrect because iron should not be taken with milk because it interferes with absorption. Answer D is incorrect because apple juice does not contain high amounts of ascorbic acid. 61. A client is admitted with burns of the right arm, chest, and head. According to the Rule of Nines, the percent of burn injury is: A. 18% B. 27% C. 36% D. 45% Answer B: Burn injury of the arm (9%), chest (9%), and head (9%) accounts for burns covering 27% of the total body surface area. Answers A, C, and D are incorrect percentages. 62. A client who was admitted with chest pain and shortness of breath has a standing order for oxygen via mask. Standing orders for oxygen mean that the nurse can apply oxygen at: A. 2L per minute B. 6L per minute C. 10L per minute D. 12L per minute Answer B: With standing orders, the nurse can administer oxygen at 6L per minute via mask. Answer A is incorrect because the amount is too low to help the client with chest pain and shortness of breath. Answers C and D have oxygen levels requiring a doctor’s order. 63. The nurse is caring for a client with an ileostomy. The nurse should pay careful attention to care around the stoma because: A. Digestive enzymes cause skin breakdown. B. Stools are less watery and contain more solid matter. C. The stoma will heal more slowly than expected. D. It is difficult to fit the appliance to the stoma site. Answer A: Stool from the ileostomy contains digestive enzymes that can cause severe skin breakdown. Answer B contains contradictory information; therefore, it is incorrect. Answers C and D contain inaccurate statements; therefore, they are incorrect. 64. The physician has ordered aspirin therapy for a client with severe rheumatoid arthritis. A sign of acute aspirin toxicity is: A. Anorexia B. Diarrhea C. Tinnitus D. Pruritis Answer C: Tinnitus is a sign of aspirin toxicity. Answers A, B, and D are not related to aspirin toxicity; therefore, they are incorrect. 65. A client is admitted to the emergency room with symptoms of delirium tremens. After admitting the client to a private room, the priority nursing intervention is to: A. Obtain a history of his alcohol use B. Provide seizure precautions C. Keep the room cool and dark D. Administer thiamine and zinc Answer B: The client with delirium tremens has an increased risk for seizures; therefore, the nurse should provide seizure precautions. Answer A is not a priority in the client’s care; therefore, it is incorrect. Answer C is incorrect because the client should be kept in a dimly lit, not dark, room. Answer D is incorrect because thiamine and multivitamins are given to prevent Wernicke’s encephalopathy, not delirium tremens. 66. The nurse is providing dietary teaching for a client with gout. Which dietary selection is suitable for the client with gout? A. Broiled liver, macaroni and cheese, spinach B. Stuffed crab, steamed rice, peas C. Baked chicken, pasta salad, asparagus casserole D. Steak, baked potato, tossed salad Answer D: Steak, baked potato, and tossed salad are lower in purine than the other choices. Liver, crab, and chicken are high in purine; therefore, answers A, B, and C are incorrect. 67. A newborn has been diagnosed with exstrophy of the bladder. The nurse should position the newborn: A. Prone B. Supine C. On either side D. With the head elevated Answer C: Placing the newborn in a side-lying position helps the urine to drain from the exposed bladder. Answer A is incorrect because it would position the child on the exposed bladder. Answers B and D are incorrect choices because they would allow the urine to pool. 68. The mother of a 3-month-old with esophageal reflux asks the nurse what she can do to lessen the baby’s reflux. The nurse should tell the mother to: A. Feed the baby only when he is hungry B. Burp the baby after the feeding is completed C. Place the baby supine with head elevated D. Burp the baby frequently throughout the feeding Answer D: Burping the baby frequently throughout the feeding will help prevent gastric distention that contributes to esophageal reflux. Answers A and B are incorrect because they allow air to collect in the baby’s stomach, which contributes to reflux. Answer C is incorrect because the baby should be placed side-lying with the head elevated, to prevent aspiration. 69. A child is hospitalized with a fractured femur involving the epiphysis. Epiphyseal fractures are serious because: A. Bone marrow is lost through the fracture site. B. Normal bone growth is affected. C. Blood supply to the bone is obliterated. D. Callus formation prevents bone healing. Answer B: Growth plates located in the epiphysis can be damaged by epiphyseal fractures. Answers A, C, and D are untrue statements; therefore, they are incorrect. 70. Before administering a nasogastric feeding to a client hospitalized following a CVA, the nurse aspirates 40mL of residual. The nurse should: A. Replace the aspirate and administer the feeding B. Discard the aspirate and withhold the feeding C. Discard the aspirate and begin the feeding D. Replace the aspirate and withhold the feeding Answer A: The nurse should replace the aspirate and administer the feeding because the amount aspirated was less than 50mL. Answers B and C are incorrect choices because the aspirate should not be discarded. Answer D is incorrect because the feeding should not be withheld. 71. A client has an order for Dilantin (phenytoin) .2g orally twice a day. The medication is available in 100mg capsules. For the morning medication, the nurse should administer: A. 1 capsule B. 2 capsules C. 3 capsules D. 4 capsules Answer B: The nurse should administer two capsules. Answers A, C, and D contain inaccurate amounts; therefore, they are incorrect. 72. The LPN is reviewing the lab results of an elderly client when she notes a specific gravity of 1.025. The nurse recognizes that: A. The client has impaired renal function. B. The client has a normal specific gravity. C. The client has mild to moderate dehydration. D. The client has diluted urine from fluid overload. Answer B: The normal specific gravity is 1.010 to 1.025. Answers A, C, and D are inaccurate statements; therefore, they are incorrect. 73. A client with acute pancreatitis has requested pain medication. Which pain medication is indicated for the client with acute pancreatitis? A. Demerol (meperidine) B. Toradol (ketorolac) C. Morphine (morphine sulfate) D. Codeine (codeine) Answer A: To prevent spasms of the sphincter of Oddi, the client with acute pancreatitis should receive non-opiate analgesics for pain. Answer B is incorrect because the client with acute pancreatitis might be prone to bleed; therefore, Toradol is not a drug of choice for pain control. Morphine and codeine, opiate analgesics, are contraindicated for the client with acute pancreatitis; therefore, answers C and D are incorrect. 74. A client with a hiatal hernia has been taking magnesium hydroxide for relief of heartburn. Overuse of magnesium-based antacids can cause the client to have: A. Constipation B. Weight gain C. Anorexia D. Diarrhea Answer D: Overuse of magnesium-containing antacids results in diarrhea. Antacids containing calcium and aluminum cause constipation; therefore, answer A is incorrect. Answers B and C are not associated with the use of magnesium antacids; therefore, they are incorrect. 75. When performing a newborn assessment, the nurse measures the circumference of the neonate’s head and chest. Which assessment finding is expected in the normal newborn? A. The head and chest circumference are the same. B. The head is 2cm larger than the chest. C. The head is 3cm smaller than the chest. D. The head is 4cm larger than the chest. Answer B: The head circumference of the normal newborn is approximately 33 cm, while the chest circumference is 31cm. Answer A is incorrect because the head and chest are not the same circumference. Answer C is incorrect because the head is larger in circumference than the chest. Answer D is incorrect because the difference in head circumference and chest circumference is too great. 76. A client with a history of clots is receiving Lovenox (enoxaparin). Which drug is given to counteract the effects of enoxaparin? A. Calcium gluconate B. Aquamephyton C. Methergine D. Protamine sulfate Answer D: Protamine sulfate is given to counteract the effects of enoxaprin as well as heparin. Calcium gluconate is given to counteract the effects of magnesium sulfate; therefore, answer A is incorrect. Answer B is incorrect because aquamephyton is given to counteract the effects of sodium warfarin. Answer C is incorrect because methergine is given to increase uterine contractions following delivery. 77. The nurse is formulating a plan of care for a client with a cognitive disorder. Which activity is most appropriate for the client with confusion and short attention span? A. Taking part in a reality-orientation group B. Participating in unit community goal setting C. Going on a field trip with a group of clients D. Meeting with an assertiveness training group Answer A: Participating in reality orientation is the most appropriate activity for the client who is confused. Answers B, C, and D are incorrect because they are not suitable activities for a client who is confused. 78. The mother of a child with hemophilia asks the nurse which over-thecounter medication is suitable for her child’s joint discomfort. The nurse should tell the mother to purchase: A. Advil (ibuprofen) B. Tylenol (acetaminophen) C. Aspirin (acetylsalicytic acid) D. Naproxen (naprosyn) Answer B: The nurse should recommend acetaminophen for the child’s joint discomfort because it will have no effect on the bleeding time. Answers A, C, and D are all nonsteroidal anti-inflammatory medications that can prolong bleeding time; therefore, they are not suitable for the child with hemophilia. 79. Which home remedy is suitable to relieve the itching associated with varicella? A. Dusting the lesions with baby powder B. Applying gauze saturated in hydrogen peroxide C. Using cool compresses of normal saline D. Applying a paste of baking soda and water Answer D: Applying a paste of baking soda and water soothes the itching and helps to dry the vesicles. The use of baby powder is not recommended because inhalation of the powder is detrimental to the client; therefore, answer A is incorrect. Answers B and C are incorrect choices because hydrogen peroxide and saline will not relieve the itching and will prevent the vesicles from crusting. 80. The nurse is caring for a newborn with hypospadias. Which statement describes hypospadias? A. The urinary meatus is located on the underside of the penis rather than the tip. B. The ureters allow a reflux of urine into the kidneys. C. The urinary meatus is located on the topside of the penis rather than the tip. D. The bladder lies outside the abdominal cavity. Answer A: Hypospadias results when the urinary meatus is located on the underside of the penis rather than the tip. Answer B is incorrect because it refers to ureteral reflux. Answer C is incorrect because it refers to epispadias. Answer D is incorrect because it refers to exstrophy of the bladder. 81. The recommended time for daily administration of Tagamet (cimetidine) is: A. Before breakfast B. Mid-afternoon C. After dinner D. At bedtime Answer D: Tagamet (cimetidine) should be administered in one dose at bedtime. Answers A, B, and C have incorrect times for dosing. 82. Which statement best describes the difference between the pain of angina and the pain of myocardial infarction? A. Pain associated with angina is relieved by rest. B. Pain associated with myocardial infarction is always more severe. C. Pain associated with angina is confined to the chest area. D. Pain associated with myocardial infarction is referred to the left arm. Answer A: Pain associated with angina is relieved by rest. Answer B is incorrect because it is not a true statement. Answer C is incorrect because pain associated with angina can be referred to the jaw, the left arm, and the back. Answer D is incorrect because pain from a myocardial infarction can be referred to areas other than the left arm. 83. The nurse is developing a bowel-retraining plan for a client with multiple sclerosis. Which measure is likely to be least helpful to the client: A. Limiting fluid intake to 1000mL per day B. Providing a high-roughage diet C. Elevating the toilet seat for easy access D. Establishing a regular schedule for toileting Answer A: It would not be helpful to limit the fluid intake of a client during bowel retraining. Answers B, C, and D would help the client; therefore, they are incorrect answers. 84. The nurse is providing dietary teaching for a client with Meniere’s disease. Which statement indicates that the client understands the role of diet in triggering her symptoms? A. “I can expect to see more problems with tinnitus if I eat a lot of dairy products.” B. “I need to limit foods that taste salty or that contain a lot of sodium.” C. “I can help control problems with vertigo if I avoid breads and cereals.” D. “I need to eat fewer foods that are high in potassium, such as raisins and bananas.” Answer B: The client with Meniere’s disease should limit the intake of foods that contain sodium. Answers A, C, and D have no relationship to the symptoms of Meniere’s disease; therefore, they are incorrect. 85. The nurse is assessing a multigravida, 36 weeks gestation for symptoms of pregnancy-induced hypertension and preeclampsia. The nurse should give priority to assessing the client for: A. Facial swelling B. Pulse deficits C. Ankle edema D. Diminished reflexes Answer A: The nurse should pay close attention to swelling in the client with preeclampsia. Facial swelling indicates that the client’s condition is worsening and blood pressure will be increased. Answer B is not related to the question; therefore, it is incorrect. Answer C is incorrect because ankle edema is expected in pregnancy. Diminished reflexes are associated with the use of magnesium sulfate, which is the treatment of preeclampsia; therefore, answer D is incorrect. 86. An adolescent with borderline personality disorders is hospitalized with suicidal ideation and self-mutilation. Which goal is both therapeutic and realistic for this client? A. The client will remain in her room when feeling overwhelmed by sadness. B. The client will request medication when feeling loss of emotional control. C. The client will leave group activities to pace when feeling anxious. D. The client will seek out a staff member to verbalize feelings of anger and sadness. Answer D: Verbalizing feelings of anger and sadness to a staff member is an appropriate therapeutic goal for the client with a risk of self-directed violence. Answers A and C place the client in an isolated situation to deal with her feelings alone; therefore, they are incorrect. Answer B is incorrect because it does not allow the client to ventilate her feelings. 87. A client with angina has an order for nitroglycerin ointment. Before applying the medication, the nurse should: A. Apply the ointment to the previous application B. Obtain both a radial and an apical pulse C. Remove the previously applied ointment D. Tell the client he will experience pain relief in 15 minutes Answer C: The nurse should remove any remaining ointment before applying the medication again. Answer A is incorrect because it interferes with absorption. Answer B does not apply to the question of how to administer the medication; therefore, it is incorrect. Answer D is incorrect because the medication’s action is more immediate. 88. The nurse is caring for a client who is unconscious following a fall. Which comment by the nurse will help the client become reoriented when he regains consciousness? A. “I am your nurse and I will be taking care of you today.” B. “Can you tell me your name and where you are?” C. “I know you are confused right now, but everything will be alright.” D. “You were in an accident that hurt your head. You are in the hospital.” Answer D: Telling the client what happened and where he is helps with reorientation. Answer A does not explain what happened to the client; therefore, it is incorrect. Answer B is not helpful because the client regaining consciousness will not know where he is; therefore, the answer is incorrect. The nurse should not offer false reassurances, such as “everything will be alright”; therefore, answer C is incorrect. 89. Following a generalized seizure, the nurse can expect the client to: A. Be unable to move the extremities B. Be drowsy and prone to sleep C. Remember events before the seizure D. Have a drop in blood pressure Answer B: Following a generalized seizure, the client frequently experiences drowsiness and postictal sleep. Answer A is incorrect because the client is able to move the extremities. Answer C is incorrect because the client can remember events before the seizure. Answer D is incorrect because the blood pressure is elevated. 90. A client with oxylate renal calculi should be taught to limit his intake of foods such as: A. Strawberries B. Oranges C. Apples D. Pears Answer A: The client with oxylate renal calculi should limit sources of oxylate, which include strawberries, rhubarb, and spinach. Answers B, C, and D are incorrect because they are not sources of oxylate. 91. A 6-year-old is diagnosed with Legg-Calve Perthes disease of the right femur. An important part of the child’s care includes instructing the parents: A. To increase the amount of dietary protein B. About exercises to strengthen affected muscles C. About relaxation exercises to minimize pain in the joints D. To prevent weight bearing on the affected leg Answer D: The child with Legg-Calve Perthes disease should be prevented from bearing weight on the affected extremity until revascularization has occurred. Answer A is incorrect because it does not relate to the condition. Answers B and C are incorrect choices because the condition does not involve the muscles or the joints. 92. The nurse is assessing an infant with Hirschsprung’s disease. The nurse can expect the infant to: A. Weigh less than expected for height and age B. Have infrequent bowel movements C. Exhibit clubbing of the fingers and toes D. Have hyperactive deep tendon reflexes Answer B: The infant with Hirschsprung’s disease will have infrequent bowel movements. Answers A, C, and D do not apply to the condition; therefore, they are incorrect. 93. The physician has prescribed supplemental iron for a prenatal client. The nurse should tell the client to take the medication with: A. Milk, to prevent stomach upset B. Tomato juice, to increase absorption C. Oatmeal, to prevent constipation D. Water, to increase serum iron levels Answer B: Iron supplements should be taken with a source of vitamin C to promote absorption. Answer A is incorrect because iron should not be taken with milk. Answer C is incorrect because high-fiber sources prevent the absorption of iron. Answer D is an inaccurate statement; therefore, it is incorrect. 94. The nurse is teaching a client with a history of obesity and hypertension regarding dietary requirements during pregnancy. Which statement indicates that the client needs further teaching? A. “I need to reduce my daily intake to 1,200 calories a day.” B. “I need to drink at least a quart of milk a day.” C. “I shouldn’t add salt when I am cooking.” D. “I need to eat more protein and fiber each day.” Answer A: The client does not need to drastically reduce her caloric intake during pregnancy. Doing so would not provide adequate nourishment for proper development of the fetus. Answers B, C, and D indicate that the client understands the nurse’s dietary teaching regarding obesity and hypertension; therefore, they are incorrect. 95. An elderly client is admitted to the psychiatric unit from the nursing home. Transfer information indicates that the client has become confused and disoriented, with behavioral problems. The client will also likely show a loss of ability in: A. Speech B. Judgment C. Endurance D. Balance Answer B: Confusion, disorientation, behavioral changes, and alterations in judgment are early signs of dementia. Answers A, C, and D do not relate to the question; therefore, they are incorrect. 96. The physician has ordered an external monitor for a laboring client. If the fetus is in the left occipital posterior (LOP) position, the nurse knows that the ultrasound transducer will be located: A. Near the symphysis pubis B. Near the umbilicus C. Over the fetal back D. Over the fetal abdomen Answer C: In the left occipital posterior position, the heart sounds will be heard loudest through the fetal back. Answers A, B, and D are incorrect locations. 97. A client develops tremors while withdrawing from alcohol. Which medication is routinely administered to lessen physiological effects of alcohol withdrawal? A. Dolophine (methodone) B. Klonopin (clonazepam) C. Narcan (naloxone) D. Antabuse (disulfiram) Answer B: Benzodiazepines such as Ativan (lorazepam) and Klonopin (clonazepam) are given to the client withdrawing from alcohol. Answer A is incorrect because methodone is given to the client withdrawing from opiates. Answer C is incorrect because naloxone is an antidote for narcotic overdose. Answer D is incorrect because disufiram is used in aversive therapy for alcohol addiction. 98. A client with Type II diabetes has an order for regular insulin 10 units SC each morning. The client’s breakfast should be served within: A. 15 minutes B. 20 minutes C. 30 minutes D. 45 minutes Answer C: The client’s breakfast should be served within 30 minutes to coincide with the onset of the client’s regular insulin. 99. A 10-year-old has an order for Demerol (meperidine) 35mg IM for pain. The medication is available as Demerol 50mg per mL. How much should the nurse administer? A. .5mL B. .6mL C. .7mL D. .8mL Answer C: The nurse should administer .07mL of the medication. Answers A, B, and D are incorrect because the dosage is incorrect. 100. Which antibiotic is contraindicated for the treatment of infections in infants and young children? A. Tetracyn (tetracycline) B. Amoxil (amoxicillin) C. Cefotan (cefotetan) D. E-Mycin (erythromycin) Answer A: Tetracycline is contraindicated for use in infants and young children because it stains the teeth and arrests bone development. Answers B, C, and D are incorrect because they can be used to treat infections in infants and children. [Show More]

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